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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.com)

Volume 6, No 2 - Spring 2005

Volume 6, No 2 - Spring 2005

Table of Contents

Differentiating Constrictive Pericarditis from Constrictive Cardiomyopathy
Constrictive pericarditis and restrictive cardiomyopathy are 2 forms of diastolic dysfunction with similar presentation but different treatment options. Whereas constrictive pericarditis has the potential of being cured with pericardiectomy, restrictive cardiomyopathy is usually incurable. It is therefore crucial to differentiate between the 2 disorders. In the last few years, new diagnostic techniques have become available to differentiate these causes of diastolic dysfunction from each other. This review provides a complete, indepth comparison of the 2 disorders with regard to their symptoms and clinical features, etiology, pathophysiology, hemodynamics, echocardiographic presentation, and finally the different available management options. [Rev Cardiovasc Med. 2005;6(2):61-71]
The No-Reflow Phenomenon: Epidemiology, Pathophysiology, and Therapeutic Approach
Over the past 20 years, advances in the management of ST segment elevation myocardial infarction have focused on the rapid achievement of patency in the infarct-related artery. The limitation of this therapeutic strategy has been exposed with the development of diagnostic techniques to assess coronary microcirculation, including myocardial contrast echo, magnetic resonance imaging, myocardial perfusion grading, and the coronary flow wire. These methods have expanded our ability to understand and recognize the no-reflow phenomenon, which describes the absence of tissue perfusion despite epicardial coronary artery patency and flow. Although the mechanisms responsible for the development of no reflow are not fully understood, the end result is microvascular damage produced by microvascular obstruction or reperfusion injury. Ideally, early recognition of the no-reflow phenomenon should provide an opportunity for therapeutic intervention designed to augment tissue perfusion and maintain the viability of myocardium at risk. A number of pharmacologic agents are being used in conjunction with percutaneous transluminal coronary angioplasty in an attempt to improve microvascular perfusion. These include IIb/IIIa receptor antagonists, adenosine, verapamil, and the experimental agent nicorandil. In the new millennium, the emphasis of reperfusion therapy is being shifted downstream from its exclusive focus on the epicardial artery to assuring normal blood flow at the tissue level. This article will review the epidemiology, pathophysiology, and therapeutic approach to this vexing clinical problem. [Rev Cardiovasc Med. 2005;6(2):72-83]
The Proinflammatory and Hypercoagulable State of Diabetes Mellitus
The diabetic population is at high risk for development of cardiovascular disease (CVD), cerebrovascular disease, and peripheral vascular disease. Approximately 80% of these patients die from a thrombotic cause, with CVD complications being involved in 75% of those. The mechanisms involved in the development of coronary artery disease (CAD) in the diabetic population are multifactorial, including hyperglycemia, hyperlipidemia, hypertension, and insulin resistance, ultimately leading to endothelial dysfunction and accelerated atherogenesis. Thus, diabetes has become a CAD risk equivalent. Early and aggressive intervention in treating risk factors may reduce the risk of developing diabetes and may prevent CVD in patients with established diabetes. [Rev Cardiovasc Med. 2005;6(2):84-97]
Percutaneous Left Ventricular Assist Device in Acute Myocardial Infarction and Cardiogenic Shock
Despite advances in coronary angioplasty for acute myocardial infarction (MI), the mortality rate for patients presenting with cardiogenic shock remains high. This case review describes the management of a patient with a non–ST segment elevation MI complicated by cardiogenic shock. The clinical and therapeutic utility of a percutaneous left atrial–to–femoral arterial ventricular assist device is discussed. [Rev Cardiovasc Med. 2005;6(2):118-123]