Hospital Chronicles (E-Journal)
Not a member yet
657 research outputs found
Sort by
Have we Made Any Progress in Preventing Sudden Cardiac Death in the Community? A Review on Automatic External Defibrillators
Get PDFABSTRACT: Automated External Defibrillators (AEDs) have been recognised lately as an important link in the chain of survival of patients experiencing Sudden Cardiac Arrest (SCA) still remaining a major public health problem in the Western countries, being responsible for more than 250,000 out-of-hospital deaths annually. Due to the fact that survival rates following SCA are still unacceptably poor and that in most of the cases the underlying heart rhythm in out-of-hospital SCA is Ventricular Fibrillation/ pulseless Ventricular Tachycardia, introduction of AEDs seems to open a new prospective. Since the early 1990’s, when first launched, significant improvement has been made in AEDs technology and in many countries Public Access Defibrillation programs are now widespread. After minimal training, lay rescuers and first responder who might not be health professionals effectively provide early defibrillation using AEDs, resulting in many cases in improved survival rates. In the present paper we review the status of AEDs in clinical practice in the year of 2010 emphasizing on their key role for the widespread prevention of sudden cardiac death in the community
Chest-Compression Alone Cardiopulmonary Resuscitation: Newer Data for a More Practical Approach / Cardio-Cerebral Resuscitation
Get PDF Background: Sudden cardiac death (SCD) is a leading cause of mortality in the industrialized nations and, accordingly, is a major public health problem. Despite the guidelines and their updates, the survival rate of victims of out of hospital cardiac arrest (OHCA) remains disappointingly low. There are many contributors to poor survival outcome of victims with OHCA. An improper resuscitation algorithm seems to be the major contributor. Chest-compression alone cardio pulmonary resuscitation (CC-CPR), and cardio-cerebral resuscitation (CCR), seems an attractive alternative to conventional CPR. Methods & Results: Reviewing the recent literature, cardiac-only resuscitation emerges as an attractive alternative to conventional CPR, as this simpler technique of CPR, in which continuous chest compressions are provided without rescue breathing avoids the need for mouth-to-mouth ventilation. Under the weight of evidence supported by several recent studies, the AHA issued a science advisory for the public recommending immediate activation of emergency medical services (EMS) after the victim’s collapse and high quality chest compression regarding location and depth with minimum interruptions. Bystanders not trained in CPR are encouraged to initiate immediately hands-only CPR and continue with compressions until an AED is available or EMS arrives at the scene. Conclusion: CC- CPR and CCR is not inferior to conventional CPR but also promises a survival benefit for victims of OHCA
Chest-Compression Alone Cardiopulmonary Resuscitation: Newer Data for a More Practical Approach/ Cardio-Cerebral Resuscitation
Get PDFCardiac-only resuscitation emerges as an attractive alternative to conventional CPR, as this simpler technique of CPR, in which continuous chest compressions are provided without rescue breathing avoids the need for mouth-to-mouth ventilation. Under the weight of evidence supported by several recent studies, the AHA issued a science advisory for the public recommending immediate activation of emergency medical services (EMS) after the victim’s collapse and high quality chest compression regarding location and depth with minimum interruptions. Bystanders not trained in CPR are encouraged to initiate immediately hands-only CPR and continue with compressions until an AED is available or EMS arrives at the scene
Postprandial endothelial function: The effect of various types of fat and of red wine intake on flow-mediated dilation in healthy volunteers
Get PDFBackground: Current evidence suggests that postprandial lipid composition may have either atherogenic or anti-atherogenic properties. This study investigated the acute postprandial effect of three different types of fat (saturated, mono-unsaturated, poly-unsaturated) and of red wine upon endothelial function of healthy subjects.Methods: We fed 21 healthy young subjects four meals containing 1000 kcal and 50 g fat each. Three of the meals contained different fat sources: yellow cheese (saturated fat-meal A), olive oil (monounsaturated fat-meal B) and margarine (polyunsaturated fat-meal C). The fourth meal contained the same amount of saturated fat as the first one together with 250 cc of red wine (meal D). We measured serum lipoproteins, with the use of standard laboratory techniques. Βrachial artery flow-mediated vasodilation (FMD), an index of endothelial function, was also assessed with B-Mode vascular ultrasound. All measurements were performed before, 2 and 4 h after each mealResults: All four meals significantly raised plasma triglycerides. Meal A was associated with a decrease in FMD 2 and 4 hours after its intake (16.5±5% vs. 13±4% vs. 12.3±6% , p=0.030) while with meal D FMD profoundly decreased 2 hours postprandially with a rapid return to baseline levels at 4 hours (14.3±9.5 vs. 8.6±5.5 vs. 12.6±7.5 , p=0.214). This type of response was associated with a concomitant increase of basal brachial artery diameter at 2 hours postpandially (3.7±0.6 mm vs 4.2±0.7 mm vs 3.9±0.7mm at 0, 2 and 4 hours respectively , p=0.000). Meals B and C did not significantly affect FMD. Conclusions. Saturated fat acutely decreases FMD while mono-unsaturated and poly-unsaturated fat do not have any harmful effect on endothelium. The concomitant intake of red wine with saturated fat is associated with a delayed counteracting effect on lipid-induced postprandial endothelial dysfunction
Bicuspid Aortic Valve and Sinus of Valsalva Aneurysm
No full textΑνδρας, 45 ετ??ν, με ιστορικ?? χειρουργηθε??σας υποβαλβιδικ??ς αορτικ??ς στ?νωσης σε παιδικ?? ηλικ??α προσ?ρχεται λ??γω παροξυσμο? κολπικ??ς μαρμαρυγ??ς ( AF) απ?? ημερ??ν. Αναφ?ρει ?¬λλα 2 επεισ??δια κολπικ??ς μαρμαρυγ??ς στο παρελθ??ν και δ?σπνοια προσπ?¬θειας απ?? μην??ν. Το ΗΚΓρ?¬φημα ?δειχνε υπερτροφ??α αριστερ?¬ς κοιλ??ας και ταχυαρρυθμ??α (καρδιακ?? συχν??τητα ≈ 140 bpm). Λ??γω της παρ?λευσης 48??ρου απ?? την ?ναρξη της AF διενεργ??θηκε διαθωρακικ?? και διοισοφ?¬γειο ηχοκαρδιογρ?¬φημα τα οπο??α αν?δειξαν: 1) Ωτ??ο αριστερο? κ??λπου ελε?θερο θρ??μβων, 2) Σοβαρ?? στ?νωση αορτ??ς (AS) σε ?δαφος διγλ??χινας αορτικ??ς βαλβ??δας, 3) Υπερτροφ??α αριστερ?¬ς κοιλ??ας με καλ?? συστολικ?? λειτουργ??α, 3) Μεγ?¬λο ανε?ρυσμα του μη-στεφανια??ου αορτικο? κ??λπου (ανε?ρυσμα του κ??λπου του Valsava)... (excerpt
Do the New Data on Second-Generation Drug Eluting Stents Provide Reassurance on Safety, Efficacy, Even for Off-Label Use?
