Hospital Chronicles (E-Journal)
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Η Αντιμετώπιση των ΟξÎων Στεφανιαίων ΣυνδÏόμων ΣήμεÏα στη Îοτιοδυτική Ελλάδα
Get PDFΕισαγωγή: Η σÏγχÏονη αντιμετώπιση του οξÎος εμφÏάγματος του μυοκαÏδίου (ΟΕΜ) με ανάσπαση του ST (STEMI) επικεντÏώνεται στην όσο το δυνατόν ταχÏτεÏη επαναιμάτωση του μυοκαÏδίου. ÎœÎµÏ„Î±Î¾Ï Ï„Ï‰Î½ τεχνικών επαναιμάτωσης, η Ï€Ïωτογενής αγγειοπλαστική (PPCI) υπεÏÎχει της θÏομβόλυση, αλλά υπάÏχουν Ï€Ïακτικά Ï€Ïοβλήματα στην άμεση και ÎγκαιÏη εφαÏμογή της, ενώ η θÏομβόλυση είναι άμεσα και ευÏÏτεÏα διαθÎσιμη. ΓενικότεÏα η εφαÏμογή τεχνικών της επεμβατικής καÏδιολογίας Îχει αποφασιστικό Ïόλο στην αντιμετώπιση όλων των ασθενών με οξÎα στεφανιαία σÏνδÏομα. Σκοπός: Σκοπός της παÏοÏσης ÎÏευνας ήταν η καταγÏαφή των ασθενών στη διάÏκεια ενός Ï„Ïιμήνου, με στεφανιαία νόσο και με Î¿Î¾Ï ÏƒÏ„ÎµÏ†Î±Î½Î¹Î±Î¯Î¿ σÏνδÏομο που υποβλήθηκαν στο Πανεπιστημιακό Îοσοκομείο ΠατÏών (ΠΓÎÎ ) σε επεμβατική αντιμετώπιση. Υλικό/ÎœÎθοδος: Υλικό της μελÎτης αποτÎλεσαν οι ασθενείς που υποβλήθηκαν σε στεφανιογÏαφία και αγγειοπλαστική από 1η ΑπÏιλίου του 2011 Îως 30 Ιουνίου του 2011. Τα ποσοτικά δεδομÎνα αναλÏθηκαν με το t-test και τα ποιοτικά με το Χ2. ΑποτελÎσματα: Συνολικά στο 3μηνο καθετηÏιάστηκαν 840 ασθενείς. Από αυτοÏÏ‚ 178 υποβλήθηκαν σε PCI και 53 (23%) σε PPCI ή rescue PCI. Όσον αφοÏά στην κατανομή των ασθενών, παÏατηÏήθηκε αÏξηση τον μήνα Μάιο. Οι πεÏισσότεÏοι ασθενείς (60%) διακομίστηκαν από ΥγειονομικÎÏ‚ Μονάδες της ΠεÏιφÎÏειας (ΓΠΠατÏών “Άγιος ΑνδÏÎαςâ€, ΓΠΠÏÏγου, Αγίου, ΑγÏινίου, Μεσολογγίου, ΖακÏνθου, Κεφαλληνίας και ΚοÏίνθου). ΣυγκÏιτικά με τους ίδιους μήνες το 2010, το 2011 αυξήθηκαν οι Ï€Ïωτογενείς αγγειοπλαστικÎÏ‚ (PPCI) και ο αÏιθμός των πεÏιστατικών που διακομίστηκαν από την ΠεÏιφÎÏεια για επείγουσα επαναιμάτωση των στεφανιαίων αγγείων. ΣυμπÎÏασμα: Καλά οÏγανωμÎνο αιμοδυναμικό εÏγαστήÏιο, με ÎμπειÏο Ï€Ïοσωπικό, μποÏεί να παÏÎχει σε 24ωÏη καθημεÏινή βάση την ενδεδειγμÎνη αντιμετώπιση της στεφανιαίας νόσου που αποτελεί η διαδεÏμική επαναιμάτωση του μυοκαÏδίου
Atrial Fibrillation Ablation Technique: State of the Art
Get PDFThe role of the pulmonary veins in the initiation of atrial fibrillation has clearly been elucidated and has led to catheter ablation of atrial fibrillation (AF) via pulmonary vein isolation, currently achieved with use of radiofrequency energy. The 2011 American guideline update on the management of AF considers catheter ablation as a Class Ia indication in patients without significant structural heart disease refractory to antiarrhythmic drug therapy. The 2011 update on the guidelines for the management of AF by the European Society of Cardiology lists catheter ablation as a class IIa recommendation in patients refractory to antiarrhythmic drug therapy. Catheter ablation may be considered first-line therapy in a select group of patients with paroxysmal AF and no significant underlying structural heart disease if an experienced operator performs the procedure (class IIb indication). It should be kept in mind that the single-procedure success rate is low, with only 40%, 37% and 29% of patients remaining free from recurrent arrhythmias at 1, 2 and 5 years of follow-up, respectively; the success rates increase after two procedures to 87%, 81% and 63% at 1, 2 and 5 years. Patients with longstanding persistent AF have lower success rates compared with patients with paroxysmal or persistent AF. This article focuses on recent developments and new technologies currently under investigation
ΚαÏδιακή ΑνεπάÏκεια και ΣτÎνωση ΑοÏτής: ο Ρόλος της ΔιαδεÏμικής Βαλβιδοτομής και ΕμφÏτευσης Î Ïοσθετικής Βαλβίδας
