Keeping fit aids bone and joint health whilst aging

Being physically active may significantly improve musculoskeletal and overall health, and minimize or delay the effects of aging, according to a review of the latest research on senior athletes (ages 65 and up) appearing in the September issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

It long has been assumed that aging causes an inevitable deterioration of the body and its ability to function, as well as increased rates of related injuries such as sprains, strains and fractures; diseases, such as obesityand diabetes; and osteoarthritis and other bone and joint conditions. However, recent research on senior, elite athletes suggests usage of comprehensive fitness and nutrition routines helps minimize bone and joint health decline and maintain overall physical health.

“An increasing amount of evidence demonstrates that we can modulate age-related decline in the musculoskeletal system,” said lead study author and orthopaedic surgeon Bryan G. Vopat, MD. “A lot of the deterioration we see with aging can be attributed to a more sedentary lifestyle instead of aging itself.”

The positive effects of physical activity on maintaining bone density, muscle mass, ligament and tendon function, and cartilage volume are keys to optimal physical function and health. In addition, the literature recommends a combined physical activity regimen for all adults encompassing resistance, endurance, flexibility and balance training, “as safely allowable for a given person.” Among the recommendations:

Resistance training. Prolonged, intense resistance training can increase muscle strength, lean muscle and bone mass more consistently than aerobic exercise alone. Moderately intense resistance regimens also decrease fat mass. Sustained lower and upper body resistance training bolsters bone density and reduces the risk of strains, sprains and acute fractures.

Endurance training. Sustained and at least moderately intensive aerobic training promotes heart health, increases oxygen consumption, and has been linked to other musculoskeletal benefits, including less accumulation of fat mass, maintenance of muscle strength and cartilage volumes. A minimum of 150 to 300 minutes a week of endurance training, in 10 to 30 minute episodes, for elite senior athletes is recommended. Less vigorous and/or short-duration aerobic regimens may provide limited benefit.

Flexibility and balance. Flexibility exercises are strongly recommended for active older adults to maintain range of motion, optimize performance and limit injury. Two days a week or more of flexibility training – sustained stretches and static/non-ballistic (non-resistant) movements – are recommended for senior athletes. Progressively difficult postures (depending on tolerance and ability) are recommended for improving and maintaining balance.

The study also recommends “proper” nutrition for older, active adults to optimize performance. For senior athletes, a daily protein intake of 1.0 to 1.5 g/kg is recommended, as well as carbohydrate consumption of 6 to 8 g/kg (more than 8 g/kg in the days leading up to an endurance event).

“Regimens must be individualized for older adults according to their baseline level of conditioning and disability, and be instituted gradually and safely, particularly for elderly and poorly conditioned adults,” said Dr. Vopat. According to study authors, to improve fitness levels and minimize bone and joint health decline, when safely allowable, patients should be encouraged to continually exceed the minimum exercise recommendations.

http://www.medicalnewstoday.com/releases/281660.php

 

 

Improved survival with earlier intervention for common form of heart attack

Changes in the treatment of the most common form of heart attack over the past decade have been associated with higher survival rates for men and women regardless of age, race and ethnicity, according to a UCLA-led analysis.

But the study also suggests that there is room for improvement in how current treatment guidelines are applied among specific patient groups.

The researchers reviewed records for 6.5 million people who were treated for heart attacks between 2002 and 2011. The analysis was among the first and largest national studies to assess the impact of the trend toward more aggressive care for patients who experience the type of heart attack known as non-ST elevation myocardial infarction, or NSTEMI.

Their findings are reported in the current online edition of the peer-reviewed Journal of the American Heart Association.

“The substantial reductions in in-hospital mortality observed for NSTEMI patients nationwide over the last decade reflect greater adherence to evidence-based, guideline-directed therapies,” said Dr. Gregg C. Fonarow, the study’s senior author and UCLA’s Eliot Corday Professor of Cardiovascular Medicine and Science.

“Nevertheless, there may be further opportunities to improve care and outcomes for patients with NSTEMI, who represent the greater proportion of patients presenting with myocardial infarction,” said Fonarow, who also is director of the Ahmanson-UCLA Cardiomyopathy Center at the David Geffen School of Medicine at UCLA.

