A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R EFERENCES
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2003 by ICON Group International, Inc. Copyright Ó2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Heart Attack: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83623-X 1. Heart Attack-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail:
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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on heart attack. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.
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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON HEART ATTACK ........................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Heart Attack.................................................................................. 6 E-Journals: PubMed Central ....................................................................................................... 43 The National Library of Medicine: PubMed ................................................................................ 48 CHAPTER 2. NUTRITION AND HEART ATTACK ............................................................................ 119 Overview.................................................................................................................................... 119 Finding Nutrition Studies on Heart Attack .............................................................................. 119 Federal Resources on Nutrition ................................................................................................. 123 Additional Web Resources ......................................................................................................... 123 CHAPTER 3. ALTERNATIVE MEDICINE AND HEART ATTACK ...................................................... 129 Overview.................................................................................................................................... 129 The Combined Health Information Database............................................................................. 129 National Center for Complementary and Alternative Medicine................................................ 130 Additional Web Resources ......................................................................................................... 136 General References ..................................................................................................................... 144 CHAPTER 4. DISSERTATIONS ON HEART ATTACK ........................................................................ 145 Overview.................................................................................................................................... 145 Dissertations on Heart Attack ................................................................................................... 145 Keeping Current ........................................................................................................................ 147 CHAPTER 5. CLINICAL TRIALS AND HEART ATTACK .................................................................. 149 Overview.................................................................................................................................... 149 Recent Trials on Heart Attack ................................................................................................... 149 Keeping Current on Clinical Trials ........................................................................................... 167 CHAPTER 6. PATENTS ON HEART ATTACK................................................................................... 169 Overview.................................................................................................................................... 169 Patents on Heart Attack ............................................................................................................ 169 Patent Applications on Heart Attack......................................................................................... 191 Keeping Current ........................................................................................................................ 200 CHAPTER 7. BOOKS ON HEART ATTACK ...................................................................................... 203 Overview.................................................................................................................................... 203 Book Summaries: Federal Agencies............................................................................................ 203 Book Summaries: Online Booksellers......................................................................................... 204 The National Library of Medicine Book Index ........................................................................... 214 Chapters on Heart Attack .......................................................................................................... 215 CHAPTER 8. MULTIMEDIA ON HEART ATTACK ........................................................................... 223 Overview.................................................................................................................................... 223 Video Recordings ....................................................................................................................... 223 Bibliography: Multimedia on Heart Attack ............................................................................... 225 CHAPTER 9. PERIODICALS AND NEWS ON HEART ATTACK ........................................................ 227 Overview.................................................................................................................................... 227 News Services and Press Releases.............................................................................................. 227 Newsletter Articles .................................................................................................................... 230 Academic Periodicals covering Heart Attack............................................................................. 233 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 237 Overview.................................................................................................................................... 237 NIH Guidelines.......................................................................................................................... 237 NIH Databases........................................................................................................................... 239 Other Commercial Databases..................................................................................................... 241
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APPENDIX B. PATIENT RESOURCES ............................................................................................... 243 Overview.................................................................................................................................... 243 Patient Guideline Sources.......................................................................................................... 243 Associations and Heart Attack................................................................................................... 262 Finding Associations.................................................................................................................. 263 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 265 Overview.................................................................................................................................... 265 Preparation................................................................................................................................. 265 Finding a Local Medical Library................................................................................................ 265 Medical Libraries in the U.S. and Canada ................................................................................. 265 ONLINE GLOSSARIES ................................................................................................................ 271 Online Dictionary Directories ................................................................................................... 277 HEART ATTACK DICTIONARY............................................................................................... 279 INDEX .............................................................................................................................................. 359
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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with heart attack is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about heart attack, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to heart attack, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on heart attack. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to heart attack, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on heart attack. The Editors
1
From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.
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CHAPTER 1. STUDIES ON HEART ATTACK Overview In this chapter, we will show you how to locate peer-reviewed references and studies on heart attack.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and heart attack, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “heart attack” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: ·
Baseline Characteristics of the Diabetic Participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Source: Diabetes Care. 24(4): 654-658. April 2001. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reports on a study that described the baseline characteristics of a cohort of hypertensive adults with diabetes who are part of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). ALLHAT is a double blind randomized trial of 42,448 high risk hypertensive participants ages 55 years or older designed to determine whether the incidence of fatal and nonfatal coronary heart disease and combined cardiovascular events differs between diuretic
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treatment (chlorthalidone) and the alternative therapies of a calcium channel blocker (amlodipine), an angiotensin converting enzyme inhibitor (lisinopril), and an alpha adrenergic blocker (doxazosin). The planned follow up is an average of 6 years, to be completed in March 2002. Of the 42,448 participants in ALLHAT, 15,297 have a history of diabetes. Of these, 50.2 percent are male, 39.4 percent are African American, and 17.7 percent are Hispanic. Demographic and laboratory characteristics of the cohort are similar to those of other studies of the U.S. elderly population with hypertension. The sample size has 42 and 93 percent confidence, respectively, for detecting a 16 percent difference between the diuretic and each of the nondiuretic treatments for the study outcomes. The article concludes that the cohort of people with diabetes in ALLHAT will be able to provide valuable information about the treatment of hypertension in older diabetic patients at risk for incident cardiovascular disease. 1 figure. 1 table. 44 references. (AA-M). ·
Life-Saving Power of Aspirin! An Aspirin a Day Helps Keep Heart Attack Away Source: Diabetes Forecast. 52(12): 56-58. December 1999. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article discusses the life saving power of aspirin. One aspirin per day can protect people who have diabetes from cardiovascular disease. Although this complication of diabetes claims more lives than any other, most people who have diabetes and who could benefit from taking aspirin do not take it. Diabetes has been associated with a condition known as sticky platelets. These platelets adhere to blood vessel walls more easily and aggregate more readily, which may be one reason why people who have diabetes are more prone to cardiovascular disease. The American Diabetes Association recommends that most people who have diabetes regularly use an antiplatelet drug to decrease the stickiness of platelets. Aspirin, which is the most readily available and commonly used antiplatelet drug, works by preventing platelets from making the chemical signals that trigger platelet activation and aggregation. Dosing depends on the individual. However, aspirin is not recommended for people who have had an allergic reaction to aspirin in the past, who have stomach ulcers, who have active liver disease, and who are taking antiplatelet drugs. In addition, aspirin does have some side effects, including stomach upset and easy bruising. 3 figures.
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Gingivitis in the Genesis of Heart Attack and Other Arteriosclerotic Diseases Source: Dentistry Today. 20(11): 94-95. November 2001. Contact: Available from Dentistry Today Inc. 26 Park Street, Montclair, NJ 07042. (973) 783-3935. Summary: New evidence of microbial aggravation and its mechanisms in coronary artery disease (CAD) and other atherosclerotic (hardening of the arteries) disorders was presented during the 50th annual session of the American College of Cardiology, held in Orlando, Florida in 2001. This article reviews the role of gingivitis in the genesis of heart attack and other arteriosclerotic diseases, reporting on data from the conference and other major recent conferences and publications. The author notes that few patients recognize how much infection and inflammation are present in their mouths. Their risks should be identified for them by a dentist. The author also reports that prior to this new information, attention was mainly directed to the progression of the arterial damage; now, increasing attention is directed to mechanisms for regression, or improvement in the vascular status. Dentists, physicians, and patients can all benefit from adequate
Studies
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evaluation of periodontal disease, and adequate professional communication among themselves. ·
How to Prevent a Heart Attack: The His and Hers Guide Source: Prevention. p. 122-131. February 2000. Summary: Cicero notes that heart disease is the leading cause of death for both men and women. She provides a guide to nutrition, exercise, and health habits with plans for both genders. Some suggestions are intended for men and women together, such as smoking cessation and walking. Others are intended for women, such as a discussion of the role of estrogen in preventing heart disease. Men are warned to not ignore the signs of a heart attack and to reduce stress.
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Inflammation-Sensitive Plasma Proteins, Diabetes, and Mortality and Incidence of Myocardial Infarction and Stroke: A Population-Based Study Source: Diabetes. 52(2): 442-447. February 2003. Contact: Available from American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 232-3472. Website: www.diabetes.org. Summary: This article reports on a study that explored the relationship of inflammationsensitive plasma proteins (ISPs) with the prevalence of diabetes and the interrelationships between ISPs and diabetes in the prediction of death and the incidence of myocardial infarction (heart attack) and stroke. Plasma levels of fibrinogen, alpha1-antitrypsin, haptoglobin, ceruloplasmin, and orosomucoid were assessed in 6,050 men, aged 28 to 61 years. All-cause and cardiovascular mortality and incidence of myocardial infarction and stroke were monitored over 18.7 years (plus or minus 3.7 years). Prevalence of diabetes (n = 321) was significantly associated with ISP levels among overweight and obese men but not among men with body mass index (BMI) less than 25. The association was similar for insulin resistance according to homeostasis model assessment. High ISP levels (two or more ISPs in the top quartile) increased the cardiovascular risk among men with diabetes. The authors conclude that, in this population-based cohort, diabetes was associated with increased ISP levels among overweight and obese men but not among men with normal weight. High ISP levels increased the cardiovascular risk similarly in men with and without diabetes. 3 figures. 3 tables. 43 references.
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Periodontal Disease Predicts and Possibly Contributes to Acute Myocardial Infarction Source: Dentistry Today. 20(4): 80-81. April 2001. Contact: Available from Dentistry Today Inc. 26 Park Street, Montclair, NJ 07042. (973) 783-3935. Summary: Patients experiencing an acute myocardial infarction (AMI, heart attack) are more likely to have periodontal disease than those free of coronary artery disease (CAD), according to a report read before the last annual session of the American Heart Association (AHA) in New Orleans (November 2000). This article summarizes that report, outlining the implications for dentists and periodontists. The researchers reported links between the presence of gum disease and coronary thrombosis, noting an amplification of the inflammation of the gums was correlated with the heart condition. The enhanced inflammatory response (as demonstrated by high C reactive protein, or CRP, levels in human blood serum) is predictive of recurrent events in both conditions. Therefore, there is reason to suspect a higher occurrence of CAD among people with
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periodontal disease compared with those free from periodontal disease. The author notes that treatment of periodontal disease may become a novel strategy for secondary prevention among patients with coronary artery disease or those surviving an AMI. The author also briefly reports on animal studies that support or explore the relationship between infection or inflammation and CAD.
Federally Funded Research on Heart Attack The U.S. Government supports a variety of research studies relating to heart attack. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to heart attack. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore heart attack. The following is typical of the type of information found when searching the CRISP database for heart attack: ·
Project Title: ALLHAT--ANTIHYPERTENSIVE & LIPID LOWERING TREATMENT TO PREVENT HEART ATTACK Principal Investigator & Institution: Lawton, William J.; University of Iowa Iowa City, IA 52242 Timing: Fiscal Year 2001 Summary: The goals of the study are to determine whether the incidence of fatal coronary heart disease and non-fatal myocardial infarction differs between subjects treated with diuretics versus treatment with a calcium antagonist, ACE inhibitor, or alpha blocker. The study will also determine whether lowering serum cholesterol with Pravastatin reduces death from all causes. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ANTIHYPERTENSIVE AND LIPID LOWERING TO PREVENT HEART ATTACK TRIAL (ALLHAT) Principal Investigator & Institution: Herrera, Carlos A.; University of Texas Hlth Sci Ctr Houston Box 20036 Houston, TX 77225 Timing: Fiscal Year 2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
2
Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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Project Title: ANTIHYPERTENSIVE AND LIPID LOWERING TREATMENT TO PREVENT HEART ATTACK Principal Investigator & Institution: Vetroveck, George; Virginia Commonwealth University Richmond, VA 232980568 Timing: Fiscal Year 2001 Summary: To determine whether the combined incidence of fatal coronary heart disease and non-fatal myocardial infarction differs between diuretic treatment and three alternative antiypertensive pharmacologic treatments--a calcium antagonist, an ACE inhibitor and an alpha adrenergic blocker. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ANTIHYPERTENSIVE PREVENTION THERAPY
LIPID-LOWERING
HEART
ATTACK
Principal Investigator & Institution: Retta, Tamrat M.; Howard University 2400 6Th St Nw Washington, DC 20059 Timing: Fiscal Year 2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: APOPTOTIC SIGNALING NETWORKS IN ATHEROGENESIS Principal Investigator & Institution: Han, David K. Assistant Professor; Physiology; University of Connecticut Sch of Med/Dnt Bb20, Mc 2806 Farmington, CT 060302806 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-AUG-2004 Summary: Myocardial infarction, the major cause of heart attack, is caused by sudden occlusion of coronary arteries. Primary cause of myocardial infarction is attributed to atherosclerosis, a disease characterized by progressive narrowing and thickening of blood vessels. It is believed that atherosclerotic plaque rupture and thrombosis cause sudden coronary artery occlusion and myocardial infarction. A number of recent papers have presented evidence that programmed cell death (apoptosis) of vascular smooth muscle cells and macrophages were found in human coronary atherosclerotic plaques. This finding has led to a paradigm that apoptosis of vascular smooth muscle cells weakens the vessel wall integrity and cause subsequent rupture. Currently, the molecular mechanisms of how death signal is received and amplified in the vascular smooth muscle cells is not well understood. It is our central hypothesis that identification and characterization of proximal and distal protein complexes from Fas pathway will provide critical information to understand apoptosis process in vascular smooth muscle cells. We will utilize novel technologies to decipher complex protein networks controlling apoptosis in the vessel wall. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ATHEROSCLEROSIS STUDIES Principal Investigator & Institution: Guyton, John R.; Duke University Durham, NC 27706 Timing: Fiscal Year 2001 Summary: Purpose: GCRC Protocol 697 entitled "Atherosclerosis Studies" enabled the procurement of fasting human plasma for isolation of lipoproteins. The lipoproteins have been used principally for investigation of the chemistry of lipoprotein oxidation.
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Methods: In collaboration with Dr. Ned Porter of the Department of Chemistry we performed studies to determine the major regioisomeric hydroperoxides and alcohols formed during the early stages of LDL and HDL oxidation initiated by the thermolabile azo free radical initiator 2,2'-azobis(2-amidinopropane) dihydrochloride. Results: After a lag time of 1 hour, significant amounts of chol-18:2-OOH and lower levels of chol-18:2OH begin to form. At this time approximately 90% of the initial alpha- tocopherol is still present in LDL. In the early phase only 13- and 9-cis,trans-chol-18:2-OOH are formed. After depletion of antioxidants, principally alpha-tocopherol, the thermodynamic products - trans,trans-chol-18:2-OOHs - were formed in equal abundance to the cis,trans isomers. In addition to these results, this study also established HPLC methodology for the direct quantitation of specific cholesteryl ester hydroperoxides. Current work is continuing to examine hydroperoxides fromed from arachidonic acid in LDL and HDL. In other ongoing work, human plasma lipoprotein preparations have been compared to lipoproteins derived from cerebrospinal fluid (CSF). In CSF, the major apolipoprotein species are apoE and apoA-I. CSF apoE-containing lipoproteins were shown to be larger than CSF apoA-I-containing lipoproteins, but with considerable overlap. The sizes of some CSF apoE lipoproteins were comparable to plasma LDL. The results are interpreted to suggest that both apoA-I and apoE function in cholesterol redistribution in brain. Significance: The significance of chemical studies on lipoprotein oxidation relates to our longstanding interest in the development of lipid-rich core in human atherosclerosis. Lipoprotein oxidation is a prominent feature in a microenvironment where cellular toxicity and survival responses are important. The understanding of the tissue destructive aspect of atherosclerosis has been hampered by a lack of complete knowledge concerning chemical and cellular aspects of lipoprotein modification. This destructive aspect is already present at the time of lesion transition from fatty streak (Type II lesion) to intermediate lesion (Type III) and then to the fibrous plaque (Type IV). In advanced atherosclerosis, the effect of tissue destruction is to weaken the arterial intima leading to plaque rupture, with consequent rapid thrombosis and often arterial occlusion causing heart attack or stroke. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: AZITHROMYCIN AND CORONARY EVENTS Principal Investigator & Institution: Cohn, Peter; State University New York Stony Brook Stony Brook, NY 11794 Timing: Fiscal Year 2001 Summary: This study is to determine whether the antibotic, azithromycin, decreases the risk of having a heart attack or other complication related to coronary artery disease in people with heart disease. Azithromycin is an antibiotic that is used to treat infections with a bacteria called Chlamydia pneumoniae. Some studies suggest that Chlamydia pneumoniae infection may be a risk factor for heart attacks and other complications related to coronary artery disease. Chlamydia pneumoniae is spread from person-toperson by sneezing and coughing (unlike a related bacteria, Chlamydia trachomatis, it is not a sexually transmitted disease). Studies show that people who have been infected with Chlamydia pneumoniae in the past have a higher chance of having a heart attack. Other studies show that Chlamydia pnreumoniae is present in the plaque, or material blocking the heart vessel, in many people with heart disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
Studies
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Project Title: BIOSYNTHESIS PLASMALOGENS
AND
FUNCTIONS
OF
ANIMAL
9
CELL
Principal Investigator & Institution: Zoeller, Raphael A. Biophysics; Boston University Medical Campus 715 Albany St, 560 Boston, MA 02118 Timing: Fiscal Year 2001; Project Start 01-DEC-1993; Project End 30-JUN-2004 Summary: Our long-term goals are to understand how animal cells regulate their phospholipid makeup and the importance of this in cell function and in human health. Our main focus has been on plasmalogens; a class of phospholipid that constitutes 18 percent of the phospholipid mass in humans and are found in very high levels in heart, muscle and brain (one-third of heart phospholipid is plasmalogen). We have generated mutants from well characterized somatic cell lines, that are defective in plasmalogen biosynthesis. These plasmalogen-deficient cells are hypersensitive to chemical hypoxia (a chemical model for ischemia/ reperfusion), as well as anoxia/reoxygenation. These and other data suggest a role for plasmalogens, as endogenous antioxidants, in the protection of cells and tissues during episodes of ischemia/reperfusion such as heart attack and stroke. In another area of interest, we have attempted to isolate mutants with general defects in, glycerolipid biosynthesis, particularly in the biosynthesis and initial metabolism of phosphatidic acid. We have recently isolated a putative mutant in phosphatidate phosphohydrolase, a key regulatory enzyme in triglyceride synthesis. Our specific aims for the near future are: 1. To isolate mutants in the first step in diacylglycerolipid biosynthesis, sn-glycero-3-phosphate acyltransferase. 2. To isolate the gene(s) involved in the first step in plasmalogen biosynthesis (dihydroxyacetonephosphate acyltransferase), and in overall glycerolipid biosynthesis (phosphatidate phosphohydrolase), using existing mutants that are deficient in these steps. 3. To define the mechanism by which plasmalogens protect cells during chemical hypoxia and anoxia/reperfusion. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: BOLD MRI: APPLICATION TO INTRARENAL OXYGENATION Principal Investigator & Institution: Prasad, Pottumarthi V.; Evanston Northwestern Healthcare 2650 Ridge Ave Evanston, IL 60201 Timing: Fiscal Year 2003; Project Start 01-FEB-1998; Project End 31-JAN-2008 Summary: (provided by applicant): Hypertension, also known as high blood pressure, affects one in four adults in the United States, and is a major risk factor for stroke, heart attack and kidney disease. It is sometimes called the "silent killer" because it often has no symptoms. Progress towards preventing and curing hypertension has been impeded by a lack of thorough understanding of its underlying pathophysiology. Significant progress made over the last decade in vascular biology has allowed for better understanding of many of the underlying mechanisms, which then has led to development of novel drug treatments for hypertension. Many now believe that kidney plays an important role in the pathophysiology of hypertension. Specifically, it is thought that renal medullary blood flow has a direct influence on hypertension. It is still a topic of debate as to the alterations in the kidney being the cause or the consequence of hypertension. In either case, availability of a non-invasive method to probe blood flow at a regional level within the kidney would allow for verifying many of the hypotheses to be tested in humans. Based on previous experience with blood oxygenation level dependent (BOLD) magnetic resonance imaging (MRI) technique to the kidney, we hypothesize that the technique would be sensitive to changes in medullary blood flow. More specifically, we believe that the technique in combination with suitable
10 Heart Attack
endothelium-dependent vasoactive agents would allow for renal microvascular reactivity studies to be performed in a non-invasive way. Vascular reactivity studies look for responses in the vessel walls to vasoactive substances or physiological paradigms that elicit an endogenous vasoactive response. It is believed that these functional changes at the microvascular level take place much earlier than the development of hypertension and if detected early enough, may be reversed with novel therapeutic approaches. In this proposal, we will perform experiments that will validate our hypothesis in several forms of hypertension in previously well established animal models and then extend them to human kidneys. Animal models will allow for direct comparison of BOLD MRI measurements against invasive laser probe assessments. Our human studies are designed to test the hypothesis that subjects at risk for developing hypertension will exhibit reduced renal microvascular reactivity. Successful outcome will provide better understanding of pathophysiology of human hypertension. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: CHEMOKINES AND IMMUNE CELLS IN HIND LIMB ISCHEMIA Principal Investigator & Institution: Shireman, Paula K. Surgery; University of Texas Hlth Sci Ctr San Ant 7703 Floyd Curl Dr San Antonio, TX 78229 Timing: Fiscal Year 2003; Project Start 01-SEP-2003; Project End 31-AUG-2007 Summary: (provided by applicant): New treatments are needed to decrease the complications of atherosclerosis, which include death, disability, heart attack, and amputation. Notably, collateral artery formation that "naturally" bypasses arterial obstructions occurs in all patients, but to a variable degree. Understanding the mechanisms of collateral artery formation and ischemic tissue necrosis could lead to new primary and adjuvant therapies for atherosclerosis. My long term research goal is to understand the basic mechanisms underlying collateral artery formation and tissue necrosis and specifically, in this application, ! will determine the influence of the immune system in collateral artery formation and tissue necrosis secondary to ischemia. Central to my hypothesis is that the recruitment and activation of inflammatory cells and the concomitant immune response influences collateral artery formation and susceptibility to tissue necrosis. I hypothesize that 1) immune differences account for their differential susceptibility to tissue necrosis in two inbred mouse strains, 2) T-cell recruitment and activation is an important determinant of susceptibility to tissue necrosis and 3) the MCP-1/CCR2 axis is an important determinant of susceptibility to tissue necrosis. Monocyte Chemoattractant Protein-1 (MCP-1) and its receptor CCR2 are important regulators of immune cell recruitment and differentiation. To test these hypotheses, I have in preliminary studies a) developed a mouse hind limb model of ischemia and have demonstrated that inbred strains of mice have differential susceptibilities to tissue necrosis; b) demonstrated that nude mice lacking T-cells and mice lacking MCP-1 or CCR2 have an increased incidence and severity of tissue necrosis as compared to wild type controls and c) shown that there is an increased recruitment of inflammatory cells to the ischemic hind limb. To test my hypothesis, I have proposed three specific aims. In aim #1, I will identify the mechanisms underlying the differential susceptibility to tissue necrosis in two inbred strains of mice. In aim #2, I will determine the role of T-cells and the Thl/Th2 immune response in tissue necrosis and in aim #3 I will determine the role of the MCP-1tCCR2 axis in tissue necrosis by using mice that are genetically inactivated for CCR2 and its ligand, MCP-1. The experiments outlined in this proposal are innovative because they utilize the power of genetic knockout mice in a hind limb ischemia model. I have assembled an experienced team of researchers in the diverse areas of vascular biology, immunology and physiology to test these hypotheses.
Studies 11
The significance of this research is that a better understanding of the mechanisms of collateral artery formation and susceptibility to tissue necrosis could lead to the design of novel primary or adjuvant treatments for atherosclerotic occlusive disease and thereby decrease death and disability rates from myocardial infarction and amputations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: CV RISK FACTORS AT AGE 25-64 & LONG-TERM MEDICARE COSTS Principal Investigator & Institution: Daviglus, Martha L. Professor; Preventive Medicine; Northwestern University Office of Sponsored Programs Chicago, IL 60611 Timing: Fiscal Year 2001; Project Start 20-SEP-2000; Project End 31-JUL-2004 Summary: (Adapted from the Investigator's Abstract) Background: Much recent effort has been directed toward controlling health care costs, but there has been little emphasis or research on prevention as a means of cost containment. This is due largely to lack of data relating to economic impact of prevention. Initial research: New data on two large Chicago cohorts followed for 22 years show that men and women with favorable baseline levels of all major CVD risk factors in middle age are at much lower agespecific risk of death from CVD, non-CVD, and all causes, and have much lower average annual Medicare costs (1984-1994), total and for CVD care, after becoming eligible at age 65 for Medicare. Aims: General - Assess in four large Chicago population cohorts whether young adult and middle-aged risk factor status has an impact not only on average annual Medicare costs, but also on cumulative and lifetime Medicare costs, to ages 70, 75, 80, >80, including to death, and during last one to two years of life. Specific Aims: 1) Assess relationships of CVD risk factors measured in young and middle-aged adult men and women to Medicare utilization and charges, from Medicare enrollment to death or attainment of age 70, 75, 80, >80, including in last one to two years of life. 2) Determine long-term relationship between earlier low-risk status vs. notlow-risk to subsequent Medicare health care charges. Baseline low risk is all six CVD risk factors favorable: systolic/diastolic pressure 120 mmHg/80 mmHg and no antihypertensive treatment, serum cholesterol <200 mg/dl, not currently smoking, no ECG abnormalities, no history of diabetes or heart attack. 3) Determine relationships between baseline habitual eating patterns and subsequent Medicare utilization and charges. 4) Further develop statistical methods for optimal analyses of health care expenditures. To accomplish these aims, the investigators propose to substantially extend their existing database by obtaining additional years of morbidity-mortality experience and of Medicare charge data to the year 2002. Significance: The investigators state that this research is unique and pioneering, with strong implications as to potential for both increasing longevity with health and saving money by shifting population risk factor status downward, to increase the percentage of low risk individuals from current low levels (<10 percent). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: FUNCTION
DEPRESSION,
EPINEPHRINE,
SEROTONIN,
&
PLATELET
Principal Investigator & Institution: Musselman, Dominique L. Assistant Professor; Psychiatry and Behavioral Scis; Emory University 1784 North Decatur Road Atlanta, GA 30322 Timing: Fiscal Year 2002; Project Start 04-FEB-2002; Project End 31-JAN-2006
12 Heart Attack
Summary: Several studies have shown that major depression and associated symptoms, such as hopelessness, are a major independent risk factor in development of ischemic heart disease (IHD), and for death after an index myocardial infarction. Not only do platelets play a central role in hemostasis, atherosclerosis, and acute coronary syndromes, but patients with major depression exhibit increased numbers of the functional platelet GPIIb/IIIa receptor, the receptor for fibrinogen and other ligands, and the final common pathway by which platelet aggregation and adhesion occurs. The overall goal is to determine in patients with major depression, the specific molecular pathways, and relative contributions of these pathways, whereby the platelet GPIIb/IIIa receptor is converted from a low- affinity to high-affinity conformation. To accomplish this goal, we will scrutinize in men with unipolar, recurrent, major depression, not only depression severity and platelet GPIIb/IIIa receptors, but characterize platelet autocrine "feed forward" pathways via: platelet serotonin (5HT) and 5HT2 receptors, platelet adenosine triphosphate (ATP) release, and urinary excretion of 11-dehydrothromboxane beta2: (1) under controlled basal conditions, (2) after the Trier Social Stress Test (a sustained mental stressor which will stimulate platelet function via peripheral release of the platelet agonist epinephrine). Moreover we will determine the molecular mechanisms whereby antidepressant treatment reduces numbers of high-affinity GPIIb/IIIa receptors, using randomized, double-blind, treatment with paroxetine (a selective 5HT reuptake inhibitor) in comparison to desipramine (a noradrenergic tricyclic). State-of- the-art techniques will be used, including fluorescence activated flow cytometry (FAFC), platelet calcium mobilization, and evaluation of in vitro antidepressant direct "drug effects" of upon platelet function. Novel information will be gleaned regarding not only the biological basis for the increased vulnerability of depressed patients to IHD, but also potential thrombovascular targets whereby psychopharmacologic interventions might reduce the future risk of heart attack and sudden death in patients with major depression. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: DETECTION OF ATHEROSCLEROSIS IN SYSTEMIC LUPUS ERYTHEMATOSUS Principal Investigator & Institution: Petri, Michelle; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2001 Summary: Atherosclerosis (hardening of the arteries) is ten times more common in patients with SLE than in the general population. The purpose of this research study is to determine how frequently SLE patients have an abnormal heart scan, indicative of atherosclerosis. Research participants will undergo a nuclear medicine cardiac SPECT scan as an outpatient. The scan requires an injection of a small amount of radioactive tracer into an arm vein. The testing procedure requires a patient to be present for approximately 6 hours. If a patient weighs over 200 pounds, a second day of testing may be necessary. As part of the scan, patients exercise. Patients who have coronary heart disease (heart problems) might be at risk for angina (heart pain) or myocardial infarction (heart attack). No one with known heart disease will enter this study. The radiation exposure received from participating in this study is equivalent to an exposure of 3.4 rems to the whole body. Naturally occurring radiation (cosmic radiation, radon, etc. ) produces whole body radiation exposures of about 0.3 rems per year. Occupationally exposed individuals are permitted to receive whole body exposures of 5 rems per year. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
Studies 13
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Project Title: DEVELOPMENT OF A DIRECT CELLULAR ENERGY DELIVERY SYSTEM Principal Investigator & Institution: Ehringer, William D.; Vitatech, Llc 1048 E Chestnut St Louisville, KY 40204 Timing: Fiscal Year 2003; Project Start 15-MAY-2003; Project End 30-APR-2004 Summary: (provided by applicant): The long-term objective of this proposal is to develop a safe and effective technique to deliver ATP directly to the human body and by-pass the body's need for oxygen. All cells of the body require oxygen and nutrients in order to make energy, and the energy is used to maintain homeostasis. Adenosine triphosphate (ATP) is the immediate source of energy that is constantly synthesized and metabolized in the body to maintain life. Without oxygen, ATP cannot be synthesized effectively in large quantities and thus the cells will die quickly from lack of energy and loss of homeostasis. Unfortunately many life-threatening conditions, such as heart attack, stroke, spinal cord injury, chronic obstructive pulmonary disease, and many surgical procedures all involve ischemia or hypoxia (low oxygen), which can cause reduced cellular energy and cell death. Over the years many attempts at restoring cellular energy have been unsuccessful, including direct intravenous infusion of ATP during ischemia. The major problem is that highly charged energetic phosphates, like ATP, do not pass through cell membranes and cannot be used for cell metabolism. The investigators have developed a new technique that delivers ATP and other high energy phosphates directly to cells, thus by-passing the need for oxygen. Our preliminary results indicate that our technique for delivering ATP can equal or supercede the cells need for ATP. Using this technique in a rat hindlimb preservation and transplantation model at room temperature, they can extend the preservation time of the severed limb to more than 20 hours, which is over 14 hours longer than previous attempts. This same technique has also been used by our company to extend heart preservation, and organism preservation. This Phase I proposal will further confirm our research concept and improve the effectiveness of our ATP delivery system. The aims are to: 1) further characterize the ATP delivery technique to improve the properties of the delivery vehicle (composition, dosage, temperature, concentration, and so on) to match the metabolic demand of different cell types; 2) study the cellular effect of this delivery technique in order to assess its toxic effects on cells; 3) study the method to deliver ATP not only to endothelial cells, but also to the cells outside of the vasculature by creating suitable gaps between endothelial cells; 4) to test the new ATP delivery technique in a composite tissue. The success of this project will have a huge impact on medicine and could change treatment strategies in many medical and surgical ischemic conditions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: DEVELOPMENTAL REGULATION OF GROWTH, SIZE AND SHAPE Principal Investigator & Institution: Baker, Nicholas E. Associate Professor; Molecular Genetics; Yeshiva University 500 W 185Th St New York, NY 10033 Timing: Fiscal Year 2001; Project Start 01-FEB-2001; Project End 31-JAN-2005 Summary: (appended verbatim from investigator's abstract): Size, shape and growth of organisms are determined by the number and size of cells in constituent organs. Cell number is determined as the balance of cell proliferation and cell death (apoptosis). Defects in proliferative control are central to malignancy. Apoptosis is a central feature of heart attack, stroke, and degenerative diseases. There is substantial molecular understanding of intracellular cell cycle and death programs. In vivo regulation must be achieved through extracellular signals which are little understood. Such regulation is
14 Heart Attack
probably absent from normal and transformed cells in culture, but can be studied in vivo using the fruitfly Drosophila melanogaster as a model system. In the fruitfly, imaginal disc size is maintained by a homeostatic mechanism called cell competition. Excessive growth on the part of some cells is compensated for by reduced growth and loss of other nearby cells. Deficient growth by some cells always leads to enhanced growth by their neighbors. The molecular and cellular basis of cell competition is unknown. A genetic screen has been developed to identify genes required for cell competition. The role of such genes in growth and homeostasis will be defined through studies of cell proliferation, cell survival and cell size, in part using a new reagent specific for the apoptotic pathway. The molecular identity and role of particular genes in cell competition will be determined. These studies will provide the first genetic and molecular understanding of cell competition. These studies will contribute to basic understanding of the spatial control of growth in vivo and identify genes and pathways that may be important in the cause, prevention , or treatment of heart attack, stroke, cancer, and degenerative diseases. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: DOWNED FIREFIGHTER LOCATION SYSTEM Principal Investigator & Institution: Fobare, Mark; Tiercent Corporation 1223 Peoples Ave Troy, NY 12180 Timing: Fiscal Year 2003; Project Start 15-SEP-2003; Project End 14-FEB-2004 Summary: (provided by applicant): Fire Fighting is a very hazardous occupation. On average, there are 600,000 structure fires annually and 3.0 deaths per 100,000 structure fire. Alarmingly, this death toll has doubled since 1977. Most of the fatalities are a result of heart attack and asphyxiation, complicated by the fact that rescuers cannot locate a downed victim in time to provide aid. Unfortunately, there is no equipment available today that will provide a rescuer with the location of a downed or lost firefighter and directions on how to best reach the victim. Tiercent is working to develop a solution: a system that will track the path and location of firefighters inside burning structures and alert the accountability officer when an individual is in need of assistance. The system will graphically display the 3D path and location of the downed firefighter such that a rescue team can quickly lend assistance. Tirecent aims to reduce firefighter fatalities 50% by reducing the average time it takes to search for a downed or lost firefighter. The firm's commercialization plans aim to penetrate 30% of the emergency services market by 2006, delivering 2,500 systems to the marketplace. Upon completion of this Phase 1 Research Project, Tiercent will demonstrate the feasibility of a system that uses a unique combination of radio frequency and inertial based technologies to locate a person within a 50'x50'x50' dwelling. More specifically, the system will provide information on the floor that a person is on, as well as their location on this floor, within five feet of accuracy. There are three sets of experiments in the Phase I research plan; floor level determination, X-Y accuracy improvement, and algorithm validation. The results of these experiments will be signal processing algorithms to determine firefighter location using a single three-axis body-mounted accelerometer and a radio frequency location system. Algorithm validations will be performed by collecting accelerometer and radio frequency tracking data during routine firefighter training exercises. The research plan calls for the use of: 1) ten paid firefighters from Troy, NY, 2) a fire training facility in Rensselaer County, NY, 3) Wearable Accelerometric Motion Analysis Systems, developed by Stanford University, and 4) the Wherenet real-time location system. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
Studies 15
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Project Title: EXERCISE AND BLOOD PRESSURE IN CHILDREN: A METAANALYSIS Principal Investigator & Institution: Kelley, George A. Professor & Director, MetaAnalytic Rese; Massachusetts General Hospital 55 Fruit St Boston, MA 02114 Timing: Fiscal Year 2001; Project Start 01-JUN-1998; Project End 30-JUN-2003 Summary: (Adapted from the Investigator's Abstract) Heart disease and stroke are the first and third leading causes of death in the United States, costing an estimated $259 billion in direct and indirect costs. Approximately 50 million Americans suffer from hypertension, a condition associated with increased risk for stroke, heart attack, and kidney failure. It is well established that blood pressure levels during childhood and adolescence track into adulthood. While pharmacologic intervention can help to control elevated blood pressure in children and adolescents, a debate continues over the efficacy of pharmacologic intervention because of deleterious side effects. As a result, there has been an increased interest in exercise as a nonpharmacologic approach for maintaining adequate blood pressure levels in children and adolescents. Recent reviews of literature have synthesized research using the "traditional" approach (chronologically arranging and describing the studies, perhaps by subtopic) which may result in subjective, nonreplicable conclusions. Consequently, the overall magnitude and direction of effect, as well as the relationships among such variables as subject characteristics, experimental design quality, training program characteristics, and how they contribute to changes in resting systolic and diastolic blood pressure are not clear. In this proposed project, the meta-analytic approach will be used to synthesize research on the overall magnitude of effect as well as the relationships among variables associated with exercise intervention and resting systolic and diastolic blood pressure in children and adolescents. Metaanalysis is a method of pooling the results of separate studies. It is a quantitative approach for increasing statistical power of primary end points and subgroups, resolving uncertainty when studies disagree, improving estimates of effect sizes, and answering questions not posed at the start of individual trials. To date, no study has quantitatively synthesized the existing literature regarding the role of exercise as a nonpharmacologic intervention in reducing or controlling resting systolic and diastolic blood pressure levels among children and adolescents. Thus, the purpose of this study is to use the meta-analytic approach to examine the effects of exercise on resting systolic and diastolic blood pressure in children and adolescents. The investigators state that the results of this project will provide clarification regarding the role of exercise in reducing resting systolic and diastolic blood pressure in children and adolescents. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: FASEB CONFERENCE: VASCULAR MEDICINE AND THROMBIN Principal Investigator & Institution: Runge, Marschall S. Professor and Director; Federation of Amer Soc for Exper Bio Bethesda, MD 208143998 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2002 Summary: (Applicant's abstract): The consequences of advanced vascular diseases. heart attack and stroke, continue to represent the most common causes of death and disability in the United States and in most industrialized countries. Despite important developments over the past three decades in this area, experimental progress in vascular medicine continues to advance our knowledge rapidly in this area. In this setting, an integrated understanding of the relative roles of thrombosis, angiogenesis and vascular cell function and biology will likely provide important insights and lead to the development of novel therapeutic and preventive strategies. This conference "Vascular
16 Heart Attack
Medicine and Thrombin, 2001" focuses on thrombin as a central mediator of hemostasis, tissue repair, vascular cell function, and development both under normal and pathological circumstances. The interest in thrombin and its function stems from: 1) thrombin's role in normal and pathological thrombus formation in cardiovascular diseases and in wound healing; 2) thrombins role in coagulation and cellular growth; 3) thrombin's amenability in the most sophisticated structure-function studies; and 4) thrombin's activation of three of the four protease activated receptors (PARs). This conference will build upon prior FASEB conferences on thrombin furthering our understanding of this important area by bringing together internationally recognized leaders from various disciplines who have a common interest in thrombin and these themes. This application is a request for funds to partially support this interdisciplinary, international conference. The small group format promoted by the FASEB Summer Research Conferences creates an ideal forum for exchanging knowledge and inevitably enhancing understanding of thrombin's nature and function. Topics to be discussed at the June 9-14, 2001 meeting in Montana include: a) thrombin structure and function; b) genetic models; c) signaling through protease activated responses; d) thrombin function in the CNS; e) role of thrombin in mitogenesis, angiogenesis, and cancer; f) interrelationships between thrombosis and the renin-angiotensin system; g) thrombin, growth factors and atherosclerosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: FUNCTIONAL MR IN ISCHEMIC CARDIOMYOPATHY Principal Investigator & Institution: Grayburn, Paul A. Professor; Baylor Research Institute 3434 Live Oak St, Ste 125 Dallas, TX 75204 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2006 Summary: (provided by applicant): Functional mitral regurgitation (MR) is a common complication of ischemic heart disease. Two large clinical trials confirmed an adverse effect of functional MR on survival after a heart attack. However, studies in heart failure are small and mainly limited to patients with nonischemic cardiomyopathy. Recent animal studies have challenged the traditional concept that functional MR is a consequence of mitral annular dilation, instead suggesting that functional MR is due to leaflet tethering by outward expansion of the left ventricular wall (i.e. LV remodeling). This has critical implications regarding the correct surgical approach to correcting functional MR. TO date, no large prospective studies have examined the mechanism(s) of functional MR in ischemic cardiomyopathy, nor has the interaction between mechanism and prognosis been explored. This is a crucial knowledge gap because 1) 70% of heart failure cases are caused by ischemic heart disease, and 2) functional MR occurs in around 60% of patients with ischemic cardiomyopathy. This proposal aims to fill these gaps by defining the mechanism(s) of functional MR by transesophageal echocardiography in a large clinical trial of patients with ischemic cardiomyopathy. The following specific aims will be addressed: Aim 1: To define the mechanism(s) of functional MR in ischemic cardiomyopathyAim 2: To define the effect of therapy on mechanism and severity of functional MRAim 3: To evaluate the effect of functional MR on prognosis is ischemic cardiomyopathyAim 4: To evaluate the effect of myocardial viability on functional MR and its response to treatment We propose to accomplish these aims as a ancillary study to the Surgical Treatment of Ischemic Heart Failure (STICH) Trial. The STICH Trial will compare surgical revascularization versus medical therapy for treatment of heart failure in 2800 patients with ischemic cardiomyopathy, and therefore affords a unique opportunity to investigate the mechanism(s) of
Studies 17
functional MR. Despite its known clinical utility of assessing the mechanism and severity of MR, TEE is not currently included in STICH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: GENDER DIFFERENCES IN THE SYMPTOMS OF UNSTABLE ANGINA Principal Investigator & Institution: Devon, Holli A. Medical-Surgical Nursing; University of Illinois at Chicago 1737 West Polk Street Chicago, IL 60612 Timing: Fiscal Year 2001; Project Start 29-SEP-2001 Summary: The objective of this proposal is to determine if there are gender differences in the symptoms of unstable angina, which are not explained by age, diabetes, or mood. A descriptive, quantitative study design will be used to identify the symptoms experienced prior to admission to the hospital for an acute episode of unstable angina. Forty-five females and forty-five males will be interviewed. An open-ended question will be used to assess the patients' symptom experience in their own words. Instruments measuring type, location, and severity of symptoms, mood, and baseline characteristics will be used to identify and explicate the symptom experience. The description of symptoms is the mechanism by which patients gain entry to the health care system. In the acute setting, the descriptors used may affect triage in the emergency department, the use of cardiac interventions, and the course of treatment. The symptoms of a heart attack and/or unstable angina listed by the American Heart Association (AHA) and accepted by practitioners have previously been based on a male model and may not be applicable to women. Recent studies, which have included women, suggest that there may be gender differences in the symptoms experienced with both acute myocardial infarction (AMI) and unstable angina. The majority of these studies have included only patients diagnosed with AMI. Because CHD in women is primarily manifested by angina and not AMI, many women have been excluded from analysis. This study will examine patients diagnosed with unstable angina in order to gather data that has been heretofore lacking in women. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: GENETIC STUDIES OF GOOD HEALTH IN AN AGING TWIN COHORT Principal Investigator & Institution: Reed, Terry E. Professor; Molecular and Medical Genetics; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, IN 462025167 Timing: Fiscal Year 2001; Project Start 30-SEP-2000; Project End 30-JUN-2003 Summary: (Abstract from application) This project involves the collection, extraction, storage and analysis of DNA samples from approximately 800 living complete twinpairs who are members of the National Academy of Sciences-National Research Council World War II twin registry. Twins will be selected from complete pairs who responded to a recent epidemiologic mail questionnaire between September 1998 and December 1999 when the participants were at a mean age of 74. Twin-pairs recruited will be those where one or both co-twins indicated they did not have (or ever had) any cardiovascular disease (heart attack, coronary surgery, stroke, or hypertension), diabetes mellitus, or prostate cancer. Such individuals are hypothesized to have a better complement of genes related to good health and aging, and a greater probability of longevity. Genome wide scanning of DNA markers will be undertaken for fraternal (DZ) twins concordant for freedom from the above diseases using sib-pair methods. Regions suggestive of
18 Heart Attack
linkage will be further analyzed and fine mapping performed using DZ pairs discordant for the trait as defined above. The discordant DZ pairs serve as a complement to the analysis of concordant pairs and provide an independent confirmatory sample. A group of identical (MZ) twins will also be collected for co-twin-control studies of potential environmental influences. The DNA collected will serve as a repository for future studies on diseases related to aging and longevity, and for confirmation of linkages suggested by other sources. The DNA samples will also be a resource for follow-up genetic epidemiologic studies on the twins' middle aged offspring. For genes of interest, the rate of change in physiologic measures associated with aging can be compared between siblings who did and did not receive the same set of genes from their twin dads. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: TREATMENTS
GENHAT-GENETICS
OF
HYPERTENSION
ASSOCIATED
Principal Investigator & Institution: Arnett, Donna K. Associate Professor; Epidemiology; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, MN 554552070 Timing: Fiscal Year 2001; Project Start 01-SEP-1999; Project End 31-AUG-2004 Summary: The Genetics of Hypertension Associated Treatments (GenHAT) is proposed as a prospective study to examine whether the association between selected hypertensive genes and combined fatal coronary heart disease and nonfatal myocardial infarction in high-risk hypertensives is modified by the type of antihypertensive treatment, leading to differential risks of coronary heart disease (CHD). Such genetreatment interactions might shed important light On the variation in patient response to antihypertensive agents, and improve our ability to pick the right antihypertensive for specific patients. GenHAT will be an ancillary study to ALLHAT (the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial). ALLHAT recruited 42,515 hypertensives and randomized them to one of four antihypertensive agents (lisinopril, chlorthalidone, amlodipine, and doxazosin); followup will be completed in March, 2002. GenHAT will characterize hypertension genetic variants and determine their interaction with antihypertensive treatments in relation to CHD. DNA from frozen clots stored at the ALLHAT Central Laboratory will be used to genotype variants of hypertension genes (angiotensinogen -6, angiotensin converting enzyme insertion/deletion, angiotensin type- 1 receptor, alpha-adducin, beta2 adrenergic receptor, lipoprotein lipase, and 10 new hypertension variants expected to be discovered during the course of the study). In addition to the primary aim, a number of secondary aims will be undertaken to evaluate gene- treatment interactions in relation to other endpoints, including all-cause mortality, stroke, heart failure, left ventricular hypertrophy, decreased renal function, peripheral arterial disease, and blood pressure lowering. Because of the ethnic and gender diversity of ALLHAT, we will also assess effects of these variants on outcomes in key subgroups (age >65 years, women, African Americans, Type II diabetics), and whether the gene-treatment interactions in relation to outcomes are consistent across subgroups. This proposal has the advantages of (1) incorporation into an already funded clinical trial, and (2) collaboration with experienced investigators in genetic analysis (Drs. Boerwinkle and Eckfeldt) and clinical trials (Drs. Davis and Ford). It will, therefore, provide an important and cost-efficient contribution to the knowledge and understanding of the treatment of hypertension. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
Studies 19
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Project Title: HEART ATTACK SURVIVAL KIT PROJECT Principal Investigator & Institution: Eisenberg, Mickey; King County Emergency Medical Service Seattle, WA 98104 Timing: Fiscal Year 2001; Project Start 20-JUL-2000; Project End 30-JUN-2004 Summary: The Heart Attack Survival Kit Project. A public education campaign delivered by emergency medical services personnel to increase appropriate responses to symptoms of acute myocardial infarction (AMI) among seniors. Objectives: Acute myocardial infarction is the leading cause of death for Americans. Two critical actions a patient can take when faced with AMI symptoms are: 1) seeking prompt medical care, preferably by calling 911 so therapy can begin soon after onset of AMI and 2) taking an aspirin at onset of a heart attack, The National Heart, Lung, and Blood Institute as well as the American Heart Association have endorsed these recommendations. However, many AMI patients do not follow these life-saving actions. Strategies to increase the proportion of AMI patients engaging in these life-saving actions are needed. Specific Aims: To test the effectiveness of a Heart Attack Survival kit delivered door-to-door by emergency medical services (EMS) personnel to seniors. The specific aims are to increase appropriate responses (calling 911 and taking an aspirin) among persons age 65 years and older to heart attack symptoms. The secondary objectives are to assess if the intervention positively affects psychological and behavioral factors suggested by Leventhal's self-regulatory model. Design and Methods: King County, Washington (excluding the city of Seattle) will be divided into 120 geographically distinct "areas", located within 25 fire districts. These 120 "areas" will be randomized, stratified by fire district and size of area, to 60 intervention and 60 control areas. The intervention will consist of home delivery of the Heart Attack Survival Kit by firefighter EMS personnel. Unique to this project is the "house- call" and face-to-face discussion about heart attack preparation. Also unique is the inclusion of an aspirin in the kit. Data on 911 calls for chest pain and self-administration of aspirin will be collected from the medical incident report forms (MIRF), completed by EMS personnel. In addition to MIRF data collection, telephone surveys will be conducted with a sample of seniors 65 years or older in the study area to assess psychological and behavioral factors as suggested by self-regulatory theory. Outcome data will be collected for 2 years post-intervention. Pilot data suggest that home delivery of the kit by EMS personnel is a powerful intervention. If the intervention proves successful, it could be adapted and integrated into EMS systems throughout the country. The significance of this innovative study lies in the medical benefits that come from appropriate actions to symptoms of AMI as well as furthering our knowledge on how to effectively reach seniors with important health information. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: HEART ATTACKS AND TRAFFIC POLLUTION Principal Investigator & Institution: Schwartz, Joel D. Director of Research & Development; Environmental Health; Harvard University (Sch of Public Hlth) Public Health Campus Boston, MA 02460 Timing: Fiscal Year 2002; Project Start 26-SEP-2002; Project End 31-JUL-2007 Summary: (provided by applicant ): Since the late 1980's, numerous studies have found particulate air pollutant concentrations to be responsible for excess mortality. More recent studies have clarified that most of these deaths are sudden deaths. We have recently shown that particles from traffic are more specifically associated with acute cardiovascular effects. We have also shown the pre-existing diabetes was an important modifier of the particle effect. All of these studies have looked at immediate effects. Two
20 Heart Attack
prospective cohort studies have indicated that long-term exposure to particles is also associated with noticeable reductions in life expectancies. To replicate the association between chronic exposure and deaths, and examine the specific role of traffic particles we will conduct a case-control study of myocardial infarctions, using data from the Worcester Heart Attack Study. We will use a GIS system to code the latitude and longitude of home and work locations of cases and controls, and fit models relating concentrations of elemental carbon (a tracer for traffic particles) to population density, distance from roadways, and traffic counts in the Worcester MSA. From this, we will assign exposures to each subject. Controls will be sampled from town census books, which are conducted annually in Massachusetts. Controls will be matched by age, sex, and 10 year age group. Socio-economic data will be merged from the block group of the subjects, and questionnaire data will assess smoking history, alcohol consumption, aspirin and other medication use, educational level, height, weight, age, race, exercise, and air conditioner use. We will also ask about the presence of medical conditions, such as diabetes, that may be modifiers of the effect of pollution. Nonlinearities in covariates will be assessed and controlled for using penalized splines, in conditional logistic regressions. A preliminary analysis will use retrospective data, and not obtain questionnaire data. Effect modification by diabetes, prior MI, COPD, smoking, and angina will be tested using interaction terms. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: HIV, CHEMOKINE RECEPTORS, AND VASCULAR SMOOTH MUSCLE Principal Investigator & Institution: Schecter, Alison D. Medicine; Mount Sinai School of Medicine of Nyu of New York University New York, NY 10029 Timing: Fiscal Year 2003; Project Start 01-MAY-2003; Project End 30-APR-2008 Summary: (provided by applicant): Inflammation is critical to the initiation and progression of atherosclerosis and to the vascular response(s) to injury. Chemokines and their receptors contribute to inflammatory responses by mediating leukocyte trafficking and function. We have demonstrated that human arterial smooth muscle cells (SMC), the major cellular components of the vessel wall, possess the functional chemokine receptors, CCR5, and CXCR4. Engagement of these receptors results in a marked induction of tissue factor (TF) activity. TF is the initiator of the coagulation cascade and its activity is the likely proximate cause of clinical events such as heart attack and stroke. Macrophage inflammatory protein-1 beta (MIP-1beta, CCL4) and stromal cellderived protein (SDF-1, CXCL12) are the endogenous ligands for CCR5 and CXCR4, respectively. Both the receptors and ligands are present in the SMC-rich areas of the human atherosclerotic plaque. CCR5 and CXCR4 are also the major co-receptors for human immunodeficiency disease (HIV) in vivo, and are responsible for HIV transmission and pathogenicity. Recently, reports of acute coronary thrombotic events indicate that patients with HIV may be prone to accelerated coronary artery disease. We have demonstrated that human arterial SMC are activated and infected by HIV. Aim 1 will examine the induction of TF by MIP-1beta, SDF-1, and HIV envelope protein, gp120, and identify the endogenous- and HIV-CCR5 and -CXCR4 receptor-specific elements of the TF promoter. Aim 2 will establish the repertoire of CCR5- and CXCR4mediated functions in SMC, focusing on those that are relevant to atherosclerosis and that are mediated by the signaling pathways we identified to be involved in chemokine receptor engagement. Aim 3 will examine the effect of HIV proteins on the vasculature using transgenic mice expressing HIV proteins, including gp120, and the HIV coreceptors, human CCR5 and human CD4. Mice will then be studied in a hyperlipidemic
Studies 21
milieu to test the hypothesis that HIV, in the presence of its receptors, accelerates atherosclerosis and results an exaggerated response to injury. These studies will contribute to an understanding of the role of chemokine receptors and HIV in the induction of TF, the mediation of inflammatory responses of SMC, and the pathogenesis of atherosclerosis. Furthermore, given that HIV patients appear to have accelerated atherosclerosis, these studies will provide potential mechanism(s) responsible for HIVassociated vasculopathies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: HYPOXIA INDUCIBLE FACTOR I AND OXYGEN HOMEOSTASIS Principal Investigator & Institution: Semenza, Gregg L. Professor of Pediatrics; Pediatrics; Johns Hopkins University 3400 N Charles St Baltimore, MD 21218 Timing: Fiscal Year 2001; Project Start 01-MAR-1996; Project End 28-FEB-2005 Summary: Humans and other mammals have a constant and absolute requirement for O2 and tissue oxygenation is maintained within a narrow physiologic range. In many disease states, however, O2 homeostasis is disrupted Hypoxia is a major factor contributing to the pathophysiology of heart attack, stroke, pulmonary hypertension, and other important causes of morbidity. The broad, long objective of the proposed research is to increase our understanding of the role of the transcriptional regulator hypoxia-inducible factor 1 (HIF-1) in the maintenance of cellular and systematic 02 homeostasis. HIF-1 is a heterodimeric basic-helix-loop- helix PAS transcription factor consisting of HIF-1alpha and HIF-1beta subunits. HIF-1alpha expression and HIF-1 transcriptional activity increase exponentially as cellular O2 concentration is decreased. Several dozen target genes that are transactivated by HIF-1 have been identified including those encoding erythropoietin, glucose transporters, glycolytic enzymes, and vascular endothelial growth factor. The products of these genes either increase O2 delivery or allow metabolic adaptation to reduced O2 availability. HIF-1 is required for cardiac and vascular development and embryonic survival. In fetal and postnatal life, HIF-1 is required for a variety of physiological responses to chronic hypoxia. The specific aims of this proposal are: to determine the role of HIF-1 in the pathogenesis of cerebral ischemia and analyze the expression of HIF-1 in ischemic kidney and liver; to determine the involvement of HIV-1 in wound healing; and to elucidate the signal transduction pathways by which insulin-like growth factor-1 receptor and V-SRC activity induce expression of HIF-1. The knowledge gained from the proposed experiments will be relevant to the treatment of many clinical conditions in which hypoxia or ischemia plays an important pathophysiologic role. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: IN VIVO EPR/NMR CO-IMAGING OF FREE RADICALS Principal Investigator & Institution: Zweier, Jay L. Professor of Medicine and Radiology/ Chi; Heart and Lung Institute; Ohio State University 1800 Cannon Dr, Rm 1210 Columbus, OH 43210 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 30-JUN-2006 Summary: (provided by applicant): Oxygen free radicals and nitric oxide are critical mediators of cellular function and injury of central importance of many disease processes including: heart attack; stroke; septic shock; cancer; and aging. In view of this importance, there has been a great need for methods enabling in vivo measurement and imaging of free radicals or animal models of disease. EPR imaging is a powerful technique that enables three-dimensional spatial mapping of free radical metabolism,
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oxygenation, and nitric oxide with submillimeter resolution. This technology has the unique ability to map paramagnetic species in living animals, however, the utility and power of EPRI has been greatly limited by the fact that it does not provide an anatomic registration of this image data within the body. We have recently demonstrated that combined use of EPRI and proton MRI techniques can enable precise image registration and provide a marked synergy in the ability to obtain important biomedical information. Combined use of these techniques in a single instrument has the potential to revolutionize the field of free radical measurement in living systems, providing high quality anatomic image registration and correlation of the unique information obtainable from EPR and NMR based MRI. Therefore, we propose to develop and optimize a unique hybrid instrument suitable for both EPRI and proton MRI. In this proposal there are a series of 5 specific aims that provide the critical development steps necessary to create and optimize this new multimodal MRI instrument. These include: I. Development of a magnet, gradient, field control, and system interface optimized for EPR and NMR MRI; 11. Development of narrow band and fixed frequency RF bridges for maximum EPR sensitivity in living animals with provisions to minimize noise from motion or other sources; 111. Development of EPIUNMR MRI resonators for maximum sensitivity and stability for in vivo biomedical applications with automatic tuning and automatic coupling capability; IV. Development of optimized software for EPR and NMR MRI control, image acquisition, reconstruction and analysis, with provisions enabling rapid image data collection and co-mapping of anatomic structure and free radical distribution. These innovations will result in development of a new type of EPIUNMR MRI instrument optimized for in vivo measurement and imaging of free radicals, oxygen, and nitric oxide in a variety of important animal models of disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: KNOWLEDGE OF SYMPTOMS IN ADULTS AT RISK FOR HEART ATTACK Principal Investigator & Institution: Ryan, Catherine J. Medical-Surgical Nursing; University of Illinois at Chicago 1737 West Polk Street Chicago, IL 60612 Timing: Fiscal Year 2001; Project Start 01-AUG-2001 Summary: (provided by applicant) The purpose of this proposal is to identify the cluster of symptoms that is commonly recognized by the lay public to represent Acute Myocardial Infarction (AMI). The specific aims of the study are: 1) to describe the cluster of symptoms representing AMI in the general population at risk for cardiac disease and 2) to compare and contrast the symptom clusters that younger and older persons identify as representative of AMI. Symptoms of AMI are varied and unique to each individual. When an individual experiences symptoms, they look to their personal history and knowledge base to identify and label these symptoms and ultimately seek treatment. There has been limited research regarding the actual knowledge base of the lay population regarding symptoms of AMI. There are no studies that attempt to identify a cluster of symptoms that is perceived to be representative of AMI. This exploratory study will utilize Q methodology which combines both qualitative and quantitative methods to describe an individual?s unique understanding of a situation. A card sort instrument will be developed and utilized to identify AMI symptom clusters as perceived by persons with known cardiac disease who are at high risk for developing AMI. Correlation and factor analysis will be performed on a by-person basis to identify a common point of view regarding symptoms of AMI. Results of this study will provide insight into the knowledge base of the lay public regarding AMI symptoms and provide
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a background for educational programs designed to educate the public related to symptoms of AMI. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: LOW DENSITY LIPOPROTEIN Principal Investigator & Institution: Smith, Lou c; Baylor College of Medicine 1 Baylor Plaza Houston, TX 77030 Timing: Fiscal Year 2001 Summary: Low density lipoproteins (LDL) are the major cholesterol transporters in the blood circulation. LDL are the end stage particles resulting from the metabolism of very low density lipoproteins (VLDL) and they stay in the blood circulation for 2-3 days until being taken up by liver. LDL contain apolipoprotein apoB-100 which is one of the largest proteins known (4536 amino acids). Very little is known about the threedimensional structure of LDL. According to existing hypotheses, LDL are simply microemulsions with a non-polar core and an outside shell which provides the water solubility for the particle. The shell is formed by the amphipathic apolipoprotein and phospholipids. Elevated levels of VLDL, LDL and apo B-100 are associated with a significantly increased risk of coronary arteriosclerosis and heart attack. We used electron cryomicroscopy of ice-embedded LDL and computer image processing to study their three-dimensional structure We proposed, based on three-dimensional reconstruction, that LDL are not structureless, easily deformable lipid sacks as was commonly believed. Rather, they have an oval shape and a consistent internal structure. The particle s core has a stable structure consisting of several compartments. Its outer shell most probably consists of apolipoprotein B-100 and phospholipids and the core compartmentalization might correspond to either ordered lipids, or protein intrusions. To distinguish between the two hypotheses further study is needed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MARITAL ADJUSTMENT, DEPRESSION AND MYOCARDIAL INFARCTION Principal Investigator & Institution: Gallo, Linda C. Psychology; San Diego State University 5250 Campanile Dr San Diego, CA 92182 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2004 Summary: (provided by applicant): Depression and Coronary Heart Disease (CHD) are each prevalent disorders, which frequently co-occur. Approximately 15-23% of individuals recovering from a heart attack (e.g., myocardial infarction; MI) will meet criteria for major depression and up to 65% will experience elevations in depressive symptoms. Yet, history of depression and disease severity are only moderately predictive of this co-morbidity. Importantly, depression is embedded within social context and, in particular, depression is strongly associated with marital adjustment. The primary goal of the current research is to examine if individuals with worse marital adjustment experience higher levels and a more persistent course of depressive symptoms following MI, in a 6-mo, 3-wave, prospective study of 150 men and women. Some research suggests that marital distress and depressive symptoms are more closely linked in women than in men. Therefore, the current research will examine if gender moderates the associations between marital adjustment and level and course of depression, with the hypothesis that associations will be stronger for women than for men. Previous research suggests that depression and possibly marital adjustment represent risk factors for negative physical health outcomes following MI. Further, when
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psychosocial risk factors occur in combination, the probability of negative outcomes is likely to increase substantially due to additive or synergistic effects. A secondary goal of the study will therefore be to examine the joint and independent effects of depression and marital adjustment on quality of life, functional status, and the probability of recurrent events following Ml. Women may experience worse outcomes following MI, and psychosocial factors could contribute to this trend. The proposed research will therefore examine if gender moderates the relationships between depression, marital adjustment, and health outcomes following CHD, with the hypothesis that effects will be stronger for women than for men. The broader goal of the proposed research is to identify aspects of social functioning that could represent potent, modifiable risk factors for CHD and depression co-morbidity, in the hopes of informing more effective prevention and intervention efforts. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: MOLECULAR MECHANISM OF TRANSDUCING CARDIAC ISCHEMIC PAIN Principal Investigator & Institution: Mc Cleskey, Edwin W. Senior Scientist/Professor; None; Oregon Health & Science University Portland, OR 972393098 Timing: Fiscal Year 2001; Project Start 01-JUN-2001; Project End 31-MAY-2006 Summary: provided by applicant) Sensory neurons that innervate the heart (cardiac afferents) detect cardiac ischemia, the condition when the heart receives insufficient oxygen. They trigger chest pain-either the acute pain of a heart attack or angina, an intermittent pain caused by coronary artery disease. They also contribute to damaging cardiac reflexes that accompany artery disease. Although it is clear that cardiac afferents transduce cardiac pain, the molecular mechanism(s) is uncertain. The driving hypothesis of this proposal is that cardiac ischemia releases a set of chemical mediators that activate ion channels and receptors on cardiac afferents, thereby triggering pain. The proposal relies heavily on a novel method we developed to fluorescently tag cardiac afferents so they can be distinguished from other kinds of sensory neurons. This is an essential step for identifying molecules that are necessary for cardiac pain but not for other sensations. Our initial work fmds that cardiac afferents have a unique molecular fmgerprint: they express an extremely Sensitive acid-sensing ion channel at grossly high levels. The result underscores the importance of protons created during ischemia as a mediator of cardiac pain. Our specific aims will: 1) definitively identify the particular clone of acid-sensing ion channel used by cardiac afferents; 2) fmd whether other putative mediators of cardiac pain act by modulating this channel; 3) explore why there is different expression of channels in the two different populations of cardiac afferents. The experimental methods are single cell electrophysiology and immunocytochemistry. The clinical significance of the project lies in the suppression of angina, which is suffered by some 6 million Americans, is debilitating in some, and which triggers damaging cardiac reflexes in all. The results might also be relevant to other forms of vaso-oclusive pain, notably that of sickle cell anemia. We will identify molecules that trigger cardiac pain, thereby providing new pharmaceutical targets for its treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: MONITORING TRENDS IN VENOUS THROMBOEMBOLISM Principal Investigator & Institution: Spencer, Frederick A. Medicine; Univ of Massachusetts Med Sch Worcester Office of Research Funding Worcester, MA 01655 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 30-SEP-2007
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Summary: (provided by applicant): Venous thromboembolism (VTE) has been estimated to be the third most common cardiovascular disorder. Frequently cited estimates of the incidence of VTE, and its associated outcomes, are based on studies conducted more than a decade ago and only in hospitalized patients. Contemporary data on the magnitude of this disorder, clinical profile of patients affected, acute and long-term outcomes, and use of different treatment strategies are needed given recent advances in diagnostic and therapeutic modalities. The goals of the proposed study are to collect population based data describing trends over time in the epidemiology of VTE including its incidence management, short and long-term recurrence rates, and mortality. The study will take place in residents of the Worcester, MA, metropolitan area, (2000 census = 477,800) and will examine changes over time in these and additional endpoints for patients with validated VTE in 1998, 2000 and 2002 with a minimum follow-up of three years. Complementing the community based surveillance of VTE, newly diagnosed cases of VTE occurring in members of the largest HMO in Central Massachusetts between 1998 and 2002 will be identified. This cohort is tracked by an outpatient computer database allowing for the systematic collection of additional data on treatment practices and outcomes occurring outside of the hospital setting. The proposed project will build on the investigators' clinical and epidemiological experience and on data collection methodologies used in the Worcester DVT study (1985-1989) and the ongoing Worcester Heart Attack Study. The medical records of Worcester area residents diagnosed with VTE and related diagnostic rubrics will be reviewed and validated according to pre-established diagnostic criteria. Records for additional hospitalizations and death certificates will be reviewed to examine trends in long-term recurrence and survival rates through 2005. The results of this study will provide much needed current reformation about the epidemiology of VTE and provide important data on current diagnostic and therapeutic strategies used in these patients. Implementation of this registry will set the stage for systematic long-term surveillance of this medically important Problem. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: MRI OF CORONARY COLLATERALS Principal Investigator & Institution: Pearlman, Justin D. Medicine; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, NH 03755 Timing: Fiscal Year 2000; Project Start 15-JAN-1998; Project End 30-JUN-2004 Summary: (Adapted from applicant's abstract): In the United States, nearly half of all deaths in the adult population are due to cardiovascular disease. Coronary collateralization is a natural bypass system which is currently the target for new therapies to prevent myocardial damage from heart attack. This investigation will develop a new and advanced diagnostic MRI tool to detect early coronary collateralization and monitor the effect of a course of treatment to stimulate coronary collateralization. Recent studies have shown that certain growth factors increase the collateral circulation in chronic ischemia. In addition, the investigators have shown, using new MRI methods, that a course of growth factor treatment can achieve sufficient increase in collateralization to preserve normal cardiac function and avoid heart damage when a coronary artery occludes. Currently, there is no clinical test available to quantify the extent of collateralization before coronary occlusion occurs. Now, the medical treatment to stimulate coronary collateral development is possible, so a noninvasive clinical test to monitor and evaluate the treatment benefit is required. The investigators have developed a collateral-sensitized MRI method. In this investigation, they will compare the assessment of collateralization by collateral-sensitized MRI with
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assessment by invasive measures. The study will clarify how well early coronary collateralization can be characterized and monitored by the new collateral-sensitized MRI. It will examine the ability to detect changes in collateralization with time and will clarify associated physiologic changes. It will examine potentially confounding factors insufficiency collateral flow distribution. The collateral-sensitized MRI methods will be optimized for clinical application. This proposal is to validate the accuracy of collateralsensitized MRI, study its ability to monitor growth factor effectiveness in an animal model, predict the functional benefits and further develop the new diagnostic tools to enable their clinical use with the new medical therapies to prevent myocardial damage from heart attacks. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: MYOCARDIAL PACEMAKERS
ISCHEMIA
SENSOR
FOR
IMPLANTABLE
Principal Investigator & Institution: Natarajan, Ananth; President; Infinite Biomedical Technologies, Llc 2850 N Charles St, Ste 100 Baltimore, MD 21218 Timing: Fiscal Year 2002; Project Start 05-AUG-2002; Project End 31-AUG-2003 Description (provided by applicant): The key to surviving a heart attack is rapid institution of reperfusion therapy. Therapy instituted within 70 minutes of the onset of symptoms is associated with a seven-fold reduction in mortality as compared to therapy started from 70- 120 minutes (1.2 percent vs. 8.7 percent). The 577,000 patients per year who require a pacemaker are at particularly high-risk. We propose a technology that enables these devices to detect myocardial ischemia and emerging infarctions. IMMedDIATE (Implantable Myocardial ischemia Detection Indication and Action Technology) will save critical early minutes by promptly alerting the patient to seek therapy. It utilizes an innovative transvenous lead-based electrode configuration and QRS depolarization-based ischemia detection. This allows for a solution that doesn?t require more invasive hardware or surgery. We have completed preliminary work analyzing non-paced beats in a porcine model. Immediate succeeded in identifying 31/31 episodes of ischemia and 0/12 controls: 100 percent sensitivity and 100 percent specificity. We now propose to further develop the technology for use during cardiac pacing. Our Phase I effort is focused on the development and testing of a hardware and software configuration which meets the unique needs of ischemia detection during ventricular pacing. In the longer-term, our goal is to license IMMeDIATE for use in implantable cardiac devices. It will serve as a sentry, thereby minimizing the morbidity and mortality of coronary artery disease in those patients with IMMeDIATE-enabled pacemakers. PROPOSED COMMERCIAL APPLICATIONS: IMMeDIATE's commercial application is clearly defined. There are 577,000 individuals per year who receive a pacemaker. They are at high risk for myocardial infarction. Deployment oif IMMeDIATE to this patient population would aid in the institution of rapid therapy, thereby minimizing the morbidity and mortality of this disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: NBMPR-BINDING SITE OF THE HUMAN ES ADENOSINE TRANSPORTER Principal Investigator & Institution: Buolamwini, John K. Associate Professor of Medicinal Chemist; Pharmaceutical Sciences; University of Tennessee Health Sci Ctr Health Science Center Memphis, TN 38163 Timing: Fiscal Year 2001; Project Start 01-SEP-2000; Project End 31-AUG-2005
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Summary: (Adapted from applicant's abstract) This is a Mentored Minority Faculty Development Award Proposal designed to provide the necessary mentoring and research activities necessary to enable the PI achieve his career goals of becoming an established independent academic investigator in the cardiovascular research and drug discovery field. The proposal responds to the timely initiative of the National Heart Lung and Blood Institute to prepare underrepresented minorities scientists as independent investigators. Cardiovascular disease is the number cause of death among the American population, afflicting 1.5 million Americans with a new or recurrent heart attack, and killing over 980,000 people every year. Minorities especially AfricanAmericans are disproportionately affected. There is definitely a need more minority researchers in the cardiovascular field especially in Mississippi, which houses a large African-American Population. This proposal seeks to provide intensive mentoring and research training for the PI who is a minority assistant professor at a predominantly white higher institution, the University of Mississippi. The overall career goals of the candidate are to acquire research capabilities in areas of experimental analysis of protein- ligand complex interactions at the molecular level using photo labeling, affinity purification and use them to structurally characterize the interaction of inhibitors with the es adenosine (nucleoside) transporter to obtain insights that will be used to design and develop more specific and potent adenosine transport inhibitors as potential cardioprotective and neuroprotective drugs. Adenosine is a physiological nucleoside that is released in ischemic conditions such as a heart attack or stroke to protect tissue injury. However, its rapid uptake by nucleoside transporters abrogates this protective action. Nucleoside transport inhibitors block adenosine uptake by cells, and therefore enhance its extracellular protective effects. The inhibition of adenosine transport has therapeutic potential in heart disease and stroke that has yet to be tapped by he design and discovery of inhibitors with the requisite pharmacological profiles. Designed compounds will be synthesized and tested as es transporter ligands and adenosine transport inhibitors by flow cytometry and radioisotope methods. The candidate will receive mentorship by established well-accomplished investigators, the primary and secondary sponsors, and a cadre of four senior faculty serving on the candidates advisory committee. Ancillary course work in advanced protein techniques, mass spectrometry and experimental design, as well as American Chemical Society techniques workshops, and our research office workshops. Biweekly research progress meetings will be held with sponsors and committee members. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: NEURAL MODULATION OF CELL-TO-CELL CONDUCTION Principal Investigator & Institution: Haug, Sara J. Cellular/Molecular Physiology; Yale University 47 College Street, Suite 203 New Haven, CT 065208047 Timing: Fiscal Year 2002; Project Start 01-SEP-2002 Summary: (provided by applicant): An increase in metabolic demand stimulates an increase in blood flow to active tissue. Within the tissue, arterioles dilate to distribute blood flow to active parenchymal cells they supply. Feed arteries lie external to the tissue and control the magnitude of blood flow entering arteriotar networks 01 the heart, brain, and skeletal muscle. As physical constraints limit direct studies of blood flow regulation by feed arteries in the brain as well as the heart, skeletal muscle can be utilized as a model system to study mechanisms of blood flow regulation through feed arteries in response to metabolic and neural activity. Our laboratory has developed the hamster retractor muscle for this purpose. During skeletal muscle contraction, the increased metabolic demand triggers a dilation that originates in arterioles and
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"ascends" into their feed arteries via cell-to-cell conduction along endothelial cells and smooth muscle cells that comprise the resistance vascular network. Release of the neurotransmitter, acetyicholine, can elicit a similar response through initiating the conduction of hyperpolarization. Perivascular sympathetic nerves are activated centrally through the neural regulation of blood pressure and peripherally through changes in skeletal muscle length. The central aim of this proposal is to investigate the interaction between sympathetic vasoconstriction and conducted vasodilation in feed arteries using the hamster retractor muscle as a model system. Specifically, in vivo experiments will examine the effect of sympathetic nerve activity on conducted vasodilation triggered by acetylcholine and the effect of sympathetic vasoconstriction on ascending vasodilation in response to muscle fiber recruitment (Aim 1). In vitro studies using isolated, pressurized feed arteries will use electrophysiological measurements to investigate the cellular mechanism by which perivascular nerve activity attenuates conducted hyperpolarization (Aim 2). The long-term goal of the project is to understand how the sympathetic nervous system influences the conduction pathway in feed arteries that control tissue perfusion. Understanding of the sympathetic vasomotor system will add new insight to blood flow regulation and aid in treating stroke, heart attack, and peripheral vascular disease. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: NMR AND MR IMAGING STUDIES OF PLAQUE RUPTURE Principal Investigator & Institution: Hamilton, James A. Professor; Biophysics; Boston University Medical Campus 715 Albany St, 560 Boston, MA 02118 Timing: Fiscal Year 2001; Project Start 08-AUG-2000; Project End 31-JUL-2004 Summary: Although the advances have been made in the detection and treatment of vascular diseases, myocardial infarctions and strokes often strike apparently healthy persons without warning and produce disabilities or death. Atherosclerosis is the underlying cause of most heart attacks and strokes. Atherosclerotic plaques can grow slowly over time and gradually block blood flow, often producing symptoms that warn the patient of the underlying disease. However, less occlusive plaques can produce acute events within minutes by rupturing and abruptly forming an occlusive thrombus. These plaques appear to have certain physical characteristics, such as a thin fibrous cap and lipid-rich core, which distinguish them from less dangerous plaques. There is new urgency to evaluate vascular disease in humans by imaging methods that provide data about the ultrastructure of plaques, rather than invasive methods such as angiography that report only luminal narrowing. This project uses the modified Constantinides animal (rabbit) model of plaque rupture to compare plaque components and ultrastructure in non-ruptured and ruptured plaques. Magnetic resonance (MR) images of the aorta in rabbits (in vivo) will be obtained before and after triggering plaque rupture, and 9with higher resolution) after excision. Comparison of the MR images of ruptured and non-ruptured plaques will provide markers for plaque rupture and determine the value of MR imaging for predicting vulnerable plaques will provide markers for plaque rupture and determine the value of MR imaging for predicting vulnerable plaques in humans before rupture occurs. Magic angle spinning (MAS) NMR spectroscopy will be used to characterize in situ the composition of each lipid phase in excised plaques. MAS NMR allows quantitation of crystalline cholesterol, liquid and liquid-crystalline cholesteryl esters, and calcium salts in the intact plaque; each of these structures alone, or interactions between them, may play a role in plaque vulnerability. To enhance the interpretation of MR images, the detailed physical chemical information from MAS NMR will be integrated with the spatial information about lipid and protein
Studies 29
components determined by magnetic resonance (MR) imaging and light microscopy/histology. Because the ultrastructure of plaques appears to be key to their stability and potential for regression, MR imaging has the potential for being a more reliable predictor of acute pathological events (heart attack and stroke). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: NURSE-MANAGED BP TELEMONITORING WITH AFRICAN AMERICANS Principal Investigator & Institution: Artinian, Nancy T. None; Wayne State University 656 W. Kirby Detroit, MI 48202 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-MAY-2005 Summary: There is an urgent need to find better ways to control and treat high blood pressure in African Americans. Although there is some evidence to suggest there may be advantages to home blood pressure (BP) telemonitoring, there is a need for more research since: a) we do not know about the effects of this strategy on long-term control of BP; and b) we do not know the mechanisms by which telemonitoring works to lower BP and achieve BP control. Accordingly, the specific aims of this "new investigator"-led randomized controlled trial are to: a) compare usual care only with home telemonitoring plus usual care to determine which has the greatest effect on change in blood pressure from baseline; and b) determine the extent to which the effects of the intervention are mediated by changes in dietary habits, physical activity level, weight loss, alcohol intake, compliance with an antihypertensive medication regimen, or contact with a primary care provider. Our study is one of the first of its kind using a community-based rather than clinic-based recruitment strategy, thereby expanding access to care. Otherwise healthy African American English speaking men and women (n=400) who are > 18 years with a SBP > 140 mmHG and a DBP > 90 mmHG (unless the individual self-identifies as a diabetic or with a history of a heart attack, then SBP> 130 mmHG, DBP > 85 mmHG) will be conveniently selected from specified community sites. Participants will be randomly assigned to one of two groups that are stratified by use or non-use of antihypertension medication: Group A--home telemonitoring plus usual care; or Group B--usual care only. Participants in Group A will receive usual care plus weekly telemonitoring for 12 months and 15 sessions of telecounseling which provide information about lifestyle modifications in accordance with JNC-VI guidelines. The proposed intervention is intended to increase the saliency of the hypertension for participants, provide a cue to take action and assist them to learn about what actions to take. Data (change in blood pressure from baseline, dietary habits, physical activity level, weight loss, alcohol intake, compliance with an antihypertensive medication regimen, and contact with a primary care provider) will be collected at baseline and at 3, 6 and 12 months. Analysis will include a general mixed linear model approach to repeated measures MANOVA and structural equation growth curve modeling. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: ORAL ESTROGEN (PREMARIN) & ACEI (RAMIPRIL) ON FIBRINOLYTIC POTENTIAL Principal Investigator & Institution: Vaughan, Douglas E. Chief, Division of Cardiovascular Medici; Vanderbilt University 3319 West End Ave. Nashville, TN 372036917 Timing: Fiscal Year 2001
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Summary: Plasminogen activator inhibitor-(PAI-1) levels are elevated in postmenopausal women compared to pre-menopausal women. Elevated levels of PAI-1 are thought to contribute to increased risk of heart attack in women after menopause. Estrogen and angiotensin converting enzyme inhibitors (ACEI) are known to decrease PAI-1 levels, and thereby can reduce the risk of heart attacks in post-menopausal women. Out aim is to compare the effect of these two agents in post-menopausal women, on PAI-1 levels and to see if combined together, they have additive effects on lowering PAI-1 levels in these women. SPECIFIC AIM: To measure the effects of oral estrogen and ACEI on lowering of PAI-1 levels in post-menopausal women. The levels of renin angiotensin II, aldosterone will also be measured as they are suspected mechanisms in the regulation of PAI-1 levels. Coagulation factor VII will be measured as its levels are known to be elevated in post-menopausal state and affected by estrogen levels. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: PET IMAGING OF HYPOXIA WITH EF1 AND EF5 Principal Investigator & Institution: Koch, Cameron J. Professor; Radiation Oncology; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2001; Project Start 01-JUL-2000; Project End 30-JUN-2004 Summary: Recent data has provided compelling evidence that hypoxic tumors (cervix, head and neck, soft tissue sarcoma) are resistant to the most widely used forms of therapy. In addition, hypoxic tumors are prone to metastasis. Thus, the early detection of tumor hypoxia is likely to play an important role in choosing the most appropriate therapies. A non-invasive assay for tissue hypoxia would be applicable to all tumors, many of which cannot be accessed by invasive methods, to aid in the selection the most appropriate therapy on an individual patient basis. The proposed work involves the detailed testing of two 2-nitroimidazoles, EF1 and EF5, in rodent tumor models. Such compounds are metabolically reduced forming covalent intracellular adducts at a rate which is maximal in severe hypoxia and decreases, with first order inhibition kinetics, as the oxygen concentration increases. The bound adducts can then be detected in various ways as a surrogate for the measurement of tissue hypoxia. Binding of EF5 has been thoroughly characterized using immunohistochemical techniques and has been shown to predict individual tumor response to radiation in rodents. EF5 is FDA approved for use in humans and is currently in phase I clinical trials using such methods. Results from this trial have shown no EF5-related toxicity, and anectdotal information regarding the ability of EF5 to detect prognosis-related hypoxia are encouraging. EF5, and its much more hydrophilic analog, EF1, have recently been labelled with 18F, allowing drug and adduct detection by positron emission tomography (PET). Thus, we will be able to compare invasive measurement of hypoxia, at very high resolution using immunohistochemistry, with non-invasive measurements (PET) at lower resolution. Our planned studies will allow several key aspects of non-invasive hypoxia imaging to be tested in detail: these include the effects of drug concentration, drug polarity and optimization of imaging algorithms and resolution. The last of these will greatly benefit from a new high-resolution PET camera under current development at the University of Pennsylvania. Our overall hypothesis is that assessment of hypoxia using appropriate PET imaging agents will predict radiation response in individual tumors. It should also be noted that the detection of hypoxia has wide-ranging applications in other pathologic conditions including stroke, heart attack, and wound healing. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PHYSICIAN AND PATIENT ATTITUDES TOWARD CHOLESTEROL Principal Investigator & Institution: Yarzebski, Jorge L. Medicine; Univ of Massachusetts Med Sch Worcester Office of Research Funding Worcester, MA 01655 Timing: Fiscal Year 2001; Project Start 01-MAY-1999; Project End 30-APR-2004 Summary: Jorge Yarzebski, M.D., M.P.H. is a Research Assistant Professor in the Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School (UMMS). He is a Hispanic physician from Guatemala who has served as the project director of the NHLBI funded Worcester Heart Attack Study for the past several years. His research mentor for this scientific career development award is Robert Goldberg, Ph.D., Professor of Medicine and Epidemiology in the UMMS Department of Medicine. Dr. Goldberg is the Principal investigator of two NHLBI funded studies: the Worcester Heart Attack Study and the Rapid Early Action for Coronary Treatment trial (REACT). Over the proposed five year period of this award, Dr. Yarzebski will utilize data from the longitudinal Worcester Heart Attack Study from 1999 to examine physicians' attitudes and practices, and patients' knowledge, attitudes and beliefs in the management of high total cholesterol following acute myocardial infarction (AMI) in twelve hospitals from a population based perspective. Standardized telephone surveys will be administered to patients at 10- 12 weeks and at 12 months following hospital discharge by trained survey staff from the UMMS to ascertain patient's knowledge, attitudes, and adherence to lipid lowering medications. Questionnaires will be mailed to the physicians of these patients within the first 3 months of the study to ascertain their reasons for prescribing or not prescribing lipid lowering medications. This will be accomplished in conjunction with the review and validation of the medical records of residents of the Worcester, MA, metropolitan area hospitalized with AMI at all greater Worcester hospitals during 1999. Further details and Dr. Yarzebski's role in the proposed project are provided in the application. Dr. Yarzebski will explore the availability of other large clinical/epidemiological databases to pursue additional research projects and collaborative research proposals. An advisory committee of active and experienced clinical and public health researchers will guide his career development. At the completion of this research training experience, Dr. Yarzebski will be provided with significant educational and research training and experiences to become a successful independent investigator. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PLASMINOGEN ACTIVATION & SK: STRUCTURE-FUNCTION Principal Investigator & Institution: Reed, Guy L. Associate Professor; Medicine; Harvard University (Medical School) Medical School Campus Boston, MA 02115 Timing: Fiscal Year 2002; Project Start 01-JUL-1998; Project End 30-JUN-2006 Summary: (provided by applicant): The plasminogen (Pg) system dissolves the thrombi (blood clots) that cause heart attacks and strokes. The Pg system is tightly regulated by protein-protein interactions with inhibitors, activators, substrates, etc. The cleavage of Pg to plasmin by streptokinase (SK), and other Pg activators, initiates fibrinolysis (clot dissolution) which saves the lives of heart attack patients. Recent studies have suggested that mechanistic insights into the regulation of the Pg system could further reduce the mortality from heart attacks, and improve the treatment of strokes, pulmonary embolism, etc. Because of its physiologic and therapeutic importance, our long term goal is to help elucidate the protein-protein interactions that regulate and modify the activity of the Pg system. The interactions between Pg and the indirect Pg activator SK are among the most biologically and medically important of these contacts.
