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Volume 10, No 3 - Summer 2009

Volume 10, No 3 - Summer 2009

Table of Contents

New Insights Into Effective CPR: Cardiocerebral Resuscitation for Primary Cardiac Arrest Treatment Update
Cardiocerebral resuscitation is a new approach to patients with primary cardiac arrestthat has been shown to dramatically increase survival. The term cardiocerebral is[Rev Cardiovasc Med. 2009;10(3):125-133 doi: 10.3909/ricm0462]used to stress that the issue is immediate and effective support of the central circulation.Cardiocerebral resuscitation consists of continuous chest compressions—withoutmouth-to-mouth ventilations—administered by bystanders, and a new algorithm foremergency medical services that consists of sets of 200 chest compressions before andimmediately after electrocardiographic analysis and, if indicated, a single shock.Ventilation is initially provided by passive oxygen insufflation rather than withintubation or bag-mask ventilation. Early establishment of intravenous or intraosseousaccess for epinephrine is emphasized. Postresuscitation care for comatose patientsincludes early coronary intervention and 24 hours of mild hypothermia. Studies showmarked improvement in prehospital cardiac arrest patients with return of spontaneouscirculation who subsequently received specialized postresuscitation care.
Clinical Application of Cardiac CMR Technique Review
Cardiovascular magnetic resonance (CMR) imaging is an important clinical tool thataids in the diagnosis and management of patients with cardiomyopathy. With itsability to assess morphologic and physiologic myocardial characteristics in the sameimaging session, CMR can effectively rule out less common causes of cardiomyopathy,including cardiac hemochromatosis, amyloidosis, and arrhythmogenic right ventriculartachycardia. The combination of cine function, myocardial perfusion at rest andunder stress, and late gadolinium enhancement provides a strong assessment thatcan establish the cause of the cardiomyopathy as well as guide therapy in cases ofischemic cardiomyopathy. CMR can also identify microvascular obstruction in acutemyocardial infarction. This technique can be especially helpful in the diagnosis ofconditions such as arrhythmogenic right ventricular dysplasia, cardiac sarcoidosis,and myocarditis. It can also be used to evaluate patients with chest pain andpericardial diseases.[Rev Cardiovasc Med. 2009;10(3):134-141 doi: 10.3909/ricm0463]
Impact of Obesity in Patients With Congestive Heart Failure Disease State Review
Obesity is a known risk factor for developing cardiovascular disease, including heartfailure. However, the impact of obesity on patients with heart failure is unclear. Weightreduction is a recommended method of prevention of cardiovascular disease. However,the phenomenon of the “obesity paradox” (or “reverse epidemiology”) revealed thatoverweight and mild to moderate obesity are associated with better outcomes in patientswith heart failure compared with patients at normal or ideal weight. Even more,increases of weight in cachectic heart failure patients might improve survival, althoughpatients with heart failure who are overweight or mildly to moderately obese havebetter outcomes than patients with heart failure who are at ideal or normal weight.In heart failure patients, weight reduction through diet regulation, moderate exercise,and bariatric surgery can improve quality of life and New York Heart Associationfunctional class, but it is yet unclear if these measures will improve survival.[Rev Cardiovasc Med. 2009;10(3):142-151 doi: 10.3909/ricm0480]
The What and Why of Cardiac CT Angiography: Data Interpretation and Clinical Practice Integration Technique Update
Noninvasive visualization of the coronary arteries is the holy grail of cardiac imaging.Cardiac catheterization, the historic gold standard for coronary imaging, is invasive,costly, and often performed unnecessarily. Cardiac computed tomographic angiography(CCTA) is a widely available, cost-effective imaging modality that effectively imagesthe coronary arteries. The most appropriate patient for a CCTA-guided approach tothe evaluation of chest pain is the symptomatic patient at low to intermediate risk.Data are rapidly evolving to further validate the accuracy, prognostic ability, andcost-effectiveness of this technique. The current landscape of the American medicalsystem and the rising cost of United States health care have led to skepticism concerningCCTA and its potential misuse. Technological misunderstanding and concernabout excessive radiation exposure also threaten its growth. When used properly byappropriately trained physicians, CCTA adds significant value to the evaluation ofchest pain and to the diagnosis of coronary artery disease.[Rev Cardiovasc Med. 2009;10(3):152-163 doi: 10.3909/ricm0481]
Best of the HRS 2009 Scientific Sessions
Highlights From the 30th Annual Heart Rhythm Society Scientific Sessions,May 13-16, 2009, Boston, MA[Rev Cardiovasc Med. 2009;10(3):168-170 doi: 10.3909/ricm0509]
Symptomatic Repetitive Right Ventricular Outflow Tract Ventricular Tachycardia in Pregnancy and Postpartum
Idiopathic ventricular tachycardias, which occur in patients without structural heartdisease, are a common entity, representing up to 10% of all ventricular tachycardiasevaluated by cardiac electrophysiology services. Pregnancy can increase the incidenceof various cardiac arrhythmias. Factors that can potentially promote arrhythmias inpregnancy include the effects of hormones, changes in autonomic tone, hemodynamicperturbations, hypokalemia, and underlying heart disease. Ventricular arrhythmias inpregnancy are repetitive monomorphic ventricular premature complexes and coupletsthat frequently originate at the right ventricular outflow tract. New onset symptomaticrepetitive right ventricular outflow tract ventricular tachycardia during pregnancy hasbeen inadequately reported in the literature. We present a case of symptomatic repetitiveright ventricular outflow tract tachycardia that started during pregnancy andcontinued in the postpartum period, requiring curative treatment with electrophysiologystudy and radiofrequency ablation.[Rev Cardiovasc Med. 2009;10(3):171-175 doi: 10.3909/ricm0469]
Hypertension News and Views From the Literature
Acute Coronary Syndromes News and Views From the Literature
Statin Therapy News and Views From the Literature
Diabetes Mellitus News and Views From the Literature
Dyslipidemia News and Views From the Literature