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    925 results match your criteria Cardiology in review[Journal]

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    Contemporary Diagnosis and Management of Atrial Flutter: A Continuum of Atrial Fibrillation and Vice Versa?
    Cardiol Rev 2017 Aug 18. Epub 2017 Aug 18.
    Third Department of Cardiology, Athens University School of Medicine, Athens, Greece.
    Atrial flutter (AFlu) is usually a fast (>240 bpm) and regular right atrial macroreentrant tachycardia, with a constrained critical region of the reentry circuit located at the cavotricuspid isthmus (CTI) (typical CTI-dependent AFlu). However, a variety of right and left atrial tachycardias, resulting from different mechanisms, can also present as AFlu (atypical non-CTI-dependent AFlu). The electrocardiogram can provide clues to its origin and location, however, additional entrainment and more sophisticated electro-anatomical mapping techniques may be required to identify its mechanism, location and target-area for a successful ablation. Read More

    Chronic Thromboembolic Pulmonary Hypertension: Epidemiology, Diagnosis, and Management.
    Cardiol Rev 2017 Aug 18. Epub 2017 Aug 18.
    1 Department of Internal Medicine, New York Medical College at Westchester Medical Center, Valhalla, NY-10595, USA. 2 Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, NY-10595, USA. 3 Department of Cardiothoracic Surgery, New York Medical College at Westchester Medical Center, Valhalla, NY-10595, USA.
    Chronic thromboembolic pulmonary hypertension (CTEPH), classified as WHO group 4 pulmonary hypertension (PH), is an interesting and rare pulmonary vascular disorder secondary to mechanical obstruction of the pulmonary vasculature from thromboembolism resulting in PH. The pathophysiology is complex, beginning with mechanical obstruction of the pulmonary arteries, which eventually leads to arteriopathic changes and vascular remodeling in the non-occluded arteries and in the distal segments of the occluded arteries mediated by thrombus non-resolution, abnormal angiogenesis, endothelial dysfunction, and various local growth factors. Based on available data, CTEPH is a rare disease entity occurring in a small proportion (0. Read More

    Pregnancy in Patients with Congenital Heart Disease: A Contemporary Challenge.
    Cardiol Rev 2017 Aug 18. Epub 2017 Aug 18.
    From the 1st Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
    The majority of female patients with congenital heart disease (CHD) survive into childbearing age and require evidence-based counseling regarding pregnancy options. Even though most of them will have an uneventful pregnancy, they may be at high risk of cardiac, obstetric and fetal complications. Predictive factors for these complications have been previously identified in numerous studies and with the use of specific scores. Read More

    Cardiovascular Manifestations of Pheochromocytoma.
    Cardiol Rev 2017 Sep/Oct;25(5):215-222
    From the Department of Medicine, Division of Endocrinology, New York Medical College/Westchester Medical Center, Valhalla, NY.
    Pheochromocytomas are rare endocrine tumors that can have a significant impact on a variety of organ systems, including the cardiovascular system. Although the pathophysiology is not completely understood, pheochromocytomas exert their effects through high levels of catecholamines, mainly epinephrine and norepinephrine, which stimulate adrenergic receptors, including those within the cardiovascular system. Although the most common cardiovascular manifestation is hypertension, patients with pheochromocytoma can present with arrhythmia, hypotension, shock, myocardial ischemia, cardiomyopathy, aortic dissection, and peripheral ischemia. Read More

    Carotid Stenosis and Impaired Cognition: The Effect of Intervention.
    Cardiol Rev 2017 Sep/Oct;25(5):211-214
    From the *Stony Brook University School of Medicine, Stony Brook, NY; †Division of Vascular Surgery, Winthrop University Hospital, Mineola, NY.
    There is a clear association between carotid artery stenosis and cognitive impairment. However, there is no consensus as to how to interpret this association, and what, if any, impact this connection should have on the management of carotid stenosis. A review of the relevant literature suggests that although an intervention to relieve carotid stenosis in patients without clinically significant cognitive impairment does not improve cognition, there may be a cognitive benefit with intervention for carotid stenosis in those patients with clinically significant cognitive disorders. Read More

