Hospital Chronicles (E-Journal)
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ST-Elevation Myocardial Infarction: Preventive Percutaneous Coronary Intervention in the Non-Culprit Vessel
Get PDFPatients with ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD) have poorer outcomes after primary percutaneous coronary intervention (PCI) compared to those with one-vessel coronary artery disease. Current STEMI guidelines recommend revascularization of the infarct related artery (IRA) only during primary PCI, while PCI for non-IRA lesions should be performed after objective evidence of residual ischemia. Evidence regarding the optimal management strategy for non-IRA lesions in STEMI patients with MVD has been limited and mainly based on retrospective, contradictory and probably biased data. A recently published randomized study, PRAMI, challenges the guidelines since preventive acute multi-vessel PCI for significant stenoses in non-IRAs has been associated with a reduction of major adverse cardiovascular events (MACE) compared to PCI limited to the IRA. A review of the literature and a discussion about the implications of the PRAMI study regarding the optimal revascularization strategy for STEMI with MVD are presented herein
Thrombosis of Left Coronary Artery During Primary Percutaneous Coronary Intervention
Get PDFWe present a case of a 51-year-old male with acute anterior myocardial infarction, who was transferred to our hospital under mechanical ventilation, after resuscitation due to cardiopulmonary arrest. The patient underwent urgent coronary angiography, which showed total thrombotic occlusion of the proximal segment of the left anterior descending (LAD) coronary artery disease. During primary percutaneous coronary intervention (PPCI), thrombosis extended into the left main coronary artery (LMCA), the LAD and the left circumflex artery (LCx) coronary arteries, causing severe hemodynamic compromise. This devastating complication was successfully managed with intracoronary administration of antithrombotic and antiplatelet drugs, as well as thrombus aspiration. We herein discuss the possible mechanisms of this complication and highlight its prevention and treatment
Pacemaker and/or Defibrillator Implantation: Continued Warfarin Outperforms Bridging with Heparin
Get PDFAmong patients undergoing pacemaker or implantable cardioverter-defibrillator (ICD) implantation, approximately 14-45% are on anticoagulation therapy. Recently updated guidelines from the American College of Chest Physicians have recommended use of bridging anticoagulation with therapeutic dose of subcutaneous low-molecularweight heparin or intravenous heparin in patients with mechanical heart valves, atrial fibrillation, or venous thromboembolism who are at moderate or high risk for thromboembolic events (estimated annual stroke risk >5%)
Prognostic Markers in Transcatheter Mitral Valve Repair
Get PDFThe Mitraclip procedure is at present the most widely available method for transcatheter correction of severe mitral regurgitation (MR). The efficacy and the safety of the device has been evaluated in the EVEREST II randomized control study1 (head to head comparison with traditional surgical repair or replacement of the mitral valve) and although not as effective in abolishing MR, it provided significant improvement in functional class, along with evidence of favorable ventricular remodeling and with low perioperative morbidity and mortality.Â
Primary PCI in STEMI: The Role of Thrombo-aspiration
Get PDFAcutemyocardial infarction is a potentially life-threatening disease that remains achallenge for the Interventional Cardiologist. Manual thrombectomy is easilyapplicable and several studies have confirmed its favorable effect onmyocardial perfusion especially when it is combined with intracoronary adjunctivepharmacotherapy. During the last years, several catheters with differentcharacteristics have been introduced in clinical practice. Newer randomizedtrials will further clarify the role and the indications of manual thrombectomyin patients with STEMI submitted to pPCI
Where Smoking was Banned in Public Places, Myocardial Infarctions were Markedly Decreased!
