Cardiology

Managing Patients after Implantation of a Cardiac Rhythm Management Device

Managing Patients after Implantation of a Cardiac Rhythm Management Device

Patients with cardiac rhythm management devices such as pacemakers and defibrillators are cared for jointly by GPs and cardiologists. GPs can manage issues such as wound care, bleeding and pain and provide guidance regarding work, travel and household appliance use. Early complications are best referred back to the interventional cardiologist; they include wound-related issues (active bleeding, infection, large haematoma), unusual postprocedural pain (pericardial or pleuritic pain) and noncardiac muscle twitching.

Modern Medicine – Dec/Jan 2019

February 4, 2019 by Cardiology

Stroke Prevention Medical interventions for everyday practice

Stroke Prevention Medical interventions for everyday practice

Paroxysmal or permanent atrial fibrillation associated with a CHA2DS2-VASc score of one or more for men, and two or more for women should prompt consideration of anticoagulation to reduce stroke risk. High-risk patients with atrial fibrillation remain significantly undertreated. Older patients, despite having a high risk of falls, are nevertheless likely to benefit from anticoagulation. Perioperative bridging anticoagulation for patients with atrial fibrillation is not routinely recommended. Direct oral anticoagulant drugs should be ceased 24 to 48 hours before procedures. Asymptomatic carotid atherosclerotic disease should be treated medically. Antiplatelet medication for secondary prevention has most benefit when given early after stroke or transient ischaemic attack.

Modern Medicine – Aug/Sept 2018

September 26, 2018 by Anticoagulants Cardiology Stroke

Duration of Dual Antiplatelet Therapy After ACS A Moving Target

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

February 17, 2017 by Cardiology

Atrial Fibrillation: A New Perspective on an Old Problem

Atrial Fibrillation: A New Perspective on an Old Problem – 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 – January 2017

January 27, 2017 by Atrial Fibrillation Cardiology

Concepts and misconceptions in oral anticoagulation

Concepts and misconceptions in oral anticoagulation – 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 ‘Carl Gustav Carus’ in Dresden, Germany. as a guest of Bayer. He stated categorically that nowadays he only uses VKAs in selected patients when it’s unavoidable.

Modern Medicine – November 2016

December 8, 2016 by Anticoagulants Cardiology

Cardioembolic Stroke – A Clinical Approach

Cardioembolic Stroke – A Clinical Approach – 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 – September 2016

October 6, 2016 by Cardiology Stroke

Treating Heart Failure With Reduced Ejection Fraction

Treating Heart Failure With Reduced Ejection Fraction – 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 – September 2016

October 6, 2016 by Cardiology Heart Failure

TIAs and Stroke Prevention | Rapid Assessment, Urgent Treatment

TIAs and Stroke Prevention | Rapid Assessment, Urgent Treatment – 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 – July 2016

July 22, 2016 by Anticoagulants Cardiology Stroke

New Imaging Modalities in Coronary Artery Disease

New Imaging Modalities in Coronary Artery Disease – 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 – May 2016

May 31, 2016 by Cardiology Radiology
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