Cardiovascular disease in patients with HIV
With the progressive increase in life expectancy of HIV-positive patient, thanks to “highly active antiretroviral therapy” (HAART), new comorbidities, and especially cardiovascular diseases (CVDs) are emerging as an important concern. An increased risk of coronary artery disease, often in a younger age, has been observed in this population. The underlying pathophysiology is com plex and partially still unclear, with the interaction of viral infection – and systemic inflammation - antiretroviral therapy and traditional risk factors. (Source: Trends in Cardiovascular Medicine)
Source: Trends in Cardiovascular Medicine - June 14, 2017 Category: Cardiology Authors: Flavia Ballocca, Fabrizio D ’Ascenzo, Sebastiano Gili, Walter GrossoMarra, Fiorenzo Gaita Source Type: research
My Approach to the Patient With CAD and Aspirin Resistance
When I encounter a patient who has had testing for aspirin resistance, the first question I ask is why. Why did the physician order the test in the first place, and how will the test result influence that patient's care? (Source: Trends in Cardiovascular Medicine)
Source: Trends in Cardiovascular Medicine - June 13, 2017 Category: Cardiology Authors: Deepak L. Bhatt Source Type: research
My approach to evaluating chest pain in the patient with no obstructive coronary artery disease
When patients are seen for persistent chest pain in the absence of obstructive coronary artery disease (CAD), the physician must decide whether or not the symptoms are due to myocardial ischemia. The concern is that ischemia due to coronary microvascular dysfunction, which is associated with an adverse prognosis, may be present. (Source: Trends in Cardiovascular Medicine)
Source: Trends in Cardiovascular Medicine - June 13, 2017 Category: Cardiology Authors: C. Noel Bairey Merz Source Type: research
My Approach to the Patient With an Infected Implantable Cardioverter Defibrillator (ICD)
Infection of an implantable cardioverter defibrillator (ICD) may be suspected if the patient has erythema, pain, swelling, or discharge from the ICD pocket, or signs of systemic infection such as fever or an elevated white blood cell count. Erosion of the skin with visible hardware by definition means the device is infected. Risk factors for infection include early reoperation (for example, because of lead dislodgment), hematoma, generator replacement, upgrade procedures, cardiac resynchronization therapy (CRT) procedures, and comorbidities such as diabetes mellitus and chronic kidney disease. (Source: Trends in Cardiovascular Medicine)
Source: Trends in Cardiovascular Medicine - June 13, 2017 Category: Cardiology Authors: Anne B. Curtis Source Type: research
My approach to the patient with a borderline long QT interval
A prolonged QT interval is typically defined in adults as a corrected QT interval exceeding 440 ms in males and 460 ms in females on resting electrocardiogram (ECG). We worry about QT prolongation because it reflects delayed myocardial repolarization, which can lead to torsades de pointes (TdP). Up to 50% of genetically affected LQTS patients actually have a normal or borderline resting QT interval, yet are still at risk for TdP, leading to syncope, cardiac arrest, or sudden death. As such, a borderline QT interval, for example, in a young, asymptomatic female undergoing routine ECG, poses a unique challenge. (Source: Tren...
Source: Trends in Cardiovascular Medicine - June 13, 2017 Category: Cardiology Authors: Thomas Roston, Andrew D. Krahn Source Type: research
Editorial commentary: Important contributions of basic electrophysiology to the prevention and therapy of drug induced cardiac arrhythmias
The article in the current issue of Trends in Cardiovascular Medicine by Cohen et al. [1], Acquired Long QT Syndrome and Phosphoinositide 3-kinase, reviews important new concepts concerning acquired Long QT (LQT) syndrome that is associated with drug-induced lethal ventricular arrhythmias. This new discovery arose from a foundation of basic electrophysiological knowledge that has enhanced our understanding of the mechanisms causing cardiac arrhythmias and has led to innovative ways to avoid drug-induced arrhythmias. (Source: Trends in Cardiovascular Medicine)
Source: Trends in Cardiovascular Medicine - June 9, 2017 Category: Cardiology Authors: Andrew L. Wit Source Type: research
Editorial commentary: Tuning in to sympathetic activity cutaneously in humans —A bench to bedside saga
Sympathetic nervous system regulation plays a crucial role in health and disease. Practically all major organs are subject to sympathetic influences and when autonomic dysfunction occurs, pathologic consequences can be dire. Abnormalities in sympathetic tone have been implicated in the pathogenesis of atrial and ventricular arrhythmias, myocardial infarction, heart failure, epilepsy, renal failure, hypertension, stroke, and diabetes, as well as other disease conditions [1 –3]. Recognition of this linkage across the decades has provided a significant impetus to develop reliable methods to monitor sympathetic tone in order...
