DOCSLIB.ORG

Depression and Cardiac Disease a Review

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Depression and Cardiac Disease a Review REVIEW ARTICLE Depression and Cardiac Disease A Review Christopher M. Celano, MD,*† and Jeff C. Huffman, MD*† acterized by Ն2 weeks of depressed mood or loss of pleasure and Abstract: Depression is highly prevalent in cardiac patients, with 20% to 40% multiple somatic symptoms (including abnormalities in sleep, inter- of patients meeting criteria for major depressive disorder or experiencing an est, energy, concentration, guilt, appetite, psychomotor functioning, elevation in depressive symptoms. These depressive symptoms are often chronic and/or suicidal ideation).6 This rate of MDD is 2- to 3-fold higher in and persistent, and they have been associated with the development and pro- patients with CVD than in the general population7 and similar to the gression of coronary artery disease, worse health-related quality of life, poor rates of MDD in patients with chronic kidney disease,8 cancer,9 and physical functioning, recurrent cardiac events, and a 2- to 2.5-fold increased risk diabetes mellitus.10 Patients with congestive heart failure (CHF) and of mortality. Impaired adherence to health behaviors and adverse physiological those undergoing implantable cardioverter defibrillator (ICD) placement effects of depression, including inflammation, endothelial dysfunction, platelet are similarly at increased risk for elevated depressive symptoms and for hyperactivity, and autonomic nervous system abnormalities, may link depression MDD.11–13 A recent meta-analysis of patients with CHF found a conser- with adverse cardiac outcomes. Pharmacologic and psychotherapeutic interven- vative (ie, MDD equivalent) prevalence rate of 20% and a liberal (ie, tions appear to be safe and effective at reducing depressive symptoms in increased depressive symptoms) prevalence rate of 36%11; recent studies of patients with cardiovascular disease and may impact cardiac outcomes. ICD patients found depression prevalence to be 24% to 33%.12,13 Unfortunately, depression often is unrecognized and untreated in this In patients with CVD, depression is often chronic and recurrent. population, despite the availability of brief screening tools that can be Among patients with CVD hospitalized for acute cardiac events and used for this purpose. We recommend the routine screening of cardiac who were found to meet criteria for depression during or shortly after patients for depression when there are adequate mechanisms for manage- admission, approximately 50% to 70% have a history of depression that ment and referral, such as available consulting psychiatrists or care predates their cardiac events.14,15 This finding is consistent with liter- management programs that facilitate the delivery of pharmacologic and ature that describes persistent depression in patients with stable CAD17 psychotherapeutic treatments in this vulnerable population. and suggests that for many patients, depression exists for months or Key Words: depression, cardiac disease, coronary artery disease, years before a cardiac event, rather than being a transient reaction to the congestive heart failure, collaborative care event. Furthermore, depressive symptoms often persist in patients with (Cardiology in Review 2011;19: 130–142) CVD. In studies that examine the course of post-MI depression, de- pressive symptoms remain at steady levels of severity over a 12-month follow-up period.18,19 Similar results have been observed in patients with chronic CVD, such as those with ICD devices; in this cohort, 80% of patients who are depressed at the time of ICD placement continue to epression commonly afflicts patients with cardiovascular dis- suffer from depressive symptoms 2 years later.13 Dease (CVD) and contributes to poor psychiatric, functional, and In summary, depression is present in a significant portion of cardiovascular outcomes. Despite the availability of safe and effec- cardiac patients across the spectrum of cardiac disease, and such tive treatments in cardiac patients, depression remains under-recog- symptoms, when present, are likely to persist unless treated. These nized and undertreated in this population. This review will focus on findings underscore the need to find better methods for identifying the prevalence of depression in patients with CVD and its effects on and managing depression in patients with CVD. psychiatric and cardiac outcomes, the potential physiological and behavioral links between depression and CVD, and the treatment EFFECTS OF DEPRESSION ON PATIENTS WITH options and models of care for depressed cardiac patients. Recom- CARDIAC DISEASE mendations for the identification and treatment of depression in this Depression is not only common in cardiac patients, but also population