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Cardiology in Review

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https://www.readbyqxmd.com/read/29746258/gi-bleeding-during-cf-lvad-support-state-of-the-field
#1
Rachna Kataria, Ulrich P Jorde
Continuous-flow left ventricular assist devices (CF-LVADs) are increasingly used for the management of advanced heart failure refractory to optimal medical therapy. Despite the encouraging outcomes with CF-LVADs, gastrointestinal bleeding (GIB) continues to be a rather concerning complication resulting in increased rates of readmission and increased morbidity. The exact pathophysiology of CF-LVAD associated GIB remains poorly understood and this lack of knowledge limits our ability to control this morbid complication...
May 9, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29746257/novel-pharmacotherapy-in-hypertrophic-cardiomyopathy
#2
Gabriela Andries, Srikanth Yandrapalli, Srihari S Naidu, Julio A Panza
Hypertrophic cardiomyopathy (HCM) is an inherited disease characterized by unexplained left ventricular hypertrophy. Although it is estimated to affect 1 out of 500 people, the HCM gene carrier prevalence is much more common, probably as high as 1 in 200 people. Most affected individuals have a normal life expectancy, while some patients may develop sudden cardiac death or end-stage heart failure. Despite significant developments in the treatment of HCM with surgical, interventional, and device-based procedures, the main focus of current pharmacological therapy has not evolved from the basic objectives of relief of symptoms and improvement in functional capacity...
May 9, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29734199/are-shorter-durations-of-dual-antiplatelet-therapy-acceptable-following-percutaneous-coronary-intervention
#3
Jessica M Lewis, James J Nawarskas
Much debate has centered on whether or not the standard 12 month duration of dual antiplatelet therapy (DAPT) is still necessary post-percutaneous coronary intervention (PCI) given recent improvements in stent technology. The benefits of shorter (3-6 months) durations of DAPT include a potential lower risk for bleeding and less patient drug cost and pill burden. While randomized clinical trials have shown non-inferiority for shorter versus longer DAPT regimens in many regards, some endpoints (e.g. myocardial infarction) may still occur less frequently with longer DAPT regimens, particularly in higher risk populations (e...
May 4, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29734198/exercise-for-preventing-hospitalization-and-readmission-in-adults-with-congestive-heart-failure
#4
Wilbert S Aronow, Tatyana A Shamliyan
We critically appraised all available evidence regarding exercise interventions for improving patient survival and reducing hospital admissions in adults with chronic heart failure (HF). We searched 4 databases up to April 2018 and graded the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group approach. We reviewed 7 meta-analyses and the publications of 48 randomized, controlled trials (RCT). In HF with reduced ejection fraction, low-quality evidence suggests that exercise prevents all-cause hospitalizations (RR 0...
May 4, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29634492/review-on-factors-influencing-physician-guideline-adherence-in-cardiology
#5
C J G M Hoorn, H J G M Crijns, A T M Dierick-van Daele, L R C Dekker
Cardiovascular disease is the most common cause of death in Western countries. Physician adherence to guidelines is often suboptimal, resulting in impaired patient outcome and prognosis. Multiple studies have been conducted to evaluate patterns and the influencing factors of patient adherence, but little is known about factors influencing physician guideline adherence. This review aims to identify factors influencing physician guideline adherence relevant to cardiology and to provide insights and suggestions for future improvement...
April 9, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29608506/the-physiological-rationale-for-incorporating-pulsatility-in-continuous-flow-left-ventricular-assist-devices
#6
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...
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29608505/sodium-glucose-cotransporter-2-inhibition-in-type-2-diabetes-mellitus-a-review-of-large-scale-cardiovascular-outcome-studies-and-possible-mechanisms-of-benefit
#7
Rinkoo Dalan
Cardiovascular (CV) disease remains the leading cause of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). However, conventional anti-hyperglycemic 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 anti-hyperglycemic 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...
