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 'Current Treatment Options in Cardiovascular Medicine' source. Thu, 18 Mar 2010 13:57:30 +0100 http://www.medworm.com/index.php?rid=3375554&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx712t3276669w3vp%2F This article summarizes current concepts in the epidemiology, natural history, treatment selection, and outcomes of open and endovascular mesenteric reconstruction for chronic mesenteric ischemia. Content Type Journal ArticleCategory Vascular DiseaseDOI 10.1007/s11936-010-0061-1Authors Gustavo S. Oderich, Mayo Clinic Division of Vascular and Endovascular Surgery, Gonda Vascular Center 200 First Street, Southwest Rochester MN 55905 USA Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-3189Print ISSN 1092-8464 (Source: Current Treatment Options in Cardiovascular Medicine) Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3375554 Tue, 16 Mar 2010 14:52:59 +0100 3375554 http://www.medworm.com/index.php?rid=3375553&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx142133v3h40088w%2F Opinion statement  The morbidity and mortality of venous thromboembolism remain underrecognized and underappreciated. Suspected pulmonary embolism should be risk stratified using a validated clinical risk prediction tool; intermediate to high clinical suspicion requires objective diagnostic testing to confirm or refute the diagnosis. Therapy with unfractionated heparin, low molecular weight heparin, or fondaparinux should be initiated while diagnostic testing is pursued. Conversion to vitamin K antagonists requires a minimum of 5 days’ overlap between the parenteral agent and the vitamin K antagonist. Anticoagulation should be continued for a minimum of 3 to 6 months. Longer or even indefinite therapy may be required with a persistent hypercoagulable state. In p... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3375553 Tue, 16 Mar 2010 14:52:59 +0100 3375553 http://www.medworm.com/index.php?rid=3360435&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr254744r55q88kw1%2F Opinion statement  The pulmonary hypertension (PH) and right heart dysfunction that results from chronic thromboembolic involvement of the pulmonary vascular bed is potentially curable with surgical endarterectomy. Over the past several decades, growing clinical experience has brought about increased recognition of this treatable form of PH. Moreover, advances in cardiothoracic surgical techniques have given an increasing number of patients with chronic thromboembolic PH (CTEPH) a surgical remedy with decreasing perioperative morbidity and mortality risks. The availability of pulmonary hypertensive—specific medical therapy for CTEPH patients with surgically inaccessible disease also has been a positive therapeutic advance over the past several years. However, despite this... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3360435 Thu, 11 Mar 2010 18:26:56 +0100 3360435 http://www.medworm.com/index.php?rid=3360436&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fmg35033123t7776x%2F Opinion statement  Anticoagulation therapy remains the cornerstone for prevention and treatment of venous thromboembolism. Currently available parenteral anticoagulants, such as heparin, low molecular weight heparin, and fondaparinux, are used widely for short-term therapy, but the need for parenteral administration limits their utility for long-term use. Vitamin K antagonists, such as warfarin, are the only oral anticoagulants available for long-term use. Although effective, these drugs produce a variable anticoagulant response and require routine coagulation monitoring and frequent dose adjustments. New anticoagulants that can be given in fixed doses without monitoring have been developed to overcome the limitations of existing agents. These drugs are in advanced stages o... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3360436 Wed, 10 Mar 2010 16:23:00 +0100 3360436 http://www.medworm.com/index.php?rid=3360437&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl813753vlv8t4575%2F Opinion statement  Although the pathophysiology of complex regional pain syndrome (CRPS) is not fully understood, it appears to reflect multiple interacting mechanisms. In addition to altered autonomic function, a role for inflammatory mechanisms and altered somatosensory and motor function in the brain is increasingly suggested. Several possible risk factors for development of CRPS, including genetic factors, have been identified. Few treatments have been proven effective for CRPS in well-designed clinical trials. However, recent work suggests that bisphosphonates may be useful in CRPS management and that the N-methyl-d-aspartate receptor antagonist ketamine significantly reduces CRPS pain when administered topically or intravenously at subanesthetic dosages. Extended use o... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3360437 Wed, 10 Mar 2010 16:22:59 +0100 3360437 http://www.medworm.com/index.php?rid=3360438&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu56m72km55qg8432%2F Opinion statement  Raynaud’s phenomenon is characterized by intense vasospasm of digital arteries on cold exposure or with emotional stress, leading to well-defined color changes of digital skin. It may be primary (Raynaud’s disease) or secondary to an underlying condition, including autoimmune rheumatic diseases. Although Raynaud’s disease is predominantly a vasospastic condition, Raynaud’s phenomenon in connective tissue diseases often is a result of an underlying vaso-occlusive process. As a result, the manifestations are more severe and persistent and often warrant pharmacologic therapy. Dihydropyridine calcium channel blockers are by far the most commonly studied and prescribed class of agents for the treatment of Raynaud’s phenomenon. There is some evidence ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3360438 Wed, 10 Mar 2010 16:22:57 +0100 3360438 http://www.medworm.com/index.php?rid=3336488&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F705164583505312n%2F Opinion statement  Selecting the appropriate treatment for venous leg ulcerations is essential for optimal wound healing and patient quality of life. Compression therapy remains the mainstay of treatment for these wounds. Compression methods should be carefully selected and tailored for compatibility with patients’ daily life. Pain management should not be neglected. When response to compression therapy is limited, adjuvant therapy such as medication, débridement, or surgical procedures should be considered on an individual basis. Content Type Journal ArticleCategory Vascular DiseaseDOI 10.1007/s11936-010-0066-9Authors Ronda S. Farah, University of Minnesota Medical School 420 Delaware St SE Minneapolis MN 55455 USAMark D. P. Davis, University of Minnesota Medical S... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3336488 Wed, 03 Mar 2010 08:08:00 +0100 3336488 http://www.medworm.com/index.php?rid=3273609&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fe8211456623p2l5x%2F Opinion statement  Acute coronary disease remains a major cause of morbidity and mortality. Investigation in established and novel therapies aimed at treating acute coronary syndromes continues. The resulting increase in available options will present a significant challenge to practitioners determining the optimal regimen for specific patients. The addition of newer, more potent antiplatelet agents, such as prasugrel and possibly ticagrelor, will require careful patient selection and risk assessment for both recurrent ischemic events and bleeding. The likely addition of newer oral anticoagulants will require knowledge as to their specific characteristics and risk/benefit ratios. Incremental updates to guideline recommendations from established expert groups will be importa... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3273609 Sun, 14 Feb 2010 06:52:20 +0100 3273609 http://www.medworm.com/index.php?rid=3270453&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fjp53t640t8548221%2F Opinion statement  Obesity is an independent risk factor for cardiovascular (CV) disease and contributes markedly to individual CV risk factors, including hypertension, diabetes mellitus, dyslipidemia, and other chronic conditions, such as osteoarthritis, obstructive sleep apnea, and physical deconditioning. Obesity, defined as a body mass index ≥30 kg/m2, is associated with increased morbidity and mortality, particularly in severely obese patients with a body mass index ≥35 kg/m2. Physical activity, healthy eating and behavioral modification are three pivotal approaches to treating obesity. Some individuals may benefit from pharmacologic agents to achieve meaningful weight loss. Unfortunately, there are few such agents at present with proven efficacy and safety... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3270453 Fri, 12 Feb 2010 07:32:53 +0100 3270453 http://www.medworm.com/index.php?rid=3270456&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh84813728133723v%2F Opinion statement  Coronary artery disease (CAD) is a major cause of heart failure with preserved ejection fraction (HFpEF). In studies of HFpEF, the reported prevalence of CAD varies widely, which may be the result of inconsistent definitions of CAD, geographic and ethnic differences in CAD burden, varying definitions of HFpEF (including different cutoffs for “preserved ejection fraction”), and differences in study design. Despite these limitations, pooled analysis of prospective HFpEF studies demonstrates that CAD is common in HFpEF, with an estimated prevalence of approximately 50%. Based on available data, patients with signs and symptoms of heart failure who have preserved left ventricular ejection fraction and evidence of CAD (HFpEF-CAD) most likely comprise a dis... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3270456 Fri, 12 Feb 2010 07:32:52 +0100 3270456 http://www.medworm.com/index.php?rid=3270455&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh3421078g155021q%2F Opinion statement  The introduction of the drug-eluting stent has raised concerns regarding the occurrence of stent thrombosis (ST), particularly late (and very late) thrombosis. This renewed attention shows that ST remains a major concern after implantation of both bare metal and drug-eluting stents. Cardiologists should be aware of this dreadful complication, because it is associated with substantial morbidity and mortality. Numerous clinical, procedural, and angiographic risk factors have been identified. Moreover, the influence of novel determinants, such as high on-treatment reactivity, genetic predisposition, and the stent’s direct effects on the (healing of the) vessel wall, now are recognized. Consequently, the pathophysiology of ST has evolved into a complex mult... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3270455 Fri, 12 Feb 2010 07:32:52 +0100 3270455 http://www.medworm.com/index.php?rid=3270454&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F2kt08p077n450917%2F Opinion statement  Determining how to treat a patient with symptomatic isolated proximal left anterior descending coronary artery disease may present a challenge. Previous randomized trials comparing percutaneous coronary intervention (PCI) with bare metal stents with minimally invasive direct coronary artery bypass surgery demonstrated significantly higher reintervention rates for stenting, with similar mortality and reinfarction rates. However, current evidence suggests that the use of drug-eluting stents may reduce the need for repeat revascularization. Also, in recent studies there were fewer periprocedural complications in patients undergoing PCI, with similar death and reinfarction rates. Moreover, the quality of life for patients who have received drug-eluting stents... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3270454 Fri, 12 Feb 2010 07:32:52 +0100 3270454 http://www.medworm.com/index.php?rid=3270457&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa2r323g76183459u%2F Opinion statement  The introduction of drug-eluting stents (DES) in 2003 has had a great impact on the management of coronary artery disease in the United States. The application of DES to older adults, the population with the highest prevalence of and worst prognosis for coronary artery disease, remains relatively more controversial. Dual-antiplatelet therapy, which is recommended for at least 12 months after DES placement, is particularly problematic for older patients because of greater age-related bleeding risks. Unfortunately, few current data are available to gauge the balance of risk and benefit in elderly community-dwelling DES patients. Although trial data show a benefit for DES among elderly patients, many older adults typically are excluded from randomized t... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3270457 Thu, 11 Feb 2010 11:41:22 +0100 3270457 http://www.medworm.com/index.php?rid=3263979&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm551715113vl772j%2F Opinion statement  Heart failure (HF) self-care relates to the decisions made outside clinical settings by the individual with HF to maintain life, healthy functioning, and well-being. The people who help patients most (ie, caregivers/family members) should be involved in care, and general principles of health behavior change should be used to guide support. Medicines should be prescribed with once-daily dosing, with pharmacists providing medication review and support. Pill boxes should be provided and patients’ health literacy levels assessed. Psychosocial interventions for smoking cessation should be undertaken. Regular aerobic exercise may benefit patients with mild to moderate HF and some with severe but stable HF; therefore, referral to cardiac rehabilitation should ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3263979 Wed, 10 Feb 2010 06:50:16 +0100 3263979 http://www.medworm.com/index.php?rid=3263980&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh501p01k23492848%2F Opinion statement  Coronary CT angiography (CCTA) is an innovative technique to visualize the coronary arteries in patients with suspected coronary artery disease. CCTA has been validated in patients with non acute symptoms. Because of its high negative predictive value in this population, some have advocated using it in patients admitted to the emergency department with chest pain to determine the presence of coronary artery disease and acute coronary syndrome (ACS). With current CCTA protocols, adequate evaluation of the coronary arteries is feasible using radiation doses similar to, and even lower than, those for single-photon emission CT, which is commonly used to stratify these patients. In addition to its unique capability of visualizing the coronary tree in a noninva... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3263980 Tue, 09 Feb 2010 06:48:29 +0100 3263980 http://www.medworm.com/index.php?rid=2968584&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F017545526574h43j%2F Opinion statement  Combined coronary artery valvular heart disease is a major cause of morbidity and mortality in the adult patient population. The standard treatment for such disease has been open heart surgery in which coronary artery bypass grafting (CABG) is performed concurrently with valve surgery using a median sternotomy and cardiopulmonary bypass. With the increasing complexity of patients referred to surgery, some patients may prove to be poor surgical candidates for combined valve and CABG surgery. In certain selected patients who fall into this category, valve surgery and percutaneous coronary intervention (PCI) have been considered a feasible alternative. Conventionally, valve surgery is performed in the cardiac surgical operating room, whereas PCI is carried o... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2968584 Thu, 05 Nov 2009 07:47:48 +0100 2968584 http://www.medworm.com/index.php?rid=2968583&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F02502g1x656gj54u%2F Opinion statement  Surgically placed valve conduits between the right ventricle and pulmonary artery often fail within 10 years. The failure may be the result of insufficiency, stenosis, or often a combination of the two. Pulmonic valve insufficiency may lead to right ventricular dilatation, heart failure, arrhythmias, and death. Reoperation requires cardiopulmonary bypass, which may aggravate an already failing right ventricle, and is associated with a higher risk of death and significant morbidity. Therefore, percutaneous implantation of a pulmonic valve is an attractive option to improve hemodynamic function and ameliorate symptoms. Initial experience with various types of percutaneous pulmonary valve systems demonstrates the procedure to be effective and safe. Improveme... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2968583 Thu, 05 Nov 2009 07:47:48 +0100 2968583 http://www.medworm.com/index.php?rid=2968586&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx5g622872712jv47%2F Opinion statement  Three decades of ongoing research into the identification of genes responsible for both cardiomyopathies and ion channel diseases has facilitated a progressive understanding of the pathophysiology of inherited arrhythmogenic diseases. Recent discoveries in the area of genetics promise to significantly change the current clinical practice of cardiology, as rapid advances in technology and a coincident reduction of costs associated with sequencing have pushed the “translation“ of genomic information from bench to bedside. In turn, clinicians have at their disposal new tools for more accurate diagnosis of diseases, as well as for better calculation of health risks for affected families. It is clear, however, that the integration of genetic analysis into ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2968586 Thu, 05 Nov 2009 07:47:45 +0100 2968586 http://www.medworm.com/index.php?rid=2968585&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F7333551724h73071%2F Opinion statement  There is convincing evidence that the renin-angiotensin-aldosterone system (RAAS) plays an important role in heart failure (HF), from the events that result in its inception through advanced disease. In particular, RAAS activation is one of the major pathways involved in maladaptive cardiac remodeling, a process that results in progressive cardiac dysfunction. Not surprisingly, strategies targeting the RAAS have substantial benefits in HF. These therapies, which include angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and aldosterone receptor antagonists, have emerged as cornerstones of HF therapy, particularly in patients with systolic dysfunction. Their role in HF with preserved ejection fraction, however, is less certain. New in... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2968585 Thu, 05 Nov 2009 07:47:45 +0100 2968585 http://www.medworm.com/index.php?rid=2968587&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn583q64628811281%2F Opinion statement  Obstructive sleep apnea (OSA) exerts several effects that may be particularly deleterious in patients with heart failure (HF). OSA should be considered especially in HF patients who are obese or have the metabolic syndrome, systemic hypertension, or pulmonary hypertension. HF patients in whom OSA is suspected should undergo a full evaluation by a sleep specialist, including a polysomnogram, to diagnose OSA and differentiate this disease from central sleep apnea. Those found to have OSA should then receive continuous positive airway pressure and/or other interventions, and standard disease management strategies should be used to maximize compliance. Those who cannot tolerate continuous positive airway pressure may be candidates for mandibular advancement d... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2968587 Thu, 05 Nov 2009 07:47:44 +0100 2968587 http://www.medworm.com/index.php?rid=2968588&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw7k2l8gw2r326k05%2F Opinion statement  Because there is no proven effective medical therapy for mitral regurgitation (MR), mitral valve repair (MVRpr) is the treatment of choice for patients with severe primary nonrheumatic MR. A successfully performed and properly timed MVRpr may lead to a normal lifestyle and life span. The alternative to repair is mitral valve replacement. Although there have been no randomized trials of repair versus replacement, almost all reported series demonstrate superior outcomes with repair, and current guidelines clearly prefer MVRpr over mitral valve replacement for patients with nonrheumatic MR. Content Type Journal ArticleDOI 10.1007/s11936-009-0044-2Authors Blase A. Carabello, Medical Service (111) Veterans Affairs Medical Center 2002 Holcombe Boulevard Hous... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2968588 Thu, 05 Nov 2009 07:47:42 +0100 2968588 http://www.medworm.com/index.php?rid=2968591&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fc0m6762061255070%2F Opinion statement  Systemic and pulmonary congestion is a central aspect of both acute and chronic heart failure and directly leads to many of the clinical manifestations of these syndromes. Therefore, diuretic therapy to treat congestion plays a fundamental role in heart failure management. However, although diuretics are the most common drugs prescribed for heart failure, there is limited quality evidence to guide their use. Unlike other components of the heart failure armamentarium, such as β-blockers and angiotensin-converting enzyme inhibitors, diuretics (with the exception of aldosterone antagonists) have not been shown to decrease heart failure progression or improve mortality. Additionally, some observational data suggest that diuretics may actually be harmful in h... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2968591 Thu, 05 Nov 2009 07:47:41 +0100 2968591 http://www.medworm.com/index.php?rid=2968590&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fc454518084321242%2F Opinion statement  Percutaneous therapy for mitral repair has emerged over the past several years as an investigational option for treating mitral regurgitation (MR). A variety of novel methods to treat MR using a percutaneous route have been developed. Most of these approaches are modifications of surgical techniques, some established and some obscure. The basic surgical approaches to mitral repair are annuloplasty and leaflet repair. Catheter-based devices mimic or approximate these surgical approaches. MR as a disease process is heterogeneous, and different therapeutic approaches are needed for different etiologies of MR and morphologies of the mitral apparatus. Primary leaflet diseases are mitral prolapse and fibroelastic deficiency. Secondary, or functional, MR exists ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2968590 Thu, 05 Nov 2009 07:47:41 +0100 2968590 http://www.medworm.com/index.php?rid=2968589&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv173v88855510154%2F Opinion statement  Aortic stenosis is the most important valvular heart disease affecting the elderly population. Surgical aortic valve replacement is the mainstay of treatment, although a substantial number of patients are considered high risk for surgery. Many of these patients do not undergo surgery and have poor outcomes from medically treated symptomatic, severe aortic stenosis. Transcatheter aortic valve implantation (TAVI) provides a promising treatment option for some of these patients. Several devices are under investigation. The Edwards Sapien valve (Edwards Lifesciences, Irvine, CA) and the CoreValve (Medtronic, Minneapolis, MN) have the largest human experience to date. Initial data suggest that these devices have an acceptable safety profile and provide excelle... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2968589 Thu, 05 Nov 2009 07:47:41 +0100 2968589 http://www.medworm.com/index.php?rid=2810754&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fe2641v945r40484x%2F Opinion statement  Electronic cardiac implants such as pacemakers, cardioverter-defibrillators, and cardiac resynchronization devices improve survival, as evidenced by recent trials for primary and secondary prevention and for cardiac resynchronization therapy. As with other forms of therapy, an important aspect of care is monitoring the patient’s condition, response to therapy, and system function. However, practice has been inconsistent. Follow-up schedules vary—for example, from every 3 months to once a year—according to facility, physician preference, and availability of resources. Importantly, no surveillance occurs between follow-up visits. In contrast, implantable devices with remote monitoring capability provide a means for performing constant surveillance, wit... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2810754 Wed, 16 Sep 2009 12:31:24 +0100 2810754 http://www.medworm.com/index.php?rid=2810755&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm85kq40710573873%2F Opinion statement  Cardiac arrest is a vexing public health problem. Fortunately, implantable cardioverter-defibrillators (ICDs) have been proven to decrease overall mortality in several populations at high risk for cardiac arrest. However, it is still unclear how to treat patients who have an elevated risk of cardiac arrest but are not in one of the identified high-risk groups proven to benefit from an ICD. It also is uncertain how to manage high-risk patients who have an accepted indication for an ICD but are unable or unwilling to have an ICD. In these clinical situations, the wearable defibrillator and automatic external defibrillator are options that should be considered. Both devices have been shown in small series to be highly effective at restoring sinus rhythm in p... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2810755 Wed, 16 Sep 2009 12:31:23 +0100 2810755 http://www.medworm.com/index.php?rid=2810757&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fc3357745705381j1%2F Opinion statement  Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and a major cause of morbidity. In the past decade, there have been significant advances in the nonpharmacologic management of AF. However, despite these advances there continues to be a great need for antiarrhythmic drugs to suppress AF. Existing medications have moderate efficacy for AF termination and suppression and have significant associated side effects, limiting their use. The need for new therapies has spawned the growth of several exciting drugs at various stages of development for the medical management of AF. Some agents are derivatives of currently available compounds, whereas others have been newly developed to focus on novel ion current targets. Dronedarone is the first antia... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2810757 Wed, 16 Sep 2009 12:31:22 +0100 2810757 http://www.medworm.com/index.php?rid=2810756&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv33101046l5131q1%2F Opinion statement  Ebstein anomaly is a myopathy of the right ventricle that results in variable degrees of failure of delamination of the tricuspid valve leaflets from the underlying endocardium, leading to severe tricuspid valve regurgitation and some degree of right ventricular dysfunction. In neonates or infants who remain in congestive heart failure or profoundly cyanotic while receiving appropriate medical therapy, operation is required. Current strategies include biventricular or single-ventricle repair. In children and adults, medical management may be used, but most patients eventually require surgery. Tricuspid valve repair is preferred; we believe the cone repair is the most anatomic repair and is the operation of choice. Tricuspid valve replacement may be necess... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2810756 Wed, 16 Sep 2009 12:31:22 +0100 2810756 http://www.medworm.com/index.php?rid=2810760&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F3j21k25198684712%2F Opinion statement  Postoperative arrhythmias in the pediatric population remain a significant source of morbidity and mortality despite advances in surgical techniques. Although our understanding of these arrhythmias has improved, the number of therapeutic options to treat them has not increased significantly in recent years. However, in the specific case of bradyarrhythmias, the use of pacemakers has reduced morbidity and mortality significantly. Additionally, various antiarrhythmic medications, in conjunction with physiologic maneuvers when necessary, have improved our ability to treat postoperative tachyarrhythmias. The prompt recognition and proper treatment of postoperative arrhythmias can reduce morbidity and mortality for these patients. Content Type Journal Articl... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2810760 Wed, 16 Sep 2009 12:31:21 +0100 2810760 http://www.medworm.com/index.php?rid=2810759&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk232u737374xu642%2F Opinion statement  Prompt initiation of appropriate and intensive treatment in children with decompensated heart failure is crucial to avoid irreversible end-organ dysfunction. Initial management of these children includes transfer to the pediatric cardiac intensive care unit, basic hemodynamic monitoring, and establishment of intravenous access. Inotropic support should be instituted peripherally before obtaining central venous and arterial access. The team should be prepared for emergent intubation and initiation of mechanical circulatory support. Two experienced physicians should work together to obtain vascular access and manage sedation, airway control, and cardiovascular support. Acute heart failure syndrome in children may be related to cardiomyopathy, myocarditis, c... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2810759 Wed, 16 Sep 2009 12:31:21 +0100 2810759 http://www.medworm.com/index.php?rid=2810758&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu241q9r747027374%2F Opinion statement  Electrophysiologic studies, radiofrequency ablation, and device implantations including pacemakers and defibrillators have become essential tools in the armamentarium of electrophysiologists. These procedures are being performed in patients with complex comorbidities, many of whom chronically take anticoagulation or antiplatelet agents. Careful management of anticoagulation before, during, and after electrophysiologic procedures including device implantations is critical to minimize bleeding and thrombotic complications and to optimize patient outcomes. Content Type Journal ArticleDOI 10.1007/s11936-009-0035-3Authors Jordana KronDaniel AlexanderMark A. Wood, Virginia Commonwealth University Medical Center Gateway Building, 1200 East Marshall Street, Th... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2810758 Wed, 16 Sep 2009 12:31:21 +0100 2810758 http://www.medworm.com/index.php?rid=2810761&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft56v031132247035%2F Opinion statement  The spectrum of presentation of pediatric myocarditis ranges from minor flu-like illness with chest pain to acute cardiogenic shock in a previously healthy child. A major change in the diagnostic evaluation of myocarditis is a shift in focus away from endomyocardial biopsy and histologic confirmation toward cardiac MRI for noninvasive diagnosis and prognostication of acute myocarditis. Cardiac MRI may be particularly useful in pediatric patients, considering the risks associated with biopsy in children. Some of the MRI characteristics seen in pediatric patients with acute myocarditis also may serve as predictors of outcome. The approach to managing myocarditis varies according to the severity of presentation; it is primarily supportive while spontaneous r... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2810761 Wed, 16 Sep 2009 12:31:20 +0100 2810761 http://www.medworm.com/index.php?rid=2810762&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa4hx71h782w01p58%2F Opinion statement  Aortopulmonary window is a rare abnormal congenital communication between the pulmonary artery and the ascending aorta with intact aortic and pulmonary valves. Because pulmonary hypertension and premature death are the natural history of the uncorrected left-to-right shunt physiology that occurs with aortopulmonary window, surgical correction, which is the gold standard of treatment, should be offered to patients at the time of diagnosis, before the development of lung injury and irreversible pulmonary hypertension. Content Type Journal ArticleDOI 10.1007/s11936-009-0040-6Authors Spencer J. MelbySanjiv K. Gandhi, Washington University School of Medicine Division of Pediatric Cardiothoracic Surgery, St. Louis Children’s Hospital, Department of Surgery... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2810762 Wed, 16 Sep 2009 12:31:19 +0100 2810762 http://www.medworm.com/index.php?rid=2603625&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fq6l2222674149891%2F Opinion statement  Heart failure (HF) still poses an enormous clinical challenge, as its incidence, morbidity, and mortality rates are continuously rising. G protein-coupled receptors (GPCRs) constitute the most ubiquitous superfamily of plasma membrane receptors and represent the single most important type of therapeutic drug target. Because there is overstimulation of the failing heart by various endogenous ligands, such as catecholamines and angiotensin II—which by activating their cognate GPCRs in cardiac muscle induce detrimental effects—therapeutic targeting of these receptors has been pursued. This research has led to the development of successful and useful drug classes, such as angiotensin-converting enzyme inhibitors and β-adrenergic receptor blockers. However... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2603625 Tue, 14 Jul 2009 10:58:24 +0100 2603625 http://www.medworm.com/index.php?rid=2603624&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh37852q5h2761n17%2F Opinion statement  Milestones in the progression to heart failure following myocardial infarction (MI) are changes in left ventricular (LV) geometry and function, termed post-MI remodeling. Critical to this adverse remodeling process are changes in the expression, synthesis, and degradation of myocardial extracellular matrix (ECM) proteins. The myocardial ECM is not a passive entity but a complex and dynamic microenvironment that represents an important structural and signaling system within the myocardium. In particular, basic and clinical studies have provided conclusive evidence that abnormal and persistent activation of the ECM degradation pathway, notably through the matrix metalloproteinases (MMPs), contribute to adverse post-MI remodeling. This review examines recent... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2603624 Tue, 14 Jul 2009 10:58:24 +0100 2603624 http://www.medworm.com/index.php?rid=2607403&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fy2k722k2r2571238%2F The objective of this review is to propose a unified theory of optimal dietary fatty acid intake for CHD prevention that integrates critical insights from evolutionary, historical, global, and modern perspectives. This broad approach may be more likely than previous methods to characterize optimal fatty acid intakes. Content Type Journal ArticleDOI 10.1007/s11936-009-0030-8Authors Christopher E. Ramsden, University of North Carolina-Chapel Hill School of Medicine Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine CB# 7200 Chapel Hill NC 27599 USAKeturah R. FaurotPedro Carrera-BastosLoren CordainMichel De LorgerilLaurence S. Sperling Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-3189Print ISSN 1092-8464 Journa... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2607403 Tue, 14 Jul 2009 10:58:23 +0100 2607403 http://www.medworm.com/index.php?rid=2603627&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F061015g702307472%2F Opinion statement  Hypertension and heart failure contribute significantly to morbidity and mortality in the United States. Suboptimal control of these disease processes is multifactorial and involves poorly understood mechanisms affected by the environment (socioeconomic factors) and genetics (cell biology). Dietary sodium is an illustrative case. Although physicians intuitively accept that sodium affects renal and cardiovascular physiology, the complex overlay of genetics, environment, and culture is not practically addressed to make a meaningful difference in patient care. Optimal control of hypertension and heart failure will require a personalized care plan for each patient that includes lifestyle changes and carefully selected pharmacotherapy and also accounts for soc... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2603627 Tue, 14 Jul 2009 10:58:23 +0100 2603627 http://www.medworm.com/index.php?rid=2603626&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg2372782254w037k%2F This article reviews cell therapy clinical trials in patients with chronic HF. The three major subgroups of cells being studied in phase 1 and beginning phase 2 trials are skeletal myoblasts, bone marrow-derived mononuclear cells, and enriched subpopulations of bone marrow and cardiac stem cells. Techniques for stimulating upregulation of endogenous bone marrow progenitor cells in the circulating blood have raised serious safety issues and need to be carefully evaluated. Intracoronary infusion and both transepicardial and transendocardial direct injection of stem cells have been tested clinically and shown to be safe. Skeletal myoblast implantation has led to improved cardiac function, but studies show formation of skeletal muscle in the heart and a lack of electrical integration wit... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2603626 Tue, 14 Jul 2009 10:58:23 +0100 2603626 http://www.medworm.com/index.php?rid=2603629&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F7121811214771242%2F Opinion statement  Cardiovascular disease is as common in individuals with chronic liver disease as in the general population. Moreover, recent data suggest that patients with nonalcoholic fatty liver disease (NAFLD) may have a cardiovascular risk greater than that conferred by the conventional risk factors. There is unequivocal evidence that cardiovascular disease is an important cause of morbidity and mortality in this patient population and thus requires consideration of aggressive therapy with lipid-lowering agents such as statins. Because all statins are hepatically cleared and can cause elevations in liver biochemistries, there is a concern that patients with underlying liver disease may be at increased risk for hepatotoxicity. However, recent data, along with an asse... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2603629 Tue, 14 Jul 2009 10:58:22 +0100 2603629 http://www.medworm.com/index.php?rid=2603628&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff817216k24362313%2F Opinion statement  Data support the relevance of blood cholesterol levels, particularly high levels of low-density lipoprotein (LDL), in the pathogenesis and progression of atherosclerosis. A strong and continuous relationship between dyslipidemia and vascular morbidity and mortality has been established. The initial approach to treating dyslipidemia consists of lifestyle modifications followed by pharmacologic therapy, usually beginning with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor. Some patients with familial hypercholesterolemia (FH) fail to achieve their LDL goal despite aggressive pharmacologic therapy. In certain cases, LDL apheresis may be an effective therapeutic option. In the United States, LDL apheresis is approved for homozygous FH patients wi... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2603628 Tue, 14 Jul 2009 10:58:22 +0100 2603628 http://www.medworm.com/index.php?rid=2603630&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn46j5j5x61406057%2F Opinion statement  Although the long- and short-term safety of statin therapy is well established, statin intolerance is common in clinical practice. Muscle symptoms are the most common side effect of statin therapy and are potentially the most hazardous and the most likely to reduce patient adherence. Clinicians can establish office protocols/procedures that will reduce the number of patients with statin intolerance. Genomic variations that result in statin-associated myopathy are likely. We await diagnostic and treatment options for this group. Alternative dosing options and the use of alternative statins are useful strategies for those with muscle symptoms. Therapeutic lifestyle changes are critical to achieving maximal risk reduction but remain difficult to implement. P... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2603630 Tue, 14 Jul 2009 10:58:18 +0100 2603630 http://www.medworm.com/index.php?rid=2391239&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj66v657756x66312%2F Opinion statement  The Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial is the largest secondary stroke prevention study completed to date. It compared extended-release dipyridamole plus aspirin (eDYP-ASA) versus clopidogrel and telmisartan versus antihypertensive regimens excluding angiotensin receptor blockers (ARBs). No statistical differences were found in either arm for the primary outcome of fatal or nonfatal stroke or prespecified secondary end points. eDYP-ASA also was associated with increases in major hemorrhagic events but not with statistical increases in combined rates of stroke recurrence or hemorrhage. Despite PRoFESS, the role of ARBs post stroke remains unclear, as concomitant angiotensin-converting enzyme inhibitor use in PRoFESS ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2391239 Sat, 02 May 2009 05:50:08 +0100 2391239 http://www.medworm.com/index.php?rid=2391238&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft46807q158716287%2F Opinion statement  Neurorehabilitation is a critical part of the overall process to achieve optimal outcome after stroke. Presently, the field of neurorehabilitation is in transition. New research suggesting novel approaches to optimize functional recovery after stroke is on the horizon, but clear knowledge of the underlying mechanisms of this recovery is still being unraveled. In practice, many rehabilitation centers continue to provide traditional compensatory rehabilitation training while many others are practicing newer, “task-oriented” approaches. A few centers are incorporating new technology, such as computer-based training devices or robotics, into rehabilitation care. This transition is happening because neuroscientific research has shown that neuroplastic chan... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2391238 Sat, 02 May 2009 05:50:08 +0100 2391238 http://www.medworm.com/index.php?rid=2391240&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa227p5v2w7466q24%2F Opinion statement  Although women have a lower incidence of stroke than men in most age groups, women have an overall increased lifetime risk of stroke. Women also have unique risk factors for stroke, including the menopausal transition, the existence of debilitating vasomotor symptoms for some women, and the issues related to hormonal treatment for those symptoms. Although the initial studies of hormone therapy (HT) use in postmenopausal women suggested significant protection against heart disease, there was no obvious protection against stroke. Randomized trials of HT for secondary prevention showed a lack of benefit for both heart disease and stroke, and the suggestion of some early risk after initiation. However, the Women’s Health Initiative (WHI), a primary preventi... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2391240 Sat, 02 May 2009 05:50:07 +0100 2391240 http://www.medworm.com/index.php?rid=2391241&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh510u00021783j25%2F Opinion statement  Patients with symptomatic carotid artery stenosis should be counseled on diet, exercise, moderation of alcohol consumption, smoking cessation, and avoidance of environmental tobacco smoke. Medical therapy generally includes a platelet antiaggregant, blood pressure control, and a statin. Other medical therapy depends on specific patient characteristics. Carotid endarterectomy in addition to best medical therapy is of proven benefit in reducing the risk of ipsilateral stroke compared with best medical therapy alone in patients with symptomatic high-grade stenosis, provided the operation can be performed safely. Although limited, data are available to support carotid angioplasty/stenting in patients with symptomatic high-grade stenosis in whom endarterectomy ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2391241 Sat, 02 May 2009 05:50:06 +0100 2391241 http://www.medworm.com/index.php?rid=2391242&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F98p4803562q56582%2F Opinion statement  Intracranial atherosclerosis represents the most prevalent form of intracranial vascular occlusive disease in the adult population and is a major contributor to is chemic stroke. The most reliable method for diagnosing intracranial stenosis relies on conventional catheter angiography; MRI and CT imaging and transcranial Doppler currently are valuable screening tools, and ongoing advances in these modalities may render angiography nonessential for accurate diagnosis in the future. Given the potential for hemodynamic compromise from intracranial occlusive disease, a variety of imaging modalities may be used to assess the adequacy of cerebral perfusion, relying on direct measurements of oxygen extraction fraction or the response to vasodilatory stimuli to det... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2391242 Sat, 02 May 2009 05:50:05 +0100 2391242 http://www.medworm.com/index.php?rid=2391243&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F8w5547vg484896k4%2F Opinion statement  Aspirin has been shown to reduce the risk of stroke, myocardial infarction, and death in patients with a history of cardiovascular disease or at high risk for cardiovascular disease. However, many individuals suffer a stroke or other cardiovascular event despite aspirin therapy. Data suggest that heritability contributes importantly to the antiplatelet and clinical responses to aspirin. Candidate genes for influencing aspirin response include those involved in platelet aggregation and in modulating cardiovascular disease risk and progression. Although several studies have examined genetic determinants of platelet responsiveness to aspirin, the results are largely inconsistent. Few studies have examined genetic association with clinical outcomes, including ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2391243 Sat, 02 May 2009 05:50:04 +0100 2391243 http://www.medworm.com/index.php?rid=2391245&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fp43664771315w657%2F Opinion statement  Medical science relies uniquely on statistical evidence from large clinical trials or laboratory experiments to deal with uncertainties regarding clinical decisions. The statistical evidence is stated in probabilities. Probability theory is based on the logical rules set forth by Aristotle: the law of noncontradiction, excluded middle, and identity. Thus, medical science assumes that variables such as disease and treatment relate or interact only in certain ways and the statistical evidence defines the presence of these relations. Experiments seek to find these certain predefined relations among variables, relations that then predict in terms of probabilities their behavior over time. Living systems are nonlinear and complex, which means that the relation... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2391245 Sat, 02 May 2009 05:50:03 +0100 2391245 http://www.medworm.com/index.php?rid=2391244&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fp21h8815770v81k0%2F This article presents an overview of the recommendations for the optimum control of blood glucose for prevention and treatment of ischemic and hemorrhagic stroke. Content Type Journal ArticleDOI 10.1007/s11936-009-0021-9Authors Veronique GuyomardPhyo Kyaw Myint, University of East Anglia School of Medicine, Health Policy and Practice Chancellors Drive, Norwich NR4 7TJ Norfolk UK Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-3189Print ISSN 1092-8464 Journal Volume Volume 11 Journal Issue Volume 11, Number 3 / June, 2009 (Source: Current Treatment Options in Cardiovascular Medicine) Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2391244 Sat, 02 May 2009 05:50:03 +0100 2391244 http://www.medworm.com/index.php?rid=2262685&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr55m488288x23pt7%2F Opinion statement  Spontaneous and traumatic cervical artery dissection is a common cause of stroke in the young. It generally carries an excellent prognosis if treatment is initiated early. Antiplatelet therapy may be as effective as or safer than warfarin, although no randomized prospective studies have addressed the issue of optimal medical therapy. Rarely, endovascular therapy may be indicated for the treatment of ruptured aneurysms or to prevent recurrent ischemia. Content Type Journal ArticleDOI 10.1007/s11936-009-0017-5Authors Alex Abou-Chebl, The Cleveland Clinic Foundation Section of Stroke and Neurological Critical Care 9500 Euclid Avenue Cleveland OH 44195 USA Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-3189Print ISSN 109... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2262685 Tue, 10 Mar 2009 08:11:57 +0100 2262685 http://www.medworm.com/index.php?rid=2262687&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg5g7432210425143%2F Opinion statement  Low molecular weight heparins (LMWHs) appear to be as safe and effective as unfractionated heparin (UFH) for venous thromboembolic disease (VTED) treatment or prophylaxis during pregnancy. Experience with other parenteral anticoagulant drugs is very limited, and no alternative oral anticoagulants are available to date. In addition to cost, challenges of long-term LMWH use during pregnancy that have not been addressed by controlled clinical trials include a) ideal dosing as pregnancy advances, b) the need for LMWH monitoring by anti-Xa activity levels, and c) ideal therapeutic management as the delivery date nears. Because therapeutic-intensity anticoagulation during pregnancy is challenging, many practitioners favor a more “aggressive” approach toward... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2262687 Tue, 10 Mar 2009 08:11:56 +0100 2262687 http://www.medworm.com/index.php?rid=2262686&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F102hg425w20g6245%2F Opinion statement  Acute aortic syndrome (AAS) encompasses a group of life-threatening aortic disorders that are increasing in prevalence. It classically presents with abrupt-onset chest pain that is of maximum intensity at onset. The syndrome requires prompt recognition and efficient treatment to optimize outcome. Contrast-enhanced CT is most commonly used as the definitive diagnostic imaging modality. Patients must be expeditiously transferred to institutions with case experience and medical, surgical, and endovascular expertise. Stanford type A dissections involve the ascending aorta and require emergent surgical consideration, unless underlying comorbidities make surgical risk prohibitive. Patients with Stanford type B, or descending, aortic dissection are less prone to... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2262686 Tue, 10 Mar 2009 08:11:56 +0100 2262686 http://www.medworm.com/index.php?rid=2262689&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F853745130176g398%2F Opinion statement  The incorporation of endovascular interventions into mainstream clinical practice for patients with deep vein thrombosis (DVT) has been changing rapidly as a result of four major trends. First, there now is a much greater appreciation among practicing physicians of the major impact of the postthrombotic syndrome (PTS) on DVT patients’ late quality of life. Second, there have been rapid advances in the methods by which thrombus can be rapidly removed using endovascular techniques, resulting in greater efficiency and treatment safety. Third, these changes together have spurred a major change in recommended DVT treatment paradigms: there is now published expert consensus that adjunctive endovascular DVT thrombolysis should be strongly considered as a first-... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2262689 Tue, 10 Mar 2009 08:11:55 +0100 2262689 http://www.medworm.com/index.php?rid=2262694&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx5246wlm75014071%2F Opinion statement  Abdominal aortic aneurysms (AAAs) continue to be a leading cause of death, with increasing incidence and prevalence. Endovascular aneurysm repair (EVAR) now represents the most common method of AAA repair in the United States. Ongoing improvements in endovascular stent-graft technology have occurred since the first published report of EVAR in 1991. These improvements have led to multiple US Food and Drug Administration-approved devices, streamlined operative techniques, and extended applicability of EVAR. Despite these facts, basic anatomic considerations still eliminate many patients from being offered EVAR. Distinct advantages of EVAR over open repair have been demonstrated, including a less invasive operative exposure, decreased transfusion requirements... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2262694 Tue, 10 Mar 2009 08:11:53 +0100 2262694 http://www.medworm.com/index.php?rid=2262692&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F7x5828v346j2p474%2F Opinion statement  Varicose veins (VVs) are the most common manifestation of chronic venous insufficiency, affecting 25% of women and 15% of men. Reticular veins and telangiectasias (spider veins) are found in more than 80% of the general population. VVs produce symptoms of pain, swelling, heaviness, fatigue, and pruritus and predispose patients to complications including bleeding, superficial thrombophlebitis, and ulcerations that interfere with activities of daily living and result in lost time from work. Current treatments for VVs include conservative measures, and when these are unsuccessful, more invasive surgical and endovenous interventions primarily aimed at reducing venous hypertension and preventing progression to chronic inflammation and ulcerations. Surgical pro... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2262692 Tue, 10 Mar 2009 08:11:53 +0100 2262692 http://www.medworm.com/index.php?rid=2262690&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff11827808vk04135%2F Abstract  As venous thrombosis is mostly caused by disturbances in the plasma coagulation system, abnormalities of coagulation factors are mostly risk factors for venous thromboembolism (VTE). Relatively little is known about thrombophilias that predispose to arterial thromboembolism. Although some abnormalities in the fibrinolytic pathway appear to predispose to arterial thrombosis, the associations are weak and often inconsistent between studies. At present, there is not enough consistent and clinically meaningful information to include fibrinolytic parameters in a clinical thrombophilia workup. Controversy exists as to which patients and family members to test for thrombophilia. Several testing guidelines exist. Routine screening for inherited thrombophilias is not indic... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2262690 Tue, 10 Mar 2009 08:11:53 +0100 2262690 http://www.medworm.com/index.php?rid=2262698&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw5n76840g3828x25%2F Opinion statement  Thoracic outlet syndrome (TOS) is a condition caused by compression of the neurovascular structures leading to the arm passing through the thoracic outlet. There are three distinct types of TOS: neurogenic (95%), venous (4%–5%), and arterial (1%). Treatment algorithms depend on the type of TOS. Although statistically the most common type, neurogenic TOS can often be the most difficult to diagnose and treat. We have good follow-up data indicating that appropriately selected patients benefit from surgical intervention. Arterial and venous TOS often present more urgently with arterial or venous thrombosis. The thrombosis is typically recognized expeditiously by thorough history taking and physical examination, augmented by duplex ultrasonography. The restor... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2262698 Tue, 10 Mar 2009 08:11:52 +0100 2262698 http://www.medworm.com/index.php?rid=2262696&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F6717r247266562hl%2F This article reviews four uncommon vascular causes of exercise-induced limb discomfort: popliteal artery entrapment syndrome, cystic adventitial disease of the popliteal artery, fibromuscular dysplasia of the lower-extremity arteries, and endofibrosis of the iliac artery. Content Type Journal ArticleDOI 10.1007/s11936-009-0016-6Authors Ethan C. KorngoldMichael R. Jaff, Massachusetts General Hospital Section of Vascular Medicine, Division of Cardiovascular Medicine 55 Fruit Street, Gray-Bigelow 832 Boston MA 02114 USA Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-3189Print ISSN 1092-8464 Journal Volume Volume 11 Journal Issue Volume 11, Number 2 / April, 2009 (Source: Current Treatment Options in Cardiovascular Medicine) Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2262696 Tue, 10 Mar 2009 08:11:52 +0100 2262696 http://www.medworm.com/index.php?rid=2098014&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fxv543543006h3708%2F Opinion statement  Medical and catheter-based therapies play complementary roles in treating patients with stable coronary atherosclerosis. The choice of therapy (or therapies) must be made for each patient based on coronary anatomic suitability and in the context of the patient’s lifestyle, functional capacity, level of symptom limitation, and ability to take the prescribed treatment. Objective evidence of myocardial ischemia on nuclear myocardial scintigraphy is quantitatively correlated with the occurrence of death or myocardial infarction in late follow-up, and percutaneous coronary intervention added to optimal medical therapy is more effective than medical therapy alone in reducing ischemia. Coronary angiography and definition of the coronary anatomy should be perfo... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2098014 Sun, 11 Jan 2009 06:43:53 +0100 2098014 http://www.medworm.com/index.php?rid=2098016&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F61m3x28180521489%2F Abstract  Despite advances in medical and surgical therapy for patients with heart disease, sudden cardiac death remains an important public health problem that prematurely ends the lives of more than 300,000 persons each year in North America. Many of these deaths occur in patients with a history of myocardial infarction (MI). Although severe left ventricular (LV) systolic dysfunction is used to identify patients at risk of sudden death after MI, most cardiac arrests occur in those with only mild LV dysfunction. Further, severe LV dysfunction is not a specific indicator for cardiac arrest. Risk stratification, to identify patients most likely to benefit from implantable defibrillator therapy after MI, is an essential area of investigation. Because the development of cardia... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2098016 Sun, 11 Jan 2009 06:43:52 +0100 2098016 http://www.medworm.com/index.php?rid=2098015&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fe356654l6v507618%2F Opinion statement  Results from pharmacodynamic and translational research studies assessing platelet reactivity have highlighted the limitations of current oral antiplatelet therapy. The data from translational research studies present strong arguments against the “one-size-fits-all” approach that has been used in large-scale clinical trials. At one end of the spectrum, selected patients with excessively low on-treatment platelet reactivity may have unnecessary bleeding, whereas patients with high platelet reactivity may experience ischemic events. Current evidence suggests that high on-treatment platelet reactivity will become a major risk factor determined as standard of care in patients with cardiovascular diseases. Future translational research holds the promise of ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2098015 Sun, 11 Jan 2009 06:43:52 +0100 2098015 http://www.medworm.com/index.php?rid=2098018&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd52w5pp34570w277%2F Opinion statement  During major vascular surgery (MVS), patients are at high risk for developing unrecognized myocardial infarction (MI) and myocardial ischemia. In reducing postoperative morbidity and mortality, preoperative cardiac risk stratification and adequate medical therapy play a pivotal role. Based on literature and current opinions, medical treatment should comprise at least a combination of β-blockers, aspirin, and statins. β-Blockers exert their beneficial effects predominantly through heart rate control, leading to reduced oxygen demand during surgery. A heart rate between 65 and 70 bpm should be achieved. Irrespective of their lipid-lowering effects, statins seem to improve postoperative cardiac outcome by stabilizing coronary artery plaques, thereby preven... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2098018 Sun, 11 Jan 2009 06:43:51 +0100 2098018 http://www.medworm.com/index.php?rid=2098017&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm514176856126n23%2F Opinion statement  Sudden cardiac death (SCD) is responsible for most deaths related to heart disease. Risk stratification in patients with ischemic heart disease can identify patients at increased risk of sudden death who may derive a mortality benefit from an implantable defibrillator. The most commonly used clinical variable for risk stratification and selection of patients for implantable cardioverter-defibrillator (ICD) therapy for primary prevention of sudden death is left ventricular ejection fraction. Because many sudden deaths occur in patients without common high-risk variables and many patients with ICDs do not receive device therapy, further investigation is warranted to improve risk stratification and patient selection for defibrillator therapy. Content Type ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2098017 Sun, 11 Jan 2009 06:43:51 +0100 2098017 http://www.medworm.com/index.php?rid=2098019&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl451n405nuu2j4m6%2F Opinion statement  Refractory angina pectoris, defined as angina refractory to maximal medical therapy and standard coronary revascularization procedures, remains a significant health problem in the United States and the world. Despite a panoply of recent therapeutic advances, patients with refractory angina pectoris are not adequately treated; therefore, scientists have been investigating new technologies to help these patients. The technique of counterpulsation, studied for almost half a century, is considered a safe, highly beneficial, low-cost, noninvasive treatment for these angina patients and now also for those with heart failure. Recent evidence suggests that enhanced external counterpulsation (EECP) therapy may improve symptoms and decrease long-term morbidity via ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2098019 Sun, 11 Jan 2009 06:43:47 +0100 2098019 http://www.medworm.com/index.php?rid=2098020&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb58g81j2211t5t53%2F Opinion statement  Although contrast-induced nephropathy (CIN) is usually self-limited, it may cause permanent renal injury and even lead to long-term dialysis in patients with preexisting renal impairment. Cardiologists face a dilemma as to whether to alleviate coronary syndromes by coronary intervention or to risk CIN in these patients. Strategies to prevent CIN, including hydration, use of low-osmolal or iso-osmolal contrast media, administration of N-acetylcysteine, and blood purification procedures, were proposed to be effective; however, there are conflicting results. Recently, we found that prophylactic hemodialysis could significantly improve renal survival in patients with advanced renal insufficiency undergoing coronary angiography in a randomized controlled trial.... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2098020 Sun, 11 Jan 2009 06:43:46 +0100 2098020 http://www.medworm.com/index.php?rid=2098022&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft56g22kl75644128%2F Opinion statement  Heart failure with preserved ejection fraction (HFpEF) is a major public health problem in the United States. However, in contrast to systolic heart failure, there are little data to guide treatment decisions in HFpEF, and no therapies have been shown to improve outcome in these patients. This review explores what is currently known about the pathophysiologic mechanisms causing HFpEF in order to frame appropriate therapeutic targets and better understand the clinical responses commonly observed in patients with HFpEF. Data from published clinical trials are reviewed, and the roles for each class of drug commonly used in practice are examined. Finally, novel therapies and future directions for basic investigation and clinical trials are discussed. Conten... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2098022 Sun, 11 Jan 2009 06:43:45 +0100 2098022 http://www.medworm.com/index.php?rid=2098021&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F375k140187up3611%2F Opinion statement  The options for coronary revascularization broadened in recent years with the introduction of bare-metal stents in the 1990s and drug-eluting stents in 2003. Since then, the rates of percutaneous coronary intervention (PCI) have increased whereas the use of coronary artery bypass grafting (CABG) has decreased. Although historically there have been disparities in the use of revascularization procedures in women, the elderly, and nonwhite patients, there is some evidence to suggest these gaps have narrowed in recent years. In any given clinical circumstance, there is ongoing debate as to whether PCI or CABG is the more appropriate revascularization method depending on coronary anatomy, ventricular function, and associated conditions. Also, trends in coronar... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=2098021 Sun, 11 Jan 2009 06:43:45 +0100 2098021 http://www.medworm.com/index.php?rid=1991261&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fyu12281kq5566g12%2F Opinion statement  The incidence of stroke in patients with atrial fibrillation (AF) is five times greater than that in age-matched controls. Warfarin reduces this incidence by two thirds and is the most effective agent for this indication. However, despite its efficacy, warfarin management is tedious and is useful only in a subsegment of the population who needs anticoagulation and has no contraindications. Many agents are poised to replace warfarin as an effective anticoagulant for stroke prevention in AF. The direct thrombin inhibitor dabigatran is furthest along in clinical development, followed by the factor Xa inhibitors rivaroxaban and apixaban. All these agents seem effective, and none appears mechanistically superior over another. Dabigatran’s advantage is that it... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1991261 Tue, 25 Nov 2008 06:58:21 +0100 1991261 http://www.medworm.com/index.php?rid=1991266&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd111xr4r6137r0l7%2F This article discusses the role of cardiac MRI, methods of evaluation, and newer application of MRI in evaluating congenital heart disease in pediatric and young adult patients. Content Type Journal ArticleDOI 10.1007/s11936-008-0033-xAuthors Pamela K. Woodard, Washington University School of Medicine Mallinckrodt Institute of Radiology 510 South Kingshighway Boulevard St. Louis MO 63110 USASanjeev BhallaCylen Javidan-NejadAndrew BierhalsFernando R. GutierrezGautam K. Singh Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-3189Print ISSN 1092-8464 Journal Volume Volume 10 Journal Issue Volume 10, Number 5 / October, 2008 (Source: Current Treatment Options in Cardiovascular Medicine) Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1991266 Tue, 25 Nov 2008 06:58:20 +0100 1991266 http://www.medworm.com/index.php?rid=1991265&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fwr16131l302r5320%2F This article reviews clinical and mechanistic studies that may explain the effects of these agents on ischemic arrhythmias, sudden death, and atrial fibrillation. Content Type Journal ArticleDOI 10.1007/s11936-008-0031-zAuthors Mina K. Chung, Cleveland Clinic Department of Cardiovascular Medicine 9500 Euclid Avenue, F-15 Cleveland OH 44195 USA Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-3189Print ISSN 1092-8464 Journal Volume Volume 10 Journal Issue Volume 10, Number 5 / October, 2008 (Source: Current Treatment Options in Cardiovascular Medicine) Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1991265 Tue, 25 Nov 2008 06:58:20 +0100 1991265 http://www.medworm.com/index.php?rid=1991264&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw17610g105312273%2F Opinion statement  Expansion of indications for implantable cardioverter-defibrillators (ICDs) has led to a significant increase in the number of patients receiving ICDs and the number of lives saved because of ICD therapy. However, appropriate or inappropriate shocks are frequent and may result in a significant decrease in quality of life in patients with ICDs. Atrial fibrillation with rapid ventricular response, sinus tachycardia, atrial tachycardia or atrial flutter with rapid conduction, and other supraventricular tachycardias are the most common arrhythmias causing inappropriate therapy. Other causes include oversensing of diaphragmatic potentials or myopotentials, T-wave oversensing, double or triple counting of intracardiac signals, lead fractures or header connectio... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1991264 Tue, 25 Nov 2008 06:58:20 +0100 1991264 http://www.medworm.com/index.php?rid=1991263&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn11411667820ru2q%2F Opinion statement  Recent advances in multidetector CT have made this modality an important part of congenital heart disease (CHD) evaluation in young patients. Faster scanning techniques combined with improved spatial resolution allow for exquisite postprocessing, enabling accurate preoperative and postoperative anatomic depiction. To optimize this technique, one must have a structured approach to the patient with CHD. Content Type Journal ArticleDOI 10.1007/s11936-008-0034-9Authors Sanjeev Bhalla, Washington University School of Medicine Cardiothoracic Imaging Section, Mallinckrodt Institute of Radiology 510 South Kingshighway St. Louis MO 63110 USACylen Javidan-NejadAndrew J. BierhalsPamela K. WoodardFernando R. Gutierrez Journal Current Treatment Options in Car... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1991263 Tue, 25 Nov 2008 06:58:20 +0100 1991263 http://www.medworm.com/index.php?rid=1991262&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff0651638475524q7%2F Opinion statement  Indications for cardiac electrophysiologic device implantation have expanded, and the target demographic has widened. Unfortunately, these changes have been accompanied by an increase in cardiac device-associated infections out of proportion to the increase in implantation rate. Diagnosing a cardiac device infection may be challenging because of the spectrum of clinical manifestations, ranging from isolated generator pocket pain to frank sepsis with clear evidence of endocarditis. Any component of the device may be involved, but the cornerstone of therapy remains extraction of the device and its leads along with appropriate antibiotic treatment. Given the inherent risks of lead extraction, making the correct diagnosis is paramount. This review outlines the... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1991262 Tue, 25 Nov 2008 06:58:20 +0100 1991262 http://www.medworm.com/index.php?rid=1991270&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb4767t7n0k2h3427%2F Opinion statement  Heart failure is one of the most common medical problems faced by patients and clinicians. It has the potential for high morbidity and mortality, and its overall financial cost to society is enormous. Management of heart failure is often difficult and time consuming, and is sometimes frustrating. The usual signs and symptoms of heart failure may not be obvious early in an exacerbation, which has prompted the development of other methods to identify early and subtle clinical changes to initiate early intervention. Current implantable devices, such as defibrillators and pacemakers, can monitor changes in heart rate and heart rate variability, patient activity, arrhythmia frequency, and thoracic impedance, all of which may be markers of clinical decline. Newe... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1991270 Tue, 25 Nov 2008 06:58:19 +0100 1991270 http://www.medworm.com/index.php?rid=1991269&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk57275645t2324x4%2F Opinion statement  Double-outlet left ventricle (DOLV) is a rare congenital cardiac malformation in which both great arteries originate entirely or predominantly from the morphologic left ventricle. DOLV occurs most commonly in the form of atrial situs solitus with atrioventricular (AV) concordance. Ventricular septal defect (VSD) is most commonly subaortic, and 90% of these patients have associated pulmonary stenosis. In most cases, there is a right anterior position of the aorta relative to the pulmonary artery. Most patients with DOLV will have pulmonary outflow obstruction and present soon after birth with cyanosis. DOLV with two well-developed ventricles is conventionally treated surgically by VSD closure, closure of the native left ventricle-to-pulmonary outflow, and p... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1991269 Tue, 25 Nov 2008 06:58:19 +0100 1991269 http://www.medworm.com/index.php?rid=1991268&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fc824320q06318k52%2F Opinion statement  Hypertrophic cardiomyopathy (HCM) is the most prevalent genetic cardiomyopathy in children and young adults. Despite advances in understanding the molecular etiology of this disorder, the clinical phenotypes vary widely from asymptomatic septal hypertrophy, to frank congestive heart failure due to left ventricular outflow tract obstruction (LVOTO), to unexpected sudden cardiac death. Thus, isolating a specific genetic defect in this disease does little to predict the clinical consequence. This is best seen in large families with several people affected by HCM who all have the identical mutation but who may have very different clinical phenotypes. Evaluating individuals with HCM consists of establishing the diagnosis through cardiac imaging, noninvasively ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1991268 Tue, 25 Nov 2008 06:58:19 +0100 1991268 http://www.medworm.com/index.php?rid=1991267&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fc445293t86m1381w%2F This article discusses only primary ventricular tachycardia. The incidence clearly increases with age after cardiac surgery, particularly in specific cardiac abnormalities, such as tetralogy of Fallot post repair, transposition of the great arteries, post atrial switch operation, and hypertrophic obstructive cardiomyopathy. In addition, as genetic abnormalities are becoming better appreciated, conditions such as long QT syndrome, arrhythmogenic right ventricular cardiomyopathy, and Brugada syndrome, with their risk for ventricular tachycardia and fibrillation, are being seen increasingly in the pediatric population. Long-term treatment of ventricular tachycardia includes drug therapy, implantable device therapy, invasive ablation therapy, and combinations of these modalities. To choo... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1991267 Tue, 25 Nov 2008 06:58:19 +0100 1991267 http://www.medworm.com/index.php?rid=1985065&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F234r0074333h0794%2F Opinion statement  Patients with abnormalities of left ventricular (LV) systolic or diastolic function may have no symptoms, especially in the early stages. These patients are not uncommon in the community, and the prevalence of this condition increases in the presence of risk factors such as diabetes, hypertension, and coronary artery disease. Patients with asymptomatic LV dysfunction have a significantly increased risk of overt heart failure and mortality. Therefore, it is of prime importance to identify and treat these patients to prevent progression of the disease. Echocardiography is an excellent tool to characterize systolic and diastolic properties of the left ventricle. However, its cost and lack of widespread availability have limited its usefulness in screening th... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1985065 Sun, 23 Nov 2008 06:50:00 +0100 1985065 http://www.medworm.com/index.php?rid=1985064&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj81j5ht836382832%2F Opinion statement  Chemotherapy (CT)-induced cardiotoxicity remains an unresolved problem that strongly affects the quality of life and overall survival of cancer patients. The most typical form of cardiotoxicity, a dilated cardiomyopathy (CMP), usually becomes manifest late in the course of the disease and is classically considered to be refractory to therapy. Preventing cardiotoxicity remains the most important strategy, and several measures have been proposed, including cardiac function monitoring, limitation of CT dose, use of anthracycline analogues and cardioprotectants, and early detection of cardiotoxicity by biomarkers. The response to modern heart failure therapy of CT-induced CMP has never been evaluated in clinical trials, and no definite guidelines have been ad... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1985064 Sun, 23 Nov 2008 06:50:00 +0100 1985064 http://www.medworm.com/index.php?rid=1985063&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F3174q473622u6387%2F Opinion statement  Hypertrophic cardiomyopathy is a heterogeneous clinical syndrome with a wide spectrum of pathophysiologic consequences. Most cases are inherited and caused by sarcomeric protein gene mutations, although phenocopies are often encountered. Genomic research and family studies have improved our recognition of the disease and understanding of its natural history; however, tenuous links exist between genotype and phenotype and thus far have done little to alter clinical management. Surgery and, more recently, implantable cardiac defibrillators have had an impact on sudden cardiac death rates, with improved short-and medium-term survival. Therefore, managing heart failure has become increasingly challenging. Although heart failure due to fibrosis and a progressiv... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1985063 Sun, 23 Nov 2008 06:50:00 +0100 1985063 http://www.medworm.com/index.php?rid=1985068&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg273g12722g77471%2F Opinion statement  It is now well established that electrical and mechanical dyssynchrony are not clinically synonymous; however, at present no individual noninvasive method can reliably and consistently identify the criteria for mechanical dysfunction correctable through device therapy. The results of the PROSPECT (Predictors of Response to CRT) trial not only highlight the complicated nature of this dilemma, but also emphasize the importance of broadening our approach to this topic. Not only do the capabilities of real-time three-dimensional echocardiography and cardiac magnetic resonance imaging need to be maximized, but the strengths and weaknesses of each modality need to be more selectively matched to the heterogeneity of this particular patient population and subsequ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1985068 Sun, 23 Nov 2008 06:49:59 +0100 1985068 http://www.medworm.com/index.php?rid=1985067&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F18ru35357470078r%2F Opinion statement  Anemia is a prevalent comorbidity in chronic heart failure (CHF). As studies have demonstrated close links between anemia and a poorer prognosis, there has been an interest in developing treatment strategies for this condition. Anemia is closely associated with disease severity and may be secondary to multiple modifiable causes; therefore, the initial strategies should always include a thorough search for etiology and should focus on optimizing heart failure treatment. Recently, more specific therapies have been assessed, namely erythropoiesis-stimulating agents and iron supplementation therapy. Studies evaluating erythropoietin in heart failure have demonstrated conflicting results to date, with smaller, singlecenter studies seeming to show a clinical be... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1985067 Sun, 23 Nov 2008 06:49:59 +0100 1985067 http://www.medworm.com/index.php?rid=1985066&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh4431358n601256w%2F Opinion statement  Diabetes mellitus and heart failure (HF) commonly coexist, and together these conditions are associated with increased morbidity and mortality compared with either condition alone. Although the optimal treatment strategy to achieve glucose control in HF patients with type 2 diabetes has not been well studied, given the common coexistence of these conditions and the need to adequately treat hyperglycemia to prevent microvascular complications, it is important for clinicians to understand the potential implications of diabetic therapy in patients with established HF. Until recently, metformin was contraindicated in patients with HF because of the potential risk of lactic acidosis; however, recent retrospective studies of metformin use in HF patients have sh... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1985066 Sun, 23 Nov 2008 06:49:59 +0100 1985066 http://www.medworm.com/index.php?rid=1985070&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff247220378028537%2F Opinion statement  Of the more than 5 million Americans who have heart failure (HF), 30% to 50% have HF with preserved ejection fraction (HF-PEF). HF-PEF commonly occurs in elderly patients, especially women, with comorbidities of hypertension, left ventricular hypertrophy, diabetes, myocardial ischemia, and obesity. HF-PEF is associated with high morbidity and mortality. Although two large multicenter randomized, placebo-controlled trials evaluating an angiotensin-converting enzyme inhibitor (ACEI) and an angiotensin receptor blocker (ARB) in patients with HFPEF did not demonstrate any statistically significant benefit in their primary end points, they did suggest that these agents may have a modest role in reducing HF hospitalizations. Although calcium channel blockers an... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1985070 Sun, 23 Nov 2008 06:49:58 +0100 1985070 http://www.medworm.com/index.php?rid=1985069&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff472713w84576181%2F This article reviews recent developments in the pathophysiology and management of ischemic mitral regurgitation. Recent imaging studies using three-dimensional echocardiography have added clarity to the mechanism responsible for this condition. This article also discusses recent studies on outcomes of surgical repair, including current results and potential risks of restrictive annuloplasty. Because of the limitations imposed by restrictive annuloplasty, adjunctive surgical methods focusing on the left ventricle or papillary muscles are being investigated to address this disease. In the interim, a downsized complete rigid or semirigid annuloplasty repair appears to offer good midterm outcomes. Content Type Journal ArticleDOI 10.1007/s11936-008-0045-6Authors Anelechi C. AnyanwuDav... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1985069 Sun, 23 Nov 2008 06:49:58 +0100 1985069 http://www.medworm.com/index.php?rid=1985071&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx2768m80g140h420%2F Opinion statement  The population of adults with congenital heart disease (CHD) is growing to the extent that there are now more adults than children with CHD. As this population ages, these patients will need optimal medical care, will be at risk for clinically significant noncardiac comorbidities, and will require methods to decrease adverse outcomes. Recognition of extracardiac risk factors and a multidisciplinary approach to management are essential in caring for this unique group of patients. Content Type Journal ArticleDOI 10.1007/s11936-008-0043-8Authors Michael N. Singh, Children’s Hospital Boston/Brigham and Women’s Hospital Department of Cardiology 300 Longwood Avenue Boston MA 02115 USA Journal Current Treatment Options in Cardiovascular MedicineOnli... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1985071 Sun, 23 Nov 2008 06:49:57 +0100 1985071 http://www.medworm.com/index.php?rid=1482153&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F7647103703787301%2F Opinion statement  The goals of microsurgical and endovascular treatment of intracranial aneurysms are to prevent subarachnoid hemorrhage and/or eliminate mass effect symptoms. Debate has raged regarding which aneurysms to treat and with which technique or combination of techniques. It is our impression that studies that have assessed aneurysm natural history and treatment options are compromised by the inherent limitations of clinical trials, with many natural history studies likely underestimating rupture risk over long-term follow-up. Endovascular therapy and open neurosurgery should both be used strategically, and our current interest is in integrating these techniques in a fashion extending beyond the simplistic clip-versus-coil debate. Content Type Journal ArticleDO... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1482153 Thu, 29 May 2008 06:55:56 +0100 1482153 http://www.medworm.com/index.php?rid=1482155&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn531qx7155321204%2F Opinion statement  Patients with recent ischemic stroke or transient ischemic attack (TIA) face a high risk of recurrent stroke as well as an increased risk of myocardial infarction and sudden cardiac death. In the absence of a clearly established indication for long-term anticoagulation, such as atrial fibrillation, antiplatelet agents are the antithrombotic drugs of choice for preventing recurrent vascular events. For many years, aspirin (ASA) has been the first-line therapy for patients at high risk of vascular ischemic events. Two large clinical trials have established the superiority of the combination of ASA and extended-release dipyridamole (ASA/ERDP) over ASA alone in patients with recent noncardioembolic ischemic stroke or TIA. Clopidogrel, another antiplatelet age... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1482155 Thu, 29 May 2008 06:55:55 +0100 1482155 http://www.medworm.com/index.php?rid=1482154&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx3p6452133k7v685%2F Opinion statement  Intracerebral hemorrhage (ICH) remains the least treatable form of stroke. Despite ongoing attempts to find effective interventions based on the physiopathologic understanding of this disease, evidence-based medical therapies for ICH are limited to recommendations on blood pressure (BP) reduction, intracranial pressure monitoring, osmotherapy with adequate fluid resuscitation, fever and glycemic control, and seizure prophylaxis. Although the value of surgical treatment remains in doubt because of the negative results of the International Surgical Trial in Intracerebral Haemorrhage (STICH), a subgroup analysis of this study suggested better outcomes among patients with superficial hematomas who underwent surgical evacuation, supporting the ongoing STICH-II ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1482154 Thu, 29 May 2008 06:55:55 +0100 1482154 http://www.medworm.com/index.php?rid=1482156&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fev171115w5134u58%2F Opinion statement  Pseudobulbar affect (PBA) is a disorder of emotional regulation characterized by uncontrollable outbursts of laughing and/or crying that are disproportionate to the emotions being experienced. The pathophysiology of PBA is currently unknown, although the disorder is thought to occur exclusively in the setting of neurologic disease, including stroke. The most influential theory on PBA posits that emotional outbursts are being generated in the brainstem autonomously due to loss of regulatory control by the frontal lobes. Although rarely life threatening, PBA can have significant impact on patients’ quality of life and thus merits treatment. Although currently there are no treatments approved by the Food and Drug Administration (FDA) for PBA, tricyclic ant... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1482156 Thu, 29 May 2008 06:55:54 +0100 1482156 http://www.medworm.com/index.php?rid=1482157&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F6k83822527v24487%2F Opinion statement  Elevated serum low-density lipoprotein cholesterol (LDL-C) and low serum highdensity lipoprotein cholesterol (HDL-C) are risk factors for atherosclerotic ischemic stroke. The National Cholesterol Education Panel and the American Heart Association have released guidelines for the treatment of dyslipidemia that stress LDL-C reduction using HMG CoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase inhibitors (statins) and are applicable to individuals who have had or are at a high risk of having a stroke. Treatment of low HDL-C is a secondary goal of these guidelines and can be best achieved by using extended-release niacin (alone or in combination with statins) and fibrates. Early and aggressive treatment of dyslipidemia is an important component of a multi... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1482157 Thu, 29 May 2008 06:55:53 +0100 1482157 http://www.medworm.com/index.php?rid=1482158&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw0jw868322761142%2F Opinion statement  Atherosclerosis follows the deposition, retention, and oxidative modification of lipoproteins, especially low-density lipoprotein (LDL) in the walls of large arteries. Uptake of oxidized LDL results in the formation of macrophage foam cells. Proliferation of vascular smooth muscle cells and secretion of extracellular matrix contribute “fibrous” components of the plaque, whereas ongoing accumulation of lipid and inflammatory cell debris forms the necrotic lipid core of the mature atherosclerotic plaque. Both the size and composition of plaques determine the clinical course. In particular, a large lipid core, thin fibrous cap, dense inflammatory cell infiltrate, and proteolytic enzyme activity are associated with adverse risk. Atherosclerosis has often ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1482158 Thu, 29 May 2008 06:55:52 +0100 1482158 http://www.medworm.com/index.php?rid=1482160&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd8643754313n41hl%2F Opinion statement  Young patients with migraine are at increased risk for stroke, particularly patients with an aura of focal neurologic deficits. Other causes of ischemia are often identified in patients with migraine, including patent foramen ovale, lupus anticoagulant, cervical carotid dissection, arteriovenous malformation, and hyperactivity of the clotting system. Migrainous stroke is only diagnosed when all other possible causes of stroke have been eliminated and the patient has irreversibility of the usual aura, associated with an ischemic infarct in the appropriate brain territory. Prophylactic therapy of migraine with aura may be beneficial in preventing migrainous stroke. Content Type Journal ArticleDOI 10.1007/s11936-008-0027-8Authors Jesse Weinberger, The Mo... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1482160 Thu, 29 May 2008 06:55:51 +0100 1482160 http://www.medworm.com/index.php?rid=1482159&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm1856l88717237r1%2F Opinion statement  In recent years, institutional bodies and scientific societies of principal Western countries have produced several guidelines dealing with risk assessment, primary prevention, and treatment of acute stroke. From a prospective, community-based, observational cohort of patients from the Framingham Heart Study, an absolute estimate of risk for stroke alone or stroke or death was determined based on several risk factors, including advanced age, female sex, increased systolic blood pressure, prior stroke or transient ischemic attack, and diabetes mellitus. This algorithm considers many variables and expresses their results as the percentage of risk of developing a fatal or nonfatal stroke in the following 5 years. The author has identified three major pitfalls... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1482159 Thu, 29 May 2008 06:55:51 +0100 1482159 http://www.medworm.com/index.php?rid=1340835&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw02026x1840v81l0%2F Opinion statement  Most patients with ischemic stroke or transient ischemic attack are screened for internal carotid artery stenosis. Although it is important to identify candidates for endarterectomy or stenting, the clinician must realize that most patients are not candidates for revascularization. Therefore, medical therapy remains the cornerstone of treatment. In this article, current thinking on medical therapy for carotid atherosclerosis is outlined, including aggressive use of statins, targeted blood pressure lowering, and antithrombotic therapy. Implementation of these therapies will likely reduce the need for revascularization procedures in the future. Content Type Journal ArticleDOI 10.1007/s11936-008-0017-xAuthors Kumar RajamaniSeemant Chaturvedi, Wayne State... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1340835 Sat, 29 Mar 2008 09:11:26 +0100 1340835 http://www.medworm.com/index.php?rid=1340834&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F617204j3q2735g13%2F Opinion statement  Takayasu’s arteritis is a rare disease that causes arterial inflammation with resulting stenosis or aneurysm of affected vessels. It primarily affects young females and has a predilection for the aorta, its primary branches, and the pulmonary arteries. Patients may present with symptoms of organ ischemia, such as stroke or claudication, or with signs of arterial stenosis, such as absent pulses or asymmetric blood pressures. Most patients require chronic immunosuppressive therapy to control inflammation. The foundation of therapy is glucocorticoids, which are often used in combination with other immunosuppressive agents, such as methotrexate, azathioprine, or mycophenolate mofetil. The goal of systemic therapy is to induce and maintain disease remission, ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1340834 Sat, 29 Mar 2008 09:11:26 +0100 1340834 http://www.medworm.com/index.php?rid=1340837&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd57477712665lu15%2F Opinion statement  The literature is filled with randomized controlled trial data to guide most steps in managing patients with deep venous thrombosis of the extremities or pulmonary embolism. Venous thrombosis, however, is not limited to these locations and may involve the cerebral venous sinuses, renal veins, splanchnic veins, and ovarian veins. The causes of these thrombi are often unique to the venous segments involved and typically stem from pathologies of the organs supplied by these veins. Very little randomized controlled trial data exist to guide therapy for these atypical venous thrombi. Treatment should focus on correcting the underlying disease and relieving venous congestion of the involved organ while preserving organ functionality. Although natural history da... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1340837 Sat, 29 Mar 2008 09:11:25 +0100 1340837 http://www.medworm.com/index.php?rid=1340836&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm86628603jhm0448%2F Opinion statement  Unfractionated heparin (UFH) and the low molecular weight heparin (LMWH) preparations are two of the most commonly prescribed medications in the hospital, and indications for their use are increasing. An increasingly recognized untoward effect of either UFH or LMWH is heparin-induced thrombocytopenia (HIT), a transient, prothrombotic condition that may result in venous or arterial thrombosis and amputation or death. This immune-mediated process generally develops within 4 to 14 days of administration, although it may occur more rapidly if there has been a recent exposure; it may even occur days to weeks after UFH or LMWH has been discontinued. Although once considered necessary for the diagnosis of HIT, thrombocytopenia is no longer essential. A 50% reduc... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1340836 Sat, 29 Mar 2008 09:11:25 +0100 1340836 http://www.medworm.com/index.php?rid=1340839&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv72170552653t537%2F Opinion statement  Median arcuate ligament syndrome (MALS) can cause a range of symptoms, including abdominal pain, nausea, vomiting, and weight loss. Because all patients have some degree of celiac artery compression by the median arcuate ligament (MAL), it may be difficult to discern which patients have a pathologic compression. Based on the multiple theories of MALS etiology, it is unlikely that we know the true cause of this syndrome. In fact, there are many physicians who question the validity of the diagnosis of MALS. Before offering intervention for MALS, a thorough gastrointestinal evaluation should be performed, including consideration of diagnostic temporary percutaneous celiac ganglion block. Patients who are on chronic narcotics preoperatively have a lower likel... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1340839 Sat, 29 Mar 2008 09:11:24 +0100 1340839 http://www.medworm.com/index.php?rid=1340838&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F55413g276342xr22%2F Opinion statement  Inferior vena cava (IVC) filter placement has increased dramatically over the past two decades. Filters are indicated to prevent pulmonary embolism in patients with venous thromboembolism (VTE) and a contraindication to anticoagulation or a complication of anticoagulation. Some of this increased use is the result of expanding relative indications for filter placement, including placement for primary prophylaxis. The US Food and Drug Administration has approved 11 filters for permanent deployment, two of which—the Günther-Tulip (Cook Medical, Bloomington, IN) and the OptEase (Cordis Endovascular, Miami Lakes, FL)—are optionally retrievable. Once anticoagulation is deemed safe, all patients should be fully anticoagulated to prevent propagation and recur... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1340838 Sat, 29 Mar 2008 09:11:24 +0100 1340838 http://www.medworm.com/index.php?rid=1340841&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fch55177g4u200613%2F Opinion statement  Treatment of Raynaud’s phenomenon in any one individual depends on the severity of symptoms and whether or not there is an underlying disease process requiring specific intervention. Many patients with primary (idiopathic) Raynaud’s phenomenon respond well to treatment with general measures, perhaps with the addition of a calcium channel blocker. Conversely, others with underlying structural vascular abnormality (as occurs in connective tissue diseases such as systemic sclerosis [SSc]) are often refractory to treatment and may progress to irreversible tissue injury, sometimes with gangrene. Because these patients are the most challenging and because a large proportion of the research into Raynaud’s phenomenon has been conducted in patients with SSc-s... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1340841 Sat, 29 Mar 2008 09:11:21 +0100 1340841 http://www.medworm.com/index.php?rid=1340840&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl23225m7022r5651%2F Opinion statement  Pernio is a vasospastic disorder that affects unprotected skin regions of individuals exposed to nonfreezing, damp cold. It may be idiopathic or associated with other systemic diseases, particularly cryopathies and lupus erythematosus. Acute pernio manifests several hours following exposure, whereas chronic pernio may persist even after the cold season has long ended. The pathophysiology is complex and related to patient and environmental factors. Pernio is diagnosed by clinical features. There are no characteristic histopathologic features that confirm the diagnosis, but biopsy of affected areas may exclude the presence of other disorders. Sequelae include superinfection, depigmentation, and scarring. Treatment involves rewarming of the whole body and av... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1340840 Sat, 29 Mar 2008 09:11:21 +0100 1340840 http://www.medworm.com/index.php?rid=1340842&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F426321v5l626032q%2F Opinion statement  Pseudoaneurysms may arise from any artery in the human body. Most commonly found to involve the femoral artery after angiography, the presentation may vary from being clinically silent to a life-threatening emergency scenario. Recognition of this condition and treatment largely depend on the hemodynamic stability and anatomy of the pseudoaneurysm. Advances in treatment have enabled nonsurgical therapy in a significant number of cases. Ultrasound-guided thrombin injection is a fairly easy and effective treatment option. Other endovascular approaches, such as stent graft repair and coil embolization, are also available. Endovascular techniques play an important role in treating pseudoaneurysms arising from the aorta as a result of blunt trauma or previous a... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1340842 Sat, 29 Mar 2008 09:11:20 +0100 1340842 http://www.medworm.com/index.php?rid=1314315&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh314j4412111014p%2F Opinion statement  The results of the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management) trial indicate that the rate control strategy is preferred for the majority of patients with paroxysmal and persistent atrial fibrillation (AF). If the patient remains symptomatic despite adequate rate control or if rate control cannot be achieved, then rhythm control therapies are indicated. The most likely explanation for the disappointing results of the AFFIRM trial is the poor efficacy and excessive toxicity of rhythm control medications, because the presence of sinus rhythm was associated with a favorable prognosis in AFFIRM. As a result, there is currently great interest in nonpharmacologic therapies such as AF ablation and development of new drugs for AF wi... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1314315 Tue, 18 Mar 2008 08:31:09 +0100 1314315 http://www.medworm.com/index.php?rid=1314314&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr62505h723702304%2F Opinion statement  Identification and treatment of hypertension should be an important focus of physicians caring for children. Ultimately, a link between hypertension in children and the risk of cardiovascular disease will be established. Further long-term studies are likely to show that morbidity and mortality will be decreased by the institution of treatment of hypertension in children. Additional risk factors such as obesity and lipid disorders should be sought and targeted for treatment as well. Lifestyle modifications are advised for all patients and can be tried solely for those with blood pressures between the 95th and 99th percentiles. Drug therapy is indicated in children with blood pressures greater than the 99th percentile, secondary hypertension, coexisting dia... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1314314 Tue, 18 Mar 2008 08:31:09 +0100 1314314 http://www.medworm.com/index.php?rid=1314316&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F96127l2642r721m3%2F Opinion statement  Sudden cardiac death in young adults can be due to a range of conditions including coronary disease, hypertrophic or dilated cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy. Although each of these disorders has typical pathologic findings, some victims display no overt abnormalities and are presumed to have died from a primary cardiac arrhythmia. Increasingly, these malignant arrhythmias have been demonstrated to be due to mutations in ion channels. In this review we focus on the two most common of these disorders, termed ion channelopathies, namely congenital long QT syndrome and Brugada syndrome. Content Type Journal ArticleDOI 10.1007/s11936-007-0056-8Authors Ryan G. AleongDavid J. MilanPatrick T. Ellinor, Massachusetts General H... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1314316 Tue, 18 Mar 2008 08:31:08 +0100 1314316 http://www.medworm.com/index.php?rid=1314317&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F11444gmu02414516%2F Opinion statement  Congenitally corrected transposition of the great arteries is a rare condition in which systemic venous blood returns to normally positioned atria. However, the atria are connected to the opposite ventricle, right atrium to left ventricle, left atrium to right ventricle; so-called atrioventricular disordance. In addition, the ventricles are inverted (right to left change in position) and are connected to the opposite great artery, left ventricle to pulmonary artery, right ventricle to aorta; thus, forming ventricular-arterial discordance. The aorta is anterior and to the left of the pulmonary artery, L-transposed. Atrioventricular discordance plus ventricular-arterial discordance results in normal blood flow (ie, congenitally corrected). The right ventric... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1314317 Tue, 18 Mar 2008 08:31:06 +0100 1314317 http://www.medworm.com/index.php?rid=1314320&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg75073v272287460%2F Opinion statement  Double inlet left ventricle is a common form of univentricular atrioventricular connection. The clinical presentation is varied depending on associated lesions and the arrangement of great arteries. Management generally involves staging toward the ultimate goal of Fontan palliation. With advances in noninvasive diagnosis, surgical and postoperative care outcomes have significantly improved in the past decade. Most patients with double inlet left ventricle can go to school, play recreationally, and are gainfully employed. Some patients continue to pose difficult and frustrating medical problems, including arrhythmias, ventricular failure, atrioventricular valve insufficiency, subaortic obstruction, protein-losing enteropathy, and plastic bronchitis. Cont... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1314320 Tue, 18 Mar 2008 08:31:05 +0100 1314320 http://www.medworm.com/index.php?rid=1314319&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F8181w027326u0656%2F Opinion statement  Primary cardiac tumors are rare in pediatrics. Their clinical presentation differs among the various age groups (fetus to the young adult). Our discussion focuses on the diagnosis and treatment of rhabdomyomas, fibromas, myxomas, and pericardial teratomas in the fetus and neonatal stages. Fetal diagnosis has been described in association with rhabdomyomas, fibromas, and pericardial teratomas. It is made by echocardiography prompted by fetal dysrhythmias, nonimmune hydrops, intrauterine growth restriction, and familial tuberous sclerosis. Based on our experience, it is of the utmost importance to refer these patients to a tertiary center for detailed evaluation, follow-up, and delivery. Tumor diagnosis in the neonatal age group may be prompted by a murmur,... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1314319 Tue, 18 Mar 2008 08:31:05 +0100 1314319 http://www.medworm.com/index.php?rid=1314318&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fqn760t6h683378v7%2F Opinion statement  Ventricular tachycardia most often arises from the ventricular outflow tracts in patients with apparently structurally normal hearts, and is often termed idiopathic ventricular tachycardia. These tachycardias are characterized by a left bundle branch block, inferior axis QRS morphology, and a unique electropharmacologic profile. The choice of treatment is dictated by the severity of symptoms, and ranges from observation for asymptomatic patients, to antiarrhythmic agents for those who are mildly to moderately symptomatic (eg, palpitations), to catheter-based ablation for those with more troubling symptoms or those who develop tachycardia-mediated cardiomyopathy. Antiarrhythmic therapy can be effective for arrhythmia suppression, and radiofrequency ablatio... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1314318 Tue, 18 Mar 2008 08:31:05 +0100 1314318 http://www.medworm.com/index.php?rid=1314321&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F0u5147083rw55207%2F Opinion statement  Based on current guidelines, most electrophysiologists today are implanting cardioverter-defibrillators (ICDs) using a low left ventricular ejection fraction alone as the sole stratifier for the risk of sudden cardiac death. However, left ventricular ejection fraction is a better marker of total mortality than sudden death. As a result, this strategy is flawed because it exposes many patients to the risk and cost of ICD therapy without its benefits. Primary prevention trials based on this strategy show that the rate of appropriate ICD shocks is only 5% to 10% per year. We believe that the effectiveness of ICD therapy can be improved by the use, in addition to ejection fraction, of one or more of the noninvasive tests, which are reviewed in this article. S... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1314321 Tue, 18 Mar 2008 08:31:04 +0100 1314321 http://www.medworm.com/index.php?rid=1314322&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fp3178502127r68n2%2F Opinion statement  Medical advancements have made it possible for more women with congenital heart defects (CHDs) to carry successful pregnancies. Most CHD surgeries or interventions are palliative with persistent residua and sequelae exacerbated by the physiologic stresses of pregnancy. Preconception assessment, a tailored multidisciplinary approach during pregnancy, and a planned, elective delivery followed by careful postpartum monitoring may improve outcomes. Teratogenic medications should be stopped and changed to safer alternatives. Major hemodynamic changes in pregnancy, labor, and delivery may aggravate the underlying cardiovascular defects. Interventions or surgeries, when anticipated, should be performed before pregnancy. Antibiotic prophylaxis is indicated for ne... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1314322 Tue, 18 Mar 2008 08:31:03 +0100 1314322 http://www.medworm.com/index.php?rid=1311374&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj5803356v6j21248%2F Opinion statement  Statin therapy has been a significant advance in the management of dyslipidemia and atherothrombotic cardiovascular disease with a resultant 30% to 40% reduction in cardiovascular events; however, a significant number of events continue to occur in statin-treated patients, including in patients treated with high-dose statins targeted to achieve mean low-density lipoprotein cholesterol levels in the range of 60 to 80 mg/dL. Therefore, development and testing of new therapies that exploit the vascular protective effects of high-density lipoprotein (HDL) constitutes a rational and complementary approach. A number of HDL-based therapies are in various stages of development and testing. It is hoped that one or more of these new HDL-based therapies, if proven e... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1311374 Sun, 16 Mar 2008 05:44:57 +0100 1311374 http://www.medworm.com/index.php?rid=1311373&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft4p35llm1851q863%2F Opinion statement  The success of intervention and clinical outcome is markedly reduced in patients who sustain distal embolization during percutaneous coronary intervention (PCI). Such embolization occurs in up to 15% of patients with acute myocardial infarction (AMI) undergoing PCI, and angiographic indicators of embolization are highly predictive of clinical and functional outcome. Saphenous vein graft (SVG) interventions carry a 20% risk of major adverse cardiac events (MACE), predominantly AMI, and significant risk of no-reflow. There are four types of embolic protection: distal occlusion/aspiration systems, filters, proximal occlusion/aspiration devices, and thrombectomy catheters. There seem to be no data to suggest that routine use of any embolic protection system i... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1311373 Sun, 16 Mar 2008 05:44:57 +0100 1311373 http://www.medworm.com/index.php?rid=1311375&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa4l371h63k65nw53%2F Opinion statement  Coronary stenting elicits vessel wall damage, and subsequent activation of platelets is implicated as a major component of complications such as acute, subacute, and late stent thrombosis. As such, dual antiplatelet therapy using aspirin and clopidogrel has become a routine adjunct to coronary stenting. Use of aspirin and clopidogrel with or without glycoprotein IIb/IIIa inhibitors after coronary stenting reduces the complication rate and improves long-term outcomes. Dual antiplatelet therapy using aspirin and clopidogrel is recommended for at least 4 weeks with bare metal stents, and for 3 to 6 months with drug-eluting stents for prevention of major adverse cardiac events. After coronary stenting, 1 year of dual antiplatelet therapy is recommended for pr... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1311375 Sun, 16 Mar 2008 05:44:56 +0100 1311375 http://www.medworm.com/index.php?rid=1311376&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F27x4085383633226%2F Opinion statement  Acute coronary syndromes involve a complex interplay between the vessel wall, inflammatory cells, and the coagulation cascade. Statins possess beneficial effects that are independent of low-density lipoprotein cholesterol lowering and that have favorable effects on inflammation, the endothelium, and the coagulation cascade. There is now accumulating evidence that these lipid-independent pleiotropic effects are clinically relevant in the management of acute coronary syndromes. Content Type Journal ArticleDOI 10.1007/s11936-007-0050-1Authors Kausik K. Ray, University of Cambridge Department of Public Health and Primary Care, Strangeways Research Laboratory Worts Causeway Cambridge CB1 8RN UKChristopher P. Cannon Journal Current Treatment Options in... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1311376 Sun, 16 Mar 2008 05:44:55 +0100 1311376 http://www.medworm.com/index.php?rid=1311378&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh977313h7724976h%2F Opinion statement  Appropriate management of lipids is a central component of risk reduction in patients with coronary artery disease (CAD). According to the most recent guidelines, low-density lipoprotein cholesterol (LDLC) is the principal target of lipid-lowering therapy and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are the mainstay of this therapy. The actual target level of LDL lowering is being reassessed in light of recent clinical trials. Once appropriate LDL lowering has been achieved, treatment of other targets such as high-density lipoprotein cholesterol (HDLC), triglycerides, and non-HDLC should be considered. In addition to dyslipidemia, multiple observational studies suggest that inflammatory markers such as C-reactive protein (CRP) ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1311378 Sun, 16 Mar 2008 05:44:54 +0100 1311378 http://www.medworm.com/index.php?rid=1311377&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr551210228p1q28h%2F Opinion statement  Multislice CT coronary angiography (CTCA) is a rapidly emerging technique for the noninvasive visualization of coronary arteries. Over the past 5 years, several scanner generations have been introduced with a progressive improvement in the diagnostic accuracy in the detection of coronary artery stenosis in selected patient populations. The introduction of 64-slice technology, which allows high resolution and nearly motion-free coronary artery imaging, has resulted in further improvement in the diagnostic accuracy. This technique is on the verge of widespread clinical implementation, and even in the absence of large clinical trials, a high demand for CTCA is already observed all over the world. Content Type Journal ArticleDOI 10.1007/s11936-007-0048-8Aut... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1311377 Sun, 16 Mar 2008 05:44:54 +0100 1311377 http://www.medworm.com/index.php?rid=1311379&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F94p2416031g34333%2F This article presents an evidence-based analysis of the current experience with CYPHER sirolimus-eluting stents (Cordis Corp., Miami Lakes, FL) and TAXUS paclitaxel-eluting stents (Boston Scientific, Natick, MA) in a broad spectrum of high-risk and/or complex subsets of patients and lesions, including those with diabetes mellitus, multivessel disease, diffuse disease, very small vessels, lesions in saphenous vein grafts, chronic total occlusions, in-stent restenosis, ostial and bifurcation lesions, unprotected left main disease, and acute myocardial infarction. Emerging data in several of these subsets suggest that drug-eluting stents are safe and effective, and their use may currently be recommended, whereas in other groups of patients and lesions the efficacy and/or safety of drug-... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1311379 Sun, 16 Mar 2008 05:44:53 +0100 1311379 http://www.medworm.com/index.php?rid=1311380&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fqw4893043163v067%2F Opinion statement  Based upon the data from observational epidemiologic studies and randomized clinical trials that are summarized in this article, as well as plausible mechanisms for benefit, the American Heart Association and several international health agencies recommend that all adults eat fish, particularly fatty fish, at least two times per week to lower risk of coronary heart disease (CHD). Patients with established CHD are advised to consume 1 g/d of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) combined. However, many individuals may find it difficult to consume 1 g/d of EPA and DHA, which translates into several meals of fish per week. Thus, fish oil in the form of supplements may be a preferable way to achieve compliance with these recommendations. ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1311380 Sun, 16 Mar 2008 05:44:51 +0100 1311380 http://www.medworm.com/index.php?rid=1195958&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F7476250l63330265%2F Opinion statement  Once the diagnosis of a thrombophilic state has been established, management must include one or more strategies designed to attenuate thrombotic risk and the likelihood of clinical events. In the case of drug-induced arterial thrombosis provoked by oral contraceptives, hormone replacement therapy, heparinoids, cocaine, or thienopyridine-related thrombotic thrombocytopenic purpura (TTP), the offending agent should be discontinued immediately. Anticoagulant therapy and platelet-directed therapies, either alone or in combination, should be considered for patients experiencing a single arterial or venous thrombosis (secondary prevention), with treatment duration determined by diagnostic studies and the persistence of a prothrombotic state. Other specific the... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1195958 Wed, 30 Jan 2008 16:33:25 +0100 1195958 http://www.medworm.com/index.php?rid=1195955&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff14042400850p432%2F Opinion statement  Drug-eluting stents (DES) are the treatment of choice for obstructive coronary artery disease when percutaneous intervention is feasible. Although there are concerns regarding increased incidence of stent thrombosis, subsequent myocardial infarction, and death in patients receiving DES, careful analysis of large randomized trials has shown that risk of stent thrombosis with both bare metal stents (BMS) and DES is small. However, late stent thrombosis seems to occur more frequently with DES and seems to be closely associated with the discontinuation of dual antiplatelet therapy with aspirin and a thienopyridine derivative (usually clopidogrel). Before placing a DES in a patient, the interventional cardiologist must ensure that there are no conditions under... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1195955 Wed, 30 Jan 2008 16:33:25 +0100 1195955 http://www.medworm.com/index.php?rid=1195959&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fxg71043111063764%2F Opinion statement  The main components of the metabolic syndrome (MS) are abdominal obesity, atherogenic dyslipidemia, raised blood pressure, insulin resistance with or without glucose intolerance, and proinflammatory and prothrombotic states. The clustering of these metabolic risk factors significantly increases the risk of type 2 diabetes and promotes vascular endothelial dysfunction, inflammation, and increased oxidative stress. The net result is an increase in the risk of atherosclerotic cardiovascular disease. Therefore, management of MS is of utmost importance, especially considering its rapidly increasing prevalence in a population with rising obesity rates and its significant cardiovascular implications. The primary management of this syndrome involves the correctio... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1195959 Wed, 30 Jan 2008 16:33:24 +0100 1195959 http://www.medworm.com/index.php?rid=1195957&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fnrq58p8h17242804%2F Opinion statement  Aortic stenosis (AS) is the most frequent valvular heart disease in the Western world. The only definitive treatment for this disorder is surgical replacement of the aortic valve. Recent histopathologic studies have provided important insights into the pathogenesis of calcific AS. These results suggest that this disease develops as the result of an active disease process at the cellular and molecular levels that shares many similarities with vascular atherosclerosis, ranging from endothelial dysfunction to, ultimately, calcification. In this review, we discuss the cellular and molecular mechanisms, natural history, diagnosis, and therapeutic options, including the potential for medical therapies, for the treatment of AS. Content Type Journal ArticleDOI ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1195957 Wed, 30 Jan 2008 16:33:24 +0100 1195957 http://www.medworm.com/index.php?rid=1195956&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fe70m7v5004jh7t25%2F Opinion statement  Cellular cardiomyoplasty has raised hopes of regenerating mechanical function in the heart. Several cell sources have been investigated for their ability to repair the damaged heart, providing reason for optimism. Multiple mechanisms have been proposed for the beneficial effects of the delivered cells; however, true reversal of cardiac damage implies the generation of new contractile myocytes. The assessment of a cell’s ability to regenerate contractile cells requires a defined set of criteria that, if met, define success. Here we review data from the four primary players in cellular cardiomyoplasty (skeletal myoblasts, bone marrow cells, embryonic stem cells, and resident cardiac stem cells) and assess their potential to differentiate into contractile ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1195956 Wed, 30 Jan 2008 16:33:24 +0100 1195956 http://www.medworm.com/index.php?rid=1195954&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F670743g1722070u8%2F Opinion statement  Sudden death claims hundreds of thousands of lives each year in the United States. Emergency resuscitation efforts are successful in only about 6% of all out-of-hospital arrests. In light of the poor survival rate, innovative research is reexamining the practice of cardiopulmonary resuscitation. Basic life support (BLS), with its stepwise management of airway, breathing, circulation, and defibrillation, is far from a rudimentary procedure. Each step has been challenged and changed in recent years, reflecting ongoing resuscitation research into the mechanisms, efficacy, and practical aspects of delivery of these interventions. Recommended modifications to BLS techniques have resulted in increased survival rates. Therefore, health professionals need to stay ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1195954 Wed, 30 Jan 2008 16:33:24 +0100 1195954 http://www.medworm.com/index.php?rid=1195953&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd273x4456rl35w13%2F Opinion statement  Cardiac magnetic resonance (CMR) has emerged as a versatile noninvasive tool for the comprehensive evaluation of patients with suspected or established coronary artery disease (CAD). In a single imaging session, CMR can assess left ventricular anatomy and function, myocardial perfusion, viability, and coronary luminal stenosis. Using specific pulse sequences, left ventricular global and regional function can be assessed by cine CMR at rest and in response to inotropic stress; first-pass perfusion quantified by vasodilator stress; myocardial viability evaluated by delayed enhancement imaging and also by functional reserve; and coronary artery stenosis assessed by angiography. All these modalities can be achieved with high spatial resolution and image contr... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1195953 Wed, 30 Jan 2008 16:33:24 +0100 1195953 http://www.medworm.com/index.php?rid=1195952&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm310674162152655%2F Opinion statement  Our understanding of the etiology of atherosclerosis and the mechanisms by which conventional cardiovascular risk factors cause disease is incomplete. Atherosclerosis may be regarded as a process of continuous injury and abnormal repair. The diagnosis and treatment of the disease should be targeted to the various stages of this process, from the early stages of vascular injury to the stabilization of the vulnerable plaque. Several novel concepts in atherosclerosis have been elucidated in the past two decades. Novel biomarkers and imaging techniques for early subclinical atherosclerotic lesions may facilitate earlier primary prevention. Future primary prevention of atherosclerosis should incorporate these novel concepts for creation of individualized risk ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1195952 Wed, 30 Jan 2008 16:33:24 +0100 1195952 http://www.medworm.com/index.php?rid=1195951&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw7507472134w5272%2F Opinion statement  Risk stratification for primary prevention of sudden cardiac death (SCD) remains a major challenge in cardiology. The utility of T-wave alternans (TWA) as a marker of risk of life-threatening ventricular tachycardia and fibrillation is supported by two decades of basic and clinical research. Both frequency-and time-domain methods have been developed, validated, and made available in clinical practice. A principal application of TWA testing has been to improve assessment of patients with depressed left ventricular ejection fraction (EF; ≤ 40%) who are considered for implantable cardioverter-defibrillator (ICD) implantation for primary prevention of SCD. TWA has been most useful in identifying patients who are unlikely to benefit from ICD therapy. Althoug... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1195951 Wed, 30 Jan 2008 16:33:24 +0100 1195951 http://www.medworm.com/index.php?rid=1195950&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F55p7mhk6223645gh%2F Opinion statement  Non-ST segment elevation myocardial infarction (non-STEMI) is a common presentation of the acute coronary syndrome (ACS) spectrum. Currently, the recommended treatment option is an invasive approach with angiography plus coronary revascularization to treat the culprit lesion. However, unlike in STEMI—in which the culprit lesion can be easily identified—in non-STEMI identifying the culprit lesion is difficult. Therefore, some have advocated for a more definitive approach to addressing all severe lesions in patients presenting with non-STEMI. The current European guidelines for percutaneous coronary intervention (PCI) for multivessel versus culprit-only stenting state that “the decision to perform either culprit vessel or complete revascularization can... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1195950 Wed, 30 Jan 2008 16:33:24 +0100 1195950 http://www.medworm.com/index.php?rid=1156023&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F4202120x7wurx3u2%2F Opinion statement  Gallbladder and biliary dyskinesia are conditions that are becoming increasingly recognized due to improved technology. They are motility disorders that affect the gallbladder and sphincter of Oddi (SO), respectively. Gallbladder dyskinesia presents with typical biliary pain in the absence of gallstones. Work-up includes laboratory tests and imaging to rule out gallstones. Further investigation leads to a functional radionuclide study to investigate gallbladder ejection fraction. An ejection fraction of less than 40% is considered abnormal, and patients should be referred for cholecystectomy. Symptom relief after the procedure has been seen in 94% to 98% of patients. The term sphincter of Oddi dysfunction (SOD) describes a collection of pain syndromes tha... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1156023 Tue, 15 Jan 2008 16:13:29 +0100 1156023 http://www.medworm.com/index.php?rid=1156018&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk1r30r25367u36v0%2F Opinion statement  Irritable bowel syndrome (IBS) is a ubiquitous but heterogeneous syndrome characterized by abdominal pain and erratic bowel habits that affects 5% to 10% of the population. Although current definitions specify that there are no structural or biochemical abnormalities to account for the symptoms, there is growing evidence that in at least a subset of IBS patients, there is low-grade inflammation characterized by increased T lymphocytes and mast cells. Whether this is cause or effect is uncertain, as there is also clear evidence of bidirectional communication between the immune and nervous systems, and at least some of the mucosal changes could be secondary to psychological stress. A small percentage (6%–17%) of patients develop IBS symptoms for the first ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1156018 Tue, 15 Jan 2008 16:13:29 +0100 1156018 http://www.medworm.com/index.php?rid=1156016&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu1jj567x56h81710%2F In conclusion, it appears that GERD is a disease with a spectrum of clinical and endoscopic manifestations, with characteristics that make it a continuum and not a categorical condition with separate entities. It is difficult to clearly delineate the spectrum of GERD based on the clinical, endoscopic, and pathophysiologic characteristics, but therapeutic trials and follow-up studies suggest that GERD is not composed of different conditions. Content Type Journal ArticleDOI 10.1007/s11936-007-0033-2Authors Lucía C. FryKlaus MönkemüllerPeter Malfertheiner, Universitätsklinikum Magdeburg, Otto-von-Guericke University Department of Gastroenterology, Hepatology, and Infectious Diseases Leipziger Straße 44 39120 Magdeburg Germany Journal Current Treatment Options in Cardiovas... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1156016 Tue, 15 Jan 2008 16:13:29 +0100 1156016 http://www.medworm.com/index.php?rid=1156022&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft18323r227g15317%2F Opinion statement  Cyclic vomiting syndrome (CVS) is a relatively rare but highly incapacitating disorder. It is seen both in children and adults, although classically it has been perceived as a pediatric gastrointestinal disorder. Recent studies have demonstrated that this disorder indeed can be seen in adults and is highly disabling. Although classically associated with migraine headaches in the pediatric form, this relationship is less well established in adults. This has major implications for management in that traditionally, one of the major avenues for treatment of pediatric CVS has been antimigraine drugs. An additional factor that obscures a review of CVS treatment is the fact that because of its relative rarity, no randomized controlled trials (RCTs) have been per... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1156022 Tue, 15 Jan 2008 16:13:28 +0100 1156022 http://www.medworm.com/index.php?rid=1156021&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa5068j7746420531%2F Opinion statement  Irritable bowel syndrome (IBS) is a common gastrointestinal condition whose cause remains unknown. Therefore, most of our effort in treating IBS has been based on a symptom approach. Recent evidence is beginning to suggest that subjects with IBS may have an alteration in gastrointestinal flora. Specifically, findings suggest that IBS patients have excessive bacteria in the small bowel, known as bacterial overgrowth. Although diagnostic testing for bacterial overgrowth is somewhat controversial, as there is no true gold standard test for bacterial overgrowth, antibiotic-based therapies for IBS are now shown to be very effective in treating IBS. Follow-up work in this area has even begun to demonstrate associative factors between gut bacteria and IBS that m... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1156021 Tue, 15 Jan 2008 16:13:28 +0100 1156021 http://www.medworm.com/index.php?rid=1156020&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj23214567nv3051w%2F Opinion statement  Functional dyspepsia (FD) is a condition commonly seen in gastroenterological practice. With the introduction of Rome III criteria in 2006, a new approach for categorizing patients has been recommended. The diagnostic criteria suggest that meal-related and pain-predominant symptom groupings that presumably have distinct pathophysiologic mechanisms and potentially different therapeutic targets exist. The new classification is in the early stages of testing; in the meantime, the umbrella term of FD should continue to be utilized in clinical practice. Treatment of FD remains a major challenge. Unfortunately, most of the agents used in practice have limited or no evidence of efficacy, and the results typically are short-lived once therapy is ceased. Appropria... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1156020 Tue, 15 Jan 2008 16:13:28 +0100 1156020 http://www.medworm.com/index.php?rid=1156019&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F3056662412466013%2F Opinion statement  The treatment goals for patients with gastroparesis are to control symptoms; to correct fluid, electrolyte, and nutritional deficiencies; and to identify and treat the underlying cause of gastroparesis. For mild symptoms, dietary modifications and a low-dose antiemetic and/or prokinetic agent might provide satisfactory control of symptoms. Dietary treatments include decreasing the solid food component while increasing the liquid nutrient component of meals. Fat and fiber intake should be minimized. Metoclopramide, despite its potential for neurological side effects, remains a prokinetic treatment for symptomatic patients. In patients with diabetic gastroparesis, careful regulation of glycemic control may help to reduce symptoms. Medical management of pati... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1156019 Tue, 15 Jan 2008 16:13:28 +0100 1156019 http://www.medworm.com/index.php?rid=1156017&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb207848272482743%2F Opinion statement  Gastroesophageal reflux disease (GERD) traditionally has been approached as a spectrum-continuum, suggesting that patients may progress over time and develop a more severe esophageal mucosal involvement. The spectrum-continuum conceptual model had a profound impact on the research priorities in GERD, as well as on proposed diagnostic algorithms and therapeutic strategies. Natural course studies in GERD are almost always retrospective and commonly afflicted with a plethora of shortcomings. Factors that affect quality of natural course studies in GERD include the following: index endoscopy results are taken at face value; antireflux treatment is consumed until index endoscopy and/or offered during the follow-up phase; pathophysiologic, anatomic, and genetic... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1156017 Tue, 15 Jan 2008 16:13:28 +0100 1156017 http://www.medworm.com/index.php?rid=1017754&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft1035591j4610717%2F Opinion statement  The use of classic inotropic agents activating the β-receptor-cyclic adenosine monophosphate (cAMP) pathway (ie, dobutamine or milrinone) should be restricted to a “rescue” therapy in patients with acute heart failure and signs of peripheral hypoperfusion (hypotension, renal dysfunction) that is refractory to volume replacement, diuretics, and vasodilators. This approach is largely supported by observations from clinical trials suggesting that both short-term treatment of acute heart failure without an essential requirement of inotropic support as well as long-term inotropic therapy in patients with severe chronic heart failure with classical inotropic agents can increase arrhythmia and mortality. Vice versa, β-receptor blockade, whenever tolerated, ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1017754 Wed, 07 Nov 2007 15:25:54 +0100 1017754 http://www.medworm.com/index.php?rid=1017753&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F3k48080442361057%2F Opinion statement  Viral infections often affect the heart. In the majority of cases, the course of the disease is benign and patients recover spontaneously. However, viral infection may persist and lead to acute cardiac failure or progress to dilated cardiomyopathy. Viral infections are considered to be the most common causes of myocarditis. There is evidence that intramyocardial viral persistence is associated with progressive ventricular dysfunction, even when the infiltrate is sparse or missing. The diagnosis of viral myocarditis necessitates the detection of viral genome by molecular biology techniques and the evaluation of myocardial inflammation by the immunohistochemistry on endomyocardial biopsy samples. Autoreactive myocarditis can also only be diagnosed by endomy... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1017753 Wed, 07 Nov 2007 15:25:54 +0100 1017753 http://www.medworm.com/index.php?rid=1017751&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa092152n722x3h51%2F Opinion statement  Sudden cardiac death is the most devastating manifestation of hypertrophic cardiomyopathy (HCM) and often occurs in young and previously asymptomatic patients. Therefore, risk stratification for sudden death has a major role in the management of HCM and has acquired even greater relevance since the implantable cardioverter-defibrillator (ICD) has proved to be highly effective in preventing sudden death in this disease. The ICD is definitely indicated for secondary prevention of sudden death in patients with HCM who have survived a cardiac arrest with documented ventricular fibrillation, or experienced one or more episodes of sustained ventricular tachycardia. However, uncertainties persist regarding the precise selection of patients for primary prophylact... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1017751 Wed, 07 Nov 2007 15:25:54 +0100 1017751 http://www.medworm.com/index.php?rid=1017750&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj573704h1r520111%2F Opinion statement  Aortic valve disease manifests in the form of stenosis, regurgitation, or some combination, yielding either excessive afterload and/or excessive preload on the left ventricle. Aortic root disease may affect valvular function, causing regurgitation; may simply be coexistent with stenotic aortic valvular disease; or may exist despite normal aortic valve function. Indications for intervening on aortic valve or root disease are determined by the presence of symptoms, by the pathology’s impact on left ventricular function, or by the inherent risk of aortic catastrophe (dissection, disruption, or sudden death). Aortic valvular and root diseases are primarily treated by surgical replacement of the pathologic structures. Mechanical aortic valve replacement has ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1017750 Wed, 07 Nov 2007 15:25:54 +0100 1017750 http://www.medworm.com/index.php?rid=1017748&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk0480576313240q8%2F Opinion statement  Aortic stenosis is a common clinical problem. The development of symptoms usually precedes the development of left ventricular (LV) dysfunction. Therefore, patients with concomitant severe aortic stenosis and LV dysfunction comprise a minority with this condition, albeit a clinically challenging group to manage. Because the only proven therapy for aortic stenosis is surgical valve replacement, the approach to the management of a patient with aortic stenosis and LV dysfunction primarily centers on risk stratification and the decision of whether to operate. Patients with aortic stenosis and low transvalvular gradients constitute a distinctly high-risk group, particularly when evidence of contractile reserve is absent after challenge with dobutamine. In the ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1017748 Wed, 07 Nov 2007 15:25:54 +0100 1017748 http://www.medworm.com/index.php?rid=1017746&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb7g70334m0q5m6gk%2F Opinion statement  In patients with carcinoid heart disease, a multidisciplinary approach to patient care is required because treatment of the systemic disease and management of cardiac involvement must be considered at the same time. Somatostatin analogue use is a therapeutic cornerstone, effective in symptomatic control of the endocrine syndrome. Chemotherapy is of limited efficacy in patients with carcinoid tumors. Hepatic resection of metastases is the preferred treatment option and has been shown to result in improved outcome. It should be considered if at least 90% of the metastases in the liver are removable. Hepatic artery embolization is usually applied if a patient is not eligible for surgical debulking. Development and progression of carcinoid heart disease compl... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1017746 Wed, 07 Nov 2007 15:25:54 +0100 1017746 http://www.medworm.com/index.php?rid=1017752&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr63340333683101g%2F Opinion statement  Myocarditis has been shown to be a common cause of cardiomyopathy; it is believed to account for 25% of all cases of heart failure in humans. Unfortunately, the disease is difficult to detect clinically before a myopathic process ensues. Treatment of myocarditis-induced heart failure includes the standard regimen of diuretics, digoxin, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and β-adrenergic blockers. Treatment of myocarditis itself is dependent on the etiology of the illness. Additional treatments under investigation for viral and autoimmune myocarditis include immunosuppressants, nonsteroidal anti-inflammatory agents, immunoglobulins, immunomodulators, and antivirals, with no specific therapy having a real advantage ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1017752 Wed, 07 Nov 2007 15:25:53 +0100 1017752 http://www.medworm.com/index.php?rid=1017749&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F267k6120131x7818%2F Opinion statement  Definitive treatment for constrictive pericarditis is surgical pericardiectomy. Because constriction may be transient in a small proportion of patients, particularly those with exudative effusions, the initial treatment for constrictive pericarditis should be conservative, with loop diuretic therapy to manage volume expansion and edema and the use of colchicine, nonsteroidal anti-inflammatory agents, or, if necessary, glucocorticoid therapy for active inflammation. For subjects with persisting evidence of constriction, symptomatic management is advised for those with only minimal symptoms. Surgical pericardiectomy is advised for subjects with New York Heart Association class II or III symptoms and persisting evidence of constriction at echocardiography an... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1017749 Wed, 07 Nov 2007 15:25:53 +0100 1017749 http://www.medworm.com/index.php?rid=1017747&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh076384n24160317%2F Opinion statement  One of the most common yet unidentified conditions in heart disease is sleep-disordered breathing (SDB). Although it is most prevalent in patients with heart failure, it has been epidemiologically and pathophysiologically linked to ischemic heart disease, hypertension, sudden cardiac death, atrial fibrillation, and stroke. There are two primary SDB syndromes: obstructive sleep apnea (OSA) and central sleep apnea (CSA; also known as Cheyne-Stokes respiration). The pathophysiologic mechanisms that underlie these disorders appear to be distinct but both involve recurrent cycles of excessive sympathetic activation, hypoxemias and hypercapnias, and increases in ventricular wall stress. Signs and symptoms may include daytime somnolence, snoring, difficult-to-co... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=1017747 Wed, 07 Nov 2007 15:25:53 +0100 1017747 http://www.medworm.com/index.php?rid=781502&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fq7415h0q298n7547%2F Opinion statement  Depression is common in the community and is a risk factor for the development of coronary heart disease (CHD). In patients with CHD, the prevalence of major depression is nearly 20% and the prevalence of minor depressive disorder is approximately 27%. When present in patients with existing CHD, depression is independently associated with worse outcome, including higher morbidity and mortality, and worse health status. Observational studies suggest that use of antidepressant medications in patients with CHD is associated with decreased risk of cardiovascular events. However, only one randomized controlled trial, the ENRICHD (Enhancing Recovery in Coronary Heart Disease) study, was designed to evaluate whether treatment of depression in patients with CHD c... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=781502 Mon, 09 Jul 2007 05:03:06 +0100 781502 http://www.medworm.com/index.php?rid=781497&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F130161qk40228h64%2F Opinion statement  Excessive adipose tissue is potentially pathogenic due to its mass effects and through adverse metabolic/immune responses, which may lead to cardiovascular disease risk factors (eg, type 2 diabetes mellitus, hypertension, dyslipidemia, and possibly atherosclerosis itself). Positive caloric balance in genetically/environmentally susceptible patients may result in adipocyte hypertrophy, visceral adipose tissue accumulation, and ectopic fat deposition, all causally associated with metabolic disease, and all anatomic manifestations of “adiposopathy” (a term used to describe adipose tissue pathology). Weight loss through improved nutrition, increased physical activity, and weight loss agents (ie, orlistat and sibutramine) improves adiposopathy and improves... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=781497 Mon, 09 Jul 2007 05:03:06 +0100 781497 http://www.medworm.com/index.php?rid=781504&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F865l537l32230834%2F Opinion statement  With an aging population, cardiovascular disease (CVD) prevalence will continue to increase for at least the next 30 years. Current clinical trial evidence expands the indications for aggressive treatment of risk factors. Concurrently, the use of new screening and diagnostic technologies will expand the number of identified high-risk individuals requiring clinical care. These likely scenarios will force efficient resource allocation. The impression of the authors is that new models of shared responsibilities of care are needed to enable CVD prevention. All stages of care for those with CVD should entail cooperation among nurses, pharmacists, primary care providers, and cardiovascular specialists in delivering comprehensive, evidence-based care. The persis... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=781504 Mon, 09 Jul 2007 05:03:05 +0100 781504