Volume 15 - Issue 3

Managing Hypercholesterolemia in the High-risk CV Patient – A New Strategy for Further Reducing Risk

By David Fitchett, MD, FRCPC

Reviewed by Gordon Moe, MD, FRCPC

Cardiovascular disease (CVD), including coronary artery and cerebrovascular disease, is the second most common cause of death in Canada, responsible for 25% of mortality in 2013. An additional 2.4 million Canadian adults live with the sequelae of CVD.

Volume 15 - Issue 2

Practical Applications of Angiotensin Receptor-Neprilysin Inhibition in Patients with Heart Failure and Reduced Ejection Fraction

By JONATHAN G. HOWLETT, MD, FRCPC, ANIQUE DUCHARME, MD, MSc, FRCPC, and GORDON MOE, MD, FRCPC

The combined angiotensin receptor and neprilysin inhibitor sacubitril/valsartan increases survival, reduces hospitalization, and improves quality of life and the feeling of well-being compared to the angiotensin-converting enzyme inhibitor enalapril in patients with heart failure and reduced ejection fraction.

Volume 15 - Issue 1

A Practical Guide to the Use of Novel Anticoagulants for Stroke Prevention in Atrial Fibrillation

By PAUL DORIAN, MD, MSc, FRCPC

Three large, randomized clinical trials have compared warfarin for stroke prevention in atrial fibrillation (AF) to novel oral anticoagulants (NOACs) – dabigatran, rivaroxaban, and apixaban – and a fourth large trial of edoxaban has recently been published. 

Volume 14 - Issue 1

Atrial Fibrillation: Integrating New Guidelines into Practice
By PAUL DORIAN, MD, MSc, FRCPC
The Canadian Cardiovascular Society (CCS), the European Society of Cardiology, and the American College of Cardiology Foundation/ American Heart Association/Heart Rhythm Society (ACCF/AHA/HRS) have recently provided guidelines or focussed updates on the investigation and management of atrial fibrillation (AF). With an emphasis on the 2010 Canadian Guidelines, this issue of Cardiology Rounds will review highlights of the guideline-recommended strategies and treatments and putting these guidelines into practice using a hypothetical patient with AF.

 

Volume 13 - Issue 10

The Role of the ICD in the Prevention of Sudden Death
By KAMRAN AHMAD, MD, FRCPC
Global cardiovascular (CV) mortality is accounted for by a limited set of causes, mainly, sudden death and pump failure. Most therapies for coronary artery disease (CAD), congestive heart failure (CHF), and nonischemic cardiomyopathy reduce mortality by reducing all causes of CV mortality. Defibrillator therapy is unique because, generally, it addresses only sudden cardiac death (SCD; arrhythmic mortality).

 

Volume 13 - Issue 9

Clopidogrel Resistance
By AWAD A.R. ALQAHTANI, MD, FRCPC, and GORDON MOE, MD, FRCPC
Antiplatelet therapy is a cornerstone of cardiovascular (CV) medicine, and acetylsalicylic acid (ASA) and clopidogrel have emerged as critical therapies in the treatment of CV disease. Despite their efficacy, patients on these medications continue to experience adverse clinical events. In fact, millions of patients are currently on low-dose antiplatelet therapy, but it is unknown how many of these patients are undertreated or on the wrong medication.

 

Volume 13 - Issue 8

Diet and Cardiovascular Disease: A Complex Relationship
By DARREN KAGAL, MD, FRCPC, and BETH ABRAMSON, MD, FRCPC, FACC
It is well known that diet has an impact on cardiovascular disease (CVD); however, it is unclear whether the effect of diet is solely due to its influence on underlying cardiac risk factors or to other mechanisms. This issue of Cardiology Rounds explores the complex relationship between dietary intake and overall CV risk.

 

1Volume 13 - Issue 7

Omega-3 Polyunsaturated Fatty Acids (Fish Oils) and Heart Disease – Clinical Benefit or Just a Fad?
By PAUL DORIAN, MD, and ANDREW RAMADEEN, BSc
The effect of marine-derived fish oils (omega-3 [?-3] polyunsaturated fatty acids [PUFAs]) on human health and disease continues to fascinate researchers in many disciplines. A PubMed search (http://www.ncbi.nlm.nih.gov/sites/entrez) in July 2008 revealed a total of 11,000 articles relating to the effects of “PUFAs, EPA, or DHA” on health.

Volume 13 - Issue 6

Evidence-based Management of Pulmonary Hypertension
By DOUGLAS NG, MD, and GORDON MOE, MD, FRCPC
Pulmonary-arterial hypertension (PAH) from any cause is more prevalent than previously believed, and significant uncertainties remain regarding the diagnosis and optimal treatment of PAH. It is now recognized that effective treatment for one cause of PAH may not necessarily be useful for PAH from a different cause. This issue of Cardiology Rounds reviews the contemporary definition, classification, and diagnosis of PAH, with a focus on recent developments in its treatment.

 

Volume 13 - Issue 5

Vascular Protection Update 2008: The ONTARGET Study
By BETH L. ABRAMSON, MD, FRCPC, FACC
The renin-angiotensin-aldosterone system (RAAS) is a hormonal system that regulates blood pressure (BP) and fluid balance; it constitutes an area of important research interest in the management of cardiovascular disease (CVD). This issue of Cardiology Rounds reviews the concept of vascular protection via renin-angiotensin system (RAS) blockade, as well as the clinical trial data to date supporting this concept.

 

Volume 13 - Issue 4

An Overview of Atrial Fibrillation After Cardiac Surgery
By AWAD A. ALQAHTANI, MD, FRCPC, and GORDON MOE, MD, FRCPC
Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery and is associated with an increased incidence of other complications (eg, postoperative stroke), increased hospital length of stay, and increased costs of hospitalization. Prevention of AF is a reasonable clinical goal and, consequently, many randomized trials have evaluated the effectiveness of pharmacological and nonpharmacological interventions.

 

Volume 13 - Issue 3

Isolated Ventricular Noncompaction: A New Cardiomyopathy
By PAALADINESH THAVENDIRANATHAN, MD, MSc, FRCPC, and CHI-MING CHOW, MDCM, MSc, FRCPC, FACC
Isolated ventricular noncompaction (IVNC) is a rare congenital disorder that was first described in a 33-year-old woman by Engberding et al, in 1984. Subsequently, many case reports and several case series in both children and adults have been published.

 

Volume 13 - Issue 2

Stroke Prophylaxis in Non-Valvular Atrial Fibrillation
By BRIAN K. COURTNEY, MD, MSEE, and PAUL DORIAN, MD, FRCPC
Atrial fibrillation (AF) is the most common cardiac arrhythmia; lifetime risk for the development of AF is 1 in 4 in people 40 years of age and older. AF is also a powerful and independent risk factor for stroke. The availability of oral anticoagulation agents, such as warfarin or other vitamin K antagonists, provides a substantial opportunity to reduce the relative risk of stroke or other cardioembolic events by >60%.

