Hospital Chronicles (E-Journal)
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The Contribution of Echocardiography in Discerning Responders to Cardiac Resynchronization Therapy
Get PDFCardiac resynchronisation therapy (CRT) has been established as a therapeutic intervention in chronic heart failure and is proven to help improve symptoms, cardiac size and function as well as improve rehospitalisation and mortality. Current selection criteria for CRT are ECG based but there is mounting evidence that cardiac imaging may be a more accurate selection tool. This abstract examines some of the commonly used echocardiography techniques for quantifying left ventricular mechanical dyssynchrony to select potential responders to CRT
Catheter Ablation of Two Accessory Pathways in Elusive Ebstein's Anomaly: Procedure Facilitation With Use of a Long Vascular Sheath
Get PDFA 17-year-old adolescent presenting with multiple episodes of palpitations over the previous 9 months refractory to antiarrhythmic drug therapy and with manifest preexcitation on the 12-lead surface electrocardiogram (type B Wolff-Parkinson-White syndrome) was referred for radiofrequency (RF) catheter ablation. The initial echocardiographic evaluation was reported normal. The first procedure was tedious and prolonged, hampered by the occurrence of mechanical block in the antegrade conduction of the accessory pathway (loss of preexcitation) for the duration of the procedure. There was only retrograde conduction noted via a right lateral accessory pathway and inducible atrioventricular tachycardia with the participation of this concealed pathway, which was successfully ablated after the delivery of 9 radiofrequency energy applications (...excerpt
Acute Myocardial Infarction: Routine Early Angioplasty after Thrombolysis
Get PDFAdjunctive percutaneous coronary intervention (PCI) performed between 2 and 24 hours after thrombolysis administered to a patient with an ST elevation myocardial infarction (STEMI) appears beneficial and safe. The rationale for routinely following fibrinolysis with PCI is that many patients have a persistent reduction in flow in the infarct-related artery; although fibrinolysis restores patency (TIMI grade 2 or 3) in 80% of infarct-related arteries, normalization of blood flow (TIMI grade 3) is seen in only 50 to 60% of arteries. Adjunctive PCI has been directly compared to a strategy of fibrinolysis and standard care (either PCI for a clinical indication or routine late PCI) in the TRANSFER AMI, GRACIA-1, NORDISTEMI, CARESS-in-AMI, and SIAM III trials, and found to have better outcomes. Based on these results, the 2010 European Society of Cardiology (ESC) guidelines recommend routine urgent PCI after successful fibrinolysis within 24 hours (class I recommendation, level of evidence A)
Drugs in Resuscitation
Get PDFCardiac arrest (CA) is defined as the sudden cessation of spontaneous circulation and ventilation. Unfortunately, survival rates of both out of hospital and in hospital cardiac arrest remain low and merely unchanged over the last 30 years. Cardiopulmonary resuscitation (CPR) is an attempt to restore effective, spontaneous circulation and ventilation through a variety of interventions including early defibrillation, chest compressions, advanced airway management, pharmacological therapy and effective post-resuscitation treatment, once return of spontaneous circulation (ROSC) has been achieved. Both, European Resuscitation Council (ERC) and American Heart Association (AHA) have published detailed guidelines in an attempt to incorporate recent scientific advances in a variety of topics underpinning CPR. The major concepts of these guidelines are the increased emphasis on high quality, minimally interrupted chest compressions of adequate rate and depth, avoidance of hyperventilation, early defibrillation for specific heart rhythms with minimization of the pre-shock pause and greater detail and importance on the treatment of the post-cardiac arrest syndrome. Pharmacologic interventions continue to be a fundamental part of advanced life support, although there are no clinical data indicating that any drug improves long term survival after CA. In addition, there is inadequate evidence to define the optimal timing, dose or order for drug administration. The primary goal of pharmacologic therapy during CA is to facilitate restoration and maintenance of a perfusing and spontaneous rhythm. Vasopressors and antiarrhythmics are the main drug categories used in CPR algorithms... (excerpt
Computed Tomography Coronary Angiography to Triage Patients With Chest Pain: The CT-STAT Trial
Get PDFCoronary computed tomography angiography (CCTA) is a non-invasive alternative to invasive coronary angiography, which is highly reliable to rule out obstructive coronary artery disease. It has also been proposed and used for the assessment of patients with acute chest pain in the emergency department setting. Recently the results of a multicenter randomized trial, the CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial have been published. In the present article the main messages of this important study will be presented and discussed
Does a Short QT Interval Presage a Short Life Span?
