Skip to main content
Volume 15, No 3 - 2014

Volume 15, No 3 - 2014

Table of Contents

Utilization of Galectin-3 in Case Management Across the Spectrum of Heart Failure Management Review
In patients with heart failure as a result of mechanical and neurohormonal derangements, macrophages secrete galectin-3, which is a paracrine and endocrine factor that stimulates additional macrophages, pericytes, myofibroblasts, and fibroblasts to proliferate and secrete procollagen I, which is irreversibly crosslinked to form fibrotic collagen. Normal plasma concentrations of galectin-3 are , 11.0 ng/mL. Galectin-3 measured in blood has been shown to predict the development of all-cause mortality and heart failure in the general population, identify increased risk for de novo heart failure and progressive loss of renal filtration function in healthy middle-aged adults, predict cardiac failure in patients after acute coronary syndromes, help establish the diagnosis of heart failure with preserved ejection fraction in patients presenting with effort intolerance, and aid in the prognosis of both systolic and nonsystolic heart failure for the outcomes of hospitalization and death. This article presents case discussions of these applications to highlight the importance of galectin-3 measurement across the spectrum of patients at risk for cardiorenal disease. [Rev Cardiovasc Med. 2014;15(3):197-207 doi: 10.3909/ricm0726] © 2014 MedReviews®, LLC
Guiding the Management of Ventricular Arrhythmias in Patients With Left Ventricular Noncompaction Cardiomyopathy: A Knowledge Gap Management Update
Left ventricular noncompaction (LVNC) is a cardiomyopathy that occurs due to an arrest of myocardial maturation during embryogenesis. The diagnostic echocardiographic features in individuals with LVNC include a thick, bilayered myocardium, prominent ventricular trabeculations, and deep intertrabecular recesses. Clinical features associated with LVNC vary in asymptomatic and symptomatic patients, and include the potential for heart failure, conduction defects (eg, left bundle branch block), supraventricular and ventricular arrhythmias, thromboembolic events, and sudden cardiac death. The authors report five cases that emphasize asymptomatic and apparently benign symptoms in patients with LVNC; despite normal physical examination and 12-lead electrocardiogram results, all of these cases unveiled potentially serious clinical consequences. These cases highlight the concern that LVNC patients with mild to moderate left ventricular systolic dysfunction, particularly in the presence of ventricular arrhythmias or a family history of sudden cardiac death, may need consideration for an implantable cardioverter defibrillator (ICD). All potential benefits of an ICD need to be balanced by the risk of device infection, lead and device malfunction, and potential for inappropriate shocks. [Rev Cardiovasc Med. 2014;15(3):208-216 doi: 10.3909/ricm0657] © 2014 MedReviews®, LLC
Nutrigenetic Associations With Cardiovascular Disease Management Review
It is becoming increasingly evident that not all people respond equally to diet. Nutrigenetics and nutrigenomics is the study of how genes affect dietary response or how nutrients affect gene expression. Understanding gene–nutrient interactions has become essential in many areas of study to account for variation in results. Identifying subgroups or individuals who might benefit from more targeted recommendations has also been a result of studying these interactions. This review summarizes findings from genetic polymorphisms in apolipoprotein E, fatty acid desaturase, lipoxygenase-5, peroxisome proliferator-activated receptors, apolipoprotein A1, apolipoprotein A2, apolipoprotein A5, and methylenetetrahydrofolate reductase associated with cardiovascular disease. [Rev Cardiovasc Med. 2014;15(3):217-225 doi: 10.3909/ricm0658] © 2014 MedReviews®, LLC
Worsening Thoracic Impedance as a Ventricular Tachyarrhythmia Risk Management Update
The use of heart failure classification to identify patients with systolic dysfunction who are at risk for ventricular tachyarrhythmias (VAs), sudden cardiac death, and shocks from implantable cardioverter defibrillators (ICDs) is limited by its subjectivity. Measurement of thoracic impedance offers a more objective tool for assessing worsening of heart failure. We sought to look at the correlation between ventricular arrhythmia and heart failure as assessed objectively by thoracic impedance. We reviewed device interrogation data on thoracic impedance from ICD with Medtronic’s OptiVol® feature (Medtronic Inc., Minneapolis, MN) at two medical centers. Data from the last two interrogations of the same device separated by at least 2 months were included. An OptiVol fluid index threshold of 60 represented early heart failure prior to appearance of symptoms. VAs included were ventricular fibrillation and/or ventricular tachycardia lasting more than 16 beats. Chi square distribution test was used in statistical data analysis. There were 24 VAs identified among the 322 interrogations reviewed (7.5%). Elevated OptiVol fluid index was seen in 71% (17/24), whereas normal OptiVol index was seen in the remaining 29% (7/24) of these interrogations with VA (P , .05). Our review shows that heart failure patients who have VA are approximately 2.5 times as likely to have worsening thoracic impedance as assessed objectively by the OptiVol fluid index. Careful monitoring of the OptiVol fluid index may identify a population at high risk of VA that merits more intense attention. [Rev Cardiovasc Med. 2014;15(3):226-231 doi: 10.3909/ricm0665] © 2014 MedReviews®, LLC
