Current Treatment Options in Cardiovascular Medicine
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Combined PCI and minimally invasive heart valve surgery for high-risk patients
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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 int...
Source: Current Treatment Options in Cardiovascular Medicine - November 5, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Percutaneous pulmonic valve implantationEmail this article to a colleague.
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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 functi...
Source: Current Treatment Options in Cardiovascular Medicine - November 5, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
The genetics of cardiomyopathy: Genotyping and genetic counselingEmail this article to a colleague.
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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 accur...
Source: Current Treatment Options in Cardiovascular Medicine - November 5, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Update on renin-angiotensin-aldosterone blockade in heart failureEmail this article to a colleague.
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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 emerge...
Source: Current Treatment Options in Cardiovascular Medicine - November 5, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Obstructive sleep apnea and heart failureEmail this article to a colleague.
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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 m...
Source: Current Treatment Options in Cardiovascular Medicine - November 5, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Mitral valve repair in the treatment of mitral regurgitationEmail this article to a colleague.
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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.
...
Source: Current Treatment Options in Cardiovascular Medicine - November 5, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
How to use diuretics in heart failureEmail this article to a colleague.
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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) h...
Source: Current Treatment Options in Cardiovascular Medicine - November 5, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Percutaneous approaches to mitral regurgitationEmail this article to a colleague.
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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 e...
Source: Current Treatment Options in Cardiovascular Medicine - November 5, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Transcatheter aortic valve implantationEmail this article to a colleague.
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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 CoreVal...
Source: Current Treatment Options in Cardiovascular Medicine - November 5, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Therapeutic implications of automatic home monitoring of implantable cardiac devicesEmail this article to a colleague.
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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 s...
Source: Current Treatment Options in Cardiovascular Medicine - September 16, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Role of wearable and automatic external defibrillators in improving survival in patients at risk for sudden cardiac deathEmail this article to a colleague.
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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 au...
Source: Current Treatment Options in Cardiovascular Medicine - September 16, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
New and emerging antiarrhythmic drugs for atrial fibrillation: What may become available to the clinician in the near futureEmail this article to a colleague.
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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...
Source: Current Treatment Options in Cardiovascular Medicine - September 16, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Ebstein malformation of the tricuspid valve: Current concepts in management and outcomesEmail this article to a colleague.
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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 surger...
Source: Current Treatment Options in Cardiovascular Medicine - September 16, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Management of postoperative pediatric cardiac arrhythmias: Current state of the artEmail this article to a colleague.
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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 tachyar...
Source: Current Treatment Options in Cardiovascular Medicine - September 16, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Pharmaceutical management of decompensated heart failure syndrome in children: Current state of the art and a new approachEmail this article to a colleague.
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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 va...
Source: Current Treatment Options in Cardiovascular Medicine - September 16, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Periprocedural management of anticoagulation and antiplatelet therapies in patients undergoing electrophysiologic proceduresEmail this article to a colleague.
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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...
Source: Current Treatment Options in Cardiovascular Medicine - September 16, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Acute myocarditis in children: Current concepts and managementEmail this article to a colleague.
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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 m...
Source: Current Treatment Options in Cardiovascular Medicine - September 16, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Current treatment of aortopulmonary windowEmail this article to a colleague.
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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
Spenc...
Source: Current Treatment Options in Cardiovascular Medicine - September 16, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Future G protein-coupled receptor targets for treatment of heart failureEmail this article to a colleague.
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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...
Source: Current Treatment Options in Cardiovascular Medicine - July 14, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Matrix metalloproteinase therapy in heart failureEmail this article to a colleague.
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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 persisten...
Source: Current Treatment Options in Cardiovascular Medicine - July 14, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Dietary fat quality and coronary heart disease prevention: A unified theory based on evolutionary, historical, global, and modern perspectivesEmail this article to a colleague.
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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-BastosL...
Source: Current Treatment Options in Cardiovascular Medicine - July 14, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Sociology meets genetics: Sociogenetic implications for future management of hypertension and heart failureEmail this article to a colleague.
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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 a...
Source: Current Treatment Options in Cardiovascular Medicine - July 14, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Stem cell therapy for heart failureEmail this article to a colleague.
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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....
Source: Current Treatment Options in Cardiovascular Medicine - July 14, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Use of statins in patients with liver diseaseEmail this article to a colleague.
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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 li...
