The Canadian journal of cardiology
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Randomized Controlled Trial
Time from first medical contact to reperfusion in ST elevation myocardial infarction: a Which Early ST Elevation Myocardial Infarction Therapy (WEST) substudy.
Recent research and contemporary ST elevation myocardial infarction guidelines emphasize the importance of prompt reperfusion and have redefined the traditional time to treatment metric to include prehospital paramedical staff as the point of first medical contact. However, an important knowledge gap exists relating to data systematically addressing the impact of arrival at the hospital by ambulance and the delays inherent in transfer from a community hospital to tertiary centres for percutaneous coronary intervention (PCI). ⋯ Prehospital diagnosis, random assignment and treatment substantially reduced treatment delay with both pharmacological and mechanical reperfusion. Those activating the prehospital medical response system without receiving prehospital random assignment experienced the longest delay from first medical contact to reperfusion, indicating a lost opportunity to enhance ST elevation myocardial infarction patient outcomes.
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Case Reports
Reversible left ventricular dysfunction resembling Takotsubo syndrome after self-injection of adrenaline.
Transient left ventricular (LV) ballooning syndrome, or Takotsubo syndrome, is characterized by a reversible LV dysfunction. The pathophysiology has not been fully elucidated, but an excess of catecholamines seems to have an essential role. The case of a 27-year-old man who developed transient LV dysfunction resembling Takotsubo syndrome after self-injection of adrenaline is described. The present case may provide additional evidence to the hypothesis of excess sympathetic activation in LV ballooning syndrome.
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Heart failure (HF) is a common emergency depart-ment (ED) presentation and a leading reason for hospitalization. Canadian practice patterns for the management of acute HF have not been well described. ⋯ The current treatment patterns for acute HF are mostly symptomatic. Proven efficacious HF therapies remain underused. Future research should focus on the integration of disease management, identifying predictors of admission and readmission, and treatments to reduce rehospitalization.
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Review Practice Guideline
The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2--therapy.
To update the evidence-based recommendations for the prevention and management of hypertension in adults for 2009. ⋯ All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95% consensus. These guidelines will continue to be updated annually.
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Comparative Study
Sex differences in resource use after on-pump and off-pump coronary artery bypass surgery: a propensity score-matched cohort.
Previous studies have demonstrated that off-pump coronary artery bypass surgery (OPCAB) is associated with less use of hospital resources compared with on-pump coronary artery bypass surgery (ONCAB). ⋯ These results suggest that the benefits of OPCAB in terms of hospital resource use are influenced by sex. The potential beneficial effects are not demonstrated in the female population.