Hospital Chronicles (E-Journal)
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In-Hospital Cardiac Arrest
Get PDFA cardiac arrest is classified as ‘in-hospital’ (IHCA) if it occurs in a hospitalized patient who had a pulse at the time of admission. Unfortunately, the majority of patients resuscitated successfully from IHCA die before hospital discharge, and their prognosis has changed little over the past 30 years. Recent data indicate that survival to hospital discharge after in-hospital cardiac arrest is approximately 20%. A variety of factors have been proposed as determinants of poor outcomes associated with IHCA, which include first monitored rhythm, time to first shock, duration of cardiac arrest, hospital location of cardiac arrest and time of day of cardiac arrest occurrence. According to current guidelines for prevention of in-hospital cardiac arrest, hospitals should provide a system of care that includes staff education for rapid response, appropriate and regular patient vital sign monitoring, clear and uniform system of timely calling for assistance. Finally, after cardiac arrest has occurred, the quality of resuscitation and early defibrillation are crucial factors for improving survival
Early Warning Systems
Get PDFCurrently, medical general wards tend to have a higher number of severely sick patients with a long period of critical illness. In addition, there is a growing recognition that several indicators of acute deterioration are being missed by both nurses and doctors. The consequences of these are an increase in the number of adverse events, such as cardiac arrest and in the number of patients admitted or readmitted in critical care units, contributing undoubtedly to higher mortality rates. As a result, many initiatives have been designed trying to reduce such problems, including the development of early warning scoring systems with the perspective of timely medical response. The aim of this project is to elucidate the dimensions of early warning systems (EWS), to raise discussion on their validity and to stimulate health leadership in introducing early warning systems into health care mechanisms. After having collected and presented data from several recent articles on the topic, this project intends to discuss about the introduction and function of EWS... (excerpt
Klotho, Spinning the Thread of Life: an Anti-Ageing Gene
Get PDFKlotho, named after the ancient Greek goddess Klotho, the spinner (of life), is an aging suppressor or longevity-related gene, discovered in 1997. A defect in the Klotho gene expression in mice leads to phenotypes resembling human premature or accelerated aging syndromes, with a short lifespan, infertility, arteriosclerosis, skin atrophy, osteoporosis and emphysema, while Klotho overexpression is associated with extended longevity. The Klotho gene encodes a transmembrane protein expressed mainly in the kidney, the parathyroid gland and the choroid plexus. The Klotho protein has multiple regulating functions, can serve as a useful biomarker and may have potential therapeutic applications, and thus an emerging role in reno-cardio-vascular disease, which is briefly explored in this overview
Fever-Induced Type 1 ECG Pattern of Brugada Syndrome
Get PDFA 38-year-old female presented to the emergency department with symptoms and signs of an upper respiratory infection. ECG on admission performed during febrile state (38.8°C) revealed the diagnostic type 1 ECG pattern of Brugada syndrome. Two hours later, a new ECG performed without fever failed to show any of these abnormalities. Due to the increased risk of ventricular arrhythmias during febrile state, fever should be vigorously treated with antipyretics in these patients
Right Ventricular Outflow Tract Obstruction in a Middle Aged Man with Right-Sided Aortic Arch
Get PDFCongenital diseases causing an obstruction of the right ventricular outflow tract are difficult to precisely diagnose, especially in elderly patients. We report a case of a 49-year-old man who presented to our hospital with longstanding shortness of breath on exertion. He was finally diagnosed as right ventricular outflow tract obstruction and referred for surgical correction. The patient had a history of descending aorta dissection which was treated by thoracic stent grafting. By that time right-sided aortic arch was diagnosed. The coexistence of right ventricular outflow tract obstraction and right sided aortic arch in the same patient is very rare, to the best of our knowledge
Ultrafiltration in Diuretic Resistant Congestive Heart Failure
Get PDFDiuretic therapy has been the cornerstone of the medical treatment in patients with heart failure for the last fifty years. However, despite the fact that the majority of them are on diuretics, fluid balance remains a challenge for their physicians. Poor response, diuretic resistance, worsening of kidney function, electrolyte disturbances, and diuretic therapy associated morbidity and mortality have stimulated interest to develop effective and safe treatment strategies that improve decongestion and preserve kidney function. Ultrafiltration has been used to remove fluid from diuretic-refractory hypervolemic patients. Recently clinical studies have suggested that ultrafiltration may be highly effective for decongesting patients with either chronic or acutely decompensated heart failure... (excerpt
