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- Jha, Sandeep, et al.
(author)
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Clinical management in the takotsubo syndrome.
- 2019
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In: Expert review of cardiovascular therapy. - : Informa UK Limited. - 1744-8344 .- 1477-9072. ; 17:2, s. 83-93
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Research review (peer-reviewed)abstract
- Takotsubo syndrome (TS) is an increasingly recognized acute heart failure syndrome which is self-limiting in most cases but can result in life-threatening complications. TS is difficult to distinguish from acute myocardial infarction (AMI) early in the disease course and currently lacks evidence-based treatment recommendations. Areas covered: Based on the available literature this systematic review discusses the clinical management of patients with TS during (i) the diagnostic workup; (ii) acutely after establishing the TS diagnosis; and (iii) after recovery of cardiac function. Expert commentary Since TS is self-limiting in most cases it is recommended to refrain from unnecessary treatment (the do no harm principle) when managing patients with TS. The management of patients with TS should focus on careful monitoring of ECG and hemodynamics, and on preventing and treating complications. Because catecholamine-mediated inotropic overstimulation is implicated in the pathogenesis of TS, and because inotropic drugs have been associated with worse outcomes for patients with TS, we recommend the treating physician to avoid these drugs. Instead, mechanical assist devices should be considered early for patients with TS who develop cardiogenic shock with signs of end-organ hypo-perfusion.
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- Leopoulou, Marianna, et al.
(author)
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Naxos disease – a narrative review
- 2020
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In: Expert Review of Cardiovascular Therapy. - : Taylor & Francis. - 1477-9072 .- 1744-8344. ; 18:11, s. 801-808
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Journal article (peer-reviewed)abstract
- IntroductionNaxos disease is a rare entity that manifests with woolly hair, keratosis of extremities, and cardiac manifestations that resemble arrhythmogenic right ventricular cardiomyopathy. It is inherited in an autosomal recessive pattern and mutations affecting plakoglobin and desmoplakin have been identified. There is an increased risk of arrhythmias, including sudden cardiac death at a young age. Right ventricular systolic dysfunction often progresses and left ventricular involvement may also occur.Areas coveredThis article reviews historic background, epidemiology, clinical characteristics, genetics, and pathogenesis as well as therapeutic management and future perspectives.Expert opinionThe principles of evaluation and treatment are based on arrhythmogenic right ventricular cardiomyopathy (ARVC) and general heart failure guidelines, because specific data on Naxos disease are limited. Therefore, larger registries on Naxos disease are welcome in order to gain more knowledge about clinical course and risk stratification. Translational research on pathophysiological mechanisms has evolved, including promising approaches using stem cells for novel targets.
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- Pouwels, Sjaak, et al.
(author)
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Interaction of obesity and atrial fibrillation : an overview of pathophysiology and clinical management
- 2019
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In: Expert Review of Cardiovascular Therapy. - : Informa UK Limited. - 1477-9072 .- 1744-8344. ; 17:3, s. 209-223
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Research review (peer-reviewed)abstract
- Introduction: Obesity, defined as a Body Mass Index (BMI) of ≥30 kg/m2, is the most common chronic metabolic disease worldwide and its prevalence has been strongly increasing. Obesity is associated with various diseases such as cardiovascular disease, type 2 diabetes, and hypertension. Regarding heart rhythm disorders, obesity is associated with an increase in atrial fibrillation (AF), the most common arrhythmia in clinical practice. AF is associated with increased cardiovascular morbidity and mortality. Obesity, a novel risk factor, is responsible for a 50%-increased incidence of AF.Areas covered: We will briefly discuss the obesity paradox and its mechanisms regarding cardiac and hemodynamic function changes. In the first main part of this review, we will be discussing risk assessment studies, pathophysiology, genetic predisposition, epicardial adipose tissue, and ventricular adaptation in relation to obesity and development of AF. In the second part, we will discuss treatment strategies like conservative management and the effect of bariatric and metabolic surgery.Expert opinion: Cardiac arrhythmias, in particular, AF, in patients with obesity comprise complex pathophysiological mechanisms that remain poorly understood. In recent literature, there has been increased interest in the role of epicardial adipose tissue and structural remodeling in obese hearts.
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