ESC CardioMedPub Date : 2018-07-01DOI: 10.1093/med/9780198784906.003.0710
T. Grodzicki, K. Piotrowicz, Jonna Sulicka
{"title":"Multimorbidity and polypharmacy in the elderly with cardiovascular diseases","authors":"T. Grodzicki, K. Piotrowicz, Jonna Sulicka","doi":"10.1093/med/9780198784906.003.0710","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0710","url":null,"abstract":"Ageing is commonly associated with multiple concomitant chronic diseases resulting in a variety of functional deficits. The average number of diseases increases from two or three in patients in their early seventies to four or five in those in their late eighties. On the top of chronic medical problems, the aged person frequently faces sensory impairments, cognitive disorders, sarcopenia, incontinence, or limitations in everyday living. Moreover, some elderly people suffer from the aftereffects of disorders previously successfully treated, such as myocardial infarction, stroke, cancer, or accidents. Although a variety of measures have been introduced to assess multimorbidity, good clinical data and proper guidelines on how to individualize diagnostic and therapeutic strategies in such complex patients are lacking. The progress in medicine leading to development of sophisticated subspecialties and innovative treatments often results in fragmentation of care, higher costs, and difficulties in establishing and achieving therapeutic goals. In addition, such a multidisciplinary approach results in ill-defined responsibilities for numerous healthcare workers involved in the care of an individual patient. Thus, in elderly patients with multimorbidity, an assembly of medical specialists, physiotherapists, nurses, and social workers ideally should assess care needs and develop healthcare model to optimize preventive and therapeutic strategies. Conceivably, providing a single care coordinator for any given geriatric patient with multimorbidities would facilitate the implementation of such a care plan. Clearly, when approaching the elderly patient with multimorbidity, the dictum ‘Quod medicina aliis, aliis est acre venenum’ (‘What is medicine to some, is bitter poison to others’) should be taken to heart.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"8 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":"115218027","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/9780198784906.003.0606
R. Erbel
{"title":"The normal aorta","authors":"R. Erbel","doi":"10.1093/MED/9780198784906.003.0606","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0606","url":null,"abstract":"The aorta connects the left ventricle to the limb arteries. The segmentation includes different landmarks of the thoracic and abdominal aorta used to describe the integrity of the whole aorta. The aorta can be regarded as a connecting tube with elastic properties for pulsatile continuous flow with systolic forward and early diastolic backward flow in the ascending aorta. Different techniques have been used for measurement of elastic aortic properties, for example, pulse wave velocity correlates with cardiovascular risk and can regarded as a surrogate parameter for risk prediction. It received a class IIa, level of evidence B recommendation in the 2014 European Society of Cardiology Guidelines on the diagnosis and treatment of aortic diseases. Normal values of the aorta have been presented for men and women and demonstrate a continuous enlargement during ageing. Aortic diameters depend on body mass index and age, increasing by approximately 0.9 mm in men and 0.7 mm in women for each decade of life. For clinical use, the diameter indexes have not been found to be of additional value except for people with stature abnormalities. In the future, not only diameters but also parameters of aortic distensibility, elasticity, and flow patterns will be used in order to better identify patients at risk.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"3 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":"115328941","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/9780198784906.003.0714
Ludovico Carrino, S. Maggi, N. Veronese
{"title":"Socioeconomic issues and cardiovascular disease (with emphasis on the caregivers)","authors":"Ludovico Carrino, S. Maggi, N. Veronese","doi":"10.1093/MED/9780198784906.003.0714","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0714","url":null,"abstract":"Cardiovascular disease (CVD) is the leading cause of death, disability, and poor quality of life. Several conditions are widely known as potential CVD risk factors. Increasing research is, however, showing a role for low socioeconomic status (SES) as a potential risk factor for CVD development. This chapter analyses the current epidemiological evidence on this topic, explaining the reasons why people who have low SES are at increased risk of CVD. People with low SES, in fact, have a higher prevalence of several potential CVD risk factors (such as hypertension and cigarette smoking), but other important factors (such as less access to medical care and psychosocial factors) are likely to play a relevant role. Moreover, in the last part of this chapter, attention is focused on caregiving, another condition that seems to be associated with a higher risk of developing CVD, probably for the same reasons given for low SES.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"52 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":"116122752","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/9780198784906.003.0224
Åsa Hörnsten
