Hospital Chronicles (E-Journal)
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Catheter Ablation of Persistent Atrial Fibrillation
Get PDF Catheter ablation of atrial fibrillation (AF) has been widely accepted as an important therapeutic modality for the treatment of patients with symptomatic, drug-refractory AF. Ablation strategies which target the pulmonary veins (PVs) and/or the PV antrum (segmental or large circumferential lesions) are the cornerstone of AF ablation procedures, irrespective of the AF type. Successful electrical PV isolation results in maintenance of sinus rhythm in 60 to 85% of patients in patients with paroxysmal AF. However, PV isolation is usually insufficient to eliminate persistent or long-lasting persistent AF leading to significantly lower success rate of this method. Up to now, no single strategy is uniformly effective in patients with persistent and long-lasting persistent AF. Many centers follow a stepwise ablation approach including (i) PV isolation as the initial step; (ii) electrogram-based ablation at all sites in the left atrium and the coronary sinus exhibiting complex fractionated atrial electrograms; (iii) If AF sustains, linear ablation (mainly roof and mitral isthmus lines) is then carried out; and (iv) the right atrium and superior vena cava are finally mapped and ablated. However, such an extensive ablation strategy lead to longer procedure time, longer fluoroscopy time, higher complication rates and higher rates of post-procedural atrial tachycardias. Therefore, the risk/benefit ratio of an extensive ablation approach has to be carefully evaluated. Catheter ablation of persistent and long-lasting persistent AF still remains challenging for the electrophysiologists. The long-term efficacy of certain ablation strategies need to be evaluated in randomized trials
Novel Therapies For Resistant Hypertension
Get PDFTwo novel invasive therapeutic strategies for the treatment of resistant hypertension, have recently emerged, carotid baroreceptor stimulation and renal denervation. Both are effective in reducing elevated blood pressure values and display a good tolerability profile without the occurrence of any major untoward effect. A third choice, immunization against components of the renin-angiotensin-aldosterone system (RAAS) is a potential therapeutic alternative under investigation
Late Reoperation for Proximal Aortic Complication in a Marfan Patient Following Ascending Aortic Grafting
Get PDFWe report a case of a female patient with Marfan syndrome who suffered a type A acute aortic dissection eleven years ago. At that time she underwent supracoronary ascending aortic grafting and resuspension of the incompetent aortic valve. Recently this patient presented to us with uncontrolled hypertension and a transthoracic echocardiographic study revealed severe dilatation of the sinuses of Valsalva. She required reoperation and a Bentall procedure was performed. Surgical treatment of the Marfan syndrome is discussed
Patient Inclusion Criteria for Left Ventricular Assist Device
Get PDFMechanical cardiac circulatory support has been established as a benefactory treatment modality for patients with end stage heart failure. There is a variety of ventricular assist devices (VAD) that are available for implantation depending on patients’ clinical characteristics, type of heart failure and intention of treatment. Current indications of VAD placement are: a) bridge to transplant, for patients who are transplant candidates but who will not survive waiting until an organ is available, b) destination therapy, for patients who are not transplant candidates, c) bridge to recovery, for patients in whom the native heart function may possibly recover... (excerpt
Secretory Phospholipase A2 and Lipoprotein-Associated Phospholipase A2 as Biomarkers of Cardiovascular Disease and Therapeutic Targets
Get PDFAtherosclerosis is not only a lipid-driven disease but it is an intricate process that also involves the simultaneous and combined effect of inflammatory and immunological factors. A substantial body of peer-reviewed studies has validated the cardiovascular risk predictive value of a variety of inflammatory markers including two members of the phospholipase A2 (PLA2) superfamily, the type IIA secretory PLA2 (sPLA2) and the lipoprotein-associated phospholipase A2 (Lp-PLA2). In animal, pathological and epidemiological studies, the increased levels of these two PLA2 have been related to an increase in complex coronary artery lesions and an increase in major cardiovascular clinical events. Therefore, inhibition of these enzymes has become the focus of research in the last decennium. Novel pharmacological inhibitors of those enzymes emerge as promising therapeutical options for treating patients with coronary artery disease.... (excerpt
Hypolipidemic Therapy and HDL
Get PDFStatins significantly reduce cardiovascular events by reducing low-density-lipoprotein cholesterol (LDL-C). However, despite achieving the LDL goals, a substantial residual risk remains. It appears that low levels of high-density lipoprotein cholesterol (HDL-C) constitute another independent risk factor for coronary artery disease (CAD). Therefore, raising HDL levels appears an attractive target to further reduce the cardiovascular risk. However, classical HDL-reducing drugs (nicotinic acid derivatives, fibrates) are not well tolerated and newer agents (torcetrapid), which seemed effective in doing that, had to be withdrawn due to increased mortality. Nevertheless, due to the importance of HDL in influencing the cardiovascular risk, efforts in developing safer drugs are continuing. Such pharmacological developments, as well as the nonpharmacological approaches to increase HDL, and other HDL-targeted therapies are discussed in this overview
