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Current Treatment Options in Cardiovascular Medicine

Ciorsti MacIntyre, Chinyere Iwuala, Ratika Parkash
PURPOSE OF REVIEWS: In this review, the challenges of managing cardiac arrhythmias and syncope in the setting of pregnancy will be discussed. RECENT FINDINGS: Arrhythmias in pregnancy are increasing, as diagnostic and therapeutic options have advanced and women are older at the time of gestation. Atrial fibrillation has become the most common arrhythmia in pregnancy. Inherited arrhythmia has become a more common entity, with advances in treatments and genetic testing, and require specialized treatments in pregnancy...
July 11, 2018: Current Treatment Options in Cardiovascular Medicine
Joseph Donnelly, James Gabriels, Andrew Galmer, Jonathan Willner, Stuart Beldner, Laurence M Epstein, Apoor Patel
PURPOSE OF REVIEW: A variety of complex vascular pathologies arise following the implantation of electronic cardiac devices. Pacemaker and defibrillator lead insertion may cause proximal venous obstruction, resulting in symptomatic venous congestion and the compromise of potential future access sites for cardiac rhythm lead management. RECENT FINDINGS: Various innovative techniques to recanalize the vein and establish alternate venous access have been pioneered over the past few years...
July 11, 2018: Current Treatment Options in Cardiovascular Medicine
Michael N Young, Vikas Singh, Rahul Sakhuja
With the advent of transcatheter aortic valve replacement (TAVR), appropriately selected intermediate-, high-, and extreme-risk patients with severe aortic stenosis (AS) are now offered a less invasive option compared to conventional surgery. In contemporary practice, TAVR is performed predominantly via a transfemoral arterial approach, whereby a transcatheter heart valve (THV) is delivered in a retrograde fashion through the iliofemoral arterial system and thoraco-abdominal aorta, into the native aortic valve annulus...
July 4, 2018: Current Treatment Options in Cardiovascular Medicine
Nino Mihatov, Eric A Secemsky, Sammy Elmariah
PURPOSE OF REVIEW: More than 9% of patients who undergo percutaneous coronary intervention (PCI) carry a concomitant indication for long-term anticoagulation (OAC). The optimal combination of anticoagulation and antiplatelet therapy for these patients remains uncertain. RECENT FINDINGS: Numerous studies have demonstrated that dual antiplatelet therapy (DAPT) remains superior to vitamin K antagonists (VKA) in the prevention of stent-related events. Nonetheless, OAC therapy is more efficacious than DAPT at reducing thromboembolism in patients with atrial fibrillation...
July 3, 2018: Current Treatment Options in Cardiovascular Medicine
Arjun K Ghosh, Tom Crake, Charlotte Manisty, Mark Westwood
PURPOSE OF REVIEW: To understand the variety of conditions in which the pericardium may be affected in cancer patients. RECENT FINDINGS: Cancer may affect the pericardium directly (primary cancer; uncommon) or through metastases (commoner). Cancer treatment (chemotherapy and radiotherapy) may affect the pericardium leading to pericarditis and myopericarditis. Pericardial effusions, tamponade and constrictive pericarditis are complications that can also occur. A variety of techniques (predominantly cardiac imaging related) are used to make the diagnosis with the treatment strategy dependent on whether the pericardial disease is due to cancer or as a result of cancer treatment...
June 23, 2018: Current Treatment Options in Cardiovascular Medicine
Tesfaye Telila, Elsayed Mohamed, Kurt M Jacobson
Rheumatic heart disease remains a major cause of significant mortality and morbidity in the developing world. Rheumatic mitral and aortic stenosis are the two most common valvular sequelae of acute rheumatic fever. Open surgical procedures with either valve replacement or surgical commissurotomy have largely been replaced by percutaneous commissurotomy and balloon valvuloplasty for selected patients since the early 1980s. The purpose of our review is to examine the literature for any recent advancement in procedural techniques of balloon valvuloplasty for selected patients with rheumatic mitral and or aortic stenosis...
