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1 Vol.12 No ISSN

3 Copyright 2010 Cardiovascular Update Editorial Board. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without permission in written form from the copyright holder. This publication is published by MMK Co., Ltd. under continuing medical educational grant from AstraZeneca Ltd. and Novartis Korea. AP-CVUP-10-04

4 Continuing Medical Education inquiry@mmkgroup.co.kr

6 TOPIC 1. 8 TOPIC TOPIC TOPIC TOPIC 5. 39

SECTION TOPIC 1 Absolute contraindications Acute MI (within 2 days) High risk unstable angina Uncontrolled cardiac arrhythmias causing symptoms of hemodynamic compromise Active endocarditis

7 SECTION TOPIC 1 Absolute contraindications Acute MI (within 2 days) High risk unstable angina Uncontrolled cardiac arrhythmias causing symptoms of hemodynamic compromise Active endocarditis Symptomatic severe aortic stenosis Decompensated symptomatic heart failure Acute pulmonary embolus or pulmonary infarction Acute noncardiac disorder that may affect exercise performance or be aggravated by exercise (eg, infection, renal failure, thyrotoxicosis) Acute myocarditis or pericarditis Physical disability that would preclude safe and adequate test performance Inability to obtain consent Relative contraindications Left main coronary stenosis or its equivalent Moderate stenotic valvular heart disease Electrolyte abnormalities Tachyarrhythmias or bradyarrhythmias Atrial fibrillation with uncontrolled ventricular rate Hypertrophic cardiomyopathy Mental impairment leading to inability to cooperate High degree AV block *MI: myocardial infarction 8 Cardiovascular Update

8 Cardiovascular Update 9

9 SECTION TOPIC 1 CABG: coronary artery bypass graft, CAD: coronary artery disease, CHF: congestive heart failure, ETT: exercise tolerance test, ICD: implantable cardioverter defibrillator, LVEF: left ventricular ejection fraction, METs: metabolic equivalents, PCI: percutaneous coronary intervention, PVC: premature ventricular contraction, SV: supra-ventricular, VF: ventricular fibrillation, VT: ventricular tachycardia 10 Cardiovascular Update

10 Target heart rate = (Maximal heart rate - Resting heart rate)(40-85%) + Resting heart rate Cardiovascular Update 11

11 SECTION TOPIC 1 12 Cardiovascular Update

12 Absolute Indications ST-segment elevation (1.0 mm) in leads without Q waves (other than V1 or avr) Drop in systolic blood pressure 10 mmhg (persistently below baseline), despite an increase in workload, when accompanied by any other evidence of ischemia Moderate-to-severe angina (grade 3 to 4) Central nervous system symptoms (eg, ataxia, dizziness, or near syncope) Signs of poor perfusion (cyanosis or pallor) Sustained ventricular tachycardia Technical difficulties monitoring the ECG or systolic blood pressure Subject's request to stop Relative Indications ST or QRS changes such as excessive ST displacement (horizontal or downsloping of 2 mm) or marked axis shift Drop in systolic blood pressure 10 mmhg (persistently below baseline) despite an increase in workload, in the absence of other evidence of ischemia Increasing chest pain Fatigue, shortness of breath, wheezing, leg cramps, or claudication Arrhythmias other than sustained ventricular tachycardia, including multifocal ectopic, ventricular triplets, supraventricular tachycardia, heart block, or bradyarrhythmias Hypertensive response (systolic BP >250 mmhg and/or diastolic BP >115 mmhg) Development of bundle-branch block that cannot be distinguished from ventricular tachycardia Cardiovascular Update 13

13 SECTION TOPIC 1 1. Ades PA. Cardiac rehabilitation and secondary prevention of coronary heart disease. N Engl J Med 2001; Fletcher GF, Balady G, Amsterdam EA, et al. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 2001;104: Lavie CJ, Thomas RJ, Squires RW, et al. Exercise training and cardiac rehabilitation in primary and secondary prevention of coronary heart disease. Mayo Clin Proc 2009;84: Leon AS, Franklin BA, Costa F, et al. Cardiac rehabilitation and secondary prevention of coronary heart disease. Circulation 2005;111: Leon AS. Exercise following myocardial infarction: current recommendations. Sports Med 2000;29: Pollock ML, Franklin BA, Balady GJ, et al. AHA Science Advisory. Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription: an advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association; position paper endorsed by the American College of Sports Medicine. Circulation 2000;101: Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systemic reviews and meta-analysis of randomized controlled trials. Am J Med 2004;116: Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease. Circulation 2003;107: Vanhees L, Stevens A, Schepers D, et al. Determinants of the effects of physical training and of the complications requiring resuscitation during exercise in patients with cardiovascular disease. Eur J Cardiovasc Prev Rehabil 2004;11: Williams MA, Ades PA, Hamm LF, et al. Clinical evidence for a health benefit from cardiac rehabilitation: An update. Am Heart J 2006;152: Cardiovascular Update

