Perspectives in Cardiology
2007 Back Issues

JanFebMarAprMayJun /JulAugSeptOctNov/Dec

November/December 2007, Volume 23, Number 10

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

Location, Location, Location

Cardio Q & A
Experts Answering Your Questions

• Choosing the Right ARB
• Approaching Newly Diagnosed Metabolic Syndrome
• Hs-CRP and Lipid Guidelines
• Canadian Guidelines for the Treatment of PAD?
• Treating Symptoms of “Cardiac Asthma”
• Cardiac Complications of Rheumatic Heart Disease

Behaviour Modification: Addressing Chronic Cardiac Disease
Michael Vallis, PhD, RPsych

Often, physicians find it difficult to help their patients modify their negative behavioural patterns when it comes to treating chronic cardiac disease. In this article, Dr. Vallis addresses how to best facilitate motivation in one’s patient towards change to ensure their continued adherence to the recommended risk reduction strategies.

CV Risk Assessment: So Many Options, So Little Time

The importance of effective and efficient cardiovascular (CV) risk assement is increasing as the rising demographic tide of aging baby boomers approaches. In this review, Dr. Fenske details the basics of risk assesment and how to use all of the tools available when classifying patients.

Heart Failure: The First-Line Approach
Viviane T. Q. Nguyen, MD, FRCPC

Heart failure is a growing threat in today’s society. In this article, Dr. Nguyen details how both medical and device therapies need to be coupled with lifestyle modifications, aggressive risk factor reduction and education for the successful management of heart failure.

Topics from CHEP
Chronic Disease Management in Hypertension Care
Richard Lewanczuk, MD, PhD, FRCPC

On behalf of the Canadian Hypertension Education Program (CHEP), Dr. Lewanczuk details the importance of chronic disease management principles in reducing the prevalence of hypertension in the Canadian population.

October 2007, Volume 23, Number 9

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

Is It or Isn't It?

Cardio Q & A
Experts Answering Your Questions

• Medication Recommendation for a Diabetic
• Lipid Therapy and the Reduction of Heart Disease
• Treating AF in the Setting of Diastolic Heart Failure
• Antibiotic Prophylaxis in Mitral Valve Prolapse
• Treating Severe Hyperkalemia in a Digoxin Toxic Patient
• The New Lower-Lipid Guidelines
• Treating Elevated Homocysteine Levels
• Investigating a Middle-Aged Patient with Chest Pain

Catheter Ablation: Another Option for AF
Razi Khan, MD; and Allan C. Skanes, MD, FRCPC

Atrial fibrillation (AF) is a highly common cardiac arrhythmia and a major risk factor for stroke. In this article, Dr. Khan and Dr. Skanes detail how catheter ablation significantly reduces morbidity and improves maintenance of cardiac rhythm in patients with AF.

Lipids and CHD: Treating to Lower Targets
David Fitchett, MD

The reduction of LDL-C is an important step to making an impact on the high prevalence of coronary heart disease in today’s society. In this article, Dr. Fitchett details the steps we must take to make an impact on the disease by treating global risk.

Topics from CHEP
Management of Hypertension: Optimizing the Interaction Between Pharmacists and Physicians
Luc Poirier, BPharm, MSc

On behalf of the Canadian Hypertension Education Program (CHEP), Mr. Poirier details the importance of a strong collaboration between pharmacists and physicians in order to improve the quality of treatment for those patients with hypertension.

September 2007, Volume 23, Number 8

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

Trials and Tribulations of a Tachycardia

CardioCase of the Month
Andrew Shih, BSc; and Thomas W. Wilson, MD, FRCPC

Check for Delay...To Avoid Delay

Cardio Q & A
Experts Answering Your Questions

• Screening for CV Risk Factors in Young Athletes
• General Types and Features of Pacemakers
• Intra-Atrial Aneurysm on ECHO
• Screening for Prolonged QT Interval
• Prevention in Patients with Hypercholesterol
• Urgent Intervention for AF?
• Indications for Ablation of Alternate Atrial Pathways
• Diagnosis of High BP in 2007
• Whether to Recommend a Calcium Scan
• The New York Heart Classification

Sodium, BP and Hypertension: Making the Connection
Jodi Silzer, RD; Wendy Shah, RD; and Norm Campbell, MD, FRCPC

Reducing the amount of sodium in the population’s diet is an attractive method for significantly reducing the prevalence of hypertension. In this article, Ms. Silzer, Ms. Shah and Dr. Campbell discuss the important connection between sodium, BP and hypertension.

