Cardiology
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Brain natriuretic peptide (BNP) levels correlate with prognosis in patients with cardiac disease and may be useful in the risk stratification of cardiac patients undergoing noncardiac surgery (NCS). The objective of this study was to examine whether BNP levels predict perioperative events in cardiac patients undergoing NCS. ⋯ BNP levels may predict perioperative complications in cardiac patients undergoing NCS, and the measurement of BNP should be considered to assess the preoperative cardiac risk.
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Randomized Controlled Trial Multicenter Study
Clinical and hemodynamic effects of bosentan dose optimization in symptomatic heart failure patients with severe systolic dysfunction, associated with secondary pulmonary hypertension--a multi-center randomized study.
To evaluate the effects of bosentan on echo-derived hemodynamic measurements, and clinical variables in symptomatic heart failure (HF) patients. ⋯ In HF patients with left ventricular dysfunction and secondary pulmonary hypertension, bosentan did not provide any measurable hemodynamic benefit, and was associated with more frequent AEs, requiring drug discontinuation.
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Hyponatremia is the most common electrolyte abnormality in hospitalized patients and is associated with increased mortality, morbidity, and longer hospital stays. Because patients with this disorder are often asymptomatic, hyponatremia is frequently undiagnosed and untreated. Serious neurologic complications may ensue when hyponatremia develops too rapidly or the serum sodium concentration ([Na(+)]) falls below 120 mEq/l. ⋯ Hypovolemic hyponatremia is due to conditions promoting renal or extrarenal sodium loss. Because AVP, which is intimately involved in regulating osmolar homeostasis, is often elevated in patients with hypervolemic and euvolemic hyponatremia, treatments that directly target the effects of this hormone may provide a more predictable correction of serum [Na(+)] than those traditionally used. The AVP receptor antagonists (conivaptan, tolvaptan, lixivaptan, and satavaptan) are a new class of agents that have been shown to normalize serum [Na(+)] by promoting aquaresis - the electrolyte-sparing excretion of free water.
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Early reperfusion by direct percutaneous coronary intervention (PCI) in patients with ST segment elevation acute myocardial infarctions (STEMI) with an out-of-hospital cardiac arrest (OHCA) reduces hospital and longterm mortality. ⋯ Short-term survival of patients after OHCA with STEMI treated with direct PCI was found to be 68.4%. Out of 6 patients not receiving reperfusion therapy 1 survived (16.7%). Over the course of the 1-year follow-up none of the patients died.
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Hybrid coronary revascularization procedures apply minimally invasive coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of multivessel coronary artery disease. For logistic reasons simultaneous procedures would be desirable. In a pilot study the feasibility of simultaneous robotic totally endoscopic CABG and PCI using drug eluting stents was assessed. ⋯ We conclude that simultaneous robotic totally endoscopic left internal mammary artery to LAD placement and PCI to non-LAD targets using drug eluting stents is feasible in one session.