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Hypertrophic Cardiomyopathy: A Welcome Guideline Update

Hypertrophic cardiomyopathy (HCM) is one of the most common genetic heart diseases in the United States, affecting approximately 600,000 to 700,000 people. In many cases, patients remain unidentified. This, in part, may explain why few cardiology practices have the opportunity to evaluate HCM patients nationwide. In 2003, the American College of Cardiology (ACC) and European Society of Cardiology created an expert consensus panel on HCM. The ACC and the American Heart Association (AHA) revisited the topic with the publication of guidelines in the December 13, 2011 issues of Circulation and the Journal of the American College of Cardiology. “HCM has become a highly treatable disease thanks to new management strategies, but many physicians are still challenged with managing it,” says Barry J. Maron, MD, who co-chaired the ACC/AHA guideline update writing committee. “We took this opportunity to clarify the most important diagnostic and management strategies. Many of the recommendations in the 2011 guidelines are similar to those in the 2003 consensus document, but newer data have provided a better understanding of these recommendations, particularly in the areas of prevention of sudden death and genetic testing.” Hypertrophic Cardiomyopathy Recommendations According to the ACC/AHA guidelines, treatment of patients with HCM must be individualized and requires an understanding of the complex pathophysiology and natural history of the disease. According to Dr. Maron, the three areas of greatest importance are use of prophylactic defibrillators, management of outflow tract obstruction, and application of genetic testing. Implantable cardioverter defibrillators (ICDs) for the prevention of sudden cardiac death are the only treatment known to prolong life in this disease, says Dr. Maron. The generally agreed upon...

Revised Guidelines for Evidence-Based PCI

Over the last decade, significant advances and innovations have rapidly evolved in the use of PCI for patients with coronary artery disease (CAD). The American College of Cardiology (ACC)/American Heart Association (AHA), together with the Society for Cardiovascular Angiography and Interventions (SCAI), released a revised clinical guideline for the management of CAD patients undergoing PCI. Published in the December 6, 2011 Journal of the American College of Cardiology, the update emphasizes careful selection of CAD treatment and includes the most extensive section to date on revascularization. The Heart Team Concept for PCI and CABG “The heart team includes an interventional cardiologist and a cardiac surgeon who review patient history and anatomy, discuss whether PCI and/or CABG are appropriate, and explain these options in detail with patients before a treatment option is chosen,” says Glenn N. Levine, MD, who chaired the ACC/AHA/SCAI guideline writing committee. The guidelines include a Class I recommendation for utilizing a heart team approach in patients with unprotected left main CAD and/or complex CAD in cases where the optimal revascularization strategy is not straightforward. New Section on CAD Revascularization For the first time ever, the CAD revascularization section was developed through a collaboration that involved experts from the ACC, AHA, and SCAI on both PCI and CABG. According to the guidelines, CABG is recommended for improving survival in patients with significant left main coronary artery stenosis, as well as those with significant stenoses in three major coronary arteries or in the proximal left anterior descending artery and one other major coronary artery. CABG or PCI is recommended for survivors of sudden cardiac death with presumed ischemia-mediated...
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