    Cardiac Auscultation in the Modern Era: Premature Requiem or Phoenix Rising?
    Cardiol Rev 2017 Sep/Oct;25(5):205-210
    From the *Morsani School of Medicine, University of South Florida, Tampa, FL; †Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; and ‡Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
    Competent cardiac auscultation remains a most important skill for the detection of heart disease. Currently it is poorly taught and often ignored or poorly performed, resulting in inaccurate and inefficient patient assessments. This review documents that teaching can be over 90% effective with new, proven teaching methods emphasizing repetition and normal-abnormal comparisons of sounds, using computer-aided and online resources. Read More

    Echocardiography in the Evaluation of Pulmonary Embolism.
    Cardiol Rev 2017 Jun 22. Epub 2017 Jun 22.
    From the Department of Medicine, Cardiology Division, New York Medical College/ Westchester Medical Center, Valhalla, NY.
    Pulmonary embolism is a major cause of mortality. Acute pulmonary embolism also encompasses a wide clinical spectrum of severity, ranging from asymptomatic silent disease to hemodynamic instability and shock. Echocardiography is a useful modality to improve treatment strategies for pulmonary embolus. Read More

    Neuroendovascular Surgery for the Treatment of Ischemic Stroke.
    Cardiol Rev 2017 Jun 22. Epub 2017 Jun 22.
    Department of Neurosurgery, New York Medical College/Westchester Medical Center, Valhalla, NY.
    This review discusses modern therapeutic interventions for acute ischemic stroke with a focus on endovascular therapy. In 2015, the American Heart Association (AHA) made major changes to the guidelines for the endovascular treatment of acute ischemic stroke. The Class IA indications for endovascular therapy of stroke patients include symptom onset within 6 hours, proven large vessel occlusion of an artery in the anterior circulation, and the use of a stent retriever as part of the mechanical thrombectomy. Read More

    Is Swimming Safe in Heart Failure? A Systematic Review.
    Cardiol Rev 2017 Jun 22. Epub 2017 Jun 22.
    Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK.
    It is not clear whether swimming is safe in patients with chronic heart failure. Ten studies examining the hemodynamic effects of acute water immersion (WI) (155 patients; average age 60 years; 86% male; mean left ventricular ejection fraction (LVEF) 29%) and 6 randomized controlled trials of rehabilitation comparing swimming with either medical treatment only (n=3) or cycling (n=1) or aerobic exercise (n=2), (136 patients, average age 59 years; 84% male, mean LVEF 31%) were considered. In 7 studies of warm WI (30 -35 ºC): heart rate (HR) fell (2-15%), and both cardiac output (CO) (7-37%) and stroke volume (SV) increased (13-41%). Read More

    Celiprolol: A Unique Selective Adrenoceptor Modulator.
    Cardiol Rev 2017 Sep/Oct;25(5):247-253
    From the *College of Pharmacy, University of New Mexico, Albuquerque, NM; †Department of Clinical Pharmacy, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; and ‡Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY.
    Celiprolol is a β-blocker with a unique pharmacologic profile: it is a β1-andrenoceptor antagonist with partial β2 agonist activity. Given this combination of effects, celiprolol may be better described as a selective adrenoreceptor modulator. It has antihypertensive and antianginal properties and is indicated for those uses in various countries around the world. Read More

    Trial of Time: Review of Frailty and Cardiovascular Disease.
    Cardiol Rev 2017 Sep/Oct;25(5):236-240
    From the *Departments of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, †Beth Israel Deaconess Medical Center, Harvard Medical College, Boston, MA; and ‡New York Medical College, Westchester Medical Center, Valhalla, New York.
    Frailty has become more frequently recognized as an indicator of predisability. It has been shown to have an association with cardiovascular disease (CVD), just as CVD has an association with frailty, and is a predictor of hospitalization and mortality. The ability to identify this population provides a measure to more accurately assess risk and prognosis which can help the early detection of disease and dictate intervention. Read More

