Hospital Chronicles (E-Journal)
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Post-Resuscitation Care: the Role of Early Percutaneous Coronary Intervention
Get PDFBACKGROUND: The outcome of resuscitated cardiac arrest (CA) patients remains poor, despite current advances in cardiopulmonary resuscitation (CPR). Although the majority of cases are of cardiac origin, the decision to perform percutaneous coronary intervention (PCI) is challenging due to the lack of randomized trials and the uncertainty of the neurological outcome. We sought to review the current evidence of early PCI in patients resuscitated after CA with regard to its feasibility, success and long - term outcome.METHODS & RESULTS: The studies for our review were identified from PubMed and references from relevant studies and review papers. We included 18 studies between 1997 to 2010, reporting adult survivors of cardiac arrest, who underwent PCI. The survival at discharge varied from 38% to 81%, with 34.2% to 71.4% of patients having a favorable neurological outcome. Main independent predictors of survival were the time interval between CA and the start of CPR, the existence of a shockable rhythm, early defibrillation, absence of cardiogenic shock, neurological status on admission, and the implementation of PCI. In some studies, significant coronary lesions amenable to PCI, were also found in cardiac arrest patients without evidence of pre-arrest myocardial infarction. As there is no sensitive marker regarding neurological prognosis and many comatose patients regained full neurological function at follow up, several authors suggest that there should be a low threshold for urgent PCI, even in patients with depressed sensorium. CONCLUSION: PCI improves survival in CA patients with STEMI, and should also be considered in survivors of cardiac arrest of presumed cardiac origin, even in cases with poor neurological status on admission. The role of PCI, its long term effectiveness and feasibility at an organizational level need further research
Severe supravalvular aortic stenosis accompanied with multiple peripheral pulmonary artery stenoses: a delayed diagnosis in an adult patient
Get PDFAbstract We present a case of a 28 years old male with delayed diagnosis of a severe supravalvular aortic stenosis accompanied with peripheral pulmonary artery stenosis and increased right ventricular pressure. The patient had been diagnosed since he was 3 years old to suffer from pulmonary artery hypertension of idiopathic origin. The diagnosis was made by tranthoracic echocardiography and magnetic resonance imaging
Challenging Percutaneous Coronary Intervention in Complicated Inferior Wall Myocardial Infarction
Get PDFA 61-year-old gentleman suffered an acute complicated inferior myocardial infarction. Coronary angiography revealed severe type C lesion in a dominant right coronary artery and the patient had an angioplasty done in the culprit vessel and a number of procedure related technical difficulties were encountered
Current Trends and Future Developments in Robotic Cardiac Surgery
Get PDFRobotic Cardiac Surgery has revolutionised operating for surgeons to provide less operative pain, shorter hospital stays and improved quality of life. As surgeons are constantly trying new techniques, Robotic Cardiac Surgery now encompasses mitral valve surgery, coronary revascularisation, atrial fibrillation surgery, pacing lead implantation, congenital cardiac operations, cardiac tumours resection and diaphragmatic pacing. Robotic technology is gradually becoming more affordable and so more centres are investing in training surgeons in these techniques. As a result, robotic cardiac surgery has developed into a rapidly evolving speciality with exciting new possibilities... (excerpt
New Developments in the Field of RAS Inhibition
