Current Treatment Options In Cardiovascular Medicine[JOURNAL]
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200 papers
Echocardiography for the Pregnant Heart.
Afari HA, Davis EF, Sarma AA
Curr Treat Options Cardiovasc Med · 2021 · PMID 34075291 · Full text
PURPOSE OF REVIEW: Pregnancy is associated with significant hemodynamic changes, making it a potentially high-risk period for women with underlying cardiovascular disease. Echocardiography remains the preferred modality...
PURPOSE OF REVIEW: Pregnancy is associated with significant hemodynamic changes, making it a potentially high-risk period for women with underlying cardiovascular disease. Echocardiography remains the preferred modality for diagnosis and monitoring of pregnant women with cardiovascular disease as it is widely available and does not require radiation. This paper reviews the role of echocardiography along the continuum of pregnancy in at-risk patients, with a focus on key cardiac disease states in pregnancy. RECENT FINDINGS: In the preconception stage, risk stratification scores such as CARPREG II, ZAHARA and the modified WHO remain central to counseling and planning. As such, echocardiography serves an important role in assessing the severity of pre-existing structural disease. Among women with pre-existing cardiovascular disease who become pregnant-as well as those who develop cardiovascular symptoms during pregnancy-echocardiography is a key imaging tool for assessment of hemodynamic and structural changes and is recommended as the first-line imaging modality when appropriate by both the American College of Obstetricians and Gynecologists (ACOG) and the Food and Drug Administration (FDA). However, routine screening intervals during pregnancy for various cardiac lesions are not well defined, resulting in clinical heterogeneity in care. SUMMARY: Echocardiography is the imaging modality of choice for defining, risk stratifying, and monitoring cardiovascular changes throughout pregnancy. Once identified, at-risk patients should receive careful individual counseling and follow-up with a multidisciplinary team. Echocardiography serves as a widely available tool for serial monitoring of pregnant women with cardiovascular disease throughout pregnancy and the postpartum period.
Hypertrophic Cardiomyopathy: Updates Through the Lens of Sports Cardiology.
Lander BS, Phelan DM, Martinez MW … +1 more , Dineen EH
Curr Treat Options Cardiovasc Med · 2021 · PMID 34054288 · Full text
PURPOSE OF REVIEW: This review will summarize the distinction between hypertrophic cardiomyopathy (HCM) and exercise-induced cardiac remodeling (EICR), describe treatments of particular relevance to athletes with HCM, an...
PURPOSE OF REVIEW: This review will summarize the distinction between hypertrophic cardiomyopathy (HCM) and exercise-induced cardiac remodeling (EICR), describe treatments of particular relevance to athletes with HCM, and highlight the evolution of recommendations for exercise and competitive sport participation relevant to individuals with HCM. RECENT FINDINGS: Whereas prior guidelines have excluded individuals with HCM from more than mild-intensity exercise, recent data show that moderate-intensity exercise improves functional capacity and indices of cardiac function and continuation of competitive sports may not be associated with worse outcomes. Moreover, recent studies of athletes with implantable cardioverter defibrillators (ICDs) demonstrated a safer profile than previously understood. In this context, the updated American Heart Association/American College of Cardiology (AHA/ACC) and European Society of Cardiology (ESC) HCM guidelines have increased focus on shared decision-making and liberalized restrictions on exercise and sport participation among individuals with HCM. SUMMARY: New data demonstrating the safety of exercise in individuals with HCM and in athletes with ICDs, in addition to a focus on shared decision-making, have led to the most updated guidelines easing restrictions on exercise and competitive athletics in this population. Further athlete-specific studies of HCM, especially in the context of emerging therapies such as mavacamten, are important to inform accurate risk stratification and eligibility recommendations.
Contemporary Catheter-Based Treatment Options for Management of Acute Pulmonary Embolism.