    Epicardial Fat: Pathophysiology and Clinical Significance.
    Cardiol Rev 2017 Sep/Oct;25(5):230-235
    From the *Department of Medicine, Weill-Cornell Medical Center, New York, NY; †Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA; and ‡Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY.
    Over the last decade and a half there has been much interest in understanding the role of epicardial adipose tissue (EAT) in cardiac pathology. EAT is a visceral adipose deposit with putative paracrine function. In the nondiseased state, EAT releases cardioprotective cytokines and chemokines to the coronary vasculature. Read More

    Novel Oral Anticoagulants in the Peri-Endoscopic Period.
    Cardiol Rev 2017 Sep/Oct;25(5):223-229
    From the *Department of Medicine, Stanford University School of Medicine, Palo Alto, CA; †Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY; and ‡Department of Medicine, Division of Gastroenterology and Hepato-Biliary Diseases, New York Medical College/Westchester Medical Center, Valhalla, NY.
    Millions of patients in the United States are currently prescribed some form of anticoagulation therapy. Recently, novel oral anticoagulants (NOACs), including direct thrombin inhibitors and direct factor Xa inhibitors, have begun to replace warfarin as the drugs of choice for anticoagulation. As the use of these medications becomes more widespread, it is increasingly important for gastroenterologists to understand the risks associated with performing endoscopic procedures on patients who are taking NOACs. Read More

    Droxidopa for Symptomatic Neurogenic Hypotension.
    Cardiol Rev 2017 Sep/Oct;25(5):241-246
    From the *Department of Pharmacy, Weiler Hospital of Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY.
    Droxidopa is a first-in-class, orally available, synthetic amino acid precursor of norepinephrine that received accelerated Food and Drug Administration approval in February 2014 after Orphan Drug status for a debilitating condition known as symptomatic neurogenic orthostatic hypotension. Neurogenic disorders often lead to postural hypotension as a result of poor norepinephrine release from its storage sites. Clinical data suggest increases in standing systolic blood pressure and improvements in many other markers for subjective relief in patients with symptomatic neurogenic hypotension who received droxidopa therapy over 1-2 weeks. Read More

    Vitamin D Deficiency and Supplementation in Cardiovascular Disorders.
    Cardiol Rev 2017 Jul/Aug;25(4):189-196
    From the *Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA; †The Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL; and ‡Cardiology Department, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL.
    Cardiovascular disease (CVD) is the leading cause of death in developed countries. Similarly, the frequency of vitamin D deficiency is increasing, and a number of epidemiologic and clinical studies have suggested that there is an increased risk of CVD among people with depletion of this vitamin. This has raised much interest in the potential pathogenic and therapeutic role of vitamin D in CVD. Read More

    Coronary Microcirculatory Dysfunction in Human Cardiomyopathies: A Pathologic and Pathophysiologic Review.
    Cardiol Rev 2017 Jul/Aug;25(4):165-178
    From the *Department for Cardiovascular Diseases, Osijek University Hospital, Osijek, Croatia; †Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; ‡Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; §Department of Pathophysiology, Semmelweis University, Budapest, Hungary; ¶Institute of Natural Sciences, University of Physical Education, Budapest, Hungary; and ‖Department of Physiology, New York Medical College, Valhalla, NY.
    Cardiomyopathies are a heterogeneous group of diseases of the myocardium. The term cardiomyopathy involves a wide range of pathogenic mechanisms that affect the structural and functional states of cardiomyocytes, extravascular tissues, and coronary vasculature, including both epicardial coronary arteries and the microcirculation. In the developed phase, cardiomyopathies present with various clinical symptoms: dyspnea, chest pain, palpitations, swelling of the extremities, arrhythmias, and sudden cardiac death. Read More

