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M Zakkar, A J Bryan, G D Angelini
No abstract text is available yet for this article.
October 19, 2016: BMJ: British Medical Journal
Ben Freedman, Tatjana S Potpara, Gregory Y H Lip
Atrial fibrillation is found in a third of all ischaemic strokes, even more after post-stroke atrial fibrillation monitoring. Data from stroke registries show that both unknown and untreated or under treated atrial fibrillation is responsible for most of these strokes, which are often fatal or debilitating. Most could be prevented if efforts were directed towards detection of atrial fibrillation before stroke occurs, through screening or case finding, and treatment of all patients with atrial fibrillation at increased risk of stroke with well-controlled vitamin K antagonists or non-vitamin K antagonist anticoagulants...
August 20, 2016: Lancet
Isabelle C Van Gelder, Michiel Rienstra, Harry J G M Crijns, Brian Olshansky
Control of the heart rate (rate control) is central to atrial fibrillation management, even for patients who ultimately require control of the rhythm. We review heart rate control in patients with atrial fibrillation, including the rationale for the intervention, patient selection, and the treatments available. The choice of rate control depends on the symptoms and clinical characteristics of the patient, but for all patients with atrial fibrillation, rate control is part of the management. Choice of drugs is patient-dependent...
August 20, 2016: Lancet
Jonathan P Piccini, Laurent Fauchier
Many patients with atrial fibrillation have substantial symptoms despite ventricular rate control and require restoration of sinus rhythm to improve their quality of life. Acute restoration (ie, cardioversion) and maintenance of sinus rhythm in patients with atrial fibrillation are referred to as rhythm control. The decision to pursue rhythm control is based on symptoms, the type of atrial fibrillation (paroxysmal, persistent, or long-standing persistent), patient comorbidities, general health status, and anticoagulation status...
August 20, 2016: Lancet
Fatima Rodriguez, Kenneth W Mahaffey
Non-ST-segment elevation acute coronary syndromes (NSTE-ACS) are the leading cause of morbidity and mortality from cardiovascular disease worldwide. The American Heart Association/American College of Cardiology and the European Society of Cardiology periodically release practice guidelines to guide clinicians in the management of NSTE-ACS, most recently in in 2014 and 2015, respectively. The present review compares and contrasts the 2 guidelines, with a focus on the strength of recommendation and level of evidence in the approach to initial presentation and diagnosis of NSTE-ACS, risk assessment, treatments, and systems of care...
July 19, 2016: Journal of the American College of Cardiology
Akshay S Desai, Pardeep S Jhund
Although patients with heart failure and preserved ejection fraction (HF-PEF) represent nearly half of the population with chronic heart failure, few evidence-based medical therapies are available. The neutral overall results of the TOPCAT trial of spironolactone in HF-PEF leave clinicians who treat heart failure with an ongoing clinical dilemma. In this review, we outline an approach to the clinical management of the patient with HF-PEF synthesizing data from available clinical trials and expert consensus.
April 13, 2016: European Heart Journal
Hesham R Omar, Maya Guglin
INTRODUCTION: Multiple studies found a significant correlation between B-type natriuretic peptide (BNP) level and clinical severity of heart failure (HF). We aim to study the ability of a single BNP measurement to predict the degree of congestion in acute systolic HF. METHODS: Patients enrolled in the ESCAPE trial who were admitted with acute systolic HF were divided into tertiles according to baseline BNP level with comparison of the degree of congestion across tertiles using clinical signs of congestion as well as objective parameters of overload checked by the pulmonary artery catheter...
June 2016: Journal of Critical Care
Glenn N Levine, Eric R Bates, John A Bittl, Ralph G Brindis, Stephan D Fihn, Lee A Fleisher, Christopher B Granger, Richard A Lange, Michael J Mack, Laura Mauri, Roxana Mehran, Debabrata Mukherjee, L Kristin Newby, Patrick T O'Gara, Marc S Sabatine, Peter K Smith, Sidney C Smith
No abstract text is available yet for this article.
September 6, 2016: Journal of the American College of Cardiology
Eric J Velazquez, Kerry L Lee, Robert H Jones, Hussein R Al-Khalidi, James A Hill, Julio A Panza, Robert E Michler, Robert O Bonow, Torsten Doenst, Mark C Petrie, Jae K Oh, Lilin She, Vanessa L Moore, Patrice Desvigne-Nickens, George Sopko, Jean L Rouleau
BACKGROUND: The survival benefit of a strategy of coronary-artery bypass grafting (CABG) added to guideline-directed medical therapy, as compared with medical therapy alone, in patients with coronary artery disease, heart failure, and severe left ventricular systolic dysfunction remains unclear. METHODS: From July 2002 to May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to undergo CABG plus medical therapy (CABG group, 610 patients) or medical therapy alone (medical-therapy group, 602 patients)...
April 21, 2016: New England Journal of Medicine
John A Bittl, Usman Baber, Steven M Bradley, Duminda N Wijeysundera
BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) after implantation of newer-generation drug-eluting stents (DES) remains uncertain. Similarly, questions remain about the role of DAPT in long-term therapy of stable post-myocardial infarction (MI) patients. AIM: Our objective was to compare the incidence of death, major hemorrhage, MI, stent thrombosis, and major adverse cardiac events in patients randomized to prolonged or short-course DAPT after implantation of newer-generation DES and in secondary prevention after MI...
