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Current Treatment Options in Cardiovascular Medicine

Aaron W Aday, Sarah E Kreykes, Christina L Fanola
PURPOSE OF REVIEW: Numerous studies have begun to unravel the genetic basis of not only aortic disease but also other forms of commonly encountered vascular diseases. The goal of this review is to provide clinicians a reference to help identify and diagnose different types of vascular disease with a genetic underpinning. RECENT FINDINGS: Ongoing studies have identified numerous genes involved in the TGF-β signaling pathway that are also associated with thoracic aortic aneurysm and dissection, and it is possible to test for pathogenic variants in these genes in the clinical setting using commercially available genetic testing panels...
November 13, 2018: Current Treatment Options in Cardiovascular Medicine
Shivani R Aggarwal, Katherine E Economy, Anne M Valente
PURPOSE OF THE REVIEW: To review the management of women with mechanical heart valves during pregnancy, from preconception counseling through delivery with a summary of the latest guidelines. RECENT FINDINGS: The hypercoagulability of pregnancy combined with the imperfect choices of anticoagulant agents contribute to a high risk of complications in pregnant women with mechanical heart valves. Valve thrombosis remains a major concern, much of which occurs during the first trimester transition to heparin-based products...
November 12, 2018: Current Treatment Options in Cardiovascular Medicine
Clea Simone S S Colombo, Gherardo Finocchiaro
PURPOSE OF THE REVIEW: For many years, competitive sport has been dominated by men. Recent times have witnessed a significant increase in women participating in elite sports. As most studies investigated male athletes, with few reports on female counterparts, it is crucial to have a better understanding on physiological cardiac adaptation to exercise in female athletes, to distinguish normal phenotypes from potentially fatal cardiac diseases. This review reports on cardiac adaptation to exercise in females...
November 3, 2018: Current Treatment Options in Cardiovascular Medicine
Daniel X Augustine, Liz Howard
PURPOSE OF REVIEW: The changes that occur in athlete's heart are influenced by a number of factors including age, gender, ethnicity and the type of cardiovascular training. It is therefore important that the clinician is able to integrate all of these factors when assessing athletes to be able to guide investigations appropriately and to distinguish pathology from physiology. This review discusses the potential diagnostic conundrums when trying to differentiate physiological left ventricular hypertrophy from pathological hypertrophic cardiomyopathy in athletes...
October 26, 2018: Current Treatment Options in Cardiovascular Medicine
Fady Ibrahim, Jonathan Dunn, John Rundback, John Pellerito, Andrew Galmer
Visceral artery aneurysms (VAAs) are a rare, but serious clinical entity as rupture confers a high rate of mortality. Data regarding the prevalence, treatment, and prognosis of VAAs is largely from case series, as true randomized trials are lacking. The incidence of VAAs has risen over the decades with advances in imaging technology, availability, and utilization. Even in the presence of symptoms, the prompt diagnosis of VAAs may be challenging as symptoms are often nonspecific and varied. Although there are no definitive treatment guidelines, asymptomatic VAAs require treatment in the following scenarios: when the aneurysm diameter is greater than 2 cm, when identified during pregnancy, when multiple aneurysms are present, and in the case of hepatic transplant...
October 26, 2018: Current Treatment Options in Cardiovascular Medicine
Mark Abela, Andrew D'Silva
PURPOSE OF REVIEW: Excessive trabeculation attracting a diagnosis of left ventricular noncompaction cardiomyopathy (LVNC) has been reported in ostensibly healthy athletes. This review aims to explain why this occurs and whether this represents a spectrum of athletic physiological remodelling or unmasking of occult cardiomyopathy. RECENT FINDINGS: Genetic studies have yet to identify a dominant mutation associated with the LVNC phenotype and reported gene mutations overlap with many distinct cardiomyopathies and ion channel disorders, implying that the phenotype is shared across different genetic conditions...
October 26, 2018: Current Treatment Options in Cardiovascular Medicine
Keshav Kohli, Zhenglun Alan Wei, Ajit P Yoganathan, John N Oshinski, Jonathon Leipsic, Philipp Blanke
PURPOSE OF REVIEW: Transcatheter mitral valve replacement (TMVR) is an emerging alternative for patients with severe mitral valve regurgitation who are considered at high risk for conventional surgical options. The early clinical experience with TMVR has shown that pre-procedural planning with computed tomography (CT) is needed to mitigate the risk of potentially lethal procedural complications such as left ventricular outflow tract (LVOT) obstruction. The goal of this review is to provide an overview of key concepts relating to TMVR pre-procedural planning, with particular emphasis on imaging-based methods for predicting TMVR-related LVOT obstruction...