June 22, 2018: Current Treatment Options in Cardiovascular Medicine
Michael C Honigberg, Amy A Sarma
PURPOSE OF REVIEW: To educate clinicians on cardiovascular considerations and management strategies surrounding pregnancy in childhood cancer survivors. RECENT FINDINGS: With advances in oncologic treatment, growing numbers of childhood cancer survivors are now able to consider pregnancy. A significant proportion of survivors have received cardiotoxic therapy, particularly anthracyclines, and/or chest radiation. Cardiomyopathy is the most common cardiac complication of cancer-directed therapy; pericardial disease, valvular disease, premature coronary artery disease, and conduction abnormalities are other potential sequelae...
June 19, 2018: Current Treatment Options in Cardiovascular Medicine
Michael C Honigberg, Nandita S Scott
PURPOSE OF REVIEW: To educate clinicians about the epidemiology, etiologies, diagnosis, and management of pregnancy-associated myocardial infarction (PAMI). RECENT FINDINGS: The risk of myocardial infarction is increased more than threefold around the time of pregnancy. In the recent series, PAMI is most commonly caused by spontaneous coronary artery dissection, followed by atherosclerosis. Percutaneous coronary intervention or coronary artery bypass grafting may be required, but conservative management with medical therapy is generally advised when possible, particularly in cases of coronary dissection...
June 19, 2018: Current Treatment Options in Cardiovascular Medicine
Christos G Mihos, Sheila L Klassen, Evin Yucel
Aortic stenosis (AS) is the most common valvular disease in the elderly and is associated with poor outcomes. Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) in high-risk patients. Herein, we describe the gender-related differences in baseline characteristics and pathophysiologic response to severe AS, imaging considerations unique to females, and short- and long-term outcomes after TAVR. Women undergoing TAVR are older and frailer, have less cardiovascular comorbidities, smaller femoral artery size, better left ventricular systolic function, hypertrophied and small left ventricles leading to a higher incidence of paradoxical low-flow low-gradient AS, and a greater prevalence of porcelain aorta, smaller aortic annulus size, and lower coronary ostia heights...
June 19, 2018: Current Treatment Options in Cardiovascular Medicine
Thais Coutinho, Olabimpe Lamai, Kara Nerenberg
PURPOSE OF THE REVIEW: Cardiovascular diseases (CVDs) are the principal killers of women. In this review, we summarize data regarding CVD and mortality after hypertensive disorders of pregnancy (HDP), and highlight clinical, research and policy needs to mitigate this risk. RECENT FINDINGS: Robust data indicate that women with HDP have substantially higher risk of future CVD, with a 3.7-fold increase in the risk of chronic hypertension, a 4.2-fold increase in the risk of heart failure, an 81% increase in the risk of stroke, and double the risk of atrial arrhythmias, coronary heart disease, and mortality when compared to women with normotensive pregnancies...
June 19, 2018: Current Treatment Options in Cardiovascular Medicine
Li-Ling Tan, Alexander R Lyon
PURPOSE OF REVIEW: As cancer survivor rates improve with early screening and modern treatment options, cardiotoxicity is becoming an increasing problem. It is imperative for physicians to recognize adverse events early so that appropriate measures can be taken before advanced and permanent cardiac dysfunction ensues. In this review, we will evaluate the literature surrounding current cardiac biomarkers in the detection of cardiotoxicity during cancer treatment as well as discuss the role of emerging novel biomarkers...
June 19, 2018: Current Treatment Options in Cardiovascular Medicine
Natalie Stokes, Jacqueline Kikucki
PURPOSE OF REVIEW: The goal of this review is to elucidate what is known about the science of maternal resuscitation and how treatment guidelines have developed to optimize management. RECENT FINDINGS: There is limited data on maternal cardiac arrest. Case reports are providing some insight into safety and efficacy of certain mechanisms of treatment, including use of extracorporeal membranous oxygenation and thrombolysis, for example. Data increasingly supports the preventability of a significant portion of maternal cardiac arrest, which remains the most important target for intervention...
June 19, 2018: Current Treatment Options in Cardiovascular Medicine
Isaac B Rhea, Guilherme H Oliveira
PURPOSE OF REVIEW: With the continuing development of newer targeted therapies in oncology, it is necessary to understand their potential cardiovascular side effects. In this review, we discuss the association of novel targeted agents and left ventricular systolic dysfunction. RECENT FINDINGS: Within the last 5 years, multiple new agents have been developed to target specific cancer pathways and found to have off-targeted cardiotoxicity. The most recent example is the recognition of myocarditis caused by immune checkpoint inhibitors...
