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.
{"title":"New Innovations to Address Sudden Cardiac Arrest","authors":"Christine P. Shen, Sanjeev P Bhavnani, John D Rogers","doi":"10.15420/usc.2023.25","DOIUrl":"https://doi.org/10.15420/usc.2023.25","url":null,"abstract":"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.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":"126 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141811262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"MI and Non-obstructive Coronary Arteries","authors":"Yetunde A Fatade, Noah A Newman, Nidhi H Patel, P. Mehta","doi":"10.15420/usc.2023.12","DOIUrl":"https://doi.org/10.15420/usc.2023.12","url":null,"abstract":"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.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":"72 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141810407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Sex and Gender Differences in Fibromuscular Dysplasia","authors":"Marianne H Khoury, Sims Hershey, R. LeLeiko","doi":"10.15420/usc.2023.03","DOIUrl":"https://doi.org/10.15420/usc.2023.03","url":null,"abstract":"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.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":"15 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141682444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sheldon E. Litwin, Christian C Faaborg-Andersen, R. J. Tedford
{"title":"Executive Summary from the 2023 Charleston HFpEF Conference","authors":"Sheldon E. Litwin, Christian C Faaborg-Andersen, R. J. Tedford","doi":"10.15420/usc.2024.04","DOIUrl":"https://doi.org/10.15420/usc.2024.04","url":null,"abstract":"","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":" 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141364897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Secondary Mitral Regurgitation: Diagnosis and Management","authors":"Nehal Dhaduk, A. Chaus, David Williams, A. Vainrib, Homam Ibrahim","doi":"10.15420/usc.2022.34","DOIUrl":"https://doi.org/10.15420/usc.2022.34","url":null,"abstract":"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.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":"226 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140233456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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。
{"title":"The Pink Tax: Sex and Gender Disparities in Peripheral Artery Disease","authors":"Andrea Martinez, Jingwen Huang, Arash Harzand","doi":"10.15420/usc.2022.28","DOIUrl":"https://doi.org/10.15420/usc.2022.28","url":null,"abstract":"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.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":"26 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140436230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Hypertensive Disorders of Pregnancy: A Literature Review – Pathophysiology, Current Management, Future Perspectives, and Healthcare Disparities","authors":"Ariana Traub, Apoorva Sharma, M. C. Gongora","doi":"10.15420/usc.2023.01","DOIUrl":"https://doi.org/10.15420/usc.2023.01","url":null,"abstract":"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.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":"73 45","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139843966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Hypertensive Disorders of Pregnancy: A Literature Review – Pathophysiology, Current Management, Future Perspectives, and Healthcare Disparities","authors":"Ariana Traub, Apoorva Sharma, M. C. Gongora","doi":"10.15420/usc.2023.01","DOIUrl":"https://doi.org/10.15420/usc.2023.01","url":null,"abstract":"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.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":"42 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139784059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Tearin’ Up My Heart: Intramural Hematoma in Spontaneous Coronary Artery Dissection","authors":"Shen, Sibi Krishnamurthy","doi":"10.15420/usc.2023.23","DOIUrl":"https://doi.org/10.15420/usc.2023.23","url":null,"abstract":"","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":"244 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140477789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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