Nurse Faculty Scholars - Cardiovascular

An Overview of the Genomics of Metabolic Syndrome

kdeming — Tue, 26 Mar 2013 16:23:38 +0000

Published Date:

Sat, 2012-09-08 (All day)

This article provides a brief overview of the diagnostic criteria and genomic risk factors for the components of metabolic syndrome (MetS).

Purpose: This article provides a brief overview of the diagnostic criteria and genomic risk factors for the components of metabolic syndrome (MetS).

Organizing Constructs: Contributions of cardiovascular, obesity, and diabetes genomic risk factors to the development of MetS as reported in the literature have been reviewed.

The Utility of Ambulatory Electrocardiographic Monitoring for Detecting Silent Arrhythmias and Clarifying Symptom Mechanism in an Urban Elderly Population with Heart Failure and Hypertension: Clinical Implications.

lsharp — Mon, 31 Jan 2011 14:20:49 +0000

Published Date:

Fri, 2010-01-01 (All day)

Abstract BACKGROUND: Atrial and ventriclar tachyarrhythmias, as well as bradyarrhythmias, in the elderly with heart failure (HF) and/or hypertension (HTN) have been well documented. However, the frequency of these arrhythmias, whether silent or symptomatic, and their association with subsequent cardiac events has not been well defined in patients 65 years or older with HF and other cardiovascular risk factors.

OBJECTIVE: To assess the value of 2 weeks of remote, transtelephonic cardiac monitoring for detecting arrhythmias in an elderly, urban population living with HF.

METHODS: Fifty-four patients with a history of systolic HF and/or HTN were consented and enrolled. All wore an auto triggered cardiac loop monitor for 2 weeks that captures EKG data and both silent and symptomatic arrhythmias were recorded.

RESULTS: Mean age was 73 +/- 6 years with 59% of subjects were females, 74% Hispanic, 22% black, and 4% white/other. All patients had HF and 94% had HTN. From the cardiac monitoring, 72% demonstrated ectopic atrial and ventricular activity, and 1 paroxysmal episode of atrial fibrillation was documented. In addition, 3 subjects had significant non-sustained ventricular tachycardia, and 4 individuals had severe bradycardia recorded on cardiac monitoring. These 7 individuals underwent placement of an implantable cardioverter defibrillator (ICD) or pacemaker based on the documented arrhythmias which may have otherwise gone undetected.

CONCLUSION: A substantial proportion of patients exhibited cardiac arrhythmias. Future morbidity was prevented because of the detection of arrhythmias on monitoring that led to specific therapies such as pacemaker or ICD implantation which otherwise may not have been implemented.

Abstract
BACKGROUND: Atrial and ventriclar tachyarrhythmias, as well as bradyarrhythmias, in the elderly with heart failure (HF) and/or hypertension (HTN) have been well documented. However, the frequency of these arrhythmias, whether silent or symptomatic, and their association with subsequent cardiac events has not been well defined in patients 65 years or older with HF and other cardiovascular risk factors.
OBJECTIVE: To assess the value of 2 weeks of remote, transtelephonic cardiac monitoring for detecting arrhythmias in an elderly, urban population living with HF.

Sudden killer: Arrhythmogenic right ventricular cardiomyopathy

lsharp — Mon, 31 Jan 2011 14:18:17 +0000

Published Date:

Wed, 2010-09-01 (All day)

ARRHYTHMOGENIC RIGHT VENTRICULAR cardiomyopathy (ARVC) is a dangerous cardiac condition that can cause sudden death. Characterized by a severely thinned and dilated right ventricle, ARVC results in abnormal contractions and blood ejection, as the ventricle walls are replaced by fibro-fatty tissue. In an athlete whose ventricle reaches maximal exertion, ARVC can cause sudden death. Accurate and early diagnosis of ARVC is crucial to prevent death.

Call to Action: Cardiovascular Disease in Asian Americans. A Science Advisory From the American Heart Association

lsharp — Wed, 20 Oct 2010 11:52:19 +0000

Published Date:

Fri, 2010-01-01 (All day)

In 2009, President Obama signed an Executive Order calling for strategies to improve the health of Asian Americans and to seek data on the health disparities in Asian American subgroups.1 Data on Asian American subgroups are scarce and many health disparities remain unknown. The purpose of this Advisory is to highlight the gaps in existing research on cardiovascular disease (CVD) among Asian Americans, and to serve as a call to action on behalf of the American Heart Association to address these areas of need.

Asian Americans are the fastest growing racial/ethnic group in the United States, representing 25% of all foreign-born people in the United States.2 They are projected to reach nearly 34 million by 2050.3 Several major Federal surveys (eg, the American Community Survey, the National Health Interview Survey, and the Behavioral Risk Factor Surveillance Survey) only recently started to classify Asian Americans into 7 subgroups: Asian Indian, Chinese, Filipino, Korean, Japanese, Vietnamese, and Other Asian. The first six of these subgroups together constitute >90% of Asian Americans in the United States.4 Although some data are available on Asian subgroups from these major federal surveys, in general, these data are not available for public use because of the privacy concerns resulting from the small sample sizes within subgroups. This situation limits their utility for health-related research.

