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Diabetes Insipidus

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Once upon a time there was a 40-year-old Caucasian homeless male who had signs of dehydration including dry skin, dry mucous membranes, confusion, sunken eyes, and muscle weakness with BP 80/65, T 99.4F, HR 120, RR 22, SpO2 97%, Na 152, absence of pain, and complaints of dizziness and unquenchable thirst and was leaving a trail of urine all over town. The nurse assesses the patient and determines he has diabetes insipidus and begins to administer vasopressin and monitor hydration and electrolyte status, strict I&O’s per doctor’s orders. As a result of the actions the patient was discharged seaside to Ventura with his friends after BP 125/82, T 98.6F, HR 82, RR 20, SpO2 99%, Na 144, absence of pain and no complaints.

Team: Jenna, Nikki, Jennifer, and Allie

Jenna Fordis 2015-02-28 00:22:01

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Heart healthy or hype?

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Heart Health or Hype? Exploring the effect of diet trends on cardiovascular disease

This article looks at diet trends for cardiovascular health, mainly foods that are supposedly “especially good for the heart,” and find out whether they are heart healthy or hyped. I already knew that omega-3 fatty acids were heart healthy, but was surprised to hear about how the others affected cardiovascular health.

Cranberries – Heart healthy! Cranberries are rich in flavonoids which help reduce the oxidation of LDLs (bad one) which usually make up atherosclerotic plaques. They also help improve lipid profiles by increasing HDL and lowering LDL levels in the blood. Only a small amount is needed to get their good effects, so an occasional cranberry snack is good enough to be cardioprotective! Just make sure to get the fresh version.

Dark chocolate and cocoa – Heart healthy! Chocolate has a lot of catechins (which are flavanoid compounds) and procyanidins (another type of flavonoid). Like the same mechanism as mentioned above, they reduce the oxidation of LDLs and accumulation of plaque. Good to note though: you can’t just gorge on chocolate on top of your normal diet! If adding chocolate, there needs to be an elimination of an equivalent source of calories and maintenance of proper nutrition. Like the commercials say: EAT DARK CHOCOLATE! (part of a balanced, nutritional diet—shows a million vegetables and fruits)

Milk – Heart healthy! Although dairy contains CVD promoting fat and cholesterol, higher milk intake decreased incidence of diabetes mellitus, insulin resistance, and weight gain (especially abdominal fat). Dairy foods regulate energy metabolism and have antihypertensive effects (peptides from lactic acid bacteria in milk inhibits ACE enzymes and endothelin release). Low fat, skim milk, and yogurt are good options for people who want to increase dairy consumption.

Omega-3 fatty acids – Heart healthy! Omega-3 fatty caids have antiatherogenic, antithrombotic, and antiarrhythmic effects – all contribute to prevention of cardiovascular disease.

Diet plays a huge role in cardiovascular health, and some foods do have more benefits than others. It’s important to remember that food alone cannot prevent heart disease but it does have the power to heal. Regular exercise on top of a balanced diet with some of these heart healthy foods can help maintain a healthy heart.

Troponin-T Levels: New A-fib Risk Factor?

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A study published last month found that serial measures of high sensitivity cardiac troponin-T (hs-cTnT) levels may be used to predict incident atrial fibrillation (AF) independent of traditional risk factors. The study suggests that circulating troponin levels caused by either myocyte damage or protein turnover predispose older adults to AF and that it is a important part of the cardiac remodeling process. Higher baseline levels of Troponin-T were associated with a higher likelihood of developing incident AF. There are currently no interventions available for elevated troponin-T levels as a risk factor for developing AF but this association is important to advance knowledge regarding the mechanisms that lead to AF.

I believe that this is an interesting study because usually sometimes people may not even recognize symptoms of A-fib and the diagnosis may be delayed if people to not seek treatment, which could potentially lead to poorer outcomes. Although there are currently no interventions for elevated troponin-T levels as predictors of A-fib, the idea of an additional risk factor for A-fib could at the very least make providers more aware of the problem so that they could monitor patients closely and educate them of the signs and symptoms of A-fib if it does occur. Hopefully in the future we will be able to use this biomarker to “catch” A-fib and implement interventions before it even happens.

