EMJ Cardiology最新文献

{"title":"Cardiac Arrest in Pregnancy: End-Tidal CO2 Monitoring Could Guide Management in the Prehospital Setting","authors":"S. Einvik, T. Lafrenz, Stein-Vegar Johansen, I. M. Ringen, P. Bredmose","doi":"10.33590/emjcardiol/10314155","DOIUrl":"https://doi.org/10.33590/emjcardiol/10314155","url":null,"abstract":"This case report describes a 27-year-old pregnant woman with a gestational age of 26 weeks and 3 days who developed cardiac arrest in her home. Resuscitation was started immediately and continued on arrival at the hospital. Guidelines for resuscitation of cardiac arrest during pregnancy in-hospital include that a perimortem caesarean section (PMCS) should be performed if there is no return of spontaneous circulation within 4 minutes. The guidelines for prehospital treatment in such circumstances are more controversial. The triage on-site was based on the end-tidal carbon dioxide (ETCO2) monitoring showing that the quality of resuscitation being done was proficient and after a short on-scene time the patient was transported to the emergency department for PMCS on arrival. The resuscitation of the mother was not successful but the baby survived with no known sequelae after a total arrest time of 28 minutes before delivery. Monitoring of ETCO2 in resuscitation of cardiac arrest in pregnancy might be helpful in making the decision on whether to perform PMCS on-site or at a somewhat more appropriate location in the hospital.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122979108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing Real-World Patient Pathways in Acute Pulmonary Embolism","authors":"Sandy Agnew","doi":"10.33590/emjcardiol/10310296","DOIUrl":"https://doi.org/10.33590/emjcardiol/10310296","url":null,"abstract":"This case-based satellite symposium chaired by Prof Konstantinides addressed important and topical aspects of the management of acute pulmonary embolism (PE) with a focus on effective management in a real-world setting. The objectives of the symposium were to provide information and expert guidance on the effective management of a patient with PE from diagnosis and assessment of severity, through to the practical use of non-vitamin K antagonist non-oral anticoagulants (NOACs) and the management of challenging cases found in routine clinical practice. Following Prof Konstantinides’ introduction, Dr Hughes presented a low-risk PE case and discussed assessment of the severity of PE, the optimisation of hospital care, and the importance of patient discharge protocols and clear integrated management pathways. Dr Jiménez went on to illustrate the use of risk assessment and non-vitamin K antagonist (VKA) therapies through consideration of an intermediate high risk PE case with comorbidities. Finally, Dr Eikelboom presented an unprovoked PE case and discussed the key question of ‘how long is long enough’, emphasising the importance of adequate anticoagulation, both acutely and in prevention of recurrence, and the potential benefits of NOACs. In a final Question and Answer Hub session, the audience were able to participate in a lively case-based discussion.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116813123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Fabry Disease Patients Through Cardiac Manifestations","authors":"Blair R. Hesp","doi":"10.33590/emjcardiol/10310715","DOIUrl":"https://doi.org/10.33590/emjcardiol/10310715","url":null,"abstract":"The meeting’s objectives were to review the principles in diagnosing Fabry disease according to the European Society of Cardiology (ESC) guidelines on hypertrophic cardiomyopathy (HCM); to discuss the practical challenges in diagnosing Fabry disease in clinical practice; to investigate the long-term benefit of enzyme replacement therapy (ERT) for patients with Fabry disease; and to identify key patient populations with Fabry disease at risk of misdiagnosis.\u0000\u0000Prof Aleš Linhart opened the symposium by highlighting that a significant number of cardiologists are not aware of Fabry disease and that the average time to diagnosis is >10 years.1 The need for treatment of rare cardiomyopathies was also discussed. Prof Perry Elliott reviewed the ESC guidelines on diagnosis and management of HCM, and how they apply to Fabry disease. Prof Linhart then outlined how these guidelines can practically be applied, using case studies to illustrate the challenges in accurately identifying patients with a potential diagnosis of Fabry disease. Prof Linhart then demonstrated the long-term benefits of ERT for patients diagnosed with Fabry disease observed in Mainz, Germany, on behalf of Prof Christoph Kampmann, while Assoc Prof Jean-Claude Lubanda highlighted key patient populations with an increased prevalence of Fabry disease who should be targeted for screening to improve therapy and clinical outcomes.