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Cardiology Clinics

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https://read.qxmd.com/read/30447721/hypertrophic-cardiomyopathy-mastering-the-multiple-facets-of-a-complex-disease
#1
EDITORIAL
Srihari S Naidu, Julio A Panza
No abstract text is available yet for this article.
February 2019: Cardiology Clinics
https://read.qxmd.com/read/30447720/surgical-myectomy-subaortic-midventricular-and-apical
#2
REVIEW
Anita Nguyen, Hartzell V Schaff
Surgical septal myectomy is the preferred method of septal reduction for most patients with obstructive hypertrophic cardiomyopathy whose symptoms do not respond to medical management. Transaortic extended septal myectomy has low operative mortality and provides durable relief of symptoms. Surgical treatment is possible for patients with less common phenotypes, such as complex long-segment septal hypertrophy, midventricular obstruction, or apical hypertrophic cardiomyopathy. For these anatomic subtypes, transapical myectomy can be used alone or combined with transaortic myectomy...
February 2019: Cardiology Clinics
https://read.qxmd.com/read/30447719/choice-of-septal-reduction-therapies-and-alcohol-septal-ablation
#3
REVIEW
Michael A Fifer
In patients with resting or provoked gradients and symptoms refractory to optimal medical therapy, alcohol septal ablation or surgical septal myectomy may be considered. Given the overall comparable outcomes after ablation and myectomy, there is, for many patients, equipoise between the two procedures. Septal ablation is performed with standard angioplasty guiding catheters, guidewires, and balloon catheters. In the Euro-ASA registry, NYHA functional class fell from 2.9 ± 0.5 to 1.6 ± 0.7 and gradient from 67 ± 36 to 16 ± 21 mm Hg at mean 3...
February 2019: Cardiology Clinics
https://read.qxmd.com/read/30447718/role-of-advanced-testing-invasive-hemodynamics-endomyocardial-biopsy-and-cardiopulmonary-exercise-testing
#4
REVIEW
Gregg M Lanier, John T Fallon, Srihari S Naidu
Hypertrophic cardiomyopathy affects 0.5% of the population. Advanced testing is considered, including cardiac catheterization, endomyocardial biopsy, and cardiopulmonary exercise testing. Right and left heart catheterization provides essential hemodynamic data, identifies patients who might benefit from septal reduction therapy, and assesses for comorbidities. Pathologic analysis reveals ventricular hypertrophy, myocardial disarray, and endocardial and interstitial fibrosis. Routine endomyocardial biopsy is not recommended unless other conditions that cause hypertrophy need to be ruled out...
February 2019: Cardiology Clinics
https://read.qxmd.com/read/30447717/sudden-cardiac-death-risk-stratification-and-the-role-of-the-implantable-cardiac-defibrillator
#5
REVIEW
Sei Iwai
Hypertrophic cardiomyopathy (HCM) is associated with an increased risk of sudden cardiac death (SCD), although perhaps not as significantly as previously believed. Given the heterogeneous nature of this disease entity, risk stratification of individuals with HCM remains challenging. The recent HCM risk-SCD prediction model seems to perform well in assessing individual SCD risk. Even though implantable cardiac defibrillators (ICDs) are effective in preventing SCD in patients at increased risk, the importance of shared decision making in deciding whether or not to undergo ICD implantation cannot be understated...
February 2019: Cardiology Clinics
https://read.qxmd.com/read/30447716/arrhythmia-evaluation-and-management
#6
REVIEW
Jason T Jacobson
Patients with hypertrophic cardiomyopathy may present with a number of arrhythmias. Although not unique, arrhythmias in hypertrophic cardiomyopathy require management approaches that may differ from other populations. Standard permanent pacemaker indications can be seen, but unique applications and implantation considerations pertain to this population. Ventricular and supraventricular tachyarrhythmias may be experienced by patients with hypertrophic cardiomyopathy, treatment for which must be tailored to the hypertrophic cardiomyopathy substrate...
February 2019: Cardiology Clinics
https://read.qxmd.com/read/30447715/lifestyle-modification-and-medical-management-of-hypertrophic-cardiomyopathy
#7
REVIEW
Stephen B Heitner, Katherine L Fischer
Hypertrophic cardiomyopathy is a heterogenous condition associated with a myriad of symptoms. Just as in other disease states, the aim of medical therapy is the alleviation of suffering, improvement of longevity, and the prevention of complications. This article focuses on the associated comorbidities seen in patients with hypertrophic cardiomyopathy, potential lifestyle interventions, and conventional medical treatments for symptomatic hypertrophic cardiomyopathy.
