How European cardiologists perceive the role of calcium antagonists in follow-up after myocardial infarction

About one hundred European cardiologists discussed the role of calcium antagonists in the follow-up management of myocardial infarction, β-blockers are the treatment of choice. Where these are contra-indicated or otherwise unsuitable, many clinicians would use a non-dihydropyridine calcium antagonist alone or in combination with an ACE inhibitor. There is broad agreement that calcium antagonists should not be used in patients with concomitant left ventricular failure. Cholesterol estimation in post-infarction patients is essentia

Books

Valuable distillations of other people's experiencesHow To Do It. Vol. 3. Pp. x + 203. Illustrated. £9 (including postage by air). London: BMJ. 1990. (Also available from Libriger Book Distributors, Bloemfontein.)Medical dictionaryConcise Medical Dictionary. 3rd ed. Ed. By Elizabeth A. Martin. Pp. 1-759. Oxford: Oxford University Press. 1990.Paediatric cardiologyPrevention in Childhood and Youth of Adult Cardiovascular Diseases: Time for Action. Ed. by WHO Expert Committee. Pp. 1 - 105. Illustrated. Sw. Fr. 12. Geneva: WHO.1990.Contraceptive safety Safety Requirements for Contraceptive Steroids. Ed. by F. Michal. pp. xv - 467. Illustrated. £65,00. Cambridge: Cambridge University Press. 1989.Psychiatry Textbook of Psychiatry. Ed. by P. J. V. Beumont and R. B. Hampshire. Pp. x + 520. Illustrated. PriCe £29,50. Oxford: Blackwell Scientific Publications. 1989

Screening for primary aldosteronism- normal ranges for aldosterone and renin in three South African population groups

Objective. To establish normal ranges for plasma aldosterone, renin and aldosterone / renin (A/ R) ratio in South African normotensives under typical ou tpatient conditions, and to estimate the prevalence of primary aldosteronism (PA) among hypertensives in primary care settings.Design and methods. One hundred and thirty-six normotensive subjects and 154 sex- and age-matched hypertensives at three primary care clinics had measurements of blood pressure, plasma creatinine, K+, aldosterone, plasma renin activity, and spot urine for urinary Na+/ creatinine ratio. Medication was not withdrawn before testing.Results. Mean plasma renin activity in black normotensive subjects (0.95 ± 1.25 ng/ ml/ h, mean± standard deviation (SD)) was significantly lower than in white (2.09 ± 1.12 ng/ ml/ h; P < 0.0001) and coloured (1.81 ± 1.86 ng/ ml/ h, P = 0.013) normotensives. Mean plasma aldosterone in black normotensives (306 ± 147 pmol/ 1) was also significantly lower than in white (506 ± 324 pmol/1, P = 0.0002) and coloured (418 ± 304 pmol/1, P = 0.0148) normotensives. In hypertensives, there were no significant differences in renin or aldosterone levels between the three population groups. Urinary Na+ /creatinine ratios, an index of Na+ intake, were not significantly different in the three population groups. None of the normotensives had an A/R ratio ≥ 1 000 plus aldosterone ≥ 750, while 7.1% of hypertensives exceeded these levels, suggesting that they are appropriate criteria for screening for PA.Conclusions. A large fraction of black normotensive subjects had low renin and aldosterone levels compared with whites, suggesting a salt-retaining tendency in black subjects. These results have important implications for the interpretation of plasma renin and aldosterone levels in hypertensive patients. In primary care settings, 7.1% of hypertensives had biochemical results indicating the need for investigation of PA

South African Hypertension Guideline 2006

Outcomes. Extensive data from many randomised controlled trials have shown the benefit of treating hypertension. The target blood pressure (BP) for antihypertensive management should be systolic BP < 140 mmHg, diastolic BP < 90 mmHg, with minimal or no drug side-effects. However, a lesser reduction will elicit benefit although this is not optimal. The reduction of BP in the elderly should generally be achieved gradually over 6 months. Stricter BP control is required for patients with end-organ damage, co-existing risk factors and co-morbidity, e.g. diabetes mellitus. Co-existent risk factors should also be controlled. Benefits. Reduction in risk of stroke, cardiac failure, renal insufficiency and coronary artery disease. The major precautions and contraindications to each antihypertensive drug recommended are listed. Recommendations. Correct BP measurement procedure is described. Evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy are stipulated. The total cardiovascular disease risk profile should be determined for all patients and this should inform management strategies. Lifestyle modification and patient education are cornerstones in the management of every patient. Drug therapy for the patient with uncomplicated hypertension should be as follows: first line – low-dose thiazide or thiazide-like diuretics; second line – add either an angiotensin-converting enzyme inhibitor (ACE-I) or a calcium channel blocker (CCB); third line – add another second-line drug not already used. In resistant hypertension where a fourth drug is needed, use either a centrally acting drug, vasodilator, alpha-blocker, or beta-blocker. The order of drug choice may change in those with compelling indications for a particular drug class. The guideline includes management of specific situations including hypertensive emergency and urgency, severe hypertension with target-organ damage and hypertension in diabetes mellitus, etc. Validity. The guideline was developed by a joint Southern African Hypertension Society and National Department of Health Directorate: Chronic Diseases, Disabilities and Geriatrics working group. Input was also obtained from representatives of the various related professional societies