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131891353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Trials for the Diagnosis and Management of Stable Ischaemic Heart Disease: Context, Status, and Future Implications","authors":"D. Corcoran, K. Mangion, C. Berry","doi":"10.33590/emjcardiol/10312953","DOIUrl":"https://doi.org/10.33590/emjcardiol/10312953","url":null,"abstract":"Chest pain and coronary artery disease (CAD) impose a substantial burden on public health and society. Diagnostic imaging tests are used by clinicians to identify the presence and extent of epicardial coronary disease and/or its consequences, including ischaemia, infarction, and left ventricular dysfunction.\u0000\u0000In this article, we discuss current practice guideline recommendations for the diagnosis and management of patients with suspected or known CAD, and the need for more evidence from clinical trials. We then focus on the recently published and ongoing multicentre clinical trials of imaging-based strategies for the diagnosis and management of ischaemic heart disease, and the potential future impact of these trials on clinical practice. The results of these trials have the potential to bring radical changes to the practice of cardiology in the future.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"116 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126384540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When the Going Gets Tough, the Tough Get Going","authors":"A. Rodríguez de Ledesma","doi":"10.33590/emjcardiol/10313301","DOIUrl":"https://doi.org/10.33590/emjcardiol/10313301","url":null,"abstract":"Patients with elevated blood pressure (BP) represent a major problem for primary care physicians, not only because of the large number of these patients, but also because BP can prove frustratingly difficult to control in some of them. The management of treatment-resistant hypertension (TRH) is indeed a topic of considerable interest over the last few years, particularly since novel, non-pharmacological interventions held out the prospect of helping these patients. The theme of this mini-symposium was how currently available therapeutic tools can be used to manage ‘difficult-to-control’ patients with persistently elevated BP who may have apparent treatment resistance.\u0000\u0000To ensure that this symposium was relevant and practical, invited experts used a patient case in which treatment fails to control BP. One option in such a case might be to assume that the patient has apparent TRH. However, by looking at the case in more detail and carrying out a thorough clinical work-up, other factors such as pseudo-resistance or poor adherence might be playing important roles. The case was used to highlight the importance of investigating the reasons behind a patient’s failure to achieve BP control and the steps that can be taken to address these issues.\u0000\u0000Professor Josep Redòn introduced the clinical case and discussed the selection of appropriate management strategies and therapies. Estimation of the risk, based on the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) treatment guidelines, and details of the ongoing difficulties in reducing the patient’s elevated BP were also covered during his presentation. Professor Michel Burnier discussed in detail difficult-to-control BP and the need for clinical assessment. Among the topics covered were the patient’s referral to a specialist treatment centre, apparent resistance to modification/intensification of treatment, detailed investigation to rule out spurious resistant hypertension, assessment of treatment adherence, and development of a plan or management strategy to educate and motivate the patient and improve adherence to treatment. Professor Massimo Volpe discussed the ongoing management of difficult-to-control patients using strategies designed to favour adherence, including single-pill, fixed-dose combination (FDC) therapy. The meeting was concluded with an interactive discussion, in which the audience raised issues arising from the case presented; these included poor adherence, spurious TRH as a misdiagnosis, and the need for a thorough clinical assessment in order to identify the true cause of the failure to control BP.