    Genetic Insights Into Bicuspid Aortic Valve Disease.
    Cardiol Rev 2017 Jul/Aug;25(4):158-164
    From the *Leicester Cardiovascular Biomedical Research Unit, Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, United Kingdom; †Department of Cardiology, University of Leicester, Northhampton General Hospital, Northhampton, United Kingdom; and ‡Department of Cardiovascular Sciences, University of Leicester, East Midlands Congenital Heart Centre, Glenfield General Hospital, Leicester, United Kingdom.
    Bicuspid aortic valve (BAV) is the most common valvular congenital heart defect in the general population. BAV is commonly associated with the presence of other congenital cardiovascular malformations, which leads to cardiovascular complications requiring surgery in around 27% of cases. Familial clustering of BAV is well-recognized, and international guidelines advocate that first-degree relatives of patients with BAV be screened. Read More

    PFO Closure for Cryptogenic Stroke: A Review and Clinical Treatment Algorithm.
    Cardiol Rev 2017 Jul/Aug;25(4):147-157
    *Division of Cardiology, Departments of Medicine and Pediatrics, Weill Cornell Medicine, New York Presbyterian Hospital, Cornell Center for Adult Congenital Heart Disease, New York, NY; and †Division of Cardiology, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla, NY.
    With a high prevalence in the general population of approximately 25%, and a prevalence in the cryptogenic stroke population approaching 40%, the propensity of a patent foramen ovale (PFO) to precipitate or enable stroke, especially in young, otherwise healthy individuals, has been the subject of much debate. With proof of concept achieved via imaging modalities documenting thrombus-in-transit, and the development of minimally-invasive percutaneous approaches to closure, multiple observational studies and, more recently, several completed randomized controlled trials have sought to answer the question of when and in whom PFO closure should occur. We describe the historical context of PFO closure and review the observational and randomized control trial evidence in this field, culminating in the recent Food and Drug Administration approval of the first dedicated closure device for PFO. Read More

    Inhaled Insulin: A Clinical and Historical Review.
    Cardiol Rev 2017 May/Jun;25(3):140-146
    From the Department of Pharmacy, Montefiore Medical Center, Bronx, NY.
    Insulin is the most effective blood glucose lowering agent and remains one of the cornerstones of diabetes management. However, many individuals with diabetes are either reluctant to initiate or are nonadherent to their insulin therapy for various reasons, including fear of frequent injections. Technosphere Insulin (TI) is a novel inhaled insulin powder that is approved by the United States Food and Drug Administration for the management of diabetes. Read More

    Cangrelor: A New Route for P2Y12 Inhibition.
    Cardiol Rev 2017 May/Jun;25(3):133-139
    From the College of Pharmacy, University of New Mexico, Albuquerque, NM.
    Antiplatelet therapy with a P2Y12 inhibitor is a key component of treatment for patients with acute coronary syndromes undergoing percutaneous coronary intervention. Before the development of cangrelor (Kengreal, The Medicines Company, Parsippany, NJ), only oral P2Y12 inhibitors were available. Cangrelor is a reversible P2Y12 inhibitor that is administered as an intravenous infusion, and its quick onset and offset make it an appealing option for antiplatelet therapy, particularly for patients who are unable to take oral medications. Read More

    The Utility of Teleultrasound to Guide Acute Patient Management.
    Cardiol Rev 2017 May/Jun;25(3):97-101
    From the *Center for Telemedicine & eHealth, Westchester Medical Center, Valhalla, NY; †Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY; ‡Division of Cardiology, Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY; and §Department of Anesthesiology, Westchester Medical Center, Valhalla, NY.
    Ultrasound has evolved into a core bedside tool for diagnostic and management purposes for all subsets of adult and pediatric critically-ill patients. Teleintensive care unit coverage has undergone a similar rapid expansion period throughout the United States. Round-the-clock access to ultrasound equipment is very common in today's intensive care unit, but 24/7 coverage with staff trained to acquire and interpret point-of-care ultrasound in real time is lagging behind equipment availability. Read More