June 19, 2018: Current Treatment Options in Cardiovascular Medicine
Takor B Arrey-Mbi, Seth M Klusewitz, Todd C Villines
The authors would like to note that this article published in Current Treatment Options in Cardiovascular Medicine journal is not showing Open Access on the website. Thus, the paper is still not available for free online.
May 16, 2018: Current Treatment Options in Cardiovascular Medicine
Prashant Rao, Eric M Isselbacher
PURPOSE OF THE REVIEW: Acute aortic dissection is a potentially catastrophic cardiovascular emergency that is associated with a high mortality rate. Pregnancy, with its attendant hormonal and physiological changes, increases the risk of dissection in women with known thoracic aortic aneurysms. In this review, we highlight the importance of preconception counseling to help women with known thoracic aortic aneurysms better understand their risk of dissection and the heritable nature of thoracic aortic disease and its associated syndromes...
May 10, 2018: Current Treatment Options in Cardiovascular Medicine
Mohamed-Salah Annabi, Marine Clisson, Marie-Annick Clavel, Philippe Pibarot
About 60% of patients with paradoxical low-flow, low-gradient (PLF-LG) aortic stenosis (AS) have a severe disease that justifies aortic valve replacement (AVR). The first step in patients with symptomatic PLF AS should be to rule out measurement errors and treat hypertension. The second step is to distinguish pseudo-severe from true severe AS (TSAS). The third step is to select the optimal treatment modality at the right time. Regarding the second step, projected aortic valve area calculated using stress echocardiography is superior to traditional severity criteria (AVA < 1...
May 2, 2018: Current Treatment Options in Cardiovascular Medicine
Anne H Blaes, G J van Londen, Nicole Sandhu, Amir Lerman, Daniel A Duprez
PURPOSE OF REVIEW: The purpose of this review is to summarize the current literature on estrogen and progesterone antagonists and their effects on the cardiovascular system. RECENT FINDINGS: Estrogen and progesterone antagonists reduce cancer-related recurrence and mortality in women with ER-positive breast cancer. Recent studies, however, suggest that women with early stage breast cancer are more likely to die of cardiovascular disease than recurrent breast cancer...
April 30, 2018: Current Treatment Options in Cardiovascular Medicine
Inbar Agmon Nardi, Zaza Iakobishvili
PURPOSE OF REVIEW: As the number of cancer survivors continues to rise with improved early-detection methods and advancing therapies, along with it, there come adverse health outcomes as a result of physiological and psychological effects of cancer, as well as adverse effects of cancer treatment itself. This paper reviews the risk of cardiovascular disease in cancer survivors. RECENT FINDINGS: Cancer survivors are at higher risk of having modifiable cardiovascular (CV) risk factors, such as hypertension, diabetes mellitus, obesity, tobacco smoking, and physical inactivity...
April 28, 2018: Current Treatment Options in Cardiovascular Medicine
Emily S Lau, Nandita S Scott
With improving reproductive assistive technologies, advancing maternal age, and improved survival of patients with congenital heart disease, valvular heart disease has become an important cause of morbidity and mortality in pregnant women. In general, stenotic lesions, even those in the moderate range, are poorly tolerated in the face of hemodynamic changes of pregnancy. Regurgitant lesions, however, fare better due to the physiologic afterload reduction that occurs. Intervention on regurgitant valve preconception follows the same principles as a non-pregnant population...
April 26, 2018: Current Treatment Options in Cardiovascular Medicine
Joanna M Joly, Akshay S Desai
PURPOSE OF REVIEW: Compared to enalapril, use of angiotensin-receptor blocker and neprilysin inhibitor sacubitril/valsartan to treat patients with heart failure and reduced ejection fraction (HFrEF) is associated with substantial reductions in both cardiovascular mortality and heart failure progression. The purpose of this review is to discuss the real-world experience of sacubitril/valsartan. RECENT FINDINGS: In the years following the publication of the landmark PARADIGM-HF trial in 2014 and its subsequent FDA approval, a growing evidence base supports the safety and efficacy of sacubitril/valsartan in a broad spectrum of patients with HFrEF...
April 23, 2018: Current Treatment Options in Cardiovascular Medicine
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