Neuromyelitis Optica Spectrum Disorder Mimicking Pontine Stroke: A Case Report and Systematic Literature Review.

Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disorder that was first described in the late 1800s as a variant of multiple sclerosis (MS). However, it has recently been categorized, as a disease, especially with the discovery of aquaporin-4 (AQP4-Ab) and myelin oligodendrocyte glycoprotein antibodies (MOG-Ab). Unfortunately, patient presentation is not always clear, and NMOSD may initially be diagnosed as an alternative neurological disease.

Impacts of Anxiety and Depression on Clinical Hypertension in Low-Income US Adults.

Introduction: Depression and anxiety are common leading causes of disability and are associated with systemic effects including cardiovascular comorbidities. Low-income populations may experience higher frequencies of depressive or anxiety-related symptoms, and be at greater risk for developing hypertension.

Aim: We performed a cross-sectional study of low-income participants who completed hypertension and disability questionnaires as part of the 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES) to identify associations between depressive/anxiety-related symptoms and hypertension status.

Sustained cannabis use does not predispose clinical hypertension: Findings from a national survey.

Cannabis is among the most used recreational and medicinal drugs in the United States. The effects of chronic use on hypertension remain poorly understood. Our study retrospectively evaluated data collected by the National Health and Nutrition Examination Survey from 2017 to 2018.

Obstructive Sleep Apnea and Cardiovascular Disease.

Obstructive sleep apnea (OSA) presents as repetitive interruptions of ventilation >10 seconds during sleep as a result of upper airway obstruction resulting in increased respiratory effort. Intermittent hypoxia causes physiologic changes resulting in increased catecholamine production, increased total peripheral resistance, tachycardia, and increased venous return, leading to increased cardiac output, hypertension, tachyarrhythmias, left ventricular hypertrophy, and heart failure. OSA causes an abnormal dip on 24-hour ambulatory blood pressure monitoring.

Preoperative nuclear stress testing in the very old patient population.

Background: Elderly patients awaiting moderate to high-risk surgery may undergo nuclear stress testing (NST) in order to evaluate their cardiovascular risk. The prognostic utility of such testing in the very elderly (≥ 85 years) has yet to be fully evaluated. Octogenarians and nonogenarians frequently have a number of concurrent conditions including a high rate of coronary disease, and therefore the prognostic value of NST for their preoperative risk assessment has been questioned.

Impact of Cardiovascular Risk on the Relative Benefit and Harm of Intensive Treatment of Hypertension.

Background: The lower rate of primary outcome events in the intensive treatment group in SPRINT (Systolic Pressure Intervention Trial) was associated with increased clinically significant serious adverse events (SAEs). In 2017, the American College of Cardiology/American Heart Association issued risk-based blood pressure treatment guidelines. The authors hypothesized that stratification of the SPRINT population by degree of future cardiovascular disease (CVD) risk might identify a group which could benefit the most from intensive treatment.

Intracerebral hemorrhage: a life-threatening complication of hypertension during pregnancy.

Intracerebral hemorrhage (ICH) is an infrequent but severe complication in pregnant women with hypertension. The authors describe a patient with chronic hypertension who developed superimposed preeclampsia and spontaneous ICH during the thirty-fifth week of pregnancy. ICH was diagnosed by computed tomographic scan.

Nuclear stress testing in elderly patients: a review of its use in the assessment of cardiac risk, particularly in patients undergoing preoperative risk assessment.

Stress myocardial perfusion imaging (MPI) plays an important role in the diagnostic and prognostic assessment of coronary artery disease (CAD) in patients of all age groups who are undergoing assessment prior to non-cardiac surgery. MPI may utilise exercise treadmill or pharmacological stress testing. While MPI has been evaluated in a wide variety of patient subpopulations, there are very limited data on its prognostic value in the elderly population, particularly those >75 years of age, who are making up an ever increasing proportion of the patient population.

Hypertensive heart disease.

Left ventricular hypertrophy (LVH) and diastolic dysfunction (CHF-D) are the early manifestations of cardiovascular target organ damage in patients with arterial hypertension and signify hypertensive heart disease. Identification of hypertensive heart disease is critical, as these individuals are more prone to congestive heart failure, arrhythmias, myocardial infarction and sudden cardiac death. Regression of left ventricular (LV) mass with antihypertensive therapy decreases the risk of future cardiovascular events.

Antihypertensive drugs and the heart.

Left ventricular hypertrophy (LVH) and diastolic dysfunction (CHF-D) are early signs of cardiac end-organ damage (hypertensive heart disease) in patients with arterial hypertension. The presence of LVH or CHF-D confers increased risk of cardiovascular morbidity and mortality in patients with hypertension. Regression of left ventricular mass with antihypertensive therapy is associated with reduction in cardiovascular events.

Regression of left ventricular hypertrophy: are there preferred drugs?

The presence of left ventricular hypertrophy (LVH) confers markedly increased risk of cardiovascular morbidity and mortality in patients with hypertension. Regression of left ventricular (LV) mass with antihypertensive therapy is associated with reduction in cardiovascular events. In studies based on monotherapy, among the classes of antihypertensive drugs that have been adequately tested, diuretics and angiotensin-converting enzyme inhibitors appear to be the most effective agents for reducing LV mass.

Interesting clinical case studies involving secondary causes of hypertension.

While essential hypertension is very prevalent, secondary hypertension does occur in clinical practice with sufficient frequency to warrant special attention being given to those patients with severe hypertension who do not respond to standard treatments. The evaluation, diagnosis and treatment of secondary hypertension pose interesting challenges to the physician. In this article, three patients are described with different secondary causes of hypertension.

Effect of hormone replacement therapy on the electrocardiographic response to exercise.

Background: Female gender and hormonal status affect electrocardiographic (ECG) response to exercise. Both are often cited as factors contributing to the decreased diagnostic accuracy of exercise stress tests in women. However, there is a paucity of data.

Interobserver Variability of Left Ventricular Measurements in a Population of Predominantly Obese Hypertensives Using Simultaneously Acquired and Displayed M-Mode and 2-D Cine Echocardiography.

Achieving low interobserver variability is a goal of echocardiographic determined left ventricular (LV) mass measurements. In a group of hypertensives, we evaluated interobserver variation using a method of simultaneously acquired two-dimensional (2-D) cine and M-mode images displayed in a split screen format. Sixty echocardiographic images from ongoing hypertension trials, including serial studies of the same patients, were obtained with an UltraMarktrade mark 6 Ultrasound System (Advanced Technology Laboratories, Inc.