will be provided. associated with adverse cardiovascular outcomes, independent of traditional risk factors. In healthy individuals, depression has been THE RELATIONSHIP BETWEEN DEPRESSION AND associated with the development and progression of CAD20–23 and CARDIAC DISEASE with CVD-related mortality.24 In patients with acute episodes of Depression is highly prevalent in cardiac patients. Between CAD who require intervention, depression is linked with inferior 31% and 45% of patients with coronary artery disease (CAD), cardiac and functional outcomes. For instance, depression in patients including those with stable CAD, unstable angina, or myocardial undergoing coronary artery bypass graft (CABG) surgery has been infarction (MI), suffer from clinically significant depressive symp- associated with poorer functional outcomes,25,26 worse health-re- toms. Furthermore, 15% to 20% of patients with CAD meet full lated quality of life (HRQoL),27 progression of atherosclerotic criteria for major depressive disorder (MDD),1–5 a condition char- disease,28 higher rates of rehospitalization,26 and mortality.29,30 Patients with unstable CAD in particular seem to be at increased risk for poor outcomes as a result of depression. The From the *Harvard Medical School, Boston, MA; and †Department of Psychiatry, presence of post-MI depression is a predictor for recurrent Massachusetts General Hospital, Boston, MA. cardiac events,31 for cardiac-related death,31–34 and for all-cause Correspondence: Christopher M. Celano, MD, Massachusetts General Hospital, 55 mortality.31,35 In fact, 2 recent meta-analyses revealed that de- Fruit Street/WACC 812, Boston, MA 02114. E-mail: [email protected]. pressed post-MI patients have a 2- to 2.5-fold increased risk Copyright © 2011 by Lippincott Williams & Wilkins 31,35 ISSN: 1061-5377/11/1903-0130 (unadjusted) for all-cause mortality ; a significantly elevated DOI: 10.1097/CRD.0b013e31820e8106 risk remains (odds ratio, 1.76) even after adjusting for other 130 | www.cardiologyinreview.com Cardiology in Review • Volume 19, Number 3, May/June 2011 Cardiology in Review • Volume 19, Number 3, May/June 2011 Depression and Cardiac Disease cardiac risk factors.35 The possible arrhythmogenic effects of depression on cardiac events.55 It, therefore, appears that inflamma- depression may explain these findings—at least in part—because tion plays at least a minor role in the mediation of depression’s depression in patients with CAD has been associated with ven- effects on cardiac outcomes. tricular arrhythmias,36 and ventricular ectopy in post-MI patients has been associated with mortality.37 Endothelial Dysfunction Depression may also impact CV outcomes in patients with other Endothelial dysfunction has been linked with the develop- forms of CVD. Depression increases the risk of incident CHF, espe- ment of ischemic CAD in patients with atherosclerosis.56 Although cially in those already at increased risk for its development; it is also a normal endothelium typically releases nitric oxide in response to related to increased health care utilization, more frequent hospitaliza- serotonin, in atherosclerotic arteries it fails to do so; this results in tions, and a 2-fold increase in mortality risk in patients with established vasoconstriction in areas of atherosclerosis and may provide a CHF.11 Increased depressive symptoms are also linked with recurrence mechanism for coronary thrombosis.57 Inflammation, which has of atrial fibrillation (AF) in patients following cardioversion38 and with been associated with CAD, also impairs endothelial nitric oxide CV mortality in patients with comorbid AF and CHF.39 release and may represent a mechanism explaining the finding of Several studies have evaluated the characteristics of psychiatric endothelial dysfunction in cardiac patients.58 In addition to its role illness and its treatment that may contribute to poor cardiac outcomes in in cardiac ischemia in patients with CAD, endothelial dysfunction depressed cardiac patients. Nonresponse to treatment for depression, for independently predicts mortality in patients with CHF.59,60 instance, seems to put depressed postacute coronary syndrome (ACS) Depression has also been associated with impaired endothe- patients at greater risk for recurrent cardiac events40 and for all-cause lial function in healthy patients,61 in those at risk for CVD,62 and in mortality.41 Poor outcomes may be exacerbated by the presence of those with established CVD.63 Evidence that treatment of depression co-occurring anxiety, which is independently associated with recurrent with selective serotonin reuptake inhibitors (SSRIs) improves endo- cardiac events and mortality42 and which has been linked with poor thelial function in patients with depression and established CAD response to treatment for depression.43,44 Other patients who seem to be may
