Managing Multivessel Coronary Artery Disease in Patients With ST-Elevation Myocardial Infarction: A Comprehensive Review
This article is a comprehensive review of the literature on the treatment of multivessel CAD in patients with STEMI, which provides the reader a critical analysis of the available information to determine the best therapeutic approach. (Source: Cardiology in Review)
Source: Cardiology in Review - June 6, 2017 Category: Cardiology Tags: Review Articles Source Type: research

Coronary Microcirculatory Dysfunction in Human Cardiomyopathies: A Pathologic and Pathophysiologic Review
Cardiomyopathies are a heterogeneous group of diseases of the myocardium. The term cardiomyopathy involves a wide range of pathogenic mechanisms that affect the structural and functional states of cardiomyocytes, extravascular tissues, and coronary vasculature, including both epicardial coronary arteries and the microcirculation. In the developed phase, cardiomyopathies present with various clinical symptoms: dyspnea, chest pain, palpitations, swelling of the extremities, arrhythmias, and sudden cardiac death. Due to the heterogeneity of cardiomyopathic patterns and symptoms, their diagnosis and therapies are great challen...
Source: Cardiology in Review - June 6, 2017 Category: Cardiology Tags: Review Articles Source Type: research

Genetic Insights Into Bicuspid Aortic Valve Disease
We present an overview of the published work on genetic linkage and its association with BAV disease. Presented articles used different discovery strategies ranging from candidate gene association to whole exome sequencing, as well as various validation protocols. Although still very limited, our understanding of the molecular pathology of BAV disease is likely to influence current clinical practice by enabling genetic counseling, prenatal diagnosis, and risk stratification for individual patients. This task will be made possible thanks to increasing availability, as well as the reduced cost of next-generation sequencing a...
Source: Cardiology in Review - June 6, 2017 Category: Cardiology Tags: Review Articles Source Type: research

PFO Closure for Cryptogenic Stroke: A Review and Clinical Treatment Algorithm
We describe the historical context of PFO closure and review the observational and randomized control trial evidence in this field, culminating in the recent Food and Drug Administration approval of the first dedicated closure device for PFO. Guidelines and consensus statements are discussed, and a novel treatment algorithm is proposed. Future directions in PFO closure will include new devices, further data from completed and upcoming clinical trials, and potential expansion into other disease states associated with PFO. (Source: Cardiology in Review)
Source: Cardiology in Review - June 6, 2017 Category: Cardiology Tags: Review Articles Source Type: research

Inhaled Insulin: A Clinical and Historical Review
This article provides a review of the historical development of TI, its safety and efficacy data, and its advantages and disadvantages over traditional injectable insulins. (Source: Cardiology in Review)
Source: Cardiology in Review - April 6, 2017 Category: Cardiology Tags: New Therapy Updates Source Type: research

Cangrelor: A New Route for P2Y12 Inhibition
Antiplatelet therapy with a P2Y12 inhibitor is a key component of treatment for patients with acute coronary syndromes undergoing percutaneous coronary intervention. Before the development of cangrelor (Kengreal, The Medicines Company, Parsippany, NJ), only oral P2Y12 inhibitors were available. Cangrelor is a reversible P2Y12 inhibitor that is administered as an intravenous infusion, and its quick onset and offset make it an appealing option for antiplatelet therapy, particularly for patients who are unable to take oral medications. Although cangrelor struggled to show benefit in early trials, the positive results of the C...
Source: Cardiology in Review - April 6, 2017 Category: Cardiology Tags: New Therapy Updates Source Type: research

Advanced Therapy in Eisenmenger Syndrome: A Systematic Review
Treatment options for patients with the Eisenmenger syndrome have until recently been scarce, but new knowledge in the field of pulmonary arterial hypertension has expanded the therapeutic possibilities for these patients. Advanced therapy with pulmonary vasodilators has become part of the standard treatment, offering long-term benefits on exercise capacity, clinical symptoms, and possibly survival. However, there are currently only few studies to guide the use of advanced therapies in this population, and important questions such as indications for initiation or escalation of advanced therapy and valid effect parameters a...
Source: Cardiology in Review - April 6, 2017 Category: Cardiology Tags: Review Articles Source Type: research

