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Volume 13, No 4 - 2012

Volume 13, No 4 - 2012

Table of Contents

The Usefulness of the Anaerobic Threshold in the Assessment and Prognostic Evaluation of the Patient With Dyspnea Diagnosis and Evaluation Update
The anaerobic threshold (AT) is defined as the oxygen consumption level above which energy production becomes determined by anaerobic metabolism, which causes a sustained increase in lactate and metabolic acidosis. The AT, as measured by cardiopulmonary stress testing, is ubiquitously used to determine the prognosis and diagnosis of cardiovascular and respiratory diseases. This measurement can help clinicians in the functional evaluation of patients and as guidance for rehabilitation and therapy. This article reviews the pathophysiological aspects and methods of measurement of the AT during a cardiopulmonary stress test, and its clinical use in assessing cardiac and respiratory diseases. [Rev Cardiovasc Med. 2012;13(4):e139-e149 doi: 10.3909/ricm0608] © 2012 MedReviews®, LLC
Hospital-Acquired Anemia in Patients With Cardiovascular Disease: Incidence, Outcomes, and Opportunities for Prevention Prevention and Management Update
Anemia is well recognized as a marker of poor prognosis in patients with cardiovascular disease. Despite increasing awareness that anemia is associated with higher mortality, more frequent hospitalization, and worse health status, it remains unclear whether treating chronic anemia improves patients’ outcomes. The importance of studying hospital-acquired anemia (HAA), and recognizing which patients are at high risk for developing HAA early in the course of their hospitalization, is underscored by the potential opportunities for HAA prevention and management. This article reviews the incidence of HAA, risk factors for developing HAA, and its relationship with clinical outcomes. [Rev Cardiovasc Med. 2012;13(4):e150-e160 doi:10.3909/ricm0614] © 2012 MedReviews®, LLC
Emerging Strategies for Chronic Heart Failure: The Role of Gene Therapy Management Update
Heart failure (HF) is a complex clinical syndrome and a major growing public health problem in Western countries. HF is a leading cause of death and morbidity in modern society, and its incidence continues to increase with the aging population. The complexity of this syndrome and its multifactorial origin constitute problems in the management of patients. Pharmacological treatments aim to interfere with the activation of the neurohormonal and adrenergic systems, which are key pathophysiological mechanisms underlying disease progression. Despite the improvements achieved by current therapies, patients in end stages of the disease still have a poor prognosis. Gene therapy represents a new approach to the treatment of HF, with the ambitious aim of repairing the molecular abnormalities that lead to the disease. Current medical management of clinical HF and novel gene therapies for treatment of HF are presented here. [Rev Cardiovasc Med. 2012;13(4):e161-e168 doi: 10.3909/ricm0609] © 2012 MedReviews®, LLC
Percutaneous Closure of Prosthetic Paravalvular Leaks Treatment Update
Paravalvular leaks (PVLs) are relatively common after valve replacement. These leaks are usually small and disappear during the follow-up. Symptomatic PVLs occur in 1% to 2% of patients undergoing valve replacement. PVLs causing clinical consequences require surgical intervention. Surgery is considered the gold standard of dehiscence repair. In recent years, the use of percutaneous closure devices for closing PVLs has been proposed as an alternative to surgery. Such techniques are less invasive and can be used in most high-risk patients instead of performing repeat surgery. This article describes how to assess the leak as well as the technical aspects of the procedure. [Rev Cardiovasc Med. 2012;13(4):e169-e175 doi: 10.3909/ricm0612] © 2012 MedReviews®, LLC
Endovascular Management of Acute Complicated Type B Aortic Dissection in North America Treatment Update
