Treating Statin-Intolerant Patients
Lowering LDL cholesterol takes a multi-disciplinary approach for statin-intolerant patients
Before you label a patient as statin-intolerant, consider this: many patients have success using a different statin, lower dosing or a combination of prescriptive and over-the-counter therapies that can produce the desired results. Cleveland Clinic ushers patients through the complex process of finding a comfortable, effective regimen that, for many, produces the same positive reductions in low-density lipoprotein (bad) cholesterol, with presumed benefits similar to that seen with traditional statin use.
Could Quality Measures Put Patients at Risk?
Numbers don’t tell all about patient care. A closer look at quality measures reveals that many well-intended processes and standards can result in negative consequences.
Quality measures that are designed to improve patient care actually may cause greater risk and unintended consequences. In other words, what looks good on paper could pose high risk to patients when put into practice. Umesh N. Khot, MD, Chief Quality Officer for Cardiovascular Medicine at Cleveland Clinic, believes that is why careful analysis of quality measures is critical to ensure that newly implemented processes and standards will truly benefit patient outcomes.
Young at Heart
Surgical options for young patients with aortic valve disease.
About 2 percent of people are born with congenital aortic valve disease, and more serious complications can present at any time in their lives. It’s important for patients and surgeons to understand surgical options, so when it’s time to operate, everyone is prepared.
Image of the Issue
This is a giant left renal artery aneurysm seen on a 3D volume rendered image from a CT scan. The image is presented by Cleveland Clinic vascular surgeon Sean Lyden, MD. He chose to address the issue through open surgery involving a kidney autotransplant.
Case Study: Retrieving an Inferior Vena Cava Filter
Cleveland Clinic’s IVC Filter Retrieval Clinic is focused on removing removable or temporary placed inferior vena cava (IVC) filters to ensure patient safety. In this case, a patient with an imbedded IVC filter avoided open surgery thanks to the Clinic’s expertise and minimally invasive approach.
Cardio-Oncology Center: Taking Cancer Treatment to Heart
Cleveland Clinic's Cardio-Oncology Center focuses on early detection and treatment of heart issues caused by cardio-toxic cancer therapies.
Patients with breast cancer, once cured, do not die from recurrence of their cancer according to Juan Carlos Plana, MD, co-director of Cleveland Clinic’s new Cardio-Oncology Center. "They die from heart failure."
The good news is that cancer therapy today is so effective that there are more survivors than ever before. Despite this encouraging trend, cancer patients have another challenge to beat: the chemotherapies used to treat cancer are damaging to the heart.
"In the past, the cardiac complications of cancer treatments were not really a concern," says Dr. Plana. The Center is focused on early detection and treatment of heart issues stemming from cancer treatment. "Today, we are delivering very successful therapies for cancer, and patients are surviving," Dr. Plana says. "And as a result, they live long enough to experience the cardiac complications of cancer therapy."
Alternative Repair for Aortic Aneurysms
Open surgery isn't the only answer for repairing complex aortic aneurysms. Cleveland Clinic’s advanced stent grafting procedures give some patients a less invasive option.
Patients facing open surgery to repair aneurysms and dissections of the ascending aorta and aortic arch could have another alternative at Cleveland Clinic, one of the only medical institutions in the country where complex endovascular stent grafting can be performed. With the introduction of new stent graft devices that can bend to accommodate the aortic arch, it’s now possible to treat more extensive disease, says Matthew Eagleton, MD, a vascular surgeon at Cleveland Clinic.
"Branched devices aren't available everywhere," Dr. Eagleton says. "Because of the research conducted here, we are not limited to only treating patients with conventional aneurysms. We can treat much more complex disease."
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A-Fib | Special Report on the Rare and Revised
The Case Study and Image of the Issue presented in this edition both highlight patients who were diagnosed with atrial fibrillation (a-fib) before coming to Cleveland Clinic for care. Following comprehensive work-ups and assessments at the Miller Family Heart and Vascular Institute, both patients were found to have other complex issues in need of treatment: pericarditis and a congenital heart defect.
Image of the Issue: Uncovering Constrictive Pericarditis
One heart condition led to another for a patient who initially presented with atrial fibrillation.
After 10 minutes mowing the lawn, Kathy*, 44, felt winded and didn't have the energy to continue. Her legs showed no swelling, but shortness of breath limited her activities. Three years before seeing physicians at Cleveland Clinic, Kathy was diagnosed at another hospital with atrial fibrillation (a-fib). She had undergone radiofrequency ablation of her pulmonary veins two times to relieve atrial fibrillation—and both times, the procedure failed.
A case study from our Summer Physician eNewsletter
When a 58-year-old male presented with fatigue and shortness of breath, his history of atrial fibrillation (a-fib) was no surprise. Previous attempts at another hospital to surgically repair the a-fib and treat it with medications were unsuccessful. The patient had an ablation in 2009, followed by a Maze procedure in 2010. Despite these surgeries and medication, the flutter in his heart still could not be controlled—until he took his case to Cleveland Clinic.
The Beat Stops Here: Managing AF with Drug Therapy vs. Ablation
Drug therapy has always been the first line of treatment for AF, but recent studies show encouraging outcomes for an ablation-first strategy.
Ablation is currently the second line of therapy for atrial fibrillation (AF), considered only after a medicine has failed to control heart rhythm or drug therapy is not well tolerated by the patient. But recent studies touting better outcomes for an ablation-first strategy could turn this clinical guideline on its head.
Image of the Issue: Seeing Pericardial Inflammation with Multi-modality Imaging
A multi-modality imaging strategy can properly diagnose pericarditis so the disease can be effectively managed.
A patient presenting with pericarditis—inflammation of the lining around the heart—can be mistakenly diagnosed and poorly treated when there is lack of understanding about the disease and its complications. Pericarditis can be confused with nonspecific chest pain, or even heart attack.
Case Study: Ischemic Stroke and Left Ventricular Dysfunction
A 22-year-old woman with Ischemic Stroke and Left Ventricular Dysfunction
Case Presentation: Shikhar Agarwal, MD, MPH, CPH, Cardiology Fellow, Cleveland Clinic
A 22-year-old female was transferred to Cleveland Clinic from an outside hospital for evaluation of acute ischemic stroke. She has presented to an outside hospital two days prior with acute onset numbness and tingling of bilateral upper extremities and mild expressive aphasia.