Singh M, Shafi I, Rali P … +3 more , Panaro J, Lakhter V, Bashir R
Curr Treat Options Cardiovasc Med · 2021 · PMID 33994774 · Full text
INTRODUCTION: Acute pulmonary embolism (PE) remains an important cause of cardiovascular mortality and morbidity in the USA and worldwide. Catheter-based therapies are emerging as a new armamentarium for improving outcom...
INTRODUCTION: Acute pulmonary embolism (PE) remains an important cause of cardiovascular mortality and morbidity in the USA and worldwide. Catheter-based therapies are emerging as a new armamentarium for improving outcomes in these patients. PURPOSE OF REVIEW: The purpose of this review is to familiarize the clinicians with (1) various types of catheter-based modalities available for patients with acute PE, (2) advantages, disadvantages, and appropriate patient selection for the use of these devices, and (3) evidence base and the relevance of such therapies in the COVID-19 pandemic. RECENT FINDINGS: There are four main types of catheter-based therapies in acute PE: (1) standard catheter-directed thrombolysis (CDT), (2) ultrasound-assisted CDT, (3) pharmacomechanical CDT, and (4) mechanical thrombectomy without thrombolysis. Ultrasound-assisted thrombolysis is the most widely studied modality in this group; however, evidence base for other catheter-based technologies is rapidly emerging. SUMMARY: Current use of catheter-based therapies is most suitable for patients with intermediate and high-risk acute PE. The adoption of a multidisciplinary approach like the pulmonary embolism response team (PERT) is desirable for appropriate patient selection and possibly/potentially improving patient outcomes. We discuss the current status of these therapies.
Evidence-Based Approach to Out-of-Hospital Cardiac Arrest.
Kashef MA, Lotfi AS
Curr Treat Options Cardiovasc Med · 2021 · PMID 33994773 · Full text
PURPOSE OF REVIEW: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death. Despite improvements in the cardiac disease management, OHCA outcomes remain poor. The purpose of this review is to provide informatio...
PURPOSE OF REVIEW: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death. Despite improvements in the cardiac disease management, OHCA outcomes remain poor. The purpose of this review is to provide information on the management of OHCA survivors, evidence-based treatments, and current gaps in the knowledge. RECENT FINDINGS: Most common cause of death from OHCA is neurological injury followed by shock and multiorgan failure. Prognostication tools are available to help with the clinical decision-making. Taking measures to improve EMS response time, encouraging bystander CPR, early defibrillation, and targeted temperature management are shown to improve survival. Early activation of cardiac catheterization lab for coronary angiography, hemodynamic assessment, and mechanical circulatory support should be considered in patients with shockable rhythm and presumed cardiac cause, those with ST elevation, ongoing ischemia, or evidence of hemodynamic and electrical instability. Randomized controlled trials are lacking in this field and benefits of interventions should be weighed against risk of pursuing a futile treatment. COVID-19 pandemic has added new challenges to the care of OHCA patients. SUMMARY: Clinical decision-making to care for OHCA patients is challenging. There is a need for trials to provide evidence-based knowledge on the care of OHCA patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11936-021-00924-3.
A Critical Review of Hemodynamically Guided Therapy for Cardiogenic Shock: Old Habits Die Hard.
Isseh IN, Lee R, Khedraki R … +1 more , Hoffman K
Curr Treat Options Cardiovasc Med · 2021 · PMID 33776402 · Full text
PURPOSE OF REVIEW: Here, we review the importance of using hemodynamic data to guide therapy and risk stratification in cardiogenic shock as well as the various definitions of this syndrome that have been used in prior s...
PURPOSE OF REVIEW: Here, we review the importance of using hemodynamic data to guide therapy and risk stratification in cardiogenic shock as well as the various definitions of this syndrome that have been used in prior studies. Furthermore, we provide perspective regarding the controversy surrounding pulmonary artery (PA) catheter use as well as current society guidelines and scientific statements. Lastly, we review the technical aspects for accurate interpretation of data of cardiogenic shock. RECENT FINDINGS: More recent studies specifically evaluating cardiogenic shock patients have shown higher mortality when PA catheters were not used. Furthermore, initiatives are underway to develop more standardized definitions of cardiogenic shock, including the SCAI Shock Classification Scheme. Only by having a standardized fashion of conveying severity of shock will we be able to more systematically study this patient population and improve outcomes moving forward. SUMMARY: PA catheters are critical to the prognostication and management of a subset of patients with cardiopulmonary disease, particularly in those with pulmonary hypertension, cardiogenic shock, or requiring mechanical circulatory support or undergoing evaluation for advanced heart failure therapies.