MicroRNAs in Ischemic Heart Disease: From Pathophysiology to Potential Clinical Applications
Despite rapid advances in cardiovascular research and therapeutic strategies, ischemic heart disease (IHD) remains the leading cause of mortality worldwide. MicroRNAs (miRNAs) are small, noncoding RNAs which post transcriptionally regulate gene expression. In the past few years, miRNAs have emerged as key tools for the understanding of the pathophysiology of IHD, with potential uses as new biomarkers and therapeutic targets. Several studies report a regulatory role of miRNAs, with regard to fundamental components of IHD pathogenesis and progression, such as lipoprotein metabolism, atherogenesis, vascular calcification, pla...
Source: Cardiology in Review - April 6, 2017 Category: Cardiology Tags: Review Articles Source Type: research

Identification of the Asymptomatic Patient With Severe Mitral Regurgitation: Discrepancy Between Research and Clinical Practice
Organic mitral regurgitation (MR) is a common disorder, and because of the increase in population and its aging, the occurrence of MR is steadily increasing. Current guideline recommendations on the management of asymptomatic severe MR are conflicting and based solely on registries or nonrandomized trials in expert heart valve clinics, resulting in a lack of evidence for the best treatment strategy. In this review, we will evaluate the latest evidence on diagnostic approaches and treatment strategies for asymptomatic patients without a clear indication for surgical intervention. Implications for management in daily practic...
Source: Cardiology in Review - April 6, 2017 Category: Cardiology Tags: Review Articles Source Type: research

Hypertension in the Kidney Transplant Recipient: Overview of Pathogenesis, Clinical Assessment, and Treatment
Cardiovascular disease is the leading cause of death in patients with chronic renal disease and the most common cause of death and allograft loss among kidney transplant recipients. Transplant patients often have multiple cardiovascular risk factors antedating transplantation. Among the most prominent is hypertension (HTN), which affects at least 90% of transplant patients. Uncontrolled HTN is an independent risk factor for allograft loss. The etiology of HTN in transplant recipients is complex and multifactorial, including the use of essential immunosuppressive medications. Post-transplant HTN management requires a system...
Source: Cardiology in Review - April 6, 2017 Category: Cardiology Tags: Review Articles Source Type: research

The Utility of Teleultrasound to Guide Acute Patient Management
Ultrasound has evolved into a core bedside tool for diagnostic and management purposes for all subsets of adult and pediatric critically-ill patients. Teleintensive care unit coverage has undergone a similar rapid expansion period throughout the United States. Round-the-clock access to ultrasound equipment is very common in today’s intensive care unit, but 24/7 coverage with staff trained to acquire and interpret point-of-care ultrasound in real time is lagging behind equipment availability. Medical trainees and physician extenders require attending level supervision to ensure consistent image acquisition and accurat...
Source: Cardiology in Review - April 6, 2017 Category: Cardiology Tags: Review Articles Source Type: research

Neurocardiac Injury After Cerebral and Subarachnoid Hemorrhages
Cerebrovascular events are associated with high mortality and morbidity rates. Neurocardiac injury after a subarachnoid hemorrhage and cerebral hemorrhage further worsen clinical outcomes. Excess catecholamine-induced cardiotoxicity is currently the most widely accepted pathophysiologic mechanism. Awareness of neurocardiac injury and the cardiac manifestations associated with it will allow for early diagnosis and appropriate management. (Source: Cardiology in Review)
Source: Cardiology in Review - February 8, 2017 Category: Cardiology Tags: Review Articles Source Type: research

