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Cardiology in Review

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https://www.readbyqxmd.com/read/28832375/contemporary-diagnosis-and-management-of-atrial-flutter-a-continuum-of-atrial-fibrillation-and-vice-versa
#1
Antonis S Manolis
Atrial flutter (AFlu) is usually a fast (>240 bpm) and regular right atrial macroreentrant tachycardia, with a constrained critical region of the reentry circuit located at the cavotricuspid isthmus (CTI) (typical CTI-dependent AFlu). However, a variety of right and left atrial tachycardias, resulting from different mechanisms, can also present as AFlu (atypical non-CTI-dependent AFlu). The electrocardiogram can provide clues to its origin and location, however, additional entrainment and more sophisticated electro-anatomical mapping techniques may be required to identify its mechanism, location and target-area for a successful ablation...
August 18, 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28832374/chronic-thromboembolic-pulmonary-hypertension-epidemiology-diagnosis-and-management
#2
Srikanth Yandrapalli, Sohaib Tariq, Jessica Kumar, Wilbert S Aronow, Ramin Malekan, William H Frishman, Gregg M Lanier
Chronic thromboembolic pulmonary hypertension (CTEPH), classified as WHO group 4 pulmonary hypertension (PH), is an interesting and rare pulmonary vascular disorder secondary to mechanical obstruction of the pulmonary vasculature from thromboembolism resulting in PH. The pathophysiology is complex, beginning with mechanical obstruction of the pulmonary arteries, which eventually leads to arteriopathic changes and vascular remodeling in the non-occluded arteries and in the distal segments of the occluded arteries mediated by thrombus non-resolution, abnormal angiogenesis, endothelial dysfunction, and various local growth factors...
August 18, 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28832373/pregnancy-in-patients-with-congenital-heart-disease-a-contemporary-challenge
#3
Despoina Ntiloudi, Thomas Zegkos, Athanasios Koutsakis, George Giannakoulas, Haralambos Karvounis
The majority of female patients with congenital heart disease (CHD) survive into childbearing age and require evidence-based counseling regarding pregnancy options. Even though most of them will have an uneventful pregnancy, they may be at high risk of cardiac, obstetric and fetal complications. Predictive factors for these complications have been previously identified in numerous studies and with the use of specific scores. (CARPREG, ZAHARA and WHO risk stratification). Importantly, the subtype of CHD is of vital importance for the pregnancy outcome...
August 18, 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28786897/cardiovascular-manifestations-of-pheochromocytoma
#4
Yu Wei Gu, Jennifer Poste, Mehta Kunal, Monica Schwarcz, Irene Weiss
Pheochromocytomas are rare endocrine tumors that can have a significant impact on a variety of organ systems, including the cardiovascular system. Although the pathophysiology is not completely understood, pheochromocytomas exert their effects through high levels of catecholamines, mainly epinephrine and norepinephrine, which stimulate adrenergic receptors, including those within the cardiovascular system. Although the most common cardiovascular manifestation is hypertension, patients with pheochromocytoma can present with arrhythmia, hypotension, shock, myocardial ischemia, cardiomyopathy, aortic dissection, and peripheral ischemia...
September 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28786896/carotid-stenosis-and-impaired-cognition-the-effect-of-intervention
#5
Sloane Heller, George Hines
There is a clear association between carotid artery stenosis and cognitive impairment. However, there is no consensus as to how to interpret this association, and what, if any, impact this connection should have on the management of carotid stenosis. A review of the relevant literature suggests that although an intervention to relieve carotid stenosis in patients without clinically significant cognitive impairment does not improve cognition, there may be a cognitive benefit with intervention for carotid stenosis in those patients with clinically significant cognitive disorders...
September 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28786895/cardiac-auscultation-in-the-modern-era-premature-requiem-or-phoenix-rising
#6
Michael J Barrett, Andrew S Mackie, John P Finley
Competent cardiac auscultation remains a most important skill for the detection of heart disease. Currently it is poorly taught and often ignored or poorly performed, resulting in inaccurate and inefficient patient assessments. This review documents that teaching can be over 90% effective with new, proven teaching methods emphasizing repetition and normal-abnormal comparisons of sounds, using computer-aided and online resources. At present, these concepts are not widely adopted by medical schools. Our current knowledge of teaching heart auscultation is critically reviewed, including traditional bedside, clinic and classroom settings, as well as computer, simulator, and multimedia-based learning...
September 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28786894/teaching-of-cardiac-auscultation
#7
Stephen Moshman
No abstract text is available yet for this article.
