International journal of cardiology
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We have followed 6 pregnancies in women affected by idiopathic pericarditis from 2002 to 2008, the largest reported clinical series. Four women were treated with aspirin 800 mg three times daily; in 3 women aspirin was gradually stopped at 20 weeks gestation, while in one case aspirin was continued till delivery. All the women were treated with prednisone, at low to moderate doses: 4 women with prednisone 10-2.5 mg daily during all the pregnancy, and 2 with prednisone starting from 25 mg daily only during the III trimester. ⋯ Five pregnancies were uneventful, while HELLP syndrome developed in the mother in which high-dose aspirin was continued till delivery, with rapid improvement after delivery. All the infants had a good outcome. No recurrences occurred during the pregnancies, while one mother had a recurrence 12 months after delivery, during a mean follow up of 21 months.
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Letter Comparative Study
Valsalva maneuver to predict dynamic intraventricular obstruction during dobutamine stress echocardiography in patients with hypertension.
We were to evaluate the effect of Valsalva maneuver with comparison to preload reduction by nitroglycerin (NTG) to predict intraventricular obstruction (IVO) during dobutamine stress echocardiography (DSE) in patients with hypertension. ⋯ Simple and safe Valsalva maneuver plays an effective role to predict dynamic IVO in patients with hypertension who might be good candidate for beta-blocker therapy and is even more sensitive than preload reduction by NTG.
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Comment Letter
Coronary allograft vasculopathy and coronary vasospasm in heart transplant recipients: a manifestation of Kounis syndrome?
The pathophysiology of vasculopathy of cardiac allografts is still unknown. Coronary vasospasm and thrombosis are some rare manifestations accompanying this entity. Hypersensitivity processes and the hypersensitivity coronary syndrome (Kounis syndrome) may be associated with this potentially fatal complication. Research efforts towards this direction may shed light for prevention and treatment of this disease.
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Randomized Controlled Trial Multicenter Study Comparative Study
Atrial septal defects versus ventricular septal defects in BREATHE-5, a placebo-controlled study of pulmonary arterial hypertension related to Eisenmenger's syndrome: a subgroup analysis.
Eisenmenger's syndrome (ES) is the most advanced form of pulmonary arterial hypertension related to congenital heart disease. Evolution of pulmonary vascular disease differs markedly between patients with atrial septal defects (ASD) versus ventricular septal defects (VSD), potentially affecting response to treatment. We compared the effects of bosentan and placebo in patients with isolated ASD (ASD subgroup) versus patients with isolated VSD or both defects (VSD subgroup). ⋯ Improvements in exercise capacity and cardiopulmonary hemodynamics, without desaturation, were observed in ES patients with both ASDs and VSDs. Although not reaching statistical significance, improvements were similar to those in the BREATHE-5 analyses, suggesting that the location of septal defects is not a key determinant of treatment response. These data further support the use of bosentan for the treatment of ES, independent of shunt location.
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Comment Letter
Is warfarin still underused in patients with atrial fibrillation? A major threat to treatment benefit.
Atrial fibrillation may cause thromboembolic events and the risk of thromboembolic events increase with the number of clinical and echocardiographic risk factors. Although the benefit of anticoagulant therapy in preventing thromboembolic events was clearly shown, a significant number of patients with atrial fibrillation were not under anticoagulant therapy. However, whatever the patient's reason for warfarin underutilisation, probably it is the main obstacle for reducing stroke risk in atrial fibrillation. Consequently, it makes the use of any risk factor calculation useless.