New Approaches to Donor Selection and Preparation in Heart Transplantation.
Tong CKW, Khush KK
Curr Treat Options Cardiovasc Med · 2021 · PMID 33776401 · Full text
PURPOSE OF REVIEW: With increasing survival of patients with stage D heart failure, the demand for heart transplantation has increased. The supply of donor hearts remains relatively limited. Strategies have been investig...
PURPOSE OF REVIEW: With increasing survival of patients with stage D heart failure, the demand for heart transplantation has increased. The supply of donor hearts remains relatively limited. Strategies have been investigated and new technologies have been developed to expand the current donor pool. These new approaches will be discussed herein. RECENT FINDINGS: Donor hearts are often considered "marginal" due to risk factors such as older age, size mismatch with the intended recipient, prolonged ischemic time, presence of left ventricular hypertrophy, and hepatitis B/C infection. We reviewed recent data regarding the use of donor hearts with these risk factors and suggest ways to safely liberalize current donor heart acceptance criteria. New technologies such as temperature-controlled transport systems and ex vivo cardiac perfusion methods have also demonstrated promising short-term and intermediate outcomes as compared with routine cold storage, by promoting heart preservation and enabling heart procurement from remote sites with shorter cold ischemic time. Recent use of hearts from donation after circulatory death donors has demonstrated comparable outcomes to conventional donation after brain death, which can further expand the current donor pool. SUMMARY: Careful selection of "marginal" donor hearts, use of ex vivo cardiac perfusion, and acceptance of hearts after circulatory death may expand our current cardiac donor pool with comparable outcomes to conventional donor selection and preparation methods.
Case Selection During the COVID-19 Pandemic: Who Should Go to the Cardiac Catheterization Laboratory?
Vemmou E, Nikolakopoulos I, Brilakis ES … +2 more , Dehghani P, Garcia S
Curr Treat Options Cardiovasc Med · 2021 · PMID 33758493 · Full text
PURPOSE OF REVIEW: To summarize the best available evidence and recommendations regarding case selection for cardiac catheterization laboratory (CCL) during the coronavirus disease 2019 (COVID-19) pandemic with emphasis...
PURPOSE OF REVIEW: To summarize the best available evidence and recommendations regarding case selection for cardiac catheterization laboratory (CCL) during the coronavirus disease 2019 (COVID-19) pandemic with emphasis on ST segment elevation myocardial infarction (STEMI) management. RECENT FINDINGS: The restructuring of cardiovascular services to preserve hospital beds and personal protective equipment during the COVID-19 pandemic had a profound effect on healthcare delivery around the world with unintended consequences. In the United States, a significant 38% reduction in CCL activations for STEMI was noted in the early phase of the pandemic. Similarly, a 34% decline in utilization of invasive angiography, an 18% reduction in primary percutaneous coronary intervention (PPCI), and a 19% increase in door-to-balloon (D2B) times were also observed. These trends coincided with a significant increase in out-of-hospital cardiac arrests and late MI presentations. A shift to pharmacological reperfusion has been advocated in Asia, which resulted in increased morbidity and mortality. SUMMARY: COVID-19 has negatively affected many aspects of STEMI care, including timely access to mechanical reperfusion, which has resulted in increased morbidity and mortality. Balancing optimal STEMI care with the risk of infection to healthcare workers during the pandemic is challenging. Recommendations provided by consensus documents are a helpful guidance.
Contemporary Cardiovascular Imaging Advancements and Social Media.
