Hospital Chronicles (E-Journal)
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Reccuring Strokes due to an Arterio-Venous Fistula in the Pulmonary Circulation
No full textA  67 year old female patient with history of smoking, and hypertension with recurring strokes was investigated for any source of cardiac emboli. Although none pathology involving atrial septum was detected with trensesophageal echocardiography, massive  inflow of microbubbles to the left atrium were suggestive of another type of right to left communication. CT-angiography of pulmonary circulation  evealed an arterio-venous fistula between the right pulmonary artery and the right superior pulmonary vein
Current Pharmacological Advances in the Treatment of Cardiac Arrest
Get PDFCardiac arrest requires immediate treatment, in order to prevent patient death. Cardiac arrest outcomes still remain very poor, especially when the patient requires vasopressor treatment. Vasopressors have been advocated, in order to increase the coronary and cerebral perfusion pressure during cardiopulmonary resuscitation (CPR). Recent data suggest an epinephrine-related benefit with respect to short- and long-term outcomes, only when epinephrine is administered within the first 10 min of collapse. Also, increasing the epinephrine dosing interval from 3-5 to 6-10 min during CPR may be associated with improved long-term outcomes. In the in-hospital setting, the combination of vasopressin, epinephrine, and corticosteroid supplementation during and after CPR (in the presence of postresuscitation shock) may be superior to epinephrine alone during CPR. The use of new formulations of amiodarone, potentially devoid of serious hypotensive effects, may contribute to increased rates of sustained return of spontaneous circulation in patients with ventricular fibrillation / pulseless ventricular tachycardia cardiac arrest. Encouraging preliminary results have been reported on the use of beta blockers in patients with shockable cardiac arrest. Other potentially promising pharmacological interventions include the use of cariporide, nitrates (and particularly inhaled nitric oxide), noble gases, levosimendan, and erythropoietin. The purpose of the current paper is to review the clinical and laboratory evidence that support new and potentially useful pharmacological interventions during CPR
A Case of Atrial Standstill
Get PDFWe describe a case of a 65-year-old patient who was hospitalized in our department due to decompensated heart failure and was diagnosed having atrial standstill
Implantable Loop Recorder and Syncope-Rhythm Correlation
Get PDFA case of syncope-rhythm correlation is presented in a patient with a history of unexplained loss of consciousness and an implantable loop recorder. A permanent pacemaker was implanted due to the bradycardia event revealed by the recorder device and the patient remained asymptomatic in the follow up period
ΤηλεπαÏακολοÏθηση ΕμφυτευμÎνων ΗλεκτÏονικών Συσκευών: Î Ïακτικά ΘÎματα
Get PDFΟι εμφυτευμÎνες ηλεκτÏονικÎÏ‚ συσκευÎÏ‚ (βηματοδότες – απινιδωτÎÏ‚) χÏησιμοποιοÏνται ευÏÎως για τη θεÏαπεία διαταÏαχών του ÏÏ…Î¸Î¼Î¿Ï ÎºÎ±Î¹ τον τεÏματισμό των απειλητικών για τη ζωή κοιλιακών αÏÏυθμιών και ως εκ τοÏτου για την Ï€Ïόληψη του αιφνίδιου καÏÎ´Î¹Î±ÎºÎ¿Ï Î¸Î±Î½Î¬Ï„Î¿Ï…
Decreased Deceleration Capacity of Heart Rate Detects Heart Failure Patients at Risk for Malignant Ventricular Arrhythmias
Get PDFBACKGROUND: Deceleration capacity (DC) of the heart rate has proved an independent predictor of total mortality in post-myocardial infarction (post-MI) patients but it is unknown whether DC predicts the arrhythmic risk as well. OBJECTIVE: Our aim was to investigate whether DC can predict the arrhythmic sudden cardiac death (SCD) surrogate in patients with heart failure (HF). PATIENTS AND METHODS: We prospectively screened 145 HF patients with electrocardiogram (ECG), signal averaged ECG, echocardiography, and 24-hour Holter ECG. After 41.2 months, patients were divided into high (n=43) and low risk (n=102) groups according to three arrhythmic surrogates: clinical ventricular tachyarrhythmia (ventricular tachycardia -VT/ ventricular fibrillation-VF) (n=18), appropriate activation of the implantable cardioverter defibrillator (ICD) device (n=23) and confirmed SCD (n=2). RESULTS: High risk patients had impaired DC with significantly lower values (3.2±1.8 ms vs 4.0±2.1 ms, p=0.025). In the Cox regression analysis model adjusted for age, gender, diabetes, left ventricular ejection fraction (LVEF), filtered QRS, QTc, nonsustained VT episode(s) ≥ 1/24 h, ventricular premature beats ≥240/24 and DC, DC emerged as an important SCD surrogate predictor with a hazard ratio of 0.804, (95% confidence intervals-CI: 0.671- 0.963, p = 0.018). The cutoff point of DC≤3.352 ms (median) presented a hazard ratio of 2.885 (95% CI: 1.342 - 6.199, p=0.007, log rank test: p=0.003) for SCD surrogate. CONCLUSION: Decreased DC was found to be an important and independent SCD surrogate predictor. The cutoff point of DC≤3.352 ms detects HF patients at increased arrhythmic risk.Â
