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Volume 11, No 4 - Fall 2010

Volume 11, No 4 - Fall 2010

Table of Contents

Safety of Drug-Eluting Stents Treatment Update
Significant evolution in catheter-based technologies for percutaneous coronary intervention has occurred since the introduction of coronary balloon angioplasty by Andreas Grüntzig in 1977. As balloon angioplasty was supplanted by bare metal stents and subsequently drug-eluting stents (DES), randomized comparative clinical trials have demonstrated a progressive decline in both angiographic and clinical restenosis with each technologic iteration. Following widespread clinical use of DES, multiple safety issues have been identified in late follow-up that have prompted efforts toward development of bioresorbable polymers and polymer-free metal platforms, as well as completely resorbable DES platforms. The ultimate goal of these efforts is to provide safe and durable coronary patency. The promise of bioresorbable DES platforms includes the additional benefits of recovery in normal autoregulatory as well as microvascular function, the capacity for late luminal enlargement/expansive remodeling, and the potential for reducing the requirement for prolonged dual antiplatelet therapy. [Rev Cardiovasc Med. 2010;11(4):186-200 doi: 10.3909/ricm0577]
Medical Management of Hypertrophic Cardiomyopathy Management Update
Hypertrophic cardiomyopathy (HCM) is the most common genetically transmitted cardiomyopathy. The underlying cause of HCM has been attributed to a number of mutations within genes encoding primarily for sarcomeric proteins, which lead to a heterogenous phenotype of left ventricular hypertrophy in the absence of other causes (eg, hypertension, aortic stenosis, or a discrete membranous subaortic stenosis). Symptoms may range from mild to severely limiting and consist of dyspnea and chest pain with exertion or at rest, syncope, or even sudden cardiac death (SCD). The majority of patients with HCM are treated medically. The primary aim of therapy is to reduce symptoms, but it should also address the risk of SCD. Throughout the years, numerous medical treatments have been used to achieve symptom control in these patients, and include medications such as -blockers, calcium channel blockers, amiodarone, disopyramide, and angiotensin receptor blockers. This review provides an overview of the current medical treatment of HCM. [Rev Cardiovasc Med. 2010;11(4):202-217 doi: 10.3909/ricm0546]
Infiltrative Diseases of the Heart Disease State Review
Infiltrative diseases targeting the cardiovascular system are a subgroup of restrictive cardiomyopathies. An early diagnosis is critical in initiating therapy to mitigate the deleterious effects of the pathologic process underlying these forms of cardiomyopathies. Infiltrative cardiac disease is rare and therefore often underdiagnosed. This review outlines the prevalence of 3 of the most common forms of restrictive cardiomyopathy: sarcoidosis, hemochromatosis, and amyloidosis. Infiltrative cardiomyopathy can have a variable prognosis depending on its etiology. It is a progressive disorder that, if left untreated, can lead to early mortality. A summary of the pathology, diagnosis, disease course, and therapy is provided, along with the utility of noninvasive testing as a means of diagnosis. [Rev Cardiovasc Med. 2010;11(4):218-227 doi: 10.3909/ricm0551]
Progesterone, Progestins, and the Heart Treatment Update
All combination hormone replacement regimens contain estrogen and a progestational agent. The Women’s Health Initiative trial demonstrated that taking the combination of conjugated estrogen and medroxyprogesterone resulted in a higher risk of myocardial infarction and stroke in the study population. However, not all progestational agents are alike in their cardiovascular properties. This article reviews what is known about the most commonly prescribed agents: progesterone, medroxyprogesterone, norethindrone, and norethindrone acetate. We compare data on markers of lipid metabolism, inflammation, and clotting function, and review studies that measure their direct effects on cardiac vessels. [Rev Cardiovasc Med. 2010;11(4):228-236 doi: 10.3909/ricm0557]
Practice Landscape: California CA ACC News
[Rev Cardiovasc Med. 2010;11(4):237-238 doi: 10.3909/ricm0576a]
Centers for Medicare & Medicaid Services Meaningful Use Compliance CA ACC News
[Rev Cardiovasc Med. 2010;11(4):238-239 doi: 10.3909/ricm0576b]
TCT 2010: Clinical Trials Focus on Device-Based Therapies for Cardiovascular Disease Meeting Review
Highlights From the 22nd Annual Transcatheter Cardiovascular Therapeutics Scientific Symposium, September 21-25, 2010, Washington, DC [Rev Cardiovasc Med. 2010;11(4):240-247 doi: 10.3909/ricm0575]
Extra Long PR Intervals Case Review
This case review presents various manifestations of extra long PR intervals, an interesting form of atrioventricular (AV) block first described in 1977. All patients in this study had organic heart diseases and various combinations of multilevel conduction impairment. Perhaps the most common cause of chronic AV conduction impairment is the ill-defined degenerative and/or fibrotic damage to the intraventricular conduction system. [Rev Cardiovasc Med. 2010;11(4):248-253 doi: 10.3909/ricm0518]
Subarachnoid Hemorrhage With Neurocardiogenic Stunning Case Review
A well-recognized complication of acute neurologic injury from intracranial bleeding is cardiotoxicity with electrocardiographic changes and transient left ventricular dysfunction. The phenomenon, called neurocardiogenic stunning (NCS), occurs in 20% to 30% cases of patients with acute subarachnoid hemorrhage (SAH). In this article, we describe a patient with acute SAH complicated by NCS and use this case to highlight the pathogenesis, diagnostic challenges, and management dilemmas that arise in such patients. We also review conventional surgical and medical treatment and present new therapeutic options for this problem. [Rev Cardiovasc Med. 2010;11(4):254-263 doi: 10.3909/ricm0544]
Coronary Stenting in Patients With Medically Resistant Vasospasm Case Review
Formally described by Prinzmetal and colleagues in 1959, variant angina represents a syndrome of resting angina that results from severe coronary artery vasospasm associated with ST elevation. The majority of patients respond to nitrates or calcium channel blockers. However, medical treatment-resistant vasospasm can occur in up to 20% of cases, thus requiring further interventions. We present a rare instance of coronary vasospasm associated with complete heart block resistant to medical therapy that was successfully treated with stenting. This case example is followed by a detailed review of the literature with regard to percutaneous or surgical coronary revascularization of patients with medically resistant vasospasm. [Rev Cardiovasc Med. 2010;11(4):264-270 doi: 10.3909/ricm0545]
Coronary Artery Disease Literature Reviews
[Rev Cardiovasc Med. 2010;11(4):271-273 doi: 10.3909/ricm0568]