Xenon: An Emerging Neuroprotectant With Potential Application for Cardiac Arrest Care
Xenon is an inert, highly polarizable noble gas with demonstrated safety and application in general anesthesia for over 50 years. A potent inhibitor of the N-methyl-D-aspartate subtype of glutamate receptors, xenon has a well-documented ameliorating effect on excitotoxic neuronal injury in numerous cellular and animal models of hypoxic-ischemic brain injury. The most important determinant of overall survival and morbidity in out-of-hospital cardiac arrest is the severity of neurological injury. The only approved neuroprotective strategy in this setting is mild therapeutic hypothermia, which has demonstrated significant, al...
Source: Cardiology in Review - June 5, 2018 Category: Cardiology Tags: Review Articles Source Type: research
His Bundle Pacing: Hemodynamics and Clinical Outcomes
From 1993 to 2009, nearly 2.9 million pacemakers were implanted in the United States; the majority of which were dual-chamber pacemakers. One of the major physiologic advantages of dual-chamber pacing over single-chamber ventricular pacing is atrioventricular synchrony, which prevents the pacemaker syndrome. However, patients who are pacemaker dependent or use right ventricle (RV) apical pacing more than 40% of the time are at a risk of developing heart failure from electromechanical dyssynchrony. Studies have also shown that RV pacing results in nonphysiological activation of the left ventricle, leading to adverse clinica...
Source: Cardiology in Review - June 5, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Was the Enalapril Dose Too Low in the PARADIGM-HF Trial?
In conclusion, based on current evidence, it is unclear whether a maximum recommended enalapril dose would promote improved patient outcomes compared with an intermediate dose. However, no prospective study to date comparing ACE inhibitor doses has documented that higher doses result in significant mortality reduction, although the data suggest that there may be a decrease in HF hospitalizations when compared with lower doses. (Source: Cardiology in Review)
Source: Cardiology in Review - June 5, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Medical Management of Rheumatic Heart Disease: A Systematic Review of the Evidence
Rheumatic heart disease (RHD) is an important cause of heart disease globally. Its management can encompass medical and procedural (catheter and surgical) interventions. Literature pertaining to the medical management of RHD from PubMed 1990–2016 and via selected article reference lists was reviewed. Areas included symptom management, left ventricular dysfunction, rate control in mitral stenosis, atrial fibrillation, anticoagulation, infective endocarditis prophylaxis, and management in pregnancy. Diuretics, angiotensin blockade and beta-blockers for left ventricular dysfunction, and beta-blockers and If inhibitors for r...
Source: Cardiology in Review - June 5, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Antithrombotic Management of Patients With Prosthetic Heart Valves
Valvular heart disease is a major public health issue. The prevalence of valvular heart disease is expected to increase due to an aging population. Valve dysfunction manifests as valve stenosis, regurgitation, or both due to various etiologies. Valve repair and replacement are the main treatment options for severe valve dysfunction. Valve replacement is achieved by using either a mechanical or a bioprosthetic valve. Mechanical valves are more durable but require lifelong anticoagulation with associated complications. Bioprosthetic valves usually require anticoagulation only transiently after implantation but are less durab...
Source: Cardiology in Review - June 5, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Diagnosis, Treatment, and Management of Orthotopic Liver Transplant Candidates With Portopulmonary Hypertension
Portopulmonary hypertension (POPH) is seen in 5–8% of orthotopic liver transplantation (OLT) candidates and has significant implications for clinical outcomes. POPH is characterized by vasoconstriction and remodeling of the pulmonary vasculature. It is exacerbated by the hyperdynamic circulation that is common in advanced liver disease. Screening all OLT candidates with transthoracic echocardiography to assess pulmonary pressures and right ventricular function is crucial, as clinical symptoms alone are not reliable. Any significant right ventricular dysfunction or dilatation along with an elevation in estimated pulmonary...
Source: Cardiology in Review - June 5, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Frank Cole Spencer, MD—Surgeon, Innovator, and Educator
No abstract available (Source: Cardiology in Review)
Source: Cardiology in Review - June 5, 2018 Category: Cardiology Tags: Editorial Source Type: research
Through the Decades: β-Blocker Use and Outcomes in Acute Coronary Syndromes
This article provides a review of the landmark clinical trials of β-blockers in ACS and highlights the chronology and evolution of guideline recommendations through the decades. (Source: Cardiology in Review)
Source: Cardiology in Review - April 6, 2018 Category: Cardiology Tags: Feature Curbside Consult Source Type: research
Effects of Anti-Inflammatory Medications in Patients With Coronary Artery Disease: A Focus on Losmapimod
Inflammation plays an integral role in atherogenesis and the pathogenesis of coronary artery disease (CAD). The question remains as to whether targeted inhibition of specific pathways of inflammation will have any clinical benefits in CAD. In this article, we will review p38 mitogen-activated protein kinase, one of the key sensors of cellular stress that plays an important role in the inflammatory cascade. In addition, we will review losmapimod, a reversible competitive inhibitor of the α and β isoforms of p38 mitogen-activated protein kinase, and its efficacy when added to standard of care in patients hospitalized with ...
