Dr. Usman's Cardiology Notes

ECG Case: Elderly woman came for follow up in cardiology clinic, what are the findings in this ECG? Click the button below to view answer: Show Answer

ECG Case: A 68 year old man with a previously functional electronic pacemaker presented with syncope. What are the findings in this ECG? Click the button below to view answer: Show Answer

ECG Case: Elderly male known case of paroxysmal atrial fibrillation came for follow up, what are the findings in his ECG? Click the button below to view answer: Show Answer

ECG Case: A 55 year old man known smoker presented with worsening dyspnea, what are the ECG findings suggesting underlying diagnosis? Click the button below to view answer: Show Answer

ECG Case: Elderly female presented in cardiology clinic with palpitations, what are the findings in this ECG? Click the button below to view answer: Show Answer

A 30 year old man known case of renal failure on regular hemodialysis came for follow up visit. What does this ECG show? Click the button below to view answer: Show Answer

ECG Case: A 70 year old female was found at home in a confused mental state, what does this ECG suggest? Click the button below to view answer: Show Answer

Case: Elderly woman presented in emergency with vague chest discomfort, what does this ECG show? Click the button below to view answer: Show Answer

ECG Case: A 60 year old woman with history of chronic kidney disease presented with dyspnea. What are the findings in this ECG? Click the button below to view answer: Show Answer

ECG Case: Elderly female known case of hyperthyroidism presented with palpitations. What are the findings in this ECG? Click the button below to view answer: Show Answer

ECG Case: A 77 year old male with history of syncope presented in cardiology clinic for evaluation. What are the findings in this ECG? Click the button below to view answer: Show Answer

This Left Heart Cath video is showing Right Coronary Artery (RCA) originating from mid portion of Left Anterior descending artery (LAD), which is a rare finding.

This cath video is showing a fistula from right pulmonary artery (RPA) to Left atrium (LA)

ECG Case: Elderly male came for follow up in cardiology clinic, co-morbids include coronary artery disease (CAD), paroxysmal atrial fibrillation and hypertension, his home medications include aspirin, atenolol, atorvastatin, dofetilide and nitrates. What are the findings in his EKG? Click the button below to view answer: Show Answer

ECG Case: A 70 year old man with history of anterior wall myocardial infarction came for follow up. What is the rhythm? Click the button below to view answer: Show Answer

A 57 year old man with episodes of fast heart beat presented in Emergency department, what are the findings in his ECG? Click the button below to view answer: Show Answer

ECG Case: A 68 year old man presented in emergency department with this ECG, What are the findings in his EKG suggesting underlying diagnosis? Click the button below to view answer: Show Answer

ECG Case: A 59 year old man presented with this EKG, What are the findings? Click the button below to view answer: Show Answer

ECG Case: A 70 year old man presented with palpitations and pre-syncope, What is the rhythm? Click the button below to view answer: Show Answer

ECG Case: A 55 year old woman on heart failure medications, now presented with worsening dyspnea. What are the EKG findings and what is the likely cause of her heart failure? Click the button below to view answer: Show Answer

This Cath lab procedure is showing Embolized ASD (Atrial Septal Defect) Device and its retrieval by Snare Technique.

Angiography showing Ligation of MAPCAs (Major aortopulmonary collateral arteries)

Angiography (Aortogram) showing Coarctation of the Aorta.

Coronary Angiography showing Clot in Left Main Stem and Left Circumflex artery.

Left Ventricle (LV) Angiogram showing Air in Left Ventricle. (Air embolism)

Coronary Angiography showing Aberrant origin of LAD and LCX from RCA.

Apical four chamber view of Echocardiogram showing Pulmonary Vein Stenosis. A. Color doppler imaging showing a turbulent jet that appears to originate from the right upper pulmonary vein. B. Pulsed Doppler (PW) imaging showing nearly continuous antegrade flow and increased velocity.

Apical Four chamber view of echocardiogram showing Ebstein anomaly, note the apical displacement of tricuspid valve (TV). Functional portion of thr right ventricle is well preserved.

