Hospital Chronicles (E-Journal)
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New Antithrombotic Drugs in Acute Coronary Syndromes: ??he Role of Fondaparinux and Bivalirudin in Reducing Major Hemorrhages and Mortality
Get PDFThe net clinical benefit of any antithrombotic drug for the treatment of acute coronary syndromes (ACS) is described by its favorable effects on major outcomes (mortality, reinfarction, stroke) and its unfavorable effects on bleeding. Traditionally, with most antithrombotic therapies an increased hemorrhagic risk is accepted in order to achieve better efficacy. Recently, the importance of bleeding as an adverse outcome has received wide attention. Major bleeding in ACS is not rare. In GRACE, the multinational registry of ACS, 4% of patients with unstable angina, STEMI or non-STEMI had a major hemorrhage.In-hospital mortality was 18.6% in those patients who experienced major bleeding versus only 5.1% in those without such an adverse event. What is more interesting is the fact that the appearance of a non-fatal major bleeding event in hospital increases the long-term risk of death and carries a similar prognostic significance to re-infarction. The odds ratio (OR) for 6-month mortality is 5.6 for a patient with re-infarction in hospital and 4.5 for a patient with major hemorrhage in hospita
Οι ÎÎες ΚατευθυντήÏιες Οδηγίες για το ÎŸÎ¾Ï ÎˆÎ¼Ï†Ïαγμα (STEMI) / STEMI Guidelines Update 2007
Get PDFΗ σημαντική και ταχεία Ï€Ïόοδος που σημειώνεται στη θεÏαπευτική αντιμετώπιση του με ανάσπαση του ST εμφÏάγματος του μυοκαÏδίου, επιβάλλει όλο και συχνότεÏα Ï€Ïοσθήκες και ανασκοπήσεις στις ΚατευθυντήÏιες Οδηγίες που κατά καιÏοÏÏ‚ εκδίδονται από τις μεγάλες διεθνείς ΚαÏδιολογικÎÏ‚ ΕταιÏείες. Στη παÏοÏσα εÏγασία θα σχολιασθοÏν οι αλλαγÎÏ‚ που επιφÎÏει η αναθεώÏηση του 20071 στις ΚατευθυντήÏιες Οδηγίες που εκδόθηκαν το 2004 για την αντιμετώπιση του με ανάσπαση του ST εμφÏάγματος του μυοκαÏδίου από American College of Cardiology και American Heart Association. Ο σχολιασμός θα αφοÏά κυÏίως τα κεφάλαια της επαναιμάτωσης και της αντιθÏομβωτικής αγωγής, που παÏουσιάζουν ιδιαίτεÏο ενδιαφÎÏον για τη κοινότητα των επεμβατικών καÏδιολόγων... (excerpt
Pacing Algorithms to Minimize Right Ventricular Pacing and Sensors to Warn for Worsening Heart Failure
Get PDFSeveral clinical studies in patients with VVI or dual-chamber pacemakers have demonstrated that right ventricular apical pacing may adversely affect myocardial function and lead to an increased number of hospital admissions for congestive heart failure. Endocardial catheter mapping studies have unequivocally demonstrated that right ventricular (RV) pacing mimics the endocardial activation patterns of left bundle branch block (LBBB). Furthermore, the effect of RV pacing on left ventricular activation patterns and times are similar to that observed during LBBB. Right ventricular apical pacing results in asynchronous ventricular activation and delayed left ventricular (LV) activation time due to slow initial propagation of the electrical wavefront through ventricular myocardium rather than through the His-Purkinje system
Οι ÎÎες ΚατευθυντήÏιες Οδηγίες για τα ΟξÎα Στεφανιαία ΣÏνδÏομα (ACC/AHA 2007)/ ΧÏονισμός ΔιενÎÏγειας ΣτεφανιογÏαφίας στο NSTEMI Î¥ÏˆÎ·Î»Î¿Ï ÎšÎ¹Î½Î´Ïνου (ΜελÎτη SYNERGY)
Get PDFΟ ÏŒÏος Î¿Î¾Ï ÏƒÏ„ÎµÏ†Î±Î½Î¹Î±Î¯Î¿ σÏνδÏομο ( ACS ) αναφÎÏεται σε Îνα φάσμα Ï„Ïιών πιθανών κλινικών εκδηλώσεων της στεφανιαίας νόσου, την ασταθή στηθάγχη (UA), το ÎμφÏαγμα χωÏίς ανάσπαση του ST (NSTEM) και το ÎμφÏαγμα με ανάσπαση του ST (STEMI). Η διάκÏιση αυτή είναι χÏήσιμη στην ανάπτυξη θεÏαπευτικών στÏατηγικών.Το ΑμεÏικανικό κολλÎγιο καÏδιολογίας ( ACC ) και η ΑμεÏικανική καÏδιολογική εταιÏία ( AHA ), από ÎºÎ¿Î¹Î½Î¿Ï Î´Î·Î¼Î¿ÏƒÎ¹ÎµÏουν κατευθυντήÏιες οδηγίες για την αντιμετώπιση των οξÎων στεφανιαίων συνδÏόμων. Η τελευταία αναθεώÏηση των Ï€Ïοτεινόμενων κατευθυντήÏιων οδηγιών Îγινε το 2007.Η ασταθής στηθάγχη ( UA ) και το NSTEMI ÎμφÏαγμα είναι δÏο δυσδιάκÏιτες Î¼ÎµÏ„Î±Î¾Ï Ï„Î¿Ï…Ï‚ οντότητες και η διαφοÏά τους Îγκειται στο γεγονός ότι το NSTEMI χαÏακτηÏίζεται από πεÏισσότεÏο εκτεταμÎνη μυοκαÏδιακή βλάβη, με απελευθÎÏωση στην κυκλοφοÏία Ï„Ïοπονίνης (TnT ή TnI ) ή CK-MB.Είναι σημαντικό στην αντιμετώπιση της ασταθοÏÏ‚ στηθάγχης/NSTEMI να επιλÎξουμε Ï€Ïώιμα ανάμεσα σε επεμβατική ή συντηÏητική θεÏαπευτική στÏατηγική. Η επιλογή γίνεται με βάση στοιχεία από το ιστοÏικό, την κλινική εικόνα και τα εÏγαστηÏιακά ευÏήματα του ασθενοÏÏ‚ ... (excerpt
Comparing Surgical With Percutaneous Revascularization in Three-vessel Disease: Current Status
Get PDFPercutaneous coronary intervention (PCI) is an alternative therapeutic modality to coronary artery bypass surgery (CABG) for the revascularization of patients with multivessel coronary artery disease (CAD). Its effectiveness has been questioned because of higher rates of repeat revascularization and anginal attacks compared to CABG.Over the recent years drug eluting stents (DES) have been used for the management of patients with multivessel CAD as a major breakthrough technology in terms of a remarkable reduction of restenosis and repeat revascularization. Results from the Artery Revascularization Therapies (ARTS II) study indicate that DES and CABG have comparative effectiveness in major adverse cardiac events (MACE) in patients with multivessel CAD. Whether DES will replace CABG in the revascularization of patients with multivessel disease remains to be seen by the impending results of ongoing multicenter comparative trials
