European heart journal. Acute cardiovascular care
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Eur Heart J Acute Cardiovasc Care · Sep 2013
Multicenter StudyManagement of acute heart failure and the effect of systolic blood pressure on the use of intravenous therapies.
To examine the use of the treatments for acute heart failure (AHF) recommended by ESC guidelines in different clinical presentations and blood pressure groups. ⋯ The management of AHF differs between ESC clinical classes and the use of i.v. vasoactive therapies is related to the initial SBP. However, there seems to be room for improvement in administration of vasodilators and NIV.
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Eur Heart J Acute Cardiovasc Care · Sep 2013
Type and timing of heralding in ST-elevation and non-ST-elevation myocardial infarction: an analysis of prospectively collected electronic healthcare records linked to the national registry of acute coronary syndromes.
It is widely thought that ST-elevation myocardial infarction (STEMI) is more likely to occur without warning (i.e. an unanticipated event in a previously healthy person) than non-ST-elevation myocardial infarction (NSTEMI), but no large study has evaluated this using prospectively collected data. The aim of this study was to compare the evolution of atherosclerotic disease and cardiovascular risk between people going on to experience STEMI and NSTEMI. ⋯ Acute myocardial infarction occurring without prior diagnosed coronary, cerebrovascular, or peripheral arterial disease was common, especially for STEMI. However, there was a high prevalence of risk factors or symptoms in patients without previously diagnosed disease. Better understanding of the antecedents in the year before myocardial infarction is required.
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Eur Heart J Acute Cardiovasc Care · Sep 2013
The role of myeloperoxidase (MPO) for prognostic evaluation in sensitive cardiac troponin I negative chest pain patients in the emergency department.
The diagnostic work-up of patients with acute chest pain in the emergency department (ED) is a challenging task. Serial troponin testing is required to rule-out acute myocardial infarction. ⋯ MPO has an independent prognostic value overall and most notably in patients tested negative with a higher sensitive cardiac troponin I assay. MPO could be a promising biomarker for the initial evaluation of patients in chest pain units and is worth further investigation.
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Eur Heart J Acute Cardiovasc Care · Sep 2013
Observational StudyFGF-23 is associated with increased disease severity and early mortality in cardiogenic shock.
Despite the increased use of percutaneous interventions, infarction-related cardiogenic shock (CS) is still associated with high mortality. Biomarkers might be helpful to identify patients at risk, and point towards novel therapeutic strategies in CS. The phosphaturic hormone fibroblast growth factor 23 (FGF-23) has recently been introduced as a predictor for mortality in patients with chronic systolic heart failure. However, its predictive role in CS has not been investigated so far. ⋯ In CS, a tremendous increase in FGF-23 occurs, and high levels of FGF-23 are associated with poor outcome.
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Eur Heart J Acute Cardiovasc Care · Jun 2013
ReviewVenous-arterial extracorporeal membrane oxygenation for refractory cardiac arrest: a clinical challenge.
Guidelines stated that extracorporeal membrane oxygenation (ECMO) may improve outcomes after refractory cardiac arrest (CA) in cases of cardiogenic shock and witnessed arrest, where there is an underlying circulatory disease amenable to immediate corrective intervention. Due to the lack of randomized trials, available data are supported by small series and observational studies, being therefore characterized by heterogeneity and controversial results. In clinical practice, using ECMO involves quite a challenging medical decision in a setting where the patient is extremely vulnerable and completely dependent on the medical team's judgment. ⋯ In the real world, patient selection occurs individually within each center based on their previous experience and expertise with a specific patient population and disease spectrum. Available evidence strongly suggests that in CA patients, ECMO is a highly costly intervention and optimal utilization requires a dedicated local health-care organization and expertise in the field (both for the technical implementation of the device and for the intensive care management of these patients). A careful selection of patients guarantees optimal utilization of resources and a better outcome.