Cardiol J
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The purpose was to assess age-related differences in hospital management and mortality in non-ST-elevation acute coronary syndrome (NSTE ACS) patients treated conservatively, with a focus on the influence of aggressive pharmacological treatment on in-hospital clinical outcome. ⋯ Advanced age is associated with less aggressive pharmacological treatment and higher in-hospital mortality in NSTE ACS patients remaining in community hospitals for conservative treatment. Broader implementation of current guidelines and more frequent invasive treatment might improve the outcomes of NSTE ACS patients regardless of age.
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At present there is consent that patients with acute pulmonary embolism (APE) and hemodynamic instability have poor prognosis and benefit from thrombolytic therapy or embolectomy, whereas hemodynamically stable patients without echocardiographic signs of right ventricular overload/dysfunction (RVO) have good prognosis and should be treated with anticoagulation alone. The optimal treatment for stable APE patients with RVO remains a challenge, and cardiac biomarkers can probably add to risk stratification and therapeutic decision making. Troponins are indicators of irreversible cardiac cell injury, and in patients with APE even a moderate rise of the blood troponin level correlates with RVO, hemodynamic instability and cardiogenic shock. ⋯ There are some proposals of algorithms that combine both biomarkers and echocardiography for risk stratification. The principal aim of ongoing studies is to find patients with hemodynamically stable APE who can be candidates for thrombolytic therapy. The usefulness of biomarkers in long-term prognosis and their value to identify APE patients in whom chronic thromboembolic pulmonary hypertension can develop should also be confirmed.
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The aim of the study was to determine the prevalence of in-hospital cardiac arrest and survival during 10 years of observation. ⋯ Cardiac arrest within the internal ward was characterized by high in-hospital mortality risk and unsuccessful late prognosis. Non-cardiac cause of cardiac arrest, relatively common in cases of in-hospital cardiac arrest, is connected with better survival after the first 24 hours; however, it does not improve the general survival to hospital discharge.
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Cardiac resynchronization therapy (CRT) has been accepted as an established therapy for advanced systolic heart failure. Electrical and mechanical dyssynchrony are usually evaluated to increase the percentage of CRT responders. We postulated that QRS notch can increase mechanical LV dyssynchrony independently of other known predictors such as left ventricular ejection fraction and QRS duration. ⋯ QRS notch was not an independent predictor of higher mechanical dyssynchrony indices in patients with wide QRS complex and symptomatic systolic heart failure; however, there was a borderline association between QRS notch and interventricular delay.
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Comparative Study
Surgical treatment of aortic coarctation in adults: Beneficial effect on arterial hypertension.
The aim of this study was to determine the outcome after surgical repair of aortic coarctation in adults, analysing its effect on arterial blood pressure. ⋯ The surgical repair of aortic coarctation in adults can be performed with low surgical risk. Surgery reduces hypertension and permits more effective medical treatment.