No abstract

Rheumatoid Arthritis (RA) is a chronic progressive inflammatory joint disorder that affects 0.5% - 1% of the general population. This review article discusses cardiovascular manifestations of rheumatoid arthritis, pathogenesis of these manifestations, and therapy. This disease not only affects the joints, but it also involves other organ systems. The majority of these patients suffer significant morbidity and mortality from cardiovascular disease. Cardiovascular manifestations of RA include predilection for accelerated atherosclerosis and endothelial dysfunction resulting in coronary artery disease (CAD), stroke, congestive heart failure, and peripheral arterial disease. Some studies have shown that the risk of developing CAD in RA patients is the same as for patients with diabetes mellitus. These patients should be treated with aggressive medical therapy such as disease modifying antirheumatic drugs, tumor necrosis factor alpha inhibitors, and corticosteroids and with appropriate control of risk factors such as smoking, dyslipidemia, hypertension, and obesity. Other manifestations include pericarditis, myocarditis, and vasculitis.

RAE, RVH, RBBB, marked clockwise rotation of heart, a QS pattern in leads III and aVF, LAD, PACs, and SVTs were significantly more prevalent in patients with severe COPD than in patients with mild or moderate COPD.

Treatment of heart failure involves management of risk factors and control of symptoms. Traditional management of heart failure involves the use of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, diuretics, aldosterone antagonists, and digitalis. Metabolic modulators are a newer class of drugs that benefit these patients by modulating cardiac metabolism without altering hemodynamics. They have the potential to relieve symptoms in patients with refractory heart failure who are already on optimal medical therapy. These drugs increase glucose metabolism at the expense of free fatty acid metabolism, thereby enhancing efficient use of oxygen. This review discusses the role of 4 metabolic modulators drugs that could potentially be used for heart failure therapy: trimetazidine, ranolazine, perhexiline, and etomoxir.