Hospital Chronicles (E-Journal)
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ECG Pearls: Reading & Interpreting Interesting ECGs
Get PDFOne can take the view that all electrocardiograms (ECGs) are interesting, even the one, which does not display any specific diagnostic features, particularly in the presence of some symptoms or established pathology in the patient from whom the ECG has been recorded. What is interesting in such a case is the mechanism rendering the ECG nondiagnostic
Three-Dimensional Echocardiography
Get PDFIn the past, routine clinical use of three-dimensional echocardiography has been hindered by the prolonged and tedious nature of data acquisition. Image processing is time consuming and requires dedicated manpower to generate three-dimensional reconstructions of the heart. The recent introduction of real-time three-dimensional echocardiographic imaging techniques has revolutionized echocardiography, as images are obtained in just one beat
Closure of Atrial Septal Defect and Patent Foramen Ovale, the Simple Way
Get PDFCatheter based closure of atrial septal defects was first described in 1974 but has only been used widely since the nineties. In 1992 the focus turned to closure of the patent foramen ovale which today is the most common atrial shunt closure. While the majority of centers advocate use of transesophageal or intracardiac echocardiographic guidance during implantation, fluoroscopy guided implantation is feasible, faster, cheaper, and more patient-friendly. Closure of a patent foramen ovale with an Amplatzer occluder (currently the preferred device) may take as little as 10 minutes with the possibility to return to full physical activity a couple of hours later. Complications are exceedingly rare ( < 1%). They include (about in the order of frequency) inguinal access problems, thrombus on the device, device embolization, cardiac perforation, erosion of the atrial wall by the device, or infection of the device. So far there are no reports of late complications although atrial fibrillation is one to be looked out for
Use and Abuse of Coronary Stenting
Get PDFThe introduction of the coronary stent in 1986 remains the only real asset to balloon angioplasty introduced about 10 years earlier. Unfortunately, the undeniable advantages of stenting in terms of preventing abrupt closure and reducing restenosis are not fully exploited. The prognostic benefit to be expected from judicious stenting has been given up by default stenting. Infarctions and lives saved initially by stenting are lost again by stent thrombosis after hospital discharge fraught with a mortality of about 50% by late infarctions. They do not exist after plain balloon angioplasty and are due to stent thrombosis. Because of the comfort benefit that prevails (reduced need for intervention), virtually all interventional cardiologists have subscribed to a policy of 100% stenting and are currently about to adopt active (drug eluting) stents as their default devices for it. Once more, active stents do not confer any prognostic benefit over passive stents but they further reduce restenosis and are appealing to operators and patients. Evidence based medicine condones stenting only in about 50% and active stents in may be 80%. Yet this is ignored for rather irrational reasons
Contemporary Stent Treatment of Coronary Bifurcations
Get PDFTreatment of coronary bifurcations is a tantalizing problem of interventional cardiology. The introduction of drug-eluting stents (DES) reduced restenosis in the main branch. However, restenosis at the ostium of the side branch remains a problem. While stenting the main branch with provisional side branch stenting seems to be the prevailing approach, in the era of DES various two-stent techniques emerged (???crush??) or were re-introduced (???V?? or ???simultaneous kissing stents??, ???crush??, ???T??, ???culottes??, ???Y??, ???Skirt??) to allow stenting in the side branch when needed
Inflammation and Atrial Fibrillation
Get PDFThere is accumulating evidence pointing to an important association between inflammation and atrial fibrillation (AF). Elevated plasma levels of several markers of the inflammatory cascade have been shown to predict future risk of AF. Inflammation is likely to represent a novel target for both the treatment and prevention of atrial fibrillation
Cardiac Pacemaker (If) Current:Physiological and Pharmacological Properties
Get PDFMammalian sinoatrial node (SAN) cells, the natural pacemaker cells of the heart, have an action potential characterized by the presence of a special phase, the slow diastolic (pacemaker) depolarization (phase 4), which drives pacemaker activity and has therefore attracted the interest of generations of cardiac physiologists. What is the basis of the pacemaker depolarization? Here the features of the ???funny?? (I) current of pacemaker cells and its involvement in the generation and autonomic regulation of heart rate are briefly addressed. I also address the involvement of If in the pharmacological control of cardiac chronotropism, and how defective ???funny?? channels can be responsible for inherited heart rhythm disturbances
Role of Angiotensin and its Inhibition in Hypertension, Ischemic Heart Disease and Heart Failure
Get PDFThe renin-angiotensin system (RAS) was extensively investigated and characterized throughout the first half of the 20th century. However, its contribution to the maintenance of high blood pressure (BP) in essential hypertension and to the development of hypertensive cardiac complications remained under debate until the advent of the first pharmacologic probes capable of blocking its actions, namely the angiotensin receptor blocker (ARB) saralasin and the angiotensin-converting enzyme inhibitor (ACEI) teprotide in the early 1970???s. Using these probes, we could demonstrate that even in normal-renin and low-rein hypertension, blockade of the RAS produced a fall in BP. And this fall was maximized if the patient had been previously submitted to sodium depletion by diuretics or low salt diet, which might produce only a small BP fall by itself, but rendered the hypertension RAS-dependent and far more responsible to RAS blockade
The Role of Mast Cells in Acute Coronary Syndromes
Get PDFOBJECTIVE:Review evidence supporting the role of mast cells in cardiovascular pathophysiology. BACKGROUND: Cardiovascular inflammation has emerged as a key pathogenetic factor in coronary artery disease (CAD) and myocardial ischemia reperfusion (IR) injury. IR complicates all forms of coronary artery revascularization. Cardiac mast cells have been implicated in CAD, IR and myocardial infarction (MI) through the release of pro-arrhythmogenic and inflammatory mediators, especially interleukin-6 (IL-6), considered an independent risk factor. 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 hr 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
Κάπνισμα και Υγεία
Get PDFΈχουν πεÏάσει πάνω από 500 χÏόνια από τότε που ο ΧÏιστόφοÏος Κολόμβος βÏήκε το φυτό nicotiana tabacum στις Avτίλλες και ÎφεÏε τους Ï€Ïώτους σπόÏους στην ΕυÏώπη. Η καλλιÎÏγειά του εξαπλώθηκε Ïαγδαία στην ΕυÏώπη και την ΑμεÏική, στην Οθωμανική αυτοκÏατοÏία και από εκεί σ' όλη την Ασία, την ΑφÏική και την ΑυστÏαλία. Η χÏήση του ÎºÎ±Ï€Î½Î¿Ï Ï€Î¿Ï… στην αÏχή, λόγω κόστους, ήταν Ï€Ïονόμιο των πλουσίων Îγινε σιγά-σιγά το μάνα των πτωχών. Η βιομηχανοποίησή του στο Ï„Îλος του 19ου αιώνα τον Îκανε παγκοσμίως Ï€Ïοσιτό στον καθÎνα, με αποτÎλεσμα τον εθισμό μεγάλου Ï€Î¿ÏƒÎ¿ÏƒÏ„Î¿Ï Ï„Î¿Ï… Ï€Î»Î·Î¸Ï…ÏƒÎ¼Î¿Ï Ï„Î·Ï‚ γης στον καπνό... (excerpt