 

Hussein A, Bartz T, Gottdiener J, et al. Serial measures of cardiac troponin-T levels by a highly sensitive assay and incident atrial fibrillation in a prospective cohort of ambulatory older adults. Heart Rhythm 2015; DOI:10.1016/j.hrthm.2015.01.020

Transcatheter Aortic Valve Replacement (TAVR)

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I am fascinated with how technology has advanced and how it works, especially to fix cardiovascular diseases. I would like to share with everyone the coolest procedure that fixes aortic stenosis, called transcatheter aortic valve replacement, best known as TAVR. This procedure is for patients who suffer from severe aortic stenosis and whose advanced age puts them at high risk for death if they were to have open-heart surgery. The University of Iowa Heart and Vascular Center is one of a select group of centers across the nation, and the first in Iowa to offer this procedure to those qualified candidates (University of Iowa Hospitals and Clinics, 2015). In 2011, this center was the first in the nation to receive certification for its cardiac valve program from The Joint Commission (University of Iowa Hospitals and Clinics, 2015). It is important to note that this procedure is minimally invasive for the repair and replacement of the aortic valve. This procedure can be performed through two distinct sites, either from the patient’s thigh through the femoral artery or through a small incision on the lower left side of the patient’s chest. Sometimes the elderly have disease of the leg blood vessels; hence, the chest can be an alternative site (University of Iowa Hospitals and Clinics, 2015).

 

Basically, with this procedure, the damaged aortic valve is replaced with a prosthetic valve. This new technology uses a catheter inserted through a small incision in a patient’s thigh that travels though blood vessels and can be used to replace a person’s failing heart valve in the aortic artery. This procedure involves a team of interventional cardiologists, cardiac surgeons, and imaging specialists of the heart (University of Iowa Hospitals and Clinics, 2015). The recovery of this procedure is faster as opposed to open-heart surgery and it has proven to be a successful procedure. As we know, the blood passes through the aortic valve and then into our body where it perfusses our tissues and organs. If the valve is stenotic, then small amounts of blood can pass through this valve and symptoms develop such as shortness of breath and one can easily become tired. In the story of a 90-year-old woman, she would complain of being tired on a day-to-day basis and that led her to visit her doctor (University of Iowa Hospitals and Clinics, 2015). She then was diagnosed with aortic stenosis and the doctor recommended for this procedure. She agreed to undergo TARV and she admits it was the best decision made for improving her health. After four days, she was allowed to go home and she says she had no pain at all after the procedure (University of Iowa Hospitals and Clinics, 2015). She recommends this procedure for those who need it and overall she is doing well. Patients who don’t get treated for aortic stenosis can develop heart failure or cardiac arrest, and most importantly can die within a year of this problem (University of Iowa Hospitals and Clinics, 2015). By the way, check out the article below and you can watch the animated video of this procedure, which is amazing!

 

Reference:

University of Iowa Hospitals and Clinics. (2015). Transcatheter aortic valve replacement. Retrieved    from        http://www.uihealthcare.org/2column.aspx?id=227967

University of Iowa Hospitals and Clinics. (2015).

Alma’s story: New lease on life.       Retrieved from    http://www.uihealthcare.org/2column.aspx?id=230803

 

 

Basic ECG from a Mobile Device: AliveCor

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AliveCor is a mobile ECG device and app that attaches to a smartphone and interprets the heart’s electrical activity equivalent to a basic 1-lead ECG. While it does not replace the standard 12-lead ECG, it does allow patients to monitor their basic heart rhythms as they go about their daily lives. AliveCor is FDA-approved to detect Atrial Fibrillation and a study published in JAMA has shown it to be able to detect wide complex tachycardia. When used to its full potential, the device and app can track an individual’s heart rhythms as they correspond to daily life. The individual records their ECG tracing then can enter details about their activity, diet, medications, etc. All of this information is stored for later reference and comparison or it can be sent to the patient’s cardiologist by email for immediate review. This device enables cardiologists to gather more comprehensive data about the activity of their patients’ hearts instead of having to rely on office visit ECG monitoring that may not be an accurate reflection of the patients’ varying conditions. As we truly live in a mobile world with increasing use and dependence on smartphones, it is exciting to see healthcare providers begin embracing the use of  smartphones in their practice to improve the health of their patients.