Advances in Continuous Flow Left Ventricular Assist Device Support for End-Stage Heart Failure: A Therapy in Evolution
The purpose of this review is to highlight recent advances and challenges in the clinical implementation of continuous flow left ventricular assist devices (CF LVADs) in patients with advanced heart failure. Post approval studies of CF LVAD therapy continue to show a progressive improvement in survival and reduction in adverse events. Major trials are ongoing to compare outcomes of an axial flow device (Heart Mate II) and smaller centrifugal flow pumps (HeartWare VADs and Heart Mate III). Numerous studies have investigated strategies to reduce major hematologic and neurologic adverse events by evaluating hemolysis, antithr...
Source: Cardiology in Review - February 8, 2017 Category: Cardiology Tags: Review Articles Source Type: research

On-X Valve: The Next Generation Aortic Valve
The On-X valve is a newer generation mechanical bileaflet valve. Its key features include the use of pure pyrolytic carbon (devoid of silicon), a length-to-diameter ratio similar to a native valve, an inlet flared orifice, a leaflet opening up to 90 degrees, a shorter leaflet closing angle, a 2-point leaflet contact, and an actuated pivot. These features have translated into increased strength, improved valve hemodynamics, reduced hemolysis, and thrombogenicity. The 2014 American Heart Association/American College of Cardiology guidelines for the management of patients with valvular heart disease recommend an intern...
Source: Cardiology in Review - February 8, 2017 Category: Cardiology Tags: Review Articles Source Type: research

A Review of the Clinical Utility of Intravascular Ultrasound and Optical Coherence Tomography in the Assessment and Treatment of Coronary Artery Disease
This article will also discuss IVUS and OCT’s clinical utility with regard to proper stent placement and follow-up after percutaneous coronary interventions. (Source: Cardiology in Review)
Source: Cardiology in Review - February 8, 2017 Category: Cardiology Tags: Review Articles Source Type: research

Enhanced External Counterpulsation Therapy: Past, Present, and Future
External counterpulsation therapy was first developed over half a century ago as a resuscitative tool to support the failing heart and was based on hemodynamic principles of the intraaortic balloon pump. Over the course of last few decades, it has evolved into the modern enhanced external counterpulsation (EECP) therapy, which has proven to be a safe, effective, and low-cost noninvasive treatment for patients with debilitating angina and chronic heart failure who are poor candidates for revascularization procedures and have suboptimal results from other therapies. Numerous studies have shown EECP to be efficacious in patie...
Source: Cardiology in Review - February 8, 2017 Category: Cardiology Tags: Review Articles Source Type: research

Pulmonary Pressure Monitoring for Patients With Heart Failure
Heart failure (HF) affects over 5.8 million patients in the United States, and can be very costly due to the number of hospitalizations and rehospitalizations during the final years of life. Due to the large number of hospitalizations for HF exacerbations, effective methods for preventing these occurrences are necessary. Improvements in the outpatient treatment of HF, aided by noninvasive and invasive home monitoring methods, can reduce the number of hospitalizations. Pulmonary pressure monitoring through the CardioMEMS system provides one method of hemodynamic assessment of patients. The efficacy of the CardioMEMS system ...
Source: Cardiology in Review - February 8, 2017 Category: Cardiology Tags: Review Articles Source Type: research

Evacetrapib: Another CETP Inhibitor for Dyslipidemia With No Clinical Benefit
Evacetrapib is a cholesteryl ester transfer protein (CETP) inhibitor that has been recently studied as a cholesterol modifying agent to reduce cardiovascular risk and mortality in high risk cardiovascular disease patients. Evacetrapib acts to decrease lipid exchange through CETP inhibition. CETP acts to transfer cholesteryl esters from high-density lipoprotein-cholesterol (HDL-C) to low-density lipoprotein cholesterol (LDL-C) and very-low-density lipoprotein (VLDL-C). HDL-C is involved in reverse cholesterol transport and its blood levels have been shown to be inversely correlated with cardiovascular risk. Thus, a pharmaco...
Source: Cardiology in Review - February 8, 2017 Category: Cardiology Tags: Review Articles Source Type: research