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Studies performed in the first phase of this grant have helped to delineate the elegant interactions through which SK converts Pg (without cleavage) into the most catalytically efficient Pg activator, Insights have been made into defining the mechanisms through which: 1) SK forms a tight stable 'activator complex' with Pg (or plasmin), 2) SK nonproteolytically generates the latent active site in Pg creating a 'virgin enzyme' (Pg*), and 3) SK modifies the substrate specificity of Pg* or plasmin so that the complex can cleave Pg molecules. This continuation proposal is directed towards further dissecting the process of indirect Pg activation, in order to determine the novel mechanisms by which SK becomes a fibrin-dependent (or t-PA-like enzyme), to define whether fibrindependent SKs have the potential to be superior fibrinolytic agents, to understand the role of the Pg kringle domains in indirect Pg activation and, to define the intermolecular interactions that occur in the SK-Pg complex which are required for a SK-type of mechanism. In a broad scientific sense, insights into this unique process of indirect Pg activation should enlarge our understanding of how the catalytic activity and specificity of Pg system is regulated, and could suggest rational ways to alter the indirect Pg activators so as to improve their therapeutic value for patients with thrombosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: PROBING THE S' SUBSITES OF CALPAIN Principal Investigator & Institution: Donkor, Isaac O. Professor; Pharmaceutical Sciences; University of Tennessee Health Sci Ctr Health Science Center Memphis, TN 38163 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2004 Summary: (provided by applicant): Heart disease and stroke are major causes of morbidity and mortality in the United States. Mounting evidence suggests that an episode of cardiac ischemia (heart attack) or cerebral ischemia (stroke) initiate a chain of biochemical events that result in increased intracellular Ca2+ concentration, which in turn activates calpain. Activated calpain degrades structural proteins resulting in cell death. Calpain is therefore considered as an attractive therapeutic target for intervention in heart attack and stroke. The long-term goal is to discover novel calpain inhibitors as treatment for heart attack and stroke. The specific aim is to determine the specificities of the S subsites of calpain with the objective of developing potent and selective inhibitors of the enzyme. The structural requirements for inhibitor binding to the S subsites of calpain has been well investigated. On the contrary, the structural requirements for inhibitor binding to the S? subsites of calpain have only been marginally investigated. This is a significant gap in the literature that must be filled because knowledge about the S? subsite specificities of calpain will provide valuable information that can aid in the design of selective inhibitors of the enzyme. Inhibitors with natural and unnatural Dand L-amino acids at the P1? and P2? positions of the inhibitors will be synthesized to probe the specificities of the S1? and S2? subsites of calpain. Comparative Molecular Field Analysis (CoMFA) will be used to generate a binding site model for the inhibitors and the model will be used to design and predict the calpain inhibitory potency of novel inhibitors before chemical synthesis and enzymology. Potent inhibitors will be tested for their ability to enter cell and inhibit intracellular calpain. Selected potent and cell permeable inhibitors will be tested in the rat isolated heart ischemia model for cardioprotective effect. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: PROTEINS OF BLOOD COAGULATION Principal Investigator & Institution: Davie, Earl W. Professor and Chairman; Biochemistry; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2003; Project Start 01-SEP-1997; Project End 31-AUG-2007 Summary: (provided by applicant): The long-term goals of this research program are to increase our basic knowledge of how plasma proteins interact with circulating blood platelets leading to their activation and shape change at the site of vascular injury. These reactions play a significant role in cardiovascular disease leading to heart attack and stroke in humans. The approach includes an investigation of the signaling process initiated on the surface of the platelet by thrombin and von Willebrand factor (VWF) and their relationship to the proteins of the cytoskeleton that control the shape of the platelets. These studies will focus on the glycoprotein Ib-lX-V complex, its binding to the a, b, and g filamins in the platelets, and the relationship of the filamins to a guanine nucleotide exchange factor (GEF) with DH-PH domains. This GEF called filamin associated protein has been characterized in our laboratory. These studies will then be extended to the specific small GTPases such as Rho, Rac, and Cdc42 that function as substrates for the GEFs and play a specific role in the development of filopodia, lamellipodia, stress fibers and focal adhesions when platelets are activated. In parallel experiments, the protease-activated receptors (PAR1 and PAR4) will be further examined for their role in platelet shape change via the small GTPases (Rho, Rac, Cdc42) and the platelet GEFs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: QUANT. MEASUREMENT OF ATHEROSCLEROTIC PLAQUES IN MRI Principal Investigator & Institution: Yuan, Chun; Radiology; University of Washington Seattle, WA 98195 Timing: Fiscal Year 2001; Project Start 01-AUG-1996; Project End 31-JUL-2005 Summary: Cardiovascular disease due to atherosclerosis remains the leading cause of death in the United States. Clinical symptoms and morbidity that result from atherosclerosis disease are due to plaque instability and are manifested as ulceration, thrombosis, and/or intraplaque hemorrhage. Much research has been directed at understanding atherogenesis, the progression of the disease and the final events that lead to heart attack or stroke. However, relatively little is known about how to identify "vulnerable" lesions in vivo noninvasively and to monitor the lesion progression longitudinally. This proposal presents a plan to measure the atherosclerotic plaque features quantitatively using lesion indices and to correlate the lesion indices to the development of clinical symptoms. We will focus our study on advanced lesions at the carotid bifurcation, due to 1) their close association to stroke, 2) their accessibility by high resolution MRI techniques, and 3) the accessibility of carotid samples due to carotid endarterectomy that provide us with an excellent opportunity to verify the MRI results by examining the samples histologically. The long term goal of this project is to identify characteristic magnetic resonance imaging markers for unstable vulnerable atherosclerotic plaque in the carotid artery. At present there are no reliable means to characterize these lesions in terms of features that are associated with vulnerable plaque in vivo. The specific aims are: 1) to develop/optimize lesion indices and 2) to test whether the size of lipid core, the thickness of the fibrous cap, and the extend of neovascularization (as expressed by MR lesion indices) can be associated with clinical symptoms. This project builds on studies that have been performed and that are on
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going in our laboratory. Improved methods of identifying high-risk plaques will result in better selection of patients for intervention. Development of an accurate, reproducible, and quantitative technique for directly assessing the status and progression of atherosclerotic lesions will significantly reduce the cost of clinical trials. Furthermore, the lesion indices will provide continuous parameter for tracking progression of the lesion rather than a categorical analysis provided by a lesion type evaluation. Lastly, prospective, serial high-resolution MRI of the developing carotid plaque will provide a unique opportunity to examine the processes involved in progression form a stable lesion to vulnerable plaque. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: RE-EXPLORING RACIAL DISPARITIES IN HOSPITAL CARE Principal Investigator & Institution: Shen, Jay J. Health Services Administration; Governors State University University Park, IL 60466 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 29-SEP-2003 Summary: Eliminating racial disparities in health care is a national priority. Although many studies have examined racial differences in aspects of hospital care such as severity of illness, care-seeking patterns, use of clinical procedures, use of resources, and outcome, no published research has integrated and examined these aspects simultaneously. Moreover, while many studies have reported racial disparities in hospital care only a few of them have examined the interactive effects between race and other factors on hospital care. Finally, while most of race-related studies on hospital care have focused on comparisons between one minority and non-Hispanic Caucasians, very few studies have examined health outcomes among the three largest racial groups (nonHispanic Caucasians, African-Americans, and Hispanic-Americans) simultaneously, let alone other ethnic groups. The proposed study forms an integrated conceptual framework, based on the concept of episode of care, the behavioral framework of health care use, and the structure-process-outcome triad, to examine the relationships between race and hospital care, in a systemic and comprehensive manner. The episode of hospital care, from the patient?s perspective, can be described by five dimensions: severity of illness, care-seeking patterns, process or receiving treatment, economic outcome, and clinical outcome. The study, with the inclusion of patients from all ethnic groups, focuses on four major diseases (heart attack, congestive heart failure, pneumonia, and stroke), extracts data from the 1995, 1997, 1999 National Inpatient Sample (NIS) datasets collected by the Hospital Cost and Utilization Project (HCUP), adopts validated administrative data based, risk adjustment methods, conducts multivariate analysis to control for potential confounding factors. This allows systemic exploration of the relationships between race and the five episode of hospital care dimensions and, in particular, to examines the interactive effects between race and other factors on outcome that are measured by the in-hospital mortality risk. Findings from this research will furnish information to help public and private sectors decision-makers better understand the racial gaps in hospital care in a more systemic way. It will also elucidate key factors that result in gaps in service to vulnerable populations. This will aid public policy development of effective interventions to improve health care deliverywith regard to eliminating racial disparities. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: REGULATION OF SMOOTH MUSCLE PROLIFERATION Principal Investigator & Institution: Patel, Rekha C. Biological Sciences; University of South Carolina at Columbia Byrnes Bldg., Room 501 Columbia, SC 29208
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Timing: Fiscal Year 2001; Project Start 01-APR-2000; Project End 31-MAR-2004 Summary: (Adapted from Investigator's Abstract): Vascular disease, which is the principal cause of heart attack, stroke and circulatory deficit disorders, is responsible for 50 percent of all mortality in the western world. Proliferation of vascular smooth muscle cells (VSMCs) is a key step in the pathogenesis of atherosclerosis and restenosis after vascular interventions such as angioplasty. Much attention has been focused on the search for an antiproliferative agent to regulate smooth muscle proliferation. Interferons (IFNs), which are cytokines secreted by the immune cells present in the atherosclerotic lesion, have been show to be antiproliferative towards VSMCs. Natural glycosaminoglycans such as heparin are also known to inhibit smooth muscles. Heparin is used widely as one of the local-delivery drugs after invasive procedures. In spite of the well-documented antiproliferative effects of IFNs and heparin on VSMCs, the molecular mechanisms that are involved have not yet been identified. PKR (protein kinase, RNA activated) is an IFN induced, growth inhibitory protein kinase, which is activated by double stranded (ds) RNA in virus-infected cells. PKR's role in regulation of cell proliferation has become clear in recent years. It's over expression or activation has been shown to be growth inhibitory. PKR is also activated by heparin in vitro and our results indicate that treatment of VSMCs with heparin results in activation of PKR. PKR is also induced at the transcriptional level by IFN treatment of VSMCs We hypothesize that, PKR is involved in mediation both heparin and IFN's antiproliferative effect towards VSMCs. We propose to test this with the following specific aims: 1. To investigate the role of PKR in the antiproliferative action of heparin and IFN on VSMCs. 2. To characterize the functional domains of PKR involved in mediating heparin's antiproliferative effect. The long-term goal of this proposal is to elucidate the molecular mechanisms involved in the inhibition of VSMC grown by heparin and IFN thereby offering on opportunity to design better ways of controlling the vascular diseases. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: REPERFUSION INJURY THERAPY: ROLE FOR IGM ANTIBODY Principal Investigator & Institution: Carroll, Elisabeth M.; Natural Antibodies, Inc. 800 Huntington Ave Boston, MA 02115 Timing: Fiscal Year 2002; Project Start 15-SEP-2002; Project End 14-MAR-2004 Summary: (provided by applicant): Ischemia and reperfusion is one of the major mechanisms underlying human disease. Ischemia occurs when the arterial or oxygenated blood supply is interrupted to an organ or tissue. Reperfusion refers to the reestablishment of blood flow after the period of ischemia. Studies in rodents and large animals demonstrate that the complement system is a major mediator of ischemiareperfusion injury in various tissues including myocardium, central nervous system, intestine and hindlimb. Our recent results identified natural IgM antibody as the initial step in complement-dependent injury. This phase I application proposes two specific aims: (1) determine the feasibility of identification of specific B-1 cell hybridomas that secrete pathogenic IgM; (2) examine the feasibility of identifying peptides that bind to the specific IgM antibodies that initiate injury. Successful completion of phase I will lead to phase II which will test the proof-of-concept that mutant IgM (does not bind complement) and/or peptides that bind IgM will block reperfusion injury in vivo. Reperfusion injury is a documented major mechanism of injury following heart attack or coronary events, stroke and trauma estimated to affect over 13 million patients per year and representing a $ 3.5 billion market. Currently, there are no effective treatments for blocking injury. Development of a specific inhibitor of reperfusion injury at the earliest stage of inflammation would provide an important medical benefit. The
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identification of an inhibitor/s that act at the induction stage of injury would have broad commercial application given the many types of tissues affected by reperfusion injury. The identification of hybridoma clones, which secrete antibody that initiates injury, or specific inhibitors of endogenous IgM will provide an important basis for development of future therapie. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: ROLE OF THE ACETYL-COA CARBOXYLASES IN ENERGY METABOLISM Principal Investigator & Institution: Wakil, Salih; Biochem and Molecular Biology; Baylor College of Medicine 1 Baylor Plaza Houston, TX 77030 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2006 Summary: provided by applicant): Diet, especially a high-fat diet, is of great concern to Americans for it has far-reaching effects on their health and well being. Obesity is a major health factor that affects the body's susceptibility to a variety of diseases such as heart attack, stroke, and diabetes. Obesity is a measure of the fat deposited in the adipose in consequence to food intake, fatty acid and triglyceride synthesis and fatty acid oxidation and energy consumption. Excess food provides not only the timely energy needs of the body, but promotes glycogen synthesis and storage in liver and muscle and fatty acid and triglyceride synthesis and storage in the fat tissues. Calorie restriction or starvation promotes glycogenolysis that supplies glucose where needed and lipolysis that supplies fatty acids for oxidation and energy production. Insulin and glucagon are the hormones that coordinate these processes. Malonyl-CoA, the key intermediate in fatty acid synthesis, has recently assumed an additional role as a second messenger that regulates energy levels (ATP) through fatty acid oxidation, which in turn affects fatty acid synthesis and carbohydrate metabolism. The acetyl-CoA carboxylases, ACC1 and ACC2, catalyze malonyl-CoA synthesis, through the carboxylation of acetylC0A, the product of pyruvate dehydrogenase. Hence, studies of the carboxylases interrelate three major metabolic pathways-carbohydrate metabolism, fatty acid synthesis, and fatty acid oxidation. The differential expression of ACC1 and ACC2 in various tissues suggests that they may have differential functions. We showed that ACC2 is associated with the mitochondria, and through its product malonyl-CoA, it may be involved in the regulation of fatty acid oxidation. ACC 1 is localized in the cytosol and generates malonyl-C0A for the synthesis of fatty acids. Results from knockout mouse models of ACC 1 and ACC2 support the hypothesis that ACC1 and ACC2 play distinct and different roles in animal physiology and energy metabolism. A mutation in ACC1 led to embryonic lethality. Acc2-/- mutant mice had normal life span, higher fatty acid oxidation rate, and accumulated less fat in their livers and adipose tissues than the wild-type mice fed the same normal diet. We plan to study the biochemical and physiological implications of these observations as they relate to our understanding of the hormonal and dietary regulation of fatty acid metabolism in normal and disease states, especially those of diabetes and obesity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SITOSTANOL & N-3 FATTY ACIDS ON STEROLS, FATTY ACIDS, LIPOPROTEINS, CHOLESTEROL Principal Investigator & Institution: Connor, William E. Professor of Medicine; Oregon Health & Science University Portland, OR 972393098 Timing: Fiscal Year 2001
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Summary: Participants in this research study will consist of 2 groups. One group will have a moderately high blood cholesterol level. The purpose of this study is to provide a nutritional, non-drug therapy to lower blood cholesterol levels and reduce the risk for heart disease. A substance in plants called sitostanol has been shown to block the absorption of dietary cholesterol that leads to a lower blood cholesterol level. Several companies have developed sitostanol-containing products. They have put sitostanol into margarine for use in this study. Another food that has been shown to decrease the risk of heart disease is fish oil. Fish oil contains omega-3 fatty acids. These fatty acids lower the blood triglyceride level, decrease the formation of blood clots that can block an artery and cause a heart attack and keep the heart beating in a normal rhythm. This study will show if sitostanol and fish oil are a good combination therapy to decrease the risk of heart disease. The second group of participants in this research study include those with an inherited disorder, sitosterolemia. The purpose of this study is to provide a nutritional, non-drug therapy to lower blood cholesterol and sitosterol levels and reduce the risk for heart disease. A substance in plants called sitostanol has been shown to block the absorption of dietary cholesterol that leads to a lower blood cholesterol level. This study will determine if sitostanol will also lower the blood sitosterol level. Several companies have developed sitostanol-containing products. They have put sitostanol into margarine for use in this study. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: SODM FOR MANAGEMENT OF ISCHEMIC HEART DISEASE Principal Investigator & Institution: Salvemini, Daniela; Metaphore Pharmaceuticals, Inc. 1910 Innerbelt Bus Center Dr St. Louis, MO 63114 Timing: Fiscal Year 2001; Project Start 30-SEP-2001; Project End 29-MAR-2003 Summary: (provided by applicant): Recent studies in models of cardiac ischemia/reperfusion injury have shown that a significant reduction in tissue damage from infarction can be achieved using MetaPhor's proprietary superoxide dismutase mimetics (SODm). In preliminary studies we found that M40403 a selective and potent SODm preserved cardiac function following ischemia/reperfusion injury. Based on the data that free radical generation, especially superoxide, may play a critical role in mediating tissue damage and death in heart following an ischemic event, such as a heart attack, we propose to develop a SODm mimetic of the M40403 class as a novel parenteral agent for administration after cardiac infarction or ischemia. M40403 will not be developed for this indication for reasons that are discussed in the proposal. Instead M40401, an SODm with higher catalytic activity, similar stability and improved toxicity to M40403 will be pursued. Given the enormous need for improving the outcome of cardiac ischemia and infarction, the novel findings of these SODm in protecting tissues from damage following ischemia/reperfusion injury, and the potential impact of this class of drugs on current management of heart disease in this country, we propose to move the program aggressively forward to clinical application and thus, are submitting this proposal for consideration. The Phase I application is focused on developing our mechanistic understanding of the role of superoxide in cardiac ischemia/reperfusion injury and to evaluate the effects of M40401 in protection against cardiac ischemia and to explore the potential use of this drug in post-ischemia management of heart disease. PROPOSED COMMERCIAL APPLICATION: NOT AVAILABLE Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: STRUCTURAL-FUNCTIONAL ANALYSIS OF COMPSTATIN Principal Investigator & Institution: Lambris, John D. Professor; Pathology and Lab Medicine; University of Pennsylvania 3451 Walnut Street Philadelphia, PA 19104 Timing: Fiscal Year 2001; Project Start 01-MAR-2001; Project End 28-FEB-2005 Summary: (Adapted from the Investigator's abstract): Complement (C') is important in normal biology but it is also a pathological factor in a large number of inflammatory diseases. C'-mediated tissue injury has been reported in a wide variety of diseases including but not limited to autoimmune diseases, adult respiratory distress syndrome, Alzheimer's disease, stroke, heart attack, burn injuries, organ transplantation, and in extracorporeal blood oxygenation. There is a critical need for a therapeutically applicable C inhibitor. Several C' inhibitors have been described; however, the lowmolecular weight inhibitors have shown low activity and high toxicity and are therefore pharmacologically undesirable. Recombinant forms of C' regulatory proteins such as CR1, DAF, MCP and CD59, and a monoclonal antibody to C5 have shown promise, as they have been effective in experimental diseases. All these inhibitors however, are large molecular weight protein, require intravenous administration and most of them have only a short half-life in vivo. Recent studies are focused on a second generation of smaller molecular weight derivatives with more desirable properties, but none of these has yet been adopted as a therapeutic agent. We have taken the alternative approach of screening a universe of random peptide information for C3-interactive peptides. Screening of a random peptide phage library yielded a novel small molecular weight cyclic peptide, Compstatin, (ICVVQDWGHHRCT) that binds specifically to human and primate C3 and inhibits the activation of C' by both the classical and alternative pathways. The peptide effectively inhibits C' in clinically relevant in vitro, ex vivo and most importantly in vivo models of C' activation. This application has three aims: In Aim 1, the structure of Compstatin bound to a C3 fragment will be determined and the relationships between the structure and function of Compstatin will be studied by use of random peptide libraries, peptide synthesis, and NMR analyses. In aim 2, photoaffinity probes, genetically engineered C3 molecules, and expressed C3 fragments will be used to identify the Compstatin binding Sites on C3, which may give important information on the C3 convertase recognition site on C3, a significant control point in the C3 architecture. In addition, we will also attempt to investigate the mechanism(s) by which Compstatin modulates C' activation. Aim 3 will examine the C' inhibiting properties of Compstatin in clinical interventions. Half-life measurements, its biotransformation, and the ability of Compstatin to inhibit C' will be assessed in in vitro and in vivo experimental models of cardiopulmonary bypass (CPB) and in an ex vivo xenotransplantation model. In addition, the contribution of individual C' activation products in these clinical situations will be assessed using Compstatin, anti-C5 and C' receptor specific inhibitors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: SYSTEMIC EFFECTS OF PERIODONTITIS Principal Investigator & Institution: Beck, James D. Professor and Chairman; Dental Ecology; University of North Carolina Chapel Hill Office of Sponsored Research Chapel Hill, NC 27599 Timing: Fiscal Year 2001; Project Start 01-MAY-1996; Project End 30-APR-2003 Summary: It is our central hypothesis that periodontal diseases, which are chronic gramnegative infections represent a previously unrecognized risk factor for atherosclerosis and thromboembolic events Previous studies have demonstrated an association between
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periodontal disease severity and risk of coronary artery disease and stroke. We hypothesize that this association may be due to an intrinsic underlying inflammatory response trait that places an individual at high risk for developing both periodontal disease and atherosclerosis. We further suggest that periodontal disease, once established, provides a biological burden of endotoxin (LPS, lipopolysaccharide) and inflammatory cytokines (especially TxA2, IL- 1B, PGE2 and TNFa) which serve to initiate and exacerbate atherogenesis and thromboembolic events. We propose to test these hypotheses by performing cross-sectional study on 14,000 participants in a longitudinal study of Atherosclerosis Risk Communities (ARIC) to determine the contribution of periodontal infection variables to existing multivariate models of atherosclerosis. Using a cross-sectional design we will measure periodontal disease variables including periodontal probing depths and clinical attachment levels. Plaque samples will be collected for storage and later quantitation of Porphyromonas gingivalis, as S. Sanguis. Gingival crevicular fluid will be collected for the quantitation of Prostaglandin E2 (PGE2) thromboxane B2 (TxB2), Interleukin-1B (IL-1B) and tumors necrosis factor a (TNFa). Serum sample will be analyzed for whole-cell and LPS-specific antibody titers against selected periodontal pathogens. These measures will be sued to test associations with clinical measures of heart disease, heart attack, death from heart disease, and direct ultrasound measures of carotid and popliteal intima-media thickening and lesions as well as atherogenic risk factors that continue to be gathered in the ARIC Study. More specifically, we will determine whether the local gingival crevicular fluid levels of TxB2, IL-1B, TNFa and PGE2 are elevated in cases of severe atherosclerotic stenosis and whether elevated levels of these mediators are associated with other atherosclerosis risk factor including elevated serum lipid variables, serum TxB2 and fibrinogen. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: THE ROLES OF PROTEIN KINASE G IN PLATELET ACTIVATION Principal Investigator & Institution: Du, Xiaoping; Associate Professor; Pharmacology; University of Illinois at Chicago 1737 West Polk Street Chicago, IL 60612 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2006 Summary: (provided by applicant): The platelet adhesion and aggregation play critical roles in the development of thrombotic diseases such as heart attack and stroke. In normal circulation, platelets are in a "resting" state. At sites of vascular injury or atherosclerotic plagues, exposure of platelets to soluble platelet agonists or sub endothelial adhesive proteins triggers platelet activation. A common consequence and characteristic of platelet activation is the activation of the platelet integrin aIIb beta3, which mediates platelet adhesion, spreading and aggregation. Over the last 20 years, it has been accepted that platelet activation is inhibited by the cGMP-dependent protein kinase (protein kinase G, PKG). However, there have been recently reports that a cGMPenhancing drug, sildenafil, was associated with heart attack and thrombosis in some patients. In our study, we have found that expression of recombinant human PKG in a reconstituted integrin activation model promotes GPIb-IX-mediated integrin alphaIIbbeta3 activation. In addition, integrin dependent platelet aggregation induced by vWF or low dose thrombin was inhibited by various PKG inhibitors and enhanced by PKG activators. Furthermore, we found that sildenafil promoted vWF- or thrombininduced platelet aggregation. Thus, cGMP-PKG may play a stimulatory role in platelet activation. Interestingly, we found that cGMP is stimulatory when elevated immediately following agonist simulation, but is inhibitory after a prolonged preincubation with platelets. Thus, we hypothesize that, when elevated by the platelet agonists during
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hemostasis, cGMP induces biphasic platelet responses: an initial phase stimulatory response leading to platelet activation and thrombus formation, and a secondary phase of inhibitory responses that desensitizes platelets and prevent overgrowth of thrombus. To test this hypothesis, we propose (1) to investigate the stimulatory roles of cGMP-PKG pathway in platelet adhesion and activation; (2) to investigate the mechanisms of the second phase platelet inhibitory response to cGMP; (3) to identify the roles and mechanisms of guanyl cyclase regulation during platelet activation; (4) to investigate the structure-function relationship and topographic regulatory mechanisms of PKG; and (5) to initiate preliminary studies on the downstream pathways of PKG-mediated integrin activation. Understanding the biphasic roles of cGMP-PKG pathway in platelets should provide new insight into molecular mechanisms of platelet activation and the mechanisms of thrombosis associated with popularly used cGMP enhancing drugs such as sildenafil. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: THE STRESS-ACTIVATED PROTEIN KINASE PATHWAY Principal Investigator & Institution: Kyriakis, John M. Massachusetts General Hospital 55 Fruit St Boston, MA 02114
Associate
Professor;
Timing: Fiscal Year 2001; Project Start 01-DEC-1995; Project End 31-MAR-2004 Summary: (adapted from applicant's abstract): Stress-activated cellular signal transduction mechanisms play a significant part in the pathogenesis of several important clinical conditions. Including ischemic injury (as occurs in heart attack and stroke), arthritis, septic shock, and the side effects of radiation and chemotherapy. The stress-activated protein kinases (SAPKs, also called JNKs) and p38 are mitogenicactivated protein kinase (MAPK) subgroups that are responsible for the activation of the activator protein-1 (AP-1) transcription factor complex in response to environmental stress and the inflammatory cytokines TNF and IL-1. Together with the nuclear factorkB (NF-kB) pathway, the SAPKs and p38s represent major mechanisms of stress- and inflammation-induced gene expression. As with all MAPK pathways, the SAPKs and p38s are themselves regulated as part of MAPK-kinase-kinase (MAP3K) -> MAPKkinase (MEK) -> MAPK core signaling molecules. While many such potential core modules have been identified, molecular basis for the regulation of these pathways has remained unclear in spite of the fact that dissecting MAP3K regulation is pivotal to the understanding of the physiologic roles of these pathways. The next phase of this on going project will be to focus on the regulation of two stress-activated MAP3Ks:MEKkinase (MEKK)-1 and apoptosis signal-regulating kinase-1 (ASK1), by elements coupled to the TNF receptor (TNFR) complex. The principal investigator's ongoing studies indicate that MEKK1 is regulated by germinal center kinase-1 (GCK), a putative effector for TNF receptor-associated factor-1 (TRAF2). The investigator's studies also support the contention that ASK1 is a potential effector for TRAf2. He will use in vitro and in vivo biochemical methods to characterize the mechanism by which TRAF2 regulates the observed in vivo association between GCK1 and MEKK1. He will use biochemical and cell biological methods to determine if MEKK1 is activated by oligomerization mediated by GCK1 and or TRAF2. Finally, he will use in vitro and in vivo biochemical methods to determine if ASK1 is regulated by dissociation of an inhibitor protein, thioredoxin, and aggregation mediated by TRAF2. These studies will clarify further mammalian stress signaling pathways and contribute to the identification of novel anti-inflammatory drug targets and therapeutic strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: TISSUE FACTOR PATHWAY INHIBITOR BINDING PROTEINS ON ENDO Principal Investigator & Institution: Mast, Alan E. Associate Professor; Pathology; University of Tennessee Health Sci Ctr Health Science Center Memphis, TN 38163 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 30-JUN-2003 Summary: (provided by applicant): Tissue factor pathway inhibitor (TFPI) rapidly inhibits both factor Xa and the factor VIIa/tissue factor catalytic complex. Thus, it is thought to be the most important inhibitor of the initiation of blood coagulation. Although its structure suggests that it is a soluble protein, most TFPI is associated with the vascular endothelium.The objective of this proposal is to define the biochemical mechanisms responsible for the association of TFPI with biological surfaces. Heparin infusion results in a prompt 2-to 10-fold increase in circulating TFPI concentration, therefore, interactions with glycosaminoglycans are considered a primary mode of cell surface association. However, flow cytometry studies demonstrate that over 95 percent of the TFPI on the surface of cultured endothelial cells is bound through a glycosyiphosphatidylinositol (GPI)-anchor in a manner that is not altered by heparin. We have previously shown that glypican-3, a GPI-anchored proteoglycan, binds to TFPI and may account for TFPI binding to the endothelium. Recently, we identified thrombospondin - 1 (TSP) as a second TFPI binding protein that may act to recruit and localize TFPI to extravascular surfaces within a bleeding wound. This revised proposal is organized into three specific aims that reflect the three long term approaches our laboratory is taking to investigate the function of TFPI as a surface associated inhibitor of tissue factor initiated blood coagulation.Specific Aim #1 is focused on in vitro structure/function studies of TFPI. Proposed projects include: the investigation of the role of the interaction between TFPI and TSP in the cellular catabolism of TFPI; defining the mechanisms responsible for the proliferative effect of TFPI on endothelial cells; and enzyme kinetic studies with altered forms of TFPI to further define the role of the third Kunitz domain and C-terminal region in the anticoagulant activity of TFPI.Specific Aim #2 involves in vivo/ex vivo studies using human placenta and TSP knock-out mice to define the relative amounts of GPI-anchored and heparin-releasable TFPI found within vascular beds in vivo and to characterize their structures. The studies with the TSP knock-out mice will define the role of TSP in the association of TFPI with the endothelial surface.Specific Aim #3 is designed to characterize how TFPI is processed within the cell to produce the heparin-releasable and GPI-anchored pools. Recombinant TFPI lacking the first two, non-translated, exons appears to be entirely secreted into the culture medium. Possible explanations for this observation include that the first two exons are required for proper intracellular targeting to a GPI-anchored binding protein or that the GPI-anchored binding sites are saturated. These hypotheses will be tested using TFPI constructs containing the first two exons. Additionally, TFPI constructs that have been tagged either with the HA or the FLAG tag will be transfected into cells to allow differentiation of endogenous and recombinant surface TFPI in flow cytometry experiments. Pulse-chase immunoprecipitation studies will be performed using TritionX-1 14 for cell lysis. These experiments will define how long after synthesis and the percentage of the total TFPI that becomes attached to a GPI-anchor.These proposed studies will provide a detailed characterization of how TFPI associates with the vascular endothelium and establish models for the study of TFPI within different vascular beds. These studies are highly clinically relevant because TFPI is a an important inhibitor of tissue factor initiated blood coagulation that produces the pathological thrombi in stroke, heart attack and many other thrombotic diseases. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: TURNING SCAR INTO VIABLE MYOCARDIUM Principal Investigator & Institution: Kao, Race L. Surgery; East Tennessee State University Box 70565 Johnson City, TN 37601 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-JUL-2005 Summary: (provided by applicant): Cardiovascular diseases remain the major cause of morbidity and mortality in United States. It is estimated that 12.4 million Americans have coronary artery disease and more than one million perople will develop a heart attack every year. The goal of this study is to induce myocardial regeneration of injured heart by trans-differentiation of cardiac fibroblasts into functional myocytes for replacing, repairing, maintaining, and enhancing the cardaic function. The hypothesis is that 5-aza-2'-deoxycytidine can induce myogenic trans-differentiation of cardiac fibroblasts to provide new muscle cells and improve ventricular function. The specific aims are 1). implant 5-aza-2'-deoxycytidine treated autologous cardiac fibroblasts into infarct heart for myocardial regeneration, 2). investigate the possible mechanisms of myocardial regeneration by implantation of trans-differentiated autologous cardiac fibroblasts. 5-Azacytidine has been used to produce functional muscle cells from nonmuscle precursor cells such as fibroblasts, keratinocytes, mescenchymal stem cells, and bone marrow stromal cells. The formation of muscle cells from cardiac fibroblasts in culture after 5-aza-2'-deoxycytidine treatment has been observed by us. The changes in gene expression induced by the drug will be investigated by Western blot or 2-D electrophoresis (for proteins) and macroarrray or quantitative PCR (for mRNA). Reproducible infarction in canine myocardium produced by occlusion of left anterior descending coronary artery and vein will be used for the proposed study. Proteins specific to cardiac or skeletal muscel (TnI, myosin, connexin 43, myogenin) will be used to indicate the phenotypes of regenerated muscle by identifying the specific mRNA (Northern blot, RT-PCR) or proteins (Western blot, immunohistology). The global and regional (ischemic vs normal areas) functions will be determined before, during, and after coronary occlusion to assess the hemodynamic benefits of the treatment. The ratio of infarct or scar area to the ischemic area (risk zone) and pathologic evaluations will be performed on all of the control and treated animals. Expected beneficial outcomes will be reduced scar area due to induced myocardial regeneration, improved regional contractility, and prevented ventricular remodeling and failure. Success of this project may provide innovative approaches to treat myocardial infarction or cardiomyopathies associated with muscle cell loss and interstitial fibrosis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
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Project Title: WORCESTER HEART ATTACK COMMUNITY SURVEILLANCE STUDY Principal Investigator & Institution: Goldberg, Robert J. Professor; Medicine; Univ of Massachusetts Med Sch Worcester Office of Research Funding Worcester, MA 01655 Timing: Fiscal Year 2001; Project Start 01-DEC-1986; Project End 29-SEP-2001 Summary: (Adapted from Investigator's Abstract) The present population-based study proposes to continue the examination of temporal trends in the incidence and survival rates of acute myocardial infarction (AMI) and out of hospital deaths due to coronary heart disease (CHD) in the setting of the Worcester, MA Standard Metropolitan Statistical Area (SMSA). The objectives of this study are to examine recent (1997 and 1999) as compared to prior (1975, 1978, 1981, 1984, 1986, 1988, 1990, 1991, 1993 and 1995) time trends in the annual attack rates of AMI and out of hospital CHD deaths, recent (1997 and 1999) as well as prior (1975-1995) changes over time in the in hospital and
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long term survival rates of AMI, and the relationship of these incidence and survival patterns of AMI to selected demographic, clinical and medical care factors. An additional objective of this study is to examine changes over time in the therapeutic management, diagnostic evaluation, and surgical workup of patients hospitalized with AMI as well as related issues of cost. To accomplish these objectives, the proposed study will be carried out in the 13 acute general hospitals in the Worcester, MA SMSA (1990 census count = 437,000). This study will utilize and extend previous approaches used in the conduct of this study. All new (incident) and recurrent episodes of definite AMI occurring among Worcester SMSA residents during calendar years 1997 and 1999 will be identified from discharge diagnostic printouts obtained from all metropolitan Worcester hospitals. The medical records of patients from the Worcester SMSA will be individually reviewed for validation purposes according to pre-established diagnostic criteria for AMI. Abstraction of the medical records of patients satisfying the diagnostic and geographic eligibility criteria will be carried out with the standardized recording of relevant data. A review of records for additional hospitalizations and a statewide and national search of death certificates will be carried out to examine the long-term survival status of discharged hospital patients from each of the proposed study years as well as those identified previously (1975-1995) through the year 2000. Death certificates of Worcester SMSA residents will be reviewed to identify cases of out of hospital deaths due to CHD occurring in 1997 and 1999 to determine temporal trends in these incidence rates. The results of this community-wide investigation may provide important insights from a twenty-four year vantage point about the role of primary and secondary preventive and therapeutic efforts to declining CHD mortality rates as it affects the population of a large representative and stable metropolitan area. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·
Project Title: XUBIX THERAPY--VASCULAR EVENTS PREVENTION AFTER CORONARY Principal Investigator & Institution: Vrobel, Thomas R.; Case Western Reserve University 10900 Euclid Ave Cleveland, OH 44106 Timing: Fiscal Year 2001 Summary: The ultimate objective of this trial is to improve upon the current standard therapy (aspirin) for the prevention of secondary vascular events in post Acute Coronary Syndrome patients. Aspirin decreases the ability of platelets to stick together and reduces the risk of a second serious heart attack by up to 39%. However, aspirin is a relatively weak anti-platelet drug. Xubix is also an anti-platelet drug that may prove more effective than aspirin given alone or when combined with aspirin in reducing the risk of a second heart attack. The primary endpoints for this study are death, myocardial infarction or reinfarction, and severe recurrent ischemia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen
E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National
3
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.
44 Heart Attack
Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “heart attack” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for heart attack in the PubMed Central database: ·
[beta] Blockade after myocardial infarction: systematic review and meta regression analysis. by Freemantle N, Cleland J, Young P, Mason J, Harrison J. 1999 Jun 26; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=31101
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Adaptation of the MacNew quality of life questionnaire after myocardial infarction in an Iranian population. by Asadi-Lari M, Javadi HR, Melville M, Oldridge NB, Gray D. 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=166140
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Adhesion molecules in different treatments of acute myocardial infarction. by Kerner T, Ahlers O, Reschreiter H, Buhrer C, Mockel M, Gerlach H. 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=31578
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Admissions for myocardial infarction and World Cup football: database survey. by Carroll D, Ebrahim S, Tilling K, Macleod J, Smith GD. 2002 Dec 21; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=139028
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Age-related differences in in-hospital mortality and the use of thrombolytic therapy for acute myocardial infarction. by Boucher JM, Racine N, Thanh TH, Rahme E, Brophy J, LeLorier J, Theroux P. 2001 May 1; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=81018
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Aldosterone blockade after myocardial infarction. by Hackam DG. 2003 Sep 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=183302
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Amok enzymes damage tissues during heart attack. by Cairney R. 2000 Jul 25; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=80230
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Association between alcohol consumption and mortality, myocardial infarction, and stroke in 25 year follow up of 49 618 young Swedish men. by Romelsjo A, Leifman A. 1999 Sep 25; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28235
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Brief intervention during hospital admission to help patients to give up smoking after myocardial infarction and bypass surgery: randomised controlled trial. by Hajek P, Taylor TZ, Mills P. 2002 Jan 12; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=64504
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Call to needle times after acute myocardial infarction in urban and rural areas in northeast Scotland: prospective observational study. by Rawles J, Sinclair C, Jennings K, Ritchie L, Waugh N. 1998 Aug 29; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28652
4
With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.
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Cardiac markers for acute myocardial infarction: When should we test? by Dyan H. 2000 Oct 31; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=80236
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Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. by [No authors listed]; 2002 Jan 12; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=64503
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Comparison of cardiovascular risk between patients with type 2 diabetes and those who had had a myocardial infarction: cross sectional and cohort studies. by Evans JM, Wang J, Morris AD. 2002 Apr 20; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=102325
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Decision making processes in people with symptoms of acute myocardial infarction: qualitative study. by Pattenden J, Watt I, Lewin RJ, Stanford N. 2002 Apr 27; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=102775
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Depression and prognosis following hospital admission because of acute myocardial infarction. by Lauzon C, Beck CA, Huynh T, Dion D, Racine N, Carignan S, Diodati JG, Charbonneau F, Dupuis R, Pilote L. 2003 Mar 4; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=149246
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Effect of beer drinking on risk of myocardial infarction: population based casecontrol study. by Bobak M, Skodova Z, Marmot M. 2000 May 20; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27381
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Endogenous tumor necrosis factor protects the adult cardiac myocyte against ischemic-induced apoptosis in a murine model of acute myocardial infarction. by Kurrelmeyer KM, Michael LH, Baumgarten G, Taffet GE, Peschon JJ, Sivasubramanian N, Entman ML, Mann DL. 2000 May 9; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=25850
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Evidence of Type A Personality in a Chinese Lady Who Died of Acute Myocardial Infarction 2,100 Years Ago. by Cheng TO. 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=116752
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Fibrinolytic therapy for acute ST-segment elevation myocardial infarction. by Kerigan A. 2002 Mar 19; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=99441
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Geography and service supply do not explain socioeconomic gradients in angiography use after acute myocardial infarction. by Alter DA, Naylor CD, Austin PC, Chan BT, Tu JV. 2003 Feb 4; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=140466
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Helicobacter pylori infection and early onset myocardial infarction: case-control and sibling pairs study. by Danesh J, Youngman L, Clark S, Parish S, Peto R, Collins R. 1999 Oct 30; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28263
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Home-based versus hospital-based cardiac rehabilitation after myocardial infarction or revascularisation: design and rationale of the Birmingham Rehabilitation Uptake Maximisation Study (BRUM): a randomised controlled trial [ISRCTN72884263]. by Jolly K, Lip GY, Sandercock J, Greenfield SM, Raftery JP, Mant J, Taylor R, Lane D, Lee KW, Stevens AJ. 2003; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=200974
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Impact of changing diagnostic criteria on incidence, management, and outcome of acute myocardial infarction: retrospective cohort study. by Pell JP, Simpson E, Rodger JC, Finlayson A, Clark D, Anderson J, Pell AC. 2003 Jan 18; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=140004
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Improving aspirin prophylaxis after myocardial infarction in primary care: collaboration in multipractice audit between primary care audit group and health authority. by Khunti K, Sorrie R, Jennings S, Farooqi A. 1999 Jul 31; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28184
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Increase in blood glucose concentration during antihypertensive treatment as a predictor of myocardial infarction: population based cohort study. by Dunder K, Lind L, Zethelius B, Berglund L, Lithell H. 2003 Mar 29; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=152364
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ISIS-2: 10 year survival among patients with suspected acute myocardial infarction in randomised comparison of intravenous streptokinase, oral aspirin, both, or neither. by Baigent C, Collins R, Appleby P, Parish S, Sleight P, Peto R. 1998 May 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28530
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Left Ventricular Pseudoaneurysm Caused by Coronary Spasm, Myocardial Infarction, and Myocardial Rupture. by Mahilmaran A, Nayar PG, Sheshadri M, Sudarsana G, Abraham KA. 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=116739
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Myocardial infarction in South Asians. by Rambihar VS. 2002 Sep 3; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=121955
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Myocardial infarction mediated by endothelin receptor signaling in hypercholesterolemic mice. by Caligiuri G, Levy B, Pernow J, Thoren P, Hansson GK. 1999 Jun 8; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=22017
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New advances in the management of acute coronary syndromes: 2. Fibrinolytic therapy for acute ST-segment elevation myocardial infarction. by Armstrong PW. 2001 Sep 18; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=81461
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Oral contraceptives and myocardial infarction. by Hoey J. 2002 Apr 2; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=100931
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Oral contraceptives and myocardial infarction: results of the MICA case-control study. by Dunn N, Thorogood M, Faragher B, de Caestecker L, MacDonald TM, McCollum C, Thomas S, Mann R. 1999 Jun 12; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28136
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Outcome and use of health services four years after admission for acute myocardial infarction: case record follow up study. by Melville M, Brown N, Gray D, Young T, Hampton J. 1999 Jul 24; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28174
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Polymorphism in high density lipoprotein paraoxonase gene and risk of acute myocardial infarction in men: prospective nested case-control study. by Salonen JT, Malin R, Tuomainen TP, Nyyssonen K, Lakka TA, Lehtimaki T. 1999 Aug 21; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28201
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Preclinical coronary atherosclerosis in a population with low incidence of myocardial infarction: cross sectional autopsy study. by Bertomeu A, Garcia-Vidal O, Farre X, Galobart A, Vazquez M, Laguna JC, Ros E. 2003 Sep 13; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=194083
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Preservation of myocardial [beta]-adrenergic receptor signaling delays the development of heart failure after myocardial infarction. by White DC, Hata JA, Shah AS, Glower DD, Lefkowitz RJ, Koch WJ. 2000 May 9; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=25845
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Primary angioplasty for ST-segment elevation myocardial infarction: Ready for prime time? by Natarajan MK, Yusuf S. 2003 Jul 8; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=164940
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Prospective observational cohort study of time saved by prehospital thrombolysis for ST elevation myocardial infarction delivered by paramedics. by Pedley DK, Bissett K, Connolly EM, Goodman CG, Golding I, Pringle TH, McNeill GP, Pringle SD, Jones MC. 2003 Jul 5; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=164234
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Randomised controlled trial of follow up care in general practice of patients with myocardial infarction and angina: final results of the Southampton heart integrated care project (SHIP). by Jolly K, Bradley F, Sharp S, Smith H, Thompson S, Kinmonth AL, Mant D. 1999 Mar 13; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27782
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Relation between socioeconomic deprivation and death from a first myocardial infarction in Scotland: population based analysis. by Macintyre K, Stewart S, Chalmers J, Pell J, Finlayson A, Boyd J, Redpath A, McMurray J, Capewell S. 2001 May 12; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=31592
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Rising to the challenge: transforming the treatment of ST-segment elevation myocardial infarction. by Ghali WA, Donaldson CR, Knudtson ML, Lewis SJ, Maxwell CJ, Tu JV. 2003 Jul 8; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=164941
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Risk factors, hospital management and outcomes after acute myocardial infarction in South Asian Canadians and matched control subjects. by Gupta M, Doobay AV, Singh N, Anand SS, Raja F, Mawji F, Kho J, Karavetian A, Yi Q, Yusuf S. 2002 Mar 19; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=99450
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Smoking and risk of myocardial infarction in women and men: longitudinal population study. by Prescott E, Hippe M, Schnohr P, Hein HO, Vestbo J. 1998 Apr 4; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28505
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Streptokinase Promotes Development of Dipeptidyl Peptidase IV (CD26) Autoantibodies after Fibrinolytic Therapy in Myocardial Infarction Patients. by Cuchacovich M, Gatica H, Vial P, Yovanovich J, Pizzo SV, Gonzalez-Gronow M. 2002 Nov; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=130130
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The effects of cost-sharing on essential drug prescriptions, utilization of medical care and outcomes after acute myocardial infarction in elderly patients. by Pilote L, Beck C, Richard H, Eisenberg MJ. 2002 Aug 6; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=117469
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Treating acute myocardial infarction. by Kollek D. 2001 Feb 6; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=80716
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Treating acute myocardial infarction. by Panton WD. 2001 Feb 6; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=80717
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Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction Perspectives on Combination Therapy. by Villareal RP, Kim P, Ferguson JJ III, Wilson JM. 2001; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=101203
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US estrogen plus progestin HRT trial stopped due to increased risk of breast cancer, stroke and heart attack. by Sibbald B. 2002 Aug 6; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=117494
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Use of cumulative mortality data in patients with acute myocardial infarction for early detection of variation in clinical practice: observational study. by Lawrance RA, Dorsch MF, Sapsford RJ, Mackintosh AF, Greenwood DC, Jackson BM, Morrell C, Robinson MB, Hall AS. 2001 Aug 11; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=37321
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Validation of Heart Failure Events in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Participants Assigned to Doxazosin and Chlorthalidone. by Piller LB, Davis BR, Cutler JA, Cushman WC, Wright JT Jr, Williamson JD, Leenen FH, Einhorn PT, Randall OS, Golden JS, Haywood LJ. 2002; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=149403
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Working hours as a risk factor for acute myocardial infarction in Japan: case-control study. by Sokejima S, Kagamimori S. 1998 Sep 19; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=28666
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 6
PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with heart attack, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “heart attack” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for heart attack (hyperlinks lead to article summaries): ·
“A stitch in time”--for the heart attack patient. Author(s): Collentine T, Collier MJ, Crews T, Davis W, Morris D, Silverman B, Wilmer C, Wilson JS Jr. Source: J Med Assoc Ga. 1995 February; 84(2): 83-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7891010&dopt=Abstract
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“Containing” an infarct: preventing the heart attack in the first place. Author(s): Bahr RD. Source: Southern Medical Journal. 1984 January; 77(1): 65-7, 74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6695221&dopt=Abstract
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“Doctor, I'm having a heart attack. What should I do?”. Author(s): Paton S. Source: Am J Manag Care. 1999 November; 5(11): 1466, 1469-70. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10662421&dopt=Abstract
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“The way to a man's heart attack”. Author(s): Jones RJ. Source: Imj Ill Med J. 1973 August; 144(2): 123-7 Passim. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4147313&dopt=Abstract
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“Yes, Eileen, heart attacks can be prevented”. Author(s): Harvey WP. Source: Med Times. 1980 August; 108(8): 8,13. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7402005&dopt=Abstract
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A “simple dynamics” approach to the problem of fatal heart attacks. Author(s): Lovegrove T. Source: The Medical Journal of Australia. 1972 September 9; 2(11): 625. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5082791&dopt=Abstract
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A better heart attack therapy. New research calls for more hospitals to be allowed to use angioplasty. Author(s): Comarow A. Source: U.S. News & World Report. 2002 May 6; 132(15): 54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12001782&dopt=Abstract
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A community-wide perspective of secular trends in the therapeutic management of patients with acute myocardial infarction. The Worcester Heart Attack Study. Author(s): Goldberg RJ. Source: Cardiology. 1989; 76(2): 105-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2568178&dopt=Abstract
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A global analysis of technological change in health care: the case of heart attacks. The TECH Investigators. Author(s): McClellan M, Kessler D. Source: Health Aff (Millwood). 1999 May-June; 18(3): 250-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10388222&dopt=Abstract
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A heart attack of her own. Author(s): Wadman M. Source: Fortune. 1999 November 22; 140(10): 224-6, 228, 230 Passim. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10662388&dopt=Abstract
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A randomised controlled trial of a dietary advice program for relatives of heart attack victims. Author(s): Heller RF, Walker RJ, Boyle CA, O'Connell DL, Rusakaniko S, Dobson AJ. Source: The Medical Journal of Australia. 1994 November 7; 161(9): 529-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7968751&dopt=Abstract
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A scoring system to identify men at high risk of a heart attack. Author(s): Shaper AG, Pocock SJ, Phillips AN, Walker M. Source: Health Trends. 1987 May; 19(2): 37-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10282990&dopt=Abstract
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A STAT cardiac marker system for detecting acute heart attacks. Author(s): Bruni J, McPherson P, Buechler K. Source: Am Clin Lab. 1999 August; 18(7): 14-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10558304&dopt=Abstract
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Abnormal sodium metabolism and plasma renin activity (renal renin secretion) and the vasoconstriction volume hypothesis: implications for pathogenesis and treatment of hypertension and its vascular consequences (heart attack, stroke). Author(s): Laragh JH, Sealey JE. Source: Clinical Chemistry. 1991 October; 37(10 Pt 2): 1820-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1914196&dopt=Abstract
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Absence of risk factor change in young adults after family heart attack or stroke: the CARDIA Study. Author(s): Kip KE, McCreath HE, Roseman JM, Hulley SB, Schreiner PJ. Source: American Journal of Preventive Medicine. 2002 May; 22(4): 258-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11988382&dopt=Abstract
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Access to early cardiac care: chest pain as a risk factor for heart attacks, and the emergence of early cardiac care centers. Author(s): Bahr RD. Source: Md Med J. 1992 February; 41(2): 133-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1565002&dopt=Abstract
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Accessing emergency care at the time of a heart attack: why people do not dial 999 for an ambulance. Author(s): Ruston A. Source: J R Soc Health. 2001 December; 121(4): 243-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11811095&dopt=Abstract
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Accuracy of perceptions of heart attack risk: what influences perceptions and can they be changed? Author(s): Avis NE, Smith KW, McKinlay JB. Source: American Journal of Public Health. 1989 December; 79(12): 1608-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2817187&dopt=Abstract
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Accuracy of recall of hip fracture, heart attack, and cancer: a comparison of postal survey data and medical records. Author(s): Paganini-Hill A, Chao A. Source: American Journal of Epidemiology. 1993 July 15; 138(2): 101-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8342528&dopt=Abstract
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Acute heart attacks in Leeds. The use of routinely recorded data in an epidemiological survey. Author(s): Bandaranayake R. Source: Public Health. 1981 March; 95(2): 100-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7244077&dopt=Abstract
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Acute myocardial infarction: are there missed opportunities for reperfusion? UK Heart Attack Study Investigators. Author(s): el Gaylani N, Weston CF, Griffith K, Wong PS, Norris RM, Penny WJ. Source: Coronary Artery Disease. 1998; 9(11): 753-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9919423&dopt=Abstract
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After a heart attack. Author(s): O'Grady M. Source: N Z Nurs J. 1986 January; 79(1): 20-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3457307&dopt=Abstract
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After heart attack: behavioral expectations for the cardiac. Author(s): Monteiro LA. Source: Social Science & Medicine (1982). 1973 July; 7(7): 555-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4724488&dopt=Abstract
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After I had a heart attack and two bypass operations, I was put on Lipitor to lower my cholesterol. My cholesterol was never high--about 170-180 mg/dL. But my HDL was always low and triglycerides were somewhat high. Now my total cholesterol is 124 and my HDL has gone up slightly. My triglycerides are way down. My LDL cholesterol has fallen from 110 to 68. Is there any downside to such a low cholesterol level, other than the need to check my liver function tests? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 1999 January; 9(5): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9916564&dopt=Abstract
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Age-related trends (1986-1993) in the use of thrombolytic agents in patients with acute myocardial infarction. The Worcester Heart Attack Study. Author(s): Chandra H, Yarzebski J, Goldberg RJ, Savageau J, Singleton C, Gurwitz JH, Gore JM. Source: Archives of Internal Medicine. 1997 April 14; 157(7): 741-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9125005&dopt=Abstract
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AHA consensus panel statement. Preventing heart attack and death in patients with coronary disease. The Secondary Prevention Panel. Author(s): Smith SC Jr, Blair SN, Criqui MH, Fletcher GF, Fuster V, Gersh BJ, Gotto AM, Gould KL, Greenland P, Grundy SM, et al. Source: Journal of the American College of Cardiology. 1995 July; 26(1): 292-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7797767&dopt=Abstract
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AHA/ACC Guidelines for Preventing Heart Attack and Death in Patients With Atherosclerotic Cardiovascular Disease: 2001 update. A statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Author(s): Smith SC Jr, Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, Fuster V, Gotto A, Grundy SM, Miller NH, Jacobs A, Jones D, Krauss RM, Mosca L, Ockene I, Pasternak RC, Pearson T, Pfeffer MA, Starke RD, Taubert KA. Source: Journal of the American College of Cardiology. 2001 November 1; 38(5): 1581-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11691544&dopt=Abstract
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AHA/ACC Scientific Statement: AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Author(s): Smith SC Jr, Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, Fuster V, Gotto A, Grundy SM, Miller NH, Jacobs A, Jones D, Krauss RM, Mosca L, Ockene I, Pasternak RC, Pearson T, Pfeffer MA, Starke RD, Taubert KA. Source: Circulation. 2001 September 25; 104(13): 1577-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11571256&dopt=Abstract
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ALLHAT: the largest and most important clinical trial in hypertension ever done in the USA. Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial. Author(s): Elliott WJ. Source: American Journal of Hypertension : Journal of the American Society of Hypertension. 1996 April; 9(4 Pt 1): 409-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8722446&dopt=Abstract
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American Heart Association consensus panel statement on preventing heart attack and death in patients with coronary disease. Author(s): Kennedy JW. Source: Journal of the American College of Cardiology. 1995 July; 26(1): 291. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7797766&dopt=Abstract
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AMIS negative on aspirin and heart attacks. Author(s): Marx JL. Source: Science. 1980 February 22; 207(4433): 859-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6986648&dopt=Abstract
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An evaluation of technologies for identifying acute cardiac ischemia in the emergency department: a report from a National Heart Attack Alert Program Working Group. Author(s): Selker HP, Zalenski RJ, Antman EM, Aufderheide TP, Bernard SA, Bonow RO, Gibler WB, Hagen MD, Johnson P, Lau J, McNutt RA, Ornato J, Schwartz JS, Scott JD, Tunick PA, Weaver WD. Source: Annals of Emergency Medicine. 1997 January; 29(1): 13-87. Erratum In: Ann Emerg Med 1997 February; 29(2): 310. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8998086&dopt=Abstract
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An evaluation of technologies for identifying acute cardiac ischemia in the emergency department: executive summary of a National Heart Attack Alert Program Working Group Report. Author(s): Selker HP, Zalenski RJ, Antman EM, Aufderheide TP, Bernard SA, Bonow RO, Gibler WB, Hagen MD, Johnson P, Lau J, McNutt RA, Ornato J, Schwartz JS, Scott JD, Tunick PA, Weaver WD. Source: Annals of Emergency Medicine. 1997 January; 29(1): 1-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8998085&dopt=Abstract
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An open-label preliminary trial of sertraline for treatment of major depression after acute myocardial infarction (the SADHAT Trial). Sertraline Anti-Depressant Heart Attack Trial. Author(s): Shapiro PA, Lesperance F, Frasure-Smith N, O'Connor CM, Baker B, Jiang JW, Dorian P, Harrison W, Glassman AH. Source: American Heart Journal. 1999 June; 137(6): 1100-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10347338&dopt=Abstract
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Analysis of experience in workmen's compensation for heart cases. Factors influencing the decision re compensability in heart attacks occurring among industrial workers. Author(s): Bergy GG, Sparkman DR. Source: Circulation. 1966 March; 33(3): 461-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4221930&dopt=Abstract
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Angioplasty in severe heart attack. Anesthesia and general management. Author(s): Ranucci M. Source: Minerva Anestesiol. 2002 April; 68(4): 192-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12024081&dopt=Abstract
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Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT): practical implications. Author(s): Oparil S. Source: Hypertension. 2003 May; 41(5): 1006-9. Epub 2003 April 14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12695423&dopt=Abstract
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Anxiety after a heart attack. Author(s): Dellipiani AW, Cay EL, Philip AE, Vetter NJ, Colling WA, Donaldson RJ, McCormack P. Source: British Heart Journal. 1976 July; 38(7): 752-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=973900&dopt=Abstract
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Anxiety preceding a heart attack--effect of person: (the heart as a potential hallucinogenic pump). Author(s): Schneider DE. Source: Cond Reflex. 1969 July-September; 4(3): 169-86. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5380731&dopt=Abstract
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Are patients with essential hypertension and low renin protected against stroke and heart attack? Author(s): Stroobandt R, Fagard R, Amery AK. Source: American Heart Journal. 1973 December; 86(6): 781-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4757789&dopt=Abstract
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Ask the doctor. A few years ago, I had a heart attack. My doctor treated me with angioplasty, and I haven't had any symptoms of heart disease since. I do carry a bottle nitroglycerin with me, but haven't taken any in years. I renew my prescription every six months because I know the pills go bad. My problem is that I also need Viagra to have sexual intercourse. Whenever I refill my prescription for Viagra, the pharmacist gives me a hard time because he knows I also have a prescription for nitroglycerin. Just how dangerous is Viagra? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2001 July; 11(11): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11511445&dopt=Abstract
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Ask the doctor. A heart attack caused me to develop heart rhythm problems. These made it necessary for me to get an implantable cardioventer/defibrillator (ICD) that can shock my heart back to a normal rhythm. My medical story is a lot like Vice President Dick Cheney's, but my social situation isn't--I don't have anyone to drive me around. My doctor doesn't want me to drive. But depending on friends and family is a major problem, and we don't live near public transportation. Any suggestions? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2003 January; 13(5): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12543615&dopt=Abstract
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Ask the doctor. I am 68 years old and had a heart attack last year. I think I am doing fine and passed my last exercise test with flying colors. But about a month ago I had a fainting spell, which occurred when I went to the bathroom after a big meal. In addition, I frequently feel lightheaded for a few seconds when I stand up. I think that problem has been there for years. Do you think these spells are related to my heart? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2000 December; 11(4): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11114796&dopt=Abstract
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Ask the doctor. I am a 40 year old lawyer, and am generally healthy and fit. However, I get a crushing chest pain every now and then. I go to the emergency department to be sure I'm not having a heart attack. After the last visit, I had a coronary angiogram to try to see whether I had heart problems, but it showed no evidence of atherosclerosis. I am still nervous that the test might have missed something. Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2000 November; 11(3): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11063531&dopt=Abstract
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Ask the doctor. I am generally healthy, but I had a heart attack last year. At my age, 78 years old, I find it hard to take it seriously when my doctor and my children tell me that I should be lowering my cholesterol and exercising. It seems to me that the idea of trying to prevent “premature” death is silly in someone my age. It's not like I feel ready to die, but it's hard for me to believe that prevention works in someone who has already gone beyond his “three score ten” years. Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2000 August; 10(12): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10927814&dopt=Abstract
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Ask the doctor. I had a heart attack last year and have resumed most of my activities, including some tennis, without problems. However, both my wife and I are reluctant to have sexual intercourse. To be frank, she is concerned that it would be dangerous for me. Is she right? If not, what can I do to put her mind at ease? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2000 February; 10(6): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10799251&dopt=Abstract
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Ask the doctor. I had a heart attack last year, and afterwards learned that my homocysteine level is elevated. I wanted to start taking vitamins to lower it, but before I make myself swallow another two or three pills per day, is there any proof vitamins will make me live longer? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2000 May; 10(9): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10762533&dopt=Abstract
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Ask the doctor. I have diabetes and use insulin two, sometimes three, times a day to keep my sugar under control. My hope is that this will help me avoid a heart attack. Is this a reasonable goal? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 1999 August; 9(12): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10402307&dopt=Abstract
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Ask the doctor. I have had heart failure since my heart attack a year ago. My physician initially prescribed lisinopril, an angiotensin-converting enzyme (ACE) inhibitor. Unfortunately, I was one of the unlucky people who got a cough with this drug that was so annoying I had to stop taking it. Now my doctor wants me to try a newer drug called valsartan. Is it likely to help me? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2002 July; 12(11): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12138046&dopt=Abstract
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Ask the Doctor. I have read in your newsletter that poor dental health can contribute to heart disease. I have always done my best with my teeth, including flossing three times a day, but still have a serious problem with gum recession and have lost a few teeth. I don t have other risk factors for heart disease. Do my dental problems raise my risk for a heart attack? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2001 November; 12(3): 7-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11724693&dopt=Abstract
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Ask the doctor. I read that Vice President Cheney received an implantable defibrillator because of some extra beats on his electrocardiogram. I've also had some extra beats, but I've never had a heart attack or any other heart problems. My doctor told me not to worry. Is the Vice President getting better care than I am? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2001 September; 12(1): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11582598&dopt=Abstract
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Ask the doctor. I've been taking estrogen since I reached menopause seven years ago, and it really helped my hot flashes and other symptoms. When I started these drugs, I was told they would lower my risk for osteoporosis and heart attacks, but I ve been reading lots of negative articles about how they may increase risk for heart problems. Should I stop them? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2001 October; 12(2): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11684494&dopt=Abstract
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Ask the Doctor. My older brother recently had a heart attack and bypass surgery at the age of 53! I am physically active and don t have any risk factors for heart disease. But neither did my brother, who also had normal cholesterol and blood pressure numbers. I ve been wondering if I should be taking a cholesterol-lowering medication, even though my cholesterol is normal. Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2001 December; 12(4): 8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11751084&dopt=Abstract
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Ask the doctor. Recently I read that aspirin can actually increase a person's risk for a stroke by causing bleeding in the brain. I have atrial fibrillation and my doctor wants me to take a blood thinner - if not warfarin, then at least aspirin. I've already had a heart attack and I don't want to run the risk of a stroke, so I have refused. What should I do? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2000 September; 11(1): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10966583&dopt=Abstract
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Ask the doctor: My heart was damaged by two heart attacks. I know that ACE inhibitors help patients with heart failure, but I just can't take them. They make me cough. is there something else I can try? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2000 February; 10(6): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10799144&dopt=Abstract
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Ask the doctor: My husband had a heart attack last winter. Although his doctor says his heart is now fine, he just has not bounced back the way I thought he would. He has trouble sleeping and no energy. I am concerned that he is going to continue on a downward spiral. Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 2000 July; 10(11): 7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10877861&dopt=Abstract
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Aspirin or warfarin: what's best after a heart attack? Risk of bleeding counters warfarin's edge in efficacy. Author(s): Ornato JP. Source: Health News. 2002 November; 8(11): 3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12523247&dopt=Abstract
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Aspirin, vitamin E and heart attack prevention. Author(s): Polasek J. Source: Thrombosis and Haemostasis. 1996 May; 75(5): 863. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8725741&dopt=Abstract
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Assessment of angina pectoris after myocardial infarction: comparison of “Rose Questionnaire” with physician judgment in the Beta-Blocker Heart Attack Trial. Author(s): Friedman LM, Byington RP. Source: American Journal of Epidemiology. 1985 April; 121(4): 555-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3893101&dopt=Abstract
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Assessment of double-blindness at the conclusion of the beta-Blocker Heart Attack Trial. Author(s): Byington RP, Curb JD, Mattson ME. Source: Jama : the Journal of the American Medical Association. 1985 March 22-29; 253(12): 1733-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3974051&dopt=Abstract
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Association between extent of periodontal attachment loss and self-reported history of heart attack: an analysis of NHANES III data. Author(s): Arbes SJ Jr, Slade GD, Beck JD. Source: Journal of Dental Research. 1999 December; 78(12): 1777-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10598906&dopt=Abstract
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Association of digitalis therapy with mortality in survivors of acute myocardial infarction: observations in the Beta-Blocker Heart Attack Trial. Author(s): Byington R, Goldstein S. Source: Journal of the American College of Cardiology. 1985 November; 6(5): 976-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4045047&dopt=Abstract
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Australian patients' delay in response to heart attack symptoms. Author(s): Dracup K, McKinley SM, Moser DK. Source: The Medical Journal of Australia. 1997 March 3; 166(5): 233-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9076265&dopt=Abstract
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Awareness of heart attack signals and cardiac risk markers amongst the general public in Dublin. Author(s): Bury G, Murphy AW, Power R, Daly S, Mehigan C, Walsh JP. Source: Ir Med J. 1992 September; 85(3): 96-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1399491&dopt=Abstract
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Baseline characteristics of the diabetic participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Author(s): Barzilay JI, Jones CL, Davis BR, Basile JN, Goff DC Jr, Ciocon JO, Sweeney ME, Randall OS; Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). ALLHAT Collaborative Research Group. Source: Diabetes Care. 2001 April; 24(4): 654-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11315826&dopt=Abstract
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Beta-blocker heart attack trial: design, methods, and baseline results. Beta-blocker heart attack trial research group. Author(s): Byington RP. Source: Controlled Clinical Trials. 1984 December; 5(4): 382-437. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6151483&dopt=Abstract
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Beta-Blocker Heart Attack Trial: impact of propranolol therapy on ventricular arrhythmias. Author(s): Morganroth J, Lichstein E, Byington R. Source: Preventive Medicine. 1985 May; 14(3): 346-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3903736&dopt=Abstract
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Beyond heart attacks and prostate cancer. Is it time for a men's health specialty? Author(s): Vishio J. Source: Adv Nurse Pract. 2001 April; 9(4): 48-52. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12420436&dopt=Abstract
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Biologic determinants of propranolol disposition: results from 1308 patients in the Beta-Blocker Heart Attack Trial. Author(s): Walle T, Byington RP, Furberg CD, McIntyre KM, Vokonas PS. Source: Clinical Pharmacology and Therapeutics. 1985 November; 38(5): 509-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4053488&dopt=Abstract
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Blocking apoptotic damage after a heart attack. Author(s): Veggeberg S. Source: Molecular Medicine Today. 1998 July; 4(7): 278. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9743987&dopt=Abstract
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Blood pressure, cigarette smoking and heart attack in the WHO co-operative trial of clofibrate. Author(s): Green KG, Heady A, Oliver MF. Source: International Journal of Epidemiology. 1989 June; 18(2): 355-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2767848&dopt=Abstract
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Body fat distribution and self-reported prevalence of hypertension, heart attack, and other heart disease in older women. Author(s): Folsom AR, Prineas RJ, Kaye SA, Soler JT. Source: International Journal of Epidemiology. 1989 June; 18(2): 361-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2767849&dopt=Abstract
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Brain-heart connection and the risk of heart attack. Author(s): Singh RB, Kartik C, Otsuka K, Pella D, Pella J. Source: Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. 2002; 56 Suppl 2: 257S-265S. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12653178&dopt=Abstract
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Breathlessness, lung function and the risk of heart attack. Author(s): Cook DG, Shaper AG. Source: European Heart Journal. 1988 November; 9(11): 1215-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3234413&dopt=Abstract
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By the way, doctor. I would like to start the resistance-training program you outlined in your August 2002 issue. I feel fine now, but I had a heart attack five years ago. Is it safe for me to do those exercises? Author(s): Robb-Nicholson C. Source: Harvard Women's Health Watch. 2002 December; 10(4): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12499130&dopt=Abstract
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By the way, doctor. I'm 84 and had a small heart attack last year. My kids tell me I should be taking a statin. But at my age, I don't see how any medication is going to clean out my arteries and get rid of my atherosclerosis. What do you think? Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2003 February; 28(4): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12604456&dopt=Abstract
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By the way, doctor. I'm 84, 5-foot-9, and weigh 160. I do an hour's exercise every day. I take a diuretic, potassium, and calcium-channel blocker. Should I also take Lipitor to avoid a heart attack? Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2003 April; 28(6): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12777236&dopt=Abstract
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By the way, doctor. My husband is 72 and had a bad heart attack six months ago. He is so depressed and some days barely wants to get out of bed. He says, “Of course I'm depressed. I have a bad heart.” My son thinks he ought to be taking an antidepressant. Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2002 August; 27(10): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12217839&dopt=Abstract
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By the way, doctor. I'm 68, and I've been taking Viagra for about a year now. The drug is working for me, but I'm always a little scared that I am going to give myself a heart attack. Should I be? Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2000 August; 25(10): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10927649&dopt=Abstract
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By the way, doctor. I've read on the Internet that people having a heart attack can keep themselves alive by coughing. Is this true? Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2000 December; 26(2): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11114802&dopt=Abstract
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By the way, doctor.I've heard that statins can cause cancer, at least in animal experiments. Is there any chance that my statin might prevent another heart attack in the short run, but give me cancer in the long run? Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2001 September; 26(11): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11572824&dopt=Abstract
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By the way, doctor.My father died of a heart attack at age 72, but he smoked and ate poorly. Now that I'm in my 50s, I'm starting to wonder if I fall into a high-risk category for heart disease. Author(s): Lee TH. Source: Harvard Health Letter / from Harvard Medical School. 2001 November; 27(1): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11724699&dopt=Abstract
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Calcium channel blockers. The jury is still out on whether they cause heart attacks and suicide. Author(s): Stanton AV. Source: Bmj (Clinical Research Ed.). 1998 May 16; 316(7143): 1471-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9582126&dopt=Abstract
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Can aspirin prevent recurrence of heart attacks and strokes? Author(s): Kent S. Source: Geriatrics. 1982 January; 37(1): 169-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7033047&dopt=Abstract
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Carbon monoxide and heart attacks. Author(s): Kuller LH, Radford EP, Swift D, Perper JA, Fisher R. Source: Archives of Environmental Health. 1975 October; 30(10): 477-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1180569&dopt=Abstract
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Cardiac arrest and heart attack: an evaluation of lay knowledge. Author(s): Egan AG, Reid JJ. Source: N Z Med J. 1986 April 9; 99(799): 237-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3517715&dopt=Abstract
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Cardiology patient page: warning signs of a heart attack. Author(s): Ornato JP, Hand MM. Source: Circulation. 2001 June 26; 103(25): E124-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11425785&dopt=Abstract
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Caring for the cardiac patient. “Ego infarction” psychological reactions to a heart attack. Author(s): Cassem NH, Hackett TP. Source: J Pract Nurs. 1979 October; 29(10): 17-20, 39. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=258670&dopt=Abstract
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Causal attribution, perceived benefits, and morbidity after a heart attack: an 8-year study. Author(s): Affleck G, Tennen H, Croog S, Levine S. Source: Journal of Consulting and Clinical Psychology. 1987 February; 55(1): 29-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3571655&dopt=Abstract
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Causes of delay in seeking treatment for heart attack symptoms. Author(s): Dracup K, Moser DK, Eisenberg M, Meischke H, Alonzo AA, Braslow A. Source: Social Science & Medicine (1982). 1995 February; 40(3): 379-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7899950&dopt=Abstract
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Changes over time in the incidence and case-fatality rates of primary ventricular fibrillation complicating acute myocardial infarction: perspectives from the Worcester Heart Attack Study. Author(s): Thompson CA, Yarzebski J, Goldberg RJ, Lessard D, Gore JM, Dalen JE. Source: American Heart Journal. 2000 June; 139(6): 1014-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10827382&dopt=Abstract
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Changing the diagnostic criteria for myocardial infarction in patients with a suspected heart attack affects the measurement of 30 day mortality but not long term survival. Author(s): Packham C, Gray D, Weston C, Large A, Silcocks P, Hampton J. Source: Heart (British Cardiac Society). 2002 October; 88(4): 337-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12231586&dopt=Abstract
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Chest pain: panic attack or heart attack? Author(s): Potokar JP, Nutt DJ. Source: Int J Clin Pract. 2000 March; 54(2): 110-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10824366&dopt=Abstract
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Chest pain--indigestion or impending heart attack? Author(s): Simpson FG, Kay J, Aber CP. Source: Postgraduate Medical Journal. 1984 May; 60(703): 338-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6739390&dopt=Abstract
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Childhood sloth and gluttony causing heart attacks. Author(s): Gorman WF. Source: Ariz Med. 1977 July; 34(7): 467-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=889456&dopt=Abstract
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Clinical Implications of Recent Findings from the Antihypertensive and LipidLowering Treatment To Prevent Heart Attack Trial (ALLHAT) and Other Studies of Hypertension. Author(s): Furberg CD, Psaty BM, Pahor M, Alderman MH. Source: Annals of Internal Medicine. 2001 December 18; 135(12): 1074-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11747386&dopt=Abstract
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Clot busters set door-to-needle time for heart attack response. Author(s): Quinn T. Source: Nurs Times. 2000 August 31-September 6; 96(35): 22. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11968358&dopt=Abstract
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Cognitive processes and recovery from heart attack: a review and theoretical analysis. Author(s): Krantz DS. Source: J Human Stress. 1980 September; 6(3): 27-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7052822&dopt=Abstract
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Combatting heart attacks on the home front. Author(s): Van Every SL, Curwen EH. Source: Nursing. 1985 October; 15(10): 55-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3850408&dopt=Abstract
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Comments on psychoanalysis of heart attack. Author(s): Gantt AH. Source: Cond Reflex. 1969 October-December; 4(4): 225-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5378172&dopt=Abstract
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Commonwealth survey could cut heart attacks. Author(s): Khan A. Source: East Afr Med J. 1981 November; 58(11): 894-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7341217&dopt=Abstract
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Community apathy in regard to sudden death due to heart attack. Author(s): Bahr RD. Source: Md State Med J. 1979 September; 28(9): 74-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=502607&dopt=Abstract
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Comparison of mortality of patients with heart attacks admitted to a coronary care unit and an ordinary medical ward. Author(s): Hill JD, Holdstock G, Hampton JR. Source: British Medical Journal. 1977 July 9; 2(6079): 81-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=871804&dopt=Abstract
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Comparisons between different syndromes of heart attack--a multivariate analysis. Author(s): Fraser GE. Source: J Chronic Dis. 1984; 37(7): 505-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6746842&dopt=Abstract
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Considerations for a national heart attack alert program. Author(s): Lenfant C, LaRosa JH, Horan MJ, Passamani ER. Source: Clin Cardiol. 1990 August; 13(8 Suppl 8): Viii9-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2208817&dopt=Abstract
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Continuing inequality: gender and social class influences on self perceived health after a heart attack. Author(s): Lacey EA, Walters SJ. Source: Journal of Epidemiology and Community Health. 2003 August; 57(8): 622-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12883071&dopt=Abstract
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Conversion of massive anxiety into heart attack. The paraconscious and Freud's cardiac crisis. Author(s): Schneider DE. Source: American Journal of Psychotherapy. 1973 July; 17(3): 360-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4721981&dopt=Abstract
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Coronary care. After a heart attack. Author(s): Barclay J. Source: N Z Nurs J. 1987 November; 80(11): 21-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3696581&dopt=Abstract
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Coronary care. 'Heart attack action'. Author(s): Roxborough E. Source: N Z Nurs J. 1987 November; 80(11): 22-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3696582&dopt=Abstract
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Coronary heart attacks--how to avoid them: causes and prevention. Author(s): Gingold NL. Source: N Y J Dent. 1968 November; 38(9): 407-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5246048&dopt=Abstract
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Coronary heart disease mortality/morbidity and risk in blacks. I: Clinical manifestations and diagnostic criteria: the experience with the Beta Blocker Heart Attack Trial. Author(s): Haywood LJ. Source: American Heart Journal. 1984 September; 108(3 Pt 2): 787-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6148005&dopt=Abstract
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Coronary proneness and approaches to preventing heart attacks. Author(s): Stamler J, Hall Y, Mojonnier L, Berkson DM, Levinson M, Lindberg HA, Andelman SL, Miller WA, Burkey F. Source: The American Journal of Nursing. 1966 August; 66(8): 1788-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5178212&dopt=Abstract
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Correlation between heart attacks and magnetic activity. Author(s): Malin SR, Srivastava BJ. Source: Nature. 1979 February 22; 277(5698): 646-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=423962&dopt=Abstract
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Correlation between heart attacks and magnetic activity--a retraction. Author(s): Malin SR, Srivastava BJ. Source: Nature. 1980 January 3; 283(5742): 111. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7350521&dopt=Abstract
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COX 2 inhibitors may increase risk of heart attack. Author(s): Gottlieb S. Source: Bmj (Clinical Research Ed.). 2001 September 1; 323(7311): 471. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11532833&dopt=Abstract
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Critical pathways for management of patients with acute coronary syndromes: an assessment by the National Heart Attack Alert Program. Author(s): Cannon CP, Hand MH, Bahr R, Boden WE, Christenson R, Gibler WB, Eagle K, Lambrew CT, Lee TH, MacLeod B, Ornato JP, Selker HP, Steele P, Zalenski RJ; National Heart Attack Alert Program (NHAAP) Coordinating Committee Critical Pathways Writing Group. Source: American Heart Journal. 2002 May; 143(5): 777-89. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12040337&dopt=Abstract
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Criticisms of exercise after heart attack--variations on an old theme? Author(s): Noakes TD. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1982 August 14; 62(8): 238-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6980489&dopt=Abstract
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Current and future hospitalization after heart attack. Author(s): Johansen H, Nair C, Taylor G. Source: Health Reports / Statistics Canada, Canadian Centre for Health Information = Rapports Sur La Sante / Statistique Canada, Centre Canadien D'information Sur La Sante. 1998 Autumn; 10(2): 21-8 (Eng); 23-31 (Fre). English, French. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9842488&dopt=Abstract
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Cutting back after a heart attack: an overview. Author(s): Mullen PD. Source: Health Educ Monogr. 1978 Fall; 6(3): 295-311. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=752666&dopt=Abstract
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Deadly delays. The National Heart Attack Alert Program is working to reduce deaths and disabilities. Author(s): Bradley J, Hand M, Horan M, Murray J, Schneiderman B, Shade B. Source: Emerg Med Serv. 1995 July; 24(7): 45-6, 48, 50-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10143870&dopt=Abstract