ECG Case: Elderly male came to you for routine follow up visit, What are the EKG findings? Click the button below to view answer: Show Answer

Para-sternal Long Axis (PLAX) view of Echocardiogram showing normally functioning St Jude Mitral prosthesis. During Systole hemidiscs are shown in closed position (arrows) and during diastole the hemidiscs are recorded in open position (arrows). St Jude Mitral Prosthesis

Para-sternal Long Axis (PLAX) view of echocardiogram showing normally functioning Starr Edwards Mitral prosthesis. During Systole poppet is seated within the sewing ring (arrows), and during Diastole poppet moves forward into the cage (arrows). Starr Edwards Mitral Prosthesis

Echocardiography of a prominent Eustachian Valve as seen on Right ventricular (RV) Inflow View. Eustachian Valve (Arrow) as seen on right ventricular (RV) Inflow View What is Eustachian Valve? The Eustachian valve also known as the valve of the inferior vena cava is a ridge like structure of  a variable thickness in the inferior right atrium (RA). It is a remnant of a fetal structure that directed incoming oxygenated blood to the foramen ovale and away from the right atrium.

Apical four chamber view of echocardiogram showing Atrial Septal Aneurysm bowing into left and right atria like a swing.

Elderly male with multiple co-morbids including diabetes and coronary artery disease came for follow up. What are the findings in this EKG? Click the button below to view answer: Show Answer

A 63 year old woman presented with a rapid heart beat, What is the rhythm? Click the button below to view answer: Show Answer

Left heart cath showing Left Ventricular (LV) mid cavity obstruction on Ventriculogram.

This Cath video is showing Pulmonary Stenosis (PS) on ventriculography, note the post stenotic dilatation.

This cath video is showing Severe Aortic Regurgitation (AR) on Ventriculogram.

This cath video is showing Severe Mitral Regurgitation (MR) on Ventriculogram.

This cath video is showing superior mesenteric artery stenosis corrected with balloon angioplasty.

Left Heart cath showing Patent ductus arteriosus (PDA)

Left Heart Cath showing Left Ventricular (LV) aneurysm on ventriculogram.

Left Heart Cath showing Dissection of Right coronary artery (RCA)

This fluoroscopy video is showing a Disc thrombosis of a Mitral Valve (MV) prosthesis.

This Left Heart Cath is showing an Anomalous Right coronary artery (RCA) originating from left main stem (LMS).

Echocardiogram showing a Patent Forman Ovale (PFO) with Left to right shunt in apical four chamber view. Arrow indicating jet via patent foramen ovale in Left to right direction.

(A) Four chamber, cine SSFP (B) Four chamber, MDE; demonstrating no evidence of late gadolinium enhancement. (C) Axial, cine SSFP (D) Axial, LGE; demonstrating no evidence of late gadolinium enhancement. A 58 year old woman with an indwelling Hickman catheter for total parenteral nutrition administration presented with bacteremia with an echocardiogram showing a right atrial mass after the catheter was removed.What are the findings in above MR images? Click the button below to view answer: Show Answer

(A) Three chamber, diastole, gradient recalled echo (GRE). (B) 3 chamber, systole, GRE (C) Short axis, cine SSFP, pre-contrast. (D) Short axis, cine SSFP, post-gadolinium contrast; demonstrating increased signal intensity. A 73 year old man with a history of advanced gastrointestinal stromal cell sarcoma presented with 3 months of chest pain, palpitations, and shortness of breat, Identify the problem in above MRI images. Click the button below to view answer: Show Answer

A 68-year-old man with a history of advanced stage melanoma with pulmonary metastases presented with a suspicious lesion on a chest computed tomographic scan. What are the findings in above MR images? Click the button below to view answer: Show Answer

Cardiac MR Case: A 55 year old man presented with symptomatic exercise induced Ventricular Tachycardia (VT), Can you identify the abnormality? Click the button below to view answer: Show Answer

ECG Case: A young female noticed a pause in her ECG, What are the findings in this ECG? Click the button below to view answer: Show Answer

ECG Case: A 77 year old man with palpitations, What is the rhythm? Click the button below to view answer: Show Answer

Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic Shock - The New England Journal of Medicine - 1999 Brief Summary: Compared to initial medical stabilization, early revascularization was associated with a nonsignificant trend towards improved survival at 30 days among patients who developed cardiogenic shock during acute MI. However, early revascularization did confer a significant benefit by 6 months. Reference: http://www.ncbi.nlm.nih.gov/pubmed/10460813

Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock - The New England Journal of Medicine - 2012 Brief Summary: In patients with acute MI complicated by cardiogenic shock, there was no difference in 30-day mortality with IABP placement. Reference: http://www.ncbi.nlm.nih.gov/pubmed/22920912

Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes - The New England Journal of Medicine - 2015 Brief Summary: In this industry sponsored trial, empagliflozin reduced the rate of CV events and slowed the progression of kidney disease among patients with T2DM and high CV risk. Reference: http://www.ncbi.nlm.nih.gov/pubmed/26378978

Canagliflozin and cardiovascular and renal events in type 2 diabetes - The New England Journal of Medicine - 2017 Brief Summary: Among patients with T2DM at high risk for CV events, canagliflozin had a lower risk of cardiovascular events and reduced the rate of renal decline and heart failure hospitalization compared to those who received placebo but a greater risk of amputation. Reference: http://www.ncbi.nlm.nih.gov/pubmed/28605608

Liraglutide and cardiovascular outcomes in type 2 diabetes - The New England Journal of Medicine - 2016 Brief Summary: Among patients with T2DM at increased risk for CVD, liraglutide was associated with a reduction in CV events when compared to placebo. Reference: http://www.ncbi.nlm.nih.gov/pubmed/27295427

Ticagrelor versus clopidogrel in symptomatic peripheral artery disease - New Engl J Med - 2017 Brief Summary: In patients with symptomatic PAD, ticagrelor is not superior to clopidogrel with regard to the primary outcome of cardiovascular death, MI, or ischemic stroke. The rate of the primary outcome was very similar with either agent (10.6% with ticagrelor and 10.8% with clopidogrel) at median follow-up 30 months. The rate of major bleeding was 1.6% in each group. Reference: http://www.ncbi.nlm.nih.gov/pubmed/27959717

A Randomized Trial of Colchicine for Acute Pericarditis - The New England Journal of Medicine - 2013 Brief Summary: In patients experiencing their first episode of acute pericarditis, the addition of colchicine to NSAID or glucocorticoid therapy significantly reduces the rate of incessant or recurrent pericarditis. Reference: http://www.ncbi.nlm.nih.gov/pubmed/23992557

Effect of Anakinra on recurrent pericarditis among patients with colchicine resistance and corticosteroid dependence - Journal of the American Medical Association - 2016 Brief Summary: In a small open label trial, patients with colchicine resistant, steroid dependent recurrent pericarditis, the IL-1B antagonist anakinra was associated with a dramatic reduction in the pericarditis recurrence rate. At 14 months, only 2 out of 11 patients on anakinra experienced recurrent pericarditis (18%) compared to 9 out of 10 (90%) in the placebo group. Reference: http://www.ncbi.nlm.nih.gov/pubmed/27825009

Cardiovascular safety of Celecoxib, Naproxen, or Ibuprofen for arthritis - The New England Journal of Medicine - 2016 Brief Summary: Among patients with RA and osteoarthritis and elevated CV risk requiring daily NSAID therapy, celecoxib is noninferior to ibuprofen and naproxen with regard to a primary safety outcome of cardiovascular death, nonfatal MI, and nonfatal stroke after mean follow up of nearly 3 years. Primary outcome events were low (approximately 2-3%) and similar among the three NSAIDs. GI events were significantly lower with celecoxib versus either naproxen or ibuprofen. Renal events were significantly lower with celecoxib versus ibuprofen. Reference: http://www.ncbi.nlm.nih.gov/pubmed/27959716

Early surgery versus conventional treatment for infective endocarditis - The New England Journal of Medicine - 2012 Brief Summary: Among patients with left sided native valve endocarditis at high risk of embolic events, early surgery reduces mortality and embolic events as compared to conventional treatment. Reference: http://www.ncbi.nlm.nih.gov/pubmed/22738096

Effects of aspirin for primary prevention in persons with diabetes mellitus - The New England Journal of Medicine - 2018 Brief Summary: In patients with well controlled diabetes (HbA1c < 8 in ~51% of patients), at 7.4 years primary prevention aspirin use was associated with a 1.1% absolute reduction in serious vascular events. Aspirin use was also associated with a 0.9% absolute increase in major bleeding. Aspirin use was not associated with any change in the incidence of gastrointestinal cancers or all cancers. Reference: http://www.ncbi.nlm.nih.gov/pubmed/30146931

