Cardiovascular Medicine

1 pages, 211 KB

Open AccessEditorial

Cardiology Update (11–15 February 2017)

by Ruth Amstein

Cardiovasc. Med. 2016, 19(10), 432; https://doi.org/10.4414/cvm.2016.00432 - 19 Oct 2016

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Abstract

Davos will once again be hosting the 22^nd biennial Cardiology Update Course in February, 2017 [...] Full article

6 pages, 1075 KB

Open AccessCase Report

Recurring Tachycardia and Syncope in a Young Person

by Giuseppe Cocco and Philipp Amiet

Cardiovasc. Med. 2016, 19(10), 272; https://doi.org/10.4414/cvm.2016.00441 - 19 Oct 2016

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Abstract

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited cardiac arrhythmia in the absence of structural cardiopathy with a strong potential for sudden cardiac death (SCD). A patient with a worrisome family history of SCD and genetically proven CPVT in various family members was found to have CPVT with exaggerated cathecolaminergic burden and stressinduced complex cardiac arrhythmias. The arrhythmias are mediated by delayed after-depolarisation. The antiarrhythmic effect of the β-blocker metoprolol was insufficient. The patient refused other antiarrhythmic drugs. He received an implantable cardioverter defibrillator (ICD), which was effective in treating the recurring arrhythmia. Vigorous physical activity and high emotional stress must be avoided by these patients. The case underlines the importance of ICD in patients with recurring syncopes, a strong family history of SCD with a genetically proven CPVT in various family members. Full article

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8 pages, 296 KB

Open AccessCase Report

Iatrogenic Left Main Coronary Artery Dissection: Mind the Catheter Tip

by Andreas Y. Andreou, Panayiotis C. Avraamides, Tereza Andoniade, Stasinos Theodorou, Chrisostomos Mavroudis and Theodoros Kyriakou

Cardiovasc. Med. 2016, 19(10), 264; https://doi.org/10.4414/cvm.2016.00436 - 19 Oct 2016

Cited by 5 | Viewed by 162

Abstract

Iatrogenic left main coronary artery dissection is a rare but potentially life-threatening complication of invasive coronary procedures, which requires prompt recognition and management. We present cases of two patients with type C guiding catheter-induced left main coronary artery dissections that were successfully tackled [...] Read more.

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4 pages, 167 KB

Open AccessArticle

Robotic Coronary Revascularisation

by Aristotelis Panos and Patrick O. Myers

Cardiovasc. Med. 2016, 19(10), 261; https://doi.org/10.4414/cvm.2016.00435 - 19 Oct 2016

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Abstract

Objectives: Robot-assisted coronary revascularisation is a relatively new strategy. By performing a minimally invasive left internal thoracic artery (LITA) to left anterior descending (LAD) artery bypass, we are taking advantage of the survival benefit of the LITA-to-LAD bypass while decreasing the morbidity of the procedure associated with sternal spreading. The objective was to assess clinical outcomes and graft patency at 3 years.
Methods: From March 2011 to July 2014, 17 consecutive patients were operated on, with robotic LITA harvesting and manual anastomosis to the LAD on the beating heart through a small anterior thoracotomy. Patients underwent coronary (n = 6) or computed tomographic angiography (n = 11) 1 year after the operation.
Results: All patients were successfully revascularised as planned. There were no early or late deaths. All patients were fast tracked, with extubation during the first 2 hours in the intensive care unit, or (for six of them) in the operating theatre. The mean hospital stay was 4 ± 1.1 days. No patient required reoperation or re-exploration for bleeding. Follow-up ranged from 18 to 48 months. At 1 year, all patients had a patent LITA-LAD anastomosis. All patients remain symptom-free with a negative stress test at latest follow-up.
Conclusions: Robotic LITA takedown and minimally invasive off-pump LAD revascularisation results in excellent perioperative outcomes, high graft patency and freedom from angina during follow-up. Full article

5 pages, 893 KB

Open AccessReview

Betablocker und Asthma bronchiale: Ja Oder Nein?

by Lars C. Hubera and Mattia Arrigo

Cardiovasc. Med. 2016, 19(10), 256; https://doi.org/10.4414/cvm.2016.00438 (registering DOI) - 19 Oct 2016

Cited by 1 | Viewed by 68

Abstract

The medical history of beta-blockers is interesting. Even in patients with heart failure, for whom beta-blockers are now standard of care, they were considered contraindicated for a long time. In patients with chronic obstructive pulmonary disease, beta-blockers, once also contraindicated, are associated with reduced mortality and exacerbation rates. The use of beta-blockers in patients with bronchial asthma, however, remains controversial and, owing to fear of adverse respiratory effects and resistance to rescue medication, many review articles and clinical guidelines list beta-blockers as contraindicated in asthmatics. While there is a lack of data on long-term safety and lung function cutoffs below which beta-blockers should be avoided, evidence to support the recommendation that beta-blockers should not be used in asthma patients is rare. In stable patients with well-controlled asthma, beta-blocker-induced respiratory effects appear to be rare, and significant changes in symptoms, lung function and use of rescue medications (including systemic steroids and inhaled betamimetics) have not been observed. Based on these findings and the fact that beta-blockers have considerable benefits in patients with cardiac diseases, we think that these agents should not be withheld from patients with asthma. In such a setting, it is prudent to use cardioselective beta-blockers. However, when indicated and used carefully, nonselective beta-blockers can also be used in asthmatics. In these patients, asthma needs to be well controlled, without markedly reduced pulmonary function at baseline. In addition, the dose of beta-blocker has to be carefully titrated and, in selected cases, therapy with inhaled anticholinergics might be indicated during the wash-in phase. Experimental data have even suggested that beta-blockers might be used as a therapeutic approach in patients with asthma. Although interesting, these data need to be confirmed in a clinical setting. Full article

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6 pages, 189 KB

Open AccessReview

Should We Measure PCSK9 Levels in Patients with Acute Coronary Syndromes?

by Baris Gencer

Cardiovasc. Med. 2016, 19(10), 249; https://doi.org/10.4414/cvm.2016.00439 - 19 Oct 2016

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Abstract

Background: Several studies have shown that inhibitors of proprotein convertase kexin 9 (PCSK9 ) efficiently lowered levels of low-density lipoprotein cholesterol (LDL-C), especially in patients with familial hypercholesterolaemia, intolerant of statins or with poorly controlled LDL-C on maximally tolerated statin treatment. However, circulating PCSK9 levels have been little studied in the acute phase of acucte coronary syndromes (ACS), especially their evolution over time and association with clinical outcomes.
Methods and results: We observed that higher PCSK9 levels at initial presentation of 2030 patients with ACS were associated with the presence of familial hypercholesterolaemia, the use of lipid-lowering therapy, the duration of chest pain and inflammation (C-reactive protein). To confirm this hypothesis, we found that PCSK9 levels increased 12–24 hours after ACS, probably with the inflammatory process during ACS. Then we assessed the increment value of adding PCSK9 to recommended risk stratification scores, such as the GRACE score, and found that PCSK9 did not predict mortality at 30 days and at 1 year. However, patients with high initial PCSK9 levels less frequently reached target LDL-cholesterol levels (<1.8 mmol/l) at 1 year.
Conclusions: The measurement of PCSK9 is currently poorly implemented in clinical practice. Our findings suggest that PCSK9 might be useful for clinicians to identify patients who might need more intensive lipid-lowering therapy (e.g. PCSK9 inhibitors) to lower LDL-C. Full article

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Cardiovasc. Med., Volume 19, Issue 10 (10 2016) – 6 articles

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