Clinical Cardiology
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FDA Approves Ivabradine for Systolic Heart Failure
ABSTRACT & COMMENTARY: In HF patients with a heart rate above 70 bpm, despite truly maximum-tolerated doses of beta-blockers, ivabradine is an option.
Athlete’s Heart vs Brugada ECG
The normal variant ECG seen predominantly in highly trained athletes of domed ST segment elevation, and negative T waves in V1-V3 can be confused with some of the ECG patterns in Brugada syndrome patients.
Cardiac Sarcoidosis: Rare or Underdiagnosed?
There is increasing evidence that sarcoidosis can be confined to the heart, but disagreements abound about the diagnosis and treatment of cardiac sarcoidosis (CS).
SIMPLE Is Better – ICD Defibrillation Testing Does Not Improve Outcomes
Traditionally, the placement of an implantable cardioverter-defibrillator (ICD) concludes with induction of ventricular fibrillation (VF) to confirm that the new device is able to appropriately sense the arrhythmia and terminate it while there is still the opportunity to reposition the ventricular lead or add an additional lead if necessary.
Are Atrial Premature Complexes Benign?
Atrial premature complexes (APCs) are commonly observed on routine ECGs and believed to be harbingers of atrial fibrillation, especially in patients with cardiovascular disease.
Is it Time to Give Up on Systemic Cooling in ST Segment Elevation MI?
Systemic hypothermia as a means to protect against tissue damage is a strategy that has found its way into clinical practice guidelines in the post-cardiac arrest population, in which cooling has demonstrated a neuroprotective effect in multiple contemporary clinical trials.
Angiotensin Receptor Blockade, Renal Function, and Outcomes in Chronic Heart Failure
Renin-angiotensin-aldosterone (RAAS) blockade is an important component of guideline-recommended therapy for heart failure with reduced ejection fraction (HFrEF).
Ticagrelor Cost Effective as Well as Efficacious, According to New Analysis
The PLATO trial randomized more than 18,000 acute coronary syndrome (ACS) patients to dual anti-platelet therapy with aspirin plus either clopidogrel or the newer P2Y12 inhibitor ticagrelor. Compared with clopidogrel-treated patients, those on ticagrelor had lower rates of death and myocardial infarction at 1 year. Despite superior ischemic outcomes, both ticagrelor and the thienopyridine prasugrel have been relatively slow to be adopted in the United States. This is at least in part due to the cost differential, as the older clopidogrel is available as a generic, while the newer agents enjoy continued brand exclusivity. The National Average Drug Acquisition Cost data collected by CMS currently reports a 70-fold difference in price between clopidogrel and ticagrelor.
Implantable Coronary Sinus Narrowing Device Shows Promise in Refractory Angina
Despite advances in medical therapy and in coronary revascularization techniques, the population of patients with chronic, stable, but debilitating angina continues to grow. The mortality of such patients is surprisingly low, such that patients with this disorder often suffer limiting symptoms for many years. Clearly more options for treatment are needed, but what?
Surgical Management of Infective Endocarditis
SOURCES: Chu VH, et al. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: A prospective study from the international collaboration on endocarditis. Circulation 2015;131:131-140; Erbel R. The new strategy in infective endocarditis: Early surgery based on early diagnosis: Are we too late when early surgery is best? Circulation 2015;131:121-123.