Clinical cardiology
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Clinical cardiology · Apr 2010
Multicenter StudyPrevalence and prognosis of chronic obstructive pulmonary disease among 8167 Middle Eastern patients with acute coronary syndrome.
The purpose of this study was to report the prevalence and the significance of clinically recognized chronic obstructive pulmonary disease (COPD) during acute coronary syndrome (ACS). ⋯ In this large cohort of patients with ACS, the prevalence of COPD was 5.3%. Atypical presentation is common among COPD patients, and this may result in delayed therapy. ACS in COPD patients was associated with higher risk of heart failure and major bleeding complications without increased risk of in-hospital mortality.
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Clinical cardiology · Mar 2010
Comparative StudyFibrinolysis versus primary percutaneous intervention in ST-elevation myocardial infarction with long interhospital transfer distances.
Current guidelines recommend rapid initiation of reperfusion therapy for ST-elevation myocardial infarction (STEMI), with short-distance transfer for primary percutaneous coronary intervention (pPCI) preferred over fibrinolysis in non-pPCI-capable hospitals. Comparative outcomes in patients with longer transfer times are unclear. ⋯ In settings with longer transfer distances, administering fibrinolytics prior to transfer to a pPCI-capable center did not cause any significant delay in transfer or worse outcomes.
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Clinical cardiology · Mar 2010
Underuse of thrombolytic therapy in acute myocardial infarction and left bundle branch block.
Thrombolytic therapy reduces mortality in patients with acute myocardial infarction (AMI) and left bundle branch block (LBBB). The difficulty in accurately diagnosing AMI in patients with LBBB, however, might result in their undertreatment. Among 3,890 patients hospitalized with chest pain, 241 (6.2%) had LBBB at presentation. ⋯ A further 19 (10%) LBBB patients without AMI also received thrombolysis. Difficulty in making an accurate early diagnosis in patients with LBBB ensures that the majority of those with AMI fail to receive thrombolytic therapy while others without AMI are treated inappropriately. Improved diagnostic and therapeutic strategies are needed for patients with acute coronary syndromes and LBBB.
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Clinical cardiology · Mar 2010
Case ReportsA case of Brugada syndrome presenting with incessant polymorphic ventricular tachycardia.
Brugada syndrome, an inherited arrhythmogenic cardiac disease, manifests with ST-segment changes in the right precordial leads, right bundle block pattern, and susceptibility to ventricular tachyarrhythmias and sudden death. The only established therapy for this disease is prevention of sudden death by implantation of a defibrillator. Herein we describe a case of a patient who presented with incessant ventricular tachycardia (VT) and syncope and who had a type 1 Brugada pattern on ECG. The patient was successfully treated with quinidine, after which the classically described type 2 and 3 patterns emerged.