Atypical Electrocardiographic Features of Cavotricuspid Isthmus-Dependent Atrial Flutter Occurring during Left Atrial Fibrillation Ablation

lsharp — Tue, 19 Oct 2010 14:12:56 +0000

Published Date:

Thu, 2010-07-01 (All day)

Background: Patients who have undergone percutaneous catheter ablation for atrial fibrillation (AF) may develop cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL), which can occur either spontaneously during left atrial (LA) ablation for AF or by induction from sinus rhythm during the procedure. The electrocardiographic (ECG) characteristics of CTI-dependent AFL occurring during LA ablation have not been described. The purpose of this study was to describe the ECG features of CTI-dependent AFL occurring during percutaneous LA catheter ablation for AF.

Methods and Results: Of 223 patients presenting for first AF ablation at our institution between May 2004 and February 2008, 20 patients (9%) developed CTI-dependent AFL during LA ablation for AF. CTI-dependent AFL developed spontaneously in 4 patients (20%) and was induced in 16 patients (80%). Among these 20 patients, 3 (15%) had typical ECG patterns and 17 (85%) had atypical ECG patterns. Flutter waves in the inferior leads were biphasic in 10 patients (50%), downward in 3 patients (15%), positive in 3 patients (15%), and not fitting the above classifications in 4 patients (20%). There was no statistically significant association between AFL pattern and LA size, left ventricular ejection fraction, total ablation time, duration of prior AF, or type of prior AF.

Conclusion: A majority of patients with CTI-dependent AFL occurring during LA ablation have atypical ECG patterns. Biphasic flutter waves in the inferior leads are common ECG features, occurring in one-half of patients. Right atrial CTI-dependent AFL should be suspected even if the ECG appearance is atypical.

Real-time stroke volume measurements for the optimization of cardiac resynchronization therapy parameters

lsharp — Tue, 19 Oct 2010 14:08:46 +0000

Published Date:

Fri, 2010-01-01 (All day)

Aims We investigated the utility of real-time stroke volume (SV) monitoring via the arterial pulse power technique to optimize cardiac resynchronization therapy (CRT) parameters at implant and prospectively evaluated the clinical and echocardiographic results.

Methods and results Fifteen patients with ischaemic or non-ischaemic dilated cardiomyopathy, sinus rhythm, Class III congestive heart failure, and QRS >150 ms underwent baseline 2D echocardiogram (echo), 6 min walk distance, and quality of life (QOL) questionnaire within 1 week of implant. Following implant, 0.3 mmol lithium chloride was injected to calibrate SV via dilution curve. Atrioventricular (AV) delay (90, 120, 200 ms, baseline: atrial pacing only) and V-V delay (−80 to 80 ms in 20 ms increments) were varied every 60 s. The radial artery pulse power autocorrelation method (PulseCO algorithm, LiDCO, Ltd.) was used to monitor SV on a beat-to-beat basis (LiDCO, Ltd.). Optimal parameters were programmed and echo, 6 min walk, and QOL were repeated at 6–8 weeks post-implant. Nine patients had >5% increase in SV after optimization (Group A). Six patients had <5% improvement in SV (Group B). Compared with Group B, Group A had significant improvements in left ventricular ejection fraction (LVEF) (11.0 ± 8.5 vs. 0.8 ± 2.0%) and decrease in left ventricular end-diastolic dimension (LVEDD) (−0.6 ± 0.4 vs. −0.2 ± 0.2 cm) and 6 min walk (346 ± 226 vs. 32 ±271 ft, P ≤ 0.05). Group A patients also tended to have greater improvement in the septal-to-posterior wall motion delay on M-mode echo (P = 0.07).

Conclusion Real-time SV measurements can be used to optimize CRT at the time of implant. Improvement in SV correlates with improvement in LVEF, LVEDD, and 6 min walk, and improvement in echocardiographic dyssynchrony.

Atrial flutter catheter ablation in adult patients with repaired tetralogy of Fallot: mechanisms and outcomes of percutaneous catheter ablation in a consecutive series.

lsharp — Tue, 19 Oct 2010 14:06:00 +0000

Published Date:

Sun, 2010-08-01 (All day)

BACKGROUND: Prior investigators note successful ablation of both typical cavotricuspid isthmus-dependent and scar-related macroreentrant right atrial flutters (AFL) in adult patients with repaired tetralogy of Fallot (TOF). However, an analysis of the mechanisms (including a description of a uniform approach to diagnose such mechanisms), and clinical outcomes of catheter ablation in a consecutive series of adult patients with AFL late after surgical TOF repair has not been previously reported.