Get PDFIn in-stent restenosis, drug-eluting stents (DES) are superior compared with bare metal stents (BMS). However, there are concerns about safety because of the reports of increased risk of late and very late stent thrombosis. Stent thrombosis remains a major pitfall in contemporary percutaneous coronary intervention (PCI), leading to high rates of death and nonfatal myocardial infarction. After the US approval of the first two DES, the sirolimus-eluting stent (Cypher) in 2003 and paclitaxel-eluting stent (Taxus) in 2004, concern was raised about the safety of the devices due to the occurrence of late and very late stent thrombosis. Pooled analyses of available randomized trails at the time, however, showed similar rates of death and myocardial infarction in patients treated with one of these DES compared to the BMS counterpart in randomized clinical trials.... (excerpt
Optimizing Cardiac Resynchronization Therapy Device Programming
Get PDFCardiac resynchronization therapy (CRT) improves symptoms and cardiac function, reduces hospitalizations and increases survival in selected patients with heart failure. It is mandatory to maximize mechanical and electrical synchronicity. Atrio-ventricular and ventriculo-ventricular intervals optimization have a substantial impact on the hemodynamic response to pacing. The number of patients with an implanted CRT system is increasing and many issues have not yet been answered about who and how will benefit the most
Therapeutic Advances: Hypertension in the Elderly
Get PDFThe incidence of hypertension and attendant biological disorders (loss of arterial wall elasticity, endothelial dysfunction, insulin resistance) increases with age and so does the frequency of cardiovascular complications. Women have a lower incidence of hypertension and a later—by an average of 10 years—onset of cardiovascular complications. During the premenopausal years, women seem to be relatively protected from cardiovascular events, in part through the effects of estrogen on endothelial function and lipid profile. After menopause however, the incidence of cardiovascular events tends to become similar in both genders, and the severity of such events, in terms of morbidity and mortality, is actually higher in women. The role of hormone replacement for cardiovascular protection has been shown to offer no long-term benefits: indeed, despite improvement in surrogate endpoints (endothelial function, lipid profile), in long-term prospective randomized trials there was no advantage in outcomes, possibly because benefits are offset by the thrombogenic and carcinogenic properties of estrogen....(excerpt
Three-Dimensional Echocardiography
Get PDFThe strength of echocardiography has always been in its capacity for convenient real-time imaging, its rapid acquisition and analysis capabilities. Echocardiography has been one of the most rapidly expanding fields in modern cardiology and has seen unprecedented advances over the last 20 years. One of the most significant advances in this area is that of three-dimensional echocardiography (3DE). 3DE is not a new idea or indeed a new technique; it has been a research tool in various guises for many years. New transducer technology coupled with advances in computing have transformed this modality from a labour-intensive imaging protocol to a real-time imaging that can be rapidly analysed online. Continued improvements in image acquisition and quantification help integrate this into clinical practice and have brought it to the cusp of widespread clinical acceptance
Recent Developments in Pediatric and Congenital Electrophysiology
Get PDFPediatric electrophysiology is a relatively young subspecialty of Pediatric Cardiology, but it has experienced rapid progress in the last 2 decades. The revolutionary therapy of tachyarrhythmias with catheter ablation transformed the field of pediatric electrophysiology in a similar or even more dramatic way to that of adult electrophysiology. Improvements in technology have made catheter ablation safe in children. Exposure to radiation can now be markedly decreased with non-fluoroscopic imaging methods. The use of cryothermal energy has made ablation safer in the vicinity of the AV node or the coronary arteries. Complex postoperative atrial arrhythmias can be managed with advanced electroanatomic mapping technologies. Postoperative ventricular tachycardia can be treated with a combination of pharmacologic therapy, catheter ablation, surgical methods and implantable defibrillator implantation. Genetically determined arrhythmias can be diagnosed and treated more effectively with molecular genetic testing, pharmacologic methods, surgical techniques such as sympathetic denervation and defibrillators. Pediatric electrophysiologists have also adapted techniques of cardiac resynchronization to children and patients with congenital heart disease. Overall, these developments make the present and feature of pediatric electrophysiology very exciting and promising