Hospital Chronicles (E-Journal)
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The Role of Mast Cells in Acute Coronary Syndromes
Get PDFBackground: Cardiovascular inflammation has emerged as a key pathogenetic factor in coronary artery disease (CAD) and myocardial ischemia reperfusion injury. Ischemia reperfusion injury complicates all forms of coronary artery revascularization. Cardiac mast cells have been implicated in CAD, reperfusion injury and myocardial infarction (MI) through the release of pro-arrhythmogenic and inflammatory mediators, especially interleukin-6 (IL-6), considered an independent risk factor. Objective: Review evidence supporting the role of mast cells in cardiovascular pathophysiology. Methods: We reviewed relevant literature and summarized our own findings. Results: We showed that CAD is associated with high intracoronary release of IL-6. Acute stress triggers mast cell- dependent release of histamine and IL-6. Moreover, acute stress in ApoE -/- mice leads to ischemia. Mast cells express corticotropin-releasing-hormone (CRH) receptors, activation of which leads to selective release of vascular endothelial growth factor (VEGF), an isoform of which is vasodilatory. In a randomized prospective study, we investigated serum IL-6 levels and cardiac tissue susceptibility in the mast cell deficient (W/Wv) mice (n=12) and their normal littermates (+/+). When the left coronary artery (LCA) was ligated followed by 6 hours of reperfusion, IL-6 levels increased significantly after reperfusion only in the +/+ mice, but not in mast cell deficient W/Wv mice; cardiac muscle viability was significantly higher in W/Wv than the +/+ mice. Conclusion: These results support targeting selective inhibition of cardiac mast cell activation as prophylactic therapy in clinical situations involving myocardial inflammation and/or revascularization
Bilateral Coronary Aneurysms in Kawasaki Disease
Get PDFThe images display aneurysmal dilation of the proximal segments of both the right and left coronary arteries in a patient with Kawasaki diseas
Surgery for Hypertrophic Obstructive Cardiomyopathy
Get PDFSurgical treatment of hypertrophic obstructive cardiomyopathy (HOCM) comprises septal myectomy which though has been limited to patients with refractory symptoms and high resting gradients. Results of surgical intervention are well documented with dramatic reduction in left ventricular outflow tract gradient and resultant relief of symptoms in about 95% of patients. Transcoronary ablation of septal hypertrophy with alcohol is a newer percutaneous technique, designed to ablate hypertrophied cardiac septal muscle through localized infarction, but its efficacy compared with that of surgical myectomy is uncertain. In the present article we briefly review the technique of septal myectomy and compare it with septal ablation, concluding that the standard septal myectomy still remains the preferred and proven therapy.  
The Nurse's Role in the Prevention of Infection After Pacemaker Implantation
Get PDFSimilarly to all devices implanted into the human body, cardiac pacemakers are also prone to infection. Depending on the area which has been contaminated, infections of pacemakers present a wide spectrum in clinical presentation, treatment and clinical outcomes. The purpose of this literature review was to determine the risk factors which are responsible for causing infection after pacemaker implantation and to study the nursing interventions which may help reduce the risk of such a serious complication.The relevant literature regarding infections following pacemaker implantation was limited and made it difficult to calculate the exact incidence rate. Nevertheless,the numbers have increased over the past few years in Greece. The risk factors are associated with the patient???s history, such as age or the presence of diabetes mellitus, the experience of the operator, progression of infection from the pacemaker pocket, or even the device type which has been used. The nurse???s role in the prevention of infection after pacemaker implantation is of vital significance, and involves observation for early diagnosis of the symptoms, the precise implementation of basic nursing principles and interventions such as aseptic techniques, and the epidemiologic surveillance of incidents. Success in all the above may assist in the formation of nursing protocols regarding the prevention of infection after pacemaker implantation
First Choice of Antihypertensive Therapy
Get PDFIt is now well established that a high blood pressure (BP) that can not be normalized by nonpharmacologic means (low salt diet, weight loss, exercise, smoking cessation), should be treated pharmacologically. The therapeutic target BP is still a moving target, as in the past it used to be 160/95 mmHg
Methods of Differentiation of Inferior, or Other Myocardial Wall Defects From Artifacts in Myocardial Scintigraphy: The Role of Prone Positioning and/or Other Techniques
Get PDFStress radionuclide myocardial perfusion scintigraphy (MPS) with the use of single photon emission computed tomography (SPECT) is a widely established method for the detection of coronary artery disease, patient management and patient risk stratification, as well as evaluation of revascularization results. MPS SPECT is traditionally being performed with patients in the supine position. This practice is, however, associated with various soft tissue attenuation artifacts, resulting in reduced test specificity.Various methods have been investigated to deal with this problem including the inspection of planar projection images, the integration of wall motion and wall thickening information from gated MPS, the application of transmission attenuation maps from radionuclide sources and the MPS SPECT with the patient in prone position.Most of the above methods suffer from several limitations.However, the addition of prone acquisition to traditional supine MPS SPECT has been proven to be an easy and efficient way to reduce attenuation artifacts (concerning mainly the inferior wall) leading to a significant improvement in the specificity of this imaging technique
Left Ventricular Long-Axis Function During Dobutamine Stress Echocardiography for the Prediction of Post- Revascularization Recovery: Comparison with SPECT Thallium Scintigraphy
