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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Several disorders resemble syncope. According to the European Society of Cardiology guidelines, certain key questions should be addressed during the initial evaluation of a patient presenting syncope. The physician should be alert to important clinical features that suggest the diagnosis and the evaluation strategy. ⋯ Cardiac bradyarrhythmia was thus established as the cause of the syncope and a permanent pacemaker was implanted, with no recurrence of symptoms. This example of an unusually long-lasting cardiac arrest with spontaneous recovery illustrates the non-specific nature of clinical features and how difficult it is to diagnose syncope in an Emergency Department setting. The authors briefly review the topic according to recent guidelines.
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This article reviews relevant clinical issues regarding sedation, analgesia and neuromuscular blockade in the cardiac intensive care unit, including monitoring tools and available therapeutic options. The pathophysiologic implications of pain, agitation, anxiety and delirium in the ventilated patient are also discussed. ⋯ Knowledge of pharmacologic mechanisms is an important tool in the development of dynamic protocols adapted to each unit. Strategies that include monitoring resources are essential for the optimization of sedation, analgesia and neuromuscular blockade.
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This article reviews relevant clinical issues regarding sedation, analgesia and neuromuscular blockade in the cardiac intensive care unit, including monitoring tools and available therapeutic options. The pathophysiologic implications of pain, agitation, anxiety and delirium in the ventilated patient are also discussed. ⋯ Knowledge of pharmacologic mechanisms is an important tool in the development of dynamic protocols adapted to each unit. Strategies that include monitoring resources are essential for the optimization of sedation, analgesia and neuromuscular blockade.
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Cardiac troponin I (cTnI) is a specific marker which allows detection of minor myocardial cell damage. In patients with severe pulmonary embolism (PE), the rise in pulmonary artery pressure can lead to progressive right ventricular dysfunction (RVD), and clinical studies have demonstrated the presence of ischemia and even right ventricular infarction. Our aims were to determine the prevalence and diagnostic utility of cTnI in identifying patients with RVD and to ascertain whether it correlates with severity of PE. ⋯ Around 70% of patients with PE have elevated cTnI values and this test is significantly associated with RVD. cTnI measurements provide additional information in the evaluation of patients with PE by identifying more severe cases and those at increased risk of hemodynamic deterioration, who can benefit from more aggressive therapeutic strategies.
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This article reviews relevant clinical issues regarding sedation, analgesia and neuromuscular blockade in the cardiac intensive care unit, including monitoring tools and available therapeutic options. The pathophysiologic implications of pain, agitation, anxiety and delirium in the ventilated patient are also discussed. ⋯ Knowledge of pharmacologic mechanisms is an important tool in the development of dynamic protocols adapted to each unit. Strategies that include monitoring resources are essential for the optimization of sedation, analgesia and neuromuscular blockade.