Butt Out For Your Heart
Andrew Pipe, CM, MD

Smoking cessation is a cost-effective intervention that can dramatically transform the health of every smoker. In this article, Dr. Pipe explains how those who treat cardiovascular patients should develop and incorporate a systematic approach to the management of their smoking patients.

Reclaiming Clinical Confidence: The Diastolic Murmur

The diastolic murmur is always a signifier of cardiac pathology and is never benign. In this article, Dr. Fenske discusses how the recognition of certain clinical clues and cardiac assessment of the carotid pulse will help clinicians discover the diastolic murmur and its underlying complications.

Topics from CHEP
A Closer Look: Renal Artery Stenosis
Sheldon W. Tobe, MD, FRCPC

On behalf of the Canadian Hypertension Education Program (CHEP), Dr. Tobe gives an overview of renal artery stenosis, including the prevalence, screening techniques, management and treatment options for this serious disease.

August 2007, Volume 23, Number 7

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

A Territorial Dispute

CardioCase of the Month
Debra L. Isaac, BN, MD, FRCPC

B-Type Naturetic Peptide in Heart Failure Management

Cardio Q & A
Experts Answering Your Questions

• Cardiovascular Complications of Anorexia
• Prolonged QT Interval on ECG
• Using Clopidogrel in STEMI
• Treatment of Post-Peripheral Vascular Surgery
• Treating Patients with Two Calcium Channel Blockers
• Combining BP Medications
• Carotid Dopplers for Which Patients?
• Cardiac Risk and Smoking Status
• Right Bundle Branch Block in a Healthy Young Patient
• Warfarin or Acetylsalicylic Acid for AF

Hypertension Resources For Your Patients
Janusz Kaczorowski, PhD; Megan Smith, BSc; and Norm Campbell, MD, FRCPC

Hypertension is one of the most common ailments in Canada, yet many Canadians are poorly informed about its causes and treatment options. In this review, Dr. Kaczorowski, Ms. Smith and Dr. Campbell provide important resources to help inform your patients about hypertension.

Temporary Pacing: It’s All About Time
Stephen M. Chihrin, BSc; Paul A. Gould, MBBS PhD FRACP; and Andrew D. Krahn, MD, FRCPC

Temporary pacing. a short-term treatment for arrhythmia that produces hemodynamic instability and provides delivery of rate support. In this artice, Dr. Chihrin, Dr. Gould and Dr. Krahn discuss the indications, delivery, complications and duration of temporary pacing.

Topics from CHEP
Lifestyle and BP: Making a Healthy Change

R. M. Touyz, MD, PhD

On behalf of the Canadian Hypertension Education Program (CHEP), Dr. Touyz details the necessary lifestyle modifications that patients must strive for in order to prevent and treat hypertension. Even a small reduction in BP has a high benefit on the occurrence of hypertension.

June/July 2007, Volume 23, Number 6

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

The Procedure was Successful, But...

Cardio Q & A
Experts Answering Your Questions

• Adjusting Cholesterol Levels
• The Role of Clopidogrel Following CABG
• Echocardiogram for LVH
• Common Causes of Non-Ischemic Cardiomyopathy
• Concerns about Atorvastatin and Clopidogrel
• Clinical Outcomes and ICDs
• Using Multiple Blood Thinners
• Ordering an ECHO for Murmurs
• Manging Hypertriglyceridemia
• Treatment of Variant Angina

CardioCase of the Month
Patrick C. Bergin, MD, FRCPC

A Case of Broken Heart Syndrome

Recognizing the Source: Angina, CAD and Women
Todd J. Anderson, MD

In this article, Dr. Anderson discusses the pathophysiology, diagnosis, management and prognosis of angina in women with minimal CAD. Given the often highly symptomatic nature of angina, cost to the healthcare system and increased risk to women, it is imperative that this condition is recognized.

Lipid Disorders: Modifying the Cardiovascular Risk
Keysan Ranjbar, MD; and Michael Chan, MBBS, FRCPC, FACC, FACP

Lipid disorders are a common and modifiable cardiovascular risk factor. In this review, Dr. Chan discusses the various trials dealing with lipid disorders, as well as diagnosis, classification, management and targets which should be considered when treating patients.