    On-X Valve: The Next Generation Aortic Valve.
    Cardiol Rev 2017 Mar/Apr;25(2):77-83
    From the *Department of Medicine, Sinai Hospital of Baltimore, Johns Hopkins University, Baltimore, MD; †Division of Cardiology, Lehigh Valley Health Network, Allentown, PA; and ‡Department of Medicine, Einstein Healthcare Network, Philadelphia, PA.
    The On-X valve is a newer generation mechanical bileaflet valve. Its key features include the use of pure pyrolytic carbon (devoid of silicon), a length-to-diameter ratio similar to a native valve, an inlet flared orifice, a leaflet opening up to 90 degrees, a shorter leaflet closing angle, a 2-point leaflet contact, and an actuated pivot. These features have translated into increased strength, improved valve hemodynamics, reduced hemolysis, and thrombogenicity. Read More

    Evacetrapib: Another CETP Inhibitor for Dyslipidemia With No Clinical Benefit.
    Cardiol Rev 2017 Mar/Apr;25(2):43-52
    From the *Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA; and †Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY.
    Evacetrapib is a cholesteryl ester transfer protein (CETP) inhibitor that has been recently studied as a cholesterol modifying agent to reduce cardiovascular risk and mortality in high risk cardiovascular disease patients. Evacetrapib acts to decrease lipid exchange through CETP inhibition. CETP acts to transfer cholesteryl esters from high-density lipoprotein-cholesterol (HDL-C) to low-density lipoprotein cholesterol (LDL-C) and very-low-density lipoprotein (VLDL-C). Read More

    A Review of the Clinical Utility of Intravascular Ultrasound and Optical Coherence Tomography in the Assessment and Treatment of Coronary Artery Disease.
    Cardiol Rev 2017 Mar/Apr;25(2):68-76
    From the *Department of Medicine, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY; and †Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY.
    Coronary artery disease remains one of the leading causes of morbidity and mortality in the United States. As a medical society, we continue to search for ways to better treat coronary artery disease and prevent acute coronary syndrome (ACS). As it stands, only statins and antiplatelet agents have been proven to significantly reduce the occurrence of ACS. Read More

    Lead Extraction: Considerations for the Referring Cardiologist.
    Cardiol Rev 2016 Nov 17. Epub 2016 Nov 17.
    Cleveland Clinic, Sydell and Arnold Miller Family Heart and Vascular Institute, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology.
    The population of patients with cardiac implantable electronic devices (CIED) continues to grow owing to increasing indications in an aging population and breakthroughs in both the medical and surgical care of patients with heart disease. In clinical practice there has been a growing need for device and lead extraction due to the growing population of patients with CIEDs and the subsequent need for system upgrades or revisions because of complications, infections and lead advisory alerts. In this condensed review, we will discuss aspects of transvenous lead extraction, with a special focus on considerations that would be relevant to the referring cardiologist. Read More

    Smartphone-Based Electrocardiographic and Cardiac Implantable Electronic Device Monitoring.
    Cardiol Rev 2016 Nov 17. Epub 2016 Nov 17.
    The Valley Hospital Health System, Ridgewood, NJ; New York, NY.
    The field of arrhythmia monitoring is changing rapidly. The rapid advent of technology in combination with marked improvements in cellular communication and an increased desire by patients to be actively engaged in their care has ushered in a new era of clinical care. Today, physicians need to think about their patients outside the traditional in-office setting. Read More

    Sports and Driving with an Implantable Cardioverter-Defibrillator.
    Cardiol Rev 2016 Nov 17. Epub 2016 Nov 17.
    1 From the Department of Medicine, Division of Cardiology, Westchester Medical Center, Valhalla, New York and 2 Division of Cardiology, Arrhythmia Service, Montefiore Medical Center, Bronx, NY.
    Many patients with implantable cardioverter-defibrillators (ICD) want to participate in sports and many need or wish to operate a personal motor vehicle. Healthcare providers need to advise patients regarding restrictions related to these activities in the context of the clinical indication for the ICD. Ethical considerations need to be considered when advising ICD patients of restrictions to reduce risk of injury to themselves and to others when participating in either sports or driving. Read More

