The adrenal medulla in cardiovascular medicine: an untold story
- Authors: Esler, Murray , Jennings, Garry , Schlaich, Markus , Lambert, Gavin , Thompson, Jane , Lambert, Elisabeth , Guo, Ling , Alvarenga, Marlies , Esler, Danielle , Eikelis, Nina , Kaye, David
- Date: 2021
- Type: Text , Journal article
- Relation: Journal of Hypertension Vol. 39, no. 5 (2021), p. 819-829
- Full Text: false
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- Description: Unlike noradrenaline, the sympathetic neurotransmitter which overflows to the circulation, adrenaline (ADR) is a secreted hormone, with a low plasma concentration, and plasma concentration for biological action a log order lower than that of noradrenaline. The venous drainage of the left adrenal medulla into the left renal vein does expose this vein to uniquely high plasma ADR concentrations and possible risk of thrombosis at high rates of ADR secretion. There is typically a different timeframe for adrenal medullary and sympathetic nervous system responsesADR release is short term in contrast with sympathetic activation persisting for years in heart failure and hypertension. The historic view of Walter Cannon, subject to recent review, that the sympathoadrenal system is a unified biological system, was deconstructed further with demonstration of frequent mismatching of adrenal medullary and sympathetic nervous responses. Under gravity stimulation with standing, there is prompt sympathetic activation without ADR release. In many diseases, notably obesity, hypertension, heart failure and depressive illness, an activated sympathetic nervous system and silent adrenal medulla coexist. The therapeutic corollary of this is that ADR blockade is much less commonly needed clinically than pharmacological antagonism of the sympathetic nervous system.
The cardiac distress inventory : a new measure of psychosocial distress associated with an acute cardiac event
- Authors: Jackson, Alun , Grande, Michael , Rogerson, Michelle , Ski, Chantal , Amerena, John , Smith, Julian , Hoover, Valerie , Alvarenga, Marlies , Higgins, Rosemary , Thompson, David , Murphy, Barbara
- Date: 2022
- Type: Text , Journal article
- Relation: BMC Cardiovascular Disorders Vol. 22, no. 1 (2022), p.
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- Description: Background: Many challenges are posed by the experience of a heart attack or heart surgery which can be characterised as ‘cardiac distress’. It spans multiple psychosocial domains incorporating patients’ responses to physical, affective, cognitive, behavioural and social symptoms and experiences related to their cardiac event and their recovery. Although some measures of the psychological and emotional impacts of a cardiac event exist, none provides a comprehensive assessment of cardiac distress. To address this gap, the study aimed to develop a Cardiac Distress Inventory (CDI) using best practice in instrument design. Method: An item pool was generated through analysis of cognate measures, mostly in relation to other health conditions and through focus group and individual review by a multidisciplinary development team, cardiac patients, and end-users including cardiac rehabilitation co-ordinators. The resulting 144 items were reduced through further reviews to 74 for testing. The testing was carried out with 405 people recruited from three hospitals, through social media and by direct enrolment on the study website. A two-stage psychometric evaluation of the 74 items used exploratory factor analysis to extract the factors followed by Rasch analysis to confirm dimensionality within factors. Results: Psychometric analysis resulted in the identification of 55 items comprising eight subscales, to form the CDI. The subscales assess fear and uncertainty, disconnection and hopelessness, changes to roles and relationships, overwhelm and depletion, cognitive challenges, physical challenges, health system challenges, and death concerns. Validation against the Kessler 6 supports the criterion validity of the CDI. Conclusion: The CDI reflects a nuanced understanding of cardiac distress and should prove to be a useful clinical assessment tool, as well as a research instrument. Individual subscales or the complete CDI could be used to assess or monitor specific areas of distress in clinical practice. Development of a short form screening version for use in primary care, cardiac rehabilitation and counselling services is warranted. © 2022, The Author(s).
Development of a short form of the cardiac distress inventory
- Authors: Le Grande, Michael , Murphy, Barbara , Rogerson, Michelle , Ski, Chantal , Amerena, John , Smith, Julian , Hoover, Valerie , Alvarenga, Marlies , Higgins, Rosemary , Thompson, David , Jackson, Alun
- Date: 2023
- Type: Text , Journal article
- Relation: BMC Cardiovascular Disorders Vol. 23, no. 1 (2023), p.
- Full Text: false
- Reviewed:
- Description: Background: Cardiac distress may be viewed as a persistent negative emotional state that spans multiple psychosocial domains and challenges a patient’s capacity to cope with living with their heart condition. The Cardiac Distress Inventory (CDI) is a disease-specific clinical assessment tool that captures the complexity of this distress. In busy settings such as primary care, cardiac rehabilitation, and counselling services, however, there is a need to administer briefer tools to aid in identification and screening. The aim of the present study was to develop a short, valid screening version of the CDI. Methods: A total of 405 participants reporting an acute coronary event in the previous 12 months was recruited from three hospitals, through social media and by direct enrolment on the study website. Participants completed an online survey which included the full version of the CDI and general distress measures including the Kessler K6, Patient Health Questionnaire-4, and Emotion Thermometers. Relationship of the CDI with these instruments, Rasch analysis model fit and clinical expertise were all used to select items for the short form (CDI-SF). Construct validity and receiver operating characteristics in relation to the Kessler K6 were examined. Results: The final 12 item CDI-SF exhibited excellent internal consistency indicative of unidimensionality and good convergent and discriminant validity in comparison to clinical status measures, all indicative of good construct validity. Using the K6 validated cutoff of