Irregular Heartbeat: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

IRREGULAR HEARTBEAT A 3-IN-1 MEDICAL REFERENCE Medical Dictionary Bibliography & Annotated Research Guide TO I NTERNET

R EFERENCES

IRREGULAR HEARTBEAT A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Irregular Heartbeat: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00612-X 1. Irregular Heartbeat-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on irregular heartbeat. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON IRREGULAR HEARTBEAT ........................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Irregular Heartbeat ....................................................................... 4 The National Library of Medicine: PubMed .................................................................................. 4 CHAPTER 2. PATENTS ON IRREGULAR HEARTBEAT ......................................................................... 7 Overview........................................................................................................................................ 7 Patents on Irregular Heartbeat ...................................................................................................... 7 Patent Applications on Irregular Heartbeat ................................................................................ 10 Keeping Current .......................................................................................................................... 11 CHAPTER 3. PERIODICALS AND NEWS ON IRREGULAR HEARTBEAT ............................................. 13 Overview...................................................................................................................................... 13 News Services and Press Releases................................................................................................ 13 Newsletter Articles ...................................................................................................................... 15 Academic Periodicals covering Irregular Heartbeat .................................................................... 15 CHAPTER 4. RESEARCHING MEDICATIONS .................................................................................... 17 Overview...................................................................................................................................... 17 U.S. Pharmacopeia....................................................................................................................... 17 Commercial Databases ................................................................................................................. 19 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 23 Overview...................................................................................................................................... 23 NIH Guidelines............................................................................................................................ 23 NIH Databases............................................................................................................................. 25 Other Commercial Databases....................................................................................................... 27 APPENDIX B. PATIENT RESOURCES ................................................................................................. 29 Overview...................................................................................................................................... 29 Patient Guideline Sources............................................................................................................ 29 Finding Associations.................................................................................................................... 36 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 39 Overview...................................................................................................................................... 39 Preparation................................................................................................................................... 39 Finding a Local Medical Library.................................................................................................. 39 Medical Libraries in the U.S. and Canada ................................................................................... 39 ONLINE GLOSSARIES.................................................................................................................. 45 Online Dictionary Directories ..................................................................................................... 45 IRREGULAR HEARTBEAT DICTIONARY............................................................................... 47 INDEX ................................................................................................................................................ 61

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with irregular heartbeat is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about irregular heartbeat, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to irregular heartbeat, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on irregular heartbeat. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to irregular heartbeat, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on irregular heartbeat. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON IRREGULAR HEARTBEAT Overview In this chapter, we will show you how to locate peer-reviewed references and studies on irregular heartbeat.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and irregular heartbeat, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “irregular heartbeat” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Truth About Potassium Source: TransDial. 4(4): 6. Winter-Spring 1990. Summary: Potassium is a mineral that is found in almost all foods. Although healthy kidneys maintain a normal balance of potassium in the body, diseased kidneys are unable to get rid of potassium adequately. Elevated blood potassium levels can cause an irregular heartbeat and can even cause heart failure. This brief article contains a list of foods that are very high in potassium and should be avoided by the person on hemodialysis. A second list of alternative foods that are more limited in potassium content is included. For each food on the list, the portion size and amount of potassium is noted.

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Federally Funded Research on Irregular Heartbeat The U.S. Government supports a variety of research studies relating to irregular heartbeat. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to irregular heartbeat. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore irregular heartbeat.

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.3 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with irregular heartbeat, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “irregular heartbeat” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for irregular heartbeat (hyperlinks lead to article summaries): •

A woman with increasing weakness of the legs and irregular heartbeat who took her husband's medication. Author(s): Wolf G, Stahl RA. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2002 September; 17(9): 1698-701. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12198228

2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH). 3 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

Studies

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Viracept and irregular heartbeat warning. Author(s): Fornataro K, Jefferys R. Source: Body Posit. 1999 October; 12(10): 10, 12. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11366874

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CHAPTER 2. PATENTS ON IRREGULAR HEARTBEAT Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.4 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “irregular heartbeat” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on irregular heartbeat, we have not necessarily excluded nonmedical patents in this bibliography.

Patents on Irregular Heartbeat By performing a patent search focusing on irregular heartbeat, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 4Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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The following is an example of the type of information that you can expect to obtain from a patent search on irregular heartbeat: •

Apparatus for assisting circulation of blood Inventor(s): Daly; Benedict D. T. (Wellesley, MA), Poirier; Victor L. (Chelmsford, MA), Robinson; William J. (Wellesley, MA) Assignee(s): Thermo Electron Corporation (Waltham, MA) Patent Number: 4,240,409 Date filed: February 21, 1979 Abstract: Apparatus is disclosed for mechanically assisting circulation of blood in a patient for periods of up to a week or two until the patient's heart strengthens sufficiently to take over the full workload. The circulatory assist device includes a valveless pump with a flexible bladder, a pneumatic driver for applying pressure pulses to the bladder, and a single flexible conduit for conveying blood between the patient and the pump. In use the pump and driver are mounted external to the patient's body and the flexible conduit is connected to the pump and in end-to-side relationship with a major blood vessel on that side of the heart, either right or left, which is in need of support. The circulatory assist device is operable either synchronously with the patient's heartbeat wherein the pump bladder fills as the heart ejects, then ejects in response to a pressure pulse from the driver while the heart is at rest, or asynchronously at a fixed rate if an irregular heartbeat of the patient precludes synchronous operation. The device, which can support up to about half of the workload of the heart, is easy to implant and remove and may be used to assist blood circulation in children as well as adults. Excerpt(s): This invention relates to apparatus for assisting circulation of blood and more particularly to a device for providing circulatory assistance to patients in ventricular failure whose hearts cannot maintain a blood circulation adequate to sustain life or to patients with acute coronary occlusion to reduce workload of the heart and limit the damage while collateral circulation develops. The need for devices to provide mechanical assistance for failing blood circulatory systems has been recognized for several years and a number of blood pumps have been developed and tested. One clinically accepted method of assistance is use of an intraaortic balloon pump, an inflatable balloon attached to the end of a catheter and positioned in the thoracic aorta of a patient. The balloon pump is operated in a counterpulsation mode wherein the balloon is inflated with a gas immediately following left ventricular ejection and deflated just prior to the next ventricular ejection, thus imparting a pumping force to the blood and reducing the load on the left ventricle. Balloon pumps, though helpful, are limited to support of the left ventricle only, typically operate only synchronously with the heartbeat of the patient, and can provide support for only a small fraction of the total workload of the left ventricle. Other drawbacks of these devices include possible blockage of arterial branches to major organs during inflation or removal/insertion of the balloon, particularly with children, and the creation of emboli during their insertion or use by fragmenting plaque in the blood vessels. Another assist device which has been tested clinically is a left ventricular assist device (LVAD) which includes an implantable pump which may be connected between the left ventricle and aorta of a person such as a patient in acute left ventricular failure following open-heart surgery. This pump, which is similar to that described in U.S. Pat. No. 4,104,005 issued in the name of V. L. Poirier, has a flexible bladder which fills from the left ventricle through an inlet valve.