Heart attacks are broadly classified into two types. The more severe form, ST-elevation myocardial infarction (STEMI), involves complete blockage of an artery supplying blood to the heart muscle. The less severe type, NSTEMI, involves partial or temporary blockage of the artery. Studies in the U.S. and Europe have found that although the incidence of STEMI heart attacks is declining, the number of NSTEMI heart attacks increased in the past decade.

Guidelines issued in 2012 by the American College of Cardiology and American Heart Association recommended initiating cardiac catheterization in high-risk NSTEMI patients within 12 to 24 hours after the patient arrives at the hospital. This strategy had been evolving since 2009 following publication of the Timing of Intervention in Acute Coronary Syndromes trial. Previously, the recommendation was to begin catheterization in high-risk NSTEMI patients within 48 hours.

Fonarow and his colleagues examined trends in the use of cardiac catheterization for people who had been hospitalized after suffering an NSTEMI, within 24 hours and within 48 hours of presentation, seeking to determine whether changes in their care may have resulted in better outcomes.

The researchers analyzed publicly available records from the Nationwide Inpatient Sample, the largest U.S. database of hospitalized individuals. Of the 6.5 million patients whose records they examined, 3.98 million were admitted to hospitals with NSTEMI diagnoses.

The study tracked the proportion of those patients who underwent cardiac catheterization each year, and their outcomes – how many died in the hospital, the average length of their hospital stays, and the cost of hospitalization. They found that as the trend toward earlier intervention in NSTEMI patients took hold – with doctors beginning treatment within 24 hours after patients arrived at the hospital, rather than within 48 hours – the rate of in-hospital death declined from 5.5 percent in 2002 to 3.9 percent in 2011. Improvements were found for men and women, older and younger patients, and across all races and ethnic groups.

In addition, the average length of patients’ hospital stays decreased during the decade-long study, from 5.7 days to 4.8 days. NSTEMI patients who underwent cardiac catheterization within the first 24 hours had the shortest average stays.

Although more NSTEMI patients in all demographic groups received early cardiac catheterization as the study progressed, there were still significant differences across age, gender, and racial and ethnic groups in how frequently early intervention was used. Men, for example, were more likely to receive earlier catheterization than women.

“Despite the improvement, there are significant differences in the age-, gender-, and ethnicity-specific trends in the use of invasive management of NSTEMI, and these findings may help guide further improvements in care and outcomes for male and female patients of all ages, races and ethnicities,” said New York Medical College’s Dr. Sahil Khera, the study’s first author. “Further efforts are needed to enhance the quality of care for patients with NSTEMI and to develop strategies to ensure more equitable care for patients with this type of heart attack.”

http://www.medicalnewstoday.com/releases/280651.php

 

 

Lack of rehab programs leaves cardiac patients underserved globally

Rehabilitation programs must become an integral part of cardiac care to significantly reduce the burden of living with heart disease, one of the most common chronic diseases and causes of death globally, according to York University Professor Sherry Grace.

“Cardiac rehabilitation is a cost-effective program offering heart patients exercise, education and risk reduction,” says Grace, noting that participation results in 25 per cent less death, lower re-hospitalization rates and better quality of life.

Despite these benefits, cardiac rehabilitation is vastly underused, particularly compared with costly revascularization and medical therapy, according to the review Grace conducted with Karam Turk-Adawi in the Cardiovascular Rehabilitation & Prevention Unit, University Health Network (UHN), and Dr. Nizal Sarrafzadegan, director of Isfahan Cardiovascular Research Center at Isfahan University of Medical Sciences in Iran.

“Cardiac rehabilitation services are insufficiently implemented, with only 39 per cent of countries providing any,” says Grace.

Heart disease has become an epidemic in low-income and middle-income countries (LMICs), and cardiac rehab can reduce the socio-economic impact of the disease by promoting return to work and reducing premature mortality, notes to Grace, who is also the director of research at the GoodLife Fitness Cardiovascular Rehabilitation Unit at the UHN.