Sports and Driving With an Implantable Cardioverter-Defibrillator
Many patients with implantable cardioverter-defibrillators (ICD) want to participate in sports and many need or wish to operate a personal motor vehicle. Healthcare providers need to advise patients regarding restrictions related to these activities in the context of the clinical indication for the ICD. Ethical considerations need to be considered when advising ICD patients of restrictions to reduce risk of injury to themselves and to others when participating in either sports or driving. Shared decision-making is necessary to have ICD patients understand and comply with recommended restrictions. Guidelines have been devel...
Source: Cardiology in Review - December 6, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Optimal Implantable Cardioverter Defibrillator Programming
Optimal programming of implantable cardioverter defibrillators (ICDs) is essential to appropriately treat ventricular tachyarrhythmias and to avoid unnecessary and inappropriate shocks. There have been a series of large clinical trials evaluating tailored programming of ICDs. We reviewed the clinical trials evaluating ICD therapies and detection, and the consensus statement on ICD programming. In doing so, we found that prolonged ICD detection times, higher rate cutoffs, and antitachycardia pacing (ATP) programming decreases inappropriate and painful therapies in a primary prevention population. The use of supraventricular...
Source: Cardiology in Review - December 6, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Current and Emerging Uses of Insertable Cardiac Monitors: Evaluation of Syncope and Monitoring for Atrial Fibrillation
Insertable cardiac monitors (ICMs) have provided clinicians with a superb tool for assessing infrequent or potentially asymptomatic arrhythmias. ICMs have shown their usefulness in the evaluation of unexplained syncope, providing high diagnostic yields in a cost-effective manner. While unexplained syncope continues to be the most common reason for their use, ICMs are increasingly being used for the monitoring of atrial fibrillation (AF). Recent trials have demonstrated that a substantial proportion of patients with cryptogenic stroke have AF detected only by the prolonged monitoring provided by ICMs. A particularly promisi...
Source: Cardiology in Review - December 6, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Lead Extraction Considerations for the Referring Cardiologist
The population of patients with cardiac implantable electronic devices (CIEDs) continues to grow due to increasing indications in an aging population and breakthroughs in both the medical and the surgical care of patients with heart disease. As a result, there has been a growing need for device and lead extractions due to the growing population of patients with CIEDs and the subsequent need for system upgrades or revisions because of complications, infections, and lead advisory alerts. (Source: Cardiology in Review)
Source: Cardiology in Review - December 6, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Smartphone-Based Electrocardiographic and Cardiac Implantable Electronic Device Monitoring
The field of arrhythmia monitoring is changing rapidly. The rapid advent of technology in combination with marked improvements in cellular communication and an increased desire by patients to be actively engaged in their care has ushered in a new era of clinical care. Today, physicians need to think about their patients outside the traditional in-office setting. Two technologies that embody this changing landscape are smartphone-based electrocardiographic (ECG) monitors and remote monitoring of cardiac implantable electronic devices (CIEDs). Smartphone-based ECG monitors allow the patient to assume a greater stake in their...
Source: Cardiology in Review - December 6, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Cardiac Resynchronization Therapy: Maximizing the Response to Biventricular Pacing
Cardiac resynchronization therapy (CRT) has become a mainstay therapy to improve clinical outcomes of patients with left ventricular systolic dysfunction and a wide QRS complex, in addition to guideline-directed medical therapy. As clinical experience with CRT continues to expand, the device and lead design, along with implantation techniques, have evolved as well. However, there is a significant proportion of patients with heart failure who do not have a favorable response to CRT. In this review article, we will discuss how to maximize the response to CRT, which includes patient characteristics, device features, positioni...
Source: Cardiology in Review - December 6, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Heart Failure With Preserved, Mid-Range, and Reduced Ejection Fraction: The Misleading Definition of the New Guidelines
No abstract available (Source: Cardiology in Review)
Source: Cardiology in Review - December 6, 2016 Category: Cardiology Tags: Editorials Source Type: research

