Cardiology Plus

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Cardiovascular diseases (CVDs) are the main cause of death worldwide representing 30% of all global deaths. Obstructive sleep apnea–hypopnea (OSAH) has been associated with several serious cardiovascular comorbidities. OSAH occurs in 17%–24% of North American adults that increase the risk of sudden cardiac deaths between 12 midnight and 6 am. OSAH is considered as an independent risk factor for CVD such as systemic hypertension (HTN), pulmonary arterial HTN, coronary artery disease, stroke, cardiac arrhythmias, heart failure, which raise both cardiovascular morbidity and mortality and the increase demand for health-care resources. Several mechanisms have been suggested to link OSAH and vascular diseases including increases in sympathetic activation, oxidative stress, inflammation, endothelial dysfunction, coagulation, and metabolic dysregulation. This review will provide insights on mechanisms by which OSAH might contribute to the pathogenesis of CVD. Continuous positive airway pressure (CPAP) is considered the gold standard in the treatment of OSAH with improved metabolic and CV endpoints. To a lesser extent, oral appliance therapy and upper airway or mandibular advancement surgery are palliative measures that leave the patient with significant residual apnea–hypopnea. There is increasing evidence that adequate CPAP therapy leads to a significant reduction in cardiovascular morbidity. Moderate-to-severe OSAH not treated with CPAP was an independent risk factor for relapse of a CVD event, and adequate CPAP treatment improved cardiovascular outcomes in elderly patients.

According to the 4^th National Nutrition and Health Survey in 2002, the prevalence of hypertension in China was 18.8%. Although there are no recent updated nationwide data, it is believed that the prevalence of hypertension has increased substantially in the past decade to more than 200 million hypertensive patients in the most populous country in China. To fight against the growing risk of hypertension, three Chinese hypertension guidelines were compiled in the past two decades, respectively, in 1999, 2005, and 2011. The current guidance document for the management of hypertension was named “2010 Chinese hypertension guideline” but published in 2011. In this guideline, all five classes of antihypertensive drugs were recommended as possible initial and maintenance therapies. The goal of treatment was a systolic/diastolic blood pressure below 140/90 mm Hg in general, 130/80 mm Hg in various groups of high-risk patients, and 150/90 mm Hg in the elderly (≥65 years). With the recent publication of several national and international hypertension guidelines, the Chinese guideline is now being considered for updates

Background: Cardiovascular diseases (CVDs) account for a large percentage of emergency room visits (ERVs), hospital admissions (HAs), and subsequent cardiac Intensive Care Unit admissions (CICUAs). CVD is still the number one killer in the Western and emerging countries and consumes the majority of health-care dollars. According to a recent report, the USA will reach $818.1 billion a year in CVD care by the year 2030; this is triple of spending for 2013–2014. We analyzed two types of cardiology care (CC) over a 20-year period: strictly CC and compared this to combined, integrated cardiology and sleep medicine (ICSM) care and looked at clinic-based costs of health-care delivery. In 2002, Chanwell Clinic with the assistance of Stanford Sleep Medicine built one of the America's first ICSM under one roof. The consequences of undiagnosed, untreated sleep-disordered breathing (SDB), obstructive sleep apnea (OSA) to worsening CVD, sudden cardiac deaths, and malignancies of all kinds have been published. Methods: We retrospectively reviewed 4550 patients under strict CC for the number of ERVs, HAs, CICUAs, and invasive cardiac surgical procedures (ICS) from 1993 to 2002 and prospectively tracked 8426 patients of HAs, ERV, CICUA, and ICS under ICSM for the years 2004–2013. Results: A single CC practice that transitions to ICSM resulted in over $21 million or 73% reduction of CV health-care over a 10-year period. Diagnosis and treatment of SDB, OSA common, in CVD resulted in marked reductions of ERV, HA, CICUA, and ICS; all are drivers of an ever-escalating financial burden of CV care. Conclusion: A single CC practice that transitions to ICSM resulted in over $21 million or 73% reduction of CV health-care cost over a 10-year period. The ICSM practice model when implemented on 27,000 cardiologists and cardiology practices nationwide could drastically slow down the rising cost of health care even with the enactment of Affordable Care Act and could make Medicare sustainable over a longer period beyond 2029; the year when Medicare is projected to be insolvent (Congressional Research Service, July 2013).

Heart failure (HF) after myocardial infarction (MI) represents a worldwide public health issue with gradually increasing incidence. HF may eventually affect all organs and tissues and is associated with significant morbidity and mortality. Current therapeutic methods to treat HF stay at only delaying the disease progression without repair and regeneration. Recently, cell transplantation has gradually become the most promising treatment for the damaged myocardial tissue. Meanwhile, the bone marrow-derived mesenchymal stem cells (MSCs) are the most used cells for the treatment of HF. In the present review, we summarize the current literature on MSCs and their potential use to treat HF after MI. So far, MSCs have been demonstrated beneficial competence in animal studies and clinical trials, which may open novel avenues for further clinical studies.

ST-segment elevation is well known for its diagnostic value for transmural myocardial infarction due to acute thrombotic occlusion of a coronary artery and often requires emergency reperfusion therapy. However, ST-segment is by no means pathognomonic for acute coronary events. Here, we report a case of ST-segment elevation after hepatectomy secondary to an unusual etiology.

Online since 8^th January 2018