Minerva cardioangiologica
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Twiddler's Syndrome and Reel Syndrome are potentially harmful lead-related complications in patients with implantable defibrillators and pacemakers. Twiddler's Syndrome is caused by device rotations around the devices long axis. ⋯ No detailed information about the underlying mechanisms of the Reel Syndrome is available. A case of a patient with a CRT-D and Reel Syndrome is reported; the mechanisms making the Reel Syndrome possible are illustrated and discussed.
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Minerva cardioangiologica · Dec 2010
ReviewArrhythmogenic hereditary syndromes: Brugada Syndrome, long QT syndrome, short QT syndrome and CPVT.
In approximately 10-20% of all sudden deaths no structural cardiac abnormalities can be identified. Important potential causes of sudden cardiac deaths in the absence of heart disease are primary electrical diseases such as Brugada syndrome, long QT syndrome (LQTS), short QT syndrome and catecholaminergic polymorphic ventricular tachyarrhythmias. Each of these cardiac channelopathies is charaterized by unique genetic and clinical features. ⋯ The success of medical therapy remains modest for prevention of sudden cardiac death and may necessitate the insertion of an implantable cardioverter. However, side effects with inappropriate therapies in this patient group with often young and active individuals have to be encountered. More insights into the arrhythmogenesis is critical for future development of effective medical treatment strategies.
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Syncope is a common symptom and accounts for approximately 1% of all emergency visits. There are four main causes of syncope: reflex, neurally mediated syncope, orthostatic hypotension and cardiac syncope. The prognosis of patients with reflex syncopes is good, whereas patients with cardiac syncope are at increased risk for sudden cardiac death. ⋯ If the underlying cause of syncope can be diagnosed during initial evaluation, the patient should be treated accordingly. If the cause of syncope remains unclear, the patient has to be stratified with respect to the risk of a cardiovascular event and sudden cardiac death and further evaluation initiated. This review gives a comprehensive summary of definition, work-up and treatment of syncope based on the current guidelines for the evaluation of syncope.
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Patients with cardiogenic shock (CS) are currently treated with acute coronary revascularization, mechanical support (i.e., IABP), and in addition with vasopressor and inotropic support. Among medical treatment dobutamine and norepinephrine are drugs of first choice. Nowadays, intravenous levosimendan, a new calcium sensitizer and K-ATP channel opener, has emerged as an alternative option of pharmacologic inotropic support in patients with cardiogenic shock. ⋯ Similar, in patients with low cardiac output syndrome upon cardiovascular surgery, levosimendan is able to improve cardiac performance when administered prior or after cardiac surgery. In the light of cardiogenic shock, the myocardial protective effects of levosimendan might be important to reduce reperfusion injury and myocardial stunning following ischemia and reperfusion. This review summarizes the evidence from current scientific literature including our recent trials regarding the mechanism of action, efficiency and the use of levosimendan in CS patients.
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Minerva cardioangiologica · Apr 2010
ReviewDiabetes and cardiovascular outcomes: finding the silver lining.
Type 2 diabetes mellitus and cardiovascular disease create a pernicious synergism that now threatens the public health in both developed and developing countries. As such, there has been a concerted therapeutic effort to mitigate the effects of hyperglycemia on adverse cardiovascular outcomes. ⋯ In this review, we will review the evidence that links diabetes to adverse cardiovascular outcomes and will examine the mechanistic evidence whereby hyperglycemia causes cellular damage in experimental models. We will extrapolate from information gleaned from recent clinical trials and discuss a new therapeutic approach that embraces glycemic control, but with less collateral side effects and perhaps by mechanisms that are also cardio-protective.