September 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28742547/celiprolol-a-unique-selective-adrenoceptor-modulator
#8
James J Nawarskas, Angela Cheng-Lai, William H Frishman
Celiprolol is a β-blocker with a unique pharmacologic profile: it is a β1-andrenoceptor antagonist with partial β2 agonist activity. Given this combination of effects, celiprolol may be better described as a selective adrenoreceptor modulator. It has antihypertensive and antianginal properties and is indicated for those uses in various countries around the world. In the United States, however, the proposed indication for this drug will be for the treatment of vascular type Ehlers-Danlos syndrome, a rare connective tissue disorder characterized by fragile arterial structure and an increased risk of life-threatening vascular complications...
September 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28604568/trial-of-time-review-of-frailty-and-cardiovascular-disease
#9
Gautam Verma, John P O'Laughlin, Lydia Bunker, Stephen Peterson, William H Frishman
Frailty has become more frequently recognized as an indicator of predisability. It has been shown to have an association with cardiovascular disease (CVD), just as CVD has an association with frailty, and is a predictor of hospitalization and mortality. The ability to identify this population provides a measure to more accurately assess risk and prognosis which can help the early detection of disease and dictate intervention. This has become even more critical over time with the advent of various therapeutic interventions that are geared toward patients who are poor candidates for aggressive surgical measures, such as transcatheter aortic valve replacement...
September 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28604567/epicardial-fat-pathophysiology-and-clinical-significance
#10
Elijah Douglass, Shana Greif, William H Frishman
Over the last decade and a half there has been much interest in understanding the role of epicardial adipose tissue (EAT) in cardiac pathology. EAT is a visceral adipose deposit with putative paracrine function. In the nondiseased state, EAT releases cardioprotective cytokines and chemokines to the coronary vasculature. In pathological states, EAT releases an inflammatory cytokine profile that is believed to contribute to the development and progression of coronary artery disease (CAD). EAT imaging with echocardiography, computed tomography, and magnetic resonance imaging has demonstrated a correlation between EAT size and CAD...
September 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28604566/novel-oral-anticoagulants-in-the-peri-endoscopic-period
#11
Michael Genualdi, Edward Lebovics, And William H Frishman
Millions of patients in the United States are currently prescribed some form of anticoagulation therapy. Recently, novel oral anticoagulants (NOACs), including direct thrombin inhibitors and direct factor Xa inhibitors, have begun to replace warfarin as the drugs of choice for anticoagulation. As the use of these medications becomes more widespread, it is increasingly important for gastroenterologists to understand the risks associated with performing endoscopic procedures on patients who are taking NOACs. In this review, we provide an overview of the NOACs and current guidelines from international societies regarding the management of patients scheduled to undergo endoscopic procedures who are prescribed these medications...
September 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28604565/droxidopa-for-symptomatic-neurogenic-hypotension
#12
Nadia Ferguson-Myrthil
Droxidopa is a first-in-class, orally available, synthetic amino acid precursor of norepinephrine that received accelerated Food and Drug Administration approval in February 2014 after Orphan Drug status for a debilitating condition known as symptomatic neurogenic orthostatic hypotension. Neurogenic disorders often lead to postural hypotension as a result of poor norepinephrine release from its storage sites. Clinical data suggest increases in standing systolic blood pressure and improvements in many other markers for subjective relief in patients with symptomatic neurogenic hypotension who received droxidopa therapy over 1-2 weeks...
September 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28574937/vitamin-d-deficiency-and-supplementation-in-cardiovascular-disorders
#13
Christos G Mihos, Javier A De La Cruz, Anaid Hernandez, Orlando Santana
Cardiovascular disease (CVD) is the leading cause of death in developed countries. Similarly, the frequency of vitamin D deficiency is increasing, and a number of epidemiologic and clinical studies have suggested that there is an increased risk of CVD among people with depletion of this vitamin. This has raised much interest in the potential pathogenic and therapeutic role of vitamin D in CVD. However, randomized trials and meta-analyses have not shown a clear benefit of vitamin D supplementation with respect to cardiovascular events...
July 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28574936/coronary-microcirculatory-dysfunction-in-human-cardiomyopathies-a-pathologic-and-pathophysiologic-review
#14
Kristina Selthofer-Relatic, Martina Mihalj, Aleksandar Kibel, Ana Stupin, Marko Stupin, Ivana Jukic, Akos Koller, Ines Drenjancevic
Cardiomyopathies are a heterogeneous group of diseases of the myocardium. The term cardiomyopathy involves a wide range of pathogenic mechanisms that affect the structural and functional states of cardiomyocytes, extravascular tissues, and coronary vasculature, including both epicardial coronary arteries and the microcirculation. In the developed phase, cardiomyopathies present with various clinical symptoms: dyspnea, chest pain, palpitations, swelling of the extremities, arrhythmias, and sudden cardiac death...
