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New Innovations to Address Sudden Cardiac Arrest 应对心脏骤停的新创新
Q4 Medicine Pub Date : 2024-07-23 DOI: 10.15420/usc.2023.25
Christine P. Shen, Sanjeev P Bhavnani, John D Rogers
Mortality from sudden cardiac arrest remains high despite increased awareness and advancements in emergency resuscitation efforts. Various gaps exist in bystander resuscitation, automated external defibrillators, and access. Significant racial, gender, and geographic disparities have also been found. A myriad of recent innovations in sudden cardiac arrest uses new machine learning algorithms with high levels of performance. These have been applied to a broad range of efforts to identify individuals at high risk, recognize emergencies, and diagnose high-risk cardiac arrhythmias. Such technological advancements must be coupled to novel public health approaches to best implement these innovations in an equitable way. The authors propose a data-driven, technology-enabled system of care within a public health system of care to ultimately improve sudden cardiac arrest outcomes.
尽管人们对心脏骤停的认识有所提高,紧急复苏工作也取得了进展,但心脏骤停导致的死亡率仍然很高。在旁观者复苏、自动体外除颤器和使用方面存在各种差距。此外,在种族、性别和地域方面也存在显著差异。最近在心脏骤停方面的无数创新都采用了性能卓越的新型机器学习算法。这些算法已被广泛应用于识别高危人群、识别紧急情况和诊断高危心律失常。这种技术进步必须与新颖的公共卫生方法相结合,才能以最公平的方式实施这些创新。作者建议在公共卫生护理系统内建立一个数据驱动、技术辅助的护理系统,以最终改善心脏骤停的预后。
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引用次数: 0
MI and Non-obstructive Coronary Arteries 心肌梗死和非阻塞性冠状动脉
Q4 Medicine Pub Date : 2024-07-23 DOI: 10.15420/usc.2023.12
Yetunde A Fatade, Noah A Newman, Nidhi H Patel, P. Mehta
MI and non-obstructive coronary arteries (MINOCA) is recognized as an important contributor to adverse cardiovascular outcomes in both men and women but is particularly prevalent in young women. Multiple coronary mechanisms such as coronary plaque disruption, coronary artery spasm, coronary microvascular dysfunction, spontaneous coronary artery dissection, and coronary thromboembolism can trigger MINOCA. Beyond routine left heart catheterization, invasive intracoronary imaging and cardiac MRI can help to clarify the cause of MINOCA. Conditions such as myocarditis, takotsubo syndrome, and cardiomyopathy are on the differential as alternate explanations in those suspected of MINOCA. Identification of the underlying cause in a case of MINOCA has therapeutic implications. While long-term management of MINOCA is not standardized, angiotensin converting enzyme inhibitors and statins appear to be of benefit. In this review, we discuss the prevalence and pathophysiology of MINOCA, diagnostic considerations, and current treatment approaches to manage this high-risk group of patients.
心肌梗死和非阻塞性冠状动脉(MINOCA)被认为是导致男性和女性心血管不良预后的重要因素,但在年轻女性中尤为普遍。多种冠状动脉机制(如冠状动脉斑块破坏、冠状动脉痉挛、冠状动脉微血管功能障碍、自发性冠状动脉夹层和冠状动脉血栓栓塞)都可能引发 MINOCA。除了常规的左心导管检查外,侵入性冠状动脉内成像和心脏核磁共振成像也有助于明确 MINOCA 的病因。心肌炎、Takotsubo 综合征和心肌病等疾病可作为 MINOCA 疑似病例的其他解释。确定 MINOCA 病例的潜在病因具有治疗意义。虽然 MINOCA 的长期治疗尚未标准化,但血管紧张素转换酶抑制剂和他汀类药物似乎有一定疗效。在这篇综述中,我们将讨论 MINOCA 的发病率和病理生理学、诊断注意事项以及目前管理这类高危患者的治疗方法。
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引用次数: 0
Sex and Gender Differences in Fibromuscular Dysplasia 纤维肌发育不良的性别差异
Q4 Medicine Pub Date : 2024-07-03 DOI: 10.15420/usc.2023.03
Marianne H Khoury, Sims Hershey, R. LeLeiko
Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular disease that was once underrecognized and is significantly more prevalent in women than men. Although it most commonly affects the renal and extracranial carotid arteries, FMD can affect any vascular bed. Complications of FMD can include hypertension, dissection, and stroke. Presentation may vary between the sexes, with male patients having an increased frequency of arterial dissection and aneurysms compared with female patients. Diagnosis requires a high index of suspicion by the treating physician. Several imaging studies can assist with diagnosis, and treatment focuses on the monitoring of affected vessels and intervention only as needed. Antiplatelet therapy for prevention of thrombotic complications is recommended. Studies are still underway to examine the genetic underpinnings of FMD pathophysiology and to evaluate the underlying mechanism of this disease that affects more female than male patients.
