Patients with congestive heart failure are not exclusively under the care of cardiologists. Indeed, the vast majority are managed by noncardiologists. Two surveys by the Italian Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO [National Association of Hospital Cardiologists]) compared characteristics, treatment, and outcome in heart failure patients admitted to Italian cardiology and internal medicine wards. TEMISTOCLE […] Read more
Natriuretic peptides are hormones produced within the heart and released into the circulation in response to stretch. Both atrial natriuretic peptide (ANP) and brain-type natriuretic peptide (BNP) relate to left ventricular filling pressure. High levels of both, and of the inactive fragment, N-terminal proANP, are associated with poor long-term prognosis in congestive heart failure and […] Read more
The ejection fraction (EF) in heart disease with high-dose dobutamine suggests associated coronary heart disease, and may help when selecting cases for coronary arteriography. The association of LV hypertrophy, hypokinesia, and sometimes significant dilatation is compatible with hypertensive heart disease or end-stage hypertrophic cardiomyopathy. Hypertensive heart disease is clearly suspected when heart failure is associated […] Read more
Several studies have shown that patients with chronic heart failure suffer mod-erate-to-severe depression or anxiety, similarly to those with other chronic diseases. However, the relationship between the two sets of variables cardiology and psychology (mental health and health-related quality of life) has rarely been explored in depth. In particular, only a few cardiology variables have […] Read more
In fluid retention, therapy is commonly initiated with a low-dose diuretic (eg, furosemide 20 mg to 40 mg daily), which is then titrated up to 250 mg daily in one or two divided doses until urine output increases and body weight decreases, generally by 0.5 kg to 1.0 kg daily. Because of its sustained effect, […] Read more
The vascular endothelium participates in the regulation of regional blood flow by modulating the release of endothelium-dependent relaxing factor, of which nitric oxide (NO) is a major component. Plasma levels of nitrate, the stable end-product of NO, are significantly increased in patients with chronic heart failure; however, the site of NO production is not completely […] Read more
How can cardiologists and primary care physicians be encouraged to practice evidence-based management in heart failure?
I vidence-based medicine is a cultural and methodological approach to clinical Hbbh practice that bases decisions on cumulative clinical expertise and an intimate knowledge of the individual patient’s global situation, and that then feeds those decisions back into a database for the advancement of clinical research. As such, it is the art of medicine raised […] Read more
Lithium exerts minimal cardiotoxicity at therapeutic doses in most patients and can be used safely in cardiac disease if it is initiated at a low dose, increased gradually, and monitored carefully. Clinically significant cardiovascular side effects are very rare and include sinus node dysfunction and increased ventricular irritability. The major toxic effect is neural (confusion, […] Read more
What are the indications for cardiological referral, hospitalization, and discharge in heart failure?
Indications for cardiological referral The causes of heart failure, with particular respect to destabilizing factors, can be determined from a standard workup in the outpatient clinic, day hospital, or during hospitalization. Echocardiography, ergometry, 24-hour Holter monitoring, and specific therapeutic options such as revascularization and valvuloplasty all require specialist referral (Table I). Mild or moderate heart […] Read more
QT dispersion, describing the range of QT intervals, was first proposed as an index of the spatial dispersion of ventricular recovery times in 1990, by Day et al. As it was thought that the different electrocardiographic (ECG) leads magnified the ECG signal from different myocardial regions, QT dispersion became an almost direct measure of the […] Read more