“If supportive health policies, funding, physician referral strategies and alternative delivery modes are implemented, we could reduce the ratio from one cardiac rehab program per 6.4 million inhabitants in a middle income country like Paraguay, to the one program per 102,000 available in the US, a high income country,” adds Grace.

Low-income countries such as Afghanistan, Bangladesh and Kenya have one rehab program each for their entire population.

The article, Global availability of cardiac rehabilitation, published online at Nature Reviews Cardiology, indicates that while 68 per cent of high-income countries have cardiac rehabilitation, only 23 per cent of LMICs do, despite the fact that 80 per cent of deaths from heart disease occur in these countries.

http://www.medicalnewstoday.com/releases/279686.php

Picture courtesy to www.docstoc.com

 

 

 

One in five people with heart conditions stop having sex, UK survey

Sex is impossible for a fifth of people with heart conditions, according to new statistics released by the British Heart Foundation (BHF).

The BHF’s Heart Matters magazine polled over 1,500 people with heart conditions (1) and found 32 per cent had sex less often, and 19 per cent have stopped having sex completely as a result of their heart condition. One in five respondents said they were worried about having a heart attack or cardiac arrest during sex.

Over 7 million people in the UK suffer from heart and circulatory conditions (2). Based on the survey results, the BHF estimates that issues with sex could mar the lives of over one million people.

It isn’t just the physical effects that are blighting peoples’ sex lives – 14 per cent said they had lost interest in sex because of the emotional impact of their heart condition, and 5 per cent said scarring from an operation made them feel sexually unattractive.

36 year old Martin Tailford, who on Christmas day 2011 had a heart attack and has since had difficulty having sex with his wife Louise, said:

“After my heart attack sex wasn’t natural, it required a lot more planning. I couldn’t spontaneously have sex. I needed to think what to wear to cover up the scars and bruises.

“Sex isn’t what you base a relationship on, but it is really important. My heart attack had put a strain on Louise, and not being able to be physically close to her really took its toll on our relationship. I would advise people in my position to get help as soon as they can, and not be disappointed if things don’t go well at first. It takes time.”

But the BHF’s survey revealed people aren’t getting this help. 30 per cent of people have not discussed the issue with anyone, including their doctor. Eight per cent would have liked to access professional help but couldn’t get any.

The BHF is urging heart patients and GPs to talk openly about issues around sex, so treatment and support can be provided.

Doireen Maddock, Senior Cardiac Nurse at the BHF, said:

“Sex is a hugely important part of life, but isn’t getting the attention it deserves in the consultation room. We’re hearing loud and clear from Heart Matters readers that they need better support and information on how to deal with issues affecting their sex lives.

“Problems like erectile dysfunction can often be tackled and rectified, but the first hurdle is identifying people who need that help. We’d like patients to feel comfortable and empowered to raise these issues, and for the NHS to proactively offer support in this area to everyone who needs it.”

For information and support visit bhf.org.uk/sex

http://www.medicalnewstoday.com/releases/278654.php

 

 

 

Air pollution linked to irregular heartbeat and lung blood clots

Air pollution is linked to an increased risk of developing an irregular heartbeat – a risk factor for stroke – and blood clots in the lung, finds a large study published online in the journal Heart.

But its impact on directly boosting the risk of heart attacks and stroke is rather less clear, the research indicates.

The evidence suggests that high levels of certain air pollutants are associated with a higher risk of cardiovascular problems, but exactly how this association works has not been clarified.

The research team therefore set out to explore the short term biological impact of air pollution on cardiovascular disease, using data from three national collections in England and Wales for the period 2003-9.

These were the Myocardial Ischaemia National Audit Project (MINAP), which tracks hospital admissions for heart attack/stroke; hospital episode statistics (HES) on emergency admissions; and figures from the Office of National Statistics (ONS) on recorded deaths.

Some 400,000 heart attacks recorded in MINAP; more than 2 million emergency admissions for cardiovascular problems; and 600,000 deaths from a heart attack/stroke were linked to average levels of air pollutants over a period of 5 days using data from the monitoring station nearest to the place of residence.

Air pollutants included carbon monoxide, nitrogen dioxide, particulate matter (PM10 and PM2.5), sulphur dioxide, and ozone. Information on ambient daily temperatures, recorded by the UK Meteorological Office, was also factored in.