Get PDFThe renin-angiotensin system (RAS) was extensively investigated and characterized throughout the first half of the 20th century. However, its contribution to the maintenance of high blood (BP) in essential hypertension and to the development of hypertensive cardiac complications remained under debate until the advent of the first pharmacologic probes capable of blocking its actions, namely the angiotensin receptor blocker (ARB) saralasin and the angiotensin-converting enzyme inhibitor (ACEI) teprotide in the early 1970's. Using these probes, we could demonstrate that even in normal-renin and low-renin hypertension, blockade of the RAS produced a fall in BP. And this fall was maximized if the patient had been previously submitted to sodium depletion by diuretics or low salt diet, which might produce only a small and possibly insignificant BP fall by itself, but rendered the hypertension RAS-dependent and far more responsive to RAS blockade....(excerpt
Primary PCI: Thromboaspiration, IIb/IIIa Infusion and the No-Reflow Phenomenon
No full textΗ μ?¬χη με το ?μφραγμα ε??ναι μ?¬χη με τον θρ??μβο. Μεγ?¬λο φορτ??ο θρ??μβου κατ?¬ τη δι?¬ρκεια της πρωτογενο?ς αγγειοπλαστικ??ς σχετ??ζεται με αυξημ?νη συχν??τητα περιφερικο? εμβολισμο? και φαινομ?νου no-reflow και μπορε?? να εμποδ??σει την επαναιμ?¬τωση σε μικροαγγειακ?? επ??πεδο. Το παραπ?¬νω φαιν??μενο αποτελε?? ανεξ?¬ρτητο γνωστικ?? παρ?¬γοντα θνητ??τητας στα 2 χρ??νια... (excerpt
Differential Diagnosis of a Left Atrial Mass: Role of 3D Transesophageal Echocardiography
Get PDFAn 81-year-old female patient was admitted to our clinic due to an episode of loss of consciousness... On admission the clinical examination revealed bradyarrhythmia with normal heart sounds, a soft systolic apical murmur consistent with mild mitral regurgitation and no signs of pulmonary congestion... A transthoracic echocardiogram showed a left ventricle of normal dimensions with a preserved systolic function and a mass inside the left atrium... (excerpt
Effects of Dark Chocolate on Cardiovascular Risk
Get PDFCocoa is rich in polyphenols, a subgroup of dietary flavonoids, which seems to be able to reduce cardiovascular risk. Since dark chocolate is popular in Europe and the United States, and it is a potent source of polyphenols, there is increasing interest on its potential effects on cardiovascular risk. Evidence suggests that dark chocolate has some beneficial effects on cardiovascular risk factors, particularly on atherogenic dyslipidemia. Beneficial effects include the reduction of elevated blood pressure in hypertensive subjects, the increase in vasodilatation with improved endothelial function, as well as the inhibition of platelet activation and function. In addition, dark chocolate seems to reduce C-reactive protein concentrations and to modulate atherogenic dyslipidemia, reducing plasma total-cholesterol, LDL-cholesterol and triglyceride levels, with a concomitant increase in HDL-cholesterol concentrations. Yet, further studies are needed before recommending habitual dark chocolate consumption for the reduction of cardiovascular risk
Heart Failure: Will There be Any light at the End of the Tunnel with Stem Cell Therapy?
Get PDFCardiac regeneration using stem cells emerges as a noveltreatment option for heart failure. Clinical applications havereported encouraging but modest favorable results, concerningcardiac functional recovery. However, many issues need clarification.The most appropriate cell type, the optimal number ofinjected cells and time for cell delivery, as well as the mode ofcell function remain to be elucidated. Furthermore, ways to improve cell survival and long term engraftment are being sought, in an effort to enhance the regenerative capability of the cells. A substantial amount of basic, translational and clinical research is still needed, in order to take advantage of the full therapeuticpotential of stem cell treatments for heart failure
Ectopic Mediastinal Thyroid Gland. A Case Report and Review of the Literature.
No full text ABSTRACTBackground: Ectopic thyroid tissue is the result of abnormal migration of the thyroid gland from the floor of the primitive foregut to its pretracheal position. Case presentation: A case of a 59-year-old man with a posterior mediastinal mass that proved to be ectopic intrathoracic thyroid is presented. The mass was completely excised through a right posterolateral thoracotomy and pathologic examination confirmed multinodular goiter. Relevant literature is briefly reviewed.Conclusions: Surgical excision is the mainstay of the treatment for almost all mediastinal masses including ectopic thyroid. KEY WORDS: ectopic thyroid, mediastinum