February 2019: Cardiology Clinics
https://read.qxmd.com/read/30447714/genetic-testing-and-counseling-for-hypertrophic-cardiomyopathy
#8
REVIEW
Allison L Cirino, Christine E Seidman, Carolyn Y Ho
Genetic testing has become more accessible and is increasingly being incorporated into the care of patients with hypertrophic cardiomyopathy. Genetic test results can help to refine diagnosis and distinguish at-risk relatives from those who are not at risk.
February 2019: Cardiology Clinics
https://read.qxmd.com/read/30447713/cardiac-magnetic-resonance-for-diagnosis-and-risk-stratification
#9
REVIEW
Abdallah Sanaani, Anthon Fuisz
Cardiac MRI (CMR) is an essential tool for the evaluation of the patient with hypertrophic cardiomyopathy (HCM). First, the accurate morphologic imaging and measures that are possible with CMR help to ascertain the diagnosis. Second, the tissue characterization that can be done with MRI helps to define the abnormalities in the myocardium and to identify areas of fibrosis that have been linked to increase risk of sudden cardiac death and heart failure. In addition, CMR can help distinguish HCM from similar disease processes...
February 2019: Cardiology Clinics
https://read.qxmd.com/read/30447712/novel-pharmacotherapy-for-hypertrophic-cardiomyopathy
#10
REVIEW
Timothy C Wong, Matthew Martinez
Medical therapy for hypertrophic cardiomyopathy (HCM) has focused on minimizing the impact of symptoms due to left ventricular outflow tract obstruction and diastolic dysfunction. This article briefly discusses currently available therapy and focuses on both clinically available medications with novel applications for HCM as well as novel medications under development with specific indication for HCM. Finally, a brief summary of the current gaps and potential targets for pharmacotherapy is discussed.
February 2019: Cardiology Clinics
https://read.qxmd.com/read/30447711/echocardiography-in-the-diagnosis-and-management-of-hypertrophic-cardiomyopathy
#11
REVIEW
Harry Rakowski, Sarah Hoss, Lynne K Williams
Hypertrophic cardiomyopathy (HCM) is an inherited condition present in about 1/500 individuals with more than 1500 causative mutations identified in primarily 10 sarcomeric proteins. Although HCM is inherited in an autosomal dominant way, there is often incomplete penetrance and variable phenotype even with the same genotype. It is characterized by a degree of hypertrophy (usually asymmetric), that is, not due to another identifiable cause, as well as variable degrees of myocardial fibrosis and microvascular abnormalities...
February 2019: Cardiology Clinics
https://read.qxmd.com/read/30447710/advanced-heart-failure-management-and-transplantation
#12
REVIEW
Avi Levine, Chhaya Aggarwal Gupta, Alan Gass
Hypertrophic cardiomyopathy is a genetic heart disease with heterogeneous clinical features, including progression to advanced heart failure. The development of these symptoms can be related to outflow obstruction but in some patients reflects an underlying process of fibrosis and progressive ventricular dysfunction. For patients with end-stage disease, traditional heart failure therapies have not proved beneficial. As such, more advanced therapies, such as left ventricular assist device or cardiac transplantation, should be considered for these patients...
February 2019: Cardiology Clinics
https://read.qxmd.com/read/30447709/historical-perspectives-in-the-evolution-of-hypertrophic-cardiomyopathy
#13
REVIEW
Julio A Panza, Srihari S Naidu
Since the first anatomic description of hypertrophic cardiomyopathy (HCM) in 1958, significant advancements have expanded the understanding of this condition. At the same time, new imaging tools and treatment modalities have contributed to an ever-changing armamentarium for the assessment and treatment of patients with HCM. The historical perspective of HCM discovery and the progress made in the last several decades shed light on the road still ahead, which is expected to lead to better forms of treatment and perhaps even prevention of this, at times, devastating disease...
February 2019: Cardiology Clinics
https://read.qxmd.com/read/30297077/defining-a-decade-of-experience-with-continuous-flow-left-ventricular-assist-devices
#14
EDITORIAL
Palak Shah, Jennifer A Cowger
No abstract text is available yet for this article.
