Care of the Post-CABG Patient
An estimated 400,000 coronary artery bypass graft operations are performed annually in the United States. Saphenous vein grafts are the most commonly used conduits; however, graft failure is common. In contrast, left internal mammary artery grafts have more favorable long-term patency rates. Guidelines recommend aggressive secondary prevention. In the 2 decades following surgery, 16% of patients require repeat revascularization, and percutaneous coronary intervention accounts for 98% of procedures performed. Post-coronary artery bypass graft patients presenting with symptoms of acute coronary syndrome or progressive heart ...
Source: Cardiology in Review - December 6, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Beta Adrenergic Blocker Use in Patients With Chronic Obstructive Pulmonary Disease and Concurrent Chronic Heart Failure With a Low Ejection Fraction
Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) often coexist and present clinicians with diagnostic and therapeutic challenges. Beta-blockers are a cornerstone of CHF treatment, in patients with a low ejection fraction, while beta-agonists are utilized for COPD. These 2 therapies exert opposing pharmacological effects. COPD patients are at an increased risk of mortality from cardiovascular events. In addition to CHF, beta-blockers are used in a number of cardiovascular conditions because of their cardioprotective properties as well as their mortality benefit. However, there is reluctance among...
Source: Cardiology in Review - December 6, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Pregnancy Complications as a Window to Future Cardiovascular Disease
Pregnancy is a time of significant hemodynamic, metabolic, and hormonal stress that can unmask underlying subclinical cardiovascular abnormalities, and pregnancy-related complications may serve as early warning signs for future risk of cardiovascular disease. The increased recognition of these sex-specific risk factors could identify women who may benefit from more intensive risk factor modification to reduce morbidity and mortality later in life. In this review, we describe several pregnancy-related complications that have been associated with the risk of cardiovascular disease, including hypertensive disorders of pregnan...
Source: Cardiology in Review - December 6, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Cardiovascular Sequelae of Sickle Cell Disease
Sickle cell disease (SCD) is one of the most common hereditary hemoglobinopathies worldwide. It is a multisystem disease that causes considerable patient morbidity. Despite advances in medical treatment, cardiopulmonary complications remain the most common cause of death in individuals with SCD. A growing body of evidence has shown that SCD results in a spectrum of cardiovascular complications through a variety of mechanisms, including chronic hemolysis, local tissue hypoxia, increased oxidative stress, and autonomic instability. Herein, we will examine the pathophysiology of sickle cell vasculopathy and discuss the spectr...
Source: Cardiology in Review - December 6, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Vulnerable Plaque: A Review of Current Concepts in Pathophysiology and Imaging
Advances in our understanding of the natural history and biology of atherosclerotic vascular disease led to the concept of a vulnerable plaque (VP), which is predisposed toward more rapid progression and acute coronary events. With newer technologies, we now have at our disposal high-quality imaging studies, both invasive and noninvasive, which promise in identifying plaque characteristics that make it more vulnerable. Upcoming trials aim to evaluate the utility of imaging VP in predicting clinical events. We discuss the role of VP imaging in managing atherosclerotic vascular disease. (Source: Cardiology in Review)
Source: Cardiology in Review - December 6, 2019 Category: Cardiology Tags: Review Articles Source Type: research
George Reed, MD: Cardiac Surgical Pioneer and Visionary
No abstract available (Source: Cardiology in Review)
Source: Cardiology in Review - December 6, 2019 Category: Cardiology Tags: Editorial Source Type: research
Functional Mitral Regurgitation in Heart Failure
Functional mitral regurgitation (FMR) in the setting of left ventricular (LV) dysfunction and heart failure portends a poor prognosis. Guideline-directed medical therapy remains the cornerstone of initial treatment, with emphasis placed on treatment of the underlying LV dysfunction, as FMR is a secondary phenomenon and a disease due to LV remodeling. Surgical correction of FMR is controversial because it typically does not address the underlying mechanism and etiology of the condition. However, new, minimally invasive transcatheter therapies, in particular the MitraClip system, have shown promise in the treatment of FMR in...
Source: Cardiology in Review - October 5, 2019 Category: Cardiology Tags: Symposium Source Type: research
Premature Ventricular Contractions and Cardiomyopathy
Premature ventricular contractions (PVCs) are a common arrhythmia that may cause symptoms of variable severity. PVCs have recently garnered interest in their ability to induce adverse structural heart remodeling in an entity known as PVC-induced cardiomyopathy. This entity is a retrospective diagnosis that likely remains under-recognized and may occur concurrently with other forms of cardiomyopathy. The appropriate identification and management of PVCs in the setting of associated cardiomyopathy may have a significant impact on cardiac function and the clinical course, including recovery of left ventricular ejection fracti...