Source: Current Treatment Options in Cardiovascular Medicine - July 14, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Low-density lipoprotein apheresis as a treatment option for hyperlipidemiaEmail this article to a colleague.
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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 phar...
Source: Current Treatment Options in Cardiovascular Medicine - July 14, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Management of the statin-intolerant patientEmail this article to a colleague.
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Opinion statement Although the long- and short-term safety of statin therapy is well established, statin intolerance is common in clinical practice.
Muscle symptoms are the most common side effect of statin therapy and are potentially the most hazardous and the most likely
to reduce patient adherence. Clinicians can establish office protocols/procedures that will reduce the number of patients
with statin intolerance. Genomic variations that result in statin-associated myopathy are likely. We await diagnostic and
treatment options for this group. Alternative dosing options and the use of alternative statins a...
Source: Current Treatment Options in Cardiovascular Medicine - July 14, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Understanding the PRoFESS study for secondary stroke preventionEmail this article to a colleague.
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Opinion statement The Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial is the largest secondary stroke prevention
study completed to date. It compared extended-release dipyridamole plus aspirin (eDYP-ASA) versus clopidogrel and telmisartan
versus antihypertensive regimens excluding angiotensin receptor blockers (ARBs). No statistical differences were found in
either arm for the primary outcome of fatal or nonfatal stroke or prespecified secondary end points. eDYP-ASA also was associated
with increases in major hemorrhagic events but not with statistical increases in combined rates o...
Source: Current Treatment Options in Cardiovascular Medicine - May 2, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Improving poststroke recovery: Neuroplasticity and task-oriented trainingEmail this article to a colleague.
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Opinion statement Neurorehabilitation is a critical part of the overall process to achieve optimal outcome after stroke. Presently, the field
of neurorehabilitation is in transition. New research suggesting novel approaches to optimize functional recovery after stroke
is on the horizon, but clear knowledge of the underlying mechanisms of this recovery is still being unraveled. In practice,
many rehabilitation centers continue to provide traditional compensatory rehabilitation training while many others are practicing
newer, “task-oriented” approaches. A few centers are incorporating new technology, such ...
Source: Current Treatment Options in Cardiovascular Medicine - May 2, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Hormone therapy and stroke: Is it all about timing?Email this article to a colleague.
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Opinion statement Although women have a lower incidence of stroke than men in most age groups, women have an overall increased lifetime risk
of stroke. Women also have unique risk factors for stroke, including the menopausal transition, the existence of debilitating
vasomotor symptoms for some women, and the issues related to hormonal treatment for those symptoms. Although the initial studies
of hormone therapy (HT) use in postmenopausal women suggested significant protection against heart disease, there was no obvious
protection against stroke. Randomized trials of HT for secondary prevention showed a lack ...
Source: Current Treatment Options in Cardiovascular Medicine - May 2, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
New data about stenting versus endarterectomy for symptomatic carotid artery stenosisEmail this article to a colleague.
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Opinion statement Patients with symptomatic carotid artery stenosis should be counseled on diet, exercise, moderation of alcohol consumption,
smoking cessation, and avoidance of environmental tobacco smoke. Medical therapy generally includes a platelet antiaggregant,
blood pressure control, and a statin. Other medical therapy depends on specific patient characteristics. Carotid endarterectomy
in addition to best medical therapy is of proven benefit in reducing the risk of ipsilateral stroke compared with best medical
therapy alone in patients with symptomatic high-grade stenosis, provided the operation can b...
Source: Current Treatment Options in Cardiovascular Medicine - May 2, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Diagnosis and neurosurgical treatment of intracranial vascular occlusive syndromesEmail this article to a colleague.
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Opinion statement Intracranial atherosclerosis represents the most prevalent form of intracranial vascular occlusive disease in the adult population
and is a major contributor to is chemic stroke. The most reliable method for diagnosing intracranial stenosis relies on conventional
catheter angiography; MRI and CT imaging and transcranial Doppler currently are valuable screening tools, and ongoing advances
in these modalities may render angiography nonessential for accurate diagnosis in the future. Given the potential for hemodynamic
compromise from intracranial occlusive disease, a variety of imaging modalit...
Source: Current Treatment Options in Cardiovascular Medicine - May 2, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Genomics and the efficacy of aspirin in the treatment of cerebrovascular diseaseEmail this article to a colleague.