The Role of Adiponectin and BNP in Predicting Cardiovascular Events
Get PDFAdiponectin and brain natriuretic peptide (BNP) are hormones released from adipocytes and myocardial cells respectively, in response to different stimuli. Adiponectin is the most abundant adipokine secreted by adipose tissue that may couple regulation of insulin sensitivity with energy metabolism. [1] Decreased plasma concentration has been observed in patients with diabetes, metabolic syndrome and coronary artery disease, and this may play a key role in the development of insulin resistance. The exact mechanism underlying anti???inflammatory properties of adiponectin is not yet well understood but there is evidence that its properties may be related, in part, to its ability to stimulate production of nitric oxide (NO), which is considered to be the potent vasodilator substance produced from endothelial cells. [2] Nowadays, adiponectin is increasingly recognized to be both a potential biomarker for the metabolic syndrome and a possible therapeutic target for the treatment of cardiovascular disease.Brain natriuretic peptide is one of the three major natriuretic peptides, atrial natriuretic peptide (ANP), B ??? type natriuretic peptide (BNP) and C ??? type natriuretic peptide (CNP), all of which share a common 17 ??? amino ??? acid ring structure and have cardioprotective actions against volume overload. [3] Although this peptide was called brain (B ??? type) natriuretic peptide (BNP), the primary site of BNP synthesis is the ventricular myocardium. [4] Its initial diagnostic value was attributed in its ability to distinguish heart failure from other causes of dyspnea. Moreover, recently BNP and NT???proBNP have been related to other cardiac diseases, such as stable and unstable angina, valvular heart disease and sudden death, adding a new angle in their diagnostic and prognostic roles. In this review, the prognostic role of adiponectin and BNP in cardiovascular diseases will be briefly presented
Beyond LDL Cholesterol; the Role of Apolipoprotein B, nonHDL-C, LDL Particles and HDL
Get PDFAtherosclerotic cardiovascular disease is the worldwide leading cause of death, which involves multiple pathways in which lipoprotein entry and retention, injury to the vessel wall from several stimuli, and inflammation seem to play a key role. Currently available treatments are aimed at reducing the high plasma lipid concentrations, most particularly low density lipoprotein (LDL)-cholesterol. Increasing evidence has revealed that the concentration and size of the LDL particles are powerfully related to the degree of atherosclerosis progression than the concentration of cholesterol contained within all the LDL particles. LDL particles actually vary in size and density, and studies have shown that a pattern that has more small dense LDL particles???called? ???Pattern B?????equates to a higher risk factor for coronary heart disease (CHD) than does a pattern with more of the larger and less dense LDL particles (???Pattern A??)
Mycotic Aneurysm of the Abdominal Aorta: Early and Late Computed Tomography Findings
Get PDFWe describe the case of a 60-year-old diabetic man who was admitted to our hospital with keto-acidosis and rapidly developed sepsis and a mycotic abdominal aortic aneurysm (AAA) with branch involvement. Early and late findings on serial computed tomography (CT) examinations are presented. Awareness and recognition of early imaging findings associated with infectious aortitis and serial CT examination in cases of patients with sepsis and predisposing factors are essential for prompt diagnosis and treatment.  
Exercise Prescription in Patients With Arrhythmias
Get PDFIn the present review we analyze some clinical aspects of arrhythmias and their relationships with physical exercise; specific recommendations for exercise prescription in various arrhythmias and in arhythmogenic heart diseases, as well as the interactions between physical activity and antiarrhythmic therapies
Indications for Renal Artery Stenting
Get PDFRenal artery disease (RAD) is a relatively common condition in the elderly, especially in the setting of concomitant vascular disease in other anatomical sites and is most often of atheromatous origin. Rarely is it encountered in young women as a result of fibromuscular dysplasia. RAD with significant renal artery stenosis is considered responsible for refractory or accelerated hypertension, progressive loss of renal function and deterioration of patients’ cardiovascular status, with episodes of angina or pulmonary edema disproportional to the extent of coronary artery disease and left ventricle functional capacity, dominating the clinical presentation. This article summarizes the pathophysiological implications and diagnostic methods and attempts a review of the current literature on indications and efficacy of the available therapeutic options for renal artery stenosis, focusing on interventional treatment