Covas P, Ismail H, Krepp J … +4 more , Choi BG, Lewis JF, Katz RJ, Choi AD
Curr Treat Options Cardiovasc Med · 2021 · PMID 33746507 · Full text
PURPOSE OF REVIEW: Social media (SoMe) as a means of knowledge dissemination has grown significantly in cardiovascular imaging in recent years. This media platform allows for a free exchange of ideas, the development of...
PURPOSE OF REVIEW: Social media (SoMe) as a means of knowledge dissemination has grown significantly in cardiovascular imaging in recent years. This media platform allows for a free exchange of ideas, the development of new communities, and the ability to disseminate advancements rapidly. While the social media platforms offer limitless potential, their public domain necessitates several important suggestions around best practices. RECENT FINDINGS: In cardiovascular imaging, specific hashtags have emerged to encompass the major modalities to include #EchoFirst, #YesCCT, #WhyCMR, and #CVNuc. Cardiovascular imaging journals have established major presences in the social media space as an avenue to present novel, high-quality, peer-reviewed content to new audiences. SUMMARY: This review paper aims to introduce basic concepts in social media and cardiovascular imaging while highlighting recent topics of high importance, influence, and attention in cardiovascular imaging to include the ISCHEMIA trial, COVID-19, structural imaging, and multimodality advances from throughout 2020.
Refocusing on the Primary Prevention of Heart Failure.
Jafari LA, Suen RM, Khan SS
Curr Treat Options Cardiovasc Med · 2020 Jul · PMID 33707937 · Full text
PURPOSE OF REVIEW: The burden of heart failure (HF) is a significant national and global public health problem, with prevalence rates on the rise. Given the significant morbidity, mortality, and healthcare costs attribut...
PURPOSE OF REVIEW: The burden of heart failure (HF) is a significant national and global public health problem, with prevalence rates on the rise. Given the significant morbidity, mortality, and healthcare costs attributable to HF, it is of utmost importance to utilize preventive strategies to prevent the development of HF. Therefore, we sought to address how a multi-modal risk assessment approach can be used to stratify patients for HF risk and guide implementation of therapeutic strategies to prevent HF. RECENT FINDINGS: New externally validated, multivariate prediction models for incident HF can be applied in the general population and may be used to aide clinicians in assessing individualized HF risk and screening for HF. Recent clinical trial data suggest a natriuretic peptide biomarker-based screening approach coupled with team-based cardiovascular care to focus on optimization of guideline-directed medical therapy may help prevent new-onset HF. However, widespread implementation of clinical risk scores and/or biomarkers is needed. SUMMARY: In addition to promoting a heart healthy lifestyle, prevention and management of modifiable risk factors, including intensive blood pressure lowering and use of sodium-glucose cotransporter-2 inhibitors, can prevent incident HF.
Sustainable Resumption of Cardiac Catheterization Laboratory Procedures, and the Importance of Testing, During Endemic COVID-19.
Zaman M, Tiong D, Saw J … +2 more , Zaman S, Daniels MJ
Curr Treat Options Cardiovasc Med · 2021 · PMID 33642850 · Full text
PURPOSE: As second and third waves of the COVID-19 pandemic challenge healthcare in North America and Europe once again, we analyze the impact of the first wave on routine elective cardiovascular care, and the differenti...
PURPOSE: As second and third waves of the COVID-19 pandemic challenge healthcare in North America and Europe once again, we analyze the impact of the first wave on routine elective cardiovascular care, and the differential COVID risk emerging within our patient groups and staff. PERSPECTIVE: We describe the need to sustainably resume, and temporarily expand, routine elective cardiac services in the face of resurgent COVID-19. Some, but not all, cardiac patient groups are particularly vulnerable to adverse outcomes following COVID-19 infection. We explore mitigation measures at the institutional level to increase resilience within cardiac services to enable them to operate deep into subsequent waves of COVID infection which place unprecedented demands on intensive care infrastructure. As measures to eradicate the virus appear to have failed in many countries, and vaccine roll-out will take many months we take the view that the threat imposed by endemic COVID-19 alters the way elective procedural care should be offered to cardiovascular patients. CONCLUSION: Our patients are at definite risk from their cardiovascular disease, and a return to suspension of proven prognostic interventional treatments on an elective basis - the default for the first wave - must be avoided at all costs.