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29608504/inter-atrial-shunting-a-novel-device-based-therapy-for-patients-with-heart-failure
#8
Brian Kw Yum, William H Frishman
Heart failure patients with either reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF) experience a high mortality rate. The most recent pharmacologic advance for treating patients with HFrEF 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 inter-atrial shunt device developed by Corvia Medical Inc...
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29608503/risk-adjusted-overall-mortality-as-a-quality-measure-in-the-cardiovascular-intensive-care-unit
#9
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...
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29608502/xenon-an-emerging-neuroprotectant-with-potential-application-for-cardiac-arrest-care
#10
Mohammad Roostan, William H Frishman
Xenon is an inert, highly polarizable noble gas with demonstrated safety and application in general anesthesia for over fifty years. A potent inhibitor of the N-methyl-D-aspartate subtype of glutamate receptors, xenon has a well-documented ameliorating effect on excitotoxic neuronal injury in numerous cellular and animal models of hypoxic-ischemic brain injury. The most important determinant of overall survival and morbidity in out-of-hospital cardiac arrest is the severity of neurological injury. The only approved neuroprotective strategy in this setting is mild therapeutic hypothermia, which has demonstrated significant, albeit modest, improvements in mortality...
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29608500/frank-cole-spencer-md-surgeon-innovator-educator
#11
George Hines
No abstract text is available yet for this article.
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29608499/diagnosis-treatment-and-management-of-orthotopic-liver-transplant-candidates-with-portopulmonary-hypertension
#12
Anna Koulava, Abdallah Sannani, Avi Levine, Chhaya Aggarwal Gupta, Sarina Khanal, William Frishman, Roxana Bodin, David C Wolf, William Aronow, Gregg M Lanier
Portopulmonary hypertension (POPH) is seen in 5-8% of orthotopic liver transplantation (OLT) candidates and has significant implications for clinical outcomes. POPH is characterized by vasoconstriction and remodeling of the pulmonary vasculature. It is exacerbated by the hyperdynamic circulation that is common in advanced liver disease. Screening all OLT candidates with transthoracic echocardiography to assess pulmonary pressures and right ventricular function is crucial, as clinical symptoms alone are not reliable...
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29608497/his-bundle-pacing-hemodynamics-and-clinical-outcomes
#13
Brijesh Patel, Jalaj Garg, Rahul Chaudhary, Naveen Sablani, Rahul Gupta, Mahek Shah, Talha Nazir, Babak Bozorgnia, Andrea Natale
From 1993 to 2009, nearly 2.9 million pacemakers were implanted in the United States; the majority of which were dual chamber pacemakers. One of the major physiologic advantages of dual chamber pacing over single chamber ventricular pacing is atrioventricular synchrony, which prevents the pacemaker syndrome. However, patients who are pacemaker dependent or use right ventricle (RV) apical pacing more than 40% of the time are at a risk of developing heart failure from electromechanical dyssynchrony. Studies have also shown that RV pacing results in non-physiological activation of the left ventricle, leading to adverse clinical outcomes...
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29608496/antithrombotic-management-of-patients-with-prosthetic-heart-valves
#14
Abdallah Sanaani, Srikanth Yandrapalli, Joseph Michael Harburger
Valvular heart disease is a major public health issue. The prevalence of valvular heart disease is expected to increase due to an aging population. Valve dysfunction manifests as valve stenosis, regurgitation, or both, due to various etiologies. Valve repair and replacement are the main treatment options for severe valve dysfunction. Valve replacement is achieved by using either a mechanical or a bioprosthetic valve. Mechanical valves are more durable but require lifelong anticoagulation with associated complications...
