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Reviews in Cardiovascular Medicine

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https://www.readbyqxmd.com/read/30207557/access-to-pcsk9-inhibitors
#1
Seth J Baum, Norman E Lepor, Jennifer G Robinson
No abstract text is available yet for this article.
2018: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/30207556/pcsk9-inhibitors-mechanism-of-action-efficacy-and-safety
#2
Eli M Roth, Michael H Davidson
Low-density lipoprotein (LDL) receptors on the surface of liver hepatocytes are the primary way that humans regulate serum LDL cholesterol levels. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a proteolytic enzyme that indirectly regulates serum LDL cholesterol (LDL-C) by causing the destruction of LDL receptors. Less LDL receptors result in increased LDL-C in the bloodstream but inhibiting or binding the circulating PCSK9 results in increased LDL receptors with the resultant decrease in serum LDL-C...
2018: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/30207555/familial-hypercholesterolemia-although-identification-advances-appreciation-and-treatment-lag
#3
Seth J Baum, Alan S Brown
Familial hypercholesterolemia is one of the most common autosomal dominant inherited genetic disorders, yet it is frequently undiagnosed, leading to a markedly increased risk for cardiovascular events. Understanding the pathophysiology of the disease as well as the importance of cascade screening is critical to appropriate treatment of patients. Though the mainstay of therapy for heterozygous familial hypercholesterolemia remains statins, many patients require additional therapy including ezetimibe and/or proprotein convertase subtilisin/kexin type 9 (PCSK9) antibodies to achieve adequate low-density lipoprotein cholesterol (LDL-C) lowering...
2018: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/30207554/can-we-cure-atherosclerosis
#4
Jennifer G Robinson, Michael H Davidson
Cardiovascular disease mortality rates have begun to rise in the United States. Based on the large body of supportive evidence, we propose a proof-of-concept, first-in-human trial to cure atherosclerosis: CURing Early ATHEROsclerosis (CURE ATHERO). This trial is based on a model of intensive induction therapy for extensive, if not complete, plaque regression, followed by intermittent maintenance therapy. An extensive body of evidence has demonstrated the causal role of apolipoprotein B lipoproteins in atherosclerosis progression and data suggest intensive low-density lipoprotein cholesterol (LDL-C) lowering may have a substantial impact on earlier stages of atherosclerosis...
2018: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/30207553/statin-intolerance
#5
Alan S Brown, Karol E Watson
Statins are critical medications to prevent and treat cardiovascular disease2 and they are generally very well tolerated. In some instances, however, statin intolerance may limit use of these lifesaving medications. Statin intolerance has many definitions but is commonly diagnosed when a patient is unable to continue statin therapy due to perceived, or objectively documented, adverse effects. A very high rate of discontinuation of statin therapy warrants a closer look at the implications from the standpoint of cardiovascular risk in statin-intolerant patients, as well as an evaluation of the available options to help patients maintain their statin therapy and understand the potential benefits of such therapy...
2018: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/30207552/identifying-patients-for-nonstatin-therapy
#6
Jennifer G Robinson, Karol E Watson
Statins are first-line therapy for reducing atherosclerotic cardiovascular disease (ASCVD) risk. Some patients remain at high ASCVD risk despite maximizing statin therapy. Ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies (mAbs) have been shown to reduce ASCVD events in randomized trials and may be of benefit in selected high-risk patients with cardiovascular disease (CVD) or familial hypercholesterolemia (FH). Number-needed-to-treat (NNT) to prevent one ASCVD event can help identify groups of patients who may gain a net benefit from added nonstatin therapy...
2018: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29111544/atrioesophageal-fistula-following-radiofrequency-catheter-ablation-of-atrial-fibrillation
#7
Molly Orosey, Lohit Garg, Sahil Agrawal, Jinu J John, David E Haines, Wai Shun Wong
Atrioesophageal fistula (AEF) is a rare but catastrophic complication of catheter ablation of atrial fibrillation (AF), with an incidence of 0.03% to 1.5% per year. We report two cases and review the epidemiology, clinical features, pathogenesis, and management of AEF after AF ablation. The principal clinical features of AEF include fever, hematemesis, and neurologic deficits within 2 months after ablation. The close proximity of the esophagus to the posterior left atrial wall is considered responsible for esophageal injury during ablation and the eventual development of AEF...