Welcome, Peter Zimetbaum, MD
No abstract available (Source: Cardiology in Review)
Source: Cardiology in Review - December 6, 2016 Category: Cardiology Tags: Editorials Source Type: research

Cardiology in Review: the First 25 Years
No abstract available (Source: Cardiology in Review)
Source: Cardiology in Review - December 6, 2016 Category: Cardiology Tags: Editorials Source Type: research

Beta-Blocker Management of Cocaine-Induced Chest Pain
No abstract available (Source: Cardiology in Review)
Source: Cardiology in Review - October 6, 2016 Category: Cardiology Tags: Letter to the Editor Source Type: research

Patiromer: The First Potassium Binder Approved in Over 50 Years
For over 50 years, there have been limited options for the management of hyperkalemia, especially among patients with chronic kidney disease (CKD), diabetic nephropathy, hypertension, and heart failure, who were receiving concomitant renin–angiotensin–aldosterone system (RAAS) inhibitor therapy. Hyperkalemia is a potential, life-threatening electrolyte abnormality that frequently challenges clinicians from maximizing the mortality benefit and organ-protective properties of RAAS inhibitors especially in CKD and heart failure populations. Patiromer is a novel nonabsorbed, cation-exchange polymer that binds and ex...
Source: Cardiology in Review - October 6, 2016 Category: Cardiology Tags: New Therapy Update Source Type: research

Reversal Agents for Direct Oral Anticoagulants: Understanding New and Upcoming Options
Direct oral anticoagulants (DOACs), originally developed as an alternative for vitamin K antagonists, are shifting the landscape of antithrombotic therapy. DOACs such as dabigatran, rivaroxaban, apixaban, and edoxaban offer enhancements in safety, convenience, and efficacy compared with warfarin. However, as choices for oral anticoagulation therapy have increased, so has the need for effectual antidotes before urgent surgical procedures and for the reversal of serious adverse events caused by DOACs. To date, one antidote has been FDA approved in the United States for the reversal of dabigatran, and two antidotes are underg...
Source: Cardiology in Review - October 6, 2016 Category: Cardiology Tags: New Therapy Update Source Type: research

The Role of Virtual Histology Intravascular Ultrasound in the Identification of Coronary Artery Plaque Vulnerability in Acute Coronary Syndromes
Markers of coronary plaque vulnerability, such as a high lipid burden, increased inflammatory activity, and a thin fibrous cap, have been identified in histological studies. In vivo, grayscale intravascular ultrasound (IVUS) provides more in-depth information on coronary artery plaque burden than conventional angiography but is unable to accurately distinguish between noncalcific tissue types within the plaque. An analysis of IVUS radiofrequency backscatter based on spectral pattern recognition, such as virtual histology IVUS, allows detailed scrutiny of plaque composition and classification of coronary lesions. This revie...
Source: Cardiology in Review - October 6, 2016 Category: Cardiology Tags: Review Articles Source Type: research

