MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Cardiology Clinics' source. Wed, 08 Feb 2012 09:32:30 +0100 http://www.medworm.com/index.php?rid=5666981&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865112000100%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666981 Wed, 01 Feb 2012 05:00:00 +0100 5666981 http://www.medworm.com/index.php?rid=5666978&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001275%2Fabstract%3Frss%3Dyes Current triage strategies are not effective in correctly identifying patients suffering from acute coronary syndrome (ACS). The diagnostic workup of patients presenting with acute chest pain continues to represent a major challenge for emergency department (ED) personnel. This statement holds especially true for patients with a low to intermediate likelihood for ACS. Taking current concepts for the diagnosis and management of patients presenting with acute chest pain to the ED into account, this article discusses the evidence and potential role of coronary computed tomography angiography to improve management of patients with possible ACS. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666978 Wed, 01 Feb 2012 05:00:00 +0100 5666978 http://www.medworm.com/index.php?rid=5666975&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS073386511100124X%2Fabstract%3Frss%3Dyes Coronary computed tomography angiography (CTA) is a highly accurate noninvasive test that is increasingly used in symptomatic patients primarily for the diagnosis of coronary artery disease (CAD). Beyond its proven accuracy, data have now clearly demonstrated the incremental prognostic information available from coronary CTA related to the presence, extent, and severity of obstructive and nonobstructive CAD across a variety of clinical settings and patient populations. Current evidence supports the use of coronary CTA not only for the diagnosis of CAD in appropriately selected symptomatic patients but also to further refine their cardiovascular risk assessment following testing. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666975 Wed, 01 Feb 2012 05:00:00 +0100 5666975 http://www.medworm.com/index.php?rid=5666967&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865112000021%2Fabstract%3Frss%3Dyes The February 2012 issue of Cardiology Clinics is our latest update on cardiac CT. The first was in November of 2003 and the second in November of 2009. Thus, the time between publications has shortened by 50%, which reflects the rapid developments in this field. It is also noteworthy that this issue is truly international, with one guest editor from Europe and one from Asia. Cardiology advances now come from all over the developed world. Being American-centric no longer serves the interests of our readers or those who discover a Clinics article on an Internet search. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666967 Wed, 01 Feb 2012 05:00:00 +0100 5666967 http://www.medworm.com/index.php?rid=5666966&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865112000094%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666966 Wed, 01 Feb 2012 05:00:00 +0100 5666966 http://www.medworm.com/index.php?rid=5666965&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865112000082%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666965 Wed, 01 Feb 2012 05:00:00 +0100 5666965 http://www.medworm.com/index.php?rid=5666964&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865112000070%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666964 Wed, 01 Feb 2012 05:00:00 +0100 5666964 http://www.medworm.com/index.php?rid=5666968&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001287%2Fabstract%3Frss%3Dyes It is not very frequently that an entirely new diagnostic modality is created to offer new possibilities and opportunities to clinicians in a short span of time. Computed tomography (CT) made its way into the cardiovascular arena approximately 10 years ago, when the first multidetector CT systems were introduced. Engineers then devised methods for synchronizing data acquisition and data reconstruction with the electrocardiograms. Much effort has focused on using CT imaging to visualize the coronary vessels, and coronary CT angiography has matured rapidly to find its way into clinical practice and a few official guidelines for selected patients. Although the emergence of coronary angiography has been the most noticeable development in the field of CT, many other innovations deserve our atte... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666968 Fri, 06 Jan 2012 05:00:00 +0100 5666968 http://www.medworm.com/index.php?rid=5666980&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001160%2Fabstract%3Frss%3Dyes Percutaneous management of valvular heart disease is becoming a reality, with multicenter trials supporting minimally invasive procedures for both aortic and mitral valve disease. Historically, the treatment of choice has been aortic valve replacement with conventional surgery for patients with severe aortic stenosis, as the prognosis of untreated patients is poor, particularly if the patient is symptomatic. Transcatheter aortic valve replacement is now available as a minimally invasive option to treat select high-risk patients with severe aortic stenosis. At present more than 30,000 procedures have been performed worldwide, mostly confined to patients at high surgical risk. The short- and medium-term outcomes have been promising. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666980 Thu, 15 Dec 2011 05:00:00 +0100 5666980 http://www.medworm.com/index.php?rid=5666979&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001263%2Fabstract%3Frss%3Dyes This article summarizes these combined technologies, emphasizing the merits and limitations of each technology and their clinical implications. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666979 Thu, 15 Dec 2011 05:00:00 +0100 5666979 http://www.medworm.com/index.php?rid=5666977&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001251%2Fabstract%3Frss%3Dyes This article discusses state-of-the-art computed tomography for the detection of these disorders, including recent advances and future perspectives. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666977 Thu, 15 Dec 2011 05:00:00 +0100 5666977 http://www.medworm.com/index.php?rid=5666972&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001238%2Fabstract%3Frss%3Dyes Measurement of traditional risk factors remains the foundation of current clinical practice guidelines when screening for coronary heart disease (CHD) risk. However, many adults who experience CHD events are not identified as higher risk based on their traditional risk factors. Observational data show that the coronary artery calcium (CAC) score improves risk prediction, even after taking into account traditional risk factors. The authors have outlined several principles of CAC testing into a list of dos and don'ts to help maximize its potential benefit while minimizing potential harm. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666972 Mon, 12 Dec 2011 05:00:00 +0100 5666972 http://www.medworm.com/index.php?rid=5666969&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001214%2Fabstract%3Frss%3Dyes Cardiac computed tomography (CT) and its main clinical application, coronary CT angiography, have made major progress during the past years. Advances were driven by progress in CT hardware technology and CT image reconstruction and processing software. Technical innovations have successfully been used to lower the radiation exposure of coronary CT angiography and to improve image quality, especially in challenging situations, such as individuals with high heart rates or severe calcification. Some of the most important recent contributions have been the development of area detectors, dual-source CT, and the introduction of iterative reconstruction algorithms. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666969 Mon, 12 Dec 2011 05:00:00 +0100 5666969 http://www.medworm.com/index.php?rid=5666971&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001093%2Fabstract%3Frss%3Dyes The presence of coronary artery calcium is closely associated with the presence of atherosclerotic lesions in the coronary vasculature. Detection of coronary calcium by imaging techniques has evolved over the last few decades and has become especially more sophisticated with advanced imaging technology. Whereas the status of coronary artery calcium as a marker of increased cardiovascular risk is well established, the indication for testing continues to be a topic of debate. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666971 Thu, 08 Dec 2011 05:00:00 +0100 5666971 http://www.medworm.com/index.php?rid=5666974&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001159%2Fabstract%3Frss%3Dyes Coronary computed tomographic angiography (CTA) is a promising noninvasive tool that allows the visualization of plaque morphology. Plaques characterized by positive remodeling, low attenuation, and napkin ring circular enhancement on contrast-enhanced coronary CTA have been regarded as rupture-prone vulnerable plaques, which account for about 60% of all vulnerable lesions and may be precursors of plaque rupture. In this article, the authors discuss the various features related to plaque morphology that are essential to detect vulnerable plaques while performing coronary CTA. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666974 Mon, 05 Dec 2011 05:00:00 +0100 5666974 http://www.medworm.com/index.php?rid=5666970&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001226%2Fabstract%3Frss%3Dyes Coronary CT angiography is a rapidly growing technique that offers distinct advantages over traditional imaging techniques. However, because of rapid growth of this technique, radiation dose safety has been placed under the spotlight. There are several main determinants of total radiation dose, and these are outlined in this review. Integration of these dose-saving techniques will go a long way in maintaining diagnostic image quality and improving patient safety. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666970 Mon, 05 Dec 2011 05:00:00 +0100 5666970 http://www.medworm.com/index.php?rid=5666976&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001172%2Fabstract%3Frss%3Dyes One of the main problems in coronary angiography using 64-row computed tomography (CT) is that the presence of severe calcification interferes with the assessment of lesions, which reduces diagnostic accuracy and may even make assessment of some coronary artery segments impossible. With 320-row CT, it is possible to avoid this problem by performing subtraction coronary CT, which fully exploits the performance capabilities of the CT system. However, subtraction coronary CT has several limitations. When these limitations have been overcome, this technique is expected to become a useful method for assessing patients with severe calcification and evaluating coronary artery stents. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666976 Fri, 02 Dec 2011 05:00:00 +0100 5666976 http://www.medworm.com/index.php?rid=5666973&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001202%2Fabstract%3Frss%3Dyes Coronary computed tomographic angiography (CCTA) has emerged as a novel noninvasive method for the evaluation of not only coronary artery stenosis but also arterial wall and plaque features. Recent developments in CCTA technology enable the simultaneous assessment of coronary stenosis, atherosclerotic plaque characteristics, physiologic significance of lesion-specific ischemia, and cardiac function. Through these studies, the prognostic significance of individual coronary lesions and ventricular function can be determined and used to direct therapy. Future studies are needed to establish the totality of coronary artery plaque measures that improve clinical utility. