Cardiology

Appropriateness for Revascularization in Stable Angina

July 22, 2010
Appropriateness for Revascularization in Stable Angina

Ramin Shayegan Hastings MD, Jonathan Willner MD, and Steven Sedlis MD

Introduction to Cases:

During the past several weeks, we have posted a series of cases addressing the appropriate treatment for patients with stable coronary artery disease. We have focused on indications for revascularization in stable angina. In all of the cases, the patients have been at high enough risk that stress tests and coronary angiography are performed.

There has been recent data and recommendations on the appropriate…

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Appropriateness for Revascularization in Stable Angina

July 1, 2010
Appropriateness for Revascularization in Stable Angina

Introduction to Cases:

During the upcoming weeks, we will post a series of cases addressing the appropriate treatment for patients with stable coronary artery disease. We will be focus on indications for revascularization in stable angina. In all of the cases, the patients will be at high enough risk that stress tests and coronary angiography will be performed.

There has been recent data and recommendations on the appropriate indications for revascularization in stable angina. These recommendations are based…

Read more »

Appropriateness for Revascularization in Stable Angina

June 9, 2010
Appropriateness for Revascularization in Stable Angina

Introduction to Cases:

During the upcoming weeks, we will post a series of cases addressing the appropriate treatment for patients with stable coronary artery disease. We will be focus on indications for revascularization in stable angina. In all of the cases, the patients will be at high enough risk that stress tests and coronary angiography will be performed.

There has been recent data and recommendations on the appropriate indications for revascularization in stable angina. These recommendations are based…

Read more »

Appropriateness for Revascularization in Stable Angina

May 19, 2010
Appropriateness for Revascularization in Stable Angina

Introduction to Cases:

During the upcoming weeks, we will post a series of cases addressing the appropriate treatment for patients with stable coronary artery disease. We will be focus on indications for revascularization in stable angina. In all of the cases, the patients will be at high enough risk that stress tests and coronary angiography will be performed.

There has been recent data and recommendations on the appropriate indications for revascularization in stable angina. These recommendations are based on…

Read more »

Breaking News: The Crestor Controversy

April 1, 2010
Breaking News: The Crestor Controversy

Devyani Kothari, MD

Patients are already talking about a New York Times front page article highlighting the risks associated with statin use as a preventive measure for cardiovascular events in relatively “healthy” people. The piece examines the newest FDA indications for the use of Crestor along with the controversies surrounding the drug.

Last month, the FDA approved Rosuvastatin Calcium, marketed as Crestor by AstraZeneca for use in a new patient population , based on the JUPITER trial. Crestor now…

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The Evolution of Cardiac Biomarkers: What’s on the Horizon?

March 24, 2010
The Evolution of Cardiac Biomarkers:  What’s on the Horizon?

Rushi Parikh

Faculty peer reviewed

Cardiac biomarkers have historically been a mainstay of the diagnostic criteria of acute coronary syndrome (ACS). Previously utilized cardiac biomarkers include aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and myoglobin; now more often troponin and to a lesser extent creatine kinase-MB are the principal biomarkers used to diagnose ACS.1

Myocardial necrosis and the subsequent loss of cardiomyocyte membrane integrity lead to the release of cardiac biomarkers into the peripheral circulation. Biomarkers, however, do…

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When Clopidogrel Fails…

March 10, 2010
When Clopidogrel Fails…

Marisa Mizus

Faculty peer reviewed

Clopidogrel (Plavix) has been the standard of care for patients with coronary artery disease following percutaneous coronary intervention (PCI) for the past decade.  Although it is a successful antiplatelet treatment in many patients, like any hero, it has a weakness: formation of its active metabolite depends on two hepatic cytochrome P450 (CYP450)-dependent steps.  Clopidogrel resistance, or non-response, is correlated with an increased risk of major adverse cardiovascular events, including reinfarction and stent thrombosis.(1)  It…

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When Minutes Matter: Why Do Patients Wait to Seek Treatment Following a Stroke or Heart Attack?

March 3, 2010
When Minutes Matter: Why Do Patients Wait to Seek Treatment Following a Stroke or Heart Attack?

Laurel Geraghty

Faculty peer reviewed

Both stroke and heart attack require rapid treatment following the onset of symptoms to minimize morbidity and mortality, but few patients seek help in a timely manner. Only about half of patients with acute myocardial infarction (AMI) or stroke arrive to the emergency department within four hours of the onset of symptoms.,,, Every 30-minute delay in treatment following AMI increases one-year mortality by 7.5%, and almost half of the 167,000 annual stroke deaths in…

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Meeting Perspectives: American Heart Association Scientific Sessions 2009

December 16, 2009
Meeting Perspectives: American Heart Association Scientific Sessions 2009

Steven Sedlis, MD

 

The annual scientific session of the American Heart Association (AHA) was held in Orlando on November 14-18 2009. It felt like a ghost town. I ran into Ira Schulman, my medicine resident at Bellevue when I was a third year medical student; we looked at one another and simultaneously blurted out “where is everybody?” Well Ira remains my role model and hero and it goes to show that although attendance at major…

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How Does Alcohol Cause Cardiomyopathy?

November 4, 2009
How Does Alcohol Cause Cardiomyopathy?

Charles Levine

Faculty peer reviewed

Excessive consumption of ethanol (EtOH) has many deleterious effects on the human body. The heart is a target of damage from EtOH consumption, as chronic consumption of EtOH leads to decreased cardiac function and structural heart disease, including dilated cardiomyopathy.(1) The exact mechanism by which EtOH exerts its deleterious effects on the heart remains poorly understood and is an area of active research. This report will focus on some of the proposed mechanisms and…

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How to interpret troponins in renal disease?

October 21, 2009
How to interpret troponins in renal disease?

Ivan Saraiva MD

Case: A 68-year-old man, with a history of stable angina and end-stage renal disease treated by hemodialysis for the past three years, presents to the hospital with leg swelling and shortness of breath. He also complains of intermittent chest pain unrelated to exertion. Physical exam reveals bilateral pitting lower extremity edema, pulmonary crackles, and an elevated jugular venous pressure. Initial electrocardiogram is notable for some nonspecific repolarization abnormalities. Troponin I levels drawn at 0, 6, and 12 hours…

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What is Wellens’ Syndrome?

October 7, 2009
What is Wellens’ Syndrome?

Erin Ducharme MD

Faculty peer reviewed

Wellens’ syndrome refers to a pattern of ECG signs occurring during chest-pain free periods in patients with unstable angina, heralding critical, proximal left anterior descending artery (LAD) stenosis . The eponym honors Dr. Hein J.J. Wellens who first described this ECG phenomenon in 1982. Wellens and colleagues identified a subgroup of patients with unstable angina who demonstrated a pattern of inverted precordial T-waves which strongly correlated with early large anterior myocardial infarction (MI)…

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