Chronic exposure to environmental noise increases risk of heart disease

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Chronic exposure to environmental noise from road traffic and aircrafts can increase the risk of coronary heart disease, heart failure, stroke and arterial hypertension. And the potential mechanisms underlying this increased risk have been explored in a study published online February 5, 2018 in the Journal of the American College of Cardiology.

The study proposes that noise induces a stress response, characterized by activation of the sympathetic nervous system and increased levels of hormones, which will initiate sequelae and ultimately lead to vascular damage. Traffic noise may disrupt the body on the cellular level in a way that increases the risk of common heart disease risk factors such as hypertension and diabetes because noise is associated with oxidative stress, vascular dysfunction, autonomic imbalance and metabolic abnormalities.

Autonomic imbalance due to environmental noise is also suggested as a potential factor contributing to the cardiovascular risk factors including progression of atherosclerotic process.

(Source: ACC Press release, February 5, 2018)

6MWT in Heart Failure

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Exercise intolerance along with dyspnea fatigue are cardinal symptoms of heart failure which adversely impact quality of life of the patient. Exercise improves well being in heart failure. ESC 2016 and AHA ACC 2013 heart failure guidelines recommend exercise to improve functional capacity QOL and also to reduce the risk of hospitalization in stable HF patients Class IA . The 6 minute walk test assesses functional capacity or exercise tolerance in patients with heart failure and defines prognosis. A 6 minute walk distance less than 200 m indicates lower functional capacity and carries a poor prognosis. If the walk distance is more than 500 m the prognosis is good. If the 6 minute walk distance ranges between 200m and 500 m patient can continue to exercise with oxygen supplementation. Oxygen saturation during 6MWT also has prognostic significance. A fall in oxygen saturation SpO2 during 6MWT of more than 4 indicates significant desaturation and is a predictor of mortality. The aim should be to increase exercise tolerance even if with oxygen supplementation.

Updated guidelines for treatment for patients with ventricular arrhythmias

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The American College of Cardiology ACC American Heart Association AHA and the Heart Rhythm Society HRS have jointly published new guidelines for the management of adults who have ventricular arrhythmias or who are at risk for sudden cardiac death including diseases and syndromes associated with a risk of sudden cardiac death from ventricular arrhythmias. According to the guidelines patients considering implantation of a new ICD or replacement of an existing one should be informed of their individual risk of sudden cardiac death and nonsudden death from heart failure or noncardiac conditions and the effectiveness and potential complications of the ICD. In patients nearing the end of life from other illness clinicians should discuss ICD shock deactivation as they reassess their patients goals and preferences. Emphasizing on the role of shared decision making between patients and their doctors the guidelines say that treatment decisions should also take into consideration the health goals preferences and values of the patients. The 2017 AHA ACC HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death have been published online October 30 2017 in the Journal of the American College of Cardiology Circulation and HeartRhythm. Source ACC News Release October 30 2017

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