Critical care clinics
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Significant advances have been made in the management of cardiac arrhythmias. New technology has enhanced the ability to understand and treat a variety of tachycardias. ⋯ A new indication for cardiac pacing is evolving as a supplemental treatment for patients with refractory congestive heart failure. These and other advances provide numerous exciting options for management of cardiac patients.
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Antiplatelet therapy with aspirin has long been established as standard therapy in the management of conditions such as ST-elevation myocardial infarction and the acute coronary syndromes (unstable angina and non-ST-elevation myocardial infarction). Recently, several more potent platelet inhibitors have been developed and tested in randomized clinical trials. This article reviews the current state of the art of antiplatelet therapy.
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Critical care clinics · Apr 2001
ReviewAntithrombotic and thrombolytic therapy in acute cardiac care.
This article explores the use of antithrombotic and thrombolytic therapy in acute cardiac care, and looks at traditional anticoagulant agents, newer antithrombin agents, thrombolytic agents, and others.
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Pulmonary hypertension has many causes and therapies. A meticulous evaluation is critical. Substantial advances in medical therapy have occurred over the past decade, and the future treatment of this syndrome is promising, with many new medications on the horizon.
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Patients with decompensated heart failure should be managed in an aggressive and proactive manner, using predominantly hemodynamic and end-organ function goals. This management is in contrast to the chronic maintenance therapy of patients with heart failure, where a neuroendocrine approach is indicated. Underlying anatomic targets for intervention should be sought aggressively and addressed. Patients who prove resistant to standard measures should be considered for early referral to heart transplant centers for more definitive measures, including evaluation for heart transplantation and mechanical circulatory support if necessary.