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Decade-long trends and factors associated with time to hospital presentation in patients with acute myocardial infarction: the Worcester Heart Attack study. Author(s): Goldberg RJ, Yarzebski J, Lessard D, Gore JM. Source: Archives of Internal Medicine. 2000 November 27; 160(21): 3217-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11088081&dopt=Abstract
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Delay in seeking appropriate medical help by individuals experiencing the symptoms of heart attack. Author(s): Rukholm E. Source: Can J Cardiovasc Nurs. 1992 March; 2(4): 2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1637491&dopt=Abstract
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Delays preceding admission to hospital and treatment with thrombolytic agents of patients with possible heart attack. Author(s): Bett N, Aroney G, Thompson P. Source: Aust N Z J Med. 1993 June; 23(3): 312-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8352713&dopt=Abstract
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Derangement of heart rate variability during a catastrophic earthquake: a possible mechanism for increased heart attacks. Author(s): Lin LY, Wu CC, Liu YB, Ho YL, Liau CS, Lee YT. Source: Pacing and Clinical Electrophysiology : Pace. 2001 November; 24(11): 1596-601. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11816627&dopt=Abstract
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Diagnostic testing in acute myocardial infarction: does patient age influence utilization patterns? The Worcester Heart Attack Study. Author(s): Gurwitz JH, Osganian V, Goldberg RJ, Chen ZY, Gore JM, Alpert JS. Source: American Journal of Epidemiology. 1991 November 1; 134(9): 948-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1951292&dopt=Abstract
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Diet, lipids and heart attacks. Author(s): Werko L. Source: Acta Med Scand. 1979; 206(6): 435-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=532706&dopt=Abstract
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Differences in management of heart attack patients between metropolitan and regional hospitals in the Hunter Region of Australia. Author(s): Lim LL, O'Connell RL, Heller RF. Source: Aust N Z J Public Health. 1999 February; 23(1): 61-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10083691&dopt=Abstract
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Differential perceptions, behaviors, and motivations among African Americans, Latinos, and whites suspected of heart attacks in two hospital populations. Author(s): Ell K, Haywood LJ, deGuzman M, Sobel E, Norris S, Blumfield D, Ning JP, Butts E. Source: J Assoc Acad Minor Phys. 1995; 6(2): 60-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7772934&dopt=Abstract
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Discontinuation of doxazosin arm of ALLHAT. Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack. Author(s): Ball SG. Source: Lancet. 2000 April 29; 355(9214): 1558. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10801204&dopt=Abstract
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Discordant nephron function. A pathogenic factor in hypertension and its vascular complications of stroke and heart attack. Author(s): Laragh JH. Source: American Journal of Hypertension : Journal of the American Society of Hypertension. 1991 January; 4(1 Pt 2): 2S-6S. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2009143&dopt=Abstract
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Disease burden of heart attack is shifting toward women and the elderly. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2002 April 5; 13(7): 7-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452172&dopt=Abstract
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Diuretics vs alpha-blockers for treatment of hypertension: lessons from ALLHAT. Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Author(s): Lasagna L. Source: Jama : the Journal of the American Medical Association. 2000 April 19; 283(15): 2013-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10789671&dopt=Abstract
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Do cigarette smokers have unrealistic perceptions of their heart attack, cancer, and stroke risks? Author(s): Strecher VJ, Kreuter MW, Kobrin SC. Source: Journal of Behavioral Medicine. 1995 February; 18(1): 45-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7595951&dopt=Abstract
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Does exercise prevent heart attacks? Author(s): Kent S. Source: Geriatrics. 1978 November; 33(11): 95-104. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=710897&dopt=Abstract
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Does life-long exercise protect against heart attack? Author(s): Robertson HK. Source: British Medical Journal (Clinical Research Ed.). 1982 September 25; 285(6345): 861-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6811046&dopt=Abstract
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Does stress cause heart attacks? Author(s): Marmot MG. Source: Postgraduate Medical Journal. 1986 July; 62(729): 683-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3748937&dopt=Abstract
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Does vitamin E decrease heart attack risk? summary and implications with respect to dietary recommendations. Author(s): Traber MG. Source: The Journal of Nutrition. 2001 February; 131(2): 395S-7S. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11160568&dopt=Abstract
·
Does workers' compensation cover on the job heart attack? Author(s): Tammelleo AD. Source: Regan Rep Nurs Law. 1997 October; 38(5): 4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9397891&dopt=Abstract
·
Doxazosin arm of the ALLHAT study discontinued: how equal are antihypertensive drugs? Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial. Author(s): Messerli FH, Grossman E. Source: Current Hypertension Reports. 2000 June; 2(3): 241-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10981155&dopt=Abstract
·
Drinking after a heart attack. Author(s): Shaper AG, Wannamethee SG. Source: Addiction (Abingdon, England). 1999 July; 94(7): 957-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10707429&dopt=Abstract
·
Drug found to help heart attack survivors. Author(s): Kolata GB. Source: Science. 1981 November 13; 214(4522): 774-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7027443&dopt=Abstract
·
Drug may protect brains of heart attack victims. Author(s): Barnes DM. Source: Science. 1987 February 6; 235(4789): 632-3. Erratum In: Science 1987 May 1; 236(4801): 236. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3027893&dopt=Abstract
Studies 71
·
Dyslipidemia and metabolic factors in the genesis of heart attack and stroke. Author(s): Horlick L. Source: Health Reports / Statistics Canada, Canadian Centre for Health Information = Rapports Sur La Sante / Statistique Canada, Centre Canadien D'information Sur La Sante. 1994; 6(1): 94-9. Review. English, French. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7919096&dopt=Abstract
·
Early discharge after heart attacks and the efficient use of hospitals. Author(s): Ross RS. Source: The New England Journal of Medicine. 1978 February 2; 298(5): 275-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=413041&dopt=Abstract
·
Early heart attack care on the World Wide Web. Author(s): Butt ZW. Source: Md Med J. 1997; Suppl: 36-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9470343&dopt=Abstract
·
Early intravenous beta-adrenoceptor blockade for victims of heart attack. Author(s): Sleight P. Source: Trends in Pharmacological Sciences. 1988 February; 9(2): 52-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2907695&dopt=Abstract
·
Effect of propranolol in reducing mortality in older myocardial infarction patients. The Beta-Blocker Heart Attack Trial experience. Author(s): Hawkins CM, Richardson DW, Vokonas PS. Source: Circulation. 1983 June; 67(6 Pt 2): I94-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6342843&dopt=Abstract
·
Effect of propranolol on ventricular arrhythmia. The beta-blocker heart attack trial experience. Author(s): Lichstein E, Morganroth J, Harrist R, Hubble E. Source: Circulation. 1983 June; 67(6 Pt 2): I5-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6342839&dopt=Abstract
·
Effects of aspirin and warfarin on fatal and non-fatal heart attacks. Author(s): Born G. Source: Lancet. 1999 October 23; 354(9188): 1472. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10543693&dopt=Abstract
72 Heart Attack
·
Effects of brief psychotherapy during the hospitalization period on the recovery process in heart attacks. Author(s): Gruen W. Source: Journal of Consulting and Clinical Psychology. 1975 April; 43(2): 223-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1120833&dopt=Abstract
·
Effects of propanolol in patients entered in the Beta-Blocker Heart Attack Trial with their first myocardial infarction and persistent electrocardiographic ST-segment depression. Author(s): Shivkumar K, Schultz L, Goldstein S, Gheorghiade M. Source: American Heart Journal. 1998 February; 135(2 Pt 1): 261-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9489974&dopt=Abstract
·
Effects of propranolol in non-Q-wave acute myocardial infarction in the beta blocker heart attack trial. Author(s): Gheorghiade M, Schultz L, Tilley B, Kao W, Goldstein S. Source: The American Journal of Cardiology. 1990 July 15; 66(2): 129-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2196771&dopt=Abstract
·
Effects of propranolol on recovery of heart rate variability following acute myocardial infarction and relation to outcome in the Beta-Blocker Heart Attack Trial. Author(s): Lampert R, Ickovics JR, Viscoli CJ, Horwitz RI, Lee FA. Source: The American Journal of Cardiology. 2003 January 15; 91(2): 137-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12521623&dopt=Abstract
·
Electronic smog as a potentiating factor in cardiovascular disease: a hypothesis of microwaves as an etiology for sudden death from heart attack in North Karelia. Author(s): Zaret MM. Source: Med Res Eng. 1976; 12(3): 13-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=994769&dopt=Abstract
·
Emergency care of the heart attack patient. Author(s): Stolfi JE. Source: J Med Assoc State Ala. 1972 December; 42(6): 446-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4645347&dopt=Abstract
·
Emergency medical service providers' role in the early heart attack care program: prevention and stratification strategies. Author(s): MacDonald GS, Steiner SR. Source: Md Med J. 1997; Suppl: 67-79. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9470351&dopt=Abstract
Studies 73
·
Emphasizing chest pain as a symptom of heart attack. Author(s): Bahr RD. Source: Jama : the Journal of the American Medical Association. 1993 November 24; 270(20): 2435-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8230616&dopt=Abstract
·
Enhancement of visit adherence in the national beta-blocker heart attack trial. Author(s): Bell RL, Curb JD, Friedman LM, McIntyre KM, Payton-Ross C. Source: Controlled Clinical Trials. 1985 June; 6(2): 89-101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3891227&dopt=Abstract
·
Essential hypertension: renin and aldosterone, heart attack and stroke. Author(s): Brunner HR, Laragh JH, Baer L, Newton MA, Goodwin FT, Krakoff LR, Bard RH, Buhler FR. Source: The New England Journal of Medicine. 1972 March 2; 286(9): 441-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4257928&dopt=Abstract
·
Estimating the risk of heart attack. Author(s): Shaper AG, Walker M. Source: Bmj (Clinical Research Ed.). 1991 November 23; 303(6813): 1333-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1747683&dopt=Abstract
·
Evaluating a dietary education program. An initial program on dietary aspects of recommendations to help lower the risk of heart attack. Author(s): Fritz CJ. Source: J Occup Med. 1973 July; 15(7): 574-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4711648&dopt=Abstract
·
Evaluating novel cardiovascular risk factors: can we better predict heart attacks? Author(s): Ridker PM. Source: Annals of Internal Medicine. 1999 June 1; 130(11): 933-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10375342&dopt=Abstract
·
Events surrounding an acute heart attack. Community aspects of instable angina and the acute heart attack. Author(s): Duncan B, Fulton M. Source: Heart & Lung : the Journal of Critical Care. 1975 January-February; 4(1): 50-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1037693&dopt=Abstract
74 Heart Attack
·
Exercise as protection against heart attack. Author(s): Paffenbarger RS Jr, Hyde RT. Source: The New England Journal of Medicine. 1980 May 1; 302(18): 1026-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7366610&dopt=Abstract
·
Exercise versus heart attack: questioning the consensus? Author(s): Morris JN. Source: Research Quarterly for Exercise and Sport. 1996 June; 67(2): 216-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8836002&dopt=Abstract
·
Experimental approaches to determining the choice of first-step therapy for patients with hypertension. The ALLHAT Research Group Antihypertensive and LipidLowering Treatment to Prevent Heart Attack Trial. Author(s): Whelton PK, Williamson JD, Louis GT, Davis BR, Cutler JA. Source: Clinical and Experimental Hypertension (New York, N.Y. : 1993). 1996 AprilMay; 18(3-4): 569-79. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8743044&dopt=Abstract
·
Experts want TIAs redefined. Transient ischemic attack symptoms are to a stroke what chest pain is to a heart attack. Author(s): Schwamm LH. Source: Health News. 2003 January; 9(1): 1-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12545946&dopt=Abstract
·
Exposure to environmental tobacco smoke and the risk of heart attack. Author(s): Muscat JE, Wynder EL. Source: International Journal of Epidemiology. 1995 August; 24(4): 715-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8550268&dopt=Abstract
·
Exposure to New York City as a risk factor for heart attack mortality. Author(s): Christenfeld N, Glynn LM, Phillips DP, Shrira I. Source: Psychosomatic Medicine. 1999 November-December; 61(6): 740-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10593623&dopt=Abstract
·
Factors determining case fatality in myocardial infarction “who dies in a heart attack”? Author(s): Wannamethee G, Whincup PH, Shaper AG, Walker M, MacFarlane PW. Source: British Heart Journal. 1995 September; 74(3): 324-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7547031&dopt=Abstract
Studies 75
·
Familial predisposition to premature heart attack and reduced heart rate variability. Author(s): Sajadieh A, Rasmussen V, Hein HO, Hansen JF. Source: The American Journal of Cardiology. 2003 July 15; 92(2): 234-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12860234&dopt=Abstract
·
Family coping with the crisis of heart attack. Author(s): Dhooper SS. Source: Soc Work Health Care. 1983 Fall; 9(1): 15-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6635901&dopt=Abstract
·
Family history of heart attack as an independent predictor of death due to cardiovascular disease. Author(s): Barrett-Connor E, Khaw K. Source: Circulation. 1984 June; 69(6): 1065-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6713610&dopt=Abstract
·
Family history of heart attack: a modifiable risk factor? Author(s): Khaw KT, Barrett-Connor E. Source: Circulation. 1986 August; 74(2): 239-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3731415&dopt=Abstract
·
Fatality outside hospital from acute coronary events in three British health districts, 1994-5. United Kingdom Heart Attack Study Collaborative Group. Author(s): Norris RM. Source: Bmj (Clinical Research Ed.). 1998 April 4; 316(7137): 1065-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9552910&dopt=Abstract
·
From heart attacks to melanoma: do common sense models of somatization influence symptom interpretation for female victims? Author(s): Martin R, Lemos K. Source: Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association. 2002 January; 21(1): 25-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11846341&dopt=Abstract
·
Gender, recovery from late life heart attack, and medical care. Author(s): Young RF, Kahana E. Source: Women Health. 1993; 20(1): 11-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8493797&dopt=Abstract
76 Heart Attack
·
Gingivitis in the genesis of heart attack and other arteriosclerotic diseases. Author(s): Wehrmacher WH. Source: Dent Today. 2001 November; 20(11): 94-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11715659&dopt=Abstract
·
Giving up smoking and the risk of heart attacks. A report from The British Regional Heart Study. Author(s): Cook DG, Shaper AG, Pocock SJ, Kussick SJ. Source: Lancet. 1986 December 13; 2(8520): 1376-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2878236&dopt=Abstract
·
Going home after a heart attack. Depression is also a risk factor. Author(s): Gill D. Source: Bmj (Clinical Research Ed.). 1996 September 21; 313(7059): 754. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8819465&dopt=Abstract
·
Going home after a heart attack. Patients should visit their general practitioner, not vice versa. Author(s): Hopcroft K. Source: Bmj (Clinical Research Ed.). 1996 September 21; 313(7059): 754. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8819464&dopt=Abstract
·
Growth in chest pain emergency departments throughout the United States: a cardiologist's spin on solving the heart attack problem. Author(s): Bahr RD. Source: Coronary Artery Disease. 1995 October; 6(10): 827-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8789676&dopt=Abstract
·
Halfway science and the heart attack. Author(s): Lamont NM. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1978 August 5; 54(6): 219-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=362567&dopt=Abstract
·
Health promotion. Heart attack. Author(s): Watson M. Source: Health Serv J. 1995 April 13; 105(5448): 29. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10142602&dopt=Abstract
Studies 77
·
Heart attack and stroke prevention guidelines emphasize lifestyle factors. Author(s): Levenson D. Source: Rep Med Guidel Outcomes Res. 2002 August 9; 13(15): 9-10, 12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12553325&dopt=Abstract
·
Heart attack care needs review--study. Author(s): Wagner L. Source: Modern Healthcare. 1994 May 23; 24(21): 32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10133968&dopt=Abstract
·
Heart attack patients take a trip for angioplasty. Author(s): Ann Intern Med. 2002 Sep 3;137(5 Part 1):I38 Source: Heart Advis. 2002 August; 5(8): 2. No Abstract Available. /entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12204046
·
Heart attack! Author(s): Brauer-Rieke G. Source: Midwifery Today Childbirth Educ. 1994 Spring; (29): 24. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8148904&dopt=Abstract
·
Heart attack! A message to John Q. Public. Author(s): Bahr RD. Source: Md State Med J. 1979 September; 28(9): 76-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=502608&dopt=Abstract
·
Heart attack, stroke, diabetes, and hypertension in West Indians, Asians, and whites in Birmingham, England. Author(s): Cruickshank JK, Beevers DG, Osbourne VL, Haynes RA, Corlett JC, Selby S. Source: British Medical Journal. 1980 October 25; 281(6248): 1108. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7427603&dopt=Abstract
·
Heart attack. Author(s): Munster M, Califf RM. Source: N C Med J. 1988 September; 49(9): 441-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3185760&dopt=Abstract
·
Heart attack. Author(s): Schutt BG. Source: The American Journal of Nursing. 1970 November; 70(11): 2339. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5201929&dopt=Abstract
78 Heart Attack
·
Heart attack. Author(s): Baker WP. Source: J Am Inst Homeopath. 1966 January-February; 59(1): 43-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5951944&dopt=Abstract
·
Heart attack. A personal account. Author(s): Lloyd P. Source: Occup Health (Lond). 1991 May; 43(5): 142-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2041642&dopt=Abstract
·
Heart attack. Fast action needed. Author(s): Clark WL. Source: Diabetes Self Manag. 2003 July-August; 20(4): 8-10, 12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12908436&dopt=Abstract
·
Heart attack. Post cardiac rehabilitation. Author(s): Davies B. Source: Occup Health (Lond). 1991 May; 43(5): 144-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2041643&dopt=Abstract
·
Heart attack: a personal encounter with the healthcare system. Author(s): Bruder P. Source: Hospital Topics. 1995 Winter; 73(1): 7-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10142206&dopt=Abstract
·
Heart attack: changing habits, reducing risks. Author(s): Moses C. Source: Postgraduate Medicine. 1973 February; 53(2): 104-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4688394&dopt=Abstract
·
Heart attack: what you don't know can hurt! Author(s): Biggers V. Source: Home Care Provider. 1996 May-June; 1(3): 149-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9216264&dopt=Abstract
·
Heart attack? Counter attack! Author(s): Kavanagh T. Source: Trans Assoc Life Insur Med Dir Am. 1978; 61: 111-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=749301&dopt=Abstract
Studies 79
·
Heart attack-action. Author(s): Hay DR. Source: N Z Med J. 1986 February 26; 99(796): 123. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3456537&dopt=Abstract
·
Heart attacks and coronary care. Author(s): Pantridge JF, Adgey AA. Source: Physiotherapy. 1972 October; 58(10): 332-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5077697&dopt=Abstract
·
Heart attacks and education of the public. Author(s): Warren JV. Source: Ohio State Med J. 1973 May; 69(5): 385. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4708971&dopt=Abstract
·
Heart attacks and geomagnetic activity. Author(s): Knox EG, Armstrong E, Lancashire R, Wall M, Haynes R. Source: Nature. 1979 October 18; 281(5732): 564-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=492317&dopt=Abstract
·
Heart attacks and homocysteine. Author(s): Graham I, Meleady R. Source: Bmj (Clinical Research Ed.). 1996 December 7; 313(7070): 1419-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8973221&dopt=Abstract
·
Heart attacks and lowered blood pressure. Author(s): Coope J. Source: Lancet. 1987 April 11; 1(8537): 865-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2882270&dopt=Abstract
·
Heart attacks and lowering of blood pressure. Author(s): Cruickshank JM, Thorp JM, Zacharias FJ. Source: Lancet. 1987 May 16; 1(8542): 1154. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2883484&dopt=Abstract
·
Heart attacks and lower-limb function in master endurance athletes. Author(s): Kujala UM, Sarna S, Kaprio J, Koskenvuo M, Karjalainen J. Source: Medicine and Science in Sports and Exercise. 1999 July; 31(7): 1041-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10416567&dopt=Abstract
80 Heart Attack
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Heart attacks and sleep apnoea. Author(s): Stradling JR, Douglas NJ. Source: Lancet. 1990 December 1; 336(8727): 1378-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1978182&dopt=Abstract
·
Heart attacks and the Newcastle earthquake. Author(s): Rose LW. Source: The Medical Journal of Australia. 1992 July 6; 157(1): 68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1640899&dopt=Abstract
·
Heart attacks and the Newcastle earthquake. Author(s): Dobson AJ, Alexander HM, Malcolm JA, Steele PL, Miles TA. Source: The Medical Journal of Australia. 1991 December 2-16; 155(11-12): 757-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1745166&dopt=Abstract
·
Heart attacks at 9:00 a.m. Author(s): Kolata G. Source: Science. 1986 July 25; 233(4762): 417-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3726536&dopt=Abstract
·
Heart attacks, smoking, and the nicotine patch. Author(s): Kafka HP. Source: Annals of Internal Medicine. 1994 September 1; 121(5): 389. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8042844&dopt=Abstract
·
Heart attacks, strokes, diabetes and periodontal diseases: the relationship between periodontal health and systemic diseases. Author(s): Dennison DK. Source: J Gt Houst Dent Soc. 1998 March; 69(8): 22-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9667177&dopt=Abstract
·
Heart attacks, vitamin E and calculus--the links explored. Author(s): Bertrand F. Source: Probe (Lond). 1989 March; 31(3): 10-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2762248&dopt=Abstract
·
Heart attacks: exploring new preventive strategies. Author(s): Mendis S. Source: Ceylon Med J. 1998 December; 43(4): 210-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10355175&dopt=Abstract
Studies 81
·
Heart attacks: gone with the century? Author(s): Brown MS, Goldstein JL. Source: Science. 1996 May 3; 272(5262): 629. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8614809&dopt=Abstract
·
Heart attacks: possible risk factor. Author(s): Page IH. Source: Proceedings of the National Academy of Sciences of the United States of America. 1972 July; 69(7): 1813-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4340160&dopt=Abstract
·
Heart throbs. A third of all patients won't feel any chest pain during a heart attack. Could you be one of them? Author(s): Gorman C. Source: Time. 2000 July 10; 156(2): 113. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10977414&dopt=Abstract
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Helping heart attack victims to save their own lives. Author(s): Langton PE, Thompson PL. Source: The Medical Journal of Australia. 1997 March 3; 166(5): 228-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9076261&dopt=Abstract
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High intake of sucrose and heart attacks. Author(s): Yudkin J. Source: The American Journal of Clinical Nutrition. 1975 December; 28(12): 1343-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=802990&dopt=Abstract
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Hospitalisation and complications in acute ischaemic heart attacks. Author(s): Radic A, Dean G. Source: Ir Med J. 1977 June 30; 70(10): 299-303. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=881302&dopt=Abstract
·
Hospitals battle heart attacks with new chest pain centers. Author(s): Anderson HJ. Source: Hospitals. 1991 December 20; 65(24): 36-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1743681&dopt=Abstract
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How common are risk factors among young patients suffering heart attacks. Author(s): Mulcahy R, Conroy R. Source: British Medical Journal (Clinical Research Ed.). 1984 November 3; 289(6453): 1228. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6437495&dopt=Abstract
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How frequent and how much alcohol prevents heart attack? Author(s): Dey AB, Choudhury D. Source: Natl Med J India. 1997 November-December; 10(6): 284-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9481101&dopt=Abstract
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How much daily aspirin should I take to prevent a heart attack or stroke? Author(s): Lilly LS. Source: Health News. 2002 July; 8(7): 12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132497&dopt=Abstract
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How much exercise to avoid heart attacks? Author(s): Klumpp TG. Source: Med Times. 1976 April; 104(4): 64-74. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1256260&dopt=Abstract
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How soon after quitting smoking does risk of heart attack decline? Author(s): Dobson AJ, Alexander HM, Heller RF, Lloyd DM. Source: Journal of Clinical Epidemiology. 1991; 44(11): 1247-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1941018&dopt=Abstract
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How to beat back a heart attack? With swift and aggressive counterpunching. Author(s): Comarow A. Source: U.S. News & World Report. 2001 January 15; 130(2): 51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11191962&dopt=Abstract
·
How to survive ten heart attacks. Author(s): Mangrum L. Source: West Med Med J West. 1966 March; 7(3): 56-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5952071&dopt=Abstract
·
Hypertension: possible differential risk for blacks in Beta-Blocker Heart Attack Trial (BHAT). Author(s): Haywood LJ. Source: American Journal of Hypertension : Journal of the American Society of Hypertension. 1989 November; 2(11 Pt 1): 865-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2574045&dopt=Abstract
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Hyperviscosity, unfitness, life stress: other risk factors in heart attack. Author(s): Schiller E. Source: The Medical Journal of Australia. 1979 May 5; 1(9): 400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=470769&dopt=Abstract
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Hyperviscosity, unfitness, life stress: other risk factors in heart attack. Author(s): Lake B. Source: The Medical Journal of Australia. 1979 February 24; 1(4): 127-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=431461&dopt=Abstract
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I am 40 years old and use birth-control pills, but I have gotten nervous because some of my friends say this could cause heart attacks. It is dangerous for me to take the pill? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 1999 January; 9(5): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9916567&dopt=Abstract
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I am married to a 63-year-old accountant who subscribes to the Harvard Men's Health Watch. My husband had a small heart attack last winter. He feels fine now, but he has to take five pills a day. He's back to his golf, and when he doesn't play he walks two miles a day. But he insists on mowing the lawn himself, pushing a heavy mower, and I'm worried. What do you think? Author(s): Simon HB. Source: Harvard Men's Health Watch. 1999 June; 3(11): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10233828&dopt=Abstract
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I ran a marathon. after a heart attack. Author(s): Reed R. Source: J Christ Nurs. 1984 Summer; 1(2): 14-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6564145&dopt=Abstract
·
Identifying men at high risk of heart attacks. Author(s): Mann J, McPherson K. Source: British Medical Journal (Clinical Research Ed.). 1986 September 27; 293(6550): 817-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3094669&dopt=Abstract
·
Identifying men at high risk of heart attacks: strategy for use in general practice. Author(s): Shaper AG, Pocock SJ, Phillips AN, Walker M. Source: British Medical Journal (Clinical Research Ed.). 1986 August 23; 293(6545): 474-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3091165&dopt=Abstract
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Illness behaviour and psychosocial outcome after a heart attack. Author(s): Byrne DG. Source: The British Journal of Clinical Psychology / the British Psychological Society. 1982 June; 21 (Pt 2): 145-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7126953&dopt=Abstract
·
Impact of a health education program and other factors on stopping smoking after heart attack. Author(s): Salonen JT, Hamynen H, Heinonen OP. Source: Scand J Soc Med. 1985; 13(3): 103-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4023664&dopt=Abstract
·
Impact of a national educational campaign to reduce patient delay in possible heart attack. Author(s): Bett N, Aroney G, Thompson P. Source: Aust N Z J Med. 1993 April; 23(2): 157-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8517840&dopt=Abstract
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Impact of community-based education on health care evaluation in patients with acute chest pain syndromes: the Wabasha Heart Attack Team (WHAT) project. Author(s): Wright RS, Kopecky SL, Timm M, Pflaum DD, Carr C, Evers K, Bell J; Wabasha Heart Attack Team. Source: Family Practice. 2001 October; 18(5): 537-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11604379&dopt=Abstract
·
Impact of smoking on heart attacks, strokes, blood pressure control, drug dose, and quality of life aspects in the International Prospective Primary Prevention Study in Hypertension. Author(s): Buhler FR, Vesanen K, Watters JT, Bolli P. Source: American Heart Journal. 1988 January; 115(1 Pt 2): 282-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2892388&dopt=Abstract
·
Implications of discontinuation of doxazosin arm of ALLHAT. Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Author(s): Messerli FH. Source: Lancet. 2000 March 11; 355(9207): 863-4. Erratum In: Lancet 2000 April 8; 355(9211): 1280. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10752699&dopt=Abstract
·
Importance of age in prehospital and hospital mortality of heart attacks. Author(s): Wilcox RG, Hampton JR. Source: British Heart Journal. 1980 November; 44(5): 503-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7437188&dopt=Abstract
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·
Incidence and case fatality rates of acute myocardial infarction (1975-1984): the Worcester Heart Attack Study. Author(s): Goldberg RJ, Gore JM, Alpert JS, Dalen JE. Source: American Heart Journal. 1988 April; 115(4): 761-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3354404&dopt=Abstract
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Increased physical activity: a protective factor against heart attacks in Puerto Rico. Author(s): Garcia-Palmieri MR, Costas R Jr, Cruz-Vidal M, Sorlie PD, Havlik RJ. Source: The American Journal of Cardiology. 1982 October; 50(4): 749-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7124632&dopt=Abstract
·
Infarct as a stress agent: life history and personality characteristics in improved versus not-improved patients after severe heart attack. Author(s): Pancheri P, Bellaterra M, Matteoli S, Cristofari M, Polizzi C, Puletti M. Source: J Human Stress. 1978 March; 4(1): 16-22, 41-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=641335&dopt=Abstract
·
Information women receive about heart attacks and how it affects their knowledge, beliefs, and intentions to act in a cardiac emergency. Author(s): Meischke H, Kuniyuki A, Yasui Y, Bowen DJ, Andersen R, Urban N. Source: Health Care for Women International. 2002 February; 23(2): 149-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11868962&dopt=Abstract
·
Initiative raises use of interventions that prevent second heart attacks. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2000 July 7; 11(14): 8-10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11771563&dopt=Abstract
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Inpatient deaths from acute myocardial infarction, 1982-92: analysis of data in the Nottingham heart attack register. Author(s): Brown N, Young T, Gray D, Skene AM, Hampton JR. Source: Bmj (Clinical Research Ed.). 1997 July 19; 315(7101): 159-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9251546&dopt=Abstract
·
Intervention with heart attack patients and families. Author(s): Sokol B. Source: Soc Casework. 1983 March; 64(3): 162-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10260453&dopt=Abstract
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Intracoronary thrombolysis to abort heart attacks: wave of the future? Author(s): Gonzalez ER. Source: Jama : the Journal of the American Medical Association. 1981 January 2; 245(1): 11-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6448930&dopt=Abstract
·
Investigating heart attacks at work. Author(s): Baxter PJ. Source: J Soc Occup Med. 1980 July; 30(3): 109-12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7431895&dopt=Abstract
·
Is it heart attack or is it GERD? Author(s): Jones KW. Source: Clin Excell Nurse Pract. 1999 March; 3(2): 130-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10646403&dopt=Abstract
·
Is it heart attack, or is it GERD? Author(s): Peters S. Source: Adv Nurse Pract. 1998 May; 6(5): 57-8, 62. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9633293&dopt=Abstract
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Is more rapid diagnosis of heart attack worthwhile? Author(s): Jaffe A. Source: American Family Physician. 1997 June; 55(8): 2591, 2594-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9191444&dopt=Abstract
·
Ischemic heart attacks following cessation of aspirin before coronary artery bypass surgery: A report of two cases. Author(s): Matsuzaki K, Matsui K, Haraguchi N, Nagano I, Okabe H, Asou T. Source: Ann Thorac Cardiovasc Surg. 1999 April; 5(2): 121-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10332118&dopt=Abstract
·
James Mosley remembers his heart attack. Author(s): Mosley JM. Source: Front Nurs Serv Q Bull. 1988 Winter; 63(3): 8-12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3356399&dopt=Abstract
·
Knowledge of heart attack symptoms in a community survey of Victoria. Author(s): Smith KL, Cameron PA, Meyer A, McNeil JJ. Source: Emergency Medicine (Fremantle, W.A.). 2002 September; 14(3): 255-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12487042&dopt=Abstract
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·
Knowledge of heart attack symptoms in a population survey in the United States: The REACT Trial. Rapid Early Action for Coronary Treatment. Author(s): Goff DC Jr, Sellers DE, McGovern PG, Meischke H, Goldberg RJ, Bittner V, Hedges JR, Allender PS, Nichaman MZ. Source: Archives of Internal Medicine. 1998 November 23; 158(21): 2329-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9827784&dopt=Abstract
·
Laragh's lessons in pathophysiology and clinical pearls for treating hypertension. Lesson XXIV: on the major roles of the renin system in the pathogenesis of hypertension and of its sequelae, heart attack, heart failure, kidney failure, and stroke: replies to commonly asked questions. Author(s): Laragh J. Source: American Journal of Hypertension : Journal of the American Society of Hypertension. 2001 August; 14(8 Pt 1): 733-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11497187&dopt=Abstract
·
Learning to recognize heart attack symptoms. Author(s): Inman MA. Source: Nurs Care. 1977 September; 10(9): 26-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=587936&dopt=Abstract
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Legal case briefs for nurses. CO.: black LPN alleges discrimination: civil rights; N.M.: was heart attack job related? Workers' compensation. Author(s): Tammelleo AD. Source: Regan Rep Nurs Law. 1991 May; 31(12): 3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1841400&dopt=Abstract
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Lewis K. Dahl Memorial Lecture. The renin system and four lines fo hypertension research. Nephron heterogeneity, the calcium connection, the prorenin vasodilator limb, and plasma renin and heart attack. Author(s): Laragh JH. Source: Hypertension. 1992 September; 20(3): 267-79. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1516945&dopt=Abstract
·
Life style, genetic factors and the risk of heart attack: the apolipoprotein B gene as an example. Author(s): Humphries SE. Source: Biochemical Society Transactions. 1993 August; 21 ( Pt 3)(3): 569-82. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8224472&dopt=Abstract
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Lifestyle and 15-year survival free of heart attack, stroke, and diabetes in middle-aged British men. Author(s): Wannamethee SG, Shaper AG, Walker M, Ebrahim S. Source: Archives of Internal Medicine. 1998 December 7-21; 158(22): 2433-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9855381&dopt=Abstract
·
Lifestyle changes in New Yorkers after September 11, 2001 (data from the PostDisaster Heart Attack Prevention Program). Author(s): Ho JE, Paultre F, Mosca L. Source: The American Journal of Cardiology. 2002 September 15; 90(6): 680-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12231109&dopt=Abstract
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Limiting heart attack injury. Author(s): Kolata G. Source: Science. 1986 June 6; 232(4755): 1198. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3704646&dopt=Abstract
·
Living with a history of a heart attack: a human science investigation. Author(s): Ford JS. Source: Journal of Advanced Nursing. 1989 March; 14(3): 173-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2715517&dopt=Abstract
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Long-term survival differences among low-anxious, high-anxious and repressive copers enrolled in the Montreal heart attack readjustment trial. Author(s): Frasure-Smith N, Lesperance F, Gravel G, Masson A, Juneau M, Bourassa MG. Source: Psychosomatic Medicine. 2002 July-August; 64(4): 571-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12140346&dopt=Abstract
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Loss of life from heart attacks at different ages. Author(s): Henderson AH, West RR. Source: Lancet. 1987 October 10; 2(8563): 866. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2889076&dopt=Abstract
·
Loss of life from heart attacks at different ages. Author(s): Rawles JM, Haites NE. Source: Lancet. 1987 September 19; 2(8560): 694-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2887985&dopt=Abstract
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Lowered risk of dying of heart attack with third generation pill may offset risk of dying of thromboembolism. Author(s): Lewis MA, Spitzer WO, Heinemann LA, MacRae KD, Bruppacher R. Source: Bmj (Clinical Research Ed.). 1997 September 13; 315(7109): 679-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9310583&dopt=Abstract
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Major outcomes in high-risk hypertensive patients randomized to angiotensinconverting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Author(s): ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Source: Jama : the Journal of the American Medical Association. 2002 December 18; 288(23): 2981-97. Erratum In: Jama 2003 January 8; 289(2): 178. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479763&dopt=Abstract
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Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). Author(s): ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Source: Jama : the Journal of the American Medical Association. 2002 December 18; 288(23): 2998-3007. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12479764&dopt=Abstract
·
Management of myocardial infarction: implications for current policy derived from the Nottingham Heart Attack Register. Author(s): Rowley JM, Mounser P, Harrison EA, Skene AM, Hampton JR. Source: British Heart Journal. 1992 March; 67(3): 255-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1554544&dopt=Abstract
·
Management of patients with diabetes after heart attack: a population-based study of 1982 patients from a heart disease register. Author(s): Lim LL, Tesfay GM, Heller RF. Source: Aust N Z J Med. 1998 June; 28(3): 334-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9673746&dopt=Abstract
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Marriage and the psychological consequences of a heart attack: a longitudinal study of adaptation to chronic illness after 3 years. Author(s): Waltz M, Badura B, Pfaff H, Schott T. Source: Social Science & Medicine (1982). 1988; 27(2): 149-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3175701&dopt=Abstract
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Measuring heart attack care performance: new indices and understanding. Author(s): Bahr RD, Tonascia J. Source: The American Journal of Emergency Medicine. 1996 January; 14(1): 89-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8630167&dopt=Abstract
·
Meta-analysis finds angioplasty more effective than thrombolytic therapy in treating heart attack. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2003 January 24; 14(2): 1-2, 5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12776698&dopt=Abstract
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Mode of referral to hospital of patients with heart attacks: relevance to home care and special ambulance services. Author(s): Hill JD, Hampton JR. Source: British Medical Journal. 1976 October 30; 2(6043): 1035-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=990750&dopt=Abstract
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Molecular mechanism of emotional stress-induced and catecholamine-induced heart attack. Author(s): Ueyama T, Senba E, Kasamatsu K, Hano T, Yamamoto K, Nishio I, Tsuruo Y, Yoshida K. Source: Journal of Cardiovascular Pharmacology. 2003 January; 41 Suppl 1: S115-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12688407&dopt=Abstract
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Mortality in the beta blocker heart attack trial: circumstances surrounding death. Author(s): Peters RW, Byington R, Arensberg D, Friedman LM, Romhilt DW, Barker A, Laubach C, Wilner GW, Goldstein S. Source: J Chronic Dis. 1987; 40(1): 75-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3543049&dopt=Abstract
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My doctor recently recommended that I take low-dose aspirin to minimize the risk of a heart attack or stroke. I routinely take ibuprofen for arthritis pain. Do I need both, and is it safe to combine the two? Author(s): Schafer A. Source: Health News. 2000 January; 6(1): 10. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11019669&dopt=Abstract
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My family dies from heart attacks. How hypercholesterolaemic men refer to their family history. Author(s): Brorsson A, Troein M, Lindbladh E, Selander S, Widlund M, Rastam L. Source: Family Practice. 1995 December; 12(4): 433-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8826061&dopt=Abstract
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My father died of a heart attack when he was 55 years old. I am in my late 40s and so far seem pretty healthy. I even go running five days a week. How important is my family history of heart disease? Author(s): Lee TH. Source: Harvard Heart Letter : from Harvard Medical School. 1998 June; 8(10): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9619140&dopt=Abstract
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National Heart Attack Alert Program position paper: chest pain centers and programs for the evaluation of acute cardiac ischemia. Author(s): Zalenski RJ, Selker HP, Cannon CP, Farin HM, Gibler WB, Goldberg RJ, Lambrew CT, Ornato JP, Rydman RJ, Steele P. Source: Annals of Emergency Medicine. 2000 May; 35(5): 462-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10783408&dopt=Abstract
·
National Heart, Lung, and Blood Institute halts part of antihypertensive and lipidlowering treatment to prevent heart attack trial (ALLHAT) Author(s): SoRelle R. Source: Circulation. 2000 March 28; 101(12): E9025. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10736305&dopt=Abstract
·
Natural history of acute coronary heart attacks. A community study. Author(s): Armstrong A, Duncan B, Oliver MF, Julian DG, Donald KW, Fulton M, Lutz W, Morrison SL. Source: British Heart Journal. 1972 January; 34(1): 67-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5059657&dopt=Abstract
·
Natural history of the first non-Q wave myocardial infarction in the placebo arm of the Beta-Blocker Heart Attack Trial. Author(s): Gheorghiade M, Schultz L, Tilley B, Kao W, Goldstein S. Source: American Heart Journal. 1991 December; 122(6): 1548-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1957749&dopt=Abstract
·
New drugs address risk of heart attack, chances of surviving one. Author(s): Goldsmith MF. Source: Jama : the Journal of the American Medical Association. 1987 December 25; 258(24): 3481. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3119875&dopt=Abstract
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New heart attack treatment discussed. Author(s): Kolata G. Source: Science. 1981 December 11; 214(4526): 1229-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7302592&dopt=Abstract
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New treatment for heart attack. Author(s): Ornato JP. Source: Health News. 2000 July; 6(7): 4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10932642&dopt=Abstract
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New ways to foil heart attacks. Author(s): Faltermayer E. Source: Fortune. 1995 February 20; 131(3): 84-8, 90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10172355&dopt=Abstract
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Nurse rejects heart attack victim: liability. Author(s): Tammelleo AD. Source: Regan Rep Nurs Law. 1986 June; 27(1): 1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3636940&dopt=Abstract
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Nuts do not prevent heart attacks. Author(s): Mirkin G. Source: Archives of Internal Medicine. 1993 January 11; 153(1): 125. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8422196&dopt=Abstract
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Occupational hazards and heart attacks. Author(s): Leigh JP. Source: Social Science & Medicine (1982). 1986; 23(11): 1181-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3810204&dopt=Abstract
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On call. I know that men have more heart disease than women and that athletes who use steroids can have heart attacks. Are male hormones responsible for heart disease in ordinary men like me? Author(s): Simon HB. Source: Harvard Men's Health Watch. 2001 January; 5(6): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11137969&dopt=Abstract
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On call. I've read that aspirin may help prevent colon cancer as well as heart attacks. I take an aspirin every day, and I wonder if it may also help with prostate cancer. Author(s): Simon HB. Source: Harvard Men's Health Watch. 2002 November; 7(4): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12453742&dopt=Abstract
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One thousand heart attacks in Grampian: the place of cardiopulmonary resuscitation in general practice. Author(s): Pai GR, Haites NE, Rawles JM. Source: British Medical Journal (Clinical Research Ed.). 1987 February 7; 294(6568): 3524. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3101873&dopt=Abstract
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Operational aspects of terminating the doxazosin arm of The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Author(s): Pressel SL, Davis BR, Wright JT, Geraci TS, Kingry C, Ford CE, Piller LB, Bettencourt J, Kimmel B, Lusk C, Parks H, Simpson LM, Nwachuku C, Furberg CD; ALLHAT Collaborative Research Group. Source: Controlled Clinical Trials. 2001 February; 22(1): 29-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11165421&dopt=Abstract
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Outpatient cardiology care improves survival odds after heart attack. Author(s): Levenson D. Source: Rep Med Guidel Outcomes Res. 2002 December 13; 13(24): 1-2, 5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12747365&dopt=Abstract
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Overview: diagnosing acute cardiac ischemia in the emergency department. A report from the National Heart Attack Alert Program. Author(s): Ornato JP, Selker HP, Zalenski RJ. Source: Annals of Emergency Medicine. 2001 May; 37(5): 450-2. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11326180&dopt=Abstract
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Pain is not the only feature of heart attack. Author(s): Treasure T. Source: Bmj (Clinical Research Ed.). 1998 August 29; 317(7158): 602-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9721131&dopt=Abstract
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Parental death from heart disease and the risk of heart attack. Author(s): Phillips AN, Shaper AG, Pocock SJ, Walker M. Source: European Heart Journal. 1988 March; 9(3): 243-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3383865&dopt=Abstract
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Participant recruitment in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Author(s): Pressel S, Davis BR, Louis GT, Whelton P, Adrogue H, Egan D, Farber M, Payne G, Probstfield J, Ward H; ALLHAT Research Group. Source: Controlled Clinical Trials. 2001 December; 22(6): 674-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11738123&dopt=Abstract
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Passive smoking and the risk of heart attack or coronary death. Author(s): Dobson AJ, Alexander HM, Heller RF, Lloyd DM. Source: The Medical Journal of Australia. 1991 June 17; 154(12): 793-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2041503&dopt=Abstract
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Paternal history of heart attack in marathoners. Author(s): Paffenbarger RS. Source: The New England Journal of Medicine. 1980 January 3; 302(1): 56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7350400&dopt=Abstract
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Patient delay in seeking care for heart attack symptoms: findings from focus groups conducted in five U.S. regions. Author(s): Finnegan JR Jr, Meischke H, Zapka JG, Leviton L, Meshack A, BenjaminGarner R, Estabrook B, Hall NJ, Schaeffer S, Smith C, Weitzman ER, Raczynski J, Stone E. Source: Preventive Medicine. 2000 September; 31(3): 205-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10964634&dopt=Abstract
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Patients' perceptions of their heart attack and recovery: the influence of epidemiological “evidence” and personal experience. Author(s): Wiles R. Source: Social Science & Medicine (1982). 1998 June; 46(11): 1477-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9665577&dopt=Abstract
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Patients' understandings of heart attack: implications for prevention of recurrence. Author(s): Wiles R, Kinmonth A. Source: Patient Education and Counseling. 2001 August; 44(2): 161-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11479056&dopt=Abstract
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Patterns of illness behavior following heart attack. Author(s): Byrne DG. Source: Psychiatr Med. 1987; 5(2): 153-62. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3685424&dopt=Abstract
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Pennsylvania's Focus on Heart Attack--grading the scorecard. Author(s): Jollis JG, Romano PS. Source: The New England Journal of Medicine. 1998 April 2; 338(14): 983-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9521989&dopt=Abstract
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Perceptions of multiple risk factors for heart attacks. Author(s): French DP, Marteau TM, Senior V, Weinman J. Source: Psychological Reports. 2000 October; 87(2): 681-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11086623&dopt=Abstract
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Perspectives on trends in mortality and case fatality from coronary heart attacks: the need for a better definition of acute myocardial infarction. Author(s): Tunstall-Pedoe H. Source: Heart (British Cardiac Society). 1998 August; 80(2): 112-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9813552&dopt=Abstract
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Physical activity as an index of heart attack risk in college alumni. Author(s): Paffenbarger RS Jr, Wing AL, Hyde RT. Source: American Journal of Epidemiology. 1978 September; 108(3): 161-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=707484&dopt=Abstract
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Physical activity as an index of heart attack risk in college alumni. 1978. Author(s): Paffenbarger RS Jr, Wing AL, Hyde RT. Source: American Journal of Epidemiology. 1995 November 1; 142(9): 889-903; Discussion 887-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7572969&dopt=Abstract
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Physical activity, hypertension and risk of heart attack in men without evidence of ischaemic heart disease. Author(s): Shaper AG, Wannamethee G, Walker M. Source: Journal of Human Hypertension. 1994 January; 8(1): 3-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8151604&dopt=Abstract
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Physician-focused disease management program contributes to reductions in heart attacks. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2002 January 25; 13(2): 1-2, 5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12425317&dopt=Abstract
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Planning for primary prevention of heart attacks: a symposium on consumer health education. Author(s): Hellmuth GA. Source: Wis Med J. 1972 August; 71(8): 18-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5053662&dopt=Abstract
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Platelet/endothelial biomarkers in depressed patients treated with the selective serotonin reuptake inhibitor sertraline after acute coronary events: the Sertraline AntiDepressant Heart Attack Randomized Trial (SADHART) Platelet Substudy. Author(s): Serebruany VL, Glassman AH, Malinin AI, Nemeroff CB, Musselman DL, van Zyl LT, Finkel MS, Krishnan KR, Gaffney M, Harrison W, Califf RM, O'Connor CM; Sertraline AntiDepressant Heart Attack Randomized Trial Study Group. Source: Circulation. 2003 August 26; 108(8): 939-44. Epub 2003 Aug 11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12912814&dopt=Abstract
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Postictal ECG: aneurysm or heart attack? Author(s): Maity CK. Source: Hosp Med. 2001 December; 62(12): 790. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11810744&dopt=Abstract
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Postmenopausal hormone therapy offers no protection against heart attacks. Author(s): American Medical Association. Source: Ginecologia Y Obstetricia De Mexico. 2002 August; 70: 404-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12448045&dopt=Abstract
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Prediction of acute heart attacks. Author(s): Oliver MF. Source: Scott Med J. 1977 January; 22(1): 42-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=836571&dopt=Abstract
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Prediction of emotional and social outcome after a heart attack. Author(s): Mayou R. Source: Journal of Psychosomatic Research. 1984; 28(1): 17-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6716324&dopt=Abstract
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Prediction of men at high risk of heart attack and its relevance to pilots. Author(s): Pocock SJ, Shaper AG, Phillips AN, Walker M. Source: European Heart Journal. 1988 May; 9 Suppl G: 25-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3402493&dopt=Abstract
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Predictors of quality of life after hospital admission for heart attack or angina. Author(s): Heller RF, Lim L, Valenti L, Knapp J. Source: International Journal of Cardiology. 1997 April 18; 59(2): 161-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9158169&dopt=Abstract
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Prehospital delay in patients hospitalized with heart attack symptoms in the United States: the REACT trial. Rapid Early Action for Coronary Treatment (REACT) Study Group. Author(s): Goff DC Jr, Feldman HA, McGovern PG, Goldberg RJ, Simons-Morton DG, Cornell CE, Osganian SK, Cooper LS, Hedges JR. Source: American Heart Journal. 1999 December; 138(6 Pt 1): 1046-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10577434&dopt=Abstract
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Prehospital emergency care of the heart attack patient. Author(s): Stolfi JE. Source: Md State Med J. 1973 September; 22(9): 94-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4774195&dopt=Abstract
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Pre-hospital emergency care of the heart attack patient. Author(s): Stolfi JE. Source: J S C Med Assoc. 1972 December; 68(12): 468-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4509790&dopt=Abstract
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Premature parental heart attack is heralding elevated risk in their offspring. Author(s): Rumboldt M, Rumboldt Z, Pesenti S. Source: Coll Antropol. 2003 June; 27(1): 221-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12974150&dopt=Abstract
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Prevalence of coronary occlusion and outcome of an immediate invasive strategy in suspected acute myocardial infarction with and without ST-segment elevation. Author(s): Koyama Y, Hansen PS, Hanratty CG, Nelson GI, Rasmussen HH. Source: The American Journal of Cardiology. 2002 September 15; 90(6): 579-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12231080&dopt=Abstract
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Preventing heart attack and death in patients with coronary disease. Author(s): Smith SC Jr, Blair SN, Criqui MH, Fletcher GF, Fuster V, Gersh BJ, Gotto AM, Gould KL, Greenland P, Grundy SM, et al. Source: Circulation. 1995 July 1; 92(1): 2-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7788911&dopt=Abstract
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Preventing heart attack and death in patients with coronary disease. Endorsed by the board of trustees of the American College of Cardiology. Author(s): Smith SC Jr, Blair SN, Criqui MH, Fletcher GF, Fuster V, Gersh BJ, Gotto AM, Gould KL, Greenland P, Grundy SM, Hill MN, Hlatky MA, Houston-Miller N, Krauss RM, LaRosa J, Ockene IS, Oparil S, Pearson TA, Rapaport E, Starke RD. Source: Cardiovasc Nurs. 1996 July-August; 32(4): 26-8. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8846481&dopt=Abstract
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Preventing heart attacks. Author(s): Streiffer RH. Source: Southern Medical Journal. 1984 September; 77(9): 1216. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6484706&dopt=Abstract
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Preventing heart attacks. Author(s): Ball K. Source: Lancet. 1984 June 23; 1(8391): 1412. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6145864&dopt=Abstract
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Prevention of heart attacks. A multifactorial preventive trial in Gothenburg, Sweden. Author(s): Werko L. Source: Ann Clin Res. 1979 April; 11(2): 71-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=453782&dopt=Abstract
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Primary prevention of heart attack. Author(s): Morris JN. Source: Bull N Y Acad Med. 1975 January; 51(1): 62-74. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1054279&dopt=Abstract
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Primary prevention of heart attacks: the multiple risk factor intervention trial. Author(s): Kuller L, Neaton J, Caggiula A, Falvo-Gerard L. Source: American Journal of Epidemiology. 1980 August; 112(2): 185-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6998287&dopt=Abstract
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Prodromal symptoms of heart attacks. Author(s): Bahr RD. Source: Journal of the American College of Cardiology. 1992 September; 20(3): 751-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1512360&dopt=Abstract
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Prognosis of acute myocardial infarction complicated by complete heart block (the Worcester Heart Attack Study). Author(s): Goldberg RJ, Zevallos JC, Yarzebski J, Alpert JS, Gore JM, Chen Z, Dalen JE. Source: The American Journal of Cardiology. 1992 May 1; 69(14): 1135-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1575181&dopt=Abstract
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Prognostic significance of electrocardiographic persistent ST depression in patients with their first myocardial infarction in the placebo arm of the Beta-Blocker Heart Attack Trial. Author(s): Gheorghiade M, Shivkumar K, Schultz L, Jafri S, Tilley B, Goldstein S. Source: American Heart Journal. 1993 August; 126(2): 271-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8337995&dopt=Abstract
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Program improves compliance with heart attack guidelines. Author(s): Levenson D. Source: Rep Med Guidel Outcomes Res. 2002 April 5; 13(7): 9-10, 12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452173&dopt=Abstract
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Propranolol and the morning increase in sudden cardiac death: (the beta-blocker heart attack trial experience). Author(s): Peters RW. Source: The American Journal of Cardiology. 1990 November 6; 66(16): 57G-59G. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2239715&dopt=Abstract
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Propranolol therapy in patients with acute myocardial infarction: the Beta-Blocker Heart Attack Trial. Author(s): Goldstein S. Source: Circulation. 1983 June; 67(6 Pt 2): I53-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6342840&dopt=Abstract
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Propranolol-induced lipid changes and their prognostic significance after a myocardial infarction: the Beta-Blocker Heart Attack Trial experience. Author(s): Byington RP, Worthy J, Craven T, Furberg CD. Source: The American Journal of Cardiology. 1990 June 1; 65(20): 1287-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2188492&dopt=Abstract
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Psychological reactions of hospitalized male patients to a heart attack. Age and socialclass differences. Author(s): Rosen JL, Bibring GL. Source: Psychosomatic Medicine. 1966 November-December; 28(6): 808-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5972494&dopt=Abstract
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Psychological status during recovery from an acute heart attack. Author(s): Cay EL, Vetter N, Philip AE, Dugard P. Source: Journal of Psychosomatic Research. 1972 October; 16(6): 425-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4666660&dopt=Abstract
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Psychological stress and fatal heart attack: the Athens (1981) earthquake natural experiment. Author(s): Trichopoulos D, Katsouyanni K, Zavitsanos X, Tzonou A, Dalla-Vorgia P. Source: Lancet. 1983 February 26; 1(8322): 441-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6131167&dopt=Abstract
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Public beliefs about causes and prevention of heart attacks. Author(s): Shekelle RB, Liu SC. Source: Jama : the Journal of the American Medical Association. 1978 August 25; 240(8): 756-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=671706&dopt=Abstract
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Public education program on the early warning signs of coronary heart attack. Author(s): McWhorter HB. Source: J Ky Med Assoc. 1974 February; 72(2): 85-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4812308&dopt=Abstract
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Public information and heart attack. Report of an educational program. Author(s): Black LA, Brown DD. Source: Ohio State Med J. 1973 May; 69(5): 369-74. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4708967&dopt=Abstract
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Publicity on beta-blocker heart attack trial criticised. Author(s): Pickering TG. Source: The New England Journal of Medicine. 1982 February 11; 306(6): 371-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6119613&dopt=Abstract
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Publicity on the beta-blocker heart attack trial (continued) Author(s): Frommer PL. Source: The New England Journal of Medicine. 1982 June 24; 306(25): 1553-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6123081&dopt=Abstract
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Quality of life and later adverse health outcomes in patients with suspected heart attack. Author(s): Lim LL, Johnson NA, O'Connell RL, Heller RF. Source: Aust N Z J Public Health. 1998 August; 22(5): 540-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9744206&dopt=Abstract
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Rationale and design for the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). ALLHAT Research Group. Author(s): Davis BR, Cutler JA, Gordon DJ, Furberg CD, Wright JT Jr, Cushman WC, Grimm RH, LaRosa J, Whelton PK, Perry HM, Alderman MH, Ford CE, Oparil S, Francis C, Proschan M, Pressel S, Black HR, Hawkins CM. Source: American Journal of Hypertension : Journal of the American Society of Hypertension. 1996 April; 9(4 Pt 1): 342-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8722437&dopt=Abstract
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Recent changes in attack and survival rates of acute myocardial infarction (1975 through 1981). The Worcester Heart Attack Study. Author(s): Goldberg RJ, Gore JM, Alpert JS, Dalen JE. Source: Jama : the Journal of the American Medical Association. 1986 May 23-30; 255(20): 2774-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3701991&dopt=Abstract
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Recent trends in hospital mortality of acute myocardial infarction--the Worcester Heart Attack Study. Have improvements been realized for all age groups? Author(s): Gurwitz JH, Goldberg RJ, Chen Z, Gore JM, Alpert JS. Source: Archives of Internal Medicine. 1994 October 10; 154(19): 2202-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7944841&dopt=Abstract
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Recognising “painless” heart attacks. Author(s): Wong CK, White HD. Source: Heart (British Cardiac Society). 2002 January; 87(1): 3-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11751649&dopt=Abstract
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Recognizing a heart attack: the process of determining illness. Author(s): Scherck KA. Source: American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses. 1997 July; 6(4): 267-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9215423&dopt=Abstract
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Recovery from a heart attack. Author(s): Bethell H. Source: Practitioner. 1990 July 16; 234(1492): 705-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2217069&dopt=Abstract
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Recruitment of African-American patients for clinical trials--the Allhat challenges. Antihypertensive and Lipid-lowering Trial to Prevent Heart Attack. Author(s): Saunders E. Source: Journal of the National Medical Association. 1995 August; 87(8 Suppl): 627-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7674359&dopt=Abstract
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Reducing the blood cholesterol level reduces the risk of heart attack. Author(s): Roberts WC. Source: The American Journal of Cardiology. 1984 February 1; 53(4): 649. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6364765&dopt=Abstract
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Reduction of ischemic heart disease risk markers in the teenage children of heart attack patients. Author(s): Walker R, Heller R, Redman S, O'Connell D, Boulton J. Source: Preventive Medicine. 1992 September; 21(5): 616-29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1438110&dopt=Abstract
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Refractory hypotension after heart attack. Author(s): Frierson JH, Winkler TR, Runckel DN, Carey TJ. Source: Hosp Pract (Off Ed). 1994 February 15; 29(2): 111-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8300759&dopt=Abstract
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Regulating information about aspirin and the prevention of heart attack. Author(s): Keith A. Source: The American Economic Review. 1995 May; 85(2): 96-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10160518&dopt=Abstract
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Rehabilitation after heart attack. Author(s): Bundy C. Source: Bmj (Clinical Research Ed.). 1997 March 29; 314(7085): 979-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9099144&dopt=Abstract
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Rehabilitation after heart attack. Author(s): Mayou R. Source: Bmj (Clinical Research Ed.). 1996 December 14; 313(7071): 1498-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8978216&dopt=Abstract
Studies 103
·
Relationship of antihypertensive treatment regimens and change in blood pressure to risk for heart failure in hypertensive patients randomly assigned to doxazosin or chlorthalidone: further analyses from the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial. Author(s): Davis BR, Cutler JA, Furberg CD, Wright JT, Farber MA, Felicetta JV, Stokes JD; ALLHAT Collaborative Research Group. Source: Annals of Internal Medicine. 2002 September 3; 137(5 Part 1): 313-20. Summary for Patients In: http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12204014&dopt=Abstract
·
Reminders boost heart attack guideline compliance. Author(s): Levenson D. Source: Rep Med Guidel Outcomes Res. 2003 April 18; 14(8): 7-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12854530&dopt=Abstract
·
Respiratory disease and heart attacks among rural workers in Ireland and other countries of the European Economic Community. Author(s): Dean G. Source: Ir Med J. 1982 September; 75(9): 338-42. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7141851&dopt=Abstract
·
Retiring may predispose to fatal heart attack. Author(s): Gonzalez ER. Source: Jama : the Journal of the American Medical Association. 1980 January 4; 243(1): 13-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7350326&dopt=Abstract
·
Return to work after a heart attack. Author(s): Cay EL, Vetter N, Philip A, Dugard P. Source: Journal of Psychosomatic Research. 1973 July; 17(3): 231-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4746346&dopt=Abstract
·
Revascularization and heart attack outcomes. Author(s): Johansen H, Nair C, Mao L, Wolfson M. Source: Health Reports / Statistics Canada, Canadian Centre for Health Information = Rapports Sur La Sante / Statistique Canada, Centre Canadien D'information Sur La Sante. 2002; 13(2): 35-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12743955&dopt=Abstract
104 Heart Attack
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Risk factors for fatal heart attack in young women. Author(s): Krueger DE, Ellenberg SS, Bloom S, Calkins BM, Jacyna R, Nolan DC, Phillips R, Rios JC, Sobieski R, Shekelle RB, Spector KM, Stadel BV, Stolley PD, Terris M. Source: American Journal of Epidemiology. 1981 April; 113(4): 357-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7211821&dopt=Abstract
·
Risk of a coronary heart attack in the normal population and how it might be modified in flyers. Author(s): Tunstall-Pedoe H. Source: European Heart Journal. 1984 March; 5 Suppl A: 43-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6373281&dopt=Abstract
·
Risko: A way to alert you to the risks of heart attack. Author(s): Hirschi RG. Source: Your Okla Dent Assoc J. 1975 April; 65(4): 9-11. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1074014&dopt=Abstract
·
Role of renin secretion and kidney function in hypertension and attendant heart attack and stroke. Author(s): Laragh JH. Source: Clin Exp Hypertens A. 1992; 14(1-2): 285-305. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1541042&dopt=Abstract
·
Saving the victims of heart attacks. Author(s): Pisa Z. Source: Who Chron. 1977 January; 31(1): 25-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=842009&dopt=Abstract
·
Secondary prevention in elderly survivors of heart attacks. Author(s): Davenport J, Whittaker K. Source: American Family Physician. 1988 July; 38(1): 216-24. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2899386&dopt=Abstract
·
Self-reported heart attack in Mexican-American elders: examination of incidence, prevalence, and 7-year mortality. Author(s): Otiniano ME, Ottenbacher KJ, Markides KS, Ray LA, Du XL. Source: Journal of the American Geriatrics Society. 2003 July; 51(7): 923-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12834511&dopt=Abstract
Studies 105
·
Serum total homocysteine concentration is related to self-reported heart attack or stroke history among men and women in the NHANES III. Author(s): Morris MS, Jacques PF, Rosenberg IH, Selhub J, Bowman BA, Gunter EW, Wright JD, Johnson CL. Source: The Journal of Nutrition. 2000 December; 130(12): 3073-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11110872&dopt=Abstract
·
Severity of heart attacks in US may be declining. Author(s): Charatan F. Source: Bmj (Clinical Research Ed.). 1999 April 3; 318(7188): 896. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10102848&dopt=Abstract
·
Sexual healing after heart attack. Author(s): McCann ME. Source: The American Journal of Nursing. 1989 September; 89(9): 1133-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2774016&dopt=Abstract
·
Short stature, lung function and risk of a heart attack. Author(s): Walker M, Shaper AG, Phillips AN, Cook DG. Source: International Journal of Epidemiology. 1989 September; 18(3): 602-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2807663&dopt=Abstract
·
Should every survivor of a heart attack be given a beta blocker? Part II. Evidence from a clinical pharmacological standpoint. Author(s): Breckenridge A. Source: British Medical Journal (Clinical Research Ed.). 1982 July 3; 285(6334): 37-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6123366&dopt=Abstract
·
Should every survivor of a heart attack be given a beta-blocker? Author(s): Furberg C, Friedman L, Cutler J. Source: British Medical Journal (Clinical Research Ed.). 1982 September 11; 285(6343): 738-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6125235&dopt=Abstract
·
Should every survivor of a heart attack be given a beta-blocker? Part I. Evidence from clinical trials. Author(s): Hampton JR. Source: British Medical Journal (Clinical Research Ed.). 1982 July 3; 285(6334): 33-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6123365&dopt=Abstract
106 Heart Attack
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Should every survivor of a heart attack be given a beta-blocker? Part III. Some conclusions. Author(s): Rose G. Source: British Medical Journal (Clinical Research Ed.). 1982 July 3; 285(6334): 39-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6123367&dopt=Abstract
·
Snow fall and heart attacks. Author(s): Persinger MA, Ballance SE, Moland M. Source: The Journal of Psychology. 1993 March; 127(2): 243-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8336299&dopt=Abstract
·
Social networks and support during the crisis of heart attack. Author(s): Dhooper SS. Source: Health & Social Work. 1984 Fall; 9(4): 294-303. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6510832&dopt=Abstract
·
Soft water, heart attacks, and stroke. Author(s): Shaper AG. Source: Jama : the Journal of the American Medical Association. 1974 October 7; 230(1): 130-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4479283&dopt=Abstract
·
Statistical aspects of early termination in the beta-blocker heart attack trial. Author(s): DeMets DL, Hardy R, Friedman LM, Lan KK. Source: Controlled Clinical Trials. 1984 December; 5(4): 362-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6151482&dopt=Abstract
·
Stressful life events: a predictor in recovery from heart attacks. Author(s): Ell KO, de Guzman M, Haywood LJ. Source: Health & Social Work. 1983 Spring; 8(2): 133-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6884875&dopt=Abstract
·
Stroke and heart attack prevention education. Author(s): Penney JB, Hahn JL. Source: Medsurg Nursing : Official Journal of the Academy of Medical-Surgical Nurses. 1994 December; 3(6): 459-64, 490. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7874208&dopt=Abstract
·
Study suggests two cardiac procedures increase risk of death after heart attack. Author(s): Burda D. Source: Modern Healthcare. 1990 August 20; 20(33): 4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10105810&dopt=Abstract
Studies 107
·
Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). Author(s): Cushman WC, Ford CE, Cutler JA, Margolis KL, Davis BR, Grimm RH, Black HR, Hamilton BP, Holland J, Nwachuku C, Papademetriou V, Probstfield J, Wright JT Jr, Alderman MH, Weiss RJ, Piller L, Bettencourt J, Walsh SM; ALLHAT Collaborative Research Group. Source: Journal of Clinical Hypertension (Greenwich, Conn.). 2002 NovemberDecember; 4(6): 393-405. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12461301&dopt=Abstract
·
Success of cardiopulmonary resuscitation after heart attack in hospital and outside hospital. Author(s): Heller RF, Steele PL, Fisher JD, Alexander HM, Dobson AJ. Source: Bmj (Clinical Research Ed.). 1995 November 18; 311(7016): 1332-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7496282&dopt=Abstract
·
Survey of general practitioners' attitudes to management of patients with heart attacks. Author(s): Hampton JR, Morris GK, Mason C. Source: British Medical Journal. 1975 October 18; 4(5989): 146-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1191971&dopt=Abstract
·
Survival analysis of adverse effects data in the Beta-Blocker Heart Attack Trial. Author(s): Davis BR, Furberg CD, Williams CB. Source: Clinical Pharmacology and Therapeutics. 1987 June; 41(6): 611-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3555942&dopt=Abstract
·
Tachycardia three months after a heart attack. Author(s): Hancock EW. Source: Hosp Pract (Off Ed). 1991 February 15; 26(2): 21-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1899252&dopt=Abstract
·
Technologies of the future: treating a heart attack in the year 2000--what the patient can expect. Author(s): Holmes B. Source: Imprint. 1991 February-March; 38(1): 39-42. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1995462&dopt=Abstract
108 Heart Attack
·
Temporal trends and factors associated with extent of delay to hospital arrival in patients with acute myocardial infarction: the Worcester Heart Attack Study. Author(s): Yarzebski J, Goldberg RJ, Gore JM, Alpert JS. Source: American Heart Journal. 1994 August; 128(2): 255-63. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8037091&dopt=Abstract
·
Termination of clinical trials: the beta-blocker heart attack trial and the hypertension detection and follow-up program experience. Author(s): Bell RL, Curb JD, Friedman LM, Payne GH. Source: Controlled Clinical Trials. 1985 June; 6(2): 102-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4006483&dopt=Abstract
·
Tests may speed heart attack diagnosis. Author(s): Hensley S. Source: Modern Healthcare. 1999 June 7; 29(23): 48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10537922&dopt=Abstract
·
The annual oration. Changing views on the heart attack. Author(s): Julian D. Source: Trans Med Soc Lond. 1987-88; 104: 149-53. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3078391&dopt=Abstract
·
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT): ALL predictable, and no big surprise out of a HAT? Author(s): Beevers DG, Lee KW, Lip GY. Source: Journal of Human Hypertension. 2003 June; 17(6): 367-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12764397&dopt=Abstract
·
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT): clinical center recruitment experience. Author(s): Wright JT Jr, Cushman WC, Davis BR, Barzilay J, Colon P, Egan D, Lucente T, Nwachuku C, Pressel S, Leenen FH, Frolkis J, Letterer R, Walsh S, Tobin JN, Deger GE; ALLHAT Research Group. Source: Controlled Clinical Trials. 2001 December; 22(6): 659-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11738122&dopt=Abstract
·
The beta blocker heart attack trial: at last, an effective medical therapy to prevent death from coronary heart disease. Author(s): Goldstein S. Source: Henry Ford Hosp Med J. 1982; 30(3): 173-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6131053&dopt=Abstract
Studies 109
·
The Beta Blocker Heart Attack Trial: recruitment experience. Author(s): Goldstein S, Byington R. Source: Controlled Clinical Trials. 1987 December; 8(4 Suppl): 79S-85S. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2894282&dopt=Abstract
·
The Beta-Blocker Heart Attack Trial in perspective. Author(s): Goldstein S. Source: Cardiology. 1983; 70(5): 255-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6141847&dopt=Abstract
·
The Beta-blocker Heart Attack Trial. Author(s): Furberg CD. Source: Zeitschrift Fur Kardiologie. 1985; 74 Suppl 6: 159-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2869615&dopt=Abstract
·
The beta-blocker heart attack trial. Author(s): Furberg C. Source: British Journal of Clinical Pharmacology. 1982; 14 Suppl 1: 3S-5S. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6126206&dopt=Abstract
·
THe beta-Blocker Heart Attack Trial: studies of platelets and factor VIII. Author(s): Green D, Rossi EC, Haring O. Source: Thrombosis Research. 1982 October 15; 28(2): 261-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6129719&dopt=Abstract
·
The changing paradigm of acute heart attack prevention in the emergency department: a futuristic viewpoint? Author(s): Bahr RD. Source: Annals of Emergency Medicine. 1995 January; 25(1): 95-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7802379&dopt=Abstract
·
The chest pain center strategy for delivering community heart attack care by shifting the paradigm of heart attack care to earlier detection and treatment. Author(s): Bahr RD. Source: Preventive Cardiology. 2002 Winter; 5(1): 16-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11872987&dopt=Abstract
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The clinical course of patients with acute myocardial infarction who are unsuitable for thrombolytic therapy because of the presenting electrocardiogram. UK Heart Attack Study Investigators. Author(s): Wong PS, el Gaylani N, Griffith K, Dixon G, Robinson DR, Norris RM. Source: Coronary Artery Disease. 1998; 9(11): 747-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9919422&dopt=Abstract
·
The combined role of atheroma, cholesterol, platelets, the endothelium and fibrin in heart attacks and strokes. Author(s): Martin W. Source: Medical Hypotheses. 1984 November; 15(3): 305-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6521675&dopt=Abstract
·
The concept and the development of chest pain emergency departments as a strategy in the war against heart attack. Author(s): Bahr RD. Source: Critical Care Nursing Clinics of North America. 1998 March; 10(1): 41-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9644347&dopt=Abstract
·
The critical period of heart attack. Author(s): Bacos JM, Mattingly TW. Source: Journal of Rehabilitation. 1966 March-April; 32(2): 29-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5906535&dopt=Abstract
·
The early heart attack care strategy in the war against heart attack deaths utilizing the chest pain center approach in emergency departments. Author(s): Bahr RD. Source: Md Med J. 1997; Suppl: 9-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9470337&dopt=Abstract
·
The early stages of an acute ischaemic heart attack. Author(s): Radic A, Dean G. Source: Ir Med J. 1976 September 18; 69(14): 369-74. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1002418&dopt=Abstract
·
The effect of a media campaign on heart attack delay and decision times. Author(s): Mitic WR, Perkins J. Source: Canadian Journal of Public Health. Revue Canadienne De Sante Publique. 1984 November-December; 75(6): 414-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6525584&dopt=Abstract
Studies 111
·
The effect of psychological intervention on recovery from surgery and heart attacks: an analysis of the literature. Author(s): Mumford E, Schlesinger HJ, Glass GV. Source: American Journal of Public Health. 1982 February; 72(2): 141-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7055315&dopt=Abstract
·
The EHAC (early heart attack care) strategy: Citizens Chart the Course for Healthy People in the Year 2000. Author(s): Bahr RD. Source: J Cardiovasc Manag. 1995 May-June; 6(3): 19-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10143350&dopt=Abstract
·
The etiology of myocardial infarction--with special reference to cigarette smoking among young coronary patients and those with second heart attacks. Author(s): Doerken H. Source: Natl Cancer Inst Monogr. 1968 June; 28: 21-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5671405&dopt=Abstract
·
The experiences of patients and their partners 1 month after a heart attack. Author(s): Thompson DR, Ersser SJ, Webster RA. Source: Journal of Advanced Nursing. 1995 October; 22(4): 707-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8708190&dopt=Abstract
·
The heart attack and doctor/patient communication. Author(s): Thompson PL, Wark J, Garland S. Source: The Medical Journal of Australia. 1976 February 7; 1(6): 166-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1263972&dopt=Abstract
·
The 'Heart Attack Survival Kit' project: an intervention designed to increase seniors' intentions to respond appropriately to symptoms of acute myocardial infarction. Author(s): Meischke H, Eisenberg M, Schaeffer S, Henwood DK. Source: Health Education Research. 2000 June; 15(3): 317-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10977379&dopt=Abstract
·
The heart patient after hospitalization: social and psychological factors in life after a heart attack. Author(s): Croog SH. Source: Conn Med. 1984 October; 48(10): 633-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6488788&dopt=Abstract
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The helping process in couples during recovery from heart attack: a single case study. Author(s): Pistrang N, Clare L, Baker C. Source: The British Journal of Medical Psychology. 1999 June; 72 ( Pt 2): 227-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10397427&dopt=Abstract
·
The impact of age on the incidence and prognosis of initial acute myocardial infarction: the Worcester Heart Attack Study. Author(s): Goldberg RJ, Gore JM, Gurwitz JH, Alpert JS, Brady P, Strohsnitter W, Chen ZY, Dalen JE. Source: American Heart Journal. 1989 March; 117(3): 543-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2919534&dopt=Abstract
·
The impact of education and heart attack on smoking cessation among middle-aged adults. Author(s): Wray LA, Herzog AR, Willis RJ, Wallace RB. Source: Journal of Health and Social Behavior. 1998 December; 39(4): 271-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9919852&dopt=Abstract
·
The joy of sex after a heart attack: counseling the cardiac patient. Author(s): Moore K, Folk-Lighty M, Nolen MJ. Source: Nursing. 1984 April; 14(4): 104-8, 111, 113. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6561419&dopt=Abstract
·
The joy of sex after a heart attack; counseling the cardiac patient. Author(s): Moore K, Lighty MF, Nolen MJ. Source: Nursing. 1977 June; 7(6): 53-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=585791&dopt=Abstract
·
The jury is still out: aspirin medication for heart attack prevention. Author(s): Krantz JC Jr. Source: Am Pharm. 1979 January; 19(1): 14-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=758750&dopt=Abstract
·
The meaning of a heart attack to some patients. Author(s): Nahum LH. Source: Conn Med. 1966 March; 30(3): 169-70. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5929943&dopt=Abstract
·
The metabolic responses to a heart attack. Author(s): Oliver MF. Source: Heart & Lung : the Journal of Critical Care. 1975 January-February; 4(1): 57-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1037694&dopt=Abstract
Studies 113
·
The Montreal Heart Attack Readjustment Trial. Author(s): Frasure-Smith N. Source: Journal of Cardiopulmonary Rehabilitation. 1995 March-April; 15(2): 103-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8542512&dopt=Abstract
·
The natural history of acute heart attacks. Cape general practitioner series. Author(s): Levenstein JH. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1982 June 5; 61(23): 863-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7079913&dopt=Abstract
·
The physician's role in minimizing prehospital delay in patients at high risk for acute myocardial infarction: recommendations from the National Heart Attack Alert Program. Working Group on Educational Strategies To Prevent Prehospital Delay in Patients at High Risk for Acute Myocardial Infarction. Author(s): Dracup K, Alonzo AA, Atkins JM, Bennett NM, Braslow A, Clark LT, Eisenberg M, Ferdinand KC, Frye R, Green L, Hill MN, Kennedy JW, Kline-Rogers E, Moser DK, Ornato JP, Pitt B, Scott JD, Selker HP, Silva SJ, Thies W, Weaver WD, Wenger NK, White SK. Source: Annals of Internal Medicine. 1997 April 15; 126(8): 645-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9103133&dopt=Abstract
·
The prevention of heart attacks. Author(s): Christie D. Source: Physiotherapy. 1972 October; 58(10): 348-51. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=5077701&dopt=Abstract
·
The relationship between blood lead, blood pressure, stroke, and heart attacks in middle-aged British men. Author(s): Pocock SJ, Shaper AG, Ashby D, Delves HT, Clayton BE. Source: Environmental Health Perspectives. 1988 June; 78: 23-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3203640&dopt=Abstract
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The role of risk factors in heart attacks occurring in men with pre-existing ischaemic heart disease. Author(s): Phillips AN, Shaper AG, Pocock SJ, Walker M, Macfarlane PW. Source: British Heart Journal. 1988 November; 60(5): 404-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3203034&dopt=Abstract
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The stress of excellence. Why our best decision-makers may face the greatest risk of heart attacks. Author(s): Streufert S. Source: Across Board (Ny). 1983 October; 20(9): 8-16. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10263062&dopt=Abstract
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The structure of readjustment after heart attack. Author(s): Ben-Sira Z, Eliezer R. Source: Social Science & Medicine (1982). 1990; 30(5): 523-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2309133&dopt=Abstract
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The time of onset of heart attacks. Author(s): Thompson D. Source: Nursing Standard : Official Newspaper of the Royal College of Nursing. 1992 February 5-11; 6(20): 33-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1547093&dopt=Abstract
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The two-day “heart attack” which may save your life. Author(s): Blitzer MH. Source: The New York State Dental Journal. 1978 October; 44(8): 324-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=280812&dopt=Abstract
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Therapeutic trends in the management of patients with acute myocardial infarction (1975-1984): the Worcester Heart Attack Study. Author(s): Goldberg RJ, Gore JM, Alpert JS, Dalen JE. Source: Clin Cardiol. 1987 January; 10(1): 3-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2880685&dopt=Abstract
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Those fragile hearts. Who dies from heart attacks? Surprisingly, more women than men. Author(s): Gupta S. Source: Time. 2003 February 10; 161(6): 84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12608018&dopt=Abstract
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Thrombolytic therapy in Missouri hospital emergency departments: compliance with the National Heart Attack Alert Program guidelines. Author(s): Steele MT, Hansen JW, Watson W. Source: Mo Med. 1998 April; 95(4): 179-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9573733&dopt=Abstract
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Trends (1986 to 1999) in the incidence and outcomes of in-hospital stroke complicating acute myocardial infarction (The Worcester Heart Attack Study). Author(s): Spencer FA, Gore JM, Yarzebski J, Lessard D, Jackson EA, Goldberg RJ. Source: The American Journal of Cardiology. 2003 August 15; 92(4): 383-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914866&dopt=Abstract
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Triggering a heart attack. Author(s): Petch MO. Source: Bmj (Clinical Research Ed.). 1996 February 24; 312(7029): 459-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8597667&dopt=Abstract
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Twenty years' experience of myocardial infarction: the value of a heart attack register. Author(s): Gray D, Hampton JR. Source: Br J Clin Pract. 1993 November-December; 47(6): 292-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8117549&dopt=Abstract
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Use of lipid-lowering medication in patients with acute myocardial infarction (Worcester Heart Attack Study). Author(s): Goldberg RJ, Ockene IS, Yarzebski J, Savageau J, Gore JM. Source: The American Journal of Cardiology. 1997 April 15; 79(8): 1095-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9114770&dopt=Abstract
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Use of mutual protective agreement after a heart attack. Author(s): Fink FS. Source: J Clin Orthod. 1993 April; 27(4): 210-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8360337&dopt=Abstract
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Use of the invasive management strategy for patients with non-Q-wave myocardial infarction: an observational database report from the Worcester Heart Attack Study. Author(s): Dauerman HL, Yarzebski J, Gore JM, Lessard D, Goldberg RJ. Source: American Heart Journal. 2002 June; 143(6): 1033-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12075260&dopt=Abstract
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Uses of coronary heart attack registers. Author(s): Pedoe HT. Source: British Heart Journal. 1978 May; 40(5): 510-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=656216&dopt=Abstract
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Validation of patient recall of doctor-diagnosed heart attack and stroke: a postal questionnaire and record review comparison. Author(s): Walker MK, Whincup PH, Shaper AG, Lennon LT, Thomson AG. Source: American Journal of Epidemiology. 1998 August 15; 148(4): 355-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9717879&dopt=Abstract
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Variations between countries in invasive cardiac procedures. UK Heart Attack Study investigators. Author(s): Norris RM, Wong PS. Source: Lancet. 1998 October 31; 352(9138): 1470-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9808015&dopt=Abstract
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Variations in the treatment of heart attack. Author(s): Phillips L. Source: Hosp Technol Ser. 1995 September; 14(10): 6-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10152449&dopt=Abstract
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VHA heart attack initiative increases aspirin and beta blocker usage. Author(s): Rollins G. Source: Rep Med Guidel Outcomes Res. 2001 May 17; 12(10): 7-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12134872&dopt=Abstract
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Warning signs of a heart attack. Author(s): Ornato JP, Hand MM. Source: Circulation. 2001 September 11; 104(11): 1212-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11551868&dopt=Abstract
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Was it a heart attack? Author(s): McKenna CJ, Forfar JC. Source: Bmj (Clinical Research Ed.). 2002 February 16; 324(7334): 377-8. Erratum In: Bmj 2002 May 11; 324(7346): 1131. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11850355&dopt=Abstract
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Was it a heart attack? Troponin measurement is not straightforward. Author(s): Kilpatrick ES. Source: Bmj (Clinical Research Ed.). 2002 May 18; 324(7347): 1216. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12016196&dopt=Abstract
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Was it a heart attack? Variations in access to and interpretation of troponin assays are wide. Author(s): Pell AC, Pell JP. Source: Bmj (Clinical Research Ed.). 2002 May 18; 324(7347): 1216. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12018221&dopt=Abstract
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Weight change and risk of heart attack in middle-aged British men. Author(s): Walker M, Wannamethee G, Whincup PH, Shaper AG. Source: International Journal of Epidemiology. 1995 August; 24(4): 694-703. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8550265&dopt=Abstract
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What are heart attacks? Rethinking some aspects of medical knowledge. Author(s): Greaves D. Source: Medicine, Health Care, and Philosophy. 1998; 1(2): 133-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11081290&dopt=Abstract
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What do subgroup analyses reveal about differential response to beta-blocker therapy? The Beta-Blocker Heart Attack Trial experience. Author(s): Furberg CD, Byington RP. Source: Circulation. 1983 June; 67(6 Pt 2): I98-101. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6133654&dopt=Abstract
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What would I want to know if my dad had a heart attack? Good sense versus dollars and cents. Author(s): Butman SM. Source: Journal of the American College of Cardiology. 1991 November 1; 18(5): 1220-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1918698&dopt=Abstract
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When can I do 'it' again nurse? Sexual counselling after a heart attack. Author(s): Piper KM. Source: Prof Nurse. 1992 December; 8(3): 168-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1484825&dopt=Abstract
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When your patients ask about heart attacks in women. Author(s): Trimmer E. Source: Midwife Health Visit Community Nurse. 1986 July; 22(7): 234. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3641006&dopt=Abstract
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White-collar and blue-collar responses to heart attack. Author(s): Hackett TP, Cassem NH. Source: Journal of Psychosomatic Research. 1976; 20(2): 85-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1271317&dopt=Abstract
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Will mountains trekkers have heart attacks? Author(s): Rennie D. Source: Jama : the Journal of the American Medical Association. 1989 February 17; 261(7): 1045-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2915411&dopt=Abstract
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Women and heart attack: a study of women's experiences. Author(s): Benson G, Arthur H, Rideout E. Source: Can J Cardiovasc Nurs. 1997; 8(3): 16-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9416023&dopt=Abstract
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Women and heart attacks: prevention, diagnosis, and care. Author(s): Arnstein PM, Buselli EF, Rankin SH. Source: The Nurse Practitioner. 1996 May; 21(5): 57-8, 61-4, 67-9; Quiz 70-1. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8734626&dopt=Abstract
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Women don't get heart attacks? Author(s): Kearney MH. Source: Reflect Nurs Leadersh. 2000; 26(2): 18-20, 45. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11987254&dopt=Abstract
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Work activity and fatal heart attack studied by multiple logistic risk analysis. Author(s): Brand RJ, Paffenbarger RS Jr, Sholtz RI, Kampert JB. Source: American Journal of Epidemiology. 1979 July; 110(1): 52-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=463864&dopt=Abstract
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Work-energy level, personal characteristics, and fatal heart attack: a birth-cohort effect. Author(s): Paffenbarger RS Jr, Hale WE, Brand RJ, Hyde RT. Source: American Journal of Epidemiology. 1977 March; 105(3): 200-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=848474&dopt=Abstract
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Working after heart attack. Author(s): Dennis C, Goins P, DeBusk RF. Source: Compr Ther. 1989 November; 15(11): 3-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2582737&dopt=Abstract
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CHAPTER 2. NUTRITION AND HEART ATTACK Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and heart attack.
