Current cardiology reports
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The advances in the early treatment of ST-segment elevation acute myocardial infarction have resulted in a significant reduction in mortality. Early pharmacologic therapy with antiplatelet and antithrombotic therapy coupled with rapid and complete mechanical or pharmacologic reperfusion has been shown to reduce infarct size, improve left ventricular function, and reduce morbidity and mortality. ⋯ The American College of Cardiology/American Heart Association guidelines recommend the goal of a door-to-balloon time of less than 90 minutes. National efforts to reduce delays and to improve access to timely therapy will significantly reduce mortality even further.
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Advances in myocardial perfusion imaging have firmly established the use of noninvasive techniques capable of providing useful information over a broad range of diagnostic and therapeutic cardiovascular problems. Evaluating regional myocardial perfusion abnormalities is a cornerstone for the diagnosis of coronary artery disease, risk assessment in those with known disease, and determination of myocardial viability. ⋯ Myocardial contrast echocardiography is an emerging technique capable of rapidly assessing myocardial perfusion at the capillary level in many different clinical settings. This article focuses on myocardial contrast-enhanced ultrasound perfusion techniques, emphasizing the unique information this modality provides compared with other noninvasive perfusion imaging techniques.
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Hemodynamics play a crucial role in diagnosing and managing heart failure (HF) as diagnostic markers and therapeutic targets. In an era of declining physical examination skills and questions about the safety of invasive monitoring, quantitative, objective data provided by echo-Doppler measurements can function as a type of "echo Swan-Ganz catheter" as an important adjustment to traditional methods of hemodynamic assessment. ⋯ Recent studies suggest these measurements can have an important role in clinical pathways treating patients admitted with decompensated HF. The availability of miniaturized echocardiographic devices with full echo-Doppler capability may make repeatable, noninvasive hemodynamic assessment readily available and cost-effective for patients in many clinical settings.
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Patients in whom any kind of stent, particularly a drug-eluting stent (DES), was recently implanted are at risk for stent thrombosis when they undergo noncardiac surgery, even months or years after their implantation. The risk of DES thrombosis is likely decreased by delaying noncardiac surgery for as long as possible and continuing dual or at least single antiplatelet therapy in the perioperative period. Preoperative identification and close monitoring of patients with DES may allow prevention and prompt detection and treatment of this catastrophic complication.
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The optimal management of coronary artery disease is based on achieving two parallel objectives: 1) prevention of major cardiovascular events, and 2) resolution of symptoms. Traditional antianginal agents improve ischemic symptoms by reducing myocardial oxygen demand through modulation of heart rate, preload, and/or afterload. ⋯ When evaluated in patients with non-ST-elevation acute coronary syndromes, ranolazine reduced recurrent ischemia but did not significantly reduce the risk of death or myocardial infarction at 1 year. Ranolazine complements traditional antianginal agents and offers clinicians a new option in the long-term treatment of patients with angina.