Cardiology in Review – Ενδιαφέροντα Αρθα

Smolenska, Zaneta; Barraclough, Rufus; Dorniak, Karolina; Szarmach, Arkadiusz; Zdrojewski, Zbigniew

Abstract. The heart is one of the major organs commonly involved in systemic sclerosis. Myocardial fibrosis has been identified in a high percentage of these patients. Most systemic sclerosis patients with cardiac involvement are subclinical, especially early on in the course of their disease. To accurately identify cardiac involvement and improve diagnosis and treatment, imaging techniques should be implemented on a regular basis following diagnosis. In this review, we discuss the up-to-date pathophysiologic basis of cardiac involvement, the cardiac manifestations, and the diagnostic methods which have been published in the literature.

Recent studies have shown that tissue Doppler imaging is a promising evaluation technique in the bedside detection of cardiac involvement. Cardiovascular magnetic resonance is an operator-independent method used for detecting systemic sclerosis cardiac involvement. It is an especially useful tool in the early stages of the disease when patients may be asymptomatic. At present, it is the most promising imaging technique for the diagnosis, follow-up and response to therapy in clinical practice.

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Temple, Norman J; Guercio, Valentina; Tavani, Alessandra
Abstract. In this article we critically evaluate the evidence relating to the effects of the Mediterranean diet (MD) on the risk of cardiovascular disease (CVD). Strong evidence indicating that the MD prevents CVD has come from prospective cohort studies. However, there is only weak supporting evidence from randomized controlled trials (RCTs) as none have compared subjects who follow a MD and those who do not. Instead, RCTs have tested the effect of one or two features of the MD. This was the case in the Prevenciόn con Dieta Mediterránea (PREDIMED) study: the major dietary change in the intervention groups was the addition of either extra-virgin olive oil or nuts. Meta-analyses generally suggest that the MD causes small favorable changes in risk factors for CVD including blood pressure, blood glucose, and waist circumference. However, the effect on blood lipids is generally weak. The MD may also decrease several biomarkers of inflammation including C-reactive protein. The seven key features of the MD can be divided into two groups. Some are clearly protective against CVD (olive oil as the main fat; high in legumes; high in fruits/vegetables/nuts; and low in meat/meat products and increased in fish). However, other features of the MD have a less clear relationship with CVD (low/moderate alcohol use, especially red wine; high in grains/cereals; and low/moderate in milk/dairy). In conclusion, the evidence indicates that the MD prevents CVD. There is a need for RCTs that test the effectiveness of the MD for preventing CVD. Key design features for such a study are proposed.
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Argueta, Erwin E; Paniagua, David
Abstract. The need to quantify blood flow through the heart has led to the development of different techniques for its measurement. The three main approaches are the Fick method, dye dilution and thermodilution techniques. The latter two are based on the use of indicators that indirectly quantify blood flow. These have slowly been developed over centuries, from the concept of measuring blood flow, to a technique, and its clinical utility. Thermodilution is the most popular dilution method used for measuring cardiac output in the clinical setting. The information obtained during this procedure is relevant in the process of clinical decision making in patients with critical illness, valvular heart disease, and congestive heart failure. The technique increased in popularity in the early 1970’s after Swan and Ganz invented the pulmonary artery catheter which simplified thermodilution enough to utilize it as a bedside procedure. This was only possible with simple yet clever engineering methods which are not commonly known in the medical community. Despite these advancements, the concept of measuring cardiac output by dilution techniques is one where its optimal use in the clinical setting continues to be an area of investigation. The thermodilution concept and the mechanism of measuring cardiac output will be discussed in the following review.
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