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5666973 Fri, 02 Dec 2011 05:00:00 +0100 5666973 http://www.medworm.com/index.php?rid=5386016&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001044%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386016 Tue, 01 Nov 2011 04:00:00 +0100 5386016 http://www.medworm.com/index.php?rid=5386015&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000737%2Fabstract%3Frss%3Dyes The authors of “Can the Occurrence of GI Bleeding in Non-Pulsatile LVAD Patients Provide Clues for the Reversal of Arteriosclerosis?” (Drs John A. Elefteriades and Louis H. Stein) make the point that arterial morphology is highly dependent on mechanical loading, especially the pulse pressure of the arterial waveform. With nonpulsatile flow of axial LVADs, the mechanical loading is light and the arterial wall involutes, thinning and losing smooth muscle cells. This observation may provide a mechanism for stopping or reversing arteriosclerosis via LVAD therapy in the future. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386015 Tue, 01 Nov 2011 04:00:00 +0100 5386015 http://www.medworm.com/index.php?rid=5386014&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000919%2Fabstract%3Frss%3Dyes This article is written not only to explore the deleterious effects of nonpulsatile flow (namely, gastrointestinal [GI] bleeding), but also to propose the novel concept that deliberate induction of nonpulsatile flow might be harnessed to produce beneficial remodeling in arteriosclerotic arteries. Continuous-flow left ventricular assist devices have proven their efficacy in the treatment of end-stage heart disease. They are a reliable option in bridge-to-transplant and destination therapy. An enigmatic consequence of this therapy has been occult GI bleeding. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386014 Tue, 01 Nov 2011 04:00:00 +0100 5386014 http://www.medworm.com/index.php?rid=5386013&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000804%2Fabstract%3Frss%3Dyes Right ventricular (RV) failure after left ventricular assist device (LVAD) placement is common and often lethal. The reader must keep the RV in mind and avoid left ventricle “tunnel vision.” (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386013 Tue, 01 Nov 2011 04:00:00 +0100 5386013 http://www.medworm.com/index.php?rid=5386012&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000841%2Fabstract%3Frss%3Dyes Nonreversible failure of the right ventricle is seen in 0.04% to 0.1% of postcardiotomy cases. The incidence of right ventricular dysfunction after left ventricular assist device (LVAD) implantation that fails to resolve in the operating room is reported to be as frequent as 20% to 50% and imposes a considerable burden in terms of postoperative morbidity and mortality. Should this syndrome supervene, the mortality of an LVAD operation increases from 19% to 43%. Although most patients can be maintained with prolonged inotropic support, 10% to 15% may require implantation of a separate right ventricular support device. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386012 Tue, 01 Nov 2011 04:00:00 +0100 5386012 http://www.medworm.com/index.php?rid=5386011&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000786%2Fabstract%3Frss%3Dyes Dr Pramod Bonde and colleagues clearly state the shortcomings of an external driveline from the ventricular assist device (VAD) to the exterior. The investigators elegantly state the case for untethering. Many of us feel that infection is inevitable as long as the integument is pierced; so, we strongly support the crusade to achieve “wireless” transmission of energy. It is important to realize that we are not talking about transmission of information, but, rather, the transmission of substantive amounts of energy. It is valuable to keep in mind that our group at Yale has used radiofrequency radio transmission of energy across the intact skin for more than 4 decades, since the inception of the technique by Glenn and Hogan. We use this for powering our diaphragm pacemakers (). We are not... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386011 Tue, 01 Nov 2011 04:00:00 +0100 5386011 http://www.medworm.com/index.php?rid=5386009&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000725%2Fabstract%3Frss%3Dyes Drs David J. Kaczorowski and Y. Joseph Woo, authors of “Who Needs an RVAD in Addition to an LVAD?” make the very important point that late, second-thought, right ventricular assist device (RVAD) placement leads to poorer survival compared with a priori placement during the same operation as left ventricular assist device (LVAD) placement. The investigators thoroughly review the pertinent literature. They identify 2 numerical grading systems for RVAD decision making. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386009 Tue, 01 Nov 2011 04:00:00 +0100 5386009 http://www.medworm.com/index.php?rid=5386007&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000798%2Fabstract%3Frss%3Dyes In his article titled “VAD or Transplant?” Dr Robert Jarvik, the brilliant motivating force behind artificial heart technology for nearly half a century, challenges us to consider which we want, a transplant or a ventricular assist device (VAD). He points out that the presumed superiority of transplant, in survival and quality of life, is narrowing or, perhaps, even reversing as VAD technology advances. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386007 Tue, 01 Nov 2011 04:00:00 +0100 5386007 http://www.medworm.com/index.php?rid=5386006&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000828%2Fabstract%3Frss%3Dyes Major advances in vascular assist device (VAD) technology and the clinical acceptance of destination therapy for patients with contraindications to transplant raise the questions of what patient benefit is necessary to recommend VAD implant for long-term support in patients who are transplant candidates. What are the appropriate indications for use and timing considerations for long-term VAD therapy in patients who qualify for transplant but are unlikely to obtain a donor? The authors suggest that VAD implantation for the indication of “maintenance therapy” where patients must remain on the VAD for two years before becoming transplant eligible, would constitute an appropriate clinical avenue to study these issues. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386006 Tue, 01 Nov 2011 04:00:00 +0100 5386006 http://www.medworm.com/index.php?rid=5386005&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000749%2Fabstract%3Frss%3Dyes Drs Carlo R. Bartoli and Robert D. Dowling, authors of “The Future of Adult Cardiac Assist Devices: Novel Systems and Mechanical Circulatory Support Strategies,” comprehensively describe imaginative novel approaches to mechanical support. Imagination and creativity are in clear evidence. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386005 Tue, 01 Nov 2011 04:00:00 +0100 5386005 http://www.medworm.com/index.php?rid=5386004&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000944%2Fabstract%3Frss%3Dyes This article discusses devices that are being developed or are in clinical trials. Devices are categorized as standard full support, less-invasive full support, partial support: rotary pumps, partial support: counterpulsation devices, right ventricular assist device, and total artificial heart. Implantation strategy, mechanism of action, durability, efficacy, hemocompatibility, and human factors are considered. The feasibility of novel strategies for unloading the failing heart is examined. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386004 Tue, 01 Nov 2011 04:00:00 +0100 5386004 http://www.medworm.com/index.php?rid=5386003&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000816%2Fabstract%3Frss%3Dyes In “Tips on ‘Tuning’ Each Device—Technical Pearls,” Dr Yoshifumi Naka and colleagues systematically review general principles and tips specific to each of several popular devices. This surgical guidance is immensely valuable, reflecting Dr Naka’s extensive clinical experience. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386003 Tue, 01 Nov 2011 04:00:00 +0100 5386003 http://www.medworm.com/index.php?rid=5386001&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000774%2Fabstract%3Frss%3Dyes That myocardial recovery can occur in some patients after LVAD support has been abundantly demonstrated by Professor Magdi Yacoub and his group (the authors of “Bridge to Recovery: What Remains to be Discovered?”) and documented in an extraordinary panel of publications, which describe not only the clinical phenomena but also their fundamental molecular and structural underpinnings. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386001 Tue, 01 Nov 2011 04:00:00 +0100 5386001 http://www.medworm.com/index.php?rid=5386000&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000889%2Fabstract%3Frss%3Dyes This article reviews the status, challenges, and future of cardiac recovery. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386000 Tue, 01 Nov 2011 04:00:00 +0100 5386000 http://www.medworm.com/index.php?rid=5385999&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000750%2Fabstract%3Frss%3Dyes Drs Daniel Pereda and John V. Conte, the authors of “Left-Ventricular Assist Device Driveline Infections,” outline clearly and in detail the pathogenesis, etiology, microbiology, recognition, and treatment of driveline infections. The investigators clarify how prevalent these infections are and how strong an impact they have on survival and effective transition to transplantation. The authors outline important concepts, including (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5385999 Tue, 01 Nov 2011 04:00:00 +0100 5385999 http://www.medworm.com/index.php?rid=5385998&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000853%2Fabstract%3Frss%3Dyes This article reviews some important aspects of driveline infection in patients under left ventricular assist device (LVAD) support, including epidemiology, causes, diagnosis, and treatment options, both medical and surgical. Focus is placed on prevention along every aspect of the process of LVAD therapy, as the authors believe this is the most efficient measure to fight driveline infections. Once driveline infection is present, early recognition and adequate treatment, including surgical measures, play a central role management, and are key to achieving the goals of LVAD support. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5385998 Tue, 01 Nov 2011 04:00:00 +0100 5385998 http://www.medworm.com/index.php?rid=5385997&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000890%2Fabstract%3Frss%3Dyes This article discusses technical issues that are common to all durable LVAD devices, with special emphasis on strategy and technical considerations aimed at avoiding surgical pitfalls. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5385997 Tue, 01 Nov 2011 04:00:00 +0100 5385997 http://www.medworm.com/index.php?rid=5385996&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000762%2Fabstract%3Frss%3Dyes Dr Yoshifumi Naka and colleagues provide a superb overview of traditional and newer devices for destination therapy in their article titled “Current Technology—Devices Available For ‘Destination’ Therapy.” The investigators point out clearly that the theoretical concerns over potential damaging effects of nonpulsatile flow are simply not borne out. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5385996 Tue, 01 Nov 2011 04:00:00 +0100 5385996 http://www.medworm.com/index.php?rid=5385995&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000865%2Fabstract%3Frss%3Dyes Left ventricular assist device therapy as a destination therapy for end-stage heart failure has made a large leap with continuous flow devices. Continuous flow does not seem to have a detrimental effect on end-organ function, at least in the midterm. Various expected and unexpected complications have been reported associated with this technology. More experience and research are warranted. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5385995 Tue, 01 Nov 2011 04:00:00 +0100 5385995 http://www.medworm.com/index.php?rid=5385994&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000907%2Fabstract%3Frss%3Dyes In “Natural History of End-Stage LV Dysfunction: Has It Improved from the Classic Franciosa and Cohn Graph?” Dr Daniel Jacoby and colleagues argue that prognosis of patients with heart failure has indeed improved since the landmark dismal depiction nearly 3 decades ago in the classic graph by Franciosa and Cohn (76% mortality at 3 years). Dr Jacoby and colleagues attribute this improvement in outlook to the advent of effective heart failure therapies, including angiotensin-converting enzyme inhibitors, β-blockers, aldosterone inhibitors, cardiac resynchronization therapy, and the implantable cardioverter defibrillator. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5385994 Tue, 01 Nov 2011 04:00:00 +0100 5385994 http://www.medworm.com/index.php?rid=5385993&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000932%2Fabstract%3Frss%3Dyes The pathophysiology of heart failure is complex, and downstream effects cause decline in multiple systems. Medical therapies intended to slow or reverse disease progression have been shown to improve prognosis in prospective trials. Improvement in prognosis has also been observed in large cohorts across time strata. However, near-term mortality for those with advanced disease remains unacceptably high. Prognosis in advanced heart failure may be assessed with the appropriate use of clinical prediction tools. Optimal timing of evaluation for heart transplantation and/or mechanical circulatory support depends on an understanding of these issues. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5385993 Tue, 01 Nov 2011 04:00:00 +0100 5385993 http://www.medworm.com/index.php?rid=5385992&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000956%2Fabstract%3Frss%3Dyes In the current issue of Cardiology Clinics, a distinguished panel of authors examines and dissects important contemporary, and often controversial, topics in the treatment of advanced heart failure by mechanical assist devices. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5385992 Tue, 01 Nov 2011 04:00:00 +0100 5385992 http://www.medworm.com/index.php?rid=5385991&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000968%2Fabstract%3Frss%3Dyes The February 2003 issue of Cardiology Clinics was titled Ventricular Assist Devices and the Artificial Heart. At that time, using the early devices as a bridge to transplantation was fairly well accepted, but destination therapy with a mechanical device was highly controversial. Now, 8 years later, destination therapy is no longer as controversial. This is not because the newer devices have achieved long-term flawless performance, but rather because use of long-term mechanical assist devices has allowed a significant proportion of diseased hearts to recover, such that the device can be removed. The concept of bridge to recovery or transplantation has re-energized this field. Thus, I was delighted when Dr John Elefteriades agreed to guest edit an issue of Cardiology Clinics to update thi... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5385991 Tue, 01 Nov 2011 04:00:00 +0100 5385991 http://www.medworm.com/index.php?rid=5385990&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001032%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5385990 Tue, 01 Nov 2011 04:00:00 +0100 5385990 http://www.medworm.com/index.php?rid=5385989&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001020%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5385989 Tue, 01 Nov 2011 04:00:00 +0100 5385989 http://www.medworm.com/index.php?rid=5385988&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111001019%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5385988 Tue, 01 Nov 2011 04:00:00 +0100 5385988 http://www.medworm.com/index.php?rid=5386010&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS073386511100083X%2Fabstract%3Frss%3Dyes Heart failure is a terminal disease with a very poor prognosis. Although the gold standard of treatment remains heart transplant, only a minority of patients can benefit from transplants. Another promising alternative is mechanical circulatory assistance using ventricular assist devices. The authors envision a completely implantable cardiac assist system affording tether-free mobility in an unrestricted space powered wirelessly by the innovative Free-Range Resonant Electrical Energy Device (FREE-D) system. Patients will have no power drivelines traversing the skin, and this system will allow power to be delivered over room distances and will eliminate trouble-prone wirings, bulky consoles, and replaceable batteries. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386010 Mon, 03 Oct 2011 04:00:00 +0100 5386010 http://www.medworm.com/index.php?rid=5386008&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000920%2Fabstract%3Frss%3Dyes Mechanical circulatory support using left ventricular assist devices (LVAD) has become an accepted mode of therapy for both bridging patients with end-stage heart failure to transplant and as a destination therapy. Right ventricular (RV) dysfunction is common after LVAD insertion and is a significant source of morbidity and mortality in patients undergoing LVAD placement. Several studies have identified clinical, laboratory, hemodynamic, and echocardiographic parameters that may serve as risk factors for RV dysfunction after LVAD placement. Furthermore, scoring systems have been established to help quantitatively predict the potential need for RV support after LVAD placement. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386008 Mon, 03 Oct 2011 04:00:00 +0100 5386008 http://www.medworm.com/index.php?rid=5386002&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000877%2Fabstract%3Frss%3Dyes Although the basic technique is relatively similar among the currently available left ventricular assist devices (LVAD), there are many subtle potential technical pitfalls for each device that could result in grave adverse events. In this article, the technical perils of the principal implantation technique and LVAD-related concomitant surgical procedures as well as of the implantation technique specific to currently available implantable LVADs, including HeartMate XVE, HeartMate II, HeartWare, and DuraHeart, are described. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5386002 Mon, 19 Sep 2011 04:00:00 +0100 5386002 http://www.medworm.com/index.php?rid=5088068&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000609%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088068 Sun, 31 Jul 2011 23:00:00 +0100 5088068 http://www.medworm.com/index.php?rid=5088067&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000506%2Fabstract%3Frss%3Dyes This article focuses on the fundamental principles of exercise physiology and on the assessment, pathophysiology, and potential treatment of exercise intolerance in diastolic heart failure. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088067 Sun, 31 Jul 2011 23:00:00 +0100 5088067 http://www.medworm.com/index.php?rid=5088066&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS073386511100052X%2Fabstract%3Frss%3Dyes Nearly half of all patients who have heart failure have preserved ejection fraction (HFpEF). Patients who have HFpEF tend to be older, female, and hypertensive, and characteristically display increased ventricular and arterial stiffening. In this article, we discuss the pathophysiology of abnormal ventriculoarterial stiffening and how it affects ventricular function, cardiovascular hemodynamics, reserve capacity, and symptoms. We conclude by exploring how novel treatment strategies targeting abnormal ventricular–arterial interaction might prove useful in the treatment of patients who have HFpEF. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088066 Sun, 31 Jul 2011 23:00:00 +0100 5088066 http://www.medworm.com/index.php?rid=5088065&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000518%2Fabstract%3Frss%3Dyes This article outlines renovascular disease as it relates to CKD, the pathophysiology of development of renovascular disease and effects leading to congestive heart failure, treatment modalities, and outcomes of treatment regimens. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088065 Sun, 31 Jul 2011 23:00:00 +0100 5088065 http://www.medworm.com/index.php?rid=5088062&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000464%2Fabstract%3Frss%3Dyes Critical limb ischemia (CLI) is primarily a disease of advanced atherosclerosis but may occur in the setting of other causes. It is essential for the treating physician to understand the complexity of patients with CLI and the appropriate and emerging treatment approaches in this patient population. The authors provide a comprehensive review of the percutaneous endovascular management of CLI in this article. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088062 Sun, 31 Jul 2011 23:00:00 +0100 5088062 http://www.medworm.com/index.php?rid=5088059&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000452%2Fabstract%3Frss%3Dyes Upper extremity arteries are affected by occlusive diseases from diverse causes, with atherosclerosis being the most common. Although the overriding principle in managing patients with upper extremity arterial occlusive disease should be cardiovascular risk reduction by noninvasive and pharmacologic means, when target organ ischemia produces symptoms or threatens the patient's well-being, revascularization is necessary. Given their minimally invasive nature and successful outcomes, percutaneous catheter-based therapies are preferred to surgical approaches. The fact that expertise in these techniques resides in not one but several disciplines (vascular surgery, radiology, cardiology, vascular medicine) makes this an area ripe for multidisciplinary collaboration to the benefit of patients. (... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088059 Sun, 31 Jul 2011 23:00:00 +0100 5088059 http://www.medworm.com/index.php?rid=5088057&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000397%2Fabstract%3Frss%3Dyes This article briefly discusses the basic principles of MDCT and provides an overview of its application in vascular diseases. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088057 Sun, 31 Jul 2011 23:00:00 +0100 5088057 http://www.medworm.com/index.php?rid=5088055&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000488%2Fabstract%3Frss%3Dyes The last decade has seen a tremendous surge of interest in peripheral arterial disease (PAD). The prevalence of multiple risk factors, chronic nature of disease, the nonspecificity of symptoms, and lack of adequate treatment options have all contributed to the large burden of disease, which is frequently unrecognized. The last issue of Cardiology Clinics devoted exclusively to peripheral vascular disease was published 9 years ago, 2 months after 9/11. Since that time, the world has quite literally changed. We have seen advertising campaigns from pharmaceutical companies about “seeing your doctor if you have PAD” come and go, and we have witnessed advances that have informed us about natural history, diagnosis, and new treatments. New guidelines for the treatment of PAD have been endors... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088055 Sun, 31 Jul 2011 23:00:00 +0100 5088055 http://www.medworm.com/index.php?rid=5088054&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS073386511100049X%2Fabstract%3Frss%3Dyes I was delighted when Dr Rajagopalan agreed to guest edit an issue of Cardiology Clinics on peripheral vascular disease. A lot has happened in the 9 years since the previous issue on this topic. Because there has been such an explosion in knowledge, this issue is focused on peripheral arterial disease (PAD). Among the first articles in the issue is one on the diagnosis of PAD using CT angiography, which has largely replaced invasive angiography. Another article discusses MR angiography, which could be considered an emerging diagnostic modality. The impact of these new imaging techniques on therapeutic trial design in PAD is discussed in another article. The articles on the diagnostic approach to PAD, medical management of intermittent claudication, and biological therapies for critical... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088054 Sun, 31 Jul 2011 23:00:00 +0100 5088054 http://www.medworm.com/index.php?rid=5088053&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000592%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088053 Sun, 31 Jul 2011 23:00:00 +0100 5088053 http://www.medworm.com/index.php?rid=5088052&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000580%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088052 Sun, 31 Jul 2011 23:00:00 +0100 5088052 http://www.medworm.com/index.php?rid=5088051&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000579%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088051 Sun, 31 Jul 2011 23:00:00 +0100 5088051 http://www.medworm.com/index.php?rid=5088063&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000476%2Fabstract%3Frss%3Dyes Gene and stem cell therapies have been shown to be safe and well tolerated. Early trial results using these therapies have had promising results on important clinical end points such as wound healing, ischemic pain, and major amputation. Despite this, there have been no pivotal trials to date that have proved the benefit of biological therapy, although there are numerous pivotal trials in progress or about to initiate enrollment. Persistent obstacles exist with current study designs that complicate the ability to successfully perform clinical critical limb ischemia trials. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088063 Sun, 19 Jun 2011 23:00:00 +0100 5088063 http://www.medworm.com/index.php?rid=5088061&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000439%2Fabstract%3Frss%3Dyes This article summarizes the latest advances in endovascular therapy of aortoiliac and femoral arteries and reviews the clinical outcomes and costs associated with the use of these treatments. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088061 Wed, 08 Jun 2011 23:00:00 +0100 5088061 http://www.medworm.com/index.php?rid=5088060&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000415%2Fabstract%3Frss%3Dyes Intermittent claudication (IC) due to peripheral arterial disease (PAD) causes substantial impairment in quality of life, and is strongly associated with increased cardiovascular morbidity and mortality. The overall medical approach to management focuses on reducing cardiovascular events, preventing progression of underlying PAD (eg, limb loss), and improving symptoms. Aggressive secondary prevention strategies (eg, statins and smoking cessation) are of critical importance. Cilostazol treatment should be considered for those with persistent IC symptoms despite exercise and risk factor control. Management of IC requires a comprehensive approach toward symptomatic relief of pain with strategies that prolong life and prevent limb loss. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088060 Sun, 05 Jun 2011 23:00:00 +0100 5088060 http://www.medworm.com/index.php?rid=5088058&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000440%2Fabstract%3Frss%3Dyes The association between gadolinium-based contrast agents and neprogenic systemic fibrosis has helped propel noncontrast angiography techniques to center stage in the MR evaluation of vascular disease, especially in individuals with intrinsic renal diseases. Although balanced steady-state free precession, phase contrast, and time-of-flight sequences are currently being revisited and improved, new noncontrast angiographic methods have been created and are under development: ECG-gated 3D partial-Fourier fast spin echo (FSE) and 3D variable flip angle FSE (SPACE). All of these are attempts to develop noncontrast methods that offer equal or superior vascular diagnosis as compared with contrast-enhanced MR angiography. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088058 Sun, 05 Jun 2011 23:00:00 +0100 5088058 http://www.medworm.com/index.php?rid=5088056&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000427%2Fabstract%3Frss%3Dyes This article discusses diagnostic imaging techniques used in the evaluation and management of patients with peripheral arterial disease (PAD). Along with a complete vascular examination, noninvasive physiologic testing is used for the initial evaluation of patients with suspected PAD. Duplex ultrasonography provides information on the degree of stenosis or occlusion within a vessel and allows assessment of the vessel wall and plaque morphology. Angiographic imaging techniques should be reserved for determining the optimal endovascular or surgical approach for patients requiring revascularization. Together, all available diagnostic modalities contribute to successful evaluation and management of patients with PAD. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088056 Sun, 29 May 2011 23:00:00 +0100 5088056 http://www.medworm.com/index.php?rid=5088064&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000403%2Fabstract%3Frss%3Dyes Surrogate endpoints are important for validation of mechanism, early proof of concept, and the rational design of clinical trials for regulatory approval of drugs. The recent failure of several drugs in peripheral arterial disease (PAD) and in atherosclerosis highlights the importance of understanding drug effect and is a clarion call for better endpoints. This review focuses on aspects relating to the current state of surrogate endpoints in PAD and reviews emerging endpoints using imaging approaches that may have the potential of improving study design in PAD. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=5088064 Thu, 19 May 2011 23:00:00 +0100 5088064 http://www.medworm.com/index.php?rid=4671493&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000282%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671493 Mon, 04 Apr 2011 15:18:43 +0100 4671493 http://www.medworm.com/index.php?rid=4671492&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000208%2Fabstract%3Frss%3Dyes This article discusses potential pathophysiologic mechanisms of cardiorenal syndrome, epidemiology, inpatient and long-term care (including investigational therapies and mechanical fluid removal), and end-of-life and palliative care. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671492 Mon, 04 Apr 2011 15:18:43 +0100 4671492 http://www.medworm.com/index.php?rid=4671491&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS073386511100018X%2Fabstract%3Frss%3Dyes This article reviews the implantable hemodynamics monitors currently available. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671491 Mon, 04 Apr 2011 15:18:43 +0100 4671491 http://www.medworm.com/index.php?rid=4671490&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000178%2Fabstract%3Frss%3Dyes The pulmonary artery catheter will likely earn a place in the history of medicine as one of the most useful tools that shaped our understanding and management of various diseases. An intense assessment of its application in nonacute and nonshock decompensated heart failure has been provided by the ESCAPE trial, a landmark investigation that showed an overall neutral impact of pulmonary artery catheter–guided therapy over therapy guided by clinical evaluation and judgment alone. The current guidelines reserve the use of a pulmonary artery catheter for the management of refractory heart failure and select conditions. The pulmonary artery catheter remains a useful instrument in clinical situations when clinical and laboratory assessment alone is insufficient in establishing the diagnosis an... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671490 Mon, 04 Apr 2011 15:18:43 +0100 4671490 http://www.medworm.com/index.php?rid=4671489&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000191%2Fabstract%3Frss%3Dyes This article reviews more specific gold standard assessments of ventricular and arterial properties, and how these relate to the parameters reported and utilized in practice, and then discusses the re-emerging importance of invasive hemodynamics in the assessment and management of heart failure. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671489 Mon, 04 Apr 2011 15:18:43 +0100 4671489 http://www.medworm.com/index.php?rid=4671488&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000087%2Fabstract%3Frss%3Dyes This article reviews pertinent concepts and studies of the more complex applications of translesional pressure measurements for optimal patient outcomes. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671488 Mon, 04 Apr 2011 15:18:42 +0100 4671488 http://www.medworm.com/index.php?rid=4671487&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000142%2Fabstract%3Frss%3Dyes The first prosthetic valve was implanted by Hufnagel in 1952 in a patient with aortic insufficiency. Since then, prosthetic valves have evolved into various mechanical and bioprosthetic shapes and sizes. Despite the excitement surrounding the current development of prosthetic heart valves, surgically implanted valves remain the mainstay of current practice, and this article discusses the hemodynamic issues associated with the more commonly placed valves. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671487 Mon, 04 Apr 2011 15:18:42 +0100 4671487 http://www.medworm.com/index.php?rid=4671486&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000130%2Fabstract%3Frss%3Dyes This article discusses the clinical evaluation, cardiac catheterization, and echocardiography of pulmonary stenosis and pulmonary regurgitation. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671486 Mon, 04 Apr 2011 15:18:42 +0100 4671486 http://www.medworm.com/index.php?rid=4671485&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000099%2Fabstract%3Frss%3Dyes Over the past two decades, echocardiography has replaced cardiac catheterization for aortic valvular hemodynamic assessment. In recent years, however, there has been a rapid evolution of transcatheter aortic valve technology and, with its refinement, there has been the increasing recognition of the value of transcatheter hemodynamic assessment in complementing the information provided by contemporary echocardiography. With an emphasis on transcatheter hemodynamics, this article reviews the symbiotic application of these assessment modalities pertaining to contemporary transcatheter aortic valve implantation. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671485 Mon, 04 Apr 2011 15:18:42 +0100 4671485 http://www.medworm.com/index.php?rid=4671484&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000129%2Fabstract%3Frss%3Dyes This article discusses the key components of the invasive hemodynamic assessment of mitral valve disease and illustrates their utility through percutaneous transluminal mitral valvuloplasty for mitral stenosis and the novel transcatheter mitral valve repair using the MitraClip for mitral regurgitation. Changes in left atrial pressure and waveform, mean gradient, and cardiac output are critical assessment parameters for both safety and efficacy. Invasive hemodynamic assessment is an essential complement to echocardiography for the optimal guidance of these procedures. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671484 Mon, 04 Apr 2011 15:18:42 +0100 4671484 http://www.medworm.com/index.php?rid=4671483&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000105%2Fabstract%3Frss%3Dyes This report describes the methods and clinical utility of invasive hemodynamic catheterization for the evaluation of constriction, restriction, and cardiac tamponade. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671483 Mon, 04 Apr 2011 15:18:42 +0100 4671483 http://www.medworm.com/index.php?rid=4671482&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000117%2Fabstract%3Frss%3Dyes This article illustrates a pragmatic problem-solving approach to 3 cardinal hemodynamic symptoms and clinical syndromes: right heart failure, dyspnea, and low-output hypotension. This treatise focuses primarily on the complementary roles of noninvasive and invasive diagnostic studies in clinical hemodynamic assessment. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671482 Mon, 04 Apr 2011 15:18:42 +0100 4671482 http://www.medworm.com/index.php?rid=4671481&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000154%2Fabstract%3Frss%3Dyes This issue of Cardiology Clinics focuses on invasive cardiac hemodynamics. It is interesting to reflect back to the day when cardiac catheterization labs used to be the center of physiologic assessment for patients with valvular heart disease. The work done by seminal figures in the field regarding the accuracy of valve area calculation, the determination of cardiac output, and the ability to understand ventricular performance remains the backbone for much of what we take for granted in the modern catheterization suite. