journal
https://read.qxmd.com/read/37743075/frailty-and-its-implications-in-heart-failure-with-reduced-ejection-fraction-impact-on-prognosis-and-treatment
#21
REVIEW
Khawaja M Talha, Stephen J Greene, Javed Butler, Muhammad Shahzeb Khan
Frailty affects half of all patients with heart failure with reduced ejection fraction (HFrEF) and carries a ∼2-fold increased risk of mortality. The relationship between frailty and HFrEF is bidirectional, with one condition exacerbating the other. Paradoxical to their higher clinical risk, frail patients with HFrEF are more often under-treated due to concerns over medication-related adverse clinical events. However, current evidence suggests consistent safety of HF medical therapies among older frail patients with HFrEF...
November 2023: Cardiology Clinics
https://read.qxmd.com/read/37743074/sequencing-quadruple-therapy-for-heart-failure-with-reduced-ejection-fraction-does-it-really-matter
#22
REVIEW
Jiun-Ruey Hu, Alexandra N Schwann, Jia Wei Tan, Abdulelah Nuqali, Ralph J Riello, Michael H Beasley
The conventional sequence of guideline-directed medical therapy (GDMT) initiation in heart failure with reduced ejection fraction (HFrEF) assumes that the effectiveness and tolerability of GDMT agents mirror their order of discovery, which is not true. In this review, the authors discuss flexible GDMT sequencing that should be permitted in special populations, such as patients with bradycardia, chronic kidney disease, or atrial fibrillation. Moreover, the initiation of certain GDMT medications may enable tolerance of other GDMT medications...
November 2023: Cardiology Clinics
https://read.qxmd.com/read/37743073/the-economic-burden-of-heart-failure-with-reduced-ejection-fraction-living-longer-but-poorer
#23
REVIEW
Larry A Allen, Emily Fryman Lowe, Dan D Matlock
Treatment of heart failure with reduced ejection fraction (HFrEF) has benefitted from a proliferation of new medications and devices. These treatments carry important clinical benefits, but also come with costs relevant to payers, providers, and patients. Patient out-of-pocket costs have been implicated in the avoidance of medical care, nonadherence to medications, and the exacerbation of health care disparities. In the absence of major health care policy and payment redesign, high-quality HFrEF care delivery requires transparent integration of cost considerations into system design, patient-clinician interactions, and medical decision making...
November 2023: Cardiology Clinics
https://read.qxmd.com/read/37743072/heart-failure-with-reduced-ejection-fraction-and-covid-19-when-the-sick-get-sicker-unmasking-racial-and-ethnic-inequities-during-a-pandemic
#24
REVIEW
Johanna Contreras, Elizabeth O Tinuoye, Alejandro Folch, Jose Aguilar, Kendall Free, Onyedika Ilonze, Sula Mazimba, Roopa Rao, Khadijah Breathett
Minoritized racial and ethnic groups have the highest incidence, prevalence, and hospitalization rate for heart failure. Despite improvement in medical therapies and overall survival, the morbidity and mortality of these groups remain elevated. The reasons for this disparity are multifactorial, including social determinant of health (SDOH) such as access to care, bias, and structural racism. These same factors contributed to higher rates of COVID-19 infection among minoritized racial and ethnic groups. In this review, we aim to explore the lessons learned from the COVID-19 pandemic and its interconnection between heart failure and SDOH...
November 2023: Cardiology Clinics
https://read.qxmd.com/read/37321696/cardiac-conduction-system-disorders
#25
EDITORIAL
Eric N Prystowsky, Benzy J Padanilam
No abstract text is available yet for this article.
August 2023: Cardiology Clinics
https://read.qxmd.com/read/37321695/pacing-of-specialized-conduction-system
#26
REVIEW
Santosh K Padala, Kenneth A Ellenbogen
Right ventricular pacing for bradycardia remains the mainstay of pacing therapy. Chronic right ventricular pacing may lead to pacing-induced cardiomyopathy. We focus on the anatomy of the conduction system and the clinical feasibility of pacing the His bundle and/or left bundle conduction system. We review the hemodynamics of conduction system pacing, the techniques to capture the conduction system and the electrocardiogram and pacing definitions of conduction system capture. Clinical studies of conduction system pacing in the setting of atrioventricular block and after AV junction ablation are reviewed and the evolving role of conduction system pacing is compared with biventricular pacing...
August 2023: Cardiology Clinics
https://read.qxmd.com/read/37321694/pacing-induced-cardiomyopathy
#27
REVIEW
Shaan Khurshid, David S Frankel
Right ventricular (RV) pacing-induced cardiomyopathy (PICM) is typically defined as left ventricular systolic dysfunction resulting from electrical and mechanical dyssynchrony caused by RV pacing. RV PICM is common, occurring in 10-20% of individuals exposed to frequent RV pacing. Multiple risk factors for PICM have been identified, including male sex, wider native and paced QRS durations, and higher RV pacing percentage, but the ability to predict which individuals will develop PICM remains modest. Biventricular and conduction system pacing, which better preserve electrical and mechanical synchrony, typically prevent the development of PICM and reverse left ventricular systolic dysfunction after PICM has occurred...
