Subarachnoid Haemorrhage in an Elderly Patient with Comorbidities

AbstractSubdural hemorrhage is usually caused by a traumatic injury. Other risk factors that may lead to subdural hemorrhage include: hypertension, anticoagulants, elderly, alcohol abuse, vascular abnormalities etc. Mortality range is between 50% and 90% depending on age, admission Glasgow Coma Scale (GCS) and anticoagulant treatment. We present a case of 74-year old patient, female, known for diabetes, high blood pressure, obesity, chronic heart failure, receiving anticoagulant treatment, bronchial asthma who develops a posttraumatic massive chronic subdural hematoma accompanied by comorbidities.

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Intestinales Mikrobiom und kardiovaskuläre Erkrankungen

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/a-0746-4002 ◽

2019 ◽

Vol 144 (14) ◽

pp. 957-963

Author(s):

Hans-Michael Steffen ◽

Münevver Demir

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Heart Failure ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Vascular Function ◽

Kardiovaskuläre Erkrankungen ◽

Intestinal Microbiome ◽

Current Review

AbstractAging, physical activity, bodyweight and diet are well established risk factors for cardiovascular disease. For all of these factors a great impact on the intestinal microbiome has been described. The current review will discuss available data regarding the role of the gut microbiome in regulating blood pressure, vascular function and its possible contribution to atherosclerosis and heart failure.

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Risk factors for development of significant chronic subdural hematoma following conservative treatment of acute subdural hemorrhage

British Journal of Neurosurgery ◽

10.3109/02688697.2014.918578 ◽

2014 ◽

Vol 28 (6) ◽

pp. 733-738 ◽

Cited By ~ 14

Author(s):

Yosef Laviv ◽

Zvi Harry Rappaport

Keyword(s):

Risk Factors ◽

Conservative Treatment ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Subdural Hemorrhage

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Clinical and Genetic Determinants of Heart Failure: Optimized by Machine Learning and Mendelian Randomization

10.21203/rs.3.rs-670567/v1 ◽

2021 ◽

Author(s):

liao li zhen ◽

chen zhi chong ◽

li wei dong ◽

liao xin xue ◽

zhuang xiao dong

Keyword(s):

Machine Learning ◽

Risk Factors ◽

Heart Failure ◽

Blood Pressure ◽

Regression Analysis ◽

Mendelian Randomization ◽

Cox Regression ◽

Atherosclerosis Risk In Communities ◽

Cox Regression Analysis ◽

Potential Risk Factors

Abstract Background: Identifying unrecognized, potentially modifiable risk factors is essential for heart failure (HF) management.Methods: The Atherosclerosis Risk in Communities (ARIC) study was used for machine learning (ML) to establish the top 20 important variables as potential risk factors for HF. Multivariable Cox regression analysis was performed in an explorative manner to find independent factors for HF and Mendelian randomization (MR) analysis to address causality.Results: Of the 14,842 participants included in the ARIC analysis, 20.4% of participants (3,028) were identified as HF. The 20 variables with the highest importance selected by ML were creatinine, glucose, age, previous coronary artery disease (CAD), systolic blood pressure, fibrinogen, albumin, income, diabetes, magnesium, insulin, white blood cell, hemoglobin, sodium, education, phosphorus, diastolic blood pressure, protein-c, heart rate and body mass index (BMI). Cox regression analysis demonstrated 19 independently associated variables except sodium. MR analysis provided evidence supporting that genetically determined BMI, CAD, diabetes and education was causally associated with HF.Conclusions: The ML plus MR framework was useful in identifying important causal factors of HF. BMI, CAD, diabetes, and education not only served as excellent prognostic factors for HF, but therapeutics targeted at these factors were likely to prevent HF effectively.

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BOTH HIGH AND LOW SUPINE BLOOD PRESSURE AS WELL AS ITS POSTURAL FALL ARE INDEPENDENT RISK FACTORS FOR THE PROGNOSIS IN PATIENTS WITH HEART FAILURE

Journal of Hypertension ◽

10.1097/01.hjh.0000539734.95740.84 ◽

2018 ◽

Vol 36 (Supplement 1) ◽

pp. e257

Author(s):

R. Imazu ◽

S. Fujishima ◽

S. Yamamoto ◽

K. Yamamori ◽

H. Shimazoe ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Blood Pressure ◽

Supine Blood Pressure ◽

Patients With Heart Failure ◽

Independent Risk Factors

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Longitudinal changes of left ventricular systolic function and risk of heart failure and mortality among men and women from a general population

European Heart Journal ◽

10.1093/ehjci/ehaa946.2844 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

B Arshi ◽

G Papageorgiou ◽

O.L Rueda-Ochoa ◽

M.A Ikram ◽

D Rizopoulos ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Blood Pressure ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Systolic Function ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Composite Outcome ◽

