A Stepwise Approach to the Management of Heart Failure and its Comorbidities.

Modern medical and technological advances provide highly effective management for the treatment of patients with heart failure with reduced ejection fraction (HFrEF). In this review, the authors propose a 2-step approach to treatment that is straightforward, practical, and thorough. For the patient whose life now includes HFrEF, the physician's first step is to ensure that the patient is taking the 3 key medications ([1] renin-angiotensin inhibitors (angiotensin receptor/neprilysin inhibitors, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers), [2] β-blockers, and [3] mineralocorticoid receptor antagonists) recommended in guideline-directed doses to attain comprehensive receptor blockade.

Heart Failure With Preserved Ejection Fraction.

Heart failure with preserved ejection fraction (HFpEF) is a complex clinical condition. Initially called diastolic heart failure, it soon became clear that this condition is more than the opposite side of systolic heart failure. It is increasingly prevalent and lethal.

Intermittent left bundle branch block: an overlooked cause of electrocardiographic changes that mimic high-grade stenosis of the left anterior descending coronary artery.

Context: The electrocardiographic (ECG) pattern of high-grade stenosis of the left anterior descending coronary artery (LAD) is important clinically because of the high risk of myocardial infarction and cardiac death if the pattern is not recognized. Although the recognition of this pattern is currently widespread, false-positive ECG changes that mimic this pattern are infrequently reported.

Objective: To demonstrate that ECG changes from intermittent left bundle branch block (LBBB) and cardiac memory can mimic anterior ischemia.

Aortic stenosis: new thoughts on a cardiac disease of older people.

We have entered a new era in understanding degenerative aortic stenosis in elderly patients. With the aging of the US population and the progressive decrease in coronary heart disease prevalence in the past 50 years, aortic stenosis has become a major cardiac concern. New perspectives of the disease now lead us to see the condition in terms of the response of the left ventricle and of systemic features, rather than just in terms of the valve area itself.

Patient-centered management of atrial fibrillation: applying evidence-based care to the individual patient.

Atrial fibrillation is the most common arrhythmia encountered in clinical practice, and it is one of the most common cardiac conditions requiring hospitalization of a patient. Several national organizations have developed guidelines for the management of atrial fibrillation. These guidelines were updated in 2011 to incorporate new advances in antiarrhythmic drug therapy and anticoagulant therapy, as well as progress in the field of catheter ablation.

Peripartum heart failure caused by left ventricular diastolic dysfunction.

Peripartum cardiomyopathy (PPCM) is a rare but serious cause of heart failure occurring in the last month of pregnancy or the first 5 months postpartum. The current definition of PPCM only includes patients with left ventricular systolic dysfunction. The authors present a case of peripartum heart failure with normal ejection fraction and raise the possibility that the definition of PPCM be expanded to include left ventricular diastolic dysfunction.

Impact of functional testing results on prescription patterns of anti-anginal medication after coronary artery bypass graft surgery: results from the ROSETTA-CABG Registry.

Background: Although coronary artery bypass graft surgery (CABG) is known to reduce angina, previous studies have suggested that anti-anginal medication use is not significantly reduced after CABG. However, it is unclear how functional testing results have an impact on anti-anginal medication prescription patterns.

Objectives: To determine whether post-CABG functional testing results impact prescription patterns of anti-anginal medication during the 12 months after CABG.

Lack of benefit for routine functional testing early after coronary artery bypass graft surgery: results from the ROSETTA-CABG Registry.

Background: There is little consensus regarding the use of functional testing after coronary artery bypass graft surgery (CABG). Some physicians opt for a routine functional testing strategy, while others employ a symptom-driven strategy.

Objective: To examine the effects of routine post-CABG functional testing on the use of follow-up cardiac procedures and clinical events.

Use of stress testing early after coronary artery bypass graft surgery.

The American College of Cardiology/American Heart Association guidelines for exercise testing do not take a position regarding the utility of routine stress testing after coronary artery bypass grafting (CABG). Our purposes were (1) to document the patterns of use of stress testing after CABG and (2) to establish whether the choice of stress testing strategy is associated with clinical characteristics of patients. The Routine versus Selective Exercise Treadmill Testing after Coronary Artery Bypass Graft Surgery (ROSETTA-CABG) Registry is a prospective multicenter study that examined the use of stress testing after CABG among 395 patients at 16 clinical centers in 6 countries.

Impact of diabetes on 12-month outcomes following coronary artery bypass graft surgery: results from the ROSETTA-CABG Registry.

Background: Diabetes mellitus is associated with poorer long-term outcomes following coronary artery bypass graft (CABG) surgery. However, little is known about the impact of diabetes mellitus on outcomes during the first 12 months following CABG.

Objectives: To examine the relationship between diabetes mellitus and outcomes during the 12 months following CABG.

Thrombolysis and counterpulsation to improve survival in myocardial infarction complicated by hypotension and suspected cardiogenic shock or heart failure: results of the TACTICS Trial.

Background: Sustained hypotension, cardiogenic shock, and heart failure all imply a poor prognosis in acute myocardial infarction (MI). We assessed the benefit of adding 48 hours of intra-aortic balloon counterpulsation (IABP) to standard treatment for MI, in an international trial among hospitals without primary angioplasty capabilities.

Methods: We randomized 57 patients with MI complicated by sustained hypotension, possible cardiogenic shock, or possible heart failure to receive either fibrinolytic therapy and IABP or fibrinolysis alone.