Progress in cardiovascular diseases
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Prog Cardiovasc Dis · Nov 2017
ReviewMitral Valve-in-Valve/Ring and Other Percutaneous Treatments of Surgical Failures.
Re-do mitral valve surgery is associated with high morbidity and mortality. In recent years a variety of percutaneous repair techniques of surgical failures have emerged as safe and effective treatment options for several post-surgical problems including bioprosthetic mitral valve failure, prosthetic regurgitation or stenosis following annuloplasty, and periprosthetic regurgitation. This review will cover the indications, techniques and outcomes of these novel percutaneous therapies.
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Acute heart failure (AHF) patients rarely present complaining of 'acute heart failure.' Rather, they initially present to the emergency department (ED) with a myriad of chief complaints, symptoms, and physical exam findings. Such heterogeneity prompts an initially broad differential diagnosis; securing the correct diagnosis can be challenging. Although AHF may be the ultimate diagnosis, the precipitant of decompensation must also be sought and addressed. ⋯ After stabilization, diagnosis, and management, most ED patients with AHF in the United States (US) are admitted. While this is understandable, it may be unnecessary. Ongoing research to improve diagnosis, initial treatment, risk stratification, and disposition may help ease the tremendous public health burden of AHF.
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Nearly 800,000 strokes occur in the United States each year, and stroke is the leading cause of preventable permanent disability. Timely recognition and treatment are imperative to reduce stroke-related morbidity and mortality. ⋯ Intravenous tissue plasminogen activator is recommended for all qualified patients and patients with presentations suggesting large vessel occlusion should be evaluated for mechanical thrombectomy. Time to treatment is the most important prognostic factor for clinical outcome, highlighting the importance of reliable and efficient local and regional systems of care.
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Health care consumers are taking control of their health information and desire a greater role in managing their health. Approximately 77% of Americans now own a smartphone and the use of health apps have doubled over the past two years. ⋯ New opportunities exist as a result of recent advances in home-based wireless devices, apps, wearables, and interactive systems enabling health delivery systems to monitor, advise and treat disease near real time and engage patients in healthy living medicine. These technologies will provide a new framework for patient engagement and care delivery that will enhance clinical outcomes and generate precision interventions that ultimately reduce HC costs.
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Constrictive pericarditis (CP) represents a form of severe diastolic heart failure (HF), secondary to a noncompliant pericardium. The true prevalence of CP is unknown but it is observed in 0.2-0.4% of patients who have undergone cardiac surgery or have had pericardial trauma or inflammation due to a variety of etiologies. Despite its poor prognosis if untreated, CP is a potentially curable disease and surgical pericardiectomy can now be performed at low perioperative mortality in tertiary centers with surgical expertise in pericardial diseases. ⋯ Computerized tomography and magnetic resonance imaging provide incremental data for the diagnosis and management of CP and are especially helpful when clinical or echocardiographic findings are inconclusive. Cardiac catheterization has been the gold-standard for the diagnosis of CP, but may not be necessary if non-invasive test(s) demonstrate diagnostic features of CP; it should then be reserved for selected cases or for assessment of concomitant coronary disease. Although most patients with CP require pericardiectomy, anti-inflammatory therapy may be curative in patients presenting with subacute symptoms, especially when evidence of marked ongoing inflammation is seen.