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Cardiology in Review

Carol L Karmen, Michael A Reisfeld, Matthew K McIntyre, Robert Timmermans, William Frishman
Public interest in health monitoring devices has increased with the availability of wearable technologies or wearables such as the Apple Watch. These devices are collecting health data that may be useful to health professionals. Most studies to date have been conducted with a limited sample size and with healthy subjects. Recent studies have suggested the usefulness of long-term cardiac monitoring to reveal atrial fibrillation and prevent cryptogenic stroke. Wearable devices may become useful in cardiac monitoring and further studies are needed...
January 8, 2019: Cardiology in Review
Saira C Khalique, Nadia Ferguson
Septic shock, a form of vasodilatory shock associated with high morbidity and mortality, requires early and effective therapy to improve patient outcomes. Current management of septic shock includes the use of intravenous fluids, catecholamines and vasopressin for hemodynamic support to ensure adequate perfusion. Despite these interventions, hospital mortality rates are still greater than 40%. Practitioners are continuously faced with cases of refractory shock that are associated with poor clinical outcomes...
December 28, 2018: Cardiology in Review
Mordechai Grabie, Cheng-Hung Tai, William H Frishman
Cholesterol metabolism and transport has been a major focus in cardiovascular disease risk modification over the past several decades. Hydroxymethylglutaryl-CoA reductase inhibitors (statins) have been the most commonly used agents, with the greatest benefit in reducing both the primary and secondary risks of cardiovascular disease. However, heart disease remains the leading cause of death in both men and women in the United States. Further investigation and intervention are required to further reduce the risk for cardiovascular disease and cardiovascular-related deaths...
December 28, 2018: Cardiology in Review
Divya Jayakumar, Rui Zhang, Amy Wasserman, Julia Ash
Idiopathic inflammatory myopathies are a group of autoimmune diseases that are characterized by muscle inflammation resulting in elevated muscle enzyme release and distinctive biopsy findings. This group of conditions includes polymyositis, dermatomyositis, inclusion body myositis and necrotizing autoimmune myopathy. Although they have many similarities, the inflammatory myopathies differ in their clinical, pathological and treatment realms. Extra-muscular manifestations may involve many organs that include the skin, joints, heart, lungs and gastrointestinal tract...
December 21, 2018: Cardiology in Review
Thomas B Fay, Martin A Alpert
A variety of psychostimulant and non-psychostimulant medications have proven to be successful in reducing inattention, impulsivity and hyperactivity in individuals with attention-deficit/hyperactivity disorder with (ADHD). Psychostimulants used to treat ADHD include methylphenidate and related drugs and various amphetamine preparations. Non-psychostimulant medications used to treat ADHD include atomoxetine and two alpha-2 adrenergic agonists; guanfacine extended-release and clonidine extended-release. The psychostimulants and atomoxetine have been shown, on average, to increase heart rate (HR) by 3-10 beats/min, systolic blood pressure by 3-8 mmHg, and diastolic BP by 2-14 mmHg...
December 7, 2018: Cardiology in Review
Matthew Lempel, William H Frishman
Computed tomography is an established tool in the assessment of cardiac anatomy and function. As demonstrated by single photon emission computed tomography, positron emission tomography, and magnetic resonance, the noninvasive evaluation of coronary hemodynamics is an important step in guiding clinical management. Nevertheless, no single modality has been shown to accurately quantify coronary artery stenosis, evaluate an atherosclerotic plaque's composition for embolic risk stratification and assess myocardial perfusion...
December 7, 2018: Cardiology in Review
Amole Ojo, Srikanth Yandrapalli, Granit Veseli, Mohammad Karim, Wilbert S Aronow, Mala Sharma, William H Frishman, Srihari S Naidu, Jason T Jacobson, Sei Iwai
Atrial fibrillation (AF) is associated with a substantially higher risk of thromboembolism, particularly stroke events, resulting in significant morbidity and mortality. Oral anticoagulation (OAC), while effective in reducing embolic events in AF patients, is associated with an increased bleeding risk. Thus, not all patients with AF are candidates for OAC and some are only candidates for OAC in the short term. Of the available non-pharmacologic strategies for the management of AF, left atrial appendage occlusion (LAAO) has emerged as a potential approach for reducing the risk of systemic thromboembolism in AF patients eligible for OAC...
December 4, 2018: Cardiology in Review
Mohammed Hasan Khan, Yogita Rochlani, Srikanth Yandrapalli, Wilbert S Aronow, William H Frishman
Advances in our understanding of the natural history and biology of atherosclerotic vascular disease led to the concept of a vulnerable plaque (VP), which is predisposed towards more rapid progression and acute coronary events. With newer technologies, we now have at our disposal high quality imaging studies, both invasive and noninvasive, which show promise in identifying plaque characteristics that make it more vulnerable. Upcoming trials aim to evaluate the utility of imaging VP in predicting clinical events...
November 26, 2018: Cardiology in Review
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No abstract text is available yet for this article.
March 2019: Cardiology in Review
Alexandra M Sible, James J Nawarskas
The direct oral anticoagulants (DOACs) have gained popularity recently among both patients and providers for their comparable or better efficacy and safety profiles compared with warfarin and the lack of need for routine monitoring of anticoagulant effect. One obstacle for the more widespread use of the DOACs in clinical practice has been the lack of a reversal agent. Most DOACs act by directly binding to and inhibiting the effects of factor Xa. Andexanet alfa (Andexxa, Portola Pharmaceuticals, San Francisco, CA) is a modified form of factor Xa that acts as a decoy binding entity for DOACs, thereby allowing endogenous factor Xa to perform its normal clotting functions...