Get PDFTobacco use is the single most important preventable health risk in the developed world. Smoking-related mortality is on the rise. Most smoking-associated deaths relate to lung cancer, chronic obstructive pulmonary disease and coronary heart disease. Epidemiological studies suggest that passive smoking is nearly as harmful as active. In the adult population passive smoking can cause coronary heart disease and lung cancer. Smoking ban in public places has been implemented in most countries of the Western World with a high degree of compliance. The results of several trials assessing the effectiveness of this measure in public health are encouraging, as a consistent decrease in the incidence of acute myocardial infarction has been reported for the period after the legislation. A brief overview of these data is herein provided
Atrioventricular Conduction Disturbances in Hyperthyroidism
Get PDFA 73-year-old man was referred from another hospital to our department for permanent pacemaker implantation due to persistent (more than 3 days) complete atrioventricular (AV) block. His past medical history included history of hyperthyroidism under treatment with carbimazol 2.5 mg once daily. On admission, serum thyroxin stimulating hormone concentration was <0.01 μIU/ml (normal 0.35-4.95 μIU/ml). Antithyroid drug treatment was intensified. Five days after admission complete heart block persisted on ECG, but 1 week later the ECG revealed a junctional rhythm, which resolved to first degree AV block on the tenth day of hospitalization and the patient was discharged. Subsequent follow up at 3 months after discharge with 24-hour holter recording, revealed normal sinus rhythm without any conduction disturbances
In-hospital Cardiac Arrest: an Update
Get PDFIn-hospital cardiac arrest has not been the focus of intensive research over the recent years. Since the last American Heart Association (AHA) and European Resuscitation Council (ERC) Guidelines in 2010, a number of studies and a consensus statement by AHA have been published concerning possible improvements in the management of in-hospital cardiac arrest, which are herein reviewed
Î Ïωτογενής Αγγειοπλαστική στο ÎŸÎ¾Ï ÎˆÎ¼Ï†Ïαγμα του ΜυοκαÏδίου
Get PDFΣΚΟΠΟΣ: Το Î¿Î¾Ï ÎμφÏαγμα του μυοκαÏδίου (ΟΕΜ) με ανάσπαση του ST διαστήματος, είναι μια χÏονικά κÏίσιμη επείγουσα κατάσταση, και απαιτεί γÏήγοÏη αποκατάσταση της Ïοής του αίματος στην επηÏεασμÎνη πεÏιοχή του καÏÎ´Î¹Î±ÎºÎ¿Ï Î¼Ï…ÏŒÏ‚, είτε με την Ï€Ïωτογενή αγγειοπλαστική (primary percutaneous coronary intervention-pPCI), είτε με την θÏομβολυτική θεÏαπεία. Οι νοσηλευτÎÏ‚ συμμετÎχουν ενεÏγά σε όλη την διαδικασία διαχείÏισης και θεÏαπείας των ασθενών με Î¿Î¾Ï ÏƒÏ„ÎµÏ†Î±Î½Î¹Î±Î¯Î¿ σÏνδÏομο. Ο σκοπός της παÏοÏσας βιβλιογÏαφικής ανασκόπησης, είναι η Ï€ÏοσÎγγιση της θεÏαπευτικής αντιμετώπισης των ασθενών με ανάσπαση του ST με Ï€Ïωτογενή αγγειοπλαστική, εστιάζοντας στα βÎλτιστα χÏονικά πλαίσια σÏμφωνα με τις κατευθυντήÏιες οδηγίες, καθώς και στον Ïόλο των νοσηλευτών σχετικά με την Îκβαση της νόσου.