Khan, Saifullah

Hyperkalemia is a common and potentially life-threatening electrolyte abnormality in patients with heart failure, particularly among those with diabetes or chronic kidney disease. It often results from the use of renin–angiotensin–aldosterone system inhibitors, which, while improving survival, increase serum potassium levels. Elevated potassium produces cardiotoxic effects, often recognized by characteristic electrocardiographic changes. Acute management focuses on stabilizing cardiac membranes with intravenous calcium and shifting potassium intracellularly through insulin-dextrose, β₂-agonists, or sodium bicarbonate, with caution to avoid fluid overload. Potassium elimination may be achieved using diuretics or hemodialysis when refractory. For chronic management, newer potassium-binding agents such as patiromer and sodium zirconium cyclosilicate offer improved safety and efficacy compared with traditional resins, enabling the continuation and up-titration of renin–angiotensin–aldosterone system inhibitors. These therapies support optimal neurohormonal blockade, improve adherence, and reduce morbidity and mortality in heart failure.

Sudden death in children and young adults, while uncommon, carries profound clinical and societal implications. Cardiac causes, particularly inherited arrhythmias and cardiomyopathies, account for most cases, though neurologic, toxicologic, traumatic, and infectious etiologies also contribute significantly. This review explores the epidemiology, classification, and pathophysiologic mechanisms of sudden death in this population, emphasizing early clinical warning signs and identifiable risk factors. We also outline diagnostic and preventive strategies, including electrocardiography, genetic testing, and postmortem evaluation. Despite guidelines advocating preparticipation screening, real-world implementation remains inconsistent. Advances in genomics and artificial intelligence offer new opportunities for early risk detection. Finally, we discuss public health interventions such as defibrillator access, cardiopulmonary resuscitation education, and school-based protocols as essential components of a broader prevention strategy.

Coronary artery disease (CAD) is the leading cause of death globally. Apolipoprotein A-1 (apoA-1), the primary protein component of high-density lipoprotein (HDL), facilitates reverse cholesterol transport and has emerged as a potential therapeutic target. While pharmacologic efforts to raise HDL-C levels have failed to reduce cardiovascular events, focus has shifted to HDL functionality, particularly cholesterol efflux capacity (CEC). ApoA-1 infusions have demonstrated antiatherogenic effects in preclinical models and early human trials by enhancing CEC and promoting cholesterol clearance. This review summarizes the rationale and evolving clinical trial landscape investigating apoA-1 infusions as a novel therapy for CAD prevention and treatment.