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By Eduardo Roque Cardiologista com foco em cardiologia hospitalar e cuidados intensivos. Professor de clínica médica.
Mihai Gheorghiade, Peter S Pang
Heart failure resulting in hospitalization represents a significant and growing health care burden. Heterogeneity characterizes this group in terms of mode of presentation, pathophysiology, and prognosis. The vast majority of patients symptomatically improve during hospitalization; however, their early post-discharge rehospitalization and mortality rates continue to be high. Worsening signs and symptoms, neurohormonal, and renal abnormalities occurring soon after discharge may contribute to these high post-discharge event rates...
February 17, 2009: Journal of the American College of Cardiology
David H Birnie, Pablo B Nery, Andrew C Ha, Rob S B Beanlands
Clinically manifest cardiac involvement occurs in perhaps 5% of patients with sarcoidosis. The 3 principal manifestations of cardiac sarcoidosis (CS) are conduction abnormalities, ventricular arrhythmias, and heart failure. An estimated 20% to 25% of patients with pulmonary/systemic sarcoidosis have asymptomatic cardiac involvement (clinically silent disease). In 2014, the first international guideline for the diagnosis and management of CS was published. In patients with clinically manifest CS, the extent of left ventricular dysfunction seems to be the most important predictor of prognosis...
July 26, 2016: Journal of the American College of Cardiology
Clyde W Yancy, Mariell Jessup, Biykem Bozkurt, Javed Butler, Donald E Casey, Monica M Colvin, Mark H Drazner, Gerasimos Filippatos, Gregg C Fonarow, Michael M Givertz, Steven M Hollenberg, JoAnn Lindenfeld, Frederick A Masoudi, Patrick E McBride, Pamela N Peterson, Lynne Warner Stevenson, Cheryl Westlake
No abstract text is available yet for this article.
September 27, 2016: Journal of the American College of Cardiology
Pardeep S Jhund, John J V McMurray
Inhibition of neurohumoural pathways such as the renin angiotensin aldosterone and sympathetic nervous systems is central to the understanding and treatment of heart failure (HF). Conversely, until recently, potentially beneficial augmentation of neurohumoural systems such as the natriuretic peptides has had limited therapeutic success. Administration of synthetic natriuretic peptides has not improved outcomes in acute HF but modulation of the natriuretic system through inhibition of the enzyme that degrades natriuretic (and other vasoactive) peptides, neprilysin, has proven to be successful...
September 1, 2016: Heart: Official Journal of the British Cardiac Society
Denise Hilfiker-Kleiner, Karen Sliwa
Cardiovascular diseases are a major cause of complications in pregnancy worldwide, and the number of patients who develop cardiac problems during pregnancy is increasing. Peripartum cardiomyopathy (PPCM) is a potentially life-threatening heart disease that emerges towards the end of pregnancy or in the first months postpartum, in previously healthy women. Symptoms and signs of PPCM are similar to those in patients with idiopathic dilated cardiomyopathy. The incidence varies geographically, most likely because of socioeconomic and genetic factors...
June 2014: Nature Reviews. Cardiology
Zolt Arany, Uri Elkayam
Peripartum cardiomyopathy is a potentially life-threatening pregnancy-associated disease that typically arises in the peripartum period and is marked by left ventricular dysfunction and heart failure. The disease is relatively uncommon, but its incidence is rising. Women often recover cardiac function, but long-lasting morbidity and mortality are not infrequent. Management of peripartum cardiomyopathy is largely limited to the same neurohormonal antagonists used in other forms of cardiomyopathy, and no proven disease-specific therapies exist yet...
April 5, 2016: Circulation
Denise Hilfiker-Kleiner, Arash Haghikia, Justus Nonhoff, Johann Bauersachs
Pregnancy is associated with marked physiological changes challenging the cardiovascular system. Among the more severe pregnancy associated cardiovascular complications, peripartum cardiomyopathy (PPCM) is a potentially life-threatening heart disease emerging towards the end of pregnancy or in the first postpartal months in previously healthy women. A major challenge is to distinguish the peripartum discomforts in healthy women (fatigue, shortness of breath, and oedema) from the pathological symptoms of PPCM...