Cardiovascular Complications of Radiation Exposure Management Review
The cardiovascular sequelae of radiation exposure are an important cause of morbidity and mortality following radiation therapy for cancer, as well as after exposure to radiation after atomic bombs or nuclear accidents. In the United States, most of the data on radiation-induced heart disease (RIHD) come from patients treated with radiation therapy for Hodgkin disease and breast cancer. Additionally, people exposed to radiation from the atomic bombs in Hiroshima and Nagasaki, Japan, and the Chernobyl, Ukraine, nuclear accident have an increased risk of cardiovascular disease. The total dose of radiation, as well as the fractionation of the dose, plays an important role in the development of RIHD. All parts of the heart are affected, including the pericardium, vasculature, myocardium, valves, and conduction system. The mechanism of injury is complex, but one major mechanism is injury to endothelium in both the microvasculature and coronary arteries. This likely also contributes to damage and fibrosis within the myocardium. Additionally, various inflammatory and profibrotic cytokines contribute to injury. Diagnosis and treatment are not significantly different from those for conventional cardiovascular disease; however, screening for heart disease and lifelong cardiology follow-up is essential in patients with past radiation exposure. [Rev Cardiovasc Med. 2014;15(3):232-244 doi: 10.3909/ricm0689] © 2014 MedReviews®, LLC
The Use of Micropuncture Technique for Vascular or Body Cavity Access Procedure Update
More than 1 million cardiac catheterizations are performed every year in the United States, and incur substantial risk of access site bleeding. Furthermore, insertion of central venous catheters and performance of pericardio- or pleurocentesis are common practice, also with substantial risk of vascular or organ injury. One of the major risks for access site bleeding is multiple or posterior arterial puncture with a large needle. Using a very small needle to obtain initial access to vessels or organ cavities has the potential to reduce the risk of bleeding or organ injury. Multiple unsuccessful attempts to achieve vascular access are more forgiving, and accidental organ injury during pericardio- or pleurocentesis is less traumatic when using a small micropuncture needle. This article reviews the use of micropuncture technique for vascular or organ cavity access, a technique that has the potential to decrease vascular access site complications and organ injury. [Rev Cardiovasc Med. 2014;15(3):245-251 doi: 10.3909/ricm0709] © 2014 MedReviews®, LLC
An Innovative, Multidisciplinary, Process-Driven Approach to Acute Stroke in a Community Health System Network Treatment Update
Stroke is one of the major causes of death and disability in the United States, yet it is undertreated by many major medical centers across the country. Timely recognition and treatment of acute ischemic stroke remains a challenge due to confusing clinical presentations, hospital logistics, communication barriers among providers, and lack of standardized treatment algorithms. By creating a system-wide Code Stroke protocol, St. John Providence Health System improved documentation, increased intravenous tissue plasminogen activator delivery, reduced specialist call-back times, improved door-to-computer tomography scan and door-to-needle time, and identified appropriate patients for endovascular therapy. [Rev Cardiovasc Med. 2014;15(3):252-265 doi: 10.3909/ricm0712] © 2014 MedReviews®, LLC
California Cardiovascular Legislation 2014
[Rev Cardiovasc Med. 2014;15(3):266-270 doi: 10.3909/ricm15-3CAACC ] © 2014 MedReviews®, LLC
Intracardiac Atypical Leiomyoma Involving All Four Cardiac Chambers and the Aorta
Intravenous leiomyomatosis is a rare gynecologic disease that can be complicated with intracardiac involvement. All reported cases with cardiac extension involved the right cardiac chambers. Intracardiac leiomyoma may present with dyspnea, chest pain, palpitations, lower extremity swelling, or syncope. This is a unique case of a 40-year-old asymptomatic woman with incidental finding of a cardiac murmur. Echocardiography showed an echodensity in all cardiac chambers. Urgent cardiac surgery revealed an intracardiac leiomyoma, extending from the inferior vena cava and involving all four cardiac chambers and the aortic root. [Rev Cardiovasc Med. 2014;15(3):271-275 doi: 10.3909/ricm0731] © 2014 MedReviews®, LLC
Undiagnosed Ebstein’s Anomaly in a Pregnant Woman
Ebstein’s anomaly is an uncommon congenital heart defect characterized by an abnormal tricuspid valve. Pregnancy can be well tolerated, although cyanosis, arrhythmias, and cardiomegaly are associated with poor prognosis. An 18-year-old woman with a history of congenital cardiomyopathy presented at 37 weeks of gestation with hypoxia, dyspnea, central cyanosis, and uterine contractions. The patient underwent emergent cesarean delivery. Echocardiography revealed Ebstein’s anomaly with patent foramen ovale and right-to-left shunting. Tricuspid valvuloplasty with primary closure of patent foramen ovale was performed. This case is presented, accompanied by a review of the literature. [Rev Cardiovasc Med. 2014;15(3):276-280 doi: 10.3909/ricm0706] © 2014 MedReviews®, LLC
Correction to “Lomitapide for the Management of Homozygous Familial Hypercholesterolemia”
[Rev Cardiovasc Med. 2014;15(3):281-282 doi:10.3909/ricm0693corr] © 2014 MedReviews®, LLC