Herz
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Endothelial dysfunction has been identified as a major predictor of future cardiovascular events and precedes the development of coronary artery disease (CAD). Regular physical exercise training--as part of a multifactorial intervention--corrects endothelial dysfunction, improves symptoms in patients with CAD, augments myocardial perfusion, and reduces mortality of these patients. This review discusses potential mechanisms, which might be responsible for the exercise training-mediated reduction of mortality in secondary prevention. ⋯ Moreover, physical exercise training is essential to maintain a body weight that has been achieved by caloric restriction. It is important to look for exercise interventions that can easily be integrated in daily life and are not associated with an increased risk of trauma, even in severely obese individuals. Most importantly, patients should enjoy the proposed kind of physical exercise.
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Obesity, defined as a body mass index>or=30 kg/m2, is a modern epidemic and is increasing worldwide. Depending on the genetic makeup, lifestyle factors such as high-caloric nutrition, lack of physical activity and certain psychosocial conditions are the main determinants of its manifestation and progression. ⋯ Each treatment program consists of a hypocaloric diet, increase in physical activity, a behavior modification training and, eventually, weight-lowering drugs. An effective treatment of this condition may not only significantly improve most somatic and psychological comorbidities of the patients but also prolong life.
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Review Case Reports Comparative Study
Complex angioplasty up to chronic total occlusion.
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Antiarrhythmic drugs are used in at least 50% of patients who received an implantable cardioverter defibrillator (ICD). The potential indications for antiarrhythmic drug treatments in patients with an ICD are generally the following: reduction of the number of ventricular tachycardias (VTs) or episodes of ventricular fibrillation and therefore reduction of the number of ICD therapies, most importantly, the number of disabling ICD shocks. Accordingly, the quality of life should be improved and the battery life of the ICD extended. ⋯ In this situation and when antiarrhythmic drugs are ineffective or have to be stopped because of serious side effects, catheter ablation of both monomorphic stable and pleomorphic and/or unstable VTs using modern electroanatomic mapping systems should be considered. The choice of antiarrhythmic drug treatment and the need for catheter ablation in ICD patients with frequent VTs should be individually tailored to specific clinical and electrophysiological features including the frequency, the rate, and the clinical presentation of the ventricular arrhythmia. Although VT mapping and ablation is becoming increasingly practical and efficacious, ablation of VT is mostly done as an adjunctive therapy in patients with structural heart disease and ICD experiencing multiple shocks, because the recurrence and especially the occurrence of "new" VTs after primarily successful ablation with time and disease progression have precluded a widespread use of catheter ablation as primary treatment.
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I. The actual data base on the decision-making process of indication for revascularization reveals that angiographic severity of coronary artery disease (CAD) is the primary determinant of referral to coronary interventional procedures. Several recent studies demonstrated that after an acute myocardial infarction, women undergo cardiac catheterization to a lesser extent than men. ⋯ After multivariate analysis, female gender was no independent risk factor of increased mortality. Thus, direct (primary) coronary angiography and PCI eliminate significant gender-specific differences in survival early after acute myocardial infarction. Long-term follow-up (4 years) also revealed no sex-related differences in mortality and cardiac morbidity after direct (primary) PCI for acute ST elevation myocardial infarction.