Asymptomatic aortic stenosis: management revisited.

Aortic stenosis (AS) is common and is the commonest reason for valve surgery in the Western hemisphere. Calcific or a degenerative process is the most common cause of this pathological process and increases with aging population. The current guidelines recommend aortic valve replacement (AVR) only for symptoms or LV dysfunction unless a concomitant cardiac surgery is planned There are no randomized studies to guide therapy. AVR is forbidden by guidelines in severe AS patients with no symptoms. The guidelines are based on an analysis of natural history studies of AS and risk and durability of AVR. We will analyze the basis of current recommendations, unreliability of symptoms for such an important decision and more contemporary data on the natural and unnatural history of asymptomatic aortic stenosis. Based on these data, we recommend that asymptomatic AS should not be a class III recommendation for AVR and surgical options should be considered in most of severe AS patients with high risk profiles.

Usefulness of Statins for Prevention of Venous Thromboembolism.

Venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism, is common with an annual incidence of 1 to 5 per 1,000, resulting in major morbidity, mortality, and increased health care costs. It is more common in the elderly, obese, those with cancer, those undergoing surgery, and those with previous VTE. Strategy to reduce its occurrence has important public health implications. Pleotropic effects of statins may have beneficial effects on a number of potential targets associated with VTE. Statins have excellent safety profile and seem to be associated with beneficial effects in VTE in case-control studies, large observational studies, meta-analyses, and a randomized trial. In conclusion, after critically reviewing the clinical data supporting statin use in the prevention of VTE, we presented clinical recommendations for the use of statins in reducing VTE occurrence, especially in high-risk situations.

Impact of iatrogenic, excessive, nondietary sodium administration in patients with acute heart failure exacerbation on hospital length of stay.

STUDY OBJECTIVE: To investigate the sources and quantities of nondietary sodium administration in patients hospitalized for acute heart failure exacerbation, and to evaluate the impact of sodium administration on length of stay. DESIGN: Retrospective analysis. SETTING: University-affiliated medical center. PATIENTS: One hundred and eighty-two consecutive patients admitted to a cardiac intensive care unit for acute heart failure exacerbation between January 1 and June 30, 2009. MEASUREMENTS AND MAIN RESULTS: Drug therapy profiles of all patients were reviewed for sources and quantities of nondietary sodium administration, and the impact of sodium administration on hospital stay was analyzed. The mean ± SD nondietary sodium load was 4.0 ± 5.0 g/day. The predominant sources of sodium were intravenous 0.9% or 0.45% sodium chloride. The daily amount of sodium administration was directly related to the duration of hospital stay, with an average sodium load of 1.2 g/day correlating with hospital stays of up to 5 days, and an average of 2.6 g/day correlating with hospital stays of up to 10 days. CONCLUSION: We observed excessive sodium administration in patients hospitalized for acute exacerbation of heart failure. We speculate that reducing sodium administration in these patents may reduce length of hospital stay and cost of hospitalization.