The Canadian journal of cardiology
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While pacemaker endocarditis is rare, it is a complication that mandates removal of the permanent pacemaker system, including the electrode lead. Many modes of lead removal have been used. The choice of method is determined largely by lead type and chronicity (i.e., risk of substantial adhesions, hence, lead tip mobility). ⋯ Transesophageal echocardiography appears to be particularly sensitive. If vegetation is detected, open heart surgery should be strongly considered for lead removal as opposed to dilator sheath counter traction. The latter method risks shearing off the vegetation, which may result in septic--even massive--pulmonary embolus.
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To test the ability of a logistic regression model (LRM) that predicts acute cardiac ischemia to make an early diagnosis of acute myocardial infarction (AMI); the ability of the LRM to predict AMI was also compared with the presenting electrocardiogram (ECG). ⋯ AMI can be diagnosed early with comparable accuracy either by placing presenting ECGs into one of seven categories, or by the LRM. The best method and 'cut-off' point for the diagnosis of AMI varies according to clinical circumstances. Categorizing ECGs requires more skill in ECG interpretation, but takes less time. The previously reported performances of the LRM were replicated, confirming portability of its use into different clinical settings and patient populations.
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To review prospective epidemiological studies and randomized clinical trials regarding the role of antioxidant vitamins (vitamins E and C and beta-carotene) in the prevention of cardiovascular diseases. ⋯ Prospective epidemiological investigations suggest a reduction in cardiovascular risk associated with increased intake of antioxidant vitamins, particularly vitamin E. Randomized clinical trials remain inconclusive with regard to the role of vitamin E in cardiovascular protection. The large, randomized clinical trials of beta-carotene in primary prevention show no effect and potential for harm associated with the use of beta-carotene. There are inconclusive and insufficient epidemiological and clinical trial data with regard to the role of vitamin C in cardiovascular protection. Overall, it is recommended that wide-spread use of antioxidant vitamins in cardiovascular protection should not be instituted and should await the results of further ongoing clinical trials.
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Randomized Controlled Trial Clinical Trial
Inhaled nitric oxide reduction in systolic pulmonary artery pressure is less in patients with decreased left ventricular ejection fraction.
To assess whether inhaled nitric oxide decreases pulmonary artery pressure in patients with depressed left ventricular ejection fraction. ⋯ These data imply that in patients with left ventricular ejection fraction of 0.25 or less, nitric oxide may not decrease systolic pulmonary artery pressure. Nitric oxide inhalation may result in a paradoxical increase in systolic pulmonary artery pressure in patients with severely depressed left ventricular ejection fraction. This effect would significantly limit the therapeutic role of nitric oxide in patients with severe heart failure.
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Case Reports
Echocardiographic detection of pulmonary embolism in transit: implications for institution of thrombolytic therapy.
Right atrial or ventricular thrombi in patients with pulmonary embolism are emboli in transit and are a medical emergency because they are associated with a high mortality rate when treated conservatively with anticoagulation. The current standard therapy is less well accepted because of the risk of clot fragmentation and distal embolization. A case in which an unsuspected right ventricular thrombus was diagnosed by echocardiography is reported. ⋯ Clinical improvement was rapidly obtained and the thrombus disappeared 10 h after the initial study. There was no complication. The case illustrates the utility of two-dimensional enchocardiography in the evaluation of patients with pulmonary embolic disease and the efficacy and safety of thrombolytic therapy in the treatment of pulmonary embolism in transit.