Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology
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To identify factors associated with "do-not-resuscitate" (DNR) decisions in patients who suffer cardiac arrest. ⋯ This is the first study aimed at identifying factors associated with DNR decisions in a Portuguese hospital with an organized emergency system. DNR decisions were taken in 33% of cases of cardiac arrest. Advanced age, cancer, and no measures initiated before arrival of the MET were associated with the DNR decision. These findings need to be confirmed in larger studies and should be taken into account when taking DNR decisions.
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The benefits of therapeutic interventions, whether pharmacologic, surgical, psychological, or others, are usually determined through clinical trials. The design of such trials involves the definition of a control group (placebo or active agent), which will be compared to one or more experimental groups (active agents). ⋯ We will present the concepts of RRR, ARR and NNT in a deliberately simple fashion, using published studies. On the basis of this knowledge the reader will be able to analyze the literature and make decisions based on it.
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Atrial fibrillation (AF) is a relatively common arrhythmia in the context of acute coronary syndromes (ACS). However, the impact of AF on these patients' survival is not well established. The present study aimed to estimate the prevalence of AF in ACS patients and to evaluate its impact on in-hospital and six-month post-event mortality, from any cause. ⋯ AF in the context of ACS is an independent predictor of increased in-hospital and six-month mortality. These findings should be taken into consideration in the management and treatment of such patients.
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Acute pulmonary embolism (PE) is a common clinical entity in the emergency department, and remains a diagnostic challenge for physicians. The role of the 12-lead electrocardiogram (ECG) in its diagnosis and assessment of severity and prognosis is not as well defined as for acute coronary syndromes. We report four cases of massive and submassive PE with differing ECG findings admitted to an acute cardiac care unit. We review the role of different ECG abnormalities and also discuss the relevance of transthoracic echocardiographic data in the diagnosis and serial evaluation of patients with PE. Treatment options for PE with hemodynamic compromise and right ventricular dysfunction are also discussed. ⋯ ECG findings have low sensitivity and specificity in the diagnosis of PE. It should be routinely used in serial evaluations, particularly when hemodynamic compromise is present, and should be included in the range of diagnostic strategies available.