DOCSLIB.ORG

Promoting Cardiovascular Health Worldwide 1

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Promoting Cardiovascular Health Worldwide 1 Promoting CONTENTSCardiovascular Health Worldwide Edited by Valentin Fuster, Jagat Narula, Rajesh Vedanthan, Bridget B. Kelly 8 INTRODUCTION 3 Promoting Global Cardiovascular Health: The Institute of Medicine Recommendations Valentin Fuster, Rajesh Vedanthan, Bridget B. Kelly and Jagat Narula RECOMMENDATION 1 8 Recognize Chronic Diseases as a Development Assistance Priority Epidemics without Borders Gregory Paton, K. Srinath Reddy and Kiti Kajana RECOMMENDATION 2 14 Advocate for Chronic Diseases as a Funding Priority Funding the Fight against Chronic Diseases Valentin Fuster RECOMMENDATION 3 30 20 Improve National Coordination for Chronic Diseases Kenyans Come Together against Chronic Diseases Gerald Yonga RECOMMENDATION 4 36 24 Implement Policies to Promote Cardiovascular Health How Policy Makers Can Advance Cardiovascular Health Sonia Angell, Jessica Levings, Andrea Neiman, Samira Asma and Robert Merritt RECOMMENDATION 5 30 Include Chronic Diseases in Health Systems Strengthening Echoing the Lessons of HIV Miriam Rabkin, Eric Goosby and Wafaa M. El-Sadr RECOMMENDATION 6 36 Improve Access to CVD Diagnostics, Medicines and Technologies Delivering Care Where It’s Needed K. Srinath Reddy, Rajesh Vedanthan, Sylvester Kimaiyo, Andrew B. Hughey, Kim A. Eagle and Thomas C. Crawford Illustration by J. F. Podevin Cover image by Bryan Christie Promoting Cardiovascular Health Worldwide 1 TOC-Masthead 6p.indd 1 5/27/14 5:01 PM CONTENTS PROMOTING Promoting CARDIOVASCULAR HEALTH WORLDWIDE Cardiovascular Health A custom publication produced in collaboration with ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI Worldwide PUBLICATION EDITORIAL BOARD Perspective on the 12 Recommendations Valentin Fuster, M.D., Ph.D. of the Institute of Medicine Physician in Chief, The Mount Sinai Hospital Director, Mount Sinai Heart Richard Gorlin, M.D., Heart Research Foundation RECOMMENDATION 7 Professor of Cardiology Icahn School of Medicine at Mount Sinai 42 Collaborate to Improve Diet Jagat Narula, M.D., Ph.D. Get Down to Business Philip J. and Harriet L. Goodhart Chair in Cardiology 42 Jose M. Saavedra Professor of Medicine, Icahn School of Medicine at Mount Sinai Associate Dean, The Arnhold Global Health Institute at Mount Sinai RECOMMENDATION 8 48 Improve Local Data Rajesh Vedanthan, M.D. Assistant Professor of Medicine, Cardiology Collecting Reliable Data Icahn School of Medicine at Mount Sinai C. James Hospedales, Reza Malekzadeh, Bridget B. Kelly, M.D., Ph.D. Daniela Godoy, Andrew Mirelman and Senior Program Officer, Institute of Medicine of the National Academies, Keck Center Paolo Boffetta Robinson Santana Administrative Coordinator RECOMMENDATION 9 Icahn School of Medicine at Mount Sinai 54 Define Resource Needs SCIENTIFIC AMERICAN CUSTOM PUBLISHING What Will It Take PUBLICATION AND MEDIA DIRECTOR: Diane McGarvey to Do More? Rachel A. Nugent and Celina Gorre ASSISTANT PUBLICATION AND MEDIA DIRECTOR: 60 Lisa Pallatroni EDITORIAL DIRECTOR: RECOMMENDATION 10 Sharon Guynup 60 Research to Assess What Works ART DIRECTOR: Edward Bell in Different Settings CONTRIBUTING EDITORS One Size Does Not Fit All Claudia Wallis, Erica Gies, Jessica Wapner Alla Katsnelson, Ingfei Chen, Roxanne Khamsi Cristina Rabadán-Diehl, Evan Bennett, Glenn Scherer, Usha Lee McFarling Carlos Peyra and Silvia Fuster ILLUSTRATORS: Bryan Christie, J. F. Podevin, Lucy Reading, Kenn Brown, Jessica Hsiung, Ron Miller, RECOMMENDATION 11 Andrew Swift, Eléonore Dixon-Roche 66 Disseminate Knowledge and Innovation PHOTO EDITOR: among Similar Countries Jamie Isaia PRODUCTION CONSULTANTS: Share What Works Richard Hunt, Michelle Wright Shanthi Mendis, C. James Hospedales COPy EDITOR: Michael Battaglia and Jagat Narula SCIENTIFIC AMERICAN PUBLISHING STAFF PRESIDENT: Steven Inchcoombe RECOMMENDATION 12 ExECUTIvE vICE PRESIDENT 72 Report on Global Progress Michael Florek The WHO Monitoring Model vICE PRESIDENT, ASSOCIATE PUBLISHER, MARKETING AND BUSINESS DEvELOPMENT Shanthi Mendis and Oleg Chestnov Michael Voss