Hospital Chronicles (E-Journal)
Not a member yet
657 research outputs found
Sort by
Three-Dimensional Echocardiography
Get PDFThis brief overview relates to the recent introduction of real-time three-dimensional echocardiographic imaging techniques, which has revolutionized echocardiography, as images are obtained in just one beat. A great potential lies ahead as clinical applications are multiple
Catheter Ablation of Ventricular Tachycardia
Get PDFCatheter ablation is highly successful and may be considered as the first line treatment in all symptomatic idiopathic forms of ventricular tachycardia (VT). Also ablation plays an important role in recurrent VTs associated with structural heart disease and relatively preserved left ventricular ejection fraction (>35%) and/or bundle branch reentry VT. It also constitutes the preferable treatment modality in incessant VTs of any origin and in patients with implantable defibrillator (ICD) devices who present with recurrent VTs and/or an electrical storm leading to multiple ICD shocks Catheter ablation appears to improve arrhythmia control in about two thirds of patients with structural heart disease and mappable VTs. Novel substrate and/or noncontact mapping techniques suggest that even hemodynamically unstable VTs and/or VTs of multiple morphologies can be successfully ablated. As the ablation method is not curative and there remains the risk of dying suddenly in patients with depressed left ventricular ejection fraction, the majority of patients with VT associated with structural heart disease also receive an ICD
Fixed Combinations in Antihypertensive Therapy
Get PDFSeveral studies have now confirmed that optimal targets of blood pressure (BP) could rarely be reached by monotherapy and various drug combinations are required to do this more effectively. However, the best way to increase patient compliance may be fixed combinations of two or more drugs in a single pill. With further research into mechanisms of action and development of new drugs, it became evident that the most effective combinations were those whose mechanisms are complementary or synergistic. Thus, for the treatment of hypertension, the use of fixed combination therapy is gaining ground as a more practical and convenient approach for today’s clinical practice
Thoracic Aortic Aneurysm: Reading the Enemy???s Playbook
Get PDFThoracic aortic aneurysm is a virulent disease which can rupture or dissect and thus hurt or kill our patients. Surgery can prevent rupture, but with inherent surgical risks, which include death, stroke, and paralysis. In order to know if operation is warranted, one must know how likely it is that rupture or dissection will occur for a given sized aorta. Based on scientific data, available todate, we recommend pre-emptive surgery of the aneurysmal ascending aorta at a diameter of 5.5 cm in order to avoid rupture or dissection in most patients, without exposing them unduly or prematurely to the dangers of aortic surgery. We recommend operating earlier, at an aortic dimension of about 5 cm, rather than the 5.5 cm, in patients with Marfan’s disease or other family history of aortic diseases, as they can dissect unpredictably, at relatively smaller diameters. Aortic aneurysm is a genetic disease. As we clarify the genetics of this disease further, we hope to be able to test family member genomes to ascertain if they are afflicted. With genetic understanding will come, in the long term, the potential for specific genetic therapies to correct the underlying causative mutations
Counseling Patients with Implanted Cardiac Devices: the Nurse???s Role
Get PDFPatients with implanted cardiac devices constitute a growing segment of the contemporary healthcare practice. Taking care of such a rapidly growing patient population constitutes a challenge for all health care providers working in a cardiology ward, operating or procedure room, or primary care practice. Nurses among them have a unique role by being the most appropriate persons to provide in-hospital and long-term health care, education and psychological support to these patients. In-hospital and long-term care will ensure an uneventful procedure and a safe discharge as well as early detection of device malfunction and late complications. Education of the patient will prevent any self or environmental interactions which can adversely affect proper device function and will increase his or her adherence to the follow-up treatment. Finally, by providing psychosocial and emotional support the nursing staff can address the immediate concerns of the patient and help him or her cope successfully with the new life situation. Continuing education is extremely important for nurses counselling patients with implanted devices in order to play successfully their role as the continuous link to the multidisciplinary team of professionals that guide the oftentimes forgotten humanistic care of these patients
