Acta cardiologica
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Case Reports
Very late drug-eluting stent thrombosis in the perioperative period of endoscopic choledocholithotomy.
Very late stent thrombosis is an uncommon but life-threatening complication after drug-eluting stent implantation in patients with coronary artery disease. Discontinuation of antiplatelet therapy is reported to be the most powerful predictor of stent thrombosis. This article reports on a case of very late stent thrombosis 54 months after implantation of a drug-eluting stent, in a patient who discontinued dual antiplatelet therapy only 11 days before endoscopic choledocholithotomy, and argues in favour of continuing aspirin therapy perioperatively in surgical patients with low bleeding risk, even if dual antiplatelet therapy has been followed more than 12 months after stent implantation.
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Type A aortic dissection manifesting as acute myocardial infarction (AMI) is relatively rare but could be catastrophic if the management is not appropriate. This study investigated the incidence, outcome and potential diagnostic pitfalls of patients with such manifestations, and proposes a useful diagnostic paradigm. ⋯ Type A aortic dissection manifesting as AMI is a catastrophe in disguise. Prompt checks of TTE and the D-dimer value would bring the hidden diagnosis of acute aortic dissection more to the forefront.
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Previous studies have shown that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) could reverse structural and electrical atria remodelling and decrease atrial fibrillation (AF) onset or recurrence. The aim of this retrospective study was to investigate whether ACEIs/ARBs had beneficial effects on ablation outcome of chronic persistent AF. ⋯ In this observational study, no effect of ACEIs or ARBs was seen on the AF recurrence after ablation of chronic persistent AF.ACEIs/ARBs did not help to predict a better ablation outcome. Predictors for ablation outcome are AF history and duration of chronic persistent AF.
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Case Reports
Paroxysmal bidirectional ventricular tachycardia with tachycardiomyopathy in a pregnant woman.
Palpitations in pregnancy are not an uncommon complaint. We present a case of palpitations in the third trimester related to bidirectional ventricular tachycardia with evidence, of left ventricular systolic dysfunction. The case was successfully managed with flecainide therapy and urgent elective caesarean section. ⋯ A literature review of bidirectional ventricular tachycardia is presented. This is the first reported case of bidirectional VT producing LV systolic dysfunction, which normalised following stabilisation of rhythm. The complex issues of management of this case in particular with regard to the pregnancy are discussed.
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Cardiac-related perioperative complications are well-known in general practice. The role of echocardiography in preoperative risk assessment before non-cardiac surgery remains unclear though. ⋯ We created a risk stratification model that can be used in daily practice. This model may increase our awareness of the risks associated with heart valve disease in the perioperative period.