简介：Somediseasesotherthancardiacdiseasecanbe“prevented”,butthepurposeofthiscommunicationwrittenbyaclinicalcardiologist,notasapreventionspecialist,istofocusstrictlyoncardiovasculardisease.Thedefinitionofpreventivemedicineinsimplesttermsmeanskeepingyourpatienthealthy.Inadditiontomaintaininghealth,ofcourse,wewanttopreventthedisabilityassociatedwithcardiacdiseaseaswellasdeathintheyoungerperson.

简介：Atrialfibrillation(AF)isthecommonestcardiacarrhythmia,withsignificantmorbidityandmortality.MorethanhalfofpatientswithAFarestillsymptomaticdespiteadequateanticoagulationandratecontrol.Ifantiarrhythmicdrugsareineffectiveorpoorlytolerated,AFpatientsarethentypicallytreatedwithcatheterablationtorestoresinusrhythm.Inthepast20years,AFablationhasdevelopedfromaspecialized,experimentalprocedureintoacommontreatmentinthecardiovascularfield.Variousablationtechniquesandmappingtechnologieshavebeendescribedandarecontinuingtoevolveforincreasedsafetyandefficacy.Anincompletelistofsuchtechniquesandtechnologieswouldincludefocalandsegmental,circumferentialandlinear,complexfractionatedatrialelectrogram,ganglionatedplexus,focalimpulseandrotormodulation,bodysurfacepotentialmapping–guided,real-timeMRI–guided,cryoballoon,visuallyguidedlaserballoon,radiofrequencyhotballoon,contactforcesensingcatheter,multielectrodecatheter,andhybridablations.ThisreviewexaminesthehistoryofinvasiveAFtreatmentanditsevolutionintocatheterablationbutmainlyfocusesonthediscussionofvariousablationtechniquesandtechnologiesleadingtoourcurrentunderstandingoftheablationtherapyofthismostcommonarrhythmia.

简介：TheDigoxinInvestigationGrouptrialhasmultipleflawsinthetrialdesignforthefindingstobeuniversallyapplicable.Digoxininlowserumconcentrations(0.5-0.9ng/mL)hasbeenshowntodecreasemortalityinheartfailurepatients.Multipletrialsindifferentpatientpopulationsalsoshowbenefitofdigoxininheartfailurepatients,includingwomen,elderlypatients,renaldiseasepatients,andpatientswithheartfailurewithpreservedejectionfraction.Retrospectiveobservationaldatalinkingdigoxinusefortreatmentofatrialfibrillationtoincreasedmortalityisnotseeninsubgroupsofrandomizedcontrolledtrialsorpopulationregistries.Digoxinremainsausefuldruginthetoolboxofphysiciansdealingwithheartfailurepatients.

简介：Conventionalrecommendationsfordiagnostictestingfortheevaluationofstableischemicheartdiseaseinwomenhavelargelyparalleledthoseinmen.Althoughtheyaredesignedprimarilyfortheidentificationofobstructivecoronaryarterydisease(CAD),traditionalapproachescanleadtoovertestinginwomenwithoutdifferentiatingwhoistrulyatrisk.Severaluniquefactorsrelatedtothepresentation,diagnosis,andunderlyingpathophysiologyofstableischemicheartdiseaseinwomennecessitateamorespecificapproachtotheassessmentoftheirrisk,completewithseparateguidelineswhenappropriate.Thisoverviewhighlightshowadvancednoninvasiveimagingtools,includingcardiaccomputedtomographyangiography,positronemissiontomography,andcardiacmagneticresonanceimaging,areenablingverysensitiveassessmentsofanatomicatheroscleroticplaqueburden,macrovessel-andmicrovessel-relatedischemia,andmyocardialfibrosis,respectively.Movingforward,effectivediagnostictestingwillneedtoidentifywomenathighriskofadversecardiovascularevents(notanatomicallyobstructiveCADperse)withoutovertestingthoseatlowrisk.JudiciousapplicationofnovelimagingapproacheswillbecriticaltobroadeningthedefinitionsofCADandischemiatobetterreflectthewholespectrumofpathologicalphenotypesinwomen,includingnonobstructiveCADandcoronarymicrovasculardysfunction,andaidinthedevelopmentofneededevidence-basedstrategiesfortheirmanagement.