The management of patients with complicated acute type B aortic dissection is challenging. Thoracic endovascular aortic repair has shown promising results in small series; however, using nonstandard definitions and improper inclusion criteria confounds the published results. This article reviews the techniques and outcome of patients who underwent endovascular treatment for complicated acute type B aortic dissection in North America. Primary stent grafting for treatment of complicated acute type B aortic dissection compares favorably with the surgical outcome. Thoracic aortic endovascular repair can be offered with a relatively low postoperative morbidity and mortality in experienced hands. It also appears to have a favorable outcome in mid-term follow-up. Longevity of the repair and durability of the stent grafts in the thoracic aorta are yet to be established. [Rev Cardiovasc Med. 2012;13(4):e176-e184 doi:10.3909/ricm0629] © 2012 MedReviews®, LLC
The Complex Association Between Cardiac Disease and Kidney Dysfunction: Cardiorenal Syndrome, Contrast-Induced Nephropathy, and Cardiac Surgery-Associated Acute Kidney Injury Disease State Review
The heart supplies oxygen-rich blood to tissues and organs, and the kidneys need to be well perfused by the heart in order to function properly in their role of maintaining fluid and salt homeostasis; therefore, it is not surprising that there is an intricate relationship between these two organs. Many studies have examined the pathophysiology and treatment options for renal failure and heart failure as separate entities, but fewer studies have investigated them jointly. Furthermore, between the many subtypes of cardiorenal syndrome, the ambiguity of contrast-induced versus cardiac-induced nephropathy after invasive cardiac procedures, and the prevalence of concomitant cardiac and renal disease, there is a need for a broad collective review of cardiac and renal disease. This article examines the pathophysiology behind cardiorenal syndrome, contrast-induced nephropathy after invasive cardiac procedures, and acute kidney injury after cardiac surgery, together with the data supporting currently available prevention and treatment options. [Rev Cardiovasc Med. 2012;13(4):e185-e195 doi: 10.3909/ricm0636] © 2012 MedReviews®, LLC
Can Docs Bridge US Over the Cliff?
[Rev Cardiovasc Med. 2012;13(4): e196-e197 doi: 10.3909/ricm1304CAACC © 2012 MedReviews®, LLC
Apical Ballooning Syndrome Associated With Isolated Severe Hyponatremia: Case Report and Suggested Pathophysiology
An 82-year-old woman who presented to her primary care physician for preoperative evaluation was incidentally found to have severe hyponatremia (sodium 5 118 mmol/L). The patient was then admitted for workup and treatment of hyponatremia. On day 2 of the admission, the patient was found to have new T-wave inversions on a telemetry monitor. Further workup, including an electrocardiogram, cardiac markers, echocardiogram, and a cardiac catheterization were consistent with the diagnosis of apical ballooning syndrome (ABS). Mechanisms of how severe hyponatremia may lead to ABS are discussed as well as a possible approach to the management of severe hyponatremia in postmenopausal women. [Rev Cardiovasc Med. 2012;13(4):e198-e202 doi: 10.3909/ricm0647] © 2012 MedReviews®, LLC
Primary Hyperaldosteronism Decoded: A Case of Curable Resistant Hypertension
Patients with resistant hypertension have a higher incidence of secondary causes of hypertension compared with the general hypertensive population. It is important to screen such patients for secondary causes of hypertension because appropriate treatment can lead to improved blood pressure control or even cure these patients, and thus avoid the cardiovascular morbidity and mortality associated with uncontrolled hypertension. One common cause of secondary hypertension, often associated with hypokalemia, is primary hyperaldosteronism or Conn syndrome. Aldosterone is a mineralocorticoid hormone produced in the outer layer of the adrenal cortex (the zona glomerulosa); its primary action is to increase sodium and water reabsorption by the kidney. Once the diagnosis of primary aldosteronism is made, it is necessary to determine if aldosterone production is unilateral or bilateral. When production is unilateral (most often from a functional adenoma), surgery is potentially curative. The authors report a case and review the diagnostic workup of Conn syndrome in which resistant hypertension and hypokalemia were cured by unilateral adrenalectomy. [Rev Cardiovasc Med. 2012;13(4):e203-e208 doi: 10.3909/ricm0650] © 2012 MedReviews®, LLC
Tetrahydrobiopterin: A New Piece of the Postmenopausal Cardiovascular Puzzle Coronary Artery Disease
[Rev Cardiovasc Med. 2012;13(4):e209-e210 doi: 10.3909/ricm0651] © 2012 MedReviews®, LLC