Caring for the Heart Failure Patient: Contemporary Nursing Interventions
Get PDFCongestive heart failure is a major public health problem with steadily increasing prevalence, high morbidity and early mortality. A multidisciplinary approach seems the best way to manage patients with heart failure since it has been shown to improve clinical outcome and especially to reduce the rate of readmission due to acute or chronic decompensation. Nurses have a leading role in this “heart failure team” due to their excellent clinical assessment and communication skills as well as due to their ability to work closely with the patient. Thus, they are able to deliver care in many forms and contexts throughout the course of the disease. Specialized in heart failure care nurses can assess the signs and symptoms of cardiac destabilisation, monitor therapy compliance, provide education, psycho-social support and counselling, develop behaviour modification techniques, and also act as the healthcare liaison for the patients and their family at any stage of the disease. The ultimate aim is, through this integrated approach, to reduce mortality, prevent rehospitalisation, increase functional ability and improve quality of life for heart failure patients
Nurse???s Role in the Modern Resuscitation Era
Get PDFObjective: This paper explores the existing literature and discusses the new roles that have emerged and have been given to nurses in the modern resuscitation era. Methods: Keywords such as cardiac arrest, resuscitation, cardio-pulmonary resuscitation (CPR), nursing role, and rapid response nurse were entered into Medline, Medscape and Science Direct databases. The relative literature found was then compared and conclusions were drawn concerning the new nursing roles. Results: Throughout the years, factors such as improvement in nursing education, increased needs for expert nurses due to the requirements of specialized fields of medicine, and an increase noted in the autonomy of the nursing role have led to a change in nurses’ responsibilities during CPR. Therefore, the traditional roles of nurses during CPR which held them responsible for limited duties, such as preparing the drugs administered and monitoring the patients’ vital signs, have evolved; hence the nurse has become a more active member of the multidisciplinary team. Conclusion/Perspective: The new nursing roles are on a good explorative track in several hospitals. Although they have not yet been implemented in the Hellenic health care setting, nurses are optimistic that their role during cardiopulmonary resuscitation is slowly but steadily improving. More nurses are interested in continuing education and training, in increasing their knowledge and improving their skills. As a result, nurses who work in departments such as Cardiology, Cardiac Care Units, Intensive Care Units and Accident and Emergency Departments where events of cardiac arrest are more common are more involved in attending CPR seminars. Finally, in the event of a cardiac arrest, nurses are perceived by the community to be competent and ready to perform effective CPR. Irrespective of their level, nurses have a professional responsibility to maintain competence in CPR through regular updates
Non-invasive Coronary Angiography: the Present and Future of Multi-slice Computed Tomography Coronary Angiography
Get PDFDuring the last five years, since the advent of 64-slice multi-slice computed tomography (MSCT) and thanks to the continuous technological improvements of this technique, the non-invasing imaging of the coronary arteries has become much more reliable. Nowadays, MSCT coronary angiography (CTCA) enables visualization of not only the coronary artery stenoses and occlusions, but also of the atherosclerotic changes and plaques that are confined to the coronary vessel wall without causing significant stenoses... (excerpt
Challenges and Caveats for Stents of New Technology /Are all the Drug- Eluting Coronary Stents the Same?
Get PDFThe introduction of drug-eluting stents (DES) has improved the efficacy of percutaneous coronary intervention (PCI), by addressing the issue of neointimal proliferation, a pathology contributing to restenosis. First-generation stents eluting sirolimus or paclitaxel were joined by second-generation stents, such as the everolimus- and the zotarolimus- eluting stents promising increased safety and efficacy. As a result, there is a plethora of DES available, with differences in the stent platform, the polymer coating and the eluted drug, which translate into differences in biological markers of efficacy, such as lumen late loss. However, it remains controversial whether these discrepancies have an impact on clinical markers of safety and efficacy, or if the improved efficacy of DES is a “class effect”. This article reviews the differences between drug-eluting stents by looking into the biological differences as well as into trials and registries of drug-eluting stents