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Opinion statement Aspirin has been shown to reduce the risk of stroke, myocardial infarction, and death in patients with a history of cardiovascular
disease or at high risk for cardiovascular disease. However, many individuals suffer a stroke or other cardiovascular event
despite aspirin therapy. Data suggest that heritability contributes importantly to the antiplatelet and clinical responses
to aspirin. Candidate genes for influencing aspirin response include those involved in platelet aggregation and in modulating
cardiovascular disease risk and progression. Although several studies have examined genetic d...
Source: Current Treatment Options in Cardiovascular Medicine - May 2, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Artificial adaptive systems and fuzzy measures for translation of clinical trial results to the bedsideEmail this article to a colleague.
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Opinion statement Medical science relies uniquely on statistical evidence from large clinical trials or laboratory experiments to deal with
uncertainties regarding clinical decisions. The statistical evidence is stated in probabilities. Probability theory is based
on the logical rules set forth by Aristotle: the law of noncontradiction, excluded middle, and identity. Thus, medical science
assumes that variables such as disease and treatment relate or interact only in certain ways and the statistical evidence
defines the presence of these relations. Experiments seek to find these certain predefined relations ...
Source: Current Treatment Options in Cardiovascular Medicine - May 2, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Optimum control of blood glucose for prevention and treatment of ischemic and hemorrhagic strokeEmail this article to a colleague.
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This article presents an
overview of the recommendations for the optimum control of blood glucose for prevention and treatment of ischemic and hemorrhagic
stroke.
Content Type Journal ArticleDOI 10.1007/s11936-009-0021-9Authors
Veronique GuyomardPhyo Kyaw Myint, University of East Anglia School of Medicine, Health Policy and Practice Chancellors Drive, Norwich NR4 7TJ Norfolk UK
Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-3189Print ISSN 1092-8464
Journal Volume Volume 11
Journal Issue Volume 11, Number 3 / June, 2009 (Source: Current Treatment Options in Cardiovascular Medicine)
Source: Current Treatment Options in Cardiovascular Medicine - May 2, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Cervical artery dissectionEmail this article to a colleague.
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Opinion statement Spontaneous and traumatic cervical artery dissection is a common cause of stroke in the young. It generally carries an excellent
prognosis if treatment is initiated early. Antiplatelet therapy may be as effective as or safer than warfarin, although no
randomized prospective studies have addressed the issue of optimal medical therapy. Rarely, endovascular therapy may be indicated
for the treatment of ruptured aneurysms or to prevent recurrent ischemia.
Content Type Journal ArticleDOI 10.1007/s11936-009-0017-5Authors
Alex Abou-Chebl, The Cleveland Clinic Foundation Section of Stroke and N...
Source: Current Treatment Options in Cardiovascular Medicine - March 10, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Venous thromboembolism in pregnancyEmail this article to a colleague.
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Opinion statement Low molecular weight heparins (LMWHs) appear to be as safe and effective as unfractionated heparin (UFH) for venous thromboembolic
disease (VTED) treatment or prophylaxis during pregnancy. Experience with other parenteral anticoagulant drugs is very limited,
and no alternative oral anticoagulants are available to date. In addition to cost, challenges of long-term LMWH use during
pregnancy that have not been addressed by controlled clinical trials include a) ideal dosing as pregnancy advances, b) the
need for LMWH monitoring by anti-Xa activity levels, and c) ideal therapeutic management as ...
Source: Current Treatment Options in Cardiovascular Medicine - March 10, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Optimal management of acute aortic dissectionEmail this article to a colleague.
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Opinion statement Acute aortic syndrome (AAS) encompasses a group of life-threatening aortic disorders that are increasing in prevalence. It
classically presents with abrupt-onset chest pain that is of maximum intensity at onset. The syndrome requires prompt recognition
and efficient treatment to optimize outcome. Contrast-enhanced CT is most commonly used as the definitive diagnostic imaging
modality. Patients must be expeditiously transferred to institutions with case experience and medical, surgical, and endovascular
expertise. Stanford type A dissections involve the ascending aorta and require emergent s...
Source: Current Treatment Options in Cardiovascular Medicine - March 10, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Thrombolytic therapy for deep vein thrombosisEmail this article to a colleague.
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Opinion statement The incorporation of endovascular interventions into mainstream clinical practice for patients with deep vein thrombosis (DVT)
has been changing rapidly as a result of four major trends. First, there now is a much greater appreciation among practicing
physicians of the major impact of the postthrombotic syndrome (PTS) on DVT patients’ late quality of life. Second, there have
been rapid advances in the methods by which thrombus can be rapidly removed using endovascular techniques, resulting in greater
efficiency and treatment safety. Third, these changes together have spurred a major chang...