vICE PRESIDENT, CONSUMER MARKETING The viewpoints expressed in these articles are those of the authors and editors alone and should not be construed as representing the Institute of Medicine of the National Academies. Christian Dorbandt SENIOR PRODUCTION MANAGER Promoting Cardiovascular Health Worldwide is published by Scientific American, a division of Nature America, Inc., 75 Varick Street, 9th Floor, New York, NY 10013- 1917. Copyright © 2014 Scientific American, a Division of Nature America, Inc. All rights reserved. No part of this publication may be reproduced by any mechanical, Christina Hippeli photographic or electronic process, or in the form of a phonographic recording, nor may it be stored in a retrieval system, transmitted or otherwise copied for public or private use without written permission of the publisher. Scientific American is a trademark of Scientific American, Inc., used with permission. PREPRESS AND QUALITy MANAGER2 Scientific American, October 2013 Silvia De Santis TOC-Masthead 6p.indd 2 5/27/14 5:00 PM INTRODUCTION Promoting Global Cardiovascular Health: The Institute of Medicine Recommendations Valentin Fuster, Rajesh Vedanthan, Bridget B. Kelly and Jagat Narula ardiovascular disease and related noncommunicable diseases were once considered a problem that only wealthy, industrialized nations faced. Together, they now rank as the leading cause of death across the globe. The vast majority of those deaths—more than 80 percent—occur in low- and middle-income countries. These diseases aff ect people from rural villages in India and Africa to small towns in Chile and major cities in the U.S., China, Europe—and everywhere in between. CBeyond the human toll, there is also heavy economic impact: Heart attack, stroke, diabetes and other cardiovascular-related illness are extremely costly, straining both personal and national fi nances. This special issue, Promoting Cardiovascular Health Worldwide, explores the problem—and outlines the solutions. The U.S. Institute of Medicine formed a committee to create a set of tangible recommendations that would catalyze and focus action around this important global health problem. The resulting report, Pro- moting Cardiovascular Health in the Developing World, was released in 2010. Funded by the U.S. National Heart, Lung and Blood Institute, it detailed the reasons behind the exponential growth in cardiovascu- lar-related illnesses and the behaviors that contribute to them and outlined ways to reduce the global burden of these diseases. The recommendations highlighted a need for new tools, national policies and results-oriented programs. They also emphasized collaborations among governments, global health and development agencies and the international business community. Illustration by Jean Francois Podevin Promoting Cardiovascular Health Worldwide 3 Intro 6p.indd 3 5/30/14 4:49 PM BARRIERS ESSENTIAL FUNCTIONS RECOMMENDATIONS Recognize Chronic Diseases as a Lack of awareness A 1 Development Assistance Priority Building Priorities, Competing Advocacy Advocate for Chronic Diseases priorities for and Funding government/donors 2 as a Funding Priority Improve National Coordination 3 for Chronic Diseases Implement Policies to Promote 4 Cardiovascular Health Weak health systems B Include Chronic Diseases in Policy and Health Systems Strengthening Conflicting Program 5 obligations in Implementation private sector Improve Access to CVD Diagnostics, Medicines 6 and Technologies 7 Collaborate to Improve Diet 8 Improve Local Data Insufficient C data on Data Define Resource Needs effectiveness Management 9 and Research Research to Assess What 10 Works in Different Settings Disseminate Knowledge and Innovation among Inadequate D 11 Similar Countries coordination Global among stakeholders Coordination and Reporting 12 Report on Global Progress SOURCE:4 Scientifi4 PromotingScientifi c American, c GlobalAmerican, October Cardiovascular October 2013 2013 Health: Moving Forward. Fuster V., et al. Circulation, 2011; 123: 1671–1678 October 2013,2013, ScientifiPhotograph cAmerican.com by Tktk Tktk 4 Intro 6p.indd 4 5/30/14 5:27 PM BARRIERS ESSENTIAL FUNCTIONS RECOMMENDATIONS