Journal of cardiovascular medicine
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J Cardiovasc Med (Hagerstown) · Jan 2009
Hormone replacement therapy and cardioprotection: a new dawn? A statement of the Study Group on Cardiovascular Disease in Women of the Italian Society of Cardiology on hormone replacement therapy in postmenopausal women.
Cardiovascular disease is the leading cause of death in women in Western countries. Despite preventive strategies, in the past decades the incidence of cardiovascular events has shown a decline in men but a rise in women, matching the growth of the population of postmenopausal women. Several epidemiological findings suggest the causative pathophysiological role of ovarian hormone deficiency in the development of cardiovascular disease in women. ⋯ Conversely, aging, time since menopause and presence of cardiovascular risk factors or cardiovascular disease may decrease its efficacy and increase the risk of cardiovascular events. It is plausible that the unfavorable effects of the estrogen/progestin combination used in the randomized studies are not related to the hormone preparation per se but rather to the use of hormones in the less receptive group of women, older and with cardiovascular risk factors. Clinical judgment, choice of the right dose and estrogen/progestin combination are of pivotal importance to maximize the beneficial effect of estrogen replacement therapy/hormone replacement therapy, especially if given within a reasonable time after the menopause to women who need the therapy for the relief of menopausal symptoms.
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J Cardiovasc Med (Hagerstown) · Jan 2009
Natriuretic peptide system is not exhausted in severe heart failure.
We aimed to investigate the prognostic value of amino-terminal B-type natriuretic peptide (NT-pro-BNP) in severe heart failure. ⋯ We conclude that in patients with severe heart failure, NT-pro-BNP has a powerful prognostic value. Patients with high NT-pro-BNP had more than five-fold increase in the 6-month risk of death. Our results do not support the hypothesis that ventricular exhaustion with inability to synthesize and secrete natriuretic peptides is the mechanism underlying decompensation. Attenuation mechanisms of compensatory systems ought to be further studied.
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J Cardiovasc Med (Hagerstown) · Dec 2008
Time of onset and outcome of cardiogenic shock in acute coronary syndromes.
The aim of our study was to evaluate the incidence, timing of the onset and outcome of cardiogenic shock in a group of 865 patients with acute coronary syndromes who were consecutively admitted to our Intensive Cardiac Care Unit (ICCU) from January 2004 to December 2005. ⋯ Primary percutaneous coronary intervention has reduced the number of patients who develop cardiogenic shock after ICCU admission. According to our results, cardiogenic shock in patients with ST-elevation myocardial infarction developed early after symptoms' onset and, despite optimal treatment, mortality in these patients remains high (about 50%). Delayed cardiogenic shock is mainly due to mechanical complications as well as due to PCI complications.
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J Cardiovasc Med (Hagerstown) · Nov 2008
Case ReportsAn uncommon case of right-sided throat pain and swallow syncope.
A 63-year-old man presented with recurrent syncopal attacks associated with swallowing and right-sided throat pain. Immediately after admission, he presented a 16-s asystolia. The patient's clinical history was unremarkable except for previous postimplant periodontitis. ⋯ A barium swallow and fibre-optic endoscopy also revealed a small sliding hiatus hernia and distal chronic oesophageal inflammation. Despite complete dental curettage, antibiotics and antigastro-oesophageal reflux therapy, only partial relief of the pain and incomplete resolution of the arrhythmic disorder were obtained after 3 weeks, and the patient underwent pacemaker implantation. At 1-month follow-up, however, he reported the complete relief of the throat pain; subsequent Holter monitoring showed normal sinus rhythm, without pacemaker-induced electrical activity.
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J Cardiovasc Med (Hagerstown) · Nov 2008
Case ReportsWitnessing a rare event - thrombus seeking its route in the right atrium: 'thrombus-in-transit'.
Pulmonary embolus and right atrial thrombus trapped in a patent foramen ovale is an unusual, rare condition. We report a case of impending paradoxical embolism with pulmonary embolism, in which a thrombus entrapped in a patent foramen ovale was detected. To our knowledge, this is the first case in the literature in which 'thrombus-in-transit' was detected in the right atrium both before and after entrapment in a patent foramen ovale.