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Cardiology Clinics

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https://www.readbyqxmd.com/read/29025552/the-pericardium-simple-and-innocent-but-complex-and-fascinating
#1
EDITORIAL
Jae K Oh, William R Miranda, Terrence D Welch
No abstract text is available yet for this article.
November 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/29025551/tuberculous-and-infectious-pericarditis
#2
REVIEW
Sung-A Chang
Viral pericarditis is the most common cause of acute pericarditis and it is typically responsive to aspirin or nonsteroidal anti-inflammatory drugs. Tuberculous pericarditis is common in immunocompromised patients or in immunocompetent patients in endemic areas. The diagnosis of tuberculous pericarditis usually requires a multidisciplinary approach, and presumptive treatment should be started for people with suspected infections living in endemic areas. Antituberculous treatment along with corticosteroid therapy can reduce complications from constrictive pericarditis...
November 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/29025550/congenital-abnormalities-of-the-pericardium
#3
REVIEW
Yuvrajsinh J Parmar, Ankit B Shah, Michael Poon, Itzhak Kronzon
Congenital abnormalities of the pericardium are a rare group of disorders that include congenital absence of the pericardium, pericardial cysts, and diverticula. These congenital defects result from alterations in the embryologic formation and structure of the pericardium. Although many cases are incidentally found, they can present as symptomatic, life-threatening disease. Owing to their rarity, many cases are inappropriately diagnosed. Alterations in the embryologic formation and structure may result in the formation of these congenital abnormalities...
November 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/29025549/neoplastic-pericardial-disease
#4
REVIEW
Joseph J Maleszewski, Nandan S Anavekar
Pericardial tumors are rare lesions that include a range of neoplastic conditions that may arise within the pericardium or metastasize to involve it secondarily. Understanding the spectrum of lesions that are included in the differential diagnosis of a pericardial mass-lesion is critical to making timely, accurate diagnoses and getting the appropriate therapy should one be necessary. This review summarizes the radiologic and pathologic findings of the most commonly encountered of these entities.
November 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/29025548/percutaneous-therapy-in-pericardial-diseases
#5
REVIEW
Bernhard Maisch, Arsen D Ristić, Sabine Pankuweit, Petar Seferovic
Interventional procedures for pericardial diseases include pericardiocentesis, drainage of pericardial effusion, intrapericardial therapy, and percutaneous balloon pericardiotomy or percutaneous pericardiostomy. Echocardiographic and fluoroscopic guidance have greatly increased safety and feasibility. Several devices for pericardiocentesis have been tested (PerDucer, PeriAttacher, visual puncture systems, Grasper, Scissors, and Reverse slitter), mainly to facilitate access to the pericardium in the absence of effusion for epicardial ablations or left atrial appendage ligation...
November 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/29025547/contemporary-techniques-of-pericardiectomy-for-pericardial-disease
#6
REVIEW
Pouya Hemmati, Kevin L Greason, Hartzell V Schaff
Pericardiectomy is a potentially curative treatment for constrictive pericarditis. We use a median sternotomy and believe that adequate resection involves removal of the diaphragmatic pericardium and the anterior pericardium. Late outcomes depend on severity of right-sided heart failure preoperatively, the etiology of constrictive pericarditis, and adequate pericardial resection. Late results are excellent in patients with idiopathic disease or those with pericarditis secondary to prior cardiac operations. However, survival is reduced in those with radiation-induced constrictive pericarditis, primarily owing to additional secondary effects of radiation on cardiac valves, epicardial coronary arteries, and ventricular myocardium where fibrosis may cause associated restrictive cardiomyopathy...
November 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/29025546/effusive-constrictive-pericarditis
#7
REVIEW
William R Miranda, Jae K Oh
Effusive-constrictive pericarditis (ECP) corresponds to the coexistence of a hemodynamically significant pericardial effusion and decreased pericardial compliance. The hallmark of ECP is the persistence of elevated right atrial pressure postpericardiocentesis. The prevalence of ECP seems higher in tuberculous pericarditis and lower in idiopathic cases. The diagnosis of ECP is traditionally based on invasive hemodynamics but the presence of echocardiographic features of constrictive pericarditis post-pericardiocentesisis can also identify ECP...
