Management of hyperlipidaemia after coronary revascularisation: follow up study.
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Angioplasty, Balloon, Coronary↗
Biomedical subjects
H Saner
Publications and source records attributed to H Saner.
[What thrombolytic rate can be realized in acute myocardial infarct? Results of the Oltner Heart Emergency Study].
BACKGROUND: Despite the benefits of thrombolytic therapy, there is evidence that not all suitable patients are receiving it. Early and accurate recognition of the ECG changes of myocardial infarction is a prerequisite for effective thrombolytic treatment. METHODS: During the Olten Heart Emergency Study we prospectively evaluated 951 consecutive patients with symptoms suggestive of myocardial infarction who were cared for by the emergency networks connected with Olten Cantonal Hospital. MAIN OUTCOME MEASURES: The final diagnosis was myocardial infarction in 173 patients (18.2%). Diagnostic ST-segment elevation was found in 48.6% and complete left bundle branch block in 13.9% of these patients, representing a total of 62.5% acute myocardial infarction patients eligible for thrombolysis based on the ECG findings. Using a time limit of 6 hours between onset of symptoms and hospital entry for small and medium-size myocardial infarctions and 12 hours for large infarctions, plus an age limit of 70 years for inferior and 75 years for anterior infarctions as exclusion criteria for thrombolysis, we found one or more contraindications for the use of thrombolytic therapy in 50.9% of these patients. The most prevalent contraindication was time delay in the prehospital phase in 38.2%, followed by advanced age in 34.5%. Medical contraindications to thrombolytic treatment were found to be present in only 10.9%. Extension of the prehospital time delay to 24 hours would have increased the candidates for thrombolytic treatment to 39.3%, and raising the upper age limit by 5 years would have increased them to 46.8%. CONCLUSIONS: Our figures for a theoretically adequate thrombolysis rate contrast with many previous studies and the clinical reality in different hospitals both in Switzerland and around the world. In view of the importance and socioeconomic consequences of thrombolytic treatment in myocardial infarction, studies focusing on possible reasons for discrepancies between guidelines for thrombolytic therapy and their implementation in hospital practice would appear to be a necessity in providing measures to improve patient care in this clinical setting.
Adult↗
[High altitude stay and air travel in coronary heart disease].
Acute exposure to high altitude produces hypoxia-associated stimulation of the sympathetic nervous system. This response is further enhanced by physical activity and induces an increase in heart rate and blood pressure. Consequently, cardiac work, myocardial oxygen consumption, and coronary blood flow are also increased. During the first 4 days of acute exposure to moderate or high altitude, coronary patients are at greatest risk of untoward events. Gradual ascent, early limitation of activity to a lower level than tolerated at low altitude, pre-ascent physical conditioning and rigorous blood pressure control should all help to minimise the cardiac risk. At altitudes of 2500 to 3000 m or lower, an asymptomatic coronary patient with good exercise tolerance, without exercise induced signs or symptoms of ischemia, and with an ejection fraction of the left ventricle > 50%, is at very low risk. However, several days' acclimatization before high-level activity at moderate or high altitude is recommended. High risk coronary patients should be investigated more carefully and precautionary measures should be more stringent. Left and right cardiac function and pulmonary artery pressure are the most helpful parameters for evaluation and counselling of patients with non-ischemic heart disease who plan to ascend to moderate or high altitudes. When advising patients who intend to fly as passengers in commercial aircraft, it is important to know that in-flight atmospheric pressure conditions in commercial jet aircraft approach altitude equivalents of 1500 to 2400 m. Propeller-driven planes are rarely pressurized but usually fly at altitudes below 3300 m. Relatively strict contraindications for air travel by coronary patients are uncomplicated myocardial infarction within the last 2 weeks, complicated myocardial infarction within the last 6 weeks, unstable angina, thoracic surgery within the last 3 weeks, and poorly controlled congestive heart failure, arrhythmia, or hypertension.
