ABSTRACT
AIM: The aim of the study was to investigate the frequency and type of cardiac manifestations in a defined group of patients with inborn errors of metabolism. This paper also explores the key role of cardiac manifestations in the diagnosis of inborn errors of metabolism in daily practice. METHODS: Out of the 287 patients with the potential for inborn errors of metabolism who had been referred to the University Hospital of Heraklion (202 children and adolescents and 85 adults), 41 were found to have a variety of cardiac manifestations, including cardiomyopathy, cardiomegaly, atrioventricular conduction disorders and coronary artery disease. RESULTS: In 15 out of the 41 patients a diagnosis of inborn errors of metabolism was established, while the total number of patients with inborn errors of metabolism was 60 out of the 287. In 6 out of the 15 patients the major symptoms were from the cardiovascular system and 7 of them were adults with symptoms initiating in childhood. CONCLUSION: The cardiac findings consist of a neglected area in the diagnosis of the inborn errors of metabolism. Neurologists, pediatricians and internists should cooperate with cardiologists in managing people with unexplained cardiac symptoms and signs and be aware that several inborn errors of metabolism are associated with cardiac abnormalities and mild neurologic findings.
Subject(s)
Heart Diseases/etiology , Metabolism, Inborn Errors/complications , 3-Hydroxyacyl CoA Dehydrogenases/metabolism , Adolescent , Adult , Cardiomyopathy, Dilated/etiology , Cardiomyopathy, Hypertrophic/etiology , Child , Child, Preschool , Coronary Artery Disease/etiology , Greece , Heart Block/etiology , Heart Diseases/diagnosis , Heart Diseases/metabolism , Humans , Infant , Metabolism, Inborn Errors/diagnosis , Metabolism, Inborn Errors/metabolism , Middle AgedABSTRACT
OBJECTIVE: Home care surveillance has been shown to reduce hospital readmission and improve functional status and quality of life of elderly patients with mild to moderate or severe congestive heart failure and in younger patients candidates for transplantation. The present study aimed to investigate the effect of home-based intervention on hospital readmission and quality of life of middle-aged patients with severe congestive heart failure. METHODS: Thirty-three patients aged 50-75 (mean age 65.4+/-6.7) with class III and IV congestive heart failure were included in this observational, community-based study. Intervention consisted of intensive home surveillance of patients, including frequent home visits associated with laboratory tests and telephone contacts to implement standard therapy, treat early symptoms and provide psychological support. RESULTS: Admissions for cardiovascular reasons decreased from 2.143+/-1.11 for the year before the initiation of the study to 1.25+/-1 after its completion (P=0.0005). Quality of life improved, as showed by a decrease of the mean score of the Minnesota Living with Heart Failure Questionnaire from 2.68+/-0.034 to 2.33+/-0.032 (P=0.0001). CONCLUSION: Intensive home care of middle-aged patients with severe heart failure results in improved quality of life and a decrease in hospital readmission rates.
Subject(s)
Community Health Nursing/standards , Heart Failure/psychology , Home Care Services/standards , Middle Aged/psychology , Patient Readmission/statistics & numerical data , Quality of Life/psychology , Activities of Daily Living , Age Factors , Aged , Community Health Nursing/education , Female , Follow-Up Studies , Greece , Heart Failure/blood , Heart Failure/etiology , Heart Failure/prevention & control , Humans , Male , Nursing Evaluation Research , Program Evaluation , Severity of Illness Index , Social Support , Surveys and QuestionnairesABSTRACT
There is substantial epidemiologic data, but limited experimental data, supporting the mortality benefit of low-dose alcohol consumption. A regimen of a single, daily alcoholic beverage was sufficient to increase both high-density lipoprotein (HDL) (4.4%, p = 0.03) and HDL2 (7.7%, p = 0.04) in men and women, but did not significantly affect hemostatic markers of cardiovascular risk.
Subject(s)
Alcohol Drinking , Blood Coagulation Factors/analysis , Cardiovascular Diseases/blood , Cardiovascular Diseases/epidemiology , Cholesterol, HDL/blood , Lipoproteins/blood , Adult , Beer , Female , Humans , Male , Middle AgedABSTRACT
OBJECTIVE: The purpose of this study was to investigate any potential hemodynamic effect of intravenously administered triiodothyronine in patients undergoing coronary artery bypass surgery. EXPERIMENTAL DESIGN: Thirty patients were randomized in this single-blind, placebo-controlled trial. Hemodynamic parameters including heart rate, stroke volume index, cardiac index, pulmonary wedge pressure, pulmonary vascular resistances, systemic vascular resistances, and mean blood pressure, were compared between the two groups preoperatively, before the initiation of cardiopulmonary bypass (CPB), 5 minutes after the end of CPB, and 2, 4, 10, 16, and 22 hours thereafter. INTERVENTION: Triiodothyronine was administered as a bolus infusion over a 1 min period after removal of the aortic cross-clamp, (0.15 microgram/kg), before the end of CPB (0.1 microgram/kg), 4 hours after the end of CPB (0.1 microgram/kg), 9 hours after CPB (0.1 microgram/kg), and 14 hours after CPB (0.1 microgram/kg). Patients received inotropes, vasodilators, and diuretics only if specifically indicated. RESULTS: Plasma FT3 levels were higher in the T3 group, but within the normal range. No significant differences were noted in the pre and post CPB hemodynamics between the two groups for the most part of the study except that heart rate was increased in T3 group. A greater number of patients in the control group received vasodilators. No adverse reactions were noted with triiodothyronine administration. CONCLUSION: Triiodothyronine administration in patients undergoing cardiopulmonary bypass surgery is safe, may lessen the need for pharmacological (vasodilator) therapy, but may increase heart rate.