No clear link with any air pollutant was found for cardiovascular deaths, with the exception of PM2.5 which was linked to an increased risk of irregular heart rhythms, irregular heartbeat (atrial fibrillation) and blood clots in the lungs (pulmonary embolism).

Only nitrogen dioxide was linked to an increased risk of a hospital admission for cardiovascular problems, including heart failure, and an increased risk of a particular type of heart attack (non-ST elevation) in the MINAP data.

The findings prompt the researchers to conclude that there is no clear evidence implicating short term exposure to air pollution in boosting the risk of heart attacks and stroke.

But there does seem to be a clear link between particulate matter levels and heightened risk of atrial fibrillation and pulmonary embolism, they say.

In an accompanying linked editorial, cardiologists from the University of Edinburgh, point out that globally particulate matter is thought to be responsible for more than 3 million deaths around the globe, primarily as a result of heart attacks and stroke.

They go on to point out that patients who sustain a non-ST elevation heart attack generally tend to be older, which may implicate air pollution as being particularly harmful for elderly people.

Nevertheless, they agree that the picture is somewhat muddled and may also be affected by improving air quality, overall.

“The current lack of consistent associations with contemporary UK data may suggest that as the fog begins to clear, the adverse health effects of air pollution are starting to have less of an impact and are more difficult to delineate,” they conclude.

http://www.medicalnewstoday.com/releases/277712.php

Picture courtesy to wikipedia.org

 

 

 

Strategies to prevent heart disease

Heart disease may be a leading cause of death, but that doesn’t mean you have to accept it as your fate. Although you lack the power to change some risk factors — such as family history, sex or age — there are some key heart disease prevention steps you can take.

You can avoid heart problems in the future by adopting a healthy lifestyle today. Here are six heart disease prevention tips to get you started.

1. Don’t smoke or use tobacco

Smoking or using tobacco of any kind is one of the most significant risk factors for developing heart disease. Chemicals in tobacco can damage your heart and blood vessels, leading to narrowing of the arteries (atherosclerosis). Atherosclerosis can ultimately lead to a heart attack.

Carbon monoxide in cigarette smoke replaces some of the oxygen in your blood. This increases your blood pressure and heart rate by forcing your heart to work harder to supply enough oxygen. Women who smoke and take birth control pills are at greater risk of having a heart attack or stroke than are those who don’t do either because both smoking and taking birth control pills increase the risk of blood clots.

When it comes to heart disease prevention, no amount of smoking is safe. But, the more you smoke, the greater your risk. Smokeless tobacco and low-tar and low-nicotine cigarettes also are risky, as is exposure to secondhand smoke. Even so-called “social smoking” — smoking only while at a bar or restaurant with friends — is dangerous and increases the risk of heart disease.

The good news, though, is that when you quit smoking, your risk of heart disease drops almost to that of a nonsmoker in about five years. And no matter how long or how much you smoked, you’ll start reaping rewards as soon as you quit.

2. Exercise for 30 minutes on most days of the week

Getting some regular, daily exercise can reduce your risk of fatal heart disease. And when you combine physical activity with other lifestyle measures, such as maintaining a healthy weight, the payoff is even greater.

Physical activity helps you control your weight and can reduce your chances of developing other conditions that may put a strain on your heart, such as high blood pressure, high cholesterol and diabetes.

Try getting at least 30 to 60 minutes of moderately intense physical activity most days of the week. However, even shorter amounts of exercise offer heart benefits, so if you can’t meet those guidelines, don’t give up. You can even get the same health benefits if you break up your workout time into three 10-minute sessions most days of the week.

And remember that activities, such as gardening, housekeeping, taking the stairs and walking the dog all count toward your total. You don’t have to exercise strenuously to achieve benefits, but you can see bigger benefits by increasing the intensity, duration and frequency of your workouts.

3. Eat a heart-healthy diet

Eating a healthy diet can reduce your risk of heart disease. Two examples of heart-healthy food plans include the Dietary Approaches to Stop Hypertension (DASH) eating plan and the Mediterranean diet.