Aircraft↗
[Pleural and pericardial effusion after pacemaker implantation as first manifestation of malignant tumors].
We report 2 cases with unusual "complications" after pacemaker implantation. One patient developed hemorrhagic pleural and 1 patient pericardial effusion. Both manifestations of hemorrhage were felt to be due to complications in relation to the pacemaker implantation. However, in both patients cytologic analysis of the effusion revealed malignant cells, in 1 case from an ovarian cell carcinoma, in the other case from an adenocarcinoma of unknown origin. Our report indicates, that under rare circumstances pleural or pericardial effusion after pacemaker implantation may be the first manifestation of a malignant process independent of the pacemaker implantation procedure.
Adenocarcinoma↗
[Stress as cardiovascular risk factor].
With appropriate assessment, stress has been shown to be an important variable for the development and course of cardiovascular diseases. Elements of stress include life events, inadequate coping strategies, deficient social support and a combination of heavy demands/ low rewards at work as well as in other situations. Dealing with stress therefore is important in cardiac rehabilitation and secondary prevention, as well as in the primary prevention of cardiovascular disease. The issue was discussed controversially at a workshop at the Annual meeting of the Swiss Society of Cardiology in 1996. The opposing views are presented.
Combined Modality Therapy↗
[The prehospital phase of patients with suspected acute myocardial infarct: results of the Oltner Cardiac Emergency Study].
Early reperfusion in acute myocardial infarction has been shown to reduce myocardial damage and to improve prognosis. The goals of this study, the Olten Cardiac Emergency Study, were to identify the factors, related to the patients or to the emergency medical services, which influenced pre-hospital delay in patients with symptoms suggestive of acute myocardial infarction. From November 1, 1992, to June 15, 1993, all the events occurring between symptom onset and hospital discharge where analyzed for 341 such patients who were cared for by the emergency networks connected with the Cantonal Hospital, Olten: in addition, follow-up at 3 months was obtained on all patients discharged alive. Of the 341 patients, 14 (4.1%) died out of the hospital. The final diagnoses of the 327 patients admitted to the emergency department were: acute myocardial infarction 18.3%; unstable angina 10.1%; stable angina 3.4%; non-ischemic cardiac diseases 29.4%; other non-cardiac diseases 38.8%. Mean delay between symptom onset and arrival at the hospital was 8 h 55 min (median delay 4 h 10 min); for patients with a final diagnosis of acute myocardial infarction, mean delay was 9 h 43 min (median delay 5 h 10 min). Patient delay was surprisingly long and represented 70.4% of the total pre-hospital delay; 56.6% of the patients did not realize that their symptoms were serious and only 47.1% (and 68.3% of the patients with acute myocardial infarction) came to the hospital by ambulance. These long pre-hospital delays were responsible for the low (13.3%) thrombolysis rate of patients with acute myocardial infarction. We conclude that pre-hospital delay was much too long in our population. Improvements can only be achieved through patient education and better efficiency of emergency networks. Our findings underline the need for public education campaigns on heart attacks.
Aged↗
[Isolated tuberculosis of the heart: a clinical and echocardiography follow-up].
A case of isolated right ventricular myocardial tuberculoma with pericardial effusion is presented. The diagnosis of myocardial tuberculoma was initially suggested by echocardiography and later by magnetic resonance imaging. The diagnosis of cardiac tuberculosis was confirmed by demonstration of tubercle bacilli in the pericardial fluid. This is a very rare condition which is usually diagnosed only by necropsy. Myocardial tuberculoma should figure on the list of intraparietal masses visualized at echocardiography.
Adult↗
Profiles of violent youth: substance use and other concurrent problems.
