Pub Date : 2024-08-16eCollection Date: 2024-01-01DOI: 10.15420/usc.2024.14
Andrea M Elliott, Sean van Diepen, Steven M Hollenberg, Samuel Bernard
The morbidity and mortality for patients having a cardiac arrest is substantial. Even if optimally performed, conventional cardiopulmonary resuscitation is an inadequate substitute for native cardiac output and results in a 'low-flow' perfusion state. Venoarterial extracorporeal membrane oxygenation during cardiac arrest, also known as extracorporeal cardiopulmonary resuscitation (eCPR), has been proposed as an alternative to restore systemic perfusion. However, conflicting results regarding its efficacy compared to routine advanced cardiac life support have left its role in clinical practice uncertain. In this article, the merits and limitations of the existing data for eCPR are reviewed in a 'point- counterpoint' style debate, followed by potential considerations for future trials.
{"title":"Extracorporeal Cardiopulmonary Resuscitation: Life-saving or Resource Wasting?","authors":"Andrea M Elliott, Sean van Diepen, Steven M Hollenberg, Samuel Bernard","doi":"10.15420/usc.2024.14","DOIUrl":"10.15420/usc.2024.14","url":null,"abstract":"<p><p>The morbidity and mortality for patients having a cardiac arrest is substantial. Even if optimally performed, conventional cardiopulmonary resuscitation is an inadequate substitute for native cardiac output and results in a 'low-flow' perfusion state. Venoarterial extracorporeal membrane oxygenation during cardiac arrest, also known as extracorporeal cardiopulmonary resuscitation (eCPR), has been proposed as an alternative to restore systemic perfusion. However, conflicting results regarding its efficacy compared to routine advanced cardiac life support have left its role in clinical practice uncertain. In this article, the merits and limitations of the existing data for eCPR are reviewed in a 'point- counterpoint' style debate, followed by potential considerations for future trials.</p>","PeriodicalId":93393,"journal":{"name":"US cardiology","volume":"18 ","pages":"e12"},"PeriodicalIF":0.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13eCollection Date: 2024-01-01DOI: 10.15420/usc.2024.16
Eric J Hall, Alexander I Papolos, P Elliott Miller, Christopher F Barnett, Benjamin B Kenigsberg
Patients undergoing cardiac surgery experience significant physiologic derangements that place them at risk for multiple shock phenotypes. Any combination of cardiogenic, obstructive, hemorrhagic, or vasoplegic shock occurs commonly in post-cardiotomy patients. The approach to the diagnosis and management of these shock states has many facets that are distinct compared to non-surgical cardiac intensive care unit patients. Additionally, the approach to and associated outcomes of cardiac arrest in the post-cardiotomy population are uniquely characterized by emergent bedside resternotomy if the circulation is not immediately restored. This review focuses on the unique aspects of the diagnosis and management of post-cardiotomy shock.
{"title":"Management of Post-cardiotomy Shock.","authors":"Eric J Hall, Alexander I Papolos, P Elliott Miller, Christopher F Barnett, Benjamin B Kenigsberg","doi":"10.15420/usc.2024.16","DOIUrl":"10.15420/usc.2024.16","url":null,"abstract":"<p><p>Patients undergoing cardiac surgery experience significant physiologic derangements that place them at risk for multiple shock phenotypes. Any combination of cardiogenic, obstructive, hemorrhagic, or vasoplegic shock occurs commonly in post-cardiotomy patients. The approach to the diagnosis and management of these shock states has many facets that are distinct compared to non-surgical cardiac intensive care unit patients. Additionally, the approach to and associated outcomes of cardiac arrest in the post-cardiotomy population are uniquely characterized by emergent bedside resternotomy if the circulation is not immediately restored. This review focuses on the unique aspects of the diagnosis and management of post-cardiotomy shock.</p>","PeriodicalId":93393,"journal":{"name":"US cardiology","volume":"18 ","pages":"e11"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aortic dissection is a critical condition, which can affect the aorta over its entire length. Characterized by a split between the tunica intima and the tunica media of the aorta, aortic dissection is seen in both sexes, and diagnosis and treatment are decisive for the survival of the patient. Aortic dissection has a wide range of risk factors that contribute to it being one of the most serious of cardiovascular conditions. Diagnosis is based on a thorough knowledge of the condition and its risk factors. This review describes the patient characteristics, drugs, and medical procedures that may contribute to an increased risk of aortic dissection, raising awareness of this life-threatening condition.
