Inflammation in Heart Failure: known knowns and unknown unknowns.

The review deals with inflammation in heart failure (HF). Many data show that systemic inflammation is frequent in HF and implicate that inflammation contributes to damage and dysfunction of the cardiovascular system. Areas Covered: Experimental data have been mainly obtained in acute laboratory animal models.

Anti-thromboembolic strategies in atrial fibrillation.

Oral anticoagulation (OAC) is highly effective for stroke prevention in high-risk-patients with atrial fibrillation (AF). AF is also a risk for dementia, and effective OAC reduces the risk of dementia. Up to 30% of patients with AF have a coronary artery disease and antiplatelets are used to avoid thrombotic complications.

New concepts in the therapy of atrial fibrillation.

Atrial fibrillation is a frequent arrhythmia with increasing prevalence. The paper reviews the most important present aspects and paradigms in the treatment of the arrhythmia. The main aim of treatment is directed to improve the quality of life while reducing morbidity and mortality.

Use of nitrates in ischemic heart disease.

Short-acting nitrates are beneficial in acute myocardial ischemia. However, many unresolved questions remain about the use of long-acting nitrates in stable ischemic heart disease. The use of long-acting nitrates is weakened by the development of endothelial dysfunction and tolerance.

Angina pectoris in patients without flow-limiting coronary artery disease (cardiac syndrome X). A forest of a variety of trees.

Coronary heart disease (CHD) represents an important problem worldwide. At present, more women than men are evaluated for CHD and it has been recognized that the prevalence of this pathology in women is at least the same as in men. We have learned that cardiac syndrome X (CSX) is frequent because worldwide each year millions of people (mostly women) with angina pectoris without flow-limiting epicardial pathology are identified.

Torsades de pointes induced by the concomitant use of ivabradine and azithromycin: an unexpected dangerous interaction.

A 68-year-old man had a cardiac syncope. He was known to have a long QT-interval and was treated with ivabradine for paroxysmal sinusal tachycardia. In the last 5 days, azithromycin had been prescribed for sinusitis.

Assessing the benefits of natriuretic peptides-guided therapy in chronic heart failure.

Heart failure (HF) is a major public heart burden among the ageing population. Optimizing management of patients remains challenging despite many advances in therapy for this pathology. Natriuretic peptides (NPs) are related to cardiac morbidity and mortality and their use in guiding treatment might help.

Comparison between ivabradine and low-dose digoxin in the therapy of diastolic heart failure with preserved left ventricular systolic function.

Multicenter trials have demonstrated that in patients with sinus rhythm ivabradine is effective in the therapy of ischemic heart disease and of impaired left ventricular systolic function. Ivabradine is ineffective in atrial fibrillation. Many patients with symptomatic heart failure have diastolic dysfunction with preserved left ventricular systolic function, and many have asymptomatic paroxysmal atrial fibrillation.

Cardiac pathology and modern therapeutic approach in Behçet disease.

Behçet disease (BD) is an enigmatic inflammatory disorder with multisystemic complications which is endemic in some countries but can be seen in the entire world. Valid diagnostic criteria are available. The pathology is related to a specific perivasculitis with involvement of both arteries and veins of all sizes.

Management of myocardial ischemia. Is ranolazine needed? For all or some patients with myocardial ischemia?

This editorial refers to 'Should ranolazine be used for all patients with ischemic heart disease or only for symptomatic patients with stable angina or for those with refractory angina pectoris? A critical appraisal' by U Thadani also published in this issue.

Sheila Jasanoff: localizing the global.

At a time when all knowledge is 'situated' and no longer 'universal' or 'neutral', the translation of Sheila Jasanoff's reflections about "how we should deploy for the good our profoundly human ingenuity" raises a question for Brazilian academia: how to 'situate' this reflection? If times are changing for the imperial West, it is plausible to take advantage of this time to problematize 'the proper building blocks' of public reason in Brazil. And there is no reason why we should not consider the indications coming from Harvard. They are no longer to be taken as privileged authorized sources of knowledge, moreover unacceptable in a world that deems itself 'deplatonized', but rather as propositions to be 'situated' in processes of choice and transformation.

Adverse cardiovascular effects of antirheumatic drugs: implications for clinical practice and research.

