Hospital Chronicles (E-Journal)
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Diastolic Heart Failure: Current Data
Get PDFThe pathophysiology, structural and functional changes in diastolic heart failure are characterized by the lack of ventricular dilatation, normal left ventricular ejection fraction and increased fibrosis and left ventricular stiffness. The hemodynamic profile is similar to that of systolic heart failure. The therapeutic modalities available remain limited. Current data on diastolic heart failure are herein briefly reviewed
Access to Catheterization Facilities in Patients Admitted With ST -Elevation Myocardial Infarction: A Pilot Study
Get PDFBACKGROUND: Thrombolytic therapy and percutaneous coronary intervention (PCI) are effective means to achieve reperfusion in ST-elevation myocardial infarction (STEMI), but current trends favour primary PCI. However, there seems to be considerable international and national differences in the management of patients with STEMI. Pertinent epidemiological data for Greece are lacking. Thus, the aim of this pilot study was to investigate the current implementation of reperfusion strategies in North-Western (NW) Greece. PATIENTS AND METHODS: The region of NW Greece is populated by 600,000 inhabitants, and is served by 6 district hospitals, and 1 tertiary university hospital, the only one offering PCI, but not on a 24-hour basis. Thus, the most prevalent reperfusion strategy in our region is thrombolytic therapy. The present study was a prospective population-based survey conducted over a 5-month period. Sources of data included cardiology departments, coronary care units, and intensive care departments located in the area. RESULTS: The total study population consisted of 170 consecutive patients (135 men) with a mean age of 67 years, divided into three groups according to time between symptom onset and presentation: 99 patients (58.2%) presented within 3 hours (group I), 23 (13.5%) between 3-12 hours (Group II), and 48 (28.2%) after 12 hours (Group III). In group I, thrombolysis was performed in 78 (78.7%), primary PCI in 8 (8%) and rescue PCI in 6 (6%); 93 patients (94%) were subjected to elective coronary angiography and subsequently 38 (40.8%) had elective PCI, 4 (4.3%) coronary artery bypass grafting (CABG), and 51 (54.8%) were managed medically. In group II, thrombolysis was given in 17 (73.9%), and rescue PCI in 2 (8.6%) patients; all patients (100%) were subjected to elective coronary angiography and subsequently 10 (43.4%) to elective PCI, and 1 (4.3%) to CABG. In group III, thrombolysis was performed in 4 (8.3%), and rescue PCI in 1 (2.1%) patient; 42 (87.5%) patients were subjected to elective coronary angiography and subsequently 11 (22.9%) had elective PCI, and 8 (16.6%) CABG. CONCLUSION: A large proportion of patients with STEMI arrive late, but reperfusion therapy is sufficiently implemented in NW Greece. The goal of 75% is certainly attainable. Organizing networks of reperfusion at regional level can help to improve the rate of reperfusion therapy. Finally, the option of next-day PCI after successful thrombolysis is gaining wider acceptance
Revascularization of the Infarct-Related Artery: Never Too Late?
Get PDFDuring the early phase of an acute myocardial infarction (MI), current consensus is that reperfusion of the infarct-related artery (IRA) should be implemented as soon as possible, more effectively accomplished via percutaneous coronary intervention (PCI). The clinical approach to the occluded IRA late after MI remains controversial, but current practice shows a strong trend in favour of PCI, which is based on the late open artery hypothesis. However, late PCI on IRAs also has the potential for harm from procedure-related complications. An attempt is made herein to critically overview the current data on this important topic, mainly based on recent meta-analyses with somewhat diverging results, indicating that clinical judgment and an individualized approach still remains a valid guide
Concomitant Radiofrequency ??? Microwave Ablation and Atrial Septal Defect Repair
Get PDFAtrial fibrillation (AF) is the most frequent form of atrial arrhythmias in adults with congenital heart disease. Some serious complications are related with the presence of AF after surgery. Because of the complexity and the risk of bleeding, the Maze III procedure has been largely replaced by alternative energy sources. A patient with multiple atrial septal defects (ASD) and AF underwent surgical closure with autologous pericardial patch and bipolar radiofrequency and microwave ablation
Aortic Dissection Involving the Ostium of Left Main Coronary Artery
