Coenzyme Q10 and utility in heart failure: just another supplement?

Heart failure affects 5.1 million people in the USA annually. It accounts for a frequent cause of hospitalizations and disability. Patients with congestive heart failure have lower plasma levels of CoQ10, which is an independent predictor of mortality in this patient population. It has been hypothesized that a deficiency of CoQ10 can play a role in the development and worsening of heart failure, and that oral supplementation can possibly improve symptoms and survival in these patients. Based on previous small studies and meta-analyses, the use of CoQ10 in heart failure suggested an improvement ejection fraction, stroke volume, cardiac output, and cardiac index with CoQ10 supplementation, however most of these small studies appeared to be underpowered to result in any significant data. The results of the recent Q-SYMBIO trial demonstrated an improvement in heart failure symptoms with a significant reduction in major adverse cardiovascular events and mortality

Pulmonary Arterial Hypertension and the Failing Ventricle: Getting It Right

Right ventricular failure (RVF) remains the primary cause of death in patients with pulmonary arterial hypertension. We review the pathophysiology of RVF, including the remodeling and ventriculoarterial uncoupling that occurs when the failing right side of the heart is unable to compensate for a rising afterload. Secondly, the noninvasive imaging techniques used in the assessment of RVF are explored, including echocardiography, cardiac magnetic resonance imaging, computed tomography, and positron emission tomography. Third, we describe how these imaging techniques and a patient’s clinical characteristics may be used to determine prognosis. Lastly, we explore the medical and surgical/interventional treatment options for RVF. Despite these treatment options, morbidity and mortality remain high in this patient population. The discovery of new prognostic indicators, use of hybrid imaging for early detection of RVF, and strategies to prevent the development of RVF will be important if outcomes in this patient population are to improve

Medication Errors in Patients With Severe Chronic Kidney Disease and Acute Coronary Syndrome: The Impact of Computer-Assisted Decision Support

OBJECTIVE: To evaluate the impact of computerized physician order entry (CPOE) with decision support on the frequency of antithrombotic medication errors in patients with chronic kidney disease (CKD) admitted with acute coronary syndrome (ACS) and to measure what effect it would have on in-hospital bleeding