Heart, lung & circulation
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Heart, lung & circulation · Jun 2012
ReviewCardiac implantable electronic device therapy for bradyarrhythmias and tachyarrhythmias.
Pacemakers originally were developed for patients with profound bradycardia and complete heart block who, without them, usually suffered from syncope, heart failure and an early demise. Since that time, devices have evolved to include pacing and shock therapies for the management of tachyarrhythmias and heart failure with the aim of improving quality, and if possible, length of life. Whether to insert a device depends on a balance between the potential benefits of device therapy and its risks, which are not inconsiderable. We discuss current agreed indications for pacemakers and implantable defibrillators and some current controversies surrounding their use.
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Heart, lung & circulation · Oct 2011
ReviewIntensive glucose control and cardiovascular outcomes in type 2 diabetes.
Numerous observational studies have clearly shown a relationship between hyperglycaemia and cardiovascular (CV) disease. However, the United Kingdom Prospective Diabetes Study (UKPDS), which involved subjects with newly diagnosed type 2 diabetes, just failed to show that intensive glucose control significantly reduces CV events. The results of three subsequent large randomised controlled trials, the Action to Control Cardiovascular Risk in Diabetes (ACCORD), Action in Diabetes and Vascular Disease Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) and the Veterans Administration Diabetes Trial (VADT), that involved approximately 25,000 subjects with established type 2 diabetes also failed to show that intensive glucose control, aiming for a glycated haemoglobin (HbA(1c)) level<7%, significantly reduces CV events. ⋯ Under certain circumstances, aiming for lower HbA(1c) levels may be appropriate. This applies in the setting of newly diagnosed diabetes in relatively young individuals without significant co-morbidities and in patients treated with agents that minimise the risk of severe hypoglycaemia such as metformin. Whether this also applies to newer glucose-lowering agents that target the incretin system will depend on CV outcomes of long-term studies which are in progress.
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Heart, lung & circulation · Jul 2011
ReviewFocused clinical review: periprocedural management of antiplatelet therapy in patients with coronary stents.
Coronary stent implantation, particularly drug eluting stents, is now the major method of coronary revascularisation. Following drug-eluting stent implantation dual antiplatelet therapy with aspirin and thienopyridine is recommended for at least 12 months. ⋯ Late (>30 days) and very late (>365 days) stent thrombosis appears to more common with DES and poses the questions of when is it safe to stop antiplatelet therapy post coronary stenting and how to manage patients who need non-cardiac surgery. This article reviews the evidence for stent thrombosis and the peri-operative management of patients with coronary stents and provides an algorithm for patient management based on multidisciplinary assessment of bleeding risk, perioperative cardiac event and stent thrombosis risk.
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Heart, lung & circulation · Feb 2011
ReviewSCAI consensus document on occupational radiation exposure to the pregnant cardiologist and technical personnel.
Concerns regarding radiation exposure and its effects during pregnancy are often quoted as an important barrier preventing many women from pursuing a career in Interventional Cardiology. Finding the true risk of radiation exposure from performing cardiac catheterisation procedures can be challenging and guidelines for pregnancy exposure have been inadequate. ⋯ Current data do not suggest a significant increased risk to the foetus of pregnant women in the cardiac catheterisation laboratory and thus do not justify precluding pregnant physicians from performing procedures in the cardiac catheterisation laboratory. However, radiation exposure amongst pregnant physicians should be properly monitored and adequate radiation safety measures are still warranted.