2017: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29111543/syncope-in-young-women-broadening-the-differential-diagnosis
#8
Nachiket Patel, Naila Choudhary, Christine Tompkins, Khawaja Afzal Ammar, A Jamil Tajik, Krishnaswamy Chandrasekaran, Timothy E Paterick
Syncope is defined as a sudden transient loss of consciousness (TLOC) with concomitant loss of postural tone followed by spontaneous recovery. It is a subset of a broader class of medical conditions, including postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension, and neurally mediated syncope (NMS), that may result in TLOC. The overlap of these clinical conditions leads to confusion regarding syncope classification that can hinder evaluation strategies, and pose challenges for diagnosis and treatment, particularly in young women...
2017: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29111542/a-call-to-action-to-develop-integrated-curricula-in-cardiorenal-medicine
#9
Claudio Ronco, Federico Ronco, Peter A McCullough
With the adoption of the new definition and classification of cardiorenal syndrome (CRS) and its relevant subtypes, much attention has been placed on elucidating the mechanisms of heart and kidney interactions. The pathophysiologic pathways are of great interest by which acute heart failure may result in acute kidney injury (AKI; type 1), chronic heart failure accelerates the progression of chronic kidney disease (CKD; type 2), AKI provokes cardiac events (type 3), and CKD increases the risk and severity of cardiovascular disease (type 4)...
2017: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29038418/two-reports-of-quadricuspid-aortic-valve-with-aortic-insufficiency
#10
Zahir Satti, Abdalla Ibrahim, Peter Kelly
We report two cases of a quadricuspid aortic valve with severe aortic incompetence. Both patients presented with dyspnea on exertion. Their physical examinations demonstrated wide pulse pressures with diastolic murmurs. Bedside transthoracic Doppler echocardiography revealed preserved left ventricular systolic function and possible quadricuspid aortic valve with severe aortic incompetence in both patients. We proceeded with transesophageal echocardiography that confirmed a quadricuspid aortic valve with severe aortic incompetence in both patients...
2017: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29038417/role-of-exogenous-phosphocreatine-in-chemotherapy-induced-cardiomyopathy
#11
Swapnil Parve, Gulnaz I Aliakberova, Albert A Gylmanov, Diana I Abdulganieva
The 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC) regimen is widely used in the management of breast cancer. The common cardiotoxic effects of doxorubicin include congestive heart failure and left ventricular dysfunction, and those of cyclophosphamide include pericarditis, myocarditis, and congestive heart failure. It has been postulated that cardiotoxicity of 5-fluorouracil presents as coronary artery diseases (eg, angina). Cardiomyopathy is a common outcome following treatment with the FAC regimen...
2017: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29038416/cardiac-metastasis-of-nonvisceral-soft-tissue-leiomyosarcoma
#12
Cristina Martinez, Jamal S Rana, Matthew D Solomon
Metastasis of a nonvisceral leiomyosarcoma to the heart is rare. We present the case of a man with a history of an upper extremity cancerous lesion that was completely resected with appropriate surveillance monitoring, which then metastasized to the heart 14 years later, presenting as superior vena cava syndrome. Full evaluation found no other metastatic lesions, including no residual sarcoma at the former primary site. We include transthoracic echocardiography and computed tomography images of unusual presentation of the large mass extending from the caudal superior vena cava to the right atrium and into the right ventricle across the tricuspid valve...
2017: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29038415/two-perspectives-of-the-appropriate-use-criteria-in-cardiology-practice-advantageous-and-useful-or-limiting-and-harmful
#13
Sandeep K Krishnan, Amit Bahia, Ralph G Brindis, Norman E Lepor, Dipti Itchhaporia, Pranav M Patel
The appropriate use criteria (AUC) has become an integral part of the cardiologist's daily practice and have evolved greatly since their inception over a decade ago. However, as health care costs continue to rise, the AUC has come to play an even more pivotal role in the way medicine-specifically cardiology-is practiced today. This editorial describes two opposing viewpoints commonly held by practicing clinicians of the AUC. Written from the perspective of two fellows-in-training looking ahead at the challenges and opportunities of clinical practice (under the auspices of several experienced clinicians and leaders of the American College of Cardiology), this article provides a fresh perspective on the impact AUC has on our patients, clinicians, and the health care system...
2017: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29038414/timing-of-percutaneous-coronary-intervention-and-therapeutic-hypothermia-in-patients-with-st-elevation-myocardial-infarction-and-out-of-hospital-cardiac-arrest
#14
Craig Basman, Michael C Kim, Neil L Coplan
The American College of Cardiology/American Heart Association guidelines include a Class 1 recommendation to initiate therapeutic hypothermia (TH) in comatose patients with out-of-hospital cardiac arrest (OHCA) with an initial shockable rhythm who have achieved return of spontaneous circulation. There is also a Class 1 recommendation for immediate angiography in these patients whose initial electrocardiography shows ST-elevation myocardial infarction (STEMI). However, due to a lack of clinical trials evaluating these patients who have received both percutaneous coronary intervention (PCI) and TH, controversy remains regarding whether the two can be safely combined...
