Constrictive pericarditis, although still a relatively rare disease, continues to be a clinical problem that most practicing cardiologists may encounter. A major clinical clue to diagnosis is the continued elevation of the central venous pressure after adequate diuresis. The diagnosis is further supported by (1) prominent X and Y descents in the jugular venous pulse, (2) a relatively normal or only slightly enlarged cardiac silhouette in a patient with congestive heart failure, (3) pericardial calcification or significant congestive failure especially when the right sided signs predominate without obvious cause. When the disease is suspected, appropriate investigation should be undertaken using both the noninvasive and the catheterization studies. If the diagnosis is supported, then the choice of therapy at present is based primarily on severity of symptoms with surgical removal of the constricting pericardium being the therapy of choice in patients unable to be managed medically.
{"title":"Constrictive pericarditis.","authors":"D. E. Wise, C. Conti","doi":"10.32388/bgyfxd","DOIUrl":"https://doi.org/10.32388/bgyfxd","url":null,"abstract":"Constrictive pericarditis, although still a relatively rare disease, continues to be a clinical problem that most practicing cardiologists may encounter. A major clinical clue to diagnosis is the continued elevation of the central venous pressure after adequate diuresis. The diagnosis is further supported by (1) prominent X and Y descents in the jugular venous pulse, (2) a relatively normal or only slightly enlarged cardiac silhouette in a patient with congestive heart failure, (3) pericardial calcification or significant congestive failure especially when the right sided signs predominate without obvious cause. When the disease is suspected, appropriate investigation should be undertaken using both the noninvasive and the catheterization studies. If the diagnosis is supported, then the choice of therapy at present is based primarily on severity of symptoms with surgical removal of the constricting pericardium being the therapy of choice in patients unable to be managed medically.","PeriodicalId":75674,"journal":{"name":"Cardiovascular clinics","volume":"7 3 1","pages":"197-209"},"PeriodicalIF":0.0,"publicationDate":"2020-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42170171","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}
e5 Heart disease is the leading cause of death among women. In comparison with men, women have greater cardiovascular mortality, report more morbidity, and have greater reductions in quality of life. Furthermore, sex disparities in cardiovascular health exist among women of all ages, socioeconomic backgrounds, and racial subgroups, which likely reflect both lingering diagnostic and treatment disparities, and underlying biological sex differences, as well. For example, there is a largely female predominance of stress-induced (Takotsubo) cardiomyopathy after menopause, a greater occurrence of heart failure with preserved ejection fraction, particularly in elderly women, and a higher incidence of rheumatic mitral stenosis among women in developing countries. In addition, after 55 years of age, hypertension is more prevalent in women than in men, particularly in black women. Clinical outcomes also differ by sex. Women with atrial fibrillation have a higher risk of thromboembolic events in comparison with men, and, among individuals younger than 55 years of age, the rate of acute myocardial infarction in the past decade has declined in men, but not in women. As the importance and impact of cardiovascular disease in women is increasingly recognized, we are learning how heart disease is distinct between the sexes, both in its pathophysiology and in our ability to diagnose and treat women. To better understand and appreciate sex differences in cardiovascular disease, there needs to be a compilation of current knowledge and an accessible tool that increases awareness of these differences. Heart Disease in Women, by Drs Navin Nanda and Nurgul Keser, is that clinical tool and an excellent resource for all providers of women’s health. Heart Disease in Women brings greater awareness to sex-specific differences in heart disease and emphasizes the unique features of cardiovascular disease in women. The book consists of 34 chapters organized into 8 sections covering prevention and risk factors, coronary heart disease, noninvasive testing, heart failure and cardiomyopathies, arrhythmias, valvular heart disease, heart disease in pregnancy, and a final segment on largely underrecognized issues in women, including peripheral arterial disease, cardio-oncology, and the current status of evidence-based medicine for the treatment of heart disease in women. Many of the chapters are written by leaders in the field of women’s cardiovascular health who have been instrumental in bringing attention to the sex-specific nature of heart disease pathophysiology and sex disparities that exist in cardiac care. It would be of great benefit to any practitioner to read this book cover to cover, but unfortunately time often dictates a more abbreviated approach to acquiring new knowledge. The following are particularly noteworthy chapters to be read if time precludes an extensive review of this topic. Chapter 3, by Sanne Peters and colleagues, provides a very well-articulated overview o