Source: Cardiology in Review - October 5, 2019 Category: Cardiology Tags: Symposium Source Type: research
Using High Sensitivity Troponins to Rule Out Acute Coronary Syndrome and Lower Admission Rates
This article will include a discussion on how to utilize common risk stratification tools in the ED to identify cohorts of patients suitable for discharge without additional testing. ED physicians must understand the limitations and benefits of hs-cTn levels and how to incorporate the information obtained from these biomarkers into risk scores in order to strengthen disposition decisions and safely discharge patients from the ED. (Source: Cardiology in Review)
Source: Cardiology in Review - October 5, 2019 Category: Cardiology Tags: Symposium Source Type: research
Role of Imaging in the Management of Ventricular Arrhythmias
The management of ventricular arrhythmias (VA) has evolved over time to an advanced discipline, incorporating many technologies in the diagnosis and treatment of the myriad types of VA. The first application of imaging is in the assessment for structural heart disease, as this has the greatest impact on prognosis. Advanced imaging has its greatest utility in the planning and execution of ablation for VA. The following review outlines the application of different imaging modalities, such as ultrasonography, magnetic resonance imaging, computed tomography, and positron emission tomography, for the treatment of VA. (Source: Cardiology in Review)
Source: Cardiology in Review - October 5, 2019 Category: Cardiology Tags: Symposium Source Type: research
Insights From Atrial Fibrillation Genomics: From Bedside to Bench and Back Again
From the bedside of patients contributing samples to large genome-wide association studies for atrial fibrillation (AF), over 100 AF risk loci have been identified. The top locus is near a gene implicated in pulmonary vein formation; the ostia of the pulmonary veins harbor initiating triggers of AF, and isolation of these areas is the cornerstone of ablation therapies for AF. Transcriptomic studies suggest that AF is associated with impaired or overwhelmed responses to cell stress. A dual risk model proposes that in genetically-susceptible individuals, inadequate transcriptional responses to stress predispose to AF in late...
Source: Cardiology in Review - October 5, 2019 Category: Cardiology Tags: Symposium Source Type: research
Third-Generation LVADs: Has Anything Changed?
The field of durable left ventricular assist devices has advanced dramatically since its introduction into the clinical realm. From the first-generation pulsatile HeartMate XVE device to the second-generation continuous axial flow HeartMate-2 to the current third-generation centrifugal flow devices, the left ventricular assist device has undergone significant evolution. This review describes the technology and its changes over the course of time, with a focus on the fundamental question: Has anything changed? (Source: Cardiology in Review)
Source: Cardiology in Review - October 5, 2019 Category: Cardiology Tags: Symposium Source Type: research
Cardiovascular Risk Assessment in Renal and Liver Transplant Candidates: A Multidisciplinary Institutional Standardized Approach
In the modern era, renal and liver transplant candidates present with a greater medical complexity driven in part by a higher prevalence of cardiovascular conditions, including coronary artery disease, valvular heart disease, and cardiomyopathies. In fact, cardiovascular disease is the most common cause of death after kidney transplantation worldwide. Similarly, an increase in the number of patients being listed with end-stage liver disease from nonalcoholic steatohepatitis and a rising model for end-stage liver disease scores at the time of liver transplant in the United States parallel an increasing cardiovascular diseas...
Source: Cardiology in Review - October 5, 2019 Category: Cardiology Tags: Review Articles Source Type: research
Very Late Stent Thrombosis in Drug-Eluting Stents New Observations and Clinical Implications
Despite the reduction in stent failure with newer-generation drug-eluting stents, very late stent thrombosis (VLST) remains an unpredictable and potentially catastrophic complication of coronary revascularization procedures and is associated with high morbidity and mortality. Here, we present an updated overview of the latest advances in understanding the causes of VLST. Clinical studies that revealed potential risk factors and pathophysiologic studies on the mechanisms of VLST are discussed. Importantly, novel insights from recent advances in intravascular imaging are included. To date, there is no clinical guideline for ...
Source: Cardiology in Review - October 5, 2019 Category: Cardiology Tags: Review Articles Source Type: research
The Incisura
Analysis of the arterial pressure waveform remains useful in modern practice to assess alterations that may indicate significant abnormalities of cardiovascular parameters. The recognition of abnormalities of the incisura and dicrotic wave should alert the clinician to seek specific etiologic factors. Understanding the physiological origins of the incisura and dicrotic notch enhance its clinical utility in accurately diagnosing abnormal hemodynamic states. This review summarizes the hemodynamic events causing and affecting the inscription of the incisura in the arterial waveform. (Source: Cardiology in Review)
Source: Cardiology in Review - October 5, 2019 Category: Cardiology Tags: Review Articles Source Type: research