Get PDFΑνδÏας, ηλικίας 93 ετών, με γνωστή καÏδιακή ανεπάÏκεια σε Îδαφος διατατικής μυοκαÏδιοπάθειας και λειτουÏγικής ανεπάÏκειας Ï„Ïιγλώχινας, Ï€Ïοσήλθε λόγω δÏσπνοιας ηÏεμίας, πλευÏιτικής συλλογής, ασκίτη και οιδημάτων άκÏων. Το ηλεκτÏοκαÏδιογÏάφημα εισόδου Îδειξε χÏόνια κολπική μαÏμαÏυγή με δεξιό σκελικό αποκλεισμό. Το υπεÏηχοκαÏδιογÏάφημα εισόδου Îδειξε σημαντική στÎνωση αοÏτής (στόμιο: 0.9 cm2) με χαμηλή Ïοή λόγω μειωμÎνης συστολικής λειτουÏγίας (κλάσμα εξώθησης-EF=35 %). H δυναμική ηχοκαÏδιογÏαφική μελÎτη με δοβουταμίνη (Stress Εcho), Îδειξε ινότÏοπη εφεδÏεία (EF 45 %) και αÏξηση της κλίσης πιÎσεως χωÏίς αÏξηση του αοÏÏ„Î¹ÎºÎ¿Ï ÏƒÏ„Î¿Î¼Î¯Î¿Ï… κατά τη κόπωση, όλα ενδεικτικά σοβαÏής στÎνωσης αοÏτής. Ο ασθενής παÏαπÎμφθηκε για  διαδεÏμική εμφÏτευση Ï€Ïοσθετικής βαλβίδας (TAVI). ÎÎο Stress Echo στο κÎντÏο εμφÏτευσης Îδειξε απÏόσμενα Îλλειψη ινότÏοπης εφεδÏείας (αÏξηση του όγκου Ï€Î±Î»Î¼Î¿Ï < 20 % κατά τη κόπωση) και αποφασίστηκε η παÏηγοÏητική εκτÎλεση διαδεÏμικής βαλβιδοτομής με μπαλόνι (BAV) αντί για TAVI...(excerpt
Microbiology of Cardiac Device Infections in a Tertiary Hospital
Get PDFA cardiac device (CD) infection is a very important challenge for cardiology and clinical microbiology specialists, because of the increasing use of implantable CDs. Several host- and procedure-related factors increase the risk of CD infection. A CD infection commonly involves a permanent pacemaker (PPM) or an implantable cardioverter defibrillator (ICD) device, which like any other foreign body can become infected. Cardiac device infection may be a primary infection when the device and/or pocket itself is the source of infection, usually due to contamination at the time of implant or a secondary infection due to bacteremia from a different source contaminating the leads and/or the device and/or the pocket... (excerpt
Resurgence of Interest in the Role of HDL / Modulating CETP to Reduce Cardiovascular Risk / dal-VESSEL, dal-PLAQUE & DEFINE Trials
Get PDFThe significance of HDL concentration in assessing cardiovascular risk has been recognized over 20 years ago by the Framingham study and it has been subsequently confirmed by other studies and meta-analyses. However, LDL cholesterol has been assigned the cardinal role in cardiovascular (CV) risk management because of its clear etiopathogenic correlation with CV outcome and the efficacy of the drugs used to manipulate its levels in order to change patient prognosis. It is rather recently that HDL has gained the scientific interest once again, with the development of novel agents exhibiting a remarkable ability in raising HDL levels. In this article we comment on the re-emerging role of HDL manipulation with regard to the new CETP inhibitors, under the light of the recent data obtained from large trials assessing their efficacy and safety
The Role of Nuclear Medicine in Imaging and Therapy of Neuroendocrine Tumors
Get PDFNeuroendocrine tumors (NET’s) constitute a heterogeneous group of tumors characterized by the simultaneous expression of specific marker proteins and cell type-specific hormonal products. Metaiodobenzyluanidine (MIBG), labelled with 131I or 123I, and 111In-pentetreotide (Octreoscan) are the radiopharmaceuticals of choice in the current clinical practice. Positron emitting radiopharmaceuticals that are used in PET imaging are 18F-fluorodeoxyglucose (18F-FDG), 18F-fluorodopamine (18F-DOPA), 11C-hydroxy-tryptophan (11C-HTP), and Gallium-68 (68Ga-DOTATATE or DOTATOC). In diagnosis of gastroenteropancreatic neuroendocrine tumors (GEPs) Octreoscan is the preferred imaging method because of its high sensitivity. 