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Current Treatment Options in Cardiovascular Medicine

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https://www.readbyqxmd.com/read/29134367/imaging-of-cardiovascular-disease-in-pregnancy-and-the-peripartum-period
#1
REVIEW
Theodore Pierce, Meline Hovnanian, Sandeep Hedgire, Brian Ghoshhajra
Cardiovascular disease is an important cause of morbidity and mortality during pregnancy and the postpartum period. During pregnancy, the cardiovascular system undergoes extensive hemodynamic, hormonal, and microstructural changes which may exacerbate a preexisting underlying cardiovascular condition or predispose to cardiovascular complications not typically seen in young healthy women. Such conditions include spontaneous coronary artery dissection, atherosclerotic coronary artery disease, and peripartum cardiomyopathy...
November 14, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29119262/role-of-cardiac-pet-in-clinical-practice
#2
REVIEW
Brian M Salata, Parmanand Singh
Early identification of atherosclerosis and at-risk lesions plays a critical role in reducing the burden of cardiovascular disease. While invasive coronary angiography serves as the gold standard for diagnosing coronary artery disease, non-invasive imaging techniques provide visualization of both anatomical and functional atherosclerotic processes prior to clinical presentation. The development of cardiac positron emission tomography (PET) has greatly enhanced our capability to diagnose and treat patients with early stages of atherosclerosis...
November 9, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29110103/ct-imaging-of-the-vulnerable-plaque
#3
REVIEW
Gary R Small, Benjamin J W Chow
Acute coronary syndromes are most often the result of vulnerable atherosclerotic plaque events. Plaques events occur when intimal fibroatheroma in the coronary artery wall becomes vulnerable to erosion or rupture. Such vulnerable plaques can be distinguished from quiescent atheroma by features that have been defined through histopathology and invasive imaging. A challenge for coronary CT angiography has been to identify vulnerable plaques non-invasively. Were this possible, CT angiography could offer comprehensive vessel assessment including stenosis severity and plaque characteristics with the hope of reducing acute coronary events through timely intervention...
November 6, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29027633/multi-modality-imaging-in-the-evaluation-and-treatment-of-mitral-regurgitation
#4
REVIEW
Marc-André Bouchard, Claudia Côté-Laroche, Jonathan Beaudoin
Mitral regurgitation (MR) is frequent and associated with increased mortality and morbidity when severe. It may be caused by intrinsic valvular disease (primary MR) or ventricular deformation (secondary MR). Imaging has a critical role to document the severity, mechanism, and impact of MR on heart function as selected patients with MR may benefit from surgery whereas other will not. In patients planned for a surgical intervention, imaging is also important to select candidates for mitral valve (MV) repair over replacement and to predict surgical success...
October 13, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29027095/multimodality-imaging-of-pericardial-diseases
#5
REVIEW
Mouaz H Al-Mallah, Fatimah Almasoudi, Mohamed Ebid, Amjad M Ahmed, Abdelrahman Jamiel
Pericardial diseases have changed their epidemiology in the past few years. With the aging population and decreasing incidence of communicable diseases, the causes of pericardial diseases have significantly changed from infectious and malignant to postradiation and cardiac surgery causes. Despite that, pericardial diseases remain difficult to diagnose. The accurate and timely diagnosis of these diseases is essential to avoid the late sequela of pericardial constriction and pericardial cirrhosis. Echocardiography remains the first test of choice for the assessment of patients with suspected pericardial diseases...
October 12, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29027093/long-term-prognostic-value-of-coronary-computed-tomography-angiography
#6
REVIEW
Takor B Arrey-Mbi, Seth M Klusewitz, Todd C Villines
Coronary CT angiography (CTA) is a highly accurate test for the diagnosis of coronary artery disease (CAD), with its use guided by numerous contemporary appropriate use criteria and clinical guidelines. Unique among non-invasive tests for CAD, coronary CTA provides direct visualization of coronary atherosclerosis for the assessment of angiographic stenosis, as well as validated measures of plaque vulnerability. Long-term studies now clearly demonstrate that the absence of CAD on coronary CTA identifies a patient that is at very low risk for future cardiovascular events...
October 12, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28990152/therapeutic-targets-for-the-multi-system-pathophysiology-of-heart-failure-exercise-training
#7
REVIEW
Erik H Van Iterson, Thomas P Olson
Adult chronic heart failure (HF) is a terminal syndrome. While the HF phenotype is inhomogeneous across the ejection fraction spectrum, exercise intolerance remains a cardinal feature of all HF patients. Impairment of a single organ system cannot independently account for exercise intolerance in HF. Thus, the multi-system integrative pathophysiology of HF leads to challenges in identifying an effective medical therapy aimed at targeting a single mechanism to improve exercise tolerance. This unresolved medical care approach raises a number of points for discussion in this field as it is well-recognized that exercise intolerance is accompanied by increased hospitalizations and mortality across the HF spectrum...