纤维肌性发育不良(FMD)是一种非动脉粥样硬化性、非炎症性血管疾病,曾一度未被充分认识,女性发病率明显高于男性。虽然 FMD 最常影响肾动脉和颅外颈动脉,但它可以影响任何血管床。FMD 的并发症包括高血压、动脉夹层和中风。表现可能因性别而异,与女性患者相比,男性患者发生动脉夹层和动脉瘤的频率更高。诊断需要主治医生高度怀疑。一些影像学检查可协助诊断,治疗重点是监测受影响的血管,并在必要时进行干预。建议使用抗血小板疗法预防血栓并发症。目前仍在研究 FMD 病理生理学的遗传基础,并评估这种女性患者多于男性患者的疾病的潜在机制。
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引用次数: 0
Executive Summary from the 2023 Charleston HFpEF Conference 2023 年查尔斯顿高频前列腺素会议执行摘要
Q4 Medicine Pub Date : 2024-06-10 DOI: 10.15420/usc.2024.04
Sheldon E. Litwin, Christian C Faaborg-Andersen, R. J. Tedford
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引用次数: 0
Early Ventricular Septal Rupture following Acute Myocardial Infarction Diagnosed on Left Ventriculogram 左心室造影诊断急性心肌梗死后的早期室间隔破裂
Q4 Medicine Pub Date : 2024-06-03 DOI: 10.15420/usc.2024.01
Arpanjeet Kaur, Yash Patel, J. Tamis-Holland
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引用次数: 0
Secondary Mitral Regurgitation: Diagnosis and Management 继发性二尖瓣反流:诊断与管理
Q4 Medicine Pub Date : 2024-03-18 DOI: 10.15420/usc.2022.34
Nehal Dhaduk, A. Chaus, David Williams, A. Vainrib, Homam Ibrahim
Secondary mitral regurgitation is one of the most common valve diseases. The disease is a result of left atrial or left ventricular dysfunction. It is generally classified into stages based on its severity. While surgical intervention does not confer improved survival in this subset of mitral disease, recent advances in transcatheter interventions have resulted in improved survival and symptomatology in carefully selected patients. In this review, the multimodality imaging evaluation of the mitral valve and secondary mitral regurgitation is discussed. Commercially available and investigational transcatheter interventions for secondary mitral regurgitation management are also reviewed.
继发性二尖瓣反流是最常见的瓣膜疾病之一。这种疾病是左心房或左心室功能障碍的结果。一般根据其严重程度分为不同阶段。虽然手术治疗并不能提高二尖瓣疾病患者的存活率,但经导管介入治疗的最新进展已经改善了精心挑选的患者的存活率和症状。本综述将讨论二尖瓣和继发性二尖瓣反流的多模式成像评估。此外,还回顾了用于治疗继发性二尖瓣反流的市售和在研经导管介入疗法。
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引用次数: 0
The Pink Tax: Sex and Gender Disparities in Peripheral Artery Disease 粉红税外周动脉疾病的性别差异
Q4 Medicine Pub Date : 2024-02-23 DOI: 10.15420/usc.2022.28
Andrea Martinez, Jingwen Huang, Arash Harzand
Peripheral artery disease (PAD) is an atherosclerotic disease associated with significant functional impairment, morbidity, and mortality. Among women, PAD remains poorly recognized and undermanaged. Compared with men, women with PAD tend to be underdiagnosed or misdiagnosed, have poorer quality of life, and experience higher rates of PAD-related morbidity and cardiovascular mortality. In this review, we describe the sex- and gender-related differences in the epidemiology, presentation, diagnosis, and management of PAD. We provide specific recommendations to overcome these factors, including greater awareness and an increased emphasis on tailored and more aggressive interventions for women with PAD. Such changes are warranted and necessary to achieve more equitable outcomes in women with PAD, including improved limb outcomes, enhanced lifestyle, and cardiovascular risk reduction.
