Cardiac rehabilitation (CR) represents a spectrum of interventions that influence physical, mental, and social well-being of an individual. These interventions can range from dietary counseling to intense physical activity. The role of CR in various cardiac disorders, particularly ischemic heart disease, has been well established across multiple studies. However, real-world utilization of CR still seems to lag behind. As coronary intervention modalities keep evolving with increasing number of patients receiving percutaneous coronary intervention, there is a need for reappraisal of the role of CR in this population. In this review, we discuss data behind the benefit of CR in patients with ischemic heart disease and highlight the barriers encountered in implementing CR in real-world practice.

Patients with unexplained chest pain continue to present a difficult challenge for clinicians, especially for cardiologists. Approximately 20% of patients undergoing diagnostic coronary arteriography for acute or chronic cardiac ischemia have angiographically normal coronary arteries. In these cases, patients with chest pain are usually reassured by their physician and other causes of substernal chest pain are searched. However, apart from a sizeable proportion of patients with gastroesophageal disorders, the remaining patients remain symptomatic without apparent reasons. The mechanism behind this phenomenon is likely to be the result of a combination of functional or anatomical abnormalities in the coronary microcirculation, a metabolic disorder which affects the handling of energy substrates by the heart, insulin resistance and neuropsychological components affecting pain perception. These patients often exhibit an increase in sympathetic outflow to the cardiovascular system, which might account for the reduction in coronary flow reserve, changes in metabolic utilization and development of insulin resistance that are seen in some of these patients. Therapeutically, beta-blockers appear to be most effective in controlling the symptoms associated with this condition, although those calcium antagonists which do not affect the neurohormonal system may be of some utility in patients with primary microvascular angina, in which microvascular spasm is operating or in whom excessive constriction of the distal component of the coronary circulation limits the vasodilatory reserve. This article reviews the clinical presentation, differential diagnosis, and approach to evaluation and therapy of this complex group of patients.

Cardiovascular dysfunction frequently complicates outcomes of traumatic brain injury (TBI), resulting in higher morbidity and mortality. TBI results in dysfunctions of the autonomic nervous system (mediated by catecholamines), altered systemic circulation homeostasis medicated by neurogenic stimuli, electrocardiographic, echocardiographic abnormities, and change in serum cardiac enzyme levels (not attributed to primary cardiac pathology). The present review attempts to find cardiovascular alterations following TBI, management to these patients, and their outcome.

Introduction: Cardiovascular diseases are the highest cause of death in the world. Many of these deaths may be workplace related. Long hours at work seem to be influencing the increased risks of heart diseases. Workplace stress can be defined as the “discrepancies between the physiological demands within a workplace and the inability of employees to either manage or cope with such work demands.” The varied nature and perception of stress are exemplified from literature that shows stress being either a stimulus, or a response, or a stimulus–response combination, also known as a transactional relationship between one or more individuals and the environment, leading to an initiative toward a physiological standpoint. Methods: This research opted for a correlational study which involves 85 full-time employees who were working at least 40 h per week in a large corporation participated in this study. The Personal and Organizational Quality Assessment and Perceived Stress Scale were used to correlate with heart rate variability (HRV). Objectives: The primary objective of this study is to introduce a new quantitative assessment tool emWave Pro Plus (Institute of HeartMath) and compare heart rate variability (HRV) results with the Personal and Organizational Quality Assessment (POQA) and the Perceived Stress Scale (PSS). Results: Astonishing findings emerged. Significant positive correlations were found between emotional stress and HRV and between intention to quit and HRV. In other words, the researcher has to make sense the following surprising findings: (1) The higher the emotional stress an employee faces, the healthier they are. (2) Healthier employees may have higher intentions of quitting their jobs. Conclusion: The surprising results may be attributed to personality, culture, emotional regulation, and age among others.

Background: Patients with diabetes are reported having inadequate response to clopidogrel treatment compared with patients without diabetes. The present study aims to investigate the effect of clopidogrel treatment in lowering in-hospital major adverse cardiovascular events (MACEs) among hospitalized myocardial infarction (MI) patients with and without diabetes. Materials and Methods: This is a post hoc analysis of the third phase of Clinical Pathways in Acute Coronary Syndromes program study. Between October 2011 and November 2014, a total of 14,997 patients with MI were consecutively recruited from 101 county hospitals without the capacity to perform onsite percutaneous coronary intervention (PCI). Results: The mean age of the 14,997 patients with MI was 64.8 ± 12.2 years, and 67.5% of the participants were male. Of these patients, 1920 (12.8%) were classified as diabetes when presenting at the hospital, and 12,875 (85.9%) patients received in-hospital clopidogrel treatment. In total, 167 patients (8.7%) with and 955 patients (7.3%) without diabetes experienced an in-hospital MACE. Multivariable-adjusted relative risk (RR) associated with clopidogrel treatment for in-hospital MACEs was 0.79 (95% confidence interval [CI]: 0.68–0.93) among all MI patients, and it was also consistent between patients with (RR = 0.79, 95% CI: 0.54–1.16) and without diabetes (RR = 0.79, 95% CI: 0.65–0.95; P for interaction = 0.970). Propensity score-matched subgroup analyses yielded similar results. Conclusion: Our large-scale study of real-world data from non-PCI-capable hospitals in China demonstrated that clopidogrel treatment was associated with a lower risk of in-hospital MACEs in MI patients, and this effect was not modified by diabetes.