Cardiology

In the Hollywood version of the heart attack, patients clutch their chests, gasp for air, and often keel over. Real life isn't usually like that. But the problem for cardiologists and other physicians whose patients have cardiac events, is that the patient may not realize he or she has had one.

During a question-and-answer session at the American Heart Association (AHA) Scientific Sessions 2014, Stefania Schüpke, MD discussed the results of her ISAR-SAFE study of the dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is still unknown.

Undetected neonatal heart defects can cause a variety of serious problems, including an increased risk of death. A recently enacted New Jersey law mandating screening for congenital heart defects has uncovered cases of congenital heart problems and likely saved lives.

Analysis of insurance claims and medical records indicates that people with mitral annular calcification may face a greatly elevated risk of incident atrial fibrillation.

Heart failure is highly debilitating and life threatening – nearly half the patients who die from cardiovascular causes do so suddenly when their heart simply stops pumping, well before medical intervention is even possible.

Recent updates by the 8th Joint National Committee (JNC 8), the American and International Societies of Hypertension (ASH-ISH), and KDIGO recommend target blood pressure of less than 140/90 mm Hg for most individuals, including those with CKD.

Can cholesterol get too low? Results from a multicenter international study called IMPROVE-IT show that adding ezetimibe to a statin regimen lowered cholesterol without harmful side effects in patients with acute coronary syndrome.

With heart failure increasing in prevalence as the US population ages, early detection and more effective treatments are important. Now, data from clinical studies show that treatment with the experimental angiotensin receptor neprilysin inhibitor LCZ696 can significantly reduce patients' risk of sudden death and hospitalization.

Two major sets of hypertension guidelines released in 2014 contain more common threads than differences, and are intended to serve different purposes. Clinicians seeking guidance for managing hypertension in chronic kidney disease (CKD) can look for this common ground to avoid "guideline overload."

Kirk Garratt, MD, presenting at the 2014 American Heart Association Scientific Sessions, said "The TAXUS Liberte Post-approval Study (TL-PAS) was designed to provide long-term safety and efficacy information about the clinical outcomes for the TL stent combined with the use of prasugrel and aspirin."

Former VP Dick Cheney spoke at AHA 2014 about his experiences as a model heart patient. Speaking with his cardiologist, Jonathan Reiner, MD, of George Washington University, Cheney recounted his 5 heart attacks, a CABG procedure, defibrillator implantation, getting a left-ventricular assistive device, and at age 71, a heart from an anonymous donor.

Guidelines for hypertension have converged on a blood pressure target of less than 140/90 mm Hg for most individuals with chronic kidney disease (CKD). However, studies still need to clarify optimal BPs for advanced disease and optimal cardiovascular prevention.

"Left heart remodeling after transcatheter aortic valve replacement (TAVR) is poorly characterized," according to Marco Magalhaes, MD, who presented at the American Heart Association (AHA) Scientific Sessions 2014.

The days of children playing outside from sunrise to sunset are long gone, and many children also do not get enough exercise at school during gym or recess. Knowing this, it is important for physicians to educated parents and children on the beneficial effect physical exercise can have on children's health now and later in life.

Living in the 21st century is stressful for just about everyone. What can change the way it affects a person's life is how they handle it. A recent study looked at whether women handle stress differently and what it can mean to a person's overall health.

High-caffeine energy drinks can cause serious cardiac and neurological symptoms in children. At the 2014 American Heart Association Scientific Sessions in Chicago, IL, Steven Lipshultz, MD, called for new labeling on the drinks that would spell out risks, particularly for the adolescent consumers manufacturers target for marketing.

As more states legalize marijuana for medical and recreational purposes doctors are taking a new look at how it can affect their patient's overall health including what it does to their heart.

Could hospitals be a bad place to have heart attacks? That's the finding of a North Carolina research team that looked at data from 303 California hospitals. Patients who had heart attacks while hospitalized for a non-cardiac ailment had a more than 3-fold greater in-hospital mortality than patients taken to a hospital.

Dual antiplatelet blood-thinning therapy (DAPT) immediately after stenting with a drug-eluting device has been shown to prevent major cardiac events and stent thrombosis in most patients. Current American College of Cardiology and American Heart Association guidelines recommend 12 months of therapy post-stenting. But out of concern over potential risks of continuing the drugs longer, or even indefinitely, the US Food and Drug Administration (FDA) asked device manufacturers to study the longer-term consequences of the therapy.

Though warfarin has long been the mainstay of anticoagulation in atrial fibrillation (AF), dosing is complicated by a host of factors, and the drug has a famously narrow therapeutic range. One way to fine-tune warfarin therapy is to account for genetic variation.

Obese patients present several challenges when it comes to gastric bypass, kidney transplant, and other surgeries. Several recent advances have reduced the risk of complications in this population.

Among diabetics, poor adherence or nonadherence results in poorer glycemic control and increased risk of complications and disability, as well as increased healthcare costs.

Anticoagulation is recommended for members of the general population with atrial fibrillation, but its significant risks must be weighed carefully in the medically fragile chronic kidney disease population.

Treatment of atrial fibrillation (AF) in patients with CKD may help prevent disease progression. Ablation has been shown produce marked improvement in kidney function as measured by eGFR. A prospective study of individuals undergoing catheter ablation for AF showed that most patients remained AF-free, and that eGFR improved significantly for those with persistent or longstanding persistent AF.

Secondary hyperparathyroidism can occur in CKD when the kidney loses its ability to produce active metabolites of vitamin D, and reduces phosphorus excretion. Cinacalcet seeks to interrupt the progression to severe unremitting hyperparathyroidism by mimicking calcium to the calcium-sensing receptors that control parathyroid hormone levels.

Physicians caring for individuals with chronic kidney disease (CKD) must strike a balance between ensuring optimal lipid control for protection from vascular events, while avoiding undue risk.

Affecting just one in every 100,000 people, ANCA-associated vasculitis is not one of the more common conditions nephrologists will encounter. However, without proper treatment it can have serious adverse effects on a patient's life.

Despite achieving optimal goals for "bad" cholesterol levels, individuals with diabetes and chronic kidney disease still have an elevated risk of vascular complications.

Heart failure and other cardiac events can leave lasting effects on the lives of patients. Scientists are working on ways to help make the recovery process easier and smoother by generating cells that can help the healing process.

Taking beta blockers-a common drug regimen for patients with clinically stable coronary heart disease (SCHD)-likely does not have a benefit or outweigh these drugs' risk for most patients, a University of Florida team report.