Journal of cardiovascular medicine
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J Cardiovasc Med (Hagerstown) · Oct 2008
ReviewRole of intraoperative transesophageal echocardiography in patients undergoing noncardiac surgery.
Major perioperative cardiac complications, including cardiac death, nonfatal myocardial infarction and nonfatal cardiac arrest, can occur in patients undergoing noncardiac surgery. To reduce the risk of these complications, some authors have reported on the utility of intraoperative transesophageal echocardiography as a complementary monitoring tool in noncardiac surgery. ⋯ In this review, we discuss published information about the use of intraoperative transesophageal echocardiography during noncardiac surgery with an attempt to clarify whether this approach may offer potential benefits compared with conventional intraoperative monitoring systems. In addition, perioperative risk determinants in noncardiac surgery are briefly summarized and information derived from intraoperative transesophageal echocardiography for evaluation of cardiac morphology and function is schematically presented.
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J Cardiovasc Med (Hagerstown) · Oct 2008
Cardiogenic shock developing in the coronary care unit in patients with ST-elevation myocardial infarction.
A relevant proportion of patients with ST-segment elevation myocardial infarction may develop cardiogenic shock after presentation, and the identification of these patients would be very important in order to improve their outcome. The aim of the current study was to identify, among patients in the BLITZ-1, the clinical predictors, and describe the outcome of patients who developed cardiogenic shock during hospitalization. ⋯ The present study shows that the largest proportion of cardiogenic shock complicating ST-segment elevation myocardial infarction is observed after initial hospitalization, particularly in patients with Killip class more than 1, low systolic blood pressure at presentation and advanced age. The identification of these patients may help in preventing this complication by more aggressive pharmacological therapies, mechanical haemodynamic support, as well as coronary revascularization.
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J Cardiovasc Med (Hagerstown) · Oct 2008
Case ReportsConcomitant submassive pulmonary embolism and paradoxical embolic stroke after a long flight: which is the optimal treatment?
Economy class stroke syndrome consists of ischemic stroke due to paradoxical embolism through patent foramen ovale after a long flight. Few cases have been described in the literature to date. The treatment choice could be tricky. ⋯ Patent foramen ovale was percutaneously closed 3 months after. In the reported case, the treatment with thrombolysis and subsequent heparin infusion was effective and safe. We discuss the rationale for this treatment in the light of literature data.
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J Cardiovasc Med (Hagerstown) · Sep 2008
Randomized Controlled Trial Multicenter StudyA randomized trial comparing eptifibatide vs. placebo in patients with diffuse coronary artery disease undergoing drug-eluting stent implantation: design of the INtegrilin plus STenting to Avoid myocardial Necrosis Trial.
Despite the availability of several potent antithrombotic agents, the optimal antiplatelet regimen in elective patients undergoing complex percutaneous coronary interventions is still debated. Aim of the INtegrilin plus STenting to Avoid myocardial Necrosis Trial will be to assess the safety and efficacy of routine usage of the glycoprotein IIb/IIIa inhibitor eptifibatide in patients already treated with aspirin and clopidogrel and undergoing implantation of at least two drug-eluting stents in the same lesion, thus identifying a clinically stable but anatomically complex patient subset. ⋯ The INtegrilin plus STenting to Avoid myocardial Necrosis Trial study will test for the first time the beneficial impact of routine glycoprotein IIb/IIIa inhibition on top of dual oral antiplatelet treatment in clinically stable yet anatomically complex patients undergoing drug-eluting stents implantation. Results of this single-blind randomized trial will provide important insights to improve the management strategy of patients and outcomes in the current drug-eluting stents era.
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J Cardiovasc Med (Hagerstown) · Sep 2008
Review Case ReportsPossible heart failure exacerbation associated with pregabalin: case discussion and literature review.
Pregabalin is an analog of the neurotransmitter gamma-aminobutyric acid that exhibits analgesic, anticonvulsant, and anxiolytic properties. Owing to its pharmacologic properties, the drug has been used worldwide in the management of diabetic peripheral neuropathy, postherpetic neuralgia, generalized anxiety disorder, and social anxiety disorder. ⋯ We present three additional cases of possible heart failure exacerbation in patients with clinically stable heart failure who received pregabalin for neuropathic pain. Additionally, we review the literature addressing the nature and possible etiology for this adverse effect.