ESC CardioMedPub Date : 2018-12-01DOI: 10.1093/med/9780198784906.003.0693_update_001
V. Regitz-Zagrosek
{"title":"Cardiomyopathies and heart failure in pregnancy","authors":"V. Regitz-Zagrosek","doi":"10.1093/med/9780198784906.003.0693_update_001","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0693_update_001","url":null,"abstract":"Treatment of cardiomyopathies (CM) and heart failure (HF) in pregnancy is based on the respective guidelines with some pregnancy-specific limitations. CM is a rare but serious cause of HF and currently the most frequent cause of maternal mortality in pregnancy. All forms of CM may occur in pregnancy, but peripartum CM (PPCM) is a specific and dangerous manifestation. Some new treatment options are arising based on its precise pathophysiology. Dilated CM (DCM) has a high risk of deterioration in pregnancy. In contrast, hypertrophic CM (HCM) is frequently tolerated well. Delivery should be well planned and some limitations on breastfeeding should be considered. HF with preserved EF (HFpEF) does presently not appear to be a major clinical problem in pregnancy.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123056094","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}
ESC CardioMedPub Date : 2018-12-01DOI: 10.1093/med/9780198784906.003.0706_update_001
A. Zorzi, D. Corrado
{"title":"Clinical assessment of the athlete’s heart","authors":"A. Zorzi, D. Corrado","doi":"10.1093/med/9780198784906.003.0706_update_001","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0706_update_001","url":null,"abstract":"The electrocardiographs (ECG) of trained athletes may show changes that represent the consequence of the heart’s adaptation to physical exercise (‘athlete’s heart’) such as enlarged cardiac chamber size and increased vagal tone. Such physiological ECG changes must be differentiated from the ECG abnormalities secondary to an underlying cardiovascular disease that can cause sudden cardiac death during exercise. The ECG changes of athletes are classified according to their prevalence, relation to exercise training, association with an increased risk of cardiovascular disease, and need for further investigations: common ECG changes should be considered as a benign sign of physiological adaptation to exercise and the athlete should be allowed to participate in competitive sports without additional evaluation; on the other hand, further work-up to exclude an underlying cardiac disease should be performed in case of uncommon and training-unrelated abnormalities, which may be associated with an underlying cardiovascular disease. The present chapter reviews the abnormalities that may be found in an athlete’s ECG and proposes criteria for interpretation of such changes as normal variants or abnormal findings that need further assessment.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123610037","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}
ESC CardioMedPub Date : 2018-12-01DOI: 10.1093/med/9780198784906.003.0604_update_001
M. Humbert
{"title":"Conclusion","authors":"M. Humbert","doi":"10.1093/med/9780198784906.003.0604_update_001","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0604_update_001","url":null,"abstract":"Pulmonary hypertension is a fast-growing field in cardiopulmonary medicine. Thanks to recent advances summarized in the 2015 European Society of Cardiology/European Respiratory Society guidelines, evidence-based pulmonary hypertension management can now be provided to all pulmonary hypertension patients. There are, however, important gaps of evidence which should be clarified in future work.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"522 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123410245","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}
ESC CardioMedPub Date : 2018-12-01DOI: 10.1093/med/9780198784906.003.0161_update_001
D. Barge-Schaapveld, M. DeRuiter, Conny C. van Munsteren, M. Jongbloed
{"title":"Genetics of CV diseases","authors":"D. Barge-Schaapveld, M. DeRuiter, Conny C. van Munsteren, M. Jongbloed","doi":"10.1093/med/9780198784906.003.0161_update_001","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0161_update_001","url":null,"abstract":"Congenital heart defects (CHD) are the most common congenital defects. As a substantial number of patients with CHD now reach the reproductive age, the cardiologist dealing with grown up patients with CHD is confronted with questions of patients regarding impact of their CHD on pregnancy and offspring, and genetic counselling is becoming more relevant to clinical practice. Developments in the field of clinical genetics do not always facilitate the clinicians' knowledge and reasoning. Interpretation of the often-large DNA datasets is challenging, especially in the light of phenotypic heterogeneity and incomplete penetrance, and requires specific expertise. In this chapter the genetics of CHD are addressed. An overview of 'causative' genes is provided, i.e. genes with a high likelihood to be involved in the development of human CHD and found so far to harbour (likely) pathogenic mutations in patients. In addition, the challenges and limitations in determining such genes are addressed and pitfalls in interpreting DNA variants in these genes discussed. The fact that single genes may in some instances be associated with different forms of CHD, may be explained by the broad range of cellular contribution during embryology, which will be briefly addressed. Finally, practical recommendations in addressing the genetics of CHD are provided.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132738389","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}