November 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/29025545/constrictive-pericarditis
#8
REVIEW
Terrence D Welch, Jae K Oh
Constrictive pericarditis is a potentially treatable cause of diastolic heart failure that arises because a diseased, inelastic pericardium restricts ventricular diastolic expansion. Affected patients present with heart failure with predominant right-sided symptoms and signs. The key to diagnosis is identification of the unique hemodynamic properties associated with constriction: dissociation of intrathoracic and intracardiac pressures and enhanced ventricular interaction. Comprehensive echocardiography with Doppler imaging is useful, but invasive hemodynamic assessment and cross-sectional imaging may be required for confirmation...
November 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/29025544/cardiac-tamponade
#9
REVIEW
Christopher Appleton, Linda Gillam, Konstantinos Koulogiannis
Cardiac tamponade is caused by an abnormal increase in fluid accumulation in the pericardial sac, which, by raising intracardiac pressures, impedes normal cardiac filling and reduces cardiac output, sometimes dramatically so. This article outlines the pathophysiology, clinical features, and treatment of this important clinical condition highlighting the important role played by echocardiography in diagnosis and management.
November 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/29025543/pericardial-effusion
#10
REVIEW
Amir Azarbal, Martin M LeWinter
The normal pericardial sac contains up to 50 mL of fluid, which consists of a plasma ultrafiltrate. Anything greater constitutes a pathologic effusion. The curvilinear pressure-volume relationship of the pericardial sac dictates hemodynamic consequences of a pericardial effusion and is responsible for rapidly accumulating fluid that causes cardiac tamponade. A variety of diseases and complications cause pericardial effusion. The most common are idiopathic pericarditis, cancer, connective tissue disorders, and hemorrhage...
November 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/29025542/acute-and-recurrent-pericarditis
#11
REVIEW
Massimo Imazio, Fiorenzo Gaita
Acute and recurrent pericarditis is the most common pericardial syndrome encountered in clinical practice either as an isolated process or as part of a systemic disease. The diagnosis is based on clinical evaluation, electrocardiogram, and echocardiography. The empiric therapy is based on nonsteroidal anti-inflammatory drugs plus colchicine as first choice, resorting to corticosteroids for specific indications (eg, systemic inflammatory disease on corticosteroids, pregnancy, renal failure, concomitant oral anticoagulants), for contraindications or failure of the first-line therapy...
November 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/29025541/imaging-of-the-pericardium-a-multimodality-cardiovascular-imaging-update
#12
REVIEW
Bo Xu, Deborah H Kwon, Allan L Klein
Pericardial diseases represent diverse conditions, ranging from painful inflammatory states, such as acute pericarditis, to life-threatening tamponade and chronic heart failure due to constrictive pericarditis. Multimodality cardiovascular imaging plays important roles in diagnosis and management of pericardial conditions. This review provides a clinical update on multimodality cardiovascular imaging of the pericardium, incorporating echocardiography, multidetector computed tomography, and cardiac magnetic resonance imaging, focusing on guiding clinicians about when each cardiac imaging modality should be used in each relevant pericardial condition...
November 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/29025540/anatomy-and-physiology-of-the-pericardium
#13
REVIEW
Brian D Hoit
The pericardium consists of a visceral mesothelial monolayer (epicardium) that reflects over the great vessels and joins an outer, relatively inelastic fibrous parietal layer of organized collagen and elastin fibers, between which is a potential space that normally contains up to 50 mL of plasma filtrate. Although not essential for life, the pericardium serves important albeit subtle functions in the euvolemic healthy individual that become increasingly important in hypervolemic states and conditions in which the heart enlarges acutely...