    Optimal Implantable Cardioverter Defibrillator Programming.
    Cardiol Rev 2016 Nov 17. Epub 2016 Nov 17.
    Department of Medicine, Division of Cardiology, Temple University Hospital, Philadelphia, Pa.
    Optimal programming of implantable cardioverter defibrillators (ICDs) is essential to appropriately treat ventricular tachyarrhythmias and to avoid unnecessary and inappropriate shocks. There have been a series of large clinical trials evaluating tailored programming of ICDs. We reviewed the clinical trials evaluating ICD therapies and detection, as well as the consensus statement on ICD programming. Read More

    Sports and Driving With an Implantable Cardioverter-Defibrillator.
    Cardiol Rev 2017 Jan/Feb;25(1):36-42
    From the *Division of Cardiology, Department of Medicine, Westchester Medical Center, Valhalla, NY, and †Division of Cardiology, Department of Medicine, Arrhythmia Service, Montefiore Medical Center, Bronx, NY.
    Many patients with implantable cardioverter-defibrillators (ICD) want to participate in sports and many need or wish to operate a personal motor vehicle. Healthcare providers need to advise patients regarding restrictions related to these activities in the context of the clinical indication for the ICD. Ethical considerations need to be considered when advising ICD patients of restrictions to reduce risk of injury to themselves and to others when participating in either sports or driving. Read More

    Optimal Implantable Cardioverter Defibrillator Programming.
    Cardiol Rev 2017 Jan/Feb;25(1):30-35
    From the Division of Cardiology, Department of Medicine, Temple University Hospital, Philadelphia, PA.
    Optimal programming of implantable cardioverter defibrillators (ICDs) is essential to appropriately treat ventricular tachyarrhythmias and to avoid unnecessary and inappropriate shocks. There have been a series of large clinical trials evaluating tailored programming of ICDs. We reviewed the clinical trials evaluating ICD therapies and detection, and the consensus statement on ICD programming. Read More

    Lead Extraction Considerations for the Referring Cardiologist.
    Cardiol Rev 2017 Jan/Feb;25(1):17-21
    From the Cleveland Clinic; Sydell and Arnold Miller Family Heart & Vascular Institute, Robert & Suzanne Tomsich Department of Cardiovascular Medicine, Section of Cardiac Pacing and Electrophysiology, Cleveland, OH.
    The population of patients with cardiac implantable electronic devices (CIEDs) continues to grow due to increasing indications in an aging population and breakthroughs in both the medical and the surgical care of patients with heart disease. As a result, there has been a growing need for device and lead extractions due to the growing population of patients with CIEDs and the subsequent need for system upgrades or revisions because of complications, infections, and lead advisory alerts. Read More

    Smartphone-Based Electrocardiographic and Cardiac Implantable Electronic Device Monitoring.
    Cardiol Rev 2017 Jan/Feb;25(1):12-16
    From the Department of Medicine, Valley Health System, Ridgewood, NJ.
    The field of arrhythmia monitoring is changing rapidly. The rapid advent of technology in combination with marked improvements in cellular communication and an increased desire by patients to be actively engaged in their care has ushered in a new era of clinical care. Today, physicians need to think about their patients outside the traditional in-office setting. Read More

    Current and Emerging Uses of Insertable Cardiac Monitors: Evaluation of Syncope and Monitoring for Atrial Fibrillation.
    Cardiol Rev 2017 Jan/Feb;25(1):22-29
    From the Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
    Insertable cardiac monitors (ICMs) have provided clinicians with a superb tool for assessing infrequent or potentially asymptomatic arrhythmias. ICMs have shown their usefulness in the evaluation of unexplained syncope, providing high diagnostic yields in a cost-effective manner. While unexplained syncope continues to be the most common reason for their use, ICMs are increasingly being used for the monitoring of atrial fibrillation (AF). Read More