Source: Trends in Cardiovascular Medicine - June 9, 2017 Category: Cardiology Authors: Richard L. Verrier Source Type: research
Important Contributions of Basic Electrophysiology to the Prevention and Therapy of Drug Induced Cardiac Arrhythmias
The article in the current issue of Trends in Cardiovascular Medicine by Ira Cohen and colleagues [1], Acquired Long QT Syndrome and Phosphoinositide 3-kinase, reviews important new concepts concerning acquired Long QT (LQT) syndrome that is associated with drug induced lethal ventricular arrhythmias. This new discovery arose from a foundation of basic electrophysiological knowledge that has enhanced our understanding of the mechanisms causing cardiac arrhythmias and has led to innovative ways to avoid drug induced arrhythmias. (Source: Trends in Cardiovascular Medicine)
Source: Trends in Cardiovascular Medicine - June 9, 2017 Category: Cardiology Authors: Andrew L Wit Source Type: research
Cardiovascular effects of alcohol consumption
Alcohol consumption has a major but complex impact on cardiovascular diseases. Both irregular and chronic heavy drinking occasions detrimentally impact on most major cardiovascular disease categories, whereas light to moderate drinking has been associated with beneficial effects on ischemic heart disease and ischemic stroke. Both detrimental and beneficial effects of alcohol consumption have been corroborated by biochemical pathways. The impact of alcohol consumption on cardiovascular disease should be evaluated within the context of other effects of alcohol on health. (Source: Trends in Cardiovascular Medicine)
Source: Trends in Cardiovascular Medicine - June 9, 2017 Category: Cardiology Authors: J. Rehm, M. Roerecke Source Type: research
Tuning in to Sympathetic Activity Cutaneously in Humans: A Bench to Bedside Saga
Sympathetic nervous system regulation plays a crucial role in health and disease. Practically all major organs are subject to sympathetic influences and when autonomic dysfunction occurs, pathologic consequences can be dire. Abnormalities in sympathetic tone have been implicated in the pathogenesis of atrial and ventricular arrhythmias, myocardial infarction, heart failure, epilepsy, renal failure, hypertension, stroke, and diabetes, as well as other disease conditions [1 –3]. Recognition of this linkage across the decades has provided a significant impetus to develop reliable methods to monitor sympathetic tone in order...
Source: Trends in Cardiovascular Medicine - June 9, 2017 Category: Cardiology Authors: Richard L. Verrier Source Type: research
Arrhythmic risk stratification in non-ischemic dilated cardiomyopathy: Where do we stand after Danish?
Publication of the DANISH randomized trial led to considerable debate, given that it demonstrated no survival benefit stemming from current implantable cardioverter-defibrillator (ICD) allocation criteria in patients with non-ischemic dilated cardiomyopathy (NIDCM). Consequently, a thorough reconsideration of our approach to sudden cardiac death (SCD)-risk stratification appears to be in order. NIDCM encompasses a wide spectrum of disease entities, often with differing arrhythmogenicity; however, in its kernel, is still defined by the fundamentals of electrophysiology that dictate that abnormal tissue, exhibiting altered e...
Source: Trends in Cardiovascular Medicine - June 7, 2017 Category: Cardiology Authors: Polychronis Dilaveris, Christos-Konstantinos Antoniou, Konstantinos A. Gatzoulis Source Type: research
Reprint of Editiorial Commentary: Genomics and drug discovery: The next frontier in precision medicine
Precision medicine has come to mean many things to many people —a perfectly precise diagnosis and treatment, incorporation of electronic health records (EHRs), and genomic information into routine clinical care, or expanded consideration of sociocultural factors in decision-making [1]. In this issue of Trends in Cardiovascular Medicine, Stitziel and Kathiresa n [2] outline an emerging frontier in this area, the use of human genetics to identify and validate new targets for drug development. This may turn out to be an especially interesting area since new drug development is extraordinarily expensive and the number of com...
Source: Trends in Cardiovascular Medicine - June 7, 2017 Category: Cardiology Authors: Dan M. Roden Source Type: research
Arrhythmic Risk Stratification in Nonischemic Dilated Cardiomyopathy Where do we Stand After Danish?
Publication of the DANISH randomized trial led to considerable debate, given that it demonstrated no survival benefit stemming from current implantable cardioverter-defibrillator (ICD) allocation criteria in patients with nonischemic dilated cardiomyopathy (NIDCM). Consequently, a thorough reconsideration of our approach to sudden cardiac death (SCD) risk stratification appears to be in order. NIDCM encompasses a wide spectrum of disease entities, often with differing arrhythmogenicity; however, in its kernel, is still defined by the fundamentals of electrophysiology that dictate that abnormal tissue, exhibiting altered el...
Source: Trends in Cardiovascular Medicine - June 7, 2017 Category: Cardiology Authors: Polychronis Dilaveris, Christos-Konstantinos Antoniou, Konstantinos A. Gatzoulis Source Type: research
Editorial commentary: Coronary artery calcification on non-cardiac chest CT: Incidental but impactful
Coronary artery calcification (CAC) by gated CT imaging has historically been used as a screening tool for the detection of atherosclerotic coronary artery disease (CAD). Advances in computed tomography (CT) technology have allowed for increased detection of CAC when performing routine non-gated chest CT for pulmonary pathology and lung cancer screening. The reporting of incidental CAC on these studies is neither common nor standardized. To date, only those patients enrolled in the American College of Radiology (ACR) lung cancer screening registry are required to have documentation of CAC, only if moderate or severe [1]. (...
Source: Trends in Cardiovascular Medicine - May 16, 2017 Category: Cardiology Authors: Aalap Chokshi, James E. Udelson Source Type: research
Acquired Long QT Syndrome and Phosphoinositide 3-kinase
The duration of the cardiac action potential is 100 times longer than the action potential duration (APD) in neurons. Unlike neurons, whose repolarization rate is less than one order of magnitude slower than the depolarization rate, the repolarization rate in the heart is between 2 and 3 orders of magnitude slower than that of depolarization. Thus, in the heart the upstroke velocity is more than 200V/s during depolarization, but the change in membrane potential during phase 2 (the plateau) is only about 0.1V/s. (Source: Trends in Cardiovascular Medicine)
Source: Trends in Cardiovascular Medicine - May 16, 2017 Category: Cardiology Authors: Ira S. Cohen, Richard Z. Lin, Lisa M. Ballou Source Type: research