Thrombolysis for Acute Ischemic Stroke: a New Paradigm
Get PDFModern day therapy of acute ischemic stroke is based upon intravenous thrombolysis, which has altered management of this potentially devastating disease. The urgent treatment of acute ischemic stroke must be of the same priority as the treatment of acute myocardial infarction. Specific networks must be established to ensure rapid transfer of stroke patients to designated hospitals that have the resources in place to deliver thrombolysis. Prior to the initiation of any treatment, diseases that mimic strokes must be ruled out. Prompt completion of computed tomography (CT) scanning should be performed to rule out hemorrhagic stroke and determination of the severity of the stroke using the various grading scales should be made. Recombinant tissue-plasminogen activator (rt-PA) is the only thrombolytic agent currently approved by the FDA for ischemic stroke treatment. It must be initiated within 3-4.5 hours of symptom onset. The extent of the difficulty in establishing the goals outlined above is evident from the observed low rate of thrombolysis. Even in the US, the proportion of stroke patients being thrombolysed does not exceed 3.5 %. This is primarily due to patient delayed presentation. However, the goal of initiating thrombolysis as soon as possible, to maximize the potential for benefit, should be strongly encouraged
Endovascular Treatment of Aortic Aneurysms: the Role of the Multilayer Stent
Get PDFAim: The purpose of this study was to evaluate the safety and effectiveness of the multilayer flow modulator and its delivery system for totally endovascular repair of aortic aneurysms in high risk patients and to demonstrate deployment success and preservation of all side-branch vessels. Methods and Results: We report on 22 cases (mean age 67 + 5 years all males) with thoracic, thoracoabdominal and abdominal aneurysm considered high risk patients for surgical treatment. In all patients, treated with a multilayer stent, there were side branches arising from the aneurysm sac and maintained patency after the procedure. Two patients died after the procedure: 1 patient who developed a stroke two weeks post procedure and 1 patient who sustained a myocardial infarction two days post-procedurally. No vascular or systematic complications were observed in the other 20 patients in the short and long term follow-up. Conclusions: Our preliminary results indicate that the use of the multilayer stent is feasible and seems to be safe for the management of aortic aneurysm with side branches
Cardiac Resynchronization Therapy in Mild Heart Failure/ REVERSE, MADIT-CRT & RAFT studies & Meta-analyses / Expanding CRT-D Indications to Lower Risk Patients
Get PDFCardiac resynchronization therapy (CRT), effected via biventricular pacing, has been shown to improve symptoms and left ventricular (LV) systolic function and to reduce mortality and hospitalizations among patients with moderate to severe heart failure symptoms (class III and IV), reduced LV ejection fraction (EF), and a wide QRS complex on electrocardiogram, usually in the form of left bundle branch block. Recent evidence from randomized clinical trials and meta-analyses demonstrate that the beneficial effects of CRT on LV remodeling, heart failure symptoms, hospitalizations, and mortality also extend to patients with milder heart failure symptoms (class II). These data support the expansion of indications for CRT to less symptomatic patients with heart failure who have LVEF <0.35 and wide QRS duration in sinus rhythm. Accordingly the guidelines for CRT therapy by the European Society of Cardiology (ESC) and the American heart Association (AHA) have been updated to expand CRT indications to patients with milder heart failure symptoms
Atrial Fibrillation and the Autonomic Nervous System
Get PDFCatheter ablation of atrial fibrillation (AF) has been increasingly employed as a therapeutic modality to maintain sinus rhythm. However, the procedure is potentially associated with major complications and its long-term efficacy is relatively poor. Thus, the quest for additional non-pharmacological, non-ablative therapies for the management of patients with AF continues. Present methodology for catheter ablation of AF includes pulmonary vein isolation by applying radiofrequency current around the pulmonary vein ostia, in order to prevent the ectopic activity arising from the pulmonary veins from reaching the atria and thereby inducing AF. However, this approach failed to answer the fundamental question of how the generally short episodes of focal firing in the pulmonary veins are converted into AF. Experimental work has provided many lines of evidence linking the intrinsic cardiac autonomic nervous system with focal firing from the pulmonary veins via activation of the ganglionated plexi (GP) adjacent to these veins. Autonomic denervation is common following pulmonary vein isolation and has been associated with decreased risk of AF recurrence. Recent clinical studies where GP ablation was performed either in addition to the standard procedure of pulmonary vein isolation, or as a stand-alone procedure support these experimental data. These intriguing new concepts and data linking the autonomic nervous system to AF will herein be briefly reviewed