Clinical cardiology
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Clinical cardiology · Apr 1990
ReviewCurrent perspectives in hypertrophic cardiomyopathy: diagnosis, clinical management, and prevention of disability and sudden cardiac death.
Hypertrophic cardiomyopathy is a rare primary myocardial disease known for its dramatic morphologic and clinical manifestations. Sudden cardiac death and functional cardiac symptoms are common. However, differing pathologic mechanisms may be responsible for similar clinical symptoms and make a unified approach to therapy impossible. This review will discuss the genetics, criteria for diagnosis, relationship among pathophysiologic abnormalities and clinical symptoms, and management of hypertrophic cardiomyopathy.
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Clinical cardiology · Mar 1990
ReviewRole of the emergency department in decreasing the time to thrombolytic therapy in acute myocardial infarction.
Delay from the onset of acute myocardial infarction (AMI) symptoms to initiation of thrombolytic therapy can be reduced by improving patient recognition of AMI symptoms and encouraging speedier action in seeking medical assistance and improving the time it takes for medical personnel to evaluate the patient's symptoms and initiate appropriate therapy. Attempts to improve patient response to AMI symptoms have met with limited success. Prehospital administration of thrombolytic drugs may be of value, but many AMI patients are not transported by the emergency medical services system. ⋯ Unfortunately, much of what is known about the time sequence of ED thrombolytic therapy in the United States comes from organized trials in a small number of centers. Little is known about how often non-ED physicians participate in the decision-making process (either in person or by phone consultation), or how many delays are potentially avoidable. Current evidence suggests that preestablished ED treatment plans and protocols can reduce the time delay for many patients who present with AMI, especially if paramedics can transmit diagnostic quality ECGs to the hospital.