August 2023: Cardiology Clinics
https://read.qxmd.com/read/37321693/systemic-diseases-and-heart-block
#28
REVIEW
Syed Rafay A Sabzwari, Wendy S Tzou
Systemic diseases can cause heart block owing to the involvement of the myocardium and thereby the conduction system. Younger patients (<60) with heart block should be evaluated for an underlying systemic disease. These disorders are classified into infiltrative, rheumatologic, endocrine, and hereditary neuromuscular degenerative diseases. Cardiac amyloidosis owing to amyloid fibrils and cardiac sarcoidosis owing to noncaseating granulomas can infiltrate the conduction system leading to heart block...
August 2023: Cardiology Clinics
https://read.qxmd.com/read/37321692/iatrogenic-atrioventricular-block
#29
REVIEW
Christopher C Cheung, Shumpei Mori, Edward P Gerstenfeld
Iatrogenic atrioventricular (AV) block can occur in the context of cardiac surgery, percutaneous transcatheter, or electrophysiologic procedures. In cardiac surgery, patients undergoing aortic and/or mitral valve surgery are at the highest risk for developing perioperative AV block requiring permanent pacemaker implantation. Similarly, patients undergoing transcatheter aortic valve replacement are also at increased risk for developing AV block. Electrophysiologic procedures, including catheter ablation of AV nodal re-entrant tachycardia, septal accessory pathways, para-Hisian atrial tachycardia, or premature ventricular complexes, are also associated with risk of AV conduction system injury...
August 2023: Cardiology Clinics
https://read.qxmd.com/read/37321691/reversible-causes-of-atrioventricular-block
#30
REVIEW
Chiara Pavone, Gemma Pelargonio
Atrioventricular blocks may be caused by a variety of potentially reversible conditions, such as ischemic heart disease, electrolyte imbalances, medications, and infectious diseases. Such causes must be always ruled out to avoid unnecessary pacemaker implantation. Patient management and reversibility rates depend on the underlying cause. Careful patient history taking, monitoring of vital signs, electrocardiogram, and arterial blood gas analysis are crucial elements of the diagnostic workflow during the acute phase...
August 2023: Cardiology Clinics
https://read.qxmd.com/read/37321690/congenital-heart-block
#31
REVIEW
Leonard Steinberg
Congenital complete heart block (CCHB) defines atrioventricular conduction abnormalities diagnosed in utero or within the first 27 days of life. Maternal autoimmune disease and congenital heart defects are most commonly responsible. Recent genetic discoveries have highlighted our understanding of the underlying mechanism. Hydroxychloroquine shows promise in preventing autoimmune CCHB. Patients may develop symptomatic bradycardia and cardiomyopathy. The presence of these and other specific findings warrants placement of a permanent pacemaker to relieve symptoms and prevent catastrophic events...
August 2023: Cardiology Clinics
https://read.qxmd.com/read/37321689/bilateral-bundle-branch-block
#32
REVIEW
Jasen L Gilge, Benzy J Padanilam
Left bundle branch block (LBBB) and right bundle branch block (RBBB) are classic manifestations of bundle branch conduction disorders. However, a third form that is uncommon and underrecognized may exist that has features and pathophysiology of both: bilateral bundle branch block (BBBB). This unusual form of bundle branch block exhibits an RBBB pattern in lead V1 (terminal R wave) and an LBBB pattern in leads I and aVL (absence of S wave). This unique conduction disorder may confer an increased risk of adverse cardiovascular events...
August 2023: Cardiology Clinics
https://read.qxmd.com/read/37321688/left-bundle-branch-block-characterization-definitions-and-recent-insights-into-conduction-system-physiology
#33
REVIEW
Margarida Pujol-López, José M Tolosana, Gaurav A Upadhyay, Lluís Mont, Roderick Tung
Left bundle branch block (LBBB) is not just a simple electrocardiogram alteration. The intricacies of this general terminology go beyond simple conduction block. This review puts together current knowledge on the historical concept of LBBB, clinical significance, and recent insights into the pathophysiology of human LBBB. LBBB is an entity that affects patient diagnosis (primary conduction disease, secondary to underlying pathology or iatrogenic), treatment (cardiac resynchronization therapy or conduction system pacing for heart failure), and prognosis...
