Unraveling the Complex Relationship-Atrial Fibrillation and Pulmonary Hypertension.

PURPOSE OF REVIEW: In this article, we underscore the importance of identifying risk factors and monitoring pulmonary hypertension patients for signs of arrhythmias, as this proactive approach can reduce morbidity and mortality. RECENT FINDINGS: Atrial fibrillation is the most prevalent among cardiac arrhythmias and is associated with an increased risk of stroke, morbidity, and mortality. Smoking, obesity, hypertension, a sedentary lifestyle, and diabetes mellitus are some of the modifiable risk factors for atrial fibrillation. Recent studies show that the risk of atrial fibrillation is rising in patients with parenchymal and vascular lung disease. Stretching in the atria and pulmonary veins may lead to the onset of atrial fibrillation in cardiac conditions like hypertension, heart failure, and valvular disease. Atrial fibrillation in patients with pulmonary hypertension (PH) denotes a more advanced disease. Patients with PH are more susceptible to hemodynamic stress caused by tachycardia and an uncoordinated atrioventricular contraction. Therefore, atrial arrhythmias need to be treated because inadequate control of cardiac arrhythmias may result in poor clinical outcomes and lead to disease progression in PH patients. Aside from being a sign of severe disease, AF can also speed up and exacerbate the condition.

Beyond survival: understanding post-intensive care syndrome.

Post-intensive care syndrome (PICS) refers to persistent or new onset physical, mental, and neurocognitive complications that can occur following a stay in the intensive care unit. PICS encompasses muscle weakness; neuropathy; cognitive deficits including memory, executive, and attention impairments; post-traumatic stress disorder; and other mood disorders. PICS can last long after hospital admission and can cause significant physical, emotional, and financial stress for patients and their families. Several modifiable risk factors, such as duration of sepsis, delirium, and mechanical ventilation, are associated with PICS. However, due to limited awareness about PICS, these factors are often overlooked. The objective of this paper is to highlight the pathophysiology, clinical features, diagnostic methods, and available preventive and treatment options for PICS.

Cardiovascular disease: extraintestinal manifestation of inflammatory bowel disease.

Inflammatory bowel disease (IBD) is a spectrum of diseases characterized by the interplay of the aberrant immune system, genetic factors, environmental factors, and intestinal microbiota, resulting in relapsing inflammation of the gastrointestinal tract. Underlying pro-inflammatory state and immune dysregulation act as a catalyst for increasing the likelihood of developing extraintestinal manifestations, including cardiovascular diseases (CVD) like atherosclerosis, pericarditis, myocarditis, venous and arterial thromboembolism, arrhythmias, despite a lower prevalence of classic CVD risk factors, like high body mass index or dyslipidemia compared to the general population. Chronic inflammation damages endothelium resulting in the recruitment of inflammatory cells, which induce cytotoxicity, lipoprotein oxidation, and matrix degradation, which increases the risk of atherosclerosis. Additionally, intestinal dysbiosis disrupts the intestinal mucosal barrier, releasing endotoxins and lipopolysaccharides into circulation, further exaggerating the atherosclerotic process. Abnormal collagen metabolism and alteration of nitric oxide-mediated vasodilation lead to blood pressure dysregulation in patients with IBD. Therefore, it is essential to make lifestyle modifications like smoking cessation, dietary changes, and increasing physical activity with adherence to medication to mitigate the risk of developing CVD in patients with IBD. This article reviews the potential links between IBD and the increased risk of CVD in such individuals.

Cardiac MRI: An Overview of Physical Principles With Highlights of Clinical Applications and Technological Advancements.

