Cardiovascular testing

Cohort sizes ranged from 340 to 21,829 men. Results of cardiovascular tests (electrocardiogram, blood pressure measurement) were similar between 22 aluminum workers exposed for 10 years or more and an unexposed control group of 16 men (Bast-Peetersen et al. 1994). 

Similar, but anecdotal reports were also described in patients without evidence of previous cardiac disease and receiving low-dose interferon alfa (SEDA-20, 326). In chronic viral hepatitis, only seven of 11 241 patients had severe cardiac adverse effects (16). The exact risk of such cardiovascular adverse effects is unknown. In patients with chronic viral hepatitis, cardiovascular test results were not modified when patients were re-examined after at least 6 months of treatment, even where there was an earlier cardiac history (26), but there was a potentially critical reversible reduction in left ventricular ejection of more than 10% in another prospective study (27). 

Measurement of electrical activity in the heart, now known as the electrocardiogram (ECG), was introduced about 75 years ago by Willem Einthoven. The ECG is simple to perform and is the most frequently used, least invasive, and cheapest cardiovascular test. ° It remains the procedure of first choice for evaluation of chest pain, dizziness, or syncope. In its simplest interpretation, the ECG characterizes rhythms and conduction abnormalities. However, the ECG also provides, by inference, information about the anatomy and structures of the heart, pathophysiologic changes, and hemodynamics of the CVD system. ECG abnormalities are often the earliest sign of adverse drug effects, ischemia, and electolyte abnormalities. 

ECHO is the use of ultrasound to visualize anatomic structures such as the valves within the heart and to describe wall motion. Clinically, ECHO is the most frequently used noninvasive cardiovascular test, aside from the ECG. It competes well with invasive techniques such as cardiac catheterization with angiography for the evaluation of ischemia and valvular abnormalities. ECHO is... 

Whereas the in vitro tests for APD prolongation and Ikr blockade have advanced the ability to screen for QT prolongation, there are a number of technical limitations, and the results do not necessarily correlate with occurrence of adverse cardiac effects in patients. Therefore, these tests are regarded as a means of identifying the presence of a potential risk. Results of all in vitro and in uivo cardiovascular tests must be considered and integrated in developing a complete risk assessment (106). 

In animal models, renin inhibitors after iv adrninistration have been shown to be equally efficacious as compared to ACE inhibitors in lowering blood pressure, and to have similar effects on the cardiovascular and renal parameters. Some of the renin inhibitors tested are enalkiren (A-64662), CGP 38 560A, CP 71362, KRI-1230, U-71039, ES6864, and PD-134672. The stmctures of enalkiren and the formula for PD-134672 are shown in Figure 4. 

KC706 stabilizes the inactive conformation of the mitogen-activated protein kinase p38a, a protein kinase involved in inflammatory reactions and cardiovascular functions. KC706 therefore holds the potential to treat conditions such as rheumatoid arthritis, psoriasis, inflammatory bowel disease and cardiovascular disease. This compound is currently being tested in phase II clinical trials with patients suffering from rheumatoid arthritis. 

It has been proposed that the development of the complications of diabetes mellitus may be linked to oxidative stress and therefore might be attenuated by antioxidants such as vitamin E. Furthermore, it is discussed that glucose-induced vascular dysfunction in diabetes can be reduced by vitamin E treatment due to the inactivation of PKC. Cardiovascular complications are among the leading causes of death in diabetics. In addition, a postulated protective effect of vitamin E (antioxidants) on fasting plasma glucose in type 2 diabetic patients is also mentioned but could not be confirmed in a recently published triple-blind, placebo-controlled clinical trial [3]. To our knowledge, up to now no clinical intervention trials have tested directly whether vitamin E can ameliorate the complication of diabetes. 

During tiie ongoing assessment, tiie nurse assesses the respiratory status every 4 hours and whenever tiie drug is administered. The nurse notes the respiratory rate, lung sounds, and use of accessory muscles in breathing, hi addition, tiie nurse keeps a careful record of the intake and output and reports any imbalance, which may indicate a fluid overload or excessive diuresis. It is important to monitor any patient with a history of cardiovascular problems for chest pain and changes in the electrocardiogram. The primary health care provider may order periodic pulmonary function tests, particularly for patients with emphysema or bronchitis, to help monitor respiratory status. 

The a-tocopherol, P-carotene (ATBC) Cancer Prevention study was a randomised-controlled trial that tested the effects of daily doses of either 50 mg (50 lU) vitamin E (all-racemic a-tocopherol acetate), or 20 mg of P-carotene, or both with that of a placebo, in a population of more than 29,000 male smokers for 5-8 years. No reduction in lung cancer or major coronary events was observed with any of the treatments. What was more startling was the unexpected increases in risk of death from lung cancer and ischemic heart disease with P-carotene supplementation (ATBC Cancer Prevention Study Group, 1994). Increases in the risk of both lung cancer and cardiovascular disease mortality were also observed in the P-carotene and Retinol Efficacy Trial (CARET), which tested the effects of combined treatment with 30 mg/d P-carotene and retinyl pahnitate (25,000 lU/d) in 18,000 men and women with a history of cigarette smoking or occupational exposure to asbestos (Hennekens et al, 1996). 

Laboratory Tests The following tests may indicate additional cardiovascular risk factors or poor control of diabetes. Elevated fasting lipid panel Elevated fasting blood glucose Hemoglobin A1c greater than 7.0%... 

Moderate risk Has three or more risk factors for coronary artery disease Has moderate, stable angina Had a recent myocardial infarction or stroke within the past 6 weeks Has moderate congestive heart failure (NYHA Class 2) Fbtient should undergo a complete cardiovascular work-up and treadmill stress testing to determine tolerance to increased myocardial energy consumption associated with increased sexual activity... 

Adverse reactions CNS Convulsions, confusion, drowsiness, myoclonus, fever Dermatologic Rash Metabolic Electrolyte imbalance Hematologic Positive Coombs test, hemolytic anemia Local Rain, thrombophlebitis Renal Acute interstitial nephritis Miscellaneous Anaphylaxis, hypersensitivity, Jarisch-Herxheimer reaction CNS Seizures, confusion, drowsiness, myoclonus, CNS stimulation Cardiovascular Myocardial depression, vasodilation, conduction disturbances Hematologic Positive Coombs test, hemolytic anemia, neutropenia Local Thrombophlebitis, sterile abscess at injection site Renal Interstitial nephritis Miscellaneous Pseudoanaphylactic reactions, hypersensitivity, Jarisch-Herxheimer reaction, serum sickness... 

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