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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 8, No 4 - Fall 2007

Volume 8, No 4 - Fall 2007

Table of Contents

Cardiac Amyloidosis: New Insights into Diagnosis and Management Treatment Update
When amyloidosis affects the heart, a devastating and progressive process can lead to congestive heart failure, arrhythmias, conduction abnormalities, angina, and death. The signs and symptoms of cardiac amyloidosis are generally dominated by diastolic heart failure resulting from restrictive cardiomyopathy. Amyloid infiltration of the heart initially causes mild diastolic dysfunction, but late disease produces a thickened heart wall with a firm and rubbery consistency, which worsens cardiac relaxation and diastolic compliance. Patients usually complain of progressive dyspnea from congestive heart failure, chest discomfort secondary to microvascular involvement, and weight loss, which might be a manifestation of cardiac cachexia. Echocardiographic findings include nondilated ventricles with concentric left ventricular thickening, right ventricular thickening, prominent valves, dilated atria, and thickening of the interatrial septum. Recent advances in our understanding of the pathophysiology of amyloid have allowed the various types to be differentiated, which has led to targeted therapy for each unique pathophysiologic process. [Rev Cardiovasc Med. 2007;8(4):189-199]
Cardiovascular Protection Paradigms: Is Change on the Horizon? Treatment Update
Recent trials of patients with cardiovascular disease (CVD) have provided a wealth of data regarding diagnosis, risk factors, and treatment. Aggressive risk factor management has been shown to improve patient survival, reduce recurrent events and the need for interventional procedures, and improve the quality of life in patients with known CVD. There have been impressive reductions in blood pressure and low-density lipoprotein cholesterol levels, and improved diabetes control. Medical therapy with options such as angiotensin receptor blockers, angiotensin-converting enzyme inhibitors, and aspirin has been shown to have positive effects. Patients in current trials are more likely to be receiving appropriate treatment upon study entry than were patients in older trials. Changes in the risk profile of high-risk patients have reduced the overall rates of cardiovascular events and will continue to affect outcomes in randomized clinical trials. Such changes should be considered in the design of new clinical trials and in the interpretation of current data. [Rev Cardiovasc Med. 2007;8(4):200-213]
The Relationship Between Erectile Dysfunction and Cardiovascular Disease. Part I: Pathophysiology and Mechanisms Prevention Update
There is increased awareness regarding the close association between cardiovascular disease and erectile dysfunction, especially because both conditions share common risk factors such as diabetes mellitus, hypertension, smoking, hyperlipidemia, and a sedentary lifestyle. Recent studies suggest that erectile dysfunction could be considered a potential marker for underlying silent cardiac or vascular disease processes. Endothelial dysfunction seems to play a major role in both sexual dysfunction and heart disease. With the initiation in 1998 of vasoactive drugs such as the phosphodiesterase-5 inhibitors for the treatment of erectile dysfunction, the underlying vascular components of erectile dysfunction have become a more prominent focus of attention in the clinical and research setting. This review critically examines the background, pathophysiology, and mechanisms behind erectile dysfunction and its close correlation to cardiovascular disease. [Rev Cardiovasc Med. 2007;8(4):214-219]
Key Findings From the 2007 European Society of Cardiology Congress Meeting Review
Highlights From the 2007 European Society of Cardiology Congress, September 1-5, 2007, Vienna, Austria [Rev Cardiovasc Med. 2007;8(4):220-227]
Stress-Induced Cardiomyopathy: Not Always Apical Ballooning Case Review
Apical ballooning (takotsubo syndrome) mimics acute myocardial infarction with transient apical dyskinesia and normal coronary arteries. It is often precipitated by emotional or physical stress. The prevalence of this syndrome has been increasing, probably because it is now more frequently recognized. Multiple theoretical hypotheses have been developed to explain its genesis, but the mechanism remains unclear. Rarely, cases of apical sparing and other wall motion involvement have been cited. We collected data on 12 patients who had acute myocardial infarction and normal coronary arteries with abnormal wall motion that had completely healed on repeat studies. Five patients had typical apical ballooning, and the other 7 had wall motion abnormalities in other segments. We determined that stress-induced cardiomyopathy can involve any wall of the myocardium and is not always apical ballooning. [Rev Cardiovasc Med. 2007;8(4):228-233]