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Cardiology in Review

Twinkle Singh, Rohan Samson, Karnika Ayinapudi, Ayush Motwani, Thierry Le Jemtel
The pathogenesis of cardiogenic shock has evolved from an acute event due to a large myocardial infarction to a semi-acute event due to rapid hemodynamic deterioration on a background of preexisting left ventricular systolic dysfunction. Pre-cardiogenic shock refers to the period of rapid hemodynamic deterioration that precedes overt cardiogenic shock with hypotension, inflammatory response and end-organ failure. Mortality remains extremely high in cardiogenic shock and has not improved over the past decades...
November 2, 2018: Cardiology in Review
Michael Shen, William H Frishman
During spaceflight, the human cardiovascular system undergoes major changes primarily related to the effects of decreased gravitational force, or microgravity, on the human body. These changes present challenges to human adaptation and operation in space. This article reviews the knowledge gained in human experiments in the past half century of spaceflight, and summarizes our knowledge on the effects of short- and long-duration microgravity exposure on cardiovascular physiology and functioning, including fluid redistribution, autonomic reflexes, cardiac parameters, orthostatic intolerance, arrhythmias, aerobic capacity, and cardiac atrophy...
October 25, 2018: Cardiology in Review
Dana Berg, Edward Lebovics, Masashi Kai, David Spielvogel
Heart failure affects over 5 million Americans, with numbers expected to rise. While heart transplantation is the most effective long-term strategy for end-stage heart failure, there is a limited cardiac donor pool, and these organs are often unavailable at the time of need. Left ventricular assist devices (LVADs), therefore, continue to be used to bridge this gap. Originally implanted as a bridge to transplant, these devices are now additionally utilized as destination therapy for patients ineligible for transplant...
October 25, 2018: Cardiology in Review
Thomas B Fay, Martin A Alpert
Attention-deficit/hyperactivity disorder (ADHD) is a clinical syndrome characterized by persistent inattention, impulsivity and hyperactivity. It is most commonly encountered in children and adolescents, but may persist into adulthood. A variety of psychostimulant and non-psychostimulant medications have proven to be successful in reducing inattention, impulsivity and hyperactivity in those with ADHD. Psychostimulants used to treat ADHD include methylphenidate and related drugs and various amphetamine preparations...
October 25, 2018: Cardiology in Review
George L Hines
No abstract text is available yet for this article.
October 25, 2018: Cardiology in Review
Alexandra M Sible, James J Nawarskas
The direct oral anticoagulants (DOACs) have gained popularity recently among both patients and providers for their comparable or better efficacy and safety profiles compared to warfarin and the lack of need for routine monitoring. One obstacle for the more widespread use of the DOACs in clinical practice has been the lack of a reversal agent. Most DOACs act by directly binding to and inhibiting the effects of factor Xa. Andexanet alfa (Andexxa®, Portola Pharmaceuticals, San Francisco, CA) is a modified form of factor Xa that acts as a decoy binding entity for DOACs, thereby allowing endogenous factor Xa to perform its normal clotting functions...
October 22, 2018: Cardiology in Review
William H Frishman
No abstract text is available yet for this article.
September 19, 2018: Cardiology in Review
Sara Paul, Karol Harshaw-Ellis
Objective, noninvasive, clinical assessment of patients with heart failure can be made using biomarker measurements, including natriuretic peptides, cardiac troponins, soluble suppression of tumorigenicity-2, and galectin-3. The aim of this review is to provide clinicians with guidance on the use of heart failure biomarkers in clinical practice. The authors provide a didactic narrative based on current literature, an exemplary case study, and their clinical experience.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4...
September 5, 2018: Cardiology in Review
Alexandra L Silverman, Alfred A Herzog, David I Silverman
Anxiety, depression and stress are exceedingly common in patients with cardiovascular disease (CVD). They increase the risk of cardiac events and are associated with much worse outcomes. A causal relationships exists between anxiety/depression and adverse cardiac events such as acute myocardial infarction and sudden cardiac death. Various treatments, including psychological therapies and pharmacotherapy, can used to treat patients with these disorders. This review discusses the epidemiology, pathogenesis and treatment options for patients with CVD who suffer from these conditions, and argues that they should be treated as concomitant risk factors for CVD...
August 20, 2018: Cardiology in Review
Matthew G Nevulis, Colby Baker, Edward Lebovics, William H Frishman
Inflammation has been shown to play an increasingly important role in the pathogenesis of atherosclerosis and in precipitating thrombotic events. Inflammatory bowel disease (IBD) is a systemic inflammatory disorder with a wide range of extraintestinal manifestations including a clinically significant increase in the risk of venous thromboembolism compared to matched controls in several studies. The data for the association between IBD and ischemic heart disease are less clear; multiple population-based studies have shown both positive and negative associations between the 2 conditions...
November 2018: Cardiology in Review
Sahil Khera, Pedro A Villablanca, Dhaval Kolte, Tanush Gupta, Mohammed Hasan Khan, Poonam Velagapudi, Ankur Kalra, Neal Kleiman, Herbert D Aronow, J Dawn Abbott, Kenneth Rosenfield, Douglas E Drachman, Sripal Bangalore, Deepak L Bhatt, Srihari S Naidu
There are no dedicated data to guide drug-eluting stent (DES) versus bare-metal stent (BMS) selection in patients with end-stage renal disease undergoing dialysis (ESRD-D). It is unclear whether long-term benefits of a specific stent type outweigh risks in this population at high risk for both bleeding and ischemic events. We performed a meta-analysis of nonrandomized studies extracted from PubMed, Scopus, and EMBASE, assessing the safety and effectiveness of DES versus BMS in ESRD-D patients. Odds ratios (OR) and 95% confidence intervals (CI) were computed with the Mantel-Haenszel method...