    Cardiac Resynchronization Therapy: Maximizing the Response to Biventricular Pacing.
    Cardiol Rev 2017 Jan/Feb;25(1):6-11
    From the Cardiac Arrhythmia Service, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
    Cardiac resynchronization therapy (CRT) has become a mainstay therapy to improve clinical outcomes of patients with left ventricular systolic dysfunction and a wide QRS complex, in addition to guideline-directed medical therapy. As clinical experience with CRT continues to expand, the device and lead design, along with implantation techniques, have evolved as well. However, there is a significant proportion of patients with heart failure who do not have a favorable response to CRT. Read More

    Wearable Cardioverter Defibrillators.
    Cardiol Rev 2016 Nov/Dec;24(6):282-287
    From the *Division of Cardiology, Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY; †Cardiology Section, Department of Medicine, Boston University Medical Center, Boston, MA; ‡Department of Medicine, Mount Vernon Hospital Center, Mount Vernon, NY; and §Ross University School of Medicine, Miramar, FL.
    The use of implantable cardioverter defibrillators (ICD) has favorably impacted the prevention and treatment of sudden cardiac death (SCD) associated with ventricular arrhythmias. However, there are situations where an ICD cannot be immediately implanted, even though the patient is at high risk for SCD. The wearable cardioverter defibrillator (WCD) is a unique technology that can bridge this gap for patients. Read More

    Electronic Cigarettes: Questions in the Mist.
    Cardiol Rev 2016 Nov/Dec;24(6):261-267
    From *The Department of Surgery, University of Maryland School of Medicine/University of Maryland Medical Center, Baltimore, MD; and †The Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY.
    In many parts of the world, electronic cigarettes (ECs) are marketed as a tool to assist users in attempts to quit smoking and are perceived to be a safer alternative to tobacco cigarettes. Numerous studies have suggested ECs may not be effective in achieving this goal and that the illusive "safety" of ECs can be enticing to consumers. The composition of the liquid solutions vaporized by these devices has not been fully disclosed and may not contain the actual advertised ingredients in the fractions reported. Read More

    High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in the Prevention/Management of Cardiovascular Disease.
    Cardiol Rev 2016 Nov/Dec;24(6):273-281
    From the *Centre for Health, Sport and Rehabilitation Sciences Research, University of Salford, Manchester, United Kingdom; and †Department of Movement, Human, and Health Sciences, University of Rome Foro Italico, Rome, Italy.
    Moderate-intensity continuous training (MICT) has long been considered the most effective exercise treatment modality for the prevention and management of cardiovascular disease (CVD), but more recently high-intensity interval training (HIIT) has been viewed as a potential alternative to MICT in accruing such benefits. HIIT was initially found to induce significant improvements in numerous physiological and health-related indices, to a similar if not superior extent to MICT. Since then, many studies have attempted to explore the potential clinical utility of HIIT, relative to MICT, with respect to treating numerous cardiovascular conditions, such as coronary artery disease, heart failure, stroke, and hypertension. Read More

    Patiromer: The First Potassium Binder Approved in Over 50 Years.
    Cardiol Rev 2016 Nov/Dec;24(6):316-323
    From the *Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy/RUSH University Medical Center, Downers Grove, IL; †Department of Pharmacy, Montefiore Medical Center, Bronx, NY; ‡Department of Medicine, Boston University Medical Center, Boston, MA; and §Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY.
    For over 50 years, there have been limited options for the management of hyperkalemia, especially among patients with chronic kidney disease (CKD), diabetic nephropathy, hypertension, and heart failure, who were receiving concomitant renin-angiotensin-aldosterone system (RAAS) inhibitor therapy. Hyperkalemia is a potential, life-threatening electrolyte abnormality that frequently challenges clinicians from maximizing the mortality benefit and organ-protective properties of RAAS inhibitors especially in CKD and heart failure populations. Patiromer is a novel nonabsorbed, cation-exchange polymer that binds and exchanges potassium for calcium, predominantly in the gastrointestinal tract. Read More