外周动脉疾病(PAD)是一种动脉粥样硬化性疾病,与严重的功能障碍、发病率和死亡率有关。在女性中,对 PAD 的认识和管理仍然不足。与男性相比,患有 PAD 的女性往往被诊断不足或误诊,生活质量较差,与 PAD 相关的发病率和心血管死亡率较高。在这篇综述中,我们描述了在 PAD 的流行病学、表现、诊断和管理方面与性别相关的差异。我们提出了克服这些因素的具体建议,包括提高对女性 PAD 患者的认识,并进一步强调为其量身定制更积极的干预措施。为了使女性 PAD 患者获得更公平的治疗结果,包括改善肢体预后、改善生活方式和降低心血管风险,这些改变是必要的,也是必须的。
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引用次数: 0
Hypertensive Disorders of Pregnancy: A Literature Review – Pathophysiology, Current Management, Future Perspectives, and Healthcare Disparities 妊娠期高血压疾病:文献综述--病理生理学、当前管理、未来展望和医疗差距
Q4 Medicine Pub Date : 2024-02-12 DOI: 10.15420/usc.2023.01
Ariana Traub, Apoorva Sharma, M. C. Gongora
Maternal mortality continues to increase in the US, with hypertensive disorders of pregnancy (HDP) remaining one of the leading causes of morbidity and mortality. In this article, the definition, classification, and pathophysiology of the different forms of HDP, current management of these disorders, disparities in prevalence and management of these conditions, and potential strategies to improve HDP outcomes and combat disparities to reduce maternal morbidity and mortality are reviewed. Current management favors a more conservative approach to treating mild chronic hypertension (140–160/90–100 mmHg) in pregnancy. However, recent data suggests active treatment of mild chronic hypertension improves maternofetal pregnancy related outcomes.
在美国,孕产妇死亡率持续上升,而妊娠高血压疾病(HDP)仍然是发病和死亡的主要原因之一。本文综述了不同形式妊娠高血压的定义、分类和病理生理学,这些疾病的当前管理,这些疾病在患病率和管理方面的差异,以及改善妊娠高血压预后和消除差异以降低孕产妇发病率和死亡率的潜在策略。目前的管理方法倾向于以更保守的方式治疗妊娠期轻度慢性高血压(140-160/90-100 mmHg)。然而,最近的数据表明,积极治疗轻度慢性高血压可改善与妊娠相关的母胎结局。
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引用次数: 0
Hypertensive Disorders of Pregnancy: A Literature Review – Pathophysiology, Current Management, Future Perspectives, and Healthcare Disparities 妊娠期高血压疾病:文献综述--病理生理学、当前管理、未来展望和医疗差距
Q4 Medicine Pub Date : 2024-02-12 DOI: 10.15420/usc.2023.01
Ariana Traub, Apoorva Sharma, M. C. Gongora
Maternal mortality continues to increase in the US, with hypertensive disorders of pregnancy (HDP) remaining one of the leading causes of morbidity and mortality. In this article, the definition, classification, and pathophysiology of the different forms of HDP, current management of these disorders, disparities in prevalence and management of these conditions, and potential strategies to improve HDP outcomes and combat disparities to reduce maternal morbidity and mortality are reviewed. Current management favors a more conservative approach to treating mild chronic hypertension (140–160/90–100 mmHg) in pregnancy. However, recent data suggests active treatment of mild chronic hypertension improves maternofetal pregnancy related outcomes.
在美国,孕产妇死亡率持续上升,而妊娠高血压疾病(HDP)仍然是发病和死亡的主要原因之一。本文综述了不同形式妊娠高血压的定义、分类和病理生理学,这些疾病的当前管理,这些疾病在患病率和管理方面的差异,以及改善妊娠高血压预后和消除差异以降低孕产妇发病率和死亡率的潜在策略。目前的管理方法倾向于以更保守的方式治疗妊娠期轻度慢性高血压(140-160/90-100 mmHg)。然而,最近的数据表明,积极治疗轻度慢性高血压可改善与妊娠相关的母胎结局。
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引用次数: 0
Tearin’ Up My Heart: Intramural Hematoma in Spontaneous Coronary Artery Dissection 撕裂我的心自发性冠状动脉夹层中的壁内血肿
Q4 Medicine Pub Date : 2024-01-31 DOI: 10.15420/usc.2023.23
Shen, Sibi Krishnamurthy
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引用次数: 0
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US Cardiology Review
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