The following year, in September 2011, the United BUILDING PRIORITIES, ADVOCACY Nations General Assembly convened a high level meeting on AND FUNDING noncommunicable diseases, placing the issue squarely on the RECOMMENDATION 1 Recognize Chronic Diseases as a world’s agenda and demanding immediate action. Recognize Chronic Diseases as a Lack of awareness Development Assistance Priority A 1 In this issue, some of the world’s foremost authorities on Development Assistance Priority cardiovascular disease elaborate on the Institute of Medicine’s Epidemics without Borders Building Priorities, 12 recommendations to address this massive, worldwide Although cardiovascular and related chronic diseases are Competing Advocacy Advocate for Chronic Diseases problem. We provide concrete examples of programs that are starting to be recognized as part of the global health agenda, priorities for and Funding 2 as a Funding Priority working eff ectively on the ground, refl ect on global progress there is still relatively little investment from international government/donors made since 2010—and defi ne a way forward. development assistance agencies and the global health donor community; in many nations, these diseases are still largely THE GLOBAL CARDIOVASCULAR EPIDEMIC ignored. Many developing countries lack well-staff ed, well- Improve National Coordination There are myriad factors feeding the current cardiovascular
Load more

Recommended publications
  • Valentin Fuster, Md, Phd
    VALENTIN FUSTER, MD, PHD Address: The Mount Sinai Medical Center One Gustave L. Levy Place, Box 1030 New York, NY 10029-6574 Date of Birth: January 20, 1943 Place of Birth: Barcelona, Spain Education: 1954-1961 B.S. Colegio Jesuitas, Barcelona, Spain (Baccalaureate) 1961-1967 M.D. Faculty of Medicine, Barcelona University, Barcelona, Spain 1971 Ph.D. University of Edinburgh, Edinburgh, Scotland Postdoctoral Training: Internship, Residencies, and Fellowships: 1967-1968 Internship (Straight Medical), Hospital Clinico, Barcelona, Spain 1968-1971 Research Fellow in Cardiovascular Diseases, Department of Medicine, Royal Infirmary, University of Edinburgh, Edinburgh, Scotland 1971-1972 Resident in Medicine, Mayo Graduate School of Medicine, Rochester, Minnesota Licensure and Certification: 1967 Internal Medicine Licensure, University of Barcelona, Spain 1970 Educational Council for Foreign Medical Graduates 1974 Minnesota State Board of Medical Examiners 1976 Internal Medicine Board Certification 1977 Cardiovascular Diseases Board Certification 1982 New York State Medicine and Surgery 1991 Massachusetts State Medicine and Surgery Military Service: 1966-1968 Spanish Army, Second Lt., Barcelona, Spain; Active Duty - 10 months, February 2006 1 Reserve - 2 years Academic Appointments: 1997- Richard Gorlin, M.D./Heart Research Foundation Professor of Cardiology, Mount Sinai School of Medicine, New York, New York 1994-1997 Arthur M. and Hilda A. Master Professor of Medicine, Mount Sinai School of Medicine, New York, New York 1994 Dean for Academic
    [Show full text]
  • Myocardial Lactate and Pyruvate Metabolism
    MYOCARDIAL LACTATE AND PYRUVATE METABOLISM Norman Krasnow, … , Joseph V. Messer, Richard Gorlin J Clin Invest. 1962;41(11):2075-2085. https://doi.org/10.1172/JCI104665. Research Article Find the latest version: https://jci.me/104665/pdf Journal of Clinical Investigation Vol. 41, No. 11, 1962 MYOCARDIAL LACTATE AND PYRUVATE METABOLISM * By NORMAN KRASNOW, WILLIAM A. NEILL, JOSEPH V. MESSER, AND RICHARD GORLIN t (From the Medical Clinics, Peter Bent Brigham Hospital, and Department of Medicine, Harvard Medical School, Boston 15, Mass.) (Submitted for publication May 23, 1962; accepted August 1, 1962) Although the heart has been considered pri- myocardial lactate extraction. Excess lactate has marily an aerobic organ, recent work (1) has re- not been found in normal or diseased human sub- emphasized the possibility that measurement of jects (10-15) at rest except in a few patients oxygen consumption alone may not 1)e adequate with progressive muscular dystrophy (16). None to define the total energy utilization under all con- has been subjected to exercise. ditions. The role of anaerobic metabolism must The purposes of this report are to describe 1) be reviewed. the effects of the stresses of physical exercise and Methods of defining as well as quantifying ischemia on myocardial lactate and pyruvate me- anaerobiosis are currently in dispute. When oxi- tabolism in man and dogs and 2) the role of dation and glycolysis proceed at the same rate, anaerobiosis during these stresses. carbohydrate is oxidized to CO2 and H20. Lac- tate arises whenever the rate of glycolysis exceeds MATERIALS AND METHODS the rate of oxidation.
