Clinical cardiology
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Clinical cardiology · Dec 2004
Comparative StudyCritical pathways in the emergency department improve treatment modalities for patients with ST-elevation myocardial infarction in a European hospital.
The use of protocols for patients with ST-elevation myocardial infarction (MI) is growing, but no definite conclusion regarding the value of critical pathways in Europe has been drawn. ⋯ A critical pathway for ST-elevation MI at the ED increases the use of evidence-based treatment strategies and improves outcome and quality of care of patients presenting to a European hospital because of acute chest pain.
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Clinical cardiology · Nov 2004
Utilization of low-profile intra-aortic balloon catheters inserted by the sheathless technique in acute cardiac patients: clinical efficacy with a very low complication rate.
Initial intra-aortic balloon pump (IABP) catheters were of large caliber and their utilization resulted in a high incidence of complications, including limb ischemia, bleeding and thrombosis, peripheral neurologic sequelae, and infection. Despite eventual decrease in the size of IABP catheters, the complication rate has remained high. ⋯ Utilization of low-profile IABP 8F catheters in a sheathless technique entails an exceedingly low complication rate despite an acute presentation, intense anticoagulant and antiaggregant therapy, frequent comorbidity, advanced age, severe coronary disease, and reduced cardiac function in a large proportion of treated patients.
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Clinical cardiology · Nov 2004
The incremental value of troponin-I testing in patients with intermediate risk unstable angina.
Classification of patients with unstable angina (UA) by Agency for Health Care Policy and Research (AHCPR) guidelines in the emergency department reliably stratifies risk of death or myocardial infarction (MI) for triage to outpatient evaluation (low-risk), hospitalization (high-risk), or additional testing (intermediate-risk). Cardiac troponin-I elevation may identify patients at higher risk, but the incremental value may vary with AHCPR clinical risk. ⋯ The AHCPR guidelines risk stratify patients with UA. High troponin-I adds significant (p < 0.001) prognostic value in the patients at AHCPR intermediate risk and should be evaluated further in larger trials of such patients.
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Clinical cardiology · Sep 2004
Review Case ReportsPersistent left superior vena cava draining into the coronary sinus: report of 10 cases and literature review.
Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly. ⋯ This study describes 10 new cases of PLSVC and supports the necessity of considering PLSVC draining into the coronary sinus in the diagnosis of patients presenting with dilated coronary sinus diagnosed by TTE. It also underlines the important role of MR imaging in the evaluation of these abnormalities. An associated heart disease must always be excluded in these patients.