Sudden Cardiac Death in Adult Patients with Stable Ischemic Heart Disease

There are approximately one half million patients with stable ischemic heart disease (SIHD) in the United States. Patients with stable ischemic heart disease who die suddenly do not maintain a Stable Ischemic profile. Benchimol, et al., reported 319 consecutive stable angina patients without clinical heart failure or a recent myocardial infarction but who had multiple risk factors and proven coronary disease which made them more prone to acute myocardial infarction or unstable angina. In the APSIS (angina prognosis in Stockholm) study, Hjemdahl reported that signs of ischemia or previous manifestations of coronary artery disease, i.e., myocardial infarction or revascularization, were found in 69% of both male and female patients at baseline. Little, retrospectively reported that minor plaques may disrupt and result in unstable angina or occlusive coronary disease which then may result in acute myocardial infarction. Stable angina patients, by definition, are stable and are not high risk unless they have multiple factors or which may make them prone to evolve an acute coronary syndrome or develop a serious arrhythmia but sudden death does occur in some patients

Ventriculography in a Single Catheterization Laboratory

Catheter based ventriculography has evolved over the last century and in many instances has been replaced by use of cardiac ultrasound. Despite the shift, ventricular function remains an important part of assessing myocardial damage and prognosis. There is no doubt that cardiac ultrasound can evaluate LV size, myocardial wall motion and wall thickening, and is non-invasive, readily available, relatively inexpensive and portable. Poor acoustic windows are the major limitation of cardiac ultrasound as are foreshortened imaging planes. In contrast, catheter based left ventriculography, can evaluate similar attributes of LV function but limitations are that it is invasive requiring arterial access, involves radiation exposure, and the use of iodinated radio-opaque contrast which may result in renal dysfunction. The Society of Cardiovascular angiography and Intervention (SCAI) recommendations for catheter based left ventriculography are consensus opinions which need rigorous prospective evaluation. Probably the most important SCAI recommendation is that local criteria should be developed to decrease variation in performance among operators within individual catheterization laboratories. No data are available to determine which patient gets catheter based left ventriculography or echo assessment of ventricular function. Decision making regarding the use of catheter based or ultrasound based angiography is quite complex because of limitation and interaction of the various determinants, e.g. creatinine, diabetes, gender, contrast volume and fluoro time

Cardiac Rehabilitation: Preliminary Results

We have always thought that patients with cardiac disease are depressed and anxious. The plan for cardiac rehab begins with exercise 3 times a week for 12 weeks. Patients are usually elderly. Typical patients are 60+ years old, inactive but stable, smoke cigarettes, are stressed, hypertensive, and anxious. After several visits the staff for the program report that patients are confident with decreased anxiety and improved exercise ability. Challenges for a rehab program are parking, education and frailness. At present we have no data on outcome (mortality, morbidity) but most measurements are improved after rehab. Outcome data after discharge for rehab program must be obtained