Clinical risk prediction tools in patients hospitalized with heart failure.
Rev C…

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Anticoagulation strategies in atrial fibrillation.
Rev Cardiovasc Med. 2012;13(1)…

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Temporal variation of heart failure hospitalization: does it exist?
Rev Cardiovas…

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Galectin-3: a novel blood test for the evaluation and management of patients with heart f…

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Clinical impact of renal dysfunction in heart failure.
Rev Cardiovasc Med. 2011;1…

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A review of electrocardiography in pulmonary embolism: recognizing pulmonary embolus masq…

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Treatment options for patients with left main coronary artery disease.
Rev Cardio…

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Statin therapy in the perioperative period.
Rev Cardiovasc Med. 2011;12(1):30-7
Authors: Lander JS, Coplan NL
Statins are frequently used as chronic therapy for reducing cardiovascular mortality and morbidity, but ther…

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Coronary stenting in patients with medically resistant vasospasm.

Rev Cardiovasc Med. 2010;11(4):264-70

Authors: Khitri A, Jayasuriya S, Habibzadeh MR, Movahed MR

Formally described by Prinzmetal and colleagues in 1959, variant angina represents a syndrome of resting angina that results from severe coronary artery vasospasm associated with ST elevation. The majority of patients respond to nitrates or calcium channel blockers. However, medical treatment-resistant vasospasm can occur in up to 20% of cases, thus requiring further interventions. We present a rare instance of coronary vasospasm associated with complete heart block resistant to medical therapy that was successfully treated with stenting. This case example is followed by a detailed review of the literature with regard to percutaneous or surgical coronary revascularization of patients with medically resistant vasospasm.

PMID: 21389918 [PubMed - in process]

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Related Articles

Chemotherapy and cardiotoxicity.

Rev Cardiovasc Med. 2008;9(2):75-83

Authors: Broder H, Gottlieb RA, Lepor NE

Newer cancer therapies have improved the survival of patients with cancer and, in some cases, turned cancer into a chronic disease. Patients are now surviving long enough for the adverse cardiovascular effects of some cancer therapies to become apparent. The anthracyclines are perhaps the most notorious offenders. Acute reactions include chest discomfort and shortness of breath consistent with a myopericarditis. Toxicity can also develop months after the last chemotherapy dose and typically presents as new onset heart failure with left ventricular systolic dysfunction. Late reactions are seen years after presentation as new-onset cardiomyopathy, often in patients who were treated for childhood neoplasms. 5-Fluorouracil, its prodrug capecitabine, and trastuzumab, a tumor-specific antibody, have also been associated with cardiotoxicity. Until adequate predictive models, prevention modalities, and treatments can be identified, the clinician’s focus should be on aggressive monitoring for early signs of cardiac dysfunction in order to prevent severe systolic dysfunction and its concomitant morbidity and mortality.

PMID: 18660728 [PubMed - indexed for MEDLINE]

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A review of evidence-based beta-blockers in special populations with heart failure.

Rev Cardiovasc Med. 2008;9(2):84-95

Authors: Fonarow GC

Guidelines recommend 1 of 3 beta-blockers (bisoprolol, carvedilol, metoprolol succinate) for the treatment of systolic heart failure (HF). beta-Blockers have been established to be effective in reducing mortality in more than 20 randomized, placebo-controlled clinical trials involving more than 20,000 patients with HF. However, they are not utilized in a substantial portion of eligible HF patients, possibly because physicians are unsure of the safety and benefit of beta-blockers in special populations (women, the elderly, African Americans, patients with diabetes, and patients with atrial fibrillation). The current standard of care is to treat all heart failure (HF) patients according to the recommendations for the overall population. A review of the clinical trial data reveals that there is no evidence that one evidence-based beta-blocker is preferential over the others in women or in the elderly with HF. In contrast, carvedilol may confer greater benefit in HF patients with diabetes and atrial fibrillation as well as in African American patients. Further data are needed to provide evidence-based recommendations.

PMID: 18660729 [PubMed - indexed for MEDLINE]

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Appropriate dose transition to a controlled-release formulation of carvedilol in patients with hypertension.

