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Volume 10, No 4 - Fall 2009

Volume 10, No 4 - Fall 2009

Table of Contents

Antiseptic Skin Agents for Percutaneous Procedures Treatment Review
Infections associated with percutaneously implanted devices, such as pacemakers, internal cardiac defibrillators, and endovascular prostheses, create difficult and complex clinical scenarios because management can entail complete device removal, antibiotic therapy, and prolonged hospitalization. A source for pathogens is often thought to be the skin surface, making skin preparation at the time of the procedure a critical part of minimizing implantation of infected devices and prostheses. The most common skin preparation agents used today include products containing iodophors or chlorhexidine gluconate. Agents are further classified by whether they are aqueous-based or alcohol-based solutions. Traditional aqueous-based iodophors, such as povidone-iodine, are one of the few products that can be safely used on mucous membrane surfaces. Alcohol-based solutions are quick, sustained, and durable, with broader spectrum antimicrobial activity. These agents seem ideal for percutaneous procedures associated with prosthesis implantation, when it is critical to minimize skin colony counts to prevent hardware infection.[Rev Cardiovasc Med. 2009;10(4):187-193 doi: 10.3909/ricm0511]© 2009 MedReviews®, LLC
Integrated Coronary Computed Tomographic Angiography in an Office-Based Cardiology Practice Technique Review
Multidetector coronary computed tomographic angiography (CCTA) visualizes coronary artery disease directly, thereby identifying atherosclerosis rather than ischemia. CCTA has the potential to be a useful, noninvasive gatekeeper for the identification of patients who are appropriate candidates for conventional coronary angiography and can also help determine the need for more aggressive risk modification, including cholesterol control. Integration of 64-slice CCTA scanning into a large, urban cardiology practice resulted in clearer stratification of patients into those with and without disease. Physicians used this information to improve lipid management while simultaneously reducing the use of other cardiac testing. The ability to assess cardiac calcium scoring was an additional advantage of integrating CCTA into the practice. Further reductions in the use of myocardial perfusion imaging may be expected as a result of the use of CCTA as the first test for the intermediate-risk patient.[Rev Cardiovasc Med. 2009;10(4):194-201 doi: 10.3909/ricm0450]© 2009 MedReviews®, LLC
Dysglycemia/Prediabetes and Cardiovascular Risk Factors Disease State Review
Obesity and diabetes are becoming a pandemic in developing and industrialized countries. Based on the current criteria, 24.1 million Americans have diabetes, and another 57 million have prediabetes. The term prediabetes refers to people who have impaired fasting glucose (100-125 mg/dL), impaired glucose tolerance (2-hour postglucose load of 140-199 mg/dL), or both. Many persons with prediabetes already have microvascular disease consequences (eg, blindness, amputations, kidney failure) similar to those seen in patients with a diagnosis of diabetes. However, it is not established whether prediabetes should be considered a coronary heart disease risk equivalent. Whether dysglycemia is a surrogate for a more complex metabolic condition and/or directly increases cardiovascular disease (CVD) risk remains unclear. However, many studies have shown that hyperglycemia, through various mechanisms, can lead to premature atherosclerosis. In this regard, several diabetes prevention trials have shown that strategies that reduce the rate of conversion to diabetes can also modify CVD risk factors.[Rev Cardiovasc Med. 2009;10(4):202-208 doi: 10.3909/ricm0474]© 2009 MedReviews®, LLC
Bridging Therapy in the Perioperative Management of Patients With Drug-Eluting Stents Treatment Review
Patients with drug-eluting stents appear to be at increased risk of thrombosis beyond 30 days (late) or even 1 year (very late) after stent placement. Patients with recent placement of drug-eluting stents who are receiving dual-antiplatelet therapy pose a challenge in the perioperative period. Current guidelines recommend discontinuation of clopidogrel 5 to 7 days prior to surgery or invasive procedures to prevent bleeding complications. When a patient with a drug-eluting stent is off of clopidogrel, he or she is at risk of stent thrombosis, even during treatment with anticoagulants, such as intravenous heparin. There are currently no universal recommendations for decreasing the risk of stent thrombosis. We herein outline a strategy involving the use of glycoprotein IIb/IIIa inhibitors as “bridging therapy” during the high-risk perioperative period and report on 8 patients who successfully underwent bridging therapy with no adverse cardiac outcomes (death, myocardial infarction, or stent thrombosis) or bleeding complications.[Rev Cardiovasc Med. 2009;10(4):209-218 doi: 10.3909/ricm0498]© 2009 MedReviews®, LLC
Quality First
[Rev Cardiovasc Med. 2009;10(4):219-221 doi: 10.3909/ricm0529]© 2009 MedReviews®, LLC
Echocardiography Preauthorization Mandates From Private Insurers
[Rev Cardiovasc Med. 2009;10(4):221-222 doi: 10.3909/ricm0527]© 2009 MedReviews®, LLC
Health Care Reform: The Implications for Cardiology
[Rev Cardiovasc Med. 2009;10(4):222-223 doi: 10.3909/ricm0528]© 2009 MedReviews®, LLC
Best of the AHA Scientific Sessions 2009
Highlights From the American Heart Association Scientific Sessions, November 11-18, 2009, Orlando, FL[Rev Cardiovasc Med. 2009;10(4):224-231 doi: 10.3909/ricm0533]© 2009 MedReviews®, LLC
Isolated Noncompaction of Left Ventricular Myocardium With an Unusual Presentation of Angina Pectoris
A 45-year-old man presented to the hospital with typical chest pain compatible with myocardial infarction. An electrocardiogram showed left bundle branch block. The patient underwent urgent coronary angiography, which revealed no significant coronary artery disease. Echocardiography showed noncompaction of the left ventricular myocardium. This unusual case of angina occurring in a patient with isolated noncompaction of the left ventricle is discussed with a review of the literature.[Rev Cardiovasc Med. 2009;10(4):232-235 doi: 10.3909/ricm0523]© 2009 MedReviews®, LLC
Radiation Dose—How Effective Are We in Reducing Radiation Dose From Cardiac CT Angiography? Cardiac CT Angiography
[Rev Cardiovasc Med. 2009;10(4):236-239 doi: 10.3909/ricm0513]© 2009 MedReviews®, LLC