Mild Therapeutic Hypothermia to Improve the Neurologic Outcome After Cardiac Arrest - The New England Journal of Medicine - 2002 Brief Summary: Among patients with return of spontaneous circulation after cardiac arrest due to VF or pulseless VT, mild therapeutic hypothermia (32-34° C) improved neurologic outcomes and reduced mortality at six months. Reference: http://www.ncbi.nlm.nih.gov/pubmed/11856793

Dual chamber pacing or ventricular backup pacing in patients with an implantable defibrillator - Journal of the American Medical Association - 2002 Brief Summary: In patients with an indication for an implantable defibrillator, ventricular backup pacing is superior to dual-chamber pacing in terms of hospitalization rate and possibly overall survival. Reference: http://www.ncbi.nlm.nih.gov/pubmed/12495391

Target Temperature Management 33°C vs. 36°C after Out-of Hospital Cardiac Arrest - The New England Journal of Medicine - 2013 Brief Summary: In patients with out-of-hospital cardiac arrest, targeted temperature management to a goal of 33°C was not associated with reduction in all-cause mortality or improvement in neurologic outcomes when compared a goal of 36°C. Reference: http://www.ncbi.nlm.nih.gov/pubmed/24237006

Biventricular versus Right Ventricular Pacing in Heart Failure Patients with Atrioventricular Block - The New England Journal of Medicine - 2013 Brief Summary: In patients with high grade AV block and mild to moderate heart failure, biventricular pacing is associated with a 10% absolute reduction in death, urgent heart failure care and adverse LV remodeling compared with right ventricular pacing, with the difference driven primarily by reduced heart failure hospitalizations and reduced LV remodeling. Reference: http://www.ncbi.nlm.nih.gov/pubmed/23614585

A randomized study of the prevention of sudden death in patients with coronary artery disease - New Engl J Med - 1999 Brief Summary: In patients with ischemic cardiomyopathy, EF <40%, and NSVT, EPS-guided therapy resulted in a 7% absolute reduction in the primary endpoint of cardiac arrest or arrhythmic death versus no intervention, driven primarily by ICD use. Patients with a known indication for ICD were not excluded, obscuring the degree to which benefit was derived for those with NSVT or by using EPS-guided therapy to direct ICD placement. Reference: http://www.ncbi.nlm.nih.gov/pubmed/10601507

Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs - The New England Journal of Medicine - 2016 Brief Summary: In patients with ischemic cardiomyopathy and an implantable cardioverter-defibrillator (ICD) who experience recurrent ventricular tachycardia (VT) while receiving first-line antiarrhythmic therapy, VT ablation resulted in a 10% absolute reduction in death, VT storm, and appropriate ICD shocks when compared to escalation of antiarrhythmic drugs. This difference was driven largely by reductions in VT storm and ICD shocks with no significant difference in mortality. Reference: http://www.ncbi.nlm.nih.gov/pubmed/27149033

Defibrillator implantation in patients with non-ischemic systolic heart failure - The New England Journal of Medicine - 2016 Brief Summary: In patients with non-ischemic cardiomyopathy with LVEF ≤35% with symptomatic heart failure, ICDs did not result in an overall mortality benefit versus standard care after 5.5 years of follow up. ICD implantation did result in a 3% absolute reduction in sudden cardiac death that was somewhat mitigated by device-related morbidity including an absolute 1.5% increase in device-related infection. Reference: http://www.ncbi.nlm.nih.gov/pubmed/27571011

Closure or medical therapy for cryptogenic stroke with patent foramen ovale - The New England Journal of Medicine - 2012 Brief Summary: Although many patients with cryptogenic stroke/TIA have a PFO, closure of the PFO does not reduce the 30 day rate of recurrent stroke/TIA, all-cause mortality, or death from neurologic causes. Reference: http://www.ncbi.nlm.nih.gov/pubmed/22417252

Closure of patent foramen ovale versus medical therapy after cryptogenic stroke - The New England Journal of Medicine - 2013 Brief Summary: Among patients with cryptogenic ischemic stroke, PFO closure does not reduce nonfatal ischemic stroke, stroke mortality, and early all-cause mortality when compared to medical therapy alone. Reference: http://www.ncbi.nlm.nih.gov/pubmed/23514286

