Cardiology in review
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Cardiology in review · Jan 2016
ReviewSacubitril/Valsartan: A Novel Cardiovascular Combination Agent.
Sacubitril/valsartan [LCZ696 (Entresto), Novartis Pharmaceuticals Corp.] is the first in a new class of drugs that combines neprilysin inhibition with angiotensin II receptor antagonism, the combination of which acts to increase endogenous natriuretic peptides while inhibiting the renin-angiotensin-aldosterone system. Sacubitril/valsartan has been studied in the treatment of hypertension, heart failure with reduced ejection fraction (HFrEF), and heart failure with preserved ejection fraction (HFpEF) and has demonstrated clinical efficacy in blood pressure reduction in hypertensive patients with and without HFpEF and a reduction in hospitalizations and mortality for patients with HFrEF. Research to evaluate clinical outcomes in HFpEF is ongoing. ⋯ Expectedly, it is much more costly than generic angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, which will be a factor in determining how widespread the use of this agent will be. In summary, although the number of published studies evaluating its use is limited, sacubitril/valsartan represents a promising new treatment option for patients with HFrEF. Ongoing studies will continue to refine the role of this agent in clinical practice.
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Cardiology in review · Jan 2016
ReviewTreatment Options in Massive and Submassive Pulmonary Embolism.
Pulmonary embolism (PE) is a common cardiovascular condition that represents a spectrum of disorders with a gradient of increased risk of adverse outcomes. The U. ⋯ Risk stratification is critical to identify the patients who may benefit from advanced therapy. This review will provide an overview of PE pathophysiology, evidence-based risk stratification strategies for patients with acute PE, a summary of traditional and novel oral anticoagulant options, and an in-depth discussion on the utilization of advanced therapeutic options, including systemic fibrinolysis, catheter-based pharmacomechanical therapy, and surgical embolectomy.
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Cardiology in review · Jan 2016
ReviewUse of Extracorporeal Membrane Oxygenation in Refractory Cardiogenic Shock.
Cardiogenic shock is a condition marked by low cardiac output and end-organ hypoperfusion frequently requiring hemodynamic support, and it carries a high mortality. Extracorporeal membrane oxygenation (ECMO) is an effective tool in providing mechanical circulatory support in patients with cardiogenic shock refractory to conventional medical therapies. ⋯ A multidisciplinary team approach is needed in managing such patients and intensive monitoring is required to avoid complications from ECMO. Nevertheless, randomized clinic trials are warranted to prove a survival benefit.