ABSTRACT
The higher prevalence of cardiovascular disease in obese individuals is indirectly mediated, to a large extent, by the increased frequency of various well known risk factors like hypertension, diabetes, and dyslipidemia, either individually or as part of the metabolic syndrome. However, there are several ways in which obesity directly affects the cardiovascular system; these will be discussed in detail. We also focus on various challenges posed by obesity in the performance and interpretation of cardiac investigations and how they can be addressed.
Subject(s)
Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/etiology , Obesity/complications , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/etiology , Cardiac Catheterization , Cardiovascular Diseases/physiopathology , Coronary Artery Disease/diagnosis , Coronary Artery Disease/etiology , Exercise Test , Humans , Hypertension/diagnosis , Hypertension/etiology , Obesity/physiopathology , Risk Factors , Stroke/diagnosis , Stroke/etiologyABSTRACT
2-Octyl Cyanoacrylate (2-OCA) is a tissue adhesive developed for skin laceration closure that has not been previously evaluated for cardiac device implant wound closure. We reviewed 460 consecutive device implants with 475 incisions between November 1993 and May 2001. From November 1993 to December 1998, all patients (n 335) had a 3-layer reabsorbable suture closure with the application of topical bacitracin and dressing material. They were advised to avoid exposure to moisture for 10 days. From January 1999 to May 2001, the superficial suture layer was replaced with 2-OCA (n=125). No topical bacitracin or dressing was applied and patients were allowed to shower within 72 hours. The two groups did not differ significantly with respect to age (69 +/- 12 vs 70 +/- 13 years, P=NS), sex (59% vs 62% male, p=NS) or device type (77% vs 68% pacemakers/loop recorders, p=NS). All incisions were evaluated at 24 hours, 7-14 days, and 6-12 weeks postprocedure. The 2-OCA and suture groups did not differ significantly with respect to allergic reaction (0% vs 1.4%, P=NS), cellulitis (0% vs 0.9%, P=NS), and infection requiring explant (0.8% vs 0.3%, P=NS), respectively. Total adverse events occurred in 1 of 125 (0.8%) of the 2-OCA group versus 9 of 350 (2.6%) of the suture group (P=NS). In cardiac device implant closure 2-OCA obviated the need for topical antibiotics and dressing materials while facilitating wound care without increased complications.