Association between early surgical intervention versus watchful waiting and outcomes for mitral regurgitation due to flail mitral valve leaflets - JAMA - 2013 Brief Summary: In this retrospective study of patients with chronic flail mitral regurgitation (MR), early surgery was associated with improved survival compared to medical management. Reference: http://www.ncbi.nlm.nih.gov/pubmed/23942679

Transcatheter Mitral Valve Repair in Patients with Heart Failure - The New England Journal of Medicine - 2018 Brief Summary: In patients with HFrEF (mean LVEF 31%, 61% ischemic) resulting in moderate-severe or severe functional MR, percutaneous mitral valve repair results in a 32.1% absolute reduction in heart failure hospitalization at 2 years compared to medical therapy alone. Device-based therapy was also associated with a 16% absolute reduction in all cause death. At 1 year, device-related complications occurred at a rate of 3.4%, meeting pre-specified criteria for safety. Reference: http://www.ncbi.nlm.nih.gov/pubmed/30280640

Coronary Artery Revascularization before elective major vascular surgery - The New England Journal of Medicine - 2004 Brief Summary: In patients with stable CAD, there is no mortality benefit performing coronary artery revascularization before elective vascular surgery. Reference: http://www.ncbi.nlm.nih.gov/pubmed/15625331

Effects of Extended-Release Metoprolol Succinate in Patients Undergoing Non-Cardiac Surgery: a Randomised Controlled Trial - The Lancet - 2008 Brief Summary: Although metoprolol reduced the risk of perioperative MI among patients undergoing non-cardiac surgery, this benefit was more than nullified by a higher rate of mortality and strokes. Reference: http://www.ncbi.nlm.nih.gov/pubmed/18479744

Aspirin in patients undergoing non-cardiac surgery - The New England Journal of Medicine - 2014 Brief Summary: Among patients with elevated operative risk, perioperative aspirin does not reduce rate of all-cause mortality or non-fatal MI when compared to placebo. It is associated with increased risk of major bleeding. Reference: http://www.ncbi.nlm.nih.gov/pubmed/24679062

Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation - The New England Journal of Medicine - 2019 Brief Summary: Among patients with AF presenting with ACS or undergoing PCI, apixaban is associated with a 4.2% absolute reduction in major or clinically relevant nonmajor bleeding when compared to warfarin at 180 days. Apixaban was also associated with a 3.9% absolute reduction in death or hospitalization when compared to warfarin (driven primarily by reduced hospitalization). Aspirin use in addition to oral anticoagulation and P2Y12 inhibitor therapy was associated with a 7.1% absolute increase in major or clinically relevant nonmajor bleeding. Overall thrombotic events were similar across individuals randomized to anticoagulation with apixaban versus warfarin, and those randomized to aspirin versus placebo. Reference: http://www.ncbi.nlm.nih.gov/pubmed/30883055

Stroke Prevention in Atrial Fibrillation Study. Final results – Circulation - 1991 Brief Summary: Among patients with non-valvular atrial fibrillation, aspirin and warfarin both reduce stroke risk. Warfarin appears to have a stronger protective effect. Reference: http://www.ncbi.nlm.nih.gov/pubmed/1860198

A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation - The New England Journal of Medicine - 2002 Brief Summary: In patients with nonvalvular AF, there is no survival benefit between rate and rhythm control, but rhythm trends toward increased mortality. Reference: http://www.ncbi.nlm.nih.gov/pubmed/12466506

Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. - The Lancet - 2006 Brief Summary: Among patients with nonvalvular AF, combination aspirin/clopidogrel is inferior to warfarin for the prevention of stroke, systemic embolism, MI, and CV death, and appears to cause at least as much bleeding. Reference: http://www.ncbi.nlm.nih.gov/pubmed/16765759

Effect of Clopidogrel Added to Aspirin in Patients with Atrial Fibrillation - The New England Journal of Medicine - 2009 Brief Summary: Compared with aspirin alone, clopidogrel plus aspirin reduces major vascular events but increases the risk of major bleeding among patients with atrial fibrillation (AF) who are not suitable candidates for vitamin K antagonists (VKAs). Reference: http://www.ncbi.nlm.nih.gov/pubmed/19336502

Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial – Lancet - 2009 Brief Summary: Among patients with non-valvular atrial fibrillation, percutaneous left atrial appendage closure with the WATCHMAN device (without continued anticoagulation) is non-inferior to warfarin for the prevention of vascular events. Reference: http://www.ncbi.nlm.nih.gov/pubmed/19683639

Dabigatran versus warfarin in patients with atrial fibrillation - The New England Journal of Medicine - 2009 Brief Summary: The RELY trial demonstrated that compared to warfarin, high dose dabigatran reduces stroke risk without increasing the risk of major bleeding among patients with atrial fibrillation. Reference: http://www.ncbi.nlm.nih.gov/pubmed/19717844

Lenient versus Strict Rate Control in Patients with Atrial Fibrillation - The New England Journal of Medicine - 2010 Brief Summary: Among patients with permanent atrial fibrillation, lenient rate control (HR <110 bpm) is as effective as strict rate control (HR <80 bpm) in preventing cardiovascular events. Reference: http://www.ncbi.nlm.nih.gov/pubmed/20231232

Apixaban in patients with atrial fibrillation - The New England Journal of Medicine - 2011 Brief Summary: In patients with atrial fibrillation thought to be unsuitable candidates for anticoagulation with a vitamin K antagonist, apixaban signficantly reduced the risk of stroke and systemic embolism without increasing the risk of major bleeding or intracranial hemorrhage when compared to aspirin. Reference: http://www.ncbi.nlm.nih.gov/pubmed/21309657

Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation - The New England Journal of Medicine - 2011 Brief Summary: Among patients with nonvalvular atrial fibrillation, rivaroxaban is noninferior to warfarin in preventing stroke and systemic thromboembolism. Reference: http://www.ncbi.nlm.nih.gov/pubmed/21830957

Apixaban versus warfarin in patients with atrial fibrillation - The New England Journal of Medicine - 2011 Brief Summary: In patients with nonvalvular atrial fibrillation and at ≥1 risk factor, apixaban is associated with a greater reduction in rates of stroke or systemic embolism while having a lower rate of lower bleeding than warfarin. Reference: http://www.ncbi.nlm.nih.gov/pubmed/21870978

Edoxaban versus warfarin in patients with atrial fibrillation - The New England Journal of Medicine - 2013 Brief Summary: Among patients with nonvalvular atrial fibrillation edoxaban is superior to warfarin in preventing stroke or systemic embolism and is associated with lower rates of bleeding and death from CV events. Reference: http://www.ncbi.nlm.nih.gov/pubmed/24251359

Use and associated risks of concomitant aspirin therapy with oral anticoagulation in patients with atrial fibrillation: insights from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Registry – Circulation - 2013 Brief Summary: In patients with atrial fibrillation (AF) treated with oral anticoagulation (OAC), this retrospective review demonstrated increased bleeding and hospitalization rates with the concomitant use of aspirin versus OAC alone. Reference: http://www.ncbi.nlm.nih.gov/pubmed/23861512

Atrial Fibrillation in Patients with Cryptogenic Stroke - The New England Journal of Medicine - 2014 Brief Summary: Ambulatory 30 day ECG monitoring improved the detection of atrial fibrillation compared to 24 hour Holter monitoring. Reference: http://www.ncbi.nlm.nih.gov/pubmed/24963566

Peri-operative Bridging Anticoagulation in Patients with Atrial Fibrillation - The New England Journal of Medicine - 2015 Brief Summary: Among patients with low- and intermediate-risk atrial fibrillation receiving anticoagulation and undergoing an invasive procedure, peri-procedural bridging anticoagulation with LMWH did not reduce the incidence of arterial thromboembolism when compared to no bridging, but did increase the risk of major bleeding. Reference: http://www.ncbi.nlm.nih.gov/pubmed/26095867

Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation - The New England Journal of Medicine - 2016 Brief Summary: In patients with symptomatic paroxysmal atrial fibrillation (pAF) resistant to antiarrhythmic drugs referred for pulmonary vein isolation (PVI), balloon cryoablation is noninferior to radiofrequency ablation in regards to a primary outcome of composite clinical failure (recurrent AF, prescription of antiarrhythmic drugs, or repeat ablation) more than 90 days after the index procedure. Reference: http://www.ncbi.nlm.nih.gov/pubmed/27042964

