ESC CardioMed最新文献_第8页

Therapeutic options in chronic rheumatic heart disease 慢性风湿性心脏病的治疗选择

ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/MED/9780198784906.003.0286

M. Essop

引用次数: 0

Assessment of coronary artery disease: nuclear myocardial perfusion imaging in specific patient populations 冠状动脉疾病的评估:特定患者群体的心肌灌注成像

ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/MED/9780198784906.003.0125

D. Neglia, J. Knuuti

{"title":"Assessment of coronary artery disease: nuclear myocardial perfusion imaging in specific patient populations","authors":"D. Neglia, J. Knuuti","doi":"10.1093/MED/9780198784906.003.0125","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0125","url":null,"abstract":"The use of nuclear myocardial perfusion imaging (MPI) for the assessment of coronary artery disease (CAD) may have advantages in specific patient populations. While in asymptomatic individuals it is in general not recommended, it can be considered to detect myocardial ischaemia and CAD in specific patients at high risk such as patients with diabetes. In patients with angina but without obstructive CAD, MPI and in particular positron emission tomography (PET), is considered the reference imaging modality to evaluate the presence and extent of coronary microvascular dysfunction. Quantitation by PET, and more recently by single-photon emission computed tomography (SPECT), of myocardial blood flow and flow reserve is able to stratify the prognostic risk in this population. This is one of the reasons why SPECT and in particular PET have a specific application to recognize suspected CAD in women. In fact, even if women frequently have less anatomical obstructive disease than men, they are not necessarily protected from ischaemic cardiovascular events, possibly because of higher prevalence of diffuse endothelial/microvascular coronary dysfunction. In the growing elderly population with higher prevalence of obstructive CAD, stress nuclear MPI (with pharmacological vasodilatation in patients unable to adequately exercise) is particularly useful for its high sensitivity to diagnose significant CAD and its ability to stratify the risk and indicate possible revascularization. Similarly, nuclear MPI is particularly useful in patients with angina and chronic kidney disease who have a higher probability of obstructive CAD. On the other hand, no data exist that demonstrate a clinical benefit for screening asymptomatic patients with chronic kidney disease by MPI imaging.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"5 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":"131875585","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}

引用次数: 0

Atrial fibrillation progression and prevention 房颤的进展和预防

ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/MED/9780198784906.003.0501

J. Luermans, J. Heijman, I. C. Gelder, H. Crijns

引用次数: 0

Lipid-lowering drugs 降脂药物

ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/med/9780198784906.003.0039

C. Sirtori, M. Ruscica

{"title":"Lipid-lowering drugs","authors":"C. Sirtori, M. Ruscica","doi":"10.1093/med/9780198784906.003.0039","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0039","url":null,"abstract":"Hyperlipidaemias, multifactorial conditions partly genetically and partly life habit induced, are the most important underlying risk factors for cardiovascular disease. They can lead to arterial lipid deposition with a consequent increased risk of coronary events. The primary effort in hypolipidaemic drug therapy is focused on the lowering of the primary carriers of cholesterol, the low-density lipoproteins (LDLs), but more recent efforts have been placed on the lowering of triglycerides. Reduced levels of the protective high-density lipoproteins (HDLs) are generally considered a primary risk factor, ‘dysfunctional’ HDL may probably be a more important factor. Among drugs primarily reducing LDL cholesterol the most important systemic agents are statins. Non-systemic agents, such as resins, have a lesser use, whereas ezetimibe is frequently given in combination with statins. A new series of systemic compounds, the inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9), recently available, have a higher activity on LDL cholesterol. Drugs indicated for the treatment of the homozygous forms of hypercholesterolaemia are lomitapide, an inhibitor of the microsomal transfer protein, and the antisense nucleotide mipomersen, designed to inhibit synthesis of apolipoprotein B. Treatment of hypertriglyceridaemias mainly relies on fibrates, activating the peroxisomal proliferator-activated receptor-α‎. They treat particularly the atherogenic dyslipidaemias (elevated triglycerides with low HDL cholesterol). Nicotinic acid is less frequently used and the omega-3 fatty acids have an as yet unclear cardiovascular protective activity.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"56 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":"115396193","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}