    Reversal Agents for Direct Oral Anticoagulants: Understanding New and Upcoming Options.
    Cardiol Rev 2016 Nov/Dec;24(6):310-315
    From the *Clinical Pharmacy, College of Pharmacy, University of Tennessee, Memphis, TN; and †Med Communications Inc., Memphis, TN; and ‡Clinical Pharmacy, College of Pharmacy, University of Tennessee, Memphis, TN.
    Direct oral anticoagulants (DOACs), originally developed as an alternative for vitamin K antagonists, are shifting the landscape of antithrombotic therapy. DOACs such as dabigatran, rivaroxaban, apixaban, and edoxaban offer enhancements in safety, convenience, and efficacy compared with warfarin. However, as choices for oral anticoagulation therapy have increased, so has the need for effectual antidotes before urgent surgical procedures and for the reversal of serious adverse events caused by DOACs. Read More

    Ghrelin and the Cardiovascular System.
    Cardiol Rev 2016 Nov/Dec;24(6):288-297
    From the *Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA; and †Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla, NY.
    Ghrelin is a small peptide released primarily from the stomach. It is a potent stimulator of growth hormone secretion from the pituitary gland and is well known for its regulation of metabolism and appetite. There is also a strong relationship between ghrelin and the cardiovascular system. Read More

    High-Density Lipoprotein Infusion Therapy and Atherosclerosis: Current Research and Future Directions.
    Cardiol Rev 2016 Nov/Dec;24(6):298-302
    From the *Department of Medicine, Baylor College of Medicine, Houston, TX; and †Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY.
    Atherosclerosis is the leading cause of heart disease, contributing to hundreds of thousands of deaths annually. The use of long-term antilipid therapy has decreased low-density lipoprotein as a target, but high-density lipoprotein (HDL) has many properties which can protect against the formation of atherosclerotic plaque and decrease plaque burden. Numerous studies have shown an inverse correlation with HDL level and the future risk of heart disease. Read More

    The Role of Virtual Histology Intravascular Ultrasound in the Identification of Coronary Artery Plaque Vulnerability in Acute Coronary Syndromes.
    Cardiol Rev 2016 Nov/Dec;24(6):303-309
    From the *Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom; †Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom; ‡Volcano Corporation, San Diego, CA; §Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH; ¶Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom; ‖Department of Cardiology, Thorax Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain; and **Division of Cardiology, Cardiovascular Research Foundation, New York, NY.
    Markers of coronary plaque vulnerability, such as a high lipid burden, increased inflammatory activity, and a thin fibrous cap, have been identified in histological studies. In vivo, grayscale intravascular ultrasound (IVUS) provides more in-depth information on coronary artery plaque burden than conventional angiography but is unable to accurately distinguish between noncalcific tissue types within the plaque. An analysis of IVUS radiofrequency backscatter based on spectral pattern recognition, such as virtual histology IVUS, allows detailed scrutiny of plaque composition and classification of coronary lesions. Read More

    Noninvasive Testing in Emergency Department Patients with Low-Risk Chest Pain: Does the Evidence Support Current Guidelines?
    Cardiol Rev 2016 Nov/Dec;24(6):268-272
    From the *Division of Cardiology, Heart and Vascular Institute, †Department of Public Health Sciences, Hershey, PA, and ‡Department of Medicine, Penn State Hershey Medical Center, Hershey, PA.
    Patients who present to the emergency department with chest pain but no evidence of ischemia on the electrocardiogram and negative cardiac markers are at very low risk. The newest American Heart Association/American College of Cardiology guidelines give noninvasive cardiac testing a IIa recommendation in this patient population. Here, we will review the existing literature that was cited in the American Heart Association/American College of Cardiology document, as well as several large, contemporary, comparative observational studies which were not included to address the following question: Do the benefits of noninvasive cardiac testing in this patient population outweigh the risks? Read More

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