ΥΛΙΚΟ-ΜΕΘΟΔΟΣ: Î Ïαγματοποιήθηκε βιβλιογÏαφική ανασκόπηση κατευθυντήÏιων οδηγιών αντιμετώπισης οξÎος εμφÏάγματος του μυοκαÏδίου με ανάσπαση του ST και συστηματική αναζήτηση σε ÎγκυÏες βάσεις δεδομÎνων όπως στις Cochrane, Medline, Cinahl, Scopus κ.α. ΠεÏιλήφθηκαν μελÎτες, στις οποίες 1) αναφÎÏεται η σÏγκÏιση της Ï€ÏωτογενοÏÏ‚ αγγειοπλαστικής Îναντι της θÏομβόλυσης, 2) καταγÏάφονται τα χÏονικά πλαίσια για την διενÎÏγεια Ï€ÏωτογενοÏÏ‚ αγγειοπλαστικής και 3) οι νοσηλευτÎÏ‚ συμμετÎχουν ενεÏγά σε όλη τη διαδικασία αντιμετώπισης των ασθενών με ΟΕΜ.ΑΠΟΤΕΛΕΣΜΑΤΑ: ΑναφοÏικά με τις μελÎτες φαίνεται ότι η Ï€Ïωτογενής αγγειοπλαστική υπεÏτεÏεί της θÏομβόλυσης, καθώς εμφανίζει μειωμÎνα ποσοστά θνησιμότητας, μικÏότεÏα ποσοστά επαναστÎνωσης και λιγότεÏες πιθανότητες εμφάνισης επιπλοκών όπως μεγάλες αιμοÏÏαγίες. Η άμεση ετοιμότητα της ÎμπειÏης ομάδας επεμβατικών καÏδιολόγων και επαÏκώς εκπαιδευμÎνου Î½Î¿ÏƒÎ·Î»ÎµÏ…Ï„Î¹ÎºÎ¿Ï Ï€ÏοσωπικοÏ, βελτιώνει τους χÏόνους καθυστÎÏησης για τη φÏοντίδα των ασθενών με STEMI. Η σημασία επίτευξης επιθυμητών χÏόνων ÎναÏξης της επαναιμάτωσης, όπως αυτοί Ï€Ïοτείνονται από τις κατευθυντήÏιες οδηγίες, οδηγοÏν σε μείωση των ποσοστών θνησιμότητας. Οι νοσηλευτÎÏ‚ στους τομείς των επειγόντων πεÏιστατικών και στη θεÏαπεία των καÏδιακών παθήσεων, διαδÏαματίζουν ουσιαστικό Ïόλο στη βελτίωση της ποιότητας πεÏίθαλψης των ασθενών με STEMI. Η παÏÎμβαση του νοσηλευτή του Î±Î¹Î¼Î¿Î´Ï…Î½Î±Î¼Î¹ÎºÎ¿Ï Ï„Î¼Î®Î¼Î±Ï„Î¿Ï‚ είναι αποτελεσματική στην επιτυχή Îκβαση της pPCI, με τη συμβολή του στην σωστή Ï€Ïοετοιμασία ÎµÎ¾Î¿Ï€Î»Î¹ÏƒÎ¼Î¿Ï Ï„Î·Ï‚ αίθουσας, τη δημιουÏγία ενός πεÏιβάλλοντος φÏοντίδας, τη συνεχή ψυχολογική ενθάÏÏυνση, τη συνεχή αιμοδυναμική παÏακολοÏθηση και την ÎγκαιÏη αναγνώÏιση επιπλοκών. Η γνώση των νοσηλευτών γÏÏω από τις κατευθυντήÏιες οδηγίες είναι σημαντική για τη βελτιστοποίηση της παÏεχόμενης ιατÏικής φÏοντίδας, τη βελτίωση της Îκβασης των ασθενών και την αποτελεσματικότεÏη διαχείÏιση των πόÏων.ΣΥΜΠΕΡΑΣΜΑΤΑ: Η Ï€Ïωτογενής αγγειοπλαστική είναι η θεÏαπεία εκλογής για το Î¿Î¾Ï ÎμφÏαγμα του μυοκαÏδίου με ανάσπαση του ST διαστήματος. Το σÏνολο του ιατÏÎ¿Î½Î¿ÏƒÎ·Î»ÎµÏ…Ï„Î¹ÎºÎ¿Ï Ï€ÏÎ¿ÏƒÏ‰Ï€Î¹ÎºÎ¿Ï Ï€Î±ÏÎχει φÏοντίδα, που είναι ασφαλής, ÎγκαιÏη, αποτελεσματική και τεκμηÏιωμÎνη.Â
Advantages of Real-Time Three-Dimensional Echocardiography Over Two-Dimensional Echocardiography
Get PDFOver the last fifty-years conventional two-dimensional (2D) echocardiography has served as a valuable clinical adjunct for the diagnosis and management of cardiovascular disease. However, the echocardiologist was expected to mentally reconstruct the complex structure of myocardium, resulting in geometrical assumptions which in turn could underestimate the validity of clinical findings