This editorial discusses cardiovascular risk in patients with HIV infection. It summarizes several studies that have shown increased cardiovascular risk in HIV patients, especially those receiving protease inhibitors as part of HAART treatment. However, the studies have limitations like low event rates, short exposure durations, and retrospective designs. The editorial evaluates a new study that provides more complete data on imaging, metabolic factors, and their association with cardiovascular risk. A key finding is that HIV patients meeting criteria for metabolic syndrome had increased markers of insulin resistance and cardiovascular risk. Larger, prospective studies are still needed to better understand cardiovascular risk in HIV patients and the effects of antiretroviral therapy, aging, and other risk factors.
Cross talk between covid-19 and ischemic strokeafnaanqureshi1
Here are some linkages between SARS-CoV-2 and Ischemic Stroke;
I made this under the guidance of my professor:- Dr. Suhel Parvez (Professor and Head of Department Toxicology)
The Coagulopathy of Trauma: A Review of MechanismsEmergency Live
Coagulopathy associated with traumatic injury is the result of multiple independent but interacting mechanisms. Early coagulopathy is driven by shock and requires thrombin generation from tissue injury as an initiator. Initiation of coagulation occurs with activation of anticoagulant and fibrinolytic pathways.
Cross talk between covid-19 and ischemic strokeafnaanqureshi1
Here are some linkages between SARS-CoV-2 and Ischemic Stroke;
I made this under the guidance of my professor:- Dr. Suhel Parvez (Professor and Head of Department Toxicology)
The Coagulopathy of Trauma: A Review of MechanismsEmergency Live
Coagulopathy associated with traumatic injury is the result of multiple independent but interacting mechanisms. Early coagulopathy is driven by shock and requires thrombin generation from tissue injury as an initiator. Initiation of coagulation occurs with activation of anticoagulant and fibrinolytic pathways.
Systemic Hypertension (HTN) accounts for the largest amount of attributable Cardiovascular (CV) mortality worldwide. There are several factors responsible for the development of HTN and its CV complications. Multicenter trials revealed that risk factors responsible for Micro Vascular Disease (MVD) are similar for those attributable to Coronary Artery Disease (CAD) which include tobacco use, unhealthy cholesterol levels, HTN, obesity and overweight, physical inactivity, unhealthy diet, diabetes, insulin resistance, increasing age and genetic predisposition. In addition, the defective release of Nitric Oxide (NO) could be a putative candidate for HTN and MVD. This study reviewed the risk stratification of hypertensive population employing cardiac imaging modalities which are of crucial importance
in diagnosis. It further emphasized the proper used of cardiac imaging to determine patients at increased CV risk and identify the management strategy. It is now known that NO has an important effect on blood pressure, and the basal release of endothelial Nitric Oxide (eNOS) in HTN may be reduced. Although there are different forms of eNOS gene allele, there is no solid data revealing the potential role of the polymorphism of the eNOS in patients with HTN and coronary vascular diseases. In the present article, the prevalence of eNOS G298 allele in hypertensive patients with micro vascular angina will be demonstrated. This review provides an update on appropriate and justified use of non-invasive imaging tests in hypertensive patients and its important role in proper diagnosis of MVD and CAD. Second, eNOS gene allele and its relation to essential hypertension and angina pectoris are also highlighted.
Cardiomyopathy in HIV patients has been shown to progress faster than idiopathic Dilated Cardiomyopathy in the HIV negative population. It is therefore important to recognize this condition early in this population and manage it appropriately. Studies need to be done to validate the current therapy for cardiomyopathy in this population since it is still unclear that LV dysfunction in this population responds in a similar fashion as in HIV negative patients with Dilated Cardiomyopathy
The Indian Consensus Document on Cardiac BiomarkerApollo Hospitals
Despite recent advances, the diagnosis and management of heart failure evades the clinicians. The etiology of congestive heart failure (CHF) in the Indian scenario comprises of coronary artery disease, diabetes mellitus and hypertension. With better insights into the pathophysiology of CHF, biomarkers have evolved rapidly and received diagnostic and prognostic value. In CHF biomarkers prove as measures of the extent of pathophysiological derangement; examples include biomarkers of myocyte necrosis, myocardial remodeling,
neurohormonal activation, etc.
