International journal of cardiology
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Amiodarone is currently the most effective antiarrhythmic drug for sinus rhythm maintenance. However, due to serious extracardiac adverse effects, prophylactic amiodarone therapy is only appropriate for patients at high risk for postoperative atrial fibrillation (AF). We hypothesized that epicardial application of an amiodarone-releasing hydrogel would produce therapeutic myocardial drug concentrations, while systemic levels would remain low. ⋯ Epicardial application of an amiodarone-releasing hydrogel reduces atrial vulnerability to tachyarrhythmias up to 3weeks, while extracardiac drug levels remain low. Therefore, amiodarone-releasing hydrogel could be applied during cardiac surgery to prevent postoperative AF at minimal risk for extracardiac adverse side effects.
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Peripartum cardiomyopathy is a rare but significant cause of maternal morbidity and mortality. Identification of silent forms of ventricular dysfunction associated with the peripartum period is challenging, yet necessary to establish specific counseling and therapeutic measures to prevent progression to overt heart failure. Our aims were to determine the prevalence of asymptomatic left ventricular systolic dysfunction in puerperium and compare its progression with that of cases of peripartum cardiomyopathy occurring in the same study period. ⋯ Asymptomatic left ventricular dysfunction in puerperal women shows a high prevalence and a pattern of long term echocardiographic changes similar to those found in overt peripartum cardiomyopathy.
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Letter Case Reports
Profound myocardial ischemia associated to occlusion of the right coronary artery.
A 75-year-old man with hypertension, hypercholesterolemia and history of coronary artery disease was admitted to the hospital because of sudden loss of consciousness. The patient suffered an acute myocardial infarction seven years before this admission, which was treated with percutaneous transluminal coronary angioplasty and stent implantation in the right coronary artery. The initial electrocardiogram showed a complete atrioventricular block, with narrow ventricular complexes at a rate of 40 bpm. ⋯ Thrombus aspiration and balloon angioplasty were successfully performed without residual stenosis. The ST-elevation alternans is a rare phenomenon which was initially described in the setting of coronary artery spasm. It is believed to be associated to profound myocardial ischemia, particularly in relation with occlusions of the left anterior descending coronary artery, and to the occurrence of malignant ventricular arrhythmia and sudden cardiac death.
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Case Reports
Late asymptomatic sirolimus-eluting stent fracture in a female with systemic lupus erythematosus.
We report a case of a sirolimus eluting (Cypher, Johnson-Johnson) stent fracture (SF) incidentally depicted 3 years post PCI in an asymptomatic female with systemic lupus erythematosus (SLE). The vessel was assessed with intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Different imaging modalities results are presented. OCT may offer superior imaging of SF compared to fluoroscopy and IVUS and might prove useful for the detailed assessment and tailored treatment of this rare complication.