Finding Nutrition Studies on Heart Attack The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail:
[email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “heart attack” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.
7
Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
120 Heart Attack
The following is a typical result when searching for recently indexed consumer information on heart attack: ·
After I had a heart attack and two bypass operations, I was put on Lipitor to lower my cholesterol. My cholesterol was never high--about 170-180 mg/dL. But my HDL was always low and triglycerides were somewhat high. Now my total cholesterol is 124 and my HDL has gone up slightly. My triglycerides are way down. My LDL cholesterol has fallen from 110 to 68. Is there any downside to such a low cholesterol level, other than the need to check my liver function tests? Source: Lee, T H Harv-Heart-Lett. 1999 January; 9(5): 7 1051-5313
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After your heart attack. Source: Anonymous Harv-Mens-Health-Watch. 1998 October; 3(3): 1-5 1089-1102
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Ask the doctor. I had a heart attack last year, and afterwards learned that my homocysteine level is elevated. I wanted to start taking vitamins to lower it, but before I make myself swallow another two or three pills per day, is there any proof vitamins will make me live longer? Source: Lee, T H Harv-Heart-Lett. 2000 May; 10(9): 7 1051-5313
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Ask the doctor. I have diabetes and use insulin two, sometimes three, times a day to keep my sugar under control. My hope is that this will help me avoid a heart attack. Is this a reasonable goal? Source: Lee, T H Harv-Heart-Lett. 1999 August; 9(12): 7 1051-5313
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Ask the doctor. I have had heart failure since my heart attack a year ago. My physician initially prescribed lisinopril, an angiotensin-converting enzyme (ACE) inhibitor. Unfortunately, I was one of the unlucky people who got a cough with this drug that was so annoying I had to stop taking it. Now my doctor wants me to try a newer drug called valsartan. Is it likely to help me? Source: Lee, Thomas H Harv-Heart-Lett. 2002 July; 12(11): 8 1051-5313
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Avoiding a heart attack: diet, drugs or both? Author(s): Harvard School of Public Health. Source: Sacks, F. Nutrition-action-health-letter (USA). (Jan-February 1997). volume 24(1) page 4-7. cholesterol diet treatment drug therapy heart diseases 0885-7792
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Baseline characteristics of the diabetic participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Author(s): Division of Endocrinology, Kaiser Permanente of Georgia, Tucker 30084, USA.
[email protected] Source: Barzilay, J I Jones, C L Davis, B R Basile, J N Goff, D C Jr Ciocon, J O Sweeney, M E Randall, O S Diabetes-Care. 2001 April; 24(4): 654-8 0149-5992
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By the way, doctor.My father died of a heart attack at age 72, but he smoked and ate poorly. Now that I'm in my 50s, I'm starting to wonder if I fall into a high-risk category for heart disease. Source: Lee, T H Harv-Health-Lett. 2001 November; 27(1): 8 1052-1577
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Estrogen and heart attack. Source: Anonymous Harv-Womens-Health-Watch. 1998 October; 6(2): 1 1070-910X
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Heart attack rehabilitation. Helping your heart heal. Source: Anonymous Mayo-Clin-Health-Lett. 1998 March; 16(3): 4-5 0741-6245
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My wife and I take a multivitamin that contains iron. I've heard that too much iron can increase my risk of having a heart attack. Should I stop taking the iron? Source: Anonymous Mayo-Clin-Health-Lett. 2000 September; 18(9): 8 0741-6245
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Read my lipids. How to lower your risk of a heart attack. Source: Liebman, B. Nutr-action-health-lett. [Washington, D.C. : Center for Science in the Public Interest,. October 2001. volume 28 (8) page 1, 3-8. 0885-7792
The following information is typical of that found when using the “Full IBIDS Database” to search for “heart attack” (or a synonym): ·
After I had a heart attack and two bypass operations, I was put on Lipitor to lower my cholesterol. My cholesterol was never high--about 170-180 mg/dL. But my HDL was always low and triglycerides were somewhat high. Now my total cholesterol is 124 and my HDL has gone up slightly. My triglycerides are way down. My LDL cholesterol has fallen from 110 to 68. Is there any downside to such a low cholesterol level, other than the need to check my liver function tests? Source: Lee, T H Harv-Heart-Lett. 1999 January; 9(5): 7 1051-5313
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After your heart attack. Source: Anonymous Harv-Mens-Health-Watch. 1998 October; 3(3): 1-5 1089-1102
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Ask the doctor. I had a heart attack last year, and afterwards learned that my homocysteine level is elevated. I wanted to start taking vitamins to lower it, but before I make myself swallow another two or three pills per day, is there any proof vitamins will make me live longer? Source: Lee, T H Harv-Heart-Lett. 2000 May; 10(9): 7 1051-5313
·
Ask the doctor. I have diabetes and use insulin two, sometimes three, times a day to keep my sugar under control. My hope is that this will help me avoid a heart attack. Is this a reasonable goal? Source: Lee, T H Harv-Heart-Lett. 1999 August; 9(12): 7 1051-5313
·
Ask the doctor. I have had heart failure since my heart attack a year ago. My physician initially prescribed lisinopril, an angiotensin-converting enzyme (ACE) inhibitor. Unfortunately, I was one of the unlucky people who got a cough with this drug that was so annoying I had to stop taking it. Now my doctor wants me to try a newer drug called valsartan. Is it likely to help me? Source: Lee, Thomas H Harv-Heart-Lett. 2002 July; 12(11): 8 1051-5313
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Avoiding a heart attack: diet, drugs or both? Author(s): Harvard School of Public Health. Source: Sacks, F. Nutrition-action-health-letter (USA). (Jan-February 1997). volume 24(1) page 4-7. cholesterol diet treatment drug therapy heart diseases 0885-7792
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Blood pressure, cigarette smoking and heart attack in the WHO co-operative trial of clofibrate. Author(s): Ex-ICI Pharmaceuticals PLC, Alderley Park, Macclesfield, UK. Source: Green, K G Heady, A Oliver, M F Int-J-Epidemiol. 1989 June; 18(2): 355-60 03005771
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By the way, doctor.My father died of a heart attack at age 72, but he smoked and ate poorly. Now that I'm in my 50s, I'm starting to wonder if I fall into a high-risk category for heart disease. Source: Lee, T H Harv-Health-Lett. 2001 November; 27(1): 8 1052-1577
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Controversy over dietary cholesterol and heart attack may have finally been settled. Source: Shurkin, Joel B. Healthline. San Mateo, Calif. : Robert A. McNeil Foundation for Health Education. April 1984 volume3 (4) page 10-11. 0736-7929
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Estrogen and heart attack. Source: Anonymous Harv-Womens-Health-Watch. 1998 October; 6(2): 1 1070-910X
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Heart attack rehabilitation. Helping your heart heal. Source: Anonymous Mayo-Clin-Health-Lett. 1998 March; 16(3): 4-5 0741-6245
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Heart attack! Source: Brauer Rieke, G Midwifery-Today-Childbirth-Educ. 1994 Spring; (29): 24 15222888
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Is it heart attack, or is it GERD? Source: Peters, S Adv-Nurse-Pract. 1998 May; 6(5): 57-8, 62 1096-6293
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Major outcomes in high-risk hypertensive patients randomized to angiotensinconverting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Source: JAMA. 2002 December 18; 288(23): 2981-97 0098-7484
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Metachronous thromboses and myocardial infarctions in a 32-year-old woman with antiphospholipid antibodies. Author(s): Morehouse School of Medicine, Department of Surgery, Atlanta, GA 303101495, USA. Source: Best, Irwin M Vasandani, Geetanjali Bumpers, Harvey L Rust, George HeartLung. 2002 Jan-February; 31(1): 30-3 0147-9563
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My wife and I take a multivitamin that contains iron. I've heard that too much iron can increase my risk of having a heart attack. Should I stop taking the iron? Source: Anonymous Mayo-Clin-Health-Lett. 2000 September; 18(9): 8 0741-6245
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Read my lipids. How to lower your risk of a heart attack. Source: Liebman, B. Nutr-action-health-lett. [Washington, D.C. : Center for Science in the Public Interest,. October 2001. volume 28 (8) page 1, 3-8. 0885-7792
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Reduction of ischemic heart disease risk markers in the teenage children of heart attack patients. Author(s): Centre for Clinical Epidemiology and Biostatistics, Faculty of Medicine, University of Newcastle, NSW, Australia. Source: Walker, R Heller, R Redman, S O'Connell, D Boulton, J Prev-Med. 1992 September; 21(5): 616-29 0091-7435
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Serum total homocysteine concentration is related to self-reported heart attack or stroke history among men and women in the NHANES III. Source: Morris, M.S. Jacques, P.F. Rosenberg, I.H. Selhub, J. Bowman, B.A. Gunter, E.W. Wright, J.D. Johnson, C.L. J-nutr. Bethesda : American Society for Nutritional Sciences. December 2000. volume 130 (12) page 3073-3076. 0022-3166
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Too young to be having a heart attack. Author(s):
[email protected] Source: Payne, M Y Lancet. 2001 December; 358 Suppl: S64 0140-6736
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Value of HDL cholesterol, apolipoprotein A-I, lipoprotein A-I, and lipoprotein A-I/AII in prediction of coronary heart disease: the PRIME Study. Prospective Epidemiological Study of Myocardial Infarction. Author(s): Department of Atherosclerosis, INSERM UR545, Institut Pasteur de Lille, and University Lille II, Lille, France.
[email protected] Source: Luc, Gerald Bard, Jean Marie Ferrieres, Jean Evans, Alun Amouyel, Philippe Arveiler, Dominique Fruchart, Jean Charles Ducimetiere, Pierre Arterioscler-ThrombVasc-Biol. 2002 July 1; 22(7): 1155-61 1524-4636
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Vitamin B-6 status after heart attack. Source: Schrijver, J. Kok, F.J. Curr-Top-Nutr-Dis. New York, N.Y. : Alan R. Liss. 1988. volume 19 page 225-228. charts. 0191-2453
Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
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Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.healthnotes.com/
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Open Directory Project: http://dmoz.org/Health/Nutrition/
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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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The following is a specific Web list relating to heart attack; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Vitamins Folic Acid Source: Healthnotes, Inc. www.healthnotes.com Folic Acid Source: Integrative Medicine Communications; www.drkoop.com Niacin Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,892,00.html Riboflavin Source: Integrative Medicine Communications; www.drkoop.com Vitamin A Source: Healthnotes, Inc. www.healthnotes.com Vitamin B12 Source: Healthnotes, Inc. www.healthnotes.com Vitamin B2 (Riboflavin) Source: Integrative Medicine Communications; www.drkoop.com Vitamin B6 Source: Healthnotes, Inc. www.healthnotes.com Vitamin B9 (Folic Acid) Alternative names: Folate, Folic Acid Source: Integrative Medicine Communications; www.drkoop.com Vitamin C Source: Healthnotes, Inc. www.healthnotes.com Vitamin C Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,904,00.html Vitamin D Source: Healthnotes, Inc. www.healthnotes.com Vitamin E Source: Healthnotes, Inc. www.healthnotes.com
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Vitamin E Alternative names: Alpha-Tocopherol, Beta-Tocopherol, D-Alpha-Tocopherol, Delta-Tocopherol, Gamma-Tocopherol Source: Integrative Medicine Communications; www.drkoop.com Vitamin E Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin E Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,906,00.html ·
Minerals Alpha-Tocopherol Source: Integrative Medicine Communications; www.drkoop.com Angiotensin-Converting Enzyme (ACE) Inhibitors Source: Healthnotes, Inc. www.healthnotes.com Beta-Tocopherol Source: Integrative Medicine Communications; www.drkoop.com Calcium Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,884,00.html Carnitine Source: Prima Communications, Inc.www.personalhealthzone.com Carnitine Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10012,00.html Carnitine (L-Carnitine) Source: Integrative Medicine Communications; www.drkoop.com D-Alpha-Tocopherol Source: Integrative Medicine Communications; www.drkoop.com Delta-Tocopherol Source: Integrative Medicine Communications; www.drkoop.com Folate Source: Integrative Medicine Communications; www.drkoop.com Gamma-Tocopherol Source: Integrative Medicine Communications; www.drkoop.com
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HMG-CoA Reductase Inhibitors (Statins) Source: Integrative Medicine Communications; www.drkoop.com Iron Source: Healthnotes, Inc. www.healthnotes.com L-Carnitine Source: Healthnotes, Inc. www.healthnotes.com L-Carnitine Source: Integrative Medicine Communications; www.drkoop.com Magnesium Source: Healthnotes, Inc. www.healthnotes.com Magnesium Source: Integrative Medicine Communications; www.drkoop.com Magnesium Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,890,00.html Potassium Source: Integrative Medicine Communications; www.drkoop.com Quercetin Source: Prima Communications, Inc.www.personalhealthzone.com Selenium Source: Healthnotes, Inc. www.healthnotes.com Selenium Source: Integrative Medicine Communications; www.drkoop.com Selenium Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10055,00.html Simvastatin Source: Healthnotes, Inc. www.healthnotes.com ·
Food and Diet Atkins Diet Source: Healthnotes, Inc. www.healthnotes.com Cartilage Alternative names: Shark Cartilage Source: Integrative Medicine Communications; www.drkoop.com
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Chondroitin Sulfate Source: Healthnotes, Inc. www.healthnotes.com Coffee Source: Healthnotes, Inc. www.healthnotes.com Garlic Source: Prima Communications, Inc.www.personalhealthzone.com Garlic Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,786,00.html High Cholesterol Source: Healthnotes, Inc. www.healthnotes.com High-Fiber Diet Source: Healthnotes, Inc. www.healthnotes.com Low-Fat Diet Source: Healthnotes, Inc. www.healthnotes.com Nutritional Yeast Source: Integrative Medicine Communications; www.drkoop.com Nutritional Yeast Alternative names: Brewer's Yeast Source: Integrative Medicine Communications; www.drkoop.com The Dean Ornish Diet Source: Healthnotes, Inc. www.healthnotes.com Walnuts Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,100,00.html Water Source: Healthnotes, Inc. www.healthnotes.com
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CHAPTER 3. ATTACK
ALTERNATIVE MEDICINE AND HEART
Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to heart attack. At the conclusion of this chapter, we will provide additional sources.
The Combined Health Information Database The Combined Health Information Database (CHID) is a bibliographic database produced by health-related agencies of the U.S. federal government (mostly from the National Institutes of Health) that can offer concise information for a targeted search. The CHID database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “heart attack” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·
Spirituality of Patients Recovering from an Acute Myocardial Infarction: A Grounded Theory Study Source: Journal of Holistic Nursing. 17(1): 34-53. March 1999. Summary: This journal article describes a study of the meaning of spirituality to patients recovering from an acute myocardial infarction (AMI), and their perceptions of how spirituality influences recovery. Data were collected through interviews with 13 patients hospitalized with an AMI. The Glaserian method of grounded theory analysis was used to analyze responses and develop a theory. Spirituality was described as a life-giving force nurtured by receiving presence from God, nature, family, friends, and community. This core category, receiving presence, was the most influential element in enhancing the life-giving force of spirituality and in positively influencing recovery. Supporting categories included developing faith, discovering meaning and purpose, and giving the
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gift of self. The following five phases to discovering meaning and purpose were identified: facing mortality, releasing fear and turmoil, identifying and making lifestyle changes, seeking divine purpose, and making meaning in daily life. Spirituality influenced recovery by providing the participants with inner strength, comfort, peace, wellness, wholeness, and enhanced coping. The implications for holistic nursing are discussed. The article has 1 figure, 2 tables, and 34 references. (AA-M).
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to heart attack and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “heart attack” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to heart attack: ·
Acute myocardial infarction and cardiac arrest in a patient receiving paclitaxel. Author(s): Nguyen-Ho P, Kleiman NS, Verani MS. Source: The Canadian Journal of Cardiology. 2003 March 15; 19(3): 300-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12677287&dopt=Abstract
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Adipose tissue alpha-linolenic acid and nonfatal acute myocardial infarction in Costa Rica. Author(s): Baylin A, Kabagambe EK, Ascherio A, Spiegelman D, Campos H. Source: Circulation. 2003 April 1; 107(12): 1586-91. Epub 2003 March 10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12668490&dopt=Abstract
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Adipose tissue n-6 fatty acids and acute myocardial infarction in a population consuming a diet high in polyunsaturated fatty acids. Author(s): Kark JD, Kaufmann NA, Binka F, Goldberger N, Berry EM. Source: The American Journal of Clinical Nutrition. 2003 April; 77(4): 796-802. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12663274&dopt=Abstract
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Angioplasty of residual stenosis after severe anteroseptal myocardial infarction: is it able to improve systolic function and to prevent cardiac failure? Author(s): Toussaint M, Guyomard F, Meliani A, Tran-Thanh X, Jouannon C, Durup F, Devaux JY. Source: European Journal of Heart Failure : Journal of the Working Group on Heart Failure of the European Society of Cardiology. 2003 January; 5(1): 81-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12559219&dopt=Abstract
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Assessment of myocardial viability using coronary zero flow pressure after successful angioplasty in patients with acute anterior myocardial infarction.
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Author(s): Shimada K, Sakanoue Y, Kobayashi Y, Ehara S, Hirose M, Nakamura Y, Fukuda D, Yamagishi H, Yoshiyama M, Takeuchi K, Yoshikawa J. Source: Heart (British Cardiac Society). 2003 January; 89(1): 71-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12482796&dopt=Abstract ·
Comparative study of dobutamine stress echocardiography and dual single-photon emission computed tomography (thallium-201 and I-123 BMIPP) for assessing myocardial viability after acute myocardial infarction. Author(s): Yasugi N, Koyanagi S, Ohzono K, Sakai K, Matsumoto T, Sako S, Homma T, Azakami S, Hiroki T. Source: Circulation Journal : Official Journal of the Japanese Circulation Society. 2002 December; 66(12): 1132-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12499620&dopt=Abstract
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Comparison of cardioprotective effects using ramipril and DanShen for the treatment of acute myocardial infarction in rats. Author(s): Ji X, Tan BK, Zhu YC, Linz W, Zhu YZ. Source: Life Sciences. 2003 August 1; 73(11): 1413-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850502&dopt=Abstract
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Continuous PC6 wristband acupressure for relief of nausea and vomiting associated with acute myocardial infarction: a partially randomised, placebo-controlled trial. Author(s): Dent HE, Dewhurst NG, Mills SY, Willoughby M. Source: Complementary Therapies in Medicine. 2003 June; 11(2): 72-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12801491&dopt=Abstract
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Correction of haemorheological disturbances in myocardial infarction by diquertin and ascorbic acid. Author(s): Plotnikov MB, Aliev OI, Maslov MJ, Vasiliev AS, Tjukavkina NA. Source: Phytotherapy Research : Ptr. 2003 January; 17(1): 86-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12557255&dopt=Abstract
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Early detection of myocardial microcirculatory disturbances after primary PTCA in patients with acute myocardial infarction: coronary blood flow velocity versus sestamibi perfusion imaging. Author(s): Stempfle HU, Schmid R, Tausig A, Auer V, Hacker M, Schiele TM, Hahn K, Klauss V. Source: Zeitschrift Fur Kardiologie. 2002; 91 Suppl 3: 126-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12641027&dopt=Abstract
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Effect of abana an ayurvedic formulation, on lipid peroxidation in experimental myocardial infarction in rats. Author(s): Sasikumar CS, Devi CS.
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Source: Indian J Exp Biol. 2000 August; 38(8): 827-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12557918&dopt=Abstract ·
Fiber intake and risk of nonfatal acute myocardial infarction. Author(s): Negri E, La Vecchia C, Pelucchi C, Bertuzzi M, Tavani A. Source: European Journal of Clinical Nutrition. 2003 March; 57(3): 464-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12627184&dopt=Abstract
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Further reduction in mortality following myocardial infarction. Author(s): Abhyankar B. Source: Hosp Med. 2002 October; 63(10): 610-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12422496&dopt=Abstract
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In vivo detection of cell death in the area at risk in acute myocardial infarction. Author(s): Thimister PW, Hofstra L, Liem IH, Boersma HH, Kemerink G, Reutelingsperger CP, Heidendal GA. Source: Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine. 2003 March; 44(3): 391-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12621005&dopt=Abstract
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Increased lipid peroxidation during long-term intervention with high doses of n-3 fatty acids (PUFAs) following an acute myocardial infarction. Author(s): Grundt H, Nilsen DW, Mansoor MA, Nordoy A. Source: European Journal of Clinical Nutrition. 2003 June; 57(6): 793-800. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12792664&dopt=Abstract
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Interpretation of reverse redistribution of 99mTc-tetrofosmin in patients with acute myocardial infarction. Author(s): Hirata Y, Takamiya M, Kinoshita N, Yamada H, Shima T, Miyazaki H, Kouno Y, Sawada N, Sakamoto K, Sugihara H. Source: European Journal of Nuclear Medicine and Molecular Imaging. 2002 December; 29(12): 1594-9. Epub 2002 September 19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12458393&dopt=Abstract
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Ischemic “memory image” in acute myocardial infarction of 123I-BMIPP after reperfusion therapy: a comparison with 99mTc-pyrophosphate and 201Tl dual-isotope SPECT. Author(s): Mochizuki T, Murase K, Higashino H, Miyagawa M, Sugawara Y, Kikuchi T, Ikezoe J. Source: Ann Nucl Med. 2002 December; 16(8): 563-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12593422&dopt=Abstract
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Mediterranean diet and all-causes mortality after myocardial infarction: results from the GISSI-Prevenzione trial. Author(s): Barzi F, Woodward M, Marfisi RM, Tavazzi L, Valagussa F, Marchioli R; GISSI-Prevenzione Investigators. Source: European Journal of Clinical Nutrition. 2003 April; 57(4): 604-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12700623&dopt=Abstract
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Mercury and the risk of myocardial infarction. Author(s): Plante M, Babo S. Source: The New England Journal of Medicine. 2003 May 22; 348(21): 2151-4; Author Reply 2151-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12761376&dopt=Abstract
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Mercury, fish oils, and the risk of myocardial infarction. Author(s): Guallar E, Sanz-Gallardo MI, van't Veer P, Bode P, Aro A, Gomez-Aracena J, Kark JD, Riemersma RA, Martin-Moreno JM, Kok FJ; Heavy Metals and Myocardial Infarction Study Group. Source: The New England Journal of Medicine. 2002 November 28; 347(22): 1747-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12456850&dopt=Abstract
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Myocardial beta-adrenoceptor density one month after acute myocardial infarction predicts left ventricular volumes at six months. Author(s): Spyrou N, Rosen SD, Fath-Ordoubadi F, Jagathesan R, Foale R, Kooner JS, Camici PG. Source: Journal of the American College of Cardiology. 2002 October 2; 40(7): 1216-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12383568&dopt=Abstract
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Myocardial infarction temporally related to ephedra--a possible role for the coronary microcirculation. Author(s): Rezkalla SH, Mesa J, Sharma P, Kloner RA. Source: Wmj. 2002; 101(7): 64-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12426924&dopt=Abstract
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Myocardial viability, coronary flow reserve, and in-hospital predictors of late recovery of contractility following successful primary stenting for acute myocardial infarction. Author(s): Beygui F, Le Feuvre C, Helft G, Maunoury C, Metzger JP. Source: Heart (British Cardiac Society). 2003 February; 89(2): 179-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12527673&dopt=Abstract
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N-3 fatty acids: priority for post-myocardial infarction clinical trials. Author(s): Grundy SM.
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Source: Circulation. 2003 April 15; 107(14): 1834-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12695281&dopt=Abstract ·
n-3 polyunsaturated fatty acids and coronary thrombosis. Author(s): Kristensen SD, Iversen AM, Schmidt EB. Source: Lipids. 2001; 36 Suppl: S79-82. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11837997&dopt=Abstract
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n-3 Polyunsaturated fatty acids, fatal ischemic heart disease, and nonfatal myocardial infarction in older adults: the Cardiovascular Health Study. Author(s): Lemaitre RN, King IB, Mozaffarian D, Kuller LH, Tracy RP, Siscovick DS. Source: The American Journal of Clinical Nutrition. 2003 February; 77(2): 319-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12540389&dopt=Abstract
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Noninvasive assessment of myocardial stunning from short-term coronary occlusion using tagged magnetic resonance imaging. Author(s): Kraitchman DL, Hillenbrand HB, Oznur I, Lima JA, McVeigh ER, Zerhouni EA, Bluemke DA. Source: Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance. 2000; 2(2): 123-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11545128&dopt=Abstract
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Omega-3 polyunsatured fatty acids role in postmyocardial infarction therapy. Author(s): Imazio M, Forno D, Quaglia C, Trinchero R. Source: Panminerva Medica. 2003 June; 45(2): 99-107. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12855934&dopt=Abstract
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Prediction of left ventricular functional recovery by dobutamine echocardiography, F18 deoxyglucose or 99mTc sestamibi nuclear imaging in patients with chronic myocardial infarction. Author(s): Lund GK, Freyhoff J, Schwaiger M, Lubeck M, Lund CH, Buchert R, Sheehan FH, Meinertz T, Nienaber CA. Source: Cardiology. 2002; 98(4): 202-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566650&dopt=Abstract
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Prognostic value of myocardial viability determined by a 201Tl SPECT study in patients with previous myocardial infarction and mild-to-moderate myocardial dysfunction. Author(s): Petrasinovic Z, Ostojic M, Beleslin B, Pavlovic S, Sobic-Saranovic D, Djordjevic-Dikic A, Nedeljkovic I, Stojkovic S, Marinkovic J, Stepanovic J, Nedeljkovic M, Vukcevic V, Arandjelovic A, Obradovic V, Bosnjakovic V.
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Source: Nuclear Medicine Communications. 2003 February; 24(2): 175-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12548042&dopt=Abstract ·
Pseudo gray platelet syndrome in a patient with acute myocardial infarction. Author(s): Toyota S, Nakamura N, Dan K. Source: International Journal of Hematology. 2002 November; 76(4): 376-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12463604&dopt=Abstract
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Quantitative regional wall motion analysis with early contrast ventriculography for the assessment of myocardium at risk in acute myocardial infarction. Author(s): Lapeyre AC 3rd, St Gibson W, Bashore TM, Gibbons RJ. Source: American Heart Journal. 2003 June; 145(6): 1051-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12796762&dopt=Abstract
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Re: “Fish and shellfish consumption in relation to death from myocardial infarction among men in Shanghai, China”. Author(s): Alonso A, Fernandez-Jarne E, Serrano-Martinez M, Martinez-Gonzalez MA. Source: American Journal of Epidemiology. 2003 January 1; 157(1): 85; Author Reply 856. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12505896&dopt=Abstract
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Severity and extent of perfusion defects provoked by transient coronary occlusion compared with myocardial damage observed after infarction. Author(s): Bontemps L, Gabain M, Doudouh A, Felecan R, Ovize M, Bonnefoy E, Itti R. Source: Nuclear Medicine Communications. 2000 February; 21(2): 147-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10758609&dopt=Abstract
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The value of the TIMI frame count method in the diagnosis of coronary no-reflow: a comparison with myocardial perfusion SPECT in patients with acute myocardial infarction. Author(s): Sahin M, Basoglu T, Canbaz F, Elcik M, Kosus A. Source: Nuclear Medicine Communications. 2002 December; 23(12): 1205-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12464786&dopt=Abstract
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Too young to be having a heart attack. Author(s): Payne MY. Source: Lancet. 2001 December; 358 Suppl: S64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11784613&dopt=Abstract
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Why did green tea not protect against coronary artery disease but protect against myocardial infarction? Author(s): Cheng TO.
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Source: The American Journal of Cardiology. 2003 May 15; 91(10): 1290-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12745129&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.healthnotes.com/
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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine
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Open Directory Project: http://dmoz.org/Health/Alternative/
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HealthGate: http://www.tnp.com/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
The following is a specific Web list relating to heart attack; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
General Overview Age-Related Cognitive Decline Source: Healthnotes, Inc. www.healthnotes.com Anaphylaxis Source: Integrative Medicine Communications; www.drkoop.com Angina Source: Healthnotes, Inc. www.healthnotes.com Angina Source: Integrative Medicine Communications; www.drkoop.com Anorexia Nervosa Source: Integrative Medicine Communications; www.drkoop.com
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Anxiety and Panic Attacks Source: Prima Communications, Inc.www.personalhealthzone.com Arteriosclerosis Source: Integrative Medicine Communications; www.drkoop.com Atherosclerosis Source: Healthnotes, Inc. www.healthnotes.com Atherosclerosis Source: Integrative Medicine Communications; www.drkoop.com Atherosclerosis and Heart Disease Prevention Source: Prima Communications, Inc.www.personalhealthzone.com Bone Cancer Source: Integrative Medicine Communications; www.drkoop.com Bone Marrow Disorders Source: Integrative Medicine Communications; www.drkoop.com Burns Source: Integrative Medicine Communications; www.drkoop.com Cardiac Arrhythmia Source: Healthnotes, Inc. www.healthnotes.com Cardiomyopathy Source: Healthnotes, Inc. www.healthnotes.com Cardiovascular Disease Overview Source: Healthnotes, Inc. www.healthnotes.com Chronic Myelogenous Leukemia Source: Integrative Medicine Communications; www.drkoop.com Congestive Heart Failure Source: Healthnotes, Inc. www.healthnotes.com Coronary Artery Disease Source: Integrative Medicine Communications; www.drkoop.com Depression Source: Healthnotes, Inc. www.healthnotes.com Depression Source: Integrative Medicine Communications; www.drkoop.com Diabetes Source: Healthnotes, Inc. www.healthnotes.com
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Diabetes Mellitus Source: Integrative Medicine Communications; www.drkoop.com Endocarditis Source: Integrative Medicine Communications; www.drkoop.com Heart Attack Source: Healthnotes, Inc. www.healthnotes.com Heart Attack Source: Integrative Medicine Communications; www.drkoop.com High Blood Pressure Source: Integrative Medicine Communications; www.drkoop.com High Cholesterol Source: Integrative Medicine Communications; www.drkoop.com High Cholesterol Source: Prima Communications, Inc.www.personalhealthzone.com High Homocysteine Source: Healthnotes, Inc. www.healthnotes.com Hypercholesterolemia Source: Integrative Medicine Communications; www.drkoop.com Hypertension Source: Integrative Medicine Communications; www.drkoop.com Hypertension Alternative names: High Blood Pressure Source: Prima Communications, Inc.www.personalhealthzone.com Myelofibrosis Source: Integrative Medicine Communications; www.drkoop.com Myeloproliferative Disorders Source: Integrative Medicine Communications; www.drkoop.com Myocardial Infarction Source: Integrative Medicine Communications; www.drkoop.com Obesity Source: Integrative Medicine Communications; www.drkoop.com Polycythemia Vera Source: Integrative Medicine Communications; www.drkoop.com Pulmonary Edema Source: Integrative Medicine Communications; www.drkoop.com
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Shock Source: Integrative Medicine Communications; www.drkoop.com Stroke Source: Healthnotes, Inc. www.healthnotes.com Stroke, Transient Source: Integrative Medicine Communications; www.drkoop.com Thrombocytosis Source: Integrative Medicine Communications; www.drkoop.com TIAs Source: Integrative Medicine Communications; www.drkoop.com Transient Ischemic Attacks Source: Integrative Medicine Communications; www.drkoop.com ·
Alternative Therapy Spirituality Source: Integrative Medicine Communications; www.drkoop.com
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Chinese Medicine Shexiang Baoxin Wan Alternative names: Shexiang Baoxin Pills; Shexiang Baoxin Wan
(She Xiang Bao Xin Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Shexiang%20Baoxin%20Wan& mh=10&sb=---&view_records=View+Records
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Herbs and Supplements Alpha2-Adrenergic Agonists Source: Integrative Medicine Communications; www.drkoop.com Alpha-linolenic acid Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,1025,00.html Antioxidants Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10004,00.html
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Aspirin Source: Healthnotes, Inc. www.healthnotes.com Astragalus Alternative names: Astragalus membranaceus Source: Healthnotes, Inc. www.healthnotes.com Astragalus Alternative names: Astragalus membranaceus, Astragalus membranaceus var. mongholicus, Huang-qi, Milk-Vetch Root Source: Integrative Medicine Communications; www.drkoop.com Astragalus mem Alternative names: Huang-Qi; Astragalus membranaceus Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Astragalus membranaceus Source: Integrative Medicine Communications; www.drkoop.com Astragalus mongholicus Alternative names: Astragalus membranaceus, Astragalus membranaceus var. mongholicus, Huang-qi, Milk-Vetch Root Source: Integrative Medicine Communications; www.drkoop.com Astragalus sp Alternative names: Vetch, Rattlepod, Locoweed; Astragalus sp. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Atenolol Source: Healthnotes, Inc. www.healthnotes.com Beta-Adrenergic Blockers Source: Healthnotes, Inc. www.healthnotes.com Beta-Blockers Source: Integrative Medicine Communications; www.drkoop.com Beta-Carotene Source: Healthnotes, Inc. www.healthnotes.com Beta-Carotene Source: Prima Communications, Inc.www.personalhealthzone.com Beta-carotene Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10103,00.html Brewer's Yeast Alternative names: Nutritional Yeast Source: Integrative Medicine Communications; www.drkoop.com
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Carotenoids Source: Healthnotes, Inc. www.healthnotes.com Carotenoids Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,763,00.html Caulophyllum Alternative names: Blue Cohosh; Caulophyllum thalictroides (MICH.) Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Cherry fruit extract Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10015,00.html Clopidogrel Source: Healthnotes, Inc. www.healthnotes.com Coenzyme Q Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,768,00.html Coenzyme Q10 Source: Healthnotes, Inc. www.healthnotes.com Coenzyme Q10 Source: Integrative Medicine Communications; www.drkoop.com CoQ10 Source: Integrative Medicine Communications; www.drkoop.com Cysteine Source: Integrative Medicine Communications; www.drkoop.com Eicosapentaenoic Acid (EPA) Source: Integrative Medicine Communications; www.drkoop.com Eleuthero Alternative names: Siberian Ginseng, Eleuthero; Acanthopanax/Eleutherococcus senticosus Rupr. & Maxim. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org EPA Source: Integrative Medicine Communications; www.drkoop.com Ephedra (Ma huang) Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,777,00.html
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Fibric Acid Derivatives Source: Integrative Medicine Communications; www.drkoop.com Flavonoids Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,782,00.html Ginkgo biloba Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,788,00.html Glycyrrhiza glabra Source: Integrative Medicine Communications; www.drkoop.com Grape seed extract Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,793,00.html Huang-qi Source: Integrative Medicine Communications; www.drkoop.com Inosine Source: Prima Communications, Inc.www.personalhealthzone.com Inositol Source: Prima Communications, Inc.www.personalhealthzone.com Isosorbide Dinitrate Source: Healthnotes, Inc. www.healthnotes.com Licorice Alternative names: Glycyrrhiza glabra, Spanish Licorice Source: Integrative Medicine Communications; www.drkoop.com Lisinopril Source: Healthnotes, Inc. www.healthnotes.com Lycopene Source: Healthnotes, Inc. www.healthnotes.com Melatonin Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,804,00.html Metoprolol Source: Healthnotes, Inc. www.healthnotes.com
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Milk-Vetch Root Source: Integrative Medicine Communications; www.drkoop.com N-Acetyl Cysteine Source: Healthnotes, Inc. www.healthnotes.com N-Acetyl Cysteine (NAC) Source: Prima Communications, Inc.www.personalhealthzone.com Phenothiazine Derivatives Source: Integrative Medicine Communications; www.drkoop.com Propranolol Source: Healthnotes, Inc. www.healthnotes.com Red yeast rice Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10054,00.html SAMe (S-adenosylmethionine) Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,818,00.html Shark Cartilage Source: Integrative Medicine Communications; www.drkoop.com Soy isoflavones Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10057,00.html Spanish Licorice Source: Integrative Medicine Communications; www.drkoop.com Sulfonylureas Source: Integrative Medicine Communications; www.drkoop.com Thiazide Diuretics Source: Healthnotes, Inc. www.healthnotes.com Thiazide Diuretics Source: Integrative Medicine Communications; www.drkoop.com Thioxanthene Derivatives Source: Integrative Medicine Communications; www.drkoop.com Timolol Source: Healthnotes, Inc. www.healthnotes.com
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Tricyclic Antidepressants (TCAs) Source: Integrative Medicine Communications; www.drkoop.com Turmeric Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10062,00.html Vasodilators Source: Integrative Medicine Communications; www.drkoop.com
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.
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CHAPTER 4. DISSERTATIONS ON HEART ATTACK Overview In this chapter, we will give you a bibliography on recent dissertations relating to heart attack. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “heart attack” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on heart attack, we have not necessarily excluded non-medical dissertations in this bibliography.
Dissertations on Heart Attack ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to heart attack. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: ·
A Ministry to Heart Attack Victims and Their Families by Dawkins, Reginald Gay, Dmin from Drew University, 1988, 145 pages http://wwwlib.umi.com/dissertations/fullcit/8822087
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A Multifaceted Educational Assessment of an Inpatient Education Program for Heart Attack Victims by Greenstein, Pearl, Edd from Rutgers the State University of New Jersey - New Brunswick, 1982, 234 pages http://wwwlib.umi.com/dissertations/fullcit/8301576
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Aspirin for Primary and Secondary Prevention of an Acute Myocardial Infarction in Worksite Program by Humbles, Patricia Lee; Phd from University of Illinois at Chicago, Health Sciences Center, 2002, 118 pages http://wwwlib.umi.com/dissertations/fullcit/3058236
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Factors Affecting Adherence to Self-care Behaviors Following Myocardial Infarction by White, Sandra Kae, Phd from University of Alberta (canada), 1991, 137 pages http://wwwlib.umi.com/dissertations/fullcit/NN70121
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Health Perception after Heart Attack: an Examination of Alterable Variables in the Illness Situation by Lange, Linda Lou, Edd from North Carolina State University, 1982, 155 pages http://wwwlib.umi.com/dissertations/fullcit/8217042
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Knowledge of Symptoms in Adults at Risk for Heart Attack by Ryan, Catherine Jean; Phd from University of Illinois at Chicago, Health Sciences Center, 2003, 153 pages http://wwwlib.umi.com/dissertations/fullcit/3083955
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Living with a History of a Heart Attack a Human Science Investigation by Ford, Joan S; Phd from University of Alberta (canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/NL37609
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Living with a History of a Heart Attack: a Human Science Investigation by Ford, Joan Shirley, Phd from University of Alberta (canada), 1987 http://wwwlib.umi.com/dissertations/fullcit/f369845
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Predicting Social Involvement and Morale Six Months after a Heart Attack by Garrity, Thomas Francis, Phd from Duke University, 1971, 178 pages http://wwwlib.umi.com/dissertations/fullcit/7205349
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Psychosocial Factors Affecting Adaptation of Patients and Spouses to Myocardial Infarction by Gunn, William Bessent, Jr., Phd from Virginia Polytechnic Institute and State University, 1986, 153 pages http://wwwlib.umi.com/dissertations/fullcit/8704674
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Psychosocial Variables Associated with Recovery after Myocardial Infarction (heart Attack) by Brimlow, Deborah Lynn, Phd from The Johns Hopkins University, 1986, 310 pages http://wwwlib.umi.com/dissertations/fullcit/8615955
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Quality of Working Life after Myocardial Infarction by Lerner, Debra J., Phd from Boston University, 1987, 201 pages http://wwwlib.umi.com/dissertations/fullcit/8707068
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The Development and Testing of an Approach to the Education of Male Business Employees on Dietary Aspects of Lowering the Risk of Heart Attack by Fritz, Carol Joan, Edd from Columbia University, 1972, 270 pages http://wwwlib.umi.com/dissertations/fullcit/7302594
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The Effect of an Education Session on the Public's Knowledge about Acute Myocardial Infarction (ami) Symptoms by Jones, Sandra J. Msn from Texas Tech University, 2002, 99 pages http://wwwlib.umi.com/dissertations/fullcit/1408332
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The Effects of Structured Learning Environments on Coping Abilities and Cognitive Achievement of Wives Whose Husbands Have Suffered Heart Attacks by Cornett, Sandra Jean Fisher, Phd from The Ohio State University, 1981, 198 pages http://wwwlib.umi.com/dissertations/fullcit/8121779
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The Relationships between Anxiety, Depression, Denial of Fear, and Sick Role Expectations in Black, Hispanic, and White Male First Myocardial Infarction Patients by Liem, Linda, Dsw from Adelphi University, School of Social Work, 1981, 157 pages http://wwwlib.umi.com/dissertations/fullcit/8115350
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The Role of Meaning and Social Ties in Adjustment to Myocardial Infarction As an Undesirable Life Event by Fowers, Blaine J., Phd from The University of Texas at Austin, 1987, 185 pages http://wwwlib.umi.com/dissertations/fullcit/8717412
Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.
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CHAPTER 5. CLINICAL TRIALS AND HEART ATTACK Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning heart attack.
Recent Trials on Heart Attack The following is a list of recent trials dedicated to heart attack.8 Further information on a trial is available at the Web site indicated. ·
A safety and efficacy trial evaluating the early administration of abciximab and reteplase combination therapy in percutaneous coronary intervention. Condition(s): Myocardial Infarction Study Status: This study is currently recruiting patients. Sponsor(s): Centocor Purpose - Excerpt: The purpose of this medical research study is to determine whether the administration of abciximab and reteplase before patients have a coronary intervention, is safe and effective in the treatment of acute myocardial infarction compared to only abciximab given during coronary intervention. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00046228
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Home Automatic External Defibrillator Trial -- HAT Condition(s): Cardiovascular Diseases; Myocardial Infarction; Heart Diseases; Death, Sudden, Cardiac Study Status: This study is currently recruiting patients.
8
These are listed at www.ClinicalTrials.gov.
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Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To compare home use of an automatic external defibrillator to the local emergency medical system in survivors of a heart attack. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00047411 ·
Look AHEAD: Action for Health in Diabetes Condition(s): Diabetes; Myocardial Infarction; Stroke; Kidney Diseases; Bone Diseases; Dyslipidemia Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Heart, Lung, and Blood Institute (NHLBI); National Institute of Nursing Research (NINR); National Center on Minority Health and Health Disparities (NCMHD); Office of Research on Women's Health (ORWH) Purpose - Excerpt: The Look AHEAD study is a multicenter, randomized clinical trial to examine the long-term effects of a lifestyle intervention designed to achieve and maintain weight loss. The study will investigate the effects of the intervention on heart attacks, stroke and cardiovascular-related death in individuals with type 2 diabetes who are also overweight or obese. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00017953
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MRI Evaluation of Chest Pain Condition(s): Chest Pain; Coronary Disease; Myocardial Infarction Study Status: This study is currently recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: This study will assess the value of magnetic resonance imaging (MRI) in detecting heart attack and heart attack risk in patients who come to the hospital emergency room because of chest pain. It will also investigate whether MRI can help predict the coronary status of patients 4 to 6 weeks and 1 year after emergency room admission. Patients who come to the emergency room of Suburban Hospital in Bethesda, MD, because of chest pain may be asked to enroll in this study if they have not been diagnosed as having a heart attack. Participating patients will undergo a MRI scan as soon as emergency room doctors determine they are in stable condition. For this procedure, the patient lies on a table that slides into the MRI scanner-a large tubular machine with a magnetic field. During the scan, a contrast material is injected into the vein. This material brightens the image of the heart so that the blood flow can be seen. The scan will show if there are areas of heart muscle that received insufficient blood flow. A second scan will be done within 72 hours to look for coronary artery blockage that may require treatment. Patients will be followed by telephone 4 to 8 weeks after the scans and again 1 year after the scans to ask about any significant medical problems that may have occurred during those time periods. This study will provide information that may improve emergency treatment of patients with acute chest pain by clarifying which
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patients require immediate medical treatment, which should be admitted to the hospital for further evaluation, and which may safely be discharged from the hospital. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001961 ·
MYOHEART(tm) (Myogenesis Heart Efficiency and Regeneration Trial) Condition(s): Congestive Heart Failure; Coronary Artery Disease; Myocardial Infarction Study Status: This study is currently recruiting patients. Sponsor(s): Bioheart, Inc. Purpose - Excerpt: The MyoCell(tm) implantation using the MyoCath(tm) delivery catheter system may have the potential to add a new dimension to the management of post-infarct deterioration of cardiac function in subjects with congestive heart failure. Based on pre-clinical studies, implantation of autologous skeletal myoblasts may lead to replacement of non-functioning myocardial scar with functioning muscle and improvement in myocardial performance. Preliminary data in human subjects suggest skeletal myoblast implantation at the time of CABG may lead to the same effects. In principal, myoblast implantation by catheter delivery may offer the same therapeutic benefit. The present clinical study is to be conducted primarily to evaluate the safety of MyoCell(tm) implantation using the MyoCath(tm) delivery system and secondarily to evaluate the effect on regional myocardial function post treatment. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00054678
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Occluded Artery Trial (OAT) Condition(s): Cardiovascular Diseases; Heart Diseases; Myocardial Infarction; Heart Failure, Congestive; Heart Failure Study Status: This study is currently recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine whether opening an occluded infarcted artery 3-28 days after an acute myocardial infarction in high-risk asymptomatic patients reduces the composite endpoint of mortality, recurrent myocardial infarction, and hospitalization for class IV congestive heart failure over a three year follow-up. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004562
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Open Study of enoxaparin vs. unfractionated heparin in patients with acute coronary syndromes Condition(s): Unstable Angina; Myocardial Infarction; Myocardial Ischemia Study Status: This study is currently recruiting patients. Sponsor(s): Aventis Pharmaceuticals Purpose - Excerpt: Patients experiencing a mild heart attack will receive one of two medications which thin the blood to discern which is superior. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00043784
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Periodontitis and Cardiovascular Events or "PAVE" Condition(s): Cardiovascular Disease; Coronary Heart Disease; Myocardial Infarction; Cerebrovascular Accident Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Dental and Craniofacial Research (NIDCR) Purpose - Excerpt: The purpose of this study is to determine if treating periodontal infections (gum problems) will lead to fewer heart problems in patients at high risk for cardiovascular disease. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00066053
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Study of Oral PG-116800 Following a Heart Attack Condition(s): Myocardial Infarction; Heart Failure; Heart Enlargement Study Status: This study is currently recruiting patients. Sponsor(s): Procter & Gamble Pharmaceuticals Purpose - Excerpt: Heart attacks cause damage to heart muscle that can weaken the heart and lead to changes in the shape and pumping ability of the heart. These changes can lead to heart failure. An enzyme called metalloproteinase (MMP) plays a role in this damage. The main purpose of the study is to test whether a possible new drug (called PG-116800) that interferes with the MMP enzyme can prevent some of the damage to heart muscle in patients who have had a heart attack. The study will also supply information regarding possble uses of this compound in cardiovascular disease. This is a Phase II "proof-of-concept" study; that is, it is a first attempt to treat sick people with the drug to see if it works. The study is interventional since we will be using a drug to interfere with the heart tissue damage that follows a heart attack. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00067236
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Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial Condition(s): Heart Disease; Stroke; Ischemic Heart Disease; Myocardial Infarction; Atrial Fibrillation Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: The purpose of this study is to determine which of two treatments, Warfarin or aspirin, is better for preventing death and stroke in patients with poor heart function. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00041938
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Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Condition(s): Cardiovascular Diseases; Coronary Disease; Diabetes Mellitus; Heart Diseases; Hypercholesterolemia; Hypertension; Myocardial Infarction; Myocardial Ischemia Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine if the combined incidence of nonfatal myocardial infarction and coronary heart disease death differs between diuretic-based and each of three alternative antihypertensive pharmacological treatments. Also, to determine, in a subset of this population, if lowering serum cholesterol with a HMG CoA reductase inhibitor in older adults reduces all-cause mortality compared to a control group receiving usual care. Conducted in conjunction with the Department of Veterans' Affairs. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000542
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Antihypertensive Drug/Gene Interactions and CV Events Condition(s): Cardiovascular Diseases; Hypertension; Cerebrovascular Accident
Heart
Diseases;
Myocardial
Infarction;
Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To investigate drug-gene interactions on the incidence of non-fatal myocardial infarction and stroke for hypertensive patients. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005332
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Genetics of CRP in Families with Myocardial Infarction Condition(s): Cardiovascular Diseases; Coronary Disease; Heart Diseases; Myocardial Infarction Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To investigate the genetics of C reactive protein in families with myocardial infarction. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00064519
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The MI-HEART Project Condition(s): Myocardial Infarction; Coronary Disease Study Status: This study is no longer recruiting patients. Sponsor(s): National Library of Medicine (NLM) Purpose - Excerpt: The purpose of the study is to examine ways in which a clinical information system can help patients better recognize the signs and symptoms of an acute myocardial infarction (heart attack) and to take actions to decrease morbidity and mortality that may be related to delay in seeking treatment. The software-based intervention will use the best scientific evidence to create tailored strategies using a patient's specific health data. This approach is based on well-established cognitive and behavioral educational models. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00013741
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Vascular Interaction with Age in Myocardial Infarction Condition(s): Myocardial Infarction Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: The body produces a natural compound, nitric oxide (NO), which is known to improve the elasticity of blood vessels effect cardiac function and play a role in the remodeling process after a heart attack. The primary source of NO is one of the amino acids that the body uses to form new proteins, L-Arginine; although many individuals with heart disease also take medicines to increase the concentrations of NO such as nitroglycerine. The VINTAGE-MI trial is intended to investigate wether supplementation of the bodies supply of NO with oral administration of L-Arginine will improve the functional recovery of older patients who have recently suffered their first heart attack. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00051376
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Vitamin therapy for prevention of stroke Condition(s): Stroke; Cerebral Infarction; Myocardial Infarction Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: A stroke occurs when part of the brain is damaged from lack of normal blood supply. This may result in difficulty with feeling, speech, muscle strength or coordination, movement, thinking, or other brain functions. Having a stroke increases the risk of another stroke occurring in the future. Higher blood levels of a natural chemical known as homocysteine may contribute to hardening of the arteries in the brain or heart and increase the risk of stroke or heart attack. Folic acid, vitamin B6 (pyridoxine), and vitamin B12 (cyanocobalamin) may lower blood levels of homocysteine and reduce the risk of having another stroke or a heart attack. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004734
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Worcester Heart Attack Community Surveillance Study Condition(s): Cardiovascular Diseases; Heart Diseases; Coronary Disease; Myocardial Infarction Study Status: This study is no longer recruiting patients. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To examine time trends in the incidence rates of acute myocardial infarction and out-of-hospital coronary heart disease deaths as well as changes in the inhospital and long-term case-fatality rates of acute myocardial infarction in the Worcester, Massachusetts Standard Metropolitan Statistical Area (SMSA). Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005196
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Aspirin-Myocardial Infarction Study (AMIS) Condition(s): Cardiovascular Diseases; Coronary Disease; Heart Diseases; Myocardial Infarction; Myocardial Ischemia Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine whether the daily administration of 1 gm of aspirin to individuals with a documented myocardial infarction would result in a significant reduction in mortality over a three year period. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000491
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Assessment of a B-Mode Ultrasound Technique for the Measurement of Carotid Artery Intima-Media Thickness Condition(s): Atherosclerosis; Myocardial Infarction Study Status: This study is completed. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: This minimal risk protocol is designed to assess the reproducibility of B-mode ultrasound measurements of carotid intima media thickness (IMT) when the scans are performed in CC Radiology and read using a computerized edge reader. Up to 20 volunteers will have two ultrasounds performed within a 6-month period. IMT thickness is used as a surrogate marker for atherosclerosis and may be of value in clinical trials. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001904
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Autologous Cultured Myoblasts (BioWhittaker) Transplanted via Myocardial Injection Condition(s): Congestive Heart Failure; Coronary Artery Disease; Myocardial Infarction Study Status: This study is not yet open for patient recruitment. Sponsor(s): Bioheart, Inc. Purpose - Excerpt: MyoCell(tm) implantation by epicardial injection during CABG surgery has the potential to add a new dimension to the management of post-infarct deterioration of cardiac function. Based on existing non-clinical studies and clinical reports, implantation of autologous skeletal myoblasts appears to lead to the replacement of non-functioning myocardial scar with functioning muscle and appears to improve myocardial performance relative to case without myoblast implantation. In a few investigational patients, myoblast implantation can be, and has been, done in conjunction with CABG and appears to have the potential to provide for additive treatment during surgery. The present study is being conducted to evaluate more fully the safety of MyoCell(tm) implantation via epicardial injection during CABG surgery and its effect on regional myocardial function. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00050765
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Beta-Blocker Heart Attack Trial (BHAT) Condition(s): Arrhythmia; Cardiovascular Diseases; Coronary Disease; Death, Sudden, Cardiac; Heart Diseases; Myocardial Infarction; Myocardial Ischemia; Ventricular Fibrillation Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI)
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Purpose - Excerpt: To determine whether the regular administration of the beta-blocker drug propranolol to people who had had at least one documented myocardial infarction would result in a significant reduction of mortality from all causes over the follow-up period. Eligible volunteer patients were recruited to participate in a double-blind clinical trial within 21 days after the onset of the acute event. One-half of the patients were randomly assigned to a beta-blocking drug (propranolol) and one-half to a placebo. The trial also evaluated the effect of propranolol on incidences of coronary heart disease mortality, sudden cardiac death, and nonfatal myocardial infarction plus coronary heart disease mortality in persons with documented previous myocardial infarction. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000492 ·
Cardiac Arrhythmia Suppression Trial (CAST) Condition(s): Cardiovascular Diseases; Coronary Disease; Death, Sudden, Cardiac; Heart Arrest; Heart Diseases; Myocardial Infarction; Myocardial Ischemia; Ventricular Arrhythmia Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine whether drug treatment of asymptomatic ventricular arrhythmias in post-myocardial infarction patients reduced the incidence of sudden cardiac death and total mortality. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000526
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Carotid Atherosclerosis Follow-up Study Condition(s): Cardiovascular Diseases; Carotid Artery Diseases; Myocardial Infarction; Coronary Disease; Heart Diseases; Cerebrovascular Accident Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine whether the degree of carotid artery atherosclerosis, as measured by B-mode ultrasound, predicts the development of myocardial infarction, stroke, and all-cause mortality in patients with angiographically defined coronary status. Also, to quantify the rate of progression of carotid artery disease and to evaluate the risk factors associated with progression of carotid atherosclerosis. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005189
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Common Variants in Candidate Genes and Premature MI Risk Condition(s): Cardiovascular Diseases; Heart Diseases; Myocardial Infarction Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To examine the impact of an interaction between common genetic susceptibility markers and environmental exposures on risk for early onset myocardial infarction in cases with myocardial infarction and matching controls. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005488
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Comparison of Asymptomatic Carotid Atherosclerosis Between Frequent and Infrequent Blood Donors Condition(s): Carotid Atherosclerosis; Myocardial Infarction Study Status: This study is completed. Sponsor(s): Warren G Magnuson Clinical Center (CC) Purpose - Excerpt: Iron has been proposed to contribute to atherogenesis in humans by facilitating the oxidation of lipoproteins. This observational study will evaluate the association between frequency of blood donation - expected to be associated with relatively reduced body iron stores in frequent donors - and carotid atherosclerosis. The primary outcome variable will be whether the presence and extent of asymptomatic carotid atherosclerosis as measured by ultrasound is greater in infrequent (less than or equal to 1 donations/year greater than or equal to 5 years) vs. frequent (greater than or equal to 4 donations/year greater than or equal to 5 years) blood donors. Body iron stores, lipid and hemostatic parameters, nitric oxide formation, inflammatory parameters, and markers of vascular oxidative stress will be analyzed as secondary outcome measures. Laboratory analysis and ultrasound testing will be performed blinded to the patient's phlebotomy and iron status. Sixty frequent (n=40 males greater than 40 y/o, n=20 females greater than 50 y/o) and 60 infrequent (n=40 males greater than 40 y/o, n=20 females greater than 50 y/o) blood donors will be recruited for this study from the Department of Transfusion Medicine, W. G. Magnuson Clinical Center. All donors will be assessed for study eligibility and cardiovascular risks during the screening visit. The presence of atherosclerotic lesions by carotid ultrasound and secondary outcome parameters will be assessed during a second visit. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001589
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Coronary Drug Project Condition(s): Cardiovascular Diseases; Coronary Disease; Heart Diseases; Myocardial Infarction; Myocardial Ischemia Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine whether regular administration of lipid modifying drugs (clofibrate, nicotinic acid, estrogen, dextrothyroxine) to men with a documented
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myocardial infarction would result in significant reduction in total mortality over a five year period. Secondarily, to determine whether the degree to which these drugs changed serum lipids was correlated with any effect on mortality and morbidity rates; to gain further information on the long-term prognosis of myocardial infarction (by studying the control group as intensively as the treatment group); to acquire further experience and knowledge concerning the techniques and methodology of long-term clinical trials; to determine, in a substudy, the effectiveness of aspirin, a platelet inhibitor, in reducing recurrences of myocardial infarction. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000482 ·
Epidemiology of Coronary Heart Disease in Blacks Condition(s): Cardiovascular Diseases; Heart Diseases; Coronary Disease; Myocardial Infarction Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To conduct an analysis of the epidemiology of coronary heart disease (CHD) in Blacks using data collected from the 'Survival and Ventricular Enlargement (SAVE) Following Myocardial Infarction' study. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005410
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Heart Rate Variability and Sudden Cardiac Death Condition(s): Cardiovascular Diseases; Coronary Disease; Heart Diseases; Myocardial Infarction; Death, Sudden, Cardiac; Ventricular Arrhythmia Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To evaluate the ability of heart rate variability to identify myocardial infarction patients at high risk of dying, particularly from sudden cardiac death. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005235
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Hormone Replacement Therapy and Prothrombotic Variants Condition(s): Cardiovascular Diseases; Heart Diseases; Cerebrovascular Accident; Myocardial Infarction; Hypertension Study Status: This study is not yet open for patient recruitment. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI)
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Purpose - Excerpt: To examine in postmenopausal women the potential interactions of hormone replacement therapy with other blood clotting factors on the risk of cardiovascular diseases such as heart attack or stroke. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00049933 ·
Inflammation, Infection, and Future Cardiovascular Risk Condition(s): Cardiovascular Diseases; Coronary Disease; Cerebrovascular Accident; Myocardial Infarction; Venous Thromboembolism; Heart Diseases; Infection; Chlamydia Infections; Cytomegalovirus Infections; Helicobacter Infections; Herpesviridae Infections; Inflammation Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To examine markers of underlying chronic inflammation and infection as potential risk factors for future myocardial infarction (MI), stroke (CVA), and venous thromboembolism (VTE) in plasma samples collected at baseline from healthy participants in the Physicians' Health Study (PHS). Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005496
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Intermittent ST Depression and Prognosis After Myocardial Infarction Condition(s): Cardiovascular Diseases; Myocardial Infarction; Heart Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine if intermittent ST depression (STD) had an independent impact on survival among myocardial infarction patients who participated in the BetaBlocker Heart Attack Trial (BHAT). Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005217
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Intravenous Streptokinase in Acute Myocardial Infarction Condition(s): Cardiovascular Diseases; Coronary Disease; Heart Diseases; Myocardial Infarction; Myocardial Ischemia Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine whether the administration of intravenous streptokinase (SK) early in the course of acute, transmural myocardial infarction would limit myocardial damage. Phase(s): Phase III Study Type: Interventional
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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000507 ·
Magnesium in Coronaries (MAGIC) Condition(s): Cardiovascular Diseases; Coronary Disease; Heart Diseases; Myocardial Infarction; Myocardial Ischemia Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine whether early intravenous magnesium treatment of patients with suspected acute myocardial infarction reduces mortality. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000610
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Montreal Heart Attack Readjustment Trial (M-HART) Condition(s): Cardiovascular Diseases; Coronary Disease; Heart Diseases; Myocardial Infarction; Myocardial Ischemia Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To examine the impact of a monitoring and social support intervention upon survival of myocardial infarction patients. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000533
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Multicenter Investigation of Limitation of Infarct Size (MILIS) Condition(s): Cardiovascular Diseases; Coronary Disease; Heart Diseases; Myocardial Infarction; Myocardial Ischemia Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To assess the ability of two separate therapeutic interventions, propranolol and hyaluronidase, to limit the ultimate size of an acute myocardial infarction. A secondary objective was to assess the influence of these therapies upon ventricular function and morbidity following myocardial infarction. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000493
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Myocardial Infarction and Current Oral Contraceptive Use Condition(s): Cardiovascular Diseases; Coronary Disease; Myocardial Infarction; Heart Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To assess whether current oral contraceptive (OC) use (within the previous month) increased the risk of myocardial infarction. Also, to assess the combined effects of cigarette smoking and oral contraceptive use. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005241
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Myocardial Infarction and Non-contraceptive Estrogen Use Condition(s): Cardiovascular Menopause; Postmenopause
Diseases;
Heart
Diseases;
Myocardial
Infarction;
Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To evaluate whether the use of noncontraceptive estrogen influenced the incidence of first myocardial infarction in women. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005185 ·
Myocardial Infarction and Past Oral Contraceptive Use Condition(s): Cardiovascular Diseases; Coronary Disease; Myocardial Infarction; Heart Diseases; Menopause; Postmenopause Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To evaluate whether the long-term use of oral contraceptives, after discontinuation, was associated with an increased incidence of first nonfatal myocardial infarction among women above the age of 50. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005173
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Myocardial Infarction Triage and Intervention Project (MITI) Condition(s): Cardiovascular Diseases; Coronary Disease; Heart Diseases; Myocardial Infarction; Myocardial Ischemia Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine the practicality, benefit, and safety of paramedic administration of thrombolytic therapy for acute myocardial infarction. The feasibility
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of paramedics correctly identifying candidates for thrombolytic therapy following myocardial infarction was assessed in Phase I. In Phase II, pre-hospital thrombolytic therapy was compared with in-hospital thrombolytic therapy. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000468 ·
Natural History of Coronary Heart Disease Condition(s): Cardiovascular Diseases; Coronary Disease; Myocardial Infarction; Heart Diseases; Death, Sudden, Cardiac; Heart Failure, Congestive; Heart Failure Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To examine the natural history of mortality due to coronary heart disease in post-myocardial infarction patients from the Beta-Blocker Heart Attack Trial (BHAT) and the Aspirin Myocardial Infarction Study (AMIS). Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005265
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Program on Surgical Control of Hyperlipidemias (POSCH) Condition(s): Cardiovascular Diseases; Coronary Disease; Heart Diseases; Myocardial Infarction; Myocardial Ischemia Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine whether a profound reduction in serum cholesterol level, induced and maintained by partial ileal bypass, would prevent a second heart attack among men and women who had one myocardial infarction and whose blood cholesterol could not be reduced sufficiently by diet. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000490
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Protein S and Myocardial Infarction Condition(s): Cardiovascular Diseases; Heart Diseases; Myocardial Infarction Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To test the hypothesis that low levels of free protein S, a natural anticoagulant protein in plasma, were associated with an increased incidence of myocardial infarction in middle aged men and women. Study Type: Observational
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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005329 ·
Randomized Clinical Trial of Non-Surgical Reperfusion of the Coronary Arteries Condition(s): Cardiovascular Diseases; Coronary Disease; Heart Diseases; Myocardial Infarction; Myocardial Ischemia Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To assess the effect of non-surgical reperfusion on infarct size in patients with acute myocardial infarction. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000503
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Stroke and MI in Users of Estrogen/Progestogen Condition(s): Cardiovascular Diseases; Heart Diseases; Coronary Cerebrovascular Accident; Myocardial Infarction; Postmenopause
Disease;
Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To estimate the relative risks of acute myocardial infarction (MI) and of stroke in postmenopausal users of estrogen/progestogen (E/P) combinations and to estimate the relative risks of MI and of stroke in users of estrogen alone. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005466 ·
Survival After Myocardial Infarction in A Biethnic Texas Community (Corpus Christi Heart Project) Condition(s): Cardiovascular Diseases; Hypertension; Coronary Disease; Myocardial Infarction Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine the natural history of coronary heart disease in the biethnic community of Corpus Christi, Texas. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005198
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The Role of Angiotensin Type I Receptor in the Regulation of Human Coronary Vascular Function Condition(s): Atherosclerosis; Heart Failure, Congestive; Hypertension; Myocardial Infarction Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: The renin angiotensin system (RAS) plays an important physiological and pathophysiological role in the control of blood pressure and plasma volume. Inhibition of the RAS is useful in the treatment of hypertension, cardiac failure and in some patients with myocardial infarction. Several recent clinical trials with angiotensin converting enzyme inhibitors (ACEI) have shown that they also reduce the incidence of myocardial infarction, but the mechanisms underlying this anti-ischemic effect are poorly understood. ACEI reduce angiotensin II synthesis and prevent bradykinin degradation. Results from ongoing studies in the Cardiology Branch (Protocol 95-H0099) designed to investigate the link between ACEI and the vascular endothelium indicate that ACEI improve both endothelial dysfunction and metabolic coronary vasodilation, an effect that is partially mediated by bradykinin. The current protocol is designed to investigate whether the beneficial effects of ACEI on endothelial function are also partly due to inhibition of angiotensin II. The recent development of selective angiotensin II type 1 (AT1) receptor antagonists allows us to specifically examine the effects of angiotensin II on vasomotor activity. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001629
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The Role of Angiotensin Type I Receptor in the Regulation of Human Peripheral Vascular Function Condition(s): Atherosclerosis; Heart Failure, Congestive; Hypertension; Myocardial Infarction Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: The renin angiotensin system (RAS) plays an important physiological and pathophysiological role in the control of blood pressure and plasma volume. Inhibition of the RAS is useful in the treatment of hypertension, cardiac failure and in some patients with myocardial infarction. Several recent clinical trials with angiotensin converting enzyme inhibitors (ACEI) have shown that they also reduce the incidence of myocardial infarction, but the mechanisms underlying this anti-ischemic effect are poorly understood. ACEI reduce angiotensin II synthesis and prevent bradykinin degradation. Results from ongoing studies in the Cardiology Branch (Protocol 95-H0099) designed to investigate the link between ACEI and the vascular endothelium indicate that ACEI improve peripheral endothelial function, an effect that is partially mediated by bradykinin. The current protocol is designed to investigate whether the beneficial effects of ACEI on peripheral endothelial function are also due to inhibition of angiotensin II. The recent development of selective angiotensin II type 1 (AT1) receptor antagonists allows us to specifically examine the effects of angiotensin II on vasomotor activity.
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Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001628 ·
Thrombogenic Factors and Recurrent Coronary Events Condition(s): Cardiovascular Diseases; Heart Diseases; Coronary Disease; Myocardial Infarction; Thrombosis; Death, Sudden, Cardiac Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine if selected circulating blood factors that reflect enhanced thrombogenesis are associated with an increased incidence of recurrent coronary events, including cardiac death or non-fatal myocardial infarction. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00005358
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Thrombolysis in Myocardial Infarction (TIMI) Condition(s): Cardiovascular Diseases; Coronary Disease; Heart Diseases; Myocardial Infarction; Myocardial Ischemia Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: In TIMI I, to assess the relative thrombolytic activity and side effects of intravenous recombinant tissue-type plasminogen activator (rt-PA) versus intravenous streptokinase in patients with acute myocardial infarction. In TIMI II, to assess whether intravenous rt-PA given in the early hours of acute myocardial infarction should be followed by percutaneous transluminal coronary angioplasty (PTCA). Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000505
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Thrombolysis in Myocardial Ischemia Trial (TIMI III) Condition(s): Angina Pectoris; Cardiovascular Diseases; Coronary Disease; Heart Diseases; Myocardial Infarction; Myocardial Ischemia Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: The Thrombolysis in Myocardial Ischemia Trial (TIMI III) focused on unstable angina and non-Q-wave myocardial infarction. The trial was designed to determine by coronary arteriography the incidence of coronary thrombi in these conditions and the response of these thrombi to tissue-type plasminogen activator (t-PA) in TIMI IIIA and the effects of thrombolytic therapy and of an early invasive strategy on
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clinical outcome in TIMI IIIB. There was also a registry with two components. A roster enumerated all patients with unstable angina or non-Q-wave myocardial infarction enrolled at cooperating hospitals. From the roster, a study population of 1,893 subjects was selected and followed prospectively for the year to determine incidence of death or myocardial infarction. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000472
Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “heart attack” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/
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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm
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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm
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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm
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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp
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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm
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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/
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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm
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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm
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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm
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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm
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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm
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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials
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CHAPTER 6. PATENTS ON HEART ATTACK Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “heart attack” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on heart attack, we have not necessarily excluded non-medical patents in this bibliography.
