Hospital Chronicles (E-Journal)
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Left Ventricular Mass One Year After Radiofrequency Ablation for Atrial Fibrillation
Get PDFMyxomas are the most common benign tumors of the heart. The exact etiology of myxomas is unknown and most cases are sporadic. It is well known though that myxomas can develop after cardiac trauma, and that radiofrequency ablation (RFA) for paroxysmal atrial fibrillation (PAF) increases the risk of thrombus or endocarditis in the atrium. The association of RFA and the formation of myxomas is not known. We report a case of a left ventricular myxoma in a patient after RFA
2013 ACC/AHA Lipid Guidelines: Mind the Gaps
Get PDFThe recently published 2013 ACC/AHA guidelines for the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk seem to have various implementation problems and have already initiated an intense debate. These guidelines identify 4 high-risk groups who could benefit from statins, patients with pre-existing atherosclerotic cardiovascular disease (CVD); people with familial (heterozygous) hypercholesterolemia, as evidenced by an LDL-cholesterol (LDL-C) of >190 mg/dl; diabetic patients aged 40-75; and people aged 40-75 with at least a 7.5% risk of developing CVD in the next decade, according to a formula described in the guidelines. In contrast to all other guidelines for the management of dyslipidemia, the 2013 ACC/AHA guidelines do not recommend specific LDL-C targets. Instead, they propose a 30-50% reduction in LDL-C administering high- or moderate-intensity statin therapy depending on the CVD risk. The problems of adopting these new guidelines are herein discussed
Άγχος και Κατάθλιψη σε Ασθενείς με ΧÏόνιες ΚαÏδιολογικÎÏ‚ Παθήσεις
Get PDFΗ καθημεÏινή μας ζωή και η συνÏπαÏξή μας με άλλα άτομα μας δίνει τη δυνατότητα να κατανοήσουμε εÏκολα, ότι υπάÏχει σχÎση ανάμεσα στον ψυχικό μας κόσμο και στην καÏδιά μας. Δυνατά συναισθήματα όπως είναι η αγάπη, ο θυμός, η μεγάλη ευτυχία, η Îντονη στενοχώÏια, το σώμα μας τα εκφÏάζει με αÏξηση του καÏÎ´Î¹Î±ÎºÎ¿Ï ÏÏ…Î¸Î¼Î¿Ï ÎºÎ±Î¹ της αÏτηÏιακής πίεσης. Πολλοί από εμάς Îχουμε χÏησιμοποιήσει εκφÏάσεις όπως η καÏδιά μου “σταμάτησε να χτυπά†από φόβο ή “Îσπασε η καÏδιά μου†από την αγωνία. Όταν κάποιος αγαπά η καÏδιά του “χτυπά δυνατάâ€, ενώ η στενοχώÏια ενός χωÏÎ¹ÏƒÎ¼Î¿Ï Î¸Î± την κάνει να “Ïαγίσειâ€. Φαίνεται λοιπόν, ότι η ψυχή και η καÏδιά Îχουν μια σχÎση αμφίδÏομη. Τα συναισθήματα επηÏεάζουν την καÏδιά άμεσα και Îμμεσα. Άμεσα μÎσω του αυτόνομου νευÏÎ¹ÎºÎ¿Ï ÏƒÏ…ÏƒÏ„Î®Î¼Î±Ï„Î¿Ï‚ και Îμμεσα μÎσω των νευÏοενδοκÏινών οδών. Από την άλλη πλευÏά και μια καÏδιολογική διαταÏαχή είναι ικανή να δημιουÏγήσει στον πάσχοντα ψυχοπαθολογικά Ï€Ïοβλήματα που μποÏοÏν να εκφÏαστοÏν με άγχος και με κατάθλιψη.Â
Management of Bleeding with Newer Anticoagulants
Get PDFSeveral novel oral anticoagulant drugs (NOACs) have recently been approved for use in patients with non-valvular atrial fibrillation or venous thromboembolic disease. These drugs are either direct thrombin inhibitors (dabigatran) or factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) and all have been compared in large randomized trials with warfarin. In general, NOACs are considered, at least, non-inferior to warfarin in terms of stroke prevention but their risk of bleeding is variable
Right Atrial Mass: Time for Contrast Echocardiography
Get PDFWe present the case of a 42-year-old man with dyspnea New York Heart Association class III-IV, leg edema and ascites for the last 3 months. ECG and chest X-ray were unremarquable. The echo study revealed a large triangular mass in the right atrium attached to the interatratrial septum with a wide base. There were also severe tricuspid stenosis and regurgitation
Multivessel Disease in a Patient Presenting With ST-Elevation Myocardial Infarction
Get PDFPatients with multivessel coronary artery disease are common among patients presenting with ST elevation myocardial infarction (STEMI). The way to treat the rest of the lesions after treating the culprit lesion is not well defined yet. In this article we present a patient with inferior STEMI, who had also an ostial left anterior descending (LAD) coronary artery stenosis
Left Main Disease: Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Grafting (CABG)? That is the Question
