Cardiology in review
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Vasopressors are a heterogeneous potent class of medications designed to increase blood pressure in emergent hypotensive situations. The goal of therapy is to increase blood pressure and maintain adequate perfusion, allowing nutrient and oxygen delivery to vital organs. Norepinephrine, phenylephrine, dopamine, epinephrine, and vasopressin are five vasopressors available in the United States. ⋯ With their different clinical features, adverse effects, and range of potency, the clinical situation usually guides therapy. Outcome data comparing different vasopressors have not demonstrated a clear mortality benefit of any one vasopressor over another, and physician preference also guides therapy. Norepinephrine, nonetheless, remains one of the preferred choices for a variety of hypotensive states, including cardiogenic and septic shock.
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Cardiology in review · Nov 2011
ReviewSubclinical hypothyroidism and cardiovascular risk: recommendations for treatment.
The definition of subclinical hypothyroidism (SCH) is solely biochemical: a serum free T4 level within the reference range in the presence of an elevated serum thyroid-stimulating hormone (TSH) level. While overt hypothyroidism is associated with an increased cardiovascular disease risk, SCH, the mildest form of hypothyroidism, may also be associated with an increased cardiovascular disease risk, but to a lesser degree. ⋯ It is generally recommended to treat with thyroid hormone those individuals with SCH and TSH values ≥10 mIU/L. Treatment of patients with SCH and TSH values <10 is controversial but may be considered in selected patients.
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Cardiology in review · Sep 2011
ReviewA systematic approach to evaluation of pericardial effusion and cardiac tamponade.
Pericardial disease leading to pericardial effusion (PEF) is a common condition encountered by the clinician in day-to-day practice. If the PEF becomes large enough, it can cause hemodynamic compromise, resulting in a cardiogenic shock state known as cardiac tamponade. ⋯ However, these signs can be either conflicting or even absent. The purpose of this review is to first, describe the physiology of the pericardium in health and how it changes with disease; second, outline the pathophysiology of pericardial tamponade and discuss how it is responsible for the physical and echocardiographic findings of cardiac tamponade; and third, suggest an approach to applying these findings in a systematic order to ensure a correct diagnosis.
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Numerous studies have shown the favorable effects of lowering the core temperature of the body in various conditions such as acute myocardial infarction, acute cerebrovascular disease, acute lung injury, and acute spinal cord injury. Therapeutic hypothermia (TH) works at different molecular and cellular levels. TH improves oxygen supply to ischemic areas and increases blood flow by decreasing vasoconstriction, as well as oxygen consumption, glucose utilization, lactate concentration, intracranial pressure, heart rate, cardiac output, and plasma insulin levels. ⋯ TH in out-of-hospital cardiac arrest is becoming a standard practice nationwide. Further studies need to be performed to develop a better understanding of the benefits and detrimental effects of TH, to identify the most efficacious TH strategy, and the candidates most likely to derive benefit from the procedure. Although many animal studies have demonstrated benefit, larger human clinical trials are recommended to investigate the beneficial effect of TH on reducing myocardial infarction size and coronary reperfusion injuries.
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Cardiology in review · May 2011
ReviewEvaluation of acute chest pain in the emergency department: "triple rule-out" computed tomography angiography.
Triage of patients with acute, potentially life-threatening chest pain is one of the most important issues currently facing physicians in the emergency department. Appropriate evaluation of these patients begins with a skilled assessment of the individual patient's presenting symptoms and a careful review of his or her history and physical examination, often followed by serial recording of electrocardiograms and measurement of serum biochemical markers such as troponin and d-dimer. Stress testing, often accompanied by rest and stress myocardial perfusion imaging or echocardiography, and other diagnostic testing such as radionuclide lung scanning and invasive angiography may be required. ⋯ The triple rule-out protocol is most appropriate for patients who present with acute chest pain, but are judged to have low to intermediate increased risk for acute coronary syndrome, and whose chest pain symptoms might also be attributed to acute pathologic conditions of the aorta or pulmonary arteries. MDCT should not be used as a routine screening procedure. Continued technical improvements in acquisition speed and spatial resolution of computed tomography images, and development of more efficient image reconstruction algorithms which reduce patient exposure to radiation and contrast, may result in increased popularity of MDCT for "triple rule-out."