Rev Cardiovasc Med. 2008;9(2):96-105

Authors: Bakris GL, Weber MA

Few patients with hypertension meet recommended target blood pressure goals, and most hypertensive patients require at least 2 antihypertensive medications from different pharmacologic classes to adequately lower blood pressure. beta-Blockers are guideline-recommended for the treatment of hypertension with compelling indications. beta-Blockers differ with respect to pharmacology (particularly receptor biology and ancillary properties), hemodynamic effects, and tolerability. In clinical practice, the choice of beta-blockers for individual patients with hypertension is often based on practical issues such as convenience and cost. However, given the pharmacologic and clinical trial data demonstrating differences, the choice of beta-blocker for the treatment of high-risk hypertension should be evidence-based. Vasodilating beta-blockers, such as carvedilol, decrease blood pressure without the concerning hemodynamic, renal, and metabolic responses associated with most beta-blockers. The use of carvedilol CR (once daily) may be preferable to a twice-daily regimen.

PMID: 18660730 [PubMed - indexed for MEDLINE]

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Nesiritide in acute decompensated heart failure: current status and future perspectives.

Rev Cardiovasc Med. 2008;9(3):151-8

Authors: Mohammed SF, Korinek J, Chen HH, Burnett JC, Redfield MM

Acute decompensated heart failure (ADHF) is a growing public health problem with high mortality and costs. ADHF often, if not usually, occurs in the setting of cardiovascular and noncardiovascular comorbidities as well as advanced age. New insights provide support for the concept of heart failure as a state of deficiency of and/or resistance to endogenous B-type natriuretic peptide. The primary goals of ADHF therapy are to relieve symptoms and optimize volume status with minimal side effects. Few therapies are proven to effectively do so. Nesiritide is a balanced vasodilator with favorable neurohumoral effects and is superior to placebo in providing rapid symptom relief and to nitroglycerin in reducing filling pressures. Recent trials confirm a lack of renal toxicity at recommended doses. An adequately powered multinational mortality trial is underway. Nesiritide represents a proven therapy for normotensive/hypertensive ADHF patients with severe symptoms at rest.

PMID: 18953274 [PubMed - indexed for MEDLINE]

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Strategies to reduce the GI risks of antiplatelet therapy.

Rev Cardiovasc Med. 2005;6 Suppl 4:S23-31

Authors: Scheiman JM

Low-dose aspirin and other antiplatelet agents are widely used for the management of cardiovascular disease. Due to their action on cyclooxygenase, aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are associated with upper gastrointestinal (GI) side effects, including ulcers and bleeding. Although the risk with low-dose aspirin alone is less than that with NSAIDs, given its widespread use, aspirin-related toxicity has become a substantial health care issue. Factors associated with an increased risk of aspirin-related upper GI complications are still being elucidated but most importantly include a prior history of ulcer or GI bleeding, aspirin dose, and concomitant use with an NSAID, anticoagulant, or additional antiplatelet drug. Various strategies are available to minimize the risk of developing upper GI side effects in patients taking aspirin. Gastroprotective agents that seem effective are prostaglandin analogues and proton pump inhibitors. Eradication of Helicobacter pylori also seems to reduce the risk of ulcers. Substitution by other antiplatelet agents such as clopidogrel alone does not seem to provide a safer alternative to low-dose aspirin for patients at high risk for GI side effects.

PMID: 17710073 [PubMed - indexed for MEDLINE]

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Noncardiac chest pain.

Rev Cardiovasc Med. 2005;6 Suppl 4:S32-9

Authors: Katz PO

The clinical approach to the patient with unexplained chest pain is complex, as the history does not clearly separate cardiac from noncardiac etiologies. After a careful work-up has excluded coronary artery disease, a systematic search for an esophageal etiology is the next step. Gastroesophageal reflux disease (GERD) is most commonly associated with noncardiac chest pain and should be the first diagnosis pursued. A therapeutic trial of antisecretory therapy with proton-pump inhibitors is the most efficient initial approach to diagnosis and therapy of GERD-related chest pain and can easily be instituted by a cardiologist familiar with the optimal use of proton-pump inhibitors.

PMID: 17710075 [PubMed - indexed for MEDLINE]

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