High-Density Lipoprotein Infusion Therapy and Atherosclerosis: Current Research and Future Directions
Atherosclerosis is the leading cause of heart disease, contributing to hundreds of thousands of deaths annually. The use of long-term antilipid therapy has decreased low-density lipoprotein as a target, but high-density lipoprotein (HDL) has many properties which can protect against the formation of atherosclerotic plaque and decrease plaque burden. Numerous studies have shown an inverse correlation with HDL level and the future risk of heart disease. HDL has the unique property of playing a key role in reverse cholesterol transport, essentially bringing cholesterol from the periphery back to the liver for excretion in bil...
Source: Cardiology in Review - October 6, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Ghrelin and the Cardiovascular System
Ghrelin is a small peptide released primarily from the stomach. It is a potent stimulator of growth hormone secretion from the pituitary gland and is well known for its regulation of metabolism and appetite. There is also a strong relationship between ghrelin and the cardiovascular system. Ghrelin receptors are present throughout the heart and vasculature and have been linked with molecular pathways, including, but not limited to, the regulation of intracellular calcium concentration, inhibition of proapoptotic cascades, and protection against oxidative damage. Ghrelin shows robust cardioprotective effects including enhanc...
Source: Cardiology in Review - October 6, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Wearable Cardioverter Defibrillators
The use of implantable cardioverter defibrillators (ICD) has favorably impacted the prevention and treatment of sudden cardiac death (SCD) associated with ventricular arrhythmias. However, there are situations where an ICD cannot be immediately implanted, even though the patient is at high risk for SCD. The wearable cardioverter defibrillator (WCD) is a unique technology that can bridge this gap for patients. The WCD has been demonstrated to terminate ventricular tachycardia/fibrillation if worn and used correctly. With proper training, it is relatively easy to put on, maintain, and use. Most patients are compliant and are...
Source: Cardiology in Review - October 6, 2016 Category: Cardiology Tags: Review Articles Source Type: research

High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in the Prevention/Management of Cardiovascular Disease
Moderate-intensity continuous training (MICT) has long been considered the most effective exercise treatment modality for the prevention and management of cardiovascular disease (CVD), but more recently high-intensity interval training (HIIT) has been viewed as a potential alternative to MICT in accruing such benefits. HIIT was initially found to induce significant improvements in numerous physiological and health-related indices, to a similar if not superior extent to MICT. Since then, many studies have attempted to explore the potential clinical utility of HIIT, relative to MICT, with respect to treating numerous cardiov...
Source: Cardiology in Review - October 6, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Noninvasive Testing in Emergency Department Patients with Low-Risk Chest Pain: Does the Evidence Support Current Guidelines?
Patients who present to the emergency department with chest pain but no evidence of ischemia on the electrocardiogram and negative cardiac markers are at very low risk. The newest American Heart Association/American College of Cardiology guidelines give noninvasive cardiac testing a IIa recommendation in this patient population. Here, we will review the existing literature that was cited in the American Heart Association/American College of Cardiology document, as well as several large, contemporary, comparative observational studies which were not included to address the following question: Do the benefits of noninvasive ...
Source: Cardiology in Review - October 6, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Electronic Cigarettes: Questions in the Mist
In many parts of the world, electronic cigarettes (ECs) are marketed as a tool to assist users in attempts to quit smoking and are perceived to be a safer alternative to tobacco cigarettes. Numerous studies have suggested ECs may not be effective in achieving this goal and that the illusive “safety” of ECs can be enticing to consumers. The composition of the liquid solutions vaporized by these devices has not been fully disclosed and may not contain the actual advertised ingredients in the fractions reported. As this market has developed largely outside the oversight of an appropriate regulatory body, we are le...
Source: Cardiology in Review - October 6, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Treating Diuretic Resistance: An Overview
Loop diuretics are central to the management of fluid overload in acute decompensated heart failure. However, a variance in the response to loop diuretics can alter a patient’s clinical course and has an adverse effect on clinical outcomes. Thus, a diminished response to loop diuretics is an important clinical issue. Factors thought to contribute to diuretic resistance include erratic oral absorption in congested states and postdiuretic sodium retention. Further contributing to diuretic resistance in patients with advanced heart failure are decreases in renal perfusion and alterations in sodium handling that occur in...
Source: Cardiology in Review - August 9, 2016 Category: Cardiology Tags: Feature Curbside Consult Source Type: research