Source: Cardiology in Review - April 6, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Sudden Cardiac Death in Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy (HCM) is a heart disease characterized by hypertrophy of the left ventricular myocardium and is most often caused by mutations in sarcomere genes. The structural and functional abnormalities are not explained by flow-limiting coronary artery disease or loading conditions. The disease affects at least 0.2% of the population worldwide and is the most common cause of sudden cardiac death in young people and competitive athletes because of fatal ventricular arrhythmia. In some patients, however, HCM has a benign course. Therefore, it is of utmost importance to properly evaluate patients and single o...
Source: Cardiology in Review - April 6, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Aorto-Atrial Fistulas: A Contemporary Review
Aorto-atrial fistulas (AAFs) are a relatively rare, but potentially life-threatening condition, where an anomalous connection forms between the aortic structures and the cardiac atria. AAFs are most often the result of an underlying condition concerning the cardiac structures. It may be congenital, secondary to conditions such as aortic dissection, infective endocarditis, or valve replacement, or iatrogenic in nature. Secondary causes incite local deterioration of cardiac wall integrity leading to formation of fistulous connections, whereas iatrogenic causes are more traumatic in nature. Signs and symptoms include those of...
Source: Cardiology in Review - April 6, 2018 Category: Cardiology Tags: Review Articles Source Type: research
The Prognostic Implications of Two-Dimensional Speckle Tracking Echocardiography in Hypertrophic Cardiomyopathy: Current and Future Perspectives
Two-dimensional speckle tracking echocardiography represents a novel, simple, and reproducible technique for the estimation of left ventricular myocardial deformation (strain) and the evaluation of left ventricular twist mechanics. During the last few years, its clinical and prognostic implications in cardiomyopathies and hypertrophic cardiomyopathy (HCM), in particular, have been rapidly increasing. Reduced global longitudinal strain is associated with more severe disease and confers an increased risk for major cardiac events, independently of other clinical and echocardiographic risk factors. Left ventricular dyssynchron...
Source: Cardiology in Review - April 6, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Cardiovascular Complications of Proteasome Inhibitors Used in Multiple Myeloma
The use of proteasome inhibitors (PI) as targeted chemotherapeutics have significantly improved survival in patients with multiple myeloma (MM). However, rare and serious cardiovascular complications have occurred as a result of their use, most commonly congestive heart failure, hypertension, and arrhythmias. MM occurs in an aged population with many concurrent cardiovascular risk factors. The primary disease process also contributes to cardiovascular complications. Furthermore, many MM patients have prior exposure to cardiotoxic chemotherapy such as anthracyclines. Because of these occurrences, the identification, prevent...
Source: Cardiology in Review - April 6, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Cardioprotection in the Modern Era of Cancer Chemotherapy
The current arsenal of cancer chemotherapy is broad and rapidly expanding and includes conventional cytotoxic agents and targeted and immune-based therapies. As cancer survival rates have improved, the acute and latent cardiotoxicities of chemotherapy have emerged as important contributors to morbidity and mortality in cancer survivors. All chemotherapeutic agents have the potential for cardiac complications, with manifestations ranging from subclinical left ventricular dysfunction and asymptomatic QT prolongation, to congestive heart failure, myocardial ischemia, myocarditis, arrhythmia, and sudden cardiac death. Efforts ...
Source: Cardiology in Review - April 6, 2018 Category: Cardiology Tags: Review Articles Source Type: research
Switching From Ticagrelor or Prasugrel to Clopidogrel
Ticagrelor and prasugrel are newer antiplatelet drugs which, like clopidogrel, block the P2Y12 platelet receptor to inhibit platelet aggregation. Compared with clopidogrel, both ticagrelor and prasugrel have greater clinical efficacy but also have a higher risk of bleeding and are much more costly. Therefore, some institutions and providers switch patients from ticagrelor or prasugrel to clopidogrel in an effort to lower bleeding risk, stem costs, or otherwise ensure that patients can safely adhere to long-term P2Y12 inhibitor therapy. From a pharmacodynamic perspective, switching patients from ticagrelor or prasugrel to c...
Source: Cardiology in Review - February 10, 2018 Category: Cardiology Tags: Feature Curbside Consult Source Type: research