March 2019: Cardiology in Review
Daniel Glicklich, M Raza Mustafa
Obesity is now common among children and adults who are kidney transplant candidates and recipients. It is associated with an increased risk of cardiovascular disease and kidney failure. This also pertains to potential living kidney donors with obesity. Obese patients with end-stage renal disease benefit from transplantation as do nonobese patients, but obesity is also associated with more risk. A complicating factor is that obesity is also associated with increased survival on maintenance dialysis in adults, but not in children...
March 2019: Cardiology in Review
Ayman El-Menyar, Ahmed Abuzaid, Ayman Elbadawi, Matthew McIntyre, Rifat Latifi
Coronary heart disease (CHD) represents a significant healthcare burden in terms of hospital resources, morbidity, and mortality. Primary prevention and early detection of risk factors for the development of CHD are pivotal to successful intervention programs and prognostication. Yet, there remains a paucity of evidence regarding differences in the assessment of these risk factors and the tools of assessment among different ethnicities. We conducted a narrative review to assess the utility of cardiac computed tomography, particularly coronary artery calcification (CAC), in different ethnicities...
January 2019: Cardiology in Review
Rachna Kataria, Ulrich P Jorde
Continuous-flow left ventricular assist devices (CF-LVADs) are increasingly used for the management of advanced heart failure refractory to optimal medical therapy. Despite the encouraging outcomes with CF-LVADs, gastrointestinal bleeding (GIB) continues to be a rather concerning complication resulting in increased rates of readmission and increased morbidity. The exact pathophysiology of CF-LVAD-associated GIB remains poorly understood, and this lack of knowledge limits our ability to control this morbid complication...
January 2019: Cardiology in Review
William H Frishman
No abstract text is available yet for this article.
January 2019: Cardiology in Review
Nicole K Zagelbaum, Srikanth Yandrapalli, Christopher Nabors, William H Frishman
Bempedoic acid (BA; ETC-1002) is a new agent that reduces cholesterol synthesis through inhibition of adenosine triphosphate citrate lyase, an enzyme upstream from 3-hydroxy-3-methylglutaryl-coenzyme A. In animal models, BA also influences fatty acid synthesis, but in humans, its role is limited primarily to lowering low-density lipoprotein cholesterol (LDL-C). In early clinical trials, BA was well tolerated and without major side effects. Alone or in various combinations with atorvastatin and/or ezetimibe, LDL-C lowering ranged from 17% to 64%...
January 2019: Cardiology in Review
Pratik Mondal, Diwakar Jain, Wilbert S Aronow, William H Frishman
Cardiotoxicity is a known complication of many cancer therapies. While the cardiotoxicity of established agents such as anthracyclines, antimetabolites and alkylating agents is well known, it is important to realize that newer anticancer therapies such as tyrosine kinase inhibitors, angiogenesis inhibitors, and checkpoint inhibitors are also associated with significant adverse cardiovascular effects. Echocardiography, magnetic resonance imaging, and radionuclide imaging have been used to identify these complications early and prevent further consequences...
November 14, 2018: Cardiology in Review
Twinkle Singh, Rohan Samson, Karnika Ayinapudi, Ayush Motwani, Thierry Le Jemtel
The pathogenesis of cardiogenic shock has evolved from an acute event due to a large myocardial infarction to a semi-acute event due to rapid hemodynamic deterioration on a background of preexisting left ventricular systolic dysfunction. Pre-cardiogenic shock refers to the period of rapid hemodynamic deterioration that precedes overt cardiogenic shock with hypotension, inflammatory response and end-organ failure. Mortality remains extremely high in cardiogenic shock and has not improved over the past decades...
November 2, 2018: Cardiology in Review
Matthew G Nevulis, Colby Baker, Edward Lebovics, William H Frishman
Inflammation has been shown to play an increasingly important role in the pathogenesis of atherosclerosis and in precipitating thrombotic events. Inflammatory bowel disease (IBD) is a systemic inflammatory disorder with a wide range of extraintestinal manifestations including a clinically significant increase in the risk of venous thromboembolism compared to matched controls in several studies. The data for the association between IBD and ischemic heart disease are less clear; multiple population-based studies have shown both positive and negative associations between the 2 conditions...
November 2018: Cardiology in Review
Sahil Khera, Pedro A Villablanca, Dhaval Kolte, Tanush Gupta, Mohammed Hasan Khan, Poonam Velagapudi, Ankur Kalra, Neal Kleiman, Herbert D Aronow, J Dawn Abbott, Kenneth Rosenfield, Douglas E Drachman, Sripal Bangalore, Deepak L Bhatt, Srihari S Naidu
There are no dedicated data to guide drug-eluting stent (DES) versus bare-metal stent (BMS) selection in patients with end-stage renal disease undergoing dialysis (ESRD-D). It is unclear whether long-term benefits of a specific stent type outweigh risks in this population at high risk for both bleeding and ischemic events. We performed a meta-analysis of nonrandomized studies extracted from PubMed, Scopus, and EMBASE, assessing the safety and effectiveness of DES versus BMS in ESRD-D patients. Odds ratios (OR) and 95% confidence intervals (CI) were computed with the Mantel-Haenszel method...
November 2018: Cardiology in Review
Katie Lee, Samantha Cham, Sum Lam
Venous thromboembolism (VTE) is a common and preventable cause of morbidity and mortality in hospitalized patients. Low-molecular-weight heparin, low-dose unfractionated heparin, fondaparinux, and warfarin have been the mainstay options for the prevention and treatment of VTE before the emergence of nonvitamin K antagonist oral anticoagulants (NOACs) such as dabigatran, rivaroxaban, apixaban, and edoxaban. Despite the advantages of NOACs in improving patient adherence, none of them are approved for the prevention of VTE in acutely ill medical patients at high risk of thromboembolism...
November 2018: Cardiology in Review
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