Rev Cardiovasc Med
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A 67-year-old male patient received a coronary artery bypass graft. Less than 2 months afterward, he presented with recurrent exacerbations of congestive heart failure. His response to a standard treatment regimen for heart failure was partly successful, but a few days after discharge he was readmitted for worsening dyspnea and edema. ⋯ Magnetic resonance imaging showed thickened pericardium with exudates in the pericardial space. Cardiac catheterization confirmed the diagnosis, showing equalization of diastolic pressures of the left and right ventricles. The patient underwent subtotal pericardiectomy with resolution of the pericardial disease, but he died from respiratory insufficiency.
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Severe stenosis of the left main coronary artery (LMCA) is a coronary artery-disease manifestation of critical prognostic importance. As a consequence of the survival advantage conferred by coronary artery bypass grafting (CABG) over medical therapy, lesions in the LMCA have been considered a standard indication for CABG for nearly 3 decades. ⋯ Outcomes of recent studies using sirolimus- and/or paclitaxel-eluting stents for treatment of LMCA disease have yielded rates of in-hospital and 1-year mortality that compare favorably with those of surgery. This article will review the natural history of LMCA disease, the outcomes of CABG for LMCA disease, and the history and recent developments regarding PCI for LMCA disease.
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Low-dose aspirin and other antiplatelet agents are widely used for the management of cardiovascular disease. Due to their action on cyclooxygenase, aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are associated with upper gastrointestinal (GI) side effects, including ulcers and bleeding. Although the risk with low-dose aspirin alone is less than that with NSAIDs, given its widespread use, aspirin-related toxicity has become a substantial health care issue. ⋯ Gastroprotective agents that seem effective are prostaglandin analogues and proton pump inhibitors. Eradication of Helicobacter pylori also seems to reduce the risk of ulcers. Substitution by other antiplatelet agents such as clopidogrel alone does not seem to provide a safer alternative to low-dose aspirin for patients at high risk for GI side effects.
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In the emergency setting, acute chest pain and shortness of breath represent common patient presentations. Cardiac biomarkers including myoglobin, creatine kinase (CK)-MB, troponin, and b-type natriuretic peptide provide diagnostic and prognostic information for patients with chest pain and shortness of breath. This article reviews the use of cardiac biomarkers in the emergency department to evaluate acute coronary syndrome and congestive heart failure.
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Heart failure is a leading cause of hospitalization for adults in the United States. Patients hospitalized with acute decompensated heart failure (ADHF) face a substantial risk of in-hospital mortality and rehospitalization. Despite the large number of patients hospitalized and this substantial risk, data on these patients have been limited and there has been little effort to improve the quality of care for patients hospitalized with ADHF. ⋯ As such, there are substantial opportunities to improve the quality of care for ADHF patients in the nation's hospitals. The ADHERE Hospital Toolkit has been designed to provide hospital teams with effective proactive instruments to improve the quality of care for patients with ADHF. If successfully implemented, the improvements in short- and long-term clinical outcomes for ADHF patients are expected to be substantial.