Clinical cardiology
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Clinical cardiology · Jul 1999
ReviewDiagnosis and management of cardiac tamponade in the era of echocardiography.
Cardiac tamponade is a life-threatening condition. Accurate diagnosis and prompt intervention are necessary. Classically, clinical features of tamponade include pulsus paradoxus, tachycardia, increased jugular venous pressure, and hypotension. ⋯ The decision regarding treatment and timing of intervention must take into account the clinical presentation and echocardiographic findings, along with careful weighing of risks and benefits to the individual patient. Echocardiographically guided pericardiocentesis is the best available therapy for initial management of cardiac tamponade. It is simple, safe, and effective for removing pericardial fluid and reversing hemodynamic instability, and the use of a pericardial catheter for extended drainage has been associated with significant reduction in recurrence of fluid accumulation.
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The diagnosis of constrictive pericarditis remains a challenge because its physical findings and hemodynamics mimic restrictive cardiomyopathy. Various diagnostic advances over the years enable us to differentiate between these two conditions. This review begins with a case report of constrictive pericarditis, followed by a brief history and discussions of etiologies. ⋯ Association of characteristic hemodynamic changes and abnormal pericardial thickness > 3 mm usually confirms the diagnosis of constrictive pericarditis. Effusive and occult varieties of constrictive pericarditis are briefly described. This review concludes with emphasizing the importance of pericardial resection.
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Clinical cardiology · May 1999
Comparative StudyDiagnostic potential of combined transthoracic echocardiography and x-ray computed tomography in suspected aortic dissection.
Transesophageal echocardiography (TEE) and magnetic resonance imaging (MRI) are considered optimal diagnostic methods in the setting of suspected aortic dissection. However, although less sensitive as single modalities, transthoracic echocardiography (TTE) and contrast-enhanced computed tomography (x-ray CT) are more widely available and less costly. ⋯ This first controlled study comparing the combined information of TTE and x-ray CT with TEE and/or MRI revealed a similar diagnostic potential of both diagnostic strategies in the setting of suspected aortic dissection. Thus, in an environment with access to color Doppler TTE and x-ray CT only, the information from both tests should be combined to decide on diagnostic management of these patients.
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Clinical cardiology · Apr 1999
Comparative Study Clinical TrialAttenuated severity of new acute ischemic events in patients with previous coronary heart disease receiving long-acting nitrates.
Platelet aggregation and secondary vasoconstriction are key events in the genesis of acute coronary syndromes. ⋯ Long-acting nitrates as well as aspirin are suggested to have a protective or modifying effect on the development of acute coronary syndromes, favoring unstable angina rather than acute MI.
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Clinical cardiology · Mar 1999
The independent effects of left ventricular ejection fraction on short-term outcomes and resource utilization following hospitalization for heart failure.
While depressed left ventricular ejection fraction is clearly associated with poor long-term outcome in heart failure (HF), the effect of ejection fraction on short-term outcomes and resource utilization following hospitalization for HF remains unclear. ⋯ Depressed left ventricular ejection fraction is associated with higher resource utilization and readmission rates following hospitalization for HF. Greater focus on patients with depressed ejection fraction may increase cost savings from HF disease management programs.