Depressionâs Links to Heart Disease
A substantial percentage of people with no history of depression become depressed after a heart attack or after developing heart failure. People with depression,with no previously detected heart disease, seem to develop heart disease at a higher rate than the general population.
Modern Medicine â Aug/Sept 2018
Duration of Dual Antiplatelet Therapy After ACS: A Moving Target – MM1702
Acute coronary syndrome (ACS) remains the major cause of morbidity and mortality worldwide.
Secondary prevention through lifestyle changes and pharmacotherapy remains pivotal to reduction. Aspirin
has improved outcomes in patients presenting with ACS. (CURE) trial was a landmark study showing improved
outcomes in an ACS cohort treated with aspirin and clopidogrel compared with aspirin alone. Inherent in
the use of more potent platelet inhibitors is a degree of obligate bleeding. Contemporary antiplatelet agents
probably provide maximal platelet inhibition with tolerable, safe bleeding in most patients for six to 12 months after
ACS.
Modern Medicine – February 2017
Atrial Fibrillation: A New Perspective on an Old Problem â MM1701
The three cornerstones of atrial fibrillation (AF) management have traditionally been anticoagulation, rate control and rhythm control. There is evidence that modification of the following main risk factors, obstructive sleep apnoea, obesity and exercise improves outcomes. Treatment of patients with sleep apnoea using continuous positive airway pressure reduces the risk and recurrence of AF. Patients undergoing cardioversion or AF ablation should be actively screened for sleep apnoea and treated if it is present. Light to moderate exercise is protective against AF. Risk factor management is essential in conjunction with antiarrhythmic medications and AF ablation to maximise treatment effects.
Modern Medicine â January 2017
Concepts and misconceptions in oral anticoagulation â MM1611
While there is still a place for vitamin K antagonists (VKAs)/warfarin in anticoagulation therapy, the direct oral anticoagulants or DOACs (previously termed the new oral anticoagulants or NOACs) offer an advantage in every possible respect.
This was the take-home message in a series of talks given recently by Professor Jan Beyer-Westendorf, head of the Thrombosis Research Unit at the Centre for Vascular Medicine, University Hospital âCarl Gustav Carusâ in Dresden, Germany. as a guest of Bayer. He stated categorically that nowadays he only uses VKAs in selected patients when itâs unavoidable.
Modern Medicine â November 2016
Cardioembolic Stroke â A Clinical Approach â MM1609
Stroke is a major cause of death, most commonly by infarct (in approximately 85% of cases). Cardioembolism accounts for 15-40% of all ischemic strokes and importantly, three year mortality from a cardioembolic stroke may be as high as 50%. The initial mortality may be related to the stroke but after six months the cause of death is often related to underlying cardiovascular disease. Identifying cardiembolic stroke is important and should be followed by a systematic workup to identify the source of cardioembolism, as it can prevent further events by treating the underlying cardiac abnormality.
Modern Medicine â September 2016
Treating Heart Failure With Reduced Ejection Fraction â MM1609
Heart failure affects about two percent of the western population, with the prevalence increasing sharply from one percent in 40-year-old individuals to 10% above the age of 75 years. It is the most common cause of hospitalisation in patients over 65 years of age. Heart failure is defined as a syndrome characterised by an impaired ability of the heart to fill with and/or to eject blood commensurate with the metabolic needs of the body, resulting in a classic constellation of signs or symptoms of pulmonary and systemic venous congestion.
Modern Medicine â September 2016
TIAs and Stroke Prevention | Rapid Assessment, Urgent Treatment â MM1607
A transient ischaemic attack (TIA) is a transient neurovascular event that resolves within 24 hours without acute infarction on MRI. Urgent investigations for TIA or stroke should include: imaging of the brain; imaging of the carotid and vertebral arteries; 12-channel ECG and Holter monitoring; transthoracic echocardiography; blood pressure, fasting lipids and glucose measurements. The American Heart Association (AHA)/American Stroke Association (ASA) have updated their guidelines on primary and secondary stroke prevention, focusing on lifestyle changes and management of hypertension, hyperlipidaemia and diabetes. The targets for primary prevention are less strict than for secondary prevention but the same principles for treatment and lifestyle changes apply.
Modern Medicine â July 2016
New Imaging Modalities in Coronary Artery Disease â MM1605
Cardiac imaging remains one of the most powerful tools in the diagnosis and management of coronary artery disease with a growing focus on characterising coronary lesions beyond angiographic features. Novel imaging modalities are expected to enhance diagnosis and treatment of coronary atherosclerosis.
Coronary computed tomographic angiography is a noninvasive imaging technique traditionally used to identify anatomically significant coronary lesions and coronary anatomy before surgical intervention. Optical coherence tomography has provided a deeper understanding of plaque morphology, progression of atherosclerosis and post-stenting outcomes. Advances in catheter-based intracoronary imaging techniques now offer unprecedented views of coronary anatomy and pathology.
Modern Medicine â May 2016
Diuretic Resistance, a Factor in Chronic Kidney Disease â MM1605
Diuretics exert their effects via the kidney, relying on secretion, and to a minor degree on glomerular filtration, to achieve therapeutic concentrations in the tubule. Diabetes and atherosclerosis can both cause glomerular damage and glomerulosclerosis, affecting glomerular filtration rate (GFR), while the Renin-Angiotensin system activation and inflammation common to both conditions also contributes to a reduced response.
Modern Medicine â May 2016
Managing Heart Failure – The key role of the GP â MM1603
HF is a complex syndrome whereby systemic perfusion is insufficient to
meet the bodyâs metabolic demands. Although its clinical features are quite
varied, it is frequently characterised by elevated left ventricular filling pressures, inadequate peripheral oxygen delivery and neurohormonal activation. In particular, activation of both the reninâangiotensinâaldosterone and sympathetic nervous systems leads to fluid retention and adverse pathological axis remodelling of the heart.
Management of most patients with heart failure occurs at an outpatient
level, with the GP playing a central role in initial diagnosis, counselling, regular
assessment of fluid status, titration and monitoring of medications and end-of life care.
Modern Medicine â March 2016
