The Canadian journal of cardiology
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To review prospective epidemiological studies and randomized clinical trials regarding the role of antioxidant vitamins (vitamins E and C and beta-carotene) in the prevention of cardiovascular diseases. ⋯ Prospective epidemiological investigations suggest a reduction in cardiovascular risk associated with increased intake of antioxidant vitamins, particularly vitamin E. Randomized clinical trials remain inconclusive with regard to the role of vitamin E in cardiovascular protection. The large, randomized clinical trials of beta-carotene in primary prevention show no effect and potential for harm associated with the use of beta-carotene. There are inconclusive and insufficient epidemiological and clinical trial data with regard to the role of vitamin C in cardiovascular protection. Overall, it is recommended that wide-spread use of antioxidant vitamins in cardiovascular protection should not be instituted and should await the results of further ongoing clinical trials.
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While supraventricular tachycardia is a common condition and seldom leads to serious consequences, it can be challenging to treat. Optimal management requires an accurate diagnosis, especially in the distinction between regular and irregular tachycardias; as well as an understanding of the mechanism responsible for the arrhythmia. In this article, the acute management of supraventricular tachycardias as they present in the emergency department is discussed, based on the underlying electrophysiological principles of arrhythmias.
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To review the cardiovascular effects of psychotropic drugs when used in therapeutic doses and to assess their clinical relevance for cardiologists. Information on newer psychopharmacological agents is also presented. ⋯ The adverse cardiovascular effects of psychotropic medications in therapeutic doses are a valid concern for cardiologists. Familiarity with these drugs and their interactions is essential to avoid important undesired reactions with potential fatal consequences.
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Historical and state-of-the-art review of clinical mechanical circulatory assist and replacement devices. Recent clinical experience at the University of Ottawa Heart Institute with various mechanical circulatory assist devices as a bridge to transplant, and experimental results with the development and testing of a new electrohydraulic ventricular assist device, are described in detail. ⋯ The use of these devices has become an accepted treatment for end-stage heart disease. Additional development and testing is required to address persistent complications in most models if they are to become alternatives to cardiac transplantation. The basis of the future successes is dependent on both technological refinements in the developments of new devices and on continued research into the physiological effects of mechanical circulatory support. However, these devices are used both as a bridge to recovery and a bridge to cardiac transplant and it is expected that they will be used increasingly to provide permanent circulatory assistance or replacement.