OBJECTIVES: This study examined the prevalence of various violent behaviors among high school-age adolescents, the co-occurrence of teenage violence with other public health problems, and gender differences in violence. METHODS: Longitudinal data for more than 4500 high school seniors and dropouts from California and Oregon were used to develop weighted estimates of the prevalence of violent behavior and its co-occurrence with other emotional and behavioral problems. RESULTS: More than half the sample had engaged in violence during the last year, and one in four had committed predatory violence. Boys were more likely than girls to engage in most types of violence, but both were equally prone to violence within the family. Violent youth were more likely than their peers to have poor mental health, use drugs, drop out of school, and be delinquent. Violent boys were more likely than violent girls to commit nonviolent felonies and sell drugs, but less likely to have poor mental health or become a parent. Prevalence estimates for violence co-occurring with three or more other problems ranged from 4% to 21%. CONCLUSIONS: Teenage violence typically coexists with additional emotional and behavioral problems. Programs must consider the broader public health context in which violence occurs.
Adolescent↗
[Nonbacterial thrombotic endocarditis: a contribution to the clinical differential diagnosis in culture-negative endocarditis].
Nonbacterial thrombotic endocarditis is rarely diagnosed before death. We report on 3 patients with nonbacterial thrombotic endocarditis to illustrate the clinical course of this disease that can cause severe systemic thromboembolism and may be the first manifestation of malignant disease. Nonbacterial thrombotic endocarditis must be considered in the differential diagnosis of culture-negative endocarditis.
Adenocarcinoma↗
Concurrent risk factors for adolescent violence.
PURPOSE: To examine the risk and protective factors for different types of violent behavior in a sample of high school age adolescents drawn from the general population, illuminate the multiple and cumulative nature of the different risk factors, and characterize gender differences in explanatory variables that foster involvement in violent activities. METHODS: Using data from a 6-year longitudinal self-report survey of over 4,500 high school seniors and high school dropouts from California and Oregon, we developed weighted estimates of the proportions of youth exhibiting different risk factors who are also involved in violent activities. We use risk scales to show the cumulative effects of multiple factors within substantive domains, and logistic regression techniques to pinpoint the effects of each risk factor relative to others included in the models. RESULTS: Major risk factors for violence include gender and deviant behaviors, such as using and selling drugs, committing nonviolent felonies, and engaging in other forms of nonviolent delinquency. Low academic orientation, lack of parental affection and support, and perceptions of parents' substance use also show strong links with violent behavior. As the number of risk factors increases, so does the likelihood of engaging in violent behavior. Boys and girls show somewhat different paths to violence, with girls being comparatively more susceptible to the effects of family problems or disruption and impaired relationships with parents. For boys, engaging in other deviant behaviors provides the most information about their propensity to commit violent acts. Weak bonds with school and family also have an impact on serious violence for boys. CONCLUSIONS: Risk factors from multiple domains--demographic, environmental, and behavioral--contribute to involvement in various types of violent behavior. The strong links between violence, drug use, and delinquency argue for prevention/intervention programs that take into account the clustering of these behaviors, while the contribution of weak familial and school bonds point to the need for efforts to strengthen these institutions. Research is needed to identify effective ways of achieving these ends.
Adolescent↗
[Cardiac rehabilitation--how and when?].
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Adaptation, Psychological↗
Low-cost flexible sigmoidoscopy screening: a community demonstration and education project.
The purpose of this project was to demonstrate that a low-cost, community-based screening and education approach (for both patients and physicians), as has been used with mammography, can be successful with flexible sigmoidoscopy. One hundred appointments over four days were made available via a targeted mailing to 12,000 health-interested community members if they were asymptomatic, 50 years old or older, and had never before been screened by flexible sigmoidoscopy. The cost for the procedure was set at $50. Professional education was accomplished by having local physicians interested in gaining greater experience with flexible sigmoidoscopy provide the screenings under supervision. All 100 patient appointments and seven physician-training slots were quickly filled. Ninety-five procedures were performed by seven local physicians, averaging 10 minutes per procedure, with an average insertion depth of 31 cm and a 4.2% premalignant-polyp detection rate. The patients were also given education and counseling about colorectal cancer screening and prevention, and were evaluated by pre- and post-testing, and satisfaction questionnaires. The patients demonstrated markedly significant knowledge gains about colorectal cancer prevention and early detection, with 99% agreeable to having the procedure repeated in the future. This project demonstrated a high level of both public and professional willingness to participate in a flexible sigmoidoscopy screening program. The project method is presented in detail to encourage future such programs.
