The Canadian journal of cardiology
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Review Comparative Study
Drug-induced long QT syndrome and torsade de pointes.
Several medications, including drugs prescribed for noncardiac indications, have been associated with a prolongation of the QT interval on the surface electrocardiogram. Under certain circumstances, this clinical manifestation may reflect an increased risk for patients presenting with a polymorphic ventricular tachycardia known as torsade de pointes. Drugs that prolong the QT interval belong to several pharmacological classes, but most of them share one pharmacological effect: they lengthen cardiac repolarization mostly by blocking specific cardiac K+ channels. ⋯ In brief, drug-induced torsade de pointes is a relatively rare event in the entire population, which nonetheless carries the risk of lethal consequences. Consequently, drug surveillance programs are very active in identifying drugs that induce the prolongation of the QT interval. Recent data have allowed us to better understand the underlying electrophysiological mechanisms of the syndrome and better identify predisposing factors.
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Comparative Study
Women have worse long-term outcomes after coronary artery bypass grafting than men.
Multiple studies have shown that women have worse in-hospital outcomes than men after coronary artery bypass grafting (CABG). The impact of sex on long-term results following CABG, however, is not as well established. ⋯ Women presented for CABG with more comorbid illness, advanced symptoms and greater urgency than did men. After adjusting for differences in clinical presentation, sex emerged as an independent predictor of long-term adverse outcomes following CABG.
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Practice Guideline Guideline
Guidelines for the provision of echocardiography in Canada: recommendations of a joint Canadian Cardiovascular Society/Canadian Society of Echocardiography Consensus Panel.
Recognizing the central role of echocardiographic examinations in the assessment of most cardiac disorders and the need to ensure the provision of these services in a highly reliable, timely, economical and safe manner, the Canadian Cardiovascular Society and Canadian Society of Echocardiography undertook a comprehensive review of all aspects influencing the provision of echocardiographic services in Canada. Five regional panels were established to develop preliminary recommendations in the five component areas, which included the echocardiographic examination, the echocardiographic laboratory and report, the physician, the sonographer and indications for examinations. ⋯ In addition, a focus group of cardiac sonograhers was recruited to review aspects of the document impacting on sonographer responsibilities and qualification. The document is intended to be used as a comprehensive and practical reference for all of those involved in the provision of echocardiography in Canada.
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Implanted venous access devices (VADs) are being used with increasing frequency in clinical practice. The complication rate is low and VADs are generally accepted as being safe. Catheter fracture is a rare but potentially life-threatening complication that must be recognized and treated promptly. The present report discusses a case in which the clinical presentation led to early recognition of catheter fracture and embolization, and the subsequent safe removal of the VAD.