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29608495/medical-management-of-rheumatic-heart-disease-a-systematic-review-of-the-evidence
#15
E Anne Russell, Warren F Walsh, Ben Costello, Alex Ja McLellan, Alex Brown, Christopher M Reid, Lavinia Tran, Graeme P Maguire
Rheumatic heart disease (RHD) is an important cause of heart disease globally. Its management can encompass medical and procedural (catheter and surgical) interventions. Literature pertaining to the medical management of RHD from PubMed 1990-2016 and via selected article reference lists was reviewed. Areas included symptom management, left ventricular (LV) dysfunction, rate control in mitral stenosis (MS), atrial fibrillation (AF), anticoagulation, infective endocarditis prophylaxis and management in pregnancy...
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29570476/patent-foramen-ovale-and-hypoxemia
#16
Mohammad K Mojadidi, Juan C Ruiz, Jason Chertoff, Muhammad O Zaman, Islam Y Elgendy, Ahmed N Mahmoud, Mohammad Al-Ani, Akram Y Elgendy, Nimesh K Patel, Ghanshyam Shantha, Jonathan M Tobis, Bernhard Meier
Patent foramen ovale (PFO), an embryonic remnant of the fetal circulation, is present in 20-25% of adults. While recent observational studies and clinical trials have established the link between PFO-mediated right-to-left shunting with cryptogenic stroke and migraine with aura, the role of a PFO in exacerbating hypoxemic medical conditions (i.e., sleep apnea, chronic obstructive pulmonary disease, pulmonary hypertension, platypnea-orthodeoxia, pulmonary arteriovenous malformation, high altitude pulmonary edema, and exercise desaturation) remains poorly evaluated...
March 22, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29570475/tocilizumab-in-giant-cell-arteritis
#17
Vincent J Mariano, William H Frishman
Giant cell arteritis is a granulomatous immune-mediated vasculitis of medium and large vessels. It most commonly affects Caucasian 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...
March 22, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29528859/emerging-implications-of-genetic-testing-in-inherited-primary-arrhythmia-syndromes
#18
Babken Asatryan, Argelia Medeiros-Domingo
Inherited primary arrhythmia syndromes are genetically determined disorders of cardiac ion channels or ion channel macromolecular complexes usually associated with a higher risk of sudden cardiac death. These conditions have a very broad spectrum of clinical manifestations, ranging from an asymptomatic course to syncope, atrial and ventricular arrhythmias, and conduction disturbances, but may produce sudden infant death syndrome and unexplained sudden cardiac death in apparently healthy individuals. During the last 20 years, the evolving knowledge on the genetic basis of inherited arrhythmia syndromes has dramatically reshaped our understanding of these conditions and, consequently, had a great impact on patient care...
March 8, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29621050/sudden-cardiac-death-in-hypertrophic-cardiomyopathy
#19
Daria M Adamczak, Zofia Oko-Sarnowska
Hypertrophic cardiomyopathy (HCM) is a heart disease characterized by hypertrophy of the left ventricular myocardium and is most often caused by mutations in sarcomere genes. The structural and functional abnormalities are not explained by flow-limiting coronary artery disease or loading conditions. The disease affects at least 0.2% of the population worldwide and is the most common cause of sudden cardiac death in young people and competitive athletes because of fatal ventricular arrhythmia. In some patients, however, HCM has a benign course...
May 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29608501/through-the-decades-%C3%AE-blocker-use-and-outcomes-in-acute-coronary-syndromes
#20
Alina Kukin, Zachary R Noel, Kristin Watson
Beta-adrenergic receptor antagonists, or β-blockers, have been a cornerstone of treatment in patients with acute coronary syndromes (ACS) for more than 4 decades. First studied in the 1960s, β-blockers in ACS have been shown to decrease the risk of death, recurrent ischemic events, and arrhythmias by reducing catecholamine-mediated effects and reducing myocardial oxygen demand. Through the decades, the β-blocker of choice, timing of initiation, duration of therapy, and dosing have evolved considerably. Despite having clear benefits in certain patient populations (eg, patients with systolic dysfunction who are hemodynamically stable), the benefit of β-blockers in other populations (ie, in patients at low risk for complications receiving modern revascularization therapies and optimal medical management) remains unclear...
May 2018: Cardiology in Review
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