The Canadian journal of cardiology
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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.
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Matrix metalloproteinases (MMPs) are a family of proteolytic enzymes that are regulated by inflammatory signals to mediate changes in extracellular matrix. Members of the MMP family share sequence homology, act on interstitial protein substrates, acutely participate in inflammatory processes and chronically mediate tissue remodelling. MMPs are important in vascular remodelling, not only in the overall vasculature architecture but also, more importantly, in the advancing atherosclerotic plaque. ⋯ MMPs also participate in cardiac remodelling following myocardial infarction and development of dilated cardiomyopathy. Soluble MMPs are now potential biomarkers in delineating cardiovascular risk for plaque rupture and coronary risk. They also constitute innovative direct or indirect targets to modify cardiovascular tissue remodelling in atherosclerosis and heart failure.