Hospital Chronicles (E-Journal)
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ΕνδοκαÏδιακή μÎσω ΚαθετήÏα Κατάλυση με Υψίσυχνο ΡεÏμα σε ΜετεμφÏαγματικό Ασθενή με ΗλεκτÏική ΘÏελλα Ï€Ïιν από την ΕμφÏτευση ΑπινιδωτοÏ: ΜακÏοχÏόνια ΠοÏεία και Έκβαση
Get PDFΠεÏιγÏάφεται η πεÏίπτωση ενός ασθενοÏÏ‚, 66 ετών, που παÏουσιάσθηκε με πολλαπλά επεισόδια εμμÎνουσας μονόμοÏφης κοιλιακής ταχυκαÏδίας 30 και 14 Îτη μετά δÏο εμφÏάγματα του κατωτÎÏου και του Ï€Ïοσθίου τοιχώματος του μυοκαÏδίου. Î‘Ï†Î¿Ï Î· ηλεκτÏική θÏελλα κατεστάλη με Îνα μεικτό σχήμα Ï„Ïιπλής αντιαÏÏυθμικής αγωγής, ο ασθενής υπεβλήθη σε ενδοκαÏδιακή κατάλυση της αÏÏυθμιογόνου εστίας με τη βοήθεια του ηλεκτÏÎ¿Î±Î½Î±Ï„Î¿Î¼Î¹ÎºÎ¿Ï ÏƒÏ…ÏƒÏ„Î®Î¼Î±Ï„Î¿Ï‚ χαÏτογÏάφησης στο ηλεκτÏοφυσιολογικό εÏγαστήÏιο. ΑκολοÏθησε η εμφÏτευση ενός αντιταχυκαÏÎ´Î¹Î±ÎºÎ¿Ï Î²Î·Î¼Î±Ï„Î¿Î´ÏŒÏ„Î¿Ï… Î±Ï€Î¹Î½Î¹Î´Ï‰Ï„Î¿Ï Ï€Î¿Ï… στους επακόλουθους 30 μήνες παÏακολοÏθησης κινητοποιήθηκε αθόÏυβα σε Îνα μοναδικό στιγμιότυπο αντιταχυκαÏδιακής βηματοδότησης
Proarrhythmic Effect of ICD Function
Get PDFThe implantable cardioverter ??? defibrillator (ICD) is a device that treats ventricular tachyarrhythmias (VT), when they appear in a sustained form. The device???s programming can deliver the following therapies: 1) antitachycardia pacing (ATP), 2) cardioversion and 3) defibrillation. Today???s devices also have the capability of every mode of cardiac pacing, i.e. atrial, ventricular, atrio-ventricular and biventricular pacing.It is well known that the antiarrhythmic drug therapy can exhibit proarrhythmic effects. Likewise, the antiarrhythmic apparatus can possibly aggravate an existing VT or cause the appearance of a new arrhythmia, attempting to convert the clinical tachyarrhythmia. A case of proarrhythmic effect related to the therapeutic sequences delivered by an ICD, is delineated in the following continuous recording of an arrhythmic event,as it was stored in the Holter function of the device
Percutaneous Mitral Valve Repair: is There a Future?
Get PDFPercutaneous mitral valve repair was introduced a few years ago for patients with symptomatic severe mitral regurgitation and can use two different approaches. The first approach is the edge-to-edge technique, which creates a double mitral valve orifice. The second approach is mitral annuloplasty, which is achieved by introducing a constraining device in the coronary sinus located in the vicinity of the mitral annulus. Preliminary results of percutaneous mitral valve repair are encouraging and show the feasibility of these techniques, which though should be carefully evaluated in comparison with surgery and standard contemporary medical treatment
Reducing Barriers for Implementation of Immediate CPR with Chest Compressions Alone
Get PDF It is well known that out-of-hospital sudden cardiac death is a leading public health problem. In the absence of early defibrillation, survival rates of patients with out-of-hospital cardiac arrest are dismal and have remained essentially unchanged. The guidelines advocate the same approach for 2 entirely different pathophysiological conditions: respiratory arrest in which severe arterial hypoxia and hypotension eventually lead to secondary cardiac arrest, and primary cardiac arrest in which the arterial blood is fully saturated with oxygen at the time of the arrest. Cardiopulmonary resuscitation (CPR) is traditionally defined as chest compressions plus ventilations. The need for chest compressions is unquestionable, while the need for mouth-to-mouth ventilations for cardiac arrest has been questioned. Recent observational studies underline the paramount role of chest compressions in an alternative way of CPR, compression only CPR. Public education and training in compression only CPR is much simpler. Compression only CPR may significantly increase bystander-initiated resuscitation efforts and thereby give patients a better chance of survival, given the reluctance of lay people to provide mouth to mouth rescue breaths. In view of the above, the principal question is, what barriers are delaying the guidelines from recommending compression only CPR? Perhaps the major problem is the difficulty to change the paradigm. For decades, the "ABCs" (airway, breathing, and circulation) have been advocated for bystander basic life support, making it extremely difficult to transform the so ingrained in the popular understanding "ABC" to "AC"
Hypersensitivity to Proton Pump Inhibitors: Lansoprazole-Induced Kounis Syndrome
Get PDFProton pump inhibitors are commonly used in clinical practice for the treatment of peptic ulcer disease and gastro-esophageal reflux and are well tolerated by patients. Their use is rarely associated with hypersensitivity and anaphylactic reactions. According to the reports in the Uppsala Monitoring Center database the frequency of hypersensitivity reactions among all reported adverse reactions for proton pump inhibitors and H2-histamine receptor antagonists were between 0.2% and 0.7%. A few cases of hypersensitivity to lansoprazole have been reported. Herein, we report a patient who developed Kounis syndrome after taking 40 mg of lansoprazole. To our knowledge, this is the first report of Kounis syndrome associated with lansoprazole administration in the world literature
Newer Antiarrhythmic Agents for Atrial Fibrillation: Shall we Eventually do away with Proarrhythmia?
