Showing papers in "Journal of Cardiovascular Nursing in 2002"
TL;DR: awareness of risk factors for developing type 2 diabetes will promote screening, early detection, and treatment in high-risk populations with the goal of decreasing both microvascular and macrovascular complications.
Abstract: Genetic, environmental, and metabolic risk factors are interrelated and contribute to the development of type 2 diabetes mellitus. A strong family history of diabetes mellitus, age, obesity, and physical inactivity identify those individuals at highest risk. Minority populations are also at higher risk, not only because of family history and genetics, but also because of adaptation to American environmental influences of poor dietary and exercise habits. Women with a history of gestational diabetes as well as their children are at greater risk for progressing to type 2 diabetes mellitus. Insulin resistance increases a person's risk for developing impaired glucose tolerance and type 2 diabetes. Individuals who have insulin resistance share many of the same risk factors as those with type 2 diabetes. These include hyperinsulinemia, atherogenic dyslipidemia, glucose intolerance, hypertension, prothrombic state, hyperuricemia, and polycystic ovary syndrome. Current interventions for the prevention and retardation of type 2 diabetes mellitus are those targeted towards modifying environmental risk factors such as reducing obesity and promoting physical activity. Awareness of risk factors for developing type 2 diabetes will promote screening, early detection, and treatment in high-risk populations with the goal of decreasing both microvascular and macrovascular complications.
290Â citations
TL;DR: The role of antioxidants in the primary and secondary prevention of coronary heart disease is currently under study as mentioned in this paper, and although epidemiologic evidence indicates that antioxidants may decrease cardiovascular risk, clinical trial data are not conclusive.
Abstract: Oxidative stress occurs when there is an imbalance between free radical production and antioxidant capacity. This may be due to increased free radical formation in the body and/or loss of normal antioxidant defenses. Oxidative stress has been associated with the development of cardiovascular disease. The role of antioxidants in the primary and secondary prevention of coronary heart disease is currently under study. Although epidemiologic evidence indicates that antioxidants may decrease cardiovascular risk, clinical trial data are not conclusive. Information regarding the use and benefits of antioxidants in persons with diabetes is limited. Persons with diabetes may be more prone to oxidative stress because hyperglycemia depletes natural antioxidants and facilitates the production of free radicals. In addition, other factors such as homocysteine, insulin resistance, and aging may be contributory. This article highlights landmark clinical trials that have examined the cardioprotective effect of antioxidants. Because these trials have not been designed to study persons with diabetes, and clinical trial data for this group are not available, correlational studies are also presented. Finally, the concept of oxidative stress, the antioxidant and pro-oxidant factors that may contribute to oxidative stress, and the consequences of oxidative stress in persons with type 2 diabetes are presented. Key words: antioxidants, clinical trials,
153Â citations
TL;DR: Results from clinical trials demonstrate that standardized leaf extracts of Ginkgo biloba (SGB extract) reduce the symptoms of age-associated memory impairment and dementia, including Alzheimer's disease, and may be of benefit in treating intermittent claudication.
Abstract: Results from clinical trials demonstrate that standardized leaf extracts of Ginkgo biloba (SGB extract) reduce the symptoms of age-associated memory impairment and dementia, including Alzheimer's disease, and may be of benefit in treating intermittent claudication. In addition, preliminary results suggest that SGB extract may be useful in preventing and treating cardiovascular disease (CVD). particularly ischemic cardiac syndrome. Since many patients with cardiovascular disease are already taking anticoagulants and antiplatelet drugs, self-medication with SGB extract is not recommended without the advice of their physician. Although SGB extracts look promising for preventing and treating CVD, well-controlled clinical trials are needed before clinical recommendations can be made.
117Â citations
TL;DR: It appears that levels of coenzyme Q10 are decreased during therapy with HMG-CoA reductase inhibitors, gemfibrozil, Adriamycin, and certain beta blockers, but because of its low toxicity it may be appropriate to recommend coen enzyme Q10 to select patients as an adjunct to conventional treatment.
Abstract: This article provides a comprehensive review of 30 years of research on the use of coenzyme Q10 in prevention and treatment of cardiovascular disease. This endogenous antioxidant has potential for use in prevention and treatment of cardiovascular disease, particularly hypertension, hyperlipidemia, coronary artery disease, and heart failure. It appears that levels of coenzyme Q10 are decreased during therapy with HMG-CoA reductase inhibitors, gemfibrozil, Adriamycin, and certain beta blockers. Further clinical trials are warranted, but because of its low toxicity it may be appropriate to recommend coenzyme Q10 to select patients as an adjunct to conventional treatment.