The purpose of this review is to serve as a concise learning tool for clinicians interested in quickly learning more about cardiac magnetic resonance imaging (CMR) and its physical principles. There is heavy coverage of the basic physical fundamentals of CMR as well as updates on the history, clinical indications, cost-effectiveness, role of artificial intelligence in CMR, and examples of common late gadolinium enhancement (LGE) patterns. This literature review was performed by searching the PubMed database for the most up-to-date literature regarding these topics. Relevant, less up-to-date articles, covering the history and physics of CMR, were also obtained from the PubMed database. Clinical indications for CMR include adult congenital heart disease, cardiac ischemia, cardiomyopathies, and heart failure. CMR has a projected cost-benefit ratio of 0.58, leading to potential savings for patients. Despite its utility, CMR has some drawbacks including long image processing times, large space requirements for equipment, and patient discomfort during imaging. Artificial intelligence-based algorithms can address some of these drawbacks by decreasing image processing times and may have reliable diagnostic capabilities. CMR is quickly rising as a high-resolution, non-invasive cardiac imaging modality with an increasing number of clinical indications. Thanks to technological advancements, especially in artificial intelligence, the benefits of CMR often outweigh its drawbacks.

The cardio-oncology continuum: Bridging the gap between cancer and cardiovascular care.

Cancer and cardiovascular disease are two of the leading causes of death worldwide. Although cancer has historically been viewed as a condition characterized by abnormal cell growth and proliferation, it is now recognized that cancer can lead to a variety of cardiovascular diseases. This is due to the direct impact of cancer on the heart and blood vessels, which can cause myocarditis, pericarditis, and vasculitis. Additionally, cancer patients frequently experience systemic effects such as oxidative stress, inflammation, and metabolic dysregulation, which can contribute to the development of cardiovascular risk factors such as hypertension, dyslipidemia, and insulin resistance. It is important to closely monitor patients with cancer, especially those undergoing chemotherapy or radiation therapy, for cardiovascular risk factors and promptly address them. This article aims to explore the clinical implications of the underlying mechanisms connecting cancer and cardiovascular diseases. Our analysis highlights the need for improved cooperation between oncologists and cardiologists, and specialized treatment for cancer survivors.

Lab testing overload: a comprehensive analysis of overutilization in hospital-based settings.

Overuse of laboratory tests has been a growing problem in the inpatient hospital setting for years, which adds to the rising cost of care. Various factors come into play, such as clinical routines, lack of cost transparency, and the convenience of electronic health record-based ordering. The financial ramifications of the overuse are significant, as lab costs drive most medical decisions. Eliminating unnecessary testing with clinical decision support and best practices is associated with marked cost savings, improved outcomes, and decreased patient distress. The excessive use of laboratory tests highly affects patients, resulting in hospital-induced anemia, low patient satisfaction, and poor outcomes. Tackling lab overuse requires a multifaceted approach that includes education, technology, and policy changes. In the era of precision healthcare, optimizing test utilization can reduce costs, decrease waste, and improve patient care.

Cardiovascular Challenges Beyond Earth: Investigating the Impact of Space Travel on Astronauts' Cardiovascular Health.

In the coming decades, as humanity aims to establish a presence on Mars, there is a growing significance in comprehending, monitoring, and controlling the diverse health challenges arising from space exploration. The extended exposure to microgravity during space missions leads to various physical alterations in astronauts, such as shifts in bodily fluids, reduced plasma volume, loss of bone density, muscle wasting, and cardiovascular deconditioning. These changes can ultimately lead to orthostatic intolerance, underscoring the increasing importance of addressing these health risks. Astronauts are exposed to cosmic radiation consisting of high-energy particles from various sources, including solar cosmic rays and galactic cosmic rays. These radiations can impact the electrical signals in the heart, potentially causing irregular heart rhythms. Understanding the risks to the heart and blood circulation brought on by exposure to space radiation and the overall stress of spaceflight is essential and this article reviews the cardiovascular effects of space travel on astronauts.

Synergistic strategies: Optimizing outcomes through a multidisciplinary approach to clinical rounds.