Volume 13 - Issue 1

Alcohol and Cardioprotection – Reality or Observational Mistake?
By AKSHAY BAGAI, MD, FRCPC, and BETH ABRAMSON, MD, MSc, FRCPC, FACC
Excessive chronic consumption of alcohol is a significant cause of morbidity and premature mortality. In contrast, an extensive body of scientific evidence indicates that drinking alcohol in moderation on a daily basis appears to offer protection against disease of the heart and the vascular system. This U-shaped alcohol-mortality relationship, in which mortality risk increases among abstainers and heavy drinkers relative to light or moderate drinkers has been observed since the 1980s.

Volume 12 - Issue 10

Universal Definition of Myocardial Infarction
By TONY C. LEE, MD, MSc, and JUAN CARLOS MONGE, MD, FRCPC
Coronary artery disease is a major cause of morbidity and mortality worldwide. During the natural progression of atherosclerotic plaque, an abrupt and potentially catastrophic event may occur, namely plaque disruption, leading to exposure to substances that promote platelet activation and aggregation, and subsequently thrombin formation.

Volume 12 - Issue 9

Ultrafiltration in Acute Decompensated Heart Failure
By WAIL ALKASHKARI, MD, and GORDON MOE, MD
Acute heart failure is a major clinical and public health problem. Advanced refractory heart failure represents an important subgroup of patients presenting with acute heart failure syndrome. Fluid congestion is a hallmark in patients with advanced heart failure, and resistance to pharmacologic therapy – particularly diuretics – frequently develops as the disease progresses.

Volume 12 - Issue 8

Endothelial Shear Stress: Impact on Atherosclerosis
By ANTONIO ROCCA MD, PhD, FRCPC and JUAN CARLOS MONGE MD, FRCPC
Atherosclerosis, a disease that can have devastating consequences, afflicts a large proportion of people in the industrialized world and, increasingly, in developing countries as well. Atherosclerosis is a chronic inflammatory condition of large- and medium-sized vessels that has serious consequences on the cardiovascular (CV) system, leading to the development of myocardial infarction (MI) and stroke.

Volume 12 - Issue 7

Exercise and Acute Cardiovascular Events
By SEAN JEDRZKIEWICZ, MD, and GORDON MOE, MD
The benefits of regular physical activity in protecting against the manifestations of coronary heart disease (CHD) have been accepted, in part due to data from basic research, as well as from clinical and epidemiologic studies. As clinicians, we encourage our patients to pursue an exercise regimen with at least 20-30 minutes of moderately intense activity on most, if not all, days of the week.

Volume 12 - Issue 6

Infective Endocarditis Prophylaxis: Update for 2007
By JEREMY EDWARDS, MD and HOWARD LEONG-POI, MD, FRCPC
The prevention of infective endocarditis (IE) is a topic that attracts much interest and contention. A recent update of the guidelines for prevention of IE by the American Heart Association (AHA) represents substantial alterations to prior recommendations that had previously become standard practice.

Volume 12 - Issue 5

An Overview of Cardiac Sarcoidosis
By FAHAD BASLAIB MD, FRCPC and GORDON MOE MD, FRCPC
Sarcoidosis, a multisystem disorder affecting individuals worldwide, is pathologically characterized by the presence of noncaseating granulomas in involved organs. Although environmental and genetic factors have been implicated in its pathogenesis, the etiology of cardiac sarcoidosis remains obscure.

Volume 12 - Issue 4

Trastuzumab and Heart Failure
By WENDY TSANG, MD, and GORDON MOE, MD, FRCPC, FACC
Trastuzumab is a life-saving therapy in the treatment of breast cancer. However, its use is associated with the development of systolic dysfunction in 5% of patients and approximately 2% of these patients will develop symptomatic congestive heart failure.

Volume 12 - Issue 3

Iron-overload Cardiomyopathy Associated with Iron-overload Conditions: Incidence, Pathophysiology, and Treatment
By GAVIN Y. OUDIT, MD, PhD, FRCPC, and GORDON MOE, MD, FRCPC
The prevalence of primary (hereditary) hemochromatosis and secondary iron-overload (hemosiderosis) is reaching epidemic levels worldwide. Iron-overload leads to excessive iron deposition in a wide variety of tissues, including the heart and endocrine tissues. Chronically elevated cardiac iron concentrations impair diastolic function, increase the propensity for arrhythmias and, ultimately, cause end-stage dilated cardiomyopathy.

Volume 12 - Issue 2

Fabry'’s Cardiomyopathy: Diagnosis, Pathophysiology and the Role of Enzyme Replacement Therapy
By GAVIN Y. OUDIT, MD, PhD, FRCPC, ROBERT M. IWANOCHKO, MD, FRCPC, FACC, and GORDON MOE, MD, FRCPC, FACC
Fabry disease is an X-linked abnormality of glycosphingolipid metabolism that results in systemic deposition of sphingolipid, especially in the vascular endothelium and myocardium, which leads to left ventricular hypertrophy (LVH), endothelial dysfunction, and valvular disease.

Volume 12 - Issue 1

Diastolic Heart Failure: An Update for 2007
By SACHA BHATIA, MD, and HOWARD LEONG-POI, MD, FRCPC
Heart failure (HF) is currently the most common primary diagnosis in hospitalized patients in the United States and an increasing cause of mortality and morbidity in the North American population. Traditionally, HF has been described as a clinical syndrome associated with impaired myocardial contractility and left ventricular (LV) cavity dilation.

Volume 11 - Issue 10

The Metabolic Syndrome: A Growing Concern

By MARC ALLARD, MD, and GORDON MOE, MD

The metabolic syndrome has become a commonly discussed medical problem and a growing

topic of interest for both researchers and the pharmaceutical industry. This issue of Cardiology

Rounds discusses the concept of the metabolic syndrome, reviews the various definitions used to

diagnose it, and describes risk factors associated with its development and the proposed mechanisms

underlying these metabolic risk factors.

Volume 11 - Issue 9

Primary Cardiac Tumours
By HANI AMAD, MD, FRCPC, and HOWARD LEONG-POI, MD, FRCPC

Primary cardiac tumours are extremely rare. In most autopsy series, they have an incidence

of approximately 0.1% and are far less common than secondary tumours that metastasize to

the heart that are reported to be 20 times more common.

Volume 11 - Issue 8

Arrhythmogenic right ventricular cardiomyopathy – not just a matter of fat
By SHELDON M. SINGH, MD, FRCPC and GORDON W. MOE, MD, FRCPC

Arrhythmogenic right ventricular cardiomyopathy (ARVC), also known as arrhythmogenic right

ventricular dysplasia, is an inherited cardiomyopathy associated with arrhythmia, heart failure, and

sudden cardiac death (SCD). Considerable strides have been made in understanding the pathogenesis,

genetics, and diagnosis of ARVC, since it was first described over 20 years ago.

Volume 11 - Issue 7

Microvolt T-Wave Alternans for Sudden Death Risk Stratification in Congestive Heart Failure
By PAUL GALIWANGO, MD, and GORDON MOE, MD

Various studies have demonstrated that automatic implantable cardioverter-defibrillators

(ICDs) reduce the risk of sudden cardiac death (SCD) in patients with heart failure. However,

identifying which high-risk patients may benefit from an ICD is sometimes problematic.

