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Volume 17, Issue 3 & 4 - 2016

Volume 17, No 3/4 - 2016

Table of Contents

ST-segment Elevation: Myocardial Infarction or Simulacrum? Diagnosis Update
A rapid diagnosis of ST-segment elevation myocardial infarction (STEMI) is mandatory for optimal treatment of an acute coronary syndrome. However, a small number of patients with suspected STEMI are afflicted with other medical conditions. These medical conditions are rare, but important clinical entities that should be considered when evaluating a STEMI alert. These conditions include coronary vasospasm, Takotsubo cardiomyopathy, coronary arteritis/aneurysm, myopericarditis, Brugada syndrome, left bundle branch block, early repolarization, aortic dissection, infective endocarditis with root abscess, subarachnoid hemorrhage, ventricular aneurysm after transmural myocardial infarction, and hemodynamically significant pulmonary embolism with right ventricular strain. Herein, we present several STEMI mimickers. [Rev Cardiovasc Med. 2016;17(3/4):85-99 doi: 10.3909/ricm0828] © 2016 MedReviews®, LLC
The Role of Novel Cardiorenal Biomarkers in the Cardiac Catheterization Laboratory for the Detection of Acute Kidney Injury Management Update
Contrast-induced nephropathy related to cardiac and peripheral vascular procedures is a major problem in the United States and abroad. Measures to prevent and treat this complication have been hampered by the lack of clinical tools to detect acute kidney injury following contrast administration. Emerging novel serum and urinary biomarkers may provide sensitive detection of early kidney injury prior to creatinine elevation and allow for more precise risk stratification and management of patients. This article discusses the biologic and clinical data supporting the development and utility of several promising biomarkers in the management of patients undergoing cardiac catheterization and percutaneous coronary intervention. [Rev Cardiovasc Med. 2016;17(3/4):100-114 doi: 10.3909/ricm0838] © 2016 MedReviews®, LLC
An Overview of Pharmacotherapy in Hypertrophic Cardiomyopathy: Current Speculations and Clinical Perspectives Treatment Review
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease. Its clinical course is variable, ranging from a benign asymptomatic or mildly symptomatic course throughout life, to severe symptoms (dyspnea, angina, palpitations) or cardiovascular events (syncope and thromboembolism). Sudden cardiac death (SCD) remains the most striking manifestation of the disease, affecting a minority of patients. This review focuses on the medical treatments applied according to the symptomatology in obstructive and nonobstructive HCM; a special reference is made to atrial fibrillation and arterial hypertension, which often coexist with the disease. Current literature about the pharmaceutical prevention of SCD is also analyzed and novel pharmacologic agents and approaches that may represent the future management of HCM are critically reviewed. The analysis of interventional techniques that are used in cases of medical treatment failure is avoided. Rather than enumerating clinical studies and guidelines, this review provides a concise and contemporary analysis of HCM pharmacotherapy, developing applicable algorithms for clinicians and highlighting promising future drug regimens. [Rev Cardiovasc Med. 2016;17(3/4):115-123 doi: 10.3909/ricm0816] © 2016 MedReviews®, LLC
Radiofrequency Coils and Pulse Sequences for Cardiac Magnetic Resonance Applications: New Perspectives and Future Developments Diagnostic Update
Cardiac magnetic resonance (CMR) is a relevant diagnostic tool for the evaluation of cardiac morphology, function, and mass. The assessment of myocardial tissue content through the measurement of longitudinal (T1) and transversal (T2) relaxation properties and the development of different technical advances are important clinical novelties of CMR. Recently, magnetic resonance spectroscopy has been explored for the assessment of the metabolic state of tissue for cardiac function evaluation by using nuclei other than protons, such as 13C and 23Na, expanding our knowledge of the kinetics of metabolic processes. The design and development of dedicated radiofrequency coils and pulse sequences are fundamental to maximizing signal-to-noise ratio data while achieving faster cardiac examination. This review highlights the new technical developments in CMR sequences and coils. [Rev Cardiovasc Med. 2016;17(3/4):124-130 doi: 10.3909/ricm0846] © 2016 MedReviews®, LLC
Cardiac Manifestations of Adrenal Insufficiency Disease State Review
