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valvular heart disease guidelines

Anthony P Carnicelli, Patrick T O'Gara, Robert P Giugliano
Valvular heart disease is prevalent and represents a significant contributor to cardiac morbidity and mortality. Several options for valve replacement exist, including surgical replacement and transcatheter valve implantation. Prosthetic valves lead to increased risk of thromboembolic disease; therefore, antithrombotic therapy after valve replacement is indicated. For patients with mechanical prostheses, indefinite vitamin K antagonist and antiplatelet therapy are the mainstays of treatment. There is no consensus regarding optimal antithrombotic therapy after bioprosthetic valve replacement, although vitamin K antagonist therapy of varying duration in addition to antiplatelet therapy is recommended by guidelines...
August 13, 2016: American Journal of Cardiology
Aimee E Moores, Michael S Cahill, Todd C Villines
Aortic mycotic aneurysms are a rare but life-threatening potential complication of infective endocarditis. Rapid deterioration of the vascular wall in highly focal areas makes these pseudoaneurysms particularly prone to rupture, resulting in uncontrolled aortic hemorrhage. While computed tomography angiography (CTA) is the imaging modality of choice for the evaluation of mycotic aneurysms, it is not routinely performed in patients with known or suspected infective endocarditis (IE). However, current valvular heart disease guidelines support the use of cardiac CTA in cases of IE and suspected perivalvular extension when there is inadequate or ambiguous visualization on echocardiography...
2016: Case Reports in Medicine
Vivienne Kim, James Pemberton, Fiona Riddell, Khang-Li Looi
AIM: A significant proportion of single-chamber ventricular pacemakers are implanted in octogenarian and nonagenarian patients. We aimed to assess whether the current pacing guideline is adhered for these populations. METHODS: We retrospectively identified patients ≥80 years of age, who received their first pacemaker from July 2010 to June 2013. RESULTS: A total of 356 patients were identified. Mean age was 86.1 years and 82.6 years for single and dual-chamber pacemakers respectively (p<0...
2016: New Zealand Medical Journal
W M Drake, C E Stiles, J S Bevan, N Karavitaki, P J Trainer, D A Rees, T I Richardson, S E Baldeweg, N Stojanovic, R D Murray, A A Toogood, N M Martin, B Vaidya, T S Han, R P Steeds, F C Baldeweg, U E Sheikh, N Kyriakakis, S Parasuraman, L Taylor, N Butt, S Anyiam
: CONTEXT Uncertainty exists whether the long-term use of ergot-derived dopamine agonist (DA) drugs for the treatment of hyperprolactinemia may be associated with clinically significant valvular heart disease; and whether current regulatory authority guidelines for echocardiographic screening are clinically appropriate. OBJECTIVE: To provide follow-up echocardiographic data on a previously described cohort of patients treated with DA for lactotrope pituitary tumors; and to explore possible associations between structural and functional valve abnormalities with the cumulative dose of drug used...
August 29, 2016: Journal of Clinical Endocrinology and Metabolism
Chirag Bavishi, Kiruthika Balasundaram, Edgar Argulian
OBJECTIVES: This study was designed to evaluate the evidence base for the 2014 American Heart Association/American College of Cardiology (AHA/ACC) guidelines for severe aortic stenosis (SAS) and preserved left ventricular ejection fraction by comparing the natural history of the disease in subgroups of low-gradient (LG) aortic stenosis patients with high-gradient (HG) patients. BACKGROUND: The 2014 AHA/ACC valvular disease guidelines recommend estimation of stroke volume index by echocardiography in patients with suspected LG SAS and preserved left ventricular ejection fraction...
August 11, 2016: JACC. Cardiovascular Imaging
Shujuan Zhao, Hongwei Zhao, Xianpei Wang, Chuanyu Gao, Yuhua Qin, Haixia Cai, Boya Chen, Jingjing Cao
Background Warfarin is efficacious for ischemic stroke prevention in intermediate- to high-risk patients with atrial fibrillation; thus, warfarin is the recommended treatment according to evidence-based guidelines. Objective This prospective study evaluated the reasons for under-utilization of warfarin in Chinese patients with non-valvular atrial fibrillation (NVAF). Setting The People's Hospital of Henan Province of Zhengzhou City, which is a 3900-bed tertiary-care teaching institution. Methods We extracted data from an existing patient database...