Volume 11 - Issue 6

Peripartum Cardiomyopathy
By MOHAMMAD I ZIA, MD, FRCPC, and GORDON MOE, MD, FRCPC

Peripartum cardiomyopathy (PPCM) is a rare cardiac condition associated with significant

morbidity and mortality. It is an idiopathic form of dilated cardiomyopathy that presents in

late pregnancy or post-delivery.

Volume 11 - Issue 5

Cell Therapy Following Acute Myocardial Infarction: Do Recent Clinical Trial Results Still Warrant Enthusiasm?
By MICHAEL R. WARD, BSc, DUNCAN J. STEWART, MD; and MICHAEL J.B. KUTRYK, MD, PhD

With advancements in pharmacologic and mechanical reperfusion strategies, survival following

myocardial infarction (MI) has greatly improved. Strategies to shorten the time from symptom-onset

to treatment in M I have been the focus of considerable study.

Volume 11 - Issue 4

Recommendations for the Management of Dyslipidemia and the Prevention of Cardiovascular Disease: 2006 Update
By RAYMOND H.M. CHAN, MD, and BETH L. ABRAMSON, MD

There is ongoing evidence that lipid lowering is important in reducing cardiovascular risk.

The first Canadian guidelines for dyslipidemia management were released in 1988 by the Working

Group on Hypercholesterolemia and other Dyslipidemias, with subsequent updates in 2000

and 2003. The latest guidelines – to be published in 2006 – will reflect findings from recent

clinical trials, as well as research on new markers of risk.

Volume 11 - Issue 3

Sensitivity to Antiplatelet Agents in Patients with Acute Coronary Syndromes: Role of Desensitization Therapy

By ANTONIO ROCCA MD, PhD, and GORDON MOE, MD

The importance of aspirin and other antiplatelet agents is well-established for several indications,

ranging from acute coronary syndromes (ACS) to percutaneous coronary intervention

(PCI). However, there is a significant proportion of patients with coronary artery disease (CAD)

who are unable to tolerate acetylsalicylic acid (ASA) and other antiplatelet agents due to drug

sensitivity.

Volume 11 - Issue 2

Non-ST Segment Elevation Myocardial Infarction: Risk Stratification and Early Management

By SAAD ALHASANIAH, MD, and GORDON MOE, MD

Non-ST segment elevation myocardial infarction (NSTEMI) is a common problem encountered in

clinical practice. A common question for the clinician is whether patients with NSTEMI would benefit

from early intervention as compared to medical therapy, or if intervention should be reserved for

unstable patients or those with a positive predischarge stress test.

Volume 11 - Issue 1

Recombinant Human Brain Natriuretic Factor (rhBNP) Therapy for the Treatment of Acute Decompensated Heart Failure

By WARREN T. BALL, MD, MSC, and GORDON MOE, MD, FRCPC

Heart failure (HF) is associated with significant morbidity and mortality. Despite advances

in the treatment of chronic HF, few, if any, novel therapies have been developed that successfully

alleviate symptoms or improve outcomes in patients with acute decompensated HF

(ADHF).

Volume 10 - Issue 10

Anemia and Heart Failure: Prevalence, Prognosis, Pathophysiology, and Treatment

By GAVIN Y. OUDIT, MD, PhD, AND GORDON MOE, MD, FRCPC

Heart failure (HF) is a disease associated with a poor prognosis. Anemia is common in

patients with diastolic and systolic HF and is one of the many predictors of poor prognosis.

Epidemiologic studies indicate that the prevalence of anemia varies from 10%-50% and

increases with severity of HF, declining renal function, and increasing age.

Volume 10 - Issue 9

Smoking Cessation

By NANCY REBELLATO, BScPHM, and BETH ABRAMSON, MD

Cigarette smoking is the leading contributor to premature death, illness, and healthcare

expense. Smoking cessation reduces the risk, slows the progression of tobacco-related

diseases, and increases life expectancy.

Volume 10 - Issue 8

Echocardiographic Evaluation of Heart Failure Patients for Cardiac Resynchronization Therapy: A Practical Primer

By CHI-MING CHOW, MD, CM, MSC, FRCPC, FACC

Despite major advances in medical therapy, morbidity and mortality remain high among

patients diagnosed with heart failure (HF). In Canada, the average in-hospital mortality per

index admission averaged 9.5 deaths/100 hospitalized cases between 1997 and 2000. The

one-year HF readmission rate was 23.6% during that same period.

Volume 10 - Issue 7

Left Ventricular Thrombus: Diagnosis, Prevention, and Management

By IAN M. BILLINGSLEY, MD, FRCP, and HOWARD LEONG-POI, MD, FRCP

Left ventricular thrombus (LVT) is a well-recognized complication of acute myocardial

infarction (AMI) and congestive heart failure (CHF) due to severely impaired LV systolic

function. While the current use of antiplatelet and anticoagulant medications in these patient

populations may have reduced the prevalence of LV thrombi, the prevention, recognition,

and appropriate treatment of this condition remain important because of the potential risk

of systemic embolization.

Volume 10 - Issue 6

Statin Therapy for Valvular Aortic Stenosis: Opportunities and Challenges

By GAVIN Y. OUDIT, MD, PhD, and CHI-MING CHOW, MDCM, MSC, FRCPC

Calcification of the aortic valve is the third leading cause of heart disease in adults. While

indications for aortic valve replacement are well established, potential medical interventions

to treat valvular aortic stenosis (VAS) have only recently been explored.

Volume 10 - Issue 5

Cardiovascular Risks of Cyclooxygenase-2 inhibitors

By FILIOBILLIA , MD , PhD., and GORDON MOE , MD

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat chronic pain and

inflammation in patients with osteoarthritis and other musculoskeletal disorders. In the United

States, these disorders affect 15 to 30 million people, aged between 50 to 60 years of age.

Volume 10 - Issue 4

The Role of Echocardiography in the Diagnosis and Management of Acute Pulmonary Embolism

By MARC ALLARD, MD, FRCPC, and HOWARD LEONG-POI, MD, FRCPC

The diagnosis of an acute pulmonary embolism is often difficult to make since many of the

clinical symptoms can be confused with other acute pulmonary or cardiac disorders.

Echocardiography is frequently performed on individuals with suspected pulmonary emboli,

either to rule-out other suspected cardiac diseases or determine the hemodynamic consequences

of the embolism, which may warrant more aggressive management.

Volume 10 - Issue 3

The Assessment and Management of Perioperative Cardiac Risk in Patients Undergoing Non-cardiac Surgery

By SHELDON M. SINGH, MD, and GORDON W. MOE, MD, FRCPC

Of the 26 million North Americans undergoing noncardiac surgery every year, between

1% to 5% suffer a major cardiovascular event.1 Managing this risk is a common challenge

encountered by surgeons, anesthetists, internists, and cardiologists and the challenge is augmented

by the increasing frequency of older patients with chronic illnesses undergoing major

surgery.

Volume 10 - Issue 2

Universal Healthcare: Equal for all? Socioeconomic Differences in Post-myocardial Infarction Care and Outcomes in Canada

By HARINDRA WIJEYSUNDERA MD, FRCP, and GORDON MOE MD, FRCP

“Canadians strongly support the core values on which our healthcare system is premised – equity, fairness and

solidarity.…These values are tied to their understanding of citizenship. Canadians consider equal and timely access…

on the basis of need as a right of citizenship, not a privilege of status or wealth…. Medicare is a worthy national

achievement, a defining aspect of our citizenship and an expression of social cohesion.”