Designing multiplayer games to facilitate emergent social behaviours online

This paper discusses an exploratory case study of the design of games that facilitate spontaneous social interaction and group behaviours among distributed individuals, based largely on symbolic presence 'state' changes. We present the principles guiding the design of our game environment: presence as a symbolic phenomenon, the importance of good visualization and the potential for spontaneous self-organization among groups of people. Our game environment, comprising a family of multiplayer 'bumper-car' style games, is described, followed by a discussion of lessons learned from observing users of the environment. Finally, we reconsider and extend our design principles in light of our observations

Language and Groundwater: Symbolic Gradients of the Anthropocene

This article argues that geographers must study the power of words as integral parts of human–environment relationships, with particular attention to local meanings, to intervene more effectively in the Anthropocene. Words are important tools by which people come to understand environmental changes and develop plans to facilitate mitigation and adaptation or, alternatively, to postpone these responses. This project considers the portion of Texas underlain by the Ogallala aquifer as a system of communication, exploring stakeholder articulations through in-depth interviews. The semiotic concepts of gradients, grading, degradation, and grace are employed to facilitate consideration of how verbal articulations intersect with resource use, conservation, anthropogenic environmental change, and action within a highly conservative political context.Office of the VP for Researc

Distribution of hyperglycaemia and related cardiovascular disease risk factors in low-income countries: a cross-sectional population-based survey in rural Uganda

Background Data on non-communicable disease (NCD) burden are often limited in developing countries in Africa but crucial for planning and implementation of prevention and control strategies. We assessed the prevalence of related cardiovascular disease risk factors (hyperglycaemia, high blood pressure and obesity) in a longstanding population cohort in rural Uganda

VEGF attenuates development from cardiac hypertrophy to heart failure after aortic stenosis through mitochondrial mediated apoptosis and cardiomyocyte proliferation

<p>Abstract</p> <p>Background</p> <p>Aortic stenosis (AS) affects 3 percent of persons older than 65 years and leads to greater morbidity and mortality than other cardiac valve diseases. Surgery with aortic valve replacement (AVR) for severe symptomatic AS is currently the only treatment option. Unfortunately, in patients with poor ventricular function, the mortality and long-term outcome is unsatisfied, and only a minority of these patients could bear surgery. Our previous studies demonstrated that vascular endothelial growth factor (VEGF) protects cardiac function in myocardial infarction model through classic VEGF-PI3k-Akt and unclear mitochondrial anti-apoptosis pathways; promoting cardiomyocyte (CM) proliferation as well. The present study was designed to test whether pre-operative treatment with VEGF improves AS-induced cardiac dysfunction, to be better suitable for AVR, and its potential mechanism.</p> <p>Methods</p> <p>Adult male mice were subjected to AS or sham operation. Two weeks later, adenoviral VEGF (Ad-VEGF), enhanced green fluorescence protein (Ad-EGFP, as a parallel control) or saline was injected into left ventricle free wall. Two weeks after delivery, all mice were measured by echocardiography and harvested for further detection.</p> <p>Results</p> <p>AS for four weeks caused cardiac hypertrophy and left ventricular dysfunction. VEGF treatment increased capillary density, protected mitochondrial function, reduced CMs apoptosis, promoted CMs proliferation and eventually preserved cardiac function.</p> <p>Conclusions</p> <p>Our findings indicate that VEGF could repair AS-induced transition from compensatory cardiac hypertrophy to heart failure.</p

State diagrams of the heart – a new approach to describing cardiac mechanics

<p>Abstract</p> <p>Background</p> <p>Cardiac time intervals have been described as a measure of cardiac performance, where prolongation, shortening and delay of the different time intervals have been evaluated as markers of cardiac dysfunction. A relatively recently developed method with improved ability to measure cardiac events is Tissue Doppler Imaging (TDI), allowing accurate measurement of myocardial movements.</p> <p>Methods</p> <p>We propose the state diagram of the heart as a new visualization tool for cardiac time intervals, presenting comparative, normalized data of systolic and diastolic performance, providing a more complete overview of cardiac function. This study aimed to test the feasibility of the state diagram method by presenting examples demonstrating its potential use in the clinical setting and by performing a clinical study, which included a comparison of the state diagram method with established echocardiography methods (E/E' ratio, LVEF and WMSI). The population in the clinical study consisted of seven patients with non ST-elevation myocardial infarction (NSTEMI) and seven control subjects, individually matched according to age and gender. The state diagram of the heart was generated from TDI curves from seven positions in the myocardium, visualizing the inter- and intraventricular function of the heart by displaying the cardiac phases.</p> <p>Results</p> <p>The clinical examples demonstrated that the state diagram allows for an intuitive visualization of pathological patterns as ischemia and dyssynchrony. Further, significant differences in percentage duration between the control group and the NSTEMI group were found in eight of the totally twenty phases (10 phases for each ventricle), e.g. in the transition phases (Pre-Ejection and Post-Ejection). These phases were significantly longer (> 2.18%) for the NSTEMI group than for the control group (p < 0.05). No significant differences between the groups were found for the established echocardiography methods.</p> <p>Conclusion</p> <p>The test results clearly indicate that the state diagram has potential to be an efficient tool for visualization of cardiac dysfunction and for detection of NSTEMI.</p