A diet rich in fruits, vegetables and whole grains can help protect your heart. Beans, other low-fat sources of protein and certain types of fish also can reduce your risk of heart disease.

Limiting certain fats you eat also is important. Of the types of fat — saturated, polyunsaturated, monounsaturated and trans fat — saturated fat and trans fat are the ones to try to limit or avoid. Try to keep saturated fat to no more than 10 percent of your daily calories. And, try to keep trans fat out of your diet altogether.

Major sources of saturated fat include:

• Red meat
• Dairy products
• Coconut and palm oils

Sources of trans fat include:

• Deep-fried fast foods
• Bakery products
• Packaged snack foods
• Margarines
• Crackers

If the nutrition label has the term “partially hydrogenated,” it means that product contains trans fat.

Heart-healthy eating isn’t all about cutting back, though. Healthy fats from plant-based sources, such as avocado, nuts, olives and olive oil, help your heart by lowering the bad type of cholesterol.

Most people need to add more fruits and vegetables to their diet — with a goal of five to 10 servings a day. Eating that many fruits and vegetables can not only help prevent heart disease but also may help prevent cancer and improve diabetes.

Eating several servings a week of certain fish, such as salmon and mackerel, may decrease your risk of heart attack.

Following a heart-healthy diet also means keeping an eye on how much alcohol you drink. If you choose to drink alcohol, it’s better for your heart to do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. At that moderate level, alcohol can have a protective effect on your heart. More than that becomes a health hazard.

4. Maintain a healthy weight

Being overweight, especially if you carry excess weight around your middle, ups your risk of heart disease. Excess weight can lead to conditions that increase your chances of heart disease — high blood pressure, high cholesterol and diabetes.

One way to see if your weight is healthy is to calculate your body mass index (BMI), which considers your height and weight in determining whether you have a healthy or unhealthy percentage of body fat. BMI numbers 25 and higher are associated with higher blood fats, higher blood pressure, and an increased risk of heart disease and stroke.

The BMI is a good, but imperfect guide. Muscle weighs more than fat, for instance, and women and men who are very muscular and physically fit can have high BMIs without added health risks. Because of that, waist circumference also is a useful tool to measure how much abdominal fat you have:

• Men are considered overweight if their waist measurement is greater than 40 inches (101.6 centimeters, or cm).
• Women are overweight if their waist measurement is greater than 35 inches (88.9 cm).

Even a small weight loss can be beneficial. Reducing your weight by just 5 to 10 percent can help decrease your blood pressure, lower your blood cholesterol level and reduce your risk of diabetes.

5. Get enough quality sleep

Sleep deprivation can do more than leave you yawning throughout the day; it can harm your health. People who don’t get enough sleep have a higher risk of obesity, high blood pressure, heart attack, diabetes and depression.

Most adults need seven to nine hours of sleep each night. If you wake up without your alarm clock and you feel refreshed, you’re getting enough sleep. But, if you’re constantly reaching for the snooze button and it’s a struggle to get out of bed, you need more sleep each night.

Make sleep a priority in your life. Set a sleep schedule and stick to it by going to bed and waking up at the same times each day. Keep your bedroom dark and quiet, so it’s easier to sleep.

If you feel like you’ve been getting enough sleep, but you’re still tired throughout the day, ask your doctor if you need to be evaluated for sleep apnea. Obstructive sleep apnea blocks the airflow through your windpipe and causes you to stop breathing temporarily. Signs and symptoms of sleep apnea include snoring loudly; gasping for air during sleep; waking up several times during the night; waking up with a headache, sore throat or dry mouth; and memory or learning problems.

Treatments for obstructive sleep apnea include losing weight or using a continuous positive airway pressure (CPAP) device that keeps your airway open while you sleep. CPAP treatment appears to lower the risk of heart disease from sleep apnea.

6. Get regular health screenings

High blood pressure and high cholesterol can damage your heart and blood vessels. But without testing for them, you probably won’t know whether you have these conditions. Regular screening can tell you what your numbers are and whether you need to take action.

