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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.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\u003EThis article gives an overview of the key messages related to cardiovascular disease (CVD) prevention in the the Fifth Joint Task Force of the Guidelines on CVD prevention in clinical practice [Perk J et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2012]. Therapeutic guideline updates include acute and chronic heart failure, acute myocardial infarction with ST-segment elevation, atrial fibrillation, valvular heart disease, an an updated third universal definition of myocardial infarction.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EFeatured Meeting - Specialty page\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EValvular Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EGuidelines Overview\u003C\/h2\u003E\n         \u003Cp id=\u0022p-2\u0022\u003EJoep Perk, MD, Linnaeus University, Kalmar, Sweden, gave an overview of the key messages related to cardiovascular disease (CVD) prevention in the the Fifth Joint Task Force of the Guidelines on CVD prevention in clinical practice [Perk J et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2012]. Over 50% of CVD mortality reductions are due to changes in risk factors, while 40% are related to improved treatments. Among the new concepts are 4 levels of CVD risk (very high, high, moderate, low), risk-factor screening for men \u0026gt;40 years and women \u0026gt;50 years or if postmenopausal, risk-age concept, importance of psychosocial risk factors, limited role of novel risk biomarkers; no exposure to passive smoking, role of specific diet patterns, and multimodal behavioral intervention effectiveness. \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E outlines the key recommendations for blood pressure, diabetes, and lipids.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14234\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14234\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14234\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-3\u0022 class=\u0022first-child\u0022\u003EKey BP, Diabetes, and Lipid Recommendations.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EAcute and Chronic Heart Failure\u003C\/h2\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EJohn McMurray, MD, Glasgow University, Glasgow, United Kingdom, summarized the new 2012 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (HF) [McMurray JJ et al. \u003Cem\u003EEur J Heart Fail\u003C\/em\u003E 2012]. The main changes from 2008 for the treatment of chronic HF are expanded indications for mineralocorticoid receptor antagonists (MRAs), a new indication for the sinus node inhibitor, ivabradine, an expanded indication for cardiac resynchronization therapy (CRT), new information on coronary revascularization in systolic HF, recognition of the growing use of ventricular assist devices, and the emergence of transcatheter valve interventions. New diagnostic tools for HF include mid-regional pro-atrial natriuretic peptide, 3D and strain imaging echocardiography, computed tomography coronary angiography, cardiac magnetic resonance, and genetic testing.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003ETreatment options for chronic symptomatic systolic HF are shown in \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E. Treatment should begin with diuretics plus an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) with the addition of a \u03b2-blocker in patients with left ventricular ejection fraction (LVEF) \u226440%. Adding an MRA is recommended followed by ivabradine if the patient remains symptomatic, with an LEVF \u226435%, and is in sinus rhythm with a heart rate \u226570 beats per minute (bpm). An implantable cardioverter-defibrillator should be considered in patients with persistent NYHA Class II and III and LVEF \u226435%; for those who also have a QRS duration \u2265120 ms, CRT should be considered. An LV assist device or biventricular assist device is recommended in select patients with end-stage HF.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/13\/6\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Treatment Options for Patients with Chronic Symptomatic Systolic HF.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1156265795\u0022 data-figure-caption=\u0022Treatment Options for Patients with Chronic Symptomatic Systolic HF.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/13\/6\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/13\/6\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/13\/6\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14228\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003ETreatment Options for Patients with Chronic Symptomatic Systolic HF.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EACE=agiotensin-converting enzyme; ARB=angiotensin receptor blocker; CRT-D=cardiac resynchronization therapy defibrillator; CRT-P=CRT plus pacemaker; H-ISDN=hydralazine and isosorbide dinitrate; HR=heart rate; ICD=implantable cardioverter-defibrillator; LVAD=left ventricular assist device; LVEF=left ventricular ejection fraction; MRA=mineralocorticoid receptor antagonist.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from the European Society of Cardiology. All rights reserved. Copyright \u00a9 2012.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EThe new algorithm for management of acute HF is shown in \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/13\/6\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Initial Assessment of a Patient with Suspected HF.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1156265795\u0022 data-figure-caption=\u0022Initial Assessment of a Patient with Suspected HF.