Cardiology in review
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Cardiology in review · Jan 2015
ReviewBeyond PARTNER: appraising the evolving trends and outcomes in transcatheter aortic valve replacement.
Transcatheter aortic valve replacement (TAVR) has become the preferred treatment in patients with symptomatic severe aortic stenosis deemed to be at prohibitive or high risk for surgical aortic valve replacement. With evolving technology, improving practices and patient selection, outcomes in TAVR have improved. In the not so distant future, TAVR may become an alternative to surgical aortic valve replacement even for patients who are not at high risk for open surgery. However, issues such as stroke, paravalvular leak and pacemaker need remain, and the unknown limitations of TAVR, including durability and undefined options for reintervention for prosthesis dysfunction, must be addressed before this therapy can be extended to younger, lower risk patients.
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Cardiology in review · Jan 2014
ReviewNew antiobesity agents: lorcaserin (Belviq) and phentermine/topiramate ER (Qsymia).
Obesity is a risk factor for a wide range of conditions, including cardiovascular disease. Although lifestyle modifications remain the cornerstone for the management of obesity, pharmacologic agents may be a helpful addition to patients who have comorbidities and do not respond adequately to diet and exercise. ⋯ This article reviews the pharmacology and clinical efficacy and safety of each of these agents. The differences among the three available agents for long-term management of obesity will also be examined.
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Cardiology in review · Jul 2013
ReviewIncreased cardiovascular risk in patients with chronic obstructive pulmonary disease and the potential mechanisms linking the two conditions: a review.
Cardiovascular diseases, especially coronary artery disease (CAD), are the leading causes of death in patients with chronic obstructive pulmonary disease (COPD). There is a high prevalence of common risk factors in the COPD/CAD patient population including smoking, sedentary lifestyle and low socio-economic status. ⋯ Statins and inhaled corticosteroids have been investigated as potential therapeutic interventions in COPD that may lower cardiovascular risk. The goals of this review are to examine the evidence for increased cardiovascular risk in COPD patients, the possible mechanisms linking these two chronic conditions, to discuss possible predictors or markers of poor outcomes among patients diagnosed with both COPD and CAD, and the therapeutic options aimed at reducing cardiovascular risks associated with COPD.
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The presence of pulmonary arterial hypertension (PAH) in pregnancy is rare and signifies a high-risk pregnancy. Although the majority of mothers have knowledge of their condition before pregnancy, approximately one-third of patients are diagnosed during pregnancy. Termination of pregnancy should be discussed, and is often advised; however, a significant proportion of patients will choose to proceed with the pregnancy despite increased maternal and fetal mortality. ⋯ The time of greatest maternal risk is in the first month after delivery. Transplantation of these patients in the nonpregnant state may be considered when those with idiopathic pulmonary hypertension have poor functional status despite optimal therapy and their projected 2-year survival is less than 50%. For patients with Eisenmenger syndrome, severe symptoms and an unacceptable quality of life may lead to transplantation.
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Heart failure (HF) poses a significant economic burden on our health-care resources with very high readmission rates. Remote monitoring has a substantial potential to improve the management and outcome of patients with HF. ⋯ Current data examining the efficacy of remote monitoring technologies in improving outcomes have shown inconsistent results. Various medicolegal and financial issues need to be addressed before widespread implementation of this exciting technology can take place.