Cardiology
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PCI in TAVR Patients with Severe Coronary Lesions Shows Benefits
In this randomized trial of patients undergoing transcatheter aortic valve replacement (TAVR), with an average of one severe coronary stenosis, percutaneous coronary intervention in addition to TAVR reduced the incidence of the combined endpoint of all-cause mortality, myocardial infarction, and urgent revascularization at two years.
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Screening for Atrial Fibrillation in Older Adults
A two-week ambulatory electrocardiogram monitor in a large group of individuals 70 years of age or older with no history of atrial fibrillation (AF) showed a very low incidence of AF (4.4%), almost all of which was paroxysmal. In less than 2% of the subjects did it represent ≥ 2% of the monitoring time. However, some patients had hours of AF, raising a concern for thromboembolic risk.
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Biomarker Enhances Screening for Atrial Fibrillation
A large Swedish population study of screening for atrial fibrillation (AF) in 75-year-old individuals that was enhanced by N-terminal pro-B-type natriuretic peptide (NT-proBNP) stratification did not identify more AF cases or prevent thromboembolic outcomes compared to unscreened control subjects. However, a low NT-proBNP (< 125 ng/L) did identify individuals at low risk for AF and thromboembolic events in whom screening could be safely forfeited.
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A New Drug for Heart Failure with Preserved Ejection Fraction?
The addition of the nonsteroidal mineralocorticoid receptor antagonist finerenone to standard therapy reduced the incidence of recurrent heart failure and death compared to placebo in patients with heart failure and mildly reduced or preserved left ventricular ejection fraction and was generally well tolerated.
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Look for the Pattern
How would you interpret the two-lead rhythm strip shown in the figure? Hint: Is there a pattern?
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Myocarditis in a Post-COVID World
Myocarditis is a rare, typically self-limited inflammatory condition of the heart. Interest in myocarditis has increased in recent years because of the COVID-19 pandemic and COVID-19 vaccinations both being associated with its development. Paralleling this interest is an increase in misinformation about this condition, its frequency associated with both COVID-19 infection and vaccination, and potential linkage to sudden cardiac death. This review article will trace the history of myocarditis from the pre-COVID-19 era to the present day, with special attention being paid to how social media has driven a large portion of the discussion.
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Risk of Atherosclerotic Coronary Artery Disease in Autoimmune Disorders
A large Danish registry study of patients with autoimmune disease referred for coronary computed tomography angiography compared to those without autoimmune disease has shown that autoimmune disease increases the incidence of atherosclerotic events and that the event rate is influenced by traditional atherosclerotic disease risk factors. These results support aggressive risk factor management in patients with autoimmune disease.
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Are Mineralocorticoid Receptor Antagonists Safe in Heart Failure Patients with Renal Dysfunction?
A post hoc analysis of the RALES and EMPHASIS HF trials has shown that, although treatment of heart failure with reduced left ventricular ejection fraction in patients with mineralocorticoid receptor antagonists can cause a significant deterioration in renal function, the benefits outweigh the adverse effects and should not lead to automatic therapy discontinuation.
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How Old Is Atherosclerosis?
Computed tomography of mummified human remains exhibits vascular calcium in almost 40% across multiple eras and geographies, which included <br />non-elites.
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Marantic Endocarditis Revisited
A single institution case series of cancer-associated thrombotic endocarditis has shown that it most frequently presents as a systemic embolism and is detected largely by transesophageal echocardiography, which displays mobile masses attached to thickened mitral and aortic valves.