October 2016: International Journal of Clinical Pharmacy
Michela Giustozzi, Maria Cristina Vedovati, Paolo Verdecchia, Lucia Pierpaoli, Melina Verso, Serenella Conti, Federica Cianella, Emanuela Marchesini, Esmeralda Filippucci, Giancarlo Agnelli, Cecilia Becattini
BACKGROUND: Current guidelines recommend vitamin K antagonists (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in patients with non-valvular atrial fibrillation (AF). METHODS: We compared the clinical features of consecutive in- and out-patients with non-valvular AF newly-treated with NOACs or on treatment with VKAs. RESULTS: Overall, 1314 patients newly-treated with NOACs and 1024 on treatment with VKAs were included in the study...
September 2016: European Journal of Internal Medicine
Shailja Verma, Krishna Agarwal, Gauri Gandhi
A 65-year-old postmenopausal pregnant woman was referred with antepartum hemorrhage at 29 weeks of gestation. Postadmission diagnosed with chronic hypertension, gestational diabetes mellitus, valvular heart disease, and placenta previa. Her pregnancy was terminated by cesarean delivery at 32 weeks as she had a bout of bleeding per vaginum. Most of the placenta was adherent with no plane of cleavage; therefore, cesarean hysterectomy was performed. Baby birth weight was 1650 g and was shifted to nursery for observation and mother needed Intensive Care Unit care postcesarean...
April 2016: Journal of Human Reproductive Sciences
Saad Ahmad, Heath Wilt
There is a clinically staggering burden of disease stemming from cerebrovascular events, of which a majority are ischemic in nature and many are precipitated by atrial fibrillation (AF). AF can occur in isolation or in association with myocardial or structural heart disease. In the latter case, and when considering health at an international level, congenital and acquired valve-related diseases are frequent contributors to the current pandemic of AF and its clinical impact. Guidelines crafted by the American Heart Association, American College of Cardiology, European Society of Cardiology and Heart Rhythm Society underscore the use of vitamin K antagonists (VKAs) among patients with valvular heart disease, particularly in the presence of concomitant AF, to reduce the risk of ischemic stroke of cardioembolic origin; however, the non-VKAs, also referred to as direct, target-specific or new oral anticoagulants (NOACs), have not been actively studied in this particular population...
2016: Open Cardiovascular Medicine Journal
Iqbal H Jaffer, Richard P Whitlock
The choice of prosthesis type in patients with valvular heart disease should always be individualised. The treating heart team must weigh the concerns surrounding durability of bioprosthetic valves compared with mechanical valves and the need for lifelong anticoagulation required with mechanical valves. In general, guidelines recommend that patients under the age of 60 would benefit from a mechanical valve, and those over 70 would benefit from a bioprosthetic valve. We would argue, in this context, that the most appropriate choice for this patient would be undertaking a mitral valve replacement with a mechanical prosthesis...
2016: Heart Asia
R Goel, P P Sengupta, F Mookadam, H P Chaliki, B K Khandheria, A J Tajik
Valvular heart disease is a growing public health problem, with an increasing prevalence due to an ageing population. Despite advances, the medical management of symptomatic valvular heart diseases remains suboptimal, necessitating surgical correction. The challenge remains in identifying an asymptomatic or mildly symptomatic patient who will benefit from timely surgery before irreversible changes in cardiac function have occurred. The potential risks of surgery versus watchful expectancy require careful decision-making...
2009: Heart Asia
Paul C Nathan, Eitan Amir, Husam Abdel-Qadir
More than 80% of children and 60% of adults with cancer will become long-term survivors, emphasizing the importance of late effects of cancer therapy. Cardiotoxicity due to chemotherapy and radiation is a frequent cause of serious morbidity and premature mortality in survivors. Anthracyclines, a core component of many treatment regimens, have been implicated as a principal cause of irreversible cardiomyopathy. Approximately 60% of anthracycline-treated children will develop echocardiographic evidence of cardiac dysfunction, and 10% of those treated with high-dose anthracyclines will develop congestive heart failure within the 20 years after therapy...
July 2016: Canadian Journal of Cardiology
Rick A Nishimura, Blase Carabello
The 2014 American College of Cardiology/American Heart Association guidelines for valvular heart disease were released to help guide the clinician in caring for patients with this ever more prevalent and complex group of diseases and have been instrumental in providing a foundation of knowledge for the management of patients with valvular heart disease. However, there are many caveats in applying the guidelines to individual patients. As clinicians, we wish to outline important aspects to be considered by other clinicians, including the integration of the echocardiogram with the history and physical examination, recognition of discordant data within an echocardiographic examination, and proper interpretation of the cutoff measurements applied to timing of intervention...