Get PDFΑ 58-year-old hypertensive man was referred from another hospital with diagnosis of myocardial infraction. He presented with a two hour sudden onset of severe chest pain radiating to his interscapular region. Pain did not respond to IV administration of nitrates and morphine. His blood pressure was 110/70 mmHg and physical examination revealed no murmurs The ECG showed extensive ST-segment elevation in the anterior and lateral leads suggesting acute anterior myocardial infarction. A transthoracic echocardiogram (TTE) demonstrated a dilated ascending aorta with an intimal flap that extended from the aortic valve to the mid-ascending aorta, (Figure 1) consistent with a Stanford type A acute aortic dissection (AAD). A multiplane transoesophageal echocardiogram (TOE) was then performed showed AAD extending into the aortic arch, the take-off of the left subclavian artery (Figure 2) and the descending aorta (Figure 3). The intimal flap was thin, smooth showed a pulsatile mobility with systolic convexity towards the false lumen (Figure 4). Flow was present in the false lumen which was larger than the true lumen (Figure 5). The left coronary ostium seemed to be obstructed by prolapse of the intimal flap during diastole (Figure 6). The aortic valve was normal and mild aortic regurgitation was noted caused by the aortic dilatation. Regional and global left ventricular function was normal.There were no periaortic or pericardial fluids. The patient was transferred for emergency surgery and the ascending aorta was successfully replaced by a supracoronary interposition prosthetic graft
In Vivo Assessment of Culprit Lesion Morphology in Acute Coronary Syndrome Using Optical Coherence Tomography
Get PDFAutopsy studies suggest that acute myocardial infarction is provoked by sudden disruption of thin-cap fibroatheromas, known as vulnerable plaques followed by subsequent thrombosis. The pathological characteristics of vulnerable plaques include a thin fibrous cap with macrophage infiltration and a large lipid pool. These findings are based largely on postmortem studies because it has previously not been possible to accurately define coronary plaque morphology in vivo. Optical coherence tomography (OCT) is an optical analogue of intravascular ultrasound (IVUS) that has recently been proposed as a high-resolution imaging method for plaque characterization. Its resolution is approximately 10 to 20 μm, which is about 10 times higher that IVUS. The histology controlled studies have shown that OCT can evaluate the characteristics of culprit lesions such as fibrous cap thickness, fibrous cap macrophage density, lipid core and intracoronary thrombus.In this case report we used OCT for in vivo assessment of culprit lesion morphology in a patient with acute coronary syndrome
Tako Tsubo Cardiomyopathy with Right Ventricular Involvement
Get PDFA 68–year–old woman, 4 hours after bronchoscopy, developed symptoms and ECG signs of inferolateral acute myocardial infarction. Emergency coronary angiography showed normal coronary arteries, but LV angiography revealed apical ballooning with apical akinesis diagnostic of Tako-tsubo cardiomyopathy. One day later cardiac MRI additionally disclosed right ventricular apical involvement, which has been reported in only very few cases in the literature associated with worse prognosis. Fortunately, our patient had an uneventful course and complete recovery
Obesity and Hypertension
Get PDFThe prevalence of hypertension is much higher in obese than in non-obese adults, particularly in younger people.? Obesity as estimated by BMI, as well as abdominal adiposity as measured by waist circumference seem to be independent cardiovascular risk factors, especially in males. A reduction of at least 4/3 mm Hg in blood pressure in the general population and a significantly larger effect in patients taking antihypertensive drugs can be expected by a weight reduction of about 5 kg. Finally, there is lack of evidence from antihypertensive trials regarding the most appropriate antihypertensive drugs for the obese hypertensive patient
The dilemma of providing cardioverter/defibrillator back-up for all patients with heart failure eligible for cardiac resynchronization therapy
Get PDFCardiac resynchronization therapy (CRT) achieved by biventricular pacing (CRT-P) has been proved to improve symptoms and prognosis of patients with refractory heart failure. Sudden cardiac death is quite common among patients with symptomatic heart failure and implantable cardioverter-defibrillator (ICD) therapy has been proved to effectively reduce sudden deaths in heart failure patients. Given the results of the recently published primary prevention trials and the high incidence of sudden cardiac death among CRT-P recipients, CRT combined with backup defibrillator therapy (CRT-D) seems a logical therapeutic option in patients eligible for CRT. However, the apparent beneficial effects of such an appealing combination do not alleviate the skepticism about the unselected use of CRT-D therapy. This skepticism is largely related to the high cost of this method, to the limited availability of human and financial resources and to our inability to appropriately define the selection criteria for CRT candidates, which are expected to influence the clinicians??? decisions when confronted with the dilemma of providing CRT-D therapy for all patients eligible for CRT