Pericardial Blood as a Trigger for POAF Affter Cardiac Surgery ~ Annals of Th...Paul Molloy
Background. Prevention strategies have long been
sought to reduce the incidence and burden of postoperative
atrial fibrillation (POAF) after heart surgery.
However, none has emerged as a dominant and widely
applicable prophylactic measure. The purpose of this
review is to consider the biological mechanisms by which
shed mediastinal blood leads to oxidation and inflammation
within the postoperative pericardial environment
and how this might trigger POAF in susceptible persons,
.....
Spontaneous coronary artery dissection (SCAD) is an infrequent and often missed diagnosis among patients presenting with acute coronary syndrome (ACS). Unfortunately, SCAD can result in significant morbidities such as myocardial ischemia and infarction, ventricular arrhythmias and sudden cardiac death. Lack of angiographic recognition from clinicians is a major factor of under-diagnosis. With the advent of new imaging modalities, particularly with intracoronary imaging, there has been improved diagnosis of SCAD. The aim of this paper is to review the epidemiology, etiology, presentation, diagnosis and management of SCAD.
2. JACC Vol. 47, No. 6, 2006 Stein 1125
March 21, 2006:1124–5 Editorial Comment
HAART, metabolic risk factors, and cardiovascular imaging carefully matched triads based on HIV serostatus, antiret-
in patients with HIV and control subjects has not been roviral therapy, and cardiovascular risk factors. At baseline,
reported previously, so it is unique in that regard. there were no differences in CIMT between the groups of
The finding that CIMT was greater among HIV- HIV-infected patients (7). Three-year follow-up of changes
infected patients with MetS is consistent with the metabolic in CIMT, risk factors, and virological markers are expected
data provided by the authors. This finding would have been in early 2006. These studies will help clarify the major
more powerful if it had been corroborated by the aortic contributors to cardiovascular risk in patients with HIV
pulse wave velocity data; however, the sample size was infection.
relatively small. Also, certain markers of MetS in HIV- Conclusions. In regard to cardiovascular risk in patients
infected patients did predict increased pulse wave velocity, with HIV, we have incomplete data. Compared with the
such as blood pressure, 2-h glucose, and fasting insulin, high death rate from AIDS in patients with inadequate viral
suggesting that insulin resistance may be involved in the suppression, cardiovascular event rates are low and control
pathophysiology of vascular dysfunction in patients on of viremia, regardless of the treatment strategy, is more
HAART. It is interesting that markers of inflammation and important for long-term survival than any increase in
viral load were more associated with CIMT than flow- cardiovascular risk that may be related to metabolic changes
mediated vasodilation or pulse wave velocity, but these associated with HAART. Uncontrolled viremia may be
associations are somewhat difficult to interpret in the more of a cardiovascular risk than controlled infection that
absence of information about the specific antiretroviral results in hyperlipidemia and insulin resistance. The overall
agents used by the subjects, because agents within classes message is that obtaining and maintaining virological con-
have different effects on insulin-glucose metabolism and trol is the overriding concern in patients with HIV infec-
lipoproteins (1). Although the imaging data in this study do tion. Metabolic and vascular effects secondary to HAART are
not conclusively demonstrate that MetS, as traditionally secondary considerations, but are worthy of rigorous investiga-
defined, is useful for identifying increased cardiovascular tion, as suggested by the paper by van Wijk et al. (5).
risk in HIV-infected patients, the metabolic abnormalities
observed in MetS patients suggest that insulin resistance Reprint requests and correspondence: Dr. James H. Stein,
may be involved and that further studies are needed (5). University of Wisconsin Medical School, Cardiology, G7/341
Future directions. To better understand cardiovascular CSC, MC 3248, 600 Highland Avenue, Madison, Wisconsin
53792. E-mail: jhs@medicine.wisc.edu.
risk in patients on HAART, larger, prospective studies are
needed. The biases inherent in observational and cross-
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