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Introduction
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
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Pulmonary Embolism I: Introduction01:29

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Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
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Acute Coronary Syndrome I: Introduction01:30

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Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
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Cardiac Output II: Effect of Stroke Volume on Cardiac Output01:22

Cardiac Output II: Effect of Stroke Volume on Cardiac Output

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Cardiac output (CO), the amount of blood the heart pumps per minute, is a parameter in cardiovascular physiology determined by stroke volume and heart rate. Stroke volume, the amount of blood pushed from one of the ventricles per heartbeat, is influenced by preload, afterload, and contractility.
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
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Regulation of Stroke Volume01:27

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The regulation of stroke volume, which is the amount of blood the heart pumps out during each heartbeat, is critical for maintaining a healthy circulatory system. Stroke volume is influenced by three main factors: preload, contractility, and afterload.
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
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Exercise and Cardiovascular Response01:20

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Exercise significantly impacts cardiovascular response, which is crucial for understanding patient health and designing effective treatment plans.
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
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Stroke in Commercial Flights.

Rodrigo Álvarez-Velasco1, Jaime Masjuan2, Alicia DeFelipe2

  • 1From the Neurology Department, Hospital Universitario Ramón y Cajal de Madrid, Madrid, Spain (R.A.-V., J.M., A.D.F., I.C., C.E.-F., L.C., A.A.-C.); Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain (J.M.); and Universidad de Alcalá, Madrid (J.M.). r.alvarez.velasco@gmail.com.

Stroke
|February 20, 2016
PubMed
Summary

The incidence of stroke during air travel is low, with one stroke per 35,000 flights. Atherothrombosis was the primary cause, often linked to significant carotid stenosis, despite good patient outcomes.

Keywords:
air traveldissectionembolism, paradoxicalforamen ovale, patentischemic attack, transientstroke

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Area of Science:

  • Neurology
  • Aerospace Medicine
  • Public Health

Background:

  • Previous studies on in-flight stroke primarily focused on "economy class stroke syndrome" through retrospective case series.
  • Limited data exists regarding the actual incidence, underlying causes (pathogenesis), and patient outcomes (prognosis) of stroke occurring during commercial flights.

Purpose of the Study:

  • To prospectively determine the incidence, pathogenesis, and prognosis of stroke and transient ischemic attack (TIA) in patients experiencing symptom onset during air travel.
  • To analyze the causes of stroke in this specific population and assess treatment outcomes.

Main Methods:

  • A prospective registry was established at an international airport to identify consecutive patients diagnosed with ischemic stroke or TIA.
  • Inclusion criteria required symptom onset during a flight or immediately post-landing.
  • Data was collected over a 76-month period (January 2008 to April 2014).

Main Results:

  • Forty-four patients (32 ischemic strokes, 12 TIAs) were identified, estimating an incidence of 1 stroke per 35,000 flights.
  • Key stroke causes included atherothrombosis (36%), economy class stroke syndrome (18%), cardioembolism (16%), and arterial dissection (9%).
  • High-grade carotid stenosis (>70%) was present in 27% of patients. Thrombolysis was administered in 44% of cases, with delayed hospital arrival being a common barrier to treatment.

Conclusions:

  • The incidence of stroke associated with air travel is low.
  • Atherothrombosis, frequently associated with significant carotid stenosis, emerged as the predominant cause of stroke in this cohort.
  • While economy class stroke syndrome and arterial dissection were noted, the overall prognosis for these patients was generally good.