Clinical cardiology
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Clinical cardiology · Sep 2006
Respiratory changes in the pulse-oximetry waveform associated with pericardial tamponade.
Timely identification of hemodynamic compromise in patients with acute pericardial effusion and tamponade is critical in patient management. Respiratory variability in pulse-oximetry waveforms has been correlated with pulsus paradoxus, but has not been reported with cardiac tamponade in adult patients. ⋯ Pulse-oximetry is a commonly used tool for monitoring critically ill patients. The present study suggests that increased respiratory variability in the pulse-oximetry waveform should raise suspicion for hemodynamic compromise in patients at risk for pericardial effusion.
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Clinical cardiology · Sep 2006
Prognostic value of serum biomarkers in association with TIMI risk score for acute coronary syndromes.
Markers of neurohormonal activation and inflammation play a pivotal role in non-ST-elevation acute coronary syndromes (NSTE-ACS). ⋯ In NSTE-ACS, baseline levels of NT-proBNP and creatinine are independently related to cardiovascular events. Both markers combined with TIMI risk score provide a better risk stratification than either test alone.
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Clinical cardiology · May 2006
ACC/AHA guidelines for preoperative cardiovascular evaluation for noncardiac surgery: a critical point of view.
This review examines the issue of preoperative cardiac evaluation from a critical point of view, based on recent medical literature. We reviewed the history of that field and focused on the American College of Cardiology and American Heart Association guidelines, which are a cornerstone in the field of cardiac patients undergoing noncardiac surgery. ⋯ Nevertheless, there are some weaknesses in the guidelines. We believe that a better understanding of the guideline limitations will allow an improved and more educated practice of its recommendations.
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Peripartum coronary artery dissection is rare, but it is an increasingly recognized risk to women of childbearing age. Literature reviews reveal that about 80% of the population with spontaneous coronary artery dissections (SCAD) are female, and approximately 25-33% of cases occurred while the woman was pregnant or in the peripartum phase. Most cases have presented within 2 weeks of delivery. ⋯ Surgical revascularization via coronary artery bypass graft remains the optimal therapy in patients whose dissection involves the LMCA, in patients with concurrent multivessel dissection, and in patients with disease refractory to medical management. It is important to consider coronary artery dissection in the differential of any young woman who presents with signs or symptoms consistent with acute coronary syndrome, particularly if she is peripartum. Furthermore, once suspected, it is imperative that a definitive diagnostic study, that is, coronary angiography, be completed prior to the initiation of treatment whenever possible.
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Clinical cardiology · Mar 2006
Comparative StudyPrimary percutaneous coronary intervention in acute myocardial infarction: direct transportation to catheterization laboratory by emergency teams reduces door-to-balloon time.
Primary percutaneous coronary intervention (PCI) is the recommended revascularization strategy for patients presenting with acute ST-elevation myocardial infarction (STEMI). In most hospitals, transfer of patients with STEMI is organized from the emergency site via emergency room (medical and cardiologic evaluation) and then to the catheterization laboratory. ⋯ The preclinical emergency diagnosis of STEMI was reliable. Direct transport of patients with STEMI to the cardiac catheterization laboratory and early preclinical alert by the interventional PCI team significantly reduces door-to-balloon-times compared with established standard processes-of-care for patients considered for primary PCI.