Cardiology in review
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Cardiology in review · Jul 2005
Review Case ReportsLeft ventricular cardiac tamponade in the setting of cor pulmonale and circumferential pericardial effusion. Case report and review of the literature.
Circumferential pericardial effusion typically results in biventricular tamponade and equalization of intracardiac and pericardial pressure during diastole. However, tamponade may involve the right or left ventricle. ⋯ This case illustrates that when evaluating patients with circumferential pericardial effusions and associated pulmonary hypertension, the typical findings of cardiac tamponade (pulsus paradoxus, right ventricular diastolic compression and hypotension) may be masked. The echocardiogram must be reviewed carefully as it may reveal left ventricular diastolic compression, the hallmark of LVCT, which may significantly compromise left ventricular filling and cardiac output.
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The most concerning adverse reaction with HMG-CoA reductase inhibitors (statins) is myotoxicity. Statins inhibit the production of mevalonate, a precursor of both cholesterol and coenzyme Q10, a compound believed to be crucial for mitochondrial function and the provision of energy for cellular processes. ⋯ Coenzyme Q10 supplementation has been shown to reverse statin-induced decreases in circulating coenzyme Q10 concentrations, although the effect of supplementation on tissue coenzyme Q10 concentrations and any resulting clinical benefit has not been adequately assessed. Although there is not much of a safety concern with coenzyme Q10 supplementation, there is also not enough evidence to support its routine use for preventing the adverse effects of statin therapy, and it is therefore not recommended for this purpose at this time.
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Cardiology in review · Sep 2004
ReviewCardiovascular pharmacotherapeutic considerations during pregnancy and lactation.
Table 2 summarizes the recommendations regarding the use of cardiovascular drugs during pregnancy and lactation.
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Cardiology in review · Jul 2004
ReviewCongenital and acquired long QT syndrome. Current concepts and management.
Congenital long QT syndrome (LQTS) is a rare but potentially lethal disease, characterized by prolongation of QT interval, recurrent syncope, and sudden death. In the pregenomic era (1959-1991), sympathetic imbalance was thought to be responsible for this disease. Since 1991 (postgenomic era), 7 LQTS genes have been discovered and more than 300 mutations have been identified to account for approximately 70% of patients affected. ⋯ For patients with a history of drug-induced LQTS, care must be taken to avoid further exposure to QT-prolonging drugs or conditions. Molecular genetic analysis could be useful to unravel subclinical mutations or polymorphisms. Physicians not only need to be aware of the pharmacodynamic and pharmacokinetic interactions of various important drugs, but also need to update their knowledge.
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Cardiology in review · Jan 2004
Review Case ReportsAcute myocardial infarction from spontaneous coronary artery dissection a case report and review of the literature.
Spontaneous coronary artery dissection is a rare event as a cause of acute myocardial infarction. Optimal treatment remains unclear. In this report, we describe a case of spontaneous acute coronary artery dissection presenting as recurrent acute myocardial infarction in a postmenopausal woman, successfully treated with systemic thrombolysis. The case is discussed with review of the pertinent literature.