October 26, 2018: Current Treatment Options in Cardiovascular Medicine
Dimitrios Stergiou, Edward Duncan
PURPOSE OF REVIEW: A complex relationship exists between exercise and atrial fibrillation (AF). Moderate exercise reduces AF risk whereas intense strenuous exercise has been shown to increase AF burden. It remains unclear at which point exercise may become detrimental. Overall, endurance athletes remain at lower cardiovascular risk and experience fewer strokes. The questions that arise therefore are whether AF is an acceptable byproduct of strenuous exercise, whether athletes who experience AF should be told to reduce exercise volume and how should they be managed...
October 26, 2018: Current Treatment Options in Cardiovascular Medicine
James Shin, Quynh A Truong
PURPOSE OF REVIEW: Describe and evaluate the integration of 3D printing-related innovations into current cardiovascular treatment paradigms and examine the state of regulatory and reimbursement hurdles ahead. RECENT FINDINGS: Mounting years of clinical experience have established the utility of printed models of patient anatomy in numerous treatment and teaching scenarios, most notably as pre- and intra-procedural planning tools guiding decision-making for congenital heart disease and catheter-based interventions...
October 25, 2018: Current Treatment Options in Cardiovascular Medicine
Jason A Ellis, Erez Nossek, Annick Kronenburg, David J Langer, Rafael A Ortiz
PURPOSE OF REVIEW: Cerebral aneurysms are commonly diagnosed incidentally with non-invasive neuro-imaging modalities (i.e., brain MRA and/or head CTA). The first decision to be made in the management of patients with unruptured cerebral aneurysms is to determine if the aneurysm should undergo treatment as any intervention carries a risk of morbidity and mortality. RECENT FINDINGS: The multiple risk factors that are associated with increased risk of aneurysm rupture should be evaluated (size, shape, and location of aneurysm; history of hypertension and cigarette smoking and family history of cerebral aneurysms)...
October 24, 2018: Current Treatment Options in Cardiovascular Medicine
Mark T Macmillan, Michelle C Williams
Improvements in imaging techniques have led to an expansion in the number of cross-sectional cardiac studies being performed. This means that incidental non-cardiac findings (INCF) identified on cardiac imaging have become an important clinical concern. The majority of INCF are not clinically significant. However, some INCF will require follow-up or changes in management. Differentiating clinically significant from non-significant INCF can be challenging, particularly given the breadth of potential findings and the range of organ systems involved...
October 23, 2018: Current Treatment Options in Cardiovascular Medicine
Mahmoud Al Rifai, Miguel Cainzos-Achirica, Sina Kianoush, Mohammadhassan Mirbolouk, Allison Peng, Josep Comin-Colet, Michael J Blaha
In the recently published review "Coronary Artery Calcium: Recommendations for Risk Assessment in Cardiovascular Prevention Guidelines," the following author name was inadvertently misspelled as Alison Peng. The correct spelling of the author's name is: Allison Peng as shown above.
October 18, 2018: Current Treatment Options in Cardiovascular Medicine
Abigail Khan, Emmanuelle Paré, Shimoli Shah
PURPOSE OF REVIEW: This review summarizes the pathophysiology, diagnosis, and treatment of peripartum cardiomyopathy (PPCM), with a focus on recent discoveries of clinical relevance. RECENT FINDINGS: An increase in oxidative stress and anti-angiogenic activity play key roles in the pathophysiology of peripartum cardiomyopathy. Therapies that target this dysregulation may have a future role in treatment. Suppression of prolactin release using bromocriptine, a dopamine-receptor antagonist, has been associated with more favorable outcomes in small studies but more research is needed...
September 29, 2018: Current Treatment Options in Cardiovascular Medicine
Fernando Telles, Thomas H Marwick
PURPOSE OF REVIEW: The prevalence of heart failure with preserved ejection fraction (HFpEF) is rising and in some places, it is already the most prevalent form of heart failure. The usual treatments of HF do not improve mortality or outcomes in HFpEF, suggesting a distinct pathophysiology that remains poorly characterized. The neutrality of clinical trial results is also attributable to the heterogeneity of patient profiles, and by poor characterization offered by classical echocardiography parameters...