    [Show full text]
  • Disclosure/Conflict of Interest Statement
    Disclosure/Conflict of Interest Statement As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME) and the American Nurses Credentialing Center (ANCC), the American College of Cardiology Foundation (ACCF) must ensure balance, independence, objectivity and scientific rigor in all of their directly provided or jointly provided/co-provided educational activities. Planners, presenters, and other contributors, in a position to control the content are required to disclose to the audience all relevant financial relationships he/she and/or his/her spouse or domestic partner may have, occurring within the past 12 months, with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. When an unlabeled use of a commercial product or an investigational use not yet approved for any purpose is discussed during an educational activity, the contributor should disclose that the product is not labeled for the use under discussion or that the product is still investigational. ACCF is committed to providing its learners with high-quality activities and materials that promote improvements and quality in health care and not a specific proprietary business or commercial interest. The intent of this disclosure is not to prevent participation in educational activities by persons with a financial or other relationship, but rather to provide learners with information on which they can make their own determination whether financial interests or relationships may influence the educational activity. ACCF assesses conflicts of interest (COI) with its faculty, planners, managers, staff and other individuals who are in a position to control the content of CME/CNE activities.
    [Show full text]
  • Arteriographie Anatomy and Mechanisms of Myocardial
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector JACC Vol. 9. No.6 1397 June 1987:1397-402 EDITORIALS Arteriographic Anatomy and Mechanisms of Myocardial Ischemia in Unstable Angina JOHN A. AMBROSE, MD, FACC , CRAIG E. HJEMDAHL-MONSEN, MD New York, New York Over the past 20 years, there has been considerable research stable angina; and 3) all ischemic rest pain without evidence into the pathogenesis of myocardial ischemia in unstable of myocardial infarction. angina. Early data (1-3) suggested that transient increases These catagories are not mutually exclusive . The cate­ in myocardial oxygen demand explained episodes of rest gory of rest pain would include some patients with previ­ pain in patients with unstable angina and severe coronary ously mild angina and a marked increase in symptoms (cres­ artery disease. In the 1970s this view changed and the con­ cendo angina) and also patients with previously severe angina cept of vasospasm became the most favored mechanism to and a slight increase in symptoms. Other proposed classi­ explain episodes of myocardial ischemia and rest pain, thus fications for unstable angina include the categories of sub­ changing the emphasis from the demand side to the supply endocardial infarction and postinfarction angina. The natural side of coronary dynamics (4,5). More recently, serial an­ history of patients with these conditions may be different giographic studies (6,7) have demonstrated that progression from that of patients classified in the preceding categories of coronary artery disease is extremely common in patients (14). More complex classifications have been proposed based with stable angina who are restudied after an episode of on clinical or angiographic criteria , or both (15,16).
