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Volume 14, No 1 - 2013

Volume 14, No 1 - 2013

Table of Contents

Long-term Follow-up of Lesion-specific Outcomes Comparing Drug-eluting Stents and Bare Metal Stents in Diseased Saphenous Vein Grafts Treatment Update
<p>Saphenous vein grafts (SVGs) are a common choice for bypassing obstructed coronary arteries. Repeat coronary artery bypass grafting has been found to have substantial rates of morbidity and mortality; therefore, SVG percutaneous intervention has emerged as a positive alternative for revascularization. Stenting of SVGs has been shown to be more beneficial than medical management or balloon angioplasty alone. The literature is conflicting with regard to which type of stent—bare metal stent (BMS) or drug-eluting stent (DES)—is best suited for treating graft failure. The authors provide long-term follow-up data of lesion-specific outcomes when comparing DES versus BMS in SVGs. [ Rev Cardiovasc Med. 2013;14(1):1-6 doi: 10.3909/ricm0663] © 2013 MedReviews®, LLC</p>
Venous Disease: The Missing Link in Cardiovascular Medicine Diagnosis and Treatment Update
Until recently, medical literature and the practice of vascular medicine focused on the cosmetic aspects of venous disease and the advanced stages of venous insufficiency such as painful varicose veins and venous ulcers. The systemic effects of venous insufficiency resulting from a reduction of venous return and increased transit time of blood from the lower extremities that can mimic heart failure are only recently being recognized. This article reviews the diagnosis and treatment options for the patients with venous insufficiency, and increases awareness about the systemic effects of venous disease and its role in the practice of cardiovascular medicine. [ Rev Cardiovasc Med. 2013;14(1):7-19 doi: 10.3909/ricm0683] © 2013 MedReviews®, LLC
New Vistas for the Treatment of Obesity: Turning the Tide Against the Leading Cause of Morbidity and Cardiovascular Mortality in the Developed World CME-certified Article
Excess adiposity and obesity are the root cause of at least 27 diseases that cause considerable lifelong morbidity and, in many scenarios, eventual cardiovascular mortality. The human body has the ability to increase the number and size of its adipocytes by approximately 10-fold over the course of a lifetime. As fat mass increases, its blood supply, supporting cells, tissue structure, and local and systemic hormonal control also increase. This results in excess adiposity, leading to progressive obesity and the resistance to weight-loss attempts. There have been numerous trials of food diets combined with exercise that, in general, have a 50% dropout rate at 1 year and lead to very modest (~ 5%) reductions in body weight. Thus, many with obesity require interventions beyond casual diet and exercise advice. Meal replacement diets and bariatric surgery offer considerably greater degrees of weight loss, but both can be plagued by weight regain. Because the ability to control food urges has been shown to be a key psychological factor for success, medicinal approaches that work in this domain are attractive adjuncts to diet, exercise, and weight-loss surgery. This article reviews the emerging role of medical therapy in the treatment of excess adiposity with the goal of reducing comorbidities and possibly improving cardiovascular survival. [Rev Cardiovasc Med. 2013;14(1):20-40 doi: 10.3909/ricm0682] © 2013 MedReviews®, LLC
Failing the Failing Heart: A Review of Palliative Care in Heart Failure Management Review
Heart failure (HF) is the most common reason for hospital admission for patients older than 65 years. With an aging population and improving survival in heart failure patients, the number of people living with HF continues to grow. As this population increases, the importance of treating symptoms of fatigue, dyspnea, pain, and depression that diminish the quality of life in HF patients becomes increasingly important. Palliative care has been shown to help alleviate these symptoms and improve patients&rsquo; satisfaction with the care they receive. Despite this growing body of evidence, palliative care consultation remains underutilized and is not standard practice in the management of HF. With an emphasis on communication, symptom management, and coordinated care, palliative care provides an integrated approach to support patients and families with chronic illnesses. Early communication with patients and families regarding the unpredictable nature of HF and the increased risk of sudden cardiac death enables discussions around advanced care directives, health care proxies, and deactivation of permanent pacemakers or implantable cardioverter defibrillators. Cardiologists and primary care physicians who are comfortable initiating these discussions are encouraged to do so; however, many fear destroying hope and are uncertain how to discuss end-of-life issues. Thus, in order to facilitate these discussions and establish an appropriate relationship, we recommend that patients and families be introduced to a palliative care team at the earliest appropriate time after diagnosis. [ Rev Cardiovasc Med. 2013;14(1):41-48 doi: 10.3909/ricm0635] © 2013 MedReviews®, LLC
Systemic Vasculitis: An Underestimated Cause of Heart Failure—Assessment by Cardiovascular Magnetic Resonance Diagnosis Review
Cardiovascular manifestations in systemic vasculitis include initially silent cardiomyopathy due to either ischemic or inflammatory causes. The combination of vasculitis and cardiomyopathy is associated with a poor prognosis. Early treatment with immunosuppressants in conjunction with appropriate cardiac pharmacotherapy is considered important and has dramatically improved prognosis. Cardiovascular magnetic resonance, due to its nonionizing, noninvasive evaluation of the cardiovascular system, can be of great value in the diagnosis, follow-up, and treatment of patients with systemic vasculitis. [Rev Cardiovasc Med. 2013;14(1):49-55 doi: 10.3909/ricm0637] © 2013 MedReviews®, LLC
Diagnosis and Risk Stratification in Acute Pulmonary Embolism: The Role of Echocardiography Diagnosis Update
Pulmonary embolism (PE) is a frequently encountered clinical condition with a high mortality rate that is affected by various factors such as age, hemodynamics, and other comorbidities. Early diagnosis and risk stratification are crucial to achieving a favorable clinical outcome. New risk stratification algorithms have been proposed in order to identify high-risk patients who will benefit from early thrombolytic treatment. Among the various validated diagnostic methods, the role of echocardiography is increasingly accepted. Recent advances in studying right ventricular function have made echocardiography an attractive tool for establishing or excluding the diagnosis of acute PE in the emergency setting and initiating optimal therapy. [Rev Cardiovasc Med. 2013;14(1):56-65 doi: 10.3909/ricm0639] © 2013 MedReviews®, LLC
Health Care Reform: What’s Wrong With 17.6% GDP?
[Rev Cardiovasc Med. 2013;14(1):66-68 doi: 10.3909/ricm0684] © 2013 MedReviews®, LLC
News and Views From the Literature Hypertension
[Rev Cardiovasc Med. 2013;14(1):69-71 doi 10.3909/ricm0664] © 2013 MedReviews®, LLC