ESC CardioMedPub Date : 2018-07-01DOI: 10.1093/med/9780198784906.003.0106
Ria Garg, M. Friedrich
{"title":"Cardiomyopathies","authors":"Ria Garg, M. Friedrich","doi":"10.1093/med/9780198784906.003.0106","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0106","url":null,"abstract":"Cardiovascular magnetic resonance (CMR) is generally recognized as the most informative imaging technology for assessing patients with non-ischaemic cardiomyopathies. Beyond its standard-of-reference-quality quantitative data, it provides unique information on myocardial tissue characteristics that allows for the detection, localization, and spatial quantification of myocardial oedema, fibrosis, and infiltration. This not only provides an accurate discrimination of non-ischaemic from ischaemic myocardial disease, but also has led to very specific diagnostic criteria for certain cardiomyopathies (e.g. myocarditis, cardiac amyloidosis, myocardial iron overload, stress-induced cardiomyopathy Takotsubo, or Fabry’s disease). Furthermore, CMR provides criteria for acute versus remote injury and, depending on the clinical context, evidence for myocardial inflammation such as in viral myocarditis. The chapter presents and discusses the important aspects of the clinical application of CMR in non-ischaemic cardiomyopathies with a focus on useful scan protocols, typical findings, added diagnostic value, and limitations. New approaches such as cardiac T1 mapping and T2 mapping are included. Key references on the current state-of-the-art use of CMR are provided and discussed.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"1 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":"116900710","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/9780198784906.003.0741
J. Cleland, I. Ford
{"title":"Trial design from a clinical perspective","authors":"J. Cleland, I. Ford","doi":"10.1093/med/9780198784906.003.0741","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0741","url":null,"abstract":"This chapter is written primarily from the perspective of investigators with limited resources designing clinical trials to assess the effects of interventions on patient well-being and outcomes with the hope that the results might influence clinical practice and guidelines. Other perspectives should be taken into account. The advice may be less applicable when resources are abundant (e.g. phase III trials sponsored by a large commercial company). Much research is funded by commercial companies hoping for a return on investment; they will design clinical trials to increase the chance of a statistically positive result. Many investigators will do the same although their motivation may differ. However, practising clinicians, patients, and health services want trials that help inform their daily clinical practice rather than merely achieving statistical significance. Large studies may be statistically positive but of dubious practical significance. This chapter gives some general guidance on selecting patients, comparators, endpoints, and study design.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"104 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":"116011314","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/9780198784906.003.0536
Fernando M. Contreras-Valdes, P. Zimetbaum
{"title":"Sustained monomorphic ventricular tachycardia associated with structural heart disease: classification, assessment, and initial treatment","authors":"Fernando M. Contreras-Valdes, P. Zimetbaum","doi":"10.1093/MED/9780198784906.003.0536","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0536","url":null,"abstract":"Sustained monomorphic ventricular tachycardia occurs in patients with structural heart disease and may lead to syncope, haemodynamic collapse, or sudden death. The diagnosis is established by the electrocardiogram, with cardiac imaging used to determine the underlying substrate. Initial management requires a combination of electrical cardioversion and antiarrhythmic drugs, mainly amiodarone and beta blockers. Nonetheless, implantable cardioverter defibrillators provide the most substantial reduction in sudden death, with catheter ablation becoming an increasingly favoured strategy to minimize shocks and possibly lower mortality from ventricular arrhythmias in this population.","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":"116170130","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/9780198784906.003.0728
S. Denus, M. Dubé, J. Tardif
{"title":"Opportunities for personalized approaches in heart failure","authors":"S. Denus, M. Dubé, J. Tardif","doi":"10.1093/med/9780198784906.003.0728","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0728","url":null,"abstract":"The diagnosis of heart failure (HF) remains difficult, as do the prediction of the prognosis of HF patients and personalizing the selection of drugs and devices used to treat specific individuals. Other than natriuretic peptides, which are useful diagnostic and prognostic biomarkers, few tools are available to personalize the management of HF patients. Investigations of rare, monogenic forms of HF have improved our understanding of HF and the management of these patients and their families. Yet, few genes have been associated with the common, polygenic forms of HF. The discovery of tools useful to predict the patients most likely to benefit from a specific drug remains a critically unmet need.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"90 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":"116293873","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/9780198784906.003.0504
R. Cappato
{"title":"Restoration of sinus rhythm: direct current cardioversion","authors":"R. Cappato","doi":"10.1093/MED/9780198784906.003.0504","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0504","url":null,"abstract":"First introduced in 1962, electrical cardioversion represents an effective and safe therapy to restore sinus rhythm in patients with atrial fibrillation (AF). Consistent with the original description by Lown, cardioversion is obtained through a ‘brief high-energy capacitor-stored electric shock … discharged across the intact chest of the lightly anesthetized patient’, electronically programmed to fall outside of the ‘vulnerable period’ of ventricular repolarization. Procedures performed according to the original description differed very little from those performed today, although a most remarkable advance was represented by the upgrading from the initial monophasic to the actual biphasic shock waveform. With this technique, atrial and ventricular defibrillation thresholds and the probability of post-shock re-initiation of fibrillating activity could be