The Canadian journal of cardiology
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Multicenter Study
The use of amiodarone for in-hospital cardiac arrest at two tertiary care centres.
Although amiodarone significantly increases survival to hospital admission when used in resuscitation of out-of-hospital pulseless ventricular tachycardia and fibrillation, there are limited data on its utility for in-hospital arrests. ⋯ Following two years' experience with the introduction of intravenous amiodarone for resuscitation in the institutions, use was less than 50% and no clinically observable survival benefit could be documented. Possible explanations for the difference between this experience and that found in out-of-hospital resuscitation trials include differing patient populations and operator bias during resuscitation. These results should provoke other institutions to question whether amiodarone has improved survival of cardiac arrest under the conditions prevailing in their hospitals. A patient registry or prospective, randomized trial will be required to assess what parameters affect the success of intravenous amiodarone for resuscitation in-hospital.
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Comparative Study
The Toronto Risk Score for adverse events following cardiac surgery.
To develop and validate an objective and reliable measure of acuity that will identify high-risk patients and predict length of stay following all cardiac surgery procedures. ⋯ The TRS is a valid measure of acuity that can identify patients who are at high risk of experiencing an AE and having prolonged length of stay after any cardiac surgery procedure, capture changes in acuity over time and allow for continuous quality performance evaluation.
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Case Reports
Nonheart failure-associated elevation of amino terminal pro-brain natriuretic peptide in the setting of sepsis.
In addition to its importance in clinical assessment, N-terminal pro-brain natriuretic peptide (NT pro-BNP) is a valuable marker for evaluation of treatment and prognosis of heart failure. However, there are situations where NT pro-BNP is not related to myocardial dysfunction. Two cases of sepsis with markedly elevated NT pro-BNP levels that are not indicative of depressed myocardial function are described.
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A 16-year-old boy presented to the emergency department with chest pain. He had no history of other health problems and did not smoke. ⋯ Coronary vasospasm associated with pseudoephedrine use, endothelial dysfunction and prothrombotic state caused by acute streptococcal infection may be the mechanisms responsible for AMI in this case. The possibility of AMI should be considered even in very young adolescents that have acute streptococcal pharyngeal infection, and it is important to obtain a complete history of the drugs used.