111Â citations
TL;DR: Findings suggest that sleep disturbance is a multifactorial process that has many correlates in patients and persists from the presurgical period throughout recovery and implications for future research and practice are discussed.
Abstract: Sleep disturbance is common in patients undergoing cardiac surgery and has been recognized for more than 30 years. Research findings suggest that sleep disturbance is a multifactorial process that has many correlates in these patients and persists from the presurgical period throughout recovery. A growing body of literature suggests the importance of sleep for function and well-being of these patients. The research literature is synthesized and implications for future research and practice are discussed.
77Â citations
TL;DR: An overview of the cardiovascular effects of various soy products, including their effects on blood lipids, LDL-C oxidation, blood pressure, and vascular reactivity is provided.
Abstract: In human clinical intervention trials, soy product consumption reduced levels of total cholesterol and low-density lipoprotein cholesterol (LDL-C). In October 1999, the US Food and Drug Administration approved a health claim for the relationship between consumption of soy protein and reduced risk of coronary heart disease. This article provides an overview of the cardiovascular effects of various soy products, including their effects on blood lipids, LDL-C oxidation, blood pressure, and vascular reactivity. Potential mechanisms of effect are discussed, emphasizing human clinical intervention trials. Soy consumption improves plasma lipids, although this effect appears to be more pronounced in individuals with elevated cholesterol. Soy and its associated isoflavones also reduce LDL oxidation and improve vascular reactivity.
66Â citations
TL;DR: This review critically examined current scientific literature concerning claims of cardiovascular benefits from regular consumption of garlic or garlic preparations and found insufficient evidence to support a role for garlic in lowering blood lipids.
Abstract: Although garlic is believed to have health-promoting benefits, many of the claimed benefits are not supported by good scientific studies. This review critically examined current scientific literature concerning claims of cardiovascular benefits from regular consumption of garlic or garlic preparations. The vast majority of recent randomized, placebo-controlled studies do not support a role for garlic in lowering blood lipids. There also is insufficient evidence to support a role in reducing blood pressure. While there have been indications of antiatherosclerotic effects associated with garlic consumption, there are insufficient data in humans. Investigation of antithrombotic effects of garlic consumption appears to hold promise, but too few data exist to draw firm conclusions.
66Â citations
TL;DR: Herbal medicines may mimic, decrease, or increase the action of prescribed drugs, which can be especially important for drugs with narrow therapeutic windows and in sensitive patient populations such as older adults, the chronically ill, and those with compromised immune systems.
Abstract: The prevalence of herb-drug interactions has been exaggerated. Nonetheless, some herbs, including garlic, ginkgo, ginseng, and St John's wort, can have a significant influence on concurrently administered drugs. Herbal medicines may mimic, decrease, or increase the action of prescribed drugs. This can be especially important for drugs with narrow therapeutic windows and in sensitive patient populations such as older adults, the chronically ill, and those with compromised immune systems.
51Â citations
TL;DR: An overview of the processes underlying HRV, the standard measures ofHRV, a basic overview of wake and sleep, the HRV patterns associated with different sleep and wake states, and the patterns of HRV exhibited in common cardiac conditions are provided.
Abstract: Heart rate variability (HRV) measurement is an important tool in cardiac care that can provide clinicians and researchers with a 24-hour noninvasive measure of autonomic nervous system activity. Sleep and wake have profoundly different effects on HRV patterns and therefore significant implications for HRV interpretation. This article provides a brief overview of the processes underlying HRV, the standard measures of HRV, a basic overview of wake and sleep, the HRV patterns associated with different sleep and wake states, and the patterns of HRV exhibited in common cardiac conditions. The article concludes with an overview of some general health history factors that are important to consider when interpreting HRV patterns in the clinical and research setting.
39Â citations
TL;DR: Both sleep-disordered breathing and CVAs are described and the related risk factors that link them together are reviewed and the clinical implications of this topic for nurses are presented.
Abstract: Sleep-disordered breathing (obstructive and central sleep apnea) is common in persons who have had a cerebrovascular accident (CVA). This article describes both sleep-disordered breathing and CVAs and reviews the related risk factors that link them together. In addition, the article discusses sleep-disordered breathing after CVA. The article concludes by presenting the clinical implications of this topic for nurses.