Patents

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Pneumatic pulses, either synchronous with the heartbeat or asynchronous at a fixed rate, apply pressure to collapse the bladder and eject blood through an outlet valve into the aorta. The LVAD, like the balloon pump, is designed to assist the left ventricle only but in contrast thereto may assume total workload of the left ventricle. However, because of the size of the LVAD pump and a requirement that it be implanted, use of the LVAD is restricted to adults. Also the LVAD pump is considerably more invasive than the balloon pump and usually requires a second rather extensive surgical procedure for removal at the end of its period of use of from about one day to two weeks. Web site: http://www.delphion.com/details?pn=US04240409__ •

DHEA-containing nutritional supplement Inventor(s): Craft; John C. (162 Essex St. P.O. Box 1522, Montauk, NY 11954) Assignee(s): none reported Patent Number: 5,883,086 Date filed: May 2, 1997 Abstract: The present invention relates to a nutritional supplement (10) containing from 5% to 2000% each of the RDA of vitamins (18) A (22), C (26), D (28), E (30) and.beta.carotene (24), from 5% to 500% of the RDA of the minerals (20) selenium (32), zinc (34), magnesium (36), calcium (38), iodine (40) and potassium (42), from 5 to 100 mg dehydroepiandrosterone (DHEA) (12), from 0.1 to 10 mg trans-ferulic acid (14), and one or more plant extracts (16) selected from ginseng (46) and garlic (44). These DHEAcontaining nutritional supplements are useful in the alleviation of an irregular heartbeat as well as the general symptoms of stress. Excerpt(s): The instant invention relates generally to vitamin and mineral-containing compositions for alleviating an irregular heartbeat and/or the symptoms of stress in humans and more specifically to compositions for alleviating an irregular heartbeat or stress which further contain dehydroxyepiandrosterone (DHEA). Vitamin-containing compositions are well known in the art. For example, U.S. Pat. No. 5,571,441 (Andon, M. B. et al., 5 Nov. 1996) discloses a vitamin supplement containing 3 to 1000% of the RDA of vitamins, 10 to 4000 mg flavanols, and a bracer equivalent to 10 to 300 mg caffeine. U.S. Pat. No. 4,837,239 (Benjamin, E. J., 6 Jun. 1989) discloses a cardiotonic composition containing a vitamin and a cardiotonic phospodiesterase inhibitor which is preferably a (2-oxo-1,2,3,5-tetrahydroimidazo›2,1-b!quinazoliniyl)-oxyalkylamide derivative. Web site: http://www.delphion.com/details?pn=US05883086__

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Hexahydroindolizinones useful for treating cardiac arrhythmia, thrombotic disorders in mammals Inventor(s): Chorvat; Robert J. (Arlington Heights, IL), Prodan; Kathleen A. (Buffalo Grove, IL), Schulz; John A. (Lindenhurst, IL) Assignee(s): G. D. Searle & Co. (Skokie, IL) Patent Number: 4,567,270 Date filed: September 17, 1984

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Abstract: This invention relates to hexahydroindolizinones, which are useful as inhibitors of cardiac arrhythmias and of platelet aggregation and are therefore useful in the treatment of irregular heartbeat and in the prevention of thrombus formation. Excerpt(s): Arrhythmias are disorders relating to electrical impulse generation in the heart. The disorders include premature contractions (extrasystoles) originating in abnormal or ectopic foci in atria or ventricles; atrial flutter; atrial fibrillation; and ventricular tachycardia and fibrillation. For a discussion on these disorders, see, for example, L. S. Goodman and A. Gilman, eds., The Pharmacological Basis of Therapeutics (New York, 1980), Sixth Edition, pp. 761-767. A number of compounds have been developed to alter cardiovascular function related to heart rate and rhythm. The cardiac glycosides, including digitalis, have as their main pharmacodynamic property the ability to increase the force of myocardial contraction. This positive inotropic action is the basis of the salutory effects of these cardiac glycosides in congestive heart failure--increased cardiac output; decreased heart size, venous pressure, and blood volume; and diuresis and relief of edema. See, e.g., Goodman and Gilman at pp. 730-731, 750-751. Quinidine is useful in the therapy of atrial fibrillation but exhibits several toxic reactions, such as cinchonism. Goodman and Gilman at pp. 768-774. Procainamide acts in essentially the same manner as quinidine, and also exhibits toxic side effects. Goodman and Gilman at pp. 774-777. Lidocaine, a widely used local anesthetic, may be used in the treatment of ventricular arrhythmias, but must be administered by injection. Goodman and Gilman at pp. 779-781. Propranolol is useful in the treatment of supraventricular tachycardias and ventricular arrhythmias, but must be used with great care because it may induce significant hypotension, left ventricular failure, or even cardiovascular collapse. Goodman and Gilman at pp. 783-786. Disopyramide has effects somewhat like procainamide and quinidine, all being so-called Type 1 antiarrhythmics. At therapeutic levels disopyramide shortens the sinus node recovery time, lengthens the effective refractory period of the atrium, and has a minimal effect on the refractory period of the A-V node. Goodman and Gilman at pp. 777-779. However, because of the anticholinergic effects of some of the Type 1 antiarrhythmics, such as disopyramide, they should not be used in patients with glaucoma, myasthenia gravis, or problems of urinary retention. Web site: http://www.delphion.com/details?pn=US04567270__

Patent Applications on Irregular Heartbeat As of December 2000, U.S. patent applications are open to public viewing.5 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to irregular heartbeat: •

Method of and apparatus for detecting arrhythmia and fibrillation Inventor(s): Wiesel, Joseph; (West Hempstead, NY) Correspondence: Gibbons, Del Deo, Dolan, Griffinger & Vecchione; 1 Riverfront Plaza; Newark; NJ; 07102-5497; US Patent Application Number: 20030055351 Date filed: October 30, 2002

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This has been a common practice outside the United States prior to December 2000.