    [Show full text]
  • VALENTIN FUSTER, M.D., PH.D. Curriculum Vitae
    VALENTIN FUSTER, M.D., PH.D. Curriculum Vitae Address: The Mount Sinai Medical Center One Gustave L. Levy Place, Box 1030 New York, NY 10029-6574 Date of Birth: January 20, 1943 Place of Birth: Barcelona, Spain Education: 1954-1961 B.S. Colegio Jesuitas, Barcelona, Spain (Baccalaureate) 1961-1967 M.D. Faculty of Medicine, Barcelona University, Barcelona, Spain 1971 Ph.D. University of Edinburgh, Edinburgh, Scotland Postdoctoral Training: Internship, Residencies, and Fellowships: 1967-1968 Internship (Straight Medical), Hospital Clinico, Barcelona, Spain 1968-1971 Research Fellow in Cardiovascular Diseases, Department of Medicine, Royal Infirmary, University of Edinburgh, Edinburgh, Scotland 1971-1972 Resident in Medicine, Mayo Graduate School of Medicine, Rochester, Minnesota Licensure and Certification: 1967 Internal Medicine Licensure, University of Barcelona, Spain 1970 Educational Council for Foreign Medical Graduates 1974 Minnesota State Board of Medical Examiners 1976 Internal Medicine Board Certification 1977 Cardiovascular Diseases Board Certification 1982 New York State Medicine and Surgery 1991 Massachusetts State Medicine and Surgery Military Service: 1966-1968 Spanish Army, Second Lt., Barcelona, Spain; Active Duty - 10 months, Reserve - 2 years Academic Appointments: 2009- General Director, CNIC-Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain 2007-2009 Scientific Director, CNIC-Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain 2006- Director, Mount Sinai Heart, , Mount Sinai School of Medicine, New York, New York 1997- Richard Gorlin, M.D./Heart Research Foundation Professor of Cardiology, Mount Sinai School of Medicine, New York, New York 1994-1997 Arthur M. and Hilda A. Master Professor of Medicine, Mount Sinai School of Medicine, New York, New York 1994 Dean for Academic Affairs, Mount Sinai Medical Center, New York, New York 1991-1994 Mallinckrodt Professor of Medicine, Harvard Medical School, Boston, Massachusetts 1 1982-1991 Arthur M.
    [Show full text]
  • Acute Coronary Hemodynamic Response to Cigarette Smoking in Patients with Coronary Artery Disease
    JACC Vol. 3, No.4 879 April 1984:879-86 CLINICAL STUDIES Acute Coronary Hemodynamic Response to Cigarette Smoking in Patients With Coronary Artery Disease LLOYD W. KLEIN, MD,* JOHN AMBROSE, MD, FACC, AUGUSTO PICHARD, MD, FACC, JAMES HOLT, MA, RICHARD GORLIN, MD, FACC, LOUIS E. TEICHHOLZ, MD, FACC New York, New York The acute changes in coronary blood flow and coronary group II (p < 0.05). Patients in group IA had a highly resistance that occur in response to cigarette smoking significant increase in coronary resistance as compared have not been accurately determined. To define the fac• with group IB (i 7.0 ± 4.2% versus t 0.9 ± 2.6%) (p tors that affect this response, coronary sinus blood flow < 0.001). Coronary sinus flow tended to decrease ( t 1.2 was measured in 16 patients (group I) with coronary ± 4.6%) in group IA but to increase ( i 3.8 ± 5.1%) artery disease and in 6 patients (group II) without an• in group IB (p = 0.06). giographically detectable coronary disease. Seven pa• It is concluded that smoking increases coronary re• tients (group IA) had severe (2. 75%) proximal left coro• sistance in patients with coronary artery disease. Agreater nary lesions and nine patients (group IB) had significant impact is observed in patients with a severe proximal distal lesions with 50% or less proximal stenoses. Group stenosis than in those with a distal stenosis. It is proposed I had a smaller overall increase ( i 1.6 ± 5.3 %) in coro• that smoking increases coronary artery tone at the site nary sinus blood flow than did group II ( i 7.7 ± 6.1 %) of the stenosis, limiting the coronary flow response pro• (p < 0.05).
