Heart, lung & circulation
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Heart, lung & circulation · Jul 2015
Review Meta AnalysisThe Role of Colchicine in Pericarditis--A Systematic Review and Meta-analysis of Randomised Trials.
Colchicine has been used in diverse clinical settings. Primary idiopathic pericarditis is complicated by recurrence in 15 to 30% of cases. Aspirin, non-steroidal anti-inflammatory drugs, colchicine and steroids are the commonly prescribed medications. We synthesised the available evidence from the randomised trials to assess the efficacy and safety of colchicine in primary and recurrent pericarditis. ⋯ Colchicine is effective in preventing both primary and recurrent episodes of pericarditis. The number needed to treat for preventing recurrent pericarditis was five. Gastrointestinal side-effects were the most common adverse events.
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Heart, lung & circulation · Jul 2015
ReviewPeri-operative Levosimendan in Patients Undergoing Cardiac Surgery: An Overview of the Evidence.
Levosimendan, a calcium sensitiser, has recently emerged as a valuable agent in the peri-operative management of cardiac surgery patients. Levosimendan is a calcium-sensitising ionodilator. By binding to cardiac troponin C and reducing its calcium-binding co-efficient, it enhances myofilament responsiveness to calcium and thus enhances myocardial contractility without increasing oxygen demand. ⋯ In addition to being used as post-operative rescue therapy for low cardiac output syndrome, a pre-operative levosimendan infusion in high risk patients with poor cardiac function may reduce inotropic requirements, the need for mechanical support, the duration of intensive care admissions as well as post-operative mortality. Indeed, it is these higher-risk patients who may experience a greater degree of benefit. Larger, multicentre randomised trials in cardiac surgery will help to elucidate the full potential of this agent.
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Scimitar syndrome is a rare congenital condition characterised by partial or total anomalous pulmonary venous drainage of the right lung. We present an adult case of Scimitar syndrome that was managed with an intra-atrial baffle repair. ⋯ We utilised a well-recognised technique for a patient that had indications for surgical repair and this resulted in a good prognosis.
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Heart, lung & circulation · Jun 2015
ReviewShould Cerebral Near-infrared Spectroscopy be Standard of Care in Adult Cardiac Surgery?
Near-infrared spectroscopy (NIRS) is non-invasive, easy to use, and offers real-time monitoring of the oxygen content of cerebral tissue. An effective and user-friendly method of cerebral monitoring stands to offer a significant advance in patient care during adult cardiac surgery, particularly for surgery in which the continuity of cerebral vessels may be compromised. While the current evidence does not definitively show improvement in neurological outcomes, it can be argued that the overall risk to benefit ratio falls on the side of NIRS. ⋯ This review will summarise the need for neuromonitoring and the principles of NIRS. It will examine the thresholds used to define desaturation, the evidence for clinical benefit from NIRS, and the criticisms and limitations of NIRS. It will also discuss the uses of NIRS beyond improving neurological outcomes alone.
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Heart, lung & circulation · Jun 2015
Multicenter Study Comparative StudySouth African and international reference values for lung function and its relationship with blood pressure in Africans.
In South Africa respiratory diseases are highly prevalent, with cardiovascular disease being a manifestation. However, international reference values for lung function are commonly used, which may not be appropriate to correctly identify reduced lung function. An inverse relationship exists between lung function and blood pressure (BP) but is not investigated extensively in black South Africans. ⋯ South African reference values yielded higher percentages of predicted FEV1 and FVC values than European and US equations suggesting that South African prediction equations may be more useful when investigating lung function in black South Africans. Elevated BP is related to reduced lung function, highlighting the importance in managing both respiratory- and cardiovascular disease.