Cardiovascular Medicine

2 pages, 1959 KB

Open AccessInteresting Images

by Marcus Mutschelknauss, Florian Voss and Stefan Osswald

Cardiovasc. Med. 2012, 15(3), 99; https://doi.org/10.4414/cvm.2012.01651 - 21 Mar 2012

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A 49-year-old man without any medical history of note was admitted to our hospital because of haemodynamically compromising wide-complex tachycardia requiring electrical cardioversion. [...] Full article

4 pages, 1651 KB

Open AccessCase Report

Expanding the Use of the Filter Embolic Protection Devices in Difficult to Protect Lesions

by Stavros Hadjimiltiades, Maria Karakyriou, Stefanos Delioglanis and Ioannis Styliadis

Cardiovasc. Med. 2012, 15(3), 95; https://doi.org/10.4414/cvm.2012.01653 - 21 Mar 2012

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Abstract

There are anatomical limitations in the effective use of distal protection devices, related to the fact that a balloon or stent can only be deployed at a certain distance from the filter. We describe a way to limit the embolic load in a [...] Read more.

There are anatomical limitations in the effective use of distal protection devices, related to the fact that a balloon or stent can only be deployed at a certain distance from the filter. We describe a way to limit the embolic load in a vein graft angioplasty, in a difficult for effective distal protection anatomic situation by doing full balloon inflations on a separate wire in parallel to the deployed FilterWire™; after removal of the Filter- Wire™, an appropriately sized stent was deployed at low pressure. Full article

4 pages, 1516 KB

Open AccessReview

Sport nach Eingriffen an der thorakalen Aorta und nach Aortenklappenoperation

by Stefan Goerre and Thierry Carrel

Cardiovasc. Med. 2012, 15(3), 91; https://doi.org/10.4414/cvm.2012.01652 - 21 Mar 2012

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Abstract

Sport after thoracic aortic surgery and aortic valve operations. The pre- and postoperative management of athletes with diseases of the aortic valve and/or the ascending aorta is challenging for the surgeon and the cardiologist. The choice of surgical procedure depends solely on the [...] Read more.

Sport after thoracic aortic surgery and aortic valve operations. The pre- and postoperative management of athletes with diseases of the aortic valve and/or the ascending aorta is challenging for the surgeon and the cardiologist. The choice of surgical procedure depends solely on the age of the athlete and not the type or intensity of the sports he practises: younger athletes should receive a mechanical prosthesis while in older athletes biological prostheses may be considered. The decision to replace the ascending aorta in athletes should be based not only on the absolute diameter of the vessel as indicated in current guidelines, but also take into account the relation of the aortic lumen to the body surface (socalled Z score). Surgical procedures such as the Ross operation are currently not strongly recommended in athletes due to a potentially high rate of postoperative complications, with dilatation of the pulmonary autograft in aortic position and mid- to long-term problems with the pulmonary conduit. To prevent postoperative complications after aortic valve surgery in younger athletes, lifelong anticoagulation and aggressive blood pressure control are mandatory. Athletes under warfarin should refrain from contact-type sports and sports with a high risk of bodily collisions and falls. For all athletes with a history of aortic surgery, participation in competitions and in sports with predominantly static stress is strongly discouraged. Preoperative counselling of athletes should include the information that the operation will not improve athletic performance and the risks and consequences of postoperative anticoagulation. Full article

6 pages, 1563 KB

Open AccessReview

Sport und Angeborene Herzfehler beim Erwachsenen

by Markus Schwerzmann, Kerstin Khattab, Jean-Paul Schmid and Kerstin Wustmann

Cardiovasc. Med. 2012, 15(3), 85; https://doi.org/10.4414/cvm.2012.01656 - 21 Mar 2012

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Abstract

Sports and grown-up congenital heart disease in adults The number of patients with “Grown-up Congenital Heart Disease” (GUCH) is steadily growing. The mortality of today’s GUCH patients is low (around <1% per year), but one third of these patients have symptoms and an [...] Read more.

Sports and grown-up congenital heart disease in adults The number of patients with “Grown-up Congenital Heart Disease” (GUCH) is steadily growing. The mortality of today’s GUCH patients is low (around <1% per year), but one third of these patients have symptoms and an impaired exercise capacity. An impaired exercise capacity and heart rate response are associated with a poorer prognosis in the general population, and also in GUCH patients. It is therefore reasonable to encourage GUCH patients to practice physical activities on a regular base. A GUCH patient’s self-estimated physical functioning in daily life poorly reflects his objective exercise capacity. Therefore, objective assessment of exercise capacity is an important part of the routine cardiac evaluation. Non-competitive, symptom- limited dynamic exercise carries no risk f or the vast majority of GUCH patients. However, GUCH patients in NYHA classes III or IV, with severe pulmonary hypertension, significant residual l esions or complex arrhythmias are at risk for exercise-related cardiac events. In these patients, as well as in GUCH patients who wish to participate in competitive sports, a more extensive cardiac evaluation, including exercise testing, is mandatory. Specific guidelines provide a valuable framework for individual counselling. The collaboration of GUCH cardiologists and cardiologists with expertise in cardiac rehabilitation and sports is strongly recommended. Full article

