Continuing Cardiology Education最新文献

{"title":"Stent selection for percutaneous coronary intervention","authors":"P. D. Williams,&nbsp;M. Awan","doi":"10.1002/cce2.54","DOIUrl":"10.1002/cce2.54","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Percutaneous coronary intervention (PCI) with stent deployment is the dominant form of myocardial revascularization, with millions of procedures performed worldwide each year. Stent design has evolved substantially over time and there are now a wide range of options available to the interventional cardiologist. This review will cover the development of intracoronary stents and the patient and vessel factors which are important in stent selection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/5430072/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"3 2","pages":"64-69"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.54","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76733481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Framing and managing cardiovascular risk in chronic kidney disease: from native to transplanted kidney","authors":"E. Dounousi,&nbsp;A. Duni,&nbsp;S. Marinaki,&nbsp;J. N. Boletis","doi":"10.1002/cce2.52","DOIUrl":"10.1002/cce2.52","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Cardiovascular disease is the most common cause of death among chronic kidney disease (CKD) patients. As renal function declines, kidney-specific risk factors for cardiovascular events emerge. The aim of this review is to provide an insight on classical as well as non-traditional, kidney-related cardiovascular risk factors with regard to different stages of CKD, including ESRD and renal transplantation, and address specific strategies of cardiovascular disease prevention. Main culprits related to increased cardiovascular risk in patients with CKD include renin–angiotensin system and sympathetic overactivity, endothelial dysfunction, chronic inflammation, and oxidative stress. The CKD associated metabolic bone disorder (CKD-MBD), is associated with cardiovascular effects beyond the already established renal osteodystrophy and hyperparathyroidism. Higher circulating levels of phosphate and fibroblast growth factor 23 (FGF-23) and low vitamin D levels have been linked to increased risk of cardiovascular disease in patients with CDK. Uremia-related as well as renal replacement modality associated factors emerge in patients who initiate renal replacement therapy. Kidney transplant recipients (KTRs) have a lower risk of major cardiovascular events compared with dialysis patients, however conventional cardiovascular risk factors such as dyslipidemia, hypertension, and diabetes are amplified in KTRs, due to the use of immunosuppressive drugs which possess diabetogenic and atherogenic effects. Renal allograft dysfunction is a major risk factor for cardiovascular disease in this patient group. Prevention in the early stages of CKD and multifactorial aggressive interventions targeting established cardiovascular risk factors should be priority whereas future research and randomized clinical trials should assess new management approaches focusing on non-classical risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/5430062/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"3 2","pages":"70-77"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.52","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88576141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of atrial fibrillation and concomitant coronary artery disease","authors":"R. I. R. Martin,&nbsp;M. G. D. Bates","doi":"10.1002/cce2.55","DOIUrl":"10.1002/cce2.55","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and associated with significant morbidity and mortality. Coronary artery disease (CAD) frequently coexists with AF, and management of these associated conditions can be challenging. Bleeding risks of different combinations of evidence-based antithrombotic regimes need to be considered and the effects of different medical therapies for AF or CAD may impact on the other condition. This article reviews the current guidance and consensus statements of the ESC on the management of AF and CAD. The principles of AF management in the context of CAD are considered including upstream therapies to prevent AF, early identification, and antithrombotic risk assessment, and symptomatic rate and rhythm control strategies. Specific scenarios and an illustrative case are discussed to highlight clinical relevance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/5381990/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"3 2","pages":"47-55"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.55","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80751137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary issues in the management of patient with coronary artery disease across the cardiology spectrum—part II","authors":"L. K. Michalis","doi":"10.1002/cce2.56","DOIUrl":"10.1002/cce2.56","url":null,"abstract":"<p>In the current issue five topics are discussed: a) assessment and management of the cardiovascular risk in patients with chronic kidney disease; b) management of patients with coronary artery disease and chronic kidney disease; c) management of patients with atrial fibrillation and concomitant coronary artery disease; d) the importance of cardiovascular magnetic resonance imaging in patients with ischemic heart disease; and e) stent selection for percutaneous coronary intervention.</p><p>Patients with chronic kidney disease are at increased cardiovascular risk due to the coexistance of traditional and kidney disease-related risk factors. Currently, it is presented that the cardiovascular risk assessment and management of the whole spectrum of patients with chronic kidney disease including transplanted and dialysis patients.</p><p>Further to this the specific problems of the management of coronary artery disease in patients with established chronic kidney disease are presented. It is known that the mortality risk of the above patients when exhibit coronary artery disease is higher than the average. In addition, their management is a real challenge due to the complexity of anatomy, possibility of acute renal failure, and special considerations, needing to be taken into account when drugs are administered.