Minerva medica
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Observational Study
Takotsubo cardiomyopathy: real life management in the intensive coronary care unit.
Takotsubo cardiomyopathy is a cardiac syndrome characterized by reversible left ventricular dysfunction, ischemic changes on electrocardiogram, elevation of cardiac biomarkers, absence of obstructive coronary artery disease in the setting of various stressing conditions. To date, little is known on best clinical management of this syndrome in coronary care units. Whe thus aimed to present our experience in a real life takotsubo population. ⋯ Takotsubo syndrome is an important safety issue occurring predominantly in post-menopausal women undergoing specific stressing condition. Heart failure and cardiogenic shock are the most serious clinical complication and leading cause of death in the short period, good prognosis is seen thereafter.
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ST-elevation myocardial infarction (STEMI) is a major cause of morbidity and mortality worldwide. Emergent reperfusion of the infarct related artery is the cornerstone of STEMI treatment in order to salvage myocardium and improve cardiovascular outcome. Basically, reperfusion strategies include fibrinolysis, primary percutaneous coronary intervention (PCI) or the combination of both methods. ⋯ However, physicians are often faced with the decision to either accept PCI-related delays due to transfer or to administer fibrinolysis immediately. A well structured regional system of STEMI care helps to select the appropriate reperfusion strategy and guarantee timely restoration of coronary blood flow. This article reviews the evidence behind the respective reperfusion therapies and summarizes current guidelines for STEMI management.
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The aim of this paper was to assess short and long term prognostic value of the OESIL risk score (ORS), a risk stratification rule for syncope which consider abnormal ECG, age > 65, history of cardiovascular diseases, lack of prodromal symptoms to identify patients at higher risk of mortality (ORS≥2) to be admitted. ⋯ Our patient group was significantly older than the ORS derivation cohort (72.4±15.1 vs. 59.5±24.3 yrs) and mostly above the age considered as 1 point in the ORS, so it is rather understandable that only a more restrictive cut-off might be advantageous for identifying high risk patients. On the evidence of a progressive ageing of patients presenting at the EDs, we suggest to use a ³3 ORS threshold when deciding for admission.
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Atrial fibrillation is the most common clinically relevant heart rhythm disorder and is associated with increased morbidity and mortality. Most important risk factors for atrial fibrillation are high age, arterial hypertension, diabetes mellitus, heart failure and rheumatic heart disease. Chronic atrial fibrillation is classified as paroxysmal, persistent, long-standing persistent and permanent atrial fibrillation. ⋯ The underuse of vitamin K antagonists in clinical practise is partly due to considerable disadvantages: an increased bleeding risk, a narrow therapeutic window and multiple drug interactions prompting frequent laboratory controls to assess an individual dosage. New oral anticoagulants targeting thrombin (dabigatran) or factor Xa (rivaroxaban, apixaban and edoxaban) may replace warfarin in many patients with atrial fibrillation due to convincing data both on efficacy and safety as well as convenience. However, challenges remain with respect to lack of specific antidotes and high costs.
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The treatment of alcohol addiction in Italy has had a progressive evolution of therapeutic structures for in-and outpatients. During the last 20 years there had been a crescent presence of short residential treatment facilities (1-6 months) characterized by a high level of medical and psychotherapeutic intervention. About two years ago 12 of them jointed together in an association called CORRAL (COordinamento of Residenzialità Riabilitive Alcologiche). The aim of this study was to describe the socio-demographic medical and other characteristics of the patients coming for this type of treatment and to describe the characteristics of the residential treatment itself including referring and aftercare. ⋯ This study outlined a model of residential rehabilitation of alcohol disorders characterized by short duration and a complex, intense therapeutic intervention mainly addressed to patients with a severe clinical condition and a low level of social problems. Further research should be useful to understand better which sort of patient characteristics obtain a better clinical result and for that even economically a major effectiveness from this type of residential treatment.