6 pages, 1553 KB

Open AccessReview

Exercise as a Treatment Option in Peripheral Arterial Disease

by Arno Schmidt-Trucksäss

Cardiovasc. Med. 2012, 15(3), 79; https://doi.org/10.4414/cvm.2012.01654 - 21 Mar 2012

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Abstract

Peripheral arterial disease (PAD) is a chronic, progressive atherosclerotic process limiting the blood flow to the lower limbs which causes an imbalance between oxygen supply and metabolic needs during physical activity with typical claudication symptoms. One important aspect of treatment besides optimal reduction [...] Read more.

Peripheral arterial disease (PAD) is a chronic, progressive atherosclerotic process limiting the blood flow to the lower limbs which causes an imbalance between oxygen supply and metabolic needs during physical activity with typical claudication symptoms. One important aspect of treatment besides optimal reduction of underlying risk factors is exercise training. Exerciseinduced increase of blood flow in arteries leading to the working and inactive musculature causes an increase of shear stress as the main physiological mechanism for the improvement in pain-free and maximal walking distances. The dominant and best examined training mode with respect to walking ability in daily life is walking exercise with an increase of maximal walking distance by around 150%. Strength training has a marginal or no effect on walking distance, however it facilitates strength dependent daily tasks like stair climbing. Arm cranking seems to be an alternative to walking, gaining a similar increase in walking distance as walking, and patients with orthopaedic problems might especially benefit from upper limb exercise. Basically, exercise training in PAD is determined by frequency, duration and intensity. A baseline walking test on a treadmill or in the field is very much recommended in order to monitor training advances and to establish a training plan. Exercise training has to be structured systematically with individual adaptation of training load. A total of 2–3 sessions per week with a duration of 30–45 min walking time per session seems to be enough to peak the increase in absolute walking distance. Supervised training has a clinical relevant advantage compared to non-supervised training with respect to an increase in walking distance. Drug treatment has to be combined with exercise training and is not a substitute for exercise. Interventional treatment is best accompanied by exercise training and is only associated with a higher increase in walking distance in a short time after treatment compared with exercise. Full article

10 pages, 2310 KB

Open AccessReview

The Athlete's Heart: Different Training Responses, Gender and Ethnicity Dependencies

by Matthias Wilhelm and Christian Seiler

Cardiovasc. Med. 2012, 15(3), 69; https://doi.org/10.4414/cvm.2012.01655 - 21 Mar 2012

Cited by 2 | Viewed by 12

Abstract

Since the first description of the athlete’s heart in 1899 by Henschen and Darling, the knowledge on cardiovascular adaptations to exercise conditioning h as expanded considerably. There is an ongoing debate about the true nature of the athlete’s heart, whether it is only [...] Read more.

Since the first description of the athlete’s heart in 1899 by Henschen and Darling, the knowledge on cardiovascular adaptations to exercise conditioning h as expanded considerably. There is an ongoing debate about the true nature of the athlete’s heart, whether it is only a physiological adaption or a potentially pathological condition, fuelled by reports about elevated biomarkers after prolonged endurance exercise. Age, gender, ethnicity a nd sporting d iscipline have a substantial impact on the magnitude of cardiac remodelling. Black athletes in particular exhibit striking repolarisation abnormalities and left ventricular (LV) hypertrophy which may be regarded as an ethnic variant of the athlete’s heart. Sport is thought to be a trigger and not a cause for life-threatening arrhythmias in athletes with underlying cardiovascular diseases. The overall incidence of sudden cardiac death in athletes is extremely low. Figures of 0.6 to 2.3 cases/100 000 athletes per year have been reported, with a striking male predominance and a greater risk for black athletes. In this article, we review the current literature of the athlete’s heart with a focus on gender and ethnicity. Full article

2 pages, 1768 KB

Open AccessInteresting Images

Multiple Silent Postinfarction Complications

by Antonio Rosa and Marco Roffi

Cardiovasc. Med. 2012, 15(3), 101; https://doi.org/10.4414/cvm.2012.01650 - 21 Mar 2012

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Abstract

A 87-year-old female patient was hospitalised for decline in general health status, fatigue and oedema following a fall two weeks earlier. [...] Full article

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Cardiovasc. Med., Volume 15, Issue 3 (03 2012) – 7 articles

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