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Abstract: The presence of irregular heartbeat and/or possible atrial fibrillation is determined by analyzing a measured pulse rate pattern or heart rate pattern. The standard deviation and mean of time intervals each corresponding to a respective heartbeat are determined and compared to a threshold value. When quotient formed by dividing the standard deviation by the mean has a value greater than or equal to the threshold value, the shortest one of the time intervals and its succeeding time intervals are determined, and the succeeding time interval is compared to the mean. If the succeeding time interval is less than the mean, then the heartbeat is irregular. Alternatively, if the succeeding time interval is greater than the mean, the shortest time interval and its succeeding time interval are eliminated from the sample values, a new mean and standard deviation are determined, and the quotient of the new standard deviation divided by the new mean are compared to the threshold value. When the quotient is greater than the threshold value, the next shortest interval is determined, and the absolute value of the difference between the next shortest interval and the shortest interval is compared to an empirically determined value. If the difference is greater than the empirically determined value, the heartbeat is irregular. Alternatively, if the difference is greater than the empirically determined value, then the next shortest interval and its succeeding interval are redefined as the new shortest interval and is succeeding interval. The steps are repeated until it is determined that the heartbeat is regular or irregular. Excerpt(s): The present invention generally relates to a method of and an apparatus for detecting irregular heartbeats and, more particularly, to monitoring and analyzing pulse rates for detecting possible atrial fibrillation. The heart is the major muscle that functions as the primary pump for blood flow throughout the body. The heart contains two upper chambers called atria and two lower chambers called ventricles. The right atrium receives oxygen-depleted blood while the left atrium receives blood enriched with oxygen from the lungs. When the atria are full, the outlet valves within the heart open and the atria squeeze blood into the ventricles. The right ventricle then pumps oxygen-depleted blood to the lungs while the left ventricle pumps oxygen-enriched blood to all parts of the body. In this fashion, the heart functions primarily as a double sided pump. The heart's internal pacemaker, known as the sinus node, signals the start of each heart beat. This signal originates in the right atrium in the sinoatrial node and travels simultaneously to the left atrium and down to the interatrial septum to the atrioventricular node. The cycle of electrical stimulation that normally occurs is referred to as normal sinus rhythm. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with irregular heartbeat, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “irregular heartbeat” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on irregular heartbeat.

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You can also use this procedure to view pending patent applications concerning irregular heartbeat. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 3. PERIODICALS AND NEWS ON IRREGULAR HEARTBEAT Overview In this chapter, we suggest a number of news sources and present various periodicals that cover irregular heartbeat.

News Services and Press Releases One of the simplest ways of tracking press releases on irregular heartbeat is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “irregular heartbeat” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to irregular heartbeat. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “irregular heartbeat” (or synonyms). The following was recently listed in this archive for irregular heartbeat: •

Sicor generic drug for irregular heartbeat gets OK Source: Reuters Industry Breifing Date: September 08, 2003

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “irregular heartbeat” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “irregular heartbeat” (or synonyms). If you know the name of a company that is relevant to irregular heartbeat, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “irregular heartbeat” (or synonyms).

Periodicals and News

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Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “irregular heartbeat” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on irregular heartbeat: •

Caution: Heart at Work!: Tips on Potassium Control for Hemodialysis Patients Source: AAKP Patient Plan Newsletter. 1(2): 5, 7. 2000. Contact: Available from American Association of Kidney Patients (AAKP). 100 South Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-AAKP or (813) 223-7099. E-mail: [email protected]. Website: www.aakp.org. Summary: This article is from a newsletter that guides kidney patients through the treatment process for their illness. The newsletter is part of a program that encourages patients to stay active and learn as much as they can about kidney disease and their treatment. The program stresses that the more patients know, the better they are able to make choices that are best for themselves and their families. The program was created by the American Association of Kidney Patients (AAKP), a national organization directed by kidney patients for kidney patients, with the mission of helping kidney patients and their families deal with the physical, emotional, and social impacts of kidney disease. This article discusses potassium, a mineral that is important in heart function, and the need for kidney patients to control their intake of potassium. A healthy kidney will regulate the amount of potassium in the bloodstream by excreting any extra potassium in the urine. When kidney function is reduced, potassium builds up in the blood to high levels. A high potassium level can make the heart stop without warning; other problems can include weak muscles (especially leg muscles), irregular heartbeat, diarrhea, and nausea or vomiting. Going to dialysis and staying for the full treatment is one of the ways to control potassium levels; diet is the other way. The author provides a list of eight tips to become aware of and control the level of potassium in one's diet. The article concludes with the instructions for 'dialyzing' vegetables to reduce their potassium content (soaking them in water for 4 hours or overnight).

Academic Periodicals covering Irregular Heartbeat Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to irregular heartbeat. In addition to these sources, you can search for articles covering irregular heartbeat that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles.

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Irregular Heartbeat

At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

17

CHAPTER 4. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for irregular heartbeat. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with irregular heartbeat. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).

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Irregular Heartbeat

The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to irregular heartbeat: Amiodarone •

Systemic - U.S. Brands: Cordarone; Cordarone I.V. http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202029.html

Beta-adrenergic Blocking Agents •

Systemic - U.S. Brands: Betapace; Blocadren; Cartrol; Corgard; Inderal; Inderal LA; Kerlone; Levatol; Lopressor; Normodyne; Sectral; Tenormin; Toprol-XL; Trandate; Visken; Zebeta http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202087.html

Calcium Channel Blocking Agents •

Systemic - U.S. Brands: Adalat; Adalat CC; Calan; Calan SR; Cardene; Cardizem; Cardizem CD; Cardizem SR; Dilacor-XR; DynaCirc; Isoptin; Isoptin SR; Nimotop; Norvasc; Plendil; Procardia; Procardia XL; Vascor; Verelan http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202107.html

Dantrolene •

Systemic - U.S. Brands: Dantrium; Dantrium Intravenous http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202181.html

Dofetilide •

Systemic - U.S. Brands: Tikosyn http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500068.html

Flecainide •

Systemic - U.S. Brands: Tambocor http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202240.html

Magnesium Supplements •

Systemic - U.S. Brands: Almora; Chloromag; Citroma; Concentrated Phillips' Milk of Magnesia; Mag-200; Mag-L-100; Magonate; Mag-Ox 400; Mag-Tab SR; Magtrate; Maox; MGP; Phillips' Chewable Tablets; Phillips' Milk of Magnesia; Slow-Mag; Uro-Mag http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202644.html

Mexiletine •

Systemic - U.S. Brands: Mexitil http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202369.html

Moricizine •

Systemic - U.S. Brands: Ethmozine http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202381.html

Researching Medications

19

Phenylephrine •

Ophthalmic - U.S. Brands: Ak-Dilate; Ak-Nefrin; Dilatair; I-Phrine; Isopto Frin; Mydfrin; Neofrin; Neo-Synephrine; Ocugestrin; Ocu-Phrin Sterile Eye Drops; Ocu-Phrin Sterile Ophthalmic Solution; Phenoptic; Prefrin Liquifilm; Relief Eye Drops for Red Eyes http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202461.html

