The Medical clinics of North America
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Med. Clin. North Am. · Jul 2015
ReviewIndications for pacemakers, implantable cardioverter-defibrillator and cardiac resynchronization devices.
Implantable cardiac devices are important management tools for patients with heart rhythm disorders and heart failure. In this article, the current implantable cardiac rhythm devices are described in their evolution. The current indications and contraindications for these cardiac rhythm devices are reviewed.
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Med. Clin. North Am. · Jul 2015
ReviewNew oral anticoagulants: their role in stroke prevention in high-risk patients with atrial fibrillation.
Based on efficacy, safety, and ease of use, novel oral anticoagulants will likely replace VKAs for many if not most patients with atrial fibrillation. Novel anticoagulants have a lower rate of intracranial hemorrhage compared with vitamin K antagonists. ⋯ Dose adjustments need to be made based on renal function and advanced age. There is at present a need for an antidote for these new drugs.
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Med. Clin. North Am. · Jul 2015
Review2014 Guideline for the Management of High Blood Pressure (Eighth Joint National Committee): Take-Home Messages.
The JNC 8 guidelines focus on 3 highest-ranked clinical questions that include BP thresholds for starting therapy, specific BP goals, and risks and benefits of specific antihypertensive drugs. Only randomized controlled trial data were used and JNC 8 panel did not include observational studies, systematic reviews, or meta-analyses. ⋯ Lifestyle modifications were considered very important for all patients with hypertension. These recommendations are not alternatives for clinical judgment, and decisions about medical care must be individualized to each patient.
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Med. Clin. North Am. · Jul 2015
ReviewCardiovascular disease risk assessment and prevention: current guidelines and limitations.
Even after decades of progress in understanding atherosclerotic cardiovascular disease (ASCVD) and improved cardiovascular event prevention, the incidence, consequences and cost of cardiovascular disease (CVD) remain a significant public health issue. Observational studies have identified major ASCVD risk factors and lead to the development of a number of risk assessment systems/scores now in use. However many patients who will develop clinically important CVD are not identified by current systems or approaches and significant numbers of recurrent cardiovascular events continue to occur even after aggressive secondary prevention treatment strategies are utilized. ⋯ The statin era revolutionized clinical practice with effective outcome-driven risk reduction. As a result there are now numerous clinical recommendations or guidelines for ASCVD risk stratification and treatment. Further disease and event prevention may rely on improved patient-centered risk stratification using novel biomarkers, imaging techniques, and new treatment approaches including emerging pharmacologic therapies.
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Chest pain is a common complaint in the emergency department. Recognition of chest pain symptoms and electrocardiographic changes consistent with acute coronary syndrome (ACS) can lead to prompt initiation of goal-directed therapy. Cardiac troponin testing confirms the diagnosis of acute myocardial infarction, but does not reveal the mechanism of injury. When patients with chest pain rule out for ACS the use of advanced, noninvasive testing has not been found to be associated with better patient outcomes.