Am J Clin Pathol. 2007;127(1):237-247. ©2007 American Society for Clinical Pathology. We encountered 16 patients with connective tissue disease in whom pulmonary fibrosis developed. Routine light microscopic, ultrastructural, and direct immunofluorescent analyses were conducted, and circulating antibodies, including those of endothelial cell derivation, were assessed using indirect immunofluorescence and Western blot assays. Underlying diseases were dermatomyositis, scleroderma, mixed connective tissue disease, sclerodermatomyositis, Sjögren syndrome, rheumatoid arthritis, and anti-Ro–associated systemic lupus erythematosus. Antibodies to one or more Ro, RNP, Jo 1, OJ, and/or nucleolar antigens were seen in all cases and antiphospholipid antibodies in half. All biopsies revealed microvascular injury in concert with intraparenchymal fibrosis; in some cases, there were corroborative ultrastructural findings of microvascular injury. Patterns of fibroplasia represented nonspecific interstitial pneumonitis and usual interstitial pneumonitis. We noted IgG, IgA, and/or complement in the septal microvasculature. In 6 cases with available serum samples, indirect immunofluorescent endothelial cell antibody studies were positive and Western blot studies showed reactivity of serum samples to numerous endothelial cell lysate–derived proteins. Pulmonary fibrosis, a recognized complication of systemic connective tissue disease, develops in connective tissue disease syndromes with pathogenetically established immune-based microvascular injury at other sites. A similar mechanism of antibody-mediated endothelial cell injury may be the basis of the tissue injury and fibrosing reparative response.

Am Fam Physician 2004;69:1107-14. Copyright© 2004 American Academy of Family Physicians

This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://www.familydoctor.org. This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject. Copyright © 2006 American Academy of Family Physicians.

Libman-Sacks (verrucous) endocarditis is the most characteristic cardiac manifestation of the autoimmune disease systemic lupus erythematosus (see Systemic Lupus Erythematosus for more information). Libman and Sacks first published a description of these atypical, sterile, verrucous vegetations in 1924. Postmortem studies describe mulberrylike clusters of verrucae on the ventricular surface of the posterior mitral leaflet, often with adherence of the mitral leaflet and chordae to the mural endocardium. The lesions typically consist of accumulations of immune complexes and mononuclear cells. The condition is not always recognized on echocardiographic images. With the introduction of steroid therapy for systemic lupus erythematosus, improved longevity of patients appears to have changed the spectrum of valvular disease. Valvular abnormalities occur as masses (classic Libman-Sacks vegetations; see Image 1), diffuse leaflet thickening, valvular regurgitation, and, infrequently, stenosis. Valvular regurgitation is noted most commonly in patients with leaflet thickening, which is thought to represent the chronic healed phase of disease. The left-sided valves are involved most often. Lesions similar to those described by Libman and Sacks also occur in association with primary or secondary antiphospholipid syndrome. The role of these autoantibodies in the pathogenesis of Libman-Sacks endocarditis is disputed. Lesions are usually clinically silent. Heart failure, valvular dysfunction, valve replacement, embolic phenomena, and secondary infective endocarditis can complicate valvular abnormalities. Last Updated: May 23, 2006

Am Fam Physician 2006;73:669-76, 677-8. Copyright © 2006 American Academy of Family Physicians.

Taking B vitamins to ward off heart attacks and stroke does no good and may even be harmful, say experts. Last Updated: Tuesday, 6 September 2005, 08:32 GMT 09:32 UK

Mar 1, 2006. Geriatrics

This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://www.familydoctor.org. This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject. Copyright © 2006 American Academy of Family Physicians.

Every 30 seconds, someone has a heart attack. Half of the people who have a heart attack die—often within the first hour of having symptoms and before reaching a hospital. Yet, most people wait 2 hours before seeking help.

Computed tomography, commonly known as a CT or CAT scan, is a test that uses x-rays and computers to produce cross-sectional images of the body. CT has been used for over 25 years to examine all parts of the body.

The Proceedings of the American Thoracic Society 3:48-57 (2006) © 2006 The American Thoracic Society

Cardiac syndrome X is a condition where patients have the pain of angina, but they do not have CAD. So even though patients with cardiac syndrome X have symptoms of CAD, the coronary arteries are clear of blockages. Cardiac syndrome X is more common in women, especially women who have gone through menopause. It is not life threatening and does not increase your risk of heart attack or CAD. Updated July 2007

Nursing2006, July 2006, Volume 36 Number 7, Pages 36 - 42.

Angina due to Cardiac Syndrome X

NS343 Coady E (2006) Nursing Standard. 20, 37, 49-56. Date of acceptance: March 27 2006.

© 2005 WebMD Inc. All rights reserved.

© 2006 Lippincott Williams & Wilkins, Inc. Nursing Made Incredibly Easy! May/June 2006 Volume 4 Number 3, Pages 42 - 52.

Feb 10, 2006, 16:00, Reviewed by: Dr. Rashmi Yadav. "We think this is a very promising treatment that could help patients with severe peripheral artery disease for whom there is now no effective therapy."

US Pharm. 2007;32(3):52-65. Cardiovascular diseases are becoming increasingly prevalent in children, due at least in part to the rise in childhood obesity. Public awareness is also increasing, and treatment options are improving. Pharmacists have the responsibility of counseling children and their caregivers about pharmacologic and nonpharmacologic therapies and interventions that can improve long-term prognosis. Adherence to complex medication regimens is key to optimal management. In cases of CHDs, for example, pharmacists can provide education about the rationale for drug therapy, and in cases of arrhythmia, they can obtain a thorough medication history to assist in diagnosis or avoidance. More important, pharmacists can stress the possibility of preventing the onset of cardiovascular diseases and encourage lifestyle changes that can help reduce the occurrence of hypertension and obesity.

US Pharm. 2007;32(5):HS-32-HS-43. IE continues to be a life-threatening infection that often requires a prolonged duration of antibiotic therapy and sometimes surgery in order to be treated appropriately. The most common organisms causing IE are Streptococcus, Staphylococcus, and Enterococcus species. The infecting organism, susceptibility patterns, and AHA guideline recommendations should be considered to guide antibiotic therapy as well as the duration of treatment. Newer treatment options for drug-resistant organisms such as MRSA and VRE need to be added to the repertoire of drugs that are currently available for the treatment of IE. However, further research on these agents is needed to establish their safety and efficacy for use in this setting.

Peripheral arterial disease (PAD) occurs when a fatty material called plaque (plak) builds up on the inside walls of the arteries that carry blood from the heart to the head, internal organs, and limbs. PAD is also known as atherosclerotic peripheral arterial disease. The buildup of plaque on the artery walls is called atherosclerosis (ath-er-o-skler-O-sis), or hardening of the arteries. Atherosclerosis causes the arteries to narrow or become blocked, which can reduce or block blood flow. PAD most commonly affects blood flow to the legs. Blocked blood flow can cause pain and numbness. It also can increase a person's chance of getting an infection, and it can make it difficult for the person's body to fight the infection. If severe enough, blocked blood flow can cause tissue death (gangrene). PAD is the leading cause of leg amputation. June 2006

Am Fam Physician 2005;72:2012-21. Copyright © 2005 American Academy of Family Physicians

Last Updated: April 15, 2005