Feature 1
Vascular Protection:
Beyond Risk Reduction
Michael McDonald, MD, FRCP; and Gabor Gyenes, MD, PhD

Vascular protection typically involves the effort to reduce major adverse events in patients who are at high risk. In this article, Dr. McDonald and Dr. Gyenes outline some of the more topical cardiovascular protection strategies and the rationale for their use.

Feature 2
Thyroid Disease and the Heart:
A Common Connection
Arnold Voth, MD, LMCC, FRCP(C), FACP

Cardiac symptoms are often the first and most prominent signs of thyroid disease. In this review, Dr. Voth discusses the connection between the heart, thyrotoxicosis and hypothyroidism.

Feature 3
The Struggle to Manage
Stroke, Aneurysm and PAD
Anthony J. Salvian, MD, FRCSC

In this article, Dr. Salvian examines the management of peripheral arterial disease, aortic aneurysmal disease and cerebrovascular disease from symptomatology to diagnosis and treatment..

ECG of the Month
A Matter of Degree
Keith J.C. Finnie, MB, ChB, FRCPC


Cardio Q & A

Experts Answering Your Questions

1. Choosing the "best" ARB or ACE inhibitor
2. Atypical chest pain
3. ARBs and the incidents of cardiac events
4. Kawasaki disease


Where, Why and How?
Helping the Heart:
Pickwickian Syndrome
A. Pausjenssen MD, MSc, FRCPC

Feature 1
Women & Heart Disease:
Non-Invasive Testing in the Diagnosis of CAD
Miriam Shanks, MD, FRCPC; and Bibiana Cujec, MD, FRCPC

Coronary artery disease (CAD) continues to be underdiagnosed in women which contributes to a higher mortality rate. Dr. Shanks and Dr. Cujec explore the important role played by non-invasive testing in the diagnosis of CAD in women.

Feature 2
"Doctor, I'm Short of Breath:
Is this Heart Failure?"
Derek J. Roberts, BSc (Pharm); and Miroslaw Rajda, MD, FRCPC

Dyspnea is the most common presenting symptom of heart failure (HF). Mr. Roberts and Dr. Rajda review the utility of various clinical tools for diagnosing HF in patients presenting with dyspnea.

Feature 3
Radiation Induced HD:
Not a New Problem
Gabor Gyenes, MD, PhD

For a long time the heart was thought to be a radio-resistant organ. However cardiac complications were noted in patients who received high-dose radition therapy. In this article, Dr. Gyenes examines the occurrence of radiation-induced heart disease (RIHD) and how, with proper protection, the rates of RIHD are becoming relatively infrequent.

ECG of the Month
An Exception to the Rule
Keith J.C. Finnie, MB, ChB, FRCPC


Cardio Q & A

Experts Answering Your Questions

1. The role of digoxin
2. Using amiodarone
3. Diet, exercise and cardiovascular disease
4. Clopidogrel: for how long?


CardioCase of the Month:
Constrictive Periocarditis
Risk for Cardiac Morbidity
N. Ghorpade, MBBS, MS, MCh; and A. Koshal, MBBS, MS, FRCSC

Feature 1
What Every Physician Should Know:
Preventing SCD
Amer M. Johri, MD, MSc, FRCPC; and Chris Simpson MD, FRCPC, FACC

DThe Canadian Heart Rhythm Society estimates that, in Canada, sudden cardiac death (SCD) is responsible for about 40,000 deaths annually; more than AIDS, breast cancer and lung cancer combined. In this article, Dr. Johri and Dr. Simpson examine SCD and provide case examples which highlight the appropriate use of implantable cardioverter defibrillators.

Feature 2
CCTA:
A Noninvasive Assessment of CAD
Brett Heilbron, MC, ChB, FRCPC, FACC; and Bruce B. Forster, MD, MSc, FRCPC

In this article, Dr. Heilbron and Dr. Forster look at the noninvasive assessment of coronary artery disease, by means of coronary computed tomography angiography.

Feature 3
Treating Clifford:
Clopidogrel use in ACS and Post-PCI
Jaroslav Hubacek, MD, MSc, FRCPC; and Stephen Fort, MD, MRCPC, FRCPC

Considering the confusion as to the appropriate duration of clopidogrel therapy for patients with acute coronary syndrome and post-percutaneous coronary intervention, due to differing recommendations, Dr. Hubacek and Dr. Fort outline the importance of sustained/lon-term dual antiplatelet therapy.