May 7, 2015: European Heart Journal
Jayasree Pillarisetti, Ashok Kondur, Anas Alani, Madhu Reddy, Madhuri Reddy, James Vacek, Carl P Weiner, Edward Ellerbeck, Theodore Schreiber, Dhanunjaya Lakkireddy
OBJECTIVES: The purpose of this study was to identify the predictors of left ventricular (LV) recovery in patients with peripartum cardiomyopathy (PPCM) and to record rates of implantable cardioverter-defibrillator (ICD) use. BACKGROUND: PPCM is a rare, life-threatening disease. The use of ICDs has not been clearly understood in this patient group. Identification of the predictors of persistent LV dysfunction can help select patients at risk for sudden cardiac death...
July 1, 2014: Journal of the American College of Cardiology
Uri Elkayam
Peripartum cardiomyopathy is a pregnancy-associated myocardial disease characterized by the development of heart failure due to marked left ventricular systolic dysfunction. Although the disease is relatively uncommon, its incidence is increasing, and it can be associated with important and lasting morbidity and with mortality. Peripartum cardiomyopathy seems to affect women in different parts of the world but with considerable differences in clinical presentation. The purposes of this review are to describe the clinical profile of peripartum cardiomyopathy in the United States and to provide recommendations for the diagnosis and the management of this disease...
August 9, 2011: Journal of the American College of Cardiology
Alyson J McGregor, Rebecca Barron, Karen Rosene-Montella
BACKGROUND: Cardiovascular emergencies in pregnant patients are often considered a rare event; however, heart disease as a cause of maternal mortality is steadily increasing. DISCUSSION: In this article, we review 3 common cardiovascular emergencies and the important subtle differences in their treatment in the pregnant patient: peripartum/postpartum cardiomyopathy, acute myocardial infarction, and cardiac resuscitation. CONCLUSION: Managing these conditions in the emergency department setting requires a high index of suspicion, knowledge of anatomical and physiologic changes associated with pregnancy, and updated management strategies related to optimizing maternal and fetal health...
April 2015: American Journal of Emergency Medicine
Dennis M McNamara, Uri Elkayam, Rami Alharethi, Julie Damp, Eileen Hsich, Gregory Ewald, Kalgi Modi, Jeffrey D Alexis, Gautam V Ramani, Marc J Semigran, Jennifer Haythe, David W Markham, Josef Marek, John Gorcsan, Wen-Chi Wu, Yan Lin, Indrani Halder, Jessica Pisarcik, Leslie T Cooper, James D Fett
BACKGROUND: Peripartum cardiomyopathy (PPCM) remains a major cause of maternal morbidity and mortality. OBJECTIVES: This study sought to prospectively evaluate recovery of the left ventricular ejection fraction (LVEF) and clinical outcomes in the multicenter IPAC (Investigations of Pregnancy Associated Cardiomyopathy) study. METHODS: We enrolled and followed 100 women with PPCM through 1 year post-partum. The LVEF was assessed by echocardiography at baseline and at 2, 6, and 12 months post-partum...
August 25, 2015: Journal of the American College of Cardiology
Cynthia Feltner, Christine D Jones, Crystal W Cené, Zhi-Jie Zheng, Carla A Sueta, Emmanuel J L Coker-Schwimmer, Marina Arvanitis, Kathleen N Lohr, Jennifer C Middleton, Daniel E Jonas
BACKGROUND: Nearly 25% of patients hospitalized with heart failure (HF) are readmitted within 30 days. PURPOSE: To assess the efficacy, comparative effectiveness, and harms of transitional care interventions to reduce readmission and mortality rates for adults hospitalized with HF. DATA SOURCES: MEDLINE, Cochrane Library, CINAHL,, and World Health Organization International Clinical Trials Registry Platform (1 January 1990 to late October 2013)...
June 3, 2014: Annals of Internal Medicine
Mikhail S Dzeshka, Gregory Y H Lip
As atrial fibrillation (AF) substantially increases the risk of stroke and other thromboembolic events, most AF patients require appropriate antithrombotic prophylaxis. Oral anticoagulation (OAC) with either dose-adjusted vitamin K antagonists (VKAs) (eg, warfarin) or non-VKA oral anticoagulants (eg, dabigatran, apixaban, rivaroxaban) can be used for this purpose unless contraindicated. Therefore, risk assessment of stroke and bleeding is an obligatory part of AF management, and risk has to be weighed individually...
