International journal of cardiology
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Letter Case Reports
Catheter closure of tube graft fenestration in extracardiac Fontan operation.
As the extracardiac Fontan operation evolves, a reliable method for creating and subsequently closing communications between the systemic and pulmonary venous chambers would become useful. We describe a simple and safe technique of fenestration amenable to coil occlusion, which can be carried out in most cardiac catheterization laboratories.
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An ideal cardiac biochemical marker should have not only high sensitivity but also high specificity to myocardial infarction. The creatine kinase-MB, a relatively specific cardiac marker, could be elevated in situations other than acute myocardial infarction, such as renal failure, muscular injury, and myopathy. Although these are more specific than creatine kinase-MB, cardiac troponins have also been reported to be elevated in conditions other than acute myocardial infarction, such as chronic renal failure, acute myocarditis, cardiomyopathy, congestive heart failure, pulmonary embolism, rhabdomyolysis, sepsis, and left ventricular hypertrophy. With the ongoing research in this field, future holds hopes of finding an ideally specific marker of myocardial infarction, but until then biochemical markers should be used in conjunction with clinical assessment and electrocardiography in making the diagnosis of myocardial infarction, and the patients should not be treated merely on the basis of elevated serum levels of cardiac biochemical markers.
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Atrial and brain natriuretic peptides (ANP and BNP) plasma concentration increases and holds a prognostic significance in patients with left ventricular dysfunction. We assessed the hypothesis that right ventricular (RV) overload might significantly contribute to plasma elevation of cardiac natriuretic hormones in patients with heart failure. ⋯ Right heart overload contributes independently to plasma elevation of natriuretic peptides. RV involvement, which is known to independently worsen prognosis in patients with cardiomyopathy, might contribute to their established prognostic power, inducing compensatory secretion of plasma cardiac natriuretic hormones.
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Comparative Study
Increased long term rates of stent thrombosis and mortality in patients given clopidogrel as compared to ticlopidine following coronary stent implantation.
Clopidogrel has largely replaced ticlopidine following coronary stent implantation. Recently, concern has been raised regarding the possibility of excess long term mortality in patients given clopidogrel rather than ticlopidine following coronary stenting. ⋯ Long term follow up after stent implantation in patients receiving the traditional 2-4 weeks course of dual antiplatelet therapy reveals increased rates of TSO and mortality in patients given clopidogrel as opposed to ticlopidine. Whether longer treatment with clopidogrel will change these observations deserves further study.
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Letter Case Reports
Chest pain and ST elevation associated with fever in patients with asymptomatic Brugada syndrome: fever and chest pain in Brugada syndrome.
Brugada syndrome is a disease with a high risk of sudden cardiac death. Genetic mutations of the cardiac sodium channel are linked to the characteristic electrocardiogram abnormality of Brugada syndrome. Dysfunction of the mutated sodium channel is reported to be temperature-sensitive. ⋯ Moreover, these patients had chest pain during precordial ST elevation. From these cases, asymptomatic Brugada syndrome should be considered as one of differential diagnoses when we examine the patients who complained of fever and chest pain. Furthermore, we should lower the elevated body temperature in patients with Brugada syndrome, because fever caused spontaneous ST elevation leading to fatal ventricular arrhythmias.