The Canadian journal of cardiology
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To pilot-test a simple checklist designed to improve coding of acute myocardial infarction (AMI) in hospital discharge abstracts. ⋯ A simple checklist can be very easily applied, has extremely high sensitivity for confirming the presence of AMI, and identifies a clinically significant proportion of charts with false positive codes for AMI. Conversely, these findings support the high sensitivity (low false negative rates) of conventional coding practices for AMI in Canadian hospital records, be it as a primary or secondary diagnosis (eg, 95% detection rate). Usual coding, combined with the checklist for tentative ICD-9 410 diagnoses, would improve the accuracy of Canadian hospital records.
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For physicians working in emergency departments, optimum management of patients with arrhythmias is an important skill. To assess the learning needs of Canadian emergency physicians with respect to arrhythmias, the members of the Canadian Association of Emergency Physicians (CAEP) were surveyed. The survey assessed perceived learning needs and included 11 scenarios assessing physician knowledge. ⋯ The topic areas ranked most highly by respondents in terms of perceived learning needs were management of ventricular arrhythmias (especially electrical strom), and clinical use of oral and intravenous antiarrhythmic drugs, particularly the clinical use of intravenous amiodarone. The assessment of knowledge showed that the respondents managed most arrhythmias in accordance with published guidelines, although the management of some wide complex tachyarrhythmias was not optimal. These results will be used to guide an ongoing program of continuing medical education.
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While supraventricular tachycardia is a common condition and seldom leads to serious consequences, it can be challenging to treat. Optimal management requires an accurate diagnosis, especially in the distinction between regular and irregular tachycardias; as well as an understanding of the mechanism responsible for the arrhythmia. In this article, the acute management of supraventricular tachycardias as they present in the emergency department is discussed, based on the underlying electrophysiological principles of arrhythmias.
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The risk of torsades de pointes in patients on sotalol is increased in the setting of renal failure. QT dispersion and prolonged QT intervals have been described as markers for pro-arrhythmia. Four cases of torsades de pointes caused by low dose sotalol in patients with renal failure are reported. All four cases demonstrated that the 12-lead electrocardiogram, with markedly prolonged QT intervals and increased QT dispersion, could have been used to predict pro-arrhythmia.
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To review the cardiovascular effects of psychotropic drugs when used in therapeutic doses and to assess their clinical relevance for cardiologists. Information on newer psychopharmacological agents is also presented. ⋯ The adverse cardiovascular effects of psychotropic medications in therapeutic doses are a valid concern for cardiologists. Familiarity with these drugs and their interactions is essential to avoid important undesired reactions with potential fatal consequences.