131Ι/123Ι-MIBG scintigraphy is useful to characterize and locate intra-adrenal (pheochromocytomas) and extra-adrenal paragangliomas. Octreoscan has also high accuracy for extra-adrenal paragangliomas. 18F-FDG-PET or PET/CT seems to be useful in detecting the pheochromocytomas and GEPs that fail to concentrate MIBG and Octreocan. 123I-MIBG scintigraphy combined with urine analysis of catecholamine metabolites is the most sensitive indicator of neuroblastoma. In diagnosis of small cell lung cancer and pituitary adenomas Octreoscan has a high sensitivity. On the contrary, in medullary thyroid cancer the sensitivity of Octreoscan and 131Ι/123Ι-MIBG is low but sensitivity of 18F-FDG PET or PET/CT and 68Ga-DOTATATE and DOTATOC PET or PET/CT seems to be higher. With the introduction of 131I-MIBG and octreotide labelled with several radioisotopes, the field of treatment with radionuclides has been extended to a wide range of NETs. 111In-DTPA-Octreotide firstly was used in some clinical trials but recent advances in somatostatin analogues have paved the way to the development of octreotate, which can be labelled with both 177Lu and 90Y radionuclides
Cardiac Resynchronization Therapy and Proarrhythmia: Weathering the Storm
Get PDFIn patients with significant left ventricular (LV) dysfunction and congestive heart failure despite optimal medical therapy, implantation of cardiac resynchronization therapy-defibrillator (CRT-D) devices has been shown to improve symptoms and diminish ventricular tachyarrhythmia susceptibility.We describe the case of a patient with dilated cardiomyopathy who developed ventricular tachycardia storm (VTS) one month after the implantation of a CRT-D device. VTS was initially controlled with pharmacotherapy, allowing the patient to continue with biventricular pacing. Two months later the patient was readmitted due to multiple episodes of polymorphic ventricular tachycardia. VTS was refractory to various intravenous antiarrhythmic drugs and it was finally controlled only when LV pacing was turned off.In patients with heart failure treated with CRT-D, VTS can occur and is best managed by turning off LV pacing. Our report raises an important and concerning issue of biventricular pacing causing ‘proarrhythmia’ in rare instances
Vernakalant: Review of a Novel Atrial Selective Antiarrhythmic Agent and its Place in Current Treatment of Atrial Fibrillation
Get PDFAtrial fibrillation (AF) remains the most common arrhythmia requiring treatment in the emergency department and is the cause of major morbidity and considerable financial burden. Choosing the appropriate therapy to treat recent-onset AF can be extremely demanding and problematic and recent efforts have been focused on identification of an intravenous antiarrhythmic drug that can provide rapid, effective and safe cardioversion of an acute episode. While the currently available antiarrhythmics show moderate efficacy and pose a risk for serious ventricular proarrhythmias, vernakalant, a recently developed multi-channel inhibitor, has consistently proved to be both effective and safe in converting recent-onset AF to sinus rhythm in randomized clinical trials. Its relatively high atrial selectivity preventing potentially lethal episodes of torsades de pointes as well as its prompt onset of action, offer intravenous vernakalant a strong advantage over its competitors and constitutes an attractive option for the physician
