{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzm8w1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzm8w1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;7\\\/5\\\/22\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;7\\\/5\\\/22\u0022}],\u0022ac\u0022:{\u0022spmdc;7\\\/5\\\/22\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;7\\\/5\\\/22\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAt its annual congress in Vienna, the European Society of Cardiology presented several new treatment guidelines. The following is an overview of the changes in coronary heart disease prevention, hypertension, NSTE-ACS diagnosis and therapy, the definition of myocardial infarction, valvular heart disease, and cardiac pacing.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology guidelines\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EThe New Guidelines Are Here\u003C\/h2\u003E\n         \u003Cp id=\u0022p-2\u0022\u003E\n            \u003Cstrong\u003EAt its annual congress in Vienna, the European Society of Cardiology presented several new treatment guidelines. The following is an overview of the changes.\u003C\/strong\u003E\n         \u003C\/p\u003E\n         \u003Cdiv id=\u0022sec-2\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003ECoronary Heart Disease (CHD) Prevention\u003C\/h3\u003E\n            \u003Cp id=\u0022p-3\u0022\u003EThe new guidelines are more rigorous for both primary and secondary prevention of stroke and myocardial infarction. The formula \u201c0\u20133\u20135\u2013140\u20135\u20133\u20130\u201d should be applied in healthy individuals (primary prevention).\u003C\/p\u003E\n            \u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n                  \u003Cp id=\u0022p-4\u0022\u003E0 cigarettes\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n                  \u003Cp id=\u0022p-5\u0022\u003E3 km of walking or 30 minutes of moderate physical exercise daily\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n                  \u003Cp id=\u0022p-6\u0022\u003E5 servings of fruit or vegetables daily\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n                  \u003Cp id=\u0022p-7\u0022\u003E140 mmHg as the upper limit for systolic blood pressure\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n                  \u003Cp id=\u0022p-8\u0022\u003E5 mmol\/l as the limit for total cholesterol (approximately 190 mg\/dl)\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n                  \u003Cp id=\u0022p-9\u0022\u003E3 mmol\/l as the limit for LDL cholesterol (approximately 116 mg\/dl)\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n                  \u003Cp id=\u0022p-10\u0022\u003E0 excess weight, no diabetes\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\n            \u003Cp id=\u0022p-11\u0022\u003ELower target values apply to high-risk individuals (secondary prevention):\u003C\/p\u003E\n            \u003Cul class=\u0022list-unord \u0022 id=\u0022list-2\u0022\u003E\u003Cli id=\u0022list-item-8\u0022\u003E\n                  \u003Cp id=\u0022p-12\u0022\u003EBP \u0026lt;130\/80 mmHg\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-9\u0022\u003E\n                  \u003Cp id=\u0022p-13\u0022\u003ETotal cholesterol \u0026lt;175 mg\/dl (ideally \u0026lt;155 mg\/dl)\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-10\u0022\u003E\n                  \u003Cp id=\u0022p-14\u0022\u003ELDL cholesterol \u0026lt;100 mg\/dl (ideally \u0026lt;75 mg\/dl)\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-11\u0022\u003E\n                  \u003Cp id=\u0022p-15\u0022\u003EGlucose \u0026lt;110 mg\/dl\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-12\u0022\u003E\n                  \u003Cp id=\u0022p-16\u0022\u003EHbA1c \u0026lt;6.5%\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\n            \u003Cp id=\u0022p-17\u0022\u003EThe new recommendations place greater emphasis on the importance of exercise and body weight. Accordingly the BMI\/waist circumference parameter has been included in the individual risk assessment tables. Heart rate, renal function and risk factors considered as CHD equivalents represent additional new parameters.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-3\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EHypertension\u003C\/h3\u003E\n            \u003Cp id=\u0022p-18\u0022\u003EThe new hypertension guidelines also place increased emphasis on exercise and weight reduction as key treatment elements. The decision on pharmacological treatment is primarily based on the risk category. The recommended target blood pressure depends on the patient\u0027s risk profile. While some blood pressure levels (eg, 130\/85 mmHg) are still considered normal in healthy individuals, these values may be excessive for patients with higher risk levels (eg, diabetes or renal insufficiency). Increased attention is paid to the early detection of hypertensive end-organ damage. In this context, the sonographic determination of the intima-media thickness and the identification of microcalcifications via high-resolution CT have gained in importance. The goal no longer is restricted to reducing cardiovascular events, but now extends to preventing the occurrence and progression of subclinical end-organ damage.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-4\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003ENSTE-ACS Diagnosis and Therapy\u003C\/h3\u003E\n            \u003Cp id=\u0022p-19\u0022\u003EGuideline changes affect the indication and timing of invasive evaluation. Immediate coronary angiography is recommended in patients exhibiting dynamic ST changes, life-threatening arrhythmia or hemodynamic instability unresponsive to treatment. Angiography should be performed within 72 hours in high- and intermediate-risk patients with stable heart rhythm and hemodynamic status. Elective angiography or no angiography is recommended in patients at low risk. This recommendation emphasizes that not all patients with NSTE-ACS necessarily require angiography. Another new aspect is reporting the \u201cnumber-needed-to-treat\u201d for all pharmacological measures, permitting a cost efficiency calculation. For the first time, special issues such as hemorrhagic complications, chronic renal disease, anemia and female gender are raised, as these factors significantly influence outcome. The indications for the use of basic medications - antianginal drugs, ASA, and clopidogrel - remain largely unchanged from the previous iteration. New guidelines are presented regarding anticoagulation therapy after the introduction of new agents tested in the ACS setting such as fondaparinux and bivalirudin. The type of anticoagulant and the indication for GPIIb\/IIIa blocker therapy depend on the individual risk and selected strategy.