Digital Health Applications in Heart Failure: a Critical Appraisal of Literature.
Farwati M, Riaz H, Tang WHW
Curr Treat Options Cardiovasc Med · 2021 · PMID 33488049 · Full text
PURPOSE OF THE REVIEW: Despite advancements in the diagnostic and therapeutic armamentarium, heart failure (HF) remains a major public health concern in the USA and worldwide. Digital health applications hold promise to...
PURPOSE OF THE REVIEW: Despite advancements in the diagnostic and therapeutic armamentarium, heart failure (HF) remains a major public health concern in the USA and worldwide. Digital health applications hold promise to bridge this gap and improve HF care. This review will provide the reader with a concise overview of the current digital health applications in HF, the main challenges to its use, and discuss the future of digital health for promoting care for HF patients. RECENT FINDINGS: Emerging evidence continues to support the potential role of digital health across the continuum of HF disease process including primary prevention, early detection, disease management, and reducing associated morbidity. There is also increasing emphasis on the need to pursue rigorous investigations to validate these promising claims, with some successful stories that have changed clinical practices. SUMMARY: Digital health technologies have emerged as potentially useful tools to complement HF care in both research and clinical realms. As digital technologies continue to play an increasing role in transforming healthcare delivery, creating the framework for its effective use would be necessary to ensure that digital health applications consistently improve outcomes and enhance care for HF patients.
Cardiopulmonary Exercise Testing in Athletes: Expect the Unexpected.
Petek BJ, Gustus SK, Wasfy MM
Curr Treat Options Cardiovasc Med · 2021 · PMID 35356387 · Full text
PURPOSE OF REVIEW: Cardiopulmonary exercise testing (CPET) is a tool designed to assess the integrated function of the cardiac, pulmonary, vascular and musculoskeletal systems to produce an exercise effort. CPET may be p...
PURPOSE OF REVIEW: Cardiopulmonary exercise testing (CPET) is a tool designed to assess the integrated function of the cardiac, pulmonary, vascular and musculoskeletal systems to produce an exercise effort. CPET may be performed for performance purposes as part of optimizing a training program or for clinical purposes in athletes with established cardiovascular disease or in those with symptoms suggestive of cardiopulmonary pathology. Most normative values used for CPET parameters have been derived in the general population, in whom there will be expected differences in exercise physiology as compared to a trained athlete. In this review, our goal is to examine current available data on expected findings on CPET in athletes, highlight how these differ from the general population-derived normative values, and identify areas in need of further research to optimize the application of CPET in athletes. RECENT FINDINGS: Athletes demonstrate differences in exercise hemodynamic and gas exchange profiles as compared to non-athletes including: higher cardiac output, faster heart rate recovery, higher peak V̇O, higher prevalence of exercise-induced arterial hypoxemia, and lower breathing reserve. SUMMARY: CPET is an important tool to optimize performance and assess for underlying pathology in an athletic population. The impact of routine, vigorous physical activity on exercise physiology should be integrated into determination of what constitutes a normal CPET result in an athletic individual.
Valvular Heart Disease in Athletes.
Petek BJ, Baggish AL
Curr Treat Options Cardiovasc Med · 2021 · PMID 35356384 · Full text
Valvular heart disease is prevalent in older athletes with primarily degenerative valvular disorders and younger athletes with congenital or genetic syndromes. Limited data exist on the risks and benefits of exercise for...
Valvular heart disease is prevalent in older athletes with primarily degenerative valvular disorders and younger athletes with congenital or genetic syndromes. Limited data exist on the risks and benefits of exercise for athletes with underlying valvular disorders, so current guidelines are primarily based upon expert consensus. This review focuses on the current data, guideline recommendations, and emerging clinical conundrums for athletes with common valvular heart conditions including aortic stenosis, bicuspid aortic valve (BAV), mitral regurgitation (MR), mitral valve prolapse (MVP), and thoracic aortic aneurysms.