Load more

Recommended publications
  • Physiological Assessment of Coronary Lesions
    CHAPTER 5 Physiological Assessment of Coronary Lesions Akl C. Fahed, MD, MPH1 and Sammy Elmariah, MD, MPH1 1Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Cardiology, Department of Medicine Introduction The treatment of symptomatic coronary artery disease (CAD) depends on the hemodynamic impairment of flow, a physiologic parameter that is not captured with coronary angiography alone. The miniaturization of sensor-guidewires capable of crossing coronary stenoses provided a rationale for physiological assessment of coronary lesions to guide coronary revascularization. Multiple clinical trials have demonstrated the superiority of using invasive physiologic assessment to guide decision-making in intermediate vessel stenosis over angiography alone. 1,2 Current guidelines give a class IA recommendation for use invasive physiological assessment to guide revascularization of angiographically intermediate lesions in patients with stable angina. 3,4 Coronary physiology measurement has therefore become routine practice in every cardiac catherization lab with expanding techniques and indications. This chapter will cover the basic physiologic principles of coronary blood flow, technical aspects of coronary physiology measurements, and the expanding clinical data supporting the use of coronary physiology measurement in every day practice. Understanding Coronary Blood Flow Myocardial blood flow provides oxygen supply in an effort to meet the myocardial oxygen demand (MVO2) and prevent ischemia or infarction. The main determinants of myocardial oxygen demand and supply are highlighted in Table 1. In a healthy coronary and capillary circuit, blood flows from the aorta though an epicardial conduit, then precapillary arterioles and the microvascular capillary bed in a highly regulated process (Figure 1). The resistance (pressure/flow) across the circuit is the sum of the resistances within the circuit: the epicardial coronaries (R epicardial), the precapillary arterioles (R arteriolar), and the microvascular capillary bed (R capillary).
    [Show full text]
  • ST-Elevation Myocardial Infarction Due to Acute Thrombosis in an Adolescent with COVID-19
    Prepublication Release ST-Elevation Myocardial Infarction Due to Acute Thrombosis in an Adolescent With COVID-19 Jessica Persson, MD, Michael Shorofsky, MD, Ryan Leahy, MD, MS, Richard Friesen, MD, Amber Khanna, MD, MS, Lyndsey Cole, MD, John S. Kim, MD, MS DOI: 10.1542/peds.2020-049793 Journal: Pediatrics Article Type: Case Report Citation: Persson J, Shorofsky M, Leahy R, et al. ST-elevation myocardial infarction due to acute thrombosis in an adolescent with COVID-19. Pediatrics. 2021; doi: 10.1542/peds.2020- 049793 This is a prepublication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version. Downloaded from©202 www.aappublications.org/news1 American Academy by of guest Pediatrics on September 27, 2021 Prepublication Release ST-Elevation Myocardial Infarction Due to Acute Thrombosis in an Adolescent With COVID-19 Jessica Persson, MD1, Michael Shorofsky, MD1, Ryan Leahy, MD, MS1, Richard Friesen, MD1, Amber Khanna, MD, MS1,2, Lyndsey Cole, MD3, John S. Kim, MD, MS1 1Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado 2Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado 3Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado Corresponding Author: John S.
    [Show full text]
  • Citric Acid Cycle Metabolites Predict Infarct Size in Pigs Submitted To
    International Journal of Molecular Sciences Article Citric Acid Cycle Metabolites Predict Infarct Size in Pigs Submitted to Transient Coronary Artery Occlusion and Treated with Succinate Dehydrogenase Inhibitors or Remote Ischemic Perconditioning Marta Consegal 1,2,3, Norberto Núñez 4, Ignasi Barba 1,2,3,5 , Begoña Benito 1,2,3, Marisol Ruiz-Meana 1,2,3, Javier Inserte 1,2,3 , Ignacio Ferreira-González 1,2,6,* and Antonio Rodríguez-Sinovas 1,2,3,* 1 Cardiovascular Diseases Research Group, Department of Cardiology, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; [email protected] (M.C.); [email protected] (I.B.); [email protected] (B.B.); [email protected] (M.R.-M.); [email protected] (J.I.) 2 Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain 3 Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain 4 Unit of High Technology, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; [email protected] Citation: Consegal, M.; Núñez, N.; 5 Faculty of Medicine, University of Vic-Central University of Catalonia (UVicUCC), Can Baumann. Ctra. de Barba, I.; Benito, B.; Ruiz-Meana, M.; Roda, 70, 08500 Vic, Spain Inserte, J.; Ferreira-González, I.; 6 Centro de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública (CIBERESP), Rodríguez-Sinovas, A.