14 Cardiovascular Update 15

15 SECTION TOPIC 2 16 Cardiovascular Update

16 Cardiovascular Update 17

17 SECTION TOPIC 2 18 Cardiovascular Update

18 Cardiovascular Update 19

19 SECTION TOPIC 2 20 Cardiovascular Update

20 Cardiovascular Update 21

21 SECTION TOPIC 2 1. Krauss RM, Eckel RH, Howard B, et al. AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation 2000;102: Lichtenstein AH, Appel LJ, Brands M, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 2006;114: Woodside JV, Kromhout D. Fatty acids and CHD. Proc Nutr Soc 2005;64: Van Horn L, McCoin M, Kris-Etherton PM, et al. The evidence for dietary prevention and treatment of cardiovascular disease. J Am Diet Assoc 2008;108: Mozaffarian D, Aro A, Willett WC. Health effects of trans-fatty acids: experimental and observational evidence. Eur J Clin Nutr 2009;63:S Cardiovascular Update

22 Cardiovascular Update 23

23 SECTION TOPIC 3 24 Cardiovascular Update

24 Cardiovascular Update 25

25 SECTION TOPIC 3 26 Cardiovascular Update

26 Cardiovascular Update 27

27 SECTION TOPIC 3 > 28 Cardiovascular Update

28 1. Chow CK, Jolly S, Rao-Melacini P, Fox KA, Anand SS, Yusuf S. Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes. Circulation 2010; 121: Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-st-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina /Non-ST-Elevation Myocardial Infarction):developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation 2007;116:e148-e Balady GJ, Williams MA, Ades PA, et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2007;115: Goble AJ, Worchester M. Best practice guidelines for cardiac rehabilitation and secondary prevention: a synopsis. Produced on behalf of Victoria Department of Human Services Heart Research Centre. Melbourne, Australia. Available at: researchcentre.org/images/assets/forms/pgsynopsis.pdf. Accessed June 22, New Zealand Guidelines Group. Cardiac Rehabilitation. Wellington, New Zealand: New Zealand Guidelines Group Leon AS, Franklin BA, Costa F, et al. Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2005;111: Stone JA, Arthur HM. Canadian Guidelines for Cardiac Rehabilitation and Cardiovascular Disease Prevention, second edition, 2004: Executive summary. Can J Cardiol 2005;21 Suppl D:3D-19D. 8. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). J Am Coll Cardiol 2004;44:E YS Song. Analyses of Studies on Cardiac Rehabilitation for Patients with Cardiovascular disease in Korea. J korean Acad Nurs 2009;39: Cardiovascular Update 29

29 SECTION TOPIC 4 30 Cardiovascular Update

30 A B C D Cardiovascular Update 31

31 SECTION TOPIC 4 Amount of EPA+DHA in different fishes species per 100 g -1,810 mg -1,800 mg -1,500 mg -1,200 mg -1,060 mg -240 mg 32 Cardiovascular Update