September 27, 2018: Current Treatment Options in Cardiovascular Medicine
Mahmoud Al Rifai, Miguel Cainzos-Achirica, Sina Kianoush, Mohammadhassan Mirbolouk, Allison Peng, Josep Comin-Colet, Michael J Blaha
PURPOSE OF REVIEW: In this review, we evaluate the coronary artery calcium (CAC) score as a biomarker for advanced atherosclerotic cardiovascular disease (ASCVD) risk assessment. RECENT FINDINGS: We summarize the evidence from multiple epidemiological studies, which show a clear advantage of CAC compared to traditional and non-traditional cardiovascular risk factors. We then compare the recommendations included in the 2013 American College of Cardiology/American Heart Association (ACC/AHA) and in the 2017 Society of Cardiovascular Computed Tomography (SCCT) guidelines for the use of CAC in ASCVD risk assessment, and examine the recent 2018 US Preventive Services Task Force (USPSTF) document...
September 26, 2018: Current Treatment Options in Cardiovascular Medicine
Rosalyn O Adigun, Amber N Boler, Rekha Mankad
PURPOSE OF REVIEW: Cardiovascular disease remains the leading cause of death in women. The goal of this review is to address known disparities in cardiovascular care with regard to diagnosis and treatment of heart disease in women. RECENT FINDINGS: Gender-specific differences in regard to the incidence, treatment, and outcomes of common cardiovascular pathology are increasingly recognized. Particular attention to ischemic heart disease, arrhythmia, congestive heart failure, and structural heart disease are reviewed in this article...
September 21, 2018: Current Treatment Options in Cardiovascular Medicine
Daniela R Crousillat, Nasrien E Ibrahim
PURPOSE OF REVIEW: Heart failure (HF) is prevalent among women and remains a leading cause of morbidity and mortality in the United States. Currently, 3 million women live with HF and the prevalence is projected to continue to increase. The purpose of this review is to highlight sex differences in the use and response to evidence-based pharmacological, device, and advanced HF therapies, as well as explore emerging areas of research in sex differences in the treatment of HF. RECENT FINDINGS: Under-representation of women in clinical HF trials has limited our understanding of sex-related differences in the treatment and outcomes of HF...
September 21, 2018: Current Treatment Options in Cardiovascular Medicine
Emmanuel Androulakis, Peter P Swoboda
PURPOSE OF REVIEW: Cardiovascular magnetic resonance (CMR) is frequently used in the investigation of suspected cardiac disease in athletes. In this review, we discuss how CMR can be used in athletes with suspected cardiomyopathy with particular reference to volumetric analysis and tissue characterization. We also discuss the finding of non-ischaemic fibrosis in athletes describing its prevalence, distribution and clinical importance. RECENT FINDINGS: The strengths of CMR include high spatial resolution, unrestricted imaging planes and lack of ionizing radiation...
August 31, 2018: Current Treatment Options in Cardiovascular Medicine
Thijs M H Eijsvogels, Paul D Thompson, Barry A Franklin
PURPOSE OF REVIEW: The "Extreme Exercise Hypothesis" is characterized by a U-shaped or reverse J-shaped, dose-response curve between physical activity volumes and cardiovascular health outcomes. In this review, we summarize recent findings that may support or refute the "Extreme Exercise Hypothesis." Furthermore, we discuss potential cardiovascular health implications of the cardiac anatomical, structural, contractility, and biomarker abnormalities that have been reported in some veteran endurance athletes...
August 28, 2018: Current Treatment Options in Cardiovascular Medicine
Harshil Dhutia, Hamish MacLachlan
PURPOSE OF REVIEW: We aim to report on the current status of cardiovascular screening of athletes worldwide and review the up-to-date evidence for its efficacy in reducing sudden cardiac death in young athletes. RECENT FINDINGS: A large proportion of sudden cardiac death in young individuals and athletes occurs during rest with sudden arrhythmic death syndrome being recognised as the leading cause. The international recommendations for ECG interpretation have reduced the false-positive ECG rate to 3% and reduced the cost of screening by 25% without compromising the sensitivity to identify serious disease...
August 28, 2018: Current Treatment Options in Cardiovascular Medicine
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