Skip to main content
Volume 7, No 1 - Winter 2006

Volume 7, No 1 - Winter 2006

Table of Contents

ß-Blockers for the Post–Myocardial Infarction Patient: Current Clinical Evidence and Practical Considerations Treatment Review
ß-Blockers significantly decrease the risk of mortality in patients after myocardial infarction (MI). Furthermore, ß-blockers reduce the risk of reinfarction and mortality in both the immediate and long term after an MI. Guidelines recommend that post-MI patients should be started on ß-blocker therapy and continued indefinitely, unless absolutely contraindicated or not tolerated. Despite compelling evidence, many patients are not prescribed ß-blockers after a myocardial event. In addition, some patients are treated with agents whose long-term use has not been shown to be effective. This article discusses practical implementation of ß-blockers, provides the rationale for choosing specific ß-blockers, and presents protocols for initiating or switching to evidence-based therapies in the acute and chronic post-MI period. [Rev Cardiovasc Med. 2006;7(1):1-9]
Thrombogenic Risk Factors for Atherothrombosis Treatment Review
Thrombosis superimposed on a disrupted plaque is the proximate event that triggers most acute ischemic syndromes and episodes of sudden cardiac death. A significant number of acute ischemic events occur in individuals without traditional atherosclerosisrelated risk factors. In an attempt to pinpoint additional risk factors, researchers are examining the thrombotic cascade and the cellular components, plasma proteins, and endothelium-derived mediators, as well as their genetic polymorphisms, that may affect this system. This article enumerates a number of potential hemostatic risk factors and discusses the evidence linking them to atherothrombotic events. [Rev Cardiovasc Med. 2006;7(1):10-16]
Ventricular Arrhythmias in Dialysis Patients Treatment Review
The occurrence of ventricular arrhythmias is common in renal failure patients who are receiving long-term hemodialysis. Associated ventricular arrhythmias may account for a major component of the cardiovascular mortality in hemodialysis patients. In the literature, a number of factors have been implicated in the genesis of these arrhythmias. Postulated theories range from hemodynamic alterations induced by dialysis, to metabolic alterations and derangements, to the molecular level of the current alterations in the L-type calcium channels of the heart. Studies have been conducted to ascertain whether testing, with signal-averaged electrocardiograms or electrophysiologic studies, can help to predict whether certain patients with renal failure might be more at risk for developing the complex arrhythmias noted in a large proportion of renal failure patients undergoing dialysis. This article examines the literature with regard to possible predictors in terms of patient characteristics, risk factors, electrophysiologic variables, and even dialysis method, all of which may play a part in determining the likelihood of a patient developing a ventricular arrhythmia. [Rev Cardiovasc Med. 2006;7(1):17-22]
Best of the AHA Scientific Sessions 2005 Meeting Review
Highlights from the American Heart Association Scientific Sessions November 13-16, 2005 Dallas, TX
Tako-Tsubo Syndrome as a Consequence of Transient Ischemic Attack Case Review
An 82-year-old woman presented to the emergency department with chest pain after sustaining a transient ischemic attack 1 week prior to presentation. Electrocardiography revealed ST-segment elevation in leads I, II, aVF, and V3 through V6. Coronary angiography demonstrated nearly normal coronaries but left ventriculography showed apical akinesis and basal hyperkinesis. One month later her follow-up echocardiography showed no wall motion abnormalities. Several reports of tako-tsubo syndrome or transient left ventricular apical ballooning have been described, especially in Japan. We present a case with the typical features of the syndrome after a cerebrovascular accident. [Rev Cardiovasc Med. 2006;7(1):37-41]