37Â citations
TL;DR: An overview of sleep disturbances in patients with HF is provided, suggests evidence-based strategies for managing the sleep problems, and identifies pertinent areas for future nursing inquiry.
Abstract: Sleep problems and symptoms of sleep disturbance are very prevalent in patients with heart failure (HF). Numerous contributing factors include sleep-related breathing disorders, increasing age, medications, anxiety and depression, and comorbidities. Thus, the cardiovascular nurse has an important role in the recognition and management of sleep-related problems in persons with HF. This article provides an overview of sleep disturbances in patients with HF, suggests evidence-based strategies for managing the sleep problems, and identifies pertinent areas for future nursing inquiry.
TL;DR: Current information related to the pathophysiology of type 2 DM alone and its relationship to the development to cardiovascular disease is explored.
Abstract: The leading cause of death among patients with type 2 diabetes mellitus (DM) is cardiovascular disease, with 75% of these deaths attributed to coronary heart disease. Over the previous two decades the pathophysiological basis of type 2 DM has been extensively investigated. Although many of the underlying molecular mechanisms involved in the development of this disorder remain to be explained, it is clear that type 2 DM is a complex medical disorder characterized by insulin resistance and defects in insulin secretion. The process through which the metabolic derangements of type 2 DM accelerate the development of cardiovascular disease in type 2 DM has yet to be determined and remains an area of intense investigation, focusing on hyperglycemia and insulin resistance as major underlying contributors. This article explores current information related to the pathophysiology of type 2 DM alone and its relationship to the development to cardiovascular disease.
TL;DR: Dysrhythmias, including sinus bradycardia, supraventricular tachy Cardia, and premature ventricular beats, were associated with apneic and hypopneic events.
Abstract: This descriptive study describes the frequency and severity of sleep-related breathing disorders in men who are hemodynamically stable who have an acute cardiovascular illness and are hospitalized in a critical care unit Sixty-four males, aged 55-79 years, with an acute cardiovascular illness, stable hemodynamics, and no ongoing chest pain or history of sleep apnea were studied for 1 night in the critical care unit using polysomnography Forty-seven percent of the sample had an apnea-hypopnea index > or = 5, with events of both obstructive and central etiologies, including Cheyne-Stokes respiration Oxygen desaturation to < or = 90% occurred in 61% of the sample There were no episodes of chest pain, ventricular tachycardia, or heart block associated with apneic or hypopneic events; however, dysrhythmias, including sinus bradycardia, supraventricular tachycardia, and premature ventricular beats, were associated with apneic and hypopneic events
TL;DR: Although the ICD is clearly a technological success, there is evidence that recipients experience strong physical and emotional reactions to the device that are worthy of a multidisciplinary effort directed at facilitating patient acceptance and adaptation to technology.
Abstract: Sudden cardiac death (SCD) remains a significant problem despite an overall reduction in other cardiac related deaths in recent years. Research supports the use of the implantable cardioverter defibrillator (ICD) as an effective means of treating dangerous ventricular tachydysrhythmias to prevent SCD. The issue that demands increasing attention is the psychologic experience of ICD recipients. Although the ICD is clearly a technological success, there is evidence that recipients experience strong physical and emotional reactions to the device. Such quality of life issues are worthy of a multidisciplinary effort directed at facilitating patient acceptance and adaptation to technology that although potentially life-saving, may also be unpredictable and anxiety provoking.
TL;DR: Current VAD technology and VAD program development are addressed, with a major focus on the education and competency challenges and solutions the authors have experienced as infrequent users of VADtechnology.
Abstract: Ventricular assist devices (VADs) have made it possible for patients with end-stage heart failure to survive until a donor heart is available. In addition to serving as a bridge to transplantation, evolving indications for VADs include bridge to recovery and destination therapy. There are many VAD programs, but in the majority of programs only a small number of devices are implanted each year. Low volume poses a challenge in terms of provision of comprehensive education and training for nurses who will care for patients with VADs and in terms of maintaining competency to care for these patients. This article briefly addresses current VAD technology and VAD program development. The major focus is on the education and competency challenges and solutions the authors have experienced as infrequent users of VAD technology.
TL;DR: The mechanism, site of action, and adverse effects of these glucose-lowering drugs used in monotherapy and in combination will be reviewed.