ECG of the Month
All in the Head?
Keith J.C. Finnie, MB, ChB, FRCPC


Cardio Q & A

Experts Answering Your Questions

1. BP Disparity
2. Pre-exercise assessment
3. Restarting anticoagulation therapy
4. Other benefits of ARBs


CardioCase of the Month:
Who was that Masked Man?
The Challenge of Masked Hypertension
Andrew Shih, BSc; Merne P. Wilson, RN, MSc; and Thomas Wilson, MD, FRCPC, FACP

Feature 1
Dyslipidemia:
What to Look For
Jiri Frohlich, MD, FRCPC

Dyslipidemia is a condition characterized by abnormal concentrations of lipids or lipoproteins in the blood. In this review, Dr. Frohlich examines the relationship that exists between dyslipidemia and cardiovascular risk for MI, while providing readers with an overview of the latest treatment options and their effects. .

Feature 2
Assessing Chest Pain in the Office
Bruce Josephson, MD, FRCPC

Patients with chest pain who present to their primary care physicians worry as to the cause of their discomfort. In this article, Dr. Josephson uses three examples of assessing an office patient with chest pain and provides readers with points to consider in order to properly diagnose coronary artery disease.

ECG of the Month
Maintaining the Pace
Keith J.C. Finnie, MB, ChB, FRCPC


Cardio Q & A

Experts Answering Your Questions

1. HRT risk on cardiovascular events
2. ß-blockers post-MI
3. Treating PAT
4. CCBs as secondary prevention


CardioCase:
Hypertrophic Cardiomyopathy
Abdullah Alshehri, MD; and Andrew Ignaszewski, MD, FRCPC

Feature 1
Acute Pulmonary Embolism:
Practical Questions GPs Want Addressed
James D. Douketis, MD, FRCPC

Pulmonary embolism is a common and potentially life-threatening disease. The objectives of this brief review are to address questions that are commonly asked by clinicians involved in the day-to-day care of patients with pulmonary embolism.


Feature 2
Cardiovascular Effects of Vitamins:
Are They Really “Amines” of Life?
Dafna Rippel, MD, MHA; Najeeb Jaha, MD; and Andrew Ignaszewski, MD, FRCPC

Vitamins are organic molecules not synthesized by the human body but are required for carrying out essential biochemical reactions. The fact that vitamin deficiency causes illness, along with the belief that an excess of the water-soluble vitamins is harmless, has encouraged their over-consumption in the last several decades. This
literature review will discuss several of the main prospective studies that were published in the last few years regarding vitamin E, folic acid and vitamins B6 and B12 and their influence on our treatment policy.


ECG of the Month
Fumble or Interception?
Keith J.C. Finnie, MB, ChB, FRCPC


Cardio Q & A

Experts Answering Your Questions

1. Which meds for WPW Syndrome?
2. Does CHD cause hypertension?
3. Small vessel coronary artery disease
4. Reducing C-reactive protein


CardioCase of the Month
Tachycardia-Induced Cardiomyopathy:
Too Fast For Your Own Good
Chris Gray, MD, FRCPC; and Magdy Basta, MB, BCh, FRACP


Cardiovascular News

• Quebec institutions unite to fight the leading
cause of infant mortality
• Induced hypothermia should be standard
of care, says ER doctor

Feature 1
The Truth About CCBs
Ten Years Later
Ellen Burgess, MD, FACP, FRCPC

In 1995, it was determined that the use of calcium channel blockers (CCBs) was associated with an increased risk of cardiovascular events and death, which ultimately resulted in heightened fears about the use of CCBs. This article reviews the significant findings of epidemiologic and hypertension studies which followed in the 10 years after these intial claims


Feature 2
A Quick Course in Stroke Prevention
Ashfaq Shuaib, MD, FRCPC, FAHA

Cerebrovascular disease remains a common neurologic problem and its incidence is likely to increase over time. It is strongly recommended that patients be aggressively investigated and the risk factors well managed. Unfortunately, many such individuals continue to be hypertensive or have high cholesterol.


ECG of the Month
Truth Concealed and Revealed
Keith J.C. Finnie, MB, ChB, FRCPC


Cardio Q & A

Experts Answering Your Questions

1. The importance of exercise
2. LV vs. RV and digoxin
3. B-blockers post MI?
4. Nitrates and CAD patients


CardioCase of the Month
Metabolic Syndrome:
Why Should We Look For It?
Dafna Rippel, MD, MHA and Andrew Ignaszewski, MD, FRCPC


Cardiovascular News
• Arxitra® reduced risk of death or recurrent
heart attack

Feature 1
Guidelines for Treating STEMI:
Case-Based Questions
Barry Rose, MD, FRCPC, FACC

As many as 25% of eligible patients presenting with STEMI do not recieve any form of reperfusion therapy. The ACC/AHA guidelines highlight steps to improve coronary blood flow and reduce events in patiennts presenting with STEMI.


Feature 2
Stroke Prevention
What Are the Options?
A.D. Bell, M.D.

Stroke is the leading cause of physical disability, functional impairment and mortality. Prevention-throug risk factor modification, antiplatelet therap, immediate management of TIA and carotid endarterectomy- remains the best approach to reducing the stroke burden.