Men And Women

Abstract Background The incidence and characteristics of heart failure (HF) differ between men and women. However, evidence regarding sex differences in determinants and changes of cardiac function in association with incidence of HF remains scarce. Purpose To study the evolution and determinants of left ventricular ejection fraction (LVEF) over time and its association with incident mortality and HF among men and women. Methods From a population-based cohort, we included 7923 participants, 3319 men and 4604 women, free of heart failure (HF) and atrial fibrillation with up to 3 repeated echocardiographic measurements. Using joint models, we analyzed the evolution of LVEF and its associated traditional cardiovascular risk factors among men and women. Second, we studied the association of LVEF changes with incident HF and mortality as a composite outcome adjusted for age (time-varying covariate) and traditional cardiovascular risk factors. We then performed the analyses with HF and mortality as competing events. Results Mean (SD) age was 65.7 (9.6) in men and 66.5 (10) in women. During a median follow-up of 9 years, 988 events in men and 840 events in women occurred. LVEF had a one-directional nonlinear declining with increasing age among men and women (Figure). Up to age of 70, LVEF showed a sharper decline per year among men compared to women. Every unit increase in systolic blood pressure (SBP) was associated with 0.03% (0.05% to 0.02%) decrease in LVEF per year in men. Among women, SBP had an inverse J-shaped association with LVEF changes (P<0.001). Diastolic blood pressure (DBP) also showed a non-linear association with LVEF in both sexes. Prevalent diabetes was not associated with LVEF change. In the survival analysis, every 5% decrease in LVEF was associated with 35% and 30% increase in the risk of the composite outcome among men [HR (95% CI): 1.35 (1.26 to 1.43)] and women [HR (95% CI): 1.30 (1.22 to 1.40)]. Conclusion(s) Despite a similar risk of LVEF decline for the composite outcome, the evolution of LVEF, especially before 70 years of age, differ between men and women. Cardiovascular risk factors, especially blood pressure, play diverse roles in the evolution of left ventricular systolic function among men and women. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam.

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Care of the Elderly Mechanically Ventilated Patient: Preserving the Fragile Environment

AACN Advanced Critical Care ◽

10.4037/15597768-1992-1016 ◽

1992 ◽

Vol 3 (1) ◽

pp. 129-136

Author(s):

Johanna K. Stiesmeyer

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Elderly Patient ◽

Congestive Heart Failure ◽

Minute Ventilation ◽

The Elderly ◽

Clinical Situation ◽

Course Of Illness ◽

Mechanically Ventilated ◽

Fragile Environment

Caring for the elderly mechanically ventilated patient is a challenging and increasingly frequent clinical situation confronting critical nurses. The key complications and states to which the elderly patient is particularly susceptible are nosocomial pneumonia; congestive heart failure; malnutrition; reactions to medications, especially antibiotics, morphine sulfate, and Valium; changes in mental status, and pneumothorax. These can significantly contribute to multisystem deterioration. It is unclear which mode of ventilation is best for sustaining the patient during the course of illness or the weaning process. It is critical to recognize the assessment indicators of failed weaning. Paramount in this assessment are rapid shallow breaths, change in blood pressure of 20 mmHg, change in respiratory rate of more than 10 breaths per minute, tidal volume of less than 250 to 300 mL, a minute ventilation with an increase of 5 L/minute, and an oxygen saturation of less than 90% per pulse oximeter. Research in these areas is needed

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Impact of risk factors for major cardiovascular diseases: a comparison of life-time observational and Mendelian randomisation findings

Open Heart ◽

10.1136/openhrt-2021-001735 ◽

2021 ◽

Vol 8 (2) ◽

pp. e001735

Author(s):

Lars Lind ◽

Martin Ingelsson ◽

Johan Sundstrom ◽

Johan Ärnlöv

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Heart Failure ◽

Blood Pressure ◽

Risk Factor ◽

Systolic Blood Pressure ◽

Ischaemic Stroke ◽

Important Risk Factor ◽

Mendelian Randomisation

BackgroundThis study compared the strength and causality of associations between major risk factors for cardiovascular disease (CVD) and the four major CVDs: myocardial infarction, ischaemic stroke, heart failure and atrial fibrillation. Both a long-term follow-up in an observational cohort and Mendelian randomisation (MR) were used for this aim.MethodsIn the Uppsala Longitudinal Study of Adult Men study, 2322 men, all aged 50 years, were assessed for CVD risk factors and then followed for four decades regarding incident CVDs. The two-sample MR part used public available Genome-Wide Association Study (GWAS) data.ResultsIn multivariate analyses, systolic blood pressure was overall by far the most important risk factor, since it was related to all four CVDs, both in observational and MR analyses. Body mass index was the second most overall important risk factor, being linked to all four CVDs, except ischaemic stroke, both in observational and MR analyses. Smoking was an important risk factor for ischaemic stroke and heart failure, both in observational and MR analyses, while low-density lipoprotein-cholesterol mainly was related to myocardial infarction. Diabetes was mainly a causal risk factor for incident myocardial infarction and heart failure. Neither HDL-cholesterol nor triglycerides were of major importance as risk factors in these multivariable models.ConclusionBy combining long-term observational data with genetic data, we show that the impact and causal role of specific established cardiovascular risk factors varies between different major CVDs. Systolic blood pressure was causally related to all four cardiovascular outcomes and was therefore, overall, the most important risk factor.