October 9, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28990149/management-of-arrhythmias-in-athletes-atrial-fibrillation-premature-ventricular-contractions-and-ventricular-tachycardia
#8
REVIEW
Ernest Lai, Eugene H Chung
Management of atrial fibrillation, premature ventricular contractions, and ventricular tachycardia without underlying cardiac disease or arrhythmogenic conditions differs in athletes from the general population. Athletes tend to be younger, healthier individuals with few comorbidities. Therapies that work well in the general population may not be appropriate or preferable for athletes. Management strategies include deconditioning, pharmacologic therapy, such as rate control with β-blockers or non-dihydropyridine calcium channel blockers and rhythm control with class I or class III antiarrhythmic drugs, and catheter ablation...
October 9, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28990148/athletes-and-the-aorta-normal-adaptations-and-the-diagnosis-and-management-of-pathology
#9
REVIEW
J Stephen Hedley, Dermot Phelan
Over a hundred years ago, physicians first recognized that participation in regular, vigorous training resulted in enlargement of the heart. Since that time, the term "athlete's heart" has entered the medical lexicon as a global expression encompassing the electrical, functional, and morphological adaptations that develop in response to physical training. Exercise-induced adaptations of the aorta, which is also exposed to large hemodynamic stresses during prolonged endurance exercise or resistance training, are less well recognized...
October 9, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28948538/the-right-heart-acute-and-chronic-issues
#10
REVIEW
Timothy W Churchill, Aaron L Baggish
Cardiovascular remodeling in response to sustained moderate and high-intensity exercise is a well-established phenomenon. Following more than a century of work focused on the left ventricle (LV), remodeling of the right side of the heart has recently become a topic of considerable scientific and clinical interest. Morphologic and functional changes have now been well documented in the right ventricle (RV) after isolated bouts of endurance exercise and in association with long-term sustained training. Although exercise-induced cardiac remodeling is classically viewed as an adaptive, clinically benign process, it has recently been hypothesized that repetitive bouts of intense exercise may trigger pathologic changes in the RV characterized by patchy fibrosis and a predisposition to arrhythmia...
September 25, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28948501/multimodality-imaging-of-the-right-ventricle
#11
REVIEW
Christiane M Abouzeid, Tara Shah, Ansh Johri, Jonathan W Weinsaft, Jiwon Kim
Right ventricular (RV) structure and function is clinically important in a wide range of conditions. While conventional echocardiography (echo) methods are widely used, its limitations in RV assessment due its complex geometry are well recognized. New applications of traditional echo methods as well as emerging echo techniques including 3-dimensional (3D) echo and speckle tracking strain have the potential to overcome limitations of conventional echo, though widespread clinical use remains to be seen. Volumetric methods using cardiac magnetic resonance (CMR) and computed tomography (CT) provide accurate assessment of RV function without geometric assumptions...
September 25, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28948466/coronary-artery-calcium-scoring-in-current-clinical-practice-how-to-define-its-value
#12
REVIEW
Sina Kianoush, Mohammadhassan Mirbolouk, Raghavendra Charan Makam, Khurram Nasir, Michael J Blaha
Detecting subclinical atherosclerosis with coronary artery calcium (CAC) is promising for identifying individuals at risk for cardiovascular events and appears to be a robust tool for guiding initiation of appropriate and timely primary prevention strategies. However, how do we best determine its clinical value? It is clear that traditional risk prediction models based primarily on age, gender, and risk factors are insufficient for ideal personalization of risk estimation. It is now well established from epidemiologic studies that CAC adds to traditional risk scores for a more accurate risk prediction...
September 25, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28948451/a-diagnostic-approach-to-stroke-in-young-adults
#13
REVIEW
Christopher A Stack, John W Cole
Optimal diagnosis and management of stroke in young adults benefit from a multidisciplinary team, including a vascular neurology specialist. In addition to the "standard" vascular risk factors including smoking, hypertension, diabetes, and hyperlipidemia, one needs to consider alternative etiologies including substance abuse, carotid/vertebral artery dissections, and rare genetic conditions among others. Once a young patient is determined to have had a stroke, the next question a clinician should ask is why did this patient have a stroke? A "heart to head" diagnostic approach is recommended...
