Current cardiology reports
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Review
Revascularization for patients with severe coronary artery disease and left ventricular dysfunction.
Heart failure is becoming increasingly prevalent, and currently coronary artery disease (CAD) is the primary cause of left ventricular (LV) systolic dysfunction. A potential therapeutic option for patients with severe CAD and LV dysfunction is a strategy of revascularization. In this review, we summarize the available literature regarding revascularization for these patients. The literature suggests that patients with severe CAD and LV dysfunction may benefit from revascularization and those patients with viable myocardium may derive the most benefit.
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Clopidogrel pretreatment before percutaneous coronary intervention (PCI) has been shown to decrease major adverse cardiovascular events (MACE) at 1 month. This benefit has been demonstrated in patients spanning the entire spectrum of coronary artery disease. ⋯ A longer course of therapy with clopidogrel (12 months) has been recommended by the most recent American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions guidelines for PCI based upon incremental reduction in cardiovascular complications (primarily myocardial infarction). This article reviews the data presently available regarding pretreatment with clopidogrel before PCI, and the strength of evidence supporting long-term dual antiplatelet therapy.
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Cardiac surgery (CS) with cardiopulmonary bypass (CPB) is currently the most common surgery in the United States. Understanding, avoiding, and preventing postoperative complications, including neurologic deficits following CS, represents a great public and economic benefit for society, especially considering our aging population. ⋯ Continuous monitoring of these variables along with systemic hemodynamics will provide a better understanding of mechanisms of brain and other organ injury during CPB. Neuroprotective interventions based on multimodality neurologic monitoring would ideally eliminate postoperative complications and improve patient outcomes.
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It is well established that strict glycemic control for the hospitalized stroke patient is associated with improved outcome compared with poor control. This is particularly true for the stroke patients because hyperglycemia can adversely affect ischemic damage. ⋯ The transition from intravenous insulin to subcutaneous insulin or oral antihyperglycemic agents must be carefully monitored. Careful discharge planning of diabetic care for the stroke patient is necessary to prevent long-term sequelae of inadequate control.
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The early lesions of atherosclerosis begin in childhood, and are related to antecedent cardiovascular disease risk factors. Environmental and genetic factors such as diet, obesity, exercise, and certain inherited dyslipidemias influence the progression of such lesions. The identification of youth at risk for atherosclerosis includes an integrated assessment of these predisposing factors. ⋯ Candidates for drug therapy often include those with familial hypercholesterolemia, familial combined hyperlipidemia, the metabolic syndrome, polycystic ovarian syndrome, type I diabetes, and the nephrotic syndrome. We review the safety and efficacy of dietary and drug therapy, and propose an updated diagnostic and therapeutic algorithm that includes the metabolic syndrome. The early identification and treatment of youth with dyslipidemias is likely to retard the atherosclerotic process.