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Topic Review
Management of Fluid Overload in Acute Settings
This entry provides a comprehensive review of fluid overload management, specifically targeting therapeutic strategies for patients with diuretic resistance or refractory volume overload. It covers the pathophysiology of edema formation and the challenges associated with fluid removal in patients with chronic conditions such as congestive heart failure, cirrhosis, and chronic kidney disease. Key treatments discussed include combination therapy with loop and thiazide diuretics, use of alternative loop diuretics with higher bioavailability, and the comparative effectiveness of bolus versus continuous drip loop diuretics. For patients unresponsive to pharmacologic management, the entry also examines mechanical ultrafiltration methods, comparing hemodialysis (HD), continuous venovenous hemofiltration (CVVH), and specialized CHF solutions (Aquamid). The entry emphasizes evidence-based approaches, highlighting studies that support optimized fluid management to improve patient outcomes and reduce hospital readmissions.
  • 1.1K
  • 30 Oct 2024
Topic Review
Apps for Coronary Heart Disease
Mobile health applications (MHA) are discussed to contribute in overcoming this gap in treatment by fostering CHD management. First, MHA may support daily monitoring of activities and symptoms. Second, adherence to treatment and lifestyle changes can be increased by self-tracking, feedback, and reminder functions of MHA.
  • 1.1K
  • 28 Oct 2021
Topic Review
Antivirals on the Cardiovascular Conditions
The COVID-19 pandemic has resulted in a complex clinical challenge, caused by a novel coronavirus, partially similar to previously known coronaviruses but with a different pattern of contagiousness, complications, and mortality. Safety profiles of antivirals are largely questioned and addressed by health agencies, in consideration of COVID-19 cardiac and pro-thrombotic complications generally experienced by predisposed subjects.
  • 1.1K
  • 25 Feb 2022
Topic Review
Exercise Training Effects on Heart Failure
Heart failure (HF) is a major public health issue worldwide with increased prevalence and a high number of hospitalizations. Patients with chronic HF and either reduced ejection fraction (HFrEF) or mildly reduced ejection fraction (HFmrEF) present vascular endothelial dysfunction and significantly decreased circulating levels of endothelial progenitor cells (EPCs).
  • 1.1K
  • 25 Jul 2022
Topic Review
Cardiomyopathies: An Overview
Cardiomyopathies are a heterogeneous group of pathologies characterized by structural and functional alterations of the heart. 
  • 1.1K
  • 30 Nov 2021
Topic Review
Technologies to Detect and Monitor Atrial Fibrillation
Up to 20% of patients with ischemic stroke or transient ischemic attack have a prior history of known atrial fibrillation (AF). Additionally, unknown AF can be detected by different monitoring strategies in up to 23% of patients with cryptogenic or non-cardioembolic stroke. However, most studies had substantial gaps in monitoring time, especially early after the index event. Following this, AF rates would be higher if patients underwent continuous monitoring early after stroke, avoiding any gaps in monitoring. The few existing randomized studies focused on patients with cryptogenic stroke but did not focus otherwise specifically on prevention strategies in patients at high risk for AF (patients at higher age or with high CHA2DS2-VASC scores). Besides invasive implantable loop recorders (ILRs), external loop recorders (ELRs) and mobile cardiac outpatient telemetry (MCOT) are non-invasive tools that are commonly used for long-term ECG monitoring in cryptogenic-stroke patients in the ambulatory setting. 
  • 1.1K
  • 01 Aug 2023
Topic Review
Sudden Cardiac Death
Sudden cardiac death (SCD) is the leading cause of cardiovascular mortality in patients with coronary artery disease without severe systolic dysfunction and in heart failure with preserved ejection fraction. From a global health perspective, while risk may be lower, the absolute number of SCDs in patients with left ventricle ejection fraction >35% is higher than in those with severely reduced left ventricle ejection fraction (defined as ≤35%). Despite these observations and the high amount of available data, to date there are no clear recommendations to reduce the sudden cardiac death burden in the population with mid-range or preserved left ventricle ejection fraction. Ongoing improvements in risk stratification based on electrophysiological and imaging techniques point towards a more precise identification of patients who would benefit from ICD implantation, which is still an unmet need in this subset of patients.
  • 1.1K
  • 18 Jan 2022
Topic Review
Cardiotoxicity of Fluoropyrimidines
The definition of cardiotoxicity includes not only clinical symptoms but also changes in left ventricular ejection fraction or histopathological changes in cardiomyocytes. Cardiotoxicity is a rare but serious complication of cytostatic agents, defined as a negative impact on heart function or cardiac cells. Fluoropyrimidine cardiotoxicity was first described in 1969, and since then, many studies have confirmed these findings, but many details such as incidence, mechanisms, and treatment are unclear and remain disputed.
