Current cardiology reports
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Left ventricular hypertrophy (LVH) is a major cardiovascular risk factor for morbidity and mortality. It is caused by arterial hypertension, although various hemodynamic and nonhemodynamic factors contribute to its development. Especially, the renin-angiotensin-aldosterone system is involved in the pathophysiology of LVH. ⋯ Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers achieve significantly better results than b-blockers. The most recently published Losartan Intervention For Endpoint reduction in hypertension study confirmed the superiority of angiotensin receptor blockers against b-blockers in a large-scale prospective trial. It also proves for the first time that regression of LVH is associated with better cardiovascular outcome.
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Review Comparative Study
Are all beta-blockers the same for chronic heart failure?
beta-Adrenergic receptor blockade has been conclusively proven to increase survival and morbidity in patients with heart failure. Hospitalization rate decreases and patients feel better after receiving beta-blockers. Furthermore, this benefit is observed in a wide range of patients. ⋯ Bucindolol, an investigational beta-blocker, showed only mild improvement in survival in patients with heart failure. The beta-blockers differ regarding beta-selectivity, vasodilation properties, and perhaps other ancillary properties. At present, the importance and consequences of these differences are unknown.
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Review
Congenital heart disease: current indications for antithrombotic therapy in pediatric patients.
This report reviews the current status of antithrombotic therapy, including anti-platelet therapy, in pediatric patients with congenital heart disease. The current medications utilized and dose recommendations are emphasized, and indications for their use are reviewed.
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Ventricular tachycardia (VT) due to reentry in and around regions of ventricular scar from an old myocardial infarction or cardiomyopathic process is often a difficult management problem. Radiofrequency catheter ablation is an option for controlling frequent VT episodes. Patient and VT characteristics determine the mapping and ablation approach and efficacy. ⋯ Ablation of these "unmappable VTs" by designing ablation lines or areas based on the characteristics of the scar as assessed during sinus rhythm, and using approaches to assess global activation from a limited number of beats has been shown to be feasible. Ablation of multiple VTs, epicardial VTs, and poorly tolerated VTs are feasible. Future studies defining efficacy and risks are needed.