Source: Current Treatment Options in Cardiovascular Medicine - March 10, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Endovascular treatment of aortic aneurysms: State of the artEmail this article to a colleague.
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Opinion statement Abdominal aortic aneurysms (AAAs) continue to be a leading cause of death, with increasing incidence and prevalence. Endovascular
aneurysm repair (EVAR) now represents the most common method of AAA repair in the United States. Ongoing improvements in endovascular
stent-graft technology have occurred since the first published report of EVAR in 1991. These improvements have led to multiple
US Food and Drug Administration-approved devices, streamlined operative techniques, and extended applicability of EVAR. Despite
these facts, basic anatomic considerations still eliminate many patients from ...
Source: Current Treatment Options in Cardiovascular Medicine - March 10, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Treatment of varicose veinsEmail this article to a colleague.
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Opinion statement Varicose veins (VVs) are the most common manifestation of chronic venous insufficiency, affecting 25% of women and 15% of
men. Reticular veins and telangiectasias (spider veins) are found in more than 80% of the general population. VVs produce
symptoms of pain, swelling, heaviness, fatigue, and pruritus and predispose patients to complications including bleeding,
superficial thrombophlebitis, and ulcerations that interfere with activities of daily living and result in lost time from
work. Current treatments for VVs include conservative measures, and when these are unsuccessful, more invasiv...
Source: Current Treatment Options in Cardiovascular Medicine - March 10, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Thrombophilia: 2009 updateEmail this article to a colleague.
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Abstract As venous thrombosis is mostly caused by disturbances in the plasma coagulation system, abnormalities of coagulation factors
are mostly risk factors for venous thromboembolism (VTE). Relatively little is known about thrombophilias that predispose
to arterial thromboembolism. Although some abnormalities in the fibrinolytic pathway appear to predispose to arterial thrombosis,
the associations are weak and often inconsistent between studies. At present, there is not enough consistent and clinically
meaningful information to include fibrinolytic parameters in a clinical thrombophilia workup. Controversy...
Source: Current Treatment Options in Cardiovascular Medicine - March 10, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Current management of thoracic outlet syndromeEmail this article to a colleague.
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Opinion statement Thoracic outlet syndrome (TOS) is a condition caused by compression of the neurovascular structures leading to the arm passing
through the thoracic outlet. There are three distinct types of TOS: neurogenic (95%), venous (4%–5%), and arterial (1%). Treatment
algorithms depend on the type of TOS. Although statistically the most common type, neurogenic TOS can often be the most difficult
to diagnose and treat. We have good follow-up data indicating that appropriately selected patients benefit from surgical intervention.
Arterial and venous TOS often present more urgently with arterial or ven...
Source: Current Treatment Options in Cardiovascular Medicine - March 10, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Unusual causes of intermittent claudication: Popliteal artery entrapment syndrome, cystic adventitial disease, fibromuscular dysplasia, and endofibrosisEmail this article to a colleague.
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This article reviews four uncommon vascular causes of exercise-induced limb discomfort: popliteal artery entrapment syndrome,
cystic adventitial disease of the popliteal artery, fibromuscular dysplasia of the lower-extremity arteries, and endofibrosis
of the iliac artery.
Content Type Journal ArticleDOI 10.1007/s11936-009-0016-6Authors
Ethan C. KorngoldMichael R. Jaff, Massachusetts General Hospital Section of Vascular Medicine, Division of Cardiovascular Medicine 55 Fruit Street, Gray-Bigelow 832 Boston MA 02114 USA
Journal Current Treatment Options in Cardiovascular MedicineOnline ISSN 1534-3189Print ISSN 1...
Source: Current Treatment Options in Cardiovascular Medicine - March 10, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Medical and catheter-based therapies for managing stable coronary disease: Lessons from the COURAGE trialEmail this article to a colleague.
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Opinion statement Medical and catheter-based therapies play complementary roles in treating patients with stable coronary atherosclerosis. The
choice of therapy (or therapies) must be made for each patient based on coronary anatomic suitability and in the context of
the patient’s lifestyle, functional capacity, level of symptom limitation, and ability to take the prescribed treatment. Objective
evidence of myocardial ischemia on nuclear myocardial scintigraphy is quantitatively correlated with the occurrence of death
or myocardial infarction in late follow-up, and percutaneous coronary intervention added t...