ESC CardioMedPub Date : 2018-07-01DOI: 10.1093/MED/9780198784906.003.0230
D. Holmes, G. Reeder, H. Mattle
{"title":"Closure of a patent foramen ovale for the prevention of stroke","authors":"D. Holmes, G. Reeder, H. Mattle","doi":"10.1093/MED/9780198784906.003.0230","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0230","url":null,"abstract":"The prevention of stroke has attracted great interest related to two major issues: (1) the enormous patient and family consequences of the impact of stroke in their lives and accordingly their great interest in preventing either an initial event or a recurrent event. Stroke may be considered the most devastating complication of cardiovascular disease. (2) The societal impact and cost of the complications of stroke both as mortality but as importantly long-term disability. Cardioembolic strokes are associated with the highest mortality and morbidity and also have the highest rate of recurrence. The role of a patent foramen ovale (PFO) has received great attention in part because of the graphic images both postmortem and echocardiographic of thrombi transiting the PFO right to left resulting in stroke or systemic thromboembolism. Several strategies have been developed including the intuitively obvious one of mechanically closing the PFO; multiple devices have been developed and are now used clinically. Assessment of the effect of device closure on stroke or transient ischaemic attack has been difficult. This is related to several factors including the high prevalence of PFO in the entire population compared with the low incidence of embolic events, the specific population in which the device is tested, and the fact that medical therapy can be effective in some patients. There is still controversy about optimal patient selection criteria for device implantation and its role relative to medical therapy. Optimal patients in whom to consider implantation include patients with cryptogenic stroke, particularly those with recurrent events.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115227110","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}
ESC CardioMedPub Date : 2018-07-01DOI: 10.1093/med/9780198784906.003.0065
Dianne Sika-Paotonu, A. Beaton, J. Carapetis
{"title":"Epidemiology and global burden of rheumatic heart disease","authors":"Dianne Sika-Paotonu, A. Beaton, J. Carapetis","doi":"10.1093/med/9780198784906.003.0065","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0065","url":null,"abstract":"Acute rheumatic fever is caused by the body’s autoimmune response to a group A streptococcal infection, classically pharyngitis. Rheumatic heart disease refers to the long-term cardiac damage caused by either a single severe episode or multiple recurrent episodes of acute rheumatic fever. It is rheumatic heart disease that remains a significant worldwide cause of morbidity and mortality, particularly in resource-poor settings. Improved living conditions and widespread treatment of superficial group A streptococcal infections have meant acute rheumatic fever/rheumatic heart disease are now rare in developed countries although some Indigenous populations living in wealthy nations are adversely affected. Acute rheumatic fever largely affects children between the ages of 5–14 years with risk factors for acute rheumatic fever/rheumatic heart disease including age, sex, environmental influences that increase exposure to group A streptococcal infections, and host susceptibility. Since rheumatic heart disease results from cumulative damage, the peak prevalence of clinically symptomatic rheumatic heart disease occurs between the ages of 20–40 years. Conservative estimates indicate between 275,000 and 345,000 deaths occur each year from rheumatic heart disease with global burden of disease figures in 2013 calculating at least 32.9 million prevalent rheumatic heart disease cases. In 2015, rheumatic heart disease was ranked as the 43rd leading cause of years of life lost and is attributed to an annual 1.8 million years lived with disability and 9 million lost disability-adjusted life years. More than 75% of the world’s children are currently living in countries where rheumatic heart disease remains endemic. Effective rheumatic heart disease prevention, control, and management warrants prioritization if World Health Organization global targets to reduce premature deaths from cardiovascular diseases by 25% by 2025 are to be achieved.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"168 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115751059","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}
ESC CardioMedPub Date : 2018-07-01DOI: 10.1093/med/9780198784906.003.0723
T. Kessler, H. Schunkert
