The Canadian journal of cardiology
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Early mortality following ST elevation myocardial infarction (MI) is declining in trial and nontrial settings. Absolute rates in nontrial settings remain significantly higher than those seen in randomized controlled trials. It is unclear if this mortality difference is due to different patient characteristics or to less frequent use of reperfusion strategies. ⋯ Mortality in ST elevation MI is disproportionately higher among patients who receive no reperfusion therapy. Many of these patients have clinical characteristics that may affect the physician's decision to provide reperfusion therapy. Improving overall survival among patients with ST elevation MI will be contingent on optimizing the number of patients receiving reperfusion therapy.
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In the antibiotic era, purulent pericarditis, an infection associated with high mortality, is uncommon. The causative organism is generally Staphylococcus aureus or Streptococcus pneumoniae arising from contiguous spread or hematogenous dissemination of an underlying infection elsewhere in the body. The present report describes a previously healthy individual who presented with acute infectious pericarditis with the offending organism identified as Lancefield group C Streptococcus equi. After an initial pericardial window was unable to prevent recurrent pericardial effusion, pericardiectomy was performed and the patient slowly recovered from the incident.
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A 43-year-old man with asystole and syncope occurring during cluster headache attacks is reported. The asystole and syncope attacks disappeared completely following prophylactic therapy with methysergide maleate. To the authors' knowledge, the present case is unique in associating asystole with cluster headache attacks and may be due to hyperactivity of the parasympathetic system.
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Review Comparative Study
An overview of the role of insulin in the treatment of hyperglycemia during acute myocardial ischemia.
Hyperglycemia on admission to the coronary care unit is associated with poor outcome. It has now been reasonably well established that intravenous insulin infusion during acute myocardial infarction has a protective role and reduces mortality. The present article reviews the current understanding of the cardioprotective effect of insulin and the recent advances in this area.
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Review Comparative Study
Mandatory physician reporting of drivers with cardiac disease: ethical and practical considerations.
Many jurisdictions in Canada have enacted legislation that requires physicians to report their patients to the Ministry of Transport if they have a medical condition that may put them at increased risk to operate a motor vehicle. The Canadian Cardiovascular Society has published guidelines that are designed to assist physicians and policy-makers in their decision-making. ⋯ However, in the present paper, important issues that have not been addressed to date are discussed. What is the efficacy of mandatory reporting legislation? What are the harms done to patients who are restricted from driving? What are the costs of the mandatory reporting system? How can the scientific/technical assessment of risk be reconciled with the social/ethical view of risk assessment? Until these issues are addressed, important questions about the ethics, efficacy and cost of mandatory physician reporting will remain unanswered.