Catheter Ablation for Atrial Fibrillation with Heart Failure - The New England Journal of Medicine - 2018 Brief Summary: In patients with AF and symptomatic (NYHA II-IV) systolic heart failure (LVEF ≤ 35%), catheter ablation is associated with a 16.1% absolute reduction in death or hospitalization for heart failure when compared to medical therapy (rate or rhythm control). This difference was driven both by a 11.6% absolute reduction in death and a 15.2% absolute reduction in hospitalization for heart failure. Catheter ablation was also associated with greater improvement in LVEF and long-term maintenance of sinus rhythm. Reference: http://www.ncbi.nlm.nih.gov/pubmed/29385358

Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation – JAMA - 2019 Brief Summary: In patients with atrial fibrillation (AF) requiring treatment, catheter ablation was not associated with a significant reduction in death, disabling stroke, serious bleeding, or cardiac arrest when compared to medical therapy at 12 months. Reference: http://www.ncbi.nlm.nih.gov/pubmed/30874766

Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients - The New England Journal of Medicine - 2008 Brief Summary: Among patients with HTN at high risk for CV complications, benazepril/amlodipine decreases the rate of CV events compared to benazepril/HCTZ. Reference: http://www.ncbi.nlm.nih.gov/pubmed/19052124

A clinical trial of the effects of dietary patterns on blood pressure - The New England Journal of Medicine - 1997 Brief Summary: In patients with SBP<160 and DBP 80-90, DASH diet rich in fruits and vegetables, low in saturated fats significantly reduced BP. Reference: http://www.ncbi.nlm.nih.gov/pubmed/9099655

Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of non-pharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group - JAMA - 1998 Brief Summary: Reduced sodium intake and weight loss are associated with improved blood pressure control among adults age 60 to 80 years with hypertension. Reference: http://www.ncbi.nlm.nih.gov/pubmed/9515998

Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs. Diuretic - Journal of the American Medical Association - 2002 Brief Summary: In patients with hypertension, chlorthalidone, amlodipine, and lisinopril performed similarly in regards to fatal CAD and nonfatal MI. Reference: http://www.ncbi.nlm.nih.gov/pubmed/12479763

Treatment of hypertension in patients 80 years of age or older - The New England Journal of Medicine - 2008 Brief Summary: Among very elderly patients (≥80 years) with hypertension, treatment with a diuretic with or without an ACE inhibitor is associated with a trend towards reduced rates of fatal and nonfatal stroke (P=0.06), and a significant reduction in the secondary outcomes of fatal stroke, all-cause mortality, and CV outcomes. Reference: http://www.ncbi.nlm.nih.gov/pubmed/18378519

Stenting and Medical Therapy for Atherosclerotic Renal-Artery Stenosis - The New England Journal of Medicine - 2014 Brief Summary: Renal artery stenting does not improve renal or cardiac clinical outcomes in patients with hypertension or chronic kidney disease due to atherosclerotic renal artery stenosis. Reference: http://www.ncbi.nlm.nih.gov/pubmed/24245566

A randomized trial of intensive versus standard blood-pressure control - The New England Journal of Medicine - 2015 Brief Summary: In patients at high risk for CVD but who do not have a history of stroke or diabetes, intensive BP control (target SBP <120 mm Hg) improved CV outcomes and overall survival compared to standard therapy (target SBP 135-139 mm Hg), while modestly increasing the risk of some serious adverse events. Reference: http://www.ncbi.nlm.nih.gov/pubmed/26551272

Effect of renal denervation on blood pressure in the presence of antihypertensive drugs - The Lancet - 2018 Brief Summary: Among patients with uncontrolled hypertension (office SBP 150-180mmHg and DBP ≥ 90mmHg as well as 24h ambulatory SBP 140-170mmHg) despite 1-3 antihypertensive medications, the addition of renal denervation to medical therapy results in a significant reduction in blood pressure at 6 months (reduction of 9mmHg in 24h ambulatory SBP and 6mmHg in DBP, with mean difference of -7.4mmHg systolic and -4.1mmHg compared to medical therapy alone, respectively). Medication adherence was about 60% in both groups. Reference: http://www.ncbi.nlm.nih.gov/pubmed/29803589