Feature 3
Clinical Viewpoint:
Reducing HF Hospitilizations with Digoxin:
A Closer Look at the DIG Trial
A Discussion Between Dr. Ali Ahmed, MD, PH, FACC, FAHA and Dr. Michel White, MD, FRCPC


ECG of the Month
A Sudden Transformation
Keith J.C Finnie, MB, ChB, FRCPC


Cardio Q & A

Experts Answering Your Questions

1. Vitamin supplementation
2. Insomnia and CV problems
3. Caring for patients with pacemakers
4. The roles of ASA & dipyridamole


CardioCase of the Month
Takotsubo Cardiomyopathy:
The Broken Heart Syndrome
Chris Gray, MD, FRCPC and Richard Townley, MD, FRCPC

Volume 22, No. 3
March 2006

Feature 1
2006 Canadian Hypertension Education Program Recommendations
What are the New Key Messages?
On behalf of the Evidence-based Recommendations Task Force of the Canadian Hypertension Education Program

As hypertension remains a significant health problem, the Canadian Hypertension Education Program provides its seventh annual revised recommendations for the management of this condition . What's new this year and what is old, but still important?


Feature 2
Combining Antihypertensives in People with Diabetes
Lori MacCallum, BScPhm, PharmD


ECG of the month
Keith J.C. Finnie, MB, ChB, FRCPC

A Matter of Camouflage


Cardio Q&A

Experts Answering Your Questions

1. Investigation palpitations
2. Examining ECHO
3. Lowering digoxin
4. Juice truth


CardioCase of the Month
Bandar Al Ghamdi, MD and Charles R Kerr, FRCPC


ARVD: What You Need to Consider


Cardiovascular News

• World's smallest ICD successfully implanted in Canada!
• Once again, Lipitor® safety is confirmed
• ACTOS® reduces chance of further heart attack
• Rimbonabant maintains improvements for up to two years
• Tracleer® shown to be efficacious for the treatment of PAH in children
• ASCOT study shows reductions in mortality and strokes

Feature 1
Selecting an ACE Inhibitor:
A Question of Class Effect?
Milan Gupta, MD

All members of a drug class are not therapeutically equivalent. In recent years, the concept of class effect has been under considerable debate, largely fueled by evidence of differing efficacy and toxicity of agents within common drug classes, including the wifely prescribed class of ACE inhibitors.


Feature 2
Rate vs. Rythm Control:
Making the Decision
Kamran Ahmad, MD, FRCP(C), and Paul Dorian, MD, MSc, FRCP(C)

As stated in recently published guidelines, there is no evidence that rythm control or rate control is superior to the other, and both are recommended as acceptable initial approaches in all but permanent AF (rate control preferred). The choice of appraoch is not trivial, and should be made to best achieve patient well being and quality of life. Pre-existing patient characteristics may make a rythm control approach impossible, and rate control should be sought instead.


ECG of the Month
Keith J.C. Finnie, MB, ChB, FRCPC

Guilt by Association


Cardio Q&A

Experts Answering Your Question

1. Statins for STEMIs
2. Which meds for AF
3. ACEIs omitted
4. Warfarin and DVT


CardioCase of the Month
Michael Bayliss, MD, Carolyn Taylor, MD, FRCPC and Krishman Ramanathan, MD, ChB D, FRACP


The Shocking Truth:
An Approach to Cardiogenic Shock


Cardiovascular News

• Study shows losartan-based treatment significantly reduces BP
• BMI challened as best obesity measure

Feature 1
When, Why and How?
Diabetic Cardiac Autonomic Neuropathy
Joaquin G. Jison, MD and Neil Brass, MD, FRCPC


Feature 2
Strategies for Stroke
Thomas Jeerakathil, BSc, MSc (epidemology), MD, FRCP(C)(Neurology)

Ischemic stroke is a complex disease, the management of which involves features of cardiology, internal medicine and rehabilitive medicine. Is there a thorough, yet simplififed, approach to acute ischemic stroke?


Feature 3
Antiplatelet Agents in CV Disease?
What's the best option?
Michelle M. Graham, MD, FRCPC

Antiplatelet agents are among the mainstays of both acute and chronic therapy for coronary artery disease. But with a variety of agents to choose from, which agent offers the most benefit in a given scenario?


ECG of the Month
Keith J.C. Finnie, MB, ChB, FRCPC

Too Much of a Good Thing


Cardio Q&A

Experts Answering Your Questions

1. Finding the zone
2. Diabetes, post-surgery
3. ASA at what age?
4. Insomnia and CV problems

CardioCase of the Month
Joaquin G. Jinson, MD and Neil Brass, MD, FRCPC


HOCM:
A Classic Hemodynamic Tracing


Cardiovascular News

• Lipitor® approved to reduce heart attack and stroke in diabetes
• Study provides important guidance for CVD prevention
• New Lipitor® study demonstrates benefit to intensive LDL-C lowering
• Pfizer establishes new CV research awards program