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https://www.readbyqxmd.com/read/28614245/wellens-syndrome-in-hiv-infected-patients-two-case-reports
#1
Bowei Tan, Carlos Morales-Mangual, Dan Zhao, Abdullah Khan, Hal Chadow
BACKGROUND: Wellens syndrome is a pattern of electrocardiographic (ECG) changes in the context of unstable angina characterized with deep inverted T-waves or biphasic T-waves in the precordial leads. These specific ECG changes are highly suggestive of stenosis in the left anterior descending artery (LAD), which can result in acute myocardial infarction, left ventricular dysfunction, or death. Human immunodeficiency virus (HIV) infection is known as an independent risk factor for the cardiovascular disease...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28607783/intramural-hematoma-of-the-esophagus-complicating-severe-preeclampsia
#2
Simone Garzon, Giovanni Zanconato, Nicoletta Zatti, Giuseppe Chiarioni, Massimo Franchi
Intramural hematoma of the esophagus is a rare injury causing esophageal mucosal dissection. Forceful vomiting and coagulopathy are common underlying causes in the elderly population taking antiplatelets or anticoagulation agents. Acute retrosternal pain followed by hematemesis and dysphagia differentiates the hematoma from other cardiac or thoracic emergencies, including acute myocardial infarction or aortic dissection. Direct inspection by endoscopy is useful, but chest computed tomography best assesses the degree of obliteration of the lumen and excludes other differential diagnoses...
2017: Case Reports in Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28598043/clinical-profile-of-hypertensive-emergencies-in-an-intensive-care-unit
#3
Shubhangi V Dhadke, Vithal N Dhadke, Dhruv S Batra
AIMS AND OBJECTIVE: To study the prevalence of hypertensive emergencies in an ICU set up and to study the clinical presentation of hypertensive emergencies related to cardiovascular, neurological and renovascular system. METHODS: Type of Study: Cross-sectional, descriptive study. DURATION OF STUDY: Two years from 1st December 2011 till 30th November 2013. SAMPLE SIZE: 50 patients of hypertensive emergencies admitted to the intensive care unit of Dr...
May 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/28580737/pragmatic-approach-to-chest-pain-patients-discharged-with-undetectable-high-sensitivity-troponin-t-and-normal-electrocardiogram-the-stabs-ct-protocol
#4
Warrick Bishop, Gary Girao
A strategy that discharges chest pain patients with negative high-sensitivity troponin and non-ischaemic electrocardiography changes may still result in 0.44% of patients experiencing myocardial infarction within 30 days. We observed that a pragmatic approach that systematically discharged 25 patients on cardio-protective medications of aspirin, metoprolol and atorvastatin followed with prompt (<10 days) coronary computed tomography angiography resulted in no major adverse cardiac event and adverse drug reaction 30 days post-presentation...
June 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28575302/impact-of-computed-tomography-myocardial-perfusion-following-computed-tomography-coronary-angiography-on-downstream-referral-for-invasive-coronary-angiography-revascularization-and-outcome-at-12-months
#5
Alexander R van Rosendael, Aukelien C Dimitriu-Leen, Michiel A de Graaf, Erik W van Zwet, J Wouter Jukema, Jeroen J Bax, Lucia J Kroft, Arthur J Scholte
Aims: The aim of this study was to assess the impact of adding stress computed tomography (CT) myocardial perfusion (CTP) to coronary CT angiography (CTA) on downstream referral for invasive coronary angiography (ICA), revascularization, and outcome in patients presenting with new-onset chest pain. Methods and results: Three hundred and eighty-four patients were referred for cardiac CT. Patients with lesions ≥50% stenosis underwent subsequently stress CTP. Perfusion scans were considered abnormal if a defect was observed in ≥ 1 segment...
May 29, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28560027/successful-surgical-employment-of-impella-recovery-system-for-right-ventricular-failure-after-previous-aortic-valve-replacement
#6
Klodian Krakulli, Edvin Prifti, Vinicio Fiorani, Mario Zogno
A 58-year-old woman underwent aortic valve replacement. On the second postoperative day the patient referred a sharply chest pain, and an emergent coronary angiography revealed total occlusion of the right coronary artery. An intra-aortic ballon pump was placed and the patient underwent emergent off-pump coronary revascularization of the right coronary artery. Five hours later, due to unstable hemodynamic the extracorporeal membrane oxygenation was implanted without improvement of the right ventricular (RV) function...
May 2017: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/28549363/-thoracic-inestability-fixed-with-bioabsorbable-screws-and-plates
#7
A L Nolasco-de la Rosa, R Mosiñoz-Montes, J Matehuala-García, A A Cuautle-Ramírez, E Román-Guzmán, A L Reyes-Miranda, F Quero-Sandoval
BACKGROUND: Flail chest is managed with mechanical ventilation or inhaloteraphy and analgesia. Little has been published on the use of bioabsorbable material and its evolution in flail chest fixation. METHODS: This is a descriptive study of patients with unstable chest undergoing fixation with bioabsorbable plates and screws in a period from February 2009 to December 2011. RESULTS: We report 18 cases, aged 33-74 years (mean 53), three with bilateral involvement; rib fixation was performed between 1-21 days of the accident (mean 1...