    [Show full text]
  • Clinical Effect of Selective Interventional Therapy on Sub-Acute
    Wang et al. Eur J Med Res (2018) 23:27 https://doi.org/10.1186/s40001-018-0319-8 European Journal of Medical Research RESEARCH Open Access Clinical efect of selective interventional therapy on sub‑acute ST‑segment elevation myocardial infarction under the guidance of fractional fow reserve and coronary arteriography Bing‑Jian Wang1, Jin Geng1, Qian‑Jun Li1, Ting‑Ting Hu1, Biao Xu2 and Shu‑Ren Ma1* Abstract Objective: This study aims to compare the clinical efects of selective interventional therapy (PCI) under the guid‑ ance of fractional fow reserve (FFR) and coronary arteriography. Methods: Patients with sub-acute ST-segment elevation myocardial infarction (sub-acute STEMI), who were under selective PCI treatment between April 2012 and June 2014, were included into this study. These patients were divided into two groups, based on FFR measurements: FFR-PCI group and radiography-PCI group. Then, diferences in clinical symptoms, coronary angiography, intervention, and endpoint events were compared between these two groups. Results: A total of 592 patients with sub-acute STEMI were included in this study (207 patients in the FFR-PCI group and 385 patients in the radiography-PCI group). No statistical diferences were observed in baseline clinical data and coronary angiography results between these two groups. Mean stent number was greater in the radiography-PCI group (1.22 0.32) than in the FFR-PCI group (1.10 0.29), and the diference was statistically signifcant (P 0.019). During the follow± -up period, 78 adverse events occurred± (21 adverse events in the FFR-PCI group and 57 adverse= events in the radiography-PCI group); and no statistical signifcance was observed between these two groups (log- rank P 0.112).
    [Show full text]
  • Detection of Myocardial Ischemia Due to Clinically Asymptomatic Coronary
    Journal of Electrocardiology 59 (2020) 100–105 Contents lists available at ScienceDirect Journal of Electrocardiology journal homepage: www.jecgonline.com Detection of myocardial ischemia due to clinically asymptomatic coronary artery stenosis at rest using supervised artificial intelligence- enabled vectorcardiography – A five-fold cross validation of accuracy☆ Till Braun a, Sotirios Spiliopoulos b, Charlotte Veltman a, Vera Hergesell b, Alexander Passow a,c, Gero Tenderich a,c, Martin Borggrefe d, Michael M. Koerner e,f,⁎ a Cardisio GmbH, The Squaire 12, D-60549 Frankfurt am Main, Germany b Department of Cardiac Surgery, University Heart Center Graz, Medical University Graz, Auenbruggerplatz 29, A-8036 Graz, Austria c Faculty of Medicine, University Bochum, Universitaetsstrasse 150, D-44801 Bochum, Germany d First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (Ger- man Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany e Nazih Zuhdi Advanced Cardiac Care & Transplant Institute, Department of Medicine, Integris Baptist Medical Center, 3400 NW Expressway, Bldg C, Suite 300, Oklahoma City, OK 73162, USA f Department of Rural Health - Medicine/Cardiology, Oklahoma State University Center For Health Sciences, 1111 W 17th Street, Tulsa, OK 74107, USA article info abstract Background: Coronary artery disease (CAD) is a leading cause of death and disability. Conventional non-invasive Keywords: diagnostic modalities for the detection of stable CAD at rest are subject to significant limitations: low sensitivity, Cardisiography and personal expertise. We aimed to develop a reliable and time-cost efficient screening tool for the detection of Coronary artery disease coronary ischemia using machine learning.