Patents on Heart Attack By performing a patent search focusing on heart attack, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 9Adapted
from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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example of the type of information that you can expect to obtain from a patent search on heart attack: ·
CK-MM myocardial infarction immunoassay Inventor(s): Shah; Vipin D. (Saratoga, CA), Yen; Shing-Erh (Foster City, CA), Anchin; Gerald M. (Santa Cruz, CA) Assignee(s): International Immunoassay Laboratories, Inc. (Santa Clara, CA) Patent Number: 4,900,662 Date filed: July 21, 1987 Abstract: Methods and reagents for early detection of myocardial infarction determine the level of CK-MM.sub.A and the level of the combined CK-MM.sub.A and CKMM.sub.B in a serum sample. From these measurements, the time of the acute phase can be more accurately determined. Novel anti-(CK-MM.sub.A) antibodies, anti-(CKMM.sub.B) antibodies, anti-(CK-MM.sub.(A+B)) antibodies, labeled and insolubilized derivatives of these antibodies, labeled CK-MM isoforms, and kits containing one or more of these reagents are also described. Excerpt(s): This invention relates to the measurement of biological markers which are released into body fluids at the onset of acute diseases for diagnostic purposes. In particular, this invention relates to the measurement of CK-MM isoforms in patient serum for purposes of diagnosis of myocardial infarction or other acute injuries which cause the release of CK-MM isoforms into the blood stream. Diagnosis of acute disease is often based on abnormal levels of disease markers such as enzymes and hormones in biological fluids such as serum, particularly when they change momentarily during the acute phase of disease. The biological activity and physical properties of proteins such as enzymes and hormones is determined by structural features of the molecule, and these features are often modified by endogenous conversions factors present in body fluids. Such conversion may cause the loss of biological activity or change in physical properties such as electrophoretic mobility of the molecule. The conversion products may coexist with the original molecule immediately following the onset of an acute disease, but with the passage of time, one may find only the altered protein in the body fluids. Web site: http://www.delphion.com/details?pn=US04900662__
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Creative kinase-MB immunoassay for myocardial infarction and reagents Inventor(s): Shah; Vipin D. (Saratoga, CA), Anchin; Gerald M. (Bellaire, TX), Yen; ShingErh (Foster City, CA) Assignee(s): International Immunoassay Laboratories, Inc. (Santa Clara, CA) Patent Number: 5,382,515 Date filed: June 25, 1993 Abstract: Methods and reagents for determining the lapse of time since an acute disease event, such as the occurrence of a myocardial infarction, are presented. A serum or plasma sample is assayed to determine the concentration of two different analytes selected from a group of creatine kinase-MB species. From these measurements, the time of the acute event can be more accurately determined. Novel antibodies, labeled and
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insolubilized derivatives of these antibodies, labeled proteins, and kits containing one or more of these reagents are also described. Excerpt(s): In another embodiment, the invention herein also relates to an improved method for immunological diagnosis of myocardial infarction. Diagnosis of acute disease is often based on abnormal levels of disease markers, such as enzymes and hormones in biological fluids such as serum, particularly when the concentration changes quickly during the acute phase of disease. For example, the enzyme creative kinase (CK, ATP:creatine N-phosphotransferase) catalyzes the reversible transfer of a phosphate group from ATP to creatine. It exists as a dimer composed of two subunits commonly identified as the M-subunit and the B-subunit. CK-MB is associated with acute myocardial infarction, and is present in serum in only trace concentrations in the absence of such an episode. Appearance of CK-MB isoenzyme in serum is therefor indicative of myocardial infarction. CK-MM isoeforms are present in the serum of normal patients in measurable amounts, but are present in significantly increased concentration following acute myocardial infarction. Assays to determine the occurrence of an acute myocardial infarction by measuring CK isoenzymes are known. The biological activity and physical properties of proteins such as enzymes and hormones are determined by structural features of the molecule. These features are often modified by endogenous conversion factors present in body fluids. Such conversion may or may not cause the loss of biological activity, or changes in physical properties such as electrophoretic mobility of the molecule. The conversion products may coexist with the original molecule immediately following the onset of an acute disease, but with the passage of time, one finds only the altered protein in the body fluids. Web site: http://www.delphion.com/details?pn=US05382515__ ·
Detection/exclusion of acute myocardial infarction using neural network analysis of measurements of biochemical markers Inventor(s): Ellenius; Johan (Geijersgatan 15B, S-752 26 Uppsala, SE), Groth; Torgny Lars (Dobelnsgatan 24A, S-752 37 Uppsala, SE) Assignee(s): none reported Patent Number: 5,690,103 Date filed: June 20, 1996 Abstract: The overall invention categorizes patients with suspected acute myocardial infarction (AMI) with regard to a) AMI/non-AMI; b) infarct size (e.g. Major/Minor); c) time since onset of infarction; and d) non-AMI with/without minor myocardial damage (MMD). Generally, the above categorization is based on frequent timed blood sampling and measurement of selected biochemical markers of AMI with different rates of appearance in circulating blood. The computations are performed by using specially designed artificial neural networks. According to a first main aspect of the invention, early, i.e. generally within 3 hours from admission of the patient, detection/exclusion of acute myocardial infarction is provided. Furthermore, early prediction of the infarct size and early estimation of the time from onset are also provided. Excerpt(s): The present invention relates to the management of patients with suspected myocardial infarction or damage, and more particularly to methods and apparatuses for early detection/exclusion of AMI, early prediction of infarct size, estimation of time from onset of infarction, and assessment of minor myocardial damage. An early diagnosis within the first hours after onset of symptoms is essential for the optimal
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treatment of patients with acute myocardial infarction (AMI) as has been documented by e.g. the National Heart Attack Alert Program Coordinating Committee, 60 minutes to Treatment Working Group (in Ann Emerg Med 1994; 23:311-329). In patients with STelevation in their initial ECG recording on admission the diagnosis is straight forward. Moreover, the total sum of ST-elevations in all ECG-leads gives a good estimate of the myocardium at risk. However, in at least 40% of patients with AMI the 12-lead ECG is nondiagnostic on admission. In these patients the diagnosis has to be based on clinical data and measurements of biochemical markers, currently a time consuming procedure that causes delay in start of treatment. An early and reliable prediction of the infarct size is also difficult for this group of patients. In the heterogeneous group of patients admitted to the hospital because of chest pain, considerable economic gains might be achieved by early identification of those patients (approximately 60-70%) who are at sufficiently low risk of AMI and its complications, to be transferred to a general ward outside the coronary care unit (CCU). Among patients with unstable angina 30-50% have minor elevations of sensitive biochemical markers such as creatine kinase MB and troponin-T. The term minor myocardial damage (MMD) has been proposed for these minor elevations. Since MMD indicates an increased risk of future cardiac events it seems important not only to detect AMI, but also to detect MMD as early as possible. Thus, in the early management of patients with acute chest pain there are several important diagnostic issues to be addressed. Does the patient have AMI? If so will the ultimate infarct size be large or small? What is the timing of the infarction? If the patient does not have an AMI: Does the patient have a high or low risk for subsequent cardiac events? The clinician has to consider the patient's history and physical status, the results of ECG and blood tests etc. This decision-making process may be time consuming and is heavily dependent on the clinician's knowledge and experience. Web site: http://www.delphion.com/details?pn=US05690103__ ·
Early warning apparatus for acute Myocardial Infarction in the first six hours of pain Inventor(s): Sesana; Arturo (Calle 100 No. 35-67 Ap 616, Sta Fe de Bogota, CO), Anzellini; Fernando (Calle 83 No. 19-36 (of. 704), Gongora; Mario (Carrera 13 No. 90-55 Ap. 404, Sta Fe de Bogota, CO) Assignee(s): none reported Patent Number: 6,339,720 Date filed: September 20, 1999 Abstract: A portable device (8) for recognizing Acute Myocardial Infarction by the patient himself without the help of medical doctors or technicians is described. The invention performs a real-time analysis of the ST segment (9) in an ambulatory electrocardiographic measurement environment to help the patient decide by himself that he is suffering an Acute Myocardial Infarct. The device (8) is capable of warning the user that he/she may be suffering a heart attack when the ST segment (9) is found to be depressed or elevated. The CARDIOST features a simple-to-use portable electrocardiographic amplifier (15) and a microcontroller unit (17) to analyze the ST segment (9) on the signal received from the electrocardiographic amplifier (15). With a software embedded in the microcontoller unit (17) the analysis of the ST segment (9) delivers the diagnosis to the patient with a visual and acoustic alarm (18,19,20,21) representing low, medium or high risk, depending on the status of the ST segment (9) shift so that he can seek medical treatment for thrombolisys or any other treatment currently available and influenced by early diagnosis within 4-6 hours without
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misinterpreting subjective chest pain symptoms, this being a worldwide medical problem since Acute Myocardial Infarction is the leading cause of mortality in the world. Excerpt(s): The CARDIOST relates to a unit capable of informing a user with no medical background when he/she is suffering an Acute Myocardial Infarction in the first 4 to 6 hours of chest pain. There are many electrocardiographic (ECG) measuring apparatuses. Many of them can measure the ST segment (and other parts of the electrocardiogram wave) but are not meant to alert as to the possibility of an Acute Myocardial Infarction, and they have to be used by qualified medical personnel. The portable electrocardiographic monitoring devices are used for long-term collection of ST segment data and many other measurements. Some of these devices perform simple real-time analyses limited to ischemia period detection and recording. These devices are used over a long period of time (usually 24 hour periods) for passive recording and analysis. After this period the data has to be downloaded from the device and analyzed by qualified medical personnel for the final opinion. These devices have to be carried by the patient for the complete period of data recording, which makes them uncomfortable no matter how small they are. Web site: http://www.delphion.com/details?pn=US06339720__ ·
Genetically altered mammalian embryonic stem cells, their living progeny, and their therapeutic application for improving cardiac function after myocardial infarction Inventor(s): Xiao; Yong-Fu (26 Paquot Rd., Wayland, MA 01778), Morgan; James P. (56 Norwood Ave., Newton Centre, MA 02459) Assignee(s): none reported Patent Number: 6,607,720 Date filed: October 7, 2000 Abstract: The present invention provides genetically altered mammalian embryonic stem cells, their living descendent progeny having an altered genomic DNA, and therapeutic methods using these cells for improving cardiac function in a living subject after myocardial infarction. The genetically altered embryonic stem and progenitor cells may be maintained in-vitro as a stable cell line; and transplanted as active, mitotic cells to an infarcted area of the myocardial using any surgical procedure. After transplantation at a chosen anatomic site within the heart of the subject, these genetically altered cells will differentiate in-site, cause a regeneration of myocardocytes, and will effect a marked improvement in cardiac function for the subject. Excerpt(s): The present invention is concerned generally with cellular compositions and methods for improving cardiac function in a living subject after the occurrence of a myocardial infarction; And is focused in particular upon the preparation and therapeutic use of novel genetically altered mammalian embryonic stem cells and their direct descendent progeny as cells for in-vivo transplantation into the infarcted areas of the myocardium in a living host subject. Myocardial infarction (MI) is a life-threatening event and may cause cardiac sudden death or heart failure. Despite considerable advances in the diagnosis and treatment of heart disease, cardiac dysfunction after MI is still the major cardiovascular disorder that is increasing in incidence, prevalence, and overall mortality (Eriksson et al., 1995). After acute myocardial infarction, the damaged cardiomyocytes are gradually replaced by fibroid nonfunctional tissue. Ventricular remodeling results in wall thinning and loss of regional contractile function. The
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ventricular dysfunction is primarily due to a massive loss of cardiomyocytes. It is widely accepted that adult cardiomyocytes have little regenerative capability. Therefore, the loss of cardiac myocytes after MI is irreversible. Each year more than half million Americans die of heart failure. The relative shortage of donor hearts forces researchers and clinicians to establish new approaches for treatment of cardiac dysfunction in MI and heart failure patients. Cell transplantation has emerged as a potential novel approach for regeneration of damaged myocardium in recent several years. Transplanted cardiomyocytes have been shown to survive, proliferate, and connect with the host myocardium (Soonpaa et al., 1994). Engrafted cells may regenerate new cardiomyocytes to replace infarcted myocardium or serve as a source for therapeutic gene transfer to infarct areas (Leor et al., 1997). Li and his coworkers (Li et al., 1996) demonstrated that transplanted fetal cardiomyocytes could form new cardiac tissue within the myocardial scar induced by cryoinjury and significantly improve heart function (Li et al. 1997). Bishop et al. (Bishop et al., 1990) reported that embryonic myocardium of rats could be implanted or cultured. They suggested that the engrafted embryonic cardiomyocytes proliferated and differentiated in host myocardium. In a recent review, Hescheler et al. (Hescheler et al., 1997) pointed out that pluripotent ES cells cultivated within embryonic bodies reproduce highly specialized phenotypes of cardiac tissue. Most of the biological and pharmacological properties of cardiac-specific ion currents were expressed in cardiomyocytes developed in vitro from pluripotent ES cells. Electrophysiological characteristics of these cells developed from ES cells were similar to those previously described in adult cardiomyocytes or neonatal mammalian heart cells (Kilborn et al., 1990; Hescheler et al., 1997). Web site: http://www.delphion.com/details?pn=US06607720__ ·
Histochrome and its therapeutic use in acute myocardial infarction and ischemic heart disease Inventor(s): Koltsova; Evgenia Alexandrovna (Vladivostok, RU), Fedoreev; Sergei Alexandrovich (Vladivostok, RU), Elyakov; Georgy Borisovich (Vladivostok, RU), Krasovskaya; Natalya Petrovna (Vladivostok, RU), Mischenko; Natalya Petrovna (Vladivostok, RU), Glebko; Ljutsia Ignatievna (Vladivostok, RU), Artjukov; Alexandr Alexeevich (Vladivostok, RU), Maximov; Oleg Borisovich (Vladivostok, RU) Assignee(s): Tikhookeansky Institut Bioorganicheskoi Khimii Dalnevostochnogo Otdeleniya (Vladivostoka, RU) Patent Number: 6,410,601 Date filed: April 12, 2001 Abstract: A pharmaceutical composition is provided, which comprises an aqeous solution containing a mixture of di- and tri-sodium salts of echinochrome in an amount of 0.90 to 1.10 g/ml (Histochrome). It meets the requirements that apply to injectable formulations. Administration of Histochrome reduces by 57% the necrosis zone in patients with acute myocardial infarction, restores the contractility of the left ventricle, reduces the incidence of reperfusion-induced ventricular arrhythmias and exerts an antiarrhythmogenic effect. Histochrome suppresses the aggregation of erythrocytes and thrombocytes, produces a beneficial effect on the clinical course of the disease, reduces the incidence of complications and lethal outcomes in cases of acute myocardial infarction. It is well tolerated by patients. Excerpt(s): The invention relates to medicine and, more specifically, to a novel pharmaceutical composition useful in the treatment of ischemic heart disease and
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capable of limiting the necrotic zone in myocardial infarction. The ischemic heart disease and myocardial infarction are the most widespread diseases that affect humans. They are a leading cause of high mortality among patients, which dictates the need for a further search of novel therapeutic drugs. It is well known that myocardial infarction is associated with lipid peroxidation and, due to an insufficient oxygen supply, is often accompanied by the formation of an extensive necrotic zone in the heart. Web site: http://www.delphion.com/details?pn=US06410601__ ·
Implantable electronic system with acute myocardial infarction detection and patient warning capabilities Inventor(s): Fischell; Tim A. (Richland, MI), Fischell; David R. (Fair Haven, NJ), Fischell; Robert E. (Dayton, MD) Assignee(s): Cathco, Inc. (Dayton, MD) Patent Number: 6,272,379 Date filed: March 17, 1999 Abstract: Disclosed is a system for detecting a myocardial infarction (i.e., a heart attack) at the earliest possible time and promptly warning the patient that he should immediately seek medical care. Specifically, a first embodiment of the present invention has an implantable electronic system that can sense a change in the patient's electrogram that is indicative of a myocardial infarction. If a myocardial infarction is sensed, the device would then cause an implantable or externally located alarm means such as an audio sound to be actuated to warn the patient of his condition. The patient could then promptly seek medical care, for example, at a hospital emergency room. Having been trained to recognize such an alarm, most patient would neither fail to recognize such an indication of a myocardial infarction nor would they ignore such an alarm signal if it were to occur. Since an implantable heart pacemaker or defibrillator already has within its structure many of the elements required for the device to recognize a myocardial infarction, it would be expeditious to add a capability to these existing devices to detect a myocardial infarction and provide an implantable or external alarm means to inform the patient to take appropriate action. Excerpt(s): This invention is in the field of devices implanted within a person for the purpose of automatically detecting the onset of myocardial infarction and promptly warning that person to immediately seek medical care. Heart disease is the leading cause of death in the United States. The most prevalent form of heart disease is myocardial infarction resulting from a thrombus that obstructs blood flow in one or more coronary arteries. The sooner thrombolytic medication such as tissue plasminogen activator or urokinase is placed into the patient's bloodstream after the occurrence of a myocardial infarction, the sooner an obstructive thrombus will be dissolved and some perfusion of the myocardium can occur. The damage to the myocardium is strongly dependent on the length of time that occurs prior to restoration of some blood flow to the heart muscle. However, at this time, no implantable system exists that provides for early and automatic detection of myocardial infarction and for warning the patient that a myocardial infarction is occurring. There are many patients who have implanted heart pacemakers or automatic defibrillators. The purpose of the pacemaker is to provide a low energy electrical stimulation pulse that causes the heart to beat at a prescribed rate. The purpose of the defibrillator is to shock the heart back into sinus rhythm after ventricular fibrillation has been detected. However, no existing implantable pacemaker or defibrillator is able to detect a partial or complete blockage of a coronary artery
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because of a thrombus in that artery and warn the patient that this potentially fatal event is occurring. Web site: http://www.delphion.com/details?pn=US06272379__ ·
Implantable responsive system for sensing and treating acute myocardial infarction Inventor(s): Fischell; Robert E. (Dayton, MD), Fischell; David R. (Fair Haven, NJ), Fischell; Tim A. (Richland, MI) Assignee(s): Cathco, Inc. (Dayton, MD) Patent Number: 6,112,116 Date filed: February 22, 1999 Abstract: Disclosed is a completely implantable system that can detect the occurrence of a myocardial infarction, i.e., a heart attack, and automatically inject a thrombolytic and/or anti-thrombogenic agent into the bloodstream to promptly dissolve the thrombus that caused the myocardial infarction and prevent the formation of additional thrombi. It is well known that a myocardial infarction can be detected from a patient's electrocardiogram by noting an ST segment voltage deviation as compared to the voltage of the patient's TP or PQ segments. Upon detection of a myocardial infarction, an ST segment deviation electronic detection circuit within the implanted device can produce an output signal that can cause a thrombolytic and/or anti-thrombogenic agent contained within an implanted, pressurized reservoir to immediately and automatically release medications into the patient's bloodstream. A patient warning system is provided by an audio alarm or an electrical tickle within the human body indicating that a myocardial infarction has been detected. The implanted system can also send a radio message to an externally located receiver that automatically dials an emergency rescue team to take the patient to a hospital for continuing treatment of his myocardial infarction. An implantable defibrillator or pacemaker that includes the capability for informing the patient that myocardial infarction has been detected is also disclosed. Still further, this invention could also be used without a defibrillator or pacemaker but as an implanted system (without medications) whose only function would be the detection and warning of myocardial infarction at the earliest possible time. Excerpt(s): This invention is in the field of devices implanted within a human body for the purpose of automatically detecting the onset of myocardial infarction, warning the patient that a myocardial infarction is occurring and promptly releasing medication into the bloodstream for the purpose of dissolving obstructive thrombus in a coronary artery thus ameliorating damage to the myocardial tissue which would otherwise occur. Heart disease is the leading cause of death in the United States. The most prevalent fatal manifestation of coronary heart disease is myocardial infarction which is caused primarily by a thrombus that obstructs blood flow in one or more coronary arteries. The medical treatment of myocardial infarction involves intravenous delivery of a thrombolytic medication such as tissue plasminogen activator to help dissolve the thrombus in a coronary artery. The sooner thrombolytic medication is placed into the patient's bloodstream after the occurrence of a myocardial infarction, the sooner an obstructive thrombus will be dissolved and some perfusion of the myocardium can occur. The extent of permanent damage to the myocardium is highly dependent upon the length of time that occurs prior to restoration of blood flow to the heart muscle. However, at this time no implantable system exists that provides for early and automatic detection of myocardial infarction. Furthermore, no system exists that would provide automatic and immediate release of an anti-thrombogenic or thombolytic agent
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into the bloodstream to dissolve an obstructive blood clot at the earliest possible time. One embodiment of the present invention is a completely implantable system that can detect the occurrence of a myocardial infarction, i.e., a heart attack, within less than a minute after it begins and then automatically inject a thrombolytic and/or antithrombogenic agent into the bloodstream to promptly dissolve the thrombus that caused the myocardial infarction and to prevent the formation of additional thrombi. Web site: http://www.delphion.com/details?pn=US06112116__ ·
Method and apparatus to improve myocardial infarction detection with blood pool signal suppression Inventor(s): Foo; Thomas K. F. (Rockville, MD) Assignee(s): GE Medical Systems Global Technology Co., LLC (Waukesha, WI) Patent Number: 6,526,307 Date filed: December 29, 2000 Abstract: A method and apparatus are disclosed for achieving suppression of blood pool signal to detect myocardial infarction using MR technology. After administering a contrast agent into the blood stream of a patient, an RF pulse sequence is applied that includes a slice-selective inversion pulse to suppress normal myocardial tissue followed by a notched inversion RF pulse designed to suppress blood pool in and around the region-of-interest. MR data is then acquired within the region-of-interest that not only has signals from normal myocardial tissue suppressed, but also has blood pool signal suppression to improve delineation of infarcted myocardium from the ventricular blood pool and normal myocardium. Excerpt(s): The present invention relates generally magnetic resonance imaging (MRI), and more particularly, to a method and apparatus, including a new pulse sequence, to achieve greater sensitivity in detecting infarcted myocardial tissue. When utilizing these signals to produce images, magnetic field gradients (G.sub.x G.sub.y and G.sub.z) are employed. Typically, the region to be imaged is scanned by a sequence of measurement cycles in which these gradients vary according to the particular localization method being used. The resulting MR signals are digitized and processed to reconstruct the image using one of many well-known reconstruction techniques. Myocardial infarction is a type of cardiac syndrome in which oxygen is deprived from a portion of the heart. The size of the myocardial infarct has been demonstrated to have a strong correlation with patient outcome/recovery. Myocardial perfusion imaging is a technique in which regions of abnormal or impaired blood flow to the heart are detected by tracking the passage of a tracer or contrast agent through myocardial tissue. Regions of impaired blood flow or poor perfusion would not exhibit the presence of the contrast material or tracer whereas in tissues with normal perfusion, the presence of the contrast material or tracer would be indicated. Web site: http://www.delphion.com/details?pn=US06526307__
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Method and system for detecting acute myocardial infarction Inventor(s): Kwong; Manlik (Corvallis, OR) Assignee(s): Hewlett-Packard Company (Palo Alto, CA) Patent Number: 5,792,066 Date filed: January 9, 1997 Abstract: A method and system for determining Acute Myocardial Infarction. The method and system work by determining whether or not at least one pre-specified component wave is present within each successive heartbeat waveform (e.g. the S wave component of the QRSTU waveform) appearing within each electrocardiographic lead. After it has been determined whether or not the pre-specified component wave is present within the heartbeat waveforms under consideration (each lead will generally have some representation of each successive heartbeat waveform present within it), a wave amplitude ratio (e.g. the ST complex amplitude divided by the S wave component amplitude at some specified instant in time) is calculated. Thus, for each successive heartbeat waveform there will generally be at least one wave amplitude ratio calculated for each electrocardiographic lead, since the same heartbeat waveform generally appears, in some form, within each electrocardiographic lead. Finally, the calculated wave amplitude ratios, which are generally calculated on each lead that every successive heartbeat waveform, are compared to predetermined criteria (e.g. traversing a classification tree), and on the basis of this comparison it is indicated whether Acute Myocardial Infarction is occurring. Excerpt(s): The present invention relates, in general, to an improved method and system to be utilized in monitoring electrocardiographic waveform data and, in particular, to an improved method and system to be utilized in monitoring electrocardiographic waveform data and which can detect the presence of Acute Myocardial Infarction, even in patients who have underlying heart conditions which mimic Acute Myocardial Infarction. Still more particularly, the present invention relates to an improved method and system to be utilized in monitoring electrocardiographic waveform data and which can detect the presence of Acute Myocardial Infarction, even in patients who have underlying heart conditions which mimic Acute Myocardial Infarction, by creating patient-specific data sets and making the assessment of the existence of an Acute Myocardial Infarction on the basis of both the created patient-specific data sets and statistical criteria. The present invention remedies a deficiency in the prior art methods and systems for detecting Acute Myocardial Infarction (AMI) on the basis of a patient's electrocardiographic waveform data. The deficiency remedied is that the prior art methods and systems are unable to detect AMI on the basis of a patient's electrocardiographic waveform data when such patient has an underlying heart condition which mimics standard AMI electrocardiographic detection criteria. In the methods and systems existing within the prior art, no attempt is made to detect AMI in such patients. Rather, in the prior art the patient's electrocardiographic data is prescreened for the presence of underlying heart conditions which mimic standard AMI detection criteria, and if such conditions are found the prior art methods and systems simply refuse to attempt AMI detection for such patients. Both the prior art and the present invention utilize certain specific electrical signals (known as "leads") derived from a device for monitoring heart function known as the electrocardiograph. In order to understand how these certain specific electrical signals are utilized, it is helpful to have a basic understanding of the electrocardiograph and to what the certain specific electrical signals refer. Accordingly, as an aid to understanding the electrocardiograph, the discussion below presents a brief description of (1) the electrochemical and
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mechanical operation of the heart, (2) how the electrochemical operation of the heart is transduced into electrical energy which is then used by the electrocardiograph to graphically denote the mechanical operation of the heart, and (3) how the certain specific electrical signals (or "leads") are derived from the electrocardiograph. Web site: http://www.delphion.com/details?pn=US05792066__ ·
Method and therapeutic compositions for the treatment of myocardial infarction Inventor(s): O'Brien; Donogh P. (Harrow, GB2), Vehar; Gordon A. (San Carlos, CA), Wilcox; Josiah N. (Belmont, CA) Assignee(s): Genentech, Inc. (South San Francisco, CA) Patent Number: 5,589,173 Date filed: June 16, 1994 Abstract: The present invention relates to a method and therapeutic composition for the treatment of myocardial infarction comprising administration of a tissue factor protein antagonist and a thrombolytic agent. Excerpt(s): This invention relates to the treatment of myocardial infarction and more particularly to a therapy capable of preventing the reocclusion of a coronary artery which often accompanies the use of thrombolytic agents in the treatment of myocardial infarction. This invention also relates to the use of tissue factor protein inhibitors to prevent reocclusion of a coronary artery. The initiating event of many myocardial infarctions (heart attacks) is the hemorrhage into an atherosclerotic plaque. Such hemorrhage often results in the formation of a thrombus (or blood clot) in the coronary artery which supplies the infarct zone (i.e., an area of necrosis which results from an obstruction of blood circulation). This thrombus is composed of a combination of fibrin and blood platelets. The formation of a fibrin-platelet clot has serious clinical ramifications. The degree and duration of the occlusion caused by the fibrin-platelet clot determines the mass of the infarct zone and the extent of damage. The primary goal of current treatment for myocardial infarction involves the rapid dissolution of the occluding thrombus and the restoration of blood flow ("reperfusion"). A successful therapy must be capable of eliminating the fibrin-platelet clot in a manner which prevents its reformation after the cessation of therapy. If the fibrin-platelet clot is able to reform, then the affected artery may become reoccluded. Web site: http://www.delphion.com/details?pn=US05589173__
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Method for diminishing myocardial infarction using protein phosphatase inhibitors Inventor(s): Downey; James M. (Mobile, AL), Honkanen; Richard Eric (Mobile, AL) Assignee(s): South Alabama Medical Science Foundation (Mobile, AL) Patent Number: 5,914,242 Date filed: October 1, 1997 Abstract: Fostriecin and a compounds structurally related to fostriecin diminish myocardial infarction and delay the onset of cell injury in an ischemic heart. There is a strong correlation between myocardial protection and the inhibition of certain serine/threonine protein phosphatases. The present invention is drawn to a method for administering fostriecin as a pharmacological compound to reduce the size of a
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myocardial infarction. Further, administration of fostriecin is useful also as an adjunct therapy to treatment with thrombolytic agents or angioplasty to limit the size of infarction. The most advantageous feature of the method of the present invention is that administration of fostriecin diminishes infarct volume and cell injury even when added after ischemia conditions occurred. In addition to the use of the method of the present invention for limiting damage due to myocardial infarction, the method of the present invention can be employed to delay damage associated with tissue storage for organ transplantation. Excerpt(s): The present invention relates generally to a method for administering protein phosphatase inhibitors to an individual to diminish myocardial infarction and minimize cell injury or death in ischemic tissue. Specifically, the present invention relates to a method for administering fostriecin, or a compound structurally related to fostriecin, to an individual to diminish myocardial infarction and delay cell injury or death in ischemic cardiac tissue following infarction. Beneficial therapeutic effects are achieved when fostriecin, or a compound structurally related to fostriecin, is administered either before or after the onset of a myocardial infarction. In Western countries, myocardial infarction is among the most common diagnoses in hospitalized patients. In the United States, approximately 1.5 million myocardial infarctions (MIs) occur each year, and mortality with acute infarction is approximately 30 percent (Pasternak, R. and Braunwald, E., Acute Myocardial Infarction, HARRISON'S PRINCIPLES OF INTERNAL MEDICINE, 13th Ed., McGraw Hill Inc., p.p. 1066-77 (1994)). More than half of the deaths that result from myocardial infarction occur before the patient reaches the hospital, and an additional 5-10% of survivors die in the first year (Pasternak, R. C. and Braunwald, E. Acute Myocardial Infarction, HARRISON'S PRINCIPLES OF INTERNAL MEDICINE, 13th Ed., McGraw Hill Inc., p.p. 1066-77 (1994)). Myocardial infarction occurs generally with an abrupt decrease in coronary blood flow that follows a thrombotic occlusion of a coronary artery. The occluded artery often has been narrowed previously by atherosclerosis, and the risk of recurrent nonfatal myocardial infarction persists in many patients. Ultimately, the extent of myocardial damage caused by the coronary occlusion depends upon the "territory" supplied by the affected vessel, the degree of occlusion of the vessel, the amount of blood supplied by collateral vessels to the affected tissue, and the demand for oxygen of the myocardium whose blood supply has suddenly been limited (Pasternak, R. and Braunwald, E. Acute Myocardial Infarction, HARRISON'S PRINCIPLES OF INTERNAL MEDICINE, 13th Ed., McGraw Hill Inc., p.p. 1066-77 (1994)). Web site: http://www.delphion.com/details?pn=US05914242__ ·
Method of detecting myocardial infarction Inventor(s): Matsumori; Akira (Minoo, JP) Assignee(s): Akira Matsumori (Osaka-Fu, JP), Otsuka Pharmaceutical Co., Ltd. (TokyoTo, JP) Patent Number: 5,827,673 Date filed: August 13, 1996 Abstract: The present invention provides a method of detecting and diagnosing myocardial infarction which detects myocardial infarction by immunoassay using a monoclonal antibody having specific reactivity for human hepatocyte growth factor (HGF) as obtained by using human HGF as immunogen as well as a disganostic agent for myocardial infarction which comprises, as essential component thereof, the
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monoclonal antibody mentioned above. The method of the present invention makes it possible to detect and diagnose patients with myocardial infarction. Excerpt(s): The present invention relates to a method of detecting and diagnosing myocardial infarction using a monoclonal antibody against human hepatocyte growth factor in immunoassay and to a diagnostic agent for myocardial infarction to be used in said method. The mechanism of acute myocardial infarction is presumably as follows: as the underlying morbid change, the atheroma disintegrates at a site of atherosclerosis relatively proximal to the coronary artery, the contents of the atheroma partially flows out into the blood vessel, whereby the intimal surface becomes unstable; thrombi are formed sequentially at the unstable sites and, in association with the originally occurring stenosis and relatively easily, they lead to luminal obstruction. It is also known that the above-mentioned thrombi, once formed, allows formation of TXA.sub.2 (thromboxane A.sub.2) at their sites, inducing, in turn, platelet aggregation and, on the other hand, causing spasm of the coronary artery. This vicious cycle is also considered as constituting an underlying morbid condition for the above-mentioned myocardial infarction or angina pectoris. In these days, the above-mentioned myocardial infarction is treated in the CCU (coronary care unit), and the introduction of electrocardiographic monitoring and cardiopulmonary resuscitation and the application of antiarrhythmic agents and cardiac pacemakers, among others, are greatly contributing to reduce the acute phase morbidity among patients with said disease. Against acute heart failure accounting for most of deaths in said acute phase or against shock syndrome, as well, efforts have been made to develop more effective therapeutic means. Web site: http://www.delphion.com/details?pn=US05827673__ ·
Method of diagnosing and treating myocardial infarction and hypertension Inventor(s): Bagrov; Alexei Y. (St. Petersburg, RU) Assignee(s): Biomedical Sciences Research Laboratories, Inc. (Millersville, MD) Patent Number: 5,770,376 Date filed: March 2, 1995 Abstract: The present invention relates to methods for diagnosing acute myocardial infarction through the measurement of the level of marinobufagin-like immunoreactivity in the blood of patients suspected of this diagnosis; a method for treating patients with acute myocardial infarction with antibody to marinobufagin, a bufodienolide, to prevent the occurrence of cardiac arrhythmias; antibodies which specifically recognize marinobufagin or other bufodienolides; hybridomas producing these antibodies; a process for preparing such antibodies; and an immunoassay method for marinobufagin for research purposes using its specific antibody.The antibodies of the present invention make it possible to conveniently measure bufodienolides with specificity and high sensitivity. This is useful in determining the existence and degree of hypertension and myocardial infarction, and in treating myocardial infarction. Excerpt(s): Hypertension is the primary risk factor for coronary, cerebral and renal vascular diseases which cause over half of all deaths in the United States. It has been estimated that the number of hypertensive patients in the United States alone is substantially 57 million and on the rise. The widespread awareness of the danger of elevated blood pressure has become the most frequent reason for visits to physicians. No single or specific cause is known for the hypertension referred to as primary (essential) hypertension. Primary hypertension has been attributed to such causes as
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hemodynamic pattern, genetic predisposition, vascular hypertrophy, hyperinsulinemia, defects in cell transport or binding, defects in the reninangiotensin system (low-renin or high renin hypertension) and along with insulin, angiotensin and natriuretic hormone, catecholamines arising in response to stress are known to be pressor-growth promoters. Increased sympathetic nervous activity may raise the blood pressure in a number of ways, for example, either alone or in concert with stimulation of renin release by catecholamines, causing arteriolar and venous constriction, by increasing cardiac output, or by altering the normal renal pressure-volume relationship. Primary hypertension is also associated with, for example, obesity, sleep apnea, physical inactivity, alcohol intake, smoking, diabetes mellitus, polycythemia and gout. Secondary forms of hypertension may arise from oral contraceptive use and parenchymal renal disease: renovascular hypertension caused by, for example, atherosclerotic disease, tumors (renin-secretory tumors); Cushing's Syndrome; heart surgery; and pregnancy. Chronic hypertension and renal disease during pregnancy may progress into eclampsia, a primary cause of fetal death. It has been theorized that blood serum and various mammalian tissues contain a substance, biologically and immunoreactively, similar to digitalis glycosides and digoxin (ouabain)-like which have been labeled endogenous digoxin-like factors (EDLF). This theory has been supported in recent years by considerable evidence of a causal role for sodium in the genesis of hypertension. The evidence includes the finding of increased intracellular sodium in hypertensive mammals. Increases have also been noted in normotensive children of hypertensive parents. It has been discovered that an increased fluid volume stimulates the secretion of EDLF that inhibits the Na+,K+-ATPase pump. The inhibition is brought about by the reaction of the EDLF with the alpha-subunit of the ouabain-sensitive-magnesiumdependent, Na+,K+-ATPase in a manner similar to the digitalis glycosides. In the case of renovascular types of hypertension, inhibition of the sodium pump increases renal sodium excretion and restores vascular volume while at the same time leading to hypertension by increasing intracellular sodium content by potentiating preexisting vasoconstriction and finally initiating a new circle in the pathogenesis of hypertension. Increased plasma concentrations of EDLF have been discovered in hypertension caused by other physical and pathological conditions. Consequently, it was discovered that the administration of an antidigoxin antiserum to hypertensive animals causes a pronounced decrease in the blood pressure. The exact chemical nature, as well as the site of origin, of EDLF is not known. It has been proposed that endogenous digoxin is a peptide originating in the hypothalamus. It has also been reported that EDLF originates in the adrenals and the heart. It has been shown that the EDLF substance exists in several different molecular forms, at least one of the forms being steroidal in nature. Confirming this, it was discovered that several steroids with digitalis-like imnunoreactivity and ability to inhibit Na+,K+-ATPase were identified in various amphibian tissues. Web site: http://www.delphion.com/details?pn=US05770376__ ·
Method of treating heart attack patients prior to the establishment of qualified direct contact personal care Inventor(s): Sarnoff; Stanley J. (Bethesda, MD) Assignee(s): Survival Technology, Inc. (Bethesda, MD) Patent Number: 4,004,577 Date filed: July 15, 1974
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Abstract: A method of treating coronary prone patients when heart attack symptoms occur before qualified direct contact personal care can be administered to the patient which comprises providing each of a multiplicity of coronary prone patients with (1) a plurality of separate medicaments in self-administering form and (2) a device operable when disposed in operative relation to a patient to provide auditory signals indicative of the existing heart beat conditions of the patient, establishing communication by telephone between the patients experiencing heart attack symptoms and a source capable of making a qualified response based upon the existing heart beat conditions of the patient as to the medicament which will be effective when administered, disposing the device in operative relation with the patient and communicating the signals to the qualified source by means of the communication, communicating by means of the communication a qualified response from the source an indicated medicament which should be administered based upon the existing heart beat conditions of the patient communicated to the source and administering said indicated medicament to said patient at a time prior to qualified direct contact personal care for the patient, the qualified source preferably includes a plurality of individuals available at all times at specific telephones having medical records of the patients immediately available, including standing orders of each patient's doctor, equipment for converting the auditory signals communicated to conventional oscilloscope pictures and electrocardiograms and outgoing telephones for notifying the patient's doctor and nextof-kin and for dispatching an ambulance to the patient. Excerpt(s): This invention relates to the treatment of individuals suspected of suffering from a coronary heart attack (acute myocardial infarction) and more particularly to improvements in the method of such treatment disclosed in my aforementioned patent which is made available to coronary prone individuals experiencing heart attack symptoms at a time prior to the establishment of qualified direct contact personal care for the individual and apparatus for use in such method. The apparatus and method of treatment disclosed in my aforesaid patent were based upon the following considerations. It has long been recognized that acute myocardial infarction is one of the greatest causes of death in the United States. It has also long been recognized that time is of the essence in successfully treating individuals undergoing acute myocaridal infarction. Most hospitals have established coronary care units with equipment and personnel provided for the specific purpose of administering qualified personal care directly to the patient in the shortest time possible after delivery of the patient to the hospital. Despite the operation of such coronary care units, it is estimated that in the United States more than 300,000 people who sustain acute coronary heart attacks die before they reach a hospital each year, many of them in the first hour. In an effort to treat such individuals prior to hospital delivery, mobile coronary units have been established in some high density population areas. These mobile units constitute, in essence, a hospital coronary care unit which can be brought directly to the patient so that qualified personal care can be administered as the patient is being transported to the hospital. During the course of the development of these mobile coronary care units, much of the diagnostic equipment necessary in treating myocardial infarction has been miniaturized and made more possible. Nevertheless, these mobile units are extremely costly to set up and maintain and, at best, do not provide the ultimate in time saving in that the time within which treatment can be administered is still dependent upon the time required to transport the qualified personal care into direct contact with the patient. Web site: http://www.delphion.com/details?pn=US04004577__
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Method to reduce myocardial injury during acute myocardial infarction Inventor(s): Hermens; Willem Theodoor (Gronsveld, NL), Hack; Cornelis Erik (Diemen, NL) Assignee(s): Stiching Centraal Laboratorium Van de Bloedtransfusiedienst Van Het (Amsterdam, NL) Patent Number: 6,090,777 Date filed: April 2, 1996 Abstract: A therapeutic or prophylactic treatment method of acute myocardial infarction, comprising administering exogenous C1-esterase inhibitor, alone or in combination with other drugs, to a patient with acute myocardial infarction or to a patient at risk for acute myocardial infarction. The treatment inhibits the inflammatory reaction, more specifically the activation of the complement system, which occurs in the course of acute myocardial infarction. The C1-esterase inhibitor may include C1-esterase inhibitor purified from plasma or other biological materials, or recombinant C1-esterase inhibitor, or recombinant variants derived therefrom, or recombinant constructs of other inhibitors having a specificity similar to C1-esterase inhibitor. Excerpt(s): This invention is in the field of immunology/cardiology/biochemistry, and describes more particularly a method to reduce myocardial cell injury during acute myocardial infarction. Mechanical failure of heart muscle is one of the leading causes of in-hospital deaths in patients with acute myocardial infarction (AMI). Friedberg C. K., 1968, Circulation 39 suppl. IV: 252. An important determinant in the development of such failure is the amount of necrotic tissue in the jeopardized myocardium. Pare D. L. et al., 1971, New Eng J Med 285: 133. Experimental studies in animals have shown that irreversible myocardial cell injury starts about 30 minutes after occlusion of coronary vessels and proceeds for hours. Maroko P. R. et al., 1973, Ann Int Med 79: 720. However, even interventions given as late as 6 hours after cornary occlusion are able to reduce infarction size after AMI by about 35% compared to untreated control animals. Libby P. et al., 1973, J Clin Invest 52: 599. Electro-cardiographic studies indicate that also in humans a substantial amount of myocardial tissue may not become irreversibly injured until hours or even days after occlusion of the coronary vessel, i.e. at a time that most patients will have been admitted to a hospital. Reid P. R. et al., 1974, New Engl J Med 290: 123. A number of experimental and clinical studies have attempted to minimize infarction size by reducing the myocardial necrosis that occurs in the later stages of AMI. Maroko P. R. et al., 1973, Ann Int Med 79: 720. The later phase of myocardial cell injury likely results from an ensuing acute inflammatory reaction characterized by infiltration of neutrophilic granulocytes (neutrophils). Entman M. L. et al., 1991, FASEB J 5: 2529. Initially, the importance of an inflammatory reaction in mediating myocardial cell injury during AMI was recognized in animal studies which showed that corticosteroids could reduce infarction size by 20 to 35%. Libby P. et al., 1973, J Clin Invest 52: 599;Maclean D. et al., 1978, J Clin Invest 61: 541. However, clinical application of methyl-prednisolone in AMI to minimize myocardial necrosis, was not successful mainly because this treatment interfered with scar formation and healing, leading in some patients to the development of aneurysm and rupture of the ventricle wall. Roberts R. et al., 1976, Circulation 53 Suppl. I: 204. A similar effect has been observed in long-term experiments in rats. Maclean D. et al., 1978, J Clin Invest 61: 541. These disappointing results tuned down further clinical studies that aimed at reducing infarction size by attenuating the inflammatory reaction following AMI. Web site: http://www.delphion.com/details?pn=US06090777__
Patents 185
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Methods of treating sexual dysfunction in an individual suffering from a retinal disease, class 1 congestive heart failure, or myocardial infarction using a PDE5 inhibitor Inventor(s): Pullman; William E. (Carmel, IN), Whitaker; John S. (Woodinvill, WA), Ferguson; Kenneth M. (Bothell, WA), Emmick; Jeffrey T. (Plainfield, IN) Assignee(s): Lilly Icos, LLC. (Wilmington, DE) Patent Number: 6,451,807 Date filed: April 26, 2000 Abstract: The present invention relates to highly selective phosphodiesterase (PDE) enzyme inhibitors and to their use in methods of treating sexual dysfunction in individuals suffering from a retinal disease, class 1 congestive heart failure, or myocardial infarction. Excerpt(s): The present invention relates to highly selective phosphodiesterase (PDE) enzyme inhibitors and to their use in pharmaceutical articles of manufacture. In particular, the present invention relates to potent inhibitors of cyclic guanosine 3',5'monophosphate specific phosphodiesterase type 5 (PDE5) that when incorporated into a pharmaceutical product are useful for the treatment of sexual dysfunction. The articles of manufacture described herein are characterized by selective PDE5 inhibition, and accordingly, provide a benefit in therapeutic areas where inhibition of PDE5 is desired, with minimization or elimination of adverse side effects resulting from inhibition of other phosphodiesterase enzymes. The biochemical, physiological, and clinical effects of cyclic guanosine 3',5'-monophosphate specific phosphodiesterase (cGMP-specific PDE) inhibitors suggest their utility in a variety of disease states in which modulation of smooth muscle, renal, hemostatic, inflammatory, and/or endocrine function is desired. Type 5 cGMP-specific phosphodiesterase (PDE5) is the major cGMP hydrolyzing enzyme in vascular smooth muscle, and its expression in penile corpus cavernosum has been reported (Taher et al., J. Urol., 149:285A (1993)). Thus, PDE5 is an attractive target in the treatment of sexual dysfunction (Murray, DN&P 6(3):150-56 (1993)). A pharmaceutical product, which provides a PDE5 inhibitor, is currently available and marketed under the trademark VIAGRA.RTM. The active ingredient in VIAGRA.RTM. is sildenafil. The product is sold as an article of manufacture including 25, 50, and 100 mg tablets of sildenafil and a package insert. The package insert provides that sildenafil is a more potent inhibitor of PDE5 than other known phosphodiesterases (greater than 80 fold for PDE1 inhibition, greater than 1,000 fold for PDE2, PDE3, and PDE4 inhibition). The IC.sub.50 for sildenafil against PDE5 has been reported as 3 nM (Drugs of the Future, 22(2), pp. 128-143 (1997)), and as 3.9 nM (Boolell et al., Int. J. of Impotence Res., 8 p. 47-52 (1996)). N.C. Sildenafil is described as having a 4,000-fold selectivity for PDE5 versus PDE3, and only a 10-fold selectivity for PDE5 versus PDE6. Its relative lack of selectivity for PDE6 is theorized to be the basis for abnormalities related to color vision. Web site: http://www.delphion.com/details?pn=US06451807__
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Myocardial infarction immunoassay Inventor(s): Shah; Vipin D. (Saratoga, CA), Yen; Shing-Erh (Foster City, CA), Anchin; Gerald M. (Bellaire, TX) Assignee(s): Internationl Immunoassay Laboratories, Inc. (Santa Clara, CA) Patent Number: 5,202,234 Date filed: January 23, 1989 Abstract: Methods and reagents for determining the lapse of time since an acute disease event, such as the occurrence of a myocardial infarction, are presented. A serum sample is assayed to determine the concentration of two analyte sets. From these measurements, the time of the acute event can be more accurately determined. Novel antibodies, labeled and insolubilized derivatives of these antibodies, labeled proteins, and kits containing one or more of these reagents are also described. Excerpt(s): In another embodiment, the invention herein also relates to an improved method for immunological diagnosis of myocardial infarction. Diagnosis of acute disease is often based on abnormal levels of disease markers, such as enzymes and hormones in biological fluids such as serum, particularly when the concentration changes quickly during the acute phase of disease. For example, the enzyme creatine kinase (CK, ATP:creatine N-phosphotransferase) catalyzes the reversible transfer of a phosphate group from ATP to creatine. It exists as a dimer composed of two subunits commonly identified as the M-subunit and the B-subunit. CK-MB is associated with acute myocardial infarction, and is present in serum in only trace concentrations in the absence of such an episode. Appearance of CK-MB isoenzyme in serum is therefor indicative of myocardial infarction. CK-MM isoforms are present in the serum of normal patients in measurable amounts, but are present in significantly increased concentration following acute myocardial infarction. Assays to determine the occurrence of an acute myocardial infarction by measuring CK isoenzymes are known. The biological activity and physical properties of proteins such as enzymes and hormones are determined by structural features of the molecule. These features are often modified by endogenous conversion factors present in body fluids. Such conversion may or may not cause the loss of biological activity, or changes in physical properties such as electrophoretic mobility of the molecule. The conversion products may coexist with the original molecule immediately following the onset of an acute disease, but with the passage of time, one finds only the altered protein in the body fluids. Web site: http://www.delphion.com/details?pn=US05202234__
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Pharmaceutical composition containing a fibrinolytic agent and a diffusion factor, useful for the treatment of myocardial infarction Inventor(s): Borrelli; Francesco (Rome, IT), Antonetti; Francesco (Rome, IT) Assignee(s): Istituto Farmacologico Serono S.p.A. (IT) Patent Number: 4,568,543 Date filed: November 8, 1984 Abstract: The association of a fibrinolytic agent and of a diffusion factor has been shown very useful in the treatment of myocardial infarction. It has been shown that it is very useful to administer urokinase and hyaluronidase in the quantity ratio of at least 8 to 1, the quantity of each compound being expressed in the appropriate international units.
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Excerpt(s): The term "myocardial infarction" describes the irreversible damaging of the cells as well as the necrosis occurring as a consequence of a total or important reduction of the coronary flow feeding some areas of the cardiac muscle; moreover, it may be a consequence of an insufficient increase of the coronary flow with reference to an increased requirement of oxygen, as may happen under some conditions of stress. In almost all cases of persons suffering an acute and/or previous myocardial infarction, one finds in a more or less evident size, a restriction of the inside diameter of the coronary artery as a result of coronary arteriosclerosis or of some other causes. An exhaustive treatment of the factors involved in cases of myocardial infarction, and of the therapeutic means being used today for it's care, it's prevention, and the reduction of the consequent irreversible damage to the cardiac muscle, may be found in a recent review by J. T. Willerson and L. M. Buja entitled "Causes and Course of the Acute Myocardial Infarction" published in The American Journal of Medicine, in December 1980, volume 69, pages 902-914. This review article discusses all current knowledge about the treatment and prevention of myocardial infarction, and represents an exhaustive description of the state of the art; it must therefore be considered incorporated as a reference within the instant text. The importance of coronary thrombosis in the genesis of acute myocardial infarction has been and is still subject to discussion. However, supported by the above-mentioned theoretical base, many authors have experimented successfully with a treatment by means of urokinase given as an intravenous infusion in the care of primary acute myocardial infarction. The usefulness of thrombolytical infarction treatment in its acute stage is still a controversial matter (Lancet, 4 October 1975, pp 624-626). Web site: http://www.delphion.com/details?pn=US04568543__ ·
Portable alarm apparatus for sudden heart attack patient Inventor(s): Li; Pao-Lang (532, Min-Tzwu Rd. Lu Chou Hsiang, Taipei, TW) Assignee(s): none reported Patent Number: 6,063,036 Date filed: May 28, 1998 Abstract: A portable alarm apparatus for use by a sudden heart attack patient is provided that is characterized by a housing part connected to a suspension member for hanging around a patient's neck. Sensors are disposed on the suspension member and connected to an extending lead, enabling the sensors to contact respective pulse spots on the patient's neck, due to the downward force resulting from gravity acting on the housing part. The sensors detect the pulse signals in an artery in the user's neck corresponding to heartbeats and output an electrical signal for input to a control circuit disposed in the housing part for storage, display and generation of a warning alarm. Excerpt(s): The present invention is particularly characterized by connecting the alarm apparatus with a suspension member to detect pulse on the patient's neck. The main object of the present invention is to connect the alarm apparatus disclosed in the prior application with a suspension member for detecting the patient's pulse in a more accurate way since neck part has denser pulse spots for detection. These and other objects structure and advantages of the invention are depicted in the drawings and will be explained in the following. Further refers to FIGS. 1, 2, and 7, showing a first embodiment of alarm apparatus (1) connected with an integral control circuit and disposed in a housing part (2) showing practical heartbeats per minute by three-digit number on a display screen (7) in the front, and along one lateral of the housing part (2)
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of the present invention are start button (10), maximum button (11), and minimum button (12). In which the stat button (10) refers to a button to start the integral circuit operation. The maximum button (11) and minimum button (12) on said housing part (2) are for recording and saving both pulse maximum and minimum limit in a recorder of an internal pre-set circuit (13) for comparison of the detected pulse to pre-set maximum and minimum in an internal comparator (14) and trigger an internal alarm (15) to generate alarm signal when the patient's practical pulse is equal to or higher than the maximum limit and equal to or lower than the minimum limit. Said housing part (2) has one lateral connected with one end of a suspension member (17) for hanging on patient's neck (16), and extending lead (18) for contact with sensors (5) disposed on the suspension member (17); with gravity of the housing part (1) of the alarm apparatus (1), the housing part (2) hangs down at patient's frontal chest and the sensors (5) on the suspension member (17) tightenedly contacts patients neck (16) to detect patient's pulse from the neck part (16) and convey the heart beats signal into the housing part (2) by said lead (18) for procession, display, and generate warning alarm when patient's heartbeats appears unstable (equal to or higher than pre-set maximum limit and equal to or lower than pre-set minimum limit). The suspension member (17) in this embodiment refers to a necklace (19) linked with metal rings, and the housing part (2) is preferable to arrange various adornment in addition to the display screen (7). Web site: http://www.delphion.com/details?pn=US06063036__ ·
Prevention of or reduction in severity of myocardial infarction Inventor(s): Bollenbacher; Paul V. (New Hope, PA) Assignee(s): Unimed, Inc. (Somerville, NJ) Patent Number: 4,159,332 Date filed: November 18, 1977 Abstract: Myocardial infarction is prevented entirely or its severity is reduced in patients subject to the same by administering to such patients after occurrence of coronary occlusion and prior to the setting in of the myocardial infarction of a myocardial infarction preventing effective amount of a beta-(2- or 4-pyridyl-alkyl)amine or a non-toxic acid addition salt thereof. Such administration acts to help prevent the onset of the myocardial infarction or acts to reduce the size of any formed infarct. Excerpt(s): Since atherosclerotic coronary heart disease is the single greatest cause of death in the United States, the need to provide a means to prevent myocardial infarction or to at least reduce the size of any infarct after a coronary occlusion occurs has resulted in considerable investigation. Attempts to increase the supply of blood to the heart by means of a coronary vasodilator in order to prevent the onset of myocardial infarction have not only been unsuccessful but have actually been found to be contraindicated. Thus, it has been found that the administration of the common vasodilators such as nitroglycerin after the occurrence of a coronary occlusion causes increased work of the heart, edema and an increase in blood pressure, all of which result in a worsening of the subsequent myocardial infarction. As a consequence, present medical practice in the case of the occurrence of a coronary occlusion is to simply have the patient rest, to treat the pain, for example with morphine, and sometimes to administer a vasopressor, namely dopamine. No drug treatment has been established to prevent or reduce the size of myocardial infarction. Generally speaking, in accordance with the present invention, there is administered to a patient subject to myocardial infarction a myocardial infarction preventing amount of a beta-(2- or 4-pyridyl-alkyl)-amine or a non-toxic acid
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addition salt thereof, the administration occurring after the coronary occlusion and prior to onsert of the myocardial infarction. Web site: http://www.delphion.com/details?pn=US04159332__ ·
Treatment and prevention of cardiovascular diseases, heart attack, and stroke, primary and subsequent, with help of aspirin and certain vitamins Inventor(s): Weissman; Donald L. (P.O. Box 15927, Beverly Hills, CA 90209) Assignee(s): none reported Patent Number: 6,323,188 Date filed: September 10, 1999 Abstract: Disclosed is the method of reducing the incidence and severity of stroke, primary heart attack, and any subsequent heart attack or stroke in humans by daily administration of an effective amount of a combination of acetylsalicylic acid (ASA),a cyanocobalamin compound (Vitamin B12), a folic acid compound, and a pyridoxine compound (Vitamin B6) in an easy to take daily administration pack. Excerpt(s): This invention relates to a combination of aspirin, certain B vitamins and folic acid to prevent and or decrease cardiovascular diseases, heart attack and stroke, to a stable daily administration pack for such combination to facilitate the patient's compliance with recommendation or instruction to take such combination, and to the method of treating and preventing cardiovascular diseases with the help of such combination. Cardiovascular disease ranks as the leading cause of mortality and morbidity in the United States today. This year, it is estimated that 1.5 million people will have a heart attack and that one third of those will die as a result of CAD. The American College of Cardiology recently identified other abnormalities as factors for which intervention is likely to lower stroke and heart disease risk. Elevated total blood cholesterol is frequently considered a risk factor for coronary artery disease (CAD), but it is important to note that in the Framingham study 80% of CAD patients had the same total cholesterol as those who did not develop CAD. Web site: http://www.delphion.com/details?pn=US06323188__
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Use of GLP-1 or analogs in treatment of myocardial infarction Inventor(s): Efendic; Suad (Lidingo, SE) Assignee(s): Eli Lilly and Company (Indianapolis, IN) Patent Number: 6,277,819 Date filed: August 21, 1997 Abstract: This invention provides a method of reducing mortality and morbidity after myocardial infarction. GLP-1, a GLP-1 analog, or a GLP-1 derivative, is administered at a dose effective to normalize blood glucose. Excerpt(s): This invention relates to a method of reducing mortality and morbidity after myocardial infarction in diabetic patients. Morbidity and mortality from cardiovascular disease is higher in patients with manifest diabetes or impaired glucose tolerance compared to patients without those disorders. Diabetics account for up to 24% of the total number of patients admitted to coronary care units for suspect infarction, whereas
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they constitute only about 5% of the general population [Malmberg and Ryden; Fuller J. H., Diabet. Metab. 19:96-99 (1993)]. In-hospital. mortality of diabetic patients with myocardial infarction is twice that of non-diabetics [Hamsten A., et al., J. Int. Med. 736:13 (1994) 236 Suppl. Malmberg K. and Ryden L., Eur. Heart J. 9:256-264 (1988)]. Diabetics experience more morbidity and die more often in the post-acute recovery phase, mostly due to fatal re-infarction and congestive heart failure [Malmberg and Ryden; Stone P., et al., J. Am. Coll. Cardiol. 14:49-57 (1989); Karlson B. W., et al., Diabet. Med. 10(5):449-54 (1993); Barbash G. I., et al., J. Am. Coll. Cardiol. 22:707-713 (1993)]. The difference in mortality and morbidity between diabetics and non-diabetics following myocardial infarction persists, despite reduction in the incidence of morbidity and mortality following acute myocardial infarction [Granger C. B., et al., J. Am. Coll. Cardiol., 21(4):920-5 (1993); Grines C., et al., N. Engl. J. Med. 328:673-679 (1993)]. Factors responsible for the poor prognosis among diabetic patients with acute myocardial infarction may act before, during, or after the acute event. They include diffuse coronary atheromatosis, with more advanced and widespread coronary artery disease, which, together with a possible diabetic cardiomyopathy, may contribute to a high prevalence of congestive heart failure. Autonomic neuropathy with impaired pain perception and increased resting heart rate variability may also be of importance. A coronary thrombus is an essential part of an evolving infarction, and notably, platelet activity, coagulation, and fibrinolytic functions have been found to be disturbed in diabetic patients [Davi G., et al., New England. J. Med., 322:1769-1774 (1990)]. Web site: http://www.delphion.com/details?pn=US06277819__ ·
Use of human growth hormone to treat acute myocardial infarction Inventor(s): Castagnino; Hugo E. (Viamonte 752, 4th Fl., #7, Buenos Aires, AR) Assignee(s): none reported Patent Number: 6,309,381 Date filed: September 1, 1998 Abstract: A method of treating an acute myocardial infarction (AMI) using human growth hormone to prevent most of the complications and the destructive process of cells and collagen framework which are linked to the AMI. This treatment can be used alone or in combination with other well-known methods of treatment. Excerpt(s): The invention relates to methods of treatment of acute myocardial infarction (AMI), in particular, treatment of AMI close to the onset in order to avoid most of the complications and the destructive race of cells and collagen framework which are linked to the AMI. For about thirty years, human growth hormone has been proposed as a possible treatment for various diseases and medical problems, such as to stimulate the fibroblasts; also to include neoangiogenesis. Efforts to reach profound degrees of experimental hibernation in animals only became possible when the threshold of ventricular fibrillation was raised through the use of human growth hormone. More recently, other investigations with human growth hormone and isolated growth factors, (like IGF1; FGF and TGF) verified parallel actions of all compounds, growth hormone may lodge more than one of the isolated growth factors mentioned above. Web site: http://www.delphion.com/details?pn=US06309381__
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Wrist alarm apparatus for sudden heart attack patient Inventor(s): Pao-Lang; Li (No. 532, Min-tzwu Rd., Lu Chou Hsiang, Taipei County, TW) Assignee(s): none reported Patent Number: 6,080,111 Date filed: February 19, 1998 Abstract: A wrist alarm apparatus for use by a heart attack patient is provided that includes a maximum button and a minimum button laterally disposed on a housing part to respectively enter a maximum pulse rate limit and minimum pulse rate limit of a patient in a pre-set circuit for comparison with a patient's detected pulse rate in a comparator. An alarm device will produce a warning alarm, if the patient's pulse is equal to or higher than the maximum pulse rate limit or lower than the minimum pulse rate limit, to warn the patient or a nurse to take whatever actions are necessary. Excerpt(s): The present invention refers to a wrist alarm apparatus for sudden heart attack patient, in particularly characterized by giving warning alarm or phonetic sound asking for help when the heartbeats of a patient reach the maximum or minimum limit predetermined in accordance with the patient's physical condition, avoiding any delay for sending to hospital or untaking action of fist aid. In general, when a patient has heart attack, it may cause fatal danger if there is no prompt action such as taking medicine or sending to hospital. When it occurs in the living room or bedroom without being noticed in time, a regretful sudden death may enuse from delay for first aid or any appropriate actions. The main object of the present invention is to solve above described problem by providing a wrist alarm apparatus for sudden heart attack patient presetting heartbeat maximum and minimum limits in accordance with the patient's condition and reminding the patient to take medicine by warning alarm when the patient's heartbeats reach the pre-setted limits preventing from having heart attack. Web site: http://www.delphion.com/details?pn=US06080111__
Patent Applications on Heart Attack As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to heart attack: ·
Antioxidant gene therapy for myocardial infarction Inventor(s): French, Brent Arthur; (Charlottesville, VA) Correspondence: Brent A. French, Ph.D. 1228 Mountford Court; Charlottesville; VA; 22901; US Patent Application Number: 20020061299 Date filed: November 19, 2001 Abstract: A method of gene therapy is described that will protect the hearts of patients against myocardial infarction. Antioxidant enzymes are known to be cardioprotective, provided that these enzymes are administered before reperfusion. However, it has not
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This has been a common practice outside the United States prior to December 2000.
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previously been practical to administer antioxidant enzymes to patients at risk for myocardial infarction because the recombinant enzymes were expensive and required continuous intravenous administration. These limitations have been overcome by using gene therapy to provide a continuous source of antioxidant enzyme. When tested in carefully controlled pre-clinical studies, antioxidant gene therapy reduced the size of myocardial infarction by >50%. This marked reduction in infarct size could mean the difference between life and death for many patients, and would improve the quality of life for every person that survived myocardial infarction. This same approach may also be used by cardiothoracic surgeons to improve the functional recovery of donor hearts after cardiac transplantation. Excerpt(s): The present application claims the benefit of the earlier filing date of the U.S. Provisional Patent Application Ser. No. 60/252,066, filed Nov. 20, 2000, which is incorporated by reference herein in its entirety. Considerable evidence indicates that reactive oxygen species (ROS), such as superoxide anion (.O.sub.2.sup.-) and hydrogen peroxide (H.sub.2O.sub.2), contribute importantly to myocardial ischemia/reperfusion injury [1]. A number of studies have shown that IV administration of antioxidant enzymes (e.g., superoxide dismutase [SOD] and catalase) can reduce infarct size; however, other studies have failed to demonstrate a protective effect [1]. These inconsistent results suggested that antioxidant enzymes had the potential to protect the heart against myocardial infarction (MI), but that experimental variables between one study and the next could greatly influence the ultimate outcome of each study. Careful examination of the pharmacology of SOD clearly showed that the enzyme had to be present in interstitial space between cells at a critical concentration in order to achieve a cardioprotective effect [8]. The cytosolic isoform of Cu/Zn-SOD was commonly used in all of these experiments. This enzyme has a very short half-life in plasma and tissue, which means that a large bolus has to be administered in bloodstream in order to obtain a short period of protection. The "size" of this narrow window of protection and the time that it occurred after an iv bolus of SOD varied from one experimental preparation to the next, leading to the variable results found in the literature. More reliable results could be obtained by administering a constant iv infusion of SOD, but this required more recombinant enzyme than most investigators could afford. In short, the major problem with using antioxidant enzymes to protect against MI was that they needed to be given parenterally and they had very short plasma half-lives. The disclosed invention overcomes this hurdle by making use of a naturally-occurring extracellullar isoform of SOD. In contrast to the cytosolic Cu/Zn-SOD, this extracellular SOD (Ec-SOD) has been adapted by the process of evolution to function optimally in an extracellular environment. It thus has a prolonged half-life when administered to intact mammals (nearly 24 hours), and furthermore has high affinity for heparin-sulfate proteoglycans present on cellular surfaces and in the interstitial extracellular matrix. In short, the use of Ec-SOD overcomes two of the most important shortcomings of Cu/Zn-SOD (i.e., the short plasma half-life and lack of affinity for the interstitial space). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Compartmentalized device to enable a process of liquefying and administering aspirin as a first aid to heart attack victims Inventor(s): Pappalardo, Edward; (Albertson, NY) Correspondence: EDWARD PAPPALARDO; 37 GARDEN DRIVE; ALBERTSON; NY; 11507; US Patent Application Number: 20020025917 Date filed: April 23, 2001 Abstract: This invention relates to a novel process of creating an admixture of liquefied aspirin or other heart attack medication and administering said admixture to the buccal mucosa of the cheek pouch (mouth), and or the nasal passages of heart attack victims.A process of delivering medication to the mucus and respiratory membranes of the mouth and or nasal passages and respiratory system, using a compartmentalized device whose contents will remain anhydrous until used.This process is faster acting and more versatile than conventional oral or nasal medication, especially in emergencies where liquid admixtures would need to be prepared at the time of use.The novelty of this invention is that it allows heart attack victim immediate access to a liquefied aspirin or heart attack medication. This is done with a convenient, pre packaged, compartmentalized device and applicator that is suitable for heart attack victims in a Varity of circumstances. Excerpt(s): It is accepted knowledge that the early administration of aspirin to a heart attack victim limits the damage to heart muscle due to the easing of platelet aggregation in the arteries. The suggested first aid for heart attack victums is the chewing of aspirin tablet. For various reasons, chewing a dry tablet can be a poor way of administering aspirin during a heart attack. Many cases of heart attack will result in partial or total loss of consciousness making it difficult or impossible to administer a dry tablet. In the remaining cases the physiological reaction to heart attacks will be stress and fear, causing a lack of saliva. Due to this lack of saliva, a substantial amount of aspirin tablet will remain unsoluable. The resulting large particles of tablet will slow or inhibit the absorption of the medication. If a heart attack victim chews a dry tablet with a lack of saliva they will be inclined to take liquid if available, this would encourage swallowing of the aspirin particles, and thus slow the rate of absorption. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Histochrome and its therapeutic use in acute myocardial infarction and ischemic heart disease Inventor(s): Mischenko, Natalya Petrovna; (Vladivostok, RU), Artjukov, Alexandr Alexeevich; (Vladivostok, RU), Koltsova, Evgenia Alexandrovna; (Vladivostok, RU), Maximov, Oleg Borisovich; (Vladivostok, RU), Elyakov, Georgy Borisovich; (Vladivostok, RU), Glebko, Ljutsia Ignatievna; (Vladivostok, RU), Fedoreev, Sergei Alexandrovich; (Vladivostok, RU), Krasovskaya, Natalya Petrovna; (Vladivostok, RU) Correspondence: PENNIE & EDMONDS LLP; 1667 K STREET NW; SUITE 1000; WASHINGTON; DC; 20006 Patent Application Number: 20010029270 Date filed: April 12, 2001
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Abstract: A pharmaceutical composition is provided, which comprises an aqeous solution containing a mixture of di- and tri-sodium salts of echinochrome in an amount of 0.90 to 1.10 g/ml (Histochrome). It meets the requirements that apply to injectable formulations. Administration of Histochrome reduces by 57% the necrosis zone in patients with acute myocardial infarction, restores the contractility of the left ventricle, reduces the incidence of reperfusion-induced ventricular arrhythmias and exerts an antiarrhythmogenic effect. Histochrome suppresses the aggregation of erythrocytes and thrombocytes, produces a beneficial effect on the clinical course of the disease, reduces the incidence of complications and lethal outcomes in cases of acute myocardial infarction. It is well tolerated by patients. Excerpt(s): The invention relates to medicine and, more specifically, to a novel pharmaceutical composition useful in the treatment of ischemic heart disease and capable of limiting the necrotic zone in myocardial infarction. The ischemic heart disease and myocardial infarction are the most widespread diseases that affect humans. They are a leading cause of high mortality among patients, which dictates the need for a further search of novel therapeutic drugs. It is well known that myocardial infarction is associated with lipid peroxidation and, due to an insufficient oxygen supply, is often accompanied by the formation of an extensive necrotic zone in the heart. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Method and apparatus for treating acute myocardial infarction with selective hypothermic perfusion Inventor(s): Samson, Wilfred J. (Saratoga, CA), Robinson, Janine; (Half Moon Bay, CA), Esch, Brady; (San Jose, CA), Macoviak, John A. (La Jolla, CA) Correspondence: Gunther Hanke; Fulwider Patton Lee & Utecht; P.O. Box 22615; Long Beach; CA; 90801-5615; US Patent Application Number: 20020161351 Date filed: March 19, 2002 Abstract: An apparatus and method are described for therapeutic hypothermia of the heart by selective hypothermic perfusion of the myocardium through the patient's coronary arteries. The apparatus and method provide rapid cooling of the affected myocardium to achieve optimal myocardial salvage in a patient experiencing acute myocardial infarction. The therapeutic hypothermia system includes one or more selective coronary perfusion catheters and a fluid source for delivering a hypothermically-cooled physiologically-acceptable fluid, such as saline solution, oxygenated venous blood, autologously-oxygenated arterial blood and/or an oxygenated blood substitute. The system may also include one or more guidewires, subselective catheters and/or interventional catheters introduced through a lumen in the selective coronary perfusion catheter. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. 09/384,467, filed on Aug. 30, 1999, which claims the benefit of U.S. provisional application serial No. 60/098,727, filed on Sep. 1, 1998, the specifications of which are hereby incorporated in their entirety. The present invention relates generally to methods and devices for treatment of heart disease. More particularly, it relates to methods and devices for treating acute myocardial infarction with selective hypothermic perfusion. Heart disease is the most common cause of death in the United States and in most countries of the western world. Coronary artery disease accounts for a large proportion
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of the deaths due to heart disease. Coronary artery disease is a form of atherosclerosis in which lipids, cholesterol and other materials deposit in the arterial walls gradually narrowing the arterial lumen, thereby depriving the myocardial tissue downstream from the narrowing of blood flow that supplies oxygen and other critical nutrients and electrolytes. These conditions can be further exacerbated by a blockage due to thrombosis, embolization or arterial dissection at the site of the stenosis. A severe reduction or blockage of blood flow can lead to ischemia, myocardial infarction and necrosis of the myocardial tissue. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
METHOD AND APPARATUS TO IMPROVE MYOCARDIAL INFARCTION DETECTION WITH BLOOD POOL SIGNAL SUPPRESSION Inventor(s): Foo , Thomas K.F. ( Rockville, MD) Correspondence: none reported Patent Application Number: 20030069496 Date filed: December 20, 2002 Abstract: A method and apparatus are disclosed for achieving suppression of blood pool signal to detect myocardial infarction using MR technology. An RF pulse sequence is applied that includes a notched inversion RF pulse designed to suppress blood pool in and around a region-of-interest. MR data is then acquired within the region-of-interest that not only has signals from normal myocardial tissue suppressed, but also has blood pool signal suppression to improve delineation of infarcted myocardium from the ventricular blood pool and normal myocardium. Excerpt(s): This application is a continuing application and claims priority of U.S. Ser. No. 09/681,081 filed December 29, 2000. The present invention relates generally magnetic resonance imaging (MRI), and more particularly, to a method and apparatus, including a new pulse sequence, to achieve greater sensitivity in detecting infarcted myocardial tissue. MRI utilizes radio frequency pulses and magnetic field gradients applied to a subject in a strong magnetic field to produce viewable images. When a substance containing nuclei with net nuclear magnetic moment, such as the protons in human tissue, is subjected to a uniform magnetic field (polarizing field B.sub.0 ), the individual magnetic moments of the spins in the tissue attempt to align with this polarizing field (assumed to be in the z-direction), but precess about the direction of this magnetic field at a characteristic frequency known as the Larmor frequency. If the substance, or tissue, is subjected to a time-varying magnetic field (excitation field B.sub.1) applied at a frequency equal to the Larmor frequency, the net aligned moment, or "longitudinal magnetization", M.sub.Z, may be nutated, or "tipped", into the x-y plane to produce a net transverse magnetic moment M.sub.t. A signal is emitted by the excited spins after the excitation signal B.sub.1 is terminated (as the excited spins decays to the ground state) and this signal may be received and processed to form an image. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Method of treatment of myocardial infarction Inventor(s): Cheresh, David A. (Encinitas, CA), Eliceiri, Brian; (Carlsbad, CA), Paul, Robert; (Munich, DE) Correspondence: OLSON & HIERL, LTD. 36th Floor; 20 North Wacker Drive; Chicago; IL; 60606; US Patent Application Number: 20030130209 Date filed: November 18, 2002 Abstract: The present invention describes methods of treating myocardial infarction in a patient administering to the patient a therapeutically effective amount of a chemical Src family tyrosine kinase protein inhibitor. The inhibitor preferably is an inhibitor of Src protein selected from the group consisting of a pyrazolopyrimidine class Src family tyrosine kinase inhibitor, a macrocyclic dienone class Src family tyrosine kinase inhibitor, a pyrido[2,3-d]pyrimidine class Src family tyrosine kinase inhibitor, and a mixture thereof. Also disclosed are articles of manufacture containing a chemical Src family tyrosine kinase inhibitor. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. Nos. 09/470,881, filed Dec. 22, 1999, and 09/538,248, filed Mar. 29, 2000, both of which claim priority to International Patent Application Number PCT/US99/11780, designating the United States of America and filed May 28, 1999, which claims priority to U.S. Provisional Application for Patent Serial No. 60/087,220 filed May 29, 1998. The complete disclosures of these applications are incorporated herein by reference. The present invention relates generally to the field of medicine, and relates specifically to methods and compositions for treating myocardial infarction. Vascular permeability due to injury, disease, or other trauma to the blood vessels is a major cause of vascular leakage and edema associated with tissue damage. For example, cerebrovascular disease associated with cerebrovascular accident (CVA) or other vascular injury in the brain or spinal tissues are the most common cause of neurologic disorder, and a major source of disability. Typically, damage to the brain or spinal tissue in the region of a CVA involves vascular leakage and/or edema. Typically, CVA can include injury caused by brain ischemia, interruption of normal blood flow to the brain; cerebral insufficiency due to transient disturbances in blood flow; infarction, due to embolism or thrombosis of the intra- or extracranial arteries; hemorrhage; and arteriovenous malformations. Ischemic stroke and cerebral hemorrhage can develop abruptly, and the impact of the incident generally reflects the area of the brain damaged. (See The Merck Manual, 16.sup.th ed. Chp. 123, 1992). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Prevention of myocardial infarction induced ventricular expansion and remodeling Inventor(s): Weiner, Bonnie H. (Harvard, MA), Lesniak, Jeanne M. (Natick, MA), Santamore, William P. (Medford, NJ) Correspondence: Finnegan, Henderson, Farabow,; Garrett & Dunner, L.L.P. 1300 I Street, N.W. Washington; DC; 20005-3315; US Patent Application Number: 20030078671 Date filed: October 24, 2002
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Abstract: A method for direct therapeutic treatment of myocardial tissue in a localized region of a heart having a pathological condition. The method includes identifying a target region of the myocardium and applying material directly and substantially only to at least a portion of the myocardial tissue of the target region through transseptal delivery. The material applied results in a physically modification the mechanical properties, including stiffness, of said tissue. Various devices and modes of practicing the method are disclosed for stiffening, restraining and constraining myocardial tissue for the treatment of conditions including myocardial infarction or mitral valve regurgitation. The novel treatment may be combined with prior art diagnostic and therapeutic techniques employing transseptal delivery methods. Excerpt(s): This application is a Continuation-In-Part of U.S. patent application Ser. No. 10/131,090, filed Apr. 25, 2002, and claims priority to Provisional U.S. Patent Application No. 60/286,521, filed Apr. 27, 2001, the contents of which are incorporated by reference herein in its entirety. The invention relates generally to medical devices and therapeutic methods for their use in the field of interventional cardiology and cardiac surgery, and more specifically to catheter-based, mini-thoracotomy, or open chest systems to stiffen a myocardial infarction area, to shrink the myocardial infarct region, and/or to reduce wall motion abnormalities in a peri-infarct and/or infarct region of a heart. The invention also has application in the treatment of mitral valve regurgitation and diastolic dysfunction. Each year over 1.1 million Americans have a myocardial infarction, usually as a result of coronary occlusion. These myocardial infarctions result in an immediate depression in ventricular function and all of these infarctions are very likely to expand, provoking a cascading sequence of myocellular events known as ventricular remodeling. In many cases, this progressive myocardial infarct expansion and ventricular remodeling leads to deterioration in ventricular function and heart failure. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
System and method for detecting new left branch bundle block for accelerating treatment of acute myocardial infarction Inventor(s): Rowlandson, G. Ian; (Milwaukee, WI) Correspondence: OSTRAGER CHONG & FLAHERTY LLP; 825 THIRD AVE; 30TH FLOOR; NEW YORK; NY; 10022-7519; US Patent Application Number: 20020087055 Date filed: December 29, 2000 Abstract: A system and a method for automatically detecting a new left bundle branch block (LBBB) in an ECG series and then issuing an alert for the purpose of accelerating treatment for acute myocardial infarction. A serial comparison program is used to compare each current ECG with a previous ECG for the same patient. Diagnostic statements, measurements and waveforms are compared and based on the comparisons, the system is able to automatically determine that the patient has a new LBBB. The system then automatically determines whether the patient belongs to the category of patients having a high probability of acute myocardial infarction. If acute myocardial infarction is suspected, the system generates a diagnostic statement stating that the new left bundle branch block may be due to acute myocardial infarction. The current ECG exhibiting a new LBBB is then identified with a special tag and sent to a central database server. The special tag enables the central database server to perform special routing of
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that record, e.g., via facsimile or digital pager, to alert on-call medical personnel to the need for immediate treatment. Excerpt(s): This invention relates to the acquisition, analysis and routing electrocardiograms (ECGs) and other physiological data. In particular, the invention relates to automated monitoring of acquired ECGs to detect characteristics indicating a specific cardiovascular condition requiring accelerated treatment. In hospitals or other health-care settings, it is frequently necessary to observe critical physiological conditions of a patient, including cardiovascular conditions. Cardiovascular condition data is obtained from sensors applied to a patient, or by imaging and sensing devices. Further, cardiovascular data may be data reported by a cardiologist based on review of a patient or a patient's monitor or image data. Hospitals or health-care centers often have hundreds or even thousands of sensor and metering devices and hundreds or even thousands of cardiac patients that require monitoring periodically over a lifetime. This data may be stored in a database for archival functions and later retrieval. A known ECG management system, the MUSE.RTM. (Marquette Universal System for Electrocardiography) system of GE Marquette Medical Systems, Inc., is a software-based product that runs on off-the-shelf hardware. In particular, this ECG management system comprises a database of ECGs plus applications software. The MUSE.RTM. system receives ECG data from a multiplicity of instruments via a plurality of networks, analyzes that ECG data using various programs such as a serial comparison program, generates reports containing the results of the analysis, and then routes those reports to various systems and peripheral devices. In particular, the MUSE.RTM. system has automatic report routing which can send reports to multiple devices, including a facsimile machine as well as a digital pager. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Thrombust; implantable delivery system sensible to self diagnosis of acute myocardial infarction for thrombolysis in the first minutes of chest pain Inventor(s): Anzellini, Fernando; (Bogota, CO) Correspondence: Fernando Anzellini; Calle 83 No 19-36 Office 704; Bogota; CO Patent Application Number: 20030176797 Date filed: March 12, 2002 Abstract: A system for recognizing Acute Myocardial Infarction through a portable device (8) and an implantable pump (13) by the patient himself in order to be able to trigger a signal for delivery of drug after symptoms arise, with the advantages of an early thrombolysis without the help of medical doctors or technicians is described in order to install treatment as soon as possible.The device (8) is capable of warning the user that he/she may be suffering a heart attack so that a signal can be triggered to activate a previously subcutaneous implanted pump (13) filled with the necessary drug for immediate thrombolysis, or any other treatment currently available, and influenced by early diagnosis of chest pain symptoms, this being a worldwide medical problem since Acute Myocardial Infarction is the leading cause of mortality in the world. Excerpt(s): Related to the present invention is the existence of prior art as illustrated in U.S. Pat. No. 6,339,720 by Anzellini et al. called the CARDIOST, in the form of a unit capable of informing a user with no medical background when he/she is suffering an Acute Myocardial Infarction within minutes of chest pain. There are many implantable drug delivery systems that delivers drugs from a reservoir at a controllable rate using a
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pump to impel a drug through a catheter. Localized drug delivery has become increasingly important in applications such as tissue engineering, growth regulation, pain control and therapeutic approaches to localized disease conditions including tumors, local nervous system conditions and local vascular conditions. The action of many drugs is greatly enhanced by, or in some cases requires long term local delivery of those drugs into the Patient's body. Implantable drug delivery devices, implantable pumps, for example have been developed to address the disadvantage of techniques that use external pump and catheter systems. Implantable drug delivery pumps often include a reservoir for storing the drug, an injection port to enable injection of fresh drug preparations at regular intervals into the reservoir, and optionally a catheter for delivering the drug to the desired site. There is the need to inject substances within the body in the exact moment the event is taking place as in Acute Myocardial Infarction when pain arises and the S-T segment of the electrocardiograph shifts either positive or negative, the sooner this is accomplished the better the prognosis. The signal received and analyzed by the CARDIOST U.S. Pat. No. 6,339,720, without the help of qualified medical personal and done by the Patient himself in the moment of chest pain in virtually any environment is then used to trigger a signal to an implantable drug delivery pump in order to provide the necessary amount of available drug in the exact moment it is needed, provided that the prognosis of Acute Myocardial Infarction, that is the leading cause of death in the world, is greatly influenced by early treatment. In accordance with one aspect of this invention, there is provided a drug administration device for providing a measured dosage of a medical liquid to a location within the body comprising a pump for metering a measured amount of drug from said device in response to a pulse, a triggerable circuit for generating a pulse and a digital computer operable at predetermined intervals to trigger said circuit to generate a plurality of pulses to deliver measured drug dosages at selected intervals. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Use of alpha 1AR subtype-selective drugs in patients with acute myocardial infarction Inventor(s): Schwinn, Debra A. (Durham, NC) Correspondence: NIXON & VANDERHYE P.C. 1100 North Glebe Road, 8th Floor; Arlington; VA; 22201; US Patent Application Number: 20010031460 Date filed: December 7, 2000 Abstract: The present invention relates to the use of.alpha.sub.1aAR-selective and/or.alpha.sub.1a/.alpha.sub.1d-selective antagonists in a method of preventing restenosis after myocardial infarction and re-perfusion. The invention further relates to a method of identifying agents suitable for us in such a method. Excerpt(s): This application claims priority from Provisional Application No. 60/169,294, filed Dec. 7, 1999, the entire content of which is incorporated herein by reference. The present invention relates to the use of.alpha.sub.1aAR-select- ive and/or.alpha.sub.1a/.alpha.sub.1d-selective antagonists in a method of preventing restenosis after myocardial infarction and re-perfusion. The invention further relates to a method of identifying agents suitable for us in such a method. Although reasons for existence of three.alpha.sub.1AR subtypes remain elusive, recent findings suggest subtype and tissue specific regulation may be important.sup.9,10 While all.alpha.sub.1AR subtypes mediate smooth muscle contraction, hypertrophic pathways
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demonstrate subtype specific signaling.sup.11.alpha.sub.1AR agonist exposure to neonatal rat myocytes results in.alpha.sub.1aAR mRNA/protein upregulation (doubling) concurrent with.alpha.sub.1b and.alpha.sub.1d downregulation, correlating with induction of myocardial hypertrophy.sup.12 In contrast, insulin and insulin-like growth factor I induces.alpha.sub.1dAR expression in cultured rat vascular smooth muscle cells.sup.13 Hence agonist exposure, disease states, and drugs alter.alpha.sub.1AR subtype expression. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Use of GLP-1 or analogs in treatment of myocardial infarction Inventor(s): Efendic, Suad; (Lidingo, SE) Correspondence: ELI LILLY AND COMPANY; PATENT DIVISION; P.O. BOX 6288; INDIANAPOLIS; IN; 46206-6288; US Patent Application Number: 20030022823 Date filed: April 12, 2001 Abstract: This invention provides a method of reducing mortality and morbidity after myocardial infarction. GLP-1, a GLP-1 analog, or a GLP-1 derivative, is administered at a dose effective to normalize blood glucose. Excerpt(s): This application claims the benefit of U.S. Provisional Application Serial No. 60/024,980, filed Aug. 30, 1996. This invention relates to a method of reducing mortality and morbidity after myocardial infarction in diabetic patients. Morbidity and mortality from cardiovascular disease is higher in patients with manifest diabetes or impaired glucose tolerance compared to patients without those disorders. Diabetics account for up to 24% of the total number of patients admitted to coronary care units for suspect infarction, whereas they constitute only about 5% of the general population [Malmberg and Rydn; Fuller J. H., Diabet. Metab. 19:96-99 (1993)]. In-hospital mortality of diabetic patients with myocardial infarction is twice that of non-diabetics [Hamsten A., et al., J. Int. Med. 736:1-3 (1994) 236 Suppl. Malmberg K. and Rydn L., Eur. Heart J. 9:256-263 (1988)]. Diabetics experience more morbidity and die more often in the post-acute recovery phase, mostly due to fatal re-infarction and congestive heart failure [Malmberg and Rydn; Stone P., et al., J. Am. Coll. Cardiol. 14:49-57 (1989); Karlson B. W., et al., Diabet. Med. 10(5):449-54 (1993); Barbash G. I., et al., J. Am. Coll. Cardiol. 22:707-713 (1993)]. The difference in mortality and morbidity between diabetics and non-diabetics following myocardial infarction persists, despite reduction in the incidence of morbidity and mortality following acute myocardial infarction [Granger C. B., et al., J. Am. Coll. Cardiol., 21(4):920-5 (1993); Grines C., et al., N. Engl. J. Med. 328:673-679 (1993)]. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with heart attack, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “heart attack” (or synonyms) into
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the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on heart attack. You can also use this procedure to view pending patent applications concerning heart attack. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.
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CHAPTER 7. BOOKS ON HEART ATTACK Overview This chapter provides bibliographic book references relating to heart attack. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on heart attack include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “heart attack” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on heart attack: ·
Fire Inside: Extinguishing Heartburn and Related Symptoms Source: New York, NY: W.W. Norton and Company. 1996. 192 p. Contact: Available from W.W. Norton and Company, Inc. 500 Fifth Avenue, New York, NY 10110. (212) 354-5500. PRICE: $23.00. ISBN: 0393038637. Summary: This book offers readers an abundance of information on heartburn, related symptoms, and complications. The introductory chapter relates facts and myths about heartburn, and includes a historical perspective of the diagnosis and treatment of the condition. Chapter 2 offers lifestyle modifications that may provide simple heartburn relief. Chapters 3 and 4 discuss acid and antacids, and acid disease (gastroesophageal reflux disease, or GERD). Chapter 5 updates readers on current medications available for heartburn. Chapter 6 explores the relationship between asthma and acid reflux. Chapter 7 outlines the ear, nose, and throat complications that can arise from acid reflux conditions. And Chapter 8 helps readers differentiate between 'indigestion' and
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cardiovascular problems (heartburn or heart attack). The concluding chapter reviews the medications and lifestyle recommendations available and encourages readers to take charge of their heartburn. The book concludes with a glossary and a subject index. ·
Mayo Clinic on High Blood Pressure Source: New York, NY: Kensington Publishing. 1999. 180 p. Contact: Available from Mayo Clinic. 200 First Street, S.W., Rochester, MN 55905. (800) 291-1128 or (507) 284-2511. Fax (507) 284-0161. Website: www.mayo.edu. PRICE: $14.95 plus shipping and handling. ISBN: 1893005011. Summary: Having high blood pressure puts Americans at greater risk for disability or death from stroke, heart attack, or kidney failure. This book from the Mayo Clinic helps readers identify, prevent, and treat high blood pressure (hypertension). Written in nontechnical language, the book describes how hypertension develops and the complications that can arise if it is not controlled. Chapters cover risk factors, diagnosis, and treatment issues. The book includes practical tips and suggestions that readers can use each day to help manage blood pressure. These include information on how to control one's weight, improve the diet, increase activity levels, reduce the stress level, and limit the use of tobacco, alcohol, and caffeine. The book also offers information about the proper use of medications, how to monitor one's own blood pressure at home, and the importance of regular followup care. The authors address issues of particular concern to special risk populations. The book includes sample menus, a list of additional resources, and a subject index.