• Blood pressure. Regular blood pressure screenings usually start in childhood. Adults should have their blood pressure checked at least every two years. You may need more-frequent checks if your numbers aren’t ideal or if you have other risk factors for heart disease. Optimal blood pressure is less than 120/80 millimeters of mercury.
• Cholesterol levels. Adults should have their cholesterol measured at least once every five years starting at age 20 if they have risk factors for heart disease, such as obesity or high blood pressure. If you’re healthy, you can start having your cholesterol screened at age 35 for men and 45 for women. Some children may need their blood cholesterol tested if they have a strong family history of heart disease.
• Diabetes screening. Since diabetes is a risk factor for developing heart disease, you may want to consider being screened for diabetes. Talk to your doctor about when you should have a fasting blood sugar test to check for diabetes. Depending on your risk factors, such as being overweight or having a family history of diabetes, your doctor may recommend early screening for diabetes. If your weight is normal and you don’t have other risk factors for type 2 diabetes, the American Diabetes Association recommends starting screening at age 45, and then retesting every three years.

http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease-prevention/art-20046502

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Daily aspirin to prevent first heart attack does not get FDA backing

The US Food and Drug Administration concludes that daily aspirin use can help ward off a heart attack or stroke in some people, but it is not for everyone.

The federal agency says while there is evidence that low-dose aspirin can prevent heart attacks, strokes and cardiovascular problems reoccurring (so-called secondary prevention), the case has yet to be made for using it to prevent a first event (primary prevention).

Aspirin works by interfering with the blood’s clotting action, so reducing the chance of clots developing and obstructing flow of oxygen and blood. Clots that obstruct a coronary artery are a cause of heart attacks, while blockages in the blood supply to the brain are a cause of stroke.

The Food and Drug Administration (FDA) draw these conclusions after “carefully examining scientific data from major studies,” according to a new Consumer Update.

Dr. Robert Temple, FDA’s deputy director for clinical science, says:

“Since the 1990s, clinical data have shown that in people who have experienced a heart attack, stroke or who have a disease of the blood vessels in the heart, a daily low dose of aspirin can help prevent a reoccurrence.”

For primary prevention, ‘benefits not established, while risks are still present’

But for people who have not had a heart attack, stroke or cardiovascular problems, “the benefit has not been established but risks – such as dangerous bleeding into the brain or stomach – are still present,” warn the FDA.

And neither does the data support the use of aspirin to prevent heart attack or stroke in people who have never had them but have a family history of them or are showing evidence of arterial disease, it adds.

However, large trials looking at use of aspirin in primary prevention of heart attack and stroke are ongoing, and the FDA will continue to monitor them and update consumers should the evidence change.

“The bottom line is,” say the FDA, “that in people who have had a heart attack, stroke or cardiovascular problems, daily aspirin therapy is worth considering.”

If you are considering using daily aspirin, says Dr. Temple, you should only do so after talking to your doctor, who can help you weigh the benefits and the risks.

How much aspirin you take is important, he adds. Your doctor should ensure the dose you take and how often you take it is right for you, and recommend the dose and frequency that will bring you the greatest benefit with the fewest side effects.

Aspirin doses range from low-strength, as in an 80 mg tablet, to regular strength, as in a 325 mg tablet.

Also, because aspirin reduces risk of blood clotting, care is needed when using it with other blood thinners like warfarin, dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis), warn the FDA.

And, if your doctor recommends daily aspirin to lower your risk of heart attack and clot-related stroke, you should read the labels carefully to make sure you use the correct product. Some combine aspirin with other painkillers and ingredients and should not be taken for long-term use.

Medical News Today recently reported on research that found use of low-dose aspirin is linked to improvedcolon cancer survival, while an earlier study showed regular aspirin is linked to age-related macular degeneration risk.

Written byCatharine Paddock PhD

http://www.medicalnewstoday.com/articles/276386.php

 

 

 

Cardiologists define new heart failure symptom: Shortness of breath while bending over

UT Southwestern Medical Center cardiologists have defined a novel heart failure symptom in advanced heart failure patients: shortness of breath while bending over, such as when putting on shoes.

