International journal of cardiology
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Long-standing aortic stenosis (AS) causes significant progressive left ventricular (LV) dysfunction and may result in subendocardial ischaemia. Following aortic valve surgery, LV function may improve and this may be accompanied by reversal of ischaemia. There is debate about the differential effects of valve substitutes. ⋯ In patients with AS and severe LV dysfunction, there is a more rapid improvement in LV function following aortic valve replacement with a stentless prosthesis. Improvements in those receiving stented valves appear delayed, although there were no differences between the groups in LV function or mass at follow-up. Normalisation of LV free wall systolic behaviour, narrowing of the QRS complex and a reduction in the QT interval suggest that AS is associated with subendocardial ischaemia that reverses following valve replacement.
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Increasingly, patients and clinicians are being confronted with congestive heart failure (CHF) as a late complication of congenital heart disease. However, medical management of heart failure in this patient group represents a challenge because of complex hemodynamics and a lack of evidence from large randomized controlled trials to guide therapy. ⋯ Some recommendations for use of angiotensin converting enzyme inhibitors and beta-blockers in heart failure due various congenital heart lesions are offered. Well-designed clinical trials are urgently needed to extend the impressive reductions in morbidity and mortality achieved with neurohormonal blockade in left ventricular (LV) heart failure to adults with congenital heart disease.
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Review
Idiopathic pulmonary arterial hypertension: current state of play and new treatment modalities.
Research in pulmonary hypertension has led to exciting advances over the last decade, both in terms of understanding aetiology and expanding treatment options. This review highlights the current approach to classification and disease management. In particular, we review the significant data and recommendations on the use of prostacyclin analogues, endothelin receptor antagonists, phosphodiesterase inhibitors and drug combinations.
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Epidemiological estimates of left ventricular mass are based on echocardiographic imaging from the parasternal view, which is often unavailable in subjects with obesity or lung disease. This study was undertaken to assess whether the subcostal view is a valid alternative to estimate left ventricular mass in an unselected older population. ⋯ In unselected older persons, the subcostal view does not improve the accuracy of echocardiographic estimation of left ventricular mass, which remains biased in epidemiological studies.
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Occlusion of the circumflex coronary artery may present with either ST elevation typical of inferior or lateral myocardial infarction, ST depression or a normal 12-lead electrocardiogram (ECG). In patients presenting with ST depression, concomitant ST elevation in the posterior leads V7, V8 and V9 is believed to reflect ST-elevation myocardial infarction of the posterior wall. However, to be confident of this diagnosis, it is necessary to know that posterior ST depression does not occur in acute subendocardial ischaemia. ⋯ ST elevation in leads V7, V8 and V9 is uncommon in patients presenting with subendocardial ischaemia. Therefore, in patients presenting with acute chest pain and ST depression in the 12-lead ECG, concomitant posterior ST elevation may be a reliable indicator of ST elevation posterior MI. This is likely due to circumflex artery occlusion and may require thrombolytic therapy.