European heart journal. Acute cardiovascular care
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Eur Heart J Acute Cardiovasc Care · Apr 2016
Comparative Study Observational StudyEmergent transvenous cardiac pacing using ultrasound guidance: a prospective study versus the standard fluoroscopy-guided procedure.
To compare time to active pacing and complication rates associated with temporary transvenous pacemaker (TTVPM) insertion between a fully echo-guided approach of vein access and lead placement, and standard placement of TTVPM under fluoroscopic guidance. ⋯ Echo-guided insertion of TTVPM through the jugular vein is a feasible and safe alternative to fluoroscopic guidance and may reduce complications and time to active pacing in patients who are not candidates for emergent cardiac catheterization.
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Eur Heart J Acute Cardiovasc Care · Apr 2016
Low prevalence of diabetes mellitus in patients with Takotsubo syndrome: A plausible 'protective' effect with pathophysiologic connotations.
The pathophysiology of Takotsubo syndrome is still elusive; coronary vasospasm, microvascular dysfunction, or catecholamine-mediated injury to the cardiomyocytes, effected by local release from the autonomic nerves and/or blood-borne catecholamines, are considered as tentative cause(s). Diabetes mellitus-induced autonomic neuropathy leads to a brain-heart disconnection, and it can conceivably ameliorate/block the effect of an unbridled adrenergic storm to the heart, and the emergence of Takotsubo syndrome. This study sought to evaluate the prevalence of diabetes mellitus in patients with Takotsubo syndrome. ⋯ The prevalence of diabetes mellitus in patients with Takotsubo syndrome is low. This insight may be useful for the diagnosis, pathophysiology unraveling, and employment of autonomic adrenergic blocking agents in the management of patients with Takotsubo syndrome.
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Eur Heart J Acute Cardiovasc Care · Feb 2016
Randomized Controlled TrialComparison of prasugrel and clopidogrel-treated patients with acute coronary syndrome undergoing percutaneous coronary intervention: A propensity score-matched analysis of the Acute Myocardial Infarction in Switzerland (AMIS)-Plus Registry.
The purpose of this study was to investigate outcomes of patients treated with prasugrel or clopidogrel after percutaneous coronary intervention (PCI) in a nationwide acute coronary syndrome (ACS) registry. ⋯ In everyday practice in Switzerland, prasugrel is predominantly used in younger patients with STEMI undergoing primary PCI. A propensity score-matched analysis suggests a mortality benefit from prasugrel compared with clopidogrel in these patients.
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A woman with palliative breast cancer presents with dyspnoea and is noted to have an unusual electrocardiogram, with an alternating electrical axis observed. Subsequent echocardiogram demonstrates the classical findings of a large pericardial effusion causing 'electrical alternans' aptly illustrating why this rare phenomenon occurs.
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Eur Heart J Acute Cardiovasc Care · Jan 2016
Cost-effectiveness of remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction.
Remote ischaemic conditioning seems to improve long-term clinical outcomes in patients undergoing primary percutaneous coronary intervention. Remote ischaemic conditioning can be applied with cycles of alternating inflation and deflation of a blood-pressure cuff. We evaluated the cost-effectiveness of remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction from the perspective of the Danish healthcare system. ⋯ Remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention appears to be a cost-effective treatment strategy in patients with ST-elevation myocardial infarction.