Cleveland Clinic journal of medicine
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The autonomic nervous system plays an important role in the genesis of ventricular arrhythmias and sudden cardiac death. Evidence is substantial for a neural component in sudden cardiac death. ⋯ Thoracic spinal cord stimulation is showing promise as a treatment for refractory angina. In addition, spinal cord stimulation has protected against ventricular tachycardia/ventricular fibrillation in animal models of postinfarction heart failure.
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Review
Inflammation as a link between brain injury and heart damage: the model of subarachnoid hemorrhage.
Subarachnoid hemorrhage (SAH) serves as a good model for the study of heart-brain interactions because it is associated with both a high incidence of arrhythmia and a low prevalence of coronary heart disease. The pathophysiology of cardiac abnormalities in SAH is unsettled. ⋯ We believe that the coupling of catecholamine release with parasympathetic dysfunction may allow unchecked inflammation that leads to myocardial dysfunction and cell death. We have developed a novel murine model of SAH to explore these potential inflammatory underpinnings of cardiac damage in SAH.
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Mounting evidence suggests that depression, anxiety, and hostility/anger may each be an independent risk factor for acute coronary syndrome (ACS) occurrence. Data specific to the role of these negative emotional states in predisposing to imminent ACS risk are limited, however. Additionally, a number of studies have indicated that certain situational triggers (such as intense physical exertion) and behavioral triggers (such as acute anxiety or anger) are predictive of imminent occurrence of an ACS. Despite these findings, the use of emotional or behavioral information to identify persons at high risk for imminent ACS to facilitate such patient identification.
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Randomized Controlled Trial Multicenter Study Clinical Trial
A perspective on the fluids and catheters treatment trial (FACTT). Fluid restriction is superior in acute lung injury and ARDS.
Restricting fluid intake and promoting fluid excretion (a "dry" or conservative strategy) is more effective than a "we or liberal strategy in patients with acute lung injury and acute respiratory distress syndrome. In a multicenter, randomized, prospective clinical comparison of the two strategies in 1000 patients, those in the conservative-strategy group experienced faster improvement in lung function and spent significantly fewer days on ventilation and in the intensive care unit (N Engl J Med 2006; 354:2564-2574). No significant differences were observed in the incidence of death by 60 days or of nonpulmonary organ failure at 28 days except for days of central nervous system failure, which were fewer in the conservative-strategy group.
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Obstructive sleep apnea is common, underdiagnosed, undertreated, and highly associated with cardiovascular risk. It is characterized by daytime sleepiness and disrupted sleep and is confirmed by overnight sleep studies (polysomnography). Treatment with continuous positive airway pressure (CPAP) improves sleep and daytime sleepiness, but its effects on cardiovascular risk while promising, are still unclear.