    [Show full text]
  • Cocaine and the Heart
    Thomas Jefferson University Jefferson Digital Commons Division of Cardiology Faculty Papers Division of Cardiology 5-1-2010 Cocaine and the heart. Suraj Maraj Albert Einstein Medical Center, Department of Cardiovascular Diseases, Philadelphia, PA Vincent M. Figueredo, M.D. Thomas Jefferson University D Lynn Morris Albert Einstein Medical Center, Department of Cardiovascular Diseases, Philadelphia, PA Follow this and additional works at: https://jdc.jefferson.edu/cardiologyfp Part of the Cardiology Commons Let us know how access to this document benefits ouy Recommended Citation Maraj, Suraj; Figueredo, M.D., Vincent M.; and Lynn Morris, D, "Cocaine and the heart." (2010). Division of Cardiology Faculty Papers. Paper 16. https://jdc.jefferson.edu/cardiologyfp/16 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Division of Cardiology Faculty Papers by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: [email protected]. As submitted to: Clinical Cardiology And later published as: Cocaine and the Heart Volume 33, Issue 5, May 2010, Pages 264-269 DOI: 10.1002/clc.20746 Suraj Maraj, MD, Vincent M. Figueredo, MD, D Lynn Morris, MD Introduction Cocaine is currently the second most commonly used illicit drug in the United States, with marijuana usage being the commonest (1).
    [Show full text]
  • A Case of Cardiac Cephalalgia Showing Reversible Coronary Vasospasm on Coronary Angiogram
    CASE REPORT Print ISSN 1738-6586 / On-line ISSN 2005-5013 J Clin Neurol 2010;6:99-101 10.3988/jcn.2010.6.2.99 A Case of Cardiac Cephalalgia Showing Reversible Coronary Vasospasm on Coronary Angiogram YoungSoon Yang, MDa; Dushin Jeong, MD, MPHb; Dong Gyu Jin, MDc; Il Mi Jang, MDd; YoungHee Jang, MDd; Hae Ri Na, MDe; SanYun Kim, MDd Department of aNeurology, Hyoja Geriatric Hospital, Yongin, Korea Departments of bNeurology and cCardiology, Soonchunhyang University College of Medicine, Seoul, Korea Department of dNeurology, Seoul National University College of Medicine, Seoul, Korea Department of eNeurology, Bobath Memorial Hospital, Seongnam, Korea Received March 2, 2009 BackgroundzzUnder certain conditions, exertional headaches may reflect coronary ischemia. Revised June 11, 2009 Accepted June 11, 2009 Case ReportzzA 44-year-old woman developed intermittent exercise-induced headaches with chest tightness over a period of 10 months. Cardiac catheterization followed by acetylcholine prov- Correspondence ocation demonstrated a right coronary artery spasm with chest tightness, headache, and ischemic Dushin Jeong, MD, MPH effect of continuous electrocardiography changes. The patient’s headache disappeared following Department of Neurology, intra-arterial nitroglycerine injection. Soonchunhyang University College of Medicine, ConclusionszzA coronary angiogram with provocation study revealed variant angina and cardi- 23-20 Bongmyeong-dong, ac cephalalgia, as per the International Classification of Headache Disorders( code 10.6). We re- Dongnam-gu, Cheonan 330-721, port herein a patient with cardiac cephalalgia that manifested as reversible coronary vasospasm Korea following an acetylcholine provocation test. J Clin Neurol 2010;6:99-101 Tel +82-41-570-2290 Fax +82-41-570-2465 Key Wordszz cardiac cephalalgia, angina pectoris, headache.