引用次数: 0

Referral centres and patient education 转介中心和病人教育

ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/med/9780198784906.003.0601

J. Simon, R. Gibbs

引用次数: 0

Medical management: pharmacological therapy 医疗管理:药物治疗

ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/MED/9780198784906.003.0337

A. Shaul, D. Hasdai

引用次数: 1

Epidemiology of supraventricular tachycardias 室上性心动过速的流行病学

ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/MED/9780198784906.003.0476

G. Lip

引用次数: 0

Management of pulmonary embolism in pregnancy 妊娠期肺栓塞的处理

ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/med/9780198784906.003.0665

T. E. Mens, S. Middeldorp

{"title":"Management of pulmonary embolism in pregnancy","authors":"T. E. Mens, S. Middeldorp","doi":"10.1093/med/9780198784906.003.0665","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0665","url":null,"abstract":"Pulmonary embolism, although rare, is a leading cause of maternal mortality. There is no strong evidence base for the diagnosis and management of pregnancy-related pulmonary embolism, hampering firm recommendations. In women with a suspicion of pulmonary embolism, the diagnosis is confirmed in 1 in 25–30 women only. However, imaging is always necessary to exclude pulmonary embolism, as no clinical decision rules or D-dimer-based strategies have been validated in pregnancy. Computed tomography pulmonary angiography and pulmonary scintigraphy are both suitable modalities, unless deep vein thrombosis is confirmed by compression ultrasonography of lower limb veins. Low-molecular-weight heparin (LMWH) in therapeutic doses is the treatment of choice during pregnancy, and anticoagulation should be continued until 6 weeks after delivery with a minimum total duration of 3 months. Use of LMWH or vitamin K antagonists does not preclude breastfeeding. Whether dosing should be based on weight or anti-Xa levels is unknown, and practices differ between centres. Management of delivery, including the type of anaesthesia if deemed necessary, requires a multidisciplinary approach, and several options are possible, depending on local preferences and patient-specific conditions. Prevention of pulmonary embolism with LMWH is indicated in all postpartum women with a history of venous thromboembolism, and in most women also during pregnancy.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"20 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":"114423075","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}

引用次数: 0

Aortitis: infectious and non-infectious diseases 大动脉炎:传染性和非传染性疾病

ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/MED/9780198784906.003.0625

R. Cocchia, R. Gorla, E. Bossone

{"title":"Aortitis: infectious and non-infectious diseases","authors":"R. Cocchia, R. Gorla, E. Bossone","doi":"10.1093/MED/9780198784906.003.0625","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0625","url":null,"abstract":"Aortitis includes infectious or more frequently non-infectious conditions leading to inflammation of the aorta. This represents a rare but potentially risky disease since it can be complicated by acute aortic syndromes and thrombosis. Non-infectious aortitis in most cases is associated with rheumatological conditions and in particular, is more frequent in giant cell arteritis and in Takayasu arteritis. It may also occasionally follow an endovascular aortic repair. Given the non-specific symptoms and physical signs, a high clinical index of suspicion is necessary to detect the disease. In the majority of cases, erythrocyte sedimentation rate and C-reactive protein level may be increased, reflecting disease activity. However, an integrated multimodality approach remains essential in order to confirm the diagnosis, detect life-threatening complications, and guide therapeutic interventions. In non-infectious aortitis, corticosteroids (prednisone) represent the first-line initial and long-term therapy. Second-line agents include methotrexate, azathioprine, and anti-tumour necrosis factor-alpha agents. However, in a substantial number of cases disease relapse may occur, requiring additional immunosuppression.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"17 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":"114594916","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}

引用次数: 0

Hypertension in special situations 特殊情况下的高血压

ESC CardioMed Pub Date : 2018-07-01 DOI: 10.1093/med/9780198784906.003.0572

T. Kahan

{"title":"Hypertension in special situations","authors":"T. Kahan","doi":"10.1093/med/9780198784906.003.0572","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0572","url":null,"abstract":"Hypertensive emergencies are a heterogeneous group of acute hypertensive disorders with very high blood pressure and acute hypertension-mediated organ damage, which require rapid recognition and treatment with the appropriate therapy to avoid progressive organ dysfunction. Key target organs of acute hypertension-mediated organ damage are the heart, retina, brain, kidneys, and large arteries. The type of organ damage will determine the preferred drug, target blood pressure, and the timeframe for blood pressure reduction. Patients without acute hypertension-mediated organ damage do not have a hypertensive emergency. Initial management of acute aortic dissections are directed at haemodynamic stabilization, including rapid reduction of blood pressure to less than 120 mmHg and heart rate to less than 60 beats/min to minimize exposure of the aortic wall to shear stress, always including a beta blocker. Preoperative severe uncontrolled hypertension is associated with an increased rate of perioperative complications and qualifies as the most frequent medical condition for postponing non-cardiac surgery. Pregnancy-related hypertensive disorders are common and are associated with an increased maternal and fetal risk during pregnancy, and an increased long-term maternal risk for future hypertension and cardiovascular disease. Hypertensive heart disease can manifest as cardiac atrial and ventricular arrhythmias, most commonly being atrial fibrillation. Appropriate blood pressure control will reduce incident atrial fibrillation. Anticoagulant therapy is often indicated in hypertensive patients with atrial fibrillation.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"14 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":"115006601","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}

引用次数: 0