April 2016: Heart Failure Clinics
Katherine Wojnowich, Ravi Korabathina
Outpatient management of heart failure (HF) is aimed at treating symptoms and preventing hospitalizations and readmissions. Management is initiated in a stepwise approach. Blockade of the renin-angiotensin system is a cornerstone of therapy and should be started, along with beta blockers, as soon as the diagnosis of HF is made. Other drugs, including diuretics, aldosterone antagonists, hydralazine, and nitrates, may be added based on symptoms and American College of Cardiology/American Heart Association stage...
March 2016: FP Essentials
Ravi Korabathina
Acute decompensated heart failure (HF) is one of most common reasons for hospitalization among individuals older than 65 years. A thorough evaluation, including history, physical examination, and laboratory assessment, is required to optimize care of these patients. In uncertain cases, serum brain-type natriuretic peptide (BNP) or N-terminal proBNP level, stress testing, and/or invasive coronary angiography may be helpful in establishing the diagnosis. The hospital setting provides an opportunity to identify etiologies and stabilize the patient...
March 2016: FP Essentials
Keane K Lee, Jingrong Yang, Adrian F Hernandez, Anthony E Steimle, Alan S Go
BACKGROUND: Readmission within 30 days after hospitalization for heart failure (HF) is a major public health problem. OBJECTIVE: To examine whether timing and type of post-discharge follow-up impacts risk of 30-day readmission in adults hospitalized for HF. DESIGN: Nested matched case-control study (January 1, 2006-June 30, 2013). SETTING: A large, integrated health care delivery system in Northern California. PARTICIPANTS: Hospitalized adults with a primary diagnosis of HF discharged to home without hospice care...
April 2016: Medical Care
Veli-Pekka Harjola, Alexandre Mebazaa, Jelena Čelutkienė, Dominique Bettex, Hector Bueno, Ovidiu Chioncel, Maria G Crespo-Leiro, Volkmar Falk, Gerasimos Filippatos, Simon Gibbs, Adelino Leite-Moreira, Johan Lassus, Josep Masip, Christian Mueller, Wilfried Mullens, Robert Naeije, Anton Vonk Nordegraaf, John Parissis, Jillian P Riley, Arsen Ristic, Giuseppe Rosano, Alain Rudiger, Frank Ruschitzka, Petar Seferovic, Benjamin Sztrymf, Antoine Vieillard-Baron, Mehmet Birhan Yilmaz, Stavros Konstantinides
Acute right ventricular (RV) failure is a complex clinical syndrome that results from many causes. Research efforts have disproportionately focused on the failing left ventricle, but recently the need has been recognized to achieve a more comprehensive understanding of RV anatomy, physiology, and pathophysiology, and of management approaches. Right ventricular mechanics and function are altered in the setting of either pressure overload or volume overload. Failure may also result from a primary reduction of myocardial contractility owing to ischaemia, cardiomyopathy, or arrhythmia...
March 2016: European Journal of Heart Failure
A Pieter Kappetein, Nicolas M van Mieghem, Stuart J Head
Coronary artery bypass grafting (CAGB) is superior to percutaneous coronary intervention (PCI) in reducing mortality in certain patients and improving the composite end points of angina, recurrent myocardial infarction, and repeat revascularization procedures. However, CABG is associated with a higher perioperative stroke risk. For patients with less complex disease or left main coronary disease, PCI is an acceptable alternative to CABG. Lesion complexity is an essential consideration for stenting, whereas patient comorbidity is an essential consideration for CABG...
January 2016: Heart Failure Clinics
Daniel A Ollendorf, Alexander T Sandhu, Steven D Pearson
No abstract text is available yet for this article.
February 2016: JAMA Internal Medicine
Abhishek Singh, Saïd Laribi, John R Teerlink, Alexandre Mebazaa
Millions of patients worldwide are admitted for acute heart failure (AHF) each year and physicians caring for these patients are confronted with the short-term challenges of reducing symptoms while preventing end organ dysfunction without causing additional harm, and the intermediate-term challenges of improving clinical outcomes such as hospital readmission and survival. There are limited data demonstrating the efficacy of any currently available therapies for AHF to meet these goals. After diuretics, vasodilators are the most common intravenous therapy for AHF, but neither nitrates, nitroprusside, nor nesiritide have robust evidence supporting their ability to provide meaningful effects on clinical outcomes, except perhaps early symptom improvement...
February 4, 2016: European Heart Journal
2016-02-23 01:22:32
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