Cardiovascular disease

Article Abstract:

Several recent developments in the treatment of cardiovascular disease are reviewed. One consistent research finding is that thrombolytic (blood clot-dissolving) drugs, administered soon after the onset of a myocardial infarction (heart attack), lead to considerable improvement in recovery. Results from several large, long-term studies are discussed. Smaller studies are underway to determine whether thrombolytic treatment is equally effective when it is given later (6 to 24 hours after symptoms begin). Treatment of dangerous ventricular arrhythmias (irregular heat beats) has been a challenging problem, but a new drug known as amiodarone appears promising. It has not yet been approved for intravenous administration by the Food and Drug Administration. Two other trial drugs, flecainide and encainide, were removed from consideration as potential therapeutic agents for these arrhythmias when mortality among patients receiving them was found to be higher than among patients receiving a placebo (inactive) drug. Controversy continues over the best care for patients with chronic, nonvalvular atrial fibrillation (irregular, random contraction of the atria, the chambers of the heart that receive blood from the body and the lungs). The roles of anticoagulants, such as warfarin (coumadin), and aspirin, in reducing the risk of thrombosis, a complication of this disorder, are being evaluated. Alternate treatments for blood clots in the left ventricle (the chamber that pumps blood to the body) are also being studied. Sixty percent of such clots, or thrombi, result from myocardial infarction, and have the potential to detach and move through the circulatory system, possibly lodging in blood vessels of the brain. Some studies conclude that short-term anticoagulation therapy with heparin might reduce the incidence of thrombosis and should begin soon after myocardial infarction, while other reports find a much lower incidence of left ventricular thrombi. The effectiveness of anticoagulation therapy requires continued investigation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Evaluation, Drug therapy, Heart diseases, Anticoagulants (Medicine), Anticoagulants, Cardiovascular research, Thrombosis, Fibrinolytic agents, Thrombolytic drugs, Cardiovascular agents

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Cardiovascular disease

Article Abstract:

The most significant development in the treatment of heart attacks in recent years is the use of enzymes to dissolve the blood clots blocking the critical heart arteries. There are several types of these enzymes, or thrombolytic agents, including streptokinase and tissue plasminogen activator. It has been demonstrated conclusively that these thrombolytic agents save lives when used within the first six hours of a heart attack. However, at present, only about 25 percent of heart attack victims are treated with these agents. The remaining patients are excluded from this treatment because they are over 75 years of age or do not show specific diagnostic changes on the electrocardiogram (ECG). It remains to be determined if thrombolytic therapy will also be benefit these patients. Although stroke involves the brain, it is intimately related to heart disease. One of the most important risk factors for stroke is atrial fibrillation, a condition of abnormal movements of the atria of the heart. These fibrillations increase the likelihood of the formation of a blood clot, which may travel to the brain and cause a stroke. Roughly 3 to 8 percent of all patients with nonvalvular atrial fibrillation will have a stroke within a year. Research has now suggested that the daily use of aspirin may have some value in reducing the risk of stroke in patients with these forms of atrial fibrillation. Much research remains to be done on the best treatment for ventricular arrhythmias, or the irregular beating of the ventricles of the heart. A large study found that flecainide and encainide, a commonly used drug combination, actually increased the death rate. However, a great advance may be in the form of an implantable electronic device, the cardioverter-defibrillator. These devices nearly eliminated sudden cardiac death in a group of 270 patients over a seven-year period. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Atrial fibrillation

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Cardiovascular disease

Article Abstract:

Dissolving the clots that cause heart attacks can improve long- and short-term survival. Only one third of patients with heart attacks meet guidelines for this treatment, and only half of eligible patients receive treatment. Physicians may be concerned about stroke from bleeding, the worst complication of this treatment. Aspirin has been effective in reducing death from heart attack and preventing more heart attacks, as well as in other cardiovascular disorders. Reducing the amount of atherosclerotic plaque in the cardiovascular system has been a major goal of research. Reducing fat concentrations in the blood is the most promising. The National Cholesterol Education Program (NCEP) has recommended cholesterol screening for all Americans over age 20. Physicians must examine the cost effectiveness of widespread screening compared to the savings in health care costs from reducing the incidence of heart attack. Laser therapy, improved percutaneous transluminal coronary angioplasty (PTCA) and mechanical removal of atherosclerotic plaque from blood vessels are other innovations.

Health aspects, Care and treatment, Prevention, Aspirin

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