</p><p>Coronary artery disease frequently coexists with atrial fibrillation. When these two conditions have to be managed together, ways of balancing the needs for antiothrombotic and antiplatelets regimes along with the bleeding risk of the patient have to be found. Also the ways of controlling heart rate in such patients or the heart rhythm restoration present a challenging situation.</p><p>Cardiovascular magnetic resonance imaging (CMR) offers a broad assessment of cardiac structure and function. In patients with known or suspected heart disease, CMR applications can provide assessment of left ventricular function, myocardial perfusion, and myocardial viability. Currently, the CMR techniques used to assess patients with known or suspected IHD along with situations in which it can be used are fully addressed.</p><p>Finally, clinically relevant information with regards to stenting, which is the backbone of the revascularization procedures, is discussed. Technology is advancing and stent characteristics along with patient and vessel factors should be taken into account for the selection of the proper vessel scaffold.</p><p>Finishing, I would like to thank again all the contributors of the current issue and especially Dr Jim Hall and Dr Robert Wright for all their effort.</p><p>I hope that all trainees and specialists find the current issue both educative and easy to read. I strongly encourage them to find the time and engage themselves to the CME activities accompanying each paper. I am sure it will help them to refresh their knowledge and hopefully improve their everyday clinical practice.</p><p>Dr. Michalis reports personal fees from Bayer, Me","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"3 2","pages":"46"},"PeriodicalIF":0.0,"publicationDate":"2017-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.56","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87351379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk stratification in stable coronary artery disease","authors":"T. Aye,&nbsp;R. Graham","doi":"10.1002/cce2.49","DOIUrl":"10.1002/cce2.49","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Coronary artery disease is a very common chronic condition affecting large numbers of people across the world. Once detected the natural history of coronary disease is very variable between individuals. Hence, the assessment of symptoms and current burden of disease is a key determinant for the recommendation of drug treatments and other interventions, for example, revascularization, with the aim of improving the quality and quantity of a patient's life. We here review our current approach to assessing the risk of future cardiovascular events in patients presenting with stable coronary artery disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/5222692/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"3 1","pages":"37-43"},"PeriodicalIF":0.0,"publicationDate":"2017-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.49","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78264380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiplatelet therapy in acute coronary syndrome","authors":"A. J. M. Brown,&nbsp;D. Austin","doi":"10.1002/cce2.48","DOIUrl":"10.1002/cce2.48","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Antiplatelet therapy is an essential component in the treatment of acute coronary syndromes (ACS). ACS management has evolved significantly over recent years with new antiplatelet agents with distinct pharmacological properties that offer a faster onset of action and greater potency. Prospective randomized controlled trials have not only focused on reducing ischemic events, but also on complications. There is a tipping point with safety/efficacy, beyond which bleeding risk can outweigh any anti-ischemic benefit. This tipping point is not fixed and estimating its position for an individual patient remains a major challenge and is critically influenced by a multitude of factors including age and comorbidity. The European Society of Cardiology (ESC) guidelines provide important direction to the trainee and practicing cardiologist. This article outlines development in antiplatelet therapy focusing on mechanism of action, the evolution in the evidence-base, clinical indications, and clinical controversies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/5222689/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"3 1","pages":"11-21"},"PeriodicalIF":0.0,"publicationDate":"2017-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.48","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83376115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of the current management of acute and chronic heart failure in the context of ischemic heart disease","authors":"P. F. Brown,&nbsp;J. Thambyrajah","doi":"10.1002/cce2.50","DOIUrl":"10.1002/cce2.50","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Heart failure secondary to left ventricular systolic dysfunction is a prevalent condition across Europe with ischemic heart disease the most common etiology. Acute heart failure is a medical emergency and management comprises diuretics and vasodilators. Several alternative intravenous treatments have been trialed in recent years but no mortality benefit has been found with these agents. For chronic heart failure there are several well-characterized disease-modifying treatments available which include beta blockers, ACE inhibitors, mineralocorticoid antagonists, and device therapy. Sacubitril/valsartan is a novel therapy that has recently been demonstrated to have additional prognostic benefit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/5222693/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"3 1","pages":"30-36"},"PeriodicalIF":0.0,"publicationDate":"2017-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.50","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80949374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventricular arrhythmias in acute coronary syndromes—mechanisms and management","authors":"D. E. Thomas,&nbsp;N. Jex,&nbsp;A. R. Thornley","doi":"10.1002/cce2.51","DOIUrl":"10.1002/cce2.51","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Ventricular arrhythmias occur commonly following myocardial infarction and carry important prognostic implications. The mechanisms involved are varied and time-dependent, changing with the evolution of the infarct, and this has implications for the management of both the arrhythmia and the index ischemic insult, which are discussed in this article. Current evidence-based best practice and management guidelines are reviewed, and consideration is given to some of the unique challenges that managing this group of patients brings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/5222694/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"3 1","pages":"22-29"},"PeriodicalIF":0.0,"publicationDate":"2017-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.51","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77290394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary issues in the management of patients with coronary artery disease across the cardiology spectrum","authors":"Jim Hall,&nbsp;Robert Wright","doi":"10.1002/cce2.46","DOIUrl":"10.1002/cce2.46","url":null,"abstract":"<p>Volume 4 of Continuing Cardiology Education focuses on the treatment of patients with coronary artery disease, CAD. All European cardiologists need to have a thorough knowledge of the issues that are discussed, since despite advances in our understanding of the prevention of CAD, patients suffering from its consequences increasingly seek help from cardiologists across all European countries and across all the subspecialty areas of cardiology. The authors of the articles are all practising clinicians working in an area with a particularly high prevalence of coronary artery disease, the North East of England. The regional cardiothoracic centre at The James Cook University Hospital in Middlesbrough serves a population of around 1.5 million people across Teesside, County Durham, North Yorkshire and Cumbria. The authors have drawn on their day to day experience of treating patients alongside the published literature to provide, for both the trainee in cardiology and the established specialist, a review and update of the essential knowledge needed to understand contemporary clinical practice. Where appropriate, the authors have referred to existing ESC guidelines. It must be remembered that not all the guideline recommendations can be based on firm evidence from randomized control trials or high quality observational research and there are unfortunately still a large number of recommendations based on only “expert opinion”. Where possible, we must work harder to reduce these sources of uncertainty with more research. It is also critical for us to be aware that when applying guidelines to individual cases, we need to know the strengths and weaknesses of the underlying evidence so that that guideline recommendations can be appropriately applied to a plan of care for an individual patient and not just follow a “one size fits all” approach.</p><p>For trainees in cardiology, the knowledge required across this area of cardiology is set out in the ESC Core Curriculum for General Cardiology (see particularly chapters 2.8 and 2.9) and how the acquisition and application of this knowledge fits into overall training is set out in the Training Requirements for the Specialty of Cardiology from the UEMS <span>1, 2</span>.Readers will be able to confirm their understanding of the material and gain EBAC CME credits by completion of the series of formative MCQs that have been prepared in conjunction with each of the articles. These MCQs have been modeled on the style of question used in the European Examination of General Cardiology, that is, there is a clinical stem, a single question followed by five possible answers with the need to select the single best answer. Further details about the EEGC are available at the UEMS-Cardiac Section website <span>3</span>. Completion of the formative MCQs can be used as evidence of successful knowledge acquisition, for example, for ongoing specialist revalidation or for the European Diploma of General Cardiology <span>4</span>.","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"3 1","pages":"2-3"},"PeriodicalIF":0.0,"publicationDate":"2017-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.46","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80780007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management strategies for severe aortic stenosis and coronary artery disease in the transcatheter aortic valve implantation era","authors":"M. M. Mahmood,&nbsp;D. F. Muir","doi":"10.1002/cce2.47","DOIUrl":"10.1002/cce2.47","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Coronary artery disease (CAD) and aortic stenosis (AS) frequently coexist. The advent of transcatheter aortic valve implantation (TAVI) and its increased use over the last decade has brought a paradigm shift in the management of patients with severe AS who are considered inoperable or high risk for sAVR. The most appropriate management of coexistent CAD in patients undergoing TAVI is yet to be defined. In this article, we present a review of the issues arising in the management of CAD in patients with severe AS—with particular reference to those who are undergoing TAVI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p><b>Answer questions and earn CME:</b> https://wileyhealthlearning.com/Activity2/5222680/Activity.aspx</p>\u0000 </section>\u0000 </div>","PeriodicalId":100331,"journal":{"name":"Continuing Cardiology Education","volume":"3 1","pages":"4-10"},"PeriodicalIF":0.0,"publicationDate":"2017-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/cce2.47","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82104707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}