{"title":"Person-centred care","authors":"Åsa Hörnsten","doi":"10.1093/MED/9780198784906.003.0224","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0224","url":null,"abstract":"Basics of person-centred care are values such as respect, autonomy, reciprocity, and understanding. A person is more than a patient. A person not only has wishes and needs, but also willpower, competence, and responsibilities. Prerequisites for person-centred care are professional competence, a functioning care environment including balanced power and relationships among professionals, a range of person-centred activities, and facilitating organizational systems with potential for innovations. In order to understand the patient as a person and become a partner, taking time to listen to his or her story facilitates the process. A story is also much more comprehensive than questions and answers. A safe relationship implies that the person dares to show weakness and will also include ‘weird’ ideas about health, illness, and treatment into their stories. Fear of pharmaceuticals or their effects (e.g. insulin) is common. Such conceptions sound strange for professionals but if we don’t listen to such stories and thereby don’t take them into account, our suggested options for treatment may be less effective and we won’t understand why. Views of illness, its severity, and the future seem to be of particular importance in person-centred care. These views on illness could easily be reflected on together with a health professional and would help people to integrate disease and its management into normal daily life.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"65 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":"122897490","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/9780198784906.003.0712_UPDATE_001
T. Strandberg, T. Nieminen
{"title":"Dementia and cardiovascular diseases","authors":"T. Strandberg, T. Nieminen","doi":"10.1093/MED/9780198784906.003.0712_UPDATE_001","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0712_UPDATE_001","url":null,"abstract":"Dementia is the end-stage of cognitive dysfunction, a syndrome where memory and/or other cognitive functions have progressively deteriorated. Dementia is typically a syndrome of older age and numbers are increasing due to the enlarging geriatric population. However, the age-adjusted incidence of dementia has been reported to be falling, implicating its risk to be modifiable. The causes and severity of dementia are very heterogeneous. Currently, Alzheimer disease (AD) is the most common specific diagnosis, but in old age, vascular cognitive impairment and dementia (VCID), and particularly a condition featuring both VCID and AD (mixed disease), is becoming increasingly important. However, any aetiology that damages the functions of the brain can cause clinical dementia. As vascular lesions in the brain become common with increasing age, the role of cardiovascular disease as a principal or contributing factor to dementias is probably underestimated. A complex and poorly understood balance between damaging and protecting factors is at the core of the disease. The diagnosis of cognitive dysfunction in older patients is predominantly clinical, and different aetiologies may give a similar phenotype. Currently, no curative treatment exist for dementia, whether AD or VCID, and treatment is symptomatic and supportive; however, it is important to treat concomitant diseases and cardiovascular disease risks optimally. Prevention of dementia is increasingly important, as it has been estimated that 30–60% of dementia could be preventable. As cardiovascular disease risk factors predispose also to AD diagnosed in clinical terms, the notion ‘what is good for the heart is good for the brain’ seems appropriate.","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":"122569541","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/9780198784906.003.0354
C. O’Mahony
{"title":"Hypertrophic cardiomyopathy: prevention of sudden cardiac death","authors":"C. O’Mahony","doi":"10.1093/med/9780198784906.003.0354","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0354","url":null,"abstract":"Sudden cardiac death (SCD) secondary to ventricular arrhythmias is the most common mode of death in hypertrophic cardiomyopathy (HCM) and can be effectively prevented with an implantable cardioverter defibrillator (ICD). The risk of SCD in HCM relates to the severity of the phenotype and regular risk stratification is an integral part of routine clinical care. For the primary prevention of SCD, risk stratification involves the assessment of seven readily available clinical parameters (age, maximal left ventricular wall thickness, left atrial diameter, left ventricular outflow tract gradient, non-sustained ventricular tachycardia, unexplained syncope, and family history of SCD) which are used to estimate the risk of SCD within 5 years of clinical evaluation using a statistical risk prediction model (HCM Risk-SCD). The 2014 European Society of Cardiology Guidelines provide a framework to aid clinical decisions and consider patients with a 5-year risk of SCD of less than 4% as low risk and recommend regular assessment while those with a risk of 6% or higher should be considered for an ICD. In patients with an intermediate risk (4% to <6%) ICD implantation may also be considered after taking into account age, co-morbid conditions, socioeconomic factors, and the psychological impact of therapy. Survivors of ventricular fibrillation arrest should receive an ICD for secondary prevention unless their life expectancy is less than 1 year. Following device implantation, patients should be followed up for device- and disease-related complications, particularly heart failure and cerebrovascular disease.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"163 35 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":"121887177","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/9780198784906.003.0084