Aged↗
Different hemodynamic effects of celipropol and atenolol in patients with mild to moderate hypertension.
The hemodynamic effects of celiprolol (CAS 56980-93-9), a betablocker with beta 1 antagonist and beta 2 agonist properties, were compared with those of atenolol (CAS 29122-68-7) in 12 patients with mild to moderately severe hypertension (diastolic BP 95-110 mmHg). Celiprolol and atenolol lead to a similar and significant reduction of systolic and diastolic blood pressure (p < 0.005). However, with celiprolol heart rate at rest was significantly less depressed then with atenolol (p = 0.004) and showed a distinctly less pronounced depression of heart rate with exercise (p = 0.004). Cardiac output at rest was reduced by 19% under atenolol, but was increased by 9% under celiprolol treatment; in this respect, the two medications differed significantly (p = 0.03). The adaptation of heart rate and cardiac output to exercise was better with celipropol as compared to atenolol treatment. The difference between arm arterial pressure and ankle occlusion pressure at rest was not significantly influenced by atenolol, whereas celiprolol treatment increased this difference by a mean of up to 16 mmHg (p = 0.009). This different effect on peripheral arterial circulation was even more pronounced after exercise. Both celiprolol and atenolol increased blood cell flow velocity in the nailfold capillaries, but this increases was statistically only significant with celiprolol (p = 0.047). These results demonstrate that the hemodynamic effects of celiprolol were significantly different from those of atenolol; celiprolol produces less bradycardia, increases cardiac output at rest and decreases peripheral arterial resistance.(ABSTRACT TRUNCATED AT 250 WORDS)
Adrenergic beta-Antagonists↗
[Ambulatory rehabilitation of cardiac patients in Switzerland].
In 1989, there were 21 rehabilitation clinics and 21 ambulatory cardiac rehabilitation programs in Switzerland. Approximately 3/4 of the cardiac rehabilitation programs are offered within rehabilitation clinics, which cater for 6000 patients. The first ambulatory cardiac rehabilitation program in Switzerland was instituted in 1972. Since then a continuous rise in the number and importance of such programs has been observed. There is a wide variety of program selection and intensity. All programs include physical activity, risk factor interventions and psychosocial support. The mean duration of the programs is 3 months, the range being from 6 weeks to a year. Evaluation after 8 years' existence of the ambulatory cardiac rehabilitation program at the Kantonspital Olten indicates that such a program in an out-patient setting in conjunction with a community hospital is feasible; it can be conducted with a high degree of safety and is followed by similar lifestyle changes to those observed after in patient rehabilitation at specialist clinics. The results with regard to cardiovascular risk factors and ability to return to work are comparable.
Ambulatory Care↗
[Cognitive and psychological effects on the population of a cardiac emergency campaign].
The major part of the delay from onset of symptoms of acute myocardial infarction to arrival in hospital is caused by patients' delayed reporting. Therefore, a media campaign was initiated by the Swiss Heart Foundation with the goal of informing people about the seriousness of chest pain and about the importance of proper action in these situations. An initial 2 months' national campaign was followed by a 3 weeks' intensive local campaign in a mixed urban/suburban area in central Switzerland. The aim of the study was to evaluate the effects of this media campaign on patients information and reaction in case of cardiac emergency, and to study the possible impact of this campaign on anxiety levels and other emotions. Telephone interviews were performed before and after both the national and the local campaign using a cohort of 500 persons in a longitudinal and 4 x 500 persons in a cross-sectional study. The information had reached about 50% of the population by the end of the local campaign. The percentage of persons who would call the emergency medical services immediately in case of chest pain increased from 40% to 57% in the cross-sectional and from 48% to 65% in the longitudinal study (p < 0.001), and the percentage of persons who would call the ambulance team immediately on witnessing a person with a heart attack increased from 25 to 92% in the cross-sectional and to 96% in the longitudinal study (p < 0.001). Anxiety levels and other negative emotions decreased slightly during the campaign (p < 0.05), whereas feelings of personal safety revealed a slight increase (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Initial results with a comprehensive ambulatory rehabilitation program for heart patients].
