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Drugs Used for Immunosuppression Post-transplant

General (including evidence of efficacy) Immunosuppression following cardiac transplantation Heart transplantation is a well-established therapeutic option for patients with end-stage heart disease.  The development of immunosuppressive agents has resulted in a dramatic improvement in the survival of heart transplant recipients, with 1- and 10-year survival rates approaching 90% and 50%, respectively. Despite this, there is a 25-30% risk of…

Exercise Training and Heart Failure

General description of procedure, equipment, technique General overview Heart failure is a common cause of morbidity, mortality, and disability affecting over 5 million patients in the United States. Although evidence-based pharmacologic and device therapy have decreased mortality, hospitalizations, and heart failure symptoms and improved quality of life, many patients treated with these regimens often remain…

Diagnosis and Management of Mitral Stenosis

I. Mitral Stenosis: What every physician needs to know. Mitral stenosis (MS) results in obstruction to left ventricular (LV) inflow and is defined by a diastolic pressure gradient between the left atrium (LA) and ventricle. Rheumatic fever following infection with group A beta-hemolytic strep (GABS) is by far the most common etiology. Other causes of…

Secondary (Functional) Mitral Regurgitation

I. Functional Mitral Regurgitation: What every physician needs to know Secondary (functional) Mitral Regurgitation Secondary mitral regurgitation (SMR) occurs when coronary disease with myocardial infarction or primary dilated cardiomyopathy cause a combination of left ventricular (LV) wall motion abnormalities, mitral annular dilatation, papillary muscle displacement and reduced closing force that prevent the mitral valve from…

Peri-partum Cardiomyopathy

I. Peri-partum Cardiomyopathy: What every physician needs to know. Peri-partum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with heart failure (HF) secondary to left ventricular (LV) systolic dysfunction toward the end of pregnancy or in the months following delivery where no other cause of HF is found. The left ventricle may not be dilated but…

Screening and Treating Transplant Coronary Artery Disease

I. Coronary Allograft Vasculopathy: what every physician needs to know Cardiac allograft vasculopathy (CAV), also known as transplant coronary artery disease and cardiac transplant vasculopathy, is characterized by diffuse intimal thickening and luminal narrowing in the arteries of the allograft. It may affect the epicardial coronary arteries as well as the microcirculation. It is the…

NSAIDS and CAD: Risks vs. Benefits

General (including evidence of efficacy) Various nonsteroidal antiinflammatory drugs (NSAIDS) are on the market worldwide. In general, the drugs are classified as traditional NSAIDS (i.e., naproxen, ibuprofen) versus cyclooxygenase-2 (COX-2) inhibitors (i.e., celecoxib). At doses tailored to equivalent pain relief, the different NSAIDS have very unique dosages. For example, for patients with osteoarthritis who often…

CAD and Chronic Kidney Disease

I. Chronic Kidney Disease: What every physician needs to know. The presence of chronic kidney disease (CKD) is a major risk factor for developing coronary artery disease (CAD). Clinicians should be aware that the risk of dying from cardiovascular causes in patients with CKD is significantly higher than developing end-stage renal disease. Moreover, the presence…

PCI, CABG Surgery and Medical Therapy in the Diabetic Patient

General description of procedure, equipment, technique Rising rates of obesity and metabolic syndrome are leading to a pandemic of diabetes across the world. Advances in management of diabetes and other risk factors for cardiovascular disease have led to reduction in mortality from cardiovascular disease in diabetics. However, cardiovascular disease remains the leading cause of mortality…

Which CAD patient should be referred for cardiac rehabilitation?

I. Cardiac Rehabilitation: What every physician needs to know. Cardiac rehabilitation (CR) is generally defined as a medically supervised secondary prevention program for patients with established cardiovascular disease (CVD). The goal of this comprehensive long-term program is to help patients with CVD to recover more quickly after a cardiac event and to reduce the risk…

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