Giornale italiano di cardiologia : organo ufficiale della Federazione italiana di cardiologia : organo ufficiale della Società italiana di chirurgia cardiaca
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G Ital Cardiol (Rome) · Sep 2018
Comparative Study[Treatment of cancer-associated venous thromboembolism].
Most clinical practice guidelines recommend low molecular weight heparin for the treatment of venous thromboembolism (VTE) in cancer patients. In the Hokusai VTE Cancer study, 1050 patients with cancer and acute VTE were randomized to oral edoxaban or subcutaneous dalteparin for at least 6 months and up to 12 months. Edoxaban was non-inferior to dalteparin with respect to the composite outcome of recurrent VTE and major bleeding. ⋯ Bleeding mostly involved the gastrointestinal tract and occurred in patients with gastroesophageal cancer. While waiting for ongoing studies on direct oral anticoagulants, the results of the Hokusai VTE Cancer suggest that edoxaban may represent a valuable alternative to low molecular weight heparin for the treatment of cancer-associated VTE. In patients with gastrointestinal cancer, the use of edoxaban requires careful benefit-risk weighting, taking into consideration patient's preferences.
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G Ital Cardiol (Rome) · Jun 2018
Comparative Study[How to choose between intra-aortic balloon pump, Impella and extracorporeal membrane oxygenation].
The use of percutaneous mechanical circulatory support systems in the setting of both high-risk percutaneous coronary intervention (PCI) and cardiogenic shock is an emerging, controversial issue in contemporary clinical cardiology. The most common devices are the intra-aortic balloon pump (IABP), the Impella and the extracorporeal membrane oxygenator (ECMO). Technical progress, equipment improvement and growing cath-lab team expertise are allowing to offer critical patients different levels of assistance according to the selected device. ⋯ In these conditions mechanical support may be promising. The lack of benefit observed with the systematic use of the IABP (combined with the increased mortality associated with higher number of inotropic drugs) is actually prompting to increasingly consider Impella and ECMO use in critically ill patients. The development of multidisciplinary local protocols is considered pivotal to improve management and outcome of those patients requiring percutaneous circulatory support devices.
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Although a new or worsening pericardial effusion is a diagnostic criterion for pericarditis, in clinical practice the presence of pericardial effusion does not necessarily imply the evidence of pericarditis. Up to 40-50% of cases of pericarditis do not show the presence of pericardial effusion (dry pericarditis). ⋯ A large, chronic pericardial effusion may have a good long-term prognosis even without routine drainage. In this paper, we will try to clarify common doubts and outline evidence-based approaches to diagnosis, therapy and follow-up of these patients, also addressing the possible complications and outcomes.
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G Ital Cardiol (Rome) · Apr 2018
Case Reports[Intravenous epinephrine for anaphylaxis: Kounis or takotsubo syndrome?]
The presence of an acute coronary syndrome in patients with anaphylaxis is a challenging diagnostic conundrum for the cardiologist. Both Kounis syndrome and takotsubo syndrome must be taken into account. We present here the case of a 46-year-old woman suffering from ventricular fibrillation after adrenaline infusion for an anaphylactic reaction. The case report shows the important role of a clear diagnostic work-up and the role of cardiac magnetic resonance in this clinical scenario to reach the final diagnosis of reverse takotsubo cardiomyopathy.
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G Ital Cardiol (Rome) · Mar 2018
Review[Lung and heart interaction: chronic obstructive pulmonary disease and ischemic heart disease].
The interaction between the lung and the heart is a vast, complex, and fascinating topic and, from a clinical point of view, disorders of the one often influence and promote disorders of the other. This is especially true for chronic diseases, with chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD) representing a classic example. Epidemiologic data indicate that cardiovascular diseases are frequent in patients with COPD, and vice versa. ⋯ However, the identification of COPD in patients with known IHD, and vice versa, is very important, due to higher risk of worse outcomes, lower quality of life, higher hospitalization and, ultimately, higher mortality. Similarly, therapeutic management may be challenging, due to apparently contrasting indications, such as the use of beta-blockers in IHD, and beta2-agonists in COPD, and possible cardiac side effects of bronchodilators. In this narrative review we will discuss these topics, providing a comprehensive evaluation of these two relevant comorbidities.