Heart, lung & circulation
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Heart, lung & circulation · Dec 2014
ReviewEvaluation and management of heart rhythm disturbances due to cardiac sarcoidosis.
Cardiac sarcoidosis (CS) affects less than 5% of patients with pulmonary or systemic sarcoidosis, but when present is often associated with a spectrum of clinically significant conduction abnormalities and arrhythmias. The cardinal manifestations of CS include conduction disturbances, arrhythmias, or congestive heart failure. Less commonly, there is concealed subclinical disease. ⋯ Cardiac pacemakers have provided important therapy for patients with conduction defects and implantable cardioverter defibrillator (ICD) therapy provides the strongest insurance to prevent fatal arrhythmias from CS. A recent consensus statement provides guidance for clinicians on the diagnosis and management of arrhythmias associated with CS including indications for ICDs. The use of pacemakers, ICD implantation and early implementation of corticosteroid therapy have led to an improvement in the overall prognosis and clinical outcomes of CS.
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Heart, lung & circulation · Nov 2014
ReviewExtracorporeal-assisted rewarming in the management of accidental deep hypothermic cardiac arrest: a systematic review of the literature.
A systematic review of the literature surrounding the use of Extra-Corporeal Assisted Rewarming (ECAR) in patients presenting with deep hypothermia or hypothermic cardiac arrest was undertaken using a structured protocol. Thirty-one papers were deemed suitable for review, 13 of these were of sufficient quality to permit systematic data analysis. The primary outcome measure was survival to hospital discharge. ⋯ Other data revealed a survival benefit for patients presenting with deep hypothermia without cardiac arrest treated with ECAR compared to those treated with conventional rewarming techniques. Hypoxic arrest, serum potassium > 10 mmol/L and presenting rhythm of asystole were found likely be significant predictors of poor outcome. Innovative reperfusion and rewarming strategies are also reviewed.
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Heart, lung & circulation · Nov 2014
Use of pressure-volume conductance catheters in real-time cardiovascular experimentation.
Most applications of pressure-volume conductance catheter measurements assess cardiovascular function at a single point in time after genetic, pharmacologic, infectious, nutritional, or toxicologic manipulation. Use of these catheters as a continuous monitor, however, is fraught with complexities and limitations. ⋯ Pressure-volume artifacts during inotropic infusion are caused by physical contact of the catheter with endocardium. Repeated correction of catheter position may be required to use pressure volume catheters as a continuous real-time monitor during manipulations that alter ventricular dimensions, such as inotropic therapy.
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Heart, lung & circulation · Oct 2014
ReviewThe use of gastrointestinal cocktail for differentiating gastro-oesophageal reflux disease and acute coronary syndrome in the emergency setting: a systematic review.
Differentiating acute chest pain caused by myocardial ischaemia from other, potentially more benign causes of chest pain is a frequent diagnostic challenge faced by Emergency Department (ED) clinicians. Only 30% of patients presenting with chest pain will have a cardiac origin for the pain, and gastro-oesophageal disorders are one of the common sources of non-cardiac chest pain, yet remain clinically difficult to differentiate from cardiac pain. ⋯ Current diagnostic protocols for Acute Coronary Syndrome (ACS) revolve around early and serial ECG monitoring and cardiac biomarker testing, imaging and careful clinical examination. In patients with chest pain and suspected ACS, the use of a GI cocktail compared with standard diagnostic protocols (serial ECG and biomarkers and provocative testing or imaging) is not proven to improve accuracy of diagnosis, and cannot reliably exclude myocardial ischaemia.
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Heart, lung & circulation · Oct 2014
Prevalence of vitamin D deficiency prior to cardiothoracic surgery.
Vitamin D deficiency is one of the most common chronic medical conditions in the world and also prevalent in Australia. A growing body of evidence suggests that low vitamin D also has adverse effects on cardiovascular health, including coronary risk factors and adverse cardiovascular outcomes such as myocardial infarction, cardiac failure and stroke. There is some evidence suggesting that a greater proportion of people with cardiovascular disease have low vitamin D compared to the general population. We examined the prevalence of vitamin D deficiency and insufficiency in elective cardiothoracic surgical patients presenting to the Alfred Hospital in Melbourne, Australia and compared this to recent Victorian statistics for people of the same age group. ⋯ Based on our small screening study, a substantial proportion of elective cardiothoracic surgical patients have less than optimal serum vitamin D3 levels prior to surgery. We found two-thirds of patients had serum vitamin D levels below 60 nmol/L, placing them at higher risk of falls. This finding is of concern as these patients would have received multiple consultations with various medical practitioners prior to hospital admission and yet their inadequate vitamin D status remained. Failing to identify patients with low vitamin D and correcting it with supplementation places older adults at unnecessary risk, especially of falls, which are associated with a high risk of mortality. In an ageing population with CVD, vitamin D status needs to be assessed and any inadequacy corrected. Whether low vitamin D status prior to cardiac surgery affects post-surgery outcomes, is another issue which deserves future investigation.