Abstract: Since 1995 there have been several new medications approved for the treatment of type 2 diabetes. The availability of these new medications has made the treatment regiment for type 2 diabetes complex. There are currently five classes of oral antidiabetic agents available in the United States. These classes include: sulfonylureas, meglitinides, alpha-glucosidase inhibitors, thiazolidinediones, and biguanides. Additionally there are several types of insulin and insulin analogs available for the treatment of hyperglycemia: regular, lispro, aspart, NPH, lente, ultralente, glargine, 70/30, 50/50, and 75/25. In this article, the mechanism, site of action, and adverse effects of these classes will be reviewed. The efficacy and important management issues of these glucose-lowering drugs used in monotherapy and in combination will be discussed.
TL;DR: The available epidemiologic and clinical evidence supporting the possible link between obstructive sleep apnea and hypertension is discussed and the clinical importance of such interaction, which may lead to excessive cardiovascular morbidity and mortality, is addressed.
Abstract: Respiratory disturbance during sleep, in its most common form, obstructive sleep apnea, is a prevalent condition in the general population. During the past several years, researchers have investigated a possible link between obstructive sleep apnea and hypertension. This article discusses the available epidemiologic and clinical evidence supporting this link. The possible mechanisms leading to the development of hypertension in patients with obstructive sleep apnea will also be discussed, as well as the effects of therapeutic interventions on arterial blood pressure. Last, the clinical importance of such interaction, which may lead to excessive cardiovascular morbidity and mortality, will be addressed.
TL;DR: In this article, glycemic, blood pressure, lipid, and antiplatelet trials relevant to the treatment of people with type 2 diabetes are reviewed.
Abstract: Major clinical trials have shown that excellent glycemic control, sustained over time, can prevent or delay the microvascular complications of diabetes, including retinopathy, nephropathy, and neuropathy. No prospective trial has clearly shown that glycemic intervention can prevent the macrovascular complications of diabetes, such as myocardial infarction, cerebrovascular accident, and amputation. However, a number of landmark clinical trials have shown the efficacy of control of blood pressure and lipids and use of antiplatelet agents (mainly aspirin) in protecting the macrovasculature of individuals with diabetes. In this article, glycemic, blood pressure, lipid, and antiplatelet trials relevant to the treatment of people with type 2 diabetes are reviewed.
TL;DR: The American Diabetes Association Standards of Medical Care for People with Diabetes assist both the health care provider and the individual with diabetes to appreciate the comprehensive treatment goals in diabetes and provide specific guidelines for achieving these goals.
Abstract: The phenomenal growth in the rate of type 2 diabetes presents an enormous burden to society. Diabetes and its complications cost billions and significantly impact quality of life in individuals with diabetes. Diabetes management has transitioned from focusing exclusively on glycemic control to an approach that addresses both glucose abnormalities and the chronic complications of the disease. Increased understanding of the underlying mechanisms of disease and the multifactorial basis of diabetes complications suggest the importance of early diagnosis and treatment of all diabetes complications. Preventive approaches emphasizing risk factor reduction strategies are essential. The American Diabetes Association Standards of Medical Care for People with Diabetes assist both the health care provider and the individual with diabetes to appreciate the comprehensive treatment goals in diabetes and provide specific guidelines for achieving these goals. This article presents these guidelines in an easy-to-remember ABC format.
TL;DR: The Acute Cardiac Ischemia Time-Insensitive Predictive instrument and the Thrombolytic Predictive Instrument are two decision-support tools designed to address the diagnosis and management of acute myocardial infarction and unstable angina pectoris.
Abstract: The diagnosis and management of acute myocardial infarction and unstable angina pectoris are frequent challenges for emergency department staff. Strategies must quickly and accurately identify all patients requiring admission, monitoring, and reperfusion therapy to maximize outcomes without overdiagnosing. The Acute Cardiac Ischemia Time-Insensitive Predictive Instrument and the Thrombolytic Predictive Instrument are two decision-support tools designed to address this need. The instruments have been shown to improve some measures of the appropriateness of and time to emergency department triage. Prospective trials will be completed soon that will examine their effects on morbidity and mortality.
TL;DR: The use of an implantable loop recording device provides continuous monitoring of heart rate and rhythm during syncopal events and may help clinicians arrive at a more precise diagnosis in a more timely manner.
Abstract: Syncope may be related to a large spectrum of medical and psychologic disorders, yet the precise etiology is often difficult to determine. Although the evaluation of syncope involves extensive testing, nearly 50% of these individuals remain without definitive diagnosis. Because of the infrequent and unpredictable nature of syncope, many ambulatory screening techniques are not suited to diagnose syncope. The use of an implantable loop recording device provides continuous monitoring of heart rate and rhythm during syncopal events and may help clinicians arrive at a more precise diagnosis in a more timely manner. The Reveal Plus implantable loop recorder (ILR) (Medtronic USA, Minneapolis, Minn) has demonstrated its clinical utility in evaluating syncope and drug-refractory seizure disorders.
