International journal of cardiology
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We sought to evaluate the impact of initial electrocardiographic findings at presentation on in-hospital mortality and 30-day outcome of patients with acute coronary syndromes (ACS). ⋯ Patients with STE had higher in-hospital mortality, but lower longer term event rate after ACS in our population, irrespective of age, gender and other characteristics.
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Cardiogenic shock is a state of tissue hypoperfusion induced by heart failure after correction of preload. There are no clear numerical cutoffs to define of the hemodynamic parameters of cardiogenic shock but it is usually characterized by low blood pressure (systolic blood pressure <90 mmHg or a drop in mean blood pressure >30 mmHg, both with a heart rate >60 bpm) with low urine output (<0.5 ml/kg/h), with or without evidence of organ congestion. Acute myocardial infarction is the most common cause. ⋯ Activation of inflammatory response resulting in expression of inducible nitric oxide synthase, activation of inflammatory cytokines, and activation of complement system appear to play an important role in the pathogenesis and outcome of cardiogenic shock. Nitric oxide synthase inhibitors and C5 complement inhibitors are being investigated as potentially useful agents for the treatment of cardiogenic shock. Historical perspective, epidemiology, etiology, pathophysiology, risk predictors, and management of cardiogenic shock are described in this review.
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Letter Randomized Controlled Trial
Effect of levosimendan on E/E' ratio in patients with ischemic heart failure.
Levosimendan is a novel positive inotropic calcium sensitizer agent used in acute heart failure. In acute heart failure, it improves hemodynamic parameters more favorably than the conventional positive inotropes. In this study, the effect levosimendan on E/E' ratio as a non-invasive indicator of LV filling pressure was evaluated compared to dobutamine in a prospective, randomized, patient-blind manner. ⋯ Levosimendan causes a greater reduction of E/E' ratio compared to dobutamine in acute systolic left heart failure. This may explain the more favorable hemodynamic effects of levosimendan when compared to conventional positive inotropics in patients with systolic left heart failure.
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Transient hyperglycemia is common during acute myocardial infarction in non-diabetic patients and is associated with a worse outcome. There is limited data on the outcome of patients who undergo primary percutaneous coronary intervention and have transient hyperglycemia. ⋯ Transient hyperglycemia in non-diabetic acute myocardial infarction patients who undergo primary percutaneous coronary interventions is associated with high one-year mortality. One year target lesion revascularization rates were significantly higher in diabetics compared to non-diabetics with normoglycemia or transient hyperglycemia.
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Letter Case Reports
Left main coronary trunk connecting into right atrium with an aneurysmal coronary artery fistula.
Congenital coronary artery fistula (CAF) is an infrequent vascular anomaly that establishes a direct link between an epicardial coronary artery and a cardiac chamber, major vessels, or other vascular structures. In this case there was an aneurysmal-CAF between a left main trunk and the right atrium, which was initially diagnosed as a Kawasaki disease by transthoracic echocardiography and subsequently confirmed by coronary angiography and multi-slice CT angiography. A multi-slice CT angiography might well become the modality of choice for the characterization of these rare congenital anomalies.