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I'm too young to get old: Health care for women after forty Source: New York, NY: Times Books. 1997. 509 pp. Contact: Available from Random House, Times Books, 201 E. 50th Street, New York, NY 10022. $16.00. Summary: This book addresses health issues of women over forty. The book is divided into four parts. Part I discusses bodily changes, contraception, pregnancy, and fertility over 40. Part II addresses menopause. Part III looks at other health concerns including heart attack, stroke, osteoporosis, cancer, autoimmune diseases, and urinary incontinence. Part IV offers information about gynecological surgeries, the maturing psyche, and disease prevention. A health care plan is provided. A list of resources for additional information and suggested readings is included.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “heart attack” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “heart attack” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “heart attack” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com):
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"Mr. King, You're Having a Heart Attack": How a Heart Attack and Bypass Surgery Changed My Life by Larry King, B. D. Colen; ISBN: 0440205220; http://www.amazon.com/exec/obidos/ASIN/0440205220/icongroupinterna
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100 Q&A About Heart Attack and Related Cardiac Problems by Edward K. Chung; ISBN: 0763712949; http://www.amazon.com/exec/obidos/ASIN/0763712949/icongroupinterna
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21st Century Complete Medical Guide to Heart Disease, Heart Attack, Cholesterol, Coronary Artery Disease, Bypass Surgery, Angioplasty ¿ Authoritative Federal Government Documents and Clinical References for Patients and Physicians with Practical Information on Diagnosis and Treatment Options by PM Medical Health News; ISBN: 1931828342; http://www.amazon.com/exec/obidos/ASIN/1931828342/icongroupinterna
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8 Steps to a Healthy Heart: The Complete Guide to Heart Disease Prevention and Recovery from Heart Attack and Bypass Surgery by Robert E. Kowalski; ISBN: 0446516643; http://www.amazon.com/exec/obidos/ASIN/0446516643/icongroupinterna
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8 Ways to Lower Your Risk of a Heart Attack or Stroke (Compact Guide to Fitness & Health) by Mason Crest Publishers (2002); ISBN: 1590842464; http://www.amazon.com/exec/obidos/ASIN/1590842464/icongroupinterna
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A coronary experience : personal account of a heart attack and open heart surgery by R. John Singh; ISBN: 0960467211; http://www.amazon.com/exec/obidos/ASIN/0960467211/icongroupinterna
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A Heart Attack Can Save Your Life: The Complete Guide on How to Lose Weight and Reduce Your Risk of Heart Attack and Cancer Without Dieting by Joseph W. Mason; ISBN: 0964610949; http://www.amazon.com/exec/obidos/ASIN/0964610949/icongroupinterna
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All about heart attacks by John R. Hampton; ISBN: 0443022216; http://www.amazon.com/exec/obidos/ASIN/0443022216/icongroupinterna
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All You Wanted to Know About Heart Attack by Savitri Ramaiah (Editor); ISBN: 8120722272; http://www.amazon.com/exec/obidos/ASIN/8120722272/icongroupinterna
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American Heart Association Guide to Heart Attack Treatment, Recovery, and Prevention: Treatment, Recovery, and Prevention by American Heart Association (1996); ISBN: 0812924088; http://www.amazon.com/exec/obidos/ASIN/0812924088/icongroupinterna
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An Arrow Through the Heart : One Woman's Story of Life, Love, and Surviving a Near-Fatal Heart Attack by Deborah Daw Heffernan; ISBN: 0743229223; http://www.amazon.com/exec/obidos/ASIN/0743229223/icongroupinterna
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An Aspirin a Day: What You Can Do to Prevent Heart Attack, Stroke, and Cancer by Michael Castleman; ISBN: 1562828800; http://www.amazon.com/exec/obidos/ASIN/1562828800/icongroupinterna
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An Emotionally Normal Heart Attack by Richard, M.D. Tenney (1999); ISBN: 1560725001; http://www.amazon.com/exec/obidos/ASIN/1560725001/icongroupinterna
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Atherosclerosis, a Book for Everybody: How to Prolong Your Life and Avoid a Heart Attack by Zaharia A. Lupovici; ISBN: 0533075165; http://www.amazon.com/exec/obidos/ASIN/0533075165/icongroupinterna
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Avoiding Heart Attacks; ISBN: 0113207719; http://www.amazon.com/exec/obidos/ASIN/0113207719/icongroupinterna
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Before the Heart Attacks by Robert H. Superko (Author), Laura Tucker (Author) (2003); ISBN: 1579548008; http://www.amazon.com/exec/obidos/ASIN/1579548008/icongroupinterna
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Caring for the Healing Heart: An Eating Plan for Recovery from Heart Attack by Eleanor Cousins, David S. Cannom (Designer); ISBN: 039302590X; http://www.amazon.com/exec/obidos/ASIN/039302590X/icongroupinterna
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Coming Back: A Guide to Recovering from Heart Attack by Keith Cohn, Darby Duke (Contributor); ISBN: 0201054981; http://www.amazon.com/exec/obidos/ASIN/0201054981/icongroupinterna
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Coming Back: A Guide to Recovering from Heart Attack and Living Confidently with Coronary Disease by Keith Cohn, et al; ISBN: 0201045613; http://www.amazon.com/exec/obidos/ASIN/0201045613/icongroupinterna
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Como Evitar UN Ataque Al Corazon/How Not to Have a Heart Attack by Morton Walker; ISBN: 8427007280; http://www.amazon.com/exec/obidos/ASIN/8427007280/icongroupinterna
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Como Prevenir Y Combatir El Infarto/How to Prevent and Treat Heart Attacks by Jean-Paul Roquebrune; ISBN: 8427258542; http://www.amazon.com/exec/obidos/ASIN/8427258542/icongroupinterna
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Consultation With a Cardiologist: Coronary, Heart Disease, and Heart Attack Prevention by Jacob I. Haft (1979); ISBN: 0882293206; http://www.amazon.com/exec/obidos/ASIN/0882293206/icongroupinterna
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Cuine Su Corazon/the Heart Attack Handbook by Joseph S. Alpert (1985); ISBN: 9501505138; http://www.amazon.com/exec/obidos/ASIN/9501505138/icongroupinterna
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Diet for a Strong Heart: Michio Kushi's Macrobiotic Dietary Guidelines for the Prevention of High Blood Pressure, Heart Attack, and Stroke by Michio Kushi, Alex Jack (Contributor); ISBN: 0312001207; http://www.amazon.com/exec/obidos/ASIN/0312001207/icongroupinterna
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Diseases Explained: Heart Attack Wall Chart by Lexi-Comp; ISBN: 193059805X; http://www.amazon.com/exec/obidos/ASIN/193059805X/icongroupinterna
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Don't Break Your Heart: All You Need to Know About Heart Attacks - and How to Avoid Them by Lynch; ISBN: 0283994665; http://www.amazon.com/exec/obidos/ASIN/0283994665/icongroupinterna
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Down but Not Out: Living Through Setbacks, Major Whacks, and Broken-Heart Attacks by Jeanne E. Sexson (1996); ISBN: 1884724078; http://www.amazon.com/exec/obidos/ASIN/1884724078/icongroupinterna
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Down but Not Out: Living Through Your Setbacks, Major Whacks, and Broken-Heart Attacks by Jeanne Elizabeth Sexson (1996); ISBN: 1884724086; http://www.amazon.com/exec/obidos/ASIN/1884724086/icongroupinterna
Books 207
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Dr Morrison's Heart Saver Programme: A Natural, Scientifically Tested Plan for the Prevention of Arteriosclerosis, Heart Attack, and Stroke by Lester Morrison, Nancy Nugent; ISBN: 0722509855; http://www.amazon.com/exec/obidos/ASIN/0722509855/icongroupinterna
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Dr. Morrison's Heart-Saver Program: A Natural, Scientifically Tested Plan for the Prevention of Arteriosclerosis, Heart Attack, and Stroke by Lester M., With Nugent Morrison; ISBN: 0312214812; http://www.amazon.com/exec/obidos/ASIN/0312214812/icongroupinterna
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Eisenhower's Heart Attack: How Ike Beat Heart Disease and Held on to the Presidency by Clarence G. Lasby (1997); ISBN: 0700608222; http://www.amazon.com/exec/obidos/ASIN/0700608222/icongroupinterna
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Emergency Diagnostic Tests for Cardiac Ischemia: A Report from the National Heart Attack Alert Program (Nhaap) Coordinating Committee: Working Group on Evaluation of Technologies for Identifying acu by Robert J. Zalenski, et al (1997); ISBN: 0632043040; http://www.amazon.com/exec/obidos/ASIN/0632043040/icongroupinterna
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Enhancing Heart Health: Preventing a Heart Attack by Matthew Budoff; ISBN: 1890694398; http://www.amazon.com/exec/obidos/ASIN/1890694398/icongroupinterna
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Every Heart Attack is Preventable by Michael Mogadam (2001); ISBN: 089526207X; http://www.amazon.com/exec/obidos/ASIN/089526207X/icongroupinterna
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Every Heart Attack Is Preventable: How to Take Control of 20 Risk Factors & Save Your Life by Michael Mogadam (2003); ISBN: 0451207769; http://www.amazon.com/exec/obidos/ASIN/0451207769/icongroupinterna
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Exercise and Cardiac Rehabilitation After Your Heart Attack (Humanatomy, 11) by Tim Peters (1994); ISBN: 1879874539; http://www.amazon.com/exec/obidos/ASIN/1879874539/icongroupinterna
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Freedom from Heart Attacks, by Benjamin Frank, Miller; ISBN: 0671213199; http://www.amazon.com/exec/obidos/ASIN/0671213199/icongroupinterna
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Good Fat, Bad Fat: How to Lower Your Cholesterol and Beat the Odds of a Heart Attack by Glen Griffen, et al; ISBN: 1555610137; http://www.amazon.com/exec/obidos/ASIN/1555610137/icongroupinterna
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Health, Hope and Healing: A Survivor of Cancer and Heart Attack Tells How He Used Holistic Techniques and a Spiritual Perspective As Well As Traditi by David A. Tate; ISBN: 0871316587; http://www.amazon.com/exec/obidos/ASIN/0871316587/icongroupinterna
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Healthy Heart Handbook: How to Prevent and Reverse Heart Disease, Lower Your Risk of Heart Attack and Cancer, Reduce Stress, Lose Weight Without Hunger by Neal Pinckney; ISBN: 1558743847; http://www.amazon.com/exec/obidos/ASIN/1558743847/icongroupinterna
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Heart Attack by Edward K. Chung; ISBN: 0838536735; http://www.amazon.com/exec/obidos/ASIN/0838536735/icongroupinterna
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HEART ATTACK & OTHER STORIES; ISBN: 0340379502; http://www.amazon.com/exec/obidos/ASIN/0340379502/icongroupinterna
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Heart Attack (Thorsons Health Series) by David Lewis, John Story; ISBN: 072253227X; http://www.amazon.com/exec/obidos/ASIN/072253227X/icongroupinterna
208 Heart Attack
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Heart attack : a personal experience by Jose B. Viloria; ISBN: 096232986X; http://www.amazon.com/exec/obidos/ASIN/096232986X/icongroupinterna
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Heart Attack : Are You a Candidate by Arthur Blumenfeld (Author); ISBN: 0839732007; http://www.amazon.com/exec/obidos/ASIN/0839732007/icongroupinterna
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Heart Attack New Hope, New Knowledge, New Life by Prinzmetal M; ISBN: 0671102788; http://www.amazon.com/exec/obidos/ASIN/0671102788/icongroupinterna
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Heart Attack Patient Guide : A Complete Picture of this Potentially Deadly Damage [DOWNLOAD: PDF]; ISBN: B00009KF21; http://www.amazon.com/exec/obidos/ASIN/B00009KF21/icongroupinterna
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Heart Attack Prevention: A Practical Approach to Reducing Your Risk of Heart Attack/Audio Cassette (Bantam Audio: Health) by Isadore Rosenfield, Isadore Rosenfeld; ISBN: 0553450131; http://www.amazon.com/exec/obidos/ASIN/0553450131/icongroupinterna
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Heart Attack Rareness in Thyroid-Treated Patients by Broda O. Barnes, Charlotte W. Barnes; ISBN: 0398025193; http://www.amazon.com/exec/obidos/ASIN/0398025193/icongroupinterna
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Heart Attack Recovery Plan by D. Family Heart A. Symes; ISBN: 0091812895; http://www.amazon.com/exec/obidos/ASIN/0091812895/icongroupinterna
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Heart Attack Survival Manual: A Guide to Using Cpr in a Crisis by Roger J. Seymour; ISBN: 0133857328; http://www.amazon.com/exec/obidos/ASIN/0133857328/icongroupinterna
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Heart Attack Survivor: A Field Guide by Brad Henson; ISBN: 0971278806; http://www.amazon.com/exec/obidos/ASIN/0971278806/icongroupinterna
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Heart Attack Symptoms and Warning Signs : What to Look For When 'The Big One' Hits [DOWNLOAD: PDF]; ISBN: B00009KF22; http://www.amazon.com/exec/obidos/ASIN/B00009KF22/icongroupinterna
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Heart Attack! by Louis S. Levine; ISBN: 0060125950; http://www.amazon.com/exec/obidos/ASIN/0060125950/icongroupinterna
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Heart Attack!: A Question and Answer Book by Oscar, Roth; ISBN: 0397012632; http://www.amazon.com/exec/obidos/ASIN/0397012632/icongroupinterna
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Heart Attack!: Advice for Patients by Patients by Kathleen Berra (Editor), et al; ISBN: 0300091907; http://www.amazon.com/exec/obidos/ASIN/0300091907/icongroupinterna
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Heart Attack, What's Ahead ? by Julia Ann and Cambre, Suzanne and Johnston, Barbara Purcell (1981); ISBN: 0939838028; http://www.amazon.com/exec/obidos/ASIN/0939838028/icongroupinterna
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Heart Attack: Bouncing Back: A Manual for Heart Attack Survivors and the People Who Love Them by Julia Ann Purcell, et al (2001); ISBN: 0939838664; http://www.amazon.com/exec/obidos/ASIN/0939838664/icongroupinterna
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Heart Attack: The Family Response at Home and in the Hospital by Edward J. Speedling (1982); ISBN: 0422778001; http://www.amazon.com/exec/obidos/ASIN/0422778001/icongroupinterna
Books 209
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Heart Attack: You Don't Have to Die by Christiaan Neethling Barnard; ISBN: 0440035368; http://www.amazon.com/exec/obidos/ASIN/0440035368/icongroupinterna
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Heart Attack--Counterattack: A Practical Plan for a Healthy Heart by Terence Kavanagh; ISBN: 0442299273; http://www.amazon.com/exec/obidos/ASIN/0442299273/icongroupinterna
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Heart Attacks by Edmund Skellings; ISBN: 0813005574; http://www.amazon.com/exec/obidos/ASIN/0813005574/icongroupinterna
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Heart Attacks & Rehabilitation: Index of New Information by Dignan (1994); ISBN: 0788300423; http://www.amazon.com/exec/obidos/ASIN/0788300423/icongroupinterna
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Heart Attacks, Hypertension, and Heart Drugs by M. Gabriel Khan; ISBN: 0878577106; http://www.amazon.com/exec/obidos/ASIN/0878577106/icongroupinterna
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Heart Attacks: Prevent and Survive by Tom Smith (2000); ISBN: 0859698408; http://www.amazon.com/exec/obidos/ASIN/0859698408/icongroupinterna
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Heart Attacks: The Answer Book by Joan Miller; ISBN: 0800784693; http://www.amazon.com/exec/obidos/ASIN/0800784693/icongroupinterna
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Heart Attacks-Real, Imagined and Suspicious: Index of New Information by Dignan (1994); ISBN: 0788300407; http://www.amazon.com/exec/obidos/ASIN/0788300407/icongroupinterna
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Heart attack--you can survive! by Donald M. Gelb; ISBN: 0892601280; http://www.amazon.com/exec/obidos/ASIN/0892601280/icongroupinterna
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Heart Diseases and Disorders Sourcebook: Basic Consumer Health Information About Heart Attacks, Angina, Rhythm Disorders, Heart Failure, Valve Disease, Congenital Heart Disorders, and More (Health Reference Series) by Karen Bellenir (Editor) (2000); ISBN: 0780802381; http://www.amazon.com/exec/obidos/ASIN/0780802381/icongroupinterna
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Heartwiseguy: How to Live the Good Life After a Heart Attack by Gary Cartwright, Ann Richards; ISBN: 031218591X; http://www.amazon.com/exec/obidos/ASIN/031218591X/icongroupinterna
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Hidden Causes of Heart Attack and Stroke: Inflammation, Cardiology's New Frontier by Christian Wilde (2003); ISBN: 0972495908; http://www.amazon.com/exec/obidos/ASIN/0972495908/icongroupinterna
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Homogenized Milk May Cause Your Heart Attack - The XO Factor by Kurt A. Oster M.D. (1983); ISBN: 0943550017; http://www.amazon.com/exec/obidos/ASIN/0943550017/icongroupinterna
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How not to have a heart attack by Morton Walker; ISBN: 0531099199; http://www.amazon.com/exec/obidos/ASIN/0531099199/icongroupinterna
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How to avoid your heart attack by Stanley L. Englebardt; ISBN: 0883490250; http://www.amazon.com/exec/obidos/ASIN/0883490250/icongroupinterna
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How to live with a heart attack by Robert Allen Miller; ISBN: 080195682X; http://www.amazon.com/exec/obidos/ASIN/080195682X/icongroupinterna
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How to Live with a Heart Attack : And How to Avoid One by Robert A. Miller (Author); ISBN: 0801966906; http://www.amazon.com/exec/obidos/ASIN/0801966906/icongroupinterna
210 Heart Attack
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How to Prevent Your Next Heart Attack: A Cardiac Rehabilitation Handbook by John K. Vyden; ISBN: 0134306619; http://www.amazon.com/exec/obidos/ASIN/0134306619/icongroupinterna
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How to Save a Heart Attack Victim by Jack Froman; ISBN: 0553340352; http://www.amazon.com/exec/obidos/ASIN/0553340352/icongroupinterna
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How to Survive in the Middle Management Cadre Without Blood Pressure, Heart Attack or Ulcers by P.V. Pathak (2002); ISBN: 8186982280; http://www.amazon.com/exec/obidos/ASIN/8186982280/icongroupinterna
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How to Survive Your Husband's Heart Attack: What You Both Need to Know to Put Your Lives Back Together by Joann. Stichman; ISBN: 0679504451; http://www.amazon.com/exec/obidos/ASIN/0679504451/icongroupinterna
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I Think I'm Having a Heart Attack by Outlet; ISBN: 0517326973; http://www.amazon.com/exec/obidos/ASIN/0517326973/icongroupinterna
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I Think I'm Having a Heart Attack by Jerry. Bishop; ISBN: 0871285002; http://www.amazon.com/exec/obidos/ASIN/0871285002/icongroupinterna
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I'm Too Young to Have a Heart Attack by Jim Castelli, James A. Metcalf; ISBN: 1559580267; http://www.amazon.com/exec/obidos/ASIN/1559580267/icongroupinterna
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Judith Schaechter : heart attacks by Judith Tannenbaum; ISBN: 0884540804; http://www.amazon.com/exec/obidos/ASIN/0884540804/icongroupinterna
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Let My Heart Attack Save Your Life: A Simple, Sound, Workable Weight Management Plan by Joseph Mason; ISBN: 0471347450; http://www.amazon.com/exec/obidos/ASIN/0471347450/icongroupinterna
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Life After a Heart Attack by Sydney H. Croog; ISBN: 0898850711; http://www.amazon.com/exec/obidos/ASIN/0898850711/icongroupinterna
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Living With Grief: After Sudden Loss Suicide, Homicide, Accident, Heart Attack, Stroke by Kenneth J. Doka (Editor), Kenneth J. Doka; ISBN: 156032578X; http://www.amazon.com/exec/obidos/ASIN/156032578X/icongroupinterna
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Magnesium: How an Important Mineral Helps Prevent Heart Attacks and Relieve Stress by Alan R. Gaby (1994); ISBN: 0879836024; http://www.amazon.com/exec/obidos/ASIN/0879836024/icongroupinterna
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Munching Maggots, Noah's Flood & TV Heart Attacks: And Other Cataclysmic Science Moments by Karl Kruszelnicki (Author); ISBN: 047137850X; http://www.amazon.com/exec/obidos/ASIN/047137850X/icongroupinterna
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On the Trail of Heart Attacks in Seven Countries by Henry Blackburn (1995); ISBN: 1887268006; http://www.amazon.com/exec/obidos/ASIN/1887268006/icongroupinterna
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Prevent Heart Attacks; ISBN: 1567520553; http://www.amazon.com/exec/obidos/ASIN/1567520553/icongroupinterna
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Prevent that heart attack by Norman Currer; ISBN: 0774024976; http://www.amazon.com/exec/obidos/ASIN/0774024976/icongroupinterna
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Prevent That Heart Attack by Tom Blaine; ISBN: 0806502991; http://www.amazon.com/exec/obidos/ASIN/0806502991/icongroupinterna
Books 211
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Prevent Your First Heart Attack: A Comprehensive Guide for the Prevention and Treatment of Cardiovascular Disease by Michael D., MD Ozner, Michael D. Ozner M. D. F. A. C. C. (2003); ISBN: 1410711935; http://www.amazon.com/exec/obidos/ASIN/1410711935/icongroupinterna
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Prevent Your Heart Attack by Norman, M.D. Kaplan; ISBN: 0523422369; http://www.amazon.com/exec/obidos/ASIN/0523422369/icongroupinterna
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Prevention of heart attack : a challenge to the health professions; ISBN: 0835701948; http://www.amazon.com/exec/obidos/ASIN/0835701948/icongroupinterna
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Recovering from the Heart Attack Experience: Emotional Feelings, Medical Facts by Elizabeth S. Weiss (1980); ISBN: 0026258307; http://www.amazon.com/exec/obidos/ASIN/0026258307/icongroupinterna
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Running Without Fear: How to Reduce the Risk of Heart Attack and Sudden Death During Aerobic Exercise by Kenneth H. Cooper; ISBN: 0553255460; http://www.amazon.com/exec/obidos/ASIN/0553255460/icongroupinterna
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Save Your Life: A Handbook for Preventing Heart Attacks, Cancer, Strokes by Lewis, Cope; ISBN: 0932272029; http://www.amazon.com/exec/obidos/ASIN/0932272029/icongroupinterna
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Serious As a Heart Attack : A Novel by Louisa Luna (Author) (2004); ISBN: 0743466608; http://www.amazon.com/exec/obidos/ASIN/0743466608/icongroupinterna
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Solved the Riddle of Heart Attacks by Broda O. Barnes, Broda O. Barnes; ISBN: 0913730270; http://www.amazon.com/exec/obidos/ASIN/0913730270/icongroupinterna
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Speaking of Heart Attacks: Early Recognition, Rehabilitation, Prevention of Recurrence: Comprehensive Guide for Coronary Patients by Carola Halhuber (1979); ISBN: 083262232X; http://www.amazon.com/exec/obidos/ASIN/083262232X/icongroupinterna
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Stop That Heart Attack! by Derrick Cutting, Peter Maddocks (Illustrator) (2001); ISBN: 1859590551; http://www.amazon.com/exec/obidos/ASIN/1859590551/icongroupinterna
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Subduing the Dragon Living Through a Heart Attack: Living Through a Heart Attack: A Simplified Textbook of Cardiology and Heart Attacks by Jacob I., MD Haft (2002); ISBN: 140104798X; http://www.amazon.com/exec/obidos/ASIN/140104798X/icongroupinterna
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Surviving Your Heart Attack: The Duke University Heart Program by James V. Warren; ISBN: 038518767X; http://www.amazon.com/exec/obidos/ASIN/038518767X/icongroupinterna
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Syndrome X: Overcoming the Silent Killer that Can Give You a Heart Attack [DOWNLOAD: ADOBE READER] by Gerald M. D. Reaven, et al (2000); ISBN: B000077T2V; http://www.amazon.com/exec/obidos/ASIN/B000077T2V/icongroupinterna
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Technological Change in Health Care: A Global Analysis of Heart Attack (Studies in Health Economics & Policy) by Mark B. McClellan (Editor), Daniel P. Kessler (Editor) (2002); ISBN: 0472111280; http://www.amazon.com/exec/obidos/ASIN/0472111280/icongroupinterna
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Thank God for My Heart Attack by Harrison Cy; ISBN: 0030272858; http://www.amazon.com/exec/obidos/ASIN/0030272858/icongroupinterna
212 Heart Attack
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The Anti-Cancer, Heart Attack, Stroke Diet Book by Bill Adler, Heather Harney; ISBN: 0840771193; http://www.amazon.com/exec/obidos/ASIN/0840771193/icongroupinterna
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The Cardiovascular Cure: How to Strengthen Your Self Defense Against Heart Attack and Stroke by Judith Zimmer, John P. Cooke; ISBN: 0767908813; http://www.amazon.com/exec/obidos/ASIN/0767908813/icongroupinterna
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The Director had a Heart Attack and the President Resigned: A Handbook on BoardStaff Relations by Gerald B. Bubis (1999); ISBN: 9652180378; http://www.amazon.com/exec/obidos/ASIN/9652180378/icongroupinterna
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The Doctor's Heart Attack Recovery Plan: How to Return to a Full, Active and Healthful Lifestyle by David Lewis, John Storey; ISBN: 0722518986; http://www.amazon.com/exec/obidos/ASIN/0722518986/icongroupinterna
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The Doctor's Modern Heart Attack Prevention Program by Hyman. Engelberg; ISBN: 0308101022; http://www.amazon.com/exec/obidos/ASIN/0308101022/icongroupinterna
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The Eskimo Diet: How to Avoid a Heart Attack by Reg Saynor, Frank Ryan; ISBN: 0852238096; http://www.amazon.com/exec/obidos/ASIN/0852238096/icongroupinterna
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The Heart Attack Germ: Prevent Strokes, Heart Attacks and the Symptoms of Alzheimer's by Protecting Yourself from the Infections and Inflammation of Cardiovascular Disease by Louis Dvonch, Russell Dvonch (Contributor) (2003); ISBN: 0595262201; http://www.amazon.com/exec/obidos/ASIN/0595262201/icongroupinterna
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The Heart Attack Handbook by Joseph S. Alpert; ISBN: 0316035068; http://www.amazon.com/exec/obidos/ASIN/0316035068/icongroupinterna
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The heart attack handbook : a commonsense guide to treatment, recovery, and prevention by Joseph S. Alpert; ISBN: 0316035017; http://www.amazon.com/exec/obidos/ASIN/0316035017/icongroupinterna
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The heart attack handbook : a commonsense guide to treatment, recovery, and staying well by Joseph S. Alpert; ISBN: 0890431353; http://www.amazon.com/exec/obidos/ASIN/0890431353/icongroupinterna
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The Heart Attack Handbook: A Commonsense Guide to Prevention, Treatment, Recovery, and Staying Well by Joseph S. Alpert; ISBN: 0316035076; http://www.amazon.com/exec/obidos/ASIN/0316035076/icongroupinterna
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The Heart Attack Handbook: The Commonsense Guide for Patients and Their Families by Joseph S. Alpert; ISBN: 0890436355; http://www.amazon.com/exec/obidos/ASIN/0890436355/icongroupinterna
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The Heart Attack Prevention & Recovery Handbook by Jack Gillis; ISBN: 0881791180; http://www.amazon.com/exec/obidos/ASIN/0881791180/icongroupinterna
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The Heart Attack Recovery Book: A Look at the Emotional and Practical Problems Encountered During Rehabilitation for Patients and Their Families by Elizabeth Wilde McCormick (1991); ISBN: 0904575373; http://www.amazon.com/exec/obidos/ASIN/0904575373/icongroupinterna
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The Heart Attack Recovery Handbook by Harvey Wolinsky, Gary Ferguson (Photographer) (1988); ISBN: 0446385824; http://www.amazon.com/exec/obidos/ASIN/0446385824/icongroupinterna
Books 213
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The Heart Disease Breakthrough : What Even Your Doctor Doesn't Know about Preventing a Heart Attack by Thomas Yannios M.D. (Author) (1999); ISBN: 0471255335; http://www.amazon.com/exec/obidos/ASIN/0471255335/icongroupinterna
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The Liver Causes Heart Attacks by W. P. Neufeld (1991); ISBN: 0889258163; http://www.amazon.com/exec/obidos/ASIN/0889258163/icongroupinterna
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The New Good Fat, Bad Fat: Lower Your Cholesterol and Reduce Your Odds of a Heart Attack by William P. Castelli, Glen C. Griffin (1997); ISBN: 1555611176; http://www.amazon.com/exec/obidos/ASIN/1555611176/icongroupinterna
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The Prevention of the Obstruction of Vital Arteries: With Emphasis on the Role of Arterial Obstruction in Causing Heart Attacks, Strokes, Impotence, by William Dock (1983); ISBN: 0875272029; http://www.amazon.com/exec/obidos/ASIN/0875272029/icongroupinterna
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The sensuous heart : guidelines for sex after a heart attack by Suzanne Cambre White; ISBN: 0939838168; http://www.amazon.com/exec/obidos/ASIN/0939838168/icongroupinterna
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The Western Way of Death: Stress, Tension, and Heart Attacks. by Malcolm, Carruthers; ISBN: 0394491602; http://www.amazon.com/exec/obidos/ASIN/0394491602/icongroupinterna
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There's Life After a Heart Attack by Jim Castelli (1992); ISBN: 1559581433; http://www.amazon.com/exec/obidos/ASIN/1559581433/icongroupinterna
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We Can Do Without Heart Attacks by Wayne Martin; ISBN: 0806219742; http://www.amazon.com/exec/obidos/ASIN/0806219742/icongroupinterna
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Why Animals Don't Get Heart Attacks by Matthias Rath (1994); ISBN: 0963876813; http://www.amazon.com/exec/obidos/ASIN/0963876813/icongroupinterna
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Why Animals Don't Get Heart Attacks but People Do by Matthias Rath (2000); ISBN: 0963876899; http://www.amazon.com/exec/obidos/ASIN/0963876899/icongroupinterna
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Why Kids Don't Have Heart Attacks: 7 Reasons Kids Have Fun While Adults Have Prozac by Julius Henderson; ISBN: 0971455600; http://www.amazon.com/exec/obidos/ASIN/0971455600/icongroupinterna
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Why Kill Yourself? My Heart Attack and How to Prevent Yours by Bernard Falk, Roger Blackwood; ISBN: 0575040068; http://www.amazon.com/exec/obidos/ASIN/0575040068/icongroupinterna
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Winning With Heart Attack: A Complete Program for Health and Well-Being by Harris H. McIlwain (Editor), et al (1994); ISBN: 0879759151; http://www.amazon.com/exec/obidos/ASIN/0879759151/icongroupinterna
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Women at Risk of Heart Attack: A Personal Experience, a Personal Research by Mickey Wapner (1997); ISBN: 093471035X; http://www.amazon.com/exec/obidos/ASIN/093471035X/icongroupinterna
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You Can Beat the Odds on Heart Attack by Irving M. Levitas; ISBN: 0672519984; http://www.amazon.com/exec/obidos/ASIN/0672519984/icongroupinterna
214 Heart Attack
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “heart attack” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 ·
9-1-1: rapid identification and treatment of acute myocardial infarction Author: National Heart Attack Alert Program (U.S.); Year: 1994; [Bethesda, Md.]: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National
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After your heart attack. Author: Guild, Warren R.,; Year: 1969; New York, Harper; Row [c1969]
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Heart attack Author: Anderson, Ian.; Year: 1980; London: Macmillan, 1980; ISBN: 0333287355
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Heart attack. Author: Kemp, Robert Parkin.; Year: 1968; [London] British Medical Assn. [1968]
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Heart attack: are you a candidate? Author: Blumenfeld, Arthur.; Year: 1964; New York, Eriksson [c1964]
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Heart attack: you don't have to die. Author: Barnard, Christiaan,; Year: 1971; New York, Delacorte Press [c1971]
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Heart attack; new hope, new knowledge, new life, for those who have suffered a coronary thrombosis and for those who have not but wish to avoid it, by Myron Prinzmetal and William Winter. Author: Prinzmetal, Myron,; Year: 1958; New York, Simon; Schuster [c1958]
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Living beyond your heart attack. Author: Mozes, Eugene B.,; Year: 1959; Englewood Cliffs, N. J., Prentice-Hall [c1959]
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Psychoanalysis of heart attack. Author: Schneider, Daniel E. (Daniel Edward),; Year: 1967; New York, Dial Press, 1967
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Running scarred; the odyssey of a heart attack victim's jogging back to health. Author: Maule, Tex,; Year: 1972; New York, Saturday Review Press [c1972]; ISBN: 0841501513 http://www.amazon.com/exec/obidos/ASIN/0841501513/icongroupinterna
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Thank God for my heart attack. Author: Harrison, Charles Yale,; Year: 1949; New York, Holt [c1949]
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The doctor has a heart attack. Author: Goodstone, Samuel B.,; Year: 1964; Boston, Beacon Press [c1964]
11
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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The heart attack survival manual: a guide to using CPR (cardiopulmonary resuscitation) in a crisis Author: Seymour, Rogers James.; Year: 1981; Englewood Cliffs, N.J.: Prentice-Hall, c1981; ISBN: 0133857409 http://www.amazon.com/exec/obidos/ASIN/0133857409/icongroupinterna
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You can predict your heart attack and prevent it. Author: Gertler, Menard M. (Menard Max),; Year: 1963; New York, Random House [c1963]
Chapters on Heart Attack In order to find chapters that specifically relate to heart attack, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and heart attack using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “heart attack” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on heart attack: ·
Heartburn Source: in Edmundowicz, S.A., ed. 20 Common Problems in Gastroenterology. New York, NY: McGraw-Hill, Inc. 2002. p. 3-18. Contact: Available from McGraw-Hill, Inc. 1221 Avenue of the Americas, New York, NY 10020. (612) 832-7869. Website: www.bookstore.mcgraw-hill.com. PRICE: $45.00;plus shipping and handling. ISBN: 0070220557. Summary: Heartburn and acid indigestion affect at least 95 million Americans monthly and these symptoms are perhaps the most common symptoms seen in clinical practice. This chapter on heartburn is from a book that focuses on the most common gastroenterological problems encountered in a primary practice setting. The chapter is organized to support rapid access to the information necessary to evaluate and treat most patients with this problems. The author discusses principal problems and typical presentations, including gastroesophageal reflux disease (GERD), myocardial ischemia or infarction (heart attack), esophageal motility disorders and hypersensitivity, and other causes of chest pain; the physical examination; ancillary tests, including endoscopy, prolonged pH monitoring, radiology, provocative testing, esophageal manometric studies, and the use of a therapeutic trial of drugs for diagnosis; optimizing the diagnostic evaluation to the particular patient; complications of GERD; treatment options, including medical therapy, nonpharmacologic (lifestyle) therapy, patient directed therapy (over the counter), antisecretory therapy, promotility therapy, combination therapy, maintenance therapy, and surgical therapy. The author concludes that once cardiac and other potentially life-threatening etiologies (causes) are excluded, a simple direct approach to heartburn can be completed. Most patients will have GERD and will also respond to medical therapy. The chapter includes a chapter outline for quick reference, the text itself, a diagnostic and treatment algorithm, and selected references. 3 figures. 5 tables. 15 references.
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Cardiovascular Complications Source: in Devlin, J.T. and Schneider, S.H., eds. Handbook of Exercise in Diabetes. Alexandria, VA: American Diabetes Association. 2002. p.415-431.
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Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $69.95 plus shipping and handling. ISBN: 1580400191. Summary: This chapter on cardiovascular complications is from a book that provides a practical, comprehensive guide to diabetes and exercise for health care professionals involved in patient care. Atherosclerotic heart disease (hardening of the arteries) and hypertension (high blood pressure) are common in patients with diabetes and are major causes of morbidity (illness) and mortality (death). Silent myocardial ischemia (lack of blood flow in the heart) is more common in the patient with diabetes and may be associated with autonomic dysfunction. Autonomic neuropathy (nerve disease) is associated with an increased mortality from myocardial infarction (heart attack) and sudden death and may be a marker for clinically unrecognized cardiac disease. Exercise may decrease cardiovascular risk in patients with diabetes. Before starting an individualized exercise program, the patient with diabetes should undergo a thorough history and physical examination to detect any signs of cardiovascular disease. A graded exercise test is necessary if the patient is at high risk for underlying cardiovascular disease. Exercise of moderate intensity is usually recommended for individuals with stable coronary artery disease or hypertension. Patients with a recent cardiac event should be stratified according to risk for exercise and should follow a cardiac rehabilitation program. 2 tables. 69 references. ·
Introduction to Diabetes: Principles of Care in the Surgical Patient with Diabetes Source: in Veves, A. Giurini, J.M. LoGerfo, F.W. Diabetic Foot: Medical and Surgical Management. Totowa, NJ: The Humana Press, Inc. 2002. p.1-34. Contact: Humana Press, Inc. 999 Riverview Dr., Suite 208 Totowa, NJ 07512. (973) 2561699. Fax (973) 256-8341. E-mail:
[email protected] PRICE: $135.00, plus shipping and handling. ISBN: 0896039250. Summary: With advances in surgical techniques and anesthesia, surgery has become safer for patients with diabetes; nonetheless, these patients are in a high-risk group for perioperative complications, such as infection and myocardial infarction (heart attack). These may be avoided or minimized with proper anticipation and awareness of the patient's condition. This chapter on the principles of care in the surgical patient with diabetes is from a textbook on the medical and surgical care of foot problems in people with diabetes. The author presents current concepts in the assessment and management of the surgical patient with diabetes, as well as the pathophysiological basis upon which these concepts rest. To this end, the author presents an brief overview of diabetes mellitus and its complications. The author notes that, despite the increase in morbidity (associated illness) and mortality (death) that has been observed in the surgical patient with diabetes, there are no widely accepted guidelines for the many clinical issues that present in the perioperative period. 5 figures. 5 tables. 99 references.
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Why Is Managing Your Blood Glucose So Important? Source: in Hirsch, I.B. 12 Things You Must Know About Diabetes Care Right Now!. Alexandria, VA: American Diabetes Association. 2000. p. 21-32. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580400612.
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Summary: This chapter focuses on the importance of self management of blood glucose and the implications of the Diabetes Control and Complications Trial (DCCT) for diabetes self care. The DCCT found that intensive treatment for people who had type 1 diabetes resulted in fewer cases of eye and kidney disease. The major drawback of intensive therapy was severe hypoglycemia. The United Kingdom Prospective Diabetes Study examined the effects of diabetes control in people with type 2 diabetes. This study found that people who were less than 120 percent of their ideal body weight slowed the progression of retinopathy by 21 percent and the progression of microalbuminuria by 34 percent. They also reduced their risk of having a heart attack by 16 percent. For overweight participants, metformin was used with one of the treatment groups. The use of this drug improved outcomes. Although these studies underscore the benefits of intensive diabetes management, intensive blood glucose control will not work for everyone, including people who do not know when they are hypoglycemic; people who have advanced complications, another serious disease, advanced heart disease, and history of stroke; and children under 13. The chapter presents guidelines so that readers can determine whether intensive therapy may be beneficial for them. The chapter includes a list of questions a patient may ask a doctor and questions a doctor may ask a patient. 1 table. ·
What You Need to Know About Hypertension Source: in Hirsch, I.B. 12 Things You Must Know About Diabetes Care Right Now!. Alexandria, VA: American Diabetes Association. 2000. p. 101-114. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580400612. Summary: This chapter provides information on hypertension. Although hypertension itself usually does not have symptoms as dramatic as those of eye or kidney disease, it is a serious problem that increases the risk of heart attack, eye problems, and kidney disease. Normal blood pressure is 120/80 mmHg. Hypertension results when blood pressure levels are consistently at 140/90 mmHg or above. Factors that influence whether a person will have hypertension include gender, race, age, how long a person has had diabetes, and whether protein is present in the urine. People who have type 2 diabetes are more likely to have hypertension than people who have type 1 diabetes. The United Kingdom Prospective Diabetes Study showed that improving hypertension control would reduce the risk of diabetes related complications. The diagnosis of hypertension should be based on blood pressure measurements obtained on at least three different occasions. The American Diabetes Association recommends that the goal of blood pressure therapy for people older than 18 who have diabetes is to keep blood pressure below 130/85 mmHg. Mild to moderate hypertension may be treated with lifestyle changes before beginning drug therapy. These changes include losing weight, restricting sodium, quitting smoking, limiting daily alcohol intake to less than 2 ounces, and doing regular aerobic exercise. Drugs available to treat hypertension include thiazide diuretics, beta blockers, angiotensin converting enzyme inhibitors, calcium channel blockers, and alpha blockers. The chapter discusses the effects of these drugs and highlights factors that people need to consider about these drugs. In addition, the chapter includes a list of questions a patient may ask a doctor and questions a doctor may ask a patient. 3 tables.
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Effect of Medications on Diabetes Source: in Carlisle, B.A. Kroon, L.A. Koda-Kimble, M.A. 101 Medication Tips for People with Diabetes. Alexandria, VA: American Diabetes Association. 1999. p. 76-83. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $14.95 plus shipping and handling. ISBN: 1580400329. Order number 483301. Summary: This chapter answers questions about the effects of common medications, alcohol, birth control pills, estrogen therapy, beta blockers, hydrochlorothiazide, and niacin on blood glucose levels. Common medications that can increase blood glucose include glucocorticoids, niacin, and protease inhibitors. Glucocorticoids taken as pills or by injection are likely to increase blood glucose levels if they are taken in large doses. If they are inhaled or applied to the skin, they are unlikely to increase blood glucose. The effect of alcohol on blood glucose depends on how much a person drinks during a particular timespan. Birth control pills will not generally make diabetes worse, and estrogen replacement therapy is safe for most women with diabetes. The benefits of beta blockers for people who have diabetes and who have had a heart attack far exceed the risks; currently prescribed doses of hydrochlorothiazide used to control blood pressure have minimal effects on blood glucose level. The amount of niacin in multivitamins is not high enough to increase blood glucose levels.
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Solving Circulation Problems Source: in Touchette, N. Diabetes Problem Solver. Alexandria, VA: American Diabetes Association. 1999. p. 161-195. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $19.95 for members; plus shipping and handling. ISBN: 1570400091. Summary: This chapter deals with solving circulation problems in people who have diabetes. High levels of sugar in the blood makes the blood thick and sticky, so it cannot flow well. Therefore, chronically high levels of blood glucose can increase the risk of cardiovascular disease and other complications of diabetes. Coronary artery disease can develop in a person whose heart does not get the blood it needs. Angina is a form of coronary artery disease in which a person experiences chest pain. Although the condition is not life-threatening, it does indicate a reduced flow of blood to the heart and should not be ignored. A heart attack occurs when the flow of blood to the heart is interrupted abruptly. The chapter presents information on the symptoms, diagnosis, and pharmacological and surgical treatment of angina and discusses the symptoms, treatment, and prevention of a heart attack. Another cardiovascular problem people who have diabetes may experience is congestive heart failure. This condition results when the heart cannot pump out enough blood to get to the parts of the body that need it. The chapter discusses this condition in terms of recognizing, handling, treating, and preventing it. Cholesterol abnormalities may also increase the risk of developing coronary artery disease. Risk factors that contribute to high cholesterol levels include heredity, age, gender, diet, weight, physical activity level, and alcohol consumption. The chapter explains how a person can determine whether his or her cholesterol level is too high and discusses the use of diet, exercise, weight loss, cholesterol-lowering medication, and hormone replacement therapy to treat high cholesterol. In addition, the
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chapter provides the reader with information on risk factors, symptoms, treatment, and prevention of stroke, hypertension, and peripheral vascular disease. ·
Solving Neuropathy Problems Source: in Touchette, N. Diabetes Problem Solver. Alexandria, VA: American Diabetes Association. 1999. p. 197-216. Contact: Available from American Diabetes Association (ADA). Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. Website: www.diabetes.org. PRICE: $19.95 for members; plus shipping and handling. ISBN: 1570400091. Summary: This chapter deals with solving neuropathy problems in people who have diabetes. Too much glucose in the blood can, over time, damage the nerves in the body. Although the nerves of the central nervous system are not usually affected by high blood glucose, the nerves of the peripheral nervous system can become damaged over time. Damage may occur to the sensory nerves that send information about how things feel from the skin and from internal organs to the brain or the motor nerves that send information from the brain to the muscles of the body about how to move. Autonomic nerves that control internal organs or autonomic processes may also be damaged. Both small and large nerve fibers may be affected. Neuropathies may also be classified as focal or diffuse. Mononeuropathy, or focal neuropathy, is caused by damage to a single nerve or group of nerves. The chapter explains how to recognize and handle cranial neuropathy; plexopathy; radiculopathy; and entrapment syndromes such as carpal tunnel syndrome, ulnar nerve entrapment, radial nerve entrapment, and peroneal nerve entrapment. Polyneuropathy is the most common type of neuropathy that occurs in people who have diabetes. This type of neuropathy can affect nerves in many parts of the body. The chapter explains how to recognize, handle, treat, and prevent this condition. Autonomic neuropathy can cause problems with bladder functions; result in cardiovascular problems such as orthostatic hypotension, an abnormal heart rate, and a silent heart attack; cause an inability to sweat; and interfere with the warning signs of hypoglycemia and contribute to hypoglycemia unawareness. The chapter explains how to recognize, handle, treat, and prevent these autonomic neuropathies.
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Medical Emergencies Source: in Terezhalmy, G. Batizy, L.G., eds. Urgent Care in the Dental Office: An Essential Handbook. Carol Stream, IL: Quintessence Publishing Company, Inc. 1998. p. 7-49. Contact: Available from Quintessence Publishing Company, Inc. 551 North Kimberly Drive, Carol Stream, IL 60188-1881. (800) 621-0387 or (630) 682-3223. Fax (630) 682-3288. E-mail:
[email protected]. Website: www.quintpub.com. PRICE: $68.00 plus shipping and handling. ISBN: 0867153237. Summary: This chapter on emergencies is from a manual on urgent care in the dental office. The authors note that, with advances in medicine and the prevalence of dental disease in the geriatric patient population, the clinician may now be called on more often to provide dental care to medically or pharmologically compromised patients. Oral health care providers must be able to recognize high risk patients and initiate immediate correction of life-threatening problems. The chapter covers basic emergency procedures, emergency steps, cardiopulmonary resuscitation, vasovagal syncope (fainting), angina pectoris, myocardial infarction (heart attack), cardiogenic shock, cerebrovascular accident (stroke), respiratory alkalosis (hyperventilation), acute
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respiratory failure (respiratory depression), respiratory obstruction (foreign body), asthma, anaphylaxis (immediate hypersensitivity reaction), Type IV allergic reaction (delayed hypersensitivity reaction), status epilepticus (seizure), and hypoglycemia. For each emergency, the authors provide a brief overview and outline the signs and symptoms, diagnosis, and recommended emergency treatment. 18 figures. 1 table. 3 references. ·
Cardiovascular Disease Source: in Scully, C. and Cawson, R.A. Medical Problems in Dentistry. 4th ed. Woburn, MA: Butterworth-Heinemann. 1998. p. 51-81. Contact: Available from Butterworth-Heinemann. 225 Wildwood Avenue, Woburn, MA 01801-2041. (800) 366-2665 or (781) 904-2500. Fax (800) 446-6520 or (781) 933-6333. E-mail:
[email protected]. Website: www.bh.com. PRICE: $110.00. ISBN: 0723610568. Summary: This chapter on cardiovascular disease is from a text that covers the general medical and surgical conditions relevant to the oral health care sciences. The introduction to the chapter covers the common signs and symptoms of cardiovascular disease, noting that dental procedures, or drugs used in dentistry, can aggravate heart disease, precipitate angina, or possibly even provoke a heart attack. The chapter then discusses different types of cardiovascular disease, including heart failure, hypertension, coronary (ischemic) heart disease, myocardial infarction, Kawasaki's disease (mucocutaneous lymph node syndrome), cardiomyopathies, dysrhythmias (including arrhythmia), thyroid-related heart disease, pulmonary heart disease, acute rheumatic fever, chronic rheumatic heart disease, congenital heart disease, infective (bacterial) endocarditis, vascular surgery, heart surgery, and cardiac transplantation. For each disease, the authors discuss general aspects, diagnosis and management issues, dental aspects, and patient care strategies. The chapter includes a lengthy summary of the points covered. 1 appendix. 11 tables. 64 references.
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Ischemic Heart Disease Source: in Little, J.W., et al. Dental Management of the Medically Compromised Patient. 5th ed. St. Louis, MO: Mosby, Inc. 1997. p. 192-205. Contact: Available from Harcourt Health Sciences. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Fax (800) 874-6418. Website: www.harcourthealth.com. PRICE: $48.00 plus shipping and handling. ISBN: 0815156340. Summary: A working knowledge of the multitude of compromised health states is essential for dental professionals, as the majority of medically compromised patients need or want oral health care. This chapter on ischemic heart disease is from a text that provides the dental practitioner with an up to date reference work describing the dental management of patients with selected medical problems. Ischemic heart disease is coronary atherosclerosis that is symptomatic; the symptoms are the result of oxygen deprivation consequent to reduced vascular flow to the heart. Other conditions such as embolism, coronary ostial stenosis, coronary artery spasm, and congenital abnormalities also may cause ischemic heart disease. The authors discuss incidence and prevalence of the condition, its etiology (including lifestyle factors), pathophysiology and complications, specific congenital heart defects, signs and symptoms (clinical presentation and laboratory findings), the medical management of patients with angina pectoris or myocardial infarction (heart attack), and the dental management of this population. 4 figures. 5 tables. 37 references.
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Congestive Heart Failure Source: in Little, J.W., et al. Dental Management of the Medically Compromised Patient. 5th ed. St. Louis, MO: Mosby, Inc. 1997. p. 231-240. Contact: Available from Harcourt Health Sciences. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 325-4177. Fax (800) 874-6418. Website: www.harcourthealth.com. PRICE: $48.00 plus shipping and handling. ISBN: 0815156340. Summary: A working knowledge of the multitude of compromised health states is essential for dental professionals, as the majority of medically compromised patients need or want oral health care. This chapter on congestive heart failure (CHF) is from a text that provides the dental practitioner with an up to date reference work describing the dental management of patients with selected medical problems. CHF represents a symptom complex that can be caused by any number of specific disease processes. Patients who have untreated or poorly managed heart failure are at high risk for complications during dental treatment, such as infection, cardiac arrest (heart attack), cerebrovascular accident (stroke), and myocardial infarction (heart attack). The authors discuss incidence and prevalence of the condition; its etiology; pathophysiology and complications; signs and symptoms (clinical presentation and laboratory findings); the medical management of patients with congestive heart failure; and the dental management of this population. 6 figures. 6 tables. 12 references.
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CHAPTER 8. MULTIMEDIA ON HEART ATTACK Overview In this chapter, we show you how to keep current on multimedia sources of information on heart attack. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.
Video Recordings An excellent source of multimedia information on heart attack is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “heart attack” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “heart attack” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on heart attack: ·
Diabetes and Heart Disease Source: Timonium, MD: Milner-Fenwick. 2000. (videocassette). Contact: Available from Milner-Fenwick, Inc. 2125 Greenspring Drive, Timonium, MD 21093-3100. (800) 432-8433. Fax (410) 252-6316. PRICE: $125.00; bulk orders available; plus shipping and handling. Summary: The goal of this video program is to help patients with diabetes understand and minimize their risk of heart disease. The program helps viewers assess their individual risks and demonstrates that it is never too late to make positive lifestyle changes to reduce those risks that can be controlled. The program covers working with the health care team, health food choices, exercise, smoking cessation, stress management, and the importance of regular check ups. The program also explains the signs and symptoms of a heart attack and what to do if they occur. The videotape was produced in cooperation with the American Association of Diabetes Educators (AADE), which defined the content of the video, selected the program consultants, and approved
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production at each stage of development. The program is closed-captioned and available in English or Spanish. ·
Preventing Long Term Complications of Diabetes Source: Timonium, MD: Milner-Fenwick. 2000. (videocassette). Contact: Available from Milner-Fenwick, Inc. 2125 Greenspring Drive, Timonium, MD 21093-3100. (800) 432-8433. Fax (410) 252-6316. PRICE: $125.00; bulk orders available; plus shipping and handling. Summary: The goal of this video program is to help patients with diabetes understand and prevent the long term complications of their disease. Viewers learn how high blood sugar (hyperglycemia) and the associated damage to blood vessels can possibly lead to heart attack, stroke, loss of vision (diabetic retinopathy), kidney disease (diabetic nephropathy), nerve damage (diabetic neuropathy), and amputation. Information is included about damage to both large and small blood vessels, updated terminology, HbA1c (glycosylated hemoglobin) testing (used to monitor blood glucose levels over time), heart disease risk factors, and erectile dysfunction (impotence). The video stresses that improving blood glucose (sugar) levels can help reduce the patient's risk of complications over time. The videotape was produced in cooperation with the American Association of Diabetes Educators (AADE), which defined the content of the video, selected the program consultants, and approved production at each stage of development. The program is closed-captioned.
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Living with Diabetes: Making the Diagnosis Source: Madison, WI: University of Wisconsin Hospitals and Clinics, Department of Outreach Education. 1999. (videocassette). Contact: Available from University of Wisconsin Hospital and Clinics. Picture of Health, 702 North Blackhawk Avenue, Suite 215, Madison, WI 53705-3357. (800) 757-4354 or (608) 263-6510. Fax (608) 262-7172. PRICE: $19.95 plus shipping and handling; bulk copies available. Order number 071899A. Summary: This videotape, part of a series on living with diabetes, focuses on the diagnosis of diabetes. A moderator discusses the new criteria for the diagnosis and classification of diabetes, the rise in the incidence of diabetes, the symptoms of diabetes, and the prevention of diabetes with an endocrinologist. The videotape begins with a discussion of what diabetes is, how insulin works, the types of diabetes, and risk factors for diabetes. Type 1 diabetes, which was formerly known as insulin dependent diabetes, usually develops quickly, whereas type 2 diabetes, which was formerly known as noninsulin dependent diabetes, usually has a gradual onset. The symptoms of diabetes, which are generally the same regardless of the type, are related to high blood sugar. They include excessive urination and thirst, fatigue, hunger, weight loss, and blurred vision. Risk factors for type 1 diabetes include a genetic predisposition for developing the disease. Risk factors for type 2 diabetes include being overweight, sedentary, and over 45 years old; having a history of stillbirth or gestational diabetes; having high blood pressure and high cholesterol; being African American, Hispanic, or Native American; and having previously been identified with impaired glucose tolerance. The acute complications of diabetes include ketoacidosis, nonketotic hyperosmolar syndrome, and hypoglycemia. The chronic complications are divided into microvascular and macrovascular complications. Microvascular complications include retinopathy, neuropathy, and nephropathy. Macrovascular complications include heart attack, stroke, and peripheral vascular disease. Early diagnosis is important in preventing
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complications. Diagnosis is based on blood sugar levels obtained from a blood glucose test, a fasting plasma glucose test, or an oral glucose tolerance test. The risk of developing type 2 diabetes may be reduced by eating properly, maintaining an ideal weight, and exercising. The videotape includes a self test that viewers can take to assess their risk of developing type 2 diabetes. ·
Pediatric Hypertension Source: New Hyde Park, NY: Schneider Children's Hospital. 2000. (Videorecording). Contact: Available from Schneider Children's Hospital. 269-01 76th Avenue, Room 365, New Hyde Park, New York 11040-1432. (718) 470-3491. Fax: (718) 470-0887. Website: www.schneiderchildrenshospital.org. Summary: This videotape program educates parents and families of children who are diagnosed with hypertension (high blood pressure). The program is narrated by three health care providers: Dr. Julie Ingelfinger, Dr. Howard Trachtman, and Rachel Frank, a nephrology nurse. The program explains why it is vital to diagnose and manage pediatric hypertension, noting the role of long term hypertension in adult problems of heart attack, stroke, and congestive heart failure. The program reviews hypertension and its causes, treatment options, how to understand blood pressure readings (systolic and diastolic), classification of the different levels of hypertension, risk factors, diagnostic considerations and tests, and management options, including nutrition, drug therapy, weight control, exercise, relaxation methods, and refraining from smoking. The program features many interviews with children and parents and their health care providers.
Bibliography: Multimedia on Heart Attack The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in heart attack (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on heart attack: ·
Educational strategies to prevent prehospital delay in patients at high risk for acute myocardial infarction [electronic resource] Source: National Institutes of Health, National Heart, Lung, and Blood Institute; Year: 1997; Format: Electronic resource; Bethesda, MD: National Institutes of Health, National
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Heart attack [videorecording] Source: Caring Community Organization; produced by EmCom, in cooperation with G. Patrick Lilja; Year: 1977; Format: Videorecording; Minneapolis: The Organization; [Glendale, Calif.: for sale by Telephone Marketing Services], 1977
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Heart attack [videorecording] Source: [presented by] Woody Clark Productions, Inc. [produced by] Woodrow W. Clark; Year: 1983; Format: Videorecording; San Francisco, Calif.: Woody Clark, c1983
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Heart attack [videorecording] Source: a presentation of Films for the Humanities & Sciences; produced for Discovery Health Channel by Big Rock Productions; Year: 2002; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c2002
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Your heart, your health [videorecording]: how to reduce your risk of heart attack and add years to your life Source: produced by Creative Directions of Stamford, Inc; Year: 1986; Format: Videorecording; [Stamford, Conn.]: Creative Directions, c1986
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CHAPTER 9. PERIODICALS AND NEWS ON HEART ATTACK Overview In this chapter, we suggest a number of news sources and present various periodicals that cover heart attack.
News Services and Press Releases One of the simplest ways of tracking press releases on heart attack is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “heart attack” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance.
Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to heart attack. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “heart attack” (or synonyms). The following was recently listed in this archive for heart attack: ·
Delay weakens angioplasty benefits for heart attack Source: Reuters Health eLine Date: October 07, 2003 http://www.reutershealth.com/archive/2003/10/07/eline/links/20031007elin013.htm l
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Yes, aspirin does prevent heart attacks Source: Reuters Health eLine Date: September 30, 2003
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Diabetes drugs can mask severity of heart attack Source: Reuters Health eLine Date: September 29, 2003
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Coughing might save heart attack victims Source: Reuters Health eLine Date: September 02, 2003
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Carotene, vitamin E don't prevent heart attacks Source: Reuters Health eLine Date: August 22, 2003
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Angioplasty for heart attack worth waiting for Source: Reuters Health eLine Date: August 20, 2003
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Gout drug looked at for prevention of heart attack Source: Reuters Health eLine Date: August 14, 2003
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Treatment after heart attack should be speedy Source: Reuters Health eLine Date: August 05, 2003
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Driving a bus or taxi ups heart attack risk: study Source: Reuters Health eLine Date: July 07, 2003
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SHL launches new heart attack diagnosis device Source: Reuters Industry Breifing Date: June 24, 2003
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Folic acid may not cut risk of heart attack, death Source: Reuters Health eLine Date: June 17, 2003
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Daytime heart attack patients may fare better Source: Reuters Health eLine Date: June 17, 2003
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Pfizer's Lipitor cuts heart attack risk in diabetics Source: Reuters Industry Breifing Date: June 16, 2003
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Higher temperatures tied to Swedish heart attacks Source: Reuters Health eLine Date: June 03, 2003
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Most Canadians at risk of heart attack, stroke Source: Reuters Health eLine Date: May 13, 2003
The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine.
Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name.
Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “heart attack” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests.
Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “heart attack” (or synonyms). If you know the name of a company that is relevant to heart attack, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/.
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BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “heart attack” (or synonyms).
Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “heart attack” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on heart attack: ·
Arthritis: Should You Be Taking a COX-2 Inhibitor? Source: Harvard Health Letter. 27(1): 1-3. November 2001. Contact: Available from Harvard Health Letter. P.O. Box 380, Department BI, Boston, MA 02117. (800) 829-9045 or (617) 432-1485. E-mail:
[email protected]. Summary: This newsletter article provides people who have arthritis with information on the use of cyclooxgenase-2 (COX-2) inhibitors in the treatment of arthritis. Celecoxib (Celebrex) and rofecoxib (Vioxx) are the most well known COX-2 inhibitors. Studies have shown that the COX-2 inhibitors cause fewer serious ulcers and gastrointestinal complications than older but far less expensive medications like ibuprofen and naproxen. These latter medications are nonprescription versions of a class of drugs known as nonsteroidal antiinflammatory drugs (NSAIDs). NSAIDs inhibit COX, which controls the production of prostaglandins, hormone like compounds critical to pain transmission. The development of COX-2 drugs was the result of the discovery that COX was not one but two enzymes. COX-1 is made continually in most cells, whereas COX-2 is made largely in response to pathological situations like tissue damage and inflammation. Most NSAIDs inhibit both COX-1 and COX-2. NSAIDs that inhibit COX-1 deprive those tissues of prostaglandins and make them vulnerable to damage. By contrast, COX-2 inhibitors focus on COX-2 activity without impeding COX-1. The American College of Rheumatology recommends that patients with arthritis begin NSAID therapy at the lowest dose possible and increase the dosage only if they continue to have pain. Candidates for COX-2 inhibitors are people who have had a prior bleeding problem with NSAIDs or anyone who is age 65 and over, has a history of ulcers, or is currently using steroids. The article includes a sidebar that discusses the possibility that COX-2 inhibitors increase the risk of heart attack. 1 figure.
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Just What Is This Thing Called PXE [Pseudoxanthoma Elasticum]? Source: PXE Awareness. 8(3): 1,5. November 2000. Contact: Available from National Association for Pseudoxanthoma Elasticum (NAPE, Inc.). 8764 Manchester Road, Suite 200, St. Louis, MO 63144-2724. Phone and Fax: (314) 962-0100. E-mail:
[email protected]. Website: www.napxe.org.
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Summary: This newsletter article provides people who have pseudoxanthoma elasticum (PXE) with information on this inherited disorder, which results in calcifications in elastic tissue throughout the body. The skin, eyes, and cardiovascular and gastrointestinal systems may be affected. Although the age at which signs of the condition appear varies, most cases seem to begin during adolescence. Skin manifestations of PXE include yellow bumps with a cobblestone appearance that usually begin on the sides of the neck and spread to other flexural areas. Eye changes can be noticed by an eye doctor, and varying degrees of visual impairment usually occur. Cardiovascular problems include high blood pressure, premature heart attack, and vascular problems leading to calf pain. Gastrointestinal bleeding can occur. Although there is no treatment for PXE, steps can be taken to reduce its complications, among them diagnosing the condition as early as possible and reducing risk factors for complications by not smoking, avoiding certain medications that might cause bleeding, and limiting activities that might cause bleeding. A study is being conducted to investigate the effectiveness of an oral phosphate binder. ·
Putting One Foot in Front of the Other Source: Harvard Health Letter. 6-7; 1997. Contact: Available from Harvard Health Letter, P.O. Box 380, Boston, MA 02117. Summary: This newsletter article for the general public discusses walking as a form of moderate-level exercise. The Centers for Disease Control and Prevention and the College of Sports Medicine recommend a minimum of 30 minutes of moderate-level exercise at least 5 days a week. Advantages of walking include its accessibility and lack of expense. Walking also burns about 100 calories per mile, reduces the risk of heart attack and stroke, increases bone density, lowers blood pressure and harmful lowdensity lipoprotein cholesterol, and keeps weight down. The article offers guidelines for sedentary individuals who want to begin a walking routine.
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Diabetes and Heart Disease: New Strategies Emerge Source: Harvard Heart Letter. 10(11): 1-4. July 2000. Contact: Available from Harvard Medical School Health Publications Group. Harvard Heart Letter, P.O. Box 420300, Palm Coast, FL 32142-0300. (800) 829-9045. E-mail:
[email protected]. Website: www.health.harvard.edu. Summary: This article explores the relationship between diabetes and cardiovascular disease. Diabetes is a risk factor for atherosclerosis in the blood vessels of the heart and throughout the body. In addition, other risk factors for heart disease are closely associated with diabetes, including obesity, hypertension, and lipid abnormalities. Although the death rates due to coronary heart disease have been steadily declining over the last few decades, this has not been the case for people who have diabetes. Middle aged women with diabetes have the same increased risk for heart disease as do men. In addition, people who have diabetes and have had heart attacks have a less favorable prognosis than heart attack victims without diabetes. Therefore, most experts recommend that physicians regard all people who have diabetes as heart disease patients, even if they show no signs of cardiovascular problems. Studies have shown that beta blockers such as atenolol, metoprolol, nadolol, and propranolol are among the best drugs to treat coronary artery disease. Doctors traditionally have avoided prescribing beta blockers for people who have diabetes because they can mask the warning signs of low blood glucose and can worsen some problems common in people who have diabetes such as impotence and fatigue. However, research suggests that
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people who have diabetes may derive even greater benefits from beta blockers when compared with people who do not have diabetes. In addition, research suggests that tight diabetes control can reduce the risk of other diabetes complications. Other studies have investigated the outcomes between people with and without diabetes following balloon angioplasty. Results suggest that angioplasty in people who have diabetes leaves more heart muscle in danger than does bypass surgery. Thus, most physicians create treatment plans under the assumption that bypass surgery is the best form of treatment for people who have diabetes and severe symptoms of coronary disease that has not responded to drug treatment. ·
Exercise and Adult-Onset Diabetes Source: Harvard Health Letter. 18(1): 6-8. November 1992. Summary: This article familiarizes readers with noninsulin-dependent diabetes mellitus (NIDDM) and the role of exercise in treating and perhaps preventing the disease. Topics include the risk factors for NIDDM; the early symptoms; how muscle cells turn glucose into energy; research studies that link exercise level with the incidence of NIDDM; and the other rationales supporting exercise, including the value of physical activity in protecting against heart attack and other cardiovascular problems. One sidebar details the recommendations for exercise for people with NIDDM, including the importance of a pre-exercise medical examination, blood glucose considerations, foot care, and avoiding problems.
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Oral Health and Heart Disease Source: Harvard Health Letter. 11(7): 1-3. March 2001. Contact: Available from Harvard Health Publications. P.O. Box 420300, Palm Coast, FL 32142-0300. (800) 829-9045. Website: www.health.harvard.edu. Summary: This article explores the recent evidence that by averting gum disease, patients might actually be reducing their chances for developing heart disease. The author notes that, at the very least, it seems clear that people with worse dental health have a higher risk of heart attack. Recent findings link periodontal disease to cardiovascular disease. Periodontal disease is any disease, including gingivitis or periodontitis, that affects the gums and associated membranes. However, not all of these studies adequately controlled for other risk factors (for example, socioeconomic status, age, or unhealthy behaviors). Poor dental health may consequently have been an indication of poor personal hygiene or suboptimal health habits. The author cautions that the observed increase in heart disease risk among those with poor dental health may have reflected a general lack of health care, rather than a lack of dental care in particular. The article also reports on present Harvard studies that are evaluating the role of inflammation and diet as potential mediators. For example, periodontal disease and resulting tooth loss may lead to poor dietary habits that, in turn, might increase heart disease risk. The article concludes by hypothesizing the role of inflammation (the body's response to infection or injury) in heart disease. 1 figure.
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To Work Up a Sweat, or Not? Source: Tufts University Health and Diet Letter. 20(8):6. December 2002. Contact: P.O. Box 420235, Palm Coast, FL 32142-0235. 1-800-274-7581. www.healthletter.tufts.edu.
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Summary: Previous exercise recommendations encouraged 20 minutes of vigorous aerobic activity three times a week. Since the mid 1990s, there has been a 'reinterpretation of old data' along with an emergence of 'new data,' notes Steven Blair, director of research at the Cooper Institute for Aerobics Research in Dallas. Current recommendations advocate 30 minutes of moderate- intensity exercise on most, if not all, days of the week. Says Blair, 'we now know that moderate-intensity physical activity also provides most of the health benefits that come from exercise.' For example, in a study from Harvard, women who walked and those who participated in more strenuous activities both significantly lowered their risk for heart attack. Blair explains that the 'primary determinant of the health benefits you receive from exercise is the total dose.' Twenty minutes of vigorous activity three times a week and 30 minutes of moderate activity five to seven times a week both equal about 1,000 calories burned a week from exercise. The article discusses the health and fitness benefits of moderate versus vigorous physical activity. Health benefits can be seen with both moderate and intense activity. Fitness benefits, such as better lung capacity and changes in body composition, are typically seen with more intense activity. ·
New Study Revisits Heart Valve Abnormalities Associated With Diet Drugs Source: WIN Notes. p. 3. Spring 2001. Contact: Weight-control Information Network. 1-877-WIN-4627. Summary: Julius Gardin, M.D., of the Division of Cardiology, the University of California, Irvine, examined the causal relationship between the appetite suppressants fenfluramine and dexfenfluramine and heart valve abnormalities. The study, originally published in the April 5, 2000, issue of the Journal of the American Medical Association (JAMA), found that these antiobesity agents are associated with an increase in the prevalence of some, but not all, valvular abnormalities. The study also explored whether these drugs are unrelated to serious cardiac events like heart attack, congestive heart failure, or ventricular arrhythmia. Participants were white obese females in their forties. Among patients who took the drugs for less than 3 months, no statistically significant difference in the prevalence of aortic regurgitation (AR) occurred between patients taking the appetite suppressants and those in the control group. With increasing exposure, prevalence rates increased. An accompanying JAMA editorial by Hershel Jick, M.D., of the Boston University School of Medicine, finds this duration effect as evidence of the causal relationship between the drugs and heart valve abnormalities. Jick agrees with Gardin and his colleagues that most drug-related cardiac abnormalities are minor and unlikely to advance to clinical disease.
Academic Periodicals covering Heart Attack Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to heart attack. In addition to these sources, you can search for articles covering heart attack that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles.
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At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”
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APPENDICES
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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.
NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25
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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm
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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm
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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375
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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/
12
These publications are typically written by one or more of the various NIH Institutes.
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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm
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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/
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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm
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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm
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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/
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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html
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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm
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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm
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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm
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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html
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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm
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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp
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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/
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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp
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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html
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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 ·
Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
13
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.
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·
Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “heart attack” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total
Items Found 91864 1222 424 167 57 93734
HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.19 Simply search by “heart attack” (or synonyms) at the following Web site: http://text.nlm.nih.gov.
15
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.
16
The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18 19
The HSTAT URL is http://hstat.nlm.nih.gov/.
Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.
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Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
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Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
20 Adapted 21
from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.
The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.
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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on heart attack can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to heart attack. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below.
Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to heart attack. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “heart attack”:
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·
Other guides Angina http://www.nlm.nih.gov/medlineplus/angina.html Circulatory Disorders http://www.nlm.nih.gov/medlineplus/circulatorydisorders.html Coronary Disease http://www.nlm.nih.gov/medlineplus/coronarydisease.html Heart Attack http://www.nlm.nih.gov/medlineplus/heartattack.html Heart Diseases http://www.nlm.nih.gov/medlineplus/heartdiseases.html Pulmonary Embolism http://www.nlm.nih.gov/medlineplus/pulmonaryembolism.html Stroke http://www.nlm.nih.gov/medlineplus/stroke.html
Within the health topic page dedicated to heart attack, the following was listed: ·
Diagnosis/Symptoms CK-MB Test Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/ckmb/test.html Coronary Angiography and Angioplasty http://www.nlm.nih.gov/medlineplus/tutorials/coronaryangiographyandangiopl astyloader.html Echocardiogram Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HB00012 Echocardiography Stress Test http://www.nlm.nih.gov/medlineplus/tutorials/echocardiographystresstestloader .html Electrocardiogram (EKG or ECG) Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HB00014 FDA Clears New Lab Test to Help Rule Out Heart Attack Source: Food and Drug Administration http://www.fda.gov/bbs/topics/ANSWERS/2003/ANS01200.html Hypertensive Crisis Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00626 JAMA Patient Page: Electrocardiograms Source: American Medical Association http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZO6D6MVED &sub_cat=569
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MUGA (Multiple Gated Acquisition) Heart Scan Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00407 Myoglobin Test Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/myoglobin/test.html Thallium Stress Test Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=4743 Troponin Test Source: American Association for Clinical Chemistry http://www.labtestsonline.org/understanding/analytes/troponin/test.html What Are the Symptoms of a Heart Attack? Source: Cleveland Clinic Foundation http://www.clevelandclinic.org/heartcenter/pub/guide/disease/cad/mi_sympto ms.htm ·
Treatment Chain of Survival and Cardiac Arrest Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=6980 FDA Approves First Co-Packaged Treatments to Reduce Occurrence of Serious Cardiovascular and Cerebrovascular Events Source: Food and Drug Administration http://www.fda.gov/bbs/topics/nEWS/2003/NEW00917.html FDA Approves Lower Cost Implantable Defibrillator Source: Food and Drug Administration http://www.fda.gov/bbs/topics/NEWS/2003/NEW00906.html How Is a Heart Attack Treated? Source: Cleveland Clinic Foundation http://www.clevelandclinic.org/heartcenter/pub/guide/disease/cad/mi_treatme nt.htm?index=10480 Implantable Cardioverter Defibrillators (ICD) Source: North American Society of Pacing and Electrophysiology http://www.naspe.org/library/patient_education/treatments/icds/ Tissue Plasminogen Activator (TPA) Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=4751 What Are Anticoagulants and Antiplatelet Agents? Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=84
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·
Specific Conditions/Aspects Aortic Dissection Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00678 Automatic External Defibrillators Source: American College of Emergency Physicians http://www.acep.org/1%2C2891%2C0.html Call 911 -- Before It's Too Late Source: Cleveland Clinic Foundation http://www.clevelandclinic.org/heartcenter/pub/guide/disease/cad/call911.htm Depression after a Heart Attack Source: American Academy of Family Physicians http://familydoctor.org/handouts/702.html Sexual Activity and Heart Disease or Stroke Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=4714 Types of Heart Attack Source: Cleveland Clinic Foundation http://www.clevelandclinic.org/heartcenter/pub/guide/disease/cad/mi_types.ht m?index=10477 What Happens during a Heart Attack? Source: Cleveland Clinic Foundation http://www.clevelandclinic.org/heartcenter/pub/guide/disease/cad/mi_whatha ppens.htm?index=10453
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From the National Institutes of Health Act in Time to: Heart Attack Signs Source: National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/actintime/index.htm
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Latest News A New Study Reconfirms Aspirin's Benefits Source: 09/24/2003, United Press International http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14066 .html Delay Weakens Angioplasty Benefits for Heart Attack Source: 10/07/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14212 .html Diabetes Drugs Can Mask Severity of Heart Attack Source: 09/29/2003, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_14126 .html
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Eating Fish May Lower Heart Rate, Reduce Risk of Sudden Death Source: 08/12/2003, American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3014425 Long-Term Survival After Cardiac Arrest Improves Over Time Source: 08/26/2003, American Heart Association http://www.americanheart.org/presenter.jhtml%3Bjsessionid=?identifier=3014867 Low-Dose Aspirin Is Best Choice for Cutting Bleeding Risks Source: 09/23/2003, American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3015512 ·
Men Women: Warning! It Could Be a Heart Attack! Source: National Women's Health Information Center http://www.4woman.gov/owh/pub/factsheets/heartattack.htm
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Organizations American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=1200000 National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/
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Prevention/Screening American Heart Association Updates Heart Attack, Stroke Prevention Guidelines Source: American Heart Association http://www.americanheart.org/presenter.jhtml%3Bjsessionid=XSFWEBYADGLT1 WFZOAHCCZQ?identifier=3003675 Anti-Inflammatory Drugs Taken by Patients with Arthritis May Increase Benefit of Aspirin in Preventing Heart Attack Source: American College of Rheumatology http://www.rheumatology.org/press/am2002/pr5.asp Aspirin: From Pain Relief to Preventive Medicine Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00269 Cardiovascular Disease Risk Assessment Tool Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3003500 C-Reactive Protein: A Simple Test to Help Predict Risk of Heart Attack and Stroke http://circ.ahajournals.org/cgi/reprint/108/12/e81.pdf FDA Announces Labeling Changes on Heart Benefit Associated with Cholesterol Drug Zocor Source: Food and Drug Administration http://www.fda.gov/bbs/topics/ANSWERS/2003/ANS01213.html
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Heart Attack: Warning Signs and Tips on Prevention Source: American Academy of Family Physicians http://familydoctor.org/handouts/291.html MEDLINEplus: Heart Diseases--Prevention Source: National Library of Medicine http://www.nlm.nih.gov/medlineplus/heartdiseasesprevention.html Risk Assessment Tool for Estimating Your 10-Year Risk of Having a Heart Attack Source: National Heart, Lung, and Blood Institute http://hin.nhlbi.nih.gov/atpiii/calculator.asp Risk Assessment Tool for Estimating Your Risk of Having a Heart Attack or Dying of Coronary Heart Disease in the Next 10 Years Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3003499 ·
Research Clopidogrel Reduces Death, Stroke, Heart Attack Now and Later Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3008816 Cocaine's Effect on Blood Components May Be Linked to Heart Attack and Stroke Source: National Institute on Drug Abuse http://www.nida.nih.gov/NIDA_notes/NNVol17N6/Cocaine.html Eating Fish May Lower Heart Rate, Reduce Risk of Sudden Death Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3014425 Employed Black Women Have Lower Heart Risk Than Black Homemakers Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3009710 Long-Term Survival After Cardiac Arrest Improves Over Time Source: American Heart Association http://www.americanheart.org/presenter.jhtml%3Bjsessionid=?identifier=3014867 Low-Dose Aspirin Is Best Choice for Cutting Bleeding Risks Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3015512 Lower Blood Pressure Decreases Heart Attack Risk in Diabetics with Clogged Leg Arteries Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3007755 NIH Study Shows MRI Provides Faster, More Accurate Way to Diagnose Heart Attacks Source: National Heart, Lung, and Blood Institute http://www.nih.gov/news/pr/jan2003/nhlbi-29.htm Study of Heart Disease Patients Treated for Depression and Low Social Support Finds No Survival Benefit But Significant Improvement in Depression and Social Functioning Source: National Heart, Lung, and Blood Institute http://www.nih.gov/news/pr/jun2003/nhlbi-17.htm
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Women with Rheumatoid Arthritis Have Marked Risk for Heart Attack Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3008815 ·
Statistics Heart Attack and Angina Statistics Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=4591
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Women Women: Warning! It Could Be a Heart Attack! Source: National Women's Health Information Center http://www.4woman.gov/owh/pub/factsheets/heartattack.htm
You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on heart attack. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Keep Moving for Life Source: Chicago, IL: American Academy of Orthopaedic Surgeons. 1996. 8 p. Contact: Available from American Academy of Orthopaedic Surgeons (AAOS). P.O. Box 75838, Chicago, IL 60675-5838. (800) 626-6726. Fax (for credit card or institutional purchase orders) (800) 823-8025. Web site: www.aaos.org. PRICE: Single copy free; bulk prices available. Summary: This brochure uses a question and answer format to provide the general public with information on maintaining physical activity throughout life. Regular exercise slows the loss of muscle mass, strengthens bones, reduces joint and muscle pain, improves mobility and balance, lowers blood pressure and the risk of heart disease or heart attack, controls diabetes, and helps maintain weight. New research suggests that 30 minutes of moderate physical activity provides most of the health benefits from exercise. Physical activity is especially important for older adults, and it is safe and beneficial for people with chronic conditions of bones and joints. The brochure provides guidelines on physical activity for people with back pain, osteoarthritis, osteoporosis,
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and total hip replacement. It also offers tips on staying fit and advises people not to fear pain. ·
Help for Common Digestive Problems Source: Zetland, New South Wales, Australia: Multicultural Health Communication Service. 1998. (web brochure). Contact: Available from Multicultural Health Communication Service. Royal South Sydney Community Health Complex, Joynton Avenue, Zetland, New South Wales, Australia 2107. (02) 9382 8111. E-mail:
[email protected]. Website: mhcs.health.nsw.gov.au/. Item is available only through the website and can be found under Diseases and Conditions. Summary: This brochure, available online through the Multicultural Health Communication Service, is one of a series of health information publications available in languages other than English. The Service facilitates the communication of quality information about health issues and services to people of non-English-speaking backgrounds. This brochure offers suggestions for handling common digestive problems, including heartburn, peptic ulcer, irritable bowel syndrome (IBS), and constipation. A burning pain (heartburn) just behind the breastbone is usually a symptom of acid reflux, a condition where gastric acid backs up into the esophagus. The brochure describes the differences in the sensations caused by heartburn and the symptoms of a heart attack. Acid reflux can be caused by some foods and drinks or by a stomach ulcer. The brochure discusses the role of Helicobacter pylori in stomach ulcers. The brochure then briefly describes IBS, including the symptoms and risk factors, and encourages readers to contact their health care providers when certain symptoms (blood in the bowel movements, weight loss, or family history of bowel cancer) are present. The section on constipation warns readers not to rely on laxatives, but instead to increase their consumption of dietary fiber and fluids and to exercise regularly. The brochure concludes by reminding readers of the importance of following a balanced diet that includes plenty of cereals and grains, and of the positive impact on the digestive system of ceasing to smoke. The brochure is not illustrated and is written in straightforward, nontechnical language.
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Prevent Diabetes Problems: Keep Your Heart and Blood Vessels Healthy. [Evite los problemas de la diabetes: Mantenga sanos el corazon y los vasos sanguineos] Source: Bethesda, MD: National Diabetes Information Clearinghouse (NDIC), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health. 2000. 17 p. Contact: Available from National Diabetes Information Clearinghouse (NDIC). 1 Information Way, Bethesda, MD 20892-3560. (800) 860-8747 or (301) 654-3327. Fax (301) 634-0716. E-mail:
[email protected]. Also available at http://www.niddk.nih.gov/. PRICE: Full-text available online at no charge; single copy free. Summary: This illustrated booklet, written in nontechnical language, uses a question and answer format to provide people who have diabetes with information on preventing heart and blood vessel problems caused by diabetes. The heart and blood vessels can be damaged by having high blood sugar, high blood pressure, and high blood cholesterol; smoking; eating foods that contain saturated fat and cholesterol; and being overweight and physically inactive. Diabetes is a risk factor for high blood cholesterol. When cholesterol is too high, the insides of large blood vessels become
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clogged and narrowed. This makes it harder for blood to get to all parts of the body. Heart problems caused by clogged and narrowed arteries include chest pain, heart attack, and cardiomyopathy. The booklet explains how a person can prevent heart and blood vessel problems and peripheral vascular disease, how heart disease causes high blood pressure, and how clogged blood vessels can damage the legs and feet. Other topics include the warning signs of a stroke and the medical tests that will help keep track of heart and blood vessel problems. The booklet also provides general tips for staying healthy. In addition, the booklet includes sources of information about diabetes and describes the activities of the National Diabetes Information Clearinghouse. Also available in Spanish. ·
Steps for Controlling Diabetes and Heart Disease. [Pasos para Controlar la Diabetes y las Enfermedades del Corazon] Source: San Bruno, CA: StayWell Company. 2000. 23 p. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-4512. E-mail:
[email protected]. Website: www.staywell.com. PRICE: $1.50 plus shipping and handling; bulk copies available. Summary: This illustrated booklet, which is available in both English and Spanish, provides people who have diabetes with information on controlling diabetes and heart disease. People who have diabetes and do not control their blood glucose may develop narrowing in their coronary arteries. This problem may lead to a heart attack. Heart disease risk factors that people can control include lowering low density lipoprotein cholesterol and blood pressure, controlling blood glucose, losing excess weight, and quitting smoking. Regular checkups and laboratory tests help people know how well they are reducing their heart health risks. The booklet offers advice for planning healthy meals, including eating less fat and less cholesterol, consuming less salt, eating more fiber, limiting carbohydrates, and understanding serving sizes. In addition, the booklet provides tips for increasing physical activity; taking oral diabetes medications, insulin, and heart medications safely; testing blood glucose levels; quitting smoking; and managing stress. Other topics include the warning signs of a silent heart attack, self care following heart surgery, and special concerns of women who have diabetes. The booklet concludes with guidelines for making lifestyle changes.
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My Healthy Heart Source: Minneapolis, MN: International Diabetes Center. 1997. 4 p. Contact: Available from Park Nicollet Health Source. 3800 Park Nicollet Boulevard, Minneapolis, MN 55416. (800) 372-7776 or (612) 993-3534. Fax (612) 993-1840. PRICE: $1.25 each for 10-49 copies; $1.12 each for 50-99 copies; $1.03 each for 100-499 copies. ISBN: 188511544X. Summary: This brochure provides people who have diabetes with information about caring for their hearts. The brochure points out that heart disease is the direct cause of 55 percent of deaths among people with diabetes. Although chest pain (angina), heart attack, and congestive heart failure often seem to appear suddenly, they are almost always the result of years of slow damage to the blood vessels and heart. The brochure advises readers to review their blood glucose control and blood pressure at each visit with a health care professional. The brochure includes a description and a target value for each of the following necessary tests: HbA1c, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and blood pressure. The risk of heart disease can be reduced
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by controlling blood glucose, refraining from smoking, eating a diet low in saturated fat, getting regular exercise, and balancing stress. If lifestyle changes alone are insufficient, it may be necessary to take medications which help to lower cholesterol and blood pressure. Two sidebars provide space for recording test results and a list of medications and their functions. The brochure also includes a questionnaire designed to assess risk. (AA-M). ·
Cholesterol and Your Heart Source: Dallas, TX: American Heart Association. 1996. 31 p. Contact: Available from Channing L. Bete Company/American Heart Association Fulfillment Center. 200 State Road, South Deerfield, MA 01373-0200. (800) 611-6083. Fax (800) 499-6464. E-mail:
[email protected]. PRICE: $9.50 for 50 copies. Summary: This booklet addresses what cholesterol is, what cholesterol and triglyceride measurements mean, and how foods can help or hinder cholesterol control. The brochure points out that too much cholesterol in the blood increases the risk of heart attack. Topics addressed in the brochure include LDL-cholesterol, HDL-cholesterol, triglycerides, and what cholesterol numbers mean. The booklet explains that of the three kinds of fats in foods, only saturated fatty acids and dietary cholesterol raise blood cholesterol. The four major risk factors for heart attack are high blood cholesterol, tobacco smoke, high blood pressure, and physical inactivity. Another factor that increases the risk of heart attack is diabetes. The brochure notes that dietary cholesterol is found only in foods from animals, such as meat, fish, poultry, and dairy products. According to American Heart Association recommendations, cholesterol intake should be limited to an average of no more than 300 milligrams per day. The booklet concludes with resources to contact for further information. (AA-M).
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Eating Plan for Healthy Americans: The American Heart Association Diet Source: Dallas, TX: American Heart Association. 1996. 17 p. Contact: Available from Channing L. Bete Company/American Heart Association Fulfillment Center. 200 State Road, South Deerfield, MA 01373-0200. (800) 611-6083. Fax (800) 499-6464. E-mail:
[email protected]. PRICE: $6.00 for 50 copies. Summary: This booklet includes information about a heart-friendly eating plan devised by the American Heart Association (AHA). Better food habits can help reduce high blood cholesterol, one of the major risk factors for heart attack. According to the AHA dietary guidelines, total fat intake should be 30 percent or less of total calories. Cholesterol intake should be less than 300 milligrams per day, and sodium intake should not exceed 2,400 milligrams (2.4 grams) per day. The booklet provides general eating plan tips and information specific to the following categories: meat, poultry, and fish; eggs; fruits and vegetables; milk products; breads, cereals, pasta, and starchy vegetables; fats and oils; desserts; snacks; and beverages. For each category, lists of healthy food options are included. Resources to consult for further information are mentioned at the end of the booklet. (AA-M).
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'E' Is for Exercise. [La 'E' Simboliza Ejercicio] Source: Dallas, TX: American Heart Association. 1995. 6 p. Contact: Available from American Heart Association. Fulfillment Center, 200 State Road, South Deerfield, MA 01373-0200. (800) 611-6083. Fax (800) 499-6464. PRICE: $8.00 for 50.
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Summary: This brochure, from the American Heart Association, focuses on the role of exercise in reducing heart attack risk. Topics include how regular exercise improves blood circulation and improves the body's ability to use oxygen; the need for people with health problems to obtain proper guidance before beginning an exercise program; the types of exercise that promote cardiovascular fitness; the role of low-intensity activities, such as pleasure walking, gardening, yard work, and dancing; deciding on an exercise program; the need for appropriate warmup and cool down periods and how to know when the conditioning period is at the recommended levels; and the role of exercise in improving quality of life. An exercise checklist summarizes and reviews the information presented. The brochure concludes with the toll free telephone number of the American Heart Association (800-242-2721). Simple line drawings illustrate the brochure, which is available in either English or Spanish. ·
Dyslipidemia and Diabetes: Beyond Glucose Control: Helpful Hints for a Healthy Heart Source: Morris Plains, NJ: Parke-Davis. 1992. 17 p. Contact: Available from Parke-Davis. Morris Plains. NJ 07950. (800) 753- 1967. PRICE: Single copy free. Distribution may be limited to health professionals. Summary: This patient education brochure is designed to provide information to people who have diabetes and dyslipidemia. Topics include a definition of dyslipidemia; dyslipidemia and heart attack; the role of lipids in the body; suggestions for preventing cardiovascular complications, including losing weight, eating less fat, stopping smoking, and exercising; the role of nutrition; the psychosocial issues around eating; and the crucial role of exercise. The booklet concludes with two blank forms, one for recording blood glucose levels and one for recording lipid levels. A glossary is also included.
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Thinking About Lowering Your Blood Pressure Source: Midland, MI: Health Enhancement Systems. 1999. 2 p. Contact: Available from Health Enhancement Systems. P.O. Box 1035, Midland, MI 48641-1035. (800) 326-2317. Fax (517) 839-0025. PRICE: $0.68 each for a pack of 10 to 50 brochures; bulk quantities available; plus shipping and handling. Item number HESBP1. Summary: This brochure introduces the concept of blood pressure and the reasons why it is important to monitor and treat high blood pressure (hypertension). Blood pressure is a measurement of the force of blood pushing against the artery walls. The top number, systolic pressure, is the force when the heart beats and sends blood into the arteries. The bottom number, diastolic pressure, is the force when the heart is resting between beats. Each heart beat produces a slightly different pressure, but both numbers tend to go up and down together. High blood pressure refers to increased tension or pressure in the arteries. Hypertension increases the risk of serious medical conditions such as heart attack, stroke, kidney failure, and congestive heart failure. The brochure notes that many people do not feel the urgency to treat hypertension because it does not create symptoms as some other health concerns do. The brochure encourages readers to think about hypertension and the importance of addressing this potentially deadly medical condition. The brochure asks readers to consider four questions that ask how the reader would respond if a close friend or family member had hypertension that needed treatment. The brochure provides blank space for readers to answer the questions, then lists resources through which readers can obtain more information.
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Benefits of Lowering Your Blood Pressure Source: Midland, MI: Health Enhancement Systems. 1999. 6 p. Contact: Available from Health Enhancement Systems. P.O. Box 1035, Midland, MI 48641-1035. (800) 326-2317. Fax (517) 839-0025. PRICE: $0.98 each for a pack of 10 to 50 brochures; bulk quantities available; plus shipping and handling. Item number HESBP2. Summary: This brochure is addressed to readers with high blood pressure (hypertension) who need encouragement to treat their condition. Hypertension increases the risk of serious medical conditions such as heart attack, stroke, kidney failure, and congestive heart failure. The brochure notes that many people do not feel the urgency to treat hypertension because it does not create symptoms as some other health concerns do. The brochure first outlines the risk factors that can be controlled, including weight, exercise, alcohol, salt intake, and smoking, then notes the additional risk factors including heredity, race, age, and gender. The brochure encourages readers to learn about the advantages of controlling high blood pressure and to think about the changes that may be required in order to control hypertension. Blank space is provided to answer directed questions about these changes. The brochure then offers a guided imagery exercise in which the reader pictures himself or herself undertaking and succeeding at the lifestyle changes that would be required. The brochure includes a section for readers to monitor and record their blood pressure readings at different times of day for a week; space is then provided to answer questions about the results of this blood pressure record. Two final sections offer strategies for learning more about hypertension and the things that a supportive friend or spouse can provide. The brochure serves as a type of self-contract for getting readers committed to their own health care plan. The brochure concludes with a list of three resource organizations that can provide additional information and assistance.
