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Commencing Volume 19, Issue 1, MedReviews has ceased the publication of this journal. Reviews in Cardiovascular Medicine will continue to be published by IMRPress, Ltd. (www.imrpress.org)

Volume 4, No 1 - Winter 2003

Volume 4, No 1 - Winter 2003

Table of Contents

Evaluating Intermediate Coronary Lesions in the Cardiac Catheterization Laboratory Treatment Update
Angiography is notoriously poor at distinguishing ischemia-producing from non–ischemiaproducing intermediate coronary lesions. Here, three invasive modalities for evaluating the physiologic significance of moderate coronary stenoses are reviewed: Doppler wire–derived measurement of coronary flow reserve (CFR), coronary pressure wire–derived fractional flow reserve (FFR), and intravascular ultrasound (IVUS) imaging. Studies investigating the correlation between each of these modalities and various noninvasive tests (eg, nuclear perfusion imaging or stress echocardiography) are discussed. Each of these invasive modalities has its limitations: CFR is limited by its dependence on heart rate and blood pressure, calling into question its reproducibility; both FFR and CFR are limited by their reliance upon achieving maximal hyperemia; and IVUS is limited by the fact that it provides anatomic information only. Ultimately, FFR appears to be the ideal method for interrogating intermediate coronary lesions. [Rev Cardiovasc Med. 2003;4(1):1–7]
Prevention of Heart Failure: Effective Strategies to Combat the Growing Epidemic Treatment Update
In light of the increasing prevalence, morbidity, and mortality of heart failure, effective preventative strategies are urgently needed. Risk factors for heart failure include coronary artery disease and other atherosclerotic vascular diseases, hypertension, diabetes, renal insufficiency, obesity, and family history of cardiomyopathy. Essential strategies for prevention of heart failure are modification of risk factors for heart failure development; comprehensive hypertension, atherosclerosis, and diabetes treatment; and detection and treatment of asymptomatic left ventricular dysfunction. The B-type natriuretic peptide assay may aid in identifying asymptomatic left ventricular dysfunction in patients with risk factors for heart failure. In patients with hypertension, atherosclerosis, and/or diabetes, angiotensin-converting enzyme inhibitor, ß-blocker, aspirin, and statin therapy can prevent progression to symptomatic heart failure. Avoidance of calcium channel-blockers as first-line antihypertensive therapy can also reduce the risk of heart failure. There remain substantial opportunities to improve implementation of therapies proven to prevent heart failure in the large number of patients at risk. [Rev Cardiovasc Med. 2003;4(1):8–17]
Pharmacotherapy and Behavioral Intervention for Peripheral Arterial Disease Treatment Update
Lower-extremity peripheral arterial disease is a chronic disease process resulting from atherosclerotic obstruction of major vessels supplying the legs. A significant manifestation of systemic atherosclerosis, it is estimated to affect more than 10 million adults in the United States alone. The reported incidence is a conservative estimate, because many patients who suffer from symptoms of peripheral arterial disease attribute them to “normal aging” and may not report them to their physician. Additionally, physicians may miss the diagnosis if a comprehensive history and vascular examination are not a routine part of their assessment. The hallmark symptom of peripheral arterial disease is intermittent claudication, defined as reproducible muscular leg pain that is precipitated by exercise and relieved by rest. Intermittent claudication not only limits functional capacity and adversely affects quality of life but is also an ominous predictor of increased risk for myocardial infarction, stroke, and cardiovascular death. Due to the chronicity of atherosclerosis, medical intervention is most successful when a comprehensive team approach is utilized, involving the patient, family, and vascular health professionals. Treatment for peripheral arterial disease is aimed at first, minimizing symptoms and disease progression via smoking cessation, supervised exercise therapy, pharmacotherapy, and/or revascularization, and second, minimizing the risk of cardiovascular mortality via risk factor identification and reduction, and the use of antiplatelet therapy. [Rev Cardiovasc Med. 2003;4(1):18–24]
Fatal Case of Delayed Repolarization Due to Cocaine Abuse and Global Ischemia
When a previously healthy, middle-aged patient presents with apparent seizures, what should alert the physician to the possibility of underlying cardiac disease? This report describes a case of long QT syndrome, initially presenting as seizures, which expressed itself at an atypically advanced age as a result of cocaine use, global myocardial ischemia, and ventricular tachycardia. [Rev Cardiovasc Med. 2003;4(1):47–53]