Danish medical journal
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Danish medical journal · Apr 2012
Large discrepancy between prehospital visitation to mobile emergency care unit and discharge diagnosis.
In Copenhagen, Denmark, patients in need of prehospital emergency assistance dial 112 and may then receive evaluation and treatment by physicians (from the Mobile Emergency Care Unit (MECU)). ST-elevation myocardial infarction (STEMI) is a severe condition leaving only a limited time frame to deliver optimal care in the form of percutaneous transluminal coronary angioplasty. In theory, all patients with chest pain could have STEMI. The aim of this study was to study which of the patients suspected of having acute cardiac disease based on the 112 calls and met by the MECU were given a cardiac diagnosis on the scene and, furthermore, to compare these on-scene diagnoses with the primary discharge diagnoses from hospital. ⋯ not relevant.
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Repaired aortic coarctation(CoA) is associated with high long-term cardiovascular mortality and morbidity. Persisting hypertension and left ventricular dysfunction are possibly associated with residual or recurrent aortic arch obstruction (ReCoA) and abnormal activation of vasoactive hormones. Furthermore, knowledge regarding these patients' functional health status late after repair is missing. ⋯ Surgical correction of CoA only repairs the anatomical narrowing, but not the associated vasculo- and valvulopathy. Increased left ventricular mass, systolic and diastolic dysfunction, aortic valve dysfunction, aortopathy, and hypertension are common. Morbidity is only weakly associated with mild and moderate degrees of ReCoA, and not associated with changes in vasoactive hormone levels and renal function. Despite late morbidity, functional health status is overall only slightly impaired in patients after surgical correction of CoA compared with healthy subjects. Nevertheless, the subgroup with reduced exercise capacity and need for cardiovascular medications have a considerable impairment of both physical and mental aspects of functional health.
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Danish medical journal · Mar 2012
ReviewGranulocyte-colony stimulating factor therapy to induce neovascularization in ischemic heart disease.
Cell based therapy for ischemic heart disease has the potential to reduce post infarct heart failure and chronic ischemia. Treatment with granulocyte-colony stimulating factor (G-CSF) mobilizes cells from the bone marrow to the peripheral blood. Some of these cells are putative stem or progenitor cells. ⋯ It is difficult to determine viability of the cells after injection in human trials, and it is thus complicated to determine if the activity in the myocardium tracks viable cells. Cell based therapy is still in the explorative phase, but based on the intense research within this field it is our hope that the clinical relevance of the therapy can be determined in the foreseeable future. Ultimately, this will require large randomized, double-blind and placebo-controlled trials with "hard" clinical endpoints like mortality and morbidity.
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The electrocardiogram (ECG) can be used for determining the presence, location and extent of jeopardized myocardium during acute coronary occlusion. Accordingly, the ECG has become essential in the treatment of patients with acute coronary syndrome (ACS). This thesis aims at optimizing the decision support, provided by the ECG, for choosing the best treatment strategy in the individual patient with ST-segment elevation acute myocardial infarction (STEMI). ⋯ Interestingly, we found that patients with compete ST-segment resolution treated with fibrinolysis had the highest risk of reinfarction. Consequently, transfer to a PCI-facility should be considered in all patients treated with fibrinolysis as the initial reperfusion therapy. Based on the findings in the present thesis we conclude that the ECG is an important tool for decision support in every step from symptom onset to post-reperfusion therapy in STEMI patients.
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Danish medical journal · Mar 2012
ReviewAssessment of right ventricular systolic function by tissue Doppler echocardiography.
This thesis summarizes a series of studies performed in order to assess the clinical usefulness of a novel echocardiographic technology that allows non-invasive assessment of regional right ventricular myocardial velocities and deformation: tissue Doppler echocardiography. While the technology is a promising tool for improving our understanding of right ventricular hemodynamics, several aspects of the technology must be evaluated. The accuracy and reproducibility of the technology is evaluated in vitro, and normal values, impact of changes in loading of the right ventricle, response to exercise and pharmacological pulmonary vasodilatation is established in normal subjects. ⋯ Also no differences in global or regional RV function can be observed after 1-3 months of pulmonary regurgitation [IX and X]. Relief of free pulmonary regurgitation by percutaneus pulmonary valve replacement in an animal model is associated with immediate reverse remodeling of the RV. No changes in tissue Doppler based measures of RV contractility can be identified [X].