TL;DR: The purpose of this article is to describe diabetes-related research opportunities, given recent findings and recommended changes in clinical practice, on research needed to address current diabetes health problems, emphasizing prevention, management, and complications such as cardiovascular disease.
Abstract: The purpose of this article is to describe diabetes-related research opportunities, given recent findings and recommended changes in clinical practice. The focus is on research needed to address current diabetes health problems, emphasizing prevention, management, and complications such as cardiovascular disease. The epidemiology of diabetes and how it affects the direction of research are explored. Gaps in diabetes-related research are identified. NINR research and research training opportunities are noted for investigators and nurse clinicians interested in the problems of diabetes and its complications affecting health outcomes.
TL;DR: The major changes to ACLS guidelines for dysrhythmias, acute coronary syndromes, and acute stroke management are outlined.
Abstract: The American Heart Association has been the recognized source for Advanced Cardiac Life Support (ACLS) education for the past three decades. Since the first ACLS course, numerous revisions have been made to the management algorithms based on evolving scientific evidence. The last revisions made in August 2000 were the first international guidelines published. These guidelines reflect the intense review and analysis of scientific work and emphasize the importance of evidence-based therapies. This article outlines the major changes to ACLS guidelines for dysrhythmias, acute coronary syndromes, and acute stroke management.
TL;DR: Diodes such as an implantable right ventricular hemodynamic monitor and impedance cardiography may improve nursing and medical management, promote appropriate use of resources, and contribute to enhanced quality of care and patient quality of life.
Abstract: Effective management of patients with heart failure is guided by hemodynamic indices that may provide more objective evidence of cardiovascular status than physical signs and symptoms and the chest radiograph. Quantitative hemodynamic data obtained without the need for hospitalization supplements physical assessment findings, daily weights, and functional status classification and provides objective data for optimization of therapies and prevention or reduction of hospitalizations. The current health care climate is characterized by shrinking health care reimbursement and increased emphasis on patient-centered care focused on enhancing quality of life and patient satisfaction. In this climate, devices such as an implantable right ventricular hemodynamic monitor and impedance cardiography may improve nursing and medical management, promote appropriate use of resources, and contribute to enhanced quality of care and patient quality of life.
TL;DR: A better understanding of the role of left ventricular remodeling in the development of heart failure has resulted in novel surgical therapies and devices that may reverse or retard the remodeling process.
Abstract: The epidemic of heart failure and its subsequent effect on public health policy is escalating. Cardiac transplantation continues to be limited by the shortage of donor organs, and the current generation of mechanical circulatory support devices has not yet approached the goal of destination therapy. A better understanding of the role of left ventricular remodeling in the development of heart failure has resulted in novel surgical therapies and devices that may reverse or retard the remodeling process.
TL;DR: Early data have been encouraging, suggesting that patients may gain important hemodynamic, functional, and quality-of-life improvements with biventricular pacing.
Abstract: Congestive heart failure (CHF) is a clinical syndrome that affects more than 4 million people in the United States. The grim prognosis for this population has led to a search for new therapies to treat CHF. Resynchronization of the ventricles is one such therapy. The pathophysiology associated with conduction defects and the evolution of the use of pacing technologies for this patient population will be discussed. Early data have been encouraging, suggesting that patients may gain important hemodynamic, functional, and quality-of-life improvements with biventricular pacing.
TL;DR: Current evidence supports risk stratification, early treatment with glycoprotein IIb/IIIa inhibitors, and an early invasive strategy in patients who are at intermediate to high risk of coronary syndromes, but the same principles can be used when evaluating alternative medicines.
Abstract: Evidence-based practice has been proposed as a means to improve the quality of care and decrease unwarranted variability in practice, but evaluating clinical trial data as evidence for practice is made more difficult because practice changes rapidly. This article reviews current clinical trial data on the management of patients with acute coronary syndromes, but the same principles can be used when evaluating alternative medicines. Current evidence supports risk stratification, early treatment with glycoprotein IIb/IIIa inhibitors, and an early invasive strategy in patients who are at intermediate to high risk. In addition, cholesterol-lowering statins should be initiated early in the patient's hospitalization.