American heart journal
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American heart journal · Jan 2004
Randomized Controlled Trial Clinical TrialRapid loading of sotalol or amiodarone for management of recent onset symptomatic atrial fibrillation: a randomized, digoxin-controlled trial.
Amiodarone and sotalol are commonly used for the maintenance of sinus rhythm, but the efficacy of these agents administered as high-dose infusions for rapid conversion of atrial fibrillation is unknown. Use in this context would facilitate drug initiation in patients in whom ongoing prophylactic therapy is indicated. ⋯ The rapid infusion of sotalol or amiodarone in patients with symptomatic recent-onset atrial fibrillation results in rapid control of ventricular rate. Even with high-dose rapid infusions, all 3 agents are associated with a poor overall reversion rate within 12 hours. Almost all patients were returned to sinus rhythm with a combination of pharmacological therapy and electrical cardioversion.
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American heart journal · Jan 2004
Microvascular alterations in patients with acute severe heart failure and cardiogenic shock.
Microvascular blood flow alterations may impair tissue oxygenation and may participate in the development of multiple organ failure in patients with severe heart failure. We hypothesized that microvascular blood flow alterations are present in patients with severe heart failure and cardiogenic shock. ⋯ Microvascular blood flow alterations are frequently observed in patients with severe heart failure and are more severe in patients who do not survive.
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American heart journal · Jan 2004
ReviewPeriprocedural thromboprophylaxis in patients receiving chronic anticoagulation therapy.
Patients receiving chronic anticoagulation therapy pose a clinical challenge when therapy needs to be interrupted for surgical or invasive procedures. Maintaining anticoagulation places them at risk for serious bleeding complications, whereas discontinuing anticoagulation puts them at risk of thromboembolic complications. Most patients can undergo dental procedures, cataract surgery, and diagnostic endoscopy without discontinuing anticoagulation. ⋯ As with the use of UFH, there are reports of maternal thromboembolic complications with LMWHs in pregnant women with mechanical heart valves. This review brings together the available data on periprocedural bridging to assess the available options for patients on long-term warfarin therapy who are undergoing surgical procedures. It provides a rationale for using LMWHs while individualizing the risks versus benefits in a given patient population.
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American heart journal · Jan 2004
Randomized Controlled Trial Multicenter Study Clinical TrialPatients with chest pain calling 9-1-1 or self-transporting to reach definitive care: which mode is quicker?
We examined differences in transport times for patients with chest pain who used private transportation compared with patients who used emergency medical services (EMS) to reach definitive medical care. ⋯ Although private transportation results in a faster trip to the ED, quicker care is obtained with the use of EMS.