  • 1.1K
  • 20 Oct 2021
Topic Review
Vascular Calcification in Chronic Kidney Disease
Chronic Kidney Disease (CKD) patients are at high risk of presenting with arterial calcification or stiffness, which confers increased cardiovascular mortality and morbidity. In recent years, it has become evident that VC is an active process regulated by various molecules that may act as inhibitors of vessel mineralization.
  • 1.1K
  • 09 Mar 2022
Topic Review
Techniques to Assess the Size of KIV-2 CNV
Apolipoprotein(a) (apo(a)) is the protein component that defines lipoprotein(a) (Lp(a)) particles and is encoded by the LPA gene. The apo(a) is extremely heterogeneous in size due to the copy number variation (CNV) in the kringle IV type-2 (KIV-2) domains. Lp(a) concentrations in the blood vary by more than a thousand-fold between individuals, ranging from less than 0.1 to more than 300 mg/dL, depending on the size of apo(a) that is encoded by the LPA gene. The KIV-2 copy number ranges from 1 to >40, and the CNV of KIV-2 shows a >95% heterozygosity in most populations. Screening patients for elevated Lp(a) is strongly encouraged as an effective tool to identify individuals requiring more aggressive lipid-lowering therapy to reduce the CVD risk. Lp(a) levels above 50 mg/dL are correlated with an increased risk for the development of CVD.
  • 1.1K
  • 13 Sep 2023
Topic Review
Bmp Signaling Regulates Hand1
The bone morphogenetic protein (Bmp) signaling pathway and the basic helix–loop–helix (bHLH) transcription factor Hand1 are known key regulators of cardiac development. In this study, we investigated the Bmp signaling regulation of Hand1 during cardiac outflow tract (OFT) development. In Bmp2 and Bmp4loss-of-function embryos with varying levels of Bmp in the heart, Hand1 is sensitively decreased in response to the dose of Bmp expression. In contrast, Hand1 in the heart is dramatically increased in Bmp4 gain-of-function embryos. We further identified and characterized the Bmp/Smad regulatory elements in Hand1. Combined transfection assays and chromatin immunoprecipitation (ChIP) experiments indicated that Hand1 is directly activated and bound by Smads. In addition, we found that upon the treatment of Bmp2 and Bmp4, P19 cells induced Hand1 expression and favored cardiac differentiation. Together, our data indicated that the Bmp signaling pathway directly regulates Hand1 expression in a dose-dependent manner during heart development.
  • 1.1K
  • 29 Sep 2021
Topic Review
Human Obstructive and Nonobstructive Hypertrophic Cardiomyopathy
Hypertrophic Cardiomyopathy (HCM) is a common inherited disorder characterized by unexplained left ventricular hypertrophy with or without left ventricular outflow tract (LVOT) obstruction. Single-nuclei RNA-sequencing (snRNA-seq) of both obstructive and nonobstructive HCM patient samples has revealed alterations in communication between various cell types, but no direct and integrated comparison between the two HCM phenotypes has been reported. 
  • 1.1K
  • 07 Mar 2022
Topic Review
SARS-CoV-2 and Acute Cerebrovascular Events
Since the coronavirus disease 2019 (COVID-19) pandemic, due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, accumulating evidence indicates that SARS-CoV-2 infection may be associated with various neurological manifestations, including acute cerebrovascular events (i.e., stroke and cerebral venous thrombosis). These events can occur prior to, during and even after the onset of COVID-19's general symptoms. Although the mechanisms underlying the cerebrovascular complications in patients with COVID-19 are yet to be fully elucidated, the hypercoagulability state, inflammation and altered angiotensin-converting enzyme 2 (ACE-2) signaling in association with SARS-CoV-2 may play key roles. ACE-2 plays a critical role in preserving heart and brain homeostasis. As the number of published COVID-19 cases with cerebrovascular events is growing, prospective studies would help gather more valuable insights into the pathophysiology of cerebrovascular events, effective therapies, and the factors predicting poor functional outcomes related to such events in COVID-19 patients.
  • 1.1K
  • 26 Aug 2021
Biography
Jennie Han
Dr Jennie Han graduated from the University of Oxford with a Masters of Arts in Medical Sciences and a Bachelor of Medicine, Bachelor of Surgery. During the course, she was awarded the Brian Johnson Prize for Pathology for the best essay in pathology in Oxford University Clinical School. During her clinical placement, she was the Tutor in Anatomy for Christ Church, Oxford. She was also the Presi
  • 1.1K
  • 17 May 2023
Topic Review
Zebrafish Models of Fibrotic Disease
Zebrafish models of fibrotic disease include, among others, cardiovascular disease models, liver disease models (categorized into Alcoholic Liver Diseases (ALD) and Non-Alcoholic Liver Disease (NALD)), and chronic pancreatitis models.
