The Journal of invasive cardiology
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There is much debate on the pathogenesis of ischemic mitral regurgitation (MR), usually related to global or regional left ventricular dysfunction or remodeling secondary to chronic ischemic changes, altering the tethering and closing forces on the mitral apparatus. There is a paucity of literature describing MR in the setting of acute ischemia. We describe a case in which the MR was dynamic and directly related to changes in coronary collateral flow.
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Recent improvements in the care of critically ill patients with cardiogenic shock (CS) should be associated with improved outcomes. The goal of this study was to evaluate the trends of age-adjusted mortality rates for all-cause and ST-elevation myocardial infarction (STEMI)-related CS in the United States. ⋯ Regardless of gender and race, age-adjusted in-hospital mortality is gradually declining in patients presenting with all causes or STEMI-related CS. However, as compared to men, women suffer from persistently higher mortality rates in the setting of STEMI-related CS despite multivariate adjustment.
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Case Reports
LAST (local anesthetic systemic toxicity) but not least: systemic lidocaine toxicity during cardiac intervention.
Lidocaine is the most common medication used for local anesthesia in cardiac procedures. Sometimes, a higher dose of lidocaine is used to improve the patient's comfort, especially in device implantation or complex interventional procedures requiring several sheath insertions for access. ⋯ This case emphasizes the importance of dose adjustment of local anesthetic agents in individual patients, especially those with advanced heart failure who undergo cardiovascular procedures. The risk factors, preventive measures, and therapeutic approaches to manage this type of complication are discussed in detail.
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A 49-year-old man underwent emergent coronary angiography for acute inferior myocardial infarction (MI). After balloon angioplasty of culprit right coronary artery (RCA) occlusion, a Promus Element stent would not advance to the target lesion. The proximal end of the stent became compressed against the tip of the guiding catheter, such that the stent could neither be advanced nor withdrawn. This case illustrates the technical aspects of snare removal of a severely deformed stent via the radial artery.
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Use of the radial artery for cardiac catheterization and percutaneous coronary intervention (PCI) continues to expand. Cannulating the radial artery can be one of the most challenging aspects of the radial approach. Ultrasound-guided vascular access may be a method to improve first-attempt success rates and shorten time to radial artery access. ⋯ UGRAA improved first-attempt success rates and shortened the time needed for radial artery cannulation when compared to historical data of palpation-directed radial artery access. A large randomized trial of palpation versus UGRAA will be required to confirm this finding. Furthermore, this technique is easy to learn and incorporate into everyday practice in the cardiac catheterization lab.