Volume 5 Issue 1, January 2008

In this Viewpoint, Edward Frohlich provides an update to his Review from 2004 and posits that the role of salt in hypertension is far more complex than thought previously—that it 'simply' raises arterial pressure.

Despite being an increasingly recognized clinical syndrome, the mechanism of stress or 'Takotsubo' cardiomyopathy remains unknown. In this thought-provoking Review, Lyon et al. present their novel hypothesis for the mechanism behind stress cardiomyopathy, and examine what implications this hypothetical pathophysiology could have for the use of drugs or devices in the treatment of patients with this syndrome.

Rapidly developing experimental work has provided new insights into atrial fibrillation pathophysiology that will lead to new mechanism-based therapies. Statins and omega-3 polyunsaturated fatty acids have shown antiarrhythmic potential, exceeding any effect related to the treatment of underlying heart disease. Here Irina Savelieva and John Camm provide a contemporary evidence-based insight into how these agents could be exploited to prevent or reverse atrial remodeling in patients with atrial fibrillation.

In light of recent studies demonstrating a lack of benefit with late reperfusion, Sammy Elmariah, Sidney Smith and Valentin Fuster review the data for and against late reperfusion for ST-segment elevation myocardial infarction. The effects of current medical therapies, risk-stratification techniques and indications for the use of late reperfusion over medical management are also examined.

Pheochromocytomas are catecholamine-producing tumors situated in the adrenal medulla. In this month's Case Study, Kobal and colleagues describe an unusual presentation of pheochromocytoma: cyclic waves of hypertension alternating with hypotension. The patient was successfully treated with phentolamine, intravenous fluids and doxazosin, before eventually undergoing surgical removal of the tumor.