Modeling the Interaction Between the Intra-Aortic Balloon Pump and the Cardiovascular System: The Effect of Timing.

Modeling the Interaction Between the Intra-Aortic Balloon Pump and the Cardiovascular System: The Effect of Timing.

Filed under: Depression Treatment

ASAIO J. 2012 Dec 19;
Schampaert S, Rutten MC, van T Veer M, van Nunen LX, Tonino PA, Pijls NH, van De Vosse FN

Because of the large number of interaction factors involved, the effects of the intra-aortic balloon pump (IABP) have not been investigated deeply. To enhance its clinical efficiency and to better define indications for use, advanced models are required to test the interaction between the IABP and the cardiovascular system. A patient with mild blood pressure depression and a lowered cardiac output is modeled in a lumped parameter computational model, developed with physiologically representative elements for relevant components of circulation and device. IABP support is applied, and the moments of balloon inflation and deflation are varied around their conventional timing modes. For validation purposes, timing is adapted within acceptable ranges in ten patients undergoing IABP therapy for typical clinical indications. In both model and patients, the IABP induces a diastolic blood pressure augmentation as well as a systolic reduction in afterload. The support capabilities of the IABP benefit the most when the balloon is deflated simultaneously with ventricular contraction, whereas inflation before onset of diastole unconditionally interferes with ejection. The physiologic response makes the model an excellent tool for testing the interaction between the IABP and the cardiovascular system, and how alterations of specific IABP parameters (i.e., timing) affect this coupling.
HubMed – depression

 

Psychometrics of the PHQ-9 as a measure of depressive symptoms in patients with heart failure.

Filed under: Depression Treatment

Eur J Cardiovasc Nurs. 2012 Dec 21;
Hammash MH, Hall LA, Lennie TA, Heo S, Chung ML, Lee KS, Moser DK

BackgroundDepression in patients with heart failure commonly goes undiagnosed and untreated. The Patient Health Questionnaire-9 (PHQ-9) is a simple, valid measure of depressive symptoms that may facilitate clinical assessment. It has not been validated in patients with heart failure.AimsTo test the reliability, and concurrent and construct validity of the PHQ-9 in patients with heart failure.MethodsA total of 322 heart failure patients (32% female, 61 ± 12 years, 56% New York Heart Association class III/IV) completed the PHQ-9, the Beck Depression Inventory-II (BDI-II), and the Control Attitudes Scale (CAS).ResultsCronbach’s alpha of .83 supported the internal consistency reliability of the PHQ-9 in this sample. Inter-item correlations (range .22-.66) and item-total correlation (except item 9) supported homogeneity of the PHQ-9. Spearman’s rho of .80, (p < .001) between the PHQ-9 and the BDI-II supported the concurrent validity as did the agreement between the PHQ-9 and the BDI-II (Kappa = 0.64, p < .001). At cut-off score of 10, the PHQ-9 was 70% sensitive and 92% specific in identifying depressive symptoms, using the BDI-II scores as the criterion for comparison. Differences in PHQ-9 scores by level of perceived control measured by CAS (t(318) = -5.05, p < .001) supported construct validity.ConclusionThe PHQ-9 is a reliable, valid measure of depressive symptoms in patients with heart failure. HubMed – depression

 

Prompt Recognition and Percutaneous Coronary Intervention Leads to Favorable Myocardial Recovery After ST-Segment Elevation Myocardial Infarction Secondary to Acute Promyelocytic Leukemia: Pediatric Case Report.

Filed under: Depression Treatment

Pediatr Cardiol. 2012 Dec 24;
Thomas TO, Ramachandran P, Jefferies JL, Beekman RH, Hor K, Lorts A

Acute myocardial infarction (AMI) is extremely rare in children, and unlike the adult disease, the etiology of the infarction is rarely due to atherosclerotic coronary disease. This unique reported case involved a 15-year-old boy with severe chest pain who presented with an ST-segment-elevation myocardial infarction secondary to in situ thrombus formation in the left anterior descending (LAD) coronary artery. The initial electrocardiogram (ECG) had a Q-wave pattern in V6 and ST depression in the inferior leads with ST-segment elevation in reciprocal leads. The cardiac enzymes and routine labs showed evidence of myocardial damage. The boy was urgently taken to the cardiac catheterization laboratory for percutaneous coronary intervention, where complete occlusion of the LAD was found and successfully stented. Eventually, a peripheral blood smear showed pancytopenia with 38 % hypergranular blast-like cells consistent with acute myeloid leukemia (AML), and chemotherapy with all-transretinoic acid was implemented. This first pediatric case report of an AML-associated AMI emphasizes the benefit resulting from expedient reperfusion of the ischemic myocardium by quick reestablishment of coronary perfusion. It also emphasizes the limitations of existing noninvasive technologies in detecting myocardial viability.
HubMed – depression

 

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