Cardiovascular Medicine

6 pages, 157 KB

Open AccessCommunication

ALMANAC 2013: Heart Failure

by Andrew L. Clark

Cardiovasc. Med. 2013, 16(11), 313; https://doi.org/10.4414/cvm.2013.00193 - 20 Nov 2013

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Epidemiology, the national audit and guidelines. The National Heart Failure Audit continues to be an invaluable resource for understanding how acute heart failure is managed in England and Wales [...] Full article

8 pages, 572 KB

Open AccessCommunication

ALMANAC 2013: Acute Coronary Syndromes

by Pascal Meier, Alexandra J. Lansky and Andreas Baumbach

Cardiovasc. Med. 2013, 16(11), 306; https://doi.org/10.4414/cvm.2013.00191 - 20 Nov 2013

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Abstract

Unstable coronary artery plaque is the most common underlying cause of acute coronary syndromes (ACS) and can manifest as unstable angina, non-ST segment elevation infarction (NSTE-ACS), and ST elevation myocardial infarction (STEMI), but can also manifest as sudden cardiac arrest due to ischaemia induced tachyarrhythmias. ACS mortality has decreased significantly over the last few years, especially from the more extreme manifestations of ACS, STEMI, and cardiac arrest. This trend is likely to continue based on recent therapeutic progress which includes novel antiplatelet agents such as prasugrel, ticagrelor, and cangrelor. Full article

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3 pages, 744 KB

Open AccessCase Report

Successful Treatment of Suspected Obstructing Thrombus with Acenocoumarol in a Patient with a Porcine Aortic Bioprosthesis

by Nicolas B. Dayal, François Ricou and Hajo Müller

Cardiovasc. Med. 2013, 16(11), 303; https://doi.org/10.4414/cvm.2013.00196 - 20 Nov 2013

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Abstract

Obstructive thrombus is a rare complication of surgical valve replacement. Current guidelines recommend treatment with repeat surgery or fibrinolysis, especially in critically ill patients, despite a high risk of complication and death linked with these treatments. The treatment of haemodynamically stable patients is, however, less well documented. We describe the rare case of a 40-year-old patient presenting with symptomatic but stable obstruction late after porcine bioprosthetic aortic valve replacement, who was successfully treated with oral anticoagulation. Interruption of oral anticoagulation resulted in rapid recurrence of obstruction, highlighting the importance of long-term anticoagulation in such cases. Full article

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4 pages, 699 KB

Open AccessArticle

Anticoagulation in Primary Care—A Cross Sectional Study in 14 Heterogeneous Countries

by Sven Streit, Richard Roberts, Robert Anders Burman, Persijn J. Honkoop and Damian N. Meli

Cardiovasc. Med. 2013, 16(11), 299; https://doi.org/10.4414/cvm.2013.00190 - 20 Nov 2013

Cited by 1 | Viewed by 49

Abstract

Background: New oral anticoagulants (NOACs) are predicted to become the new standard treatment for stroke prevention in patients with atrial fibrillation, and may replace vitamin K antagonists (VKAs). NOACs are prescribed less than expected, even though they do not require international normalised ratio (INR) monitoring. In this study we assessed methods for INR monitoring after the introduction of NOACs a in heterogeneous sample of countries. Methods: We asked representatives of the Vasco da Gama Movement, a network of junior and future general practitioners (GPs) in Europe, and WONCA, the World Organization of Family Doctors, to describe the way INR is monitored in their respective countries. Results: Representatives of 14 countries responded. In most countries, the INR is monitored by GPs; in some countries, these patients are treated by other specialists or in specialised anticoagulation centres. In only a few countries, anticoagulated patients monitor the INR themselves. Conclusion: Our study showed several strategies for managing anticoagulation in different countries. In most countries, the INR is monitored by GPs. These consultations offer opportunities to address other issues, such as blood pressure control or medication adherence. These factors may be considered when deciding to switch patients from VKAs to NOACs. Full article

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10 pages, 1008 KB

Open AccessReview

Assessment of Myocardial Viability After the STICH-Trial: Still Viable?

by Ines Valenta, Alessandra Quercioli, Terrence T. Ruddy and Thomas H. Schindler

Cardiovasc. Med. 2013, 16(11), 289; https://doi.org/10.4414/cvm.2013.00189 - 20 Nov 2013

Cited by 5 | Viewed by 58

Abstract

Ischaemic heart disease predominantly accounts for the majority of patients with heart failure symptoms. The prevalence of ischaemic cardiomyopathy (CMP) is continuously increasing owing to an increasingly elderly population and improved survival of acute coronary syndrome patients. Coronary revascularisation may improve left ventricular function, heart failure symptoms and cardiovascular outcome in those highrisk patients who have evidence of a sufficient degree of myocardial viability subtended to the target epicardial lesion. Optimal assessment of myocardial viability, therefore, remains essential for an optimal medical decision-making process in these patients. Recently, the STICH (Surgical Treatment for Ischemic Heart Failure) trial was performed, in which 1212 ischaemic CMP patients were randomly assigned to receive medical therapy alone or medical therapy plus coronary artery bypass grafting. Although in these inter mediaterisk patients the presence of viable myocardium was associated with a greater likelihood of survival, in patients with coronary artery disease and left ventricular dysfunction, this relationship did not hold after adjustment for other baseline clinical variables. At first glance, these observations may be surprising and contradictory to previous retrospective or observational investigations in the assessment of myocardial viability in ischaemic CMP patients. Several factors, however, may reconcile, at least in part, this controversy in viability assessment, treatment and clinical outcome of ischaemic CMP patients, such as (1.) the timing of coronary revascularisation, (2.) absence or presence of ischaemically compromised but viable myocardium, (3.) stage of the myocardial remodelling process and (4.) use of suboptimal imaging protocols and techniques to determine the presence or absence of ischaemically jeopardised but viable myocardium. These aspects and the role of other imaging modalities will be discussed. Full article

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Cardiovasc. Med., Volume 16, Issue 11 (11 2013) – 5 articles

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