Hypertrophic Cardiomyopathy- The Case for Alcohol Ablation Therapy
Get PDFNon-surgical reduction of septal hypertrophy by means of transcoronary alcohol septal ablation has recently emerged as an alternative to surgical myectomy treatment modality in patients with obstructive hypertrophic cardiomyopathy (HCM) refractory to medical therapy. Advantages of the percutaneous ablation technique include the avoidance of a major surgical procedure, the lack of post-operative pain and need for transfusion, the shorter hospital stay and the low incidence of atrial fibrillation. However, until more comparative data between these two techniques become available, surgical myectomy remains the standard approach as the most effective and long-lasting treatment for alleviating symptoms of obstructive HCM
Aortic Dissection Involving the Ostium of Left Main Coronary Artery
Get PDFAcute aortic dissection can occasionally extend and involve the right coronary artery and lead to a concomitant inferior wall acute myocardial infarction. We herein report a case of an acute aortic dissection involving the left coronary artery, which was initially diagnosed solely as an anterior wall acute myocardial infarction. Such an incomplete diagnosis could lead to thrombolysis or primary percutaneous coronary intervention with catastrophic consequences
Beyond LDL Cholesterol: the Role of LDL Particles and HDL
Get PDFCurrently available hypolipidemic treatments aim at reducing low density lipoprotein (LDL)-cholesterol. Unfortunately, cardiovascular events continue to occur despite LDL-lowering therapy with use of statins. Recent evidence has revealed that having increased concentrations of small LDL particles, though common, is an unhealthy pattern; high concentrations of small LDL particles correlate with much faster growth of atheroma, progression of atherosclerosis and earlier and more severe cardiovascular events and death. In addition, at any given level of total cholesterol, the relative risk of coronary artery disease increases with decreasing levels of high density lipoprotein (HDL)-cholesterol. Thus, the target for new interventions would be to reduce small LDL particles and increase HDL and/or its apolipoproteins, which are recognized to have major vascular protective effects ranging from prevention to stabilization and regression of atherosclerosis
Non-invasive Coronary Angiography: the Role, Limitations and Future of 64-Slice Spiral Computed Tomography Coronary Angiography
Get PDFNoninvasive coronary imaging can now be accomplished with use of computed tomography coronary angiography (CTCA) which is becoming an important alternative to invasive coronary angiography in selected patients. CTCA is best applied in patients with intermediate risk for coronary artery disease (CAD). It is a reliable technique for patient screening, thus reducing the number of unnecessary invasive coronary angiography examinations, but cannot yet replace invasive coronary angiography in all patients suspected of CAD. Concerns remain regarding the radiation exposure, which is expected to be significantly reduced with the availability of improved technology and newer multi-channel scanners offering the potential to image the entire heart during a single heartbeat. The current status of CTCA is herein briefly reviewed
Endoscopic Ultrasonography In Portal Hypertension
Get PDFEndoscopic ultrasonography (EUS) has recently emerged as an alternative means of providing data for patients with portal hypertension that is more accurate, less invasive and reproducible. It is well established that video-echo endoscopy, with combined endoscopic and sonographic examination, is comparable to endoscopy in diagnosing esophageal varices, but is more sensitive in diagnosing the presence of gastric varices. Dilated venous abnormalities outside the gastroesophageal lumen, which cannot be diagnosed by endoscopy, are readily visible by means of EUS or miniature probes. In the clinical setting of portal hypertension, endoscopic ultrasonography is also useful to predict the risk of variceal recurrence or rebleeding, which cannot be reliably predicted using endoscopy alone. The introduction of echo endoscopes equipped with Doppler facilities together with the performance of haemodynamic studies has allowed sonographic visualization of the vessels, playing thus an important role in the management of cirrhotic patients. It has thus become feasible not only to assess the vascular blood flow but also to evaluate possible morphologic and haemodynamic changes of the vessels after endoscopic or pharmacologic therapy. It is, nowadays, obvious that EUS is an exciting technological advance that has established its position in the diagnosis of varices and cirrhosis; what lies ahead for EUS is to positively find application in predicting the risk of variceal bleeding and in managing portal hypertension