  • 1.1K
  • 20 Jan 2022
Topic Review
Studying Epigenetics of Cardiovascular Diseases on Chip Guide
Epigenetics is defined as the study of inheritable changes in the gene expressions and phenotypes that occurs without altering the normal DNA sequence. These changes are mainly due to an alteration in chromatin or its packaging, which changes the DNA accessibility. DNA methylation, histone modification, and noncoding or microRNAs can best explain the mechanism of epigenetics. There are various DNA methylated enzymes, histone-modifying enzymes, and microRNAs involved in the cause of various CVDs (cardiovascular diseases) such as cardiac hypertrophy, heart failure, and hypertension. Moreover, various CVD risk factors such as diabetes mellitus, hypoxia, aging, dyslipidemia, and their epigenetics are also discussed together with CVDs such as CHD (coronary heart disease) and PAH (pulmonary arterial hypertension). Furthermore, different techniques involved in epigenetic chromatin mapping are explained.
  • 1.1K
  • 13 Jul 2022
Topic Review
Calpains as Potential Therapeutic Targets for Myocardial Hypertrophy
Despite advances in its treatment, heart failure remains a major cause of morbidity and mortality, evidencing an urgent need for novel mechanism-based targets and strategies. Myocardial hypertrophy, caused by a wide variety of chronic stress stimuli, represents an independent risk factor for the development of heart failure, and its prevention constitutes a clinical objective. Recent studies performed in preclinical animal models support the contribution of the Ca2+-dependent cysteine proteases calpains in regulating the hypertrophic process and highlight the feasibility of their long-term inhibition as a pharmacological strategy.
  • 1.1K
  • 18 May 2022
Topic Review
Natriuretic Peptides and Troponins for HFpEF
Heart failure (HF) is a significant cause of morbidity and mortality worldwide. HF with preserved ejection fraction (HFpEF) is a complex syndrome, often participated by several cardiac and extracardiac conditions, including chronic kidney disease, pulmonary disease, anaemia and advanced age. Circulating biomarkers reflecting pathophysiological pathways involved in HFpEF development and progression may assist clinicians in early diagnosis and management of this condition. Natriuretic peptides (NPs) are cardioprotective hormones released by cardiomyocytes in response to pressure or volume overload and in response to activation of neuro-endocrine-immune system. The relevance of B-type NP (BNP) and N-terminal pro-B-type NP (NT-proBNP) for diagnosis and risk stratification has been extensively demonstrated, and these biomarkers are emerging tools for population screening and as guides to the start of treatment in subclinical HF. On the contrary, conflicting evidence exists on the value of NPs to guide HF therapy. Among the other biomarkers, high-sensitivity troponins and soluble suppression of tumorigenesis-2 are the most promising biomarkers for risk stratification, predicting outcome independently from NPs. 
  • 1.1K
  • 25 Aug 2022
Topic Review
An Updated Classification of Cardiorenal Syndrome
Cardiorenal syndrome (CRS) is defined as progressive, combined cardiac and renal dysfunction. Here, the pathomechanisms and clinical hallmarks of both chronic heart failure and chronic kidney disease are presented, and an updated classification of CRS is proposed.
  • 1.1K
  • 10 Jun 2022
Topic Review
Cardiac Arrest
Cardiac arrest (CA) is a frequent cause of death and a major public health issue. To date, conventional cardiopulmonary resuscitation (CPR) is the only efficient method of resuscitation available that positively impacts prognosis. Extracorporeal membrane oxygenation (ECMO) is a complex and costly technique that requires technical expertise. It is not considered standard of care in all hospitals and should be applied only in high-volume facilities. ECMO combined with CPR is known as ECPR (extracorporeal cardiopulmonary resuscitation) and permits hemodynamic and respiratory stabilization of patients with CA refractory to conventional CPR. This technique allows the parallel treatment of the underlying etiology of CA while maintaining organ perfusion. However, current evidence does not support the routine use of ECPR in all patients with refractory CA. Therefore, an appropriate selection of patients who may benefit from this procedure is key. Reducing the duration of low blood flow by means of performing high-quality CPR and promoting access to ECPR, may improve the survival rate of the patients presenting with refractory CA. Indeed, patients who benefit from ECPR seem to carry better neurological outcomes.
  • 1.1K
  • 25 Feb 2021
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