METHODS: Background clinical data and follow-up were evaluated in a consecutive series of TOF patients evaluated from September 2001 to June 2008.

RESULTS: We report a prevalence of sustained, symptomatic AFL in patients with repaired TOF equal to 20% (28/140 patients), and of recurrent, drug-refractory and/or severely symptomatic AFL to be 11% (16/140 patients). The AFLs manifested variable cycle lengths ranging from 215 to 525 ms. Underlying mechanisms were: (1) cavotricuspid (CTI)-dependent, counterclockwise atrial flutter (n=8 patients); (2) non-CTI-dependent macroreentrant scar-related AFL (n=6 patients); and (3) both CTI- and non-CTI-dependent macroreentrant AFL (n=2 patients). Recurrent arrhythmias occurred in six patients, five of whom were successfully treated with repeat ablation. After a mean follow-up of 23 months, 15 of 16 patients were alive and free of sustained AFL.

CONCLUSIONS: AFL late after surgical TOF repair occurs in 20% of such patients. In more than half of these patients, the AFLs are drug-refractory and/or severely symptomatic. Despite the presence of congenital heart disease treated with prior cardiac surgery and AFLs with variable atrial cycle lengths, the CTI-dependent mechanism underlies approximately half of the sustained, symptomatic AFLs.

The Utility of Ambulatory Electrocardiographic Monitoring for Detecting Silent Arrhythmias and Clarifying Symptom Mechanism in an Urban Elderly Population with Heart Failure and Hypertension: Clinical Implications.

lsharp — Tue, 19 Oct 2010 13:57:49 +0000

Published Date:

Fri, 2010-01-01 (All day)

BACKGROUND: Atrial and ventriclar tachyarrhythmias, as well as bradyarrhythmias, in the elderly with heart failure (HF) and/or hypertension (HTN) have been well documented. However, the frequency of these arrhythmias, whether silent or symptomatic, and their association with subsequent cardiac events has not been well defined in patients 65 years or older with HF and other cardiovascular risk factors.

OBJECTIVE: To assess the value of 2 weeks of remote, transtelephonic cardiac monitoring for detecting arrhythmias in an elderly, urban population living with HF.

Long QT Syndrome: A Case Report, Genomics, and Clinical Implications

lsharp — Tue, 19 Oct 2010 13:55:10 +0000

Published Date:

Fri, 2010-01-01 (All day)

Long QT syndrome (LQTS) is a hereditary disorder in which the majority of affected individuals present with QT prolongation on electrocardiograms (ECGs), arising from delayed ventricular repolarization. This commonly arrhythmia-associated genetic syndrome can lead to sudden cardiac death (SCD) and increased propensity for arrythmogenic syncope. The authors describe the case of a young patient who presented with episodes of syncope, prolonged QTc interval on ECG, and family history of SCD. He subsequently received an ICD for protection against SCD based on his prior clinical history. The article discusses the clinical manifestations, electrocardiographic (ECG) findings, management of LQTS, and role of the clinician in testing, teaching, and counseling the affected patients and families.

Pilot testing of the PRAISEDD intervention among African American and low-income older adults.

lsharp — Tue, 19 Oct 2010 13:12:50 +0000

Published Date:

Tue, 2009-09-01 (All day)

BACKGROUND AND RESEARCH OBJECTIVE: The incidence of cardiovascular disease (CVD) is particularly high among African American (AA) older adults, and these individuals are least likely to have access to CVD prevention activities. The purpose of this study was to test the feasibility of People Reducing Risk and Improving Strength through Exercise, Diet and Drug Adherence (PRAISEDD), which is geared at increasing adherence to CVD prevention behaviors among AA and low-income older adults.

METHODS: This feasibility study was conducted in a senior housing site, using a single-group repeated-measures design and testing physical activity, diet, medication adherence beliefs and behaviors, and blood pressure at baseline and after a 12-week intervention period. Of 22 participants, mean (SD) age was 76.4 (7.6) years, and most were female (64%) and AA (86%). An intention-to-treat analysis was used.

RESULTS: There were significant decreases in systolic (P = .02) and diastolic blood pressure (P = .01) and a nonsignificant trend toward improvement in cholesterol intake (P = .09). There were no changes in time spent in moderate-level physical activity, sodium intake, medication adherence, or self-efficacy and outcome expectations across all 3 behaviors.

CONCLUSION: The PRAISEDD intervention was feasible in a group of AA and low-income older adults and, after 12 weeks, resulted in improvements in blood pressure. Future research is needed to test a revised PRAISEDD intervention using a randomized controlled design, a larger sample, and a longer follow-up period. The PRAISEDD intervention should be revised to incorporate environmental and policy changes that influence CVD prevention behaviors and explore the impact of social networking as it relates to diffusion of the intervention among participants in low-income housing facilities.