Get PDFLeft main (LM) coronary artery disease, arbitrarily defined as >50% diameter stenosis of the LM coronary artery, has long been a topic of intense diagnostic and therapeutic investigation, due to its poor prognosis. As the majority of the left ventricular myocardium is supplied by the LM stem, any ischemic insult may lead to hemodynamic compromise, significant ventricular arrhythmias or death
Socioeconomic Crisis and Incidence of Acute Myocardial Infarction in Messinia, Greece
Get PDFIn the last 5 years Greece is facing the worst socioeconomic crisis since the end of the Second World War. The purpose of the current study was to gather all the incident cases of acute myocardial infarction (AMI) that were hospitalized in the General Hospital of Kalamata during the last 10 years. Our results suggest that the prolonged financial crisis may have led to a higher incidence of AMI in the population of Messinia, Greece
Measures to Prevent Sudden Cardiac Death Early after Acute Myocardial Infarction
Get PDFOf all patients having an acute myocardial infarction (AMI), 25-35% will die of sudden cardiac death (SCD) due to ventricular fibrillation (VF) before seeking medical attention. For those who reach the hospital, prognosis is considerably better and has improved over the years. Reperfusion therapy, which is superior with primary percutaneous coronary intervention (PCI) versus thrombolysis, has made the difference. There is currently overwhelming evidence in favor of an expanded role and use of primary PCI in an attempt to reduce the risk of SCD early and late after an AMI. In-hospital SCD due to acute (<48 hours) ventricular tachyarrhythmias is manageable, with either preventive measures or electrical cardioversion; these arrhythmias do not portend an adverse late outcome. Secondary prevention of SCD in the early post-AMI period is accomplished via an implantable cardioverter defibrillator (ICD) for sustained ventricular arrhythmias emerging >48 hours after an AMI, not due to reversible or correctable causes. However, the major challenge remains that of primary prevention of SCD between the 48-hour period and the first 40 days post-AMI for patients who have low left ventricular ejection fraction (LVEF) and are not candidates for an ICD according to current guidelines. Two ICD trials (DINAMIT and IRIS) have shown no benefit of ICD in this early period. Two recent documents may provide direction as to how to bridge this early gap. The first relates to the “appropriate use criteria for ICDs and cardiac resynchronization therapy (CRT) ICDâ€, and the second is an “expert consensus statement on the use of ICD therapy in patients who are not included or not well represented in clinical trialsâ€
Advances in the Clinical Management of Cardiac Arrest
Get PDFCardiac arrest constitutes an extremely life-threatening condition that inevitably and promptly results in death if left untreated. Cardiac arrest outcomes still remain very poor, especially when the presenting cardiac rhythm is nonshockable. Important, recent, clinical research has focused on the quality of cardiopulmonary resuscitation (CPR), the mechanical augmentation of the circulation during CPR, CPR drugs, and therapeutic hypothermia. Chest compression depth of at least 51 mm increases the probability of neurologically favorable survival. Despite initially promising results, a large effectiveness study failed to confirm the efficacy of the mechanical augmentation of the circulation. Epinephrine has finally been shown to slightly improve functional outcome after out-of-hospital cardiac arrest, especially when given early. In a recent, in-hospital study of 268 patients, the addition of vasopressin and methylprednisolone during CPR and the administration of hydrocortisone in postresuscitation shock improved functional outcome after vasopressor-requiring cardiac arrest; however, corticosteroid efficacy still needs to be separately confirmed in a large, international trial. Lastly, preliminary human data may support the conduct of high quality trials evaluating the efficacy of beta adrenergic antagonists in shockable cardiac arrest. The purpose of this paper is to review these potentially important advances in the management of cardiac arrest. Â