The condition, which UT Southwestern cardiologists named “bendopnea” (pronounced “bend-op-nee-ah”), is an easily detectable symptom that can help doctors diagnose excessivefluid retention in patients with heart failure, according to the findings published in a recent edition of the Journal of the American College of Cardiology: Heart Failure.

“Some patients thought they were short of breath because they were out of shape or overweight, but we wondered if there was something more to it. So we developed this study to further investigate this symptom,” said Dr. Jennifer Thibodeau, Assistant Professor of Internal Medicine in the Division of Cardiology.

Dr. Thibodeau cautions that bendopnea is not a risk factor for heart failure, but rather a symptom that heart failure patients are becoming sicker and may need to have their medications or treatments adjusted.

Bendopnea is a way for both doctors and patients to recognize something may be amiss with their current heart failure treatment. Patients should speak with their cardiologist or health care provider if they experience bendopnea, notes Dr. Thibodeau.

Of the 5.7 million Americans living with heart failure, about 10 percent have advanced heart failure, according to the American Heart Association. The condition is considered advanced when conventional heart therapies and symptom management strategies no longer work.

UT Southwestern doctors enrolled 102 patients who were referred to the cardiac catheterization lab for right heart catheterization and found that nearly one-third of the subjects had bendopnea.

When the patients were lying flat, clinicians measured both the pressures within the heart as well as the cardiac output – how well the heart is pumping blood to the rest of the body – in all 102 patients. Then, they repeated these measurements in 65 patients after they were sitting in a chair for two minutes, and then bending over for one minute.

“We discovered that patients with bendopnea had too much fluid in their bodies, causing elevated pressures, and when they bent forward, these pressures increased even more,” said Dr. Thibodeau, first author of the study.

http://www.medicalnewstoday.com/releases/274274.php

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3D-printed membrane ‘could predict heart attack risk

 

According to The Heart Foundation, more than 920,000 Americans will have a heart attack this year. But now, researchers have created a 3D custom-fitted elastic membrane that can be implanted onto the outer layer of the heart wall, which they say could predict the occurrence of heart attacks and “transform” patient treatment.

The research team, including Prof. Igor Efimov of the School of Engineering and Applied Science at Washington University, recently published details of the creation in the journal Nature Communications.

Using an inexpensive 3D printer, the creators were able to develop an elastic membrane made of a soft and flexible silicon material. This membrane is made to match the shape of a patient’s epicardium – the outer layer of the heart wall.

The researchers then printed small sensors onto the membrane. These are made of semiconductor materials, including silicon, gallium arsenide, gallium nitride, metals, metal oxides and polymers.

The sensors are able to measure a number of markers of arrhythmia – a condition characterized by problems with the rate or rhythm of heartbeat.

Further explaining how the elastic membrane was created, Prof. Efimov says:

“We image the patient’s heart through MRI (magnetic resonance imaging) or CT (computed tomography) scan, then computationally extract the image to build a 3D model that we can print on a 3D printer.”

 

He adds that they then “mold the shape of the membrane that will constitute the base of the device deployed on the surface of the heart.”

There are already similar devices available that are 2D. But the researchers say because such devices are unable to cover the full surface of the epicardium, they can produce unreliable results.

3D membrane ‘could monitor vital organ functions’

The creators say the new 3D elastic membrane could help doctors predict the occurrence of heart attacks in at-risk patients and improve treatment.

Furthermore, the device could help treat treat a variety of heart disorders, including arterial fibrillation – a condition that causes an irregular heart rate.

Prof. Efimov says:

“Because this is implantable, it will allow physicians to monitor vital functions in different organs and intervene when necessary to provide therapy.

In the case of heart rhythm disorders, it could be used to stimulate cardiac muscle or the brain, or in renal disorders, it would monitor ionic concentrations of calcium, potassium and sodium.”

It is possible, according to Prof. Efimov, that the membrane could even hold a sensor that measures troponin – a protein in heart cells that is believed to be a marker of a heart attack.

He says that in the future, devices such as the 3D membrane could be used alongside ventricular assist devices (VADs) – mechanical pumps that are used to support heart function and blood flow in individuals who have weakened hearts.

“This is just the beginning,” adds Prof. Efimov. “Previous devices have shown huge promise and have saved millions of lives. Now we can take the next step and tackle some arrhythmia issues that we don’t know how to treat.”

