Clinical cardiology
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This report describes an example of a patient with chest pain and classic electrocardiographic changes consistent with ischemia in the proximal left anterior descending coronary artery (LAD) territory. This electrocardiogram (ECG) abnormality is known as Wellens' syndrome. However, the same abnormality is also described as inverted U-waves. The significance of this abnormality and the controversy of describing this syndrome is reviewed and discussed.
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Clinical cardiology · Feb 2008
Positive troponin in diabetic ketoacidosis without evident acute coronary syndrome predicts adverse cardiac events.
Elevated troponin I has been associated with increased mortality in critically ill patients without acute coronary syndrome (ACS). However, the prognostic significance of troponin elevation in patients with diabetic ketoacidosis (DKA) without evident ACS has not been studied. ⋯ Elevated troponin I in diabetic patients admitted with DKA identifies a group at very high risk for future cardiac events and mortality. Whether cardiac risk stratification of these patients will improve long term outcome remains to be studied.
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Clinical cardiology · Dec 2007
ReviewAntiplatelet therapy in cerebrovascular disease: implications of Management of Artherothrombosis with Clopidogrel in High-risk Patients and the Clopidogrel for High Artherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance studies' results for cardiologists.
Cardiovascular disease is prevalent among patients with stroke; thus, cardiologists frequently treat patients at high risk for stroke. Results from recent clinical trials of antiplatelet medications, given alone or in combination, may be of special interest to cardiologists. The MATCH study demonstrated no significant difference between clopidogrel alone and clopidogrel plus aspirin in reducing risk of vascular events after stroke or transient ischemic attack. ⋯ Selection of an antiplatelet agent must be based on patient history, including previous MI and stroke, susceptibility to bleeding, and other high-risk factors (e.g. advanced age and diabetes). Aspirin plus extended-release dipyridamole may be more effective than clopidogrel for preventing stroke in high-risk patients. This article strives to put MATCH and CHARISMA results into context by providing an overview of antiplatelet therapy, including relevant clinical trial results, a review of current practice guidelines, and a summary of an ongoing study that will improve clinical decision making.
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Clinical cardiology · Dec 2007
Comparative StudyDevelopment and validation of a noninvasive method to estimate cardiac output using cuff sphygmomanometry.
Obtaining cardiac output (CO) measurements noninvasively during routine blood pressure recording can improve hypertension management. A new method has been developed that estimates cardiac output using pulse-waveform analysis (PWA) from a brachial cuff sphygmomanometer. This study evaluates the ability of PWA to track changes in CO as derived by Doppler ultrasound during dobutamine stimulation. ⋯ The CO measured noninvasively from a sphygmomanometer using this PWA method correlates well with those of Doppler through a range of dobutamine-stimulated levels. The CO by PWA should be useful for monitoring hemodynamic changes in hypertensive and cardiac patients during routine blood pressure measurement.
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Clinical cardiology · Nov 2007
Initial presenting electrocardiogram as determinant for hospital admission in patients presenting to the emergency department with chest pain: a pilot investigation.
Evaluation of chest pain accounts for millions of costly Emergency Department (ED) visits and hospital admissions annually. Of these, approximately 10-20% are myocardial infarctions (MI). ⋯ Patients with chest pain and initial ECGs with ST segment abnormalities suggestive or diagnostic for ischemia, should be admitted to the hospital for further evaluation and management. Patients with ECGs that do not display acute ST segment changes are at a lower risk for acute myocardial infarction than those with acute ST segment changes and should be admitted on the basis of cardiac risk profile. (i.e., age, gender, hypertension, diabetes, smoking, known coronary artery disease, etc.) Patients with normal ECGs (category 1) are at extremely low risk, and it may be acceptable to consider further evaluation on an outpatient basis.