Multidisciplinary rounds (MDR) constitute a patient-centered care model wherein professionals from diverse disciplines collaborate in real time to provide specialized expertise. The MDR team, encompassing care partners, hospitalists, nurses, pharmacists, and more, employs a collaborative approach that optimizes patient care through shared goals, electronic record access, regular reviews, and patient involvement. MDRs have evolved to reduce patient mortality, complications, length of stay, and readmissions, and they enhance patient satisfaction and utilization of ancillary services. Family engagement in MDRs further transforms relationships from adversarial to collaborative, leading to improved comprehension of treatment strategies and smoother navigation of challenging conversations. Despite challenges such as time constraints, limited patient coverage, and hierarchical barriers, MDRs are being increasingly conducted across healthcare settings, with positive outcomes.

Shedding light on weight loss: A narrative review of medications for treating obesity.

Obesity and overweight are the major risk factors for numerous chronic diseases, including cardiovascular diseases such as heart disease and stroke, which are the leading causes of death worldwide. The prevalence of obesity has dramatically risen in both developed and developing countries, making it a significant public health concern and a global crisis. Despite lifestyle modifications being the first-line treatment, the high risk of relapse has led to a growing interest in non-invasive pharmacotherapeutic interventions to achieve and maintain weight loss and reverse the growth of the obesity epidemic. Cardiovascular diseases and cancer account for the highest mortality rates among other comorbidities associated with obesity and overweight. Excess and abnormally deposited adipose tissue secretes various inflammatory mediators, leading to cardiovascular diseases and cancers. Weight loss of 5-10% significantly reduces cardiometabolic risk. Medications currently approved in the USA for long-term management of obesity are orlistat, naltrexone, bupropion, phentermine/topiramate, and Glucagon Like Peptide-1 (GLP-1) agonists such as liraglutide and semaglutide. The benefit-to-risk of medications, comorbidities, and individual responses should guide the treatment decisions. The article provides a comprehensive overview and discussion of several weight loss medications used previously and currently, including their efficacy, mechanisms of action, and side effects.

Covid- 19 Vaccine-induced Myocarditis.

Myocarditis and pericarditis are rare adverse reactions, more commonly seen in young males after receiving the second dose of an mRNA vaccine. However, the benefits of vaccination heavily outweigh the risk of these side effects. In addition, vaccination boosters are effective against the newest, more infective variants. Therefore we expect more vaccines to be administered in the following years. The objective of this study is to review the current understanding of the mechanism, diagnosis, and treatment of myocarditis and pericarditis. Proposed mechanisms include molecular mimicry against the S protein and hypersensitivity reactions with mRNA vaccines and platelet aggregation and thrombus formation in cardiac blood vessels with adenoviral vaccines. Diagnosis of myocarditis is based on clinical findings, cardiac enzymes, ECG, MRI, and echocardiographic findings. Management includes NSAIDs and cardiovascular support in selected cases with ventricular dysfunction. Most patients have a mild presentation with preservation of cardiac function and recover entirely within seven days; the average hospital stay is three days. Long-term complications are infrequent.

Epidemiological shifts: the emergence of malaria in America.

Plasmodium is a genus of parasites that comprises different species. The species falciparum, vivax, malariae, ovale, and knowlesi are known to cause a vector-borne illness called malaria, and among these, falciparum is known to cause major complications. The vector, the Anopheles mosquito, is commonly found in warmer regions close to the equator, and hence transmission and numbers of cases tend to be higher in Sub-Saharan Africa, South Asia, and Central America. The number of cases of malaria in the United States has remained stable over the years with low transmission rates, and the disease is mostly seen in the population with a recent travel history to endemic regions. The main reason behind this besides the weather conditions is that economically developed countries have eliminated mosquitos. However, there have been reports of locally reported cases with Plasmodium vivax in areas such as Florida and Texas in patients with no known travel history. This paper aims to familiarize US physicians with the pathophysiology, clinical features, and diagnostic modalities of malaria, as well as available treatment options.

Herbal Medicine- A Friend or a Foe of Cardiovascular Disease.