November 2016: Acta Ortopédica Mexicana
https://www.readbyqxmd.com/read/28528430/risk-classification-of-highly-sensitive-troponin-i-predict-presence-of-vulnerable-plaque-assessed-by-dual-source-coronary-computed-tomography-angiography
#8
Ting Liu, Guan Wang, Peiling Li, Xu Dai
Patients presenting to the emergency department with acute chest pain, negative conventional troponin and electrocardiogram require serial testing to rule out acute coronary syndrome (ACS). We studied the association of highly sensitive troponin (hsTn) I with vulnerable plaque features as detected by coronary dual source computed tomography angiography (DSCTA) and determined whether hsTn I at the time of presentation combined with early DSCTA could improve classification of patients as high-risk or low risk for ACS...
May 20, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28523160/do-low-profile-implants-provide-reliable-stability-in-fixing-the-sternal-fractures-as-a-fourth-vertebral-column-in-sternovertebral-injuries
#9
Sebastian Krinner, Sina Grupp, Pascal Oppel, Andreas Langenbach, Friedrich F Hennig, Stefan Schulz-Drost
BACKGROUND: Flexion and compression forces to the trunk can cause severe instability of the vertebral column and the anterior chest wall, mostly associated with an unstable fracture of the sternum. In combination, the worst case would be a complete disruption of the trunk. Some authors consider the sternum-rib-complex to be the fourth vertebral column. This study discusses the possibilities to treat instable trunk injuries with sternal fractures concomitant to vertebral spine fractures through anterior sternal plating employing a locked plate osteosynthesis in a low profile design instead of the use of bulky implants...
April 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28507573/admission-d-dimer-testing-for-differentiating-acute-aortic-dissection-from-other-causes-of-acute-chest-pain
#10
Wenlong Li, Bi Huang, Li Tian, Yanmin Yang, Weili Zhang, Xiaojian Wang, Jingzhou Chen, Kai Sun, Rutai Hui, Xiaohan Fan
INTRODUCTION: The present study aims to evaluate the utility of D-dimer testing for differentiating the causes of acute chest pain, including acute aortic dissection (AAD), pulmonary embolism (PE), acute myocardial infarction (AMI), unstable angina (UA), and other uncertain diagnoses of chest pain. MATERIAL AND METHODS: Consecutive patients admitted for acute chest pain within 24 h from symptom onset were enrolled prospectively, and plasma D-dimer levels were measured on admission...
April 1, 2017: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/28506276/redo-coronary-bypass-grafting-for-congenital-left-main-coronary-atresia-a-case-report
#11
Shin Yajima, Koichi Toda, Hiroyuki Nishi, Daisuke Yoshioka, Teruya Nakamura, Shigeru Miyagawa, Yasushi Yoshikawa, Satsuki Fukushima, Yoshiki Sawa
BACKGROUND: Congenital left main coronary atresia is an extremely rare coronary anomaly. Long-term surgical outcomes and the optimal management strategies for recurrence of ischemia remain uncertain. Herein, we present a case involving successful redo coronary artery bypass grafting for unstable angina 27 years after the initial coronary artery bypass grafting for congenital left main coronary atresia. CASE PRESENTATION: A 33-year-old woman was referred to our department with unstable angina...
May 15, 2017: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28500753/a-0h-1h-protocol-for-safe-early-discharge-of-chest-pain-patients
#12
Arash Mokhtari, Bertil Lindahl, Alexandru Schiopu, Troels Yndigegn, Ardavan Khoshnood, Patrik Gilje, Ulf Ekelund
OBJECTIVES: Guidelines recommend a 0h/1h high-sensitivity cardiac troponin T (hs-cTnT) diagnostic strategy in acute chest pain patients. There is however little data on the performance of this strategy when combined with clinical risk stratification. We aimed to evaluate the diagnostic accuracy of an accelerated diagnostic protocol (ADP) using the 0h/1h hs-cTnT strategy together with an adapted Thrombolysis In Myocardial Infarction (TIMI) score and ECG for ruling out major adverse cardiac events (MACE) within 30 days...
May 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28427001/emergency-room-thoracotomy-for-acute-traumatic-cardiac-tamponade-caused-by-a-blunt-cardiac-injury-a-case-report
#13
Kenichiro Ishida, Yoshihiro Kinoshita, Nobutaka Iwasa, Masaro Nakae, Masayuki Sakaki, Yohei Ieki, Kyosuke Takahashi, Yumiko Shimahara, Taku Sogabe, Keiichiro Shimono, Mitsuhiro Noborio, Daikai Sadamitsu
INTRODUCTION: Traumatic blunt cardiac injuries have a high mortality rate, and prompt diagnosis and treatment can be lifesaving in cardiac tamponade. PRESENTATION OF CASE: A 62-year-old man was transferred to the emergency department after a motor vehicle accident. He was hemodynamically unstable. A focused assessment with sonography in trauma (FAST) showed pericardial fluid with right ventricular collapse consistent with cardiac tamponade in the subxiphoid view...