May 17, 2016: Journal of the American College of Cardiology
Adedotun A Ogunsua, Amir Y Shaikh, Mohamed Ahmed, David D McManus
Atrial fibrillation (AF) is an increasingly prevalent condition and the most common sustained arrhythmia encountered in ambulatory and hospital practice. Several clinical risk factors for AF include age, sex, valvular heart disease, obesity, sleep apnea, heart failure, and hypertension (HTN). Of all the risk factors, HTN is the most commonly encountered condition in patients with incident AF. Hypertension is associated with a 1.8-fold increase in the risk of developing new-onset AF and a 1.5-fold increase in the risk of progression to permanent AF...
October 2015: Methodist DeBakey Cardiovascular Journal
Joseph Yeboah, Carlos J Rodriguez, Waqas Qureshi, Songtao Liu, J Jeffrey Carr, Joao A Lima, W Gregory Hundley, David M Herrington
BACKGROUND: Reduced left ventricular systolic function predicts worse outcomes. However, the optimal threshold for "normal" left ventricular ejection fraction (LVEF) is uncertain. In general, LVEF ≥ 55% is considered to be "normal" by guidelines, with a low normal designation for LVEF being 50%-55%. We assessed the prognosis of participants with low normal LVEF in the Multiethnic Study of Atherosclerosis. All participants were asymptomatic and had no known clinical cardiovascular disease at baseline...
October 2016: Journal of Cardiac Failure
Loren F Hiratzka, Mark A Creager, Eric M Isselbacher, Lars G Svensson, Rick A Nishimura, Robert O Bonow, Robert A Guyton, Thoralf M Sundt
Two guidelines from the American College of Cardiology (ACC), the American Heart Association (AHA), and collaborating societies address the risk of aortic dissection in patients with bicuspid aortic valves and severe aortic enlargement: The "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease" (J Am Coll Cardiol. 2010;55:e27-130) and the "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease" (J Am Coll Cardiol...
April 2016: Journal of Thoracic and Cardiovascular Surgery
C Meurice, E Dulgheru, L Piérard
Aortic stenosis (AS) is the most common valvular heart disease in adults. The most frequent aetiology is now degenerative AS. There is general agreement that, in the absence of serious co-morbidity, surgery must be recommended for patients with symptomatic disease. The management of asymptomatic patients with severe aortic disease remains controversial for several reasons: sudden death in asymptomatic patients has been reported with an incidence < 1 % per year. In addition, operative mortality is significantly higher in symptomatic, when compared with asymptomatic, patients...
January 2016: Revue Médicale de Liège
WanZhu Zhang, Emmy Okello, Wilson Nyakoojo, Peter Lwabi, Charles K Mondo
INTRODUCTION: Since the establishment of the Uganda Rheumatic Heart Registry, over 900 patients have been enrolled. We sought to stratify the patients in the registry according to disease severity and optimal management strategy. METHODS: We reviewed data of 618 patients who had enrolled in the Registry between March 2010 and February 2013. The 67 patients who had died were excluded leaving 551 patients who were recruited. The optimum management strategy was determined according to the 2012 European Society of Cardiology guidelines on the management of valvular heart disease...
December 2015: African Health Sciences
Farwa Ali, Jimmy Young, Alejandro A Rabinstein, Kelly D Flemming, Jennifer E Fugate
BACKGROUND: Obtaining serum troponin levels in every patient with acute stroke is recommended in recent stroke guidelines, but there is no evidence that these contribute positively to clinical care. We sought to determine the clinical significance of measuring troponin levels in acute ischemic stroke patients. METHODS: We reviewed 398 consecutive patients with acute ischemic stroke at a large academic institution from 2010 to 2012. Troponin levels were measured as a result of protocol in place during part of the study period...
May 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Lorne A Clarke, Paul Harmatz, Edward W Fong
Morquio A Syndrome (mucopolysaccharidosis IVA [MPS IVA]) is an inherited, autosomal recessive lysosomal storage disorder that occurs in ~1 in 200,000 to 300,000 live births.(1) (Online access Individuals with Morquio A Syndrome have mutations in the gene that encodes N-acetylgalactosamine-6-sulfate sulfatase (GALNS), an enzyme responsible for the metabolism of the glycosaminoglycans (GAGs) keratin sulfate and chondroitin-6-sulfate.(2-4) Reduced activity or lack of GALNS leads to cellular and tissue accumulation of these GAGs to result in progressive, multisystem dysfunction and impaired functional capacity...
February 2016: Molecular Genetics and Metabolism
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