References:

Home

http://www.alivecor.com/research

Waks, J. W., Fein, A. S., & Das, S. (2015). Wide complex tachycardia recorded with a smartphone cardiac rhythm monitor. JAMA Internal Medicine.

doi:10.1001/jamainternmed.2014.7586.

Retrieved from http://archinte.jamanetwork.com/article.aspx?articleid=2091739#

Customizing cardiac implants

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While conducting research for this week’s assignment regarding the newest cardiovascular technology, I came across this great article discussing heart implants and them being “tailor-made” (Bourzac, 2014). Current cardiac implants, such as pacemakers and defibrillators, are not custom made as they are basically “one size fits all” (Bourzac, 2014, para. 1). The article discusses researchers who have created a personalized heart sensor using a 3-D printer and their utilization of a stretchy material to create a perfect fit that would increase the level of monitoring and treatment of cardiac implants (Bourzac, 2014). The stretchy material would increase the effectiveness of oxygen monitoring, strain gauges, electrodes, and temperature monitoring as it would be customized to the person’s heart (Bourzac, 2014). An interesting concept presented in the article is the idea of sensors being placed on cardiac implants that could measure acidic conditions (Bourzac, 2014). In addition, light sensors could be placed on this stretchy material and would “provide information about heart-tissue health by identifying areas with poorly oxygenated blood, which is less transparent to light,” and could ultimately identify the occurrence of a myocardial infarction (Bourzac, 2014, para. 5). I think any time we are able to customize a treatment, we are able to better serve our patients and this concept of 3-D printing will most certainly contribute to higher quality patient care.

References:

Bourzac, K. (2014). Heart Implants, 3-D- – Printed to Order. Retrieved from:http://www.technologyreview.com/news/525221/heart-implants-3-d-printed-to-  order/

Cardiovascular Treatment: Stem Cell Therapy for Heart Disease

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We have all learned about stem cell therapy in the context of procedures such as bone marrow transplantation for cancer patients. Recently, there has also been significant research regarding testing the use of stem cells in the treatment of heart disease and the improvement of complications from acute myocardial infarction (AMI), heart failure, and cardiomyopathies. With AMI, percutaneous coronary intervention (PCI) has become standard treatment, and it is successful in reducing mortality (Puliafico, Penn, & Silver, 2013). This reduction in mortality however is associated with people living with the long-term complications of AMI, such as heart failure, in which half will die within five years of diagnosis (Puliafico, Penn, & Silver, 2013).

Then came the discovery of cardiac stem cells (Puliafico, Penn, & Silver, 2013). These stem cells are activated in the event of an AMI to attempt to repair damaged myocardium. It was then found that non-cardiac stem cells, such as those from bone marrow or adipose, can transdifferentiate into cardiomyocytes to help repair damaged heart tissue. There have been a multitude of different types of stem cells tested, along with different routes of infusing or injecting them into heart or vessel tissue. Research has shown that the introduction of stem cells after an AMI can improve ventricular ejection fraction (EF), volumes, wall motion, and infarct size. In heart failure patients, stem cells have also improved ventricular function through EF, improved functional class, reduced infarct size, decreased mortality, and acceptable safety outcomes (Puliafico, Penn, & Silver, 2013).

I think that this topic is fascinating because it has so much potential to save lives and improve outcomes for those with heart disease. Heart disease is the number one leading cause of death in the United States, and that will most likely not be changing anytime soon (Puliafico, Penn, & Silver, 2013). The research that is done now regarding stem cells can not only lead to improved outcomes for heart disease patients, but it can lead to future research for so many other conditions. While results presented in the article showed that improved outcomes were not consistent across a number of studies, it could be due to the multitude of different stem cells and administration methods possible. More research will be needed because cardiovascular stem cell therapy is still in its infancy. It is exciting to see where this research could potentially lead to though.

Reference:

Puliafico, S.B., Penn, M.S., & Silver, K.H. (2013). Stem cell therapy for heart disease. Journal of General Internal Medicine, 28(10), 1353-1363.

Image: http://www3.imperial.ac.uk/newseventsimages?p_image_type=mainnews2012&p_image_id=23503