Rev Cardiovasc Med
-
In the emergency setting, acute chest pain and shortness of breath represent common patient presentations. Cardiac biomarkers including myoglobin, creatine kinase (CK)-MB, troponin, and b-type natriuretic peptide provide diagnostic and prognostic information for patients with chest pain and shortness of breath. This article reviews the use of cardiac biomarkers in the emergency department to evaluate acute coronary syndrome and congestive heart failure.
-
Heart failure is a leading cause of hospitalization for adults in the United States. Patients hospitalized with acute decompensated heart failure (ADHF) face a substantial risk of in-hospital mortality and rehospitalization. Despite the large number of patients hospitalized and this substantial risk, data on these patients have been limited and there has been little effort to improve the quality of care for patients hospitalized with ADHF. ⋯ As such, there are substantial opportunities to improve the quality of care for ADHF patients in the nation's hospitals. The ADHERE Hospital Toolkit has been designed to provide hospital teams with effective proactive instruments to improve the quality of care for patients with ADHF. If successfully implemented, the improvements in short- and long-term clinical outcomes for ADHF patients are expected to be substantial.
-
Chronic kidney disease (CKD) and congestive heart failure (CHF) are epidemiologically and pathophysiologically linked. A recent study in patients with severe CHF demonstrated that renal plasma flow was inversely correlated with pulmonary capillary wedge pressure, right atrial pressure, pulmonary pressure, and right ventricular ejection fraction. This article reviews the utility of B-type natriuretic peptide (BNP) levels in assessing cardiac function and volume status in patients with CKD and examines the safety and efficacy of BNP therapy in patients with renal insufficiency and decompensated heart failure.
-
Fenoldopam, a selective agonist of dopamine-1 receptors, is a regional and systemic vasodilator. In randomized, controlled clinical trials, fenoldopam has been found to preserve renal function in situations of potential renal ischemia, such as during radiocontrast administration, cardiac and peripheral vascular surgery, liver transplantation, and treatment of severe hypertension. Fenoldopam lowers blood pressure in patients with hypertension, but has little or no effect on blood pressure in those who are normotensive. The role of fenoldopam in managing critically ill, transplant, and hypertensive patients is reviewed in this article.
-
Case Reports
Transesophageal echocardiographic evaluation of perioperative systolic murmur in aortic pathology.
Development of a new systolic murmur in patients following a Bental procedure with a prosthetic or homograft aortic valve usually indicates an aortic valve-related complication. Here, we report new etiologies of a loud systolic murmur in patients with aortic disease. One patient developed a new loud systolic murmur as an initial manifestation of acute type A aortic dissection without any complication, and two patients developed a loud systolic murmur as the major manifestation of aortic graft failure following aortic root surgery. Auscultation of a new loud systolic murmur in the upper chest in patients with known aortic disease should alert one to a complication within the ascending aorta.