The Association of Adverse Pregnancy Outcomes and Cardiovascular Disease: Current Knowledge and Future Directions.
Minhas AS, Ying W, Ogunwole SM … +9 more , Miller M, Zakaria S, Vaught AJ, Hays AG, Creanga AA, Cedars A, Michos ED, Blumenthal RS, Sharma G
Curr Treat Options Cardiovasc Med · 2020 Dec · PMID 35296064 · Full text
PURPOSE OF REVIEW: Adverse pregnancy outcomes are associated with increased risk for future cardiovascular disease. The goal of this review is to share what is currently known about the increased risk and to identify are...
PURPOSE OF REVIEW: Adverse pregnancy outcomes are associated with increased risk for future cardiovascular disease. The goal of this review is to share what is currently known about the increased risk and to identify areas for future research. RECENT FINDINGS: Severe studies have identified a strong association between adverse pregnancy outcomes and cardiovascular disease such as heart failure, valvular disease, ischemic heart disease, stroke, hypertension, and metabolic syndrome. The recognition of this increased risk is reflected in recent changes in prevention guidelines. The guidelines now recognize sex-specific risks such as preeclampsia and preterm delivery and recommend incorporating a pregnancy history to identify them earlier. However, no robust risk prediction tools incorporating these pregnancy risk factors have been developed and validated. While smaller clinical trials have been performed in reducing cardiovascular risk factors in the postpartum timeframe, there remains a paucity of large-scale randomized clinical trials that continue to show a risk reduction in these women. SUMMARY: While there is increasing recognition of the long-term cardiovascular risks associated with adverse pregnancy outcomes, there remains a need for interventional studies aimed at reducing this risk and for incorporation of pregnancy risk factors into traditional cardiovascular risk prediction tools.
Arrhythmias Associated with Inflammatory Cardiomyopathies.
Karki R, Janga C, Deshmukh AJ
Curr Treat Options Cardiovasc Med · 2020 · PMID 33230384 · Full text
PURPOSE OF REVIEW: To provide an approach to the diagnosis and treatment of arrhythmias associated with inflammatory cardiomyopathies. RECENT FINDINGS: Inflammatory cardiomyopathies are increasingly recognized as the eti...
PURPOSE OF REVIEW: To provide an approach to the diagnosis and treatment of arrhythmias associated with inflammatory cardiomyopathies. RECENT FINDINGS: Inflammatory cardiomyopathies are increasingly recognized as the etiology of both ventricular and supraventricular arrhythmias. There have been recent studies providing novel insights into the pathogenesis of arrhythmias in inflammatory cardiomyopathies and exploring the role of various diagnostic tools and treatment strategies. SUMMARY: Patients with inflammatory cardiomyopathies often present with one or more arrhythmias, including atrioventricular block, atrial and ventricular tachyarrhythmias, and occasionally sudden cardiac death. Given dynamic pathophysiology and heterogeneous presentation, the management of arrhythmias in these patients presents unique challenges. We review the current approach to the diagnosis and treatment of arrhythmias in this challenging cohort of patients with an emphasis on cardiac sarcoidosis. SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s11936-020-00871-5) contains supplementary material, which is available to authorized users.
Disparities in Cardiovascular Care and Outcomes for Women From Racial/Ethnic Minority Backgrounds.
Balla S, Gomez SE, Rodriguez F
Curr Treat Options Cardiovasc Med · 2020 · PMID 33223802 · Full text
PURPOSE OF REVIEW: Racial, ethnic, and gender disparities in cardiovascular care are well-documented. This review aims to highlight the disparities and impact on a group particularly vulnerable to disparities, women from...