Medical News Today recently reported on a study detailing a new blood test that researchers say could accurately predict the risk of heart attack.

Written by Honor Whiteman

http://www.medicalnewstoday.com/articles/273343.php

 

 

FDA approves droxidopa for neurogenic orthostatic hypotension

Droxidopa, a prodrug that is converted into norepinephrine, has been approved for the treatment of patients with neurogenic orthostatic hypotension, a rare, chronic, and often debilitating condition associated with Parkinson’s disease, multiple system atrophy, and pure autonomic failure, the Food and Drug Administration announced on Feb 18.

The approval is based on two clinical trials of people with NOH, who, over 2 weeks of treatment, reported improvements in dizziness, light-headedness, feeling faint, “or feeling as if they might black out,” compared with those taking a placebo, the FDA said in a statement announcing the approval. The most common adverse events reported by patients in the studies were headache, dizziness, nausea, hypertension, and fatigue.

The approval is an accelerated approval, which enables the FDA to approve a drug for a serious disease with few treatment options, based on data showing that the treatment has an effect on a clinical measure that is considered “reasonably likely” to predict longer-term benefit. In the case of droxidopa, approval was based on short-term relief of dizziness. The manufacturer, Chelsea Therapeutics, is required to conduct a postmarketing study to confirm the drug’s benefits.

Droxidopa is “a synthetic catecholamine that is directly converted to norepinephrine (NE) via decarboxylation, resulting in increased levels of NE in the nervous system, both centrally and peripherally,” according to the company, which will market the drug under the trade name Northera.

“There are limited treatment options for people with NOH, and we are committed to helping make safe and effective treatments available,” Dr. Norman Stockbridge, director of the Division of Cardiovascular and Renal Drugs in the FDA’s Center for Drug Evaluation and Research, said in the statement. People with NOH “are often severely limited in their ability to perform routine daily activities that require walking or standing,” he added.

The prescribing information states that droxidopa is indicated for “the treatment of orthostatic dizziness, light-headedness, or the ‘feeling that you are about to black out’ in adult patients with symptomatic neurogenic orthostatic hypotension (NOH) caused by primary autonomic failure [Parkinson’s disease (PD), multiple system atrophy, and pure autonomic failure], dopamine beta-hydroxylase deficiency, and nondiabetic autonomic neuropathy.”

The indications and usage statement also adds that effectiveness past 2 weeks “has not been established,” and that the “continued effectiveness of Northera should be assessed periodically.”

The prescribing information includes a boxed warning about the risk of supine hypertension, and recommends that supine blood pressure be monitored before and during treatment, and more often when doses are increased – and that elevating the head of the bed reduces the risk of supine hypertension.

At a meeting on Jan. 14, the FDA’s Cardiovascular and Renal Drugs Advisory Committee voted 16 to 1 to recommend approval. In the FDA’s briefing documents filed prior to the meeting, the agency did not support approval of the drug, for reasons that included a lack of evidence indicating the drug had a durable effect, as well as safety issues.

Until the approval of droxidopa, the only drug approved for symptomatic NOH was midodrine, a vasoconstrictor that was approved in 1996. But midodrine may soon be off the market because postmarketing studies have failed to provide convincing evidence that treatment improves symptoms, according to the FDA’s briefing documents for the droxidopa panel meeting. Midodrine was approved on the basis of a surrogate endpoint – standing systolic blood pressure – which was considered “reasonably likely” to predict symptomatic benefit, but several postmarketing studies have failed to show that the drug is beneficial, despite its effect on increasing blood pressure.

NOH affects almost 300,000 people in the United States and European Union, according to Chelsea.

A statement on the approval issued by Chelsea said the company had a “preliminary” agreement with the FDA to conduct a postmarketing study to evaluate the clinical effects of droxidopa, which would be a multicenter, placebo-controlled, randomized study of about 1,400 patients enrolled over 6 years.

http://www.ecardiologynews.com/single-view/fda-approves-droxidopa-for-neurogenic-orthostatic-hypotension/138cf2a757264c256e82661ba60a3859.html