    [Show full text]
  • Effects of Chronic Tobacco Smoking on the Coronary Circulation
    J AM cou, CARDIOl 421 1983 .1(2)421-6 Effects of Chronic Tobacco Smoking on the Coronary Circulation LLOYD W. KLEIN, MD, AUGUSTO D. PICHARD, MD, FACC, JAMES HOLT, MA, HARRY SMITH, PhD, RICHARD GORLIN, MD, FACC, LOUIS E. TEICHHOLZ, MD, FACC New York. New York The effects of chronic smoking on the coronary circu• was 74.1 ± 20.1% in the smokers versus 117.1 ± 45.1% lation were studied by evaluating the coronary vascular in the nonsmokers (p < 0.02). In patients who smoked reserve in 12 chronic smokers (group 1) and 10 non• 1 pack a day or less and in those who smoked more than smokers (group 2). All patients were referred to cardiac 1 pack a day, the mean coronary reserve was 89.5 and catheterization for evaluation of chest pain and were 64.9%, respectively (p < 0.05). Additionally, of 20 pa• found to have normal coronary and left ventricular an• tients followed up for an average of 20 months, 7 of 10 giograms. Coronary vascular reserve was measured by smokers and 1 of 10 nonsmokers continued to have chest analyzing the hyperemic response to selective coronary pain (p < 0.03). The cause for the chest pain has not injection of contrast agent. There was no statistically been established in these patients. These results suggest significantdifference between groups 1and 2 with regard that coronary vascular reserve is significantly less in to age, baseline electrocardiogram or response to tread• chronic smokers than in nonsmokers, and that this de• mill or thallium·201 exercise tests.
    [Show full text]
  • Commencement2019 THURSDAY, JUNE 20, 2019 This Program Is Also Available in Spanish
    ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI Commencement2019 THURSDAY, JUNE 20, 2019 This program is also available in Spanish. Please see an usher in the back of the Hall. Este programa también se encuentra disponible en español. Por favor, observe al acomodador en el fondo de la sala. ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI COMMENCEMENT EXERCISES THURSDAY, JUNE 20, 2019 LEO C. STERN AUDITORIUM ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI NEW YORK CITY Commencement Program PROCESSIONAL Opus 5 Brass Quintet ACADEMIC PROCESSION Grand Marshal JANICE L. GABRILOVE, MD, FACP Director, Clinical Research Education Program (CRTP, Master of Science in Clinical Research, and PhD in Clinical Research) Co-Director, PORTAL (MD/MSCR) Program Graduate School of Biomedical Sciences The James F. Holland Professor of Medicine and Oncological Sciences Associate Director, Education and Training The Tisch Cancer Institute Icahn School of Medicine at Mount Sinai Procession Marshals CHRISTINE CORTALANO, MPH, CHES Manager, Public Health Practice Graduate Program in Public Health Graduate School of Biomedical Sciences Icahn School of Medicine at Mount Sinai KELLY GENTRY, MA, LPC Manager, Career Services and Alumni Relations Graduate Program in Public Health Graduate School of Biomedical Sciences Icahn School of Medicine at Mount Sinai ARJANA GJOKAJ Program Coordinator, Curriculum Support Graduate School of Biomedical Sciences Icahn School of Medicine at Mount Sinai HERB LOPEZ Program Manager, Master of Science in Health Care Delivery Leadership Graduate School of Biomedical Sciences Icahn School of Medicine at Mount Sinai DEIDRA L. MCKOY Educational Coordinator, Master of Science in Biostatistics Graduate School of Biomedical Sciences Icahn School of Medicine at Mount Sinai ROLAND PINZON Program Manager, Master of Science in Biomedical Informatics Graduate School of Biomedical Sciences Icahn School of Medicine at Mount Sinai 2 ORDER of PROCESSION Candidates for Degrees Faculty Platform Party Guests Are Asked To Remain Seated During The Processional.
