The Canadian journal of cardiology
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Interventional cardiology is a subspecialty of adult cardiology dedicated to the use and application of imaging-based diagnostic techniques and minimally invasive modalities for the treatment of cardiovascular disease. Currently, interventional cardiologists must demonstrate expert knowledge of cardiac imaging, along with cardiovascular anatomy and the pathophysiology of cardiovascular disease. ⋯ The 2010 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiologists Guidelines for Training and Maintenance of Competency in Adult Interventional Cardiology are the first such guidelines to be published in Canada. These guidelines should allow for more-fluid provision of high-quality interventional cardiology education, along with less geographic variation, resulting in more-widespread high-level services to the population.
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Therapeutic hypothermia preserves neurologic function in post-cardiac arrest patients. Several studies suggest that hypothermia may preserve myocardial function in patients with acute myocardial infarction (AMI). We carried out a systematic review to evaluate the efficacy of therapeutic hypothermia at reducing infarct size and decreasing major adverse cardiac events (MACEs) and all-cause mortality in AMI patients. ⋯ Subgroup analyses suggested that hypothermia may reduce infarct size in patients with anterior wall infarction. Our review suggests that therapeutic hypothermia is safe and feasible. However, more evidence is needed to determine whether therapeutic hypothermia is associated with improved infarct size, MACEs, or all-cause mortality in RCTs of AMI patients.
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Little is known regarding potential differences in antihypertensive prescribing practices at a Canadian provincial level. Our objective was to determine provincial differences in the use of antihypertensive drug therapy in Canada. ⋯ Large increases in antihypertensive prescriptions occurred in all provinces of Canada, but the provinces varied substantially in the increase in total and drug-specific classes of antihypertensive drugs. The basis for provincial differences in antihypertensive prescriptions remains unknown and is likely multifactorial but may relate in part to initial provincial variations in diagnosis, treatment, and control of hypertension, as well as individual provincial drug policies.
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Ventricular assist devices (VADs) are used in cases of heart failure refractory to medical therapy. Most VADs are used as a bridge to heart transplantation; however, in certain cases, myocardial function recovers and VADs can be explanted after the patient is weaned. The objectives of this study were to describe patients who required Heartmate II VAD insertion, followed by myocardial recovery and explanation in a quaternary heart centre. ⋯ Patients requiring VAD support for myocardial failure can undergo significant reverse remodelling. Explantation can lead to optimal outcome with minimal morbidity. Methods for assessment of reverse remodelling, weaning protocol, and optimal timing of explantation remain under evaluation.