PURPOSE OF REVIEW: Racial, ethnic, and gender disparities in cardiovascular care are well-documented. This review aims to highlight the disparities and impact on a group particularly vulnerable to disparities, women from racial/ethnic minority backgrounds. RECENT FINDINGS: Women from racial/ethnic minority backgrounds remain underrepresented in major cardiovascular trials, limiting the generalizability of cardiovascular research to this population. Certain cardiovascular risk factors are more prevalent in women from racial/ethnic minority backgrounds, including traditional risk factors such as hypertension, obesity, and diabetes. Female-specific risk factors including gestational diabetes and preeclampsia as well as non-traditional psychosocial risk factors like depressive and anxiety disorders, increased child care, and familial and home care responsibility have been shown to increase risk for cardiovascular disease events in women more so than in men, and disproportionately affect women from racial/ethnic minority backgrounds. Despite this, minimal interventions to address differential risk have been proposed. Furthermore, disparities in treatment and outcomes that disadvantage minority women persist. The limited improvement in outcomes over time, especially among non-Hispanic Black women, is an area that requires further research and active interventions. SUMMARY: Understanding the lack of representation in cardiovascular trials, differential cardiovascular risk, and disparities in treatment and outcomes among women from racial/ethnic minority backgrounds highlights opportunities for improving cardiovascular care among this particularly vulnerable population.
Management and Treatment of Myocarditis in Athletes.
Hurwitz B, Issa O
Curr Treat Options Cardiovasc Med · 2020 · PMID 33169059 · Full text
PURPOSE OF REVIEW: Myocarditis is an inflammation of the myocardium that can often be associated with cardiac dysfunction and arrhythmias, and is even one of the leading causes for sudden cardiac death (SCD) in athletes....
PURPOSE OF REVIEW: Myocarditis is an inflammation of the myocardium that can often be associated with cardiac dysfunction and arrhythmias, and is even one of the leading causes for sudden cardiac death (SCD) in athletes. This review aims to summarize the current evidence and treatment guidelines for the management of myocarditis in the active population. RECENT FINDINGS: Physical exertion is likely a trigger for dangerous arrythmias and further propagates myocardial damage in athletes with myocarditis. For this reason, abstinence from sports is a critical facet of management in the initial inflammatory period. The use of cardiac magnetic resonance imaging, specifically late gadolinium enhancement, to guide return to play decisions is becoming more common in clinical practice. SUMMARY: Establishing a stepwise approach for proper diagnosis and risk stratification, with an emphasis on contemporary cardiac magnetic resonance (CMR) imaging techniques, in myocarditis is critical. After a diagnosis of myocarditis is made, it is imperative for any athlete or highly active individual to refrain from physical exercise. Additionally, therapy for heart failure should be applied in cases of myocarditis with cardiac dysfunction. Undoubtedly, COVID 19, and its potential to cause myocarditis, is sure to change the landscape of management of this disease.
Cardiotoxicity of Contemporary Anticancer Immunotherapy.
Dal'bo N, Patel R, Parikh R … +4 more , Shah SP, Guha A, Dani SS, Ganatra S
Curr Treat Options Cardiovasc Med · 2020 · PMID 33162729 · Full text
PURPOSE OF REVIEW: Contemporary anticancer immunotherapy, particularly immune checkpoint inhibitors (ICI) and chimeric antigen receptor (CAR) T cell therapy, has changed the landscape of treatment for patients with a var...