It is estimated that the prevalence of primary adrenal insufficiency (Addison disease) is 1 in 10,000 people. There are multiple case reports and several studies that suggest a correlation between Addison disease and abnormalities of cardiac function. The pathophysiology of cardiac abnormalities in this condition is incompletely understood. This review explores what is currently known about the cardiac manifestations of Addison disease. [Rev Cardiovasc Med. 2016;17(3/4):131-136 doi: 10.3909/ricm0820] © 2016 MedReviews®, LLC
Rotational Atherectomy in a Dissected Coronary Artery That Propagated Into the Sinus of Valsalva: Is This the Last Hope?
<a>Percutaneous coronary intervention (PCI) of a resistant, undilatable lesion can result in coronary dissection. Retrograde propagation of a dissection flap into the sinus of Valsalva is a rare phenomenon. It is commonly seen at the time of PCI to a right coronary artery (RCA) and is associated with potentially fatal consequences. Use of rotational atherectomy (RA) is contraindicated in the presence of a coronary dissection. Coronary dissection with preserved flow in asymptomatic patients should be managed conservatively until the dissection heals, but in the case presented here, as coronary flow was compromised, the patient complained of chest pain and ST elevation was observed on electrocardiogram. [Rev Cardiovasc Med. 2016;17(3/4):137-139 doi: 10.3909/ricm0819] © 2016 MedReviews®, LLC</a>
An Unusual Presentation of Native Valve Endocarditis Caused by Staphylococcus warneri
Staphylococcus warneri is a coagulase-negative staphylococcal (CoNS) bacterium. It is a common saprophyte on human skin, present in approximately 50% of the healthy adult population; it has emerged as a cause of serious infection in the past two decades. In most cases, there is a predisposing condition, such as a new implant or surgical procedure, before the identification of S warneri as the pathogen. It is believed that CoNS are mostly associated with prosthetic valve infections. S warneri can lead to a slow growing and an indolent course and late diagnosis. Cases of CoNS infective endocarditis are less likely to have a vascular or immunologic phenomenon and can lead to large vegetations requiring valve replacement if not detected in time. There are currently only two cases of native valve endocarditis from community-acquired S warneri in the literature. We report a case of native valve endocarditis in an immunocompetent patient without any of the usual predisposing risk factors. Our case illustrates the importance of CoNS bacteremia and the implications of delayed diagnosis of CoNS endocarditis in clinical practice. [Rev Cardiovasc Med. 2016;17(3/4):140-143 doi: 10.3909/ricm0823] © 2016 MedReviews®, LLC
Utility of Procalcitonin for Diagnosis of Superimposed Infections in Patients With Acute Heart Failure
Respiratory infections are well-known precipitant factors for heart failure decompensations. Nevertheless, the diagnosis of life-threatening infections, such as pneumonia, is challenging. Pneumonia and acute heart failure often display overlapping clinical findings and, in other cases, more accurate infection-related findings are missing. In recent years, procalcitonin has emerged as a promising tool for early and accurate diagnosis of pneumonia and, interestingly, for guiding antibiotic therapy in patients with acute heart failure. We discuss two cases of acute heart failure with high procalcitonin on admission and different clinical outcomes. In this setting, procalcitonin may be a useful tool for guiding antibiotic therapy. Further controlled studies are warranted. [Rev Cardiovasc Med. 2016;17(3/4):144-148 doi: 10.3909/ricm0824] © 2016 MedReviews®, LLC
Myocardial Bridge Complicated by Acute Myocardial Infarction
Typically, myocardial bridging (MB) is considered a relatively benign condition; however, serious complications such as angina pectoris, myocardial infarction (MI), and sudden cardiac death may occur. The diagnosis and appropriate treatment of this pathology are important. We report a case of acute anterior wall ST-elevation MI occurring as a complication of MB involving the mid segment of the left anterior descending artery in a young, otherwise healthy woman who underwent a primary stenting procedure. Pathophysiologic mechanisms underlying the process leading from MB to acute MI vary, and so should the therapy for those patients. Coronary angiography, intravascular ultrasound, and, potentially, optical coherence tomography should be used to assist in establishing an accurate diagnosis in these complex patients and should guide the therapeutic decision in acute settings. [Rev Cardiovasc Med. 2016;17(3/4):149-153 doi: 10.3909/ricm0843] © 2016 MedReviews®, LLC