August 2023: Cardiology Clinics
https://read.qxmd.com/read/37321687/epidemiology-and-outcomes-associated-with-pr-prolongation
#34
REVIEW
Larry R Jackson, Francis Ugowe
PR prolongation is defined primarily as delayed conduction through the AV node, but can also signify delayed electrical impulse propagation through any part of the conduction system. The prevalence of PR prolongation ranges from 1% to 5% in patients younger than 50 years, with increasing prevalence, after the sixth decade of life and in patients with organic heart disease. Contemporary studies have documented increased risk of atrial arrhythmias, heart failure, and mortality in patients with PR prolongation...
August 2023: Cardiology Clinics
https://read.qxmd.com/read/37321686/sinus-node-dysfunction
#35
REVIEW
Neeraj Sathnur, Emanuel Ebin, David G Benditt
Sinus node dysfunction (SND) is a multifaceted disorder most prevalent in older individuals, but may also occur at an earlier age. In most cases, the SND diagnosis is ultimately established by documenting its ECG manifestations. EPS has limited utility. The treatment strategy is largely dictated by symptoms and ECG manifestations. Not infrequently, both bradycardia and tachycardia coexist in the same patients, along with other diseases common in the elderly (e.g., hypertension, coronary artery disease), thereby complicating treatment strategy...
August 2023: Cardiology Clinics
https://read.qxmd.com/read/37321685/genetic-abnormalities-of-the-sinoatrial-node-and-atrioventricular-conduction
#36
REVIEW
Andreu Porta-Sánchez, Silvia Giuliana Priori
The peculiar electrophysiological properties of the sinoatrial node and the cardiac conduction system are key components of the normal physiology of cardiac impulse generation and propagation. Multiple genes and transcription factors and metabolic proteins are involved in their development and regulation. In this review, we have summarized the genetic underlying causes, key clinical findings, and the latest available clinical evidence. We will discuss clinical diagnosis and management of the genetic conditions associated with conduction disorders that are more prevalent in clinical practice, for this reason, very rare genetic diseases presenting sinus node or cardiac conduction system abnormalities are not discussed...
August 2023: Cardiology Clinics
https://read.qxmd.com/read/37321684/physiologic-variants-of-cardiac-conduction-aberration-gap-supernormal-conduction
#37
REVIEW
William M Miles, Philip George
Wide QRS complexes during supraventricular rhythms can be caused by fixed bundle branch block, functional (intermittent) bundle branch block, preexcitation, or toxic/metabolic causes. Functional bundle branch block can be caused by long-short aberrancy (usually physiologic), or acceleration/deceleration dependent aberrancy (usually pathologic). Electrocardiogram criteria have been proposed to differentiate aberration from ventricular tachycardia; they are not always accurate. The gap phenomenon "paradox" is that with increasingly premature extrastimuli, progressive proximal conduction delay allows time for distal recovery of excitability...
August 2023: Cardiology Clinics
https://read.qxmd.com/read/37321683/electrocardiography-of-atrioventricular-block
#38
REVIEW
Bradley A Clark, Eric N Prystowsky
Delayed atrioventricular (AV) conduction most commonly occurs in the AV node, resulting from AH prolongation on an intracardiac electrocardiogram and PR prolongation on a surface electrocardiogram. AV conduction may be blocked in a 2:1 manner, with a normal PR interval and wide QRS suggesting infranodal disease, whereas a prolonged PR interval and narrow QRS are more suggestive of AV nodal disease. Block within the His is suspected when there is 2:1 AV block with normal PR and QRS intervals. Complete heart block occurs when the atrial rhythm is totally independent of a junctional or lower escape rhythm...
August 2023: Cardiology Clinics
https://read.qxmd.com/read/37321682/atrioventricular-conduction-physiology-and-autonomic-influences
#39
REVIEW
Eric N Prystowsky, Jasen L Gilge
Atrioventricular (AV) nodal conduction is decremental and very prone to alterations in autonomic tone. Conduction through the His-Purkinje system (HPS) is via fast channel tissue and typically not that dependent on autonomic perturbations. Applying these principles, when the sinus rate is stable and then heart block suddenly occurs preceded by even a subtle slowing of heart rate, it typically is caused by increased vagal tone, and block occurs in the AV node. Heart block with activity strongly suggests block in the HPS...
August 2023: Cardiology Clinics
https://read.qxmd.com/read/37321681/anatomy-and-pathology-of-the-cardiac-conduction-system
#40
REVIEW
Roshan Karki, Anvi Raina, Fatima M Ezzeddine, Melanie C Bois, Samuel J Asirvatham
The cardiac conduction system is formed of histologically and electrophysiologically distinct specialized tissues uniquely located in the human heart. Understanding the anatomy and pathology of the cardiac conduction system is imperative to an interventional electrophysiologist to perform safe ablation and device therapy for the management of cardiac arrhythmias and heart failure. The current review summarizes the normal and developmental anatomy of the cardiac conduction system, its variation in the normal heart and congenital anomalies, and its pathology and discusses important clinical pearls for the proceduralist...
August 2023: Cardiology Clinics
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