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1.
Heart Fail Clin ; 9(2): 217-23, ix, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23562122

ABSTRACT

Takotsubo cardiomyopathy is classically stress induced and characterized by regional wall motion abnormalities in the absence of coronary occlusion. It predominantly affects postmenopausal women; emotional and physical stressors can trigger the classic cardiomyopathic findings. These changes are likely mediated by catecholamines, which cause a distinctive pattern of ventricular dysfunction with a unique pathologic phenotype of apical ballooning. Underlying mood disorders increase the risk for developing takotsubo cardiomyopathy after a triggering event. Takotsubo cardiomyopathy is one of several brain-heart disorders; its unique pathology can shed light on the complex interactions between the brain, sympathetic nervous system, and the cardiovascular system.


Subject(s)
Brain/physiopathology , Heart/physiopathology , Takotsubo Cardiomyopathy/physiopathology , Aged , Disease Susceptibility , Female , Humans , Middle Aged , Prognosis , Stress, Physiological , Stress, Psychological , Takotsubo Cardiomyopathy/etiology , Ventricular Dysfunction
2.
J Vasc Surg ; 53(3): 826-36.e1, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21236620

ABSTRACT

Fibromuscular dysplasia (FMD) is a nonatherosclerotic noninflammatory vascular disease that primarily affects women from age 20 to 60, but may also occur in infants and children, men, and the elderly. It most commonly affects the renal and carotid arteries but has been observed in almost every artery in the body. FMD has been considered rare and thus is often underdiagnosed and poorly understood by many health care providers. There are, however, data to suggest that FMD is much more common than previously thought, perhaps affecting as many as 4% of adult women. When it affects the renal arteries, the most common presentation is hypertension. When it affects the carotid or vertebral arteries, the patient may present with transient ischemic attack or stroke, or dissection. An increasing number of patients are asymptomatic and are only discovered incidentally when imaging is performed for some other reason or by the detection of an asymptomatic bruit. FMD should be considered in the differential diagnosis of a young person with a cervical bruit; a "swishing" sound in the ear(s); transient ischemic attack, stroke, or dissection of an artery; or in individuals aged ≤ 35 years with onset hypertension. Treatment consists of antiplatelet therapy for asymptomatic individuals and percutaneous balloon angioplasty for patients with indications for intervention. Patients with aneurysms should be treated with a covered stent or open surgical repair. Little new information has been published about FMD in the last 40 years. The recently instituted International Registry for Fibromuscular Dysplasia will remedy that situation and provide observational data on a large numbers of patients with FMD.


Subject(s)
Fibromuscular Dysplasia , Adult , Angioplasty, Balloon , Asymptomatic Diseases , Female , Fibromuscular Dysplasia/complications , Fibromuscular Dysplasia/diagnosis , Fibromuscular Dysplasia/epidemiology , Fibromuscular Dysplasia/therapy , Humans , Incidental Findings , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Predictive Value of Tests , Risk Factors , Treatment Outcome , Vascular Surgical Procedures , Young Adult
3.
Mayo Clin Proc ; 85(7): 678-92, 2010 Jul.
Article in English | MEDLINE | ID: mdl-20592174

ABSTRACT

Peripheral artery disease (PAD), which comprises atherosclerosis of the abdominal aorta, iliac, and lower-extremity arteries, is underdiagnosed, undertreated, and poorly understood by the medical community. Patients with PAD may experience a multitude of problems, such as claudication, ischemic rest pain, ischemic ulcerations, repeated hospitalizations, revascularizations, and limb loss. This may lead to a poor quality of life and a high rate of depression. From the standpoint of the limb, the prognosis of patients with PAD is favorable in that the claudication remains stable in 70% to 80% of patients over a 10-year period. However, the rate of myocardial infarction, stroke, and cardiovascular death in patients with both symptomatic and asymptomatic PAD is markedly increased. The ankle brachial index is an excellent screening test for the presence of PAD. Imaging studies (duplex ultrasonography, computed tomographic angiography, magnetic resonance angiography, catheter-based angiography) may provide additional anatomic information if revascularization is planned. The goals of therapy are to improve symptoms and thus quality of life and to decrease the cardiovascular event rate (myocardial infarction, stroke, cardiovascular death). The former is accomplished by establishing a supervised exercise program and administering cilostazol or performing a revascularization procedure if medical therapy is ineffective. A comprehensive program of cardiovascular risk modification (discontinuation of tobacco use and control of lipids, blood pressure, and diabetes) will help to prevent the latter.


Subject(s)
Peripheral Vascular Diseases/diagnosis , Peripheral Vascular Diseases/therapy , Ankle Brachial Index , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Cilostazol , Diagnosis, Differential , Disease Progression , Fibrinolytic Agents/therapeutic use , Humans , Intermittent Claudication/etiology , Magnetic Resonance Angiography , Mass Screening/methods , Pentoxifylline/therapeutic use , Peripheral Vascular Diseases/complications , Peripheral Vascular Diseases/epidemiology , Platelet Aggregation Inhibitors/therapeutic use , Prognosis , Risk Factors , Risk Reduction Behavior , Tetrazoles/therapeutic use , Tomography, X-Ray Computed , Ultrasonography, Doppler, Duplex , United States/epidemiology , Vasodilator Agents/therapeutic use
4.
Cardiol Clin ; 28(2): 261-9, 2010 May.
Article in English | MEDLINE | ID: mdl-20452539

ABSTRACT

Thoracic aortic aneurysms (TAA) often represent the final manifestation of hereditary or degenerative disease processes. TAA are primarily caused by age-related degenerative changes. In this article, the authors highlight the most common pathophysiologic mechanisms responsible for TAA formation and review the paucity of evidence supporting the spectrum of medical therapies for TAA other than renin-angiotensin inhibition. More clinical trials on TAA are required before medical therapies such as beta-blockers, statins, and macrolide antibiotics can be recommended.


Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Aortic Aneurysm, Thoracic/drug therapy , Aortic Aneurysm, Thoracic/physiopathology , Blood Pressure/drug effects , Humans , Stroke Volume/drug effects , Treatment Outcome
5.
J Gen Intern Med ; 23(11): 1904-8, 2008 Nov.
Article in English | MEDLINE | ID: mdl-18688681

ABSTRACT

BACKGROUND: Takotsubo cardiomyopathy is a novel, yet well-described, reversible cardiomyopathy triggered by profound psychological or physical stress with a female predominance. OBJECTIVE: This review is designed to increase general clinician awareness about the diagnosis, incidence, pathogenesis, and therapies of this entity. DATA SOURCES: A complete search of multiple electronic databases (Pubmed, EMBASE, Science Citation Index) was carried out to identify all full-text, English-language articles published from 1980 to the present date and relevant to this review. REVIEW METHODS: The following search terms were used: takotsubo cardiomyopathy, stress-induced cardiomyopathy, and left ventricular apical ballooning syndrome. Citation lists from identified articles were subsequently reviewed and pertinent articles were further identified. RESULTS: Takotsubo cardiomyopathy is typically characterized by the following: 1) acute onset of ischemic-like chest pain or dyspnea, 2) transient apical and mid-ventricular regional wall-motion abnormality, 3) minor elevation of cardiac biomarkers, 4) dynamic electrocardiographic changes, and 5) the absence of epicardial coronary artery disease. The pathogenesis of the syndrome is unknown but has mostly been associated with acute emotional or physiologic stressors. Dote, Sato, Tateishi, Uchida, Ishihara (J Cardiol. 21(2):203-214, 1991); Desmet, Adriaenssens, Dens (Heart. 89(9):1027-1031, Sep., 2003); Bybee, Kara, Prasad, et al. (Ann Intern Med. 141(11):858-865, Dec 7, 2004); Sharkey, Lesser, Zenovich, et al. (Circulation. 111(4):472-479, Feb 1, 2005) The short and long-term prognosis of these patients is overwhelmingly favorable and often only requires supportive therapy. CONCLUSION: Whether an emotional or physical event precedes one's symptoms, it is apparent that takotsubo cardiomyopathy case presentations mimic ST-segment elevation myocardial infarction, and thus is an important entity to be recognized by the medical community.


Subject(s)
Takotsubo Cardiomyopathy/diagnosis , Takotsubo Cardiomyopathy/physiopathology , Electrocardiography , Female , Humans , Male , Middle Aged , Sex Distribution , Stress, Psychological/complications , Stress, Psychological/physiopathology
6.
J Stroke Cerebrovasc Dis ; 17(4): 241-3, 2008.
Article in English | MEDLINE | ID: mdl-18589346

ABSTRACT

Transient global amnesia (TGA) is characterized by sudden, temporary dysfunction of antegrade and recent retrograde memory without other neurologic deficits. Although there is sometimes a precipitating event, the origin of TGA remains controversial. We encountered a patient who developed recurrent TGA when upright, in whom the symptom promptly and regularly resolved when supine. Symptoms began about a week after cardiac surgery concurrent with marked hyperfibrinogenemia and acceleration of the erythrocyte sedimentation rate, and abated without recurrence when these laboratory abnormalities were ameliorated by anticoagulant and corticosteroid therapy. Diagnostic studies, including temporal artery biopsy and cerebral angiography, disclosed no anatomic vascular pathology. This is the first report of TGA associated with postoperative inflammation in which amnesia was provoked by orthostatic positioning. In conclusion, these observations implicate ischemia caused by hemodynamic vascular insufficiency as a possible cause of TGA.


Subject(s)
Amnesia, Transient Global/etiology , Bioprosthesis , Coronary Artery Bypass , Dizziness , Fibrinogen/analysis , Heart Valve Prosthesis Implantation , Postoperative Complications/etiology , Thrombophilia/complications , Adrenal Cortex Hormones/therapeutic use , Aged , Amnesia, Transient Global/blood , Amnesia, Transient Global/drug therapy , Anticoagulants/therapeutic use , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/surgery , Blood Sedimentation , Humans , Male , Myocardial Infarction/complications , Myocardial Infarction/surgery , Optic Neuropathy, Ischemic/complications , Postoperative Complications/blood , Postoperative Complications/drug therapy , Recurrence , Supine Position , Tachycardia, Supraventricular/complications , Thrombophilia/blood
7.
J Investig Med ; 51(6): 353-9, 2003 Nov.
Article in English | MEDLINE | ID: mdl-14686638

ABSTRACT

It has recently been established that bone marrow-derived endothelial progenitor cells (EPCs) are recruited to the systemic circulation and, in response to various cytokines, pharmacologic agents, and/or tissue ischemia, incorporate into sites of new blood vessel growth (neovascularization). These findings have changed our understanding of adult neovascularization by demonstrating that both preexisting endothelial cells and EPCs contribute to blood vessel formation during adult life. The following review article highlights the discovery of EPCs, their relationship to various clinical diseases, and their therapeutic potential for augmenting blood vessel formation.


Subject(s)
Blood Vessels/physiology , Endothelial Cells/physiology , Neovascularization, Physiologic , Regeneration/physiology , Stem Cells/physiology , Animals , Endothelial Cells/cytology , Humans , Stem Cells/cytology
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