Herz
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In patients with an acute chest pain syndrome the primary requirement is to diagnose or exclude acute myocardial ischemia or myocardial infarction. However, only 30% of patients admitted and evaluated for chest pain ultimately reveal the diagnosis of acute coronary syndrome. Traditionally, the initial evaluation of patients presenting with chest discomfort or pain to an emergency department or any general practice involves the triad of history, physical examination, and ECG and chest film evaluation. ⋯ When a cardiac origin of any non-suggestive chest pain syndrome has been excluded, a broad spectrum of other causes for noncardiac chest pain needs to be evaluated. Potential underlying disorders are listed in this overview and grouped according to pathoanatomic origin into aortic, respiratory, and gastroesophageal disorders, musculoskeletal pathology, and somatization disorders. This article reviews both symptoms and diagnostic pathways in patients with noncardiac chest pain, and eventually offers a rational strategy for an efficacious workup of a wide spectrum of important differential diagnoses.
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Diabetes mellitus has reached epidemic proportions and is associated with decreased event-free survival following coronary revascularization. Although the historical complication rates for diabetic patients following percutaneous coronary intervention have been less than acceptable, the emerging drug-eluting stent technology when coupled with an aggressive adjunctive pharmacological regimen will improve the complication rates following percutaneous revascularization for this high-risk group of patients. This review will focus on the historical data associated with revascularization, percutaneous and surgical, and diabetes mellitus and will highlight the emerging data of drug-eluting stents and adjunctive pharmacology.
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Diving with self-contained underwater breathing apparatus (scuba) has become a popular recreational sports activity throughout the world. A high prevalence of cardiovascular disorders among the population makes it therefore likely that subjects suffering from cardiovascular problems may want to start scuba diving. Although scuba diving is not a competitive sport requiring athletic health conditions, a certain medical fitness is recommended because of the physical peculiarities of the underwater environment. ⋯ Metabolic disorders are of concern, since adiposity is associated with both, higher bubble grades in Doppler ultrasound detection after scuba dives when compared to normal subjects, and an increased epidemiologic risk of suffering from decompression illness. In conclusion, cardiovascular aspects are important in the assessment of fitness to dive, and certain cardiovascular conditions preclude scuba diving. Any history of cardiac disease or abnormalities detected during the routine medical examination should prompt to further evaluation and specialist referral.
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Comparative Study
[Protective effects of a delta-opioid-receptor agonist and an oxygen radical scavenger on postischemic hearts].
The cardioprotective effects of delta-opioid receptor agonists is mediated-at least in part-via oxygen radicals. Mannitol that is used in cardiac surgery because of its osmotic properties exerts its beneficial effects on stunned myocardium via scavenging hydroxyl radicals. The effects of a delta-opioid receptor agonist (D-Ala2-D-Leu5-Enkephalin [DADLE]), the radical scavenger mannitol and their combination on postischemic dysfunction in rabbit hearts were investigated. ⋯ Both substances improve the postischemic systolic and diastolic function and the relation between cardiac work and oxygen needed for this work. Thus, both substances offer promising properties in the clinic.