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114683541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Blood Pressure Control: At the Cutting Edge","authors":"Lynda M. McEvoy","doi":"10.33590/emjcardiol/10311935","DOIUrl":"https://doi.org/10.33590/emjcardiol/10311935","url":null,"abstract":"Prof Williams opened the symposium by discussing the current state of blood pressure (BP) control in Europe and the key barriers to improving BP control rates. Prof Weiss presented the ‘Low BP in Vienna’ initiative that has been initiated in Austria in order to improve BP control. Prof Mourad discussed the ongoing campaign to improve BP control rates in France, and Prof Volpe presented a case study of an elderly patient with hypertension and chronic kidney disease (CKD). Prof Parati concluded the symposium by commenting on the improvements in technology with respect to BP control.\u0000\u0000The meeting objectives were to review the current achievement of BP goals in Europe since 2008; to evaluate the 70% BP goal initiatives in France and Italy; to use practical examples to assess the use of single-pill fixed-dose combinations (FDCs); and to assess the impact of technological advances on BP control.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"131 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114434220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Hypertension in New Frontiers","authors":"A. L. RODRIGUEZ DE LEDESMA","doi":"10.33590/emjcardiol/10314892","DOIUrl":"https://doi.org/10.33590/emjcardiol/10314892","url":null,"abstract":"This symposium provided an excellent forum in which to discuss the global burden of hypertension (HTN), its challenges, and approaches to best management in new frontiers. The symposium speakers also reviewed recent data for clinical practice, especially those relevant for patients at high risk of HTN. The presentations were delivered within a highly interactive setting to facilitate audience questions and discussion.\u0000\u0000The symposium was opened by Prof Bryan Williams, who gave a description of the global burden of HTN, emphasising the need for effective, simplified treatment strategies and algorithms to effectively control blood pressure (BP). Prof Gordon Thomas McInnes then gave an overview of the challenges faced when treating HTN in the developing world and the best management practices of HTN adopted across different countries. HTN control in Latin America (LA) and the Caribbean region, and its opportunities and challenges was the subject of the next presentation given by Dr Jesús Isea-Pérez. Lastly, Dr Jorge Sison discussed HTN control in Asia and the Middle East, presenting real-world data in addition to a review of the latest clinical data on optimal management of HTN, and focussing on the use of single-pill combination (SPC) therapies. This engaging and interactive symposium was facilitated by multiplechoice questions posed by speakers, allowing audience participation via an electronic voting system. The meeting closed with a lively panel discussion and concluding remarks from Prof Bryan Williams.\u0000\u0000This truly international symposium brought together more than 550 delegates from across Europe and North America, Africa and the Middle East, Asia and Pacific regions, and Central and South America, with attendees representing a wide range of clinical and professional settings.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129920109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Program on the Surgical Control of the Hyperlipidemias (POSCH) and the Lipid Regulatory Hypothesis","authors":"William E. Feeman, Jr., Stanley E. Williams, H. Buchwald","doi":"10.33590/emjcardiol/10313436","DOIUrl":"https://doi.org/10.33590/emjcardiol/10313436","url":null,"abstract":"Background: The Lipid Regulatory Hypothesis (LRH) states that the best way to regress atherosclerotic plaque is to simultaneously decrease the cholesterol being transported into the arterial wall by low-density lipoprotein (LDL) and increase the cholesterol being removed from the arterial wall, via reverse cholesterol transport, by high-density lipoprotein (HDL). The cholesterol retention fraction (CRF) is defined as (LDL cholesterol minus HDL cholesterol) divided by LDL cholesterol. The Program on the Surgical Control of the Hyperlipidemias (POSCH), which employed partial ileal bypass as the intervention modality, was selected for verification of the LRH and the validity of the CRF.\u0000Methods: POSCH coronary arteriographic plaque progression or non-progression (stabilisation/regression) from baseline to 3 years was stratified on a five-by-five factorial grid with 25 cohort cells combining LDL cholesterol and HDL cholesterol changes from baseline to 1 year following intervention. Predictive capacity for arteriography changes of LDL cholesterol and CRF were compared. Statistics used were logistic regressions.