Chest Pain Evaluation: Diagnostic Testing.

Chest pain/discomfort (CP) is a common symptom and can be a diagnostic dilemma for many clinicians. The misdiagnosis of an acute or progressive chronic cardiac etiology may carry a significant risk of morbidity and mortality. This review summarizes the different options and modalities for establishing the diagnosis and severity of coronary artery disease.

Electrophysiology Study and Catheter Ablation With Superior Vena Cava Stump.

We report the complete absence of a superior vena cava in a patient without prior history of cardiac surgery or device implantation. This is a very rare congenital cardiac abnormality, which if unrecognized, may lead to complications in patients undergoing electrophysiological studies.

Activity with ambulation attenuates diuretic responsiveness in chronic heart failure.

Introduction: We hypothesized that discharged heart failure (HF) patients could develop clinical congestion despite adhering to prescribed diuretics, because ambulation attenuates diuretic and natriuretic responsiveness.

Methods: We studied 9 patients aged 57 ± 13 (mean ± SD) years with New York Heart Association functional class II-III symptoms and ejection fraction <40% (28 ± 7%) and receiving furosemide (≥80 mg/d [113 ± 53 mg/d]) plus renin-angiotensin system antagonists and beta-blockade. Inulin and p-amminohippuric acid were infused to estimate glomerular filtration rate (GFR) and renal plasma flow (RPF).

Prognostic value of 64-slice cardiac computed tomography severity of coronary artery disease, coronary atherosclerosis, and left ventricular ejection fraction.

Objectives: We sought to determine the prognostic and incremental value of coronary artery disease (CAD) severity, coronary atherosclerosis, and left ventricular ejection fraction (LVEF) measured with cardiac computed tomography angiography (CTA).

Background: CTA is an emerging tool used for the detection of obstructive CAD. However, there are limited data supporting the prognostic value of 64-slice CTA and its ability to predict all-cause mortality and major adverse cardiac events such as cardiac death and nonfatal myocardial infarction.

Mycophenolate mofetil dose reduction for gastrointestinal intolerance is associated with increased rates of rejection in heart transplant patients.

Background: Gastrointestinal (GI) intolerance to mycophenolate mofetil (MMF) is a frequent problem. We conducted a retrospective analysis of all the heart transplant patients followed up at the Toronto General Hospital from the years 1999 to 2006 to determine the impact of dose reductions for GI intolerance on rejection rates.

Methods: The charts of all patients followed up in the heart transplant clinic at the Toronto General Hospital from the years 1999 to 2006 were reviewed.

Inferior infarction following alcohol septal ablation: a consequence of "collateral damage"?

Alcohol septal ablation is fast becoming the most common method to reduce left ventricular outflow tract gradient in patients with symptomatic hypertrophic obstructive cardiomyopathy. Myocardial contrast echocardiography (MCE) is routinely used as an adjunct to avoid the spread of alcohol to non-target areas of myocardium. We report two cases where despite the careful use of MCE, remote inferior wall myocardial infarctions occurred.