reduced. The anteroapical dual electrode configuration is the most commonly used and self-adhesive paddles obviate the operator-dependent variability of electrode location, pressure, and surface contact on the chest. Acute cardioversion is indicated in subjects with new-onset AF, high-rate recurrent AF, or recurrent AF in the setting of severely impaired left ventricular function with haemodynamic instability. In all other cases, elective cardioversion is offered under adequate anticoagulation using an early or a delayed approach. Pre-treatment with antiarrhythmic drugs increases the likelihood of restoration of sinus rhythm and helps prevent recurrent AF. Arrhythmia duration, cardiac size, P-wave duration, presence of rheumatic heart disease, and previous cardioversion are predictors of AF recurrence. Post cardioversion, antiarrhythmic drugs are mandatory. Patients receiving long-term treatment with antiarrhythmic drugs have a larger probability of maintaining sinus rhythm during follow-up than patients receiving short-term treatment.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"72 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":"116305059","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/9780198784906.003.0049
F. Verheugt
{"title":"Unfractionated heparin","authors":"F. Verheugt","doi":"10.1093/med/9780198784906.003.0049","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0049","url":null,"abstract":"Unfractionated heparin is a very widely used and inexpensive parenteral anticoagulant with a narrow therapeutic window, which makes careful monitoring necessary. Common indications are acute coronary syndromes with or without ST-segment elevation, percutaneous coronary intervention, early treatment of venous thromboembolism, and bridging therapy for interrupted oral anticoagulation. Bleeding is its most common side effect followed by thrombocytopenia and osteoporosis, the latter of which is only seen with longer periods of treatment.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"124 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":"116330603","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/9780198784906.003.0195
M. Gewillig, W. Budts
{"title":"Single ventricle/total cavopulmonary connection (Fontan circulation)","authors":"M. Gewillig, W. Budts","doi":"10.1093/MED/9780198784906.003.0195","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0195","url":null,"abstract":"The Fontan operation has improved the outlook for many patients born with complex congenital heart disease and only one functioning ventricle. The circulation, however, imposes a number of haemodynamic limitations and late failure is due to several issues. Management of the failing Fontan is a major challenge for adult congenital heart disease practitioners.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"70 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":"116350674","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/9780198784906.003.0315
L. Galiuto, F. Crea
{"title":"Mechanisms of takotsubo syndrome","authors":"L. Galiuto, F. Crea","doi":"10.1093/MED/9780198784906.003.0315","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0315","url":null,"abstract":"The pathogenesis of takotsubo syndrome can be considered the result of a catecholamine surge that, in predisposed and susceptible individuals, produces microvascular spasm responsible for myocardial dysfunction. The reversibility of microvascular dysfunction along with the activation of the cell survival cascade guarantees prompt and complete functional recovery in the majority of patients. Yet, about 20% of patients have serious in-hospital complications probably related to the severity of left ventricular dysfunction and/or lack of resolution. The reasons for these different outcomes are still unknown.","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":"123409363","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/9780198784906.003.0758
D. Katritsis, Mark A. Anderson, M. Webb-peploe
{"title":"Regulations concerning individual risk and public safety","authors":"D. Katritsis, Mark A. Anderson, M. Webb-peploe","doi":"10.1093/MED/9780198784906.003.0758","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0758","url":null,"abstract":"Regulations and guidelines with recommendations on driving and flying following a major cardiac event or cardiac intervention, or both, have been published by national and international cardiology societies, including the European Society of Cardiology. However, most of them are mainly based on consensus of opinion of experts and/or small studies and registries, and become outdated in the light of emerging new evidence. What constitutes an acceptable risk cannot always be answered by scientific evidence and may have to be a matter of consensus. The balance between individual freedom and protection of the public is not easily achieved and requires ongoing review and update.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"22 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":"123606761","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/9780198784906.003.0491
J. Chrispin, H. Calkins
{"title":"Asymptomatic pre-excitation","authors":"J. Chrispin, H. Calkins","doi":"10.1093/med/9780198784906.003.0491","DOIUrl":"https://doi.org/10.1093/med/9780198784906.003.0491","url":null,"abstract":"Manifest pre-excitation on the surface electrocardiogram (ECG) with a short PR interval and delta wave occurs in a very small percentage of the population based on epidemiological data. For the vast majority, this ECG finding will have no clinical manifestation and over time the ECG manifestation of pre-excitation may even go away. A small minority of individuals, however, develop clinical signs related to ventricular pre-excitation, most notably atrioventricular reentrant (reciprocating) tachycardia. This non-life-threatening arrhythmia is associated with clinical symptoms of palpitations, dyspnoea, and presyncope. Those with ventricular pre-excitation are at increased risk for atrial fibrillation. Multiple invasive electrophysiological and longitudinal studies have shown that those with atrial fibrillation and robust conduction down the atrioventricular accessory pathway are at an increased risk of sudden cardiac death from ventricular fibrillation. This chapter reviews the available and recommended strategies for assessing the patient with asymptomatic pre-excitation.","PeriodicalId":339880,"journal":{"name":"ESC CardioMed","volume":"28 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":"117082722","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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