PURPOSE OF REVIEW: Contemporary anticancer immunotherapy, particularly immune checkpoint inhibitors (ICI) and chimeric antigen receptor (CAR) T cell therapy, has changed the landscape of treatment for patients with a variety of malignancies who historically had a poor prognosis. However, both immune checkpoint inhibitors and CAR T cell therapy are associated with serious cardiovascular adverse effects. As immunotherapy evolves to include high-risk patients with preexisting cardiovascular risk factors and disease, the risk and relevance of its associated cardiotoxicity will be even higher. RECENT FINDINGS: ICI can cause myocarditis, which usually occurs early after initiation, can be fulminant, and prompt treatment with high-dose corticosteroids is crucial. CAR T cell therapy frequently leads to cytokine release syndrome, which is associated with cardiomyopathy or arrhythmia development and may also result in circulatory collapse. Supportive treatment, as well as tocilizumab, an anti-interleukin-6 receptor antibody, is the cornerstone of treatment. Recent findings suggest that preexisting cardiovascular risk factors and disease may increase the risk of such cardiotoxicity, and prompt recognition, as well as treatment, may favorably alter the outcomes. SUMMARY: ICI and CAR T cell therapy have improved cancer-related outcomes; however, they both are associated with potentially therapy-limiting cardiotoxicity. Cardio-oncologists are required to play an important role in patient selection, pretherapy cardiovascular optimization, and prompt recognition and treatment of cardiotoxicity.
Targeted Temperature Management for Treatment of Cardiac Arrest.
Rasmussen TP, Bullis TC, Girotra S
Curr Treat Options Cardiovasc Med · 2020 · PMID 33071538 · Full text
PURPOSE OF REVIEW: Cardiac arrest is a common condition associated with high mortality and a substantial risk of neurological injury among survivors. Targeted temperature management (TTM) is the only strategy shown to re...
PURPOSE OF REVIEW: Cardiac arrest is a common condition associated with high mortality and a substantial risk of neurological injury among survivors. Targeted temperature management (TTM) is the only strategy shown to reduce the risk of neurologic disability cardiac arrest patients. In this article, we provide a comprehensive review of TTM with an emphasis on recent trials. RECENT FINDINGS: After early studies demonstrating the benefit of TTM in out-of-hospital cardiac arrest due to a shockable rhythm, newer studies have extended the benefit of TTM to patients with a nonshockable rhythm and in-hospital cardiac arrest. A target temperature of 33 °C was not superior to 36 °C, suggesting that a lenient targeted temperature may be appropriate especially for patients unable to tolerate lower temperatures. Although early initiation of TTM appears to be beneficial, the benefit of prehospital cooling has not been shown and use of intravenous cold saline in the prehospital setting may be harmful. SUMMARY: There is substantial risk of neurological injury in cardiac arrest survivors who remain comatose. TTM is an effective treatment that can lower the risk of neurological disability in such patients and ideally delivered as part of a comprehensive, goal-directed post-resuscitation management by a multidisciplinary team in a tertiary medical center.
Balloon Pulmonary Angioplasty as a Treatment in Chronic Thromboembolic Pulmonary Hypertension: Past, Present, and Future.
Karyofyllis P, Demerouti E, Papadopoulou V … +2 more , Voudris V, Matsubara H
Curr Treat Options Cardiovasc Med · 2020 Feb · PMID 32056029 · Publisher ↗
PURPOSE OF REVIEW: Chronic thromboembolic pulmonary hypertension (CTEPH) is a major cause of precapillary pulmonary hypertension leading to right heart failure and death if left untreated. In addition to pulmonary endart...
PURPOSE OF REVIEW: Chronic thromboembolic pulmonary hypertension (CTEPH) is a major cause of precapillary pulmonary hypertension leading to right heart failure and death if left untreated. In addition to pulmonary endarterectomy, which is considered the standard of care, and specific drug therapy that is not however expected to offer relief from the mechanical component of the disease, the therapeutic options for CTEPH have expanded with the development of balloon pulmonary angioplasty (BPA). The purpose of this review is a better understanding and evaluation of BPA as a treatment option in CTEPH patients. RECENT FINDINGS: With the evolution of BPA almost all over the world, more centers outside Japan, which remains the leader for the technique, presented their results confirming the efficacy, safety, and feasibility of this procedure as a complementary strategy in the treatment algorithm of CTEPH. Summarizing, more data from all over the world confirm that BPA is a challenging but potentially effective intervention for the treatment of inoperable CTEPH patients. However, there is a need for standardization of the technique, and furthermore, large, international, multicenter randomized controlled trials comparing BPA with the other treatment modalities of CTEPH are imperative.
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