In November 2002, Roy Romonov gave the above description in the Commission on the

Future of Health Care in Canada.

Volume 10 - Issue 1

Complications of Intra-aortic Balloon Pump: Can We Prevent Them?

By SANJIT JOLLY, MD, FRCP and GORDON MOE, MD, FRCP

The complications of intra-aortic balloon pump (IABP) often occur in critically-ill patients

who are least able to tolerate them. This issue of Cardiology Rounds presents several cases

illustrating the complications of IABP and describes the incidence of these complications

based on a literature review.

Volume 9 - Issue 10

Role of Anticoagulation in Patients with Atrial Fibrillation

By GILLIAN NESBITT, MD, and IQWAL MANGAT, MD

Atrial fibrillation (AF) is the most common sustained arrhythmia. It is estimated that >200,000

Canadians suffer from this rhythm disturbance and, in 2000, 555 hospitalizations per 100,000

population in Canada were attributed to AF or atrial flutter. The prevalence of AF is dependent

on age: >5% of individuals >80 years are affected and approximately 70% of individuals with AF

are between the ages of 65 and 85 years.

Volume 9 - Issue 9

HIV and Coronary Artery Disease: A Heart to HAART Discussion

By PAUL GALIWANGO, MD, GORDON MOE, MD

Health Canada estimates that there were approximately 56,000 people living with

the human immunodeficiency virus (HIV) in Canada at the end of 2002, approximately

one-third of whom were undiagnosed. The increased use of highly active antiretroviral

therapy (HAART) over the past decade has changed the face of this disease in the

developed world, taking it from a rapidly-advancing terminal illness to a more chronically-

managed medical condition.

Volume 9 - Issue 8

Heart Failure as a Neuroendocrine Syndrome: The role of natriuretic peptides in diagnosis, prognosis, and management

By RAYMOND YAN, MD and GORDON MOE, MD

Increasing recognition of heart failure (HF) as a neuroendocrine syndrome has produced

remarkable progress in its management, including the development of many contemporary

medical therapies with favourable neurohormonal-modulatory properties that reduce mortality

and morbidity. The pathophysiological and clinical relevance of the renin-angiotensin-aldosterone

and sympathetic adrenergic systems have been extensively investigated.

Volume 9 - Issue 7

The Role of Continuous ECG Monitoring in the Management of Acute Coronary Syndromes

By ANDREW T. YAN, MD, and SHAUN G. GOODMAN, MD, MSc

Accurate diagnosis and risk stratification are critical in the management of acute coronary

syndromes (ACS) by enabling clinicians to appropriately triage patients and target

pharmacological and interventional therapies. The standard 12-lead electrocardiogram

(ECG) is a well-established tool in both the diagnosis and prognostication of ACS.

Volume 9 - Issue 6

Coronary Computed Tomographic Angiography

By TEJ SHETH, MD, FRCPC; TARANG SHETH, MD, FRCPC; and BRADLEY STRAUSS, MD, PhD

Catheter-based coronary angiography has played a central role in the evolution of

cardiology since it was first developed over 50 years ago. The procedure provides a detailed

examination of coronary anatomy and is the gold standard for the diagnosis of obstructive

coronary artery disease (CAD), serving as the roadmap for bypass surgery and percutaneous

coronary intervention (PCI).

Volume 9 - Issue 5

Anticipating Acute Coronary Syndromes: Identifying Vulnerable Plaque in Vulnerable Patients

By TEJ SHETH, MD, FRCPC, and BRADLEY STRAUSS, MD, PhD, FRCPC

The manifestations of atherosclerotic coronary artery disease (CAD) can be classified into

those that arise from stable plaques and those that arise from unstable plaques. Stable

plaques may not cause clinical symptoms or, in some patients, may lead to the symptom of stable

angina.

Volume 9 - Issue 4

Is an Open Artery Enough? Assessment and Optimization of Myocardial Perfusion in ST-Elevation MI

By HARINDRA WIJEYSUNDERA, MD, and WARREN CANTOR, MD, FRCP

For over two decades, the cornerstone of therapy for acute myocardial infarction (MI) has been

the restoration of flow in the infarct-related artery (IRA), based on the “open artery hypothesis.”

In 1977, Reimer demonstrated that the extent of irreversible ischemic myocardial cell injury is proportional

to the duration of epicardial artery occlusion.

Volume 9 - Issue 3

The Long QT Syndrome

By FAYEZ BOKHARI, MD, FRCPC, and PAUL DORIAN, MD, FRCPC

A 27-year-old patient is referred for the assessment of multiple episodes of loss of consciousness.

She began to have syncope at about age 19, initially once or twice a year, but 5 times in

the past year. A neurologist diagnosed seizure disorder and placed her on anti-seizure drugs. The

syncopal episodes usually occur without any warning, leaving her unconscious for a few minutes,

but feeling well thereafter. There are no prodromal symptoms whatsoever. On several occasions,

she has fainted after hearing a telephone ring or upon being awakened by an alarm clock. What

would you do now? What advice would you give her?

Volume 9 - Issue 2

Refractory Angina Pectoris: A Therapeutic Challenge

By ADEL HAMAD, MD, and CHI-MING CHOW, MD

Since the advent of coronary artery bypass graft (CABG) surgery in 1966 and percutaneous

transluminal coronary angioplasty (PTCA) in 1977, there has been significant progress

in the field of coronary revascularization. However, an increasing number of patients remain

severely disabled by refractory angina pectoris (RAP) despite optimal conventional medical

and invasive management.

Volume 9 - Issue 1

Stem Cells for Myocardial Revascularization and Regeneration

By NEIL P. FAM, MD, MSC, and DUNCAN J. STEWART MD, FRCPC

Early reperfusion of the infarct-related artery (IRA) improves both early and late

outcomes in patients with acute myocardial infarction (MI). However, adverse left

ventricular (LV) remodeling and the subsequent development of heart failure (HF)

remain important causes of morbidity and mortality, as well as significant cost to

the healthcare system.

Volume 8 - Issue 10

Drug-eluting stents for the treatment of coronary artery disease
Part 4: New results from clinical trials and future directions

By MICHAEL J. B. KUTRYK, MD, PhD, FRCPC

The implantation of drug-eluting stents has become the percutaneous treatment of choice

for many patients with coronary lesions. In 2002, two issues of Cardiology Rounds reviewed

the development and early trials of drug-eluting stents for the treatment of coronary artery disease.

Volume 8 - Issue 9

Drug-eluting stents for the treatment of coronary artery disease
Part 3: New results from clinical trials

By MICHAEL J. B. KUTRYK, MD, PhD, FRCPC

Since the first reports of the success of drug-eluting stents for prevention of in-stent

restenosis by Sousa et al and Rensing et al in 2001, the implantation of drug-eluting stents

has become the percutaneous treatment of choice for many coronary lesion subsets.