213 patients (197 males and 16 females, mean age 58.5 years) have taken part during the first 5 years in our comprehensive out-patient cardiac rehabilitation program (101 patients after acute myocardial infarction, 73 patients after heart surgery and 39 patients with various cardiac problems). The program consists of three elements: (1.) regular physical training in an out-patient group three times a week for 6-12 weeks; (2.) information and education of the patient and if possible of the family about risk factors and life-style changes, and (3.) psychosocial support. During 10,838 hours of active rehabilitation, no life-threatening complication occurred. After completion of the program, 73% of the patients were fully rehabilitated (return to work in the active working population, reintegration in the family and daily life in the retired and non-working patients), 15% of the patients interrupted the program because of further invasive treatment, and in 11% the goal of the rehabilitation program was not achieved. Follow-up was carried out by a questionnaire 3-56 months (mean 25 months) later. The percentage of smokers decreased from 55% before the program to 18% (p < 0.05), regular physical exercise increased from 49% to 76% (p < 0.05), and the perceived stress level of high intensity decreased from 53 to 9% (p < 0.05). Our findings indicate that a comprehensive cardiac rehabilitation program in an out-patient setting in conjunction with a community hospital is feasible; it can be conducted with a high degree of safety and is followed by considerable lifestyle changes.
Adult↗
[Aortic valve stenosis in the old age: clinical and echocardiographic aspects].
Among 380 consecutive patients > 70 years of age, patients with a systolic heart murmur were investigated both clinically and by doppler echocardiography. The aim of the study was to compare the validity of the clinical diagnosis of valvular aortic stenosis in elderly patients with the results of doppler echocardiography. 138/380 patients (36%) had a systolic heart murmur. 130 were investigated by doppler echocardiography. 23/130 patients with systolic murmur (18%) had moderate or severe aortic stenosis. Clinically, patients with moderate or severe aortic stenosis had a pulsus parvus et tardus of the carotid artery more often than patients with only slight or no evidence of aortic stenosis (61% vs 16%; p < 0.0001). In patients with moderate or severe aortic stenosis, the murmur radiated more often to the carotid vessels (65% vs 19%; p < 0.0001). Systolic blood pressures and pressure amplitudes were lower in patients with moderate or severe aortic stenosis (132 vs 141 mm Hg; p < 0.01; 61 vs 68 mm Hg; p < 0.001). Electrocardiography showed left ventricular hypertrophy or bundle branch block more often in patients with moderate or severe aortic stenosis (57% vs 15%; p < 0.01). We conclude that moderate or severe aortic stenosis is a frequent finding in elderly patients. Diagnosis by clinical examination may be difficult. For this reason, doppler echocardiography should be performed, especially when therapeutic consequences are to be expected from the diagnosis, such as aortic valve replacement or vasodilator treatment in the case of congestive heart failure.
Aged↗
[The elderly patient in cardiology].
This paper summarizes the special aspects of cardiovascular disease in the elderly. Arterial hypertension, heart failure and electrical disturbances may often lead to a different therapeutic approach in this clinical setting. Myocardial infarction is often complicated and may lead to considerable disability; therefore, thrombolytic therapy should be considered also in elderly patients. Coronary angioplasty and heart surgery are successfully performed in patients greater than or equal to 80 years of age, but special consideration has to be given to the functional states and the presence of concomitant disease in these patients.
Aged↗