Potassium Supplements •

Systemic - U.S. Brands: Cena-K; Effer-K; Gen-K; Glu-K; K+ 10; K+ Care; K+ Care ET; K-8; Kaochlor 10%; Kaochlor S-F 10%; Kaon; Kaon-Cl; Kaon-Cl 20% Liquid; Kaon-Cl-10; Kato; Kay Ciel; Kaylixir; K-Dur; K-Electrolyte; K-G Elixir; K-Ide; KLease; K-Lor; Klor-Con 10; Klor-Con 8; Klor-Con Powder; Klor-Con/25 Powder; Klor-Con/EF; Klorvess; Klorvess 10% Liquid; Klorvess Effervescent Granules; Klotrix; K-Lyte; K-Lyte DS; K-Lyte/Cl; K-Lyte/Cl 50; K-Lyte/Cl Powder; KNorm; Kolyum; K-Sol; K-Tab; K-Vescent; Micro-K; Micro-K 10; Micro-K LS; Potasalan; Rum-K; Slow-K; Ten-K; Tri-K; Twin-K http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202473.html

Procainamide •

Systemic - U.S. Brands: Procan SR; Promine; Pronestyl; Pronestyl-SR http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202483.html

Tocainide •

Systemic - U.S. Brands: Not commercially available http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202571.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html.

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Irregular Heartbeat

Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

21

APPENDICES

23

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute6: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

6

These publications are typically written by one or more of the various NIH Institutes.

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Irregular Heartbeat

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources

25

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.7 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:8 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

7 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 8 See http://www.nlm.nih.gov/databases/databases.html.

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Irregular Heartbeat

•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The NLM Gateway9

The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.10 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “irregular heartbeat” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 37 3 999 0 19 1058

HSTAT11 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.12 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.13 Simply search by “irregular heartbeat” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 11 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 12 The HSTAT URL is http://hstat.nlm.nih.gov/. 13 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 9

10

Physician Resources

27

Coffee Break: Tutorials for Biologists14 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.15 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.16 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 16 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 14

15

29

APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on irregular heartbeat can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internetbased services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to irregular heartbeat. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to irregular heartbeat. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “irregular heartbeat”:

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Irregular Heartbeat

Arrhythmia http://www.nlm.nih.gov/medlineplus/arrhythmia.html Cardiomyopathy http://www.nlm.nih.gov/medlineplus/cardiomyopathy.html Congenital Heart Disease http://www.nlm.nih.gov/medlineplus/congenitalheartdisease.html Heart Attack http://www.nlm.nih.gov/medlineplus/heartattack.html Heart Diseases http://www.nlm.nih.gov/medlineplus/heartdiseases.html Heart Failure http://www.nlm.nih.gov/medlineplus/heartfailure.html Pacemakers and Implantable Defibrillators http://www.nlm.nih.gov/medlineplus/pacemakersandimplantabledefibrillators.ht ml

Within the health topic page dedicated to irregular heartbeat, the following was listed: •

Diagnosis/Symptoms Diagnosing Arrhythmias Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3 Echocardiogram http://www.nlm.nih.gov/medlineplus/tutorials/echocardiogramloader.html Electrophysiology (EP) Study Source: Heart Rhythm Society http://www.hrspatients.org/patients/heart_tests/electrophysiology_study.asp Fainting (Syncope) Source: Heart Rhythm Society http://www.hrspatients.org/patients/signs_symptoms/fainting/default.asp Other Symptoms of Heart Rhythm Disorders Source: Heart Rhythm Society http://www.hrspatients.org/patients/signs_symptoms/other.asp Rapid Heartbeat Source: Heart Rhythm Society http://www.hrspatients.org/patients/signs_symptoms/too_fast.asp Slow Heartbeat Source: Heart Rhythm Society http://www.hrspatients.org/patients/signs_symptoms/too_slow.asp Transesophageal Echocardiogram (TEE) Source: National Institutes of Health, Clinical Center http://www.cc.nih.gov/ccc/patient_education/procdiag/tee.pdf

Patient Resources

•

31

Treatment Antiarrhythmics Source: Texas Heart Institute http://www.tmc.edu/thi/antiarrh.html Arrthythmia Medications Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=18 Cardiac Ablation Source: Heart Rhythm Society http://www.hrspatients.org/patients/treatments/cardiac_ablation.asp Cardiac Ablation Catheter Source: Food and Drug Administration http://www.fda.gov/hearthealth/treatments/medicaldevices/cardiacablationcath eter.html Cardioversion Source: American Heart Association http://circ.ahajournals.org/cgi/reprint/106/22/e176.pdf Defibrillation Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=30 Implantable Cardioverter Defibrillators (ICDs) Source: Heart Rhythm Society http://www.hrspatients.org/patients/treatments/cardiac_defibrillators/default.as p Management of Newly Detected Atrial Fibrillation: Recommendations from the American College of Physicians and the American Academy of Family Physicians Source: American College of Physicians http://www.annals.org/cgi/content/full/139/12/I-32 Maze Surgery Source: Texas Heart Institute http://www.tmc.edu/thi/mazes.html Surgical Treatment of Atrial Fibrillation Source: Cleveland Clinic Foundation http://www.clevelandclinic.org/health/healthinfo/docs/2400/2453.asp?index=9518

•

Nutrition Caffeine, Diet and Heart Arrhythmias Source: Heart Rhythm Society http://www.hrspatients.org/patients/substances/diet.asp

•

Children Checklist for Parents of Children with Arrhythmias Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=20

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Irregular Heartbeat

Children and Arrhythmia Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=2 Diagnosing Arrhythmias in Children Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=4 Treating Arrhythmias in Children Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=26 Types of Arrhythmia in Children Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=7 •

Latest News Eating Broiled, Baked Fish May Lower Incidence of Irregular Heart Rhythm in the Elderly Source: 07/20/2004, American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3023422 Exercise Safe for People with Defibrillators Source: 08/05/2004, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_19361 .html Lifetime Risk of Abnormal Heart Rhythm 25% Source: 08/16/2004, Reuters Health http://www.nlm.nih.gov//www.nlm.nih.gov/medlineplus/news/fullstory_19545 .html One in Four Adults Over 40 Could Develop Irregular Heartbeat Source: 08/16/2004, American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3024021 Parental Atrial Fibrillation Increases Risk in Offspring Source: 06/15/2004, National Heart, Lung, and Blood Institute http://www.nih.gov/news/pr/jun2004/nhlbi-15.htm

