Cardiology

Ivabradine

General (including evidence of efficacy) Ivabradine (Corlanor®) is a novel selective inhibitor of the I f channel current in the pacemaker cells of the sinoatrial (SA) node. Its predominant effect is to reduce heart rate without affecting contractility. Heart rate reduction with beta blockers has been identified in clinical literature and trials as a contributor…

LCZ696

General (including evidence of efficacy) LCZ696 (sacubitril/valsartan) is a member of a new class of agents called angiotensin receptor-neprilysin inhibitors (ARNIs) which combine a neprilysin inhibitor and angiotensin receptor blocker (ARB). LCZ696 is currently indicated for treating patients with heart failure with reduced ejection fraction (HFrEF) in place of an angiotensin converting enzyme (ACE) inhibitor…

Management of Hypertension

I. Management of hypertension: What every physician needs to know Hypertension is THE disease. It is present for all to consider and deal with regardless of the specialty. However, it is the quintessential internist’s dilemma. To date, the proposed surgical remedies for hypertension have only had paltry results and serve such a small fraction of…

Sleep Disordered Breathing

I. Sleep Disordered Breathing: What every physician needs to know. Sleep disordered breathing is common in patients with cardiovascular disease and is associated with hypertension, atrial fibrillation, ventricular arrhythmias, vascular disease, and diabetes. In particular, sleep disordered breathing has been linked to worsening heart failure, decreased left ventricular function, and left ventricular hypertrophy both directly…

Outcomes and Management of Women with Microvascular Angina and Microvascular Coronary Dysfunction

I. Microvascular and Coronary Microvascular Dysfunction: What every physician needs to know. Cardiovascular disease remains the number one killer of women in the Western world.  There is a growing body of research demonstrating sex differences in presentation, etiology, and outcomes in women with ischemic chest pain. Many studies have discovered that women are more likely…

Congenital Intervention – PDA, Coarctation, Pulmonary AVM, and Coronary Fistulae

General description of procedure, equipment, technique Patent ductus arteriosus A patent ductus arteriosus (PDA) accounts for 5% to 10% of all congenital heart disease and, if left unclosed, can lead to congestive heart failure, pulmonary hypertension, or infective arteritis. Currently, most PDAs can be safely and effectively closed percutaneously using coils or other devices, including…

Congenital Intervention – Pulmonary Valve Replacement

General description of procedure, equipment, technique Transcatheter management of conduit stenosis with bare metal stents has been used to effectively relieve conduit stenosis to delay the need for surgical valve replacement. Unfortunately, bare metal stenting may exacerbate chronic pulmonary insufficiency. More recently, percutaneous PV replacement has become an option to approach this patient population to…

Congenital Intervention – Angioplasty (Pulmonary Arteries and Veins)

General description of procedure, equipment, technique Angioplasty of the pulmonary arteries Balloon or stent angioplasty of the branch pulmonary arteries is occasionally necessary for patients with a history of complex congenital heart disease, such as transposition after the arterial switch operation and with tetralogy of Fallot. Branch pulmonary artery obstructions may be isolated, multiple, or…

Congenital Intervention – Systemic Venous

General description of procedure, equipment, technique Venovenous collateral occlusion Venovenous collaterals can occur in patients with elevated systemic venous pressure, such as in the Fontan physiology. These vessels can result in connections from the systemic veins to the pulmonary venous return. Consequently, they can cause systemic hypoxemia and thus contribute to the polycythemia seen in…

Congenital Intervention – Atrial Septal

General description of procedure, equipment, technique Atrial septal interventions include the following: Transseptal Puncture Septoplasty /Atrial Septal Defect Creation Transseptal Puncture Currently, many of the percutaneous catheter-based treatments for adult “structural” heart diseases require access to the left heart via transseptal puncture. However, septal anatomy can often in this patient population be complex due to…

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