September 6, 2016: Circulation
Antonio Granata, Anna Clementi, Grazia Maria Virzì, Alessandra Brocca, Massimo de Cal, Viviana Rosalia Scarfia, Luca Zanoli, Claudio Ronco, Salvatore Corrao, Lorenzo Malatino
Cardiorenal syndrome type 4 (CRS type 4), or chronic renocardiac syndrome, has been defined as "chronic abnormalities in renal function leading to cardiac disease" and recognizes the extreme burden of cardiovascular disease (CVD) risk in patients with chronic kidney disease (CKD). CKD is common and increasingly recognized as a risk factor for CVD. Even though the treatment for CVD has dramatically improved over the past decades, it still takes responsibility for up to 50% of deaths in CKD patients. For this reason, patients with CKD should be thoroughly evaluated for cardiovascular risk factors that require careful management, given the significant burden of CRS type 4 on the healthcare system...
May 2016: European Journal of Internal Medicine
Jeanne E Poole, Jagmeet P Singh, Ulrika Birgersdotter-Green
The beneficial effects of cardiac resynchronization therapy (CRT) have been well established in large, randomized trials. Despite the documented success of this treatment strategy, a significant proportion of patients with heart failure do not achieve the desired response. The aim of this review was to delineate factors contributing to a successful CRT response, emphasizing the interrelated roles of QRS morphology and QRS interval duration. More data are available on QRS duration, as this factor has been used as an enrollment criterion in clinical trials...
March 8, 2016: Journal of the American College of Cardiology
Jelena R Ghadri, Annahita Sarcon, Johanna Diekmann, Dana Roxana Bataiosu, Victoria L Cammann, Stjepan Jurisic, Lars Christian Napp, Milosz Jaguszewski, Frank Scherff, Peter Brugger, Lutz Jäncke, Burkhardt Seifert, Jeroen J Bax, Frank Ruschitzka, Thomas F Lüscher, Christian Templin
AIMS: Takotsubo syndrome (TTS) is typically provoked by negative stressors such as grief, anger, or fear leading to the popular term 'broken heart syndrome'. However, the role of positive emotions triggering TTS remains unclear. The aim of the present study was to analyse the prevalence and characteristics of patients with TTS following pleasant events, which are distinct from the stressful or undesirable episodes commonly triggering TTS. METHODS AND RESULTS: Takotsubo syndrome patients with preceding pleasant events were compared to those with negative emotional triggers from the International Takotsubo Registry...
March 2, 2016: European Heart Journal
Hae-Young Lee, Sang Hong Baek
Beta-blockers are the cornerstone treatment for congestive heart failure (HF). Current HF guidelines commonly recommend β-blockers for the treatment of HF with reduced left ventricular ejection fraction (LVEF). The effect of β-blockers, however, is less clear for HF patients with preserved LVEF, unstable severe acute HF, or right ventricular failure. This review summarizes the effect of β-blockers in various clinical situations and suggests a strategy for optimal use. (Circ J 2016; 80: 565-571).
2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Christopher B Fordyce, David E Newby, Pamela S Douglas
SCOT-HEART (Scottish COmputed Tomography of the HEART) and PROMISE (PROspective Multicenter Imaging Study for Evaluation of chest pain) represent the 2 largest and most comprehensive cardiovascular imaging outcome trials in patients with stable chest pain and provide significant insights into patient diagnosis, management, and outcomes. These trials are particularly timely, given the well-recognized knowledge gaps and widespread use of noninvasive imaging. The overall goal of this review is to distill the data generated from these 2 pivotal trials to better inform the practicing clinician in the selection of noninvasive testing for stable chest pain...
February 23, 2016: Journal of the American College of Cardiology
Houssein Youness, Tarek Al Halabi, Hussein Hussein, Ahmed Awab, Kellie Jones, Jean Keddissi
The maximal duration of cardiopulmonary resuscitation (CPR) is unknown. We report a case of prolonged CPR. We have then reviewed all published cases with CPR duration equal to or more than 20 minutes. The objective was to determine the survival rate, the neurological outcome, and the characteristics of the survivors. Measurements and Main Results. The CPR data for 82 patients was reviewed. The median duration of CPR was 75 minutes. Patients mean age was 43 ± 21 years with no significant comorbidities. The main causes of the cardiac arrests were myocardial infarction (29%), hypothermia (21%), and pulmonary emboli (12%)...
2016: Critical Care Research and Practice
Daniel J Friedman, Jagmeet P Singh, Jeptha P Curtis, W H Wilson Tang, Haikun Bao, Erica S Spatz, Adrian F Hernandez, Uptal D Patel, Sana M Al-Khatib
BACKGROUND: Patients with moderate-to-severe chronic kidney disease (CKD) are poorly represented in clinical trials of cardiac resynchronization therapy (CRT). OBJECTIVES: This study sought to assess the real-world comparative effectiveness of CRT with defibrillator (CRT-D) versus implantable cardioverter-defibrillator (ICD) alone in CRT-eligible patients with moderate-to-severe CKD. METHODS: We conducted an inverse probability-weighted analysis of 10,946 CRT-eligible patients (ejection fraction <35%, QRS >120 ms, New York Heart Association functional class III/IV) with stage 3 to 5 CKD in the National Cardiovascular Data Registry (NCDR) ICD Registry, comparing outcomes between patients who received CRT-D (n = 9,525) versus ICD only (n = 1,421)...
December 15, 2015: Journal of the American College of Cardiology
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