Cardiovascular Medicine

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Angiographic Visualisation of a Right Atrial Myxoma

by Stéphane Noble, Caroline Frangos and Jean-François Tanguay

Cardiovasc. Med. 2008, 11(7), 256; https://doi.org/10.4414/cvm.2008.01340 - 22 Aug 2008

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Case report A 58-year-old woman presented with one year history of fatigue and gradually increasing exertional dyspnoea [...] Full article

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Torsade de Pointes?

by Christoph Schmidt and Augusto Aragão

Cardiovasc. Med. 2008, 11(7), 254; https://doi.org/10.4414/cvm.2008.01342 (registering DOI) - 22 Aug 2008

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Abstract

Fallbeschreibung Die 81-jährige Patientin wurde uns zur kardialen Rehabilitation bei St. n. subakutem inferolateralem STEMI zugewiesen [...] Full article

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Open AccessEditorial

Konservative Oder Invasive Therapie Bei Stabiler Angina Pectoris?

by Hugo Saner

Cardiovasc. Med. 2008, 11(7), 246; https://doi.org/10.4414/cvm.2008.01344 - 22 Aug 2008

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Abstract

Conservative versus invasive strategy in stable angina: changing paradigms and perception. Percutaneous coronary intervention (PCI) is effective at reducing angina in patients with symptomatic coronary artery disease and at reducing mortality in patients who have acute myocardial infarction with ST-segment elevation and in those who have high-risk acute coronary syndromes without ST-segment elevation. Such success has often been extrapolated in support of more widespread use of PCI in patients with stable coronary artery disease in hopes of reducing subsequent cardiac events. In 2004, more than one million coronary stent procedures were performed in the United States, and recent registry data indicate that approximately 85% of all PCI procedures are undertaken electively in patients with stable coronary artery disease. Whereas PCI reduces the incidents of death and myocardial infarction in patients who present with acute coronary syndromes, similar benefit has not been shown in patients with stable coronary artery disease. Whether primary intervention with PCI is the treatment of choice in patients with stable angina or not is actually under debate. (1.) Plaque-rupture and subsequent thrombosis are major causes of acute coronary syndroms. Plaque-disruption is a reflexion of inhanced inflammatory activity within the plaque. Several studies have documented that ruptured plaque and/or vulnerable plaque exist not only at the culprit lesion but also in a pan-coronary artery setting in ACS patients. Most of myocardial infarctions result from thrombosis of a lesion that by itself is not haemodynamically significant, reflecting the fact that mild/moderate lesions by far outnumber significant lesions. (2.) Assessment of the severity of coronary lesions is a major challenge in the catheterisation laboratory. The two-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those that simply need appropriate medical therapy. Intervascular ultrasound and fractional flow reserve index provide anatomic and functional information and are promising tools to be used in the categorisation laboratory to designate patients to the most appropriate therapy. (3.) Due to technical progress and relatively low complication rates PTCA has been increasingly used in patients with stable angina without being a proven therapy based on solid scientific knowledge. This leads to enormous differencies in the number of coronary interventions per inhabitant between different regions and countries. (4.) During the past years not only interventional cardiology but also medical therapy has led to improved prognosis in patients with stable coronary disease. This positive effect may be potentiated by lifestyle intervention programmes as causal therapy for arteriosclerosis. (5.) An increasing number of prospective randomised studies and meta-analyses of such studies indicate that there is no significant advantage in regard to risk reduction with primary intervention therapy in this patients if high-risk patients are appropriately selected. Also PTCA is superior for immediate symptom relief there is no benefit with this procedures in regard to future cardiovascular events and mortality when compared with optimised medical therapy even without comprehensive lifestyle intervention. Based on an Euro Heart Survey on ambulatory patients with recent onset stable angina a risk score has been developed to target patients with increased risk for cardiovascular complications. The development of such risk scores may become helpful to decide which treatment modality is best for specific patient groups and subgroups. However, current scientific evidence indicates that optimised medical therapy combined with lifestyle interventions is an appropriate initial strategies in most patients with stable angina of mild to moderate severity. Full article