2017: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29038413/percutaneous-coronary-intervention-for-coronary-bifurcation-lesions
#15
William Finch, Michael S Lee
Percutaneous coronary intervention (PCI) of lesions at coronary bifurcations poses a technical challenge. Short-term complications, including periprocedural myocardial infarction, and long-term complications such as in-stent restenosis and stent thrombosis, are higher in patients with bifurcation lesions. Techniques for PCI of bifurcation lesions include stenting of the main branch alone, and the use of two or more stents to cover the main and side branches. Two- or three-stent techniques include T-stenting, crush, culotte, simultaneous kissing stents, V-stenting, and Y-stenting...
2017: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28509894/swallowing-induced-supraventricular-tachyarrhythmia
#16
Umair Khalid, Ali Massumi, Aziz Shaibani
Swallowing-induced supraventricular tachyarrhythmia is an extremely rare entity with unclear pathophysiology. A 55-year-old man presented with a 2-year history of worsening presyncopal symptoms triggered only by drinking liquids of any temperature. Results of a physical examination were unremarkable except for reproducible atrial tachycardias to 180 to 210 beats/minute documented on rhythm strips when the patient was given water to drink. He underwent radiofrequency ablation with complete resolution of symptoms...
2017: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28509893/spontaneous-coronary-artery-dissection-insights-from-histology-and-optical-coherence-tomography
#17
Sandeep K Krishnan, Alex Zhu, Brent Larson, Timothy D Henry, Suhail Dohad
Spontaneous coronary artery dissection (SCAD) is a well-known but infrequent cause of acute coronary syndrome (ACS), and often goes unrecognized. Although management of SCAD is, at times, controversial, when a patient presents with ACS, percutaneous coronary intervention (PCI) is frequently necessary. We present a patient with ST-segment elevation myocardial infarction (STEMI) with SCAD that illustrates two important points: use of intracoronary optical coherence tomography to guide PCI, and histologic assessment to provide a unique insight into the etiology of SCAD...
2017: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28509892/arrhythmogenic-right-ventricular-dysplasia-an-under-recognized-form-of-inherited-cardiomyopathy
#18
George O Adesina, Shelly A Hall, Jose C Mendez, Susan M Joseph, Robert L Gottlieb, Parag P Kale, Amarinder S Bindra
We report a case of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVD) in order to evaluate the course of an under-recognized form of cardiomyopathy with a vast array of clinical manifestations. The patient is a 49-year-old white woman transferred from an outside hospital due to dyspnea and persistent hypoxia. She had a pertinent family history that included a sister who died suddenly in her 30s from unexplained heart failure. Initial work-up for hypoxia was unrevealing. Transthoracic echocardiography revealed isolated right ventricular dysfunction with dilation and multiple trabeculations...
2017: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28509891/spontaneous-coronary-artery-dissection-a-review-of-pathogenesis-presentations-treatment-and-outcomes
#19
Aasim Afzal, Syed Sarmast, James W Choi, Peter A McCullough, Jeffrey M Schussler
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndromes and sudden cardiac death. The epidemiology, pathogenesis, and optimal approaches to diagnosis and management are poorly understood. Additionally, SCAD as a syndrome is commonly under-recognized and its prognosis is not well studied. Guidelines on management of SCAD have not yet been established. We present three cases of SCAD that varied in their clinical presentation and describe the different management strategies utilized...
2017: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28509890/balancing-low-density-lipoprotein-cholesterol-reduction-and-hepatotoxicity-with-lomitapide-mesylate-and-mipomersen-in-patients-with-homozygous-familial-hypercholesterolemia
#20
Jane I Won, Jun Zhang, Kristen M Tecson, Peter A McCullough
Homozygous familial hypercholesterolemia (HoFH) is an autosomal codominant disorder manifested by high concentrations of total cholesterol and low-density lipoprotein (LDL) cholesterol, and premature cardiovascular disease. Despite conventional lipid-lowering therapy, LDL cholesterol levels remain elevated in patients with HoFH; these patients are considered to be at high risk for cardiovascular events. In 2012-2013, two drugs with novel mechanisms of action were approved by the US Food and Drug Administration for the treatment of HoFH: lomitapide mesylate and mipomersen...
2017: Reviews in Cardiovascular Medicine
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