Source: Current Treatment Options in Cardiovascular Medicine - January 11, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Role of risk stratification after myocardial infarctionEmail this article to a colleague.
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Abstract Despite advances in medical and surgical therapy for patients with heart disease, sudden cardiac death remains an important
public health problem that prematurely ends the lives of more than 300,000 persons each year in North America. Many of these
deaths occur in patients with a history of myocardial infarction (MI). Although severe left ventricular (LV) systolic dysfunction
is used to identify patients at risk of sudden death after MI, most cardiac arrests occur in those with only mild LV dysfunction.
Further, severe LV dysfunction is not a specific indicator for cardiac arrest. Risk stratificatio...
Source: Current Treatment Options in Cardiovascular Medicine - January 11, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Selecting optimal antiplatelet therapy based on platelet function monitoring in patients with coronary artery diseaseEmail this article to a colleague.
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Opinion statement Results from pharmacodynamic and translational research studies assessing platelet reactivity have highlighted the limitations
of current oral antiplatelet therapy. The data from translational research studies present strong arguments against the “one-size-fits-all”
approach that has been used in large-scale clinical trials. At one end of the spectrum, selected patients with excessively
low on-treatment platelet reactivity may have unnecessary bleeding, whereas patients with high platelet reactivity may experience
ischemic events. Current evidence suggests that high on-treatment platele...
Source: Current Treatment Options in Cardiovascular Medicine - January 11, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Treatment recommendations to prevent myocardial ischemia and infarction in patients undergoing vascular surgeryEmail this article to a colleague.
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Opinion statement During major vascular surgery (MVS), patients are at high risk for developing unrecognized myocardial infarction (MI) and
myocardial ischemia. In reducing postoperative morbidity and mortality, preoperative cardiac risk stratification and adequate
medical therapy play a pivotal role. Based on literature and current opinions, medical treatment should comprise at least
a combination of β-blockers, aspirin, and statins. β-Blockers exert their beneficial effects predominantly through heart rate
control, leading to reduced oxygen demand during surgery. A heart rate between 65 and 70 bpm should...
Source: Current Treatment Options in Cardiovascular Medicine - January 11, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
ICD implantation in patients with ischemic left ventricular dysfunctionEmail this article to a colleague.
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Opinion statement Sudden cardiac death (SCD) is responsible for most deaths related to heart disease. Risk stratification in patients with ischemic
heart disease can identify patients at increased risk of sudden death who may derive a mortality benefit from an implantable
defibrillator. The most commonly used clinical variable for risk stratification and selection of patients for implantable
cardioverter-defibrillator (ICD) therapy for primary prevention of sudden death is left ventricular ejection fraction. Because
many sudden deaths occur in patients without common high-risk variables and many patients wit...
Source: Current Treatment Options in Cardiovascular Medicine - January 11, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Treatment options for refractory angina pectoris: Enhanced external counterpulsation therapyEmail this article to a colleague.
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Opinion statement Refractory angina pectoris, defined as angina refractory to maximal medical therapy and standard coronary revascularization
procedures, remains a significant health problem in the United States and the world. Despite a panoply of recent therapeutic
advances, patients with refractory angina pectoris are not adequately treated; therefore, scientists have been investigating
new technologies to help these patients. The technique of counterpulsation, studied for almost half a century, is considered
a safe, highly beneficial, low-cost, noninvasive treatment for these angina patients and now also ...
Source: Current Treatment Options in Cardiovascular Medicine - January 11, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
Preventing contrast-induced nephropathy in patients with baseline renal dysfunction undergoing coronary angiographyEmail this article to a colleague.
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Opinion statement Although contrast-induced nephropathy (CIN) is usually self-limited, it may cause permanent renal injury and even lead to
long-term dialysis in patients with preexisting renal impairment. Cardiologists face a dilemma as to whether to alleviate
coronary syndromes by coronary intervention or to risk CIN in these patients. Strategies to prevent CIN, including hydration,
use of low-osmolal or iso-osmolal contrast media, administration of N-acetylcysteine, and blood purification procedures, were proposed to be effective; however, there are conflicting results.
Recently, we found that prophylacti...
Source: Current Treatment Options in Cardiovascular Medicine - January 11, 2009 Category: Cardiology Tags: Current Treatment Options in Cardiovascular Medicine Source Type: journals