{"title":"Personalized management of coronary artery disease","authors":"T. Kessler, H. Schunkert","doi":"10.1093/med/9780198784906.003.0723","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0723","url":null,"abstract":"Coronary artery disease and myocardial infarction are main causes of morbidity and mortality. In the past decades, several modifiable and non-modifiable risk factors underlying the disease have been identified. Recently, genome-wide association studies and next generation sequencing led to the discovery of genetic risk factors. Knowledge of these genetic risk factors has been shown to help to understand the pathophysiology of coronary atherosclerosis. Their knowledge might also be useful in risk prediction and diagnostics. Ultimately, an integrated approach using genetic information and novel imaging technologies should improve treatment strategies towards a personalized medicine. Here, we want to summarize recent findings in this research field and provide insight how these developments could be used to improve prevention and treatment of coronary atherosclerosis and its sequelae.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125205940","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}
ESC CardioMedPub Date : 2018-07-01DOI: 10.1093/MED/9780198784906.003.0319
R. Citro, E. Bossone
{"title":"Diagnostic testing in takotsubo syndrome","authors":"R. Citro, E. Bossone","doi":"10.1093/MED/9780198784906.003.0319","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0319","url":null,"abstract":"At onset, takotsubo syndrome (TTS) resembles the clinical picture of an acute coronary syndrome. The most frequent electrocardiographic findings are ST-segment elevation, T-wave inversion, and Q waves. The detection of ST-segment depression in lead aVR is associated with high specificity with TTS and can be useful for early suspicion. Although increased serum troponin levels are reported in about 90% of patients, the concentrations of troponin and other cardiac necrosis enzymes are usually lower in TTS than in acute myocardial infarction. Transthoracic echocardiography is the first-line non-invasive imaging modality in the acute phase showing a depressed left ventricular (LV) ejection fraction, which recovers within few days or weeks. LV wall motion abnormalities extend beyond the territory of distribution of a single coronary artery and involve symmetrically the LV walls (‘circumferential pattern’). Echocardiography also provides additional information regarding the presence of reversible significant mitral regurgitation, LV outflow tract obstruction, right ventricular involvement, and intraventricular thrombi. Coronary angiography is the cornerstone of diagnosis since TTS is characterized by the absence of atherothrombotic lesions of the epicardial coronary arteries. Coronary computed tomography angiography is an alternative to coronary angiography only in stable and pain-free patients showing the typical features of TTS, especially if coronary angiography is not readily available. Cardiac magnetic resonance is useful in patients with poor acoustic windows or with suspected TTS and incomplete LV myocardial function recovery during follow-up, helping to exclude a different aetiology. Nuclear imaging tests can be performed for prognostic purposes during the acute and subacute phase.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117067094","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}
ESC CardioMedPub Date : 2018-07-01DOI: 10.1093/MED/9780198784906.003.0508
J. Tamargo
{"title":"Rhythm control: antiarrhythmic drugs","authors":"J. Tamargo","doi":"10.1093/MED/9780198784906.003.0508","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0508","url":null,"abstract":"Atrial fibrillation (AF) is the most common chronic arrhythmia and a major cause of cardiovascular morbidity and mortality. The rhythm control strategy involves the use of antiarrhythmic drugs (AADs) to (1) facilitate the cardioversion of recent-onset AF (<7 days) to sinus rhythm in symptomatic patients without haemodynamic instability. Pre-treatment with AADs facilitates direct current cardioversion and their use for 1–2 months prevents immediate/early recurrences of AF after direct current cardioversion or catheter ablation; and (2) maintain sinus rhythm and prevent recurrences of AF. AADs reduce rather than eliminate AF recurrences. However, a recurrence is not equivalent to treatment failure if AADs render AF less symptomatic, briefer, and less frequent. A significant reduction in AF burden with an improvement in quality of life represents a therapeutic success for many patients. However, AADs present a limited efficacy and can produce serious adverse effects, mainly proarrhythmia and organ toxicity. Therefore, the benefit/risk ratio of the rhythm control should be carefully considered before starting the treatment, and safety, rather than efficacy, should be the primary guide to the final choice of AADs. Combination of AADs with non-pharmacological strategies and upstream therapies and optimal management of co-morbidities which promote AF should be pursued to reduce AF burden and facilitate maintenance of sinus rhythm.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":" 14","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120832201","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}
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