Cardiology
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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.
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Several studies have associated elevated C-reactive protein (CRP) levels to the occurrence of atrial fibrillation (AF). We sought to estimate the frequency and prognostic impact of AF in patients with bacteremia, and to study the possible association between AF and CRP as well as between AF and mortality in this population. ⋯ The frequency of new-onset AF in bacteremia is substantial. Initial CRP levels or white blood cell count do not seem to predict new-onset AF, as opposed to systemic inflammatory response syndrome. On the other hand, in patients with bacteremia, new-onset AF should be viewed as an indicator of increased mortality and morbidity.
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Case Reports
Serial hemodynamics and complications of pregnancy in severe pulmonary arterial hypertension.
We report a case of a woman who became pregnant after the diagnosis of moderate to severe pulmonary hypertension and underwent successful full-term pregnancy. Pulmonary hemodynamics were monitored before pregnancy and in the peripartum period. The patient was followed closely by the cardiology and high-risk obstetric specialists in the outpatient setting until she underwent c-section with epidural anesthesia. ⋯ The postoperative course was complicated by a spontaneous, acute rise in pulmonary vascular resistance, which was managed with intravenous epoprostenol. In addition, abdominal bleeding, likely related to postoperative anticoagulation and platelet dysfunction, was controlled with transfusion and spontaneously resolved after discontinuing the anticoagulation. This case presents a favorable outcome in a pregnant patient undergoing cesarian section despite several complications related to pulmonary hypertension and right ventricular dysfunction, which are often fatal.
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Case Reports
Pulmonary artery aneurysm as a cause for chest pain in a patient with Noonan's syndrome: a case report.
A pulmonary artery aneurysm is defined as pulmonary artery dilatation >4 cm. Pulmonary artery aneurysms are rare findings and are usually not associated with chest pain. ⋯ The patient underwent pulmonary valvuloplasty as well as pulmonary arterioplasty to repair the pulmonary artery aneurysm, and experienced subsequent relief of chest pain. In conclusion, pulmonary artery aneurysm is a rare complication in patients with Noonan's syndrome and can be the cause of chest pain in such patients.