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/13\/6\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/13\/6\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/13\/6\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14230\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003EInitial Assessment of a Patient with Suspected HF.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EIV=intravenous; NTG=nitroglycerin; SBP=systolic blood pressure.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-4\u0022\u003EReproduced with permission from the European Society of Cardiology. All rights reserved. Copyright \u00a9 2012.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EAcute Myocardial Infarction with ST-Segment Elevation\u003C\/h2\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EPhilippe Gabriel Steg, MD, H\u00f4pital Bichat, Paris, France, and Stefan James, MD, PhD, Uppsala University Hospital, Uppsala, Sweden, presented the changes and additions to the new European Society of Cardiology (ESC) Guidelines on ST-segment elevation myocardial infarction (STEMI), which include expanded sections on early diagnosis and cardiac arrest as well as updated recommendations on pre-hospital logistics of care, reperfusion strategies, percutaneous coronary intervention (PCI) strategies, and routine therapies [Steg PG et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EIn the emergency setting, an ECG should be recorded within 10 minutes of first medical contact (FMC). Reperfusion is indicated in all patients with symptoms of \u0026lt;12 hours and persistent STE or new left bundle branch block, and in patients with ongoing ischemia even if symptoms started \u0026gt;12 hours before. For patients presenting with a STEMI to a PCI-capable hospital, the guidelines advise primary PCI, to be achieved within \u0026lt;60 minutes (\u003Ca id=\u0022xref-fig-3-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F3\u0022\u003EFigure 3\u003C\/a\u003E). For patients with STEMI presenting to a non-PCI-capable hospital, the selection of reperfusion therapy is based on whether PCI is possible in \u2264120 minutes; if it is, PCI should be attempted with a target of FMC to primary PCI, \u226490 minutes. If not, patients should receive immediate fibrinolysis with a target time from FMC to fibrinolysis, \u226430 minutes. Following successful fibrinolysis, routine angiography is recommended within a window of 3 to 24 hours.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F3\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/13\/6\/F3.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Prehospital and In-Hospital Management and Reperfusion Strategies within 24 Hours of FMC.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1156265795\u0022 data-figure-caption=\u0022Prehospital and In-Hospital Management and Reperfusion Strategies within 24 Hours of FMC.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 3.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/13\/6\/F3.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/13\/6\/F3.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 3.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/13\/6\/F3.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14232\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 3.\u003C\/span\u003E \n               \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003EPrehospital and In-Hospital Management and Reperfusion Strategies within 24 Hours of FMC.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-5\u0022\u003E*The time point the diagnosis is confirmed with patient history and ECG ideally within 10 minutes from the FMC; All delays are related to FMC; ECG=electrocardiogram; EMS=emergency medical service; FMC=first medical contact; PCI=percutaneous coronary intervention; STEMI= ST-segment elevation myocardial infarction.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-6\u0022\u003EReproduced with permission from the European Society of Cardiology. All rights reserved. Copyright \u00a9 2012.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EOther key recommendations include the following:\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-14\u0022\u003EPrimary PCI with stenting is preferred over thrombolysis\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n               \u003Cp id=\u0022p-15\u0022\u003ELimit primary PCI to culprit vessel\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n               \u003Cp id=\u0022p-16\u0022\u003ERadial access preferred over femoral access if operator experienced\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n               \u003Cp id=\u0022p-17\u0022\u003EDrug-eluting stent preferred to bare-metal stent if no prolonged dual antiplatelet therapy contraindications\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n               \u003Cp id=\u0022p-18\u0022\u003EAspirin antiplatelet therapy, with the addition of an adenosine diphosphate\u2013receptor blocker\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n               \u003Cp id=\u0022p-19\u0022\u003EConsider Gb IIb\/IIIa inhibitors for bailout therapy\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n               \u003Cp id=\u0022p-20\u0022\u003EInjectable anticoagulant required for primary PCI; bivalirudin preferred and enoxaparin may be preferred over unfractionated heparin\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EAtrial Fibrillation\u003C\/h2\u003E\n         \u003Cp id=\u0022p-21\u0022\u003EJohn Camm, MD, St. George\u0027s University, London, United Kingdom, presented the 2012 focused update on the ESC Guidelines for the management of atrial fibrillation (AF) [Camm AJ et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2012]. The focus of the 2012 update was on anticoagulation risk stratification, novel oral anticoagulants (NOACs), left