The Subcutaneous Implantable Cardioverter Defibrillator
The subcutaneous implantable cardioverter defibrillator (S-ICD) is a subcutaneous alternative to conventional transvenous ICD (TV-ICD) systems, which have previously been shown to treat life-threatening ventricular tachyarrhythmias in cardiac disease patients. A review of the literature reveals that S-ICDs have similar shock efficacy rates for both induced and spontaneous ventricular tachyarrhythmias when compared with TV-ICDs. Furthermore, S-ICDs seem to have a higher specificity for withholding therapy when supraventricular tachycardia is present compared with TV-ICDs. The advantages of the S-ICD system are numerous: few...
Source: Cardiology in Review - August 9, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Nonbacterial Thrombotic Endocarditis: Pathogenesis, Diagnosis, and Management
Nonbacterial thrombotic endocarditis (NBTE), formerly known as marantic endocarditis, is a potentially overlooked condition that involves the formation of sterile, fibrin vegetations on heart valve leaflets. Often confused with classic infective endocarditis during its early stages, NBTE can lead to valvular dysfunction, heart failure, and systemic embolization when unchecked. The pathogenesis is not entirely clear but involves a preexisting hypercoagulable state. Diagnosis requires ruling out infection and establishing the presence of valvular vegetations using echocardiography. Therapy for NBTE includes treating the unde...
Source: Cardiology in Review - August 9, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Narrowing of the Coronary Sinus: A Device-Based Therapy for Persistent Angina Pectoris
Alongside the remarkable advances in medical and invasive therapies for the treatment of ischemic heart disease, an increasing number of patients with advanced coronary artery disease unsuitable for revascularization continue to suffer from angina pectoris despite optimal medical therapy. Patients with chronic angina have poor quality of life and increased levels of anxiety and depression. A considerable number of innovative therapeutic modalities for the treatment of chronic angina have been investigated over the years; however, none of these therapeutic options has become a standard of care, and none are widely utilized....
Source: Cardiology in Review - August 9, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Right-Sided Infective Endocarditis and Pulmonary Infiltrates: An Update
Sixty years after its initial description, right-sided infective endocarditis (RSIE) still poses a challenge to all medical practitioners. Epidemiological data reveal a rising incidence attributable to the global surge in the number of intravenous drug users and the increased use of central vascular catheters and implantable cardiac devices. RSIE differs from left-sided infective endocarditis in more than just the location of the involved cardiac valve. They have different clinical presentations, diagnostic findings, and prognoses; hence, they require different management strategies. Cardiac murmurs and systemic emboli are...
Source: Cardiology in Review - August 9, 2016 Category: Cardiology Tags: Review Articles Source Type: research

The Use of Statins in the Treatment and Prevention of Atrial Fibrillation
The hydroxy-methyl-glutaryl-CoA reductase inhibitors (statins) are used extensively in the treatment of hyperlipidemia and in the primary and secondary prevention of cardiovascular and cerebrovascular diseases. Statins have also been demonstrated to confer secondary pleiotropic benefits in a variety of other disease processes, including a potential advantage in treating and preventing atrial fibrillation. These effects are primarily due to the up-regulation of endothelial nitric oxide synthase activity and a decrease in nicotinamide adenine dinucleotide phosphate oxidase production, which leads to downstream effects that i...
Source: Cardiology in Review - August 9, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Non-Vitamin K Antagonist Oral Anticoagulants and Antiplatelet Therapy for Stroke Prevention in Patients With Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials
Non-vitamin K antagonist oral anticoagulants (NOACs) are frequently used to prevent stroke in patients with atrial fibrillation. These patients are often also on aspirin or other antiplatelet agents. It is possible that treatment with both NOACs and aspirin or other antiplatelet drug may be effective in decreasing stroke, but data are sparse regarding the efficacy and safety of using both agents for stroke prevention. To address these issues, data were pooled from the 4 recent randomized, controlled trials of NOACs: apixaban, rivaroxaban, dabigatran, and edoxaban, which included 42,411 patients; 14,148 (33.4%) were also on...
Source: Cardiology in Review - August 9, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Role of Antiplatelet Therapy and Anticoagulation in Nonischemic Cardiomyopathy
Heart failure continues to be a leading cause of morbidity and mortality throughout the United States. The pathophysiology of heart failure involves the activation of complex neurohormonal pathways, many of which mediate not only hypertrophy and fibrosis within ventricular myocardium and interstitium, but also activation of platelets and alteration of vascular endothelium. Platelet activation and vascular endothelial dysfunction may contribute to the observed increased risk of thromboembolic events in patients with chronic heart failure. However, current data from clinical trials do not support the routine use of chronic a...
Source: Cardiology in Review - August 9, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Edoxaban: A Novel Factor Xa Inhibitor for the Management of Non-valvular Atrial Fibrillation and Venous Thromboembolism
This article provides an overview of the safety and efficacy along with the advantages and disadvantages of edoxaban. (Source: Cardiology in Review)
Source: Cardiology in Review - June 4, 2016 Category: Cardiology Tags: New Therapy Update Source Type: research