T. Binder
{"title":"Technical equipment for echocardiography","authors":"T. Binder","doi":"10.1093/med/9780198784906.003.0084","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0084","url":null,"abstract":"Advances in ultrasound technology are shaping the way we apply echocardiography today. The industry has now developed a vast array of scanners that are targeted to different clinical requirements, budgets, and applications. In general, they can be categorized into high-end, mid-range, portable, and handheld scanners. Aside from image quality, much emphasis is placed on ergonomics, the user interface, and the patient data archiving system, which are all important to optimize workflow. Phased array transducers are used in echocardiography. Much of the signal processing (i.e. beam forming) occurs within the transducer. Further developments in computer processing and transducer technology have also led to the development of three-dimensional (3D) matrix array probes. Other transducer types necessary for a fully functional echocardiography laboratory include the pencil probe (for continuous wave spectral Doppler recordings) and the transoesophageal probe, which now also permits live 3D transoesophageal echocardiography scanning. Many of the functionalities of modern scanners are ‘software based’, where packages for specific applications such as stress echocardiography, speckle tracking, or advanced 3D image analysis can be integrated into the systems.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"50 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":"122018489","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/9780198784906.003.0799
J. Kaski, G. Norrish
{"title":"Childhood cardiomyopathy","authors":"J. Kaski, G. Norrish","doi":"10.1093/med/9780198784906.003.0799","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0799","url":null,"abstract":"Cardiomyopathy in childhood is a rare and heterogeneous disease. The true prevalence is unknown; however, epidemiological studies from the United States, Australia, and Finland have reported an annual incidence of between 0.65 and 12.4 per 100,000. The most common type of cardiomyopathy in childhood is dilated cardiomyopathy followed by hypertrophic cardiomyopathy, while restrictive cardiomyopathy and other forms are much rarer (58.6% vs 25.5% vs 2.5% respectively). Although children may present at any age, the majority present under 1 year of age (63.4%).","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"55 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":"122125704","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/9780198784906.003.0281
A. Cilliers
{"title":"Clinical features and diagnosis of acute rheumatic fever","authors":"A. Cilliers","doi":"10.1093/med/9780198784906.003.0281","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0281","url":null,"abstract":"The diagnosis of acute rheumatic fever cannot be made using a single test. The diagnosis requires the recognition of a complex of clinical signs divided into major and minor manifestations as well as laboratory investigations aided by application of the Jones criteria, originally devised in 1944. The clinical manifestations are secondary to the effects of antibodies produced against the group A Streptococcus organism which cross-react against cardiac, skin, synovial, and neurological tissue associated with signs of inflammation. Several adjustments to the Jones criteria have been published over the last 70 years. The latest 2015 American Heart Association modification includes echocardiography/Doppler studies to diagnose subclinical carditis and also incorporates risk stratification whereby at-risk populations are divided into low- and moderate-to-high-risk groups. The presence of a single episode of a fever of at least 38°C and a slight elevation of the erythrocyte sedimentation rate to at least 30 mm/hour are classified as minor criteria in moderate- and high-risk populations. A monoarthritis or polyarthralgia are included as major criteria in the same risk group.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"251 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":"122148167","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/9780198784906.003.0662
C. Becattini, G. Agnelli
{"title":"Treatment: anticoagulation","authors":"C. Becattini, G. Agnelli","doi":"10.1093/med/9780198784906.003.0662","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0662","url":null,"abstract":"Anticoagulant treatment should be given for at least 3 months to all patients with venous thromboembolism (VTE) in the absence of absolute contraindications. Several parenteral (unfractionated or low-molecular-weight heparin, fondaparinux) and oral anticoagulants are currently available for the treatment of VTE according to a sequential regimen (parenteral pretreatment followed by oral anticoagulants) or to a single-drug approach (completely managed with a single anticoagulant agent). Despite similar pharmacokinetics across direct oral anticoagulants, dabigatran and edoxaban have been developed according to a sequential regimen, and apixaban and rivaroxaban according to a single-drug approach. Improved practicality (with no need for laboratory monitoring or dose adjustment) and favourable safety profile are the main reasons to prefer direct oral anticoagulants over conventional anticoagulation in patients without severe renal failure or antiphospholipid syndrome.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"2 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":"129500939","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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