    [Show full text]
  • Clinical Dilemma - Cardiac Memory Vs Myocardial Ischemia
    Open Access Case Report DOI: 10.7759/cureus.7129 Clinical Dilemma - Cardiac Memory vs Myocardial Ischemia Rastko Rakočević 1, 2 , Renjit Thomas 3 , Ralph G. Oriscello 4 1. Internal Medicine, University Hospital - Rutgers New Jersey Medical School, Newark, USA 2. Pulmonary and Critical Care Medicine, University of Southern California, Los Angeles, USA 3. Cardiology, University Hospital - Rutgers New Jersey Medical School, Newark, USA 4. Cardiology/Critical Care, Veterans Affairs (VA) East Orange/Rutgers New Jersey Medical School, East Orange, USA Corresponding author: Rastko Rakočević, [email protected] Abstract Cardiac memory (CM) is a commonly unrecognized entity in which electrocardiograph (EKG) changes demonstrate T wave inversions (TWI) that appear consistent with ischemia. Inability to recognize and distinguish CM from actual ischemia can be a burden for both patients and hospitals, leading to unnecessary hospital admission, cardiac testing, and cardiac catheterization. Simple EKG analysis and meticulous interpretation of T-wave axis and morphology can help differentiate between the two. We present a case with such a dilemma, and an overview literature and physiology behind this entity. Categories: Cardiology, Emergency Medicine, Internal Medicine Keywords: cardiac memory, twi, pacemaker, critical care, t wave inversion, ischemia, ischemia trial Introduction In the right constellation of signs and symptoms, T wave inversions (TWI) on electrocardiograph (EKG) may represent ischemic event that requires immediate care. Orientation to details must be emphasized when interpreting EKGs, or some entities could be missed. Cardiac memory (CM) is one of those physiological manifestations that has specific set of clues that can be observed on a simple 12 lead EKG. With this report we aim to demonstrate some of the difficulties a clinician can encounter during everyday evaluation of patients with initial symptom of chest pressure, with emphasis on EKG interpretation and deeper understanding of the physiology of cardiac memory.
    [Show full text]
  • Echocardiographic Evaluation of Coronary Artery Disease Yiannis S
    Review in depth 613 Echocardiographic evaluation of coronary artery disease Yiannis S. Chatzizisisa,*, Venkatesh L. Murthyb,* and Scott D. Solomona Although the availability and utilization of other emerging technologies that are anticipated to further noninvasive imaging modalities for the evaluation of increase the clinical utility of echocardiography in the coronary artery disease have expanded over the last evaluation of patients with coronary artery disease. Coron decade, echocardiography remains the most accessible, Artery Dis 24:613–623 c 2013 Wolters Kluwer Health | cost-effective, and lowest risk imaging choice for many Lippincott Williams & Wilkins. indications. The clinical utility of mature echocardiographic Coronary Artery Disease 2013, 24:613–623 methods (i.e. two-dimensional echocardiography, stress echocardiography, contrast echocardiography) across Keywords: contrast echocardiography, coronary artery disease, emerging echocardiography methods, stress echocardiography the spectrum of coronary artery disease has been well established by numerous clinical studies. With continuing aNon-Invasive Cardiovascular Imaging Program, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts and advancements in ultrasound technology, emerging bDivisions of Cardiovascular Medicine, Nuclear Medicine and Cardiothoracic ultrasound technologies such as three-dimensional Radiology, University of Michigan, Ann Arbor, Michigan, USA echocardiography, tissue Doppler imaging, and speckle Correspondence to Scott D. Solomon, MD, Non-Invasive Cardiovascular Imaging tracking methods hold significant promise to further widen Program, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA the scope of clinical applications and improve diagnostic Tel: + 1 857 307 1960; fax: + 1 857 307 1944; accuracy. In this review, we provide an update on the role e-mail: [email protected] of echocardiography in the diagnosis, management, *Yiannis S.
