Cardiology
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During atrial fibrillation (AF), the renin-angiotensin-aldosterone system (RAAS) may be activated. In this study, our aim was to evaluate at a long-term follow-up visit the levels of plasma aldosterone and natriuretic peptides as markers of neurohormonal remodeling in patients with earlier, documented AF in relation to present heart rhythm, clinical data, and the left ventricular ejection fraction (LVEF). We hypothesized that increased levels of aldosterone and natriuretic peptides were significantly associated with present AF as markers of RAAS activation during the arrhythmia. ⋯ In patients with earlier AF, AF at long-term follow-up visit was independently associated with raised levels of Nt-proANP and Nt-proBNP and to some extent with plasma aldosterone indicating neurohormonal activation during arrhythmia.
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We describe a unique case of congenital absence of a right pulmonary artery presenting in a patient of advanced age and initially misdiagnosed as coronary artery disease. Perfusion of the affected lung was accomplished via anomalous collaterals from right and left circumflex coronary arteries which induced myocardial ischemia, as demonstrated by myocardial perfusion scan. ⋯ However, here we describe, to our knowledge, for the first time that in a patient with unilateral pulmonary artery agenesis, the existence of collaterals from the coronary arteries to the affected lung can actually have a negative effect in myocardial perfusion and can induce myocardial ischemia. In conclusion, clinicians should be aware of the possibility of undiagnosed cases of unilateral pulmonary artery agenesis presenting with chest pain in advanced age.
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Comparative Study
The specific electrophysiologic characteristics in children with the atypical forms of atrioventricular nodal reentrant tachycardia.
Atrioventricular nodal reentrant tachycardia (AVNRT) is well known to be one of the most common supraventricular tachycardias in childhood. However, information about the atypical forms of AVNRT in childhood is limited. The purpose of this retrospective study was to investigate the clinical and electrophysiologic characteristics in pediatric patients with the atypical forms of AVNRT. ⋯ This study demonstrated that the pediatric patients with the atypical forms of AVNRT had different electrophysiologic characteristics than those with the slow-fast or fast-slow forms of AVNRT. The results of radiofrequency catheter ablation were similar for all children with the slow-fast, fast-slow and atypical forms of AVNRT.
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Since most acute decompensated heart failure (ADHF) patients present for hospital care via the emergency department (ED), we sought to determine the impact of early ED initiation of ADHF-specific therapy, as indicated by nesiritide use, on subsequent outcomes. ⋯ Initiation of ADHF-specific therapy early, while the patient is in the ED, is associated with improved clinical outcomes.