International journal of cardiology
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Comment Letter
Chill therapy in the patients with resuscitated cardiac arrest: a new weapon in the battle against anoxic brain injury.
Improved cooling technologies (such as newer intravascular cooling devices) may result in earlier attainment of target temperature and even more robust clinical benefits in the management of the survivors of cardiac arrest. Earlier cooling may also be facilitated by the introduction of cooled saline infusions in the emergency room setting, prior to induction of cooling in the intensive care unit. However, there is a need for studies of adjunctive therapies to minimize the risk of medical complications associated with hypothermia, the most serious of which is infection. We strongly believe that larger confirmatory studies might encourage more widespread adoption of therapeutic hypothermia for survivors of cardiac arrest and further studies are also needed to evaluate the utility of this procedure for more expanded indications, including asystole, pulseless electrical activity, and in-hospital arrest in patients without significant comorbidity.
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Regular physical activity is associated with a range of health benefits; however the influence of regular exercise training on exercise capacity and quality of life in adults with congenital heart disease [ACHD] has not been previously reported. ⋯ A simple physical activity intervention like regular walking is feasible, safe and significantly increases the exercise capacity of adult patients at all stages of congenital heart disease. It is also helpful in improving the quality of life by improving physical self-perception, satisfaction with life, physical activity levels and general health.
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Letter Case Reports
Post-PCI fatal bleeding in aspirin and clopidogrel hyper responder: shifting from antiplatelet resistance to bleeding risk assessment?
A 64 year old woman with previous history of coronary stenting five days before was admitted in our institution for intracranial bleeding while receiving aspirin and clopidogrel. At hospital discharge, platelet testing showed hyper response to antiplatelet therapy with very low post treatment platelet reactivity.
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Transient left ventricular ballooning also called tako-tsubo syndrome, is increasingly being recognized as cardiomyopathy mimicking the clinical scenario of an acute myocardial infarction. Generally, it is characterized by apical ballooning appearance of the left ventricle in the presence of normal coronary arteries on the angiogram. ⋯ This syndrome is more prevalent in postmenopausal woman and usually preceded by extreme emotional and/or physical stress. We describe a case never reported before of transient left ventricular ballooning occurring during the early postpartum period after ergonovine injection rapidly evolving from a 'typical apical' ballooning into a 'midventricular' myocardial dysfunction.
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In chronic heart failure (CHF) skeletal muscle insulin resistance occurs independently of etiology and contributes to impaired energy metabolism. GLUT4, the predominant glucose transporter in the skeletal muscle promotes the rate-limiting step of glucose utilization in skeletal muscle. The significance of skeletal muscle GLUT4 in patients with CHF has not been studied in detail. ⋯ In non-diabetic patients with CHF, skeletal muscle GLUT4 transport protein is reduced in parallel to disease severity, independently of body composition. Low skeletal muscle GLUT4 contributes to insulin resistance in CHF.