Heart Protection Study Collaborative Group Writers - MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial - The Lancet - 2002 Brief Summary: In patients with high risk for CVD, simvastatin is safe and cholesterol lowering is associated with reduction in all-cause mortality and major vascular event risk, as compared to placebo. The benefit of cholesterol lowering was neither limited by a threshold LDL-C level nor dependent on the pretreatment cholesterol level. Reference: http://www.ncbi.nlm.nih.gov/pubmed/12114036

Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial - JAMA Internal Medicine - 2015 Brief Summary: Among patients with life expectancy <1 year who are not on a statin for active CVD, discontinuation of statin therapy does not increase 60 day all-cause mortality when compared to statin continuation. Discontinuation may be associated with improved quality of life (QOL) and reduced medication costs. Reference: http://www.ncbi.nlm.nih.gov/pubmed/25798575

Efficacy and safety of alirocumab in reducing lipids and cardiovascular events". The New England Journal of Medicine - 2015 Brief Summary: In patients at high risk for cardiovascular events by virtue of a confirmed diagnosis of heterozygous familial hypercholesterolemia, established coronary disease, or a coronary disease equivalent followed for 1.5 years, the use of the monoclonal antibody alirocumab in addition to high-intensity statin therapy resulted in an additional 62% reduction in LDL cholesterol with no significant increase in serious adverse events. Furthermore, a post-hoc analysis demonstrated a 2% absolute risk reduction in major adverse cardiovascular events with alirocumab therapy. Reference: http://www.ncbi.nlm.nih.gov/pubmed/25773378

Ticagrelor or prasugrel in patients with acute coronary syndromes - New England Journal of Medicine - 2019 Brief Summary: In patients with acute coronary syndrome (ACS), for whom an invasive evaluation is planned, prasugrel was associated with a 2.4% absolute reduction in the primary outcome of death, nonfatal MI, and stroke, driven primarily by reduction in nonfatal myocardial infarction (although there was also numerically lower all-cause mortality). Stent thrombosis was rare in both groups, but numerically lower with prasugrel. Major bleeding rates were similar in both groups. Reference: http://www.ncbi.nlm.nih.gov/pubmed/31475799

Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban - New England Journal of Medicine - 2001 Brief Summary: In patients with unstable angina or non-ST segment elevation MI, an early invasive strategy (in combination with glycoprotein IIb/IIIa inhibition with tirofiban) significantly reduced major cardiovascular events versus a selectively invasive strategy. This benefit was largely limited to higher risk patients with TIMI score > 2. Reference: http://www.ncbi.nlm.nih.gov/pubmed/11419424

Effect of vasodilator therapy on mortality in chronic congestive heart failure - The New England Journal of Medicine - 1986 Brief Summary: In the era before beta-blockers and ACE inhibitors, ISDN/hydralazine showed a trend towards improved survival among patients with systolic heart failure. Reference: http://www.ncbi.nlm.nih.gov/pubmed/3520315

Effects of enalapril on mortality in severe congestive heart failure, results of the cooperative north Scandinavian enalapril survival study - The New England Journal of Medicine - 1987 Brief Summary: Enalapril improves survival in NYHA class IV HFrEF when added to standard therapy. Reference: http://www.ncbi.nlm.nih.gov/pubmed/2883575

Effect of Enalapril on Survival in Patients with Reduced Left Ventricular Ejection Fractions and Congestive Heart Failure - The New England Journal of Medicine - 1991 Brief Summary: Enalapril reduces 4-year mortality by 16% and reduces HF hospitalizations when added to conventional therapy in patients with HFrEF. Reference: http://www.ncbi.nlm.nih.gov/pubmed/2057034

A Comparison of Enalapril with Hydralazine–Isosorbide Dinitrate in the Treatment of Chronic Congestive Heart Failure - The New England Journal of Medicine - 1991 Brief Summary: In patients with mild-to-moderate HFrEF, enalapril improved survival compared to the combination of ISDN (isosorbide Dinitrate) and hydralazine. Reference: http://www.ncbi.nlm.nih.gov/pubmed/2057035

Effect of Captopril on Mortality and Morbidity in Patients with Left Ventricular Dysfunction after Myocardial Infarction — Results of the Survival and Ventricular Enlargement Trial - The New England Journal of Medicine - 1992 Brief Summary: In patients with acute MI complicated by asymptomatic LV dysfunction, captopril led to a 19% reduction in all-cause mortality. Reference: http://www.ncbi.nlm.nih.gov/pubmed/1386652