Get PDFA case of a 16-year old adolescent is presented who was referred for investigation of a syncopal episode. The ECG displayed a very short QT interval of 280 ms, compatible with the newly described short QT syndrome, which is genetic primary electrical disease of abnormal potassium currents responsible for the repolarization process of the cardiac muscle. The prognosis is similar to the other well known familial cardiac channelopathies, such as the long QT or the Brugada syndromes which are associated with a high risk of sudden cardiac death, requiring an implantable cardioverter defibrillator device for life-long protection
Pathogenesis of Helicobacter Pylori Infection: Colonization, Virulence Factors of the Bacterium and Immune and Non-immune Host Response
Get PDFHelicobacter pylori (Hp), a gram-negative, spiral-shaped bacterium is one of the most widely spread pathogens in humans, as it concerns half of the world population. Mechanisms that allow Hp to cause a life-long infection involve modulation of the immune response and host cellular processes which include activation of the innate immune response, resistance to phagocytosis, modulation of dendritic cell activity and regulatory T cells, and production of proinflammatory cytokines. This is accomplished via virulence factors such as colonization factors (a variety of adhesins), factors that allow it to evade host defence (flagella and motility, urease system, induction of hypochlorhydria) and factors that are responsible for tissue injury (heat shock proteins A and B, vacuolating cytotoxin A, neutrophil activating protein of Hp, and cytotoxin-associated gene A). The interaction between bacterial effectors, environmental factors (genetic susceptibility to infection) and factors that modulate the host's response, such as polymorphisms in genes encoding cytokines or cytokine receptors, have been shown to influence the clinical outcome of Hp infection either towards peptic ulcer and/or cancer. Future studies, directed toward understanding interactions between Hp and immune cells in vivo, may lead to the development of novel therapeutic approaches for eradication of Hp
Acute ST-Segment Elevation Due to Coronary Vasospasm After Cefuroxime Induced Anaphylactic Shock
Get PDFA 41-year-old patient presented to the emergency room after intake of cefuroxime 500 mg. He had dyspnea and hypotension and the ECG showed ST elevation in leads II, III, aVF, V2-V6. He was successfully managed with oxygen, intravenous corticoids, antihistamines and epinephrine. This constellation of presenting symptoms and signs was attributed to a manifestation of Kounis syndrome (allergic angina). The connection between acute coronary syndromes and anaphylaxis seems to be strong. The same mediators released during acute allergic reactions are increased in blood or urine of patients suffering from acute coronary syndromes of non allergic etiology
Adenosine for Unmasking Latent Pre-Excitation: an Unpleasant Surprise
Get PDFA 33-year-old kickboxing athlete presented to the emergency room (ER) with an intermittent chest pain, which had started an hour earlier. ECG on arrival revealed q wave in the inferior leads, minimal ST elevation in the same leads, without depolarization abnormalities. The patient was able to recall having been kicked in the chest a few months back during training. While being in the ER the pain recurred. The second ECG had no repolarization changes, but revealed a positive QRS (R>S) in lead V1... (excerpt
Left Main Coronary Artery Disease: CABG is superior to PCI
Get PDFLeft main coronary artery disease (LMCAD) is a special part of coronary pathology and its gold standard treatment is coronary artery bypass surgery (CABG). Over the last two decades, the evolution in technology and materials and the growing experience of interventional cardiologist treating acute coronary syndrome improved the results of percutaneous coronary interventions even in patients with LM disease. Recent prospective randomized studies though (SYNTAX) as well as large registries comparing the two methods showed comparable results concerning safety and inferiority of PCI regarding restenosis and need for reintervention. Up to now CABG remains the treatment of choice for LM disease with PCI being a reliable alternative solution in cases of patients of high surgical risk. The above is strongly recommended by the new guidelines