Volume 8 - Issue 8

Cardiovascular syndromes associated with cocaine use
By ADEL HAMAD, BMEDSc, MD, and CHI-MING CHOW, MDCM, MSc, FRCPC

Cocaine is one of the most commonly used illicit drugs among people seeking care in

hospital emergency departments or drug-treatment centres. In addition, it is the most

frequent cause of drug-related deaths reported by medical examiners.

Volume 8 - Issue 7

Troponin: A window for assessing the high cardiovascular mortality in chronic renal failure
By ANDREW YAN, MD, DAVID H. FITCHETT, MD

Cardiovascular disease (CVD) is the leading cause of death in patients with end-stage

renal disease (ESRD) and accounts for about 50% of overall mortality. The prevalence of

coronary artery disease (CAD) is high in this patient population, likely the result of associated

comorbidities such as advanced age, diabetes, hypertension, and dyslipidemia.

Volume 8 - Issue 6

Prevention of radiocontrast-induced nephropathy
By JOHN JANEVSKI, MSc, MD, FRCPC, and GORDON MOE, MD, FRCPC

Radiocontrast-induced nephropathy (RCIN) is a common and important complication of coronary

angiography and percutaneous coronary intervention (PCI). RCIN is the third most common

cause of hospital-acquired acute renal failure and is associated with increased morbidity, mortality,

and length of hospitalization.

Volume 8 - Issue 5

Bedside right heart catheterization and invasive monitoring
By AFSANEH POURDOWAT, MD, and GORDON MOE, MD

In 1929, Werner Forssmann first demonstrated that a catheter could be advanced safely

into the human heart from a peripheral vessel; he did this by advancing a urethral catheter into

his own heart. During the late 60s and early 70s, H.J.C. Swan and William Ganz developed

a balloon-tipped floatation catheter that could be inserted into the pulmonary artery (PA).

Volume 8 - Issue 4

Papillary muscle rupture post-myocardial infarction
By SANJIT JOLLY, MD and STUART HUTCHISON, MD, FRCPC

Among the mechanical complications of myocardial infarction (MI), papillary muscle rupture

(PMR) poses a worthy challenge to the clinician. When unrecognized, it is lethal in nearly all

patients; however, when it is promptly recognized and surgically corrected, survival is possible

in the majority of cases.

Volume 8 - Issue 3

Valvular heart disease in pregnancy
By AFSANEH POURDOWLAT, MD

Management of pregnancy in patients with valvular heart disease (VHD) continues to pose a

challenge to clinicians. VHD may have a significant impact on fetal and maternal health during

pregnancy, labour, and delivery. Its presence may be recognized for the first time during pregnancy

when hemodynamic changes associated with the gravid state cause symptoms in a previously

asymptomatic patient or accentuate a preexisting condition.

Volume 8 - Issue 2

Diastolic heart failure
By SALEM ALKAABI, MD, and GORDON MOE, MD

Congestive heart failure (HF) may be considered a condition in which cardiac output is not

adequate to meet the metabolic needs of the body either at rest, or during exercise. It is usually

accompanied by an increase in cardiac filling pressure and/or circulating volume.

Volume 8 - Issue 1

Primary angioplasty in acute myocardial infarction
By HAHN HOE KIM, MD and WARREN CANTOR, MD

The patient who suffers an acute ST-elevation myocardial infarction (STEMI) continues

to present a difficult challenge to the treating physician. The ultimate therapeutic objective is

to achieve rapid and sustained reperfusion of the occluded coronary artery in order to salvage

the myocardium.

Volume 7 - Issue 10

Bypass surgery versus PCI for multivessel coronary artery disease: Competing or complimentary strategies?
By MARK S. HANSEN, MD; SHAUN GOODMAN, MD, FRCPC; and WARREN J. CANTOR, MD, FRCPC

Coronary artery bypass graft surgery (CABG), in comparison to medical therapy,

reduces mortality in patients with high-risk coronary anatomy and/or ventricular dysfunction.

Percutaneous coronary angioplasty relieves angina and is the preferred treatment for

most single-vessel disease.

Volume 7 - Issue 9

The emerging role of cardiovascular MRI in the evaluation of cardiovascular disorders
By FAYEZ BOKHARI, MD, FRCPC; LOUIS WU, MD, FRCPC; and CHI-MING CHOW, MD, MSC, FRCPC

Cardiovascular magnetic resonance imaging (CVMRI) is a rapidly emerging field in cardiovascular

medicine that has enormous potential. The first MRI examination on a human was performed

on July 3rd, 1977. Although impressive at the time, it took almost 5 hours to produce

1 image and the image quality was poor when compared with the standards of today.

Volume 7 - Issue 8

Cardiogenic shock from right ventricular infarction
By CHRISTOPHER OVERGAARD, MD, and DAVID FITCHETT, MD

Cardiogenic shock associated with right ventricular infarction (RVI) is a challenging

clinical entity with important therapeutic implications. Unlike cardiogenic shock due to left

ventricular (LV) pump failure, shock associated with RVI may be associated with good long-term

survival if recognized and managed appropriately.

Volume 7 - Issue 7

Drug-eluting stents for the treatment of coronary artery disease
Part 2: Trials with rapamycin and other coating agents

By MICHAEL J.B. KUTRYK, MD, PhD, FRCPC

Despite their success, coronary stenting procedures may be limited by subsequent in-stent

restenosis. To help control this occurrence, local delivery of antirestenotic compounds using drugeluting

stents may be the most important addition to the armamentarium of the interventional

cardiologist since the introduction of the stainless steel coronary stent.

Volume 7 - Issue 6

Drug-eluting stents for the treatment of coronary artery disease
Part 1: Background and trials with paclitaxel

By MICHAEL J.B. KUTRYK, MD, PhD, FRCPC

Despite their success, coronary stenting procedures may be limited by subsequent in-stent

restenosis. To help control this occurrence, local delivery of antirestenotic compounds using drugeluting

stents may be the most important addition to the armamentarium of the interventional

cardiologist since the introduction of the stainless steel coronary stent.

Volume 7 - Issue 5

Carcinoid heart disease: The heart is part of the whole body
By AJAI PASRICHA, MD and TREVOR ROBINSON, MD

Carcinoid tumours are rare neoplasms that have unique and challenging cardiovascular

manifestations. The incidence of carcinoid tumours is about 1.5/100,000 in the general population

and it is estimated that about 30% of affected individuals go on to develop carcinoid

syndrome.

Volume 7 - Issue 4

The role of transesophageal echocardiography in the cardioversion of atrial fibrillation
By ANDREW T. YAN, MD and CHI-MING CHOW, MD, MSc, FRCPC

Atrial fibrillation (AF) is the most common sustained arrhythmia in the general population,

and its incidence rises with increasing age. The loss of “atrial kick” and the shorter variable

diastolic filling time result in a 20%-30% reduction in stroke volume that may manifest

as poor functional capacity and worsening heart failure.

Volume 7 - Issue 3

Endothelial dysfunction/Erectile dysfunction: Common mechanisms, common management
By JUAN CARLOS MONGE, MD

Endothelial dysfunction, considered by many to be at the root of atherosclerotic vascular

disease, shares many common risk factors with erectile dysfunction. In addition, they frequently

occur in the same patients.

