Cardiology clinics
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Pregnant women with hypertension can be divided into two groups: normotensive women who develop the uniquely pregnancy-related syndrome of preeclampsia, which is characterized by hypertension, proteinuria, and edema; and women with chronic hypertension who become pregnant and are at increased risk for developing superimposed preeclampsia. Preeclampsia is a syndrome of generalized endothelial dysfunction initiated by abnormal placentation and consequent placental under-perfusion, release of cytokines and other toxins, and vasoconstriction and platelet activation. ⋯ The process is completely reversible by delivery of the fetus and placenta, but intrauterine growth retardation and premature delivery pose major threats to the fetus and may require care in tertiary care center. Treatment of preexisting or pregnancy-induced hypertension does not prevent or reverse the process, but is justified to prevent maternal cardiovascular complications, especially during labor and delivery.
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Review
Current role of pharmacologic therapy for patients with paroxysmal supraventricular tachycardia.
Intravenous antiarrhythmic drugs will continue to have an important role in the acute management of SVT. Long-term antiarrhythmic drug therapy is often effective in preventing or reducing frequency and severity of arrhythmic episodes. The cost, adverse effects, and inconvenience of long-term drug therapy will result in the increasing use of curative ablation for most individuals with problematic SVT.
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Atrial fibrillation is associated with a resting heart rate in excess of age-matched subjects in sinus rhythm, and there is an additional steep rise in rate during exertion. This article reviews the factors responsible for this tachycardia, the pharmacologic agents commonly used for heart rate control, and the effects of atrial antiarrhythmic agents on the heart rate during paroxysmal atrial fibrillation.
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Burns represent a major cause of accidental death in industrialized countries. Before the recognition of the key role of aggressive volume resuscitation in successful management, early mortality was common secondary to burn shock. Salvage of patients with major burns is optimized only if the pathophysiology of burn injury and the time course of hemodynamic derangements is understood. ⋯ In selected high-risk patients and in those failing resuscitation to clinical goals, invasive hemodynamic monitoring should be used to refine fluid management and identify those patients who may benefit from cardiotonic drugs. The potential contribution of carbon monoxide or cyanide intoxication to hemodynamic instability should be considered in all patients with a compatible history, including a history of inadequate response to treatment. With resolution of the phase of potential burn shock, the increased metabolic needs of the patient and the demands imposed by those needs on the cardiovascular system should be anticipated and supported.
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Blunt cardiac trauma presents unusual fare for the average cardiologist. The pathogenesis of blunt cardiac injuries is reviewed, and a spectrum of cardiac lesions resulting from blunt trauma is presented, with emphasis on noninvasive diagnostic techniques.