Objective: A nitrate-augmented 99mTc-sestamibi cardiac single-photon emission computed tomography imaging protocol has been shown to improve detection of viable cardiac segments. This protocol usually makes use of a short-acting nitrate and requires patients to stop prescribed long-acting nitrate medication for at least two days prior to the study. No previous studies have used long-acting nitrate in myocardial viability research. Materials and Methods: Ten adult patients who had routinely used long-acting nitrate medication participated in this nitrate-augmented myocardial viability study. A long-acting nitrate was given one hour prior to 99mTc-sestamibi injection, and results were evaluated based on uptake changes after nitrate augmentation. Myocardial reversibility was assessed using visual scoring with a 17-segment model, with increased uptake ≥10% considered viable. Results: Eight of 10 patients had a greater than 10% increase in uptake compared to baseline, and nine of 10 patients showed significant changes in sum rest score (SRS) and sum rest nitrate score (SRNS) p<0.001. In most patients, blood pressure dropped significantly after nitrate administration. One patient with no uptake changes or myocardial reversibility based on SRS and SRNS demonstrated increased blood pressure after nitrate administration. Conclusion Oral long-acting nitrates are a feasible option for nitrate-augmented myocardial viability studies. Patients on long-acting nitrate therapy who require myocardial viability study do not need to discontinue the medication prior to the study. Further evaluations with larger samples are needed to confirm these findings.

Cardio-oncology is an emerging multi-disciplinary field, which aims to reduce morbidity and mortality of cancer patients by preventing and managing cancer treatment-related cardiovascular toxicities. With the exponential growth in cancer and cardiovascular diseases in Asia, there is an emerging need for cardio-oncology awareness among physicians and country-specific cardio-oncology initiatives. In this state-of-the-art review, we sought to describe the burden of cancer and cardiovascular disease in Asia, a region with rich cultural and socio-economic diversity. From describing the uniqueness and challenges (such as socio-economic disparity, ethnical and racial diversity, and limited training opportunities) in establishing cardio-oncology in Asia, and outlining ways to overcome any barriers, this article aims to help advance the field of cardio-oncology in Asia.

Cardiogenic shock (CS) is a complex condition causing end-organ hypoperfusion and high mortality rates especially in patients with acute myocardial infarction. It remains a challenge for clinician to provide good outcomes despite the development of evidence-based therapeutic strategies, especially for interventional management. Although there has been an improvement in survival, the mortality remains high. There are still many uncertainties regarding the best treatment, as clinicians need to weigh the risks and benefits. This review aims to elaborate the latest updates in the field of CS. To enhance contractility and systemic vascular resistance and hence avoid organ damage, inotropic and vasopressin agents are often administered in the therapy of CS. Despite their usefulness and widespread use, administration of these medicines requires close monitoring and the lowest effective dosage administered in the shortest amount of time possible to prevent adverse effects including increased oxygen demand, arrhythmia, and impaired microcirculation of the tissue. When pharmacological agents fail to provide an adequate response, mechanical circulatory support (MCS) devices like the intraaortic balloon pump (IABP), left ventricular assist devices (LVAD), venoarterial extracorporeal membrane oxygenation (VA-ECMO), and revascularization become an option to provide haemodynamic support.
Shock, Cardiogenic