November 2018: Cardiology Clinics
https://read.qxmd.com/read/30297076/right-ventricular-failure-and-biventricular-support-strategies
#15
REVIEW
Diyar Saeed
Some degree of right ventricular (RV) dysfunction can be observed in most patients with advanced heart failure assed for left ventricular assist device (LVAD) implantation. This article describes critical factors that need to be considered in the assessment of the RV before LVAD surgery. Further, detailed description of the most important perioperative management strategies to prevent (RV) dysfunction is included. Finally, the most commonly used temporary and permeant RV support strategies are discussed, including anatomic and physiologic challenges and barriers associated with the off-label use of continuous-flow LVAD pumps for the right-sided circulation...
November 2018: Cardiology Clinics
https://read.qxmd.com/read/30297075/a-comprehensive-imaging-approach-to-guide-the-management-of-patients-with-continuous-flow-left-ventricular-assist-devices
#16
REVIEW
Bashar Hannawi, Jerry D Estep
Recent advances in mechanical circulatory support have allowed patients with end-stage heart failure to be successfully bridged to heart transplantation or live for many years on continuous-flow left ventricular assist devices (CF-LVADs) as destination therapy. As survival and quality of life continue to improve and the number of patients supported by CF-LVADs continues to grow, utilization of different imaging modalities in the care for these patients has become an integral part of many heart failure centers...
November 2018: Cardiology Clinics
https://read.qxmd.com/read/30297074/ambulatory-ventricular-assist-device-patient-management
#17
REVIEW
Tonya Elliott, Lori G Edwards
Understanding the ventricular assist device (VAD) patient pump interface and developing expertise in monitoring patients with a VAD are the goals of care in the ambulatory setting. The objective is to improve long-term outcomes. The purpose of expert, focused, routine outpatient surveillance is to facilitate the integration of pulseless, electrically dependent VAD patients into the community. Other goals of outpatient care include maximizing quality of life, maintaining equipment integrity, treating heart failure symptoms, monitoring for common VAD-related complications, ensuring viability as a heart transplant candidate, consideration for patients implanted to become transplantable, and monitoring for possible cardiac recovery...
November 2018: Cardiology Clinics
https://read.qxmd.com/read/30297073/hemodynamic-pump-patient-interactions-and-left-ventricular-assist-device-imaging
#18
REVIEW
Nikhil Narang, Jayant Raikhelkar, Gabriel Sayer, Nir Uriel
Left ventricular assist devices (LVAD) provide a durable option for patients with advanced hear failure. Axial and centrifugal pump physiology differs with regard to the relationship between pump inflow-outflow cannula pressure differential and flow, which results in device behavior that can vary drastically under different loading conditions. Ramp studies can aid the clinician in choosing the optimal speed to adequately unload the left ventricle. Advances in 3-dimensional echocardiography enhance the understanding of chamber geometry for both types of LVADs...
November 2018: Cardiology Clinics
https://read.qxmd.com/read/30297072/impact-of-mechanical-circulatory-support-on-posttransplant-outcomes
#19
REVIEW
Todd F Dardas
Mechanical circulatory support (MCS) has markedly improved the likelihood of transplant among patients with advanced heart failure. Transplant survival following MCS is similar for supported and unsupported recipients. Transplant survival is only reduced following left ventricle assist device (LVAD) support complicated by infection, total artificial heart support, and extracorporeal life support. Despite allosensitization and a higher incidence of vasoplegia syndrome, posttransplant survival for durable LVADs is similar to patients with inotropes alone at the time of transplant...
November 2018: Cardiology Clinics
https://read.qxmd.com/read/30297071/antithrombotic-strategies-and-device-thrombosis
#20
REVIEW
Paul A Gurbel, Palak Shah, Shashank Desai, Udaya S Tantry
Despite improvements in left ventricular assist device (LVAD) technology, bleeding and thrombotic complications are major concerns that adversely influence morbidity and mortality. Current antithrombotic therapy recommendations for LVAD thrombosis prophylaxis are largely derived from clinical device trials that implement a one-size-fits-all strategy. Objective serial laboratory-based assessment of thrombogenicity is needed to balance the risk of bleeding and thrombotic complications. Finally, the newest-generation device, the HeartMate 3, has been associated with lower levels of shear and reduced hemolysis that may mitigate thrombotic event occurrences...
November 2018: Cardiology Clinics
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