    [Show full text]
  • Hemoglobin Affinity for Oxygen in the Anginal Syndrome with Normal Coronary Arteriograms
    Hemoglobin Affinity for Oxygen in the Anginal Syndrome with Normal Coronary Arteriograms PANTEL S. VOKONAS, PETRr F. COHN, MICHAEL D. KLEIN, MYRON B. LAvE, and RiCHARD GORLIN From the Cardiovascular Division, Department of Medicine, Peter Bent Brigham Hospital, and the Anesthesia Laboratory, Department of Anesthesia, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts 02115 A B S T R A C T Oxyhemoglobin dissociation (OHD) raphy has become well recognized in recent years (1-9). curves were performed on whole blood (WB) from 20 Individuals with this syndrome comprise approximately patients with anginal pain, normal hemodynamics, and 10-20% of several large series of patients who have normal coronary arteries, as demonstrated by selective undergone angiographic study for suspected coronary coronary cinearteriography. OHD curves in 19 of 20 artery disease. To further complicate the clinical pic- patients, from zero to full saturation, were nearly ture, a number of these patients exhibit objective evi- identical to those in normal control subjects with values dence for myocardial ischemia as manifested by abnor- for Pso (Po2 at 50% saturation and pH 7.4) of 26.7± mal S-T segment changes after exercise and myocardial 1.5 (mean+SD of the mean) torr (mm Hg) and red lactate production during cardiac catheterization (4, 9). blood cell (RBC) levels of 2,3-diphosphoglyceric acid Several possible hypotheses have been proposed to ex- (2, 3-DPG) of 0.72±0.10 (mean±SD of the mean) plain the underlying symptomatology of this syndrome. M/M hemoglobin (Hb). Normal values for nonsmoking These include: disease of the small vessels of the myo- adults were: Pw, 26.6+1.4 (mean+SD of the mean) cardium (10), spasm of the large coronary vessels, torr; and RBC 2,3-DPG, 0.81±0.09 (mean±SD of the maldistribution of coronary blood flow, and abnormalities mean) M/M Hb.
    [Show full text]
  • Application for Amend to License 20-00551-07,Authorizing Use of Xe
    - , l f !', ; e * ' ] # "' ' Ferm AEC-313 '.'m ops".'ed- N') ' " ' " ' " * " " ' ' ' " ' ' ' ) APPLICATION FOR BYPRODUCT MATERIAL LICENSE l 1 INSTRUCTIONS.-Complete items I throui,h 16 if this is en initial application. If application is for renewel of a license, com- ) plete only items 1 through 7 and indicato new information et changes in the program os requested in items 8 through 15. Use supplementel sheets where necessary. item 16 must be completed on all applicetions. Mell three copies 'on U. 5. Atomic Energy D. C. Attention: Isotopes Branch, Division of Licensing end Reguletion. Upon opproval of this Commission,applicetion; the Washington opplicent wi 25, ll receive en AEC Byproduct Meterial License. An AEC Syproduct Meterial License is issued in accordance with the general requirements contained in Title 10, Code of Federal Reguletions, Port 30 end the Licensee is sub- iect to Title 10, Code of Federal Reguleelons, Port 20. l. (e) NAME AND ATRiti ADDatSS Of APPLICANT. (inefetufen, Arm, hospefoi, (b) STRit? ADDatS5(t5) AT WHICH SYPRODUCT MAfft|AL WILL Bt UltD. (if | , ej d.ae e.e som (.j s Richard Gorlin, M.D. Peter Bent Brigham Hospital g 721 Huntington Avenue . , Boston 15, Massachusetts . ; 1 2. OtPARTMENT TO USE BYPRODUCT MAftetAL 3. PetVIOU5 LICENSE NUMAER(5). (W Ihes es en opphcareen for renew.f..f a Cardiovascular Division ' Department of Medicine '"b'"" *E- ,7''"" Amendment I*"* ""d 6 '""(E64) """'" 8 , 4. D4DivlDUAL U5tt(5). (Nem. and es#8. of inde. dve#s) wh. N vs. er directly S. RADIATION PROftCTION OFflCER (Neme of person d.s.y es d es redesteen pre.
