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Overview

China is currently facing an aging population. With the number of elderly people increasing, the management of chronic diseases by geriatricians is of significant importance. Around the world, chronic diseases consistently top the lists in endangering human health. Examples include coronary heart disease, diabetes, chronic obstructive pulmonary disease and benign prostatic hyperplasia. Old age is a risk factor in all these diseases. Therefore, management of chronic diseases should be the focus of health management.
Frailty among the elderly is also prevalent, and is detrimental to the health and lifestyle of the elderly. It leads to increased risk of chronic diseases and challenges in treatment. Therefore, it is necessary to take appropriate measures to optimize patient health whilst not risking its deterioration. Finally, cardiovascular diseases make up a large proportion of chronic diseases in elderly patients.

1. Risk

Four main causes for the manifestations of systemic vascular disease and vascular disease of the heart:
1- Atherosclerosis, hypertensive arteriosclerosis, arteritis and other vascular factors
2- Hemodynamic factors such as hypertension
3- Hyperlipidemia, diabetes and other hemorheology
4- Blood factors such as leukemia, anemia, thrombocytosis.

2. Clinical presentations

Common symptoms of cardiovascular disease are: Crushing, tight pain posterior to the sternum (especially angina), referred pain in the left arm, palpitations, dyspnea, chest tightness, paroxysmal nocturnal dyspnea, oedema, cyanosis, syncope, cough, hemoptysis, fatigue, upper abdominal pain, nausea and vomiting etc.

Investigations and Diagnosis

ReLIA’s Biomarker Guide

1. Hypersensitive Troponin I (hs-cTnI)

Hypersensitive Troponin is an incredibly sensitive and practical biomarker for myocardial injury. With the highest sensitivity and specificity, hs-cTnl can be used as an independent diagnostic indicator for myocardial infarction. Due to its high sensitivity, even small amounts of damage to the myocardium can be detected. As myocardial injury is very strong evidence of myocardial disease, early detection of this allows for a more rapid diagnosis and treatment.

2. N terminal pro-brain natriuretic peptide (NT-proBNP)

Compared to BNP, NT-proBNP has a longer half life (1-2 hours compared to BNP’s 20 minutes), a higher concentration in blood (15-20 times that of BNP) and is also biologically inactive. It also wont be affected by BNP related drugs. Therefore, NT-proBNP is recognized as a good biochemical marker that reflects cardiac function. It can be used to diagnose symptomatic heart failure, estimate the prognosis of patients with heart failure and acute coronary syndrome and to monitor treatment.

3. Heart-type fatty acid-binding protein (H-FABP)

H-FABP is small cytoplasmic protein that is involved in the growth and differentiation of cardiomyocytes. Blood levels of h-FABP in normal people are very low or absent. However, these levels will rapidly increase in acute myocardial infarction. Studies have shown that h-FABP is more specific to myoglobin in myocardial damage. It is therefore a novel biomarker in the early detection of myocardial infarction.

4. D-Dimers

D-dimer is a fibrin degradation product present after fibrinolysis. Blood levels of D-dimers increase in disseminated intravascular coagulation, kidney disease, organ transplant rejection and thrombolytic therapy. Myocardial infarction, cerebral infarction, pulmonary embolism, venous thrombosis, surgery, tumors, disseminated intravascular coagulation, infection, and tissue necrosis can all lead to an increase in D-dimers. As long as there is active thrombotic and fibrinolytic activity in the body, levels of D-dimers will rise. For elderly or hospitalized patients, elevated D-dimer levels can be due to abnormal coagulation caused by bacteremia or other diseases.

5. Neutrophil gelatinase-associated lipocalin (NGAL)

NGAL, especially urinary levels of NGAL, can be used for the early diagnosis of AKI. Causes of AKI in this case include postoperative cardiac surgery, kidney transplantation, renal ischemia and nephrotoxicity. Note that the 2hour urinary NGAL level is more sensitive and specific compared to serum NGAL. It can also be used in assessing the severity of renal impairment. In patients with delayed renal function, serum NGAL can be used to monitor patient recovery and assess whether hemodialysis is required after transplantation. There is a positive correlation between urinary NGAL levels at 2, 4 and 6 hours after a cardiopulmonary bypass to duration of hospital stay. Finally, urinary NGAL levels predict whether dialysis treatment is required within one week of renal transplant patients and to assess kidney function after 3 months