1,721,056 research outputs found
Colchicine is safe and effective for secondary prevention of recurrent pericarditis
No full textThe CORP (COlchicine for Recurrent Pericarditis) trial [7]is a prospective, randomized, double-blind, placebo controlled, multicenter trial to evaluate the efficacy and safety of colchicine (1.0–2.0 mg on the first day, followed by a maintenance dose of 0.5–1.0 mg/day for 6 months) in association with conventional anti-inflammatory therapy for the secondary prevention of recurrence in patients with a first relapse of pericarditis. Patients were excluded if they were having their first episode of acute pericarditis, or their second or subsequent recurrence, or had pericarditis with tuberculous, purulent, or neoplastic causes. The primary study end point was the recurrence rate at 18 months. Secondary end points were symptom persistence after 72 h, remission rate at 1 week, number of recurrences, time to first recurrence, disease-related hospitalizations,cardiac tamponade, and constrictive pericarditis rates.120 patients (60 in the colchicine and 60 in the placebo group) were included in the analysis. The recurrence rate is 24 % in the colchicine group and 55 % in the placebo group (absolute risk reduction 0.31 [95 % CI 0.13–0.46];relative risk reduction 0.56 [0.27–0.73]; number needed to treat 3 [2–7]). Colchicine improves the persistence of symptoms at 72 h (absolute risk reduction 0.30 [95 % IC,0.13–0.45]; relative risk reduction 0.56 [0.27–0.74]). It also reduces the mean number of recurrences, increases the remission rate at 1 week and prolongs the time to subsequent recurrence. Colchicine and placebo groups have similar rates of side effects (7 %) and drug withdrawal (8 vs. 5 %, P = 0.89);no severe side effects occurred in any of the groups. Gastrointestinal intolerance was the main side effect during the study
Implantable rhythm devices in the management of vasovagal syncope
No full textThe ECG registration during syncope allows physicians either to confirm or exclude an arrhythmia as the mechanism of syncope. Implantable loop recorders have an over-writeable memory buffer that continuously records and deletes the patient's ECG for up to three years. Many studies have analyzed the utility of implantable loop recorders in recurrent unexplained or high risk syncope. These studies suggest that early use of the ILR provides more and earlier diagnoses and could help in selecting patients with vasovagal syncope and prolonged asystolic pauses who might benefit from pacemaker therapy. However many questions remain, including its performance in the community by physicians with a range of experience in diagnosing syncope. Furthermore there is no evidence that the use of the ILR changes outcome.Numerous attempts have been made to determine whether patients with predominantly cardioinhibitory syncope benefit from permanent pacemakers, especially if symptoms are frequent and debilitating. While the first open label trials of pacemakers in the treatment of vasovagal syncope showed promising results, this effect has not been confirmed by blinded randomized clinical trials. More recent data seem to suggest that patients over 40. years with severe asystolic vasovagal syncope might benefit from permanent pacemakers
Therapeutic induced hypothermia does not improve the prognosis of out-of-hospital cardiac arrest patients
No full textUnconscious patients admitted to critical care units after out-of-hospital cardiac arrest are at high risk for death, and neurologic deficits are common among those who survive. The target temperature management (TTM), 33 vs. 36 °C, after out-of-hospital cardiac arrest trial was conducted to assess the benefits and harms of two targeted temperature regimens after out-of-hospital cardiac arrest of presumed cardiac cause. The study randomized 950 unconscious survivors of out-of-hospital cardiac arrest with presumed cardiac cause to a target temperature of 33 vs. 36 °C following return of spontaneous circulation (ROSC), irrespective of the initial rhythm. At the end of the trial, 50 % of the patients in the 33 °C group (235 of 473 patients) had died, as compared to 48 % of the patients in the 36 °C group (225 of 466 patients) [hazard ratio with a temperature of 33 °C 1.06; 95 % confidence interval (CI) 0.89–1.28; p = 0.51]. In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33 °C does not confer a survival benefit as compared to a targeted temperature of 36 °C
Managing syncope in the elderly: The not so simple faint in aging patients
No full textProviding care to the elderly patient with syncope poses problems that are unusual in their complexity. The differential diagnosis is broad, and sorting through it is made more difficult by the relative lack of symptoms surrounding the faint. Indeed, distinguishing faints from falls is often problematic. Many elderly patients are frail and are at risk of trauma if they should have an unprotected faint or fall to the ground. However, not all elderly patients are frail, and definitions of frailty vary. Providing accurate, effective, and appropriate care for the frail elderly patient who faints may require a multidisciplinary approach
Transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis reduces 1-year mortality compared to standard therapy
No full text
NT-pro-BNP for differential diagnosis in patients with syncope
No full textNT-pro-BNP has been proposed as a good predictor of syncope adverse outcome in the Emergency Department (ED) [Pfister R, Diedrichs H, Larbig R, Erdmann E, Schneider CA. NT-pro-BNP for differential diagnosis in patients with syncope. Int J Cardiol 2008 Jan 29]. We hereby summarize four critical points that should be taken into account when seeking to identify a cardiac cause of syncope or dealing with a risk stratification approach of the patient in the ED. The first issue is that patients admitted to the hospital after syncope are usually sicker than those discharged because of a higher rate of co-morbidity. Secondly, the focus on discharged patients is of paramount importance to assess the goodness of a predictor. Aging, which affects NT-pro-BNP levels, is a limiting factor in interpreting results. Finally, in order to add valuable information to the clinical practice, we suggest to compare results obtained by NT-pro-BNP values and the most used prognostic risk scores, such as the OESIL and SFSR
- …