Volume 7 - Issue 2

Identifying Patients for High Risk Primary Prevention:
The Role of Electron Beam CT Calcium Scoring

By TEJ SHETH, MD and ROBERT J. CHISHOLM, MD

Electron beam computed tomography (EBCT) offers a non-invasive, validated assessment

of the extent of atherosclerosis in the coronary tree. Elevated calcium scores identify

patients at high risk for cardiac events, although the incremental prognostic value of EBCT

over traditional cardiovascular risk factors remains to be established.

Volume 7 - Issue 1

Angiotensin receptor blockade in the treatment of heart failure: New data from the Valsartan Heart Failure Trial (Val-HeFT)
By GORDON MOE, MD

Inhibition of the renin-angiotensin-aldosterone system remains the most important strategy in

the treatment of heart failure. The angiotensin-converting enzyme (ACE) inhibitors and aldosterone

antagonists are the most commonly used agents in this treatment strategy.

Volume 6 - Issue 10

Natriuretic peptides in heart failure: Potential role in diagnosis and therapy
By TEJ SHETH, MD and GORDON W. MOE, MD

The natriuretic peptides have been the subject of intense research for over two decades.

Both experimental and clinical studies have implicated the natriuretic peptides as an important

neurohormonal system for regulating cardiorenal homeostasis in heart failure.

Volume 6 - Issue 9

The Brugada syndrome: A new malignant cardiac channelopathy
By FAYEZ BOKHARI, MD and DAVID NEWMAN, MD, FRCPC, FACC

The Brugada syndrome was first described in 1986, although there is an earlier, less-cited,

description. The syndrome is a congenital disorder of sodium cardiac channel function characterized

by typical ECG changes and a high incidence of sudden cardiac death that is often preceded by multiple
episodes of loss of consciousness.

Volume 6 - Issue 8

Novel risk factors for coronary artery disease
By SALEEM KASSAM, MD and DUNCAN STEWART, MD

With the rise in the prevalence of coronary artery disease (CAD), predicting and modifying the

risks associated with CAD have gained importance in modern medicine. Large cohort studies have

quantified the relative risks attributable to various disease states.

Volume 6 - Issue 7

Percutaneous coronary intervention in the management of coronary artery disease
By FAYEZ BOKHARI, MD and WAYNE BATCHELOR, MD

Modern invasive cardiology stems from a legacy dating back more than a century and a

half. Cardiac catheterization was first performed in a horse by the French physiologist

Claude Bernard in 1844. Human cardiac catheterization did not occur until 1929, when

Dr.Waner Forssmann (a surgical intern at a small German hospital) passed a catheter through

his antecubital vein and, guided by fluoroscopy, entered the right atrium.

Volume 6 - Issue 6

Angiogenesis: An emerging technology for the treatment of coronary artery disease
By MICHAEL J.B. KUTRYK, MD, PhD; SALEEM A. KASSAM, MD, MCE; and DUNCAN J. STEWART, MD

Ischemic heart disease is the major cause of death in adults in most developed and many developing

countries and is now the most common cause of death worldwide. Effective treatments of

coronary artery disease involve the percutaneous revascularization techniques of balloon angioplasty

and stenting or coronary artery bypass grafting (CABG).

Volume 6 - Issue 4

Resynchronization therapy: the arrival of a new cardiac device indication
By DAVID NEWMAN, MD

In general, physicians using implanted device therapy have paid relatively little attention

to the exact effects of pacing on left ventricular mechanical function. However, over the last

10 years, intense research and development efforts have led to a new Health Canada-approved

device indication.

Volume 6 - Issue 3

Catheter-based reperfusion for acute myocardial infarction
By WARREN CANTOR, MD, and JACEK LINDE, MD

Despite tremendous progress in the development of newer thrombolytic agents, morbidity

and mortality in the acute phase of myocardial infarction (MI) remains high. In ST-elevation

MI, coronary thrombosis results in complete occlusion of the infarct artery.

Volume 6 - Issue 2

Hypertrophic cardiomyopathy in 2001
By GEOFF PULEY, MD and ROBERT CHISHOLM, MD

Hypertrophic cardiomyopathy is a clinically heterogeneous disease caused by a wide variety

of mutations in genes encoding cardiac sarcomeric proteins. These ultimately result in

inappropriate hypertrophy of the myocardium, usually involving the interventricular septum

in an asymmetric fashion.

Volume 6 - Issue 1

The emerging role of angiotensin receptor blockers in the therapy of chronic heart failure
By GORDON MOE, MD

Blockade of the renin-angiotensin-aldosterone system (RAAS) is the most established therapeutic

approach in the management of patients with heart failure. Within this approach, the

angiotensin-converting enzyme (ACE) inhibitors (ACEIs) reduce mortality and morbidity and

have been the cornerstone of therapy of patients with left ventricular dysfunction and heart

failure for nearly two decades.

Volume 5 - Issue 8

Stress echocardiography
By PAUL CHONG, MD and ANATOLY LANGER, MD

Noninvasive tests play a pivotal role in everyday cardiology practice in risk-stratifying

patients for adverse cardiac events. They are particularly useful for the 10-80% of patients at

intermediate risk after initial clinical assessment. If noninvasive tests are indicative of lower risk,

invasive investigations could then be avoided in such patients, saving them from the inherent

risks of invasive procedures.

Volume 5 - Issue 7

Intra-aortic balloon counterpulsation in the CCU

By GEOFF PULEY, MD and STUART J. HUTCHISON, MD

For the treatment of a variety of conditions seen in the CCU, intra-aortic balloon

counterpulsation (IABC) is an effective intervention. IABC reduces left myocardial oxygen

demand and may improve supply, and may thereby alleviate refractory myocardial

ischemia.

Volume 5 - Issue 6

Failed thrombolysis following acute myocardial infarction

By LORNE E. GOLDMAN, MD and WARREN J. CANTOR, MD

Clinical outcome following thrombolytic therapy for acute myocardial infarction (AMI) is

strongly associated with patency of the infarct-related artery. Unfortunately, thrombolytic

therapy fails to restore patency in 15-50% of patients. Early percutaneous transluminal coronary

angioplasty (PTCA) of persistently occluded infarct-related arteries (‘rescue’ PTCA) may

potentially improve outcome in patients with failed thrombolysis following AMI.

Volume 5 - Issue 5

In-stent restenosis: new approaches to an old problem
By BRADLEY STRAUSS, MD, and SALEEM KASSAM, MD

Intracoronary stents have an unequivocal role in the realm of percutaneous coronary

intervention. By preventing early complications and attenuating restenosis, they have been

widely adopted by the cardiology community. Re-narrowing of dilated coronary arterial segments,

however, has proven to be a consistent and resistant problem. This shift in practice

means most restenotic lesions are occurring in a previously stented vessel.

Volume 5 - Issue 4

Implantable left ventricular assist devices
By MICHAEL HEFFERNAN, MD PhD and ANATOLY LANGER, MD

Congestive heart failure (CHF) is a major cause of morbidity and mortality in

Canada. The syndrome is characterized by a reduction in cardiac output and ineffective

emptying of the left ventricle during systole. This results in lower systemic perfusion

pressure to vital organs, an elevation of the left ventricular end-diastolic pressure

(LVEDP), and neurohumoral activation.

