Cardiovascular Events After Partner Bereavement, What is the Role of Low Dose Aspirin and Beta-Blockers?

Bereavement due to loss of a partner is one of the most stressful life events, often leading to adverse physiological responses. Spousal loss has been associated with an increased morbidity and mortality, particularly from cardiovascular disease. Use of aspirin and/or beta adrenergic blockers have previously been suggested to play a role in cardiovascular risk associated with early bereavement. However, the available literature regarding this topic is limited. In this review article, we explore the potential beneficial role of aspirin and beta blockers in early bereavement. Our systematic review suggests that most studies have found aspirin and beta blockers to be beneficial in preventing adverse cardiovascular outcomes associated with early bereavement. Further randomized controlled long-term studies are warranted with adequate sample size to clearly establish the role of these medications on cardiovascular disease in late bereavement.

Mind-Body Connection: Cardiovascular Sequelae of Psychiatric Illness.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. Mental health disorders are associated with the onset and progression of cardiac disease. The adverse sequelae of this association include worsened quality of life, adverse cardiovascular outcomes, and heightened mortality. The increased prevalence of CVD is partly explained by increased rates of traditional cardiovascular risk factors including hypertension, hyperlipidemia, diabetes mellitus, obesity, and smoking, but mental illness is an independent risk factor for CVD and mortality. Given the association between mental health disorders and poor cardiovascular health, it is vital to have an early and accurate identification and treatment of these disorders. Our review article shares the current literature on the adverse cardiovascular events associated with psychiatric disorders. We present a review on depression, anxiety, bipolar disorder, schizophrenia, type A and D personality disorders, obsessive-compulsive disorder, and stress.

Chronic Systemic Inflammatory Skin Disease as a Risk Factor for Cardiovascular Disease.

Chronic systemic skin disease and cardiovascular disease are multisystem disorders which have been associated with each other for centuries. Recent research has strengthened this association, particularly in systemic inflammatory disease. Here we explore the current literature on psoriasis, hidradenitis suppurativa, lupus erythematosus, acanthosis nigricans, atopic dermatitis, and bullous pemphigoid. Psoriasis is a chronic inflammatory disorder that has been labeled as a risk-modifier for hyperlipidemia and coronary artery disease by the American College of Cardiology ACC lipid guidelines. Cardiovascular disease is also found at a significantly higher rate in patients with hidradenitis suppurativa and lupus erythematosus. Some associations have even been noted between cardiovascular disease and acanthosis nigricans, atopic dermatitis, and bullous pemphigoid. While many of these associations have been attributed to a shared underlying disease process such as chronic systemic inflammation and shared underlying risk factors, these dermatologic manifestations can help to identify patients at higher risk for cardiovascular disease.

Emerging Technologies in Cardiac Pacing From Leadless Pacers to Stem Cells.

Modern pacemakers can sense and pace multiple chambers of the heart. These pacemakers have different modes and features to optimize atrioventricular synchrony and promote intrinsic conduction. Despite recent advancements, current pacemakers have several drawbacks that limit their feasibility. In this review article, we discuss several of these limitations and detail several emerging technologies in cardiac pacing aimed to solve some of these limitations. We present several technological advancements in cardiac pacing, including the use of leadless pacemakers, physiologic pacing, battery improvements, and bioartificial pacemakers. More research still needs to be done in testing the safety and efficacy of these new developments.

Review of Hypothermia Protocol and Timing of the Echocardiogram.

Targeted temperature management, also known as therapeutic hypothermia (TH), is recommended for out-of-hospital cardiac arrest (OHCA). Both internal or external methods of cooling can be applied. Individuals resuscitated from OHCA frequently develop postarrest myocardial dysfunction resulting in decreased cardiac output and left ventricular systolic function. This dysfunction is usually transient and improves with spontaneous recovery over time. Echocardiogram (ECHO) can be a vital tool for the assessment and management of these patients. This manuscript reviewed methods available for TH after OHCA and reviews role of ECHO in the diagnosis and prognosis in this setting.

Number of Pregnancies and Risk of Atrial Fibrillation.

Pregnancy is associated with major structural and hemodynamic changes in the cardiovascular system that predispose women to an increased risk of atrial fibrillation. While these changes generally resolve after parturition, the impact of subsequent pregnancies on the risk of atrial fibrillation is unknown. We searched through PubMed for studies that have investigated the impact of multiparity on the risk of atrial fibrillation. The following Medical Subject Headings terms were used: ([repeated pregnancies] OR parity) AND ([Atrial fibrillation] OR AF). Studies with complete data were included in the current study. Out of 135 studies identified through the prespecified criteria, we selected 2 studies with relevant data. Increasing number of pregnancies was associated with an increased risk of atrial fibrillation in a dose-response relationship. Our systematic review suggests that multiparity is associated with an increased risk of atrial fibrillation. More studies are warranted to elucidate the association between repeated pregnancies and atrial fibrillation.

