Clinical cardiology
-
Since the Randomized Aldactone Evaluation Study (RALES), the use of spironolactone is recommended in systolic heart failure (HF) patients that have been in New York Heart Association (NYHA) class III or IV. There is limited information on the use, side effects, and withdrawal rate of spironolactone in routine clinical practice. ⋯ Spironolactone side effects are common and are mostly related to effects on the angiotensin-aldosterone axis. Our results reinforce the need to closely monitor serum K+ and Cr levels in patients treated with spironolactone, as its side effects are more common than reported in clinical trials.
-
Clinical cardiology · Jun 2008
Case ReportsCerebral hemorrhage: precipitating event for a tako-tsubo-like cardiomyopathy?
There have been some reports in medical literature of patients with profound, reversible left-ventricular (LV) dysfunction after sudden emotional stress. Originally, in Japan, the pattern was called tako-tsubo cardiomyopathy. ⋯ The authors describe a case involving a cerebral hemorrhage and a potential tako-tsubo-like cardiomyopathy in the same patient. In conclusion, even though the patient's presentation appears to be a tako-tsubo syndrome, the radiographic evidence of a cerebral hemorrhage presents as a stronger etiology for the cardiac changes that occur in our patient.
-
Clinical cardiology · May 2008
Review Case ReportsAn unusual manifestation of Takotsubo cardiomyopathy.
Takotsubo cardiomyopathy typically presents with chest pain, ST changes, and transient left ventricular apical ballooning in the absence of epicardial coronary artery disease. This process is reversible and usually benign. ⋯ Recognition of this finding is critical in patient management especially in the setting of cardiogenic shock, as inotropes are likely to aggravate and worsen the clinical condition. We provide a systematic review and an illustrative case and discuss treatment strategies.
-
Clinical cardiology · Mar 2008
Prognostic value of troponins in patients with non-ST-segment elevation acute coronary syndromes and chronic kidney disease.
The prognostic value of cardiac troponins (cTn) in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) and chronic kidney disease (CKD) is debated. ⋯ In patients with CKD, cTnI and cTnT perform equally in differentiating short-term prognosis following NSTE ACS; however, the prognostic impact of cTn is dependent upon the degree of CKD severity.