{"title":"Risk Factors for Aortic Dissection","authors":"Harold Djodjo Kano, Wei Sun","doi":"10.15420/usc.2022.36","DOIUrl":"https://doi.org/10.15420/usc.2022.36","url":null,"abstract":"Aortic dissection is a critical condition, which can affect the aorta over its entire length. Characterized by a split between the tunica intima and the tunica media of the aorta, aortic dissection is seen in both sexes, and diagnosis and treatment are decisive for the survival of the patient. Aortic dissection has a wide range of risk factors that contribute to it being one of the most serious of cardiovascular conditions. Diagnosis is based on a thorough knowledge of the condition and its risk factors. This review describes the patient characteristics, drugs, and medical procedures that may contribute to an increased risk of aortic dissection, raising awareness of this life-threatening condition.","PeriodicalId":93393,"journal":{"name":"US cardiology","volume":"3 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135217371","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}
Jimmy Kerrigan, Timir K Paul, Jay Patel, Walid Saad, Andrew Morse, Elias Haddad, Angel Chandler, Jonathan Emling, Hady Lichaa
Vascular access is a crucial step, which every interventional cardiologist needs to be skilled with to consistently achieve excellent periprocedural outcomes. Some operators argue that it is the most important aspect of the entire intervention. Hence, careful planning of vascular access in an individualized fashion – based on the patient’s clinical status, anatomy, and technical requirements of the intervention – is the first step in securing optimal procedural safety and successful results. We briefly review multiple aspects of vascular access and management including site selection, ultrasound guidance, micro-puncture techniques, sheathless techniques, limb perfusion, clinical monitoring, large bore closure, and management of complications. Approaching every vascular access in a systematic way, even in emergent situations, allows operators to minimize the risk of complications, especially in an often severely ill patient population.
{"title":"Vascular Access Management in Complex Percutaneous Coronary Interventions","authors":"Jimmy Kerrigan, Timir K Paul, Jay Patel, Walid Saad, Andrew Morse, Elias Haddad, Angel Chandler, Jonathan Emling, Hady Lichaa","doi":"10.15420/usc.2023.04","DOIUrl":"https://doi.org/10.15420/usc.2023.04","url":null,"abstract":"Vascular access is a crucial step, which every interventional cardiologist needs to be skilled with to consistently achieve excellent periprocedural outcomes. Some operators argue that it is the most important aspect of the entire intervention. Hence, careful planning of vascular access in an individualized fashion – based on the patient’s clinical status, anatomy, and technical requirements of the intervention – is the first step in securing optimal procedural safety and successful results. We briefly review multiple aspects of vascular access and management including site selection, ultrasound guidance, micro-puncture techniques, sheathless techniques, limb perfusion, clinical monitoring, large bore closure, and management of complications. Approaching every vascular access in a systematic way, even in emergent situations, allows operators to minimize the risk of complications, especially in an often severely ill patient population.","PeriodicalId":93393,"journal":{"name":"US cardiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135619657","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}
This review highlights sex- and gender-specific considerations in cardiovascular diseases with a particular focus on pathophysiology, epidemiology, clinical presentation, risk factors, diagnosis, and management of spontaneous coronary artery dissection. It aims to summarize the most up to date evidence and gaps in knowledge that exist in the spontaneous coronary artery dissection space while highlighting salient points with regards to sex- and gender-based differences in clinical implications, current management, and recommended counseling practices.
{"title":"Sex and Gender Differences in Cardiovascular Disease: A Review of Spontaneous Coronary Artery Dissection","authors":"Aishat F Mustapha, Anna M Goebel, Bryan J Wells","doi":"10.15420/usc.2023.02","DOIUrl":"https://doi.org/10.15420/usc.2023.02","url":null,"abstract":"This review highlights sex- and gender-specific considerations in cardiovascular diseases with a particular focus on pathophysiology, epidemiology, clinical presentation, risk factors, diagnosis, and management of spontaneous coronary artery dissection. It aims to summarize the most up to date evidence and gaps in knowledge that exist in the spontaneous coronary artery dissection space while highlighting salient points with regards to sex- and gender-based differences in clinical implications, current management, and recommended counseling practices.","PeriodicalId":93393,"journal":{"name":"US cardiology","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135095086","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}
Dilatation of the thoracic or abdominal aorta can progress to dissection or rupture with significant associated morbidity and mortality. Aortic disease remains a treatable contributor to mortality in the US and its burden is likely underestimated. Recent clinical studies have uncovered sex and gender distinctions in the epidemiology, pathophysiology, and outcomes of aortic disease. Despite this, there has been little progress in the application of these findings to clinical practice. Improved understanding of the sex-specific mechanisms of aortic disease may inform personalized indications for elective repair and thus reduce the morbidity of aortic catastrophe. The objective of this review is to summarize known clinical and biological sex differences in both thoracic and abdominal aortic disease and highlight promising areas for future investigation.