September 25, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28936594/transcatheter-aortic-valve-replacement-outcomes-indications-complications-and-innovations
#14
REVIEW
Michael N Young, Ignacio Inglessis
Transcatheter aortic valve replacement (TAVR) has become the standard of care for the treatment of severe aortic stenosis in individuals who are at prohibitive surgical risk and presents a viable alternative to surgery in selected patients who are at high operative risk. To date, outcomes from the PARTNER (Placement of AoRtic TraNscathetER Valve) and Medtronic CoreValve® US Pivotal trials continue to show the benefits of TAVR in these high-risk subgroups out to 5 and 3 years, respectively (as reported by Mack et al...
September 22, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28913817/return-to-play-in-2017-and-the-role-of-shared-decision-making-in-patients-with-inherited-and-acquired-channelopathies-and-cardiomyopathies
#15
REVIEW
Kia Afshar, T Jared Bunch
Shared decision-making is based upon a physician-patient encounter in which there is adequate education using aids if needed, a mutual discussion of how to assist the patient in weighing risks and benefits, and a supportive environment that allows the patient to deliberate on the clinical decision and make their own choice. This decision-making paradigm centers on the principles of autonomy and self-determination. Physical activity is a critical part of healthy lifestyle choices that helps lower risk of cardiovascular disease or the progression of it...
September 14, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28913740/temporary-mechanical-circulatory-support-for-cardiogenic-shock
#16
REVIEW
Jean Touchan, Maya Guglin
Cardiogenic shock is a life-threatening presentation of severe heart failure with high morbidity and mortality. Given the modest increased in cardiac output and neutral/negative survival benefits with today's available inotropes (namely, dobutamine and milrinone), the use of mechanical circulatory support (MCS) has increased dramatically over the past 2 decades. In this review article, we discuss the physiologic concept, clinical evidence of benefit, and current use and indications/potential complications of the four most commonly used devices for MCS: intra-aortic balloon pump, Impella percutaneous ventricular assist device, TandemHeart, and extracorporeal membrane oxygenation (ECMO)...
September 14, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28913725/exercise-and-competitive-sport-physiology-adaptations-and-uncertain-long-term-risks
#17
REVIEW
Patrick T Gleason, Jonathan H Kim
The benefits of regular and moderate exercise training on cardiovascular outcomes have been well established. In addition, strenuous exercise training leads to corollary cardiac structural and functional adaptations that are sport-specific and facilitate athletic performance. In this review, the normal physiologic and hemodynamic changes that occur during exercise and the subsequent differential exercise-induced cardiac remodeling patterns that develop will be discussed. Paradoxically, recent data have raised concern about the long-term impact of higher doses of physical activity and exercise on mortality and cardiovascular health outcomes...
September 14, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28913687/non-atherosclerotic-vascular-disease-in-women
#18
REVIEW
Lee Joseph, Esther S H Kim
Takayasu arteritis, fibromuscular dysplasia (FMD), spontaneous arterial dissection, Raynaud's phenomenon, and chilblains are vascular conditions that are associated with an increased predisposition in women and are often underdiagnosed. Takayasu arteritis has an incidence rate of 2.6 cases per million individuals per year in the USA and predominantly affects women of childbearing age. HLA-B5 genetic locus is linked with Takayasu arteritis susceptibility. Methods to determine active disease are limiting; currently utilized clinical and imaging findings and laboratory tests are of limited value for this purpose...
September 14, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28913677/thus-far-and-no-further-should-diastolic-hypotension-limit-intensive-blood-pressure-lowering
#19
REVIEW
Marcel Ruzicka, Cedric Edwards, Brendan McCormick, Swapnil Hiremath
Intensive blood pressure lowering to systolic blood pressure thresholds of less than 120 mmHg is making a slow comeback with the publication of trials supporting its benefit, especially in lowering stroke and congestive heart failure. At the same time, there is an increasing awareness of the prevalence and risk of diastolic hypotension, especially at levels of less than 60 mmHg, with support for the existence of a J-curve coming from post hoc analyses of trials and epidemiological data from large cohort studies...
September 14, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28913590/challenges-of-anticoagulation-therapy-in-pregnancy
#20
REVIEW
Annemarie E Fogerty
Thrombotic complications in pregnancy represent a major cause of morbidity and mortality. Pregnancy is a primary hypercoagulable state due to enhanced production of clotting factors, a decrease in protein S activity, and inhibition of fibrinolysis. These physiologic changes will yield a collective rate of venous thromboembolism (VTE) of about 1-2 in 1000 pregnancies for the general obstetric population, which represents a five- to tenfold increased risk in pregnancy compared to age-matched non-pregnant peers...
September 14, 2017: Current Treatment Options in Cardiovascular Medicine
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