Asunto(s)

RESUMEN

OBJECTIVES: To assess frequency and predictors of post-traumatic stress disorder (PTSD), measured by the Post Traumatic Stress-self report version, at three months after admission for acute coronary syndromes (ACS). DESIGN: Two-phase prospective study. SETTING: Four coronary care units. PATIENTS: 135 patients admitted to hospital with ACS confirmed by ECG and cardiac enzyme changes. RESULTS: 20 patients (14.8%) showed a symptom pattern characteristic of PTSD at three months assessed by a conservative scoring criterion. Severity of chest pain and psychological factors during admission were predictive of PTSD severity. Acute stress symptoms, depression, negative affect, hostility, and pain scores were independent predictors of three-month PTSD symptoms (R(2) = 0.495, p < 0.001). In contrast, demographic factors (age, sex, education level and income) were unrelated to post-traumatic symptoms, as were markers of clinical disease severity. CONCLUSIONS: Patient vulnerability to PTSD three months after ACS is predictable on the basis of psychological state and chest pain at the time of admission. This may be valuable to the clinician, as PTSD after myocardial infarction is associated with poorer quality of life, reduced adherence to drug treatment and increased likelihood of cardiovascular morbidity.

Asunto(s)

RESUMEN

OBJECTIVE: To investigate the role of vigorous physical exertion and anger as triggers of acute coronary syndromes (ACS) and to identify the clinical and sociodemographic correlates of triggering. DESIGN: Prospective observational clinical cohort study. SETTING: Four coronary care units in the London area. PATIENTS: 295 men and women with electrocardiographically and biochemically verified ACS. MAIN OUTCOME MEASURES: Physical exertion in the 1 h and anger in the 2 h before symptom onset were assessed with structured interviews. Control periods were the equivalent hours one day earlier and usual rates over the past six months. Data were analysed by case-crossover methods. RESULTS: Physical exertion was reported by 10% and anger by 17.4% of patients in the hazard period. The risk of ACS onset after physical exertion compared with light or no activity was 3.50 (95% confidence interval (CI) 1.37 to 10.6). The risk of onset with anger was 2.06 (95% CI 1.12 to 3.92). Physical exertion during the hazard period was related to an absence of premonitory symptoms, presentation with an ST elevation myocardial infarction (STEMI), low socioeconomic deprivation and higher future cardiovascular risk. Anger during the hazard period was more common in younger, socioeconomically deprived patients who presented with a STEMI. CONCLUSIONS: Triggers are relevant across the spectrum of ACS. The distinct clinical and sociodemographic factors associated with physical exertion and anger suggest that different pathophysiological processes may be involved.

Asunto(s)

RESUMEN

Inflammatory diseases are commonly associated with depressed mood. This association may be influenced by the production of proinflammatory cytokines. Accordingly, we assessed whether cytokine levels and mood (measured with the profile of mood states) could be altered by a mild, non-sickness inducing, acute inflammatory stimulus. Using a randomised placebo-controlled, double-blind design, 30 healthy male volunteers were injected with Salmonella typhi vaccine or placebo. Assessments of mood, symptoms of illness and temperature were made at baseline and at 1.5, 3, and 6 h post-injection. Plasma concentrations of interleukin-6 (IL-6), interleukin-1 receptor antagonist (IL-1Ra), and tumour necrosis factor-alpha (TNF-alpha) were assessed at baseline and 3 h post-injection. No significant symptoms of illness were reported in either group. Mood was more negative following injection in the vaccine than the placebo group, and the vaccine group experienced a 106% increase in IL-6 concentration. Negative changes in mood following injection were significantly correlated with increases in IL-6 production. No changes in TNF-alpha or IL-1Ra concentration were recorded in either group. It is concluded that S. typhi vaccination may be a useful model of mild inflammatory challenge, producing a significant transient cytokine-induced decrease in mood in the absence of any febrile response. Implications for depressed mood in physical illness are discussed.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Giant coronary artery aneurysm is a rare manifestation of coronary artery disease. This patient presented at echocardiography and was successfully managed by surgical resection.

Asunto(s)

RESUMEN

BACKGROUND AND AIMS OF THE STUDY: Exercise treadmill testing was used to evaluate the functional rest and stress hemodynamic profile of the Medtronic Intact aortic bioprosthesis. METHODS: A group of 93 patients (mean age at operation 72.9 years; range: 61-79 years) was studied. Mean time to follow up was 20.8 months. The preoperative diagnosis was aortic stenosis (AS; n = 66), aortic regurgitation (AR; n = 19) or AS/AR (n = 8). Left ventricular function was assessed as normal (n = 78), moderate (n = 14) or poor (n = 1). Patients received a range of valve sizes: 21 mm (n = 7); 23 mm (n = 41); 25 mm (n = 32); 27 mm (n = 7); and 29 mm (n = 6). RESULTS: For all valve sizes, Doppler-derived hemodynamics at rest and peak exercise, respectively were: mean aortic valve gradient (AVG) 13.2 +/- 5.2 mmHg and 22.2 +/- 8.9 mmHg; peak aortic valve gradient (AVG) 24.3 +/- 9.6 mmHg and 39.1 +/- 13.5 mmHg; effective orifice area (EOA) 1.39 +/- 0.49 cm2 and 1.38 +/- 0.5 cm2; and effective orifice area index (EOAI) 0.76 +/- 0.26 cm2/m2 and 0.75 +/- 0.26 cm2/m2. Mean and peak AVG decreased as valve sizes increased, while both EOA and EOAI increased as valve sizes increased. CONCLUSIONS: The Medtronic Intact aortic bioprosthesis provides good hemodynamics both at rest and exercise, across the range of implanted valve sizes.

Asunto(s)

RESUMEN

Between 1993 and 1996 the CarboMedics Top Hat supraannular aortic valve was implanted in 41 patients at the Wessex Cardiothoracic Centre (age, 39 to 74 years; mean, 61.3+/-8.9 years). Comparisons of annular dimensions made at surgery indicate that conventional annular valve replacement would have required at least a size smaller valve. This was particularly marked when a prosthetic mitral valve was in place. Operative mortality was 2.4%. There were also three late deaths. Echocardiography before and after symptom-limited treadmill testing has been performed in 21 patients. The mean time to follow-up was 16.1 months. The Doppler-derived indices of forward flow pre- and postexercise were expressed as mean+/-standard deviation. For 23-mm valves the values were: peak valve gradient 21.43+/-7.46 mm Hg and 35.86+/-14.4 mm Hg, aortic valve area 1.13+/-0.39 cm2 and 1.24+/-0.54 cm2. For 21-mm valves the values were: peak valve gradient 24.84+/-8.2 mm Hg and 31.29+/-5.84 mm Hg, aortic valve area 1.08+/-0.44 cm2 and 0.95 +/-0.2 cm2. The Top Hat valve has a good hemodynamic profile at rest and during exercise. Surgical considerations make it particularly useful in patients with a small aortic annulus and in patients undergoing combined aortic and mitral valve replacement.

Asunto(s)