Decision Support in Medicine

Aortic Stenosis

I. Aortic Stenosis: What every physician needs to know. Aortic stenosis (AS) refers to any condition that narrows the orifice of the aortic valve. While once caused primarily by rheumatic heart disease, this etiology is now rare in developed countries where calcific disease is now the major cause. Historically referred to as calcific degeneration, it…

Cardiopulmonary Exercise Testing

General description of procedure, equipment, technique What is cardiopulmonary exercise testing? Cardiopulmonary exercise (CPX) testing is a provocative test that combines standard methods of electrocardiogram (ECG) stress testing with indices of gas exchange. The exercise component entails the same challenges and mechanisms as standard ECG stress testing (i.e., a progressive exercise stimulus [usually on a…

Mitral Regurgitation

I. Mitral Regurgitation: What every physician needs to know. Primary mitral regurgitation The mitral valve is composed of its leaflets, the chordae tendineae, the mitral annulus, and the papillary muscles that link the chordae to the left ventricle (LV). Primary mitral regurgitation (PMR) may occur from pathology of any of these valve components. In developed…

Depression

I. Co-morbid Depression in Patients with Chronic Heart Failure: What Every Physician Needs to Know Why depression is important in patients with chronic heart failure Depression is a common co-morbid condition in patients with coronary heart disease (CHD) and chronic heart failure (HF). We have found that 35% of 374 HF patients who were hospitalized…

Anemia

I. Anemia: What every physician needs to know. The presence of anemia in heart failure (HF) patients is associated with cognitive impairment, a higher New York Heart Association (NYHA) class, lower exercise capacity, worse quality of life, increased number of hospitalizations, and higher mortality. Although the prevalence and prognostic roles of anemia have been well…

Tachycardia

I. Problem/Condition. Tachycardias include all heart rhythms with a rate > 100 bpm. They can be divided into two primary categories: ) Narrow Complex Tachycardias (NCT) which have a QRS duration < 120 msec ) Wide Complex Tachycardias (WCT) which have a QRS duration > 120 msecContinue Reading The NCT’s are due to rapid activation…

Ivabradine

General (including evidence of efficacy) Ivabradine (Corlanor®) is a novel selective inhibitor of the I f channel current in the pacemaker cells of the sinoatrial (SA) node. Its predominant effect is to reduce heart rate without affecting contractility. Heart rate reduction with beta blockers has been identified in clinical literature and trials as a contributor…

LCZ696

General (including evidence of efficacy) LCZ696 (sacubitril/valsartan) is a member of a new class of agents called angiotensin receptor-neprilysin inhibitors (ARNIs) which combine a neprilysin inhibitor and angiotensin receptor blocker (ARB). LCZ696 is currently indicated for treating patients with heart failure with reduced ejection fraction (HFrEF) in place of an angiotensin converting enzyme (ACE) inhibitor…

Management of Hypertension

I. Management of hypertension: What every physician needs to know Hypertension is THE disease. It is present for all to consider and deal with regardless of the specialty. However, it is the quintessential internist’s dilemma. To date, the proposed surgical remedies for hypertension have only had paltry results and serve such a small fraction of…

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