European heart journal. Acute cardiovascular care
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Eur Heart J Acute Cardiovasc Care · Sep 2014
Staphylococcus lugdunensis: a rare but destructive cause of coagulase-negative staphylococcus infective endocarditis.
Staphylococcus lugdunensis is a coagulase-negative organism that causes a rare but destructive form of infective endocarditis (IE). We sought to evaluate the clinical and echocardiographic profile of S. lugdunensis IE at our institution and compare it to that of Staphylococcus aureus IE. ⋯ Unlike other coagulase-negative staphylococci, S. lugdunensis causes a rare but destructive form of IE that can involve structurally normal native valves. Echocardiographic imaging is characterized by bulky vegetations and profound valvular destruction similar to that seen with S. aureus IE, thus isolation of this organism in the blood should not be disregarded as a contaminant. Confirmation of left-sided valvular endocarditis warrants surgical intervention.
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Eur Heart J Acute Cardiovasc Care · Sep 2014
Review Case ReportsPulmonary artery pseudoaneurysm after Swan-Ganz catheterization: a case presentation and review of literature.
The Swan-Ganz catheter for pulmonary artery (PA) cannulation was introduced in 1970 and has been utilized in the management of critically ill and cardiac patients. Although the routine use of this catheter has not been associated with better patient outcomes in prospective randomized trials, their ability to provide crucial hemodynamic measurements and the ease of bedside insertion makes them valuable in certain complex clinical scenarios. However, Swan-Ganz catheter insertion is not without complications. PA injury is the most serious complication suspected by the occurrence of hemoptysis after the procedure. We present a case of PA injury with pseudoaneurysm formation after Swan-Ganz catheterization along with a comprehensive review of literature. ⋯ PA injury is a feared complication after Swan-Ganz catheterization and can be fatal. In patients who develop massive or recurrent hemoptysis after Swan-Ganz catheter use, PA injury must be considered and airway protection should be employed along with appropriate catheter based or surgical interventions.
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Eur Heart J Acute Cardiovasc Care · Sep 2014
Randomized Controlled Trial Multicenter StudyVorapaxar, a platelet thrombin-receptor antagonist, in medically managed patients with non-ST-segment elevation acute coronary syndrome: results from the TRACER trial.
This study characterized a medically managed population in a non-ST-segment elevation acute coronary syndrome (NSTEACS) cohort and evaluated prognosis and outcomes of vorapaxar vs. placebo. ⋯ NSTEACS patients who were initially medically managed had a higher risk-factor burden, and one-third had normal coronary arteries. Outcome in the medically managed cohort was significantly related to degree of CAD, highlighting the importance of coronary angiography. Efficacy and safety of vorapaxar appeared consistent with the overall trial results.
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Eur Heart J Acute Cardiovasc Care · Sep 2014
Observational StudyPre-hospital electrocardiogram triage with tele-cardiology support is associated with shorter time-to-balloon and higher rates of timely reperfusion even in rural areas: data from the Bari- Barletta/Andria/Trani public emergency medical service 118 registry on primary angioplasty in ST-elevation myocardial infarction.
We report the preliminary data from a regional registry on ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty in Apulia, Italy; the region is covered by a single public health-care service, a single public emergency medical service (EMS), and a single tele-medicine service provider. ⋯ Pre-hospital triage with tele-cardiology ECG in an EMS registry from an area with more than one and a half million inhabitants was associated with shorter time-to-balloon and higher rates of timely treated patients, even in 'rural' areas.