{"title":"Sex and Gender Differences in Aortic Disease","authors":"Lauren V Huckaby, Bradley G Leshnower","doi":"10.15420/usc.2022.39","DOIUrl":"https://doi.org/10.15420/usc.2022.39","url":null,"abstract":"Dilatation of the thoracic or abdominal aorta can progress to dissection or rupture with significant associated morbidity and mortality. Aortic disease remains a treatable contributor to mortality in the US and its burden is likely underestimated. Recent clinical studies have uncovered sex and gender distinctions in the epidemiology, pathophysiology, and outcomes of aortic disease. Despite this, there has been little progress in the application of these findings to clinical practice. Improved understanding of the sex-specific mechanisms of aortic disease may inform personalized indications for elective repair and thus reduce the morbidity of aortic catastrophe. The objective of this review is to summarize known clinical and biological sex differences in both thoracic and abdominal aortic disease and highlight promising areas for future investigation.","PeriodicalId":93393,"journal":{"name":"US cardiology","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135426274","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}
Rachel Koch Warnock, Roshan D Modi, Stacy B Westerman
Ventricular arrhythmias, including ventricular tachycardia and VF, commonly occur in patients with underlying cardiomyopathy. Sex differences exist in almost every aspect of ventricular arrhythmia from epidemiology, anatomy, and physiology to management and response to therapy. Some of these may be attributed to variations in etiology, types, and rates of cardiomyopathy as well as biological differences between males and females, but the full explanation for these differences remains incomplete. Additionally, women have been underrepresented in many trials studying therapies for ventricular arrhythmias including ICD placement and ablation; thus, there remains a need for continued research in this population. This review will discuss the differences between the sexes as well as outline opportunities for future research in women with ventricular arrhythmias.
{"title":"Sex and Gender Differences in Ventricular Arrhythmias","authors":"Rachel Koch Warnock, Roshan D Modi, Stacy B Westerman","doi":"10.15420/usc.2022.38","DOIUrl":"https://doi.org/10.15420/usc.2022.38","url":null,"abstract":"Ventricular arrhythmias, including ventricular tachycardia and VF, commonly occur in patients with underlying cardiomyopathy. Sex differences exist in almost every aspect of ventricular arrhythmia from epidemiology, anatomy, and physiology to management and response to therapy. Some of these may be attributed to variations in etiology, types, and rates of cardiomyopathy as well as biological differences between males and females, but the full explanation for these differences remains incomplete. Additionally, women have been underrepresented in many trials studying therapies for ventricular arrhythmias including ICD placement and ablation; thus, there remains a need for continued research in this population. This review will discuss the differences between the sexes as well as outline opportunities for future research in women with ventricular arrhythmias.","PeriodicalId":93393,"journal":{"name":"US cardiology","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135107306","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}
Rebecca S Steinberg, Weston Dicken, Alexis Cutchins
Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous disorder that presents with positional tachycardia and a constellation of other symptoms. Peer-reviewed evidence for treatment options is limited. In addition, there are various associated conditions with overlapping symptoms. These factors can make the diagnosis and management of POTS a frustrating experience for both providers and patients. This paper aims to combine available scientific data with anecdotal evidence derived from extensive clinical experience to provide information on recognizing the clinical features of POTS, identifying associated conditions, and understanding treatment strategies to help providers better diagnose and manage patients with this condition.
{"title":"Narrative Review of Postural Orthostatic Tachycardia Syndrome: Associated Conditions and Management Strategies","authors":"Rebecca S Steinberg, Weston Dicken, Alexis Cutchins","doi":"10.15420/usc.2022.35","DOIUrl":"https://doi.org/10.15420/usc.2022.35","url":null,"abstract":"Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous disorder that presents with positional tachycardia and a constellation of other symptoms. Peer-reviewed evidence for treatment options is limited. In addition, there are various associated conditions with overlapping symptoms. These factors can make the diagnosis and management of POTS a frustrating experience for both providers and patients. This paper aims to combine available scientific data with anecdotal evidence derived from extensive clinical experience to provide information on recognizing the clinical features of POTS, identifying associated conditions, and understanding treatment strategies to help providers better diagnose and manage patients with this condition.","PeriodicalId":93393,"journal":{"name":"US cardiology","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135109099","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}
Pub Date : 2022-05-25eCollection Date: 2022-01-01DOI: 10.15420/usc.2021.29
Mansi Oberoi, Nitesh Ainani, J Dawn Abbott, Mamas A Mamas, Poonam Velagapudi
The elderly constitute a major proportion of patients admitted with acute coronary syndrome (ACS) in the US. Due to pre-existing comorbidities, frailty, and increased risk ofcomplications from medical and invasive therapies, management ofACS in the elderly population poses challenges. In patients with ST-elevation MI, urgent revascularization with primary percutaneous coronary intervention remains the standard of care irrespective of age. However, an early invasive approach in elderly patients with non-ST-elevation MI is based on individual evaluation of risks versus benefits. In this review, the authors discuss the unique characteristics of elderly patients presenting with ACS, specific geriatric conditions that need to be considered while making treatment decisions in these situations, and available evidence, current guidelines, and future directions for invasive management of elderly patients with ACS.