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Preparing to Control Your Blood Pressure Source: Midland, MI: Health Enhancement Systems. 1999. 14 p. Contact: Available from Health Enhancement Systems. P.O. Box 1035, Midland, MI 48641-1035. (800) 326-2317. Fax (517) 839-0025. PRICE: $1.96 each for a pack of 10 to 50 brochures; bulk quantities available; plus shipping and handling. Item number HESBP3. Summary: This brochure is addressed to readers with high blood pressure (hypertension) who need to learn and practice skills for controlling their blood pressure on a long term basis. Hypertension increases the risk of serious medical conditions such as heart attack, stroke, kidney failure, and congestive heart failure. The brochure first outlines the benefits of controlling hypertension and asks readers to record what they expect in terms of changes that may be required in order to control hypertension. Blank space is provided to answer directed questions about these changes. The brochure outlines the risk factors that can be controlled, including weight, exercise, alcohol, salt intake, and smoking, then notes the additional risk factors including heredity, race, age, and gender. The brochure lists strategies to address the risk factors that can be controlled and emphasizes the importance of nutrition and physical activity. Even with healthy lifestyle habits, medication may still be needed to reduce high blood pressure. The brochure offers suggestions for getting the most from these medications. The brochure includes a section for readers to monitor and record their blood pressure readings at different times of day for a week. A final section encourages readers to outline a personal action plan and to list goals that are specific, measurable, achievable,
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relevant, and trackable (the acronym SMART). The brochure serves as a type of selfcontract for getting readers committed to their own health care plan. The brochure concludes with a list of three resource organizations that can provide additional information and assistance. ·
Feeling Good About Controlling Your Blood Pressure Source: Midland, MI: Health Enhancement Systems. 1999. 6 p. Contact: Available from Health Enhancement Systems. P.O. Box 1035, Midland, MI 48641-1035. (800) 326-2317. Fax (517) 839-0025. PRICE: $0.98 each for a pack of 10 to 50 brochures; bulk quantities available; plus shipping and handling. Item number HESBP4. Summary: This brochure is addressed to readers with high blood pressure (hypertension) who need encouragement to control their blood pressure on a long term basis. Hypertension increases the risk of serious medical conditions such as heart attack, stroke, kidney failure, and congestive heart failure. The brochure first offers strategies for maintaining one's lifestyle changes and medications, then asks readers to list the obstacles to managing hypertension that they have already faced. A final section encourages readers to outline a personal action plan and to list goals that are specific, measurable, achievable, relevant, and trackable (the acronym SMART). The brochure serves as a type of self-contract for getting readers committed to their own health care plan; one section entitled Personal Wellness Contract asks readers to list how they will achieve blood pressure control objectives. The brochure reminds readers to reward themselves for staying on their health care plan. The brochure concludes with a list of three resource organizations that can provide additional information and assistance.
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Maintaining Healthy Blood Pressure for Life Source: Midland, MI: Health Enhancement Systems. 1999. 6 p. Contact: Available from Health Enhancement Systems. P.O. Box 1035, Midland, MI 48641-1035. (800) 326-2317. Fax (517) 839-0025. PRICE: $0.98 each for a pack of 10 to 50 brochures; bulk quantities available; plus shipping and handling. Item number HESBP5. Summary: This brochure is addressed to readers with high blood pressure (hypertension) who need encouragement to control their blood pressure on a long term basis. Hypertension increases the risk of serious medical conditions such as heart attack, stroke, kidney failure, and congestive heart failure. The brochure first reminds readers that it is easy to slip off the track of health blood pressure control and then offers strategies for staying focused. The brochure focuses on the need for balance in life, and offers an exercise in which readers consider how their time is spent and how they would like to spend their time. The next section asks readers to scrutinize the steps they have taken in the past to control their blood pressure, where they have faltered, and ideas for how to avoid those problems in the future. The brochure serves as a type of self-contract for getting readers committed to their own health care plan. The brochure concludes with a list of three resource organizations that can provide additional information and assistance.
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Cigars: What's It Going to Cost You? Source: Waco, TX: HEALTH EDCO. 1997. [4 p.].
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Contact: Available from HEALTH EDCO. P.O. Box 21207, Waco, TX 76702-1207. (800) 299-3366 or (817) 776-6461. Fax (888) 977-7653. E-mail:
[email protected]. Website: www.healthedco.com. PRICE: $2.00; bulk copies available. Order number JG38098. Summary: This brochure offers young adults the chance to consider cigar advertising and more easily identify the myths such advertising perpetuates. The brochure first debunks five myths: cigars are safer than cigarettes, not inhaling prevents cancer, smoking cigars is sophisticated and cool, cigars are a power symbol, and secondhand smoke is harmless. The brochure then discusses how the cigar advertisements use manipulation and deception to entice viewers, particularly young adults, to smoke cigars. The brochure emphasizes that none of the advertisements depict the pain and suffering of losing a jaw or a life to mouth or throat cancer. The brochure then lists the personal costs of cigar smoking, including short term (bad breath, stained teeth, premature wrinkling, and high blood pressure), and long term (oral cancer, birth defects, heart attack, stroke, and lung disease). The brochure concludes with the contact information, including websites, of four resource organizations: the American Lung Association, the American Cancer Society, the American Heart Association, and the Office on Smoking and Health at the CDC. ·
Exercise and Your Heart Source: American Heart Association. 36 pages. Contact: American Heart Association. National Center. 7272 Greenville Avenue, Dallas, TX 75231-4596. 1-800-242-8721. www.americanheart.org. Summary: This updated booklet, developed jointly by the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), provides information on the benefits of physical activity. Benefits include reducing the risk of heart attack and stroke, feeling and looking better, and burning calories. Practical guidelines for starting and staying on an exercise program are featured along with safety tips. Five common myths about exercise are explored. A table listing activities that condition the heart and lungs is included in addition to two sample programs for walking and jogging.
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Life Matters Contact: KERA, 3000 Harry Hines Blvd, Dallas, TX, 75201, (214) 871-1390. Summary: This packet of materials describes a 13-part television series that focuses on people who lead active and productive lives despite having Acquired immunodeficiency syndrome (AIDS) or other diseases. Individual half-hour segments also focus on addiction, arthritis, heart attacks, epilepsy, Alzheimer's disease, cancer, obesity, diabetes, depression and glaucoma.
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Causes of Dizziness Source: Portland, OR: Vestibular Disorders Association (VEDA). 199x. 4 p. Contact: Available from Vestibular Disorders Association (VEDA). P.O. Box 4467, Portland, OR 97208-4467. (503) 229-7705. Fax (503) 229-8064. E-mail:
[email protected]. Website: www.vestibular.org. PRICE: $0.50 plus shipping and handling. Order number S-9. Summary: This fact sheet summarizes the various causes of dizziness and vertigo. The author begins with a review of how patients tend to describe different types of
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dizziness, and then describes the possible causes for each type. The fact sheet discusses cardiovascular disorders and dizziness, including arrhythmia, embolism, heart attack, defective heart valve, aneurysm, orthostatic hypotension, hardening of the vertebral arteries, and slowness of the carotid sinus reflex. Other topics include vestibular disorders and dizziness and multiple sensory deficits. The author concludes with a brief discussion of the drug therapy available to treat dizziness. ·
Long-Term Complications of Diabetes Source: San Bruno, CA: Krames Communications. 1997. 2 p. Contact: Available from Krames Communications. 1100 Grundy Lane, San Bruno, CA 94066-3030. (800) 333-3032. Fax (415) 244-4512. PRICE: $12.50 for pad of 50 sheets. Summary: This two-sided handout provides information about long-term diabetes complications. The fact sheet points out that people should work with their health care professionals in order to keep their blood glucose within a normal range and avoid complications. Hyperglycemia (high blood sugar) increases the risk of eye diseases, foot problems, nerve damage, blood vessel problems, and kidney disease. The handout briefly outlines complications including diabetic retinopathy, glaucoma, cataracts, problems with healing, damage to sensory nerves and involuntary nerves, peripheral vascular disease, angina or heart attack, stroke, urinary tract infections, and nephropathy (kidney disease). The fact sheet is written in nontechnical language and includes color pictures relevant to each of the five sections. An area for recording special instructions is provided at the end of the fact sheet. (AA-M).
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Cardiovascular Health Source: Alexandria, VA: American Diabetes Association. 199x. 4 p. Contact: Available from American Diabetes Association, Inc. Order Fulfillment Department, P.O. Box 930850, Atlanta, GA 31193-0850. (800) 232-6733. Fax (770) 4429742. PRICE: $9.95 (members), $11.95 (nonmembers) for 50 copies; single copy free. Order number CDBD39. Summary: This fact sheet, which is one in a series of 42 fact sheets about daily living and coping with diabetes, provides information on cardiovascular health. Being in good cardiovascular health means having a healthy heart and blood vessels. The fact sheet recommends keeping blood glucose levels as near to normal as possible; quitting smoking; keeping blood pressure under control; keeping blood fat levels in the good range; seeing the doctor regularly; eating a heart-healthy diet; discussing an exercise program with the doctor; and, if applicable, taking aspirin to help avoid a second heart attack. Topics include risk factors, preventive measures, heart disease diagnosis, and treatment options for heart disease. (AA-M).
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Potassium and Renal Diet Source: New York, NY: National Kidney Foundation. 1999. 3 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Website: www.kidney.org. PRICE: Single copy free. Summary: This patient education fact sheet reviews the importance of potassium for patients following a renal (kidney) diet. Potassium is a mineral found in many foods; it plays a role in heartbeat regulation and keeping the muscles working right. The kidneys normally keep the right amount of potassium levels in the body. In people with kidney
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disease, the kidneys may not perform this regulation function very well, and dietary limitation of potassium can be helpful. Symptoms of too much potassium in the blood (hyperkalemia) include muscle weakness, numbness, and tingling; additional complications include irregular heartbeat or even a heart attack. The fact sheet offers strategies for controlling potassium in the diet, recommending that readers work closely with their dietitian to first learn about their diet therapy. The author emphasizes the importance of portion size; a large amount of a low potassium food can turn it into a high potassium food. The fact sheet includes a table that lists foods that are high in potassium (more than 200 milligrams per portion); the portion size is noted at one-half cup for most foods. A second table lists foods that are low in potassium (lower than 200 milligrams per portion). The fact sheet includes a space for readers to note their own recommended blood potassium level (as determined by their health care provider). The fact sheet concludes with a brief description of the activities of the National Kidney Foundation (800-622-9010). ·
Health Risk Appraisal: Smoking Source: Columbia, SC: South Carolina Department of Health and Environmental Control. 1992. 2 p. Contact: Available from Materials Library. South Carolina Department of Health and Environmental Control, 2600 Bull Street, Columbia, SC 29201. (803) 737-3941; FAX: (803) 737-3946. PRICE: Single copy free. Mail orders only; material only distributed within the state of South Carolina. Order Number 02027. Summary: This fact sheet discusses the health risks of smoking. The fact sheet documents how cigarette smoke affects the smoker's body; smokers' increased risk for lung cancer, cancers of the mouth, bladder, kidney, pancreas and other organs, heart attack, high blood pressure, and stroke; the benefits of quitting smoking; how to quit smoking; and additional resources to help. The document is provided by the Materials Library, a distribution center for health and environmental educational materials and teaching aids.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “heart attack” (or synonyms). The following was recently posted: ·
1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infar Source: American College of Cardiology Foundation - Medical Specialty Society; 1996 November 1 (revised 1999 Sep); 22 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2006&nbr=1232&a mp;string=heart+AND+attack
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ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Source: American College of Cardiology Foundation - Medical Specialty Society; 2000 (revised online 2002 Mar); 95 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3190&nbr=2416&a mp;string=heart+AND+attack
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Clinical policy: critical issues in the evaluation and management of adult patients presenting with suspected acute myocardial infarction or unstable angina Source: American College of Emergency Physicians - Medical Specialty Society; 2000; 24 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3297&nbr=2523&a mp;string=heart+AND+attack
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Intravenous thrombolysis in acute myocardial infarctions. In: Sixth ACCP Consensus Conference on Antithrombotic Therapy Source: American College of Chest Physicians - Medical Specialty Society; 2001 January; 25 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2730&nbr=1956&a mp;string=heart+AND+attack
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Management of acute myocardial infarction in patients presenting with ST-segment elevation Source: European Society of Cardiology - Medical Specialty Society; 1996 (revised 2003); 39 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3590&nbr=2816&a mp;string=heart+AND+attack
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Prophylaxis for patients who have experienced a myocardial infarction: drug treatment, cardiac rehabilitation and dietary manipulation Source: University of Newcastle upon Tyne, Centre for Health Services Research Academic Institution; 2001 April 23; 115 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2954&nbr=2180&a mp;string=heart+AND+attack
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·
Secondary prevention of coronary heart disease following myocardial infarction. A national clinical guideline Source: Scottish Intercollegiate Guidelines Network - National Government Agency [Non-U.S.]; 2000 January; 26 pages http://www.guideline.gov/summary/summary.aspx?doc_id=2303&nbr=1529&a mp;string=heart+AND+attack
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The pre-hospital management of acute heart attacks Source: European Society of Cardiology - Medical Specialty Society; 1998; 25 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1931&nbr=1157&a mp;string=heart+AND+attack
Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Act in Time to Heart Attack Signs Summary: The National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, designed this Web page as part of a campaign to increase Americans' awareness of the need to act fast Source: National Heart, Lung, and Blood Institute Information Center http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6301
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Chest pain: is it just indigestion or a heart attack? Source: New South Wales Multicultural Health Communication Service http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7526
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Cholesterol Information for Patients and General Public Summary: If you have CHD, that's the bad news. But the good news is that by lowering your cholesterol you can reduce your risk of having a heart attack. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1411
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Estimate Your Heart Attack Risk Summary: This risk assessment tool uses information from the Framingham Heart Study to predict a person’s chance of having a heart attack in the next 10 years. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6423
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·
Guide to Assessing Your Risks for Cardiovascular Disease and Stroke Summary: A health risk awareness quiz that focuses on heart attack & stroke allows you to assess your risk for heart disease and stroke. Includes a stroke risk score card, and questions to ask your doctor. Source: American Heart Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4109
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Heart Attack Source: Federation of Chinese American and Chinese Canadian Medical Societies http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7276
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Heart Attack Symptoms and Warning Signs Summary: This online guide lists the symptoms that commonly signal a heart attack. Source: American Heart Association http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2414
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Improving Cardiovascular Health in African Americans Summary: A package of seven easy-to-read booklets designed to help you reduce your chances of having a heart attack or stroke. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=2609
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National Heart Attack Alert Program Summary: The National Heart Attack Alert Program (NHAAP) was launched in June 1991 and is the newest of the National Heart, Lung, and Blood Institute's (NHLBI) national education programs. Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=729
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National Heart Attack Information Summary: This site, maintained by National Heart, Lung, and Blood Institute (NHLBI), provides information on rapid identification and treatment of Acute Myocardial Infarction for the health care and other Source: National Heart, Lung, and Blood Institute, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=714 The NIH Search Utility
The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an
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ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to heart attack. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
Additional Web Sources
A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDÒHealth: http://my.webmd.com/health_topics
Associations and Heart Attack The following is a list of associations that provide information on and resources relating to heart attack: ·
Foundation for Sarcoidosis Research Telephone: (773) 665-2400 Fax: (773) 665-0805 Email:
[email protected] Web Site: http://www.fsrchicago.org Background: The Foundation for Sarcoidosis Research (FSR) is a 501(c)3 organization dedicated to supporting research into the causes of sarcoidosis and to finding a cure. Sarcoidosis is a debilitating and potentially fatal disease causing massive tissue inflammation and damaging major organs, primarily the lungs. The disease can also attack the heart, eyes, central nervous system, liver, spleen, skin, joints, and bones. A chronic disease of unknown cause, it affects one of every 2,000 Americans, primarily African-Americans.
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Inherited High Cholesterol Foundation Telephone: (801) 581-8720 Toll-free: (888) 244-2465 TTY: Fax: (801) 581-5402
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Background: The Inherited High Cholesterol Foundation (IHCF) is a not-for-profit organization dedicated to promoting the early diagnosis and treatment of inherited cholesterol disorders by assisting in the identification of family members who may be predisposed to such disorders. Established in 1995 and currently consisting of approximately 5,400 members, the Foundation works in association with the MEDPED (Make Early Diagnoses and Prevent Early Deaths in Medical Pedigrees) program, an international collaboration consisting of research centers around the world dedicated to developing and implementing programs to identify affected individuals and their relatives. The Inherited High Cholesterol Foundation educates members of high risk families, health care providers, insurance companies, appropriate medical institutions and agencies, and the general public about inherited cholesterol disorders such as familial hypercholesterolemia, familial defective apoB, polygenic hypercholesterolemia, and familial combined hyperlipidemia. Individuals with such inherited conditions may be prone to highly elevated levels of cholesterol and an associated risk of early heart attack. The Inherited High Cholesterol Foundation also offers local support to affected individuals and family members and provides a variety of educational materials including pamphlets, brochures, leaflets, and newsletters. ·
Syncope Trust and Reflex Anoxic Seizures Telephone: 44-1789-450564 Toll-free: 0800 0286362 Fax: 44-1789-450682 Email:
[email protected] Web Site: http://www.stars.org.uk Background: Syncope Trust and Reflex Anoxic Seizures is an information and support group that exists to bring about public and professional awareness of Reflex Anoxic Seizures (RAS). These are seizures that can occur at any age, but are most common in young children and tend to be clustered in 'batches' of attacks. In an RAS episode, an unexpected stimulus, such as pain, shock, or fright, causes the heart to stop, the eyes to roll up into the head, the complexion to become deathly white, and the body to stiffen. After several seconds, the body relaxes and the heart starts beating, but the sufferer loses consciousness and may remain unconscious for an hour or longer. Established in 1993, this organization provides educational materials for patients and health professionals, gathers information to aid research into RAS, and provides support groups and other services for families. It offers information on all types of syncopes including reflex anoxic seizures, for adults and children.
Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to heart attack. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with heart attack.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about heart attack. For more information, see
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the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “heart attack” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “heart attack”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “heart attack” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “heart attack” (or a synonym) into the search box, and click “Submit Query.”
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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.23
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of
23
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)24: ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html
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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html
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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
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California: Gateway Health Library (Sutter Gould Medical Foundation)
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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/
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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/
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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html
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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/
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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
24
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 267
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Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml
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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm
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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html
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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp
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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/
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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm
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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html
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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/
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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm
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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/
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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/
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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm
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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html
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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm
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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/
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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp
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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
Finding Medical Libraries 269
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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm
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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm
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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/
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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/
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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html
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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp
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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/
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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/
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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp
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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/
270 Heart Attack
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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72
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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/
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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp
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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on heart attack: ·
Basic Guidelines for Heart Attack Heart attack Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000195.htm Heart attack first aid Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000063.htm
·
Signs & Symptoms for Heart Attack Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Back pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm
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Breathing difficulty when lying down Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003076.htm Cardiac arrest Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003078.htm Cessation of breathing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003069.htm Chest pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003079.htm Cough Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003072.htm Diaphoresis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003218.htm Dizziness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003093.htm Face pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003027.htm Fainting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm Fatigue Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003088.htm Heartburn Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003114.htm Indigestion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003260.htm Light-headedness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm Lightheadedness - dizzy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003093.htm Low blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003083.htm Muscle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm
Online Glossaries 273
Obese Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003101.htm Obesity Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003101.htm Rapid pulse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003077.htm Respiratory arrest Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003069.htm Seizures Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm Shortness of breath Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm Shoulder pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003171.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Sweating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003218.htm Toothaches Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003067.htm Unusual or strange behavior Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003255.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Weakness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003174.htm ·
Diagnostics and Tests for Heart Attack Aldolase Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003566.htm ALT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003473.htm Angiography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003327.htm
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Apolipoprotein B100 Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003502.htm Apolipoprotein CII Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003505.htm AST Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003472.htm Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm Blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm BUN Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003474.htm Chem-20 Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003468.htm Cholesterol test Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003492.htm Coronary angiography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003875.htm Coronary angiography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003876.htm CPK Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003503.htm CPK isoenzymes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003504.htm ECG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003868.htm Echocardiography Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003869.htm Electrocardiogram Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003868.htm Heart MRI Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003795.htm Hemodialysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003421.htm
Online Glossaries 275
LDH Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003471.htm LDH isoenzymes Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003499.htm LDL Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003495.htm Lipids - serum Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003491.htm MRI Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003335.htm Myoglobin - serum Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003663.htm Myoglobin - urine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003664.htm Nuclear ventriculography (MUGA or RNV) Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003822.htm Pulse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003399.htm RNV Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003822.htm Total cholesterol Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003492.htm ·
Nutrition for Heart Attack Caffeine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002445.htm Fat Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002468.htm
·
Surgery and Procedures for Heart Attack Angioplasty Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002953.htm Balloon angioplasty Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002953.htm CABG Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002946.htm
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Neurosurgery Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003018.htm ·
Background Topics for Heart Attack Allergic reaction Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000005.htm Analgesic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002123.htm Auscultation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002226.htm Bleeding Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm Cardiovascular Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002310.htm Clot Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001124.htm CPR Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000010.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Foreign body aspiration Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000036.htm Head trauma Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000028.htm Heart disease Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000147.htm Heart disease - support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002203.htm Intravenous Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002383.htm Relieved by Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002288.htm Safety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001931.htm
Online Glossaries 277
Shock Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000039.htm Smoking Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002032.htm Unconscious Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000022.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
·
MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
·
Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
·
Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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HEART ATTACK DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Acatalasia: A rare autosomal recessive disorder resulting from the absence of catalase activity. Though usually asymptomatic, a syndrome of oral ulcerations and gangrene may be present. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] ACE: Angiotensin-coverting enzyme. A drug used to decrease pressure inside blood vessels. [NIH]
Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylgalactosamine: The N-acetyl derivative of galactosamine. [NIH] Acetylglucosamine: The N-acetyl derivative of glucosamine. [NIH] Acidity: The quality of being acid or sour; containing acid (hydrogen ions). [EU] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acoustic: Having to do with sound or hearing. [NIH] Actin: Essential component of the cell skeleton. [NIH] Acute Disease: Disease having a short and relatively severe course. [NIH] Acyl: Chemical signal used by bacteria to communicate. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adduct: Complex formed when a carcinogen combines with DNA or a protein. [NIH] Adenine: A purine base and a fundamental unit of adenine nucleotides. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA
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and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenosine Triphosphate: Adenosine 5'-(tetrahydrogen triphosphate). An adenine nucleotide containing three phosphate groups esterified to the sugar moiety. In addition to its crucial roles in metabolism adenosine triphosphate is a neurotransmitter. [NIH] Adhesions: Pathological processes consisting of the union of the opposing surfaces of a wound. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adrenergic beta-Antagonists: Drugs that bind to but do not activate beta-adrenergic receptors thereby blocking the actions of beta-adrenergic agonists. Adrenergic betaantagonists are used for treatment of hypertension, cardiac arrythmias, angina pectoris, glaucoma, migraine headaches, and anxiety. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Aerobic Exercise: A type of physical activity that includes walking, jogging, running, and dancing. Aerobic training improves the efficiency of the aerobic energy-producing systems that can improve cardiorespiratory endurance. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making
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emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]
Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Aged, 80 and Over: A person 80 years of age and older. [NIH] Aggravation: An increasing in seriousness or severity; an act or circumstance that intensifies, or makes worse. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Aldosterone: (11 beta)-11,21-Dihydroxy-3,20-dioxopregn-4-en-18-al. A hormone secreted by the adrenal cortex that functions in the regulation of electrolyte and water balance by increasing the renal retention of sodium and the excretion of potassium. [NIH] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alkalosis: A pathological condition that removes acid or adds base to the body fluids. [NIH] Allylamine: Possesses an unusual and selective cytotoxicity for vascular smooth muscle cells in dogs and rats. Useful for experiments dealing with arterial injury, myocardial fibrosis or cardiac decompensation. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alpha-1: A protein with the property of inactivating proteolytic enzymes such as leucocyte collagenase and elastase. [NIH] Alpha-Linolenic Acid: A fatty acid that is found in plants and involved in the formation of prostaglandins. [NIH] Alprenolol: 1-((1-Methylethyl)amino)-3-(2-(2-propenyl)phenoxy)-2-propanol. Adrenergic beta-blocker used as an antihypertensive, anti-anginal, and anti-arrhythmic agent. [NIH]
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Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amlodipine: 2-((2-Aminoethoxy)methyl)-4-(2-chlorophenyl)-1,4-dihydro-6-methyl-3,5pyridinedicarboxylic acid 3-ethyl 5-methyl ester. A long-acting dihydropyridine calcium channel blocker. It is effective in the treatment of angina pectoris and hypertension. [NIH] Ammonia: A colorless alkaline gas. It is formed in the body during decomposition of organic materials during a large number of metabolically important reactions. [NIH] Amplification: The production of additional copies of a chromosomal DNA sequence, found as either intrachromosomal or extrachromosomal DNA. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Analytes: A component of a test sample the presence of which has to be demonstrated. The term "analyte" includes where appropriate formed from the analyte during the analyses. [NIH]
Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast
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cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Angiogenesis: Blood vessel formation. Tumor angiogenesis is the growth of blood vessels from surrounding tissue to a solid tumor. This is caused by the release of chemicals by the tumor. [NIH] Angiogram: An x-ray of blood vessels; the person receives an injection of dye to outline the vessels on the x-ray. [NIH] Angiography: Radiography of blood vessels after injection of a contrast medium. [NIH] Angioid Streaks: Small breaks in the elastin-filled tissue of the retina. [NIH] Angioplasty: Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called endarterectomy. [NIH] Angiotensin converting enzyme inhibitor: A drug used to decrease pressure inside blood vessels. [NIH] Angiotensin-Converting Enzyme Inhibitors: A class of drugs whose main indications are the treatment of hypertension and heart failure. They exert their hemodynamic effect mainly by inhibiting the renin-angiotensin system. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility. [NIH] Angiotensinogen: An alpha-globulin of which a fragment of 14 amino acids is converted by renin to angiotensin I, the inactive precursor of angiotensin II. It is a member of the serpin superfamily. [NIH] Anhydrous: Deprived or destitute of water. [EU] Animal model: An animal with a disease either the same as or like a disease in humans.
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Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anoxia: Clinical manifestation of respiratory distress consisting of a relatively complete absence of oxygen. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Anti-Arrhythmia Agents: Agents used for the treatment or prevention of cardiac arrhythmias. They may affect the polarization-repolarization phase of the action potential, its excitability or refractoriness, or impulse conduction or membrane responsiveness within cardiac fibers. Anti-arrhythmia agents are often classed into four main groups according to their mechanism of action: sodium channel blockade, beta-adrenergic blockade, repolarization prolongation, or calcium channel blockade. [NIH] Antiarrhythmic: An agent that prevents or alleviates cardiac arrhythmia. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]
Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Antihypertensive Agents: Drugs used in the treatment of acute or chronic hypertension regardless of pharmacological mechanism. Among the antihypertensive agents are diuretics (especially diuretics, thiazide), adrenergic beta-antagonists, adrenergic alpha-antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, ganglionic blockers, and vasodilator agents. [NIH] Anti-infective: An agent that so acts. [EU]
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Anti-inflammatory: Having to do with reducing inflammation. [NIH] Anti-Inflammatory Agents: Substances that reduce or suppress inflammation. [NIH] Antimetabolite: A chemical that is very similar to one required in a normal biochemical reaction in cells. Antimetabolites can stop or slow down the reaction. [NIH] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antiproliferative: Counteracting a process of proliferation. [EU] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antiserum: The blood serum obtained from an animal after it has been immunized with a particular antigen. It will contain antibodies which are specific for that antigen as well as antibodies specific for any other antigen with which the animal has previously been immunized. [NIH] Antiviral: Destroying viruses or suppressing their replication. [EU] Anuria: Inability to form or excrete urine. [NIH] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Aorta: The main trunk of the systemic arteries. [NIH] Apathy: Lack of feeling or emotion; indifference. [EU] Apnea: A transient absence of spontaneous respiration. [NIH] Apnoea: Cessation of breathing. [EU] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid transport and metabolism. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriography: A procedure to x-ray arteries. The arteries can be seen because of an injection of a dye that outlines the vessels on an x-ray. [NIH]
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Arteriolar: Pertaining to or resembling arterioles. [EU] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articular: Of or pertaining to a joint. [EU] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aspiration: The act of inhaling. [NIH] Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH] Atherectomy: Endovascular procedure in which atheromatous plaque is excised by a cutting or rotating catheter. It differs from balloon and laser angioplasty procedures which enlarge vessels by dilation but frequently do not remove much plaque. If the plaque is removed by surgical excision under general anesthesia rather than by an endovascular procedure through a catheter, it is called endarterectomy. [NIH] Atheromatosis: A diffuse atheromatous disease of the arteries. [EU] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrial Natriuretic Factor: A potent natriuretic and vasodilatory peptide or mixture of different-sized low molecular weight peptides derived from a common precursor and secreted by the heart atria. All these peptides share a sequence of about 20 amino acids. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Auditory: Pertaining to the sense of hearing. [EU] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH]
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Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Autopsy: Postmortem examination of the body. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Back Pain: Acute or chronic pain located in the posterior regions of the trunk, including the thoracic, lumbar, sacral, or adjacent regions. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basement Membrane: Ubiquitous supportive tissue adjacent to epithelium and around smooth and striated muscle cells. This tissue contains intrinsic macromolecular components such as collagen, laminin, and sulfated proteoglycans. As seen by light microscopy one of its subdivisions is the basal (basement) lamina. [NIH] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Beer: An alcoholic beverage usually made from malted cereal grain (as barley), flavored with hops, and brewed by slow fermentation. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]
Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Beta blocker: A drug used to slow the heart rate and reduce pressure inside blood vessels. It also can regulate heart rhythm. [NIH]
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Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Acids: Acids made by the liver that work with bile to break down fats. [NIH] Binding Sites: The reactive parts of a macromolecule that directly participate in its specific combination with another molecule. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biochemical reactions: In living cells, chemical reactions that help sustain life and allow cells to grow. [NIH] Biological Markers: Measurable and quantifiable biological parameters (e.g., specific enzyme concentration, specific hormone concentration, specific gene phenotype distribution in a population, presence of biological substances) which serve as indices for health- and physiology-related assessments, such as disease risk, psychiatric disorders, environmental exposure and its effects, disease diagnosis, metabolic processes, substance abuse, pregnancy, cell line development, epidemiologic studies, etc. [NIH] Biological therapy: Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also used to lessen side effects that may be caused by some cancer treatments. Also known as immunotherapy, biotherapy, or biological response modifier (BRM) therapy. [NIH] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Biphasic: Having two phases; having both a sporophytic and a gametophytic phase in the life cycle. [EU] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH]
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Blood Coagulation Factors: Endogenous substances, usually proteins, that are involved in the blood coagulation process. [NIH] Blood Flow Velocity: A value equal to the total volume flow divided by the cross-sectional area of the vascular bed. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blot: To transfer DNA, RNA, or proteins to an immobilizing matrix such as nitrocellulose. [NIH]
Body Composition: The relative amounts of various components in the body, such as percent body fat. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Mass Index: One of the anthropometric measures of body mass; it has the highest correlation with skinfold thickness or body density. [NIH] Bolus: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus infusion. [NIH] Bolus infusion: A single dose of drug usually injected into a blood vessel over a short period of time. Also called bolus. [NIH] Bone Density: The amount of mineral per square centimeter of bone. This is the definition used in clinical practice. Actual bone density would be expressed in grams per milliliter. It is most frequently measured by photon absorptiometry or x-ray computed tomography. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Plexus: The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (C5-C8 and T1), but variations are not uncommon. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary
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permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Hypoxia: Lack of oxygen leading to unconsciousness. [NIH] Brain Infarction: The formation of an area of necrosis in the brain, including the cerebral hemispheres (cerebral infarction), thalami, basal ganglia, brain stem (brain stem infarctions), or cerebellum secondary to an insufficiency of arterial or venous blood flow. [NIH] Brain Ischemia: Localized reduction of blood flow to brain tissue due to arterial obtruction or systemic hypoperfusion. This frequently occurs in conjuction with brain hypoxia. Prolonged ischemia is associated with brain infarction. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]
Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Buccal mucosa: The inner lining of the cheeks and lips. [NIH] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Bypass: A surgical procedure in which the doctor creates a new pathway for the flow of body fluids. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calcium channel blocker: A drug used to relax the blood vessel and heart muscle, causing pressure inside blood vessels to drop. It also can regulate heart rhythm. [NIH] Calcium Channel Blockers: A class of drugs that act by selective inhibition of calcium influx through cell membranes or on the release and binding of calcium in intracellular pools. Since they are inducers of vascular and other smooth muscle relaxation, they are used in the drug therapy of hypertension and cerebrovascular spasms, as myocardial protective agents, and in the relaxation of uterine spasms. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH]
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Calpain: Cysteine proteinase found in many tissues. Hydrolyzes a variety of endogenous proteins including neuropeptides, cytoskeletal proteins, proteins from smooth muscle, cardiac muscle, liver, platelets and erythrocytes. Two subclasses having high and low calcium sensitivity are known. Removes Z-discs and M-lines from myofibrils. Activates phosphorylase kinase and cyclic nucleotide-independent protein kinase. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU] Capillary Permeability: Property of blood capillary walls that allows for the selective exchange of substances. Small lipid-soluble molecules such as carbon dioxide and oxygen move freely by diffusion. Water and water-soluble molecules cannot pass through the endothelial walls and are dependent on microscopic pores. These pores show narrow areas (tight junctions) which may limit large molecule movement. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Cardiac: Having to do with the heart. [NIH] Cardiac arrest: A sudden stop of heart function. [NIH] Cardiac Glycosides: Substances obtained from species of Digitalis, Strophanthus, and other plants that contain specific steroid glycosides or their semisynthetic derivatives and used in congestive heart failure. They increase the force of cardiac contraction without significantly affecting other parameters, but are very toxic at larger doses. Their mechanism of action usually involves inhibition of the Na(+)-K(+)-exchanging ATPase and they are often used in cell biological studies for that purpose. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiogenic: Originating in the heart; caused by abnormal function of the heart. [EU] Cardiology: The study of the heart, its physiology, and its functions. [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Bypass: Diversion of the flow of blood from the entrance of the right atrium directly to the aorta (or femoral artery) via an oxygenator thus bypassing both the heart and lungs. [NIH] Cardiopulmonary Resuscitation: The artificial substitution of heart and lung action as indicated for heart arrest resulting from electric shock, drowning, respiratory arrest, or other causes. The two major components of cardiopulmonary resuscitation are artificial ventilation and closed-chest cardiac massage. [NIH]
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Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardioselective: Having greater activity on heart tissue than on other tissue. [EU] Cardiotonic: 1. Having a tonic effect on the heart. 2. An agent that has a tonic effect on the heart. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Carotid Sinus: The dilated portion of the common carotid artery at its bifurcation into external and internal carotids. It contains baroreceptors which, when stimulated, cause slowing of the heart, vasodilatation, and a fall in blood pressure. [NIH] Carpal Tunnel Syndrome: A median nerve injury inside the carpal tunnel that results in symptoms of pain, numbness, tingling, clumsiness, and a lack of sweating, which can be caused by work with certain hand and wrist postures. [NIH] Carrier Proteins: Transport proteins that carry specific substances in the blood or across cell membranes. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Catalase: An oxidoreductase that catalyzes the conversion of hydrogen peroxide to water and oxygen. It is present in many animal cells. A deficiency of this enzyme results in acatalasia. EC 1.11.1.6. [NIH] Cataracts: In medicine, an opacity of the crystalline lens of the eye obstructing partially or totally its transmission of light. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Catheterization: Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from intubation in that the tube here is used to restore or maintain patency in obstructions. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of
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reference; same as inferior, in human anatomy. [EU] Causal: Pertaining to a cause; directed against a cause. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell motility: The ability of a cell to move. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cell Size: The physical dimensions of a cell. It refers mainly to changes in dimensions correlated with physiological or pathological changes in cells. [NIH] Cell Survival: The span of viability of a cell characterized by the capacity to perform certain functions such as metabolism, growth, reproduction, some form of responsiveness, and adaptability. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Hemorrhage: Bleeding into a cerebral hemisphere of the brain, including lobar, subcortical white matter, and basal ganglia hemorrhages. Commonly associated conditions include hypertension; intracranial arteriosclerosis; intracranial aneurysm; craniocerebral trauma; intracranial arteriovenous malformations; cerebral amyloid angiopathy; and cerebral infarction. [NIH] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction). [NIH]
Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH]
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Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chest wall: The ribs and muscles, bones, and joints that make up the area of the body between the neck and the abdomen. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by
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calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] Civil Rights: Legal guarantee protecting the individual from attack on personal liberties, right to fair trial, right to vote, and freedom from discrimination on the basis of race, religion, national origin, age, or gender. [NIH] Cleave: A double-stranded cut in DNA with a restriction endonuclease. [NIH] Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]
Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clone: The term "clone" has acquired a new meaning. It is applied specifically to the bits of inserted foreign DNA in the hybrid molecules of the population. Each inserted segment originally resided in the DNA of a complex genome amid millions of other DNA segment. [NIH]
Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clot Retraction: Retraction of a clot resulting from contraction of platelet pseudopods attached to fibrin strands that is dependent on the contractile protein thrombosthenin. Used as a measure of platelet function. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational beliefs with more realistic and functional ones. [NIH] Cohort Effect: Variation in health status arising from different causal factors to which each birth cohort in a population is exposed as environment and society change. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all
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consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Collateral Circulation: Maintenance of blood flow to an organ despite obstruction of a principal vessel. Blood flow is maintained through small vessels. [NIH] Colloidal: Of the nature of a colloid. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH]
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Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Cones: One type of specialized light-sensitive cells (photoreceptors) in the retina that provide sharp central vision and color vision. [NIH] Confounding: Extraneous variables resulting in outcome effects that obscure or exaggerate the "true" effect of an intervention. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjugation: 1. The act of joining together or the state of being conjugated. 2. A sexual process seen in bacteria, ciliate protozoa, and certain fungi in which nuclear material is exchanged during the temporary fusion of two cells (conjugants). In bacterial genetics a form of sexual reproduction in which a donor bacterium (male) contributes some, or all, of its DNA (in the form of a replicated set) to a recipient (female) which then incorporates differing genetic information into its own chromosome by recombination and passes the recombined set on to its progeny by replication. In ciliate protozoa, two conjugants of separate mating types exchange micronuclear material and then separate, each now being a fertilized cell. In certain fungi, the process involves fusion of two gametes, resulting in union of their nuclei and formation of a zygote. 3. In chemistry, the joining together of two compounds to produce another compound, such as the combination of a toxic product with some substance in the body to form a detoxified product, which is then eliminated. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connexin 43: A 43 kD peptide which is a member of the connexin family of gap junction proteins. Connexin 43 is a product of a gene in the alpha class of connexin genes (the alpha-1 gene). It was first isolated from mammalian heart, but is widespread in the body including the brain. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH]
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Constipation: Infrequent or difficult evacuation of feces. [NIH] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contractility: Capacity for becoming short in response to a suitable stimulus. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contrast medium: A substance that is introduced into or around a structure and, because of the difference in absorption of x-rays by the contrast medium and the surrounding tissues, allows radiographic visualization of the structure. [EU] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Arteriosclerosis: Thickening and loss of elasticity of the coronary arteries. [NIH] Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion. [NIH] Coronary Care Units: The hospital unit in which patients with acute cardiac disorders receive intensive care. [NIH] Coronary Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]
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Coronary Disease: Disorder of cardiac function due to an imbalance between myocardial function and the capacity of the coronary vessels to supply sufficient flow for normal function. It is a form of myocardial ischemia (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels. [NIH] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Coronary Vessels: The veins and arteries of the heart. [NIH] Corpus: The body of the uterus. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroid: Any of the steroids elaborated by the adrenal cortex (excluding the sex hormones of adrenal origin) in response to the release of corticotrophin (adrenocorticotropic hormone) by the pituitary gland, to any of the synthetic equivalents of these steroids, or to angiotensin II. They are divided, according to their predominant biological activity, into three major groups: glucocorticoids, chiefly influencing carbohydrate, fat, and protein metabolism; mineralocorticoids, affecting the regulation of electrolyte and water balance; and C19 androgens. Some corticosteroids exhibit both types of activity in varying degrees, and others exert only one type of effect. The corticosteroids are used clinically for hormonal replacement therapy, for suppression of ACTH secretion by the anterior pituitary, as antineoplastic, antiallergic, and anti-inflammatory agents, and to suppress the immune response. Called also adrenocortical hormone and corticoid. [EU] Cosmic Radiation: High-energy radiation or particles from extraterrestrial space that strike the earth, its atmosphere, or spacecraft and may create secondary radiation as a result of collisions with the atmosphere or spacecraft. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Creatine: An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as creatinine in the urine. [NIH]
Creatine Kinase: A transferase that catalyzes formation of phosphocreatine from ATP + creatine. The reaction stores ATP energy as phosphocreatine. Three cytoplasmic isoenzymes have been identified in human tissues: MM from skeletal muscle, MB from myocardial tissue, and BB from nervous tissue as well as a mitochondrial isoenzyme. Macro-creatine kinase refers to creatine kinase complexed with other serum proteins. EC 2.7.3.2. [NIH] Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Cryptosporidiosis: Parasitic intestinal infection with severe diarrhea caused by a protozoan,
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Cryptosporidium. It occurs in both animals and humans. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some nonleukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytoskeleton: The network of filaments, tubules, and interconnecting filamentous bridges which give shape, structure, and organization to the cytoplasm. [NIH] Cytotoxic: Cell-killing. [NIH] Dairy Products: Raw and processed or manufactured milk and milk-derived products. These are usually from cows (bovine) but are also from goats, sheep, reindeer, and water buffalo. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Death Certificates: Official records of individual deaths including the cause of death certified by a physician, and any other required identifying information. [NIH] Deception: The act of deceiving or the fact or condition of being deceived. [NIH] Decidua: The epithelial lining of the endometrium that is formed before the fertilized ovum reaches the uterus. The fertilized ovum embeds in the decidua. If the ovum is not fertilized, the decidua is shed during menstruation. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] Deoxycytidine: A drug that protects healthy tissues from the toxic effects of anticancer drugs. [NIH] Deoxyglucose: 2-Deoxy-D-arabino-hexose. An antimetabolite of glucose with antiviral activity. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the
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cell membrane potential to become positive with respect to the potential outside the cell. [EU] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Desipramine: A tricyclic dibenzazepine compound that potentiates neurotransmission. Desipramine selectively blocks reuptake of norepinephrine from the neural synapse, and also appears to impair serotonin transport. This compound also possesses minor anticholingeric activity, through its affinity to muscarinic receptors. [NIH] Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Dexfenfluramine: The S-isomer of fenfluramine. It is a serotonin agonist and is used as an anorectic. Unlike fenfluramine, it does not possess any catecholamine agonist activity. [NIH] Dextrothyroxine: O-(4-Hydroxy-3,5-diiodophenyl)-3,5-diiodo-D-tyrosine. The dextrorotary isomer of thyroxine. It is used as an oral anticholesteremic agent, mainly to treat hypercholesteremia in euthyroid patients. [NIH] Diabetes Insipidus: A metabolic disorder due to disorders in the production or release of vasopressin. It is characterized by the chronic excretion of large amounts of low specific gravity urine and great thirst. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diabetic Retinopathy: Retinopathy associated with diabetes mellitus, which may be of the background type, progressively characterized by microaneurysms, interretinal punctuate macular edema, or of the proliferative type, characterized by neovascularization of the retina and optic disk, which may project into the vitreous, proliferation of fibrous tissue, vitreous hemorrhage, and retinal detachment. [NIH] Diagnostic Equipment: Nonexpendable items used in examinination. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diastole: Period of relaxation of the heart, especially the ventricles. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diastolic blood pressure: The minimum pressure that remains within the artery when the heart is at rest. [NIH] Diastolic pressure: The lowest pressure to which blood pressure falls between contractions of the ventricles. [NIH] Diathermy: The induction of local hyperthermia by either short radio waves or highfrequency sound waves. [NIH] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Dietary Fiber: The remnants of plant cell walls that are resistant to digestion by the alimentary enzymes of man. It comprises various polysaccharides and lignins. [NIH] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]
Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel
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movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Digitalis: A genus of toxic herbaceous Eurasian plants of the Scrophulaceae which yield cardiotonic glycosides. The most useful are Digitalis lanata and D. purpurea. [NIH] Digitalis Glycosides: Glycosides from plants of the genus Digitalis. Some of these are useful as cardiotonic and anti-arrhythmia agents. Included also are semi-synthetic derivatives of the naturally occurring glycosides. The term has sometimes been used more broadly to include all cardiac glycosides, but here is restricted to those related to Digitalis. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilate: Relax; expand. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilator: A device used to stretch or enlarge an opening. [NIH] Diploid: Having two sets of chromosomes. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disposition: A tendency either physical or mental toward certain diseases. [EU] Dissection: Cutting up of an organism for study. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Dissociative Disorders: Sudden temporary alterations in the normally integrative functions of consciousness. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4-benzothiadiazine-1,1dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dobutamine: A beta-2 agonist catecholamine that has cardiac stimulant action without evoking vasoconstriction or tachycardia. It is proposed as a cardiotonic after myocardial
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infarction or open heart surgery. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Doxazosin: A selective alpha-1-adrenergic blocker that lowers serum cholesterol. It is also effective in the treatment of hypertension. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Delivery Systems: Systems of administering drugs through controlled delivery so that an optimum amount reaches the target site. Drug delivery systems encompass the carrier, route, and target. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyes: Chemical substances that are used to stain and color other materials. The coloring may or may not be permanent. Dyes can also be used as therapeutic agents and test reagents in medicine and scientific research. [NIH] Dyslipidemia: Disorders in the lipoprotein metabolism; classified as hypercholesterolemia, hypertriglyceridemia, combined hyperlipidemia, and low levels of high-density lipoprotein (HDL) cholesterol. All of the dyslipidemias can be primary or secondary. Both elevated levels of low-density lipoprotein (LDL) cholesterol and low levels of HDL cholesterol predispose to premature atherosclerosis. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Dyspareunia: Painful sexual intercourse. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. [NIH] Eclampsia: Onset of convulsions or coma in a previously diagnosed pre-eclamptic patient. [NIH]
Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efferent: Nerve fibers which conduct impulses from the central nervous system to muscles and glands. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion
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applied by a force. [EU] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Electric shock: A dangerous patho-physiological effect resulting from an electric current passing through the body of a human or animal. [NIH] Electrocardiogram: Measurement of electrical activity during heartbeats. [NIH] Electrocardiograph: Apparatus which, by means of currents produced by contractions of the cardiac muscle, records heart movements as electro-cardiograms. [NIH] Electrocoagulation: Electrosurgical procedures used to treat hemorrhage (e.g., bleeding ulcers) and to ablate tumors, mucosal lesions, and refractory arrhythmias. [NIH] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrophoresis: An electrochemical process in which macromolecules or colloidal particles with a net electric charge migrate in a solution under the influence of an electric current. [NIH]
Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Elementary Particles: Individual components of atoms, usually subatomic; subnuclear particles are usually detected only when the atomic nucleus decays and then only transiently, as most of them are unstable, often yielding pure energy without substance, i.e., radiation. [NIH] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embolism: Blocking of a blood vessel by a blood clot or foreign matter that has been transported from a distant site by the blood stream. [NIH] Embolization: The blocking of an artery by a clot or foreign material. Embolization can be done as treatment to block the flow of blood to a tumor. [NIH] Embolus: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emergency Medical Services: Services specifically designed, staffed, and equipped for the emergency care of patients. [NIH] Emergency Treatment: First aid or other immediate intervention for accidents or medical conditions requiring immediate care and treatment before definitive medical and surgical management can be procured. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Endarterectomy: Surgical excision, performed under general anesthesia, of the atheromatous tunica intima of an artery. When reconstruction of an artery is performed as an endovascular procedure through a catheter, it is called atherectomy. [NIH]
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Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endopeptidases: A subclass of peptide hydrolases. They are classified primarily by their catalytic mechanism. Specificity is used only for identification of individual enzymes. They comprise the serine endopeptidases, EC 3.4.21; cysteine endopeptidases, EC 3.4.22; aspartic endopeptidases, EC 3.4.23, metalloendopeptidases, EC 3.4.24; and a group of enzymes yet to be assigned to any of the above sub-classes, EC 3.4.99. EC 3.4.-. [NIH] Endorphins: One of the three major groups of endogenous opioid peptides. They are large peptides derived from the pro-opiomelanocortin precursor. The known members of this group are alpha-, beta-, and gamma-endorphin. The term endorphin is also sometimes used to refer to all opioid peptides, but the narrower sense is used here; opioid peptides is used for the broader group. [NIH] Endoscopy: Endoscopic examination, therapy or surgery performed on interior parts of the body. [NIH] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium, Lymphatic: Unbroken cellular lining (intima) of the lymph vessels (e.g., the high endothelial lymphatic venules). It is more permeable than vascular endothelium, lacking selective absorption and functioning mainly to remove plasma proteins that have filtered through the capillaries into the tissue spaces. [NIH] Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components from interstitium to lumen; this function has been most intensively studied in the blood capillaries. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] Endotoxin: Toxin from cell walls of bacteria. [NIH] Energetic: Exhibiting energy : strenuous; operating with force, vigour, or effect. [EU] Enkephalins: One of the three major families of endogenous opioid peptides. The enkephalins are pentapeptides that are widespread in the central and peripheral nervous systems and in the adrenal medulla. [NIH] Enoxaparin: A drug used to prevent blood clots. It belongs to the family of drugs called anticoagulants. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing
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radiation, pathogenic organisms, or toxic chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]
Environmental tobacco smoke: ETS. Smoke that comes from the burning of a tobacco product and smoke that is exhaled by smokers (second-hand smoke). Inhaling ETS is called involuntary or passive smoking. [NIH] Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Enzyme Inhibitors: Compounds or agents that combine with an enzyme in such a manner as to prevent the normal substrate-enzyme combination and the catalytic reaction. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Episode of Care: An interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e.g., emergency, inpatient, outpatient), thus serving as one measure of health care provided. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH]
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Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophageal Motility Disorders: Disorders affecting the motor function of the upper or lower esophageal sphincters, the esophageal body, or a combination of these parts. The failure of the sphincters to maintain a tonic pressure may result in the impeding of the passage of food, regurgitation of food, or reflux of gastric acid into the esophagus. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]
Estrogen: One of the two female sex hormones. [NIH] Estrogen Replacement Therapy: The use of hormonal agents with estrogen-like activity in postmenopausal or other estrogen-deficient women to alleviate effects of hormone deficiency, such as vasomotor symptoms, dyspareunia, and progressive development of osteoporosis. This may also include the use of progestational agents in combination therapy. [NIH]
Ether: One of a class of organic compounds in which any two organic radicals are attached directly to a single oxygen atom. [NIH] Ethnic Groups: A group of people with a common cultural heritage that sets them apart from others in a variety of social relationships. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Excrete: To get rid of waste from the body. [NIH] Exercise Test: Controlled physical activity, more strenuous than at rest, which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used. The intensity of exercise is often graded, using criteria such as rate of work done, oxygen consumption, and heart rate. Physiological data obtained from an exercise test may be used for diagnosis, prognosis, and evaluation of disease severity, and to evaluate therapy. Data may also be used in prescribing exercise by determining a person's exercise capacity. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Exons: Coding regions of messenger RNA included in the genetic transcript which survive the processing of RNA in cell nuclei to become part of a spliced messenger of structural RNA in the cytoplasm. They include joining and diversity exons of immunoglobulin genes.
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[NIH]
Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]
Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extracellular Space: Interstitial space between cells, occupied by fluid as well as amorphous and fibrous substances. [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extravascular: Situated or occurring outside a vessel or the vessels. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]
Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Febrile: Pertaining to or characterized by fever. [EU] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Femoral: Pertaining to the femur, or to the thigh. [EU] Femoral Artery: The main artery of the thigh, a continuation of the external iliac artery. [NIH] Fenfluramine: A centrally active drug that apparently both blocks serotonin uptake and provokes transport-mediated serotonin release. [NIH] Fermentation: An enzyme-induced chemical change in organic compounds that takes place in the absence of oxygen. The change usually results in the production of ethanol or lactic acid, and the production of energy. [NIH] Fetal Death: Death of the young developing in utero. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin,
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resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Fibrin: A protein derived from fibrinogen in the presence of thrombin, which forms part of the blood clot. [NIH] Fibrinogen: Plasma glycoprotein clotted by thrombin, composed of a dimer of three nonidentical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products. [NIH] Fibrinolysis: The natural enzymatic dissolution of fibrin. [NIH] Fibrinolytic: Pertaining to, characterized by, or causing the dissolution of fibrin by enzymatic action [EU] Fibrinolytic Agents: Fibrinolysin or agents that convert plasminogen to fibrinolysin (plasmin). [NIH] Fibroblasts: Connective tissue cells which secrete an extracellular matrix rich in collagen and other macromolecules. [NIH] Fibroid: A benign smooth muscle tumor, usually in the uterus or gastrointestinal tract. Also called leiomyoma. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fibula: The bone of the lower leg lateral to and smaller than the tibia. In proportion to its length, it is the most slender of the long bones. [NIH] Fish Oils: Oils high in unsaturated fats extracted from the bodies of fish or fish parts, especially the livers. Those from the liver are usually high in vitamin A. The oils are used as dietary supplements, in soaps and detergents, as protective coatings, and as a base for other food products such as vegetable shortenings. [NIH] Flow Cytometry: Technique using an instrument system for making, processing, and displaying one or more measurements on individual cells obtained from a cell suspension. Cells are usually stained with one or more fluorescent dyes specific to cell components of interest, e.g., DNA, and fluorescence of each cell is measured as it rapidly transverses the excitation beam (laser or mercury arc lamp). Fluorescence provides a quantitative measure of various biochemical and biophysical properties of the cell, as well as a basis for cell sorting. Other measurable optical parameters include light absorption and light scattering, the latter being applicable to the measurement of cell size, shape, density, granularity, and stain uptake. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Fluorescent Dyes: Dyes that emit light when exposed to light. The wave length of the emitted light is usually longer than that of the incident light. Fluorochromes are substances that cause fluorescence in other substances, i.e., dyes used to mark or label other compounds with fluorescent tags. They are used as markers in biochemistry and immunology. [NIH] Focal Adhesions: An anchoring junction of the cell to a non-cellular substrate. It is composed of a specialized area of the plasma membrane where bundles of microfilaments terminate and attach to the transmembrane linkers, integrins, which in turn attach through their extracellular domains to extracellular matrix proteins. [NIH] Focus Groups: A method of data collection and a qualitative research tool in which a small
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group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Food Habits: Acquired or learned food preferences. [NIH] Food Preferences: The selection of one food over another. [NIH] Foot Care: Taking special steps to avoid foot problems such as sores, cuts, bunions, and calluses. Good care includes daily examination of the feet, toes, and toenails and choosing shoes and socks or stockings that fit well. People with diabetes have to take special care of their feet because nerve damage and reduced blood flow sometimes mean they will have less feeling in their feet than normal. They may not notice cuts and other problems as soon as they should. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Free Association: Spontaneous verbalization of whatever comes to mind. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gallstones: The solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Ganglionic Blockers: Agents having as their major action the interruption of neural transmission at nicotinic receptors on postganglionic autonomic neurons. Because their actions are so broad, including blocking of sympathetic and parasympathetic systems, their therapeutic use has been largely supplanted by more specific drugs. They may still be used in the control of blood pressure in patients with acute dissecting aortic aneurysm and for the induction of hypotension in surgery. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Juices: Liquids produced in the stomach to help break down food and kill bacteria. [NIH]
Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac,
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gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]
Gastroesophageal Reflux: Reflux of gastric juice and/or duodenal contents (bile acids, pancreatic juice) into the distal esophagus, commonly due to incompetence of the lower esophageal sphincter. Gastric regurgitation is an extension of this process with entry of fluid into the pharynx or mouth. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]
Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors, transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly for leukemia. [NIH] General practitioner: A medical practitioner who does not specialize in a particular branch of medicine or limit his practice to a specific class of diseases. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germinal Center: The activated center of a lymphoid follicle in secondary lymphoid tissue where B-lymphocytes are stimulated by antigens and helper T cells (T-lymphocytes, helperinducer) are stimulated to generate memory cells. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Gestational: Psychosis attributable to or occurring during pregnancy. [NIH] Giant Cells: Multinucleated masses produced by the fusion of many cells; often associated with viral infections. In AIDS, they are induced when the envelope glycoprotein of the HIV virus binds to the CD4 antigen of uninfected neighboring T4 cells. The resulting syncytium leads to cell death and thus may account for the cytopathic effect of the virus. [NIH] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH]
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Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Gluconeogenesis: The process by which glucose is formed from a non-carbohydrate source. [NIH]
Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH] Glucuronic Acid: Derivatives of uronic acid found throughout the plant and animal kingdoms. They detoxify drugs and toxins by conjugating with them to form glucuronides in the liver which are more water-soluble metabolites that can be easily eliminated from the body. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]
Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]
Glycerophospholipids: Derivatives of phosphatidic acid in which the hydrophobic regions are composed of two fatty acids and a polar alcohol is joined to the C-3 position of glycerol through a phosphodiester bond. They are named according to their polar head groups, such as phosphatidylcholine and phosphatidylethanolamine. [NIH] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycogen: A sugar stored in the liver and muscles. It releases glucose into the blood when cells need it for energy. Glycogen is the chief source of stored fuel in the body. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Glycosaminoglycans: Heteropolysaccharides which contain an N-acetylated hexosamine in a characteristic repeating disaccharide unit. The repeating structure of each disaccharide involves alternate 1,4- and 1,3-linkages consisting of either N-acetylglucosamine or Nacetylgalactosamine. [NIH] Glycoside: Any compound that contains a carbohydrate molecule (sugar), particularly any such natural product in plants, convertible, by hydrolytic cleavage, into sugar and a nonsugar component (aglycone), and named specifically for the sugar contained, as
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glucoside (glucose), pentoside (pentose), fructoside (fructose) etc. [EU] Goats: Any of numerous agile, hollow-horned ruminants of the genus Capra, closely related to the sheep. [NIH] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gp120: 120-kD HIV envelope glycoprotein which is involved in the binding of the virus to its membrane receptor, the CD4 molecule, found on the surface of certain cells in the body. [NIH]
Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Grading: A system for classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The objective of a grading system is to provide information about the probable growth rate of the tumor and its tendency to spread. The systems used to grade tumors vary with each type of cancer. Grading plays a role in treatment decisions. [NIH]
Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Guanine: One of the four DNA bases. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Half-Life: The time it takes for a substance (drug, radioactive nuclide, or other) to lose half of its pharmacologic, physiologic, or radiologic activity. [NIH] Haploid: An organism with one basic chromosome set, symbolized by n; the normal condition of gametes in diploids. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody
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response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart Arrest: Sudden and usually momentary cessation of the heart beat. This sudden cessation may, but not usually, lead to death, sudden, cardiac. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemolytic: A disease that affects the blood and blood vessels. It destroys red blood cells,
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cells that cause the blood to clot, and the lining of blood vessels. HUS is often caused by the Escherichia coli bacterium in contaminated food. People with HUS may develop acute renal failure. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]
Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatic: Refers to the liver. [NIH] Hepatocyte: A liver cell. [NIH] Hepatocyte Growth Factor: Multifunctional growth factor which regulates both cell growth and cell motility. It exerts a strong mitogenic effect on hepatocytes and primary epithelial cells. Its receptor is proto-oncogene protein C-met. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]
Hibernation: The dormant state in which some animal species pass the winter. It is characterized by narcosis and by sharp reduction in body temperature and metabolic activity and by a depression of vital signs. It is a natural physiological process in many warm-blooded animals. [NIH] High blood cholesterol: Cholesterol is the most abundant steroid in animal tissues, especially in bile and gallstones. The relationship between the intake of cholesterol and its manufacture by the body to its utilization, sequestration, or excretion from the body is called the cholesterol balance. When cholesterol accumulates, the balance is positive; when it declines, the balance is negative. In 1993, the NHLBI National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults issued an updated set of recommendations for monitoring and treatment of blood cholesterol levels. The NCEP guidelines recommended that total cholesterol levels and subfractions of high-density lipoprotein (HDL) cholesterol be measured beginning at age 20 in all adults, with subsequent periodic screenings as needed. Even in the group of patients at lowest risk for coronary heart disease (total cholesterol 200 mg/dL and HDL 35 mg/dL), the NCEP recommended that rescreening take place at least once every 5 years or upon physical examination. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin
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help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone Replacement Therapy: Therapeutic use of hormones to alleviate the effects of hormone deficiency. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Hospital Mortality: A vital statistic measuring or recording the rate of death from any cause in hospitalized populations. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Human growth hormone: A protein hormone, secreted by the anterior lobe of the pituitary, which promotes growth of the whole body by stimulating protein synthesis. The human gene has already been cloned and successfully expressed in bacteria. [NIH] Hyaluronidase: An enzyme that splits hyaluronic acid and thus lowers the viscosity of the acid and facilitates the spreading of fluids through tissues either advantageously or disadvantageously. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridoma: A hybrid cell resulting from the fusion of a specific antibody-producing spleen cell with a myeloma cell. [NIH] Hydrochlorothiazide: A thiazide diuretic often considered the prototypical member of this class. It reduces the reabsorption of electrolytes from the renal tubules. This results in increased excretion of water and electrolytes, including sodium, potassium, chloride, and magnesium. It has been used in the treatment of several disorders including edema, hypertension, diabetes insipidus, and hypoparathyroidism. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hypercholesterolemia, Familial: A familial disorder characterized by increased plasma concentration of cholesterol carried in low density lipoproteins (LDL) and by a deficiency in a cell surface receptor which regulates LDL degradation and cholesterol synthesis. [NIH]
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Hyperglycemia: Abnormally high blood sugar. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hypertriglyceridemia: Condition of elevated triglyceride concentration in the blood; an inherited form occurs in familial hyperlipoproteinemia IIb and hyperlipoproteinemia type IV. It has been linked to higher risk of heart disease and arteriosclerosis. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Hyperventilation: A pulmonary ventilation rate faster than is metabolically necessary for the exchange of gases. It is the result of an increased frequency of breathing, an increased tidal volume, or a combination of both. It causes an excess intake of oxygen and the blowing off of carbon dioxide. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hypoglycemic: An orally active drug that produces a fall in blood glucose concentration. [NIH]
Hypotension: Abnormally low blood pressure. [NIH] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hypoxic: Having too little oxygen. [NIH] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Ileal: Related to the ileum, the lowest end of the small intestine. [NIH] Ileum: The lower end of the small intestine. [NIH] Illusion: A false interpretation of a genuine percept. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]
Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunity: Nonsusceptibility to the invasive or pathogenic microorganisms or to the toxic effect of antigenic substances. [NIH]
effects
of
foreign
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Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunodeficiency syndrome: The inability of the body to produce an immune response. [NIH]
Immunogen: A substance that is capable of causing antibody formation. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunoglobulin: A protein that acts as an antibody. [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implantable pump: A small device installed under the skin to administer a steady dose of drugs. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incision: A cut made in the body during surgery. [NIH] Incompetence: Physical or mental inadequacy or insufficiency. [EU] Incontinence: Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Indigestion: Poor digestion. Symptoms include heartburn, nausea, bloating, and gas. Also called dyspepsia. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infant, Newborn: An infant during the first month after birth. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an
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area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]
Infiltration: The diffusion or accumulation in a tissue or cells of substances not normal to it or in amounts of the normal. Also, the material so accumulated. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Ingestion: Taking into the body by mouth [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Initiator: A chemically reactive substance which may cause cell changes if ingested, inhaled or absorbed into the body; the substance may thus initiate a carcinogenic process. [NIH] Inlay: In dentistry, a filling first made to correspond with the form of a dental cavity and then cemented into the cavity. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inorganic: Pertaining to substances not of organic origin. [EU] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Integrins: A family of transmembrane glycoproteins consisting of noncovalent heterodimers. They interact with a wide variety of ligands including extracellular matrix glycoproteins, complement, and other cells, while their intracellular domains interact with the cytoskeleton. The integrins consist of at least three identified families: the cytoadhesin receptors, the leukocyte adhesion receptors, and the very-late-antigen receptors. Each family contains a common beta-subunit combined with one or more distinct alpha-subunits. These receptors participate in cell-matrix and cell-cell adhesion in many physiologically important processes, including embryological development, hemostasis, thrombosis, wound healing, immune and nonimmune defense mechanisms, and oncogenic transformation. [NIH]
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Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]
Intermediate Filaments: Cytoplasmic filaments intermediate in diameter (about 10 nanometers) between the microfilaments and the microtubules. They may be composed of any of a number of different proteins and form a ring around the cell nucleus. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intracellular: Inside a cell. [NIH] Intracranial Aneurysm: A saclike dilatation of the walls of a blood vessel, usually an artery. [NIH]
Intramuscular: IM. Within or into muscle. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]
Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoenzyme: Different forms of an enzyme, usually occurring in different tissues. The isoenzymes of a particular enzyme catalyze the same reaction but they differ in some of their properties. [NIH] Isoflavones: 3-Phenylchromones. Isomeric form of flavones in which the benzene group is attached to the 3 position of the benzopyran ring instead of the 2 position. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kallidin: A decapeptide bradykinin homolog produced by the action of tissue and glandular kallikreins on low-molecular-weight kininogen. It is a smooth-muscle stimulant and hypotensive agent that functions through vasodilatation. [NIH]
