COVID-19: Health Care Implications
The coronavirus disease 2019 (COVID-19) pandemic has challenged the capacity of healthcare systems around the world, including substantial disruptions to cardiovascular care across key areas of healthcare delivery. In this narrative review, we examine implications of the COVID-19 pandemic for cardiovascular healthcare, including excess cardiovascular mortality, acute and elective cardiovascular care, and disease prevention. Additionally, we consider the long-term public health consequences of disruptions to cardiovascular care across both primary and secondary care settings. Finally, we review healthcare inequalities and t...
Source: Cardiology Clinics - March 28, 2022 Category: Cardiology Authors: Zahra Raisi-Estabragh, Mamas A. Mamas Source Type: research
Mechanical Circulatory Support in COVID-19
Despite aggressive care, patients with cardiopulmonary failure and COVID-19 experience unacceptably high mortality rates. The use of mechanical circulatory support devices in this population offers potential benefits but confers significant morbidity and novel challenges for the clinician. Thoughtful application of this complex technology is of the utmost importance and should be done in a multidisciplinary fashion by teams familiar with mechanical support devices and aware of the particular challenges provided by this complex patient population. (Source: Cardiology Clinics)
Source: Cardiology Clinics - March 24, 2022 Category: Cardiology Authors: Kari Gorder, Wesley Young, Navin K. Kapur, Timothy D. Henry, Santiago Garcia, Raviteja R. Guddeti, Timothy D. Smith Source Type: research
The Cardiovascular Manifestations of COVID-19
The Coronavirus 2019 (COVID-19) pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus, has resulted in unprecedented morbidity and mortality worldwide. While COVID-19 typically presents as viral pneumonia, cardiovascular manifestations such as acute coronary syndromes, arterial and venous thrombosis, acutely decompensated heart failure, and arrhythmia are frequently observed. Many of these complications are associated with poorer outcomes, including death. Herein we review the relationship between cardiovascular risk factors and outcomes among patients with COVID-19, cardiovascular mani...
Source: Cardiology Clinics - March 22, 2022 Category: Cardiology Authors: David W. Louis, Marwan Saad, Shilpa Vijayakumar, Suleman Ilyas, Aravind Kokkirala, Herbert D. Aronow Source Type: research
The Direct and Indirect Effects of COVID-19 on Acute Coronary Syndromes
The novel SARS-CoV-2 virus has directly and indirectly impacted patients with acute coronary syndrome (ACS). The onset of the COVID-19 pandemic correlated with an abrupt decline in hospitalizations with ACS and increased out-of-hospital deaths. Worse outcomes in ACS patients with concomitant COVID-19 have been reported, and acute myocardial injury secondary to SARS-CoV-2 infection is recognized. A rapid adaptation of existing ACS pathways has been required such that overburdened healthcare systems may manage both a novel contagion and existing illness. As SARS-CoV-2 is now endemic, future research is required to better def...
Source: Cardiology Clinics - March 22, 2022 Category: Cardiology Authors: Thomas A. Kite, Susil Pallikadavath, Chris P. Gale, Nick Curzen, Andrew Ladwiniec Source Type: research
Impact of COVID-19 on Acute Myocardial Infarction Care
The global health crisis caused by the coronavirus disease-2019 (COVID-19) pandemic has evolved rapidly to overburden healthcare organizations around the world and has resulted in significant morbidity and mortality. Many countries have reported a substantial and rapid reduction in hospital admissions for acute coronary syndromes (ACS) and percutaneous coronary intervention. The reasons for such abrupt changes in healthcare delivery are multifactorial and include lockdowns, reduction in outpatient services, reluctance to seek medical attention for fear of contracting the virus, and restrictive visitation policies adopted d...