Redo Ventricular Tachycardia Ablation in a Frail Patient with Ischemic Cardiomyopathy. Benefit of Survival versus Risk of Complications
Get PDFWe present a case of repeated successful ventricular tachycardia ablation in an elderly frail post-myocardial infarction patient who presented with recurrent and often incessant episodes of slow ventricular tachycardia. An 85-year old thin male was presented with a hemodynamically stable, slow ventricular tachycardia, temporarily terminated after multiple anti-tachycardia pacing attempts. A previous recent ventricular tachycardia ablation procedure due to multiple ICD activations yielded poor result. Identification and elimination of late potentials was accompanied by final non-inducibility and a free from ventricular tachycardia mid-term outcome
Prospective Comparison of Multi-Detector Computed Tomographic Angiography with Digital Subtraction Angiography for the Diagnosis of Intracranial Aneurysms in Patients with Acute Non-Traumatic Subarachnoid Hemorrhage
Get PDFBackground Rupture of intracranial aneurysms and malformations are the main causes of spontaneous subarachnoid hemorrhage (SAH). Multi-detector computed tomography angiography (CTA) and intra-arterial digital subtraction angiography (DSA) are used to evaluate cerebrovascular structures and to detect such abnormalities with an intention to treat them. Objective The aim of the present study was to compare CTA and DSA findings in the detection of a cerebral aneurysm in patients with acute non-traumatic SAH and to depict the diagnostic value of CTA. Methods During the last 3 years 52 patients with non-traumatic SAH were prospectively studied. Four patients underwent only 16-slice multi-detector CTA and 48 patients underwent both CTA and DSA in an acute setting. Aneurysm morphologic information on CTA was compared to DSA, which is considered the gold standard imaging technique. Results The sensitivity of CTA per aneurysm was 97.9% (95% confidence intervals-CI 0.83-1), the specificity 100% (CI 0.50-0.99), the positive diagnostic likelihood ratio 0 and the negative diagnostic likelihood ratio 0.02. DSA successfully depicted 47 aneurysms in 40 patients from our study group. One aneurysm was missed on CTA (2 mm) which retrospectively was identified. In 8 patients with SAH no aneurysm was detected by either CTA or DSA. Conclusion 16-slice multi-detector CTA can be successfully used as a first choice imaging tool in the diagnostic algorithm of non-traumatic SAH and efficiently guide the therapeutic strategy
New Developments in Cardiopulmonary Resuscitation
Get PDFCardiopulmonary resuscitation (CPR) is the only therapeutic option for patients with cardiac arrest. Resuscitation guidelines change every 5 years in order to follow the emerging scientific data. All changes focus on increasing survival rate witch remains surprisingly low. Newer developments and recently published scientific statements emphasize the need for adequate implementation of the existing guidelines and improvement of the CPR quality
Modern Medical Ethics and the Legacy of Hippocrates
Get PDFThe most enduring guideline for medical ethics in the history of medicine is the Hippocratic Oath. Four of the six core values currently recognized in medical ethics (beneficence, non-maleficence, justice, and confidentiality), are in accordance with ideas codified in the Hippocratic Oath or in the Hippocrates work, in general. With the passing of the years, however, new ethics created by the society added new values, such as autonomy and respect, to values proposed by Hippocrates. On the other hand, certain social ethics, predominating in various countries, are in marked contrast to Hippocratic principles. The most significant of them are the issues of aid in suicide and of abortion. Regardless the rules of conduct prevailing in a given society, the primary task of a physician is to provide competent medical care, with compassion and respect for human dignity and rights, a principle in accordance with the Hippocratic motto “επ’ ωφελείη καμνόντων†("for the benefit of patients")