Hospital Chronicles (E-Journal)
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Admissions to the Coronary Care Unit (CCU): Comparison With International Data
Full text linkBackground: Cardiovascular diseases constitute the cardinal cause of death in the industrialized world, although a decrease in their mortality has been achieved during the last few years. Cardiac emergencies pose a significant hazard for the patient’s life and need to be managed in a coronary care unit (CCU), which can provide intensive monitoring and safety to perform advanced invasive and non-invasive therapeutic maneuvers. Based on data derived from patients admitted to the CCU of our institution, we present a comparison against international data, in terms of the patients’ basic epidemiological features. Patients and Methods: Epidemiological data from the patients admitted to the CCU of Evagelismos Hospital during the year 2007 were recorded and analyzed. Comparison with data available in the litterature regarding CCU admissions in European and American hospitals was also performed. Results: In the CCU of our institution 529 patients were admitted and managed by the staff of the first department of cardiology in the year 2007. Forty-four per cent of them had suffered an ST-elevation acute myocardial infarction, 18% were admitted due to a non-ST-elevation myocardial infarction or unstable angina, 21% because of significant arrythmias and in 17% the reason of admission was decompensated heart failure and/or pulmonary edema. The mean length of stay was 2.36 days. We found our data in agreement with other European reports although certain differences were noted in comparison with registries from the US, where heart failure prevails in admission diagnoses and there is a slightly longer duration of stay in the CCU. Conclusion: The characteristics of the patients admitted in the CCU of a large Greek tertiary medical center are similar to those of the average European patients. On the other hand, CCU patients in the US have a somewhat different profile, which may in part reflect differences in the organization and delivery of health care services
Clinical Utility of Cardiovascular Magnetic Resonance Imaging for Diagnosis of Acute Myocarditis
Full text linkCardiac magnetic resonance imaging (CMR) is a novel imaging technique that may help differentiate between myocarditis and acute coronary syndrome and compares favorably to other imaging techniques because it also provides information on tissue consistency and characteristics. We herein present a case, whereby CMR was most useful in providing such a differential diagnosis
Restitution of the Infarcted Myocardium- the Role of Stem Cells
Full text linkEven after optimal reperfusion strategies implementing percutaneous coronary intervention (PCI) with stent implantation and modern medical regimen for patients with acute myocardial infarction, myocardial salvage is often incomplete and adverse ventricular remodeling with subsequent heart failure develops. The transplantation of autologous bone marrow stem cells (BM-SCs) via the intracoronary delivery route after PCI of the infarct related artery (IRA) has been investigated in several observational studies which proved the safety and feasibility of the method. The results of the randomized studies were rather controversial. The BOOST study (Bone Marrow transfer to enhance ST-elevation infarction regeneration) was the first randomized study with patients receiving either bone-marrow derived mononuclear cells or placebo 5 days after primary PCI. The improvement of the ejection fraction reported in the cell infusion group at 6 months was attenuated during a follow-up study of 18 months. Of note, a similar restenosis rate (13%) was reported between the 2 groups
Recurrent Stent Thrombosis After Rescue Angioplasty
Full text linkA 70-year-old woman with hypertension and family history of coronary artery disease (CAD) was admitted with acute chest pain to Kalavrita general hospital. ECG was compatible with an anterior wall STEMI. The patient was on Killip class III heart failure. Thrombolysis (reteplase) was administered along with diuretics,heparine, ASA, clopidogrel, nitroglycerin and an ACE inhibitor. However the chest pain persisted as did the ST elevation. She developed cardiac arrest (VF), from which she was successfully resuscitated and transferred to the next larger on call hospital (???Agios Andreas?? general hospital) in Patras. The chest pain persisted and the patient was next transferred to Patras University Hospital for possible rescue angioplasty
How Innocent is the Restenosis of the Infarct-related Coronary Artery After Successful Initial Recanalization?
Full text linkThe present case report describes a patient who sustained an acute inferior wall myocardial infarction, but initially remained clinically stable, then he underwent a successful coronary angioplasty and stenting procedure of a totally occluded right coronary artery, subsequently developing a dramatic clinical course with cardiogenic shock and cardiac arrest due to acute stent thrombosis which was successfully managed with repeat coronary angioplasty. We attributed this discrepant clinical manifestation of acute coronary occlusion to coronary collaterals, initially being present and then disappearing following the recanalization procedure, as being responsible for the dramatic clinical picture following the stent thrombosis
Current Indications for Percutaneous Coronary Intervention for Chronic Stable Angina: Implications of the COURAGE Trial
Full text linkPatients presenting with symptoms of chronic stable angina represent a relatively significant portion of general population, especially among older aged. Among people 45-54 years old, stable angina is reported between 2-5% in men and 0.5-1% in women,while among people 65-74 years old the corresponding incidence is reported 11-20% for men and 10-14% for women respectively. In >50% of these patients angina limits significantly everyday activities leading to premature retirement, according to various national health and insurance surveys. Chronic stable angina is a slowly progressive disease and the patients show a relative mortality of approximately 2% per year, significantly lower than the mortality of patients with unstable acute coronary syndromes or vascular disease and only slightly higher than that of patients with several risk factors who are under treatment for primary prevention. Mortality among patients with stable angina is related to the extension and the severity of coronary artery disease (CAD), their left ventricular function, exercise capacity, nature of the symptoms and ECG findings both at rest and during stress
Surgery for Hypertrophic Obstructive Cardiomyopathy
Full text linkHypertrophic obstructive cardiomyopathy (HOCM) is an inherited disorder with variable expressivity, resulting in asymmetric septal hypertrophy and left ventricular outflow tract obstruction (LVOTO). Symptoms are similar to those of aortic stenosis and are due to LV diastolic dysfunction and myocardial ischemia in the absence of epicardial coronary narrowing. Goals of treatment include symptomatic control, resolution of hemodynamic abnormalities and their sequelae, reduction of sudden cardiac death risk and screening of family members. Left ventricular outflow tract obstruction at rest is a predictor of severe symptoms, heart failure, and death. The majority of patients are managed medically, predominantly with b-blockers and calcium channel blockade.Disopyramide, a negative inotrope, can be used in cases with persistently high resting gradients. To prevent sudden cardiac death, implantable cardioverterdefibrillators are used aggressively