Volume 5 - Issue 3

HIV and the heart
By MICHAEL HEFFERNAN, MD, PhD and BETH L. ABRAMSON, MD

HIV infection is an increasingly important health problem in developed and Third World

countries. Cardiac involvement was thought to be rare during the early years of the HIV epidemic.

As primary and supportive treatment has improved, and as prevention of opportunistic infections

has become more effective, cardiac disease has emerged as an important component of

AIDS.

Volume 5 - Issue 2

Who gets an invasive electrophysiological study for ventricular arrhythmias in 2000?
By ARNOLD PINTÉR, MD and DAVID NEWMAN, MD, FRCPC

Diastolic dysfunction, a syndrome characterized by impaired ventricular filling, is increasingly

Programmed electrical stimulation of the ventricle is often regarded as the ‘gold standard’

for risk stratification in patients susceptible to malignant ventricular arrhythmias and sudden

cardiac death. However, data from the recent Multicenter UnSustained Tachycardia Trial

(MUSTT) suggest that in patients with coronary artery disease, left ventricular ejection fraction

<40% and asymptomatic nonsustained ventricular tachycardia (VT), negative programmed

electrical stimulation largely fails to identify patients with a lower risk of death.

Volume 5 - Issue 1

Diastolic dysfunction
By HOWARD LEONG-POI, MD and STUART HUTCHISON, MD

Diastolic dysfunction, a syndrome characterized by impaired ventricular filling, is increasingly

recognized as an important cause of symptoms and as a prognostic indicator in many patients with

congestive heart failure. As many as one-third of patients with congestive heart failure will have preserved

left ventricular (LV) systolic function, implicating diastolic dysfunction as the main cause of

their symptoms.

Volume 4 - Issue 6

Management of hypertension in the late 1990s

By JUAN CARLOS MONGE, MD

The status of hypertension management in this decade allows us some grounds for optimism. We

have entered an accelerated phase of large randomized clinical trials that have provided, or are in the

p rocess of investigating, the answers to important clinical questions in hypertension.

Volume 4 - Issue 5

Coronary artery bypass surgery for congestive heart failure: An evidence-based approach

By I . MANGAT MD and MICHAEL R . FREEMAN MD

Despite ongoing advances in medical care, congestive heart failure (CHF) continues to

be a leading cause of cardiovascular morbidity and mortality. In the USA, 400,000 new

cases of CHF are diagnosed annually, with a mortality rate of 80,000 patients per year.

Volume 4 - Issue 4

Preoperative cardiac risk assessment for vascular surgery: Can it make a difference?
By K. NANTHAKUMAR, MD and MICHAEL R. FREEMAN, MD

Angiographically significant coronary artery disease (CAD) is common among patients

with aortic and peripheral vascular disease. This burden of CAD predisposes the vascular

surgery patient to cardiac complications in the post-operative period.

Volume 4 - Issue 3

Be still my beating heart: Panic disorder and the cardiologist
By FARIDA M. JEEJEEBHOY, MD and DAVID M. NEWMAN, MD

Panic disorder is a common condition with symptoms that can masquerade as a primary cardiovascular

disorder. In addition, many patients with cardiovascular disease also have panic disorder.

However, many patients go undiagnosed and incur large costs to the healthcare system as a result.

Panic disorder is a treatable condition, and cardiologists can easily identify affected patients and

initiate appropriate therapy.

Volume 4 - Issue 2

The role of angioplasty when thrombolysis fails
By S. DOUGLAS LEE, MD, DAVID H. F ITCHETT, MD, ROBERT J. CHISHOLM, MD

The restoration of normal coronary artery blood flow early after the onset of acute myocardial

infarction (MI) is associated with an improvement of both survival and left ventricular function.

Patients found to have normal (TIMI 3) flow at 90 minutes after thrombolysis have a 30-day mortality

of 2.7%, in contrast to those with impaired (TIMI 2) flow or an occluded artery (TIMI 0–1 flow)

who have mortality of 6.6% or 7.1%, respectively.

Volume 4 - Issue 1

Non-pharmacological treatment of atrial fibrillation
By PAUL DORIAN, MD

Atrial fibrillation is the most common clinical arrhythmia and may be precipitated by various clinical

risk factors (Table 1). It is a major public health problem since it very frequently causes severe

symptoms such as palpitations, dyspnea, and light-headedness that can markedly impair quality of life

and are, on occasion, disabling.

Volume 3 - Issue 4

Use of implantable cardioverter defibrillators: From trials to practice

By PHILIP JONG, MD and PAUL DORIAN, MD

Patients with sustained ventricular tachycardia or ventricular fibrillation are at high risk of sudden

cardiac death. Recent clinical trials have suggested a benefit of implantable converter defibrillators

(ICDs) over conventional drug therapy in selected patients who are at high risk of fatal ventricular

tachyarrhythmia. Despite promising results from these trials, more studies are needed to

better define those patients who would benefit most from ICD therapy.

Volume 3 - Issue 3

Role of inflammation and infection in atherosclerotic heart disease

By PHILIP JONG, MD and JUAN CARLOS MONGE , MD

Ample evidence now exists to suggest a role of inflammation and infection in the development

and progression of athero sclerotic heart disease. Numerous mechanisms have also been proposed

as to how inflammation and infection can promote atherosclerosis. Despite promising intervention

trials with anti-inflammatory drugs and antibiotics in coronary artery disease prevention, more

studies are needed before such knowledge can be generally applied to clinical practice.3

Volume 3 - Issue 2

After HERS: What is the role of HRT in the prevention of CAD in women?

By STUART HUTCHISON, MD and HOWARD LEONG-POI, MD

Cardiovascular disease—coronary artery disease (CAD), cerebrovascular disease, and aneurysm—

remains the leading cause of death in women in North America, accounting for 45% of all deaths in

females in the U.S. in 1994. One in two North American women will eventually die of coronary

artery disease or stroke, whereas 1 in 25 will die of breast cancer.

Volume 3 - Issue 1

New directions in thrombolytic therapy

By WAYNE HO PING KONG MD, FRCPC and SHAUN GOODMAN, MD, FRCPC

The most frequent cause of acute myocardial infarction is occlusive thrombus of the coronary

arteries. Optimal therapeutic strategies must aim to achieve early and complete reperfusion of the

infarct-related art e ry. The validity of this open-artery concept has been demonstrated by the angiographic

substudy of the GUSTO trial.

Volume 2 - Issue 7

Viable but Dysfunctional Myocardium: Pathophysiology, Detection, and Treatment

By HOWARD LEONG-POI, MD and MICHAEL R. FREEMAN, MD

One of the greatest determinants of survival in patients with coronary artery disease (CAD) is

left ventricular (LV) function. Since improvement in ventricular function improves prognosis, the

detection of LV dysfunction that has potential for improvement is a clinically important issue, especially

in patients immediately after MI (myocardial infarction), and in those who have chronic CAD

with LV dysfunction.