July 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28574935/genetic-insights-into-bicuspid-aortic-valve-disease
#15
Radoslaw Debiec, Hanish Sall, Nilesh J Samani, Aidan Bolger
Bicuspid aortic valve (BAV) is the most common valvular congenital heart defect in the general population. BAV is commonly associated with the presence of other congenital cardiovascular malformations, which leads to cardiovascular complications requiring surgery in around 27% of cases. Familial clustering of BAV is well-recognized, and international guidelines advocate that first-degree relatives of patients with BAV be screened. Studies of genetic linkage in affected families, syndromic forms of BAV, and sporadic patients led to discoveries of genetic loci harboring genes involved in the development of BAV...
July 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28574934/pfo-closure-for-cryptogenic-stroke-a-review-and-clinical-treatment-algorithm
#16
Harsimran S Singh, Farhan Katchi, Srihari S Naidu
With a high prevalence in the general population of approximately 25%, and a prevalence in the cryptogenic stroke population approaching 40%, the propensity of a patent foramen ovale (PFO) to precipitate or enable stroke, especially in young, otherwise healthy individuals, has been the subject of much debate. With proof of concept achieved via imaging modalities documenting thrombus-in-transit, and the development of minimally-invasive percutaneous approaches to closure, multiple observational studies and, more recently, several completed randomized controlled trials have sought to answer the question of when and in whom PFO closure should occur...
July 2017: Cardiology in Review
https://www.readbyqxmd.com/read/27124268/managing-multivessel-coronary-artery-disease-in-patients-with-st-elevation-myocardial-infarction-a-comprehensive-review
#17
Andrés M Pineda, Nikita Carvalho, Saqib A Gowani, Kavit A Desouza, Orlando Santana, Christos G Mihos, Gregg W Stone, Nirat Beohar
Multivessel coronary artery disease (CAD) is found in up to 60% of the patients presenting with an ST-elevation myocardial infarction (STEMI) and worsens the prognosis proportional to the extent of CAD severity. However, the 2013 American College of Cardiology/American Heart Association STEMI guidelines, based on mostly observational data, had recommended against a routine noninfarct-related artery percutaneous coronary intervention (PCI). After these guidelines were published, a handful of randomized trials became available, and they suggested that PCI of significant lesions in a noninfarct-related artery at the time of primary PCI might result in improved patient outcomes...
July 2017: Cardiology in Review
https://www.readbyqxmd.com/read/27054604/influence-of-pregnancy-in-patients-with-congenital-long-qt-syndrome
#18
Lohit Garg, Jalaj Garg, Parasuram Krishnamoorthy, Amy Ahnert, Neeraj Shah, Raman S Dusaj, Babak Bozorgnia
Congenital long QT syndrome (LQTS) is a disorder of myocardial repolarization and is characterized by a prolonged QT interval on an electrocardiogram. A prolonged QT predisposes patients to an increased risk of syncope and sudden cardiac death secondary to polymorphic ventricular tachycardia. Several mutations linked to the LQTS have been identified, the most common of which have been found in the potassium channel KCNQ1 (LQT1) and hERG (LQT2) genes and in the sodium channel SCN5A (LQT3) gene. Female sex is an independent risk factor for the development of torsades de pointes in LQTS...
July 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28767504/echocardiography-in-the-evaluation-of-pulmonary-embolism
#19
Tanya Dutta, William H Frishman, Wilbert S Aronow
Pulmonary embolism is a major cause of mortality. Acute pulmonary embolism also encompasses a wide clinical spectrum of severity, ranging from asymptomatic silent disease to hemodynamic instability and shock. Echocardiography is a useful modality to improve treatment strategies for pulmonary embolus. Echocardiography plays a role in risk stratification at the time of diagnosis. The evaluation of the right ventricle (RV) has evolved over time. RV variables evaluated by echocardiography include RV size, RV/left ventricular (LV) ratio, RV fractional area of change, tricuspid annular plane systolic excursion, RV systolic pressure and RV Tei index...
June 22, 2017: Cardiology in Review
https://www.readbyqxmd.com/read/28767503/neuroendovascular-surgery-for-the-treatment-of-ischemic-stroke
#20
Arthur Wang, Meic H Schmidt
This review discusses modern therapeutic interventions for acute ischemic stroke with a focus on endovascular therapy. In 2015, the American Heart Association (AHA) made major changes to the guidelines for the endovascular treatment of acute ischemic stroke. The Class IA indications for endovascular therapy of stroke patients include symptom onset within 6 hours, proven large vessel occlusion of an artery in the anterior circulation, and the use of a stent retriever as part of the mechanical thrombectomy. Advanced perfusion imaging helps identify patients with a low ratio of ischemic core to salvageable penumbra...
June 22, 2017: Cardiology in Review
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