•

Organizations American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=1200000 Heart Rhythm Society http://www.hrsonline.org/ National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/

•

Prevention/Screening Am I at Risk? Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=562

Patient Resources

33

Risk Factors and Prevention Source: Heart Rhythm Society http://www.hrspatients.org/patients/risk_factors/default.asp •

Research Cardiac Imaging Can Be 'Gatekeeper' for Implantable Heart-Shocker Source: American Heart Association http://www.americanheart.org/presenter.jhtml?identifier=3015775 Outcomes of Patients with Lone Atrial Flutter Source: American College of Physicians http://www.annals.org/cgi/content/full/140/4/I-55 Parental Atrial Fibrillation Increases Risk in Offspring Source: National Heart, Lung, and Blood Institute http://www.nih.gov/news/pr/jun2004/nhlbi-15.htm

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on irregular heartbeat. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Hemochromatosis (HH) Source: Richmond, BC, Canada: Canadian Hemochromatosis Society. 1997. 2 p. Contact: Available from Canadian Hemochromatosis Society. 272-7000 Minoru Boulevard, Richmond, BC, Canada V6Y 3Z5. (604) 279-7135. Fax (604) 279-7138. E-mail: [email protected]. PRICE: Single copy free. Summary: This brochure describes hemochromatosis (HH), a genetic disorder that results in an overload of iron in the body. Iron accumulates over a number of years and collects in vital organs, such as the heart, liver, and pancreas, causing damage and, in some cases, total destruction. Symptoms include chronic fatigue, arthritis, diabetes, enlarged liver, cirrhosis, weight loss, mood swings, irregular heartbeat, abdominal pain and distention, menstrual irregularities, loss of body hair, impotence, testicular atrophy, changes in skin color, and jaundice. The brochure discusses the incidence of HH in Canada, treatment options, diagnostic tests, family screening, and monitoring of children. HH patients can be successfully treated by regular blood withdrawals (phlebotomies), which will reduce the buildup of excess iron. If diagnosed early enough,

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Irregular Heartbeat

iron buildup can be stopped in time and irreversible damage to vital organs will be avoided. •

Importance of Family Screening Source: Richmond, BC, Canada: Canadian Hemochromatosis Society. 1993. 1 p. Contact: Available from Canadian Hemochromatosis Society. 272-7000 Minoru Boulevard, Richmond, BC, Canada V6Y 3Z5. (604) 279-7135. Fax (604) 279-7138. E-mail: [email protected]. PRICE: Single copy free. Summary: This fact sheet describes the role of family screening for hemochromatosis (HH), a genetic disorder that results in an overload of iron in the body. Iron accumulates over a number of years and collects in vital organs, such as the heart, liver, and pancreas, causing damage and, in some cases, total destruction. The fact sheet reviews the genetic risk factors for HH and then lists the symptoms. They are chronic fatigue, arthritis, diabetes, enlarged liver, cirrhosis, weight loss, mood swings, irregular heartbeat, abdominal pain and distention, menstrual irregularities, loss of body hair, impotence, testicular atrophy, changes in skin color, and jaundice. HH is also frequently misdiagnosed as chronic hepatitis, gallbladder or thyroid problems, and iron deficiency. The fact sheet concludes by emphasizing that only the correct blood tests will lead to an accurate diagnosis and enable successful treatment.

•

Hemochromatosis: A Common Genetic Disorder Source: Richmond, BC, Canada: Canadian Hemochromatosis Society. 1997. 2 p. Contact: Available from Canadian Hemochromatosis Society. 272-7000 Minoru Boulevard, Richmond, BC, Canada V6Y 3Z5. (604) 279-7135. Fax (604) 279-7138. E-mail: [email protected]. PRICE: Single copy free. Summary: This fact sheet reviews the genetics of hemochromatosis (HH), a genetic disorder that results in an overload of iron in the body. Iron accumulates over a number of years and collects in vital organs, such as the heart, liver, and pancreas, causing damage and, in some cases, total destruction. The fact sheet first discusses the incidence of the disorder and the importance of family screening, noting that it is not necessary for parents to have the disorder for their children to develop it. Symptoms include chronic fatigue, arthritis, diabetes, enlarged liver, cirrhosis, weight loss, mood swings, irregular heartbeat, abdominal pain and distention, menstrual irregularities, loss of body hair, impotence, testicular atrophy, changes in skin color, and jaundice. HH patients can be treated successfully by regular blood withdrawals (phlebotomies), which will reduce the buildup of excess iron in the body. If diagnosed early enough, the iron buildup can be stopped in time and irreversible damage to vital organs will be avoided. Special diagnostic tests (a fasting iron profile) can be used. 3 references.

•

Potassium and Renal Diet Source: New York, NY: National Kidney Foundation. 1999. 3 p. Contact: Available from National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. Website: www.kidney.org. PRICE: Single copy free. Summary: This patient education fact sheet reviews the importance of potassium for patients following a renal (kidney) diet. Potassium is a mineral found in many foods; it plays a role in heartbeat regulation and keeping the muscles working right. The kidneys normally keep the right amount of potassium levels in the body. In people with kidney

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disease, the kidneys may not perform this regulation function very well, and dietary limitation of potassium can be helpful. Symptoms of too much potassium in the blood (hyperkalemia) include muscle weakness, numbness, and tingling; additional complications include irregular heartbeat or even a heart attack. The fact sheet offers strategies for controlling potassium in the diet, recommending that readers work closely with their dietitian to first learn about their diet therapy. The author emphasizes the importance of portion size; a large amount of a low potassium food can turn it into a high potassium food. The fact sheet includes a table that lists foods that are high in potassium (more than 200 milligrams per portion); the portion size is noted at one-half cup for most foods. A second table lists foods that are low in potassium (lower than 200 milligrams per portion). The fact sheet includes a space for readers to note their own recommended blood potassium level (as determined by their health care provider). The fact sheet concludes with a brief description of the activities of the National Kidney Foundation (800-622-9010). •

Anemia and Kidney Disease Source: San Bruno, CA: Krames Communications. 1997. 2 p. Contact: Available from Krames Communications. 1100 Grundy Lane, San Bruno, CA 94066-3030. (800) 333-3032. Fax (415) 244-4512. PRICE: $12.50 for pad of 50 sheets. Summary: This patient education handout explains the basics of anemia and how it can become a problem for people with kidney disease. Anemia occurs when the blood does not have enough red cells; therefore, the blood cannot carry the necessary oxygen to the body. The handout lists the symptoms of anemia, including ongoing fatigue; shortness of breath; rapid, irregular heartbeat; trouble concentrating; erectile dysfunction (impotence); feeling dizzy or lightheaded; and constantly feeling cold. Normally, the kidneys send out a signal (erythropoietin) that tells the body when to make new red blood cells. But in people with kidney disease, the kidneys may not be able to send this signal. A medication called epoetin alfa (EPO), a synthetic version of erythropoietin, can be given. EPO controls anemia by signaling the body to make red blood cells. Most often, EPO is used to treat people on dialysis. The handout also discusses the role of iron in making blood cells. Most people who take EPO need extra iron. The handout offers a list of strategies for people who are taking iron (particularly suggestions for avoiding the constipation that can accompany iron intake). The handout is written in nontechnical language and is illustrated with colorful drawings. The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to irregular heartbeat. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.