Topics from CHEP
There is More to HT Than High BP

On behalf of the Canadian Hypertension Education Program (CHEP), Dr. Abbott and Dr. Bolli detail how HT is a more complicated issue than can be diagnosed after a single incidence of high BP and, once diagnosed, HT requires a lifetime of management.

May 2007, Volume 23, Number 5

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

Life is a Masquerade

Cardio Q & A
Experts Answering Your Questions

1.Clopidogrel Duration in Patients with Stents
2. Digoxin in Congestive Heart Failure
3. Increasing Patient Adherence
4. Vitamin E Supplemenation and Risk of Stroke
5. Primary Prevention of MI with ASA
6. Contraindications of Anticholinesterases
7. Risks of COX-2 and NSAIDs
8. Pickwickian Syndrome
9. Prescribing Niacin
10. Risks of Intermittent vs. Chronic AF
11. The Optimal Stroke Prevention Treatment

Antiplatelet Therapy: Preventing Recurrent Stroke
Theodore Wein, MD, FRCPC

Recurrent stroke accounts for significant mortality, morbidity and disability in today’s society. In this article, Dr. Wein describes the various methods of antiplatelet therapy that are currently recommended for use in the prevention of recurrent stroke.

STEMI in 2007: What's Best, What's Practical?
Ben Tyrell, MD, FRCPC; and Neil Brass, MD, FRCPC

There have been significant advances and refinement in the treatment of the acute MI patient over the last few years and in this article, Dr. Tyrell and Dr. Brass will review current approaches to therapy.

Topics from CHEP
2007 CHEP Recommendations

April 2007, Volume 23, Number 4

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

A Little Known Sign

Cardio Q & A
Experts Answering Your Questions

1.When to Operate on an Abdominal Aortic Aneurysm
2. When to do Routine Hs-CRP Testing
3. Autonomic Dysfunction
4. Role of EB-CT for CAD
5. Alternative to Warfarin Therapy
6. Using HMA-CoA Reducers
7. Managing Isolated Systolic Hypertension
8. Ideal LDL-C Level in Diabetics
9. Duration of Clopidogrel Therapy
10. Testing patients with Significant Cardiac Atherosclerosis

CardioCase of the Month
Hayder Kubba, MBChB, FRCS(UK), DFFP, DPD

Dressler's Syndrome: A Rare Complication

Optimizing Energy Metabolism: A Novel Approach to Treating Ischemic Heart Disease
Wendy Keung, PhD; and Gary D. Lopaschuk, PhDM

Metabolic therapies have recently emerged as a novel approach to treat myocardial ischemia. In this review, Dr. Keung and Dr. Lopaschuk will discuss the rationale for metabolic agents. The use of different metabolic agents for treatment of ischemic heart disease will also be examined.

Pulmonary Arterial Hypertension: A Serious Problem
Nancy R. Porhownik, MD; and Zoher Bshouty, MD, PhD, FRCPCC

Pulmonary arterial hypertension (PAH) is a serious disease with significant morbidity and mortality and no cure. In this article, Dr. Porhownik and Dr. Bshouty detail how early recognition of the disease and appropriate workup of possible underlying etiologies are essential.

Topics from CHEP
Treatment of Hypertension in Stroke Patients

Simon W. Rabkin, MD, FRCPC, FACC

On behalf of the Canadian Hypertension Education Program (CHEP), Dr. Rabkin details the importance of the management of hypertension in those patients who have experienced a stroke. Reduction in BP in these patients can significantly decrease morbidity and mortality.

March 2007, Volume 23, Number 3

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

High and Low

Cardio Q & A
Experts answering your questions

1. Treatment of Hypercholesterolemia
2. Prevalence of Carotid Artery Disease Under 40
3. Stopping Fluctuations of INR
4. LABA/SABA Inhalers Triggering Arrhythmias
5. Ruling Out MI Using ECGs in Small, Rural Centres
6. ECHO findings in patients with AF
7, Recommended age for ASA use for MI prevention
8. Treatment of CHF

CardioCase of the Month
Oren K. Steinmetz, MD, FRCSC

EVAR vs. OR: An Attractive Alternative

Kicking Butt: Smoking Cessation to Help the Heart
Charl Els, MBChB, FC Psych, M Med Psych, ASAM; and Peter Selby, MBBS, MHSc, FASAM

Tobacco addiction remains the leading preventable cause of death, disease and disability. Yet, effective treatment is available. In this article, Dr. Els and Dr. Selby detail the techiques used in smoking cessation and how to ensure your patients achieve their goals.