32 Cardiovascular Update 33

33 SECTION TOPIC 4 34 Cardiovascular Update

34 Cardiovascular Update 35

35 SECTION TOPIC 4 36 Cardiovascular Update

36 Cardiovascular Update 37

37 SECTION TOPIC 4 1. Young Cheol Woo, Dong Choon Ha. Analysis of preoperative echocardiography in 381 geriatric patients. Korean Journal of Anesthesiology 2000;39: Tricia LP,Sarah KG, Penny KE. Dietary Omega-3 Fatty Acid Intake and Cardiovascular Risk. Am J Cardiol 2006;98:3i -18i. 3. Goodnight S H, et al. The effects of dietary omega 3 fatty acids on platelet composition and function in man: a prospective, controlled study. Blood 1981;58: Goran B, et al. Mortality in Randomized Trials of Antioxidant Supplements for Primary and Secondary Prevention. JAMA 2007;297: Miller ER, et al. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med 2005;142: Lonn E, et al. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA 2005;293: Mart-Carvajal AJ, Sol I, Lathyris D, Salanti G. Homocysteine lowering interventions for preventing cardiovascular events. Cochrane Database Syst Rev Jull AB, et al. Chitosan for overweight or obesity. Cochrane Database Syst Rev Kristi R, et al. A Meta-Analysis of the Effect of Soy Protein Supplementation on Serum Lipids. Am J Cardiol 2006;98: Livesey G, Tagami H.Interventions to lower the glycemic response to carbohydrate foods with a low-viscosity fiber (resistant maltodextrin): metaanalysis of randomized controlled trials. Am J Clin Nutr 2009;89: Shui Ping Zhao, et al. Xuezhikang, an Extract of Cholestin, Protects Endothelial Function Through Antiinflammatory and Lipid-Lowering Mechanisms in Patients With Coronary Heart Disease. Circulation 2004;110: Cardiovascular Update

38 Cardiovascular Update 39

39 SECTION TOPIC 5 40 Cardiovascular Update

40 Cardiovascular Update 41

41 SECTION TOPIC 5 42 Cardiovascular Update

42 Cardiovascular Update 43

43 SECTION TOPIC 5 44 Cardiovascular Update

44 Cardiovascular Update 45

45 SECTION TOPIC 5 46 Cardiovascular Update

46 Cardiovascular Update 47

47 SECTION TOPIC Folkman S, et al. Appraisal, coping, health status, and psychological symptoms. J Pers Soc Psychol 1986 ;50: Friedman, M. & Rosenman, R. H. Type A behavior. 8. Hayes, S.C., & Smith, S.. 9. Segal, Z.V., Williams, J.M.G., & Teasdale, J.D.., Lazarus, R.S., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer. 48 Cardiovascular Update

48 THE MOST ADVANCED CONTINUING MEDICAL EDUCATION SERVICE VOL 1 NO VOL 1 NO VOL 2 NO VOL 2 NO VOL 2 NO VOL 2 NO VOL 3 NO VOL 3 NO VOL 4 NO VOL 4 NO VOL 4 NO VOL 4 NO VOL 5 NO VOL 5 NO VOL 5 NO VOL 5 NO VOL 6 NO VOL 6 NO VOL 6 NO VOL 6 NO VOL 6 NO VOL 7 NO VOL 7 NO VOL 7 NO VOL 7 NO VOL 7 NO VOL 7 NO VOL 8 NO VOL 8 NO VOL 8 NO VOL 8 NO VOL 8 NO VOL 8 NO VOL 9 NO VOL 9 NO VOL 9 NO VOL 9 NO VOL 9 NO VOL 9 NO VOL 10 NO VOL 10 NO VOL 10 NO VOL 10 NO VOL 10 NO VOL 10 NO VOL 11 NO VOL 11 NO VOL 11 NO VOL 11 NO VOL 11 NO VOL 11 NO VOL 12 NO VOL 12 NO VOL 12 NO VOL 12 NO VOL 12 NO Cardiovascular Update 49

1. Elmfeldt D et al. Blood Press 2002;11:293 301 2. Bönner, Fuchs. Curr Med Res Opin 2004; 20:597-602 3. McMurray et al. Lancet 2003; 362:767-71 4. Mcmurray J et al. Am Heart J 2006; 151:985-91 5.

49 1. Elmfeldt D et al. Blood Press 2002;11: Bönner, Fuchs. Curr Med Res Opin 2004; 20: McMurray et al. Lancet 2003; 362: Mcmurray J et al. Am Heart J 2006; 151: Ogihara T. CASE-J study. Presented at the ISH, Oct Mogensen CE, BMJ 2000;321: Rossing K et al. Diabetes Care 2003; 26: Susan C Fagan et al. J Hypertens 2006; 24: Papademetrious V et al. JACC 2004;44: P ( )-V1.0

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$(Microsoft PowerPoint - S13-3_\261\350\273\363\307\366 [\310\243\310\257 \270\360\265\345])$ Cardiovascular Disease in Metabolic Syndrome 김상현 보라매병원내과 서울대학교의과대학내과학교실 Contents Metabolic syndrome and Cardiovascular system CVD Mortality Coronary artery disease Heart failure Atrial fibrillation Management

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