\u0000Results: There were 731 paired arteriographic assessments of individual POSCH patients: 163 progression (22%) and 568 non-progression (stabilisation/regression) (78%). A reciprocal LDL cholesterol and HDL cholesterol relationship represented as a five-by-five factorial showed non-progression above and progression below the dividing diagonal. 100% (163/163) of patients with plaque progression had a rise in their CRF; and 100% (568/568) of patients with plaque non-progression had a fall in their CRF. LDL cholesterol, HDL cholesterol, and CRF were all highly significant predictors of plaque progression and non-progression (p<0.0001).\u0000Conclusion: In POSCH, the partial ileal bypass-induced changes in the LDL cholesterol, HDL cholesterol, and the CRF are highly correlated with the sequential coronary arteriography changes of plaque progression and non-progression. This study affirms that individual patient prognosis can be predicted by the magnitude of response to lipid intervention.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117080219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How I Treat: Coronary Heart Disease: The Pleiotropic Effects of Statins","authors":"P. Vitulli, M. Peruzzi, G. Biondi‐Zoccai, E. Greco, A. Marullo, G. Frati","doi":"10.33590/emjcardiol/10311100","DOIUrl":"https://doi.org/10.33590/emjcardiol/10311100","url":null,"abstract":"EMJ EUROPEAN MEDICAL JOURNAL CARDIOLOGY • February 2015 EMJ EUROPEAN MEDICAL JOURNAL 78 79 Cardiovascular (CV) diseases currently represent the first cause of death in industrialised countries with coronary heart disease (CHD) corresponding to the zenith of the phenomenon being responsible either for acute CV events or chronic heart failure (HF). Over 7 million people every year die from CHD, accounting for 12.8% of all deaths. Dyslipidaemias undeniably play a pivotal role in the pathogenesis and progression of atherosclerosis, and lipid lowering with statins is an essential and integral part of CHD prevention and management. Statins are the most widely prescribed drugs worldwide for lowering blood cholesterol levels. They have been used for over 20 years, and have been found to be effective, safe, and well tolerated over a broad range of patients.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130863442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter Options for Treatment of Mitral Regurgitation","authors":"Schaefer Schaefer, H. Treede, H. Reichenspurner, L. Conradi","doi":"10.33590/emjcardiol/10313924","DOIUrl":"https://doi.org/10.33590/emjcardiol/10313924","url":null,"abstract":"Transcatheter therapy for valvular heart disease (VHD) as an alternative for surgery, as the standard of care, has emerged rapidly over the last 10 years. Since the first transcatheter heart valve (THV) implantation in pulmonary position, in 2000, and in aortic position, in 2002, an enormous number of high-risk patients have undergone percutaneous aortic valve implantation and a wide variety of commercially available THVs have emerged within the medical sector. Interventional mitral valve repair (MVR) and implantation started with a variety of devices developed by industry, but few are available at the moment. In this article percutaneous systems for the treatment of mitral regurgitation (MR) in high-risk patients are introduced and discussed. Technologies currently under development can be classified by their anatomical approach. To date, only the percutaneous edge-to-edge approach is applied on a larger scale in clinical routine with the MitraClip device. Several other technologies for percutaneous MVR have achieved first-in-man results. For comparable results of transcatheter MVR to surgical MVR a combination of these technologies may be required. The field of transcatheter mitral valve implantation is evolving quickly as well. With half a dozen devices under development right now and a few entering the clinical test stage it may be just a matter of time until a THV for the mitral position will become commercially available. Considering that MR is among the most frequent entities in VHD and, furthermore, that life expectancy will continue to increase, it can be anticipated that in the near future there will be percutaneous strategies needed for the treatment of MR in high-risk patients. At present, all devices have to be restricted to inoperable patients or to compassionate use settings. However, once clinical proof of safety and efficacy have been demonstrated, extension to a broader patient spectrum seems likely. To ensure cautious and safe clinical introduction of these novel therapeutic options, guidance by interdisciplinary dedicated heart teams is of paramount importance.","PeriodicalId":284912,"journal":{"name":"EMJ Cardiology","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114392823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}