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Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to irregular heartbeat. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with irregular heartbeat. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about irregular heartbeat. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “irregular heartbeat” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received

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your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “irregular heartbeat”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “irregular heartbeat” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “irregular heartbeat” (or a synonym) into the search box, and click “Submit Query.”

39

APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.17

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

17

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)18: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

18

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

41

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

43

•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

45

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

47

IRREGULAR HEARTBEAT DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Ablation: The removal of an organ by surgery. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Afterload: The tension produced by the heart muscle after contraction. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anti-infective: An agent that so acts. [EU]

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Aorta: The main trunk of the systemic arteries. [NIH] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Asynchronous: Pacing mode where only one timing interval exists, that between the stimuli. While the duration of this interval may be varied, it is not modified by any sensed event once set. As no sensing occurs, the upper and lower rate intervals are the same as the pacema. [NIH] Atrial: Pertaining to an atrium. [EU] Atrial Fibrillation: Disorder of cardiac rhythm characterized by rapid, irregular atrial impulses and ineffective atrial contractions. [NIH] Atrial Flutter: Rapid, irregular atrial contractions due to an abnormality of atrial excitation. [NIH]

Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrioventricular Node: A small nodular mass of specialized muscle fibers located in the interatrial septum near the opening of the coronary sinus. It gives rise to the atrioventricular bundle of the conduction system of the heart. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bile Pigments: Pigments that give a characteristic color to bile including: bilirubin, biliverdine, and bilicyanin. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH]

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Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood Volume: Volume of circulating blood. It is the sum of the plasma volume and erythrocyte volume. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiac Glycosides: Substances obtained from species of Digitalis, Strophanthus, and other plants that contain specific steroid glycosides or their semisynthetic derivatives and used in congestive heart failure. They increase the force of cardiac contraction without significantly affecting other parameters, but are very toxic at larger doses. Their mechanism of action usually involves inhibition of the Na(+)-K(+)-exchanging ATPase and they are often used in cell biological studies for that purpose. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiotonic: 1. Having a tonic effect on the heart. 2. An agent that has a tonic effect on the heart. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic

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hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Circulatory system: The system that contains the heart and the blood vessels and moves blood throughout the body. This system helps tissues get enough oxygen and nutrients, and it helps them get rid of waste products. The lymph system, which connects with the blood system, is often considered part of the circulatory system. [NIH] Cirrhosis: A type of chronic, progressive liver disease. [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Collateral Circulation: Maintenance of blood flow to an organ despite obstruction of a principal vessel. Blood flow is maintained through small vessels. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conduction: The transfer of sound waves, heat, nervous impulses, or electricity. [EU] Congestive heart failure: Weakness of the heart muscle that leads to a buildup of fluid in body tissues. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constitutional: 1. Affecting the whole constitution of the body; not local. 2. Pertaining to the constitution. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU]

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Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Counterpulsation: A technique for assisting the circulation by decreasing the afterload of the left ventricle and augmenting the diastolic pressure. It may be achieved by intra-aortic balloon, or by implanting a special pumping device in the chest, or externally by applying a negative pressure to the lower extremities during cardiac systole. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydroepiandrosterone: DHEA. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Dietitian: An expert in nutrition who helps people plan what and how much food to eat. [NIH]

Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digitalis: A genus of toxic herbaceous Eurasian plants of the Scrophulaceae which yield cardiotonic glycosides. The most useful are Digitalis lanata and D. purpurea. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disopyramide: Alpha-(2-(Bis(l-methylethyl)amino)ethyl)-alpha-phenyl-2-pyridine acetamide. A class I anti-arrhythmic agent (one that interferes directly with the depolarization of the cardiac membrane and thus serves as a membrane-stabilizing agent) with a depressant action on the heart similar to that of guanidine. It also possesses some anticholinergic and local anesthetic properties. [NIH] Distention: The state of being distended or enlarged; the act of distending. [EU] Diuresis: Increased excretion of urine. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Emboli: Bit of foreign matter which enters the blood stream at one point and is carried until it is lodged or impacted in an artery and obstructs it. It may be a blood clot, an air bubble, fat or other tissue, or clumps of bacteria. [NIH]

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Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epoetin alfa: A colony-stimulating factor that is made in the laboratory. It increases the production of red blood cells. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Erythrocyte Volume: Volume of circulating erythrocytes. It is usually measured by radioisotope dilution technique. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Evacuation: An emptying, as of the bowels. [EU] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Exocrine: Secreting outwardly, via a duct. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrillation: A small, local, involuntary contraction of muscle, invisible under the skin, resulting from spontaneous activation of single muscle cells or muscle fibres. [EU] Flatus: Gas passed through the rectum. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body

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through the rectum (flatus) or the mouth (burp). [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glutathione Peroxidase: An enzyme catalyzing the oxidation of 2 moles of glutathione in the presence of hydrogen peroxide to yield oxidized glutathione and water. EC 1.11.1.9. [NIH]

Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gravis: Eruption of watery blisters on the skin among those handling animals and animal products. [NIH] Guanidine: A strong organic base existing primarily as guanidium ions at physiological pH. It is found in the urine as a normal product of protein metabolism. It is also used in laboratory research as a protein denaturant. (From Martindale, the Extra Pharmacopoeia, 30th ed and Merck Index, 12th ed) It is also used in the treatment of myasthenia and as a fluorescent probe in HPLC. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Heartbeat: One complete contraction of the heart. [NIH] Hemochromatosis: A disease that occurs when the body absorbs too much iron. The body stores the excess iron in the liver, pancreas, and other organs. May cause cirrhosis of the liver. Also called iron overload disease. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH]

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Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hyperbilirubinemia: Pathologic process consisting of an abnormal increase in the amount of bilirubin in the circulating blood, which may result in jaundice. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Implantable pump: A small device installed under the skin to administer a steady dose of drugs. [NIH] Impotence: The inability to perform sexual intercourse. [NIH] Incision: A cut made in the body during surgery. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU] Intestinal: Having to do with the intestines. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intracellular: Inside a cell. [NIH] Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH]

Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Left ventricular assist device: A mechanical device used to increase the heart's pumping ability. [NIH]

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Ligaments: Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Myocardial Contraction: Contractile activity of the heart. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Pacemaker: An object or substance that influences the rate at which a certain phenomenon occurs; often used alone to indicate the natural cardiac pacemaker or an artificial cardiac pacemaker. In biochemistry, a substance whose rate of reaction sets the pace for a series of interrelated reactions. [EU] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU]

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Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Pigments: Any normal or abnormal coloring matter in plants, animals, or micro-organisms. [NIH]

Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma Volume: Volume of plasma in the circulation. It is usually measured by indicator dilution techniques. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis,

Dictionary 57

therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Procainamide: A derivative of procaine with less CNS action. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Quinidine: An optical isomer of quinine, extracted from the bark of the Cinchona tree and similar plant species. This alkaloid dampens the excitability of cardiac and skeletal muscles by blocking sodium and potassium currents across cellular membranes. It prolongs cellular action potential, and decreases automaticity. Quinidine also blocks muscarinic and alphaadrenergic neurotransmission. [NIH] Quinine: An alkaloid derived from the bark of the cinchona tree. It is used as an antimalarial drug, and is the active ingredient in extracts of the cinchona that have been used for that purpose since before 1633. Quinine is also a mild antipyretic and analgesic and has been used in common cold preparations for that purpose. It was used commonly and as a bitter and flavoring agent, and is still useful for the treatment of babesiosis. Quinine is also useful in some muscular disorders, especially nocturnal leg cramps and myotonia congenita, because of its direct effects on muscle membrane and sodium channels. The mechanisms of its antimalarial effects are not well understood. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refractory: Not readily yielding to treatment. [EU] Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH]

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Irregular Heartbeat

Screening: Checking for disease when there are no symptoms. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Septum: A dividing wall or partition; a general term for such a structure. The term is often used alone to refer to the septal area or to the septum pellucidum. [EU] Septum Pellucidum: A triangular double membrane separating the anterior horns of the lateral ventricles of the brain. It is situated in the median plane and bounded by the corpus callosum and the body and columns of the fornix. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Sinoatrial Node: The small mass of modified cardiac muscle fibers located at the junction of the superior vena cava and right atrium. Contraction impulses probably start in this node, spread over the atrium and are then transmitted by the atrioventricular bundle to the ventricle. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] a hydrogenated Steroid: A group name for lipids that contain cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH]

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Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subcutaneous: Beneath the skin. [NIH] Superior vena cava: Vein which returns blood from the head and neck, upper limbs, and thorax. It is formed by the union of the two brachiocephalic veins. [NIH] Supraventricular: Situated or occurring above the ventricles, especially in an atrium or atrioventricular node. [EU] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Systemic: Affecting the entire body. [NIH] Systole: Period of contraction of the heart, especially of the ventricles. [NIH] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Testicular: Pertaining to a testis. [EU] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thoracic: Having to do with the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and

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pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary Retention: Inability to urinate. The etiology of this disorder includes obstructive, neurogenic, pharmacologic, and psychogenic causes. [NIH] Urinate: To release urine from the bladder to the outside. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Valves: Flap-like structures that control the direction of blood flow through the heart. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venous Pressure: The blood pressure in a vein. It is usually measured to assess the filling pressure to the ventricle. [NIH] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH]

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INDEX A Abdominal, 33, 34, 47, 56 Abdominal Pain, 33, 34, 47 Ablation, 31, 47 Adenosine, 47, 49, 56 Adrenergic, 18, 47, 52, 57 Adverse Effect, 47, 58 Afterload, 47, 51 Agar, 47, 56 Alertness, 47, 49 Algorithms, 47, 48 Alkaline, 47, 49 Alkaloid, 47, 57 Alternative medicine, 14, 47 Anatomical, 47, 48 Anemia, 35, 47 Antagonism, 47, 49 Anticholinergic, 10, 47, 51 Anti-infective, 47, 54 Aorta, 8, 48, 60 Arrhythmia, 9, 10, 30, 32, 48 Arterial, 8, 48, 57 Arteries, 48, 49, 50, 55 Arterioles, 48, 49 Artery, 48, 51, 57 Asynchronous, 9, 48 Atrial, 10, 11, 31, 32, 33, 48 Atrial Fibrillation, 10, 11, 31, 32, 33, 48 Atrial Flutter, 10, 33, 48 Atrioventricular, 11, 48, 58, 59 Atrioventricular Node, 11, 48, 59 Atrium, 10, 11, 48, 58, 59, 60 Atrophy, 33, 34, 48 B Bacteria, 48, 51, 52 Bacteriophage, 48, 56 Bile, 48, 52, 54, 55, 58 Bile Pigments, 48, 54 Biotechnology, 4, 14, 25, 48 Bladder, 8, 48, 60 Blood Coagulation, 49 Blood pressure, 49, 54, 58, 60 Blood vessel, 8, 49, 50, 54, 58, 59, 60 Blood Volume, 10, 49 Bone Marrow, 49, 52 C Caffeine, 9, 31, 49 Calcium, 9, 18, 49

Cardiac, 9, 10, 31, 33, 48, 49, 51, 52, 55, 57, 58 Cardiac Glycosides, 10, 49 Cardiac Output, 10, 49 Cardiomyopathy, 30, 49 Cardiotonic, 9, 49, 51 Cardiovascular, 10, 49 Carotene, 9, 49 Catheter, 8, 31, 50 Cell, 48, 49, 50, 51, 52, 54, 55, 56 Central Nervous System, 49, 50, 53 Chronic, 33, 34, 50, 54 Circulatory system, 8, 50 Cirrhosis, 33, 34, 50, 53 Clinical trial, 4, 25, 50 Cloning, 48, 50 Collagen, 50, 56 Collapse, 9, 10, 50 Collateral Circulation, 8, 50 Computational Biology, 25, 50 Conduction, 48, 50 Congestive heart failure, 10, 49, 50 Constipation, 35, 50 Constitutional, 50, 55 Contraindications, ii, 50 Coronary, 8, 48, 50, 51, 55 Coronary Thrombosis, 51, 55 Counterpulsation, 8, 51 Curative, 51, 59 Cyclic, 49, 51 D Degenerative, 51, 54 Dehydroepiandrosterone, 9, 51 Depolarization, 51 Diagnostic procedure, 7, 14, 51 Dialyzer, 51, 53 Diarrhea, 15, 51 Diastolic, 51 Dietitian, 35, 51 Digestion, 48, 51, 55, 59 Digitalis, 10, 49, 51 Direct, iii, 17, 51, 57, 59 Disopyramide, 10, 51 Distention, 33, 34, 51 Diuresis, 10, 49, 51 Drug Interactions, 19, 51 E Edema, 10, 51