Get PDFDespite advances in drug therapy for the treatment of atrial fibrillation (AF), there continues to be a need for antiarrhythmic agents that have improved safety and efficacy profile. Unfortunately, drugs that block the potassium channels or are multichannel blockers, although they may be effective antiarrhythmics, they delay repolarization and thus they confer a proarrhythmic effect by inducing torsade de pointes, a potentially lethal ventricular arrhythmia. Most newer antiarrhythmic drugs are potassium channel blockers and this limits their usefulness. A less toxic agent compared to amiodarone, the noniodinated analogue of amiodarone (dronedarone) is being investigated; however, it appears already unsafe in patients with heart failure. Future antiarrhythmic agents will probably be atrial-selective blocking agents without affecting repolarization in the ventricular myocardium and thus avoid ventricular proarrhythmia with its attendant life-threatening consequences
In Vivo Assessment of Culprit Lesion Morphology in Acute Coronary Syndrome Using Optical Coherence Tomography
Get PDFOptical coherence tomography (OCT) is an optical analogue of intravascular ultrasound that has recently been proposed as a high-resolution imaging method for atheromatous plaque characterization. In this case report we used OCT for in vivo assessment of culprit lesion morphology in a patient with acute coronary syndrome
The Role of Adiponectin and Brain Natriuretic Peptide in Predicting Cardiovascular Events
Get PDFAdiponectin and brain natriuretic peptide (BNP) are hormones produced by adipocytes and myocardial cells respectively, and have emerged as important diagnostic and prognostic tools in cardiovascular disease. Levels of adiponectin are down-regulated in obese and diabetic individuals and this hormone exhibits favorable effects on atherogenesis, endothelial function and vascular remodeling. On the other hand, BNP and the fragment N – terminal proBNP (NT – proBNP) are natriuretic peptides released from the heart in response to pressure and volume overload and have become diagnostic tools and predictors in several cardiac abnormalities, beyond heart failure. This brief review will discuss the prognostic significance of these two hormones and epidemiological and clinical data from studies will be presented
A Paradigm Shift and New Therapeutic Options for the Metabolic Syndrome
Get PDFThe metabolic syndrome, characterized by obesity, dyslipidemia, insulin resistance and hypertension, increases the risk of cardiovascular morbidity and mortality. Most current views on the pathogenesis of the metabolic syndrome and its existing treatments have been dominated by a glucocentric approach: the glycemic response to insulin is suboptimal, with dire metabolic consequences. Such consequences are compensatory hyperinsulinemia, ?? cell glucotoxicity and lipotoxicity and the deposition of amyloid in pancreatic islets, with concomitant inflammation, endothelial dysfunction, a procoagulant state and dyslipidemia. In addition, these views have been applied on the premise that effector molecules involved in disease pathogenesis or response to therapy are invariant across the population.However, most current therapies have limited efficacy and limited tolerability
Advances in Post Resuscitation Care:Mild Therapeutic Hypothermia
Get PDFOut of hospital cardiac arrest remains a major cause of mortality and morbidity despite progress in resuscitative practices. The number of survivors with severe neurologicalimpairment at hospital discharge is similarly dismal. Recently, much attention has been directed toward the use of mild therapeutic hypothermia in postresuscitation care of comatose survivors of cardiac arrest. Two randomized, controlled clinical trials published in the New England Journal of Medicine showed that after resuscitation mild hypothermia lowers mortality, improves neurological outcome after successfully treated cardiac arrest, and is recommended by the 2005 update guidelines of International Liaison Committee on Resuscitation and European Resuscitation Council (ERC). In the present article pathophysiological mechanisms of hypothermia, cooling methods and potential side effects are briefly discussed. Questions regarding implementation of therapeutic hypothermia recommendations in every day clinical practice and future investigation are also addressed