{"title":"Heart Disease in Women","authors":"N. Nanda, N. Keser","doi":"10.5005/jp/books/12562","DOIUrl":"https://doi.org/10.5005/jp/books/12562","url":null,"abstract":"e5 Heart disease is the leading cause of death among women. In comparison with men, women have greater cardiovascular mortality, report more morbidity, and have greater reductions in quality of life. Furthermore, sex disparities in cardiovascular health exist among women of all ages, socioeconomic backgrounds, and racial subgroups, which likely reflect both lingering diagnostic and treatment disparities, and underlying biological sex differences, as well. For example, there is a largely female predominance of stress-induced (Takotsubo) cardiomyopathy after menopause, a greater occurrence of heart failure with preserved ejection fraction, particularly in elderly women, and a higher incidence of rheumatic mitral stenosis among women in developing countries. In addition, after 55 years of age, hypertension is more prevalent in women than in men, particularly in black women. Clinical outcomes also differ by sex. Women with atrial fibrillation have a higher risk of thromboembolic events in comparison with men, and, among individuals younger than 55 years of age, the rate of acute myocardial infarction in the past decade has declined in men, but not in women. As the importance and impact of cardiovascular disease in women is increasingly recognized, we are learning how heart disease is distinct between the sexes, both in its pathophysiology and in our ability to diagnose and treat women. To better understand and appreciate sex differences in cardiovascular disease, there needs to be a compilation of current knowledge and an accessible tool that increases awareness of these differences. Heart Disease in Women, by Drs Navin Nanda and Nurgul Keser, is that clinical tool and an excellent resource for all providers of women’s health. Heart Disease in Women brings greater awareness to sex-specific differences in heart disease and emphasizes the unique features of cardiovascular disease in women. The book consists of 34 chapters organized into 8 sections covering prevention and risk factors, coronary heart disease, noninvasive testing, heart failure and cardiomyopathies, arrhythmias, valvular heart disease, heart disease in pregnancy, and a final segment on largely underrecognized issues in women, including peripheral arterial disease, cardio-oncology, and the current status of evidence-based medicine for the treatment of heart disease in women. Many of the chapters are written by leaders in the field of women’s cardiovascular health who have been instrumental in bringing attention to the sex-specific nature of heart disease pathophysiology and sex disparities that exist in cardiac care. It would be of great benefit to any practitioner to read this book cover to cover, but unfortunately time often dictates a more abbreviated approach to acquiring new knowledge. The following are particularly noteworthy chapters to be read if time precludes an extensive review of this topic. Chapter 3, by Sanne Peters and colleagues, provides a very well-articulated overview o","PeriodicalId":75674,"journal":{"name":"Cardiovascular clinics","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70691542","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":"Arrhythmias in valvular heart disease.","authors":"L S Dreifus","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75674,"journal":{"name":"Cardiovascular clinics","volume":"23 ","pages":"65-74"},"PeriodicalIF":0.0,"publicationDate":"1993-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19401004","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}
The management of the patient after valvular surgery is influenced by the preoperative left ventricular function and by the specific type of valvular lesion that has been corrected. The hemodynamics of the patient immediately after surgery must be evaluated carefully, and the patient can be supported with a variety of pharmacologic and mechanical measures as ventricular function recovers. Perioperative ischemia, arrhythmias, and bleeding may occur and should be specifically treated. Initiation of anticoagulation and adjustment of warfarin doses is an important aspect of postoperative care. Finally, the patient needs to be counseled that the presence of a prosthetic valve carries a risk for infective endocarditis and instructed on appropriate regimens for antibiotic prophylaxis.
{"title":"Immediate postoperative management.","authors":"D M Kolansky, L S Cohen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The management of the patient after valvular surgery is influenced by the preoperative left ventricular function and by the specific type of valvular lesion that has been corrected. The hemodynamics of the patient immediately after surgery must be evaluated carefully, and the patient can be supported with a variety of pharmacologic and mechanical measures as ventricular function recovers. Perioperative ischemia, arrhythmias, and bleeding may occur and should be specifically treated. Initiation of anticoagulation and adjustment of warfarin doses is an important aspect of postoperative care. Finally, the patient needs to be counseled that the presence of a prosthetic valve carries a risk for infective endocarditis and instructed on appropriate regimens for antibiotic prophylaxis.</p>","PeriodicalId":75674,"journal":{"name":"Cardiovascular clinics","volume":"23 ","pages":"277-91"},"PeriodicalIF":0.0,"publicationDate":"1993-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19401000","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":"Timing of surgery for valvular heart disease.","authors":"R J Gray, R H Helfant","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75674,"journal":{"name":"Cardiovascular clinics","volume":"23 ","pages":"209-31"},"PeriodicalIF":0.0,"publicationDate":"1993-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19399595","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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