简介：ObjectivesTocomparetheshortandmid-termoutcomesincasesofpercutaneoustransluminalcoronaryangioplasty(PTCA)inpatientswithunstablevstableangina.MethodsPatientsselectedforPTCA/stentingweredividedintotwogroups,onewithstableanginapectoris(SAgroup,n=92)andonewithunstableanginapectoris(UAgroup,n=112).Theoutcomesofcoronaryangiographies(CAG),initial(30-d)successoftheprocedure,andfollow-upstatusinthetwogroupswerecompared.ResultsBaselinecharacteristicsweresimilar,althoughthepatientswithunstablesymptomsmorefemales(P<0.05),andhadahigheraverageCCSclass(P<0.05)andahigherincidenceofpostinfarctionangina(P<0.01).Thefrequencyof’complexstenosisinpatientswithunstableanginawashigherthanthatofpatientswithstableangina,33%v20%(P<0.01).Atotalof309vesselsacceptedtheprocedure;including210stentsweresuecessfullydeliveredto156patients.143and67stentswereimplantedinthe

简介：Itisestimatedthatmorethanonemillionheartfailurehospitalizationsoccureachyear.Systolicheartfailureandheartfailurewithpreservedejectionfractioncontributeequallytoheartfailurehospitalizations.Heartfailurereadmissionratescontinuetobeabout25%.Strategiestoreduceheartfailurereadmissionarekeytoreducinghospitalizationrates.Thestrategiestoreduceheartfailurehospitalizationareasfollows:(1)Duringhospitalization,diuresistotheeuvolemicstateisessential.Fiftypercentofdischargedheartfailurepatientshaveminimalweightlossduringthehospitalization,representingminimaldiuresis,butstillfluidoverload.(2)Duringhospitalization,interrogatethedefibrillatororbiventricularpacemaker(ifapplicable)toensurethatthereisnorightventricularpacingandthereisappropriatebiventricularpacing.Interrogationofdevicescanidentifyarrhythmiaorsuboptimalbiventricularpacing,whichcancontributetodecompensation.(3)Beforedischarge,identifythereasonfordecompensation,suchasatrialfibrillation,infection,pulmonaryembolism,ornoncompliance.(4)Beforedischargeamultidisciplinaryteamisneededtoeducatethepatientondiet,medications,fluidweightsurveillance,andexercise.(5)Apostdischargevisitshouldoccurwithin10daysandwithemphasisonuptitrationofneurohormonalblockersandcontinuedcongestionmanagement.Suchinterventionsconductedbyamultidisciplinaryteamhavethepotentialtoreduceheartfailurehospitalizationrates.

简介：Substratecharacterizationisthemainstayofablationforventriculartachycardia(VT).Althoughtheuseofelectroanatomicvoltagemapping(EAVM)intheelectrophysiology(EP)laboratoryhasenabledreal-timeapproximationofmyocardialscar,ithaslimitations.Thisisrelatedtothesubjectiveandtediousnatureofvoltagemappingandthechallengesofdefiningthetransmuralityofscar.Variousnoninvasivemethodsofscarassessmenthaveemerged,withmagneticresonanceimaging(MRI)beingthemostaccurate.IntegratedMRIandelectroanatomicvoltagemappingstudiesdemonstrategoodcorrelation.Nonetheless,MRIhasadvantages.Theseinclude(1)preprocedureidentificationofepicardialandintramuralscar,(2)assessmentofablativelesionformationafterunsuccessfulablations,(3)identifi-cationofheterogeneousregionsofscar,wherecriticalconductingchannelsarelikelytooccur,and(4)predictivevalueintheassessmentofsuddencardiacdeath(SCD).Integrationofscarimaginginventriculartachycardiaablationandriskstratificationhasgreatpotentialtoadvancethepracticeofarrhythmiamanagement.

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