The Face Is the Mirror of the Soul. The Cardiovascular Physical Exam Is Not Yet Dead!

Cardiac pathology can be congenital or acquired with underlying genetic predispositions. In this era of medicine there is a concern that the comprehensive physical examination doctors prided themselves on is becoming a lost art. Research studies have also revealed a decline in physical examination skills. The full clinical cardiovascular examination is indeed quite complex and does take significant time to master. It is critical that physicians be competent in the physical exam. Not identifying subtle clinical findings leading to missed or delayed diagnosis which can lead to significant morbidity and mortality. In this paper we intend to highlight the clinical cardiovascular findings that may be detected on patients even before initiating the physical exam. The head and neck visual examination may be quite revealing.

Fish Oil Dilemma: Does It Increase the Risk of Ventricular Arrhythmias and Death? Can Fish Oil Kill You?

Omega-3-fatty-acids are now increasingly being used for potential beneficial anti-inflammatory effect in the treatment and management of cardiovascular disease. Eicosapentaenoic acid and Docosahexaenoic acid are 2 essential omega-3 fatty acids found predominately in fish and fish oil supplements. Despite the increased use of fish oil products for both primary and secondary prevention of cardiovascular morbidity and mortality, the available literature evidence are controversial. We searched through PubMed for studies that have investigated the impact of omega-3 fatty acids on coronary heart disease and mortality. Our systemic review suggests that most studies, which are mostly observational, have found there to be a potential benefit of omega-3 fatty acids on coronary heart disease whereas some other studies have found conflicting results. More randomized controlled studies are warranted with adequate sample size to clearly establish the risk and benefits of omega-3 fatty acids on cardiovascular disease.

From WOEST to AUGUSTUS: a review of safety and efficacy of triple versus dual antithrombotic regimens in patients with atrial fibrillation requiring percutaneous coronary intervention for acute coronary syndrome.

For patients with atrial fibrillation with concomitant acute coronary syndrome (ACS) requiring percutaneous coronary intervention (PCI), the increased risk of bleeding associated with the use triple therapy is well established. However, there is question whether it is a necessary risk for patients to prevent stroke and stent thrombosis. The purpose of this article is to highlight the findings of prior studies evaluating the comparative safety and efficacy of dual and triple antithrombotic regimens in the subgroup of atrial fibrillation patients requiring PCI for ACS. Trials that evaluated dual versus triple antithrombotic therapy demonstrated post-PCI treatment with a P2Y12 inhibitor alone was safer than aspirin plus a P2Y12 inhibitor in patients also taking an anticoagulant for atrial fibrillation. Data regarding ischemic outcomes have not suggested harm with the omission of aspirin, but these studies have not been powered to assess efficacy outcomes, especially in ACS patients. These studies also demonstrate a significant reduction in bleeding events when aspirin is excluded from the post-PCI regimen in the ACS subgroup of atrial fibrillation patients. Further studies, with added focus on the ACS subgroup, are needed to potentially confirm that dual therapy may be as efficacious as triple therapy in ACS patients with atrial fibrillation.

Current status of oral anticoagulant reversal strategies: a review.

Utilization of direct oral anticoagulants (DOAC) have steadily increased since their approval and are now recommended over warfarin for both stroke prevention in nonvalvular atrial fibrillation and treatment of venous thromboembolism (VTE). With increased DOAC use, the number of major bleeding events requiring medical intervention will continue to rise. Until 2015, warfarin maintained an advantage as the only oral anticoagulant with a specific reversal agent. Since then, idarucizumab has been approved for dabigatran reversal and recently, andexanet alfa was granted approval for the reversal of apixaban or rivaroxaban in patients with life-threatening or uncontrolled bleeding events. Due to the manufacturing practices required to yield these reversal therapies, they are available at high cost to hospital systems and as a result, have been met with resistance. Data exists describing both prothrombin complex concentrates (PCC) and andexanet alfa for DOAC reversal, however, without head-to-head comparison. Until future studies are available, current literature must be critically evaluated to aid in the clinical decision-making process of how to treat patients with life-threatening DOAC-related bleeding.