Clinical manifestations of most rheumatic diseases have changed over the past few decades, largely due to advances in therapies targeting autoimmune and (auto)inflammatory pathways. Improvements in the management of rheumatic diseases have also now brought to the fore the issue of comorbidities. It has become evident that the burden of cardiovascular morbidity and mortality is increased in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and the spondyloarthropathies, amongst other conditions.

A case report of a patient with Ribbing disease underlines the connections between the skeletal and cardiovascular complications.

A 69-year-old woman suffered from Ribbing disease, a hereditary X autosomal dominant disease with multiple sclerosing dysplasias. However, it is less known that the genetic mutation can often induce cardiovascular complications. The patient had a hypertensive cardiopathy and had been treated with percutaneous coronary angioplasty and stenting because of a myocardial infarction.

Physical exercise with weight reduction lowers blood pressure and improves abnormal left ventricular relaxation in pharmacologically treated hypertensive patients.

In spite of appropriate pharmacologic therapy, many hypertensive patients develop an abnormal left ventricular relaxation with preserved systolic function. This cardiac dysfunction increases the risk of cardiovascular complications. The authors assessed the therapeutic effects of an intervention with exercise training and weight reduction in patients with pharmacologically well-treated hypertension who had abnormal left ventricular relaxation with normal systolic function.

Colchicine in clinical medicine. A guide for internists.

Colchicine (COL) has been used in medicine for a long time. It is well recognized as a valid therapy in acute flares of gouty arthritis, familial Mediterranean fever (FMF), Behçet's disease, and recurring pericarditis with effusion. It has also been used to treat many inflammatory disorders prone to fibrosis, mostly with disappointing therapeutic results.

Myocardial ischemia in Wegener's granulomatosis: coronary atherosclerosis versus vasculitis.

Wegener's granulomatosis (WG) is one of the most common small- and medium-sized necrotizing vasculitides that mainly affects the upper and lower respiratory tract and the kidneys. Cardiac manifestations in WG are relatively rare, and their role and place among different causes of mortality remain largely unknown. Substantially increased number of reports describing involvement of all structures of the heart, which underlie conduction disturbances, valvular disease, ischemic heart disease and other potentially serious conditions, underscores importance of comprehensive cardiovascular investigations and monitoring of patients with WG.

Behçet's Disease: an Insight from a Cardiologist's Point of View.

Behçet's disease (BD) is an enigmatic inflammatory disorder, with vasculitis (perivasculitis) underlying pathophysiology of its multisystemic affections. Venous pathology and thrombotic complications are hallmarks of BD. However, it has been increasingly recognized that cardiac involvement and arterial complications (aneurysms, pseudoaneurysms, rupture and thrombosis) are important part of the course of BD.

Cardiac complications in rheumatoid arthritis in the absence of occlusive coronary pathology.

Cardiovascular disease is the leading cause of premature mortality in patients with rheumatoid arthritis (RA). Pathophysiology of rheumatoid cardiovascular phenomenon is not fully understood, but systemic inflammation is thought to play a crucial role in the endothelial damage and accelerated course of atherosclerotic disease. Rheumatoid inflammation can also cause coronary pathology and heart failure.

The anti-ischemic effect of metoprolol in patients with chronic angina pectoris is gender-specific.

Several gender-specific differences in cardiovascular diseases are known and pharmacokinetics of beta-blockers shows relevant sex-specific differences. The plasma levels of metoprolol, for example, are higher in women compared to men. However, randomized studies have shown that metoprolol has little or no greater reduction in the mortality of women following myocardial infarction.

Comparative efficacy of ranolazine versus atenolol for chronic angina pectoris.

We investigated whether ranolazine therapy improves exercise-induced angina pectoris and myocardial ischemia compared with placebo or with standard doses of atenolol in patients who had chronic angina and evaluated the effects on hemodynamics at rest and during exercise. In this trial, 158 patients who had symptom-limited exercise discontinued beta-blocker therapy and were randomized into a double-blind, 3-period, crossover study of 400 mg of immediate-release ranolazine 3 times daily, 100 mg/day of atenolol, or placebo, each administered for 1 week. Exercise tests were administered at the end of each treatment period.