Rev Cardiovasc Med
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Natriuretic peptide (NPs) levels have achieved worldwide acceptance. They are excellent rule-in and rule-out biomarkers for patients presenting with dyspnea. ⋯ NP levels drop during hospitalization as the patient is decongested. In the future, NP levels may be used as a surrogate to titrate outpatient therapy.
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Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome, cardiogenic shock, and sudden cardiac death in women of reproductive age who have no traditional risk factors for coronary artery disease. The etiology, prognosis, and treatment of SCAD remain poorly defined. Coronary angiography is the gold standard for diagnosis. ⋯ Possible mechanisms of SCAD include rupture of atherosclerotic plaque or vasa vasorum, hemorrhage between the outer media and external lamina with intramedial hematoma expansion, and compression of the vessel lumen. We report a case of SCAD in a 39-year-old woman presenting with ST-elevation myocardial infarction midway through her menstrual cycle. Her medications included fenfluramine for obesity and hydrochlorothiazide, amlodipine, and atenolol for hypertension.
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In the past 10 years, there has been interest in a "metabolic syndrome" that might be associated with cardiovascular disease or diabetes. The first sets of criteria differed markedly, and their accuracy was equivocal. More recent definitions may be an improvement over previous ones. ⋯ It encourages healthcare providers who are confronted with a single risk factor to look for others. When multiple risk factors are found, it promotes consideration of behavioral interventions, such as weight loss and increased physical activity, instead of a pharmacological treatment for each risk factor. Such behavioral interventions were more effective than metformin in reducing the incidence of diabetes and of other components of the metabolic syndrome in one randomized, controlled study.
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The anticoagulant properties of heparin were discovered in 1916, and by the 1930s researchers were evaluating its therapeutic use in clinical trials. Treatment of unstable angina with unfractionated heparin (UFH), in addition to aspirin, was introduced into clinical practice in the early 1980s. UFH was combined with aspirin to suppress thrombin propagation and fibrin formation in patients presenting with acute coronary syndromes (ACS) or patients undergoing percutaneous coronary intervention (PCI). ⋯ DTIs have antiplatelet effects, anticoagulant action, and most do not bind to plasma proteins, thereby providing a more consistent dose-response effect than UFH. The FDA has approved 4 parenteral DTIs for various indications: lepirudin, argatroban, bivalirudin, and desirudin. The antiplatelet, anticoagulant, and pharmacokinetic properties of bivalirudin support its use as the anticoagulant of choice for both lower- and higher-risk patients, including those undergoing PCI.