Percutaneous Coronary Intervention for Intra-stent Chronic Total Occlusion Assisted by Stent Visualization Enhancement Technology
Get PDFA 50-year-old female patient with a history of prior acute inferior myocardial infarction successfully treated 2 years earlier by primary percutaneous coronary intervention (PCI) with thrombus aspiration and implantation of a 3x30 mm bare-metal stent in the proximal right coronary artery (RCA) was submitted to coronary angiography after reappearance of effort angina. An initial coronary angiogram showed a chronic total occlusion (CTO) intra-stent with Rentrop III collateral filling of the RCA originating from distal left anterior descending (LAD). A mid LAD 60% stenosis and a 60% mid circumflex stenosis were considered non-significant since fractional flow reserve (FFR) was measured at 0.84 and 0.90 respectively. After demonstrating inferior wall viability by cardiac magnetic resonance imaging (MRI), a PCI was programmed two months after the initial coronary angiogram. The intra-stent CTO was ≥ 30 mm long, with no blunt stump and at least 2 small branches originating at its proximal cap level. Mid and distal RCA antegrade filling existed due to bridging collaterals. The crossing technique by guidewire exchange and use of a microcatheter is described. After balloon predilatation the RCA was recanalized. The use of a stent visualization enhancement technology (StentViz) helped understand the most probable procedure-related restenosis mechanisms (stent undersizing and underexpansion) and guided the subsequent successful implantation of two drug-eluting stents. The use of this technology is described step by step for this intervention
The Concept of Communication Between Nurse and Patient in the Catheterization Laboratory
Get PDFBACKGROUND: The nurse working in the catheterization laboratory through his/her physical presence is required to establish the appropriate therapeutic environment to successfully meet the physical and emotional needs of the patient. PURPOSE: The purpose of this study is to approach the very complex issue of communication of nurses with patients coming through the catheterization laboratory. METHODS: We studied articles and bibliographic references which have been published in authoritative databases (Pub med, Medscape, Iatrotek, Medline, Scopus, etc).RESULTS: The results of studies show that people often express the need for support, feedback from nurses, and obtaining information about the upcoming process of diagnostic or therapeutic intervention. Communication is the most important variable in this patient-relationship. It is exactly this parameter that gives the patient the feeling of receiving care of high quality and which generally increases the overall satisfaction that both parties derive from health services. A good communication contributes to the smooth conduct of any examination and procedure and has a positive impact on health outcomes, and provides satisfaction to the health care professional who influences and is influenced by his relationship with the patient. In any case, knowledge and practical application of appropriate communication strategies are required for this working relationship.CONCLUSION: Through communication given to the patient it is felt that high quality health care is delivered, which generally increases the overall satisfaction that the patient derives from the health care services. The nurse working in the high technology and rapid response environment of a catheterization laboratory should balance between clinical and psychological support, centering the focus to best possible patient care