Journal of cardiovascular medicine
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J Cardiovasc Med (Hagerstown) · Aug 2010
ReviewManagement of pericardial diseases during pregnancy.
Relatively few data have been published on the management of pericardial diseases during pregnancy. Pericardial involvement is sporadic during pregnancy, and pregnant women do not show any specific predisposition to pericardial diseases. The more common form of pericardial involvement is hydropericardium, usually as a benign mild effusion recorded in about 40% of pregnant women by the third trimester, followed by pericarditis as the more common disease requiring medical therapy. ⋯ Low-medium doses of prednisone are allowed during all pregnancy and breastfeeding. Colchicine is generally contraindicated during pregnancy, except in women with familial Mediterranean fever. These pregnancies should be followed by a dedicated multidisciplinary teams.
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J Cardiovasc Med (Hagerstown) · Aug 2010
Comparative StudyPredictive value of cardiac troponin-I compared to creatine kinase-myocardial band for the assessment of infarct size as measured by cardiac magnetic resonance.
The estimation of infarct size by biochemical myocardial necrosis markers is used in current clinical practice, rather than the more expensive and not always available imaging techniques. However, for this purpose, the peak value of serum biomarkers can overestimate the necrotic area, especially after reperfusion. ⋯ In patients with a first acute myocardial infarction, cTnI value assessed at 72 h from symptom onset shows the best correlation with predischarge infarct volume as assessed by DE-CMR and is superior to cTnI and creatine kinase-myocardial band peak and total values.
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J Cardiovasc Med (Hagerstown) · Aug 2010
ReviewUnloading therapy by intravenous diuretic in chronic heart failure: a double-edged weapon?
A well established part of therapeutic approaches applying to cases of chronic heart failure (CHF) with extreme fluid retention is represented by intensive intravenous (i.v.) therapy with loop diuretics. This kind of therapy, if appropriately modulated according to the individual clinical picture and biohumoral pattern, is able to decrease the abnormally high ventricular filling pressures, thereby relieving the breathlessness while being able to retrieve a suitable urine output, so as to propitiate regression or disappearance of edema without unfavorable influences on renal clearance of nitrogenous compounds. Nevertheless, the intensive i.v. diuretic therapy should be tailored on the basis of a close assessment of baseline hemodynamic data and hemodynamic response to the medications, in addition to the careful diuretic dose titration and cautious evaluation of risk/benefit ratio. ⋯ The measures, thought to be able to prevent renal arterial constriction and to impede deterioration of glomerular filtration rate (GFR) due to the ischemic-necrotic tubular injury, as occurring in the set of intensive unloading therapy with i.v. furosemide or other loop diuretic, are represented by application of inotropic and renal vasodilator support by dopamine i.v. infusion at low doses or by other inotropic agents provided with recognized renal vasodilator properties and/or by addition to i.v. furosemide of osmotic agents able to expand the hematic volume, so counteracting or minimizing the reflex renal vasoconstriction induced by furosemide-related reduction in intravascular circulating volume: i.v. infusion of small volumes of hypertonic saline solution, as well as administration of albumin, mannitol and/or plasma expanders. Because renal impairment, as developing in the setting of CHF, has proven to represent a very important indicator of adverse outcome, every effort should be addressed to prevent any significant (>25% of basal value) rise in serum creatinine consequent to diuretic unloading therapy or to other procedures (paracentesis of tense ascites, ultrafiltration) aimed at rapid fluid removal in edematous or ascitic CHF or cardiogenetic anasarca. Ultrafiltration, even though a promising technique highly valued for its acknowledged property to obtain a more rapid fluid and weight loss in CHF patients with marked fluid retention, has been demonstrated so far to produce neurohumoral activation, creatinine abnormalities and symptomatic hypotensions similar to those due to i.v. loop diuretics; thus, the hypothesized advantages of this technique remain to be further clarified and confirmed, with regard to its safety profile and cost-effectiveness.
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J Cardiovasc Med (Hagerstown) · Jul 2010
Comparative StudyCerebral oximetry during carotid clamping: is blood pressure raising necessary?
Carotid endarterectomy is subject to a significant risk of intraoperative stroke. Anesthetic management of patients must provide optimal monitoring of cerebral blood perfusion to establish whether intraluminal carotid shunting is necessary. Cerebral oximetry (regional cerebral oxygen saturation, rSO2) measurement can ascertain whether brain perfusion is adequate. During carotid cross-clamping, a rise of blood pressure may be required to guarantee a collateral blood supply throughout the circle of Willis. We retrospectively evaluated the relationship between blood pressure and rSO2 in our experience. ⋯ During carotid cross-clamping, an excessive rise of blood pressure is not necessary to guarantee safe values of rSO2. On the contrary, hypertension could expose the patient to risk of cardiac accident. So we have modified our intraoperative strategy avoiding controlled hypertension for normotensive management during carotid clamping.