Clinical cardiology
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Patients who experience a stroke or transient ischemic attack (TIA) are at high risk for subsequent vascular events, most commonly stroke. This article focuses on clinical trials examining secondary prevention of stroke and reviews the various commonly used methods of stroke prevention: surgical approaches, antihypertensive treatment, lipid- and cholesterol-lowering medications, anticoagulant therapies, and antiplatelet therapies.
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Clinical cardiology · Dec 2003
Review Case ReportsOsborn waves in the electrocardiogram, hypothermia not due to exposure, and death due to diabetic ketoacidosis.
Hypothermia usually occurs because a patient has been exposed to a cold environment; however, a number of nonenvironmental conditions may produce hypothermia. This report relates the clinical course of a patient whose hypothermia was due to severe diabetic ketoacidosis. ⋯ Hypothermia due to diabetic ketoacidosis is an uncommon complication of a common disease that carries with it clinically significant consequences. Accordingly, we believe that all clinicians should be aware of this potential complication of diabetic ketoacidosis and should be able to recognize the importance of the electrocardiogram in such patients.
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Clinical cardiology · May 2002
ReviewReducing global risk for cardiovascular disease: using lifestyle changes and pharmacotherapy.
Cardiovascular disease (CVD) is the leading cause of death and disability in industrialized societies, due in large part to the lack of a comprehensive approach to control the risk factors for atherosclerosis. One strategy for reducing an individual's global CVD risk relies on a targeted approach that modifies each of the major independent risk factors prevalent in both symptomatic (secondary prevention) and asymptomatic (primary prevention) patients. These interventions include lipid lowering, smoking cessation, blood pressure control, glycemic control, regular exercise, and the use of various medications. This review offers an evidence-based strategy toward reducing an individual's global risk for CVD by addressing the modifiable, major independent risk factors.
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Clinical cardiology · Aug 2001
ReviewSpinal cord stimulation for chronic intractable angina pectoris: a unified theory on its mechanism.
The use of spinal cord stimulation (SCS) for chronic intractable anginal pain was first described in 1987. Numerous studies have demonstrated its efficacy in improving exercise tolerance, decreasing frequency of anginal episodes, and prolonging time to electrocardiographic signs of ischemia. This review will examine the potential mechanisms of this antianginal effect and propose a unified hypothesis explaining it. ⋯ Improvement of myocardial blood flow at the microvascular level has been demonstrated by positron emission tomography (PET). A decreased sympathetic tone has been shown by norepinephrine kinetics, tests of sympathetic reflexes, and the use of ganglionic blockers. We hypothesize that SCS exerts its beneficial effects by decreasing pain and decreasing sympathetic tone, the result of which is decreased myocardial oxygen consumption along with an improved myocardial microcirculatory blood flow.