Skip to main content
Volume 11, No 1 - Winter 2010

Volume 11, No 1 - Winter 2010

Table of Contents

Management of Atrial Fibrillation: Focus on Rate Versus Rhythm Contr Management Update
Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults and accounts for approximately one-third of all arrhythmias requiring admission to the hospital. Treatment strategies are determined by the classification of AF, whether paroxysmal or persistent, as well as numerous patient-specific cardiac and medical considerations (eg, pre-existing congestive heart failure or previous myocardial infarction). Thromboembolic risk also influences whether patients are treated with antiplatelet or anticoagulant medications. Several large clinical trials have deemed both rate and rhythm control acceptable treatment strategies for AF. Additionally, nonpharmacologic approaches such as surgical and electroablative options also exist. The clinician must exercise sound clinical judgment when deciding which treatment approach is best suited for a particular patient.[Rev Cardiovasc Med 2010;11(1):1-12 doi: 10.3909/ricm0504]
Heparin-Induced Thrombocytopenia: A Practical Review Management Update
Heparin-induced thrombocytopenia (HIT) remains under-recognized despite its potentially devastating outcomes. It begins when heparin exposure stimulates the formation of heparin-platelet factor 4 antibodies, which in turn triggers the release of procoagulant platelet particles. Thrombosis and thrombocytopenia that follow comprise the 2 hallmark traits of HIT, with the former largely responsible for significant vascular complications. The prevalence of HIT varies among several subgroups, with greater incidence in surgical as compared with medical populations. HIT must be acknowledged for its intense predilection for thrombosis and suspected whenever thrombosis occurs after heparin exposure. Early recognition that incorporates the clinical and serologic clues is paramount to timely institution of treatment, as its delay may result in catastrophic outcomes. The treatment of HIT mandates an immediate cessation of all heparin exposure and the institution of an antithrombotic therapy, most commonly using a direct thrombin inhibitor. Current “diagnostic” tests, which primarily include functional and antigenic assays, have more of a confirmatory than diagnostic role in the management of HIT. Special attention must be paid to cardiac patients who are often exposed to heparin multiple times during their course of treatment. Direct thrombin inhibitors are appropriate, evidence-based alternatives to heparin in patients with a history of HIT, who need to undergo percutaneous coronary intervention. As heparin remains one of the most frequently used medications today with potential for HIT with every heparin exposure, a close vigilance of platelet counts must be practiced whenever heparin is initiated.[Rev Cardiovasc Med. 2010;11(1):13-25 doi: 10.3909/ricm0495]
Pitavastatin: The Newest HMG-CoA Reductase Inhibitor New Drug Review
Statins were first introduced in the 1980s as a treatment of hypercholesterolemia. They provide a remarkable array of clinical benefits, including the reduction of low-density lipoprotein cholesterol, total cholesterol, and triglycerides, and elevation of high-density lipoprotein cholesterol. The US Food and Drug Administration has recently approved a new statin—pitavastatin—for launch in 2010. In several clinical trials, pitavastatin has shown favorable clinical efficacy, a positive safety profile, and encouraging clinical experience in Japan and other parts of Asia.[Rev Cardiovasc Med. 2010;11(1):26-32 doi: 10.3909/ricm0535]
Einthoven’s Triangle Transparency: A Practical Method to Explain Limb Lead Configuration Following Single Lead Misplacements Technique Review
Limb lead switches remain a significant source of electrocardiographic error that may lead to faulty diagnosis and improper clinical action. Methods to identify such errors have been the subject of many prior publications. A brief review of the mathematical derivation of the limb lead system is presented here, together with an additional method to help understand limb lead reversals using a transparency of the Einthoven’s triangle.[Rev Cardiovasc Med. 2010;11(1):33-38 doi: 10.3909/ricm0506]
Alternating Bundle Branch Block Together With Alternation of PR Intervals: Advanced Mobitz II Atrioventricular Block Case Review
Certain electrocardiographic patterns are well recognized for their propensity to progress to more severe forms of atrioventricular (AV) block, thus requiring pacemaker implantation. This article presents an infrequently recognized and deceptively benign pattern of conduction abnormality with great potential for advancement to severe AV block and necessity for pacemaker therapy. The pattern consists of alternating bundle branch block (BBB) in unison with alternation of the PR interval so that the right BBB beats and left BBB beats appear to be wedded to their own but different PR intervals.It is hoped that the publication of these cases will contribute to the awareness of practicing cardiologists and electrophysiologists to the existence of this potentially serious form of AV conduction abnormality and hasten the implantation of pacemakers in patients who require them.[Rev Cardiovasc Med. 2010;11(1):44-52 doi: 10.3909/ricm0494]