Clinical cardiology
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Clinical cardiology · Sep 2010
ReviewRenin inhibitors in chronic heart failure: the Aliskiren Observation of Heart Failure Treatment study in context.
Renin-angiotensin aldosterone system (RAAS) activation is a key neurohormonal contributor to the progression of chronic heart failure. Strategies that block this activation have consistently demonstrated major beneficial impacts on morbidity and mortality in this setting. Direct renin inhibitors (DRIs) present a novel opportunity to block at an additional or alternative step in this pathway, that being conversion of angiotensinogen to angiotensin I. ⋯ Large-scale outcome trials are, however, required to definitively determine the benefits of a DRI strategy additional to, or as an alternative to, conventional approaches such as ACE inhibitors in the systolic chronic heart failure setting. Copyright © 2010 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose.
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Clinical cardiology · Aug 2010
Comparative StudyAccuracy of transthoracic echocardiography for the measurement of the ascending aorta: comparison with transesophageal echocardiography.
There has been a substantial increase in the number of imaging studies performed to assess thoracic aortic pathology. We sought to determine the accuracy of transthoracic echocardiography (TTE) compared to transesophageal echocardiography (TEE) for measuring ascending aortic size. ⋯ Transthoracic echocardiography using nonstandard imaging windows is accurate in comparison to TEE for measurement of the ascending aorta at multiple levels in patients with or without aortic pathology. The findings of this study provide support for selected serial follow-up of patients with aortic disease by TTE only.
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Clinical cardiology · Aug 2010
Review Case ReportsLate perforation by cardiac implantable electronic device leads: clinical presentation, diagnostic clues, and management.
Late intracardiac lead perforation is defined as migration and perforation of an implanted lead after 1 month of cardiac electronic device implantation. It is an under-recognized complication with significant morbidity and mortality, particularly if not recognized early. ⋯ We conducted a thorough review of the available English language literature pertaining to this complication to draw relevant conclusions regarding presentation, diagnosis, and management. Early recognition of this complication is important as the indications for and numbers of patients who receive cardiac implantable electronic devices continue to expand.
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Clinical cardiology · Jul 2010
ReviewThe effectiveness and cost effectiveness of public-access defibrillation.
Many sudden cardiac deaths are due to ventricular fibrillation (VF). The use of defibrillators in hospitals or by outpatient emergency medical services (EMS) personnel can save many cardiac-arrest victims. Automated external defibrillators (AEDs) permit defibrillation by trained first responders and laypersons. ⋯ AEDs save very few lives in residential units such as private homes or apartment complexes. AEDs are cost effective at sites where there is a high density of both potential victims and resuscitators. Placement at golf courses, health clubs, and similar venues is not cost effective; however, the visible devices are good for public awareness of the problem of sudden cardiac death and provide reassurance to patrons.