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Cardio Notes are brief, to-the-point articles on controversial and novel issues in cardiology today, and that incorporate views from world leading experts. These articles can be accessed by clicking on the relevant links or using the category search form.
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Transfemoral vs Transradial approach for PCI - The DRAGON STUDY
2015-10-27 by Prof Juan Carlos Kaski, Dr Pitt Lim
The DRAGON trial (1) recently presented at the recent TCT meeting in San Francisco, which included more than 1700 consecutive patients from 29 centers in China, showed that subjects who were randomized to the transradial …
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Macrolide antibiotic use: cardiotoxicity issues
2015-10-16 by Prof Juan Carlos Kaski, Prof Juan Tamargo
A nationwide based study in Denmark assessed the risk of cardiac death associated with the use of clarithromycin and roxithromycin. Participants included Danish adults, 40-74 years of age, who received seven day treatment courses with …
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New pharmacological compound shown to reduce mortality in heart failure patients approved by FDA
2015-10-16 by Prof Giuseppe Rosano
A drug developed by Novartis for management of patients with heart failure - Entresto (sacubitril/valsartan) - also termed LCZ696, was approved for clinical use by the FDA. LCZ696 was assessed in the PARADIGM-HF trial (1), where …
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ARBs, ACEIs and direct renin inhibitors not to be used in combination
2015-10-16 by Prof Giuseppe Rosano
The European Medicines Agency (EMA) has recommended that angiotensin-receptor blockers (ARBs), ACE inhibitors, and direct renin inhibitors should not routinely be combined. EMA also recommended that particularly in patients with diabetic nephropathy ARBs and ACE …
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ACUITY trial: what's been discovered?
2015-09-16 by Prof Juan Carlos Kaski, Dr Pitt Lim
The large-scale Acute Catheterization and Early Intervention Triage Strategy (ACUITY) trial showed that in patients with diabetes, acute coronary syndrome (ACS) and multivessel coronary artery disease, Percutaneous Coronary Revascularization (PCI) versus coronary artery bypass grafting …
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Culprit lesion only or multivessel percutaneous coronary intervention in patients with ST-elevation myocardial infarction?
2015-09-02 by Prof Charles Knight, Prof Abhiram Prasad
In acute ST-elevation myocardial infarction (STEMI), coronary reperfusion with percutaneous coronary intervention (PCI) to treat the culprit lesion responsible for infarction improves clinical outcomes in nearly all patients. Complete revascularization and treatment of non-infarct vessels …
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Sudden unexpected death in epilepsy (SUDEP): What is the cause?
2015-09-02 by Dr Aidan Neligan, Dr Hannah Cock, Dr Elijah R Behr
Epilepsy patients have a 24-fold increased risk of sudden death compared to the general population, with sudden unexpected death in epilepsy (SUDEP) representing one of the commonest causes of death in these patients. Although no …
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Long QT syndrome and epilepsy
2015-09-02 by Dr Aidan Neligan, Dr Elijah R Behr
It has been proposed that pathogenic hyperexcitability may underlie both epilepsy and inherited cardiac arrhythmias, such as long QT syndrome (LQTS) or Bruguda’s Syndrome. LQTS is a genetic condition characterized by prolongation of the QT …
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QT prolongation associated with the use of anti-epileptic drugs (AEDs)
2015-09-02 by Dr Hannah Cock
Epilepsy, a disorder of the brain characterized by an enduring predisposition to seizures, affects approximately 1 in 105 people in the UK. The aim of treatment is to control seizures and maintain or restore quality …
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Poorer clinical outcome in seizure-related “takotsubo syndrome”.
2015-09-02 by Prof Juan Carlos Kaski, Dr Hannah Cock
Takotsubo stress cardiomyopathy (TS) is characterized by a clinical presentation compatible with acute myocardial infarction despite angiographically unobstructed coronary arteries, associated with left ventricular wall motion abnormalities typically showing apical akinesis and basal hyperkinesis that …
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Distinguishing between epileptic seizures and cardiac syncope
2015-09-02 by Dr Hannah Cock, Dr Velislav N. Batchvarov
Distinguishing between epileptic seizures and cardiac syncope in patients with recurrent, unexplained, episodic loss of consciousness can be difficult. Historical studies have estimated that between 20-30% of patients thought to have epileptic seizures have been …
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Dual antiplatelet therapy: A two-edged sword?
2015-08-14 by Prof Albert Ferro
The use of antiplatelet therapy in cardiovascular prophylaxis has always been a two-edged sword: on the one hand it inhibits arterial thrombosis and on the other promotes bleeding – a classic pharmacological lesson in benefit …
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Guidelines (ESC & NICE) for the pharmacological management of angina pectoris - What's new?