Volume 2 - Issue 6

Serum troponin in the risk stratification of acute coronary syndromes
By DAVID FITCHETT, MD

The risk stratification of patients with chest pain and no ECG evidence of ST-segment elevation

allows triage of patients to the most appropriate level of care. Elevated serum cardiac troponin T or I

identifies patients with a three- to five-fold increase in the risk of adverse outcome, and it has a predictive

value independent of clinical or electrocardiographic data.

Volume 2 - Issue 5

Angiotensin-converting Enzyme Inhibitors and Endothelial Function
By JUAN CARLOS MONGE, MD

We have now become quite accustomed to the fact that we can intervene with pharmacological

therapy to modify the function of many organs or tissues. In fact, some interventions, such as the

administration of a beta-blocker to a patient with angina or a myocardial infarction, have become so

routine that we no longer pause to think that we are modifying cardiac chronotropic, lusitropic, and

inotropic function every time we prescribe one of these agents.

Volume 2 - Issue 4

Transmyocardial Laser Revascularization
By IQWAL MANGAT, MD and DUNCAN J . S TEWA RT, MD

Revascularization of ischemic myocardium is classically achieved by improving perfusion

through epicardial coronary arteries. A novel method of enhancing myocardial blood flow

in patients who are not candidates for conventional revascularization has received great

attention in the scientific and lay press.

Volume 2 - Issue 3

Transesophageal Echocardiographic-Guided Cardioversion of Atrial Fibrillation
By F. AL-BAKSHY, MD and S . HUTCHISON, MD

Atrial fibrillation, the most common sustained tachyarrhythmia is characterized by

disorganized electrical and mechanical activity of the atria. From a clinical standpoint and

particularly in patients with structural heart disease, this results in impaired functional

capacity, and an increased risk of congestive heart failure, embolic events, and death. Direct

current electrical cardioversion may be used to restore sinus rhythm, with the intention of

i m p roving functional capacity and of obviating the increased thromboembolic risk associated

with chronic atrial fibrillation.

Volume 2 - Issue 2

Stress Cardiolite Imaging: Do The Results in Clinical Practice Meet Our Expectations?
By MICHAEL FREEMAN, MD

Stress myocardial perfusion imaging fulfills an important role in the physician’s assessment

of patients with known or suspected coronary artery disease. In the past several years, the

performance of perfusion imaging utilizing technetium-99m sestamibi or Cardiolite has

progressively increased. This increase in utilization is based on comparable sensitivity and

specificity to thallium scintigraphy and the additional ability to assess ventricular function

either with first pass techniques or with gated acquisition of the perfusion data.

Volume 2 - Issue 1

Ventricular Assist Devices
By SUZANNA MAK, MD and GORDON MOE, MD

The term ventricular assist device, or VAD, describes any of a variety of mechanical blood

pumps employed singly to replace the function of either the right or left ventricle. Two blood

pumps can be utilised for biventricular support. For left ventricular assistance, blood is withdrawn

from either the left atrium or the apex of the left ventricle and is returned to the aorta.

Volume 1 - Issue 9

Primary Pulmonary Hypertension

By ANNA WOO, MD and DUNCAN J . STEWART, MD

Primary pulmonary hypertension (PPH) remains one of medicine’s more difficult challenges

since it is a rare disease, its causes are obscure, its natural history is unclear, and there are

few treatment options. The unifying finding is that of a pulmonary vasculature which undergoes

extensive remodeling, leading to elevations in pulmonary artery pressure and pulmonary

vascular resistance.

Volume 1 - Issue 8

Thrombolysis or PTCA for Acute Transmural Myocardial Infarction

By IQWAL MANGAT MD and MICHAEL FREEMAN MD, FRCP

Early and sustained infarct related art e ry (IRA) patency contributes to improved left

ventricular function and outcome after myocardial infarc t i o n. Both thrombolysis and perc utaneous

transluminal coronary angioplasty (PTCA) are well documented to achieve IRA

patency during acute myocardial infarction. Angiographic studies of tissue plasminogen activator

(tPA) for acute myocardial infarction demonstrate IRA patency rates of up to 90%.

PTCA has been shown to substantially improve IRA patency and TIMI 3 flow with rates

between 89-95%.

Volume 1 - Issue 7

The Role of Low Molecular Weight Heparin in the Management of Ischemic Heart Disease:
Platelet Activation and Thrombin Generation in Acute Coronary Syndromes

By SHAUN GOODMAN, MD

There is now extensive evidence implicating partial or complete thrombotic occlusion of the coronary

artery in the pathogenesis of unstable angina and acute myocardial infarction. The rupture of an

atherosclerotic plaque causes platelet activation and aggregation and elicits the coagulation cascade by

tissue factor release.

Volume 1 - Issue 6

Assessment of the Delta Wave: Wolves in the 90s

By MICHAEL GEIST, MD and DAVID NEWMAN, MD

When Wolff, Parkinson and White first described the syndrome that carries their name in 1930,

it was thought to be a sign of good health. Since then, WPW syndrome has been shown to be

rarely associated with sudden cardiac death (SCD), in addition to its more common

manifestation with tachyarrhythmia symptoms.

Volume 1 - Issue 5

Homocysteine and Vascular Disease

By STEVEN E. S. MINER, MD, DAVID E. C. COLE, MD, PhD and DUNCAN J. STEWART, MD

Homocysteine is a naturally occurring, sulfur-containing amino acid. Continuously formed

and catabolized in vivo, its metabolism is dependent on a complex interaction of genetics

and physiology (Fig. 1). Its relevance is based on the increasing recognition of the correlation

between elevated levels of homocysteine and human disease.

Volume 1 - Issue 4

Vitamin E in Cardiovascular Disease

By IQWAL MANGAT, MD and SHAUN GOODMAN, MD

Plaque rupture and coronary thrombus formation is critical in the pathogenesis of acute

ischemic syndromes. Despite successful pharmacologic therapy directed at thrombolysis,

antithrombotic treatment remains suboptimal.

Volume 1 - Issue 3

Acute ischemic syndromes and new antithrombotic agents
By S. CONNORS, MD, DPHIL and A. LANGER, MD

Plaque rupture and coronary thrombus formation is critical in the pathogenesis of acute

ischemic syndromes. Despite successful pharmacologic therapy directed at thrombolysis,

antithrombotic treatment remains suboptimal.

Volume 1 - Issue 2

The Role of ß-Blockers in Congestive Heart Failure
By B . SONNENBERG and GORDON W. MOE , MD

Congestive heart failure (CHF) is a common medical disorder, affecting

approximately 1% of the adult population. The disease is associated with a poor

prognosis, with a median survival after diagnosis of less than 5 years, as well as

substantial morbidity. Despite the documented effect of angiotensin converting

enzyme inhibitors (ACE I) on survival, the mortality remains very high.

Volume 1 - Issue 1

Coronary Angioplasty vs. Coronary Bypass Surgery: Results of BARI and Review of Literature
By WARREN J . CANTOR , MD, and ROBERT J . CHISHOLM, MD, FRCP

Both percutaneous coronary angioplasty (PTCA) and coronary artery bypass graft surgery

(CABG) are highly effective in reducing symptoms of angina as well as improving exercise

capacity and quality of life in patients with coronary artery disease. Both procedures are

superior to medical therapy for alleviating symptoms. Bypass surgery prolongs life compared

with medical therapy in higher risk groups.