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671481 Mon, 04 Apr 2011 15:18:42 +0100 4671481 http://www.medworm.com/index.php?rid=4671480&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000166%2Fabstract%3Frss%3Dyes As the cardiac catheterization laboratory has developed from a largely diagnostic role to a predominately therapeutic arena, operator skills in catheter-based hemodynamics have waned. This is an unfortunate state of affairs for several reasons. There are hemodynamic diagnostic areas where noninvasive techniques may not always provide a clear answer such as the distinction between myocardial and pericardial disease and the severity of valve stenosis. An accomplished cardiac interventionalist should know how to accurately evaluate these hemodynamic conditions. The significance of some coronary artery lesions can be unclear by angiography alone, necessitating a hemodynamic approach. Today the availability of percutaneous valve disease therapies necessitates a thorough knowledge of invasive he... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671480 Mon, 04 Apr 2011 15:18:41 +0100 4671480 http://www.medworm.com/index.php?rid=4671479&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000270%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671479 Mon, 04 Apr 2011 15:18:41 +0100 4671479 http://www.medworm.com/index.php?rid=4671478&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000269%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671478 Mon, 04 Apr 2011 15:18:41 +0100 4671478 http://www.medworm.com/index.php?rid=4671477&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865111000257%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4671477 Mon, 04 Apr 2011 15:18:41 +0100 4671477 http://www.medworm.com/index.php?rid=4406721&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001311%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406721 Fri, 28 Jan 2011 14:49:11 +0100 4406721 http://www.medworm.com/index.php?rid=4406720&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001177%2Fabstract%3Frss%3Dyes Chronic coronary artery disease (CAD) is a highly prevalent and complex health problem in the United States. The goals of treatment in patients with stable CAD are to reduce symptoms and thus improve quality of life, reduce myocardial ischemia, and, more importantly, reduce the risk of myocardial infarction and death. In this article, the authors review the evidence regarding the role of medical versus interventional strategies in reducing the risk of future coronary events in patients with stable CAD. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406720 Fri, 28 Jan 2011 14:49:11 +0100 4406720 http://www.medworm.com/index.php?rid=4406719&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001190%2Fabstract%3Frss%3Dyes This article reviews the latest evidence of isolated ACEI or ARB use, their combination, and the role of aldosterone blockers and direct renin inhibitors in patients at risk, and makes recommendations for their use in the prevention of morbidity and mortality in cardiovascular disease. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406719 Fri, 28 Jan 2011 14:49:11 +0100 4406719 http://www.medworm.com/index.php?rid=4406717&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001219%2Fabstract%3Frss%3Dyes This article presents a review of the biologic actions of HDL that can serve as a potential basis for antiatherosclerotic activity and discusses strategies for targeting HDL for CHD risk reduction. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406717 Fri, 28 Jan 2011 14:49:10 +0100 4406717 http://www.medworm.com/index.php?rid=4406716&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS073386511000113X%2Fabstract%3Frss%3Dyes Cardiovascular disease (CVD) still ranks as the top cause of mortality worldwide. Lipid-modifying therapy has revolutionized the treatment of the disease and is partly responsible for the recent decline in deaths due to CVD. Treatment strategies have evolved since the introduction of the earlier lipid-lowering agents (fibrates, niacin, bile acid resins) to the advent of statins, which have become the standard drugs in cholesterol therapy. The strategy of using high-intensity statin therapy as the initial treatment approach in high-risk individuals, rather than focusing on specific cholesterol levels alone, remains a subject of debate. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406716 Fri, 28 Jan 2011 14:49:10 +0100 4406716 http://www.medworm.com/index.php?rid=4406715&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001128%2Fabstract%3Frss%3Dyes Platelets are central to the pathogenesis of coronary heart disease (CHD). An ever-growing number of antiplatelet therapies used in different doses and combinations have helped manage atherothrombosis, both acutely and in primary and secondary prevention. Despite modern therapy, nearly 800,000 individuals suffer annually from an initial coronary event in the United States alone; almost 500,000 experience a recurrent event. This review provides a current appraisal of antiplatelet drug use in CHD prevention and discusses key barriers to achieving its full potential in real-world practice. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406715 Fri, 28 Jan 2011 14:49:10 +0100 4406715 http://www.medworm.com/index.php?rid=4406714&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001207%2Fabstract%3Frss%3Dyes The majority of individuals with diabetes die from cardiovascular disease (CVD) and related complications. The risk of CVD is 2 to 4 fold greater in diabetes and largely magnified by co-morbidities that aggregate along with it. Sufficient evidence-based data now exist to support multifactorial risk intervention with specific targets for goal-directed therapy for both primary and secondary prevention. These interventions have shown survival benefit in addition to prevention of vascular complications. Prevention of diabetes and delaying its onset should also be an important aspect in future health care strategy and research to confront the oncoming tsunami of CVD related to diabetes. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406714 Fri, 28 Jan 2011 14:49:10 +0100 4406714 http://www.medworm.com/index.php?rid=4406712&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001165%2Fabstract%3Frss%3Dyes This article discusses preventive strategies focusing on policy and clinical initiatives including primordial prevention (lifestyle changes involving smoking, diet and exercise), primary prevention (risk factor control), and secondary prevention (acute and chronic disease management). Combined use of all the three strategies can have an immediate and large impact on reducing CVD morbidity and mortality. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406712 Fri, 28 Jan 2011 14:49:10 +0100 4406712 http://www.medworm.com/index.php?rid=4406710&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001220%2Fabstract%3Frss%3Dyes “Superior doctors prevent the disease;Mediocre doctors treat the disease before it is evident;Inferior doctors treat the full blown disease”Adapted from Huang Dee: Nai-Ching (2600 BC, First Chinese Medical Tex) (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406710 Fri, 28 Jan 2011 14:49:10 +0100 4406710 http://www.medworm.com/index.php?rid=4406709&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001232%2Fabstract%3Frss%3Dyes Increasingly cardiologists are being called upon to advise higher risk individuals regarding the prevention of atherosclerotic cardiovascular disease. For most of us this was not something we learned a lot about during our training. Consequently, it is difficult to put new trials into prospective, yet our patients read trial reports on various news services and want our advice. The last time an issue of Cardiology Clinics was dedicated to the prevention of cardiovascular disease was August 2003. Since then much has happened surrounding this topic. Major trials have been completed and reported such as REVERSAL, PROVE-IT, TNT, RITA 3, ICTUS, COURAGE, JUPITER, and many more. Clearly it was time to update our readers on the current state of prevention strategies. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406709 Fri, 28 Jan 2011 14:49:09 +0100 4406709 http://www.medworm.com/index.php?rid=4406708&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS073386511000130X%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406708 Fri, 28 Jan 2011 14:49:09 +0100 4406708 http://www.medworm.com/index.php?rid=4406707&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001293%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406707 Fri, 28 Jan 2011 14:49:09 +0100 4406707 http://www.medworm.com/index.php?rid=4406706&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001281%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406706 Fri, 28 Jan 2011 14:49:09 +0100 4406706 http://www.medworm.com/index.php?rid=4406718&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001141%2Fabstract%3Frss%3Dyes Atherosclerosis is a chronic immunoinflammatory disease involving medium and large arteries, resulting from a complex interaction between genetic and environmental risk factors. Acute atherosclerotic vascular disease largely results from thrombosis that supervenes on a disrupted atherosclerotic plaque. A healthy lifestyle coupled with management of modifiable risk factors reduces the adverse clinical consequences of atherothrombosis. Reducing low-density lipoprotein cholesterol levels using statins and other agents is the primary pharmacologic approach to stabilize atherosclerosis, but a large residual risk burden remains, stimulating the search for additional therapies for atherosclerosis management. This review focuses on new and emerging therapeutic strategies targeting atherosclerosis.... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406718 Mon, 20 Dec 2010 00:00:00 +0100 4406718 http://www.medworm.com/index.php?rid=4406713&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001189%2Fabstract%3Frss%3Dyes This article reviews recent data regarding unique sex-specific characteristics of both risk for, and presentation of, CVD in women. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406713 Mon, 20 Dec 2010 00:00:00 +0100 4406713 http://www.medworm.com/index.php?rid=4406711&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001153%2Fabstract%3Frss%3Dyes Observational studies with incidence of cardiovascular disease (CVD) events have typically provided the information that is used. Prediction of risk is dependent on accurate and precise baseline measurements in persons without coronary disease at baseline. Follow-up of 5 to 10 years is a typical interval of interest for the prediction of coronary disease events in adults who are asymptomatic at the baseline. Performance criteria for risk estimation include discrimination, calibration, and reclassification, and newer heart disease risk factors and biomarkers can be evaluated in the context of existing risk estimation approaches. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4406711 Mon, 20 Dec 2010 00:00:00 +0100 4406711 http://www.medworm.com/index.php?rid=4253789&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001001%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253789 Mon, 01 Nov 2010 00:00:00 +0100 4253789 http://www.medworm.com/index.php?rid=4253787&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000895%2Fabstract%3Frss%3Dyes Hypertension is the leading risk factor for death worldwide, even surpassing tobacco use, high blood glucose, high blood cholesterol, and obesity. Globally, the estimated prevalence of hypertension is nearly 1 billion persons with an annual mortality of almost 7.5 million deaths. In the United States, hypertension affects an estimated 65 million Americans, and is the leading risk-factor cause of death in women and only second to tobacco use as a contributory cause of death in men. Multiple sources of data from prospective observational, cohort, and randomized controlled clinical trials show that hypertension and its complications are highly preventable when the raised blood pressure is prevented, or treated and controlled. To promote positive behavior change and create a broader impact on ... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253787 Mon, 01 Nov 2010 00:00:00 +0100 4253787 http://www.medworm.com/index.php?rid=4253785&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000822%2Fabstract%3Frss%3Dyes Hypertension is a very common modifiable risk factor for cardiovascular morbidity and mortality. Patients with hypertension represent a diverse group. In addition to those with primary hypertension, there are patients whose hypertension is attributable to secondary causes, those with resistant hypertension, and patients who present with a hypertensive crisis. Secondary causes of hypertension account for less than 10% of cases of elevated blood pressure (BP), and screening for these causes is warranted if clinically indicated. Patients with resistant hypertension, whose BP remains uncontrolled in spite of use of 3 or more antihypertensive agents, are at increased cardiovascular risk compared with the general hypertensive population. After potentially correctible causes of uncontrolled BP (p... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253785 Mon, 01 Nov 2010 00:00:00 +0100 4253785 http://www.medworm.com/index.php?rid=4253783&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000901%2Fabstract%3Frss%3Dyes Hypertension and prehypertension are major public health challenges. Prevention and control of prehypertension through lifestyle changes and the treatment of hypertension to goal blood pressure (BP) are important objectives. In most patients, 2 or more medications with complementary mechanisms of action should be used in combination. Referral for evaluation of resistant hypertension should be made when goal BP is not attained while patients are adherent on 3 or more appropriately dosed antihypertensive medications, including a diuretic. There are compelling indications for the use of specific drugs in patients with underlying ischemic heart disease, chronic heart failure, diabetes, chronic kidney disease, stroke, peripheral arterial disease, left ventricular hypertrophy, obesity, and metab... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253783 Mon, 01 Nov 2010 00:00:00 +0100 4253783 http://www.medworm.com/index.php?rid=4253782&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000846%2Fabstract%3Frss%3Dyes Hypertension in childhood is now recognized to be a common and serious problem with a prevalence of 2% to 5%. Large epidemiologic studies have established normative tables for blood pressure beginning in early childhood based on age, gender, and height. Making a diagnosis of hypertension in a child or adolescent identifies an individual at increased risk for early-onset cardiovascular disease who requires specific treatment. Routine blood pressure measurement is recommended at every health care encounter beginning at 3 years of age, but often this is not being accomplished. This measurement is especially important in relation to the obesity epidemic, because approximately one-third of obese children have high blood pressure. Hypertension can be effectively managed with effective lifestyle ... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253782 Mon, 01 Nov 2010 00:00:00 +0100 4253782 http://www.medworm.com/index.php?rid=4253781&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000913%2Fabstract%3Frss%3Dyes The initial encounter with the patient with hypertension presents the opportunity to reprogram the trajectory of overall cardiovascular risk in the patient with suspected or established hypertension. The practicing clinician should strive to recognize other important considerations beyond drug prescription and treatment guidelines, such as the patient's level of health literacy, social and economic implications of lifelong drug therapy and health care costs, and readiness for and effectiveness of patient self-management. This should be followed by delivery of patient education that is appropriate for literacy level. Self-monitoring should be a tool to engage patients in active participation. Comprehensive risk stratification should be encouraged in all patients. Careful clinician adherence... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253781 Mon, 01 Nov 2010 00:00:00 +0100 4253781 http://www.medworm.com/index.php?rid=4253780&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS073386511000086X%2Fabstract%3Frss%3Dyes Although the mercury sphygmomanometer is widely regarded as the gold standard for office blood pressure measurement, the ban on use of mercury devices continues to diminish their role in office and hospital settings. To date, mercury devices have largely been phased out in United States hospitals. This situation has led to the proliferation of nonmercury devices and has changed (probably forever) the preferable modality of blood pressure measurement in clinic and hospital settings. In this article, the basic techniques of blood pressure measurement and the technical issues associated with measurements in clinical practice are discussed. The devices currently available for hospital and clinic measurements and their important sources of error are presented. Practical advice is given on how t... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253780 Mon, 01 Nov 2010 00:00:00 +0100 4253780 http://www.medworm.com/index.php?rid=4253778&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000810%2Fabstract%3Frss%3Dyes This article presents an overview of the physiology of normal blood pressure control and the pathophysiologic mechanisms that predispose individuals and populations to primary hypertension. The role of genetics, environment, and the gene-environment interaction is discussed. The spectrum of changes in physiologic states that result in chronic increases of arterial blood pressure are reviewed. The nature and characteristics of feedback loops and the primary modulating systems, the central and peripheral nervous systems, and circulating and tissue hormones are reviewed. The role of the endothelium of the artery and its production of endothelin, nitric oxide, angiotensin II, as well as other vasoactive substances in response to various stimuli, is also discussed. A unifying pathway for the de... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253778 Mon, 01 Nov 2010 00:00:00 +0100 4253778 http://www.medworm.com/index.php?rid=4253777&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000925%2Fabstract%3Frss%3Dyes Hypertension is a powerful predictor of cardiovascular mortality and death from all causes. In fact, it is the leading risk factor for global mortality and accounted for 13% of worldwide deaths in 2004, far exceeding the contribution from tobacco use (9%), diabetes (6%), physical inactivity (6%), or overweight and obesity (5%). Hypertension is also a major risk factor for nonfatal events, including stroke, end-stage kidney failure, myocardial infarction, and hypertensive heart disease. Through these nonfatal events, hypertension contributes significantly to outpatient doctor visits, repeat hospitalizations, reduced quality of life, and a substantial global economic burden. The prevention and control of hypertension therefore takes on tremendous clinical, public health, and economic signifi... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253777 Mon, 01 Nov 2010 00:00:00 +0100 4253777 http://www.medworm.com/index.php?rid=4253776&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110001062%2Fabstract%3Frss%3Dyes I am very pleased that Dr George Mensah again agreed to guest edit an issue of Cardiology Clinics on Hypertension. Despite recent advances, it remains a major public and personal health issue. Also, it remains a challenge for physicians since the perfect therapy has not been discovered. In addition, there is a constant stream of new drugs and clinical information for the clinician to keep up with. Thus, the time is overdue for another issue on this topic. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253776 Mon, 01 Nov 2010 00:00:00 +0100 4253776 http://www.medworm.com/index.php?rid=4253775&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000998%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253775 Mon, 01 Nov 2010 00:00:00 +0100 4253775 http://www.medworm.com/index.php?rid=4253774&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000986%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253774 Mon, 01 Nov 2010 00:00:00 +0100 4253774 http://www.medworm.com/index.php?rid=4253773&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000974%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253773 Mon, 01 Nov 2010 00:00:00 +0100 4253773 http://www.medworm.com/index.php?rid=4253784&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000871%2Fabstract%3Frss%3Dyes The benefits of appropriate blood pressure (BP) control include reductions in proteinuria and possibly a slowing of the progressive loss of kidney function. Overall, medication therapy to lower BP during pregnancy should be used mainly for maternal safety because of the lack of data to support an improvement in fetal outcome. The major goal of hypertension treatment in those with baroreceptor dysfunction is to avoid the precipitous, severe BP elevations that characteristically occur during emotional stimulation. The treatment of hypertension in African Americans optimally consists of comprehensive lifestyle modifications along with pharmacologic treatments, most often with combination, not single-drug, therapy. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253784 Fri, 10 Sep 2010 00:00:00 +0100 4253784 http://www.medworm.com/index.php?rid=4253779&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000883%2Fabstract%3Frss%3Dyes From 2005 to 2006, approximately 3 of 8 adults in the United States had blood pressure (BP) in the prehypertensive range of 120 to 139/80 to 89 mm Hg and roughly 1 in 8 adults had BP in the range of 130 to 139/85 to 89 mm Hg, which is referred to as high normal BP or stage 2 prehypertension. Adults with stage 2 prehypertension are also roughly twice as likely as adults with normotension to suffer cardiovascular disease. The Seventh Report of the Joint National Committee on Hypertension recommended only lifestyle changes for most prehypertensive patients. BP in the range of 120 to 129/80 to 84 mm Hg is also associated with increased risk but roughly half of that of stage 2 prehypertension. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253779 Wed, 01 Sep 2010 00:00:00 +0100 4253779 http://www.medworm.com/index.php?rid=4253788&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000858%2Fabstract%3Frss%3Dyes Hypertensive heart disease (HHD), a result of long-standing hypertension, is characterized by changes in the myocardial structure and function in the absence of other primary cardiovascular abnormalities. Although increased blood pressure is the initiating stimulus, neurohormonal factors, particularly the renin-angiotensin system, play a key role in remodeling of cardiac chamber geometry and walls. Optimal antihypertensive therapy in the setting of therapeutic lifestyle changes is crucial in the prevention and control of HHD. Regression of left ventricular hypertrophy (LVH) is achievable and associated with improved prognosis. However, prevention of myocardial remodeling before LVH establishes would further increase the benefits to cardiac function and prognosis. Antihypertensive agents ex... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253788 Fri, 27 Aug 2010 00:00:00 +0100 4253788 http://www.medworm.com/index.php?rid=4253786&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000834%2Fabstract%3Frss%3Dyes This article addresses how patient self-management is a crucial component of effective high-quality health care for hypertension and CVD. The patient must be a collaborator in this process, and methods of improving patients' ability and confidence for self-management are needed. Successful self-management programs have often supplemented the traditional patient-physician encounter by using nonphysician providers, remote patient encounters (telephone or Internet), group settings, and peer support for promoting self-management. Several factors need to be considered in self-management. Given the health care system's inability to achieve several quality indicators using traditional office-based physician visits, further consideration is needed to determine the degree to which these interventio... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=4253786 Fri, 27 Aug 2010 00:00:00 +0100 4253786 http://www.medworm.com/index.php?rid=3744602&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000755%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3744602 Tue, 13 Jul 2010 05:16:41 +0100 3744602 http://www.medworm.com/index.php?rid=3744600&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS073386511000041X%2Fabstract%3Frss%3Dyes A large body of evidence strongly links aldosterone to development and progression of cardiovascular disease, including vascular stiffness, left ventricular hypertrophy, congestive heart failure, chronic kidney disease, and, especially, hypertension. Emerging data suggest that adipocytes may serve as a source of aldosterone, either directly or indirectly, through the release of aldosterone-stimulating factors. If adipocytes are confirmed to have an important contribution to hyperaldosteronism, it would have significant clinical implications in linking aldosterone to obesity-related increases in cardiovascular risk. Such a cause-and-effect situation would then provide the opportunity to reverse that risk with preferential use of aldosterone antagonists in obese patients. (Source: Cardiology... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3744600 Tue, 13 Jul 2010 05:16:41 +0100 3744600 http://www.medworm.com/index.php?rid=3744599&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000482%2Fabstract%3Frss%3Dyes This article discusses the various drug classes used to treat diabetes mellitus, and reviews the current clinical evidence linking glycemic control using these drug classes on diabetic kidney and cardiovascular disease. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3744599 Tue, 13 Jul 2010 05:16:41 +0100 3744599 http://www.medworm.com/index.php?rid=3744598&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000457%2Fabstract%3Frss%3Dyes This article reviews the evidence accumulated to date on four polymorphic loci with the aim of explaining how these polymorphisms modify the risk for CVD in DM by modifying the functional activity of a specific gene. Use of the knowledge of these genetic differences among individuals in targeting drug therapy (pharmacogenomics) is also discussed. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3744598 Tue, 13 Jul 2010 05:16:41 +0100 3744598 http://www.medworm.com/index.php?rid=3744593&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000470%2Fabstract%3Frss%3Dyes Patients with an estimated glomerular filtration rate (eGFR) of less than 60mL/min per 1.72 m2, and presence of microalbuminuria (MA), have an increased risk of cardiovascular (CV) events, compared with patients with normal renal function. The strength of the association among patients with a mild reduction in eGFR depends largely on the population studied, whereas the data regarding MA show an elevated risk among both low- and high-risk populations. Patients with mildly reduced eGFR or MA experience a reduction in CV events and progression of renal disease with treatment of CV risk factors. For patients who experience a myocardial infarction, observational data suggest that patients with a mildly reduced eGFR also have improved outcomes with an early invasive strategy, compared with a non... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3744593 Tue, 13 Jul 2010 05:16:40 +0100 3744593 http://www.medworm.com/index.php?rid=3744592&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000664%2Fabstract%3Frss%3Dyes The importance of kidney dysfunction in the context of cardiovascular risk is now well validated. Those with an estimated glomerular filtration rate below 45 mL/min are known to have more than a 3-fold higher risk of myocardial infarction and stroke as well as a higher risk of heart failure. The mechanisms that portend this higher cardiovascular risk are not well delineated, but more recent studies are helping to elucidate the role of various markers, such as microalbuminuria, in understanding the contribution of kidney dysfunction to endothelial dysfunction. The articles in this issue were coauthored, for the most part, by nephrologists and cardiologists so that the approaches and attitudes of each discipline could be captured. We hope that these new insights into the common problem of ki... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3744592 Tue, 13 Jul 2010 05:16:40 +0100 3744592 http://www.medworm.com/index.php?rid=3744591&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000676%2Fabstract%3Frss%3Dyes Chronic kidney disease is a known risk factor for, or cotraveler with, cardiovascular disease. Chronic kidney disease patients often have traditional atherosclerotic risk factors, such as hypertension, dyslipidemia, and diabetes. In addition, they may have unique endothelial dysfunction often manifested as albuminuria. Also, the combination of renal dysfunction and cardiovascular disease often leads to a vicious cycle of rapid deterioration in renal and cardiac function. Finally, there is the problem that treatment of cardiovascular disease may worsen renal disease and vice versa. A classic example is the diminution in renal function when very high blood pressures in chronic kidney disease patients are quickly returned to normal pharmacologically. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3744591 Tue, 13 Jul 2010 05:16:39 +0100 3744591 http://www.medworm.com/index.php?rid=3744590&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000743%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3744590 Tue, 13 Jul 2010 05:16:39 +0100 3744590 http://www.medworm.com/index.php?rid=3744589&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000731%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3744589 Tue, 13 Jul 2010 05:16:39 +0100 3744589 http://www.medworm.com/index.php?rid=3744588&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS073386511000072X%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3744588 Tue, 13 Jul 2010 05:16:39 +0100 3744588 http://www.medworm.com/index.php?rid=3744601&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000494%2Fabstract%3Frss%3Dyes Patients with chronic kidney disease (CKD) are at high cardiovascular risk and we can consider them to have a risk equivalent to coronary heart disease, putting them into the high-risk category. A mixed dyslipidemia with high triglyceride levels; low high-density lipoprotein (HDL) levels; and small, dense low-density lipoprotein (LDL) particles is a common pattern in patients with CKD, contributing to their high cardiovascular disease (CVD) risk. A treatment strategy to reduce LDL cholesterol to the current high-risk category goals reduces risk similar to patients without CKD. Emerging evidence suggests that targeting non-HDL cholesterol can have the potential to bring about further CVD risk reduction. Non-HDL cholesterol should be a secondary target for all patients with CKD. Further stud... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3744601 Thu, 10 Jun 2010 23:00:00 +0100 3744601 http://www.medworm.com/index.php?rid=3744597&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000469%2Fabstract%3Frss%3Dyes Diabetic patients with chronic kidney disease are at high risk for cardiovascular disease (CVD). All aspects of risk reduction should be rigorously applied to such patients. Statins should be used with reduction of low-density lipoprotein cholesterol levels, and blood pressure management is important. Glycemic control remains important for reduction in the development and progression of retinopathy, neuropathy, and even nephropathy itself. Reduction of other risk factors, such as smoking cessation and weight reduction, should also be implemented. Multiple risk factor reduction can have a large effect on reduction of CVD outcomes. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3744597 Sun, 30 May 2010 23:00:00 +0100 3744597 http://www.medworm.com/index.php?rid=3744596&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000445%2Fabstract%3Frss%3Dyes Heart-kidney interactions have been increasingly recognized by clinicians and researchers who study and treat heart failure and kidney disease. A classification system has been developed to categorize the different manifestations of cardiac and renal dysfunction. Work has highlighted the significant negative prognostic effect of worsening renal function on outcomes for individuals with heart failure. The etiology of concomitant cardiac and renal dysfunction remains unclear; however, evidence supports alternatives to the established theory of underfilling, including effects of venous congestion and changes in intra-abdominal pressure. Conventional therapy focuses on blockade of the renin-angiotensin-aldosterone system with expanding use of direct renin and aldosterone antagonists. Novel th... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3744596 Sun, 30 May 2010 23:00:00 +0100 3744596 http://www.medworm.com/index.php?rid=3744595&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000433%2Fabstract%3Frss%3Dyes This review highlights the paucity of data that support actively decreasing blood pressures (BP) to a level of less than 130/80 mm Hg. Although the data support a lower cardiovascular (CV) event rate with this lower level of pressure in high-risk CV people, early aggressive intervention to prevent levels from going above this mark prevent development of worsening atherosclerosis. Although no trial will ever prove this concept of prevention, common sense and multiple animal experiments support it. Most patients should have their systolic BP reduced to levels well below 140 mm Hg approaching 130 mm Hg, not 140 mm Hg. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3744595 Sun, 30 May 2010 23:00:00 +0100 3744595 http://www.medworm.com/index.php?rid=3744594&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000421%2Fabstract%3Frss%3Dyes Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States as well as the rest of the world. Chronic kidney disease (CKD) is considered a CVD risk equivalent. The development of albuminuria has been identified as an additional possible risk marker that is almost unique to patients with CKD and a marker for predicting CVD risk. This review focuses on clinical and epidemiologic evidence regarding the role of albuminuria in the context of CVD development. It reviews the association of albuminuria with other comorbidities associated with increased cardiovascular risk and the modalities aimed at the reduction of albuminuria and maximizing of cardiovascular risk reduction. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3744594 Sun, 30 May 2010 23:00:00 +0100 3744594 http://www.medworm.com/index.php?rid=3550118&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000573%2Fabstract%3Frss%3Dyes (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550118 Fri, 30 Apr 2010 23:00:00 +0100 3550118 http://www.medworm.com/index.php?rid=3550117&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000305%2Fabstract%3Frss%3Dyes Despite the steamrolling of endovascular therapy in clinical practice, the mid-term results are extremely discouraging, and the theoretic concerns are legion (). In overall assessment, it is fair to say that the ultimate fate of this therapy, without transformative improvements, remains guarded (). (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550117 Fri, 30 Apr 2010 23:00:00 +0100 3550117 http://www.medworm.com/index.php?rid=3550116&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000172%2Fabstract%3Frss%3Dyes This article discusses available data regarding the use of stent therapy for degenerative aneurysms. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550116 Fri, 30 Apr 2010 23:00:00 +0100 3550116 http://www.medworm.com/index.php?rid=3550115&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000123%2Fabstract%3Frss%3Dyes Although the long-term durability of stent grafts is still a concern, stent-graft treatment is already the best option in a large number of patients with descending thoracic aortic diseases who are poor candidates for surgical repair, or in an acute setting. With improved capability to recognize proper anatomy and select clinical candidates, the choice of endovascular stent-graft placement may offer a strategy to optimize management and improve prognosis. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550115 Fri, 30 Apr 2010 23:00:00 +0100 3550115 http://www.medworm.com/index.php?rid=3550114&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000329%2Fabstract%3Frss%3Dyes The conventional wisdom on the street (to mix metaphors) is that retrograde cerebral perfusion is useless, not providing any significant amount of blood flow or oxygen substrate to the brain. In his article in this issue of Cardiology Clinics, however, Dr Yuichi Ueda, a pioneer of this technique, in giving his particular interpretation of animal and clinical data, provides a more positive perspective. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550114 Fri, 30 Apr 2010 23:00:00 +0100 3550114 http://www.medworm.com/index.php?rid=3550113&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000159%2Fabstract%3Frss%3Dyes Despite considerable progress in the operative management of lesions involving the transverse aortic arch, replacement of this portion of the vessel remains a surgical challenge and is still associated with mortality and morbidity. This situation is due not only to the technical difficulties of the procedure but, often, to the unsatisfactory preservation of the integrity of the central nervous system during the period of arch exclusion. The techniques of cerebral protection during surgery of the aortic arch can be divided into those aimed at suppressing the metabolic demand of the central nervous system and those aimed at maintaining the metabolic supply during the time of exclusion of the cerebral vessels. Whichever technique is used, it must maintain the normal metabolism of the central ... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550113 Fri, 30 Apr 2010 23:00:00 +0100 3550113 http://www.medworm.com/index.php?rid=3550112&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000238%2Fabstract%3Frss%3Dyes Straight deep hypothermic circulatory arrest (DHCA) is a technique available for brain preservation during deep hypothermic arrest in aortic arch replacement. In this article, the author discusses the practice of straight DHCA in his institute and the advantage of this technique over other brain preservation techniques. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550112 Fri, 30 Apr 2010 23:00:00 +0100 3550112 http://www.medworm.com/index.php?rid=3550111&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS073386511000007X%2Fabstract%3Frss%3Dyes The technical simplicity of retrograde cerebral perfusion (RCP) together with a highly favorable effect upon stroke rates and survival after aortic arch surgery justifies continued clinical use of RCP in patients requiring hypothermic circulatory arrest (HCA), in particular patients with dissecting or atheromatous arch branches. In clinical practice, using RCP can provide effective brain protection in HCA for about 40 to 60 minutes, although there is a time limitation. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550111 Fri, 30 Apr 2010 23:00:00 +0100 3550111 http://www.medworm.com/index.php?rid=3550110&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS073386511000038X%2Fabstract%3Frss%3Dyes Dr Jacobs beautifully describes his surgical techniques and the conduct of motor evoked potential (MEP) monitoring. The results are excellent in his hands, and potentially paralysis-preventing modifications can be made in cases of diminution in MEPs. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550110 Fri, 30 Apr 2010 23:00:00 +0100 3550110 http://www.medworm.com/index.php?rid=3550109&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000020%2Fabstract%3Frss%3Dyes Thoracoabdominal aortic aneurysms (TAAAs) have a dismal natural history that frequently necessitates surgical repair, but such repairs sometimes result in paraplegia and paraparesis. To reduce the risk of these complications, intraoperative monitoring of spinal cord motor evoked potentials (MEPs) can be used to guide TAAA repair procedures and may potentially minimize spinal cord ischemia. However, the use of MEP monitoring techniques requires important changes to anesthetic management, entails certain risks, and has important contraindications. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550109 Fri, 30 Apr 2010 23:00:00 +0100 3550109 http://www.medworm.com/index.php?rid=3550108&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000147%2Fabstract%3Frss%3Dyes Paraplegia is one of the most severe complications of the repair of open descending thoracic aortic aneurysms and thoracoabdominal aortic aneurysms. To reduce these complications, a comprehensive strategy for spinal cord protection is mandatory. Motor evoked potentials provide the surgeon with important information about spinal cord integrity throughout the operation. Neuroprotective measures include extracorporeal circulation, cerebrospinal fluid drainage, hypothermia, and selective segmental artery revascularization. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550108 Fri, 30 Apr 2010 23:00:00 +0100 3550108 http://www.medworm.com/index.php?rid=3550107&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000275%2Fabstract%3Frss%3Dyes In their article in this issue of Cardiology Clinics, Dr Paul P. Urbanski and colleagues analyze the entire spectrum of surgical options in the care of acute type A aortic dissection, from imaging to categorization, cannulation, brain protection, use of glues, aortic resection, and extent of repair. They make excellent points regarding all of these variables (). Regarding the specific topic of the debate, the authors make a reasonable case, based on their excellent recent experience, for extending resection to include the aortic arch. Their point is that extended resection permits removal of all dissected tissue and that anastomosis to nondissected branches are quite cogent. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550107 Fri, 30 Apr 2010 23:00:00 +0100 3550107 http://www.medworm.com/index.php?rid=3550106&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000093%2Fabstract%3Frss%3Dyes This article reviews the literature pertaining to extent of distal aortic replacement in acute type A aortic dissection, arguing that a conservative approach is associated with more favorable outcome. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550106 Fri, 30 Apr 2010 23:00:00 +0100 3550106 http://www.medworm.com/index.php?rid=3550105&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000081%2Fabstract%3Frss%3Dyes This article presents the authors' experiences during their uniform procedures in diagnostics and surgical strategy. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550105 Fri, 30 Apr 2010 23:00:00 +0100 3550105 http://www.medworm.com/index.php?rid=3550104&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000330%2Fabstract%3Frss%3Dyes There is no clear winner here (). Both essayists leave room for exceptions in their policies (), and both argue for individualized decisions. Both advocate a very aggressive overall surgical approach for acute type A aortic dissection. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550104 Fri, 30 Apr 2010 23:00:00 +0100 3550104 http://www.medworm.com/index.php?rid=3550103&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000299%2Fabstract%3Frss%3Dyes This article considers the role for interval or permanent medical therapy for specific groups of acute type A aortic dissection patients. These include patients with extremely advanced age or prohibitive comorbidities, realized stroke, prior aortic valve replacement, and those who have already survived several days after onset of symptoms. This consideration represents a “back to the future” paradigm shift reminiscent of the earliest recommendations before surgical therapy was feasible or safe. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550103 Fri, 30 Apr 2010 23:00:00 +0100 3550103 http://www.medworm.com/index.php?rid=3550102&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000135%2Fabstract%3Frss%3Dyes Acute aortic dissection remains the most common of all aortic catastrophes and is associated with significant morbidity and mortality. Urgent surgical intervention should be considered in all patients with acute type A aortic dissection. Immediate repair is performed for those who are hypotensive due to rupture and tamponade and who exhibit malperfusion of the coronary, cerebrovascular, visceral, or peripheral arterial systems. Selective delayed management with eventual repair may be assumed in patients with type A intramural hematoma and in those with coma (potential neurologic devastation), assuming that neurologic status improves. Urgent repair should not be precluded in patients presenting with active stroke, older age, and previous cardiac surgery. Ultimately, each patient should be i... Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550102 Fri, 30 Apr 2010 23:00:00 +0100 3550102 http://www.medworm.com/index.php?rid=3550101&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000391%2Fabstract%3Frss%3Dyes In their article in this issue of Cardiology Clinics, Dr Oz M. Shapira and colleagues do a masterful job at guiding us through the epidemiologic, genetic, molecular, and clinical aberrations consequent on having a bicuspid aortic valve (). They make a strong case that the entire segment from aortic valve and annulus to ligamentum arteriosum is inherently abnormal in bicuspid aortic valve disease. They take a leap of faith, however, in making their specific recommendations. There is no proved scientific basis for applying the earlier criteria that they enumerate at the end of their installment. The editor agrees fully, however, with those criteria as enumerated, sharing the clinical judgment of the authors. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550101 Fri, 30 Apr 2010 23:00:00 +0100 3550101 http://www.medworm.com/index.php?rid=3550100&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000226%2Fabstract%3Frss%3Dyes Bicuspid aortic valve (BAV)-associated aortopathy is a complex phenomenon, and the current lack of univocal interpretation of its causes and treatment can be ascribed to the multiform nature of its clinical presentation. Although there is strong bias in the literature favoring more aggressive treatment of ascending aortic dilatation in patients with BAV, evidence supporting this opinion is lacking. This review discusses some of the relevant issues relating to causation to facilitate a better analysis of the current recommendations used to guide surgical management, and concludes that treatment should be tailored by individual valvular pathology, clinical phenotype, and relevant comorbidities, using well-documented evidence-based clinical size criteria. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550100 Fri, 30 Apr 2010 23:00:00 +0100 3550100 http://www.medworm.com/index.php?rid=3550099&cid=s_33208_7_f&fid=33208&url=http%3A%2F%2Fwww.cardiology.theclinics.com%2Farticle%2FPIIS0733865110000068%2Fabstract%3Frss%3Dyes Bicuspid aortic valve (BAV) is the most frequently occurring congenital cardiac anomaly, affecting 1% to 2% of the population. BAV disease is increasingly recognized as a disease of the entire proximal aorta up to the level of the ligamentum arteriosum. The recent unfolding of the genetic and biologic background of the disease and the accumulating data regarding the natural history of BAV-associated aortic dilatation have accrued multiple levels of evidence strongly supporting early surgical intervention. (Source: Cardiology Clinics) Cardiology Clinics journals http://www.medworm.com/rss/comments.php?id=3550099 Fri, 30 Apr 2010 23:00:00 +0100 3550099