The Canadian journal of cardiology
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Point-of-care echocardiography is revolutionizing the management of patients presenting with undifferentiated shock and cardiac arrest in the emergency department (ED). Its primary purpose is to aid the clinician in rapidly ruling in and ruling out life-threatening diagnoses at the bedside. ⋯ The use of echocardiography in the ED continues to expand, with advanced applications that include valvular assessment, diastolic dysfunction, and regional wall motion abnormalities, as well as the use of point-of-care transesophageal echocardiography. As the diffusion of these new skills continues and becomes routine, it will alter the practice of emergency medicine and the interaction with consulting cardiologists.
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The ever-increasing use of immune checkpoint inhibitors in cancer is leading to a high incidence of autoimmune side effects. This report discusses an autoimmune fulminant myocarditis in an elderly patient with metastatic pulmonary adenocarcinoma in whom the most advanced invasive heart failure therapies were used successfully. She was treated with nivolumab. This case illustrates a severe cardiovascular complication of immunotherapy and highlights to cardiologists the importance of aggressive treatments in patients with metastatic cancers whose prognosis has improved dramatically.
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QT-interval variations in response to exercise-induced increases in heart rate have been reported in children and adults in the diagnosis of long QT syndrome (LQTS). A quick standing challenge has been proposed as an alternative provocative test in adults, with no pediatric data yet available. ⋯ This first characterization of QTc changes on standing in children shows substantial alterations, which are greater than those seen in adults. Two-thirds of the children would have been misclassified as having LQTS by adult criteria, indicating the need to create child-specific standards.
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Review Meta Analysis
Diagnostic Value of Neurological Studies in Diagnosing Syncope: A Systematic Review.
Syncope is common and approaches to establishing etiology remain a matter of clinical and financial importance. Patients often undergo comprehensive neurologic investigations despite a lack of compelling indications. The aim was to determine the prevalence of use and diagnostic yield of electroencephalography (EEG), head computed tomography (CT), head magnetic resonance imaging (MRI), and carotid Doppler ultrasound (CUS) examinations. ⋯ Neurologic investigations for assessment of patients deemed to have syncope are used widely and are widely ineffective. Neurologic investigations should be obtained only with a very high degree of clinical suspicion.
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Atrial fibrillation (AF) and dementia are major health issues, with growing evidence suggesting a consistent association between AF and all forms of dementia. Although dementia and AF share several risk factors, the association appears to be independent of a history of clinical stroke and other comorbidities such as hypertension, heart failure, and diabetes. Proposed mechanisms linking AF to cognitive decline include altered hemodynamics resulting in cerebral hypoperfusion, inflammation, genetic factors, and silent cerebral ischemia due to subclinical microemboli. ⋯ Preventive therapies are currently being investigated and include anticoagulation, antiplatelet therapy, statins, pharmacological rhythm and rate control treatment strategies for AF, and catheter ablation procedures. Blinded Randomized Trial of Anticoagulation to Prevent Ischemic Stroke and Neurocognitive Impairment in Atrial Fibrillation (BRAIN-AF) trial is currently assessing whether oral anticoagulation can prevent cognitive decline in patients at low risk of overt stroke. Considering the strong and independent association between AF and neurocognitive outcomes and the major clinical implications, evidence-based preventive approaches are critically required to diminish the health burden from the scourge of dementia and related conditions.