BACKGROUND: Herbal remedies are used by 80% of the Asian population in primary health care as per WHO. According to current research, the herbal medicine market was valued at nearly USD 166 billion in 2021 and is expected to reach approximately USD 348 billion by 2028. Increased incidence of chronic conditions such as diabetes, asthma, coronary artery disease, osteoarthritis, has fueled the growing interest in traditional herbal and plant-derived treatments among researchers. In addition, rural communities in developing nations have renewed interest in herbal treatments due to lower cost and easy availability. OBJECTIVE: Aim of the paper is to highlight the role of five of more commonly used herbal medicines that are Ginkgo biloba, Garlic, Flaxseed, Ginseng, Salvia miltiorrhiza in cardiovascular disorders. METHODS: A PubMed search was done using the keywords Herbal Medicine, Ginkgo biloba, Garlic, Flaxseed, Ginseng, Salvia miltiorrhiza. Articles which were available for free access were utilized. No formula inclusion or exclusion criteria was followed. A total of 42 papers were included for the study. CONCLUSION: Although there have been encouraging outcomes with the use of these herbal medications, many of these products are poorly monitored and are yet to be studied in detail regarding their adverse effects. Moreover, these medicinal products are known to interact with various drugs. To compete with the expanding pharmaceutical industry, more medicinally helpful herbal items must be used and scientifically validated.

Unraveling the link: exploring the effects of environmental change on the cardiovascular system.

Climate change has a particularly detrimental effect on the cardiovascular system, which is highly vulnerable to harmful impacts. The accumulation of particulate matter (PM) and greenhouse gasses in the environment negatively impacts the cardiovascular system through several mechanisms. The burden of climate change-related diseases falls disproportionately on vulnerable populations, including the elderly, the poor, and those with pre-existing health conditions. A key component of addressing the complex interplay between climate change and cardiovascular diseases is acknowledging health disparities among vulnerable populations resulting from climate change, familiarizing themselves with strategies for adapting to changing conditions, educating patients about climate-related cardiovascular risks, and advocating for policies that promote cleaner environments and sustainable practices.

Insomnia and Cardiovascular Health: Exploring the Link Between Sleep Disorders and Cardiac Arrhythmias.

Cardiovascular diseases (CVDs), driven by modern lifestyles, have increased, with atrial fibrillation (AF) being a major concern linked to heart failure and stroke. Insomnia affects a large population, especially younger individuals, males, and menopausal women, decreasing the quality of life and potentially causing autonomic disturbances and cardiac arrhythmias. PURPOSE OF REVIEW: This review explores the link between insomnia and cardiac arrhythmias, particularly AF, and its impact on cardiovascular health and emphasizes the need to address insomnia in individuals with cardiac arrhythmias by tailored strategies for sleep management to improve their overall well-being. RECENT FINDINGS: Recent findings emphasize maintaining a regular sleep schedule to lower AF and bradyarrhythmia risks. Better sleep scores correlate with reduced AF and bradyarrhythmia risks, while insomnia increases AF risk, particularly in those under 40 years of age. Studies underscore the potential impact of sleep management in reducing cardiovascular risks and highlight the importance of addressing sleep issues to improve cardiovascular health outcomes. Our review presents compelling evidence connecting insomnia and AF. Improving sleep patterns and addressing sleep issues can reduce AF risk, benefiting cardiovascular health. A comprehensive approach for managing at-risk individuals with cardiac arrhythmias, considering co-existing conditions, can decrease long-term disease burden and expenses. Incorporating sleep assessments and interventions into cardiovascular risk management, especially for those with insomnia, is recommended. Further research is needed to fully comprehend the complex relationship between insomnia and cardiac arrhythmias.

From the inside out: understanding the gut-heart connection.

The gut microbiome was first termed as 'Animalcules' by Antonie van Leeuwenhoek in the 17th century. The diverse composition and complex interactions of gut microbes are essential for good human health. They play a crucial role in inflammation, which by itself leads to the development of cardiovascular diseases. Although the mechanisms are not fully understood, it has been studied that the gut microbiota produce several bioactive metabolites impacting cardiovascular health mainly through TMAO pathway, SCFA pathway and bile acid pathway. Moreover, studies have found that using dietary interventions like high fiber diet and probiotics to re-establish a healthy equilibrium show promising results on improving cardiovascular health and thus, could be potentially used for prevention and management of cardiovascular diseases.

