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. Wed, 08 Feb 2012 09:32:37 +0100 http://www.medworm.com/index.php?rid=5659567&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk6424580j0652pk9%2F Opinion statement  Sympathetic nervous system activation of the heart, kidney and peripheral vasculature increases cardiac output, fluid retention and vascular resistance and plays an important role in acute and chronic BP elevation. Renal sympathetic denervation via a percutaneous radiofrequency catheter based approach is a safe and effective procedure that lowers BP in patients with resistant hypertension. Exploratory studies in patients with resistant hypertension and a variety of comorbidities, including insulin resistance/metabolic syndrome, obstructive sleep apnea and the polycystic ovary syndrome, have shown benefit of renal denervation in attenuating the severity of the comorbid conditions, as well as reducing BP. However, more studies are needed to further address ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5659567 Tue, 31 Jan 2012 16:46:16 +0100 5659567 http://www.medworm.com/index.php?rid=5638366&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj770375103623g56%2F Opinion statement  Hyperlipidemia increases the incidence of atherosclerotic vascular disease and is associated with greater rates of recurrent cardiovascular events among individuals with established vascular disease. Several large population studies have confirmed the link between all cholesterol components (including elevated low-density lipoprotein [LDL] cholesterol, total cholesterol, and triglyceride levels, and reduced high-density lipoprotein [HDL] levels) with coronary heart disease and other manifestations of systemic atherosclerosis. In addition, landmark clinical trials have clearly established that lowering LDL cholesterol levels with statins (HMG-CoA reductase inhibitors) can lower recurrent cardiovascular events by nearly 25%. The benefits of altering non-LDL... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5638366 Tue, 24 Jan 2012 07:27:16 +0100 5638366 http://www.medworm.com/index.php?rid=5638365&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft772797815536663%2F This article focuses on GPA only, as complete management includes modalities that are unique to this disease. The current treatment of GPA is stratified based on severity. For those patients who have active but non-severe GPA and do not have contraindications, methotrexate and glucocorticoids can induce and maintain remission. For patients with severe disease, options include glucocorticoids combined with either cyclophosphamide or rituximab. When cyclophosphamide is used, it is given for 3 to 6 months, after which time it is stopped and switched to methotrexate or azathioprine for remission maintenance. In randomized trials, rituximab was found to be as effective as cyclophosphamide to induce remission of severe active GPA. Given the recency of experience with rituximab, there ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5638365 Tue, 24 Jan 2012 07:27:16 +0100 5638365 http://www.medworm.com/index.php?rid=5619939&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk58123g866u8q02p%2F Opinion statement  The management of infrapopliteal peripheral arterial occlusive disease (PAD) is challenging. For patients with asymptomatic disease or claudication, exercise and optimal medical management, including antiplatelet agents, blood pressure control, statin therapy and tight glucose control for patients with diabetes mellitus, are the mainstays of therapy. However, patients with isolated tibial artery occlusive disease often have diabetes mellitus or renal insufficiency and present with critical limb ischemia (CLI). CLI is advanced occlusive disease marked by the development of rest pain, ischemic ulceration, or gangrene and is associated with a high mortality rate. Limb salvage requires an intervention in cases of CLI, but careful operative planning is require... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5619939 Tue, 17 Jan 2012 07:07:16 +0100 5619939 http://www.medworm.com/index.php?rid=5552213&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff4rt84623840w534%2F Opinion statement  Using an implantable cardiac monitor (ICM) in patients with acute myocardial infarction (MI) allows continuous electrocardiogram monitoring and provides a much more detailed picture of the incidence of brady- and tachyarrhythmias than conventional follow-up. The CARISMA study was the first to use the ICM in post-MI patients with moderate to severe left ventricular systolic dysfunction. Atrial fibrillation (AF) events lasting longer than 30 s were associated with an almost threefold increase in the risk of major cardiac events. This confirms the current definition of clinically significant AF episodes, as patients with episodes of shorter duration were not at increased risk. The association of AF to progressive heart failure, reinfarction, and cardiova... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5552213 Mon, 26 Dec 2011 16:45:58 +0100 5552213 http://www.medworm.com/index.php?rid=5544401&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft47h2u115264602x%2F Opinion statement  Contrast-induced acute kidney injury (AKI) is an important complication associated with coronary angiography, percutaneous coronary intervention, and computed tomography studies. The increasing utilization of contrast agents for imaging makes the importance of this complication even greater. Patients can be risk stratified for the risk of contrast-induced AKI by several clinical factors including hypotension, renal function, age, advanced heart failure, anemia, and diabetes mellitus. Contrast volume is also an important and modifiable risk factor for AKI. For the prevention of contrast-induced AKI, multiple approaches have been tried. The most effective prevention strategy is hydration. Normal saline has been the standard, but other options such as sodium... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5544401 Sat, 24 Dec 2011 16:45:11 +0100 5544401 http://www.medworm.com/index.php?rid=5544402&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fy3452257664677l5%2F Opinion statement  Coronary artery stent thrombosis (ST), defined as the thrombotic occlusion of a stented segment, is an infrequent but serious complication of percutaneous coronary intervention (PCI). The clinical consequences of ST are severe, because acute stent occlusion results in myocardial infarction and death in up to 45% of cases. Specific patient and procedural characteristics increase the risk of ST, but optimized interventional techniques and antiplatelet therapies have the potential to decrease ST and improve cardiovascular outcomes following PCI. Content Type Journal ArticleCategory Coronary Artery Disease (PH Stone, Section Editor)Pages 1-17DOI 10.1007/s11936-011-0155-4Authors Julio F. Marchini, Cardiovascular Division, Brigham and Women’s Hospital, H... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5544402 Thu, 22 Dec 2011 16:37:52 +0100 5544402 http://www.medworm.com/index.php?rid=5524388&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fjh78866476058255%2F Opinion statement  Dual antiplatelet therapy (aspirin and a P2Y12 antagonist) is required after the insertion of a coronary artery stent. If the stent has been inserted in the context of an acute coronary syndrome (ACS), then clopidogrel or a high-potency P2Y12 antagonist such as prasugrel or ticagrelor should be considered. Current indications for the use of prasugrel in this situation include ST elevation, diabetes, or previous stent thrombosis on clopidogrel therapy. If the stent has been inserted electively for stable ischemic heart disease, then the patient should normally receive clopidogrel. Next, it is important to consider the patient’s bleeding risk. The CRUSADE score can be used to determine the likelihood of a subsequent gastrointestinal (GI) bleed. For patient... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5524388 Mon, 19 Dec 2011 16:54:29 +0100 5524388 http://www.medworm.com/index.php?rid=5515283&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl8574287j6w5v531%2F Opinion statement  Sudden cardiac death (SCD) is a very prevalent cause of death in the United States. The majority of individuals who experience SCD do not survive the episode. Although there are ongoing efforts to improve resuscitation (ie, training in cardiopulmonary resuscitation, easy access to automatic external defibrillators), the primary modality addressing this public health problem is prevention by identification and treatment of high-risk cohorts. Current screening techniques have focused on identifying patients for primary prevention of ventricular tachyarrhythmias. Primary prevention therapies include medications, such as beta-blockers, statins, and angiotensin-converting enzyme inhibitors, and the implantable cardioverter defibrillator (ICD), whose use is cur... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5515283 Fri, 16 Dec 2011 16:55:05 +0100 5515283 http://www.medworm.com/index.php?rid=5476365&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fc3879256213g133k%2F Opinion statement  Although carotid intima-media thickness (IMT) has been broadly used as a tool to evaluate cardiovascular risk, its role as a surrogate endpoint is still debated. The main issue is the fact that no study has ever been powered to show a relationship between changes in carotid IMT during follow-up and cardiovascular events. A meta-analysis of existing clinical studies was performed to investigate this relationship but it failed to demonstrate a predictive role of regression in carotid IMT for cardiovascular events. The reasons for the lack of a clear evidence for a predictive role of IMT progression are unknown but are likely multifactorial. Firstly, it may depend on the fact that this index is not a pure atherosclerosis index. Second, carotid atherosclerosi... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5476365 Fri, 02 Dec 2011 17:30:37 +0100 5476365 http://www.medworm.com/index.php?rid=5476366&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fc677up72331t268u%2F Opinion statement  Considering lesion priority and its clinical consequences, coronary artery bypass grafting (CABG) has been a treatment of choice for revascularization in patients with significant left main coronary artery (LMCA) disease, However, with remarkable advancements in techniques of percutaneous coronary intervention (PCI), supporting devices, and adjunctive pharmacologic therapy, PCI with stenting has emerged to be a less invasive and feasible revascularization treatment for these patients. The cumulative evidence suggests that the safety outcomes such as mortality or composite of death, myocardial infarction, and stroke are similar among PCI and CABG, with the only difference being the rate of repeat revascularization. Based on these data, the current guidelin... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5476366 Thu, 01 Dec 2011 19:21:13 +0100 5476366 http://www.medworm.com/index.php?rid=5468684&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fm087063h5h710h10%2F Opinion statement  Although clear algorithms for diagnosis and treatment of patients with chest pain at low or high risk for an acute coronary syndrome (ACS) exist, they are less well delineated for patients presenting with chest pain with an intermediate risk for ACS. In patients presenting acutely or subacutely to emergency departments (EDs) at high risk for ACS, such as those with ST segment elevation on their 12-lead electrocardiogram (ECG), immediate contrast coronary angiography is performed. On the other hand, chest pain observation units (OUs) are recommended for managing those with chest pain at low risk for an ACS event. In this setting, these OUs are associated with lower healthcare resource utilization and improved cost-effectiveness. Cost-effective diagnosis an... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5468684 Wed, 30 Nov 2011 04:53:01 +0100 5468684 http://www.medworm.com/index.php?rid=5457438&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg125612008qg4321%2F Opinion statement  The first step towards approaching a patient with an inconclusive stress test is to identify the initial reason why a stress test was ordered and examine what factors led to inconclusive test results. Next, it is important to ask whether the patient will benefit from further testing, as not all patients with inconclusive test results require additional testing. In patients who are at low-to-intermediate risk, it may be useful to perform coronary CT angiography (CTA) to exclude the presence of obstructive coronary atherosclerosis. Among individuals with no prior history of coronary artery disease, a possible advantage of CTA is that if subclinical atherosclerosis is identified, intensification of lifestyle interventions, and often pharmacotherapy, should b... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5457438 Mon, 28 Nov 2011 16:59:30 +0100 5457438 http://www.medworm.com/index.php?rid=5431577&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F363wgg2653759236%2F Opinion statement  Subclinical coronary artery disease (CAD) is widespread and under-diagnosed. Preventive efforts are required to reduce the burden of this disease and its complications. Imaging of coronary artery calcium (CAC) with cardiac computed tomography is highly specific for the diagnosis of subclinical CAD and can also facilitate treatment decisions in preventive cardiology. Indeed, CAC testing has been recommended by the American Heart Association for asymptomatic patients at intermediate risk for future cardiac events (as defined by clinical risk factors) to refine existing risk estimates. However, the optimal follow-up of those patients who have already undergone CAC testing remains unclear, particularly with regards to repeat CAC testing. This especially relat... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5431577 Fri, 18 Nov 2011 07:01:41 +0100 5431577 http://www.medworm.com/index.php?rid=5347267&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv3785485221264x6%2F Opinion statement  Antithrombotic pharmacotherapy is an essential component in the pharmacologic arsenal of physicians dealing with diseases at high thromboembolic potential, such as coronary artery disease and atrial fibrillation. Age has a non-negligible impact on the pharmacokinetic and pharmacodynamic effects of antithrombotic medications. Although the benefits of antithrombotic pharmacotherapy in the elderly are well established, the elderly are generally more vulnerable to the adverse effects of antithrombotic drugs, particularly bleeding. Factors that may affect therapeutic agents in general (e.g., renal function, hepatic metabolism, body mass distribution) as well as factors more specific to thrombosis and hemostasis (e.g., platelet dysfunction, coagulation disorder... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5347267 Fri, 21 Oct 2011 05:48:42 +0100 5347267 http://www.medworm.com/index.php?rid=5335468&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv7mvu2h264376532%2F Opinion statement  Our approach to the management of the patient with a bicuspid aortic valve (BAV) takes several factors into consideration. First, is the dysfunction of the valve due to aortic stenosis (AS), aortic regurgitation (AR), or a combination of stenosis and regurgitation, and what is the severity? Next, is there aortic dilation in any of the regions (sinuses of Valsalva, sinotubular junction, tubular ascending aorta, or transverse arch) discussed in this article. In general, we follow patients with a BAV and moderate valve dysfunction (AS or AR) with yearly surveillance transthoracic echocardiography for left ventricular function, jet velocity, gradient, and valve area with AS, whereas left ventricular (LV) function and LV dimensions are monitored for patients w... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5335468 Wed, 19 Oct 2011 05:52:28 +0100 5335468 http://www.medworm.com/index.php?rid=5314290&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F4v60k33833263563%2F Opinion statement  Prompt recognition of the signs and symptoms of pericardial disease is critical so that appropriate treatments can be initiated. Acute pericarditis has a classical presentation, including symptoms, physical examination findings, and electrocardiography abnormalities. Early recognition of acute pericarditis will avoid unnecessary invasive testing and prompt therapies that provide rapid symptom relief. Non-steroidal anti-inflammatory drugs (NSAIDs) remain first-line therapy for uncomplicated acute pericarditis, although colchicine can be used concomitantly with NSAIDS as the first-line approach, particularly in severely symptomatic cases. Colchicine should be used in all refractory cases and as initial therapy in all recurrences. Aspirin should replace NSAI... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5314290 Tue, 11 Oct 2011 15:53:03 +0100 5314290 http://www.medworm.com/index.php?rid=5314291&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb7645041k4g4957l%2F Opinion statement  The systemic amyloidoses are a group of heterogeneous disorders characterized by extracellular deposition of misfolded fibrillar protein that results in organ dysfunction. Involvement of the heart (cardiac amyloidosis) is manifest by increased cardiac wall thickness and impairment of myocardial diastolic and systolic properties, changes that result in heart failure, dysrhythmia, and death. Amyloidosis is classified by precursor protein, with light-chain (AL) and transthyretin (TTR) disease being most common in the United States. TTR amyloid can result from misfolding of variant TTR, a genetically inherited disease, or wild-type TTR, an acquired form of disease (termed senile systemic amyloidosis). In recent years, advances in the diagnosis and treatment o... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5314291 Tue, 11 Oct 2011 15:53:02 +0100 5314291 http://www.medworm.com/index.php?rid=5304292&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F07rx465344041xxg%2F Opinion statement  Treatment goals of acute decompensated heart failure are to decrease congestion, afterload, and neurohormonal activation in order to improve hemodynamics and symptoms and, perhaps, reduce in-hospital events, re-hospitalizations, and mortality while avoiding toxicities of therapy such as hypotension, arrhythmias, and renal dysfunction. Relief of congestion through intravenous loop diuretics is a mainstay of therapy. In cases where diuretics are not effective, ultrafiltration may be used to achieve euvolemia. Beta-blockers should be continued or reduced in dose at admission but should not typically be held. In patients with normotensive or hypertensive heart failure, afterload reduction with vasodilators should be instituted at presentation. Choice of a par... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5304292 Thu, 06 Oct 2011 05:42:50 +0100 5304292 http://www.medworm.com/index.php?rid=5285422&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F27816j2g7p4j1184%2F This article aims to update the body of evidence surrounding conventional HF biomarkers and to highlight some emerging evidence on the use of novel markers. We believe that in select patients there may be a role for monitoring and cautious interpretation of HF biomarker levels to facilitate diagnosis, prognostication, and optimization of tailored therapy. However, there are not yet convincing data to suggest that routine hormone monitoring should be applied broadly and algorithmically to all HF patients. Moreover, to the extent that they are measured, HF biomarkers should serve only as a complement to—never as a substitute for—sound clinical judgment, watchful follow-up, and reliance on expert consultation when necessary. Content Type Journal ArticleCategory Valvular, Myocar... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5285422 Sat, 01 Oct 2011 05:44:50 +0100 5285422 http://www.medworm.com/index.php?rid=5285423&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F07107wr1g564h01p%2F Opinion statement  The treatment of acute decompensated heart failure in the presence of progressive renal dysfunction is a commonly encountered dilemma in clinical practice. Also known as cardiorenal syndrome, this complex disease state has forced researchers and clinicians to develop new treatment strategies to relieve the symptomatic congestion of heart failure while preserving renal function. Loop diuretics remain the standard of pharmacologic treatment of acute heart failure, but their effects on renal function have been called into question. The DOSE trial set out to determine optimal diuretic dosing strategies but no clear regimen was firmly established. Initial studies with vasopressin antagonists showed promise in their ability to increase urine output, provide sho... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5285423 Thu, 29 Sep 2011 06:18:10 +0100 5285423 http://www.medworm.com/index.php?rid=5237051&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff65772247j4765p3%2F Opinion statement  Infective endocarditis is an uncommon cardiac condition but is associated with significant morbidity and mortality despite advancements in diagnosis and treatment. Recent epidemiologic changes in this disease have resulted in additional challenges for treatment and improving outcome. Health care-associated infection is a growing cause of endocarditis, and the predominance of Staphylococcus aureus infection is associated with increased co-morbid medical conditions, lower rate of surgical intervention, and worse outcome. In order to reduce the high rate of complications and mortality related to endocarditis, attention to the role of antibiotic prophylaxis has been given by major cardiology societies including the American College of Cardiology, American Hear... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5237051 Thu, 15 Sep 2011 15:46:16 +0100 5237051 http://www.medworm.com/index.php?rid=5208437&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F136173k5nk00121m%2F Opinion statement  Sleep disordered breathing (SDB) is common in heart failure patients across the range of ejection fractions and is associated with adverse prognosis. Although effective pharmacologic and device-based treatment of heart failure may reduce the frequency or severity of SDB, heart failure treatment alone may not be adequate to restore normal breathing during sleep. Continuous positive airway pressure (CPAP) is the major treatment for SDB in heart failure, especially if obstructive rather than central sleep apnea (CSA) predominates. Adequate suppression of CSA by PAP is associated with a heart transplant-free survival benefit, although randomized trials are ongoing. Bilevel PAP (BPAP) may be as effective as CPAP in treating SDB and may be preferable over CPAP ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5208437 Mon, 05 Sep 2011 16:15:44 +0100 5208437 http://www.medworm.com/index.php?rid=5161447&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw30795760551h807%2F Opinion statement  For almost the past decade, recommendations for the use of implantable cardioverter defibrillators (ICDs) for primary prevention of sudden cardiac death have been based upon the left ventricular ejection fraction (LVEF). Current guidelines recommend an ICD for heart failure patients with LVEF ≤35% and NYHA functional class of II or III; however, because the majority of heart failure patients who qualify for ICD implantation based on these criteria will never have an event requiring ICD therapy over several years of follow-up, additional methods of risk stratification for sudden death are clearly needed. Additionally, most of the nearly 300,000 cardiac arrests that occur each year occur in patients without heart failure or significant left ventricular dy... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5161447 Thu, 18 Aug 2011 06:02:39 +0100 5161447 http://www.medworm.com/index.php?rid=5070178&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx6k4203264604n63%2F Opinion statement  The past decade of ablation for atrial fibrillation (AF) has seen the adaptation of catheters designed for “focal” tachycardias or single pathways to perform wide encirclement of the pulmonary veins (PV). During the next decade, technologies designed specifically for PV isolation will emerge. Each system has its unique attributes. The cryoballoon system offers rapid PV isolation and the promise of enhanced safety, whereas the success rate is likely to be similar to catheter-based approaches. Although preclinical studies do suggest a very low likelihood of left atria-esophageal fistula using this technology, concerns of phrenic nerve damage and a small incidence of PV stenosis need to be addressed. It is likely that use of the larger 28-mm balloon will... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5070178 Mon, 25 Jul 2011 15:45:06 +0100 5070178 http://www.medworm.com/index.php?rid=5063600&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F5336612505q44753%2F Opinion statement  The major diagnoses carried by children undergoing cardiac transplantation worldwide are congenital heart defects, cardiomyopathies, and retransplantation. The leading diagnosis in infancy is congenital heart disease, whereas cardiomyopathy predominates in older children. In view of this wide spectrum of diagnoses, the perioperative management of these children requires medical, interventional, and surgical expertise in treatment of complex congenital heart defects, end-stage heart failure, and cardiac transplantation. According to the Pediatric Heart Transplantation Survey database, the majority of children listed for cardiac transplantation eventually require higher levels of cardiac support before transplantation. The team caring for these children sho... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5063600 Tue, 19 Jul 2011 23:38:14 +0100 5063600 http://www.medworm.com/index.php?rid=5063601&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1013j2t3ghr71242%2F Opinion statement  Pulmonary hypertension (PHTN) is common to a variety of conditions occurring in infants and children presenting to the intensive care unit. A fundamental understanding of the response of the right ventricle to an increase in afterload and the clinical syndromes responsible for PHTN is essential for managing patients with PHTN and critical heart disease. There are important distinguishing features between PHTN syndromes, and although one form of PHTN may predominate, often more than one mechanism of PHTN is contributing to the pathophysiologic state. Thus, it is imperative to tailor therapies accordingly in order to optimize outcomes. Content Type Journal ArticlePages 1-12DOI 10.1007/s11936-011-0142-9Authors Ronald A. Bronicki, Division of Pediatric ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5063601 Tue, 19 Jul 2011 06:08:17 +0100 5063601 http://www.medworm.com/index.php?rid=5030345&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Faxj717174w3v5g56%2F Opinion statement  The treatment of cardiovascular failure in the perioperative period with the use of mechanical circulatory support is a well-recognized, well-developed, and commonly utilized treatment modality. Regardless of the exact circumstances of initiation, the use of a support device is a “bridge.” Where there has been an acute myocardial insult, short-term assist devices can serve as a “bridge to immediate survival,” a “bridge to recovery,” or even a “bridge to the next decision.” Mechanical circulatory support can serve as a treatment of cardiovascular decompensation caused by myocarditis, acute myocardial insult, low cardiac output following surgery, and congenital heart disease. The utilization of such support carries significant risks such as b... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5030345 Tue, 12 Jul 2011 06:01:58 +0100 5030345 http://www.medworm.com/index.php?rid=5009851&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff58543v2543q8952%2F Opinion statement  Stroke is a dreaded complication of atrial fibrillation. In the past, preventive therapy included aspirin and oral anticoagulation. Selected patients who are not suitable for oral anticoagulation may benefit from the addition of clopidogrel with aspirin. This combination, when compared with aspirin, offers a reduced risk of stroke at a cost of more major bleeding. We use this therapy in patients with atrial fibrillation who have unstable coronary syndromes or in patients who receive coronary artery stents who are not good candidates for “triple therapy” with aspirin, clopidogrel, and warfarin. The duration of therapy is tempered by many variables. In the case of coronary stents, we ask the interventionalist to consider a bare metal stent to shorten th... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=5009851 Wed, 06 Jul 2011 05:54:20 +0100 5009851 http://www.medworm.com/index.php?rid=4985795&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fav92805472ku345p%2F Opinion statement  Over five decades have passed since the first permanent cardiac pacemakers were introduced into clinical medicine. Evolving technology and falling costs have demanded adaptation to clinical practice and implantation trends and, with the advent of evidenced-based medicine, the specific roles and benefits of individual pacemaker technologies have never been so carefully scrutinized. Pacing mode choice continues to be a subject of great controversy, and there are great regional variations in practice. We believe that single chamber atrial pacing use (AAI/R) has become an anachronism that should generally be abandoned (obviously with rare exceptional cases) and be replaced by dual chamber pacemakers (DDD/R) equipped with modern pacing algorithms that minimize... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4985795 Mon, 27 Jun 2011 17:51:34 +0100 4985795 http://www.medworm.com/index.php?rid=4970213&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr235753553978111%2F Opinion statement  Because a minority of patients with D-transposition of the great arteries are diagnosed in utero by ultrasound, most present after delivery with cyanosis. In the absence of apparent lung disease, cyanotic neonates suspected of having a cardiac lesion should be immediately transferred to an intensive care unit at a pediatric tertiary care center for monitoring, resuscitation, and to define the cardiac anatomy and physiology. A prostaglandin E-1 infusion is usually initiated to maintain ductal patency and promote intra-cardiac mixing. In the past, balloon atrial septostomy (BAS) was routinely performed to enlarge the atrial septal defect and improve intra-cardiac mixing while the infants awaited surgery. Recent literature has reported an increase risk of st... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4970213 Fri, 24 Jun 2011 16:03:49 +0100 4970213 http://www.medworm.com/index.php?rid=4970214&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa3u8p525u0j76132%2F Opinion statement  It is our belief that a well-designed cardiac device management program should include end-of-life patient and family planning, addressing potential decisions regarding withdrawal of pacemaker and/or implantable cardioverter defibrillator therapy. Guided by the basic ethical and legal principles outlined in the article, it is the responsibility of the electrophysiologist and other involved health care providers to introduce this topic to patients, provide guidance and resources for decision making, and honor both patient and family requests. Content Type Journal ArticlePages 1-8DOI 10.1007/s11936-011-0136-7Authors Blair P. Grubb, Cardiology, University of Toledo Medical Center, 3000 Arlington Avenue, Mail Stop 1118, Toledo, OH 43614, USABeverly Karab... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4970214 Tue, 21 Jun 2011 20:55:26 +0100 4970214 http://www.medworm.com/index.php?rid=4946492&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj776543541w32px2%2F Opinion statement  Cardiogenic shock (CS), a state of cardiac dysfunction that results in systemic hypoperfusion and end-organ dysfunction, is associated with high in-hospital mortality. Various forms of mechanical circulatory support have been used to treat CS. First employed in the 1960s, the intra-aortic balloon pump (IABP) has been a mainstay in the treatment of acute CS. However, the IABP is unable to provide adequate support in many patients, and newer technologies, including extracorporeal membrane oxygenation and percutaneous ventricular assist devices, appear to be more effective in reversing CS. These devices are also useful for supporting patients during complex percutaneous coronary intervention. Perhaps most importantly, they can be used as a bridge to decision... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4946492 Wed, 15 Jun 2011 05:47:39 +0100 4946492 http://www.medworm.com/index.php?rid=4946493&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F975080g221m678n8%2F Opinion statement  Among patients with congenital heart defects, neonates with single ventricle disease continue to challenge clinicians despite significant improvements in survival over the past 30 years. The cardiac anatomical variants associated with the term “single ventricle” are characterized by severe hypoplasia (or absence) of either ventricle, typically in association with obstruction or atresia of either the pulmonary or systemic outflow tracts. Physiologically, the single ventricle receives both pulmonary and systemic venous blood and ejects simultaneously into the pulmonary and systemic circulations, a pattern commonly referred to as single ventricle physiology. Medical and surgical management strategies, though palliative, are aimed at achieving the op... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4946493 Tue, 14 Jun 2011 06:02:22 +0100 4946493 http://www.medworm.com/index.php?rid=4913507&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fq2u756n530122wqr%2F Opinion Statement  Complete surgical repair of tetralogy of Fallot (TOF) around 3 months of age is the commonly undertaken management strategy in many centers and has excellent outcomes. Intervention at an earlier age, including the newborn period, may be required for children with symptoms. Early extubation from mechanical ventilation where possible may help improve outcomes for children undergoing complete repair of TOF. Content Type Journal ArticlePages 1-11DOI 10.1007/s11936-011-0135-8Authors Satish K. Rajagopal, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USARavi R. Thiagarajan, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-31... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4913507 Mon, 06 Jun 2011 14:57:39 +0100 4913507 http://www.medworm.com/index.php?rid=4904079&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fc18wr2760h517h84%2F Opinion statement  Atrial and ventricular arrhythmias commonly arise in the setting of cardiogenic shock and often result in hemodynamic deterioration. Causative factors include myocardial ischemia, volume overload, and metabolic disturbances. Correcting these factors plays an important role in managing arrhythmias in this setting. Ventricular arrhythmias are more ominous compared to atrial arrhythmias but both require prompt intervention with electrical shock and anti-arrhythmic drug suppression. Coronary reperfusion is key to improving survival, including reducing the risk of sudden cardiac arrest, in acute myocardial infarction. Case series have also demonstrated the value of intra-aortic balloon pump counter-pulsation in suppressing ventricular arrhythmias in cardiogenic... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4904079 Mon, 30 May 2011 16:54:39 +0100 4904079 http://www.medworm.com/index.php?rid=4821847&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F915645221q15038w%2F Opinion Statement  Moderate alcohol intake is beneficial to the heart and cardiovascular system. A J- or U-shaped response has been shown in the majority of studies examining alcohol’s effect on cardiovascular mortality and downstream cardio-metabolic effects, with heavy alcohol intake associated with worse outcomes. These effects apply to individuals with and without underlying coronary artery disease. However, care must be taken in defining “moderate” intake between the sexes. Males appear to have a wider therapeutic window and can afford 2 to 3 drinks per day whereas women should limit intake to 1 to 2 drinks per day (a “drink” being classified as 10 to 14 grams of alcohol). More than half of alcohol’s cardioprotective effects can be attributed to its effect ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4821847 Wed, 11 May 2011 15:49:36 +0100 4821847 http://www.medworm.com/index.php?rid=4821848&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fqr326hk41327h6p6%2F Opinion statement  Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among women of reproductive age, impacting 5–10% of premenopausal American women. During the reproductive years, women with PCOS seek medical attention related to infertility, hirsutism, and acne. About 60% of women with PCOS are obese and insulin resistant. Up to 40% of women with PCOS will develop diabetes by the age of 50 and many are dyslipidemic. In addition to treating the cosmetic and fertility issues associated with PCOS, health care providers must educate patients regarding the long-term cardiovascular consequences associated the this disorder. At menopause, a woman with PCOS is likely to have had multiple cardiac risk factors for several decades. Postmenopausal women with ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4821848 Wed, 11 May 2011 15:49:35 +0100 4821848 http://www.medworm.com/index.php?rid=4790253&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F17m361317404g0l8%2F Opinion statement  Clinical trials have demonstrated the benefit of reduction of low-density lipoprotein (LDL) cholesterol levels in the prevention of atherosclerotic cardiovascular disease. Evidence is less robust for the effect of reduction of triglyceride levels and increase of high-density lipoprotein (HDL) cholesterol levels. In spite of the decrease of cardiovascular events in trials of LDL cholesterol–lowering medications, considerable residual risk remains, even with the use of high-dose statins. The fibric acid derivatives or fibrates reduce triglyceride and increase HDL cholesterol levels, effects that would be expected to affect cardiovascular events. However, clinical outcomes trials with fibrates have shown mixed results. Post-hoc analyses of fibrate trials a... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4790253 Wed, 04 May 2011 14:53:11 +0100 4790253 http://www.medworm.com/index.php?rid=4782369&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F870637x0595351u6%2F Opinion statement  Pharmacogenomics holds the promise of transforming patient care by allowing providers to tailor therapy to each individual patient based on his or her genetic information. Although no established pharmacogenomic applications in cardiovascular medicine yet exist, there are at least three emerging applications that may ultimately become routine clinical practice; these are related to warfarin, clopidogrel, and statins. Of the three, warfarin pharmacogenomics has been the most rigorously evaluated to date, with several clinical trials either completed or underway. Clopidogrel pharmacogenomics has a growing body of supporting scientific evidence and warrants evaluation in prospective clinical trials. Statin pharmacogenomics remains the least developed applica... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4782369 Mon, 02 May 2011 15:00:03 +0100 4782369 http://www.medworm.com/index.php?rid=4782370&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn1116u458vn70611%2F Opinion statement  There is increasing evidence that restricting caloric intake may have considerable health benefits in humans. Significant evidence in non-primate animals demonstrates that caloric restriction increases average and maximal life span. However, historically, caloric intake reduction in humans has been involuntary and accompanied by poverty, malnutrition, poor sanitation, and a lack of modern health care. As a result, caloric restriction in people typically has been accompanied by a reduction of both average and maximal life span. Conversely, improvements in standards of living usually are accompanied by an increased food supply and resultant improved health and longevity. The majority of the world is now in a new era where an abundance of caloric intake and ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4782370 Wed, 27 Apr 2011 08:45:17 +0100 4782370 http://www.medworm.com/index.php?rid=4725518&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn6416682q1226662%2F Opinion statement  The pathogenesis of cardiovascular disease is a complex and dynamic process. The renin-angiotensin-aldosterone system (RAAS) is a potent and powerful mediator in the homeostasis of the cardiovascular and renal systems. RAAS blockade via angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) has been consistently proven to be an effective and safe strategy for the primary and secondary prevention of cardiovascular disease in patients across a wide spectrum of risk. Although the beneficial effects of RAAS blockade may be due to its effects on central and peripheral blood pressure, there are many additional mechanisms to consider that may contribute additional protection. While a combination of ACE inhibitors and ARBs has not... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4725518 Thu, 14 Apr 2011 17:01:52 +0100 4725518 http://www.medworm.com/index.php?rid=4686186&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb762417077623064%2F Opinion statement  During the past few years, the branch syndromes have been ascribed to pontine lesions, and the development of neuroimaging techniques has renewed the interest in exploring their clinical–radiological correlation. Brain imaging via MRI has helped in the diagnosis and accurate localization of lesions. From classic studies it is now accepted that the pathogenic mechanism of lacunar pontine infarction (LPI) is perforating small arterial disease or microangiopathy caused by lipohyalinosis, whereas paramedian pontine infarction (PPI) are caused by paramedian or circumferential basilar branch disease due to atheromatous branch occlusion. The importance of basilar artery disease not only in severe posterior circulation infarcts but also in minor brainstem strok... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4686186 Sat, 02 Apr 2011 05:53:46 +0100 4686186 http://www.medworm.com/index.php?rid=4644320&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fmt8027718166135g%2F Opinion statement  Intravenous recombinant tissue plasminogen activator is the only medication approved by the US Food and Drug Administration for treatment of acute stoke. Despite established efficacy, less than 3% of stroke patients receive treatment, and that number is even smaller for patients living in remote locations. This is in part due to a lack of neurologists and stroke specialists in these rural communities. The traditional model of “ship and drip” wastes crucial time, resulting in delays or loss of treatment. In this review, we discuss strategies to overcome geographic disparities in stroke care and improve acute treatment in remote locations. Helicopter transport from field to stroke center is one option to rapidly deliver patients to stroke centers. Howeve... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4644320 Fri, 25 Mar 2011 18:51:48 +0100 4644320 http://www.medworm.com/index.php?rid=4632278&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk101072478574851%2F Opinion statement  Intravenous alteplase or tissue plasminogen activator (tPA) has been the standard of care with proven efficacy for acute ischemic stroke for over a decade. Despite this, only a small fraction of potentially eligible stroke patients receive this medication. There seems to be a fear among practitioners of legal repercussions as a result of an increased risk of intracerebral hemorrhage due to tPA. This review of legal cases involving tPA will show that instead, physicians are often found liable as a result of not treating with tPA. Content Type Journal ArticlePages 1-7DOI 10.1007/s11936-011-0122-0Authors Nhu T. Bruce, San Diego VA Healthcare System, Neurology Service (127), 3350 La Jolla Village Drive, San Diego, CA 92161, USAWilliam P. Neil, San Diego ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4632278 Mon, 21 Mar 2011 19:00:38 +0100 4632278 http://www.medworm.com/index.php?rid=4601376&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb65n203p727r5755%2F Opinion statement  Dolichoectasia is a dilatation and elongation of the arteries, usually affecting intracranial basilar and vertebral arteries. It may cause posterior circulation stroke or transient ischemic attacks independent of atherosclerotic disease. Compression of cranial nerves or brainstem leads to hemifacial spasm, trigeminal neuralgia, or brainstem dysfunction (temporary or permanent). Intracranial bleeding is another possible manifestation. In general, the mortality and morbidity is higher in patients with dolichoectasia. Progression of arterial dilatation or elongation is an ominous sign for poor prognosis. Optimal treatment for vertebrobasilar dolichoectasia is uncertain. Adequate control of blood pressure may prevent ischemic or hemorrhagic stroke. In case of... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4601376 Mon, 14 Mar 2011 16:54:51 +0100 4601376 http://www.medworm.com/index.php?rid=4541411&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F4q607822jtl2924r%2F Opinion statement  Malignant middle cerebral artery (MCA) infarction occurs in about 10% of all patients with supratentorial ischemic strokes. The infarction involves the entire MCA territory. Due to the consequences of severe brain edema, brain herniation, elevated intracranial pressure (ICP), and midline shift, these events carry a mortality rate of up to 80%. No clinical trials have been conducted to study the efficacy of the osmotic agents such as mannitol or hypertonic saline. Furthermore, aggressive use of such treatments may be detrimental. Surgical decompression has previously been proposed as a way to relieve the vicious cycle of malignant cerebral edema and reduced cerebral perfusion. Its use in relieving ICP is also controversial. Recently, a pooled analysis of t... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4541411 Mon, 28 Feb 2011 16:48:51 +0100 4541411 http://www.medworm.com/index.php?rid=4513360&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1px08u1273wtqx74%2F Opinion statement  Currently available data suggest that patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) with stenting who do not continue oral anticoagulation are at increased risk for mortality and morbidity. In this patient population, therapy directed at reducing both thromboembolism (via oral anticoagulation) and stent thrombosis (via dual antiplatelet therapy) is necessary but is associated with an increased risk for bleeding. For patients with a high risk for thromboembolism based on published AF risk scores, the use of bare metal stents is recommended to minimize the duration of triple therapy. During the time period when triple therapy is used, the International Normalized Ratio (INR) should be maintained at the lower end ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4513360 Mon, 21 Feb 2011 17:08:00 +0100 4513360 http://www.medworm.com/index.php?rid=4513361&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F8632u31782167330%2F Opinion statement  Venous angiomas are currently widely referred to as developmental venous anomalies (DVAs), reflecting the prevailing concept that they represent anomalous, but functional, venous channels within the brain parenchyma. Although DVAs are not infrequently associated with other vascular malformations that harbor hemorrhage risk or can present symptomatically, isolated DVAs themselves appear to be benign lesions with little demonstrable link to hemorrhage, seizures, or headaches. Treatments to remove or occlude DVAs are consequently unnecessary. Furthermore, obliteration of a DVA can be harmful as it can lead to impairment in regional cerebral venous drainage, with the resultant risk of venous congestion, infarction, and hemorrhagic conversion, and the potential... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4513361 Mon, 21 Feb 2011 17:07:58 +0100 4513361 http://www.medworm.com/index.php?rid=4502694&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff637r4103g05436n%2F Opinion statement  For some time, posterior circulation stroke has been neglected in diagnostic and therapeutic studies for various reasons, such as minor incidence compared to anterior circulation stroke or anatomical and vascular characteristics. This changed at least partly when the New England Medical Center (NEMC) Posterior Circulation Registry was initiated, and now the number of publications concerning posterior circulation stroke is continuously increasing. Whether the differences outweigh the similarities between posterior and anterior circulation stroke remains open to debate, but both are the subject of intensive investigations. In this article, we review the most recent literature on different MRI techniques, such as diffusion-weighted and diffusion tensor imagi... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4502694 Thu, 17 Feb 2011 17:03:41 +0100 4502694 http://www.medworm.com/index.php?rid=4495975&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F43j42567457451t3%2F Opinion Statement  Aortoiliac occlusive disease (AIOD) is an insidious, progressive atherosclerotic process that can lead to claudication, rest pain, tissue loss, and eventual lower extremity amputation. The patient with AIOD is also at risk for both fatal and nonfatal cardiovascular events. Treatment of the disease includes both risk factor modification and efforts to improve blood flow to the lower extremity. For mild to moderate intermittent claudication, medical therapy as well as a supervised exercise program is advised. For debilitating claudication or critical limb ischemia, a number of recent studies support an endovascular approach for patients with AIOD, citing patency rates that compare favorably to open surgery. Surgical revascularization, however, should still ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4495975 Wed, 16 Feb 2011 07:00:04 +0100 4495975 http://www.medworm.com/index.php?rid=4484123&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F95387726637n0500%2F Opinion statement  Cerebrovascular disease remains a leading cause of morbidity, mortality, and health care expenditure in the United States. Approximately 80% of strokes are ischemic in origin, with 20% to 25% due to atherosclerotic disease of the carotid artery. It is well established that untreated, symptomatic carotid stenosis confers a 25% risk of stroke within 2 years, and that asymptomatic carotid stenosis > 60% is associated with an 11% stroke risk at 5 years. Over the past six decades, surgical revascularization with carotid endarterectomy, when performed by experienced surgeons, has been demonstrated to be effective in reducing stroke risk in patients with severe stenosis. During the same time, medical therapy has improved considerably, and endovascul... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4484123 Fri, 11 Feb 2011 11:53:41 +0100 4484123 http://www.medworm.com/index.php?rid=4442710&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F84705465368mp235%2F Opinion statement  Livedo reticularis is a violaceous mottling of the skin with a “fishnet” reticular appearance. Primary and secondary etiologies exist, including a pathologic variant termed livedo racemosa. No evidence-based medicine exists to guide therapy for this disorder, but most patients with primary and secondary livedo reticularis are asymptomatic and do not require treatment. In the rare instance that a patient with primary livedo reticularis experiences mild symptoms such as episodic numbness and tingling, avoidance of cold and vasoconstricting substances should be encouraged. Lastly, judicious dosing of a vasodilator such as a calcium channel blocker can be prescribed. Patients with secondary livedo reticularis or livedo racemosa may benefit from these same... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4442710 Thu, 03 Feb 2011 07:08:24 +0100 4442710 http://www.medworm.com/index.php?rid=4442711&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn023221j75444773%2F Opinion statement  Although compression therapy was initially described over 2,000 years ago (Felty and Rooke Semin Vasc Surg Mar 18:36-40, 1), several patients with edema do not receive appropriate compression therapy. Instead, most patients with edema are treated primarily with diuretics. Compression therapy is the cornerstone of treatment of venous edema and lymphatic disorders. Compression therapy decreases the foot and leg volume and reduces venous reflux and venous hypertension. Compression can be achieved by multiple different modalities, such as inelastic bandages; multilayered wraps; short, medium, and long stretch bandages; graduated compression stockings; and pneumatic compression devices. The major criticism of compression therapy is poor patient compliance. ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4442711 Tue, 01 Feb 2011 08:39:39 +0100 4442711 http://www.medworm.com/index.php?rid=4415403&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff4855g1q80685v63%2F Opinion statement  Upper extremity deep venous thrombosis (UEDVT) accounts for between 4% and 10% of all deep venous thromboses, and may be due to primary or secondary causes. The incidence of UEDVT is increasing, partly due to the exponential growth in the use of central venous catheters and the increasing placement of permanent cardiac pacemaker or defibrillator devices. UEDVT not only compromises future vascular access but results in significant morbidity and mortality, with symptomatic pulmonary embolus occurring in approximately 12%, post-thrombotic syndrome in 13%, and mortality ranging from 15–50%. Treatment of UEDVT depends on the underlying cause, primary or secondary. In this review, we will evaluate the management options and present a proposed treatment algorit... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4415403 Thu, 27 Jan 2011 01:08:43 +0100 4415403 http://www.medworm.com/index.php?rid=4412229&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1m637t5t35255687%2F Opinion statement  In the patient with vascular disease, cigarette smoking is particularly perilous; the benefits of smoking cessation greatly exceed any risks associated with pharmacologic treatment. The patient with claudication is often uniquely motivated to quit smoking because 1) there is a chance that the leg pain will improve and 2) smoking cessation may prevent disease progression and thus invasive procedures. The first step toward success is a systematic approach with focus on the 5 A’s (Ask, Advise, Assess, Assist, and Arrange). Multiple clinical trials have demonstrated the efficacy of pharmacologic therapy for smoking cessation. The most effective medications available are bupropion and varenicline. If the patient is ready to quit, varenicline is typically fir... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4412229 Tue, 25 Jan 2011 23:47:48 +0100 4412229 http://www.medworm.com/index.php?rid=4400825&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ftt23g157322p0121%2F Opinion statement  Renal artery stenosis (RAS) is a relatively common manifestation of atherosclerosis, although in a small percentage of cases it is due to fibromuscular dysplasia and less frequently may have other etiologies. RAS may be treated by revascularization, using either percutaneous or open surgical techniques. Currently, technical success with percutaneous revascularization utilizing angioplasty and stenting is achieved in 95% or more of cases in which it is attempted. Despite this, at least one third of patients undergoing renal artery stenting do not receive any measurable benefit. Furthermore, randomized trials of stenting for RAS have failed to demonstrate a benefit over medical management alone. Thus, the clinician is faced with a challenge when determining... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4400825 Wed, 19 Jan 2011 17:00:00 +0100 4400825 http://www.medworm.com/index.php?rid=4378565&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx600717857tr5l28%2F Opinion statement  Venous thromboembolism (VTE) is frequently encountered in cancer patients, acts as an important cause of morbidity and mortality, and may be a predictor of worse prognosis. In cancer patient who have a poor life expectancy, preventing death from pulmonary embolism is the mainstay of treatment. Patients who present with severe hypotension or other clinical manifestations suggestive of critical pulmonary embolism and do not have contraindications to thrombolysis should promptly be administered thrombolytic drugs. Except for selected cases requiring aggressive therapy, treatment of VTE in patients with cancer should not differ from that of patients without malignancy; the initial treatment should be conducted with adjusted dose of unfractionated heparin (UH)... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4378565 Tue, 18 Jan 2011 15:07:24 +0100 4378565 http://www.medworm.com/index.php?rid=4378566&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fy32217435v6x2r82%2F Opinion statement  Vascular arterial compression syndromes are uncommon disorders due to dynamic anatomic compression of an artery resulting in significant ischemia in the supplied territories with ensuing symptoms. The diagnosis of these disorders requires heightened awareness and a high index of suspicion by the clinician. These diagnoses should be particularly suspected in young patients with typical symptoms but without underlying cardiovascular risk factors. Physical examination may be unremarkable, although the clinical symptoms or signs may be elicited with provocative maneuvers. The diagnostic work-up may include noninvasive tests such as Doppler waveforms, duplex ultrasonography, computed tomographic angiography, and MRI/angiography, but may require conventional an... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4378566 Mon, 17 Jan 2011 20:40:34 +0100 4378566 http://www.medworm.com/index.php?rid=4267333&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw13241l16h4kwq56%2F Opinion statement  There is abundant evidence to guide the management of chest pain patients with a confirmed or reasonably suspected diagnosis of acute coronary syndrome (ACS). But when it comes to the low-risk chest pain patient in the emergency department, there is limited evidence to support one approach over another. As a result, the evaluation of low-risk chest pain represents a distinct challenge for the emergency physician. Missing a diagnosis of ACS is certainly undesirable. However, the overuse of technology can result in misleading test results in populations with a low incidence of coronary disease. In this article, we dispel several myths surrounding low-risk chest pain and put forward a number of common-sense recommendations. We endorse taking a focused but th... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4267333 Tue, 14 Dec 2010 13:25:38 +0100 4267333 http://www.medworm.com/index.php?rid=4242518&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fcv85171538620741%2F Opinion statement  The following are general guidelines for the management of patients on dual antiplatelet therapy as they undergo gastrointestinal procedures with potential for bleeding complications: •  Avoid cessation of all antiplatelet therapies after percutaneous coronary intervention (PCI) with stent placement when possible. •  Avoid cessation of clopidogrel (even when aspirin is continued) within the first 30 days after PCI and either drug-eluting stent (DES) or bare metal stent placement. •  Defer elective endoscopic procedures, possibly up to 12 months, if clinically acceptable from the time of PCI and DES placement. •  Perform endoscopic procedures, particularly those associate... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4242518 Mon, 06 Dec 2010 18:50:12 +0100 4242518 http://www.medworm.com/index.php?rid=4230841&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl84568751805l7x4%2F Opinion statement  Lung transplantation in children is an effective treatment for end-stage pulmonary disease after all medical therapy has failed. It requires a huge investment in resources and absolute commitment on the part of the parents and patients. In spite of all these efforts and expense, the results with pediatric lung transplantation are the worst of all solid organ transplants. Much lies ahead to overcome the obstacles faced to improve this therapy. Content Type Journal ArticleDOI 10.1007/s11936-010-0105-6Authors Charles B. Huddleston, Children’s Hospital, #1 Children’s Place, Suite 5S 50, St. Louis, MO 63110, USA Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-3189Print ISSN 1092-8464 (Source: Current Treatment Option... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4230841 Thu, 02 Dec 2010 18:17:24 +0100 4230841 http://www.medworm.com/index.php?rid=4230842&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F8w36581542612mr1%2F Opinion Statement  You have a consultation from a 67-year-old patient with severe effort angina. Full-dose prescription could not relieve his symptoms. He had bypass surgery (coronary artery bypass graft [CABG]) more than 10 years ago. Saphenous vein graft (SVG) to a big right coronary artery (RCA) was recently occluded. SVG to a small circumflex artery was occluded before. Left internal mammary artery graft to left anterior descending artery was nicely patented. His native RCA has been occluded since before he received CABG. How can we treat these patients? Among the treatment options between redo CABG and percutaneous coronary intervention (PCI) for the chronic total occlusion of his native RCA, I propose choosing the latter option. Content Type Journal ArticleDO... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4230842 Wed, 01 Dec 2010 20:20:23 +0100 4230842 http://www.medworm.com/index.php?rid=4226052&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fp2j67114734448k2%2F Opinion Statement  Medical therapy is the foundation upon which all treatment for patients with stable coronary artery disease (CAD) is based, regardless of whether revascularization is performed. Although professional societies recommend comprehensive lifestyle and pharmacologic interventions with specific risk factor targets, in practice this does not usually occur. The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial tested multiple simultaneous lifestyle and pharmacologic interventions (referred to as “optimal medical therapy” [OMT]) with or without percutaneous coronary intervention (PCI) in patients with stable CAD. Nurse case managers were trained to counsel patients according to protocols designed to achieve predefined... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4226052 Tue, 30 Nov 2010 17:55:21 +0100 4226052 http://www.medworm.com/index.php?rid=4206533&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F321g4gxv8p447541%2F Opinion statement  Fractional flow reserve (FFR) is an invasive pressure–derived index of epicardial stenosis severity used in the catheterization laboratory to assess the hemodynamic significance of coronary lesions when non-invasive functional assessment has either not been performed or is inconclusive. The rationale for the use of FFR is that coronary angiography cannot accurately predict the hemodynamic significance of lesions with diameter stenosis <90% and that there is a large body of literature supporting the use of FFR for directing coronary revascularization. Specifically, in patients with stable angina and low-risk acute coronary syndromes, revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery s... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4206533 Thu, 25 Nov 2010 19:57:54 +0100 4206533 http://www.medworm.com/index.php?rid=4206534&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr0x85926u214g903%2F Opinion Statement  Heart failure (HF) is a major cause of mortality and morbidity and one of the most frequent reasons for hospital admission in the United States and Europe. Currently, more than 50% of HF patients have a normal (N) left ventricular (LV) ejection fraction (EF) (LVEF >50%). The main pathophysiologic processes involved in HFNEF are increased LV stiffness and abnormal relaxation, resulting in impaired LV filling. Hypertension and myocardial ischemia are the most common causes of HFNEF. Precipitating factors include volume overload, tachycardia, physical exercise, systemic stressors (such as fever and infection), arrhythmia, increased salt intake, and use of nonsteroidal anti-inflammatory drugs. There is little evidence to guide treatment, as previously HFNE... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4206534 Thu, 25 Nov 2010 19:57:53 +0100 4206534 http://www.medworm.com/index.php?rid=4187378&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh794pm6054386v34%2F Content Type Journal ArticleDOI 10.1007/s11936-010-0101-xAuthors Erland Erdmann, Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937 Köln, Germany 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=4187378 Wed, 17 Nov 2010 20:58:26 +0100 4187378 http://www.medworm.com/index.php?rid=4141083&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F977611081116x507%2F Opinion Statement  I individualize my approach to each patient based upon their understanding of their disease process, acuity of their progression to Stage D heart failure, clinical setting (hospitalized vs outpatient), and family needs. My first goal is to prove intolerance of traditional therapies for heart failure by challenging patients with various medication combinations, including staggered dosing regimens and alternatives to angiotensin-converting enzyme inhibitors/β-blockers, and by considering cardiac resynchronization therapy if they meet criteria. As patients develop progressive hypotension and side effects from medicines, I often will discontinue these medicines after careful communication. For patients with refractory heart failure, I consider cardiac transpl... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4141083 Thu, 04 Nov 2010 17:51:37 +0100 4141083 http://www.medworm.com/index.php?rid=4089545&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F5582rq454h521412%2F Opinion statement  As heart transplantation and mechanical assist technology are inadequate solutions for the growing clinical epidemic of heart failure, myocardial regeneration has moved to the forefront. Multiple laboratories using a variety of cell types have demonstrated myocardial repair in different animal models. Translating these results into clinical practice through clinical trial research has thus far proved challenging. Amassing clinical evidence suggests that cell therapy is safe and offers a modest clinical benefit, but the long-term effect of such therapy as well as the overall impact on the natural progression of heart failure and, ultimately, survival are unknown. Furthermore, cost-benefit analysis of such therapy, which will likely become increasingly impo... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4089545 Sat, 16 Oct 2010 08:54:08 +0100 4089545 http://www.medworm.com/index.php?rid=4068305&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn854731482r37tkh%2F Opinion statement  Biomarkers, especially natriuretic peptides such as B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP), are a valuable addition to standard clinical assessment in the diagnosis and prognosis of heart failure (HF). Furthermore, there is an increasing amount of evidence suggesting that natriuretic peptide–guided HF management may improve mortality, morbidity, and cost effectiveness. This work focuses on the use of BNP or NT-proBNP for the outpatient management of patients with chronic HF. Content Type Journal ArticleDOI 10.1007/s11936-010-0096-3Authors Han-Na Kim, Cardiology Division, Massachusetts General Hospital, 32 Fruit Street, Yawkey 5984, Boston, MA 02114, USAJames L. Januzzi, Cardiology Division, Massachusetts General Hospital... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4068305 Tue, 12 Oct 2010 16:52:52 +0100 4068305 http://www.medworm.com/index.php?rid=4068306&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd706430p42305695%2F Opinion statement  Both acute and chronic systolic heart failure can progress to an advanced phase, resulting in stage D heart failure and even cardiogenic shock. Despite significant progress in the treatment of systolic heart failure using medical and device therapies, this terminal phase continues to be prevalent and associated with unacceptably high morbidity and mortality. Given the inability to offer cardiac transplantation to the majority of those presenting with advanced heart failure, alternative strategies for cardiac replacement therapy are often required. Although there has been interest in using mechanical devices to support the circulation since the advent of cardiopulmonary bypass, it is only in the past 20 years that ventricular assist devices (VAD) have... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4068306 Mon, 11 Oct 2010 16:56:11 +0100 4068306 http://www.medworm.com/index.php?rid=4068307&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv42242753j133534%2F Opinion statement  More attention has been paid to the mitral valve (MV) than the tricuspid valve (TV), and this relative paucity of data has led to confusion regarding the timing of TV surgery. We review the American College of Cardiology/American Heart Association and European Society of Cardiology guidelines to identify areas of concordance (severe tricuspid regurgitation [TR] in a patient undergoing mitral valve surgery); discordance (less than severe TR but with markers for late TR recurrence such as pulmonary hypertension, a dilated TV annulus, atrial fibrillation, permanent transtricuspid pacing wires and others); and disagreement (surgery for primary TR). We provide our perspective from Northwestern University on these issues and where the guidelines are silent (TR ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4068307 Mon, 11 Oct 2010 16:56:09 +0100 4068307 http://www.medworm.com/index.php?rid=4041321&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx58j6m05n16q3417%2F Opinion statement  Arrhythmogenic right ventricular dysplasia (ARVD) is a genetic disorder that is characterized by ventricular arrhythmias and structural abnormalities of the right ventricle. Due to significant heterogeneity in its manifestation, the diagnosis of ARVD is challenging and requires a multifaceted approach to patient evaluation. It is important to not rush and diagnose ARVD prematurely, as the implications both for the patient and also for family members are enormous. Similarly, it is important for clinicians to be aware of this condition because it is potentially life threatening. There are three keys aspects to treatment once a diagnosis is established. The first issue concerns risk stratification and deciding whether to implant an implantable cardioverter d... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4041321 Wed, 06 Oct 2010 16:46:43 +0100 4041321 http://www.medworm.com/index.php?rid=4041322&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F98x5u634640q86g7%2F Opinion statement  The impact of the very significant advances in the management of heart failure over the past several decades had been limited by a lack of appropriate infrastructure for heart failure care delivery in the community. The development of disease management programs has brought about significant advances in ensuring improved care of the wider heart failure population, allowing for effective prescription of proven strategies, structured follow-up, and education of patients and families to encourage involvement in self-care. The impact of these programs on reduction in hard cardiovascular endpoints, including death and heart failure rehospitalization, has been substantial. Continued research aims to optimize this strategy in terms of what additional aspects are... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4041322 Tue, 05 Oct 2010 18:09:36 +0100 4041322 http://www.medworm.com/index.php?rid=4032578&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk0064820v128784q%2F Opinion statement  Anemia is independently associated with an increased risk of mortality and morbidity in patients with heart failure (HF). The diagnosis of anemia should prompt assessment of the underlying cause(s), first by using routine laboratory measurements (i.e., serum creatinine and estimated glomerular filtration rate [eGFR], serum iron, transferrin saturation, ferritin, vitamin B12, folic acid, and thyroid stimulating hormone). In clinical practice, it remains unclear whether using levels of the soluble transferrin receptor in HF patients to assess iron deficiency is warranted. Further investigation should follow these simple tests when judged appropriate (e.g., if occult gastrointestinal blood losses are suspected). Hemodilution may contribute significantly to a... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4032578 Sat, 02 Oct 2010 05:56:59 +0100 4032578 http://www.medworm.com/index.php?rid=4032579&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb8612948470m2231%2F Opinion statement  Inherited forms of cardiomyopathy are common causes of heart failure. Applications of genetics in the evaluation and management of heart failure include the determination of inheritance patterns within families with cardiomyopathy, the evaluation of affected patients for syndromic features, the determination of people within families who are at risk of heart failure, and the identification of responsible gene mutations. Family planning may also be assisted by determination of a clear mutation that predisposes to heart failure. Genetic counseling is critical, and it should accompany the use of genetic testing in cardiovascular diseases. With the rapid pace of growth in technology that is used to determine DNA sequence, costs have declined and clinical appl... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=4032579 Sat, 02 Oct 2010 05:56:58 +0100 4032579 http://www.medworm.com/index.php?rid=3886583&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv37855766p532646%2F Opinion statement  Right ventricular failure (RVF) is a cause of major morbidity and mortality in the left ventricular assist device (LVAD) population. Many LVAD candidates have clinical or subclinical right ventricular (RV) dysfunction, and the perioperative period is fraught with insults that may provoke reactive pulmonary vascular hypertension and acute or chronic development of RVF. Thus, preoperative patient optimization using diuretics, pulmonary vasodilators, and inotropes to reduce RV wall stress and improve contractility is critical. An assessment of the LVAD candidate’s risk for developing postoperative RVF is also key, especially in the destination therapy population for whom good options for long-term RV support currently are lacking. Intraoperatively, various ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3886583 Thu, 19 Aug 2010 16:48:58 +0100 3886583 http://www.medworm.com/index.php?rid=3865957&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Frr64236v31214381%2F Opinion statement  The need to drive is universal in many countries. Patients with syncope, cardiac arrhythmias, or implantable cardioverter–defibrillators (ICDs) have an ongoing risk of sudden incapacitation that may cause harm to themselves and/or others when driving. Restrictions on driving and driving guidelines have been developed with the intent to reduce and prevent motor vehicle accidents, thereby improving personal and public safety. Several guidelines and consensus statements recently were updated. This review focuses on the syncope-related driving guidelines and restrictions. Driving issues related to other causes of loss of consciousness, such as drug or alcohol intoxication, epilepsy, or metabolic disorders, are not included in this review. Approximately 1% t... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3865957 Wed, 11 Aug 2010 02:20:31 +0100 3865957 http://www.medworm.com/index.php?rid=3832481&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu65308q8t627j313%2F Opinion statement  Positive inotropic agents play an important role in the management of acute decompensated heart failure (HF) patients with reduced cardiac output and poor end-organ perfusion. However, despite their acute hemodynamic benefits, the role of inotropes in the management of chronic advanced HF remains limited. Although digoxin has demonstrated the ability to improve symptoms in HF patients, numerous small, mostly nonrandomized studies have shown that patients with advanced HF improve symptomatically when administered continuous or intermittent intravenous β-agonists or phosphodiesterase inhibitors. However, this improvement occurs at the expense of an increased risk of cardiac arrhythmias, sudden cardiac death, and mortality. Similarly, several oral inotropes... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3832481 Fri, 06 Aug 2010 07:14:26 +0100 3832481 http://www.medworm.com/index.php?rid=3824812&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1368777mmm145831%2F Opinion statement  Heart failure is a constantly progressing disease involving patients with ischemic and nonischemic cardiac disease. Cardiac resynchronization therapy (CRT) has been used successfully in patients with severe heart failure symptoms, poor left ventricular (LV) function, and a prolonged QRS duration. Large trials in patients with New York Heart Association (NYHA) class III/IV heart failure have demonstrated that heart failure symptoms can be reduced and exercise capacity improved, overall mortality decreased, and ventricular function increased. How long these beneficial effects of CRT will last in patients with an already advanced stage of heart failure, particularly in NYHA IV, is still unknown. Therefore, it is more reasonable to initiate CRT in appropriate... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3824812 Wed, 04 Aug 2010 08:06:32 +0100 3824812 http://www.medworm.com/index.php?rid=3800062&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F800666x2x6733023%2F Opinion statement  The heart is a complex and sophisticated pump that cycles between two phases: diastole, during which a compliant chamber (ventricle) allows the blood to fill from a reservoir chamber (atrium) of low pressure, and systole, during which a stiff chamber with rapidly rising pressure ejects the blood into an arterial circuit of high pressure. However, the systolic and diastolic cycles are not dichotomous. They have complex interactions with interrelated segments of the cardiac cycle. Although the entity of “diastolic heart failure with preserved systolic function” has been applied in adult patients, a discrete diagnosis of systolic and diastolic heart failure may be difficult to apply in pediatric patients. Advances in echocardiography have helped decipher ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3800062 Tue, 27 Jul 2010 19:50:11 +0100 3800062 http://www.medworm.com/index.php?rid=3800061&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg6088q97g6p21803%2F Opinion statement  Vasovagal syncope (VVS) remains the most common cause of syncope and transient loss of consciousness in all age groups. The treatment of VVS focuses on measures that interrupt or prevent its pathophysiologic mechanism, as well as on avoidance of triggers. Although the evidence supporting an increase in salt and water intake is weak, it is a cost-effective and safe strategy that should always be used as first-line therapy. Patients should be educated on how to respond to further episodes of syncope, especially if they experience prodromal warning signs. In these cases, counterpressure maneuvers in younger patients are clearly effective. Orthostatic training exercises may improve symptoms in patients with recurrent VVS; however, this strategy is only effect... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3800061 Tue, 27 Jul 2010 19:50:11 +0100 3800061 http://www.medworm.com/index.php?rid=3800063&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F062541015h05413x%2F Opinion statement  Outcomes following cardiac transplantation in childhood continue to improve. Advances in immunosuppressive therapy over the past two decades likely have contributed to this trend. The evolution in the management of immunosuppression in children has been based on clinical experience rather than on evidence-based medicine; indeed, there have been no pivotal randomized controlled trials of any form of immunosuppression in pediatric thoracic transplantation. Important trends in immunosuppressive therapy and transplant outcomes have been obtained from large transplant registries. Several trends have been identified since the last review of this topic in this journal. First, there is increased knowledge of the pharmacodynamics and pharmacokinetics of immunosupp... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3800063 Tue, 27 Jul 2010 19:50:10 +0100 3800063 http://www.medworm.com/index.php?rid=3785078&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fhw300004n7484543%2F This article reviews the appropriate evaluation and management of cardiac arrhythmias in the pregnant patient. Any treatment strategy in this patient population has the inherent potential to adversely affect the health of the unborn child. As such, there is no room for empiric therapy in these patients. Adequate arrhythmia documentation is paramount, preferably by noninvasive means. The decision to treat should be based on symptom severity and the risk to both mother and fetus posed by potentially recurring arrhythmia episodes throughout the pregnancy. Minimal symptoms in the setting of a structurally normal heart call for a conservative approach. Less is better. If pharmacologic therapy is justified, drugs with historically demonstrated safety profiles in pregnancy should be tried f... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3785078 Fri, 23 Jul 2010 12:10:05 +0100 3785078 http://www.medworm.com/index.php?rid=3649770&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F7h5861uh326p47v7%2F Opinion statement  The treatment of lipid abnormalities generally has focused on low-density lipoprotein cholesterol (LDL-C) reduction based on extensive clinical trials and the National Cholesterol Education Program Adult Treatment Panel III guidelines. Unfortunately, it has become increasingly clear that a significant percentage of patients continue to have cardiovascular events despite being on LDL-C–lowering medications and having LDL-C levels below 100 mg/dL. Numerous epidemiologic studies have associated low high-density lipoprotein cholesterol (HDL-C) levels with increased risk of cardiovascular disease (CVD). Furthermore, recent data show that up to 55% of patients hospitalized for CVD have low HDL-C levels (<40 mg/dL) on admission, suggesting a possi... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3649770 Mon, 07 Jun 2010 17:15:54 +0100 3649770 http://www.medworm.com/index.php?rid=3642206&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg6868355mn520810%2F This article summarizes the current literature regarding the associations between sleep-disordered breathing and adverse cardiovascular outcomes and reviews the lesser body of data demonstrating the cardiovascular benefits of therapy. Content Type Journal ArticleCategory PreventionDOI 10.1007/s11936-010-0082-9Authors David E. Green, Emory University School of Medicine Division of Pulmonary, Allergy and Critical Care Medicine 1365 Clifton Road Northeast, Building A-4 Atlanta GA 30322 USADavid A. Schulman, Emory University School of Medicine Division of Pulmonary, Allergy and Critical Care Medicine 1365 Clifton Road Northeast, Building A-4 Atlanta GA 30322 USA Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-3189Print ISSN 1092-8464 (Source: Curren... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3642206 Fri, 04 Jun 2010 06:53:54 +0100 3642206 http://www.medworm.com/index.php?rid=3626908&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1g74047374223786%2F Opinion statement  Obesity in the United States has become a public health crisis, with one third of the US population having a body mass index ≥30 kg/m2. Given the profound impact of obesity on cardiovascular disease (CVD), studies of lifestyle modification, pharmacotherapy, and surgical interventions must be reappraised to better define the roles of these approaches in preventing cardiovascular events. Recent clinical trials have attempted to quell the debate over macronutrient composition versus caloric restriction in the dietary approach to weight loss. Our interpretation of these results is that caloric reduction and adherence to diets are of greater consequence than the particular dietary content for weight reduction. For cardiovascular risk factor modification,... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3626908 Tue, 01 Jun 2010 07:02:37 +0100 3626908 http://www.medworm.com/index.php?rid=3626909&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fq627430360x6w401%2F Opinion statement  Microvascular coronary dysfunction (MCD) is an increasingly recognized cause of cardiac ischemia and angina that is diagnosed more commonly in women. Patients with MCD present with the triad of persistent chest pain, ischemic changes on stress testing, and no obstructive coronary artery disease on cardiac catheterization. Data from the National Heart, Lung, and Blood Institute–sponsored Women’s Ischemia Syndrome Evaluation (WISE) study show that the diagnosis of MCD is not benign, with a 2.5% annual risk of adverse cardiac events including myocardial infarction, stroke, congestive heart failure, and death. The gold standard diagnostic test for MCD is the invasive coronary reactivity test (CRT), which uses acetylcholine, adenosine, and nitroglycerin to ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3626909 Tue, 01 Jun 2010 07:02:36 +0100 3626909 http://www.medworm.com/index.php?rid=3626910&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl735237930417070%2F   Opinion statement  Currently, there are significant data to support a link between lipoprotein(a) [Lp(a)] levels and cardiovascular risk. However, there has not been a clinical trial examining the effects of Lp(a) reduction on cardiovascular risk in a primary prevention population. Until such a trial is conducted, current consensus supports using an Lp(a) percentile greater than 75% for race and gender as a risk stratification tool to target more aggressive low-density lipoprotein cholesterol (LDL-C) or apolipoprotein B (apoB) goals. Therefore, Lp(a) measurements should be considered in the following patients: individuals with early-onset vascular disease determined by clinical presentation or subclinical imaging, intermediate and high Framingham risk patients with ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3626910 Fri, 28 May 2010 18:05:43 +0100 3626910 http://www.medworm.com/index.php?rid=3611045&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fnp33r79g7x76r655%2F Opinion statement  Major dietary sources of omega-3 fatty acids are fish containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), as well as nuts, seeds, and vegetable oils containing α-linolenic acid (ALA). Omega-3 fatty acids, especially those derived from marine sources, may be a useful tool for the primary and secondary prevention of cardiovascular disease. Omega-3s exert their cardioprotective effects through multiple mechanisms, including reducing arrhythmias and altering production of prostaglandins, which reduces inflammation and improves platelet and endothelial function. To date, no serious adverse effects of omega-3s have been identified, despite extensive study. In adults, any potential harm from mercury exposure from consuming fish rich in omega-... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3611045 Thu, 27 May 2010 11:03:10 +0100 3611045 http://www.medworm.com/index.php?rid=3611044&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx237t8072878l307%2F Opinion statement  Regular physical activity decreases the risk of cardiovascular disease and modifies multiple cardiovascular risk factors. The optimum amount of exercise continues to generate debate; however, the general recommendation is that all adults should engage in 30 min of moderate-intensity physical activity on five, and preferably all, days of the week. Despite extensive data and recommendations, a significant proportion of the US adult population remains sedentary. Promoting physical activity at a public level remains a major challenge because of the presence of multiple behavioral, physical, and environmental barriers. Health care providers have an opportunity and a responsibility to include exercise counseling in routine office visits. Content Type J... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3611044 Thu, 27 May 2010 11:03:10 +0100 3611044 http://www.medworm.com/index.php?rid=3491719&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F456h35427j7g716p%2F Opinion statement  Vulnerable carotid plaques at risk for rupture/ulceration do not always correlate with the severity of stenosis at bifurcation sites. Therefore, information on plaque morphology and composition is essential for identifying patients at high risk for acute major cerebrovascular events. Traditional imaging modalities, including angiography and ultrasound, are slowly being replaced by CT imaging, as this technology is readily available in most hospitals and provides high-resolution capabilities at relatively low cost. Improvements in MRI, particularly high-resolution gadolinium-enhanced MRI, currently make this modality the most informative technology, as it allows easy identification of lesion morphometry, calcification, and hemorrhage. Further, multimodal i... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3491719 Tue, 20 Apr 2010 11:21:27 +0100 3491719 http://www.medworm.com/index.php?rid=3481473&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fq3703x7638v0g648%2F Opinion statement  Stroke is the second leading cause of cardiovascular mortality in the modern world, accounting for 80% of strokes of ischemic origin. There are two main etiologies of ischemic stroke: 70% to 80% are caused by carotid atherosclerotic plaque rupture and superimposed thrombus formation, whereas 30% are caused by systemic embolism of a cardiac thrombus (mainly in atrial fibrillation [AF] patients). Therefore, antithrombotic therapy is the cornerstone of stroke treatment. In AF patients, thrombotic risk should be assessed by means of the CHADS2 score. Patients with a score of 0 should be treated with aspirin; for those with a score of 1, oral anticoagulation (target international normalized ratio, 2–3) or aspirin is recommended. For patients with a CHADS2 sc... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3481473 Wed, 14 Apr 2010 16:54:11 +0100 3481473 http://www.medworm.com/index.php?rid=3481475&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff8523v80471l5648%2F Opinion statement  Medical science is now synonymous with probability-based statistics. Statistics deals with a group; it does not need probability theory. Probability theory is consistent with the worldview that the universe is infinite, bounded, random, and governed by chance. Its logic is binary, its geometry is Cartesian, its rules offer a scientific method by which hypotheses may be tested. Clinical trials and even hypothesis testing at the bedside have nestled into the probability foundation. As a result, scientific “evidence” now appears only through the lens of probability theory. Because there is no definitive truth in the worldview of probability theory, the truth of evidence lies in probabilities only. The probabilistic view of science has a firm impact on th... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3481475 Wed, 14 Apr 2010 06:56:44 +0100 3481475 http://www.medworm.com/index.php?rid=3481474&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fy67l5t1602217670%2F Opinion statement  Results of acute MRI studies may help guide the management of acute stroke. Patients with a malignant MRI pattern may be poor candidates for reperfusion therapies yet may benefit from hemicraniectomy. Preliminary data suggest that patients with a carefully identified diffusion weighted imaging (DWI)/perfusion weighted imaging (PWI) mismatch may benefit from intravenous recombinant tissue plasminogen activator in a 3- to 6-hour time window; however, confirmatory studies with larger sample sizes are required before clinical use of this strategy can be generally recommended. Post hoc analyses of recent studies suggest that PWI techniques that use a threshold to exclude benign oligemia from penumbra and DWI techniques that use apparent diffusion coefficient th... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3481474 Wed, 14 Apr 2010 06:56:44 +0100 3481474 http://www.medworm.com/index.php?rid=3477034&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fy581lm835017t562%2F Opinion statement  Critical limb ischemia (CLI), defined as chronic ischemic rest pain, ulcers, or gangrene attributable to objectively proven arterial occlusive disease, is the most advanced form of peripheral arterial disease. Traditionally, open surgical bypass was the only effective treatment strategy for limb revascularization in this patient population. However, during the past decade, the introduction and evolution of endovascular procedures have significantly increased treatment options. In a certain subset of patients for whom either surgical or endovascular revascularization may not be appropriate, primary amputation remains a third treatment option. Definitive high-level evidence on which to base treatment decisions, with an emphasis on clinical and cost effectiv... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3477034 Tue, 13 Apr 2010 18:08:36 +0100 3477034 http://www.medworm.com/index.php?rid=3477035&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff2tu3tj5lmq550n5%2F We describe alternative treatments for AF and provide an overview on emerging therapies. Content Type Journal ArticleCategory Cerebrovascular Disease and StrokeDOI 10.1007/s11936-010-0071-zAuthors Fernando D. Testai, University of Illinois College of Medicine at Chicago Section of Cerebrovascular Disease and Neurologic Critical Care, Department of Neurology and Rehabilitation 912 South Wood Street, Room 855N Chicago IL 60612 USAPhilip B. Gorelick, University of Illinois College of Medicine at Chicago Section of Cerebrovascular Disease and Neurologic Critical Care, Department of Neurology and Rehabilitation 912 South Wood Street, Room 855N Chicago IL 60612 USA Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-3189Print ISSN 1092-8464 (Source: Curren... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3477035 Tue, 13 Apr 2010 18:08:35 +0100 3477035 http://www.medworm.com/index.php?rid=3469177&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu867576320170334%2F This article reviews the role of combination antiplatelet regimens in stroke prevention for patients with AF. Other therapies discussed include oral anticoagulation, single antiplatelet therapies, oral anticoagulation plus antiplatelet treatment, direct thrombin inhibitors, and factor Xa inhibitors. Content Type Journal ArticleCategory Cerebrovascular Disease and StrokeDOI 10.1007/s11936-010-0069-6Authors Hermelinda G. Abcede, University of California, Los Angeles Department of Neurology 710 Westwood Plaza, Suite 1-240 Los Angeles CA 90095 USABruce Ovbiagele, University of California, Los Angeles Department of Neurology 710 Westwood Plaza, Suite 1-240 Los Angeles CA 90095 USA Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-3189Print ISSN 1092-84... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3469177 Fri, 09 Apr 2010 05:45:47 +0100 3469177 http://www.medworm.com/index.php?rid=3469178&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fcm57327226u74j61%2F Opinion statement  The use of endovascular modalities for the treatment of simple descending thoracic aneurysms has become standard of care. Expanding endovascular techniques for the treatment of thoracoabdominal aneurysms is now possible with the evolution of branched and fenestrated grafts. Content Type Journal ArticleCategory Vascular DiseaseDOI 10.1007/s11936-010-0070-0Authors Tara M. Mastracci, The Cleveland Clinic Foundation Vascular Surgery 9500 Euclid Avenue Cleveland OH 44195 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=3469178 Thu, 08 Apr 2010 18:03:56 +0100 3469178 http://www.medworm.com/index.php?rid=3430522&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fq6h8782g15630723%2F Opinion statement  The cardiorenal syndrome refers to the interdependence of cardiocirculatory aberrations and renal dysfunction that signify a worsening in heart failure outcome. Biochemically, it appears covertly as an abnormality in renal function and when progressive, is manifested by symptom exacerbation and worsening renal impairment during application of therapy to ameliorate such symptoms. The pathways leading to these distinct impairments involve not only hemodynamic deterioration but also neurohormonal, inflammatory, and intrinsic renal mechanisms that produce this syndrome. Traditional therapy with diuretics typically worsens the cardiorenal syndrome, and vasodilator or inotropic therapy has not been shown to help either. New therapeutic avenues involving vasopres... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3430522 Wed, 31 Mar 2010 05:48:14 +0100 3430522 http://www.medworm.com/index.php?rid=3430521&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fgx58w7227521853l%2F Opinion statement  Hospitalization for acute heart failure syndromes (AHFS) is a significant negative predictor of prognosis. Although patients’ presenting symptoms generally improve throughout hospitalization in response to therapy, post-discharge event rates, defined as rehospitalization and/or mortality, remain unacceptably high. In the past decade, many lifesaving therapies for heart failure, such as β-blockers, aldosterone antagonists, and cardiac resynchronization therapy (CRT), have been defined. Hospitalization presents a unique opportunity to implement these and other lifesaving therapies. However, these opportunities are often missed, perhaps because the traditional focus of hospitalization has been on symptom relief, not improvement of post-discharge outcomes. ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3430521 Wed, 31 Mar 2010 05:48:14 +0100 3430521 http://www.medworm.com/index.php?rid=3430523&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F0827u406714kp8m1%2F Opinion statement  Right ventricular (RV) dysfunction in the setting of cardiomyopathy, ischemia, and pulmonary hypertension is associated with high morbidity and mortality, but therapeutic clinical trials examining RV failure as a primary outcome are lacking. This review focuses on the ontologic, morphologic, and microscopic differences between the right and left ventricles. It also discusses the rationale and potential risks associated with the extrapolation of medical therapies used in left ventricular failure and pulmonary arterial hypertension management to the treatment of RV failure. Finally, it introduces the reader to new echocardiographic techniques that may be used to diagnose clinical and subclinical RV systolic and diastolic dysfunction. Given the anticipated r... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3430523 Wed, 31 Mar 2010 05:48:12 +0100 3430523 http://www.medworm.com/index.php?rid=3430524&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff88137q82r124u0u%2F Opinion statement  Many patients do not respond clinically to cardiac resynchronization therapy (CRT), despite clinical and survival benefits demonstrated in numerous clinical trials. This has led to focused evaluation from preimplant issues, as to who is an appropriate candidate for CRT, to postimplant issues, more specifically, optimizing device programming in CRT. CRT studies have used simultaneous biventricular pacing, but with advancing echocardiographic technology, the role of dyssynchrony, or mechanical delay in contraction of the ventricles, suggests that individually tailoring ventricular pacing improves hemodynamics. Atrial to ventricular timing affects left ventricular filling and cardiac output, whereas the right to left ventricular pacing delay also improves sys... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3430524 Wed, 31 Mar 2010 05:48:11 +0100 3430524 http://www.medworm.com/index.php?rid=3430526&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn112638v2727188j%2F Opinion statement  Several treatment strategies, including lowering low-density lipoprotein cholesterol with intensive statin therapy, reducing triglycerides with fibrates, and raising high-density lipoprotein cholesterol with nicotinic acid, have the potential to induce atherosclerosis regression. Atherosclerosis imaging techniques including intravascular ultrasound, carotid ultrasound to measure carotid intima-media thickness, and cardiovascular MRI are established modalities for describing longitudinal changes in the quantity and quality of atherosclerotic plaque. An increasing number of clinical trials are using radiologic measures of subclinical atherosclerosis as surrogate end points in lieu of the traditional “hard” end points of myocardial infarction and death. T... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3430526 Wed, 31 Mar 2010 05:48:10 +0100 3430526 http://www.medworm.com/index.php?rid=3430525&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx536473044421278%2F Opinion statement  This review focuses on the recent progress in and future prospects for the widened use of biomarkers of inflammation to modify lipid treatment goals in individuals assessed according to traditional risk factors to be at moderate or higher risk for clinical cardiovascular disease events. Elevated blood levels of high-sensitivity C-reactive protein or lipoprotein-associated phospholipase A 2 independently predict increased risk after adjustment for an individual’s clinical risk status. When elevated individually, each is associated with an approximate doubling of risk for primary or recurrent cardiovascular events. Fourteen major studies, encompassing healthy adults, patients with chronic coronary heart disease, and those with a recent coronary event or st... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3430525 Wed, 31 Mar 2010 05:48:10 +0100 3430525 http://www.medworm.com/index.php?rid=3430527&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd71204wnv843v4r7%2F Opinion statement  Despite significant success in reducing plasma cholesterol, especially low-density lipoprotein cholesterol, risks for cardiovascular disease (CVD) complications remain. Among these risks are circulating levels of oxidative modified lipoproteins, primarily oxidized low-density lipoproteins (oxLDL). The evidence supporting oxLDL as a potential target for therapeutic management to reduce metabolic complications and CVD events is reviewed in this report. Content Type Journal ArticleDOI 10.1007/s11936-008-0047-4Authors Ngoc-Anh Le, Emory University and Atlanta Veterans’ Affairs Medical Center Emory Lipid Research Laboratory 1670 Clairmont Road, Room 4A187 Decatur GA 30033 USA Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN ... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3430527 Wed, 31 Mar 2010 05:48:06 +0100 3430527 http://www.medworm.com/index.php?rid=3430529&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv2485326r2254897%2F Opinion statement  Although cardiovascular disease is commonly recognized as a disease of the elderly, young patients are also at risk for coronary atherosclerosis, which has a devastating impact on their more active lifestyle. In identifying patients at risk for a cardiovascular event, global risk models often fail to assess family history, an important risk factor in patients with premature coronary artery disease (P-CAD). P-CAD refers to the accelerated development of coronary atherosclerosis before age 55 in men and 65 in women, which may be the result of acquired or primary causes. Acquired P-CAD is associated with an underlying medical condition or influencing factor, such as systemic lupus erythematosus or cocaine use, that directly contributes to the rapid progressio... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3430529 Wed, 31 Mar 2010 05:48:05 +0100 3430529 http://www.medworm.com/index.php?rid=3430528&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F550007m113h70283%2F Opinion statement  Prehypertension was defined as a discrete category in 1993. There is evidence to support active management of this entity given the increased risk of hypertension, cardiovascular disease, heart failure, and stroke. There have been few comprehensive summaries on the management of this population. Therefore, this article summarizes the latest guidelines and studies on the detection, evaluation, and management of prehypertension. Content Type Journal ArticleDOI 10.1007/s11936-008-0048-3Authors Ross PaciniDhaval R. PatelVenkata BavikatiLaurence S. Sperling, Emory University Hospital, Emory Clinic Division of Cardiology 1525 Clifton Road, Suite 214 Atlanta GA 30322 USA Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-3189... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3430528 Wed, 31 Mar 2010 05:48:05 +0100 3430528 http://www.medworm.com/index.php?rid=3430530&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl301656563884005%2F This article reviews the current status of the emerging field of cell-based therapies for CVD, with particular focus on HF treatment. Content Type Journal ArticleDOI 10.1007/s11936-008-0056-3Authors Bruno K. PodesserMichael BauerRonglih Liao, Harvard Medical School Cardiac Muscle Research Laboratory, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital 77 Avenue Louis Pasteur, NRB 431 Boston MA 02115 USA Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-3189Print ISSN 1092-8464 Journal Volume Volume 10 Journal Issue Volume 10, Number 4 / August, 2008 (Source: Current Treatment Options in Cardiovascular Medicine) Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3430530 Wed, 31 Mar 2010 05:48:04 +0100 3430530 http://www.medworm.com/index.php?rid=3421908&cid=s_35952_7_f&fid=35952&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F8n27536j7m24l381%2F Opinion statement  Stroke care has become progressively more complicated with advances in therapies necessitating timely intervention. There are multiple potential providers of stroke care, which traditionally has been the province of general neurologists and primary care physicians. These new players, be they vascular neurologists, neurohospitalists, internal medicine hospitalists, or neurocritical care physicians, at the bedside or at a distance, are poised to make a significant impact on our care of stroke patients. The collaborative model of care may be or become the most prevalent as physicians apply their distinct skill sets to the complex care of inpatients with cerebrovascular disease. Content Type Journal ArticleCategory Cerebrovascular Disease and StrokeDOI 10... Current Treatment Options in Cardiovascular Medicine journals http://www.medworm.com/rss/comments.php?id=3421908 Mon, 29 Mar 2010 17:15:28 +0100 3421908 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