在美国，老年人在急性冠状动脉综合征（ACS）入院患者中占很大比例。由于原有的合并症、身体虚弱以及医疗和侵入性疗法引起并发症的风险增加，老年人群的急性冠状动脉综合征管理面临着挑战。对于 ST 段抬高型心肌梗死患者，无论年龄大小，通过经皮冠状动脉介入治疗进行紧急血运重建仍是治疗标准。然而，对于非 ST 段抬高型心肌梗死的老年患者，早期有创介入治疗是基于对风险与收益的个体评估。在这篇综述中，作者讨论了急性冠状动脉综合征老年患者的独特特征、在这些情况下做出治疗决定时需要考虑的特定老年疾病，以及急性冠状动脉综合征老年患者有创治疗的现有证据、现行指南和未来方向。
{"title":"Age Considerations in the Invasive Management of Acute Coronary Syndromes.","authors":"Mansi Oberoi, Nitesh Ainani, J Dawn Abbott, Mamas A Mamas, Poonam Velagapudi","doi":"10.15420/usc.2021.29","DOIUrl":"10.15420/usc.2021.29","url":null,"abstract":"<p><p>The elderly constitute a major proportion of patients admitted with acute coronary syndrome (ACS) in the US. Due to pre-existing comorbidities, frailty, and increased risk ofcomplications from medical and invasive therapies, management ofACS in the elderly population poses challenges. In patients with ST-elevation MI, urgent revascularization with primary percutaneous coronary intervention remains the standard of care irrespective of age. However, an early invasive approach in elderly patients with non-ST-elevation MI is based on individual evaluation of risks versus benefits. In this review, the authors discuss the unique characteristics of elderly patients presenting with ACS, specific geriatric conditions that need to be considered while making treatment decisions in these situations, and available evidence, current guidelines, and future directions for invasive management of elderly patients with ACS.</p>","PeriodicalId":93393,"journal":{"name":"US cardiology","volume":"16 ","pages":"e14"},"PeriodicalIF":0.0,"publicationDate":"2022-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142735252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-26eCollection Date: 2022-01-01DOI: 10.15420/usc.2021.30
Tasveer Khawaja, Scott Janus, Sadeer G Al-Kindi
Advances in CT technology have resulted in improved imaging of the coronary anatomy in patients with stable coronary artery disease, using coronary CT angiography (CCTA). Recent data suggest that CCTA may play a role in higher risk patients, such as those evaluated in the emergency room with acute chest pain. Data thus far support the use of CCTA in low-risk patients with acute chest pain. Recent literature suggests that CCTA may play a role in the risk stratification of selected intermediate-risk patients. In this review, the authors discuss the emerging role of CCTA in higher risk patients, such as those with suspected or confirmed acute coronary syndrome (ACS). The excellent accuracy of CCTA in detecting obstructive coronary artery disease in patients with ACS is detailed, along with a highlighting of the safety of using CCTA in this setting. The authors also discuss the role for CCTA atheromatous plaque characterization, which is being increasingly recognized as an important predictor of clinical outcomes.
{"title":"Role of Coronary CT Angiography in the Evaluation of Acute Chest Pain and Suspected or Confirmed Acute Coronary Syndrome.","authors":"Tasveer Khawaja, Scott Janus, Sadeer G Al-Kindi","doi":"10.15420/usc.2021.30","DOIUrl":"10.15420/usc.2021.30","url":null,"abstract":"<p><p>Advances in CT technology have resulted in improved imaging of the coronary anatomy in patients with stable coronary artery disease, using coronary CT angiography (CCTA). Recent data suggest that CCTA may play a role in higher risk patients, such as those evaluated in the emergency room with acute chest pain. Data thus far support the use of CCTA in low-risk patients with acute chest pain. Recent literature suggests that CCTA may play a role in the risk stratification of selected intermediate-risk patients. In this review, the authors discuss the emerging role of CCTA in higher risk patients, such as those with suspected or confirmed acute coronary syndrome (ACS). The excellent accuracy of CCTA in detecting obstructive coronary artery disease in patients with ACS is detailed, along with a highlighting of the safety of using CCTA in this setting. The authors also discuss the role for CCTA atheromatous plaque characterization, which is being increasingly recognized as an important predictor of clinical outcomes.</p>","PeriodicalId":93393,"journal":{"name":"US cardiology","volume":"16 ","pages":"e11"},"PeriodicalIF":0.0,"publicationDate":"2022-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142735259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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