Heart : official journal of the British Cardiac Society
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To describe patients with a distinct electrocardiogram (ECG) pattern without ST-segment elevation in the presence of an acute occlusion of the proximal left anterior descending (LAD) artery. ⋯ In patients presenting with chest pain, ST-segment depression at the J-point with upsloping ST-segments and tall, symmetrical T-waves in the precordial leads of the 12-lead ECG signifies proximal LAD artery occlusion. It is important for cardiologists and emergency care physicians to recognise this distinct ECG pattern, so they can triage such patients for immediate reperfusion therapy.
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South America comprises widely different environments consisting of many complex and heterogeneous ethnicities, societies and cultures. During recent decades conspicuous advances in human and societal development have been made. South America now faces three major demographic shifts: population growth; urbanisation (almost 90% of the population live in urban areas) and ageing. ⋯ Urbanisation has brought unfavourable and prominent changes, such as increased smoking rates, stress, lack of physical activity and poor diets (more fat and calories). Consequently, owing to the interaction between environment and genetic susceptibility, the modifications induced by urbanisation have resulted in enhancement of the cardiovascular risk factors and cardiovascular disease (CVD). This situation is responsible for the burden of CVD in South America, requiring effective action towards better detection and control of cardiovascular risk factors aimed at reducing the burden of disease in the region, which tends to be higher and increasingly serious.
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Coronary artery stenting is increasingly used as a treatment for coronary artery disease. A period of antiplatelet therapy is mandatory following coronary stenting, in order to minimise the risk of stent thrombosis. About 5% of patients who undergo coronary stenting will require non-cardiac surgery within 12 months, and the management of antiplatelet therapy in this setting is complex, requiring a balance between the risks of both operative haemorrhage and stent thrombosis. The available evidence to guide decision-making in the management of antiplatelet therapy in this setting is reviewed.