HF Management: What the FP Can Do
Debra Lynne Isaac, BN, MD, FRCPC

Heart failure (HF) is extremely prevalent in today’s society and therefore the FP must play an important role in its management. In this article, Dr. Isaac details the importance of an accurate and timely diagnosis, as well as the techniques for management of HF in the FP’s office.

Topics from CHEP
Pass the Salt? Sodium Recommendations

Norm Campbell, MD, FRCPC

On behalf of the Canadian Hypertension Education Program (CHEP), Dr. Campbell details the importance of a reduction in our sodium consumption in order to help protect against the associated risks of hypertension.

February 2007, Volume 23, Number 2

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

High and Low

Cardio Q & A
Experts Answering Your Questions

1. Discontinuing warfarin
2. ACE inhibitors and vascular endothelial cells
3. Homocysteine as a risk factor for CAD
4. Testing for CRP
5. The role of ARBs in post-MI patients
6. Combining niacin with a statin for lipids
7. 24-hour BP monitoring
8. AF and anticolinesterases

When, Why and How?
Wayne Warnica, MD, FACC, FACP, FRCPC

A Tale of Two 'Synching' Teenagers: What is LQTS Anyway?

CHEP Topics
Treatment of Uncomplicated Hypertension in 2007

Richard Lewanczuk, MD, FACC, FACP, FRCPC

On behalf of the Canadian Hypertension Education Program (CHEP), Dr. Lewanczuk details the 2007 recommendations for the treatment of hypertension, including when to start treatment, scheduling treatments, target BP levels and recommended drug combinations.

Amiodarone and the Thyroid: Deadly Potential
Arnold Voth, MD, LMCC, FRCPC, FACP

Amiodarone, an antiarrythmic drug, is gaining popularity and its use has dramatically increased in recent years. In this article, Dr. Voth details the downside of amiodarone use, namely its potentially deadly effects on the thyroid gland and the risk of developing thyroid disease.

Reducing the Risk: Measures to Lower CRP in CVD
Kailash Prasad, MBBS (Hons), MD, PhD, FRCPC, FACC, FICA, FIACS

C-reactive protein (CRP), an inflammatory protein, can be found in elevated levels in numerous disease states, such as hypertension, hyperlipidemia and Type 2 diabetes. In this review, Dr. Prasad describes the relationship between CRP and cardiovascular disease, including pathogenesis and measures to lower CRP levels.

January 2007, Volume 23, Number 1

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

Spurious Tachycardia

Cardio Q & A
Experts Answering Your Questions

1. Anticoagulating a high-risk cardiac patient
2. ASA and severe CAD
3. Switching from ACE inhibitors to ARBs
4. Warfarin use in AF patients
5. Homocysteine and C-reactive protein
6. Vitamin E supplementation

CardioCase of the Month
Patrick C. Bergin, MD, FRCPC; and John L. Sapp, MD, FRCPC

An Anxious Patient: Reviewing Asymptomatic WPW

Spotting the Signs: Metabolic Syndrome and Cardiovascular Risk
Mohamed Ravalia, MB, ChB, CCFP

The development of metabolic syndrome can be a significant precursor to the development of serious cardiovascular risk and Type 2 diabetes. In this article, Dr. Ravalia reviews the diagnosis, pathophysiology, treatment and associated diseases of metabolic syndrome.

Fighting the Epidemic: Diabetes and Heart Disease
David Fitchett, MD

The prevalence of diabetes in today’s society is at epidemic proportions and with it comes serious risk of cardiovascular disease and coronary heart disease. In this article, Dr. Fitchett details the controversies in the treatment and management of diabetes and heart disease.

Improving Mortality: The Future of Stroke Treatment
Muhammad S. Hussain, MD, FRCPC; and Ashfaq Shuaib MD, FRCPC, FAHA

Stroke is one of the most prevalent causes of mortality in the world today. In this review, Dr. Hussain and Dr. Shuaib explore the new directions stroke treatment can take in order to better manage and reduce the devastating effects of this condition.