Source: Cardiology Clinics - March 22, 2022 Category: Cardiology Authors: Raviteja R. Guddeti, Mehmet Yildiz, Keshav R. Nayak, M. Chadi Alraies, Laura Davidson, Timothy D. Henry, Santiago Garcia Source Type: research
The Pathobiology of Pulmonary Arterial Hypertension
Pulmonary arterial hypertension is characterized by obliteration and obstruction of the pulmonary arterioles that in turn results in high right ventricular afterload and right heart failure. The pathobiology of pulmonary arterial hypertension is complex, with contributions from multiple pathophysiologic processes that are regulated by a variety of molecular mechanisms. This nature likely explains the limited efficacy of our current therapies, which only target a small portion of the pathobiological mechanisms that underlie advanced disease. Here we review the pathobiology of pulmonary arterial hypertension, focusing on the...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Sudarshan Rajagopal, Yen-Rei A. Yu Source Type: research
Update on Medical Management of Pulmonary Arterial Hypertension
Pulmonary arterial hypertension is a rare disease characterized by pulmonary microvasculature remodeling leading to right ventricular failure and death. Medical management of pulmonary hypertension has grown increasingly complex as more therapeutic agents have been developed. Evolving treatment strategies leveraging the endothelin, nitric oxide, and prostacyclin pathways lead to improved exercise capacity and outcomes in patients; however, significant opportunities for advancement remain. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Alexander E. Sherman, Rajan Saggar, Richard N. Channick Source Type: research
Pulmonary Hypertension Associated with Connective Tissue Disease
Pulmonary hypertension (PH), a syndrome characterized by elevated pulmonary pressures, commonly complicates connective tissue disease (CTD) and is associated with increased morbidity and mortality. The incidence of PH varies widely between CTDs; patients with systemic sclerosis are most likely to develop PH. Several different types of PH can present in CTD, including PH related to left heart disease and respiratory disease. Importantly, CTD patients are at risk for developing pulmonary arterial hypertension, a rare form of PH that is associated with high morbidity and mortality. Future therapies targeting pulmonary vascula...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Stephen C. Mathai Source Type: research
Pulmonary Arterial Hypertension in Patients Infected with the Human Immunodeficiency Virus
It is important to recognize and treat human immunodeficiency virus-associated pulmonary arterial hypertension (HIV-PAH) because of the associated morbidity and mortality. With the introduction of antiretroviral therapies (ART), improved survival has changed the focus of treatment management from immunodeficiency-related opportunistic infections to chronic cardiovascular complications, including HIV-PAH. The 2018 6th World Symposium of Pulmonary Hypertension recommended a revised definition of PAH that might result in a greater number of patients with HIV-PAH; however, the implication of this change is not yet clear. Here,...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Stephanie M. Hon, Rodolfo M. Alpizar-Rivas, Harrison W. Farber Source Type: research
Lung Disease –Related Pulmonary Hypertension
Patients with advanced lung disease can develop pulmonary hypertension and succumb to right ventricular failure/cor pulmonale. Patients with pulmonary hypertension owing to chronic lung disease, or World Health Organization group 3 pulmonary hypertension, are more limited and carry a high risk of mortality. Adjunctive therapies remain the cornerstones of treatment. Recent evidence suggests that inhaled pulmonary vasodilator therapy can be helpful in patients with pulmonary hypertension owing to interstitial lung disease. Lung transplantation may be the only life-saving option in select patients, whereas palliative care and...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Kareem Ahmad, Vikramjit Khangoora, Steven D. Nathan Source Type: research
Pulmonary Hypertension in Adults with Congenital Heart Disease
Pulmonary arterial hypertension related to congenital heart disease (PAH-CHD) affects 5% to 10% of adults with CHD and is associated with significant morbidity and mortality. PAH-CHD develops as a consequence of intracardiac or extracardiac systemic-to-pulmonary shunts that lead to pulmonary vascular remodeling through a pathologic process that is similar to other causes of PAH. Eisenmenger syndrome is the most severe phenotype of PAH-CHD and is characterized by severe elevation in pulmonary vascular resistance, with shunt reversal causing hypoxemia and central cyanosis. The primary management strategy for most patients wi...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Sarah A. Goldstein, Richard A. Krasuski Source Type: research
Left Heart Disease-Related Pulmonary Hypertension
Pulmonary hypertension (PH) due to left heart disease (LHD; group 2 PH) is a common complication of heart failure with reduced ejection fraction and heart failure with preserved ejection fraction and is often related to disease severity and duration of these diseases. PH due to LHD is associated with negative impact on outcomes in addition to worse symptoms and exercise capacity. Risk factors for group 2 PH are older age, hypertension, atrial fibrillation, and features of metabolic syndrome. The main mechanisms for group 2 PH are believed to be vascular remodeling secondary to sustained elevated intravascular pressure. (So...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Ayedh K. Alamri, Christy L. Ma, John J. Ryan Source Type: research
Surgical Management of Chronic Thromboembolic Pulmonary Hypertension
Chronic thromboembolic pulmonary hypertension is a progressive disease, which may lead to severe right ventricular dysfunction and debilitating symptoms. Pulmonary thromboendarterectomy (PTE) provides the best opportunity for complete resolution of obstructing thromboembolic disease and functional improvement in appropriately selected patients. In this article, the authors review preoperative workup, patient selection, operative technique, postoperative care, and outcomes after PTE. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Andrew M. Vekstein, Joseph R. Nellis, Sharon L. McCartney, John C. Haney Source Type: research
Interventional Management of Chronic Thromboembolic Pulmonary Hypertension
Chronic thromboembolic pulmonary hypertension is a distinct form of pulmonary hypertension characterized by the nonresolution of thrombotic material in the pulmonary tree; whenever feasible and safe, first-line treatment should be pulmonary thromboendarterectomy. In patients who are not operative candidates, balloon pulmonary angioplasty (BPA) has emerged as an effective treatment modality that results in improvements in functional class, symptoms, hemodynamics, 6-minute walk distance, and right ventricular and pulmonary artery mechanics. Careful attention to procedural technique and rapid identification and treatment of c...
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: J.D. Serfas, Richard A. Krasuski Source Type: research
Management of Pulmonary Hypertension in the Pediatric Patient
This article reviews the various forms of PH in childhood, with a focus on both established and investigational therapies that are available for children with PH. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 20, 2021 Category: Cardiology Authors: Rebecca Epstein, Usha S. Krishnan Source Type: research