Relaxin for the Treatment of Acute Decompensated Heart Failure: Pharmacology, Mechanisms of Action, and Clinical Evidence
Acute heart failure remains a major cause of morbidity, and its treatment requires an increasing investment of the health care system. Whereas success in treating chronic heart failure has been achieved over the last decades, several pharmacological approaches for acute heart failure have been introduced but have failed to demonstrate any clinical benefit. Serelaxin is a recombinant human relaxin-2 vasoactive peptide that causes systemic and renal vasodilation. Data suggest that the clinical benefits may be attributable to a potential combination of multiple actions of serelaxin, including improving systemic, cardiac, and ...
Source: Cardiology in Review - June 4, 2016 Category: Cardiology Tags: New Therapy Update Source Type: research

Short QT Syndrome in Current Clinical Practice
Short QT syndrome is a rare inherited autosomal dominant cardiac channelopathy associated with malignant ventricular and atrial arrhythmias. A shortened corrected QT interval is a marker for risk of malignant arrhythmias, which are secondary to increased transmural dispersion of repolarization. The underlying gain of function mutations in the potassium channels are most common but genetic testing remains low yield. This review discusses the cellular mechanisms, genetic involvement, clinical presentation, and current recommended management of patients with short QT syndrome relevant to current clinical practice. (Source: Cardiology in Review)
Source: Cardiology in Review - June 4, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Antianginal Agents for the Management of Stable Ischemic Heart Disease: A Review
Antianginal medications are an important aspect of optimal medical therapy for the management of angina in patients with stable ischemic heart disease. The lack of a standardized definition of effective antianginal therapy and the lack of clear understanding of the underlying evidence have often been cited as reasons for the large variations in the use of these particular classes of pharmacologic agents in contemporary clinical practice. Hence, we performed a search of the PubMed database and identified published manuscripts examining the effect of common antianginal agents on improving anginal parameters and on important ...
Source: Cardiology in Review - June 4, 2016 Category: Cardiology Tags: Review Articles Source Type: research

Antiplatelet and Anticoagulation Treatment in Patients With Non–ST-Segment Elevation Acute Coronary Syndrome: Comparison of the Updated North American and European Guidelines
In 2014, the American Heart Association and the American College of Cardiology (AHA/ACC) published their guideline for the management of patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS), whereas the European Society of Cardiology published their latest guideline for the management of patients with NSTE-ACS in 2011. In this article, we review the main updates in antiplatelet and anticoagulation therapy in the 2014 AHA/ACC guideline and compare them with the 2011 European guidelines. Key recommendations in the AHA/ACC guidelines include the addition of ticagrelor to a broad spectrum of patient...
Source: Cardiology in Review - June 4, 2016 Category: Cardiology Tags: Review Articles Source Type: research