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Percutaneous management of acute ischaemic stroke
Learning objectives To understand both the rationale and principles behind percutaneous management of stroke. To be aware of the evidence base for this treatment. To appreciate the current logistical challenges and how they might be overcome. Introduction In principle, the similarity between opening an occluded cerebral artery and an occluded coronary artery, when the perfusion to that organ is acutely compromised, is inescapable: to re-establish antegrade flow as quickly as possible to minimise downstream damage. There are, of course, important differences between an acute myocardial infarction (MI) and an acute ischaemic...
Source: Heart - April 25, 2023 Category: Cardiology Authors: Routledge, H., Curzen, N. Tags: Education in Heart Source Type: research

Contemporary management of persistent atrial fibrillation
Learning objectives Develop a basic understanding of the underlying mechanisms of atrial fibrillation and classification of the disease. Review the main principles in contemporary management of atrial fibrillation with a focus on persistent atrial fibrillation. Discuss catheter ablation in the context of atrial fibrillation. Introduction Atrial fibrillation (AF) is a multisystemic disorder that is associated with an excess risk of stroke, heart failure and mortality.1 It remains the most common sustained arrhythmia and its significance should not be underestimated. Research focused on unveiling the mechanisms of AF began o...
Source: Heart - December 22, 2021 Category: Cardiology Authors: Gupta, D., Ding, W. Y. Tags: Education in Heart Source Type: research

Carotid artery stenting
Learning objectives After reading this article the reader should:Know the appropriate diagnostic workup for patients with carotid artery disease. Be able to put in perspective, based on strengths and limitations, the results of randomised trials comparing carotid artery stenting and carotid endarterectomy. Be able to identify patients that may benefit from carotid artery stenting. Introduction In western countries, stroke is the fourth leading cause of death, after heart disease, cancer and chronic respiratory diseases.1 Carotid artery disease may be responsible for 10–15% of all ischaemic strokes.2 Randomised contro...
Source: Heart - June 9, 2016 Category: Cardiology Authors: Roffi, M., Kulcsar, Z., Carrera, E., Cremonesi, A. Tags: Education in Heart, Drugs: cardiovascular system, Interventional cardiology, Epidemiology, Tobacco use Source Type: research

Non-vitamin K antagonist oral anticoagulants (NOACs) for the management of venous thromboembolism
Learning objectives Understand the importance of venous thrombosis in cardiovascular medicine. Appreciate the mode of action of different oral anticoagulants. Recall the uses, risks and benefits of each non-vitamin K antagonist oral anticoagulants. Introduction Thrombosis is the common pathophysiology responsible for ischaemic heart disease, ischaemic stroke and venous thromboembolism (VTE), and a major contributor to the global disease burden.1 This effect is markedly more pronounced by considering the view that cancer is also a thrombotic disease.2 3 Cardiovascular disease (CVD, manifesting as acute coronary syndromes, m...
Source: Heart - June 5, 2016 Category: Cardiology Authors: Blann, A. D., Lip, G. Y. H. Tags: Education in Heart, Drugs: cardiovascular system, Acute coronary syndromes, Venous thromboembolism, Epidemiology Source Type: research

Patent foramen ovale: the current state of play
Learning objectives Understand the anatomy and embryology of the interatrial septum and patent foramen ovale (PFO). Develop an overview of the many clinical associations of a PFO. Appraise the clinical evidence for and against closure of PFO. Introduction Patent foramen ovale (PFO) is a common finding, occurring in up to 25% of people.1 2 An association between PFO and stroke has consistently been seen in up to 50% of patients without an identifiable cause, that is, the so-called cryptogenic stroke (CS) and only in 20% with an identified cause.3 4 Many studies have been published testing the hypothesis that paradoxical emb...
Source: Heart - November 12, 2015 Category: Cardiology Authors: Asrress, K. N., Marciniak, M., Marciniak, A., Rajani, R., Clapp, B. Tags: Education in Heart, Echocardiography, Clinical diagnostic tests Source Type: research

Diabetes, incretin hormones and cardioprotection
The diabetes pandemic In 2012 an estimated 371 million people had diabetes and of those about a half were undiagnosed. That number is set to expand to 552 million by 2030. Type 2 diabetes mellitus (T2DM) constitutes 85–95% of all diabetes in high income nations and may account for an even greater proportion in their low and middle income counterparts (figure 1). As a global pandemic, diabetes claimed the lives of 4.8 million people in 2012, half of whom were below the age of 60 years.w1 The predominant cause of morbidity and mortality in diabetes is cardiovascular disease, with at least a twofold excess risk of ...
Source: Heart - September 9, 2014 Category: Cardiology Authors: Myat, A., Redwood, S. R., Gersh, B. J., Yellon, D. M., Marber, M. S. Tags: Diabetic heart disease, Education in Heart, Drugs: cardiovascular system, Epidemiology, Diabetes, Metabolic disorders Source Type: research

Molecular imaging of atherosclerosis: clinical state-of-the-art
Physicians depend greatly on imaging techniques that help them make clinical decisions. However, when a diagnosis is made on the basis of anatomical imaging alone, the disease process has often advanced beyond the point where preventative therapy can be applied. In many cardiovascular diseases, it is vital to detect pathological and normal processes at an early, subclinical stage, to enable early and improved diagnosis, prediction and treatment (figure 1A). This is particularly relevant to atherosclerosis, which can be clinically silent for decades and then manifest suddenly as an acute myocardial infarction (MI) or stroke...
Source: Heart - August 21, 2014 Category: Cardiology Authors: Jaffer, F. A., Verjans, J. W. Tags: Non-invasive imaging, Education in Heart, Drugs: cardiovascular system, Acute coronary syndromes, Clinical diagnostic tests Source Type: research

Cardiac MRI assessment of atrial fibrosis in atrial fibrillation: implications for diagnosis and therapy
Atrial fibrillation (AF) is the most commonly encountered cardiac arrhythmia in clinical practice, with a prevalence of 0.4–1% in the US population.w1 AF is a potent risk factor, increasing the risk of stroke fivefold and accounting for approximately 15% of all strokes in the USA.w2 AF also significantly increases the risk of mortality from heart failure.w3–7 Many therapies, including pharmacological approaches and direct current cardioversion, have been tried to treat this malignant arrhythmia, but were not found to be that effective.1 w8–w11 Catheter ablation of AF has provided better outcomes compared ...
Source: Heart - March 5, 2014 Category: Cardiology Authors: Higuchi, K., Akkaya, M., Akoum, N., Marrouche, N. F. Tags: Tachyarrhythmias, Atrial fibrillation, Education in Heart, Dilated cardiomyopathy, Hypertrophic cardiomyopathy, Drugs: cardiovascular system, Echocardiography, Heart failure, Acute coronary syndromes, Clinical diagnostic tests, Epidemiology Source Type: research

Methods of accelerated atherosclerosis in diabetic patients
This article will focus on the effect of diabetes on the initiation and progression of arterial occlusive disease, preceded by a short outline of the enormous impact of this issue from a societal-economic perspective. Diabetes, a major healthcare issue The prevalence and associated costs of diabetes are expected to increase significantly. There are currently over 240...
Source: Heart - April 18, 2013 Category: Cardiology Authors: Pasterkamp, G. Tags: Diabetic heart disease, Health policy, Education in Heart, Drugs: cardiovascular system, Hypertension, Acute coronary syndromes, Stable coronary heart disease, Epidemiology, Diabetes, Metabolic disorders Source Type: research