Opinion statement Microvascular coronary dysfunction (MCD) is an increasingly recognized cause of cardiac ischemia and angina, more commonly diagnosed in women. Patients with MCD present with the triad of persistent chest pain, ischemic changes on stress testing, and no obstructive coronary artery disease (CAD) on cardiac catheterization. Data from National Heart, Lung and Blood Institute (NHLBI)-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study has shown that the diagnosis of MCD is not benign, with a 2.5% annual risk of adverse cardiac events including myocardial infarction, stroke, congestive heart failure, or death. The gold standard diagnostic test for MCD is an invasive coronary reactivity test (CRT), which uses acetylcholine, adenosine, and nitroglycerin to test the endothelial dependent and independent, microvascular and macrovascular coronary function. The CRT allows for diagnostic and treatment options as well as further risk stratifying patients for future cardiovascular events. Treatment of angina and MCD should be aimed at ischemia disease management to reduce risk of adverse cardiac events, ameliorating symptoms to improve quality of life, and to decrease the morbidity from unnecessary and repeated cardiac catheterization in patients with open coronary arteries. A comprehensive treatment approach aimed at risk factor managment, including lifestyle counseling regarding smoking cessation, nutrition and physical activity should be initiated. Current pharmacotherapy for MCD can include the treatment of microvascular endothelial dysfunction (statins, angiotensin-converting enzyme inhibitor, low dose aspirin), as well as treatment for angina and myocardial ischemia (beta blockers, calcium channel blockers, nitrates, ranolazine). Additional symptom management techniques can include tri-cyclic medication, enhanced external counterpulsation, autogenic training, and spinal cord stimulation. While our current therapies are effective in the treatment of angina and MCD, large randomized outcome trials are needed to optimize strategies to improve morbidity and mortality.
The present study was undertaken to study the effect of corticosteroids on lecithin production in fetal lung. Rabbit fetuses were injected intraperitoneally with hydrocortisone succinate at 24 days of gestation and sacrificed at 27 days. Lung DNA concentration was not changed, but evidence is presented to suggest that total lung DNA content was decreased by saline injection and by steroid injection. Minimum surface tension of pooled lungs was increased by control injections but was reduced to ‘normal’ levels by the steroids. Steroids caused no significant change in lung total phospholipid or lecithin contents. The specific activity of labelled choline, methionine and palmitate indicated increased incorporation of choline and palmitate into lung lecithin in steroid-injected fetuses. It is suggested that steroids accelerate fetal lung development by influencing the composition of surfactant at the alveolar surface.
Conditions facilitating diabetics' learning were sought. Diabetic clients ( N = 114) from five hospitals in Western United States were studied to determine relationships between clients' knowledge, demographic descriptors, and various teaching approaches. Relationships were analyzed using correlation, multiple correlation and t tests. High pretest scores, as determined by multiple regression ( R .64), were obtained by clients who: (a) were better educated, (b) had obtained information in a hospital, (c) had diabetes longer, and (d) were younger. High posttest scores, determined by multiple regression ( R .53), were obtained by clients who: (a) were better educated, (b) were younger, (c) obtained diabetic information on an outpatient basis, and (d) had read more written material about diabetes. High difference scores, determined by multiple regression ( R .40), were obtained by clients who: (a) were more recently diagnosed, (b) received instruction in an outpatient course, and (c) had less formal education. Knowledge scores of clients who received instruction in the hospital or on an outpatient basis were not different at pretest but were at posttest. Diabetic clients learned more about management of their disease in classes taught after hospitalization.
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