atrial appendage (LAA) occlusion\/excision, pharmacologic cardioversion, oral antiarrhythmic therapy, and left atrial catheter ablation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-22\u0022\u003EAntithrombotic therapy is recommended for all patients with AF except those at low risk or with contraindications. OAC therapy is recommended in patients with CHA\u003Csub\u003E2\u003C\/sub\u003EDS\u003Csub\u003E2\u003C\/sub\u003E-VASc score \u22652 and should be considered in those with CHA\u003Csub\u003E2\u003C\/sub\u003EDS\u003Csub\u003E2\u003C\/sub\u003E-VASc score of 1, with an adjusted-dose vitamin K antagonist (VKA), direct thrombin inhibitor, or factor Xa inhibitor. If patients refuse any OAC, antiplatelet therapy should be considered. A NOAC is recommended when an adjusted-dose VKA cannot be used. The oral antiarrhythmic dronedarone is recommended for patients with recurrent AF but not in patients with permanent AF due to an increase in mortality in the latter group.\u003C\/p\u003E\n         \u003Cp id=\u0022p-23\u0022\u003ELAA closure may be considered in patients with high stroke risk and contraindications for long-term OAC. When pharmacologic cardioversion is preferred and there is no or minimal structural heart disease, IV flecainide, propafenone, ibutilide, or vernakalant are recommended. Catheter ablation is recommended in patients who have symptomatic recurrences of AF on antiarrhythmic drug therapy and who prefer further rhythm control therapy.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EValvular Heart Disease\u003C\/h2\u003E\n         \u003Cp id=\u0022p-24\u0022\u003EThe 2012 ESC\/European Association for Cardio-Thoracic Surgery (EACTS) Guidelines on the management of valvular heart disease were developed because of new evidence on risk stratification, diagnostic methods, and therapeutic options [Vahanian A et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2012; \u003Cem\u003EEur J Cardio Thorac Surg\u003C\/em\u003E 2012]. Alec Vahanian, MD, H\u00f4pital Bichat, Paris, France, and Ottavio Alfieri, MD, Universit\u00e0 Vita-Salute San Raffaele, Brescia, Italy, presented an overview of these updates. The guidelines address the following key areas: patient evaluation, aortic regurgitation (AR), aortic stenosis (AS), mitral regurgitation (MR), tricuspid disease, and valve prostheses.\u003C\/p\u003E\n         \u003Cp id=\u0022p-25\u0022\u003EPatients should be evaluated for symptoms, severity of valvular disease, life expectancy, quality of life, and benefits versus risks of intervention. In the absence of a perfect quantitative score, risk assessment should primarily rely on the heart team\u0027s clinical judgment in addition to a combination of scores.\u003C\/p\u003E\n         \u003Cp id=\u0022p-26\u0022\u003ESurgery is recommended for patients with AR with a significantly enlarged ascending aorta, severe symptomatic AR, or severe asymptomatic AR with LVEF \u226450% or LV end-diastolic diameter \u226570 mm or LV end-systolic diameter \u0026gt;50 mm (or \u0026gt;25 mm\/mm\u003Csup\u003E2\u003C\/sup\u003E body surface area). Transcatheter aortic valve implantation (TAVI) is indicated for patients with severe symptomatic AS not suitable for surgical aortic valve replacement (SAVR) with a life expectancy of \u0026gt;1 year.\u003C\/p\u003E\n         \u003Cp id=\u0022p-27\u0022\u003ETAVI should not be performed in patients at intermediate risk for surgery. SAVR is indicated for the following:\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-28\u0022\u003ESevere symptomatic AS\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-9\u0022\u003E\n               \u003Cp id=\u0022p-29\u0022\u003EPatients undergoing coronary artery bypass graft (CABG) surgery, ascending aorta surgery, or other valve surgery\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-10\u0022\u003E\n               \u003Cp id=\u0022p-30\u0022\u003ESevere asymptomatic AS with systolic LV dysfunction, abnormal exercise test showing AS-related symptoms, or if low surgery risk and peak transvalvular velocity \u0026gt;5.5 m\/s or severe valve calcification and peak transvalvular velocity progression \u22650.3 m\/s per year\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\n         \u003Cp id=\u0022p-31\u0022\u003EMitral valve repair for symptomatic severe primary MR is preferred when it is expected to be durable. For secondary severe MR, surgery is indicated in patients undergoing CABG and who have LVEF \u0026gt;30% and should be considered for patients with LVEF \u0026lt;30%, option for revascularization, and evidence of viability.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-6\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EThird Universal Definition of Myocardial Infarction\u003C\/h2\u003E\n         \u003Cp id=\u0022p-32\u0022\u003EJoseph S. Alpert, MD, University of Arizona College of Medicine, Tucson, Arizona, USA, presented the ESC third universal definition of MI [Thygesen K et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2012]. \u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E shows the definitions of the 5 MI classifications.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14236\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14236\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14236\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-33\u0022 class=\u0022first-child\u0022\u003EUniversal Classification of MI.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\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\/12\/13\/6.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_figures.js?nznat1\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_openurl.js?nznat1\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_tables.js?nznat1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}