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Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Keratinocytes: Epidermal cells which synthesize keratin and undergo characteristic changes as they move upward from the basal layers of the epidermis to the cornified (horny) layer of the skin. Successive stages of differentiation of the keratinocytes forming the epidermal layers are basal cell, spinous or prickle cell, and the granular cell. [NIH] Ketoacidosis: Acidosis accompanied by the accumulation of ketone bodies (ketosis) in the body tissues and fluids, as in diabetic acidosis. [EU] Ketone Bodies: Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy. Ketone bodies can poison and even kill body cells. When the body does not have the help of insulin, the ketones build up in the blood and then "spill" over into the urine so that the body can get rid of them. The body can also rid itself of one type of ketone, called acetone, through the lungs. This gives the breath a fruity odor. Ketones that build up in the body for a long time lead to serious illness and coma. [NIH] Ketosis: A condition of having ketone bodies build up in body tissues and fluids. The signs of ketosis are nausea, vomiting, and stomach pain. Ketosis can lead to ketoacidosis. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kidney Failure: The inability of a kidney to excrete metabolites at normal plasma levels under conditions of normal loading, or the inability to retain electrolytes under conditions of normal intake. In the acute form (kidney failure, acute), it is marked by uremia and usually by oliguria or anuria, with hyperkalemia and pulmonary edema. The chronic form (kidney failure, chronic) is irreversible and requires hemodialysis. [NIH] Kidney Failure, Acute: A clinical syndrome characterized by a sudden decrease in glomerular filtration rate, often to values of less than 1 to 2 ml per minute. It is usually associated with oliguria (urine volumes of less than 400 ml per day) and is always associated with biochemical consequences of the reduction in glomerular filtration rate such as a rise in blood urea nitrogen (BUN) and serum creatinine concentrations. [NIH] Kidney Failure, Chronic: An irreversible and usually progressive reduction in renal function in which both kidneys have been damaged by a variety of diseases to the extent that they are unable to adequately remove the metabolic products from the blood and regulate the body's electrolyte composition and acid-base balance. Chronic kidney failure requires hemodialysis or surgery, usually kidney transplantation. [NIH] Kinetic: Pertaining to or producing motion. [EU] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Lag: The time elapsing between application of a stimulus and the resulting reaction. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large
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intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Least-Squares Analysis: A principle of estimation in which the estimates of a set of parameters in a statistical model are those quantities minimizing the sum of squared differences between the observed values of a dependent variable and the values predicted by the model. [NIH] Leiomyoma: A benign tumor derived from smooth muscle tissue, also known as a fibroid tumor. They rarely occur outside of the uterus and the gastrointestinal tract but can occur in the skin and subcutaneous tissues, probably arising from the smooth muscle of small blood vessels in these tissues. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lethal: Deadly, fatal. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]
Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Likelihood Functions: Functions constructed from a statistical model and a set of observed data which give the probability of that data for various values of the unknown model parameters. Those parameter values that maximize the probability are the maximum likelihood estimates of the parameters. [NIH] Linear Models: Statistical models in which the value of a parameter for a given value of a factor is assumed to be equal to a + bx, where a and b are constants. The models predict a linear regression. [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipid A: Lipid A is the biologically active component of lipopolysaccharides. It shows strong endotoxic activity and exhibits immunogenic properties. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH]
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Lipolysis: The hydrolysis of lipids. [NIH] Lipopolysaccharide: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Lipoprotein Lipase: An enzyme of the hydrolase class that catalyzes the reaction of triacylglycerol and water to yield diacylglycerol and a fatty acid anion. The enzyme hydrolyzes triacylglycerols in chylomicrons, very-low-density lipoproteins, low-density lipoproteins, and diacylglycerols. It occurs on capillary endothelial surfaces, especially in mammary, muscle, and adipose tissue. Genetic deficiency of the enzyme causes familial hyperlipoproteinemia Type I. (Dorland, 27th ed) EC 3.1.1.34. [NIH] Lisinopril: An orally active angiotensin-converting enzyme inhibitor that has been used in the treatment of hypertension and congestive heart failure. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor. [NIH] Longitudinal study: Also referred to as a "cohort study" or "prospective study"; the analytic method of epidemiologic study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of this type of study is to observe large numbers of subjects over an extended time, with comparisons of incidence rates in groups that differ in exposure levels. [NIH] Loop: A wire usually of platinum bent at one end into a small loop (usually 4 mm inside diameter) and used in transferring microorganisms. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lower Esophageal Sphincter: The muscle between the esophagus and stomach. When a person swallows, this muscle relaxes to let food pass from the esophagus to the stomach. It
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stays closed at other times to keep stomach contents from flowing back into the esophagus. [NIH]
Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]
Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphatic system: The tissues and organs that produce, store, and carry white blood cells that fight infection and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and a network of thin tubes that carry lymph and white blood cells. These tubes branch, like blood vessels, into all the tissues of the body. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Maintenance therapy: Treatment that is given to help a primary (original) treatment keep working. Maintenance therapy is often given to help keep cancer in remission. [NIH] Malignancy: A cancerous tumor that can invade and destroy nearby tissue and spread to other parts of the body. [NIH] Mammary: Pertaining to the mamma, or breast. [EU] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Meat: The edible portions of any animal used for food including domestic mammals (the major ones being cattle, swine, and sheep) along with poultry, fish, shellfish, and game. [NIH]
Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Median Nerve: A major nerve of the upper extremity. In humans, the fibers of the median nerve originate in the lower cervical and upper thoracic spinal cord (usually C6 to T1), travel via the brachial plexus, and supply sensory and motor innervation to parts of the forearm and hand. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU]
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Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Megaloblastic: A large abnormal red blood cell appearing in the blood in pernicious anaemia. [EU] Melanin: The substance that gives the skin its color. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Membrane Lipids: Lipids, predominantly phospholipids, cholesterol and small amounts of glycolipids found in membranes including cellular and intracellular membranes. These lipids may be arranged in bilayers in the membranes with integral proteins between the layers and peripheral proteins attached to the outside. Membrane lipids are required for active transport, several enzymatic activities and membrane formation. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mercury: A silver metallic element that exists as a liquid at room temperature. It has the atomic symbol Hg (from hydrargyrum, liquid silver), atomic number 80, and atomic weight 200.59. Mercury is used in many industrial applications and its salts have been employed therapeutically as purgatives, antisyphilitics, disinfectants, and astringents. It can be absorbed through the skin and mucous membranes which leads to mercury poisoning. Because of its toxicity, the clinical use of mercury and mercurials is diminishing. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted,
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usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microcirculation: The vascular network lying between the arterioles and venules; includes capillaries, metarterioles and arteriovenous anastomoses. Also, the flow of blood through this network. [NIH] Microfilaments: The smallest of the cytoskeletal filaments. They are composed chiefly of actin. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Microtubules: Slender, cylindrical filaments found in the cytoskeleton of plant and animal cells. They are composed of the protein tubulin. [NIH] Microwaves: That portion of the electromagnetic spectrum lying between UHF (ultrahigh frequency) radio waves and heat (infrared) waves. Microwaves are used to generate heat, especially in some types of diathermy. They may cause heat damage to tissues. [NIH] Milliliter: A measure of volume for a liquid. A milliliter is approximately 950-times smaller than a quart and 30-times smaller than a fluid ounce. A milliliter of liquid and a cubic centimeter (cc) of liquid are the same. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Mitotic: Cell resulting from mitosis. [NIH] Mitral Valve: The valve between the left atrium and left ventricle of the heart. [NIH] Mobility: Capability of movement, of being moved, or of flowing freely. [EU] Mobilization: The process of making a fixed part or stored substance mobile, as by separating a part from surrounding structures to make it accessible for an operative procedure or by causing release into the circulation for body use of a substance stored in the body. [EU]
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Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monophosphate: So called second messenger for neurotransmitters and hormones. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motivations: The most compelling inner determinants of human behavior; also called drives, urges, impulses, needs, wants, tensions, and willful cravings. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]
Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucocutaneous: Pertaining to or affecting the mucous membrane and the skin. [EU] Mucocutaneous Lymph Node Syndrome: An acute, febrile, mucocutaneous condition accompanied by swelling of cervical lymph nodes in infants and young children. The principal symptoms are fever, congestion of the ocular conjunctivae, reddening of the lips and oral cavity, protuberance of tongue papillae, and edema or erythema of the extremities. [NIH]
Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables. [NIH] Muscle Contraction: A process leading to shortening and/or development of tension in muscle tissue. Muscle contraction occurs by a sliding filament mechanism whereby actin filaments slide inward among the myosin filaments. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic
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unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myeloma: Cancer that arises in plasma cells, a type of white blood cell. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardial Reperfusion: Generally, restoration of blood supply to heart tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. Reperfusion can be induced to treat ischemia. Methods include chemical dissolution of an occluding thrombus, administration of vasodilator drugs, angioplasty, catheterization, and artery bypass graft surgery. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing myocardial reperfusion injury. [NIH] Myocardial Reperfusion Injury: Functional, metabolic, or structural changes in ischemic heart muscle thought to result from reperfusion to the ischemic areas. Changes can be fatal to muscle cells and may include edema with explosive cell swelling and disintegration, sarcolemma disruption, fragmentation of mitochondria, contraction band necrosis, enzyme washout, and calcium overload. Other damage may include hemorrhage and ventricular arrhythmias. One possible mechanism of damage is thought to be oxygen free radicals. Treatment currently includes the introduction of scavengers of oxygen free radicals, and injury is thought to be prevented by warm blood cardioplegic infusion prior to reperfusion. [NIH]
Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myofibrils: Highly organized bundles of actin, myosin, and other proteins in the cytoplasm of skeletal and cardiac muscle cells that contract by a sliding filament mechanism. [NIH] Myogenic Regulatory Factors: A family of muscle-specific transcription factors which bind to DNA in control regions and thus regulate myogenesis. All members of this family contain a conserved helix-loop-helix motif which is homologous to the myc family proteins. These factors are only found in skeletal muscle. Members include the myoD protein, myogenin, myf-5, and myf-6 (also called MRF4 or herculin). [NIH] Myogenin: A myogenic regulatory factor that controls myogenesis. Myogenin is induced during differentiation of every skeletal muscle cell line that has been investigated, in contrast to the other myogenic regulatory factors that only appear in certain cell types. [NIH] Myoglobin: A conjugated protein which is the oxygen-transporting pigment of muscle. It is made up of one globin polypeptide chain and one heme group. [NIH] Myosin: Chief protein in muscle and the main constituent of the thick filaments of muscle fibers. In conjunction with actin, it is responsible for the contraction and relaxation of muscles. [NIH] Nadolol: A non-selective beta-adrenergic antagonist with a long half-life, used in cardiovascular disease to treat arrhythmias, angina pectoris, and hypertension. Nadolol is
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also used for migraine and for tremor. [NIH] Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Natriuresis: The excretion of abnormal amounts of sodium in the urine. [EU] Natriuretic Hormone: A low-molecular weight substance, possibly from the hypothalamus, which is released due to plasma volume expansion. It causes natriuresis in part by inhibiting sodium potassium ATPase. The development of hypertension may be the consequence of an abnormality in volume regulation induced by a defect in the renal response to the natriuretic effect of the natriuretic hormone. Do not confuse with atrial natriuretic factor or cardionatrin which is a different, well characterized hormone. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Nephron: A tiny part of the kidneys. Each kidney is made up of about 1 million nephrons, which are the working units of the kidneys, removing wastes and extra fluids from the blood. [NIH] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Fibers: Slender processes of neurons, especially the prolonged axons that conduct nerve impulses. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU]
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Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropeptides: Peptides released by neurons as intercellular messengers. Many neuropeptides are also hormones released by non-neuronal cells. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]
Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nitroglycerin: A highly volatile organic nitrate that acts as a dilator of arterial and venous smooth muscle and is used in the treatment of angina. It provides relief through improvement of the balance between myocardial oxygen supply and demand. Although total coronary blood flow is not increased, there is redistribution of blood flow in the heart when partial occlusion of coronary circulation is effected. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between
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individuals in ways other than the spoken language. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Normotensive: 1. Characterized by normal tone, tension, or pressure, as by normal blood pressure. 2. A person with normal blood pressure. [EU] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclear Medicine: A specialty field of radiology concerned with diagnostic, therapeutic, and investigative use of radioactive compounds in a pharmaceutical form. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Observational study: An epidemiologic study that does not involve any intervention, experimental or otherwise. Such a study may be one in which nature is allowed to take its course, with changes in one characteristic being studied in relation to changes in other characteristics. Analytical epidemiologic methods, such as case-control and cohort study designs, are properly called observational epidemiology because the investigator is observing without intervention other than to record, classify, count, and statistically analyze results. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Oliguria: Clinical manifestation of the urinary system consisting of a decrease in the amount of urine secreted. [NIH] Omega-3 fatty acid: A type of fat obtained in the diet and involved in immunity. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Opsin: A protein formed, together with retinene, by the chemical breakdown of metarhodopsin. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At
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the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]
Optic Disk: The portion of the optic nerve seen in the fundus with the ophthalmoscope. It is formed by the meeting of all the retinal ganglion cell axons as they enter the optic nerve. [NIH]
Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Organ Transplantation: Transference of an organ between individuals of the same species or between individuals of different species. [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteoporosis: Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis and age-related (or senile) osteoporosis. [NIH] Ouabain: A cardioactive glycoside consisting of rhamnose and ouabagenin, obtained from the seeds of Strophanthus gratus and other plants of the Apocynaceae; used like digitalis. It is commonly used in cell biological studies as an inhibitor of the NA(+)-K(+)-exchanging atpase. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Overweight: An excess of body weight but not necessarily body fat; a body mass index of 25 to 29.9 kg/m2. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]
Oxidation-Reduction: A chemical reaction in which an electron is transferred from one molecule to another. The electron-donating molecule is the reducing agent or reductant; the electron-accepting molecule is the oxidizing agent or oxidant. Reducing and oxidizing agents function as conjugate reductant-oxidant pairs or redox pairs (Lehninger, Principles of Biochemistry, 1982, p471). [NIH] Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Oxygenation: The process of supplying, treating, or mixing with oxygen. No:1245 -
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oxygenation the process of supplying, treating, or mixing with oxygen. [EU] Oxygenator: An apparatus by which oxygen is introduced into the blood during circulation outside the body, as during open heart surgery. [NIH] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the action of the proto-oncogene proteins c-mos. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Paramedic: An emergency medical technician (EMT) who received further training for the delivery of some aspects of advanced life support (ALS) care. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Parotid: The space that contains the parotid gland, the facial nerve, the external carotid artery, and the retromandibular vein. [NIH] Paroxetine: A serotonin uptake inhibitor that is effective in the treatment of depression. [NIH]
Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]
Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]
Pelvic: Pertaining to the pelvis. [EU] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Pepsin A: Formed from pig pepsinogen by cleavage of one peptide bond. The enzyme is a single polypeptide chain and is inhibited by methyl 2-diaazoacetamidohexanoate. It cleaves
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peptides preferentially at the carbonyl linkages of phenylalanine or leucine and acts as the principal digestive enzyme of gastric juice. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Peptic Ulcer: Ulcer that occurs in those portions of the alimentary tract which come into contact with gastric juice containing pepsin and acid. It occurs when the amount of acid and pepsin is sufficient to overcome the gastric mucosal barrier. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Periodontal Attachment Loss: Loss or destruction of periodontal tissue caused by periodontitis or other destructive periodontal diseases or by injury during instrumentation. Attachment refers to the periodontal ligament which attaches to the alveolar bone. It has been hypothesized that treatment of the underlying periodontal disease and the seeding of periodontal ligament cells enable the creating of new attachment. [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontal Ligament: Fibrous connective tissue surrounding the root of a tooth that separates it from and attaches it to the alveolar bone. [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex. [NIH]
Perioperative: Around the time of surgery; usually lasts from the time of going into the hospital or doctor's office for surgery until the time the patient goes home. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peripheral Vascular Disease: Disease in the large blood vessels of the arms, legs, and feet. People who have had diabetes for a long time may get this because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood. The signs of PVD are aching pains in the arms, legs, and feet (especially when walking) and foot sores that heal slowly. Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control. [NIH] Perivascular: Situated around a vessel. [EU] Peroneal Nerve: The lateral of the two terminal branches of the sciatic nerve. The peroneal (or fibular) nerve provides motor and sensory innervation to parts of the leg and foot. [NIH]
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PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phlebotomy: The letting of blood from a vein. Although it is one of the techniques used in drawing blood to be used in diagnostic procedures, in modern medicine, it is used commonly in the treatment of erythrocytosis, hemochromocytosis, polycythemia vera, and porphyria cutanea tarda. Its historical counterpart is bloodletting. (From Cecil Textbook of Medicine, 19th ed & Wintrobe's Clinical Hematology, 9th ed) Venipuncture is not only for the letting of blood from a vein but also for the injecting of a drug into the vein for diagnostic analysis. [NIH] Phosphates: Inorganic salts of phosphoric acid. [NIH] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the cyclic GMP. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylase: An enzyme of the transferase class that catalyzes the phosphorylysis of a terminal alpha-1,4-glycosidic bond at the non-reducing end of a glycogen molecule, releasing a glucose 1-phosphate residue. Phosphorylase should be qualified by the natural substance acted upon. EC 2.4.1.1. [NIH] Photocoagulation: Using a special strong beam of light (laser) to seal off bleeding blood vessels such as in the eye. The laser can also burn away blood vessels that should not have grown in the eye. This is the main treatment for diabetic retinopathy. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]
Physiology: The science that deals with the life processes and functions of organismus, their
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cells, tissues, and organs. [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]
Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasma protein: One of the hundreds of different proteins present in blood plasma, including carrier proteins ( such albumin, transferrin, and haptoglobin), fibrinogen and other coagulation factors, complement components, immunoglobulins, enzyme inhibitors, precursors of substances such as angiotension and bradykinin, and many other types of proteins. [EU] Plasmalogens: Any glycerophospholipid in which one of the two acyl chains is attached to glycerol with an ether alkenyl linkage instead of an ester as with the other glycerophospholipids. [NIH] Plasmin: A product of the lysis of plasminogen (profibrinolysin) by plasminogen activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins. EC 3.4.21.7. [NIH] Plasminogen: Precursor of fibrinolysin (plasmin). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent. [NIH] Plasminogen Activators: A heterogeneous group of proteolytic enzymes that convert plasminogen to plasmin. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation. EC 3.4.21.-. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment
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for laboratory and industrial use. It occurs as a black powder (platinum black) and as a spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]
Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Polyunsaturated fat: An unsaturated fat found in greatest amounts in foods derived from plants, including safflower, sunflower, corn, and soybean oils. [NIH] Popliteal: Compression of the nerve at the neck of the fibula. [NIH] Population Density: Number of individuals in a population relative to space. [NIH] Porphyria: A group of disorders characterized by the excessive production of porphyrins or their precursors that arises from abnormalities in the regulation of the porphyrin-heme pathway. The porphyrias are usually divided into three broad groups, erythropoietic, hepatic, and erythrohepatic, according to the major sites of abnormal porphyrin synthesis. [NIH]
Porphyria Cutanea Tarda: A form of hepatic porphyria (porphyria, hepatic) characterized by photosensitivity resulting in bullae that rupture easily to form shallow ulcers. This condition occurs in two forms: a sporadic, nonfamilial form that begins in middle age and has normal amounts of uroporphyrinogen decarboxylase with diminished activity in the liver; and a familial form in which there is an autosomal dominant inherited deficiency of uroporphyrinogen decarboxylase in the liver and red blood cells. [NIH] Port: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port-a-cath. [NIH] Port-a-cath: An implanted device through which blood may be withdrawn and drugs may be infused without repeated needle sticks. Also called a port. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postmenopausal: Refers to the time after menopause. Menopause is the time in a woman's life when menstrual periods stop permanently; also called "change of life." [NIH] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiating: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government
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agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Pravastatin: An antilipemic fungal metabolite isolated from cultures of Nocardia autotrophica. It acts as a competitive inhibitor of HMG CoA reductase (hydroxymethylglutaryl CoA reductases). [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prednisolone: A glucocorticoid with the general properties of the corticosteroids. It is the drug of choice for all conditions in which routine systemic corticosteroid therapy is indicated, except adrenal deficiency states. [NIH] Pre-eclamptic: A syndrome characterized by hypertension, albuminuria, and generalized oedema, occurring only in pregnancy. [NIH] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Prickle: Several layers of the epidermis where the individual cells are connected by cell bridges. [NIH] Primary endpoint: The main result that is measured at the end of a study to see if a given treatment worked (e.g., the number of deaths or the difference in survival between the treatment group and the control group). What the primary endpoint will be is decided before the study begins. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Private Sector: That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progeny: The offspring produced in any generation. [NIH] Progestogen: A term applied to any substance possessing progestational activity. [EU] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH]
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Prone: Having the front portion of the body downwards. [NIH] Proneness: Susceptibility to accidents due to human factors. [NIH] Propanolol: Beta blocker. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostaglandins D: Physiologically active prostaglandins found in many tissues and organs. They show pressor activity, are mediators of inflammation, and have potential antithrombotic effects. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protease Inhibitors: Compounds which inhibit or antagonize biosynthesis or actions of proteases (endopeptidases). [NIH] Protective Agents: Synthetic or natural substances which are given to prevent a disease or disorder or are used in the process of treating a disease or injury due to a poisonous agent. [NIH]
Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein Kinases: A family of enzymes that catalyze the conversion of ATP and a protein to ADP and a phosphoprotein. EC 2.7.1.37. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino
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acids determines the shape and function of the protein. [NIH] Proteoglycan: A molecule that contains both protein and glycosaminoglycans, which are a type of polysaccharide. Proteoglycans are found in cartilage and other connective tissues. [NIH]
Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Prothrombin: A plasma protein that is the inactive precursor of thrombin. It is converted to thrombin by a prothrombin activator complex consisting of factor Xa, factor V, phospholipid, and calcium ions. Deficiency of prothrombin leads to hypoprothrombinemia. [NIH]
Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proto-Oncogene Proteins: Products of proto-oncogenes. Normally they do not have oncogenic or transforming properties, but are involved in the regulation or differentiation of cell growth. They often have protein kinase activity. [NIH] Proto-Oncogene Proteins c-mos: Cellular proteins encoded by the c-mos genes. They function in the cell cycle to maintain maturation promoting factor in the active state and have protein-serine/threonine kinase activity. Oncogenic transformation can take place when c-mos proteins are expressed at the wrong time. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Proximate cause: The abnormal event in a causal chain lying closest to an accidental event. [NIH]
Pseudoxanthoma: A rare disease of the skin characterized by the appearance of elevated yellowish papules or plaques, particularly on the neck, chest an abdomen and infrequently on the eyelids. [NIH] Pseudoxanthoma Elasticum: A rare, progressive inherited disorder resulting from extensive basophilic degeneration of elastic tissue, usually presenting after puberty and involving the skin, eye, and cardiovascular system. Characteristic manifestations are small, circumscribed yellowish patches at sites of considerable movement of the skin, angioid streaks in the retina, and a tendency towards hemorrhage and arterial insufficiency. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoanalysis: The separation or resolution of the psyche into its constituent elements. The term has two separate meanings: 1. a procedure devised by Sigmund Freud, for investigating mental processes by means of free association, dream interpretation and interpretation of resistance and transference manifestations; and 2. a theory of psychology developed by Freud from his clinical experience with hysterical patients. (From Campbell, Psychiatric Dictionary, 1996). [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]
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Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary Embolism: Embolism in the pulmonary artery or one of its branches. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]
Pupil: The aperture in the iris through which light passes. [NIH] Purines: A series of heterocyclic compounds that are variously substituted in nature and are known also as purine bases. They include adenine and guanine, constituents of nucleic acids, as well as many alkaloids such as caffeine and theophylline. Uric acid is the metabolic end product of purine metabolism. [NIH] Pyrimidines: A family of 6-membered heterocyclic compounds occurring in nature in a wide variety of forms. They include several nucleic acid constituents (cytosine, thymine, and uracil) and form the basic structure of the barbiturates. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radial Nerve: A major nerve of the upper extremity. In humans the fibers of the radial nerve originate in the lower cervical and upper thoracic spinal cord (usually C5 to T1), travel via the posterior cord of the brachial plexus, and supply motor innervation to extensor muscles of the arm and cutaneous sensory fibers to extensor regions of the arm and hand. [NIH]
Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radio Waves: That portion of the electromagnetic spectrum beyond the microwaves, with wavelengths as high as 30 KM. They are used in communications, including television. Short Wave or HF (high frequency), UHF (ultrahigh frequency) and VHF (very high frequency) waves are used in citizen's band communication. [NIH] Radioactive: Giving off radiation. [NIH] Radioisotope: An unstable element that releases radiation as it breaks down. Radioisotopes
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can be used in imaging tests or as a treatment for cancer. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Radium: A radioactive element symbol Ra, atomic number 88, disintegration of uranium and is is used clinically as a source brachytherapy. [NIH]
of the alkaline earth series of metals. It has the atomic and atomic weight 226. Radium is the product of the present in pitchblende and all ores containing uranium. It of beta and gamma-rays in radiotherapy, particularly
Radon: A naturally radioactive element with atomic symbol Rn, atomic number 86, and atomic weight 222. It is a member of the noble gas family and released during the decay of radium and found in soil. There is a link between exposure to radon and lung cancer. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and non-radicals. These substances are constantly formed in the human body and have been shown to kill bacteria and inactivate proteins, and have been implicated in a number of diseases. Scientific data exist that link the reactive oxygen species produced by inflammatory phagocytes to cancer development. [NIH] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH]
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Reflux: The term used when liquid backs up into the esophagus from the stomach. [NIH] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see linear models) the relationship is constrained to be a straight line and least-squares analysis is used to determine the best fit. In logistic regression (see logistic models) the dependent variable is qualitative rather than continuously variable and likelihood functions are used to find the best relationship. In multiple regression the dependent variable is considered to depend on more than a single independent variable. [NIH]
Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Renin: An enzyme which is secreted by the kidney and is formed from prorenin in plasma and kidney. The enzyme cleaves the Leu-Leu bond in angiotensinogen to generate angiotensin I. EC 3.4.23.15. (Formerly EC 3.4.99.19). [NIH] Renin-Angiotensin System: A system consisting of renin, angiotensin-converting enzyme, and angiotensin II. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming angiotensin I. The converting enzyme contained in the lung acts on angiotensin I in the plasma converting it to angiotensin II, the most powerful directly pressor substance known. It causes contraction of the arteriolar smooth muscle and has other indirect actions mediated through the adrenal cortex. [NIH] Renovascular: Of or pertaining to the blood vessels of the kidneys. [EU] Reperfusion: Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing reperfusion injury. [NIH] Reperfusion Injury: Functional, metabolic, or structural changes, including necrosis, in ischemic tissues thought to result from reperfusion to ischemic areas of the tissue. The most common instance is myocardial reperfusion injury. [NIH] Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into
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the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory distress syndrome: A lung disease that occurs primarily in premature infants; the newborn must struggle for each breath and blueing of its skin reflects the baby's inability to get enough oxygen. [NIH] Respiratory failure: Inability of the lungs to conduct gas exchange. [NIH] Respiratory System: The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. Pertaining to the retina. 2. The aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retinopathy: 1. Retinitis (= inflammation of the retina). 2. Retinosis (= degenerative, noninflammatory condition of the retina). [EU] Retractor: An instrument designed for pulling aside tissues to improve exposure at operation; an instrument for drawing back the edge of a wound. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Rhamnose: A methylpentose whose L- isomer is found naturally in many plant glycosides and some gram-negative bacterial lipopolysaccharides. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rheumatology: A subspecialty of internal medicine concerned with the study of inflammatory or degenerative processes and metabolic derangement of connective tissue structures which pertain to a variety of musculoskeletal disorders, such as arthritis. [NIH] Rhodopsin: A photoreceptor protein found in retinal rods. It is a complex formed by the
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binding of retinal, the oxidized form of retinol, to the protein opsin and undergoes a series of complex reactions in response to visible light resulting in the transmission of nerve impulses to the brain. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Risk patient: Patient who is at risk, because of his/her behaviour or because of the type of person he/she is. [EU] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saphenous: Applied to certain structures in the leg, e. g. nerve vein. [NIH] Saphenous Vein: The vein which drains the foot and leg. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Saturated fat: A type of fat found in greatest amounts in foods from animals, such as fatty cuts of meat, poultry with the skin, whole-milk dairy products, lard, and in some vegetable oils, including coconut, palm kernel, and palm oils. Saturated fat raises blood cholesterol more than anything else eaten. On a Step I Diet, no more than 8 to 10 percent of total calories should come from saturated fat, and in the Step II Diet, less than 7 percent of the day's total calories should come from saturated fat. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Sciatic Nerve: A nerve which originates in the lumbar and sacral spinal cord (L4 to S3) and supplies motor and sensory innervation to the lower extremity. The sciatic nerve, which is the main continuation of the sacral plexus, is the largest nerve in the body. It has two major branches, the tibial nerve and the peroneal nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secondary tumor: Cancer that has spread from the organ in which it first appeared to another organ. For example, breast cancer cells may spread (metastasize) to the lungs and cause the growth of a new tumor. When this happens, the disease is called metastatic breast cancer, and the tumor in the lungs is called a secondary tumor. Also called secondary cancer. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a
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gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Secular trends: A relatively long-term trend in a community or country. [NIH] Sedentary: 1. Sitting habitually; of inactive habits. 2. Pertaining to a sitting posture. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Sensor: A device designed to respond to physical stimuli such as temperature, light, magnetism or movement and transmit resulting impulses for interpretation, recording, movement, or operating control. [NIH] Septic: Produced by or due to decomposition by microorganisms; putrefactive. [EU] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serologic: Analysis of a person's serum, especially specific immune or lytic serums. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Serous: Having to do with serum, the clear liquid part of blood. [NIH] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH]
Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]
Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU]
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Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]
Smooth Muscle Tumor: A tumor composed of smooth muscle tissue, as opposed to leiomyoma, a tumor derived from smooth muscle. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Social Class: A stratum of people with similar position and prestige; includes social stratification. Social class is measured by criteria such as education, occupation, and income. [NIH]
Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH]
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Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Soft tissue sarcoma: A sarcoma that begins in the muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solid tumor: Cancer of body tissues other than blood, bone marrow, or the lymphatic system. [NIH] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Sound wave: An alteration of properties of an elastic medium, such as pressure, particle displacement, or density, that propagates through the medium, or a superposition of such alterations. [NIH] Soybean Oil: Oil from soybean or soybean plant. [NIH] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sphincters: Any annular muscle closing an orifice. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Nerves: The 31 paired peripheral nerves formed by the union of the dorsal and ventral spinal roots from each spinal cord segment. The spinal nerve plexuses and the spinal roots are also included. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side
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of the abdomen near the stomach. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]
Standard therapy: A currently accepted and widely used treatment for a certain type of cancer, based on the results of past research. [NIH] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Status Epilepticus: Repeated and prolonged epileptic seizures without recovery of consciousness between attacks. [NIH] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stillbirth: The birth of a dead fetus or baby. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]
Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Streptococci: A genus of spherical Gram-positive bacteria occurring in chains or pairs. They are widely distributed in nature, being important pathogens but often found as normal commensals in the mouth, skin, and intestine of humans and other animals. [NIH] Streptokinase: Streptococcal fibrinolysin . An enzyme produced by hemolytic streptococci. It hydrolyzes amide linkages and serves as an activator of plasminogen. It is used in thrombolytic therapy and is used also in mixtures with streptodornase (streptodornase and streptokinase). EC 3.4.-. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress Fibers: Bundles of actin filaments (microfilaments) and myosin-II that span across the cell attaching to the cell membrane at focal adhesions and to the network of intermediate filaments that surrounds the nucleus. [NIH] Stress management: A set of techniques used to help an individual cope more effectively with difficult situations in order to feel better emotionally, improve behavioral skills, and often to enhance feelings of control. Stress management may include relaxation exercises, assertiveness training, cognitive restructuring, time management, and social support. It can be delivered either on a one-to-one basis or in a group format. [NIH]
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Stricture: The abnormal narrowing of a body opening. Also called stenosis. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stromal: Large, veil-like cell in the bone marrow. [NIH] Stromal Cells: Connective tissue cells of an organ found in the loose connective tissue. These are most often associated with the uterine mucosa and the ovary as well as the hematopoietic system and elsewhere. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]
Substrate: A substance upon which an enzyme acts. [EU] Substrate Specificity: A characteristic feature of enzyme activity in relation to the kind of substrate on which the enzyme or catalytic molecule reacts. [NIH] Sudden cardiac death: Cardiac arrest caused by an irregular heartbeat. [NIH] Sudden death: Cardiac arrest caused by an irregular heartbeat. The term "death" is somewhat misleading, because some patients survive. [NIH] Superoxide: Derivative of molecular oxygen that can damage cells. [NIH] Superoxide Dismutase: An oxidoreductase that catalyzes the reaction between superoxide anions and hydrogen to yield molecular oxygen and hydrogen peroxide. The enzyme protects the cell against dangerous levels of superoxide. EC 1.15.1.1. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods. [NIH] Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral
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column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Syncope: A temporary suspension of consciousness due to generalized cerebral schemia, a faint or swoon. [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Systolic pressure: The highest pressure to which blood pressure rises with the contraction of the ventricles. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thioredoxin: A hydrogen-carrying protein that participates in a variety of biochemical reactions including ribonucleotide reduction. Thioredoxin is oxidized from a dithiol to a disulfide during ribonucleotide reduction. The disulfide form is then reduced by NADPH in a reaction catalyzed by thioredoxin reductase. [NIH] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the
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lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thoracic: Having to do with the chest. [NIH] Thoracotomy: Surgical incision into the chest wall. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thromboembolism: Obstruction of a vessel by a blood clot that has been transported from a distant site by the blood stream. [NIH] Thrombolytic: 1. Dissolving or splitting up a thrombus. 2. A thrombolytic agent. [EU] Thrombolytic Therapy: Use of infusions of fibrinolytic agents to destroy or dissolve thrombi in blood vessels or bypass grafts. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]
Thromboses: The formation or presence of a blood clot within a blood vessel during life. [NIH]
Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tidal Volume: The volume of air inspired or expired during each normal, quiet respiratory cycle. Common abbreviations are TV or V with subscript T. [NIH] Time Management: Planning and control of time to improve efficiency and effectiveness. [NIH]
Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tissue Plasminogen Activator: A proteolytic enzyme in the serine protease family found in
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many tissues which converts plasminogen to plasmin. It has fibrin-binding activity and is immunologically different from urinary plasminogen activator. The primary sequence, composed of 527 amino acids, is identical in both the naturally occurring and synthetic proteases. EC 3.4.21.68. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tooth Loss: The failure to retain teeth as a result of disease or injury. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH] Torsion: A twisting or rotation of a bodily part or member on its axis. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Toxoplasmosis: The acquired form of infection by Toxoplasma gondii in animals and man. [NIH]
Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Tracer: A substance (such as a radioisotope) used in imaging procedures. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH]
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Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Triad: Trivalent. [NIH] Triage: The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained primarily from fat in foods. [NIH] Tropomyosin: A protein found in the thin filaments of muscle fibers. It inhibits contraction of the muscle unless its position is modified by troponin. [NIH] Troponin: One of the minor protein components of skeletal muscle. Its function is to serve as the calcium-binding component in the troponin-tropomyosin B-actin-myosin complex by conferring calcium sensitivity to the cross-linked actin and myosin filaments. [NIH] Trustees: Board members of an institution or organization who are entrusted with the administering of funds and the directing of policy. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Tumor model: A type of animal model which can be used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tunica: A rather vague term to denote the lining coat of hollow organs, tubes, or cavities. [NIH]
Tunica Intima: The innermost coat of blood vessels, consisting of a thin lining of endothelial cells longitudinally oriented and continuous with the endothelium of capillaries on the one hand and the endocardium of the heart on the other. [NIH] Type 2 diabetes: Usually characterized by a gradual onset with minimal or no symptoms of metabolic disturbance and no requirement for exogenous insulin. The peak age of onset is 50
Dictionary 355
to 60 years. Obesity and possibly a genetic factor are usually present. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A localized necrotic lesion of the skin or a mucous surface. [NIH] Ulceration: 1. The formation or development of an ulcer. 2. An ulcer. [EU] Ulnar Nerve: A major nerve of the upper extremity. In humans, the fibers of the ulnar nerve originate in the lower cervical and upper thoracic spinal cord (usually C7 to T1), travel via the medial cord of the brachial plexus, and supply sensory and motor innervation to parts of the hand and forearm. [NIH] Ultrasound test: A test that bounces sound waves off tissues and internal organs and changes the echoes into pictures (sonograms). [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Unsaturated Fats: A type of fat. [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Ureters: Tubes that carry urine from the kidneys to the bladder. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]
Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Plasminogen Activator: A proteolytic enzyme that converts plasminogen to plasmin where the preferential cleavage is between arginine and valine. It was isolated originally from human urine, but is found in most tissues of most vertebrates. EC 3.4.21.73. [NIH]
Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]
Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Urokinase: A drug that dissolves blood clots or prevents them from forming. [NIH] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy, infection, or stress. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH]
356 Heart Attack
Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular endothelial growth factor: VEGF. A substance made by cells that stimulates new blood vessel formation. [NIH] Vasoactive: Exerting an effect upon the calibre of blood vessels. [EU] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which constriction, pathologic is used. [NIH] Vasodilatation: A state of increased calibre of the blood vessels. [EU] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] Vasomotor System: The neural systems which act on vascular smooth muscle to control blood vessel diameter. The major neural control is through the sympathetic nervous system. [NIH]
Vasopressor: 1. Stimulating contraction of the muscular tissue of the capillaries and arteries. 2. An agent that stimulates contraction of the muscular tissue of the capillaries and arteries. [EU]
VE: The total volume of gas either inspired or expired in one minute. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Venous Thrombosis: The formation or presence of a thrombus within a vein. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Ventricular Dysfunction: A condition in which the ventricles of the heart exhibit a decreased functionality. [NIH] Ventricular fibrillation: Rapid, irregular quivering of the heart's ventricles, with no effective heartbeat. [NIH] Ventricular Function: The hemodynamic and electrophysiological action of the ventricles. [NIH]
Ventricular Remodeling: The geometric and structural changes that the ventricle undergoes, usually following myocardial infarction. It comprises expansion of the infarct
Dictionary 357
and dilatation of the healthy ventricle segments. While most prevalent in the left ventricle, it can also occur in the right ventricle. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertebral: Of or pertaining to a vertebra. [EU] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Vitreous: Glasslike or hyaline; often used alone to designate the vitreous body of the eye (corpus vitreum). [EU] Vitreous Hemorrhage: Hemorrhage into the vitreous body. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Volition: Voluntary activity without external compulsion. [NIH] War: Hostile conflict between organized groups of people. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]
Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to
358 Heart Attack
treat cancer. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]
359
INDEX A Abdominal, 271, 279, 333 Acatalasia, 279, 292 Acceptor, 279, 322, 332 ACE, 6, 7, 57, 58, 120, 121, 125, 272, 279 Acetylcholine, 28, 279, 294, 330 Acetylgalactosamine, 279, 312 Acetylglucosamine, 279, 312 Acidity, 279, 335 Acidosis, 279, 321 Acoustic, 172, 279 Actin, 279, 326, 327, 328, 349, 354 Acute Disease, 170, 171, 186, 279 Acyl, 279, 336 Adaptability, 279, 293 Adaptation, 21, 44, 89, 146, 279 Adduct, 30, 279 Adenine, 279, 280, 341 Adenosine, 12, 13, 27, 279, 280, 290, 335 Adenosine Triphosphate, 12, 280, 335 Adhesions, 280 Adipose Tissue, 36, 280, 323 Adjustment, 23, 34, 147, 279, 280 Adjuvant, 10, 280, 311 Adolescence, 15, 231, 280 Adrenal Cortex, 280, 281, 299, 343 Adrenal Medulla, 280, 292, 305, 306, 331 Adrenergic, 4, 7, 18, 47, 139, 140, 280, 281, 284, 286, 303, 306, 326, 328, 339, 351 Adrenergic beta-Antagonists, 280, 284 Adverse Effect, 16, 107, 280, 346 Aerobic, 211, 217, 233, 280, 307, 326 Aerobic Exercise, 211, 217, 280 Affinity, 12, 27, 192, 280, 281, 301, 348 Agar, 280, 336 Age Groups, 101, 281 Age of Onset, 281, 354 Aged, 80 and Over, 281 Aggravation, 4, 281 Agonist, 12, 39, 200, 281, 301, 302, 303, 330 Airway, 281, 347 Albumin, 281, 326, 336 Aldosterone, 30, 44, 73, 281 Alertness, 281, 290 Algorithms, 14, 30, 281, 288 Alimentary, 281, 301, 333, 334 Alkaline, 279, 281, 282, 290, 342 Alkaloid, 281, 327, 330
Alkalosis, 219, 281 Allylamine, 281, 282 Alpha Particles, 281, 341 Alpha-1, 281, 297, 303, 335 Alpha-Linolenic Acid, 130, 281 Alprenolol, 281, 326 Alternative medicine, 229, 282 Ameliorating, 176, 282 Amine, 188, 282 Amino Acid Sequence, 282, 284 Amlodipine, 4, 18, 282 Ammonia, 282, 350, 355 Amplification, 5, 282 Amputation, 10, 224, 282 Amyloid, 282, 293 Anaesthesia, 282, 318 Anal, 15, 282, 306, 323, 327 Analgesic, 276, 282, 317, 327, 329, 331 Analog, 30, 189, 200, 282 Analytes, 170, 244, 245, 282 Anaphylatoxins, 282, 296 Anaphylaxis, 136, 220, 283 Anatomical, 283, 286, 294, 298, 302, 318 Anemia, 24, 283, 310 Anesthesia, 54, 216, 281, 283, 286, 304 Anesthetics, 283, 306 Aneurysm, 96, 184, 257, 283, 310, 356 Angina Pectoris, 59, 166, 181, 219, 220, 280, 282, 283, 326, 328, 339 Angiogenesis, 15, 283 Angiogram, 56, 283 Angiography, 28, 45, 244, 273, 274, 283 Angioid Streaks, 283, 340 Angiotensin converting enzyme inhibitor, 4, 30, 165, 217, 283 Angiotensin-Converting Enzyme Inhibitors, 283, 284 Angiotensinogen, 18, 283, 343 Anhydrous, 193, 283 Animal model, 10, 21, 26, 283, 354 Anions, 281, 284, 320, 350 Anoxia, 9, 284 Antagonism, 284, 290 Anti-Arrhythmia Agents, 284, 302 Antiarrhythmic, 181, 284 Antibiotic, 8, 284, 287, 307, 348 Antibodies, 35, 122, 170, 181, 186, 284, 285, 313, 318, 324, 336
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Antibody, 35, 38, 39, 180, 181, 280, 284, 296, 300, 313, 315, 316, 318, 319, 324, 327, 348 Anticoagulant, 41, 163, 284, 339, 357 Antidepressant, 12, 61, 284 Antigen, 280, 283, 284, 285, 296, 311, 315, 317, 318, 319, 324 Antigen-Antibody Complex, 284, 296 Antihypertensive Agents, 18, 284 Anti-infective, 284, 316, 347 Anti-inflammatory, 40, 285, 286, 299, 312, 317, 329 Anti-Inflammatory Agents, 285, 286, 299 Antimetabolite, 285, 300 Antioxidant, 191, 192, 285, 286, 332 Antiproliferative, 35, 285 Antipyretic, 285, 329 Antiserum, 182, 285 Antiviral, 285, 300 Anuria, 285, 321 Anus, 282, 285, 289, 296 Anxiety, 55, 65, 137, 146, 271, 280, 285, 333, 339 Aorta, 28, 285, 291, 298, 356 Apathy, 65, 285 Apnea, 285 Apnoea, 80, 285 Apolipoproteins, 285, 323 Apoptosis, 7, 13, 40, 45, 285 Aqueous, 285, 287, 300, 316, 322 Arachidonic Acid, 8, 285, 322, 339 Arginine, 154, 282, 285, 330, 355 Arrhythmia, 71, 137, 156, 157, 159, 220, 233, 257, 284, 285 Arteriography, 166, 285 Arteriolar, 182, 286, 289, 343 Arterioles, 27, 286, 289, 291, 326, 328 Arteriosclerosis, 137, 207, 286, 293, 317 Arteriovenous, 196, 286, 293, 326 Articular, 286, 332 Ascorbic Acid, 131, 286, 316 Aspiration, 276, 286 Assay, 30, 286, 318 Asymptomatic, 151, 157, 158, 279, 286 Atenolol, 140, 231, 286 Atherectomy, 286, 304 Atheromatosis, 190, 286 Atrial, 58, 153, 286, 298, 329, 357 Atrial Fibrillation, 58, 153, 286, 357 Atrial Natriuretic Factor, 286, 329 Atrium, 286, 291, 298, 326, 356 Auditory, 183, 286
Autoimmune disease, 38, 204, 286 Autologous, 42, 151, 156, 286 Autonomic, 190, 216, 219, 279, 287, 310, 331, 334, 350 Autonomic Nervous System, 287, 334, 350 Autopsy, 47, 287 Axons, 287, 329, 332 Azithromycin, 8, 287 B Back Pain, 249, 287 Bacteria, 8, 279, 284, 287, 297, 304, 305, 308, 310, 313, 316, 326, 342, 348, 349, 353, 355 Bacterial Physiology, 279, 287 Bacteriophage, 287, 336, 353 Basal Ganglia, 287, 290, 293 Base, 22, 187, 279, 281, 287, 300, 309, 321, 351 Basement Membrane, 287, 308 Basophils, 287, 313, 322 Beer, 45, 287 Benign, 287, 309, 314, 322 Benzene, 287, 320 Beta blocker, 72, 90, 105, 108, 116, 217, 218, 231, 287, 339 Bile, 288, 310, 311, 315, 323, 349 Bile Acids, 288, 311, 349 Binding Sites, 41, 288 Biochemical, 32, 36, 40, 41, 87, 171, 172, 185, 285, 288, 309, 321, 332, 346, 351 Biochemical reactions, 288, 351 Biological Markers, 170, 288 Biological therapy, 288, 313 Biomarkers, 96, 288 Biopsy, 274, 288, 334 Biotechnology, 43, 48, 214, 229, 239, 288 Biotransformation, 38, 288 Biphasic, 40, 288 Bladder, 219, 258, 288, 296, 318, 339, 355 Blastocyst, 288, 297, 336 Bloating, 288, 318 Blood Coagulation, 41, 288, 289, 290, 352 Blood Coagulation Factors, 288, 289 Blood Flow Velocity, 131, 289 Blood Platelets, 33, 179, 289, 346 Blot, 42, 289 Body Composition, 233, 289 Body Fluids, 170, 171, 186, 281, 288, 289, 290, 303, 348, 354 Body Mass Index, 5, 289, 332 Bolus, 192, 289 Bolus infusion, 289
Index 361
Bone Density, 231, 289 Bone Marrow, 42, 137, 287, 289, 307, 311, 318, 324, 348, 350 Bone scan, 289, 345 Bowel, 250, 282, 289, 301, 320, 349 Bowel Movement, 250, 289, 302, 349 Brachial, 289, 324, 341, 355 Brachial Plexus, 289, 324, 341, 355 Bradykinin, 165, 289, 320, 330, 336 Brain Hypoxia, 290 Brain Infarction, 290 Brain Ischemia, 196, 290 Branch, 165, 197, 269, 290, 304, 311, 324, 333, 341, 348 Bronchi, 290, 306, 353 Bronchitis, 290, 294 Buccal, 193, 290 Buccal mucosa, 193, 290 Burns, 137, 231, 290 Burns, Electric, 290 Bypass, 25, 44, 52, 58, 120, 121, 163, 205, 232, 290, 328, 352 C Caffeine, 204, 275, 290, 341 Calcium channel blocker, 4, 62, 89, 122, 217, 282, 284, 290 Calcium Channel Blockers, 217, 284, 290 Calculi, 290, 313 Calpain, 32, 291 Capillary, 289, 291, 323, 357 Capillary Permeability, 290, 291 Carbohydrate, 36, 291, 299, 312, 337 Carbon Dioxide, 291, 310, 317, 336, 344, 356 Carcinogen, 279, 291 Carcinogenic, 287, 291, 319, 338, 349 Cardiac arrest, 63, 130, 221, 272, 291, 350 Cardiac Glycosides, 291, 302 Cardiac Output, 182, 291 Cardiogenic, 219, 291 Cardiomyopathy, 16, 137, 190, 251, 291 Cardiopulmonary, 38, 93, 107, 113, 181, 215, 219, 291 Cardiopulmonary Bypass, 38, 291 Cardiopulmonary Resuscitation, 93, 107, 181, 215, 219, 291 Cardiorespiratory, 280, 292 Cardioselective, 286, 292, 339 Cardiotonic, 292, 302 Cardiovascular System, 292, 340 Carotene, 140, 228, 292, 344 Carotid Sinus, 257, 292
Carpal Tunnel Syndrome, 219, 292 Carrier Proteins, 292, 336 Case report, 292, 295 Case series, 292, 295 Catabolism, 41, 292 Catalase, 192, 279, 292 Cataracts, 257, 292 Catecholamine, 90, 292, 301, 302, 303 Catheter, 151, 194, 197, 199, 286, 292, 304 Catheterization, 283, 292, 328 Caudal, 292, 301, 317, 337 Causal, 63, 182, 233, 293, 295, 306, 340 Cause of Death, 5, 19, 27, 33, 175, 176, 188, 194, 199, 293, 300 Cell Death, 7, 13, 32, 132, 285, 293, 311 Cell Differentiation, 293, 347 Cell Division, 287, 293, 313, 326, 336 Cell membrane, 13, 290, 292, 293, 300, 335, 349 Cell motility, 293, 315 Cell proliferation, 13, 35, 286, 293, 347 Cell Respiration, 293, 326, 344 Cell Size, 14, 293, 309 Cell Survival, 14, 293, 313 Cellulose, 293, 336 Central Nervous System, 35, 219, 262, 279, 287, 290, 293, 303, 310, 312, 314, 322, 327, 346 Cerebral, 21, 32, 155, 181, 196, 287, 290, 293, 294, 298, 306, 307, 351, 352 Cerebral Hemorrhage, 196, 293 Cerebral Infarction, 155, 290, 293 Cerebrospinal, 8, 293 Cerebrospinal fluid, 8, 293 Cerebrovascular, 152, 153, 157, 159, 160, 164, 196, 219, 221, 245, 290, 292, 294 Cerebrum, 293, 294 Cervical, 289, 294, 324, 327, 341, 355 Cervix, 30, 294 Character, 283, 294, 300 Chemotactic Factors, 294, 296 Chemotherapy, 40, 294 Chest wall, 294, 352 Chin, 294, 325 Cholesterol Esters, 294, 323 Cholinergic, 294, 330 Chromatin, 285, 294, 306, 330 Chromosomal, 282, 294 Chromosome, 294, 297, 313, 322 Chronic Disease, 262, 294 Chronic Obstructive Pulmonary Disease, 13, 294
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Chylomicrons, 294, 323 CIS, 8, 294, 344 Citrus, 286, 295 Civil Rights, 87, 295 Cleave, 32, 295 Clinical Medicine, 295, 338 Clinical study, 151, 295 Clone, 24, 295 Cloning, 288, 295 Clot Retraction, 295, 336 Coagulation, 16, 20, 30, 41, 190, 289, 295, 315, 336, 352, 357 Coenzyme, 141, 286, 295 Cofactor, 295, 339, 352 Cognitive restructuring, 295, 349 Cohort Effect, 118, 295 Cohort Studies, 20, 45, 295, 306 Collagen, 190, 282, 287, 295, 308, 309, 311, 336, 338 Collapse, 283, 296, 347 Collateral Circulation, 25, 296 Colloidal, 281, 296, 304 Colon, 93, 108, 296, 322 Combination Therapy, 37, 48, 149, 215, 296, 307 Complement, 17, 35, 38, 184, 282, 296, 319, 336 Complementary and alternative medicine, 129, 130, 144, 296 Complementary medicine, 130, 296 Compliance, 29, 99, 103, 114, 189, 296 Computational Biology, 239, 297 Computed tomography, 131, 289, 297, 345 Computerized tomography, 297 Conception, 297, 298, 308 Concomitant, 10, 297 Conduction, 28, 284, 297 Cones, 297, 344 Confounding, 26, 34, 297 Congestion, 297, 306, 327 Conjugated, 297, 328 Conjugation, 288, 297 Connective Tissue, 286, 289, 295, 297, 309, 310, 311, 324, 334, 340, 344, 345, 350 Connexin 43, 42, 297 Consciousness, 193, 263, 282, 297, 302, 349, 351 Constipation, 250, 298 Constriction, 182, 298, 320, 356 Constriction, Pathologic, 298, 356 Consumption, 20, 36, 44, 135, 218, 250, 298, 332
Contraception, 204, 298 Contractility, 42, 133, 174, 194, 283, 298 Contraindications, ii, 298 Contrast medium, 283, 298 Control group, 153, 159, 233, 298, 338 Convulsions, 298, 303 Coordination, 155, 298 Cor, 298 Coronary Arteriosclerosis, 23, 187, 298, 328 Coronary Artery Bypass, 86, 298 Coronary Care Units, 183, 189, 200, 298 Coronary Circulation, 283, 298, 330 Coronary Thrombosis, 5, 134, 187, 214, 299, 326, 328 Coronary Vessels, 184, 298, 299 Corpus, 164, 185, 299, 351, 357 Cortex, 299, 307 Cortical, 299, 346 Corticosteroid, 299, 338 Cosmic Radiation, 12, 299 Cranial, 219, 299, 314, 334 Creatine, 170, 171, 172, 186, 299 Creatine Kinase, 170, 172, 186, 299 Creatinine, 299, 321 Cross-Sectional Studies, 299, 306 Cryptosporidiosis, 287, 299 Curative, 300, 330 Cutaneous, 300, 341 Cyclic, 38, 185, 290, 291, 300, 313, 330, 335 Cytokines, 35, 39, 40, 300 Cytoplasm, 285, 287, 293, 300, 306, 307, 313, 328, 330 Cytoskeleton, 33, 300, 319, 326 Cytotoxic, 300, 347 D Dairy Products, 252, 300, 345 Data Collection, 19, 22, 25, 300, 309 Death Certificates, 25, 43, 300 Deception, 256, 300 Decidua, 300, 336 Degenerative, 13, 300, 332, 344 Deletion, 18, 285, 300 Delivery of Health Care, 300, 314 Dendrites, 300, 330 Density, 23, 47, 133, 183, 251, 289, 300, 303, 309, 315, 316, 323, 331, 348 Dental Care, 219, 232, 300 Dentists, 4, 5, 300 Deoxycytidine, 42, 300 Deoxyglucose, 134, 300 Depolarization, 26, 300, 347
Index 363
Deprivation, 47, 220, 301 Desipramine, 12, 301 Detergents, 301, 309 Deuterium, 301, 316 Dexfenfluramine, 233, 301 Dextrothyroxine, 158, 301 Diabetes Insipidus, 301, 316 Diabetes Mellitus, 17, 138, 153, 182, 216, 232, 301, 312, 314 Diabetic Retinopathy, 224, 257, 301, 335 Diagnostic Equipment, 183, 301 Diagnostic procedure, 169, 229, 301, 335 Diastole, 301 Diastolic, 11, 15, 197, 225, 253, 301, 317 Diastolic blood pressure, 15, 301 Diastolic pressure, 11, 253, 301, 317 Diathermy, 301, 326 Diencephalon, 301, 317, 351 Dietary Fiber, 250, 301 Dietitian, 258, 301 Digestion, 281, 288, 289, 301, 303, 318, 320, 323, 334, 349 Digestive system, 168, 250, 301 Digitalis, 59, 182, 291, 302, 332 Digitalis Glycosides, 182, 302 Dihydrotestosterone, 302, 342 Dilatation, 283, 302, 320, 338, 356, 357 Dilatation, Pathologic, 302, 356 Dilate, 27, 302 Dilation, 16, 27, 286, 289, 302, 356 Dilator, 302, 330 Diploid, 302, 336 Direct, iii, 8, 9, 12, 13, 15, 27, 39, 173, 182, 183, 197, 215, 251, 295, 302, 303, 342, 351 Discrimination, 87, 295, 302 Disposition, 60, 302 Dissection, 195, 246, 302 Dissociation, 40, 280, 302 Dissociative Disorders, 302 Distal, 7, 298, 302, 304, 311, 340 Diuresis, 290, 302 Diuretics, Thiazide, 284, 302 Dizziness, 256, 272, 302, 357 Dobutamine, 131, 134, 302 Dopamine, 188, 303, 330, 335 Double-blind, 12, 59, 157, 303 Doxazosin, 4, 18, 48, 69, 70, 84, 93, 103, 303 Drive, ii, vi, 17, 55, 119, 196, 219, 220, 221, 223, 224, 303 Drug Delivery Systems, 198, 303 Duct, 292, 303, 307, 345, 349, 350 Duodenum, 288, 303, 333, 349
Dyes, 282, 287, 303, 309, 330 Dyslipidemia, 71, 150, 253, 303 Dysmenorrhea, 303, 329 Dyspareunia, 303, 307 Dyspepsia, 303, 318 E Echocardiography, 16, 131, 134, 244, 274, 303 Eclampsia, 182, 303 Edema, 188, 196, 301, 303, 316, 327, 328 Effector, 40, 279, 296, 303, 335 Efferent, 303, 327 Efficacy, 15, 58, 149, 303 Elastic, 231, 303, 340, 348 Elasticity, 154, 286, 298, 304 Elastin, 283, 296, 304, 308 Electric shock, 291, 304 Electrocardiogram, 57, 110, 173, 176, 244, 274, 304 Electrocardiograph, 178, 199, 304 Electrocoagulation, 295, 304 Electrode, 26, 304 Electrolyte, 281, 299, 304, 321, 337, 348 Electrophoresis, 42, 304 Electrophysiological, 28, 174, 304, 356 Elementary Particles, 304, 330, 340 Emboli, 195, 304, 357 Embolism, 196, 220, 257, 304, 341, 357 Embolization, 195, 304, 357 Embolus, 304, 319 Embryo, 288, 293, 304, 318 Emergency Medical Services, 19, 304 Emergency Treatment, 150, 220, 304 Emphysema, 294, 304 Endarterectomy, 33, 283, 286, 304 Endocarditis, 138, 220, 305 Endocardium, 305, 354 Endogenous, 9, 10, 20, 36, 41, 45, 170, 171, 182, 186, 289, 291, 303, 305 Endopeptidases, 305, 339 Endorphins, 305, 330 Endoscopy, 215, 305 Endothelial cell, 13, 28, 41, 305, 352, 354 Endothelium, 10, 41, 110, 165, 305, 330, 336, 354 Endothelium, Lymphatic, 305 Endothelium, Vascular, 305 Endothelium-derived, 305, 330 Endotoxic, 305, 322 Endotoxin, 39, 305, 354 Energetic, 13, 305 Enkephalins, 305, 330
364 Heart Attack
Enoxaparin, 152, 305 Environmental Exposure, 158, 288, 305, 331 Environmental Health, 19, 62, 113, 238, 240, 306 Environmental tobacco smoke, 74, 306 Enzymatic, 282, 290, 292, 296, 306, 309, 325, 344 Enzyme, 9, 18, 32, 41, 57, 89, 120, 121, 122, 125, 152, 171, 185, 186, 192, 279, 288, 292, 295, 303, 306, 308, 311, 313, 316, 320, 323, 326, 328, 333, 335, 336, 339, 340, 342, 343, 347, 349, 350, 352, 355, 357, 358 Enzyme Inhibitors, 185, 306, 336 Eosinophils, 306, 313, 322 Epidemiologic Studies, 18, 288, 306 Epidemiological, 25, 31, 51, 94, 122, 306 Epidermal, 306, 321, 325 Epidermis, 306, 321, 338 Epigastric, 306, 333 Epinephrine, 12, 280, 303, 306, 330, 331, 355 Episode of Care, 34, 306 Epithelial, 300, 306, 315 Epithelial Cells, 306, 315 Epithelium, 287, 305, 306, 310 Erectile, 224, 306 Erection, 306 Erythema, 306, 327, 355 Erythrocytes, 174, 194, 283, 289, 291, 307 Erythromycin, 287, 307 Erythropoietin, 21, 307 Esophageal, 215, 307 Esophageal Motility Disorders, 215, 307 Esophagus, 250, 302, 307, 311, 314, 323, 335, 343, 349 Estrogen, 5, 30, 48, 57, 120, 121, 158, 162, 164, 218, 307 Estrogen Replacement Therapy, 218, 307 Ether, 307, 336 Ethnic Groups, 34, 307 Evacuation, 298, 307 Evoke, 307, 349 Excitation, 195, 307, 309, 330 Excrete, 285, 307, 321 Exercise Test, 56, 216, 307 Exocrine, 307, 333 Exogenous, 184, 288, 305, 307, 354 Exons, 41, 307 Extensor, 308, 341
Extracellular, 13, 27, 192, 282, 297, 308, 309, 319, 348 Extracellular Matrix, 192, 297, 308, 309, 319 Extracellular Matrix Proteins, 308, 309 Extracellular Space, 308 Extracorporeal, 38, 308 Extraction, 17, 308 Extrapyramidal, 303, 308 Extravascular, 41, 308 Extremity, 289, 308, 324, 341, 345, 355 F Family Planning, 239, 308 Fat, 36, 60, 127, 207, 213, 251, 252, 253, 257, 275, 280, 285, 289, 292, 298, 299, 304, 308, 321, 322, 331, 332, 337, 344, 345, 348, 354, 355 Fatigue, 224, 231, 272, 308, 314 Fatty acids, 36, 37, 130, 132, 133, 134, 281, 308, 312, 339, 347 Febrile, 308, 327 Feces, 298, 308, 349 Femoral, 291, 308 Femoral Artery, 291, 308 Fenfluramine, 233, 301, 308 Fermentation, 287, 308 Fetal Death, 182, 308 Fetus, 307, 308, 336, 349, 355 Fibrillation, 156, 308 Fibrin, 32, 110, 179, 288, 295, 309, 336, 352, 353 Fibrinogen, 5, 12, 39, 309, 336, 352 Fibrinolysis, 31, 309 Fibrinolytic, 32, 45, 46, 48, 186, 190, 309, 352 Fibrinolytic Agents, 32, 309, 352 Fibroblasts, 42, 190, 309 Fibroid, 173, 309, 322 Fibrosis, 42, 281, 309, 345 Fibula, 309, 337 Fish Oils, 133, 309 Flow Cytometry, 12, 27, 41, 309 Fluorescence, 12, 309 Fluorescent Dyes, 309 Focal Adhesions, 33, 309, 349 Focus Groups, 94, 309 Folate, 124, 125, 310 Fold, 26, 41, 185, 310 Folic Acid, 124, 189, 310 Food Habits, 252, 310 Food Preferences, 310 Foot Care, 232, 310
Index 365
Forearm, 289, 310, 324, 355 Free Association, 310, 340 Free Radicals, 21, 285, 302, 310, 328 G Gallbladder, 279, 302, 310 Gallstones, 310, 315 Ganglia, 279, 310, 329, 334, 351 Ganglionic Blockers, 284, 310 Gas, 282, 291, 310, 316, 318, 330, 341, 342, 344, 356 Gas exchange, 310, 344, 356 Gastric, 250, 307, 310, 311, 314, 334 Gastric Juices, 310, 334 Gastric Mucosa, 310, 334 Gastrin, 311, 315 Gastroesophageal Reflux, 203, 215, 311 Gastrointestinal, 230, 231, 290, 306, 309, 311, 322, 346, 350, 354 Gastrointestinal tract, 309, 311, 322, 346, 354 Gelatin, 311, 312, 352 Gene, 9, 18, 40, 42, 47, 87, 153, 174, 191, 214, 288, 297, 311, 316, 331 Gene Expression, 40, 42, 311 Gene Therapy, 191, 311 General practitioner, 76, 107, 113, 311 Genetics, 13, 17, 18, 154, 297, 311 Genotype, 18, 311, 335 Germinal Center, 40, 311 Gestation, 311, 336 Gestational, 224, 311 Giant Cells, 311, 345 Gingivitis, 4, 76, 232, 311 Gland, 280, 299, 311, 317, 324, 333, 339, 346, 349, 350, 352 Glucocorticoid, 312, 338 Gluconeogenesis, 312 Glucose Intolerance, 301, 312 Glucose tolerance, 189, 200, 224, 312 Glucose Tolerance Test, 225, 312 Glucuronic Acid, 312, 315 Glutamic Acid, 310, 312, 330, 338 Glycerol, 312, 335, 336 Glycerophospholipids, 312, 335, 336 Glycine, 282, 312, 330, 346 Glycogen, 36, 312, 335 Glycoprotein, 33, 307, 309, 311, 312, 313, 352, 354 Glycosaminoglycans, 35, 41, 308, 312, 340 Glycoside, 312, 332 Goats, 300, 313 Gout, 182, 228, 313, 329
Governing Board, 313, 338 Gp120, 20, 313 Grade, 313 Grading, 95, 313 Graft, 313, 316, 328 Grafting, 298, 313, 318 Gram-negative, 38, 305, 313, 344 Granulocytes, 184, 313, 347, 357 Grasses, 310, 313 Growth factors, 16, 25, 190, 313 Guanine, 33, 313, 341 Guanylate Cyclase, 313, 330 H Habitual, 11, 294, 313 Half-Life, 38, 192, 313, 328 Haploid, 313, 336 Haptens, 280, 313 Headache, 290, 314 Health Care Costs, 11, 314 Health Education, 84, 96, 111, 121, 314 Health Expenditures, 314 Health Services, 34, 47, 259, 300, 314 Health Status, 295, 314 Heart Arrest, 157, 291, 314 Heart failure, 16, 18, 34, 47, 57, 58, 87, 103, 120, 121, 151, 152, 173, 181, 185, 190, 197, 200, 218, 220, 221, 225, 233, 251, 253, 254, 255, 283, 291, 297, 314, 323 Heartbeat, 178, 191, 257, 314, 350, 356 Heartburn, 203, 215, 250, 272, 314, 318 Heme, 314, 328, 337 Hemodialysis, 274, 314, 321 Hemoglobin, 224, 283, 307, 314 Hemoglobinopathies, 311, 314 Hemolytic, 314, 349 Hemorrhage, 33, 179, 196, 304, 314, 315, 328, 340, 350, 357 Hemostasis, 12, 16, 40, 315, 319, 346 Heparin, 35, 41, 152, 192, 315 Hepatic, 281, 312, 315, 337 Hepatocyte, 180, 181, 315 Hepatocyte Growth Factor, 180, 181, 315 Heredity, 218, 254, 311, 315 Heterogeneity, 87, 280, 315 Hibernation, 190, 315 High blood cholesterol, 37, 250, 252, 315 Histology, 29, 315 Homeostasis, 5, 13, 14, 21, 315 Homologous, 311, 315, 328, 351 Hormonal, 36, 299, 307, 315
366 Heart Attack
Hormone, 96, 159, 160, 190, 218, 230, 281, 288, 299, 306, 307, 311, 315, 316, 319, 329, 344, 347, 351, 352 Hormone Replacement Therapy, 159, 160, 218, 316 Hormone therapy, 96, 316 Hospital Mortality, 34, 44, 84, 101, 200, 316 Host, 173, 287, 316, 318, 322, 357 Human growth hormone, 190, 316 Hyaluronidase, 161, 186, 316 Hybrid, 22, 295, 316 Hybridoma, 36, 316 Hydrochlorothiazide, 218, 316 Hydrogen, 192, 279, 282, 287, 291, 292, 301, 308, 316, 322, 327, 330, 332, 335, 340, 350, 351 Hydrogen Peroxide, 192, 292, 316, 322, 350 Hydrolysis, 288, 316, 323, 335, 340 Hydrophilic, 30, 301, 316 Hydrophobic, 301, 312, 316, 323 Hydroxylysine, 296, 316 Hydroxyproline, 282, 296, 316 Hypercholesterolemia, 138, 153, 263, 303, 316 Hypercholesterolemia, Familial, 263, 316 Hyperglycemia, 224, 257, 317 Hyperlipidemia, 263, 303, 317 Hypersensitivity, 215, 220, 283, 317, 322, 344 Hyperthyroidism, 317, 339 Hypertriglyceridemia, 303, 317 Hypertrophy, 18, 182, 200, 298, 317 Hyperuricemia, 313, 317 Hyperventilation, 219, 317 Hypoglycemia, 217, 219, 220, 224, 317 Hypoglycemic, 217, 317 Hypotension, 102, 219, 257, 298, 310, 317 Hypothalamus, 182, 287, 301, 317, 329, 351 Hypothermia, 194, 317 Hypoxia, 9, 13, 21, 30, 317 Hypoxic, 30, 317 I Ibuprofen, 90, 230, 317 Id, 123, 136, 244, 245, 246, 247, 258, 259, 260, 262, 268, 270, 317 Idiopathic, 317, 345 Ileal, 163, 317 Ileum, 317 Illusion, 317, 357
Immune response, 10, 280, 284, 286, 299, 313, 317, 318, 350, 357 Immune system, 10, 288, 317, 318, 322, 324, 355, 357 Immunity, 317, 318, 331 Immunization, 318, 338 Immunoassay, 170, 180, 181, 186, 318 Immunodeficiency, 20, 256, 318 Immunodeficiency syndrome, 256, 318 Immunogen, 180, 318 Immunogenic, 318, 322 Immunoglobulin, 284, 307, 318, 327 Immunohistochemistry, 30, 318 Immunologic, 294, 318 Immunology, 10, 184, 280, 309, 318 Impairment, 231, 318, 325 Implantable pump, 198, 199, 318 Implantation, 42, 151, 156, 297, 318 Impotence, 185, 213, 224, 231, 306, 318 In situ, 28, 318 In vitro, 12, 28, 35, 38, 40, 41, 174, 311, 318 In vivo, 13, 20, 21, 28, 33, 35, 38, 40, 41, 132, 311, 315, 318, 352 Incision, 318, 320, 352 Incompetence, 311, 318 Incontinence, 204, 318 Indicative, 12, 171, 175, 183, 186, 204, 318, 333, 356 Indigestion, 64, 203, 215, 260, 272, 318 Induction, 20, 36, 200, 301, 310, 318 Infant, Newborn, 281, 318 Infiltration, 184, 319 Infusion, 13, 41, 187, 192, 319, 328 Ingestion, 312, 319, 337 Initiation, 20, 41, 319 Initiator, 8, 20, 319 Inlay, 319, 344 Innervation, 289, 319, 324, 334, 341, 345, 355 Inorganic, 319, 327, 335 Inotropic, 286, 303, 319 Insight, 22, 28, 40, 319 Insulin, 5, 21, 36, 57, 120, 121, 182, 200, 224, 251, 312, 319, 321, 354 Insulin-dependent diabetes mellitus, 319 Insulin-like, 21, 200, 319 Integrins, 309, 319 Intensive Care, 298, 320 Intermediate Filaments, 320, 349 Intermittent, 24, 160, 320 Internal Medicine, 52, 64, 67, 73, 80, 87, 88, 92, 101, 103, 113, 320, 329, 344
Index 367
Interstitial, 42, 192, 308, 320 Intestinal, 292, 299, 312, 320 Intestine, 35, 289, 320, 321, 349 Intracellular, 13, 30, 32, 41, 182, 290, 319, 320, 325, 330, 337, 342, 347 Intracranial Aneurysm, 293, 320 Intramuscular, 320, 333 Intravenous, 13, 38, 46, 71, 160, 161, 166, 176, 187, 192, 259, 276, 319, 320, 333 Intrinsic, 39, 280, 287, 320 Invasive, 9, 26, 28, 30, 35, 97, 115, 116, 166, 317, 320, 324 Involuntary, 257, 306, 308, 320, 328, 342, 347, 348 Ion Channels, 24, 320, 351 Ionizing, 281, 305, 320 Ions, 279, 287, 302, 304, 316, 320, 327, 340 Isoenzyme, 171, 186, 299, 320 Isoflavones, 143, 320 J Joint, 24, 249, 286, 320, 332, 351 K Kallidin, 289, 320 Kb, 238, 321 Keratin, 321 Keratinocytes, 42, 321 Ketoacidosis, 224, 321 Ketone Bodies, 321 Ketosis, 321 Kidney Disease, 9, 150, 168, 217, 224, 238, 250, 257, 258, 321 Kidney Failure, 15, 87, 204, 253, 254, 255, 321 Kidney Failure, Acute, 321 Kidney Failure, Chronic, 321 Kinetic, 41, 320, 321 L Labile, 296, 321 Lag, 8, 321 Large Intestine, 302, 320, 321, 342, 347 Latent, 32, 322, 338 Least-Squares Analysis, 322, 343 Leiomyoma, 309, 322, 347 Lens, 292, 322, 343 Lethal, 174, 194, 322 Leukemia, 137, 311, 322 Leukocytes, 287, 289, 294, 300, 306, 313, 322, 330, 354 Leukotrienes, 285, 322 Library Services, 268, 322 Life cycle, 288, 322 Ligament, 322, 334, 339
Ligands, 12, 20, 27, 319, 322 Likelihood Functions, 322, 343 Linear Models, 322, 343 Linkage, 18, 322, 336 Lipid A, 28, 158, 231, 322 Lipid Peroxidation, 131, 132, 175, 194, 322, 332 Lipolysis, 36, 323 Lipopolysaccharide, 39, 313, 323 Lipoprotein, 7, 18, 47, 122, 251, 303, 313, 315, 323 Lipoprotein Lipase, 18, 323 Lisinopril, 4, 18, 57, 120, 121, 142, 323 Liver, 4, 21, 23, 36, 52, 120, 121, 213, 262, 279, 281, 285, 288, 291, 302, 307, 308, 309, 310, 312, 315, 323, 337, 342, 343, 345, 355 Liver scan, 323, 345 Lobe, 293, 316, 323 Localization, 177, 318, 323 Localized, 36, 197, 199, 290, 319, 323, 336, 355 Locomotion, 323, 336 Logistic Models, 323, 343 Longitudinal study, 39, 89, 323 Loop, 21, 323, 328 Low-density lipoprotein, 231, 303, 323 Lower Esophageal Sphincter, 307, 311, 323 Lumbar, 287, 324, 345 Lumen, 194, 195, 305, 324 Lymph, 294, 305, 324, 327, 345 Lymph node, 294, 324, 327, 345 Lymphatic, 305, 319, 324, 348 Lymphatic system, 324, 348 Lymphocyte, 284, 324 Lymphoid, 284, 311, 324 M Magnetic Resonance Imaging, 9, 33, 134, 150, 177, 195, 324, 345 Maintenance therapy, 215, 324 Malignancy, 13, 324 Mammary, 298, 323, 324 Manifest, 189, 200, 324 Meat, 252, 324, 345 Medial, 286, 324, 332, 355 Median Nerve, 292, 324 Mediate, 199, 303, 324 Mediator, 16, 24, 35, 324, 346 Medical Records, 25, 31, 43, 51, 183, 325 Medicament, 183, 325 MEDLINE, 239, 325 Medullary, 9, 325
368 Heart Attack
Megaloblastic, 310, 325 Melanin, 325, 335, 355 Melanocytes, 325 Melanoma, 75, 325 Membrane, 284, 293, 296, 301, 309, 313, 320, 325, 327, 334, 335, 344, 347 Membrane Lipids, 325, 335 Memory, 132, 311, 325 Meninges, 293, 325 Menopause, 30, 57, 162, 204, 325, 337, 339 Menstruation, 300, 303, 325 Mental, iv, 6, 12, 168, 238, 240, 294, 302, 308, 318, 325, 338, 340, 341, 355 Mental Disorders, 168, 325, 338 Mental Health, iv, 6, 168, 238, 240, 325, 338, 341 Mental Processes, 302, 325, 340 Mercury, 133, 309, 325 Meta-Analysis, 45, 325 Metabolic disorder, 301, 313, 325 Metabolite, 288, 326, 338, 342 Metastasis, 30, 326 Metoprolol, 142, 231, 326 Microbe, 326, 353 Microbiology, 279, 326 Microcirculation, 133, 326, 336 Microfilaments, 309, 320, 326, 349 Microorganism, 295, 326, 357 Microscopy, 29, 287, 326 Microtubules, 320, 326, 333 Microwaves, 72, 326, 341 Milliliter, 289, 326 Mitochondria, 36, 326, 328 Mitosis, 285, 326 Mitotic, 173, 326 Mitral Valve, 197, 326 Mobility, 170, 171, 186, 249, 326 Mobilization, 12, 326 Modeling, 29, 327 Modification, 8, 20, 197, 282, 327, 341 Molecular Structure, 327, 354 Monitor, 25, 33, 198, 204, 224, 253, 254, 299, 327, 331 Monoclonal, 38, 180, 181, 327 Mononuclear, 327, 354 Monophosphate, 185, 327 Morphine, 188, 327, 329, 331 Motility, 327, 346 Motion Sickness, 327, 329 Motivations, 68, 327 Motor nerve, 219, 327 Mucins, 327, 345
Mucocutaneous, 220, 327 Mucocutaneous Lymph Node Syndrome, 220, 327 Mucosa, 311, 327, 350 Mucus, 193, 327 Multivariate Analysis, 34, 65, 327 Muscle Contraction, 27, 199, 282, 327 Muscle Fibers, 327, 328, 354 Mydriatic, 302, 328 Myeloma, 316, 328 Myocardial Reperfusion, 328, 343 Myocardial Reperfusion Injury, 328, 343 Myocardium, 35, 42, 135, 172, 173, 175, 176, 177, 180, 184, 194, 195, 197, 283, 326, 328 Myofibrils, 291, 328 Myogenic Regulatory Factors, 328 Myogenin, 42, 328 Myoglobin, 245, 275, 328 Myosin, 42, 327, 328, 349, 354 N Nadolol, 231, 328 Naproxen, 230, 329 Narcosis, 315, 329 Narcotic, 327, 329 Natriuresis, 283, 329 Natriuretic Hormone, 182, 329 Nausea, 131, 272, 318, 321, 329, 355 NCI, 1, 167, 237, 295, 329 Neonatal, 174, 200, 329 Nephrology, 225, 329 Nephron, 69, 87, 329 Nephropathy, 224, 257, 321, 329 Nerve Fibers, 219, 289, 329 Nervous System, 199, 287, 293, 324, 329, 330, 334, 351 Networks, 7, 27, 106, 171, 198, 329 Neural, 27, 171, 282, 301, 310, 329, 356 Neurologic, 196, 329 Neuromuscular, 279, 329, 330 Neuromuscular Junction, 279, 330 Neurons, 24, 300, 310, 329, 330, 350, 351 Neuropathy, 190, 216, 219, 224, 330 Neuropeptides, 291, 330 Neurophysiology, 300, 330 Neurotransmitter, 28, 279, 280, 282, 290, 303, 312, 320, 330, 331, 347, 350, 351 Neutrons, 281, 330, 341 Neutrophils, 184, 313, 322, 330 Niacin, 124, 218, 330, 354 Nicotine, 80, 330 Nitric Oxide, 21, 154, 158, 330
Index 369
Nitrogen, 281, 282, 308, 321, 330, 354 Nitroglycerin, 55, 188, 330 Nonverbal Communication, 330, 340 Norepinephrine, 280, 301, 303, 330, 331 Normotensive, 182, 331 Nuclear, 12, 40, 132, 134, 135, 195, 275, 287, 297, 331 Nuclear Medicine, 12, 132, 135, 331 Nuclei, 195, 281, 297, 307, 311, 324, 326, 330, 331, 340 Nucleus, 285, 287, 294, 300, 301, 304, 306, 320, 327, 330, 331, 340, 349 O Observational study, 44, 48, 158, 331 Ocular, 327, 331 Odds Ratio, 331, 343 Oliguria, 321, 331 Omega-3 fatty acid, 37, 331 Oncogene, 315, 331 Opacity, 292, 300, 331 Opiate, 327, 331 Opium, 327, 331 Opsin, 331, 344, 345 Optic Chiasm, 317, 331 Optic Disk, 301, 332 Oral Health, 220, 221, 232, 332 Organ Transplantation, 38, 180, 332 Orthostatic, 219, 257, 332 Osteoarthritis, 249, 332 Osteoporosis, 57, 204, 249, 307, 332 Ouabain, 182, 332 Outpatient, 12, 25, 93, 306, 332 Ovary, 332, 350 Overweight, 5, 123, 150, 217, 224, 250, 332 Oxidation, 7, 36, 158, 279, 285, 288, 322, 332 Oxidation-Reduction, 288, 332 Oxidative Stress, 158, 332 Oxygen Consumption, 307, 332, 344 Oxygenation, 9, 21, 22, 38, 332 Oxygenator, 291, 333 P Pacemaker, 26, 175, 176, 333 Paclitaxel, 130, 333 Pancreas, 258, 279, 288, 302, 319, 333, 354 Pancreatic, 311, 333 Pancreatic Juice, 311, 333 Panic, 64, 137, 333 Paramedic, 47, 162, 333 Parenteral, 37, 333 Parotid, 333, 345 Paroxetine, 12, 333
Paroxysmal, 283, 333 Patch, 80, 333 Pathogenesis, 21, 35, 40, 51, 87, 182, 333 Pathologic, 30, 42, 279, 285, 288, 298, 317, 333 Pathologic Processes, 285, 333 Pathophysiology, 9, 21, 87, 220, 221, 333 Patient Education, 94, 249, 253, 257, 266, 268, 277, 333 Pelvic, 333, 339 Pepsin, 333, 334 Pepsin A, 333, 334 Peptic, 250, 334 Peptic Ulcer, 250, 334 Peptide, 38, 182, 282, 286, 297, 305, 321, 333, 334, 339, 340 Perception, 146, 190, 334 Percutaneous, 149, 166, 334 Perfusion, 28, 131, 135, 175, 176, 177, 194, 199, 317, 334 Periodontal Attachment Loss, 59, 334 Periodontal disease, 5, 38, 80, 232, 334 Periodontal Ligament, 334 Periodontitis, 152, 232, 311, 334 Perioperative, 216, 334 Peripheral Nervous System, 219, 305, 330, 334, 350 Peripheral Vascular Disease, 28, 219, 224, 251, 257, 334 Perivascular, 28, 334 Peroneal Nerve, 219, 334, 345 PH, 33, 74, 116, 117, 131, 289, 335 Pharmacist, 55, 335 Pharmacologic, 7, 15, 283, 313, 335, 353 Pharynx, 311, 335 Phenotype, 288, 335 Phenylalanine, 334, 335, 355 Phlebotomy, 158, 335 Phosphates, 13, 335 Phosphodiesterase, 185, 335 Phospholipases, 335, 347 Phospholipids, 23, 308, 323, 325, 335 Phosphorus, 290, 335 Phosphorylase, 291, 335 Photocoagulation, 295, 335 Physical Examination, 215, 216, 315, 335 Physiologic, 18, 21, 26, 31, 40, 281, 313, 325, 335, 342, 354 Physiology, 7, 10, 27, 36, 288, 291, 304, 329, 330, 335, 356 Pigments, 292, 336, 344 Placenta, 41, 336
370 Heart Attack
Plants, 37, 281, 291, 295, 302, 312, 331, 332, 336, 337, 353 Plaque, 7, 8, 20, 28, 33, 39, 179, 283, 286, 336 Plasma cells, 284, 328, 336 Plasma protein, 5, 33, 281, 305, 336, 340 Plasmalogens, 9, 336 Plasmin, 31, 309, 336, 353, 355 Plasminogen, 30, 31, 166, 309, 336, 349, 353, 355 Plasminogen Activators, 336 Platelet Activation, 4, 39, 336, 347 Platelet Aggregation, 12, 39, 181, 193, 283, 330, 336, 352 Platelets, 4, 12, 33, 39, 43, 109, 110, 291, 330, 336, 352 Platinum, 323, 336 Pneumonia, 34, 298, 337 Poisoning, 325, 329, 337 Polysaccharide, 284, 293, 337, 340 Polyunsaturated fat, 130, 134, 337, 352 Popliteal, 39, 337 Population Density, 20, 337 Porphyria, 335, 337 Porphyria Cutanea Tarda, 335, 337 Port, 199, 337 Port-a-cath, 337 Posterior, 282, 287, 333, 337, 341 Postmenopausal, 96, 160, 164, 307, 332, 337 Postnatal, 21, 337, 349 Postsynaptic, 337, 347, 351 Potassium, 61, 126, 257, 281, 302, 316, 329, 337, 347 Potentiates, 301, 337 Potentiating, 72, 182, 337 Potentiation, 337, 347 Practice Guidelines, 240, 258, 259, 337 Pravastatin, 6, 89, 338 Precursor, 42, 283, 285, 286, 303, 305, 306, 331, 335, 336, 338, 340, 354, 355 Predisposition, 75, 182, 224, 338 Prednisolone, 184, 338 Pre-eclamptic, 303, 338 Presynaptic, 330, 338, 351 Prevalence, 5, 60, 97, 104, 173, 190, 219, 220, 221, 233, 331, 338 Prickle, 321, 338 Primary endpoint, 43, 338 Primary Prevention, 84, 96, 338 Private Sector, 34, 338 Probe, 9, 32, 80, 338
Prodrug, 338, 342 Progeny, 173, 297, 338 Progestogen, 164, 338 Progression, 4, 20, 33, 157, 217, 284, 338, 354 Progressive, 7, 197, 293, 307, 313, 321, 332, 336, 338, 340 Proline, 296, 316, 338 Promoter, 20, 338 Prone, 4, 20, 30, 183, 263, 339 Proneness, 66, 339 Propanolol, 72, 339 Prophylaxis, 46, 259, 339, 357 Propranolol, 60, 71, 72, 99, 143, 157, 161, 231, 286, 339 Prospective Studies, 16, 339 Prospective study, 18, 23, 323, 339 Prostaglandins, 230, 281, 285, 339 Prostaglandins A, 230, 339 Prostaglandins D, 339 Prostate, 17, 60, 93, 288, 339, 354 Protease, 16, 33, 218, 296, 339, 352 Protease Inhibitors, 218, 339 Protective Agents, 290, 339 Protein C, 7, 29, 281, 282, 285, 287, 321, 323, 339, 354, 355 Protein Kinases, 40, 339 Protein S, 163, 196, 214, 288, 307, 316, 339 Proteoglycan, 41, 340 Proteolytic, 281, 296, 309, 336, 340, 352, 355 Prothrombin, 340, 352 Protocol, 7, 156, 165, 340 Protons, 24, 195, 281, 316, 320, 340, 341 Proto-Oncogene Proteins, 333, 340 Proto-Oncogene Proteins c-mos, 333, 340 Proximal, 7, 181, 302, 338, 340 Proximate cause, 20, 340 Pseudoxanthoma, 230, 231, 340 Pseudoxanthoma Elasticum, 230, 231, 340 Psychiatric, 288, 325, 340 Psychic, 325, 340, 346 Psychoanalysis, 64, 214, 340 Psychology, 23, 63, 72, 75, 84, 106, 112, 302, 340 Psychotherapy, 65, 72, 340 Puberty, 340, 341 Public Health, 19, 31, 51, 68, 100, 110, 111, 120, 121, 214, 240, 341 Public Policy, 34, 239, 341 Pulmonary, 21, 31, 138, 220, 244, 289, 298, 307, 317, 321, 322, 341, 344, 356, 357
Index 371
Pulmonary Artery, 289, 341, 356 Pulmonary Edema, 138, 321, 341 Pulmonary Embolism, 31, 244, 341, 357 Pulmonary hypertension, 21, 298, 341 Pulmonary Ventilation, 317, 341, 344 Pulse, 41, 175, 177, 187, 191, 195, 199, 273, 275, 327, 341 Pupil, 302, 328, 341 Purines, 341, 346 Pyrimidines, 341, 346 Q Quality of Life, 24, 44, 84, 97, 192, 253, 341 R Race, 20, 34, 42, 190, 217, 254, 295, 341 Radial Nerve, 219, 341 Radiation, 12, 30, 40, 283, 299, 304, 306, 309, 310, 320, 341, 345, 357 Radio Waves, 301, 326, 341 Radioactive, 12, 289, 313, 316, 318, 323, 331, 341, 342, 345 Radioisotope, 27, 341, 353 Radiological, 334, 342 Radiology, 21, 33, 156, 215, 331, 342 Radium, 342 Radon, 12, 342 Ramipril, 131, 342 Randomized, 3, 12, 18, 19, 29, 89, 96, 122, 150, 164, 303, 342 Randomized clinical trial, 150, 342 Reactive Oxygen Species, 192, 342 Reagent, 14, 342 Receptor, 10, 12, 18, 20, 21, 38, 40, 46, 47, 165, 279, 284, 303, 313, 315, 316, 342, 346, 347 Receptors, Serotonin, 342, 346 Recombinant, 38, 39, 41, 166, 184, 192, 342 Recombination, 297, 311, 342 Rectum, 285, 289, 296, 302, 310, 318, 321, 339, 342 Recurrence, 25, 62, 94, 211, 342 Reductase, 126, 153, 338, 342, 351 Refer, 1, 91, 178, 290, 296, 302, 305, 323, 330, 342, 357 Reflex, 55, 64, 257, 263, 342 Reflux, 203, 250, 307, 311, 343 Regeneration, 42, 151, 173, 174, 343 Regimen, 29, 303, 343 Regression Analysis, 44, 343 Regurgitation, 16, 197, 233, 307, 311, 314, 343 Relative risk, 164, 343 Remission, 324, 342, 343
Renin, 16, 30, 51, 55, 73, 87, 104, 165, 182, 283, 343 Renin-Angiotensin System, 16, 283, 343 Renovascular, 182, 343 Reperfusion, 9, 26, 35, 37, 52, 132, 164, 174, 179, 191, 192, 194, 328, 343 Reperfusion Injury, 35, 37, 192, 343 Resolving, 15, 343 Respiration, 285, 291, 327, 343 Respiratory distress syndrome, 38, 344 Respiratory failure, 220, 344 Respiratory System, 193, 344 Restoration, 175, 176, 179, 328, 343, 344, 357 Retina, 283, 297, 301, 322, 332, 340, 344 Retinal, 185, 301, 332, 344 Retinol, 344, 345 Retinopathy, 217, 224, 301, 344 Retractor, 27, 344 Retrospective, 20, 46, 344 Retroviral vector, 311, 344 Rhamnose, 332, 344 Rheumatism, 317, 344 Rheumatoid, 249, 329, 344 Rheumatoid arthritis, 329, 344 Rheumatology, 230, 247, 344 Rhodopsin, 331, 344 Ribose, 279, 345 Rigidity, 336, 345 Risk patient, 45, 219, 345 S Saliva, 193, 345 Salivary, 302, 345 Salivary glands, 302, 345 Saphenous, 298, 345 Saphenous Vein, 298, 345 Sarcoidosis, 262, 345 Sarcoma, 345, 348 Saturated fat, 250, 252, 345 Scans, 150, 156, 345 Sciatic Nerve, 334, 345 Screening, 38, 158, 247, 295, 345 Secondary tumor, 326, 345 Secretion, 51, 104, 182, 299, 319, 327, 345, 346 Secretory, 182, 346, 351 Secular trends, 50, 346 Sedentary, 224, 231, 346 Seizures, 263, 273, 333, 346, 349 Self Care, 217, 251, 346 Semen, 339, 346 Senile, 332, 346
372 Heart Attack
Sensor, 198, 346 Septic, 21, 40, 346 Serine, 179, 305, 340, 346, 352 Serologic, 318, 346 Serotonin, 12, 96, 301, 308, 330, 333, 342, 346, 354 Serous, 305, 346 Sertraline, 54, 96, 346 Sex Characteristics, 280, 341, 346, 351 Shock, 21, 40, 55, 139, 175, 181, 219, 263, 277, 283, 346, 354 Side effect, 4, 15, 40, 166, 185, 280, 288, 317, 346, 353 Signal Transduction, 21, 40, 347 Signs and Symptoms, 154, 220, 221, 223, 343, 347 Skeletal, 27, 42, 151, 156, 299, 328, 347, 348, 354 Skeleton, 279, 320, 347 Skull, 347, 351 Sleep apnea, 182, 347 Small intestine, 294, 303, 316, 317, 320, 347 Smoking Cessation, 5, 112, 223, 347 Smooth Muscle Tumor, 309, 347 Sneezing, 8, 347 Soaps, 309, 347 Social Class, 65, 347 Social Environment, 341, 347 Social Support, 161, 248, 347, 349 Sodium, 51, 174, 182, 194, 217, 252, 281, 284, 302, 313, 316, 329, 347, 348, 350 Soft tissue, 30, 289, 347, 348 Soft tissue sarcoma, 30, 348 Solid tumor, 283, 348 Soma, 348 Somatic, 9, 280, 326, 334, 348 Sound wave, 297, 301, 348, 355 Soybean Oil, 337, 348 Spasm, 46, 181, 220, 348 Spatial disorientation, 302, 348 Specialist, 264, 302, 348 Species, 8, 22, 170, 291, 306, 315, 316, 326, 327, 332, 341, 342, 348, 350, 354, 357 Specificity, 26, 32, 181, 184, 280, 305, 348 Spectrum, 326, 341, 348 Sphincters, 307, 348 Spinal cord, 13, 289, 293, 294, 324, 325, 329, 330, 334, 341, 342, 345, 348, 351, 355 Spinal Nerves, 334, 348 Spinous, 306, 321, 348 Spleen, 262, 316, 324, 345, 348 Staging, 345, 349
Standard therapy, 43, 349 Statistically significant, 233, 349 Status Epilepticus, 220, 349 Stem Cells, 42, 173, 307, 349 Stenosis, 39, 130, 181, 195, 220, 349, 350 Steroid, 291, 315, 349 Stillbirth, 224, 349 Stimulant, 290, 302, 320, 349 Stimulus, 263, 298, 303, 304, 307, 319, 320, 321, 342, 349, 352 Stomach, 4, 250, 279, 302, 307, 310, 311, 312, 316, 321, 323, 329, 333, 335, 343, 347, 349 Stool, 296, 318, 321, 349 Streptococci, 349 Streptokinase, 31, 46, 48, 160, 166, 349 Stress Fibers, 33, 349 Stress management, 223, 349 Stricture, 349, 350 Stromal, 20, 42, 350 Stromal Cells, 42, 350 Subacute, 319, 350 Subclinical, 319, 346, 350 Subcutaneous, 198, 303, 322, 333, 350 Subspecies, 348, 350 Substance P, 307, 326, 338, 346, 350 Substrate, 32, 306, 309, 350 Substrate Specificity, 32, 350 Sudden cardiac death, 99, 157, 159, 350 Sudden death, 12, 19, 65, 72, 173, 191, 216, 350 Superoxide, 37, 192, 350 Superoxide Dismutase, 37, 192, 350 Supplementation, 154, 350 Support group, 263, 276, 350 Suppression, 24, 157, 177, 195, 299, 350 Survival Rate, 25, 42, 101, 350 Sweat, 219, 232, 350 Sweat Glands, 350 Sympathetic Nervous System, 28, 283, 287, 350, 351, 356 Sympathomimetic, 303, 306, 331, 351 Symphysis, 294, 339, 351 Symptomatic, 220, 351 Synapse, 280, 301, 330, 338, 351, 354 Synaptic, 330, 347, 351 Synaptic Transmission, 330, 351 Syncope, 219, 263, 351 Synergistic, 24, 351 Systemic, 34, 80, 283, 285, 289, 290, 306, 319, 338, 345, 351, 357 Systemic disease, 80, 351
Index 373
Systolic, 11, 15, 130, 225, 253, 317, 351 Systolic pressure, 253, 351 T Tachycardia, 107, 302, 351 Temporal, 42, 108, 351 Testosterone, 342, 351 Thermal, 302, 330, 351 Thioredoxin, 40, 351 Third Ventricle, 317, 351 Thoracic, 287, 289, 324, 341, 352, 355, 357 Thoracotomy, 197, 352 Threonine, 179, 340, 346, 352 Threshold, 190, 317, 352 Thrombin, 16, 33, 39, 309, 336, 339, 340, 352 Thrombocytes, 174, 194, 336, 352 Thromboembolism, 25, 89, 160, 352 Thrombolytic, 44, 52, 68, 90, 110, 114, 162, 166, 175, 176, 179, 180, 336, 349, 352 Thrombolytic Therapy, 44, 90, 110, 162, 166, 349, 352 Thrombomodulin, 339, 352 Thromboses, 122, 352 Thromboxanes, 285, 352 Thrombus, 16, 28, 40, 175, 176, 179, 190, 299, 319, 328, 336, 352, 356 Thyroid, 208, 220, 317, 352, 355 Thyroxine, 281, 301, 335, 352 Tidal Volume, 317, 352 Time Management, 349, 352 Tin, 258, 292, 336, 352 Tissue Plasminogen Activator, 175, 176, 245, 352 Tolerance, 279, 312, 353 Tomography, 30, 297, 345, 353 Tone, 331, 353 Tonic, 292, 307, 353 Tooth Loss, 232, 353 Tooth Preparation, 279, 353 Topical, 316, 347, 353 Torsion, 319, 353 Toxic, iv, 13, 188, 287, 291, 297, 300, 302, 306, 313, 317, 330, 353 Toxicity, 8, 30, 37, 38, 325, 353 Toxicology, 240, 353 Toxins, 284, 312, 319, 353 Toxoplasmosis, 287, 353 Trace element, 352, 353 Tracer, 12, 20, 177, 353 Trachea, 290, 335, 352, 353 Transduction, 347, 353 Transfection, 288, 311, 353
Translation, 282, 307, 353 Transmitter, 279, 303, 320, 324, 331, 354 Transplantation, 13, 173, 192, 220, 318, 321, 354 Trauma, 35, 196, 276, 293, 314, 354 Tremor, 329, 354 Triad, 34, 354 Triage, 17, 162, 354 Tricyclic, 12, 144, 301, 354 Triglyceride, 9, 36, 37, 252, 317, 354 Tropomyosin, 354 Troponin, 116, 117, 172, 245, 354 Trustees, 98, 354 Tryptophan, 296, 346, 354 Tumor marker, 288, 354 Tumor model, 30, 354 Tumor Necrosis Factor, 45, 354 Tunica, 304, 327, 354 Tunica Intima, 304, 354 Type 2 diabetes, 45, 150, 217, 224, 354 Tyrosine, 196, 301, 303, 355 U Ulcer, 250, 334, 355 Ulceration, 33, 355 Ulnar Nerve, 219, 355 Ultrasound test, 158, 355 Unconscious, 263, 277, 283, 317, 355 Unsaturated Fats, 309, 355 Urea, 321, 350, 355 Uremia, 321, 355 Ureters, 355 Urethra, 339, 355 Uric, 313, 317, 341, 355 Urinary, 12, 204, 257, 290, 318, 331, 353, 355 Urinary Plasminogen Activator, 353, 355 Urinary tract, 257, 355 Urinary tract infection, 257, 355 Urine, 217, 275, 285, 288, 299, 301, 302, 318, 321, 329, 331, 355 Urokinase, 175, 186, 187, 355 Urticaria, 283, 355 Uterus, 294, 299, 300, 309, 322, 325, 355, 356 V Vaccine, 280, 340, 355 Vagina, 294, 325, 356 Vascular, 4, 7, 9, 10, 15, 20, 21, 28, 33, 35, 39, 41, 43, 51, 69, 154, 158, 165, 181, 185, 196, 199, 200, 220, 231, 281, 283, 289, 290, 305, 319, 326, 330, 336, 352, 355, 356
374 Heart Attack
Vascular endothelial growth factor, 21, 356 Vasoactive, 10, 356 Vasoconstriction, 28, 51, 182, 302, 306, 356 Vasodilatation, 292, 320, 356 Vasodilation, 28, 165, 283, 356 Vasodilator, 87, 188, 284, 290, 303, 328, 356 Vasomotor, 28, 165, 307, 356 Vasomotor System, 28, 356 Vasopressor, 188, 356 VE, 57, 58, 62, 93, 120, 122, 356 Vein, 12, 42, 150, 283, 286, 320, 331, 333, 335, 345, 356 Venous, 25, 160, 182, 194, 286, 290, 293, 330, 339, 356, 357 Venous blood, 194, 290, 293, 356 Venous Thrombosis, 356, 357 Ventilation, 291, 356 Ventricle, 174, 184, 194, 298, 326, 341, 351, 352, 356 Ventricular Dysfunction, 174, 356 Ventricular fibrillation, 63, 175, 190, 356 Ventricular Function, 42, 134, 161, 197, 356 Ventricular Remodeling, 42, 197, 356 Venules, 289, 291, 305, 326, 357 Vertebrae, 348, 357
Vertebral, 257, 357 Vertigo, 256, 357 Vestibular, 256, 257, 357 Vestibule, 357 Veterinary Medicine, 239, 357 Virulence, 353, 357 Virus, 35, 287, 311, 313, 336, 344, 353, 357 Viscosity, 316, 357 Vitreous, 301, 322, 344, 357 Vitreous Hemorrhage, 301, 357 Vitro, 38, 40, 173, 315, 357 Vivo, 14, 22, 33, 38, 40, 41, 173, 357 Volition, 320, 357 W War, 17, 110, 357 Warfarin, 58, 71, 153, 357 White blood cell, 284, 322, 324, 327, 328, 336, 357 Windpipe, 335, 352, 357 Wound Healing, 16, 21, 30, 319, 357 X Xenograft, 284, 354, 357 X-ray, 283, 285, 289, 297, 298, 309, 331, 342, 345, 357 Z Zymogen, 339, 358
Index 375
376 Heart Attack