November 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/29025539/pericardial-effusion-and-compressive-disorders-of-the-heart-influence-of-new-technology-on-unraveling-its-pathophysiology-and-hemodynamics
#14
REVIEW
Ralph Shabetai, Jae K Oh
Constrictive pericarditis and cardiac tamponade cause severe diastolic dysfunction, but do not depress systolic function until the agonal state has been reached. Multimodality cardiovascular imaging has brought the nuances of pericardial disease to the domain of the practicing cardiologist. This introduction is a revised article originally written by the late Dr Shabetai for a pericardial diseases textbook which was not published. He was the editor of previous Pericardial Diseases issue for Cardiology Clinics in the 1980s, it is most appropriate to begin our issue with his insights...
November 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/28683914/aortic-disease-past-and-present
#15
EDITORIAL
Fernando Fleischman
No abstract text is available yet for this article.
August 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/28683913/neuroprotection-strategies-in-aortic-surgery
#16
REVIEW
Edward J Bergeron, Matthew S Mosca, Muhammad Aftab, George Justison, Thomas Brett Reece
Neurologic injury is a potentially devastating complication of aortic surgery. The methods used in aortic surgery, including systemic cooling, initiation of circulatory arrest, and rewarming during the replacement of the aortic arch, are the most complex circulatory management and surgical procedures performed in modern-day surgery. Despite the plethora of published literature, neuroprotection in aortic surgery is largely based on observational studies and institutional-based practices. This article summarizes the current evidence and emerging strategies for neuroprotection in aortic arch operations...
August 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/28683912/blunt-trauma-of-the-aorta-current-guidelines
#17
REVIEW
Marc D Trust, Pedro G R Teixeira
Blunt thoracic aortic injury remains a major cause of prehospital deaths. For patients who reach the hospital alive, diagnosis and management have undergone dramatic changes over the last 50 years. Computed tomography scanning is the imaging modality of choice for injury diagnosis and repair planning. Medical management with antihypertensives dramatically decreases the risk of rupture, allowing for delayed repair, while abnormal physiology and more immediately life-threatening injuries can be addressed. Endovascular techniques and endograft technology have reduced significantly the risks associated with repair...
August 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/28683911/treatment-of-abdominal-aortic-pathology
#18
REVIEW
Karol Meyermann, Francis J Caputo
Abdominal aortic pathology is a diverse topic, ranging through a broad span of possible pathologies. The treatment options are equally vast, particularly with the ever-expanding endovascular techniques. In this article, we discuss management strategies for abdominal aortic aneurysms and aortic occlusive disease, because they represent some of the most common pathologies encountered in clinical scenarios.
August 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/28683910/treatment-of-complex-thoracoabdominal-aortic-disease
#19
REVIEW
Eric C Kuo, Sukgu M Han
Thoracoabdominal aortic aneurysms are increasing in incidence. Rupture is associated with a high rate of morbidity and mortality. The historic gold standard of open repair can be performed with low rates of complications at centers of excellence. However, these results are not universally achievable, with significantly higher rates of mortality reported from statewide studies. With the advent of endovascular therapy, techniques to mitigate the physiologic stress of open surgery have been developed. Hybrid open/endovascular operations are being undertaken with total visceral debranching followed by endografting...
August 2017: Cardiology Clinics
https://www.readbyqxmd.com/read/28683909/type-b-aortic-dissections-current-guidelines-for-treatment
#20
REVIEW
Daniel B Alfson, Sung W Ham
Stanford type B aortic dissections (TBADs) involve the descending aorta and can present with complications, including malperfusion syndrome or aortic rupture, which are associated with significant morbidity and mortality if left untreated. Clinical diagnosis is straightforward, typically confirmed using CT angiography. Treatment begins with immediate anti-impulse medical therapy. Acute TBAD with complications should be repaired with emergent thoracic endovascular aortic repair (TEVAR). Uncomplicated TBAD with high-risk features should undergo TEVAR in the subacute phase...
August 2017: Cardiology Clinics
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