Volume 10 Issue 4, April 2013

Inhibition of the renin–angiotensin–aldosterone system (RAAS) is a successful therapy for hypertension, heart failure, and renal insufficiency. Overdosing of RAAS inhibitors is occasionally observed when several agents are used together, and can cause adverse events such as hypotension, hyperkalaemia, and renal failure. We advocate optimal, rather than complete, RAAS blockade.

The Look AHEAD trial did not show that a lifestyle modification programme aimed at weight loss could reduce the incidence of cardiovascular disease events. We attempt to address why this trial was 'negative', and emphasize that further randomized lifestyle modification trials focusing on the effects of physical activity and exercise are needed.

In a meta-analysis of predominantly observational data, blood transfusion was independently associated with adverse outcomes in patients with myocardial infarction. These findings are consistent with previously published research, but clinical application of these data is hindered by the lack of prospective, randomized trials and the inherent bias in observational studies.

In a new, observational study, survival and neurological outcome at 1 month after out-of-hospital cardiac arrest were worse in patients treated with an advanced airway than in those treated with bag–mask ventilation. These results contradict the common assumption that advanced airway management is associated with improved outcome.

Tricuspid valve disease generally occurs secondary to other cardiac conditions, particularly mitral valve regurgitation or stenosis. Repair gives excellent results, but a substantial proportion of patients experience late failure, and appropriate selection of patients and repair technique remain a challenge. In this article, Shinn and Schaff review the pathophysiology of tricuspid valve disease and describe its surgical management.

Right ventricular failure is a complex problem with several possible aetiologies—including pulmonary hypertension, cardiomyopathy, myocardial infarction, congenital or valvular heart disease, and sepsis—and commonly has a very poor prognosis. Many of the signs and symptoms of this condition are nonspecific and can be acute or chronic. In this Review, Dr Marc Simon describes the various pathophysiological causes of right ventricular failure, and discusses available diagnostic and management strategies, with a focus on patients who have underlying pulmonary hypertension.

Cigarette smoke is an aerosol that exerts multiple atherothrombotic effects on smokers and the individuals around them. In this Review, Drs Csordas and Bernhard describe the current knowledge of the mechanisms through which cigarette smoke affects all stages of plaque formation and development, as well as pathological thrombus formation.

In many clinical trials, procedure-related myocardial infarctions are assigned a similar prognostic value to spontaneous myocardial infarctions. Robbert de Winter and colleagues argue that procedure-related myocardial infarctions do not necessarily have important prognostic implications, and that the recent definition of a procedure-related myocardial infarction, including a relevant biomarker increase and supporting evidence, needs to be closely followed.