    [Show full text]
  • Refractory Angina—An Overview and Recent Trends
    THIEME 94 Review Article Refractory Angina—An Overview and Recent Trends Meenakshi Kadiyala1 Rameshwar Roopchandar2 Chandrshekaran Krishnaswamy3 1 Department of Cardiology, Saveetha Medical College and Hospital, Address for correspondence Meenakshi Kadiyala, MD, DM, Department Tandalam, Chennai, Tamil Nadu, India of Cardiology, Saveetha Medical College and Hospital, Tandalam, 2 Department of General Medicine, Saveetha Medical College, Chennai 602105, Tamil Nadu, India (e-mail: [email protected]). Tandalam, Chennai, Tamil Nadu, India 3 Department of Medicine, Mayo School of Medicine, Rochester, Minnesota, United States Indian J Cardiovasc Dis Women-WINCARS 2017;2:94–98 Abstract Because of improvement in survival from coronary artery disease and increasing life expectancy of the population, chronicity and resistance to therapy have become growing problems confronting the cardiologist. Refractory angina pectoris is an entity based on clinical diagnosis, and it refers to recurrent and sustained chest pain more than 3 months duration caused by coronary insufficiency that is unamenable to con- ventional modalities of treatment, including drugs, percutaneous coronary interven- Keywords tions, or coronary bypass grafting. Individuals with this entity may have an impaired ► coronary artery quality of life, with recurrent angina, poor general health and psychological distress disease impairing functional and productive sustenance. A multitude of therapeutic options ► myocardial oxygen exists for patients with refractory angina pectoris, and
    [Show full text]
  • Depression and Cardiovascular Disease
    PROGRESS IN CARDIOVASCULAR DISEASES 55 (2013) 511– 523 Available online at www.sciencedirect.com www.onlinepcd.com Depression and Cardiovascular Disease Larkin Elderona, Mary A. Whooleyb,⁎ aUCSF School of Medicine, San Francisco, CA bDepartments of Medicine, Epidemiology & Biostatistics, UCSF School of Medicine and San Francisco Veterans Affairs Medical Center, San Francisco, CA ARTICLE INFO ABSTRACT Keywords: Approximately one out of every five patients with cardiovascular disease (CVD) suffers from Cardiovascular disease major depressive disorder (MDD). Both MDD and depressive symptoms are risk factors for Major depressive disorder CVD incidence, severity and outcomes. Great progress has been made in understanding Health-related behaviors potential mediators between MDD and CVD, particularly focusing on health behaviors. Diagnosis Investigators have also made considerable strides in the diagnosis and treatment of Treatment depression among patients with CVD. At the same time, many research questions remain. In what settings is depression screening most effective for patients with CVD? What is the optimal screening frequency? Which therapies are safe and effective? How can we better integrate the care of mental health conditions with that of CVD? How do we motivate depressed patients to change health behaviors? What technological tools can we use to improve care for depression? Gaining a more thorough understanding of the links between MDD and heart disease, and how best to diagnose and treat depression among these patients, has the potential to substantially reduce morbidity and mortality from CVD. Published by Elsevier Inc. Major depressive disorder (MDD) is present in approximately link MDD and CVD, but also on how to best screen and treat 1 1 out of every 5 patients with cardiovascular disease (CVD).
    [Show full text]
  • The Relationship Between Depression, Anxiety, and Cardiovascular Outcomes in Patients with Acute Coronary Syndromes
    Neuropsychiatric Disease and Treatment Dovepress open access to scientific and medical research Open Access Full Text Article REVIEW The relationship between depression, anxiety, and cardiovascular outcomes in patients with acute coronary syndromes Jeff C Huffman1 Abstract: Depression and anxiety occur at high rates among patients suffering an acute coronary Christopher M Celano1 syndrome (ACS). Both depressive symptoms and anxiety appear to adversely affect in-hospital James L Januzzi2 and long term cardiac outcomes of post-ACS patients, independent of traditional risk factors. Despite their high prevalence and serious impact, mood and anxiety symptoms go unrecognized 1Department of Psychiatry, 2Department of Cardiology, and untreated in most ACS patients and such symptoms (rather than being transient reactions Massachusetts General Hospital, to ACS) persist for months and beyond. The mechanisms by which depression and anxiety are Boston, MA USA linked to these negative medical outcomes are likely a combination of the effects of these con- ditions on inflammation, catecholamines, heart rate variability, and endothelial function, along with effects on health-promoting behavior. Fortunately, standard treatments for these disorders For personal use only. appear to be safe, well-tolerated and efficacious in this population; indeed, selective serotonin reuptake inhibitors may actually improve cardiac outcomes. Future research goals include gaining a better understanding of the combined effects of depression and anxiety, as well as definitive prospective studies of the impact of treatment on cardiac outcomes. Clinically, protocols that allow for efficient and systematic screening, evaluation, and treatment for depression and anxiety in cardiac patients are critical to help patients avoid the devastating effects of these illnesses on quality of life and cardiac health.
    [Show full text]