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9 pages, 522 KB

Open AccessEditorial

Koronare Herzkrankheit: Konservative Statt Invasive Therapie?

by Burkhard Hornig and Christoph Kohler

Cardiovasc. Med. 2008, 11(7), 237; https://doi.org/10.4414/cvm.2008.01345 - 22 Aug 2008

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Abstract

Coronary heart disease: conservative instead of invasive therapy? Endothelial dysfunction: myth or reality? In patients with stable coronary artery disease (CAD) percutaneous coronary interventions (PCI) have the potential to improve symptoms. Obviously, PCI increases locally the coronary artery lumen area, but does not affect the atherosclerotic process per se located generalised within the arterial wall of the arterial tree. Accordingly, the evidence that PCI improves outcome in these patients is limited. In contrast, several conservative therapeutic interventions that improve the impaired endothelial function in patients with CAD—such as physical training, ACE-inhibitors/ARBs and statins—have been shown to improve both, symptoms and prognosis in patients with stable CAD. Endothelial function as a target of conservative therapies as mentioned above is therefore not a myth but a therapeutic chance and reality not to be underscored in the therapy of patients with CAD. Furthermore, the existing evidence supports the concept that improvement of endothelial function (ie improvement of the health of the vascular wall) as achieved by physical training, ACE-inhibitors/ARBs and statins can be translated into improved outcome in patients with CAD. Endothelial function represents therefore one of the decisive targets that make conservative therapy successful by affecting the atherosclerotic process per se. Full article

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7 pages, 260 KB

Open AccessArticle

Eine Kritische Überprüfung der Indikationsstellung zur Koronarangiographie

by Philipp Wagdi

Cardiovasc. Med. 2008, 11(7), 230; https://doi.org/10.4414/cvm.2008.01343 - 22 Aug 2008

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Abstract

A critical appraisal of the indication for coronary angiography. Background: One of the quality control criteria applied to the indication for coronary angiography consists of the percentage of patients examined with “normal” coronary arteries. This has been suggested to be between 10 and 20%. Few published data exist about the population characteristics of patients undergoing invasive examination in the private health care setting. Material and methods: Prospective analysis of the data of all patients examined by the author during one year (n = 248). Referral patterns of patients with versus without significant coronary artery disease (CAD) are analysed, as well as patterns of pretest diagnosis. Results: 19% of patients evaluated by coronary angiography showed no relevant CAD or other structural (excluding hypertensive) heart disease. In the group in which no relevant CAD was found, patients were referred by the primary care physician in 17%, by an external cardiologist in 52%, by a primary care hospital in 2% and by the examining cardiologist in 29%. The corresponding figures for patients with first time diagnosis of relevant CAD are 28%, 37%, 12%, and 23%. Conclusion: In spite of potential conflict of interest, the percentage of patients undergoing invasive examination lies within the expected, published range. More data are needed concerning “acceptable” figures of patient selfreferral by the invasive cardiologist. Nonetheless, improving non-invasive diagnosis is a real need. Full article

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3 pages, 169 KB

Open AccessEditorial

Konservative Versus Invasive Strategie in der Behandlung der Chronisch Koronaren Herzkrankheit: Wir Brauchen sie Beide!

by Christoph A. Kaiser and Matthias E. Pfisterer

Cardiovasc. Med. 2008, 11(7), 227; https://doi.org/10.4414/cvm.2008.01341 (registering DOI) - 22 Aug 2008

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Abstract

Gleich zwei Übersichtsartikel befassen sich im vorliegenden Heft mit der Frage nach dem Stellenwert der konservativen und der invasiven Therapie bei Patienten mit chronischer Angina pectoris [...] Full article

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Cardiovasc. Med., Volume 11, Issue 7 (08 2008) – 6 articles

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