Get PDFAim: ???? compare echocardiographic left ventricular (LV) long axis function and single photon emission computed tomography (SPECT) thallium-201 scintigraphy for the prediction of recovery of LV dyssynergies after revascularization.Methods: Thirty patients with a history of previous myocardial infarction and LV dysfunction underwent a transthoracic echocardiographic study before and after successfulrevascularization (101?±14 days), in order to evaluate post-revascularization recovery of asynergic myocardial walls. In these patients and in 25 age- and sex-matched healthysubjects, an additional study during dobutamine infusion was also performed. All subjects also underwent SPECT thallium-201 scintigraphy. Prior and during dobutamine infusion the LV systolic atrioventricular (AV) plane displacement was recorded from the apical four and two chamber views, by M-Mode, at four LV sites, corresponding to the septal, lateral, anterior and inferior walls.Results: Healthy subjects showed a significant increase in AV displacement at all LV sites during dobutamine infusion (p2 mm, the method proved to have a sensitivity of 91%, specificity of 83%, positive predictive value of 88% and negative predictive value of 87%. When SPECT thallium scans were used, the above indices were 86%, 65%, 74% and 79% respectively.Conclusion: The assessment of LV long axis function with the measurement of left systolic AV plane displacement during dobutamine infusion constitutes a simple and accurate method, better than SPECT thalium images, for the prediction of recovery of LV asynergy after revascularization
Management of Cryptogenic Strokes by Percutaneous Closure of Interatrial Communications
Get PDFIn patients with a cryptogenic stroke the prevalence of a patent foramen ovale (PFO) is increased to approximately 50% compared with a 25%-30% prevalence rate in the general population. This leads to a plausible assumption that a considerable number of strokes could potentially be attributed to a PFO, most likely due to paradoxical embolism. It is estimated that the risk for an embolic stroke due to the presence of a PFO may be 9-fold higher than that related to hypertension, diabetes or hypercholesterolemia. Furthermore, in the presence of an interatrial septal aneurysm (IASA), this risk may even be 30-fold higher. The management of patients with a cryptogenic stroke and a PFO is currently based on antithrombotic or anti-platelet therapy, however the recurrence rate remains high (4-25%), and this has led to the recommendation of percutaneous PFO closure, which is now effected via a simple and relatively safe technique, which appears to reduce recurrences to 0-5%. However, the studies which provide such favorable data are only retrospective, which means that we are in dire need of prospective randomized studies that compare the two therapeutic approaches, before the interventional method is more widely adopted. In addition to cryptogenic stroke, the presence of a PFO has been also associated, among other conditions, with bouts of migraine and its percutaneous closure has been shown, albeit via retrospective and observational data, to eliminate or significantly improve this common condition. The only prospective randomized trial available (MIST trial) failed to show conclusively the superiority of PFO closure to medical treatment with regards to elimination of migraine.Another large group of patients undergoing percutaneous closure of an interatrial communication are those with a secundum atrial septal defect (ASD). The majority of these patients, at least those having defects as large as 35-38 mm and an adequate rim to support a closure device, can now be successfully submitted to the percutaneous technique and thus avoid surgery. Certainly, these patients could also suffer from cryptogenic strokes and migraine, however, most of them usually require intervention because of hemodynamic reasons.The technique of percutaneous closure of a PFO or an ASD performed by adult interventional cardiologists is indeed a relatively simple and swift procedure of right heart catheterization, carried out from the groin area via the femoral vein with use of local anesthesia. Complications related to the procedure are limited to ≤1-3.4%. Due to this paradigm of technological progress, a rapid growth of procedures of percutaneous closure of ASD and PFO has been noted over the last decade, particularly over the recent 4-5 years. Nevertheless, one has to resist in widely and hastily adopting such methods before further strong evidence becomes available via randomized prospective studies
New Biochemical Markers of Ischemia: The Diagnostic and Prognostic Role of Brain Natriuretic Peptide, C-Reactive Protein, Ischemia Modified Albumin and Myeloperoxidase
Get PDFThe traditional biomarkers, CK-MB and troponins, used for the diagnosis of myocardial ischemia and the risk stratification of patients with acute coronary syndromes (ACS) are of limited use mainly because they require some degree of necrosis in order to become detectable. Based on the knowledge gained into the pathophysiology of ACS, several new biomarkers have been developed. Brain natriuretic peptides (BNP and NT-proBNP) as markers of hemodynamic stress have shown in several studies a good diagnostic and prognostic performance. C-reactive protein (CRP) reflecting systemic inflammation, has mainly a role as risk stratifier. Ischemia modified albumin (IMA) a pure ischemia marker may offer a substantial aid in diagnosing an acute coronary event in patients with negative troponin. Finally, myeloperoxidase (MPO), a marker of oxidative stress, may also contribute to the diagnosis of ischemia although this is not yet supported by a fair amount of data. Nevertheless, although highly sensitive, these new biomarkers are not specific enough and a multi-marker approach seems the most appropriate strategy for diagnosis of myocardial ischemia and for assessing the risk of an adverse outcome in patients with an acute coronary syndrome
Exercise Prescription in Patients With Arrhythmias
Get PDFEpidemiological, clinical and laboratory studies have yielded definitive evidence that physical activity is able to reduce the morbidity and mortality of cardiovascular diseases and to improve physical fitness and quality of life. Moreover, physical activity seems to be capable of significantly reducing the risk of developing other chronic diseases, such as obesity, osteoporosis, diabetes, some neoplasms and depression. For these reasons, physical exercise has been proposed as an efficacious, low-cost, physiological means of disease prevention and therapy. However, although enormous amounts of scientific data have demonstrated the benefits of a physically active lifestyle, only a minority of people in Europe take regular physical exercise. One of the prime objectives of healthcare institutions is therefore to promote physical activity in the general population, as well as in patients with cardiovascular diseases.In the present review, we analyze the following points: some clinical aspects of arrhythmias and their relationships with physical exercise; the specific recommendations for exercise prescription in the various arrhythmias and in arhythmogenic heart diseases; the interactions between physical activity and antiarrhythmic therapies