The cardiovascular system is regulated by the autonomic nervous system, under cortical modulation. Stroke can induce cardiac autonomic imbalance, therefore, causing secondary cardiovascular complications. Heart rate variability (HRV) analysis is a simple method to appraise the autonomic nervous function. The purpose of this study was to investigate the cardiac autonomic activity in patients that suffered an ischemic stroke in middle cerebral artery (MCA) territory. Using Biopac Acquisition System, we monitored ECG in rest condition and during Ewing's tests. From these measurements, HRV parameters (using time and frequency domain analysis) were determined in 20 right MCA and 20 left MCA ischemic stroke patients, in the first 6 months after the acute event. Data were compared with 20 age- and sex-matched healthy controls. All the patients were right handed. In ischemic stroke patients, HRV parameters were significantly modified compared to controls (p < 0.05) and we found asymmetric responses to different stimulation autonomic tests between right and left hemisphere. Parameters illustrating the parasympathetic predominance in time domain (RMSSD) and frequency domain (HF) analysis were higher in left hemisphere stroke compared to right hemisphere stroke patients (p < 0.01) in resting state. From Ewing's battery test, patients with left hemisphere ischemic stroke showed predominance of parasympathetic activity to deep breathing (p < 0.01), while HRV parameters in right hemisphere ischemic stroke patients described a reduced cardiac parasympathetic innervation (p < 0.01). Cardiac autonomic imbalance occurs more often after right hemisphere ischemic stroke. HRV study may highlight cardiac dysfunctions that increase the risk of cardiovascular complications and portends a poor long-term outcome.

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Maintenance is a crucial topic in the life cycle management of medical equipment. Evidence-based maintenance consists of continuous monitoring of equipment performance, starting from evidence—the current state from the point of view of fault history—and improving its efficiency through the necessary modifications. This process is very important for optimizing the use and allocation of the resources available by the clinical engineering departments. Maintenance of medical equipment consists of two basic activities: scheduled maintenance and corrective maintenance. The purpose of this chapter is to present document-based methods to evaluate every aspect of the medical equipment maintenance process and to provide a correct, objective and standardized approach that supports clinical engineering activities. Following the analysis, the results show that the combination of the use of the two methods provides an overview, in a periodic manner, of maintenance performance that indicates the use of the most appropriate procedures.

Medical equipment risk assessment is part of an overall medical equipment management program for a healthcare facility or system. A complete program includes corrective maintenance or repair, equipment control, asset management, health care technology planning, education, and activities directed toward improving medical device-related patient safety. The purpose of this paper is to provide some guidance lines in establishing and managing a medical equipment quality assurance program and to present some procedures for inspection, maintenance, evaluation, and performance testing for some medical devices. A computerized medical equipment management system is described. The results demonstrate that it is a useful tool in tracking device inventory and maintenance history. Also risk classes have been designed for medical devices based on the time of testing, risk must be identified in relation to patient and staff member. The results of this paper take into consideration the advances in device reliability, reduced preventive maintenance requirements, and internal device surveillance (self test) along with changes in standards.

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Atherosclerosis remains the leading cause of mortality and morbidity worldwide characterized by the deposition of lipids and fibrous elements in the form of atheroma plaques in vascular areas which are hemodynamically overloaded. The global burden of atherosclerotic cardiovascular disease is steadily increasing and is considered the largest known non-infectious pandemic. The management of atherosclerotic cardiovascular disease is increasing the cost of health care worldwide, which is a concern for researchers and physicians and has caused them to strive to find effective long-term strategies to improve the efficiency of treatments by managing conventional risk factors. Primary prevention of atherosclerotic cardiovascular disease is the preferred method to reduce cardiovascular risk. Fasting, a Mediterranean diet, and caloric restriction can be considered useful clinical tools. The protective impact of physical exercise over the cardiovascular system has been studied in recent years with the intention of explaining the mechanisms involved; the increase in heat shock proteins, antioxidant enzymes and regulators of cardiac myocyte proliferation concentration seem to be the molecular and biochemical shifts that are involved. Developing new therapeutic strategies such as vagus nerve stimulation, either to prevent or slow the disease’s onset and progression, will surely have a profound effect on the lives of millions of people.

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