Heart, lung & circulation
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Heart, lung & circulation · May 2015
Review Comparative StudyNarrative review comparing the benefits of and participation in cardiac rehabilitation in high-, middle- and low-income countries.
Cardiovascular disease is a leading cause of morbidity worldwide. Cardiac rehabilitation (CR) is a comprehensive secondary prevention approach, with established benefits in reducing morbidity in high-income countries (HICs). The objectives of this review were to summarise what is known about the benefits of CR, including consideration of cost-effectiveness, in addition to rates of CR participation and adherence in high-, as well as low- and middle-income countries (LMICs). ⋯ CR is a beneficial intervention for heart patients in high and LMICs, but is underutilised with low participation and adherence rates worldwide. While more research is needed in LMICs, strategies shown to increase participation and program adherence should be implemented.
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Heart, lung & circulation · Apr 2015
Case ReportsImproved quality of life two-years post Transcatheter Aortic Valve Replacement for a regurgitant aortic homograft.
The limited durability of prosthetic cardiac valves together with an aging population will present ongoing management challenges. This paper describes the case of an 82 year-old male with symptomatic severe regurgitation in an aortic homograft which remains successfully treated with Transcatheter Aortic Valve Replacement (TAVR) at two-year follow-up.
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Heart, lung & circulation · Apr 2015
Case ReportsKounis syndrome: a stinging case of ST-elevation myocardial infarction.
Kounis syndrome is not a rare but an infrequently diagnosed non-thrombogenic cause of angina or myocardial infarction triggered by the release of inflammatory mediators following an allergic or anaphylactic reaction. This so-called "allergic angina" is seen in the setting of anaphylactic reactions and is believed to be due to mast cell release causing coronary vasospasm. The treatment of such cases is often with epinephrine, which has also been described in the literature as another rare cause of coronary vasospasm. ⋯ Interestingly this syndrome was not provoked when re-challenged with this therapy, suggestive of an allergic reaction rather than epinephrine as the aetiology of his presumed vasospasm. This patient's ST segment elevation and troponin elevation was due to Kounis syndrome. Awareness that anaphylactic reactions can lead to Kounis syndrome can lead to prompt appropriate treatment for this life threatening condition.
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Heart, lung & circulation · Mar 2015
Comparative StudyShorter ischaemic time and improved survival with pre-hospital STEMI diagnosis and direct transfer for primary PCI.
We sought to determine if our regional program for pre-hospital STEMI diagnosis and direct transfer for primary PCI (PPCI) was associated with shorter ischaemic times and improved survival compared with ED diagnosis. ⋯ Pre-hospital diagnosis of STEMI and direct transfer to the cath lab reduced total ischaemic time by 57 minutes and mortality by >50% following PPCI. Further efforts are needed to increase the proportion of STEMI patients treated using this strategy.
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Heart, lung & circulation · Mar 2015
Radiation exposure during cardiac catheterisation is similar for both femoral and radial approaches.
Radial approach invasive coronary angiography has been shown to be superior to the femoral approach in terms of reducing vascular access complications and improving patient comfort. However, one major limitation has been the perception of higher patient radiation exposure, with guidelines recommending 7mSv as an appropriate average effective dose (E) for routine coronary angiography. Therefore, we sought here to assess differences in radiation exposure between the femoral and radial access routes in patients undergoing diagnostic coronary angiography with or without angioplasty (CA +/- PCI), as performed by two operators, experienced in both techniques. ⋯ In our high volume cardiac catheterisation laboratory, radiation doses for routine angiography were near UNSC targets. Patient radiation exposure was comparable between femoral and radial approaches, for both CA and CA +/- PCI. Thus, our results allay concerns that radial cardiac catheterisation might be associated with greater radiation exposure.