Entries Tagged as 'Arch Cardiovasc Dis'
Acute heart failure: How to evaluate left ventricular filling pressure in practice?
Arch Cardiovasc Dis. 2009 Apr;102(4):319-26
Authors: Jondeau G, Detaint D, Arnoult F, Phan G, Morgan C, Mercadier JJ, Aumont MC
Heart failure is one of the most frequent reasons for hospitalization due to a cardiac event. In most instances, the main difficulty is how to accurately evaluate left ventricular filling pressure. It can be evaluated clinically, biologically and invasively. Although historically, invasive management has been the reference, it is being used less and less frequently and expertise in the technique is being lost. This paper discusses the strength and weaknesses of the different techniques for evaluating filling pressure in these patients, and the importance of this parameter for their optimal treatment.
PMID: 19427609 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Arch Cardiovasc Dis
Should new oral anticoagulants replace low-molecular-weight heparin for thromboprophylaxis in orthopaedic surgery?
Arch Cardiovasc Dis. 2009 Apr;102(4):327-33
Authors: Rosencher N, Bellamy L, Arnaout L
Current anticoagulant provision is dominated by parenteral low-molecular-weight heparin and oral vitamin K antagonists (VKAs), which indirectly inhibit several steps of the coagulation pathway. Two unmet needs for anticoagulation are safety and ease of use. Safety relates primarily to the incidence of major bleeding, which remains the key concern of orthopaedic surgeons and anaesthetists, over and above any efficacy advantage, and convenience of use, which centres on oral administration replacing the need for injections or monitoring platelets or coagulation with VKA. Recent research efforts towards identifying small-molecule inhibitors of coagulation enzymes as novel therapies for thrombotic disorders have been particularly successful in developing orally available molecules to directly inhibit the key proteases, factors IIa and Xa. Of the new oral anticoagulants in development, dabigatran etexilate (BIBR 1048) and rivaroxaban (BAY 59-7939), which inhibit factors IIa and Xa, respectively, are the most advanced and were approved in Europe in 2008. Based on the available data, we can conclude that dabigatran etexilate is non-inferior to enoxaparin in terms of efficacy and safety, and two different doses (220 and 150 mg/day) have now been approved. The 150 mg/day dose is intended for elderly patients and those with moderate renal impairment, which allows clinicians to decrease the risk of bleeding in the increasing number of fragile patients undergoing major orthopaedic surgery. In conclusion, rivaroxaban is superior in efficacy to enoxaparin, even with the US enoxaparin dosing regimen (30 mg b.i.d.), without significant differences in safety.
PMID: 19427610 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Arch Cardiovasc Dis
Recurrent unexplained syncope may have a cerebral origin: report of 10 cases of arrhythmogenic epilepsy.
Arch Cardiovasc Dis. 2009 May;102(5):397-407
Authors: Kouakam C, Daems C, Guédon-Moreau L, Delval A, Lacroix D, Derambure P, Kacet S
BACKGROUND: Despite thorough investigation, approximately 15-20% of syncope cases remain unexplained. An underrecognized cause of syncope may occur when partial epileptic discharges profoundly disrupt normal cardiac rhythm, including cardiac asystole, the so-called arrhythmogenic epilepsy (AE). AIM: To report initial results of observations of AE in patients with recurrent, unexplained, traumatic and/or convulsive syncope. METHODS: Ten patients aged 49+/-20 years (median 49.5 years; nine women) underwent complete cardiological (including ambulatory Holter electrocardiogram (ECG), echocardiography and head-up tilt test [plus electrophysiology in four patients]) and neurological (including standard electroencephalogram [EEG], computed tomography [CT] and magnetic resonance imaging scan [MRI]) assessments. RESULTS: After initial evaluation, neurocardiogenic syncope was suspected in six patients with tilt-induced hypotension+/-bradycardia. Further evaluation (prolonged inpatient video-EEG/ECG monitoring) was undertaken because of non-diagnostic syncope or uncertainty about the diagnosis of neurocardiogenic syncope. While monitored in the neurophysiology lab, a syncopal episode similar to the spontaneous episodes recurred in all 10 patients. Cardiac asystole preceded by partial seizure of temporal onset was documented in nine patients; a second-degree atrioventricular (AV) block with a cardiac rhythm of 30 beats per minute preceded by partial seizure of temporal onset was noted in one patient. Eight patients were treated successfully with antiepileptic drugs; two were refractory to antiepileptic therapy and required pacemaker implantation. No patient had recurrent syncope during a median follow-up of 102.5 months (mean 82.2+/-42; range 16-128 months). CONCLUSIONS: In patients with recurrent, unexplained, traumatic and/or convulsive syncope, AE should be considered as a possible aetiology.
PMID: 19520325 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Arch Cardiovasc Dis
Recommendations on prophylaxis for infective endocarditis: dramatic changes over the past seven years.
Arch Cardiovasc Dis. 2009 Mar;102(3):233-45
Authors: Delahaye F, Harbaoui B, Cart-Regal V, de Gevigney G
Recommendations on antibiotic prophylaxis against infective endocarditis have changed dramatically since 2002. In 2002, the French were the first to make a profound change: they proposed that antibiotic prophylaxis should be optional when a medical, surgical or dental procedure that carries a risk of infective endocarditis was performed in a patient at risk but not at very high risk of infective endocarditis (group B: native valve disease, non-cyanotic congenital heart disease, obstructive hypertrophic cardiomyopathy). In 2004, the European Society of Cardiology and the British Society of Cardiology made almost no changes to their previous recommendations. In 2006, the British Society for Antimicrobial Chemotherapy made another radical change: no antibiotic prophylaxis in group B patients. In 2007, the American Heart Association went a step further: no antibiotic prophylaxis before a gastrointestinal or genitourinary procedure in group A patients (valvular prosthesis, cyanotic congenital heart disease, history of infective endocarditis). In 2008, the British National Institute for Health and Clinical Excellence adopted an extreme position: no antibiotic prophylaxis at all in patients at risk for infective endocarditis.
PMID: 19375677 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Arch Cardiovasc Dis
Non-invasive investigations of the right heart: how and why?
Arch Cardiovasc Dis. 2009 Mar;102(3):219-32
Authors: Selton-Suty C, Juillière Y
The importance of right ventricular (RV) function in the clinical management of patients with cardiopulmonary disorders is now well recognized. However, due to both its shape and location and to the load dependence of its ejection fraction, accurate evaluation of its function is still a challenge. Echocardiography allows morphological, hemodynamic and functional assessment of the right heart. Displacement and deformation parameters derived from new techniques are promising tools. 3D echocardiography also has a potential interest in the quantification of RV volumes and ejection fraction. Radionuclide technique allows an easy and accurate measurement of right ventricular ejection fraction. MRI remains nowadays the technique of choice for the quantification of volumes and function of the RV. All these techniques have proven their interest in various diseases affecting the right heart. RV function is an important prognostic factor in heart failure and is a major component of functional capacity in such patients. In pulmonary arterial hypertension, echocardiography is the best tool for the routine follow-up of patients. Finally, all these non-invasive techniques of investigation of the right heart enable the diagnosis of specific right ventricular damage such as myocardial infarction or arrhythmogenic right ventricular dysplasia.
PMID: 19375676 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Arch Cardiovasc Dis