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Cardiovascular Disease among Breast Cancer Survivors

10.31487/j.cdm.2020.01.01 ◽

2020 ◽

pp. 1-5

Author(s):

Steven S. Coughlin ◽

Ban Majeed ◽

Deepak Ayyala ◽

Gaston Kapuku ◽

Letisia Cortes ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Heart Failure ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Congestive Heart Failure ◽

Cancer Survivors ◽

Cardiovascular Events ◽

Breast Cancer Survivors ◽

History Of

Background: Among breast cancer survivors age > 50 years, deaths due to cardiovascular disease account for 35% of non-cancer related deaths. The increases in cardiovascular disease among breast cancer survivors is due to the cardiotoxic effects of breast cancer treatment and to overlapping risk factors for breast cancer and cardiovascular disease. Methods: We conducted a study of a sample of 164 breast cancer patients in order to examine the frequency of cardiovascular disease. The overall objective was to examine the frequency of high blood pressure, myocardial infarction, cardiomyopathy, congestive heart failure, stroke, and venous thrombosis/thromboembolism among women who have been diagnosed with stage I-IV breast cancer and who had completed primary therapy for the disease. Data were collected by postal survey and abstraction of electronic medical records. Results: A high percentage of the women (62.8%) had a reported history of high blood pressure. Fifty percent of the women had a reported history of high cholesterol. About 8.3% of the women were current smokers and 36.0% were former smokers. About 23.8% of the women had a reported history of diabetes. About 4.9% of the women had a reported history of congestive heart failure and 6.1% had a history of stroke. Discussion: Additional studies are needed of cardiovascular risk factors and adverse cardiovascular events among breast cancer survivors. Of particular concern is whether patients with hypertension, hypercholesterolemia, and diabetes are receiving appropriate therapy to reduce their cardiovascular risk and prevent morbidity and mortality from adverse cardiovascular events.

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Abstract P157: Challenging Blood Pressure Control In Heart Failure Patients And Related Factors

Hypertension ◽

10.1161/hyp.76.suppl_1.p157 ◽

2020 ◽

Vol 76 (Suppl_1) ◽

Author(s):

Hong Seok c Lee ◽

Hong Seok c Lee

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Blood Pressure ◽

Logistic Regression ◽

Blood Pressure Control ◽

Beta Blocker ◽

Pressure Control ◽

Medical Reason ◽

Heart Failure Patients ◽

Neprilysin Inhibitor

Background: The 2017 ACC/AHA hypertension guidelines were released, and it specified blood pressure (BP) control goals in diverse situation. We will determine how the guideline can affect heart failure blood pressure control and risk factors for the control. There is not enough data how BP is controlled and what risk factors are related to controlled BP in heart failure patients according to the 2017 hypertension guideline. Method: 3276 heart failure patients who visited a community hospital for any medical reason were included and analyzed retrospectively from November 2017 to December 2018. Control of blood pressure will be defined based on the guidelines which show that heart failure patients’ blood pressure target is less than 130 /80 mmHg. ACE inhibitors/Aldosterone receptor blocker, diuretics(HCTZ, Furosemide, Butamex), Spironolactone, calcium channel blocker, and Angiotensin Receptor Neprilysin Inhibitor( Entresto), comorbidities(diabetes, chronic kidney disease, hyperlipidemia), age, gender, and ethnicities were collected and used for multi-variable adjusted logistic regression model. Results: 29.6% (555/1873) male patients were controlled based on the guidelines, on the contrary, 34.3%(482/1403) female patients revealed blood pressure control.The African american population’s BP was the most uncontrolled among all ethnicities. Multivariable logistic regression analysis was performed. Age of less than 65 years old [Odds ratio (OR): 2.81,95% Confidence Interval(CI): 2.41-3.26] was associated with controlled blood pressure. DM [OR: 0.71,95% CI: 0.61-0.82], beta-blocker [OR: 0.79,95% CI: 0.64-0.96] and LDL of more than 100mg/dl [OR: 0.57,95%, CI: 0.45-0.71] were noted to have significantly the uncontrolled BP. Conclusion: It appears about only one third of heart failure patients may be having their BP controlled based on 2017 ACC/AHA guideline. Beta-blocker were associated with uncontrolled blood pressure, which might suggest their dose of beta-blocker was not maximized for heart failure patients’ care. Clinicians may need to consider to try the higher dose if patients are tolerating. Elderly heart failure patients with DM or high LDL level (>100mg/dl)may need strict blood pressure control by better management of DM and LDL.

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