Influence of Plant-Based Diet on the Cardiovascular System: A Narrative Review.

A plant-based diet (PBD) includes multiple dietary patterns such as vegetarianism, veganism, lacto-ovo-vegetarianism, etc. A well-balanced PBD has positive effects on body mass index, hyperlipidemia, and type 2 diabetes, and it is associated with decreased risk of cardiovascular diseases. Due to its high fiber content, which lowers levels of low-density lipoprotein cholesterol, high antioxidant content, which prevents capillary wall damage; the presence of polyunsaturated fatty acids, which have an anti-inflammatory effect, improvement in glucose homeostasis through improved insulin sensitivity, and impact on the gut microbiota, it has been proven to be beneficial for the heart. Despite their possible benefits, PBDs can be low in essential nutrients such as vitamin B12, zinc, vitamin D, iodine, and amino acids. This review aims to analyze the influence of PBDs on the cardiovascular system and associated disease progression.

Understanding the Interplay between Iron Deficiency and Congestive Heart Failure: A comprehensive review.

Iron is an essential micronutrient for abounding physiological processes in the body, and its deficiency can be caused by various factors, such as low iron intake due to economic difficulties or loss of appetite, decreased iron absorption due to gastrointestinal issues, or increased iron loss due to hemorrhages or proteinuria. Iron deficiency is a prevalent issue among heart failure (HF) patients and is a significant contributor to anemia, affecting 30-50% of patients regardless of their gender, ethnicity, or left ventricular ejection fraction. Individuals with HF have high levels of pro-inflammatory cytokines, which can inhibit erythropoiesis by degrading the membrane iron exporter ferroportin, mediated by an increased release of hepcidin. In addition, elevated sympathetic and renin-angiotensin-aldosterone system activity retains salt and water, resulting in high cardiac output HF in people with normal left ventricular function. This review provides an overview of iron deficiency and HF.

Migraine and heart: A reality check.

Migraine is a common neurological disorder affecting 12% of the global population. The common risk factors are adolescent age, genetics, and female sex, and are triggered by hormonal fluctuations, emotional stress, sensory overload, weather changes, alcohol consumption, fasting, cheese, chocolate, smoked fish, yeast extract, cured meats, artificial sweeteners, food preservatives containing nitrates and nitrites, and sleep disturbances. Migraine with aura is associated with an increased risk of cardiovascular disease events, such as myocardial infarction, angina pectoris, and cardiac arrhythmias, and has recently been added to the QRISK3 cardiovascular disease prediction score. Population-based cohort studies have shown a significant association of migraine with aura and cardiac arrhythmias, most importantly atrial fibrillation. Patients suffering from migraine with aura are at an increased risk for cardiac arrhythmias; thus, it is essential to screen these patients for undiagnosed cardiovascular disorders.

Narrative Review of Anomalous Origin of Coronary Arteries: Pathophysiology, Management, and Treatment.

Coronary artery anomalies (CAA) are a diverse group of congenital anomalies and are the second most common cause of sudden cardiac death in the young population after Hypertrophic Cardiomyopathy (HCM). Symptoms range from chest pain, syncope, or sudden cardiac arrest to completely asymptomatic. The prevalence of congenital coronary artery anomalies in the general population is estimated to be between 1% and 2%. CAA often gets underdiagnosed due to the lack of knowledge of the disease process. Approximately 5% of patients with acute myocardial infarction do not have atherosclerotic coronary artery disease or luminal narrowing due to other causes. Congenital coronary artery anomalies account for 50-60% of this 5% of patients. Most patients are asymptomatic for most of their lives, and chest pain is the most common symptom in symptomatic patients when referred for coronary angiography, typically when the diagnosis is typically made. The malignant coronary artery is a rare presentation of a coronary anomaly when associated with atherosclerotic coronary artery disease or valvular heart disease. Patients with symptoms of an abnormal coronary artery origin will receive medical treatment/observation, exercise restriction, coronary angioplasty with stent deployment, or surgical repair.