Cleveland Clinic journal of medicine
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Venous thromboembolism (VTE) is a major cause of cardiovascular death, and its close association with increased age portends an increasing clinical and economic impact for VTE as the US population ages. Studies show that rates of VTE prophylaxis remain inadequate both in the hospital and at the time of discharge. Health care accreditation and quality organizations are taking interest in VTE risk assessment and prophylaxis as a measure for hospital performance ratings and even reimbursement. To set the stage for the rest of this supplement, this article reviews the rationale for VTE prophylaxis, surveys current prophylaxis rates and strategies to increase those rates, and provides an overview of risk factors for VTE and therapeutic options for VTE prophylaxis.
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Breast reconstruction can help to address the disfigurement and sense of loss that often follow mastectomy. The decision whether to pursue reconstruction and the choice of reconstructive strategy are individualized decisions that must take into account the patient's body characteristics, overall health, breast cancer treatment plan, and personal preferences. Options for reconstruction broadly include placement of breast implants or use of the patient's own tissue (autologous reconstruction). ⋯ Autologous reconstruction usually involves transfer of tissue from the abdomen, with recent advances allowing preservation of the abdominal muscles. Both implant-based and autologous procedures have advantages and drawbacks, and both types of reconstruction may be compromised by subsequent radiation therapy. For this and other reasons, consultation with a plastic surgeon early in treatment planning is important for women considering postmastectomy reconstruction.
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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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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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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.