    [Show full text]
  • Late Thrombolytic Therapy Preserves Left Ventricular Function in Patients
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector 58 JACC Vol . 14, No . I July 18 58-64 Late Thrombolytic Therapy Preserves Left Ventricular Function in Patients With Collateralized Total Coronary Occlusion Primary End Point Findings of the Second Mount Sinai-New York University Reperfusion Trial K. PETER RENTROP, MD, FACC,* FREDERICK FELT, MD, FACC,t WARREN SHERMAN, MD, FACC,* PETER STECY, MD, FACC,t SUSAN HOSAT, MS,* MARC COHEN, MD, FACC,* MARIANO REY, MD, FACC,t JOHN AMBROSE, MD, FACC,* MARK NACHAMIE, MD,t WILLIAM SCHWARTZ, MD, FACC,* WILLIAM COLE, MD,t ROBERT PERDONCIN, MD,* JOHN C . THORNTON, PHD New York, New York The change in left ventricular ejection fraction from prein- icant improvement over those without collateral flow in the tervention to predischarge was prospectively assessed in streptokinase (5 .4 ± 2.5%) and streptokinase-nitroglycerin 33 patients with acute myocardial infarction . Within 12 h (10 .6 ± 2 .7 %) arms, but not in the nitroglycerin arm . Time of symptom onset (mean 6.3 ± 2 .7 h), patients were to treatment did not influence the change in ejection randomly assigned to a double-blind intracoronary infusion fraction . In patients with initial subtotal occlusion, throm- of streptokinase, nitroglycerin, both streptokinase and ni- bolytic therapy was of no short-term benefit because ejec- troglycerin or conventional therapy without acute cardiac tion fraction increased by 6% in all three intervention catheterization . Treatment effects were also assessed in arms. prospectively defined angiographic subsets . These findings indicate that relatively late thrombolytic There was a significant interaction between streptoki- therapy results in significant myocardial salvage in those nase and nitroglycerin (p < 0 .01), resulting in an increase patients with collateralized total coronary occlusion .
    [Show full text]
  • Arxiv:1801.04008V1 [Q-Bio.QM] 11 Jan 2018 Accumulation of Atheromatous Plaques Under Angina Pectoris
    Comorbid CAD and Ventricular Hypertrophy Compromise The Perfusion of Myocardial Tissue at Subcritical Stenosis of Epicardial Coronaries Eslam Abbas Kobri El Kobba Medical Complex, Cairo, Egypt Abstract BACKGROUND: Most studies of CAD revascularization have been based on and reported according to angiographic criteria which don’t consider the relation between the resulting effective flow distal to the stenosis and the demand of a hypertrophied myocardial tissue. MODEL: Mathematical model of the myocardial perfusion in comorbid CAD and ventricular hypertrophy using Poiseuille’s law. The analysis yields that the curve, which represents the relation between the perfusion and the severity of CAD depending on angiographic and/or angiophysiologic criteria, is shifted to the right by the effect of myocardial tissue hypertrophy. The right shift of said curve, which is directly proportional to the degree of ventricular hypertrophy, indicates that the perfusion of the corresponding myocardial tissue is compromised at angiographically and/or angiophysiologically subsignificant stenosis of the supplying epicardial vessel. RESULTS: Patients with comorbid CAD and left ventricular hypertrophy are more sensitive to CAD-related hemodynamic changes. They are more prone to develop ischemic complications, than their peers with isolated CAD regarding the same degree of coronary stenosis. CONCLUSION: Patients with comorbid CAD and ventricular hypertrophy suffer from myocardial hypoperfusion at angiographically and/or angiophysiologically subcritical epicardial stenosis. Accordingly; the comorbidity of both diseases should be considered upon designing of the treatment regime. Background irritate the nerve endings leading to anginal pain [5]. Combined coronary artery disease and ven- tricular hypertrophy are not uncommon; they The treatment strategy for treating CAD both share hypertension, which affects ∼ 26% aims to improve survival and/or relieve of the world population [1], as a risk factor.
    [Show full text]