November 2018: Cardiology in Review
Katie Lee, Samantha Cham, Sum Lam
Venous thromboembolism (VTE) is a common and preventable cause of morbidity and mortality in hospitalized patients. Low-molecular-weight heparin, low-dose unfractionated heparin, fondaparinux, and warfarin have been the mainstay options for the prevention and treatment of VTE before the emergence of nonvitamin K antagonist oral anticoagulants (NOACs) such as dabigatran, rivaroxaban, apixaban, and edoxaban. Despite the advantages of NOACs in improving patient adherence, none of them are approved for the prevention of VTE in acutely ill medical patients at high risk of thromboembolism...
November 2018: Cardiology in Review
Michael D Goldberg, Natasha Vadera, Srikanth Yandrapalli, William H Frishman
Acromegaly is a rare endocrine disorder that carries a significant burden of cardiovascular morbidity and mortality. Abnormalities of the growth hormone/insulin-like growth factor-1 axis in acromegaly lead to the characteristic cardiovascular manifestations of this disease. One hallmark feature of the disease is acromegalic cardiomyopathy, a syndrome of progressive cardiac dysfunction characterized by left ventricular hypertrophy, diastolic dysfunction, and combined systolic and diastolic dysfunction in the very advanced stage...
November 2018: Cardiology in Review
Liza Grosman-Rimon, Filio Billia, Jeremy Kobulnik, Stacey Pollock Bar-Ziv, David Z Cherney, Vivek Rao
Over the past few decades, left ventricular assist device (LVAD) support has extended the lives of many patients with end-stage heart failure. The most common devices are continuous-flow (CF) LVADs. The use of the CF-LVADs has required that clinicians learn the physiological and clinical consequences of long-term continuous blood flow. While this alteration in the normal physiology still offers advantages from mechanical circulatory support, the lack of pulsatility may also increase the likelihood of adverse events...
November 2018: Cardiology in Review
Rinkoo Dalan
Cardiovascular (CV) disease remains the leading cause of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). However, conventional antihyperglycemic medications seem to have minimal effect on lowering CV risk despite achieving excellent reductions in glycated hemoglobin A1c and associated reductions in microvascular risk. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have emerged as noteworthy antihyperglycemic agents with concomitant CV and renal protection in T2DM patients. In this comprehensive review, we present the key CV findings from major large-scale outcome trials of SGLT2 inhibitors to date...
November 2018: Cardiology in Review
Michael Goldfarb
Risk-adjusted mortality has been proposed as a quality of care indicator to gauge cardiovascular intensive care Unit (CICU) performance. Mortality is easily measured, readily understandable, and a meaningful outcome for the patient, provider, administrative agencies, and other key stakeholders. Disease-specific risk-adjusted mortality is commonly used in cardiovascular medicine as an indicator of care quality, for external accreditation, and to determine payer reimbursement. However, the evidence base for overall risk-adjusted mortality in the CICU is limited, with most available data coming from the general critical care literature...
November 2018: Cardiology in Review
Vincent J Mariano, William H Frishman
Giant cell arteritis is a granulomatous immune-mediated vasculitis of medium and large vessels. It most commonly affects white females over the age of 50 and is the most common primary vasculitis in the United States. Treatment of this disease has classically been with high-dose corticosteroids, but this therapy has been associated with severe morbidity and mortality. Tocilizumab, a humanized monoclonal antibody targeting the interleukin-6 receptor, has been used with great efficacy and safety in rheumatoid arthritis and systemic-onset juvenile idiopathic arthritis...
November 2018: Cardiology in Review
Brian K W Yum, William H Frishman
Heart failure (HF) patients with either reduced ejection fraction or preserved ejection fraction experience a high mortality rate. The most recent pharmacologic advance for treating patients with HF with reduced ejection fraction has been with sacubitril/valsartan. Along with pharmaceutical research, there has been interest in device-based therapies as another treatment approach. One novel interventional device therapy that has shown promise in early tests and trials is the interatrial shunt device developed by Corvia Medical Inc...
September 2018: Cardiology in Review
Lowie M R Van Assche, Mark J Ricciardi
Functional mitral regurgitation (FMR) is common in patients with heart failure and portends a poor prognosis. The etiology is secondary to nonischemic or ischemic (postmyocardial infarction) adverse remodeling. Treatment includes guideline-directed medical therapy, cardiac resynchronization therapy, and in some cases, surgical repair or replacement. Transcatheter mitral valve (MV) repair with the MitraClip device is approved in patients with degenerative MR and is currently under investigation for use in FMR, as are several transcatheter MV replacement devices...
September 2018: Cardiology in Review
Tanveer Rab, Spencer B King
Percutaneous coronary intervention of the left main coronary artery has evolved through registries and meta analyses, supported by results from the EXCEL [Everolimus-Eluting Stents (EES) or Bypass Surgery for Left Main Coronary Artery Disease] and NOBLE (Percutaneous Coronary Angioplasty versus Coronary Artery Bypass Grafting in Treatment of Unprotected Left Main Stenosis) trials as an acceptable alternative to coronary artery bypass grafting in patients with low and intermediate Syntax scores. Advances in stenting strategies and the availability of larger diameter drug-eluting stents improve patient safety and optimize procedural and patient outcomes...
September 2018: Cardiology in Review
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