Hospital Chronicles (E-Journal)
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Public Access Defibrillation
Get PDFThe single most important cause of death in the adult population of the industrialized word is sudden cardiac death (SCD) due to coronary artery disease (CAD). In a population based study the overall yearly incidence of SCD was 1 per 1000 persons aged20 to 75 years of age. Overall 21% of deaths in men and 15% in women were sudden and unexpected. The vast majority of out of hospital deaths occur at home and about 15% in a public place or on the street. Forty percent of SCDs were unwitnessed. Themajority of patients have ventricular tachycardia or fibrillation as the first recorded rhythm after patients collapse
Implementation of Primary and Secondary Prevention Measures in Patients Following Acute Coronary Syndromes
Get PDFDespite primary and secondary methods for the prevention of acute coronary syndromes, there is still poor patient and physician understanding of the importance of smoking cessation. Cardiovascular risk decreases significantly after smoking cessation, however, there is a paucity of counseling programs regarding this issue after hospitalization. Such programs have proved to be cost effective and should be provided as standard care
New Universal Definition of Myocardial Infarction
Get PDFRecently, a joint ESC/ACCF/AHA/WHF Task Force published an expert consensus document on the universal definition of myocardial infarction [1]. The following points are extracts from this document that summarize its main features. The main reason for agreeing on a new definition of myocardial infarction derives from the development and the wide availability of very sensitive and specific serological biomarkers that are able to detect even minimal myocardial necrosis. Acute myocardial infarction is diagnosed when there is evidence of myocardial cell necrosis in the clinical setting of myocardial ischemia. In contrast to the historical World Health Organization (WHO) definition where symptoms, ECG and enzymes had equal weight for the diagnosis (the presence of any two would suffice), today biomarkers take precedence with imaging having also a diagnostic role. Consequently, acute myocardial infarction is diagnosed if a rise and fall of cardiac biomarkers (preferably troponin) is detected together with at least one of the following: a) symptoms of ischemia, b) new ST-T changes or new left bundle branch block (LBBB), c) development of pathological Q waves and d) imaging evidence of new loss of viable myocardium or new regional wall motion abnormality.Prior myocardial infarction requires for its diagnosis any of the following criteria: a) new Q waves, b) imaging of a regional loss of viable myocardium that is thinned and fails to contract and c) pathological findings of a healed or healing myocardium
Treating Diffuse Three-vessel Coronary Artery Disease with Percutaneous Coronary Intervention
Get PDFWe present a case of a 57-year-old man, with a history of heavy smoking, noninsulin dependent diabetes mellitus (NIDDM) and untreated hypercholesterolemia.He was complaining for typical angina on effort which started one month ago. He had a treadmill stress test which was terminated very early because of angina and ECG changes evident of myocardial ischemia.Coronary angiogram showed diffuse disease of the right coronary artery (RCA) and 100% obstruction (Fig. 1), a non significant plaque at the distal part of left main coronary artery, diffuse disease in the left anterior descending (LAD) and left circumflex (LCx) (Fig. 2 & 3) with very significant and complex lesions at the proximal parts, and left ventricular ejection fraction impaired, estimated about 35%. We proposed that according to the evidence and the guidelines he should have surgery (CABG).Although we insisted on CABG, the patient rejected this treatment and asked for coronary angioplasty (PTCA)
The Contribution of Cardiac MRI: Data from our Recent Experience at ???Evagelismos?? Hospital
Get PDFCardiovascular magnetic resonance imaging (MRI) is established in clinical practice for the diagnosis and management of diseases of the cardiovascular system and has been shown to provide highly accurate and reproducible measurements of cardiodynamic parameters and for the assessment of cardiac morphology. We present our recent experience in cardiac imaging with MRI. The aim of this presentation is to focus on MRI findings of various cardiovascular diseases, as an alternative non invasive imaging method for diagnosis and follow-up of these patients. Cardiovascular magnetic resonance (CMR) is established in clinical practice for the diagnosis and management of diseases of the cardiovascular system. CMR is very safe and no long-term ill effects have been demonstrated. Considerable technical and practice advances have been made over the last several years??. MRI was introduced into clinical routine for the assessment of cardiac morphology more than 10 years ago. The multiplanar crosssectional nature inherent to cine-MR imaging coupled with high spatial and temporal resolution has been shown to provide highly accurate and reproducible measurements of cardiodynamic parameters and must be considered as the standard of reference for the assessment of ventricular volumes, ejection fraction, and regional wall motion abnormalities
Hypertrophic Cardiomyopathy - The Case for Alcohol Ablation Therapy
Get PDFHypertrophic Cardiomyopathy (HCM) is a genetic disease caused by a variety of mutations in proteins, mostly but not exclusively, of the cardiac sarcomere. It is characterized by hypertrophy of the left ventricle (LV), often with obstruction of the LV outflow tract (LVOT), in the absence of another cause, such as hypertension or aortic stenosis, capable of producing the degree of hypertrophy observed. It presents with markedly variable morphologic and hemodynamic abnormalities and clinical manifestations. The present review will briefly summarize the genetics,pathophysiology, clinical features and management of this disease and will mainly deal with the non-surgical reduction of septal hypertrophy by means of transcoronary alcohol septal ablation
Reuse of Electrode Catheters and Pacemakers
Get PDFReuse of electrophysiology catheters and pacemaker devices has been practiced safely in several countries with significant cost-savings. Data from the literature evaluating clinical end-points, device-related complications, such as infections, and mechanical performance, suggest that this is a safe practice with no increased risk of complications or mortality. However, there remain practical, legal and ethical concerns which need to be addressed before a more widespread use of such practice is adopted. Also, protocols for validation of cleaning and sterilization, and estimations of the potential risks of infective agent transmission need to be more rigorous
Role of Angiotensin and its Inhibition in Hypertension, Ischemic Heart Disease and Heart Failure
Get PDFSuppression of the renin-angiotensin system (RAS) has proven efficacy not only in the treatment of hypertension, but it also greatly benefits and protects patients with ischemic cardiomyopathy and heart failure. This inhibition not only leads to symptomatic and functional improvement but it also prolongs life. The role of angiotensin inhibition in cardiovascular disease is herein briefly discussed
Stable Coronary Artery Disease: When is Percutaneous Coronary Intervention Indicated?
Get PDFIn patients with chronic coronary artery disease (CAD) and good left ventricular function, percutaneous coronary intervention (PCI) does not confer any clear benefit in terms of hard long-term clinical outcomes, such as mortality, myocardial infarction or the need for subsequent revascularization, as compared with medical conservative treatment. Indeed, a meta-analysis of early data from 6 randomised controlled trials has showed convincingly that PCI improves anginal symptoms compared to conservative management, but there has been limited evidence on the effect of PCI on hard clinical outcomes. At the same time, the early fear of increased need for revascularization after PCI is probably not warranted. By comparing the benefits against cost considerations, it seems hat many percutaneous interventions that are currently performed in patients with non-acute CAD are probably not justified
Evolving Indications for Conventional Pacing
Get PDFOfficial guidelines for the indications of conventional permanent pacing are being updated periodically as the indications evolve continually. Also nontraditional indications for pacing emerge, such as marked first-degree AV block, malignant vasovagal syncope, obstructive hypertrophic cardiomyopathy, and paroxysmal atrial fibrillation. A critical review and analysis of these indications is undertaken in this review article