2015-06-26 by Dr Chris Arden, Prof Juan Carlos Kaski
Treatment aims and current recommendations. The pharmacological management of patients with stable angina represents a major clinical and health-economic challenge for both clinicians and healthcare providers. The pharmacological management of stable angina patients aims mainly …
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Pharmacological treatment of stable angina - Conventional and novel anti-anginal agents
2015-06-26 by Prof Juan Carlos Kaski, Prof John Camm
Stable angina (symptoms stable for > 3 months) is caused by myocardial ischaemia, which, in turn, usually results from obstructive coronary artery disease (CAD) that limits the ability of the coronary circulation to increase coronary …
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Ranexa - Mode of action, dosing and side effects
2015-06-26 by Dr Rajan Sharma, Dr Ravi Patel
ISCHAEMIA AND INCREASED LEFT VENTRICULAR WALL TENSION. An increase in intracellular sodium (Na) is an early event during myocardial ischemia1. Increased Na concentration in the myocardium leads to calcium (Ca++) overload as a result of decreased …
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Ranolazine: indications, adverse reactions and contraindications
2015-06-26 by Dr Rajan Sharma, Dr Chris Arden
Ranolazine is generally very well tolerated but as a relatively new member of the anti-anginal armamentarium physicians have questions regarding its indications, contraindications and patient selection for the effective use of this agent in “real …
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Use of ranolazine in chronic stable angina patients and patients with type 2 diabetes mellitus - Summary of CARISA, MARISA & TERISA trials
2015-06-26 by Dr Ravi Patel, Prof Juan Carlos Kaski
Ranolazine is a novel antianginal drug with a mechanism of action that differs from that of conventional antianginal agents. Ranolazine is a selective inhibitor of the late sodium current in the myocardium and as such …
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Concomitant use of ranolazine and conventional anti-anginal agents
2015-06-26 by Prof Juan Carlos Kaski, Dr Chris Arden
Many patients with stable angina require treatment with more than one anti-anginal drug, particularly those who are very symptomatic and cannot –for different reasons- undergo myocardial revascularization. Reasons why the treating physician decides to prescribe …
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Cilostazol in coronary artery spasm
2014-10-27 by Prof Juan Carlos Kaski
In a recent double blind, placebo controlled trial (STELLA study), Shin et al (1) assessed the efficacy and safety of cilostazol, a selective inhibitor of phosphodiesterase-3, for the treatment of vasospastic angina pectoris. Cilostazol is …
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Diclofenac and cardiovascular risk – An underestimated problem?
2014-04-10 by Prof Dimitrios N. Tziakas
Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used of current medications usually bought over the counter. Taken singly or in combination with other classes of drug, they relieve symptoms across multiple clinical indications, …
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The Plato Trial – The controversy continues
2014-04-10 by Prof Albert Ferro
Ticagrelor (a member of the cyclopentyltriazolopyrimidines) is an anti-platelet agent that binds reversibly rather than irreversibly with the P2Y12 platelet receptor and has a more rapid onset of action than clopidogrel. The efficacy and safety …
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Management of Dyslipidemia in Post-Myocardial Infarction and Interventional Cardiology
2014-04-08 by Prof Juan Carlos Kaski
Over 150 Italian cardiologists visited the Cardiovascular and Cell Sciences Research Institute at St George’s, University of London - a centre of excellence in cardiovascular research. The Italian cardiologists attended a two day meeting organised …
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Clopidogrel with aspirin better than aspirin alone in patients who develop an acute minor stroke or transient ischemic attacks?
2014-02-21 by Prof Carlo Patrono
Stroke is common during the first few weeks after a transient ischemic attack (TIA) or minor ischemic stroke. Dual antiplatelet therapy with clopidogrel and aspirin may provide greater protection against subsequent stroke than aspirin alone. …
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Testosterone treatment increases risk of death, infarction and stroke or does it?
2014-02-21 by Prof Giuseppe Rosano
The recent study from Vigen R et al. aimed at assessing the association between testosterone therapy and all-cause mortality, myocardial infarction, or stroke among 8709 male patients who underwent coronary angiography between 2005 and 2011 …
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Percutaneous coronary intervention or medical treatment for stable angina?
2014-02-09 by Dr Pablo Avanzas
A recent meta-analysis published in JAMA by Stergiopoulos et al. compared the effects of PCI and medical treatment (MT) combined, with MT alone in patients with stable coronary artery disease (CAD) and objectively documented myocardial …
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Coronary artery spasm – Dangerous or not dangerous?
2014-02-09 by Prof Filippo Crea, Prof John Beltrame
The incidence of coronary artery spasm in patients presenting with chest pain remains uncertain, with estimates varying according to the population studied. However, experts agree that the condition is widely under-recognised as a cause of …
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Angiotensin-converting enzyme inhibitors reduce mortality in hypertensive patients
2012-07-06 by Prof Juan Tamargo
A meta-analysis of randomised clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158,998 patients has shown that these drugs reduce mortality in hypertension. Renin-angiotensin-aldosterone system (RAAS) inhibitors are well established in the reduction in cardiovascular morbidity, but …
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Dual blockage of the RAS caused increased adverse events in hypertensive patients
2012-07-06 by Prof Juan Tamargo
Recent research suggests that dual blockade of the Renin-angiotensin system (RAS) results in increased adverse events in hypertensive patients. A meta-analysis of randomized controlled trials published between 1990 and 2011 compared dual RAS blockade with a single …
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Thiazide diuretics increase risk of CV events in lean and overweight individuals but not in obese patients
2012-07-06 by Prof Juan Tamargo
People with normal body-mass index (BMI) tend to have unexpectedly higher cardiovascular event rates than overweight or obese patients. To understand this paradoxical finding Dr Michael Weber from SUNY Downstate Medical Centre, New York, USA, performed a prespecified …
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Azitrhomycin can increase the risk of cardiovascular death
2012-07-06 by Prof Juan Tamargo
Dr Wayne A. Ray from the Department of Preventative Medicine, Vanderbilt University School of Medicine, Nashville, US, examined data from patients enrolled in the Tennessee Medicaid program between 1992 and 2006. The study cohort included patients …
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How can the global cardiology community cope with the increase in CVD?
During the European Society of Cardiology 2011 in Paris, France, Professor Salim Yusuf from McMaster University, Hamilton, Ontario, Canada presented results from the Prospective Urban Rural Epidemiological (PURE) trial, and the results made for very …
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