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-5\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EUniversal Definition of Myocardial Infarction\u003C\/h3\u003E\n            \u003Cp id=\u0022p-20\u0022\u003EThe efforts to achieve a universal definition and classification of myocardial infarction, which began in 1999, have now come to fruition. The ESC, ACC and WHO all contributed to the process. Globally, the term myocardial infarction should only be used when at least one biomarker is elevated above the upper reference limit in the context of sustained ischemia, and, at least one of the following criteria is met: typical symptoms, new ST elevation (or new left bundle branch block), new Q-wave formation or imaging evidence of new necrosis or a new regional wall motion disturbance. In terms of classification, five types of myocardial infarction are differentiated:\u003C\/p\u003E\n            \u003Cblockquote id=\u0022disp-quote-1\u0022 class=\u0022disp-quote\u0022\u003E\n               \u003Cp id=\u0022p-21\u0022\u003EType 1: Spontaneous infarction based on stenosing\/occluding plaques\u003C\/p\u003E\n               \u003Cp id=\u0022p-22\u0022\u003EType 2: Infarctions due to increased oxygen demand or decreased supply not caused by occluding plaques (eg, coronary spasm)\u003C\/p\u003E\n               \u003Cp id=\u0022p-23\u0022\u003EType 3: Infarctions with cardiac arrest or sudden cardiac death\u003C\/p\u003E\n               \u003Cp id=\u0022p-24\u0022\u003EType 4a: Infarctions associated with PCI or angiography\u003C\/p\u003E\n               \u003Cp id=\u0022p-25\u0022\u003EType 4b: Infarctions associated with stent thrombosis\u003C\/p\u003E\n               \u003Cp id=\u0022p-26\u0022\u003EType 5: Infarctions associated with bypass surgery\u003C\/p\u003E\n            \u003C\/blockquote\u003E\n            \u003Cp id=\u0022p-27\u0022\u003EThe evaluation of the cardiac biomarker increase in the context of PCI and bypass surgery has changed. The event is only to be classified as an infarction if the levels are three times (PCI) or five times (CABG) higher than the upper reference limit. Events with lower levels are now to be identified as periprocedural necrosis. Imaging diagnostics have clearly become more important in the new definition. Troponin was confirmed as the most important biomarker.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-6\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003EValvular Heart Disease\u003C\/h3\u003E\n            \u003Cp id=\u0022p-28\u0022\u003EFor the first time, European guidelines are now available for the diagnosis and therapy of valvular heart disease (VHD). They are important, since older, multimorbid individuals are increasingly affected by VHD, rendering decisions regarding the further approach difficult at times. The guidelines address the classification of severity, required examinations, indications for valve replacement, possibilities of reconstruction and target values for antithrombotic medication. They support the key role of echocardiography. At the same time, all echocardiographic findings are to include quantitative parameters and an exact description of the lesion. The invasive assessment of valvular function should be reserved for rare cases where echocardiography findings and clinical findings do not correlate. Age represents only one of many factors to be considered when deciding on an intervention. The decision process should be multidisciplinary, including cardiologists, surgeons and anesthesiologists. Less invasive techniques are preferred wherever possible. In mitral insufficiency, the therapy of choice is surgical reconstruction, while percutaneous commissurotomy is preferred in mitral stenosis. In aortic valve disease, valvular replacement continues to be the gold standard.\u003C\/p\u003E\n         \u003C\/div\u003E\n         \u003Cdiv id=\u0022sec-7\u0022 class=\u0022subsection\u0022\u003E\n            \u003Ch3\u003ECardiac Pacing\u003C\/h3\u003E\n            \u003Cp id=\u0022p-29\u0022\u003EFor the first time, the European guidelines now include recommendations for cardiac resynchronization therapy in patients with cardiac insufficiency. Indication criteria are persistent symptoms despite optimal basic therapy (NYHA III-IV), and additionally EF \u0026lt;=35%, LVEDD \u0026gt; 55mm, QRS width \u0026gt;=12 ms with maintained sinus rhythm. Compared with the American guidelines published in 2002, the European guidelines establish a lower QRS width. In addition, the overall available data are considered better (recommendation class I, level of evidence A). Together with the guidelines for the management of ventricular arrhythmia and the prevention of sudden cardiac death (published in 2006), the new guidelines for cardiac pacing ensure the correct use of pacemakers and ICDs.\u003C\/p\u003E\n            \u003Cdiv class=\u0022boxed-text\u0022 id=\u0022boxed-text-1\u0022\u003E\u003Cbr\/\u003E\u003Cdiv class=\u0022graphic\u0022 id=\u0022graphic-1\u0022\u003E\u003Cdiv class=\u0022graphic-inline anchor\u0022\u003E\u003Cimg class=\u0022highwire-embed\u0022 alt=\u0022Embedded Image\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/highwire\/spmdc\/7\/5\/22\/embed\/graphic-1.gif\u0022\/\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-30\u0022\u003EFor the complete version of all new guidelines, please visit the ESC website at \u003Ca href=\u0022http:\/\/www.escardio.org\u0022\u003Ewww.escardio.org\u003C\/a\u003E.\u003C\/p\u003E\u003C\/div\u003E\n         \u003C\/div\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/5\/22.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm8w1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}