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Electrolyte, 19, 51, 56, 58 Emboli, 8, 51 Environmental Health, 24, 26, 52 Enzymatic, 49, 50, 52 Epigastric, 52, 56 Epinephrine, 47, 52, 55 Epoetin alfa, 35, 52 Erectile, 35, 52 Erection, 52 Erythrocyte Volume, 49, 52 Erythrocytes, 47, 49, 52, 57 Erythropoietin, 35, 52 Evacuation, 50, 52 Excitability, 52, 57 Excitation, 48, 52 Exocrine, 52, 56 F Family Planning, 25, 52 Fat, 49, 51, 52 Fatigue, 33, 34, 35, 52, 53 Feces, 50, 52 Fetus, 52 Fibrillation, 10, 52 Flatus, 52, 53 G Gallbladder, 34, 47, 52 Gas, 8, 52 Gene, 48, 53 Genetics, 34, 53 Ginseng, 9, 53 Gland, 53, 56, 58, 59 Glutathione Peroxidase, 53, 58 Governing Board, 53, 57 Gravis, 10, 53 Guanidine, 51, 53 H Headache, 49, 53 Heart attack, 35, 53 Heart failure, 3, 53 Heartbeat, 3, 4, 5, 8, 9, 10, 11, 13, 15, 30, 32, 33, 34, 35, 53 Hemochromatosis, 33, 34, 53 Hemodialysis, 3, 15, 51, 53 Hemoglobin, 47, 52, 53 Hepatitis, 34, 54 Hepatocytes, 54 Heredity, 53, 54 Hormonal, 48, 54 Hormone, 52, 54, 59 Hyperbilirubinemia, 54 Hypotension, 10, 54

I Implantable pump, 8, 54 Impotence, 33, 34, 35, 52, 54 Incision, 54 Infarction, 51, 54, 55 Inotropic, 10, 54 Intestinal, 50, 54 Intestines, 47, 52, 54 Intracellular, 49, 54, 56, 58 Invasive, 9, 54 Involuntary, 52, 54, 55 Iodine, 9, 54 Ischemia, 48, 54 J Jaundice, 33, 34, 54 K Kb, 24, 54 Kidney Disease, 15, 24, 35, 54 L Left ventricular assist device, 8, 54 Ligaments, 50, 55 Liver, 33, 34, 47, 48, 50, 52, 53, 54, 55 Localized, 55, 56 Lymph, 50, 55 M Malnutrition, 48, 55 MEDLINE, 25, 55 Membrane, 51, 52, 55, 57, 58 Mental, iv, 4, 24, 26, 52, 55, 57 MI, 45, 55 Molecular, 25, 27, 48, 50, 55 Motion Sickness, 55 Muscle Fibers, 48, 55, 58 Myasthenia, 10, 53, 55 Myocardial Contraction, 10, 55 Myocardium, 55 N Nausea, 15, 55 Necrosis, 54, 55 Nephropathy, 54, 55 Nerve, 47, 55, 57, 58 Norepinephrine, 47, 55 P Pacemaker, 11, 55 Palliative, 55, 59 Pancreas, 33, 34, 47, 53, 56 Pathologic, 50, 54, 56 Patient Education, 33, 34, 35, 40, 42, 45, 56 Pharmacodynamic, 10, 56 Pharmacologic, 56, 60 Phenyl, 51, 56 Phosphorus, 49, 56

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Pigments, 48, 49, 56 Plants, 47, 49, 51, 53, 55, 56 Plaque, 8, 56 Plasma, 49, 53, 56 Plasma Volume, 49, 56 Platelet Aggregation, 10, 56 Platelets, 56, 59 Pneumonia, 50, 56 Poisoning, 55, 56 Posterior, 56 Potassium, 3, 9, 15, 19, 34, 56, 57 Practice Guidelines, 26, 56 Procainamide, 10, 19, 57 Procaine, 57 Progressive, 50, 55, 57 Protein S, 48, 57 Psychogenic, 57, 60 Public Policy, 25, 57 Pulmonary, 49, 57, 60 Pulmonary Artery, 49, 57, 60 Pulse, 8, 11, 57 Q Quinidine, 10, 57 Quinine, 57 R Rectum, 52, 53, 57 Red blood cells, 35, 52, 57 Refer, 1, 57, 58 Refractory, 10, 57 Retinoids, 57, 60 Risk factor, 34, 57 S Screening, 32, 33, 34, 50, 58 Selenium, 9, 58 Semisynthetic, 49, 58 Septal, 58 Septum, 11, 48, 58 Septum Pellucidum, 58 Side effect, 10, 17, 47, 58, 59 Sinoatrial Node, 11, 58 Skeletal, 57, 58 Smooth muscle, 49, 58 Sodium, 57, 58 Specialist, 36, 58 Species, 49, 52, 57, 58 Stem Cells, 52, 58 Steroid, 49, 58 Stimulant, 49, 58

Stimulus, 52, 58, 59 Stomach, 47, 54, 55, 59 Stress, 9, 55, 59 Stroke, 24, 49, 59 Subcutaneous, 51, 59 Superior vena cava, 58, 59 Supraventricular, 10, 59 Synapse, 47, 59 Systemic, 18, 19, 48, 49, 52, 59 Systole, 51, 59 T Tachycardia, 10, 59 Testicular, 33, 34, 59 Testis, 59 Therapeutics, 10, 20, 59 Thoracic, 8, 59, 60 Threshold, 11, 52, 59 Thrombin, 56, 59 Thrombus, 10, 51, 54, 56, 59 Thyroid, 34, 54, 59 Tissue, 48, 49, 50, 51, 52, 55, 58, 59 Tonic, 49, 59 Toxic, iv, 10, 49, 51, 58, 59, 60 Toxicity, 51, 59 Toxicology, 26, 59 Trachea, 59, 60 Transfection, 48, 60 U Urethra, 60 Urinary, 10, 60 Urinary Retention, 10, 60 Urinate, 60 Urine, 15, 48, 51, 53, 60 V Valves, 11, 60 Vascular, 54, 59, 60 Vein, 59, 60 Venous, 10, 57, 60 Venous Pressure, 10, 60 Ventricle, 8, 11, 48, 51, 57, 58, 60 Ventricular, 8, 10, 60 Venules, 49, 60 Veterinary Medicine, 25, 60 Virus, 48, 56, 60 Vitamin A, 9, 60 W Windpipe, 59, 60

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Irregular Heartbeat