Fast vs slow rubidium-82 infusion profiles and test-retest precision of myocardial perfusion using contemporary 3D cardiac analog positron emission tomography-computed tomography imaging.

Background: On legacy 2D positron emission tomography (PET) systems utilizing a 50 mL/min Rb-82 profile, test-retest precision of quantitative perfusion is ∼10%. It is unclear whether Rb-82 infusion rate significantly impacts quantitative perfusion and/or image quality on modern analog 3D PET-CT systems. We aimed to determine whether the Rb-82 infusion profile significantly impacts test-retest precision of quantitative perfusion, perfusion metrics, and/or image quality on a modern analog 3D PET-CT scanner.

Secondary hypertension: evaluation and management.

Purpose Of Review: Hypertension (HTN) that can be attributed to a particular source is known as secondary HTN (SH). Often, SH is difficult to control and thus referred to as resistant HTN, although the two terms are not mutually exclusive.

Recent Findings: A common theme across several contributors to SH are coactivation of the sympathetic drive and hormonal changes, independent of hormonal axis activation.

Hypertensive crisis: diagnosis, presentation, and treatment.

Purpose Of Review: Hypertensive crisis (HTN-C) is a condition of increasing prevalence. It carries significant morbidity and mortality, and prompt recognition and treatment are crucial. There is a paucity of controlled trials, so a working knowledge of the most recent literature in the area of HTN-C is helpful.

Traumatic Intramyocardial Dissection With Anterior Papillary Muscle Avulsion and Severe Mitral Regurgitation.

• LV IMD is a rare complication of blunt chest trauma. • Associated papillary muscle avulsion led to severe MR. • Transthoracic echocardiography provides a rapid diagnosis of this rare entity.

Left ventricular hypertrophy and hypertension.

Hypertension (HTN) is a major modifiable risk factor for cardiovascular disease (CVD) morbidity and mortality. The left ventricle (LV) is a primary target for HTN end-organ damage. In addition to being a marker of HTN, LV geometrical changes: concentric remodeling, concentric or eccentric LV hypertrophy (LVH) are major independent risk factors for not only CVD morbidity and mortality but also for all-cause mortality and neurological pathologies.

Management of resistant hypertension.

Purpose Of Review: Resistant hypertension is defined as blood pressure above patient goal despite three different antihypertensive agents at optimal dose including a diuretic. Resistant hypertension is increasingly common issue in clinical practice and it is a major risk factor of cardiovascular disease.

Recent Findings: All patients with resistant hypertension should be evaluated for possible correctable factors associated with pseudoresistance, such as poor adherence, white coat hypertension and suboptimal measurement of blood pressure.

Emerging Therapy in Hypertension.

Purpose Of The Review: Pharmacology remains the mainstay of treatment for hypertension across the globe. In what may seem like a well-trodden field, there are actually an exciting array of new pathways for the treatment of hypertension on the horizon. This review seeks to discuss the most recent research in ongoing areas of drug development in the field of hypertension.

Role of Transesophageal Echocardiography in Patients with Ischemic Stroke.

Acute ischemic stroke is a condition with considerable mortality and morbidity. When used appropriately, Transesophageal Echocardiography (TEE) can be an incredibly useful tool to identify potential causes of stroke and guide management. The crucial distinction in this modality lies in separating common incidental findings from those likely to have contributed to ischemic stroke.

Prognostic Implications of Left Ventricular Hypertrophy.

Left ventricular hypertrophy (LVH) was one of the earliest studied echocardiographic characteristics of the left ventricle. As the myriad of measurable metrics has multiplied over recent years, this reliable and relevant variable can often be overlooked. In this paper, we discuss appropriate techniques for accurate analysis, underlying pathophysiology, and the contributions from various risk factors.

Implantable Cardioverter-defibrillators in Adult Congenital Heart Disease.

With improved surgical techniques and medical therapies, many patients who are born with complex congenital heart defects are now living well into adulthood. As these patients age, an increasingly common cause of mortality is sudden cardiac death (SCD) from ventricular tachyarrhythmias. The implantable cardioverter-defibrillator (ICD) is a therapy with the ability to prevent some of these deaths; however, there are many diagnostic and technical challenges that remain in the congenital heart disease (CHD) population.

Future pharmacological therapy in hypertension.

Purpose Of Review: Hypertension (HTN) is a widespread and growing disease, with medication intolerance and side-effect present among many. To address these obstacles novel pharmacotherapy is an active area of drug development. This review seeks to explore future drug therapy for HTN in the preclinical and clinical arenas.

Management of Perioperative Anticoagulation for Device Implantation.

Periprocedural management of anticoagulation for cardiac device implantation has evolved over the past 20 years. The traditional paradigm of vitamin K antagonist interruption with heparin bridging has now been shown to be less safe than continuation of vitamin K antagonists at therapeutic levels. Dual antiplatelet therapy during device implantation poses substantial risk but is often necessary.

Valvular Heart Disease in Cancer Patients: Etiology, Diagnosis, and Management.

Cardiac valvular disease as consequence of radiation and chemotherapy during treatment for malignancy is growing in its awareness. While the overwhelming emphasis in this population has been on the monitoring and preservation of left ventricular systolic function, we are now developing a greater appreciation for the plethora of cardiac sequelae beyond this basic model. To this end many institutions across the country have developed cardio-oncology programs, which are collaborative practices between oncologists and cardiologists in order to minimize a patient's cardiovascular risk while allowing them to receive the necessary treatment for their cancer.

The Evolving Role of Percutaneous Mitral Valve Repair.

Background: Mitral regurgitation (MR) is the second leading cause of valvular heart disease in the United States behind aortic stenosis. The percutaneous repair of the mitral valve (MitraClip, Abbott, Inc.) has been approved in the United States since 2013 as an alternative to traditional mitral valve surgery.