2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28414682/a-left-main-coronary-artery-thrombus-presenting-as-a-non-st-elevation-mi
#14
U Ezema, D Daberkow, T Delord, L Guidry, N R Sells
INTRODUCTION: Left main coronary artery (LMCA); thrombus with an acute myocardial infarction identified with coronary angiography is a clinically rare condition with an extremely high mortality rate. We present a case of LMCA thrombus that presented as a non-ST elevation myocardial infarction (NSTEMI);. CASE: A 45-year-old woman with a history of tobacco use and hyperlipidemia presented with a complaint of 10/10 "hard pain" across her chest radiating to her left shoulder and breast which woke her from sleep...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28412436/noninvasive-ffr-derived-from-coronary-ct-angiography-management-and-outcomes-in-the-promise-trial
#15
Michael T Lu, Maros Ferencik, Rhonda S Roberts, Kerry L Lee, Alexander Ivanov, Elizabeth Adami, Daniel B Mark, Farouc A Jaffer, Jonathon A Leipsic, Pamela S Douglas, Udo Hoffmann
OBJECTIVES: The purpose of this study was to determine whether noninvasive fractional flow reserve derived from computed tomography (FFRCT) predicts coronary revascularization and outcomes and whether its addition improves efficiency of referral to invasive coronary angiography (ICA) after coronary computed tomography angiography (CTA). BACKGROUND: FFRCT may improve the efficiency of an anatomic CTA strategy for stable chest pain. METHODS: This observational cohort study included patients with stable chest pain in the PROMISE trial (PROspective Multicenter Imaging Study for Evaluation of Chest Pain) referred to ICA within 90 days after CTA...
April 7, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28400937/graft-compression-by-drain-tube
#16
Monish S Raut, Arvind Verma, Mayank Agarwal, Arun Maheshwari
Hemodynamic compromise immediately after chest closure can be potentially fatal event. Such condition warrants urgent reopening of sternum. In the present case, we discover An uncommon cause of unstable hemodynamics.
October 2016: Heart Views: the Official Journal of the Gulf Heart Association
https://www.readbyqxmd.com/read/28396618/apixaban-for-the-treatment-of-saphenous-vein-graft-thrombosis-presenting-as-unstable-angina-a-case-report
#17
Makoto Saigan, Tsuyoshi Isawa, Tatsushi Ootomo
BACKGROUND: Saphenous vein graft thrombosis can present as unstable angina. However, percutaneous coronary intervention for saphenous vein graft lesions poses a high risk of slow flow related to the procedure. Here we present the utilization of the novel oral anticoagulant, apixaban, in the treatment of unstable angina with extensive saphenous vein graft thrombus, leading to considerable thrombus resolution and eliminating the need of percutaneous coronary intervention. CASE PRESENTATION: A 72-year-old man with 3-vessel coronary artery bypass graft surgery using a saphenous vein graft and a left internal mammary artery, performed 25 years earlier, presented at our hospital with recurrent chest tightness...
2017: Thrombosis Journal
https://www.readbyqxmd.com/read/28389572/prognostic-value-of-noninvasive-cardiovascular-testing-in-patients-with-stable-chest-pain-insights-from-the-promise-trial-prospective-multicenter-imaging-study-for-evaluation-of-chest-pain
#18
Udo Hoffmann, Maros Ferencik, James E Udelson, Michael H Picard, Quynh A Truong, Manesh R Patel, Megan Huang, Michael Pencina, Daniel B Mark, John F Heitner, Christopher B Fordyce, Patricia A Pellikka, Jean-Claude Tardif, Matthew Budoff, George Nahhas, Benjamin Chow, Andrzej S Kosinski, Kerry L Lee, Pamela S Douglas
BACKGROUND: Optimal management of patients with stable chest pain relies on the prognostic information provided by noninvasive cardiovascular testing, but there are limited data from randomized trials comparing anatomic with functional testing. METHODS: In the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain), patients with stable chest pain and intermediate pretest probability for obstructive coronary artery disease (CAD) were randomly assigned to functional testing (exercise electrocardiography, nuclear stress, or stress echocardiography) or coronary computed tomography angiography (CTA)...
June 13, 2017: Circulation
https://www.readbyqxmd.com/read/28377021/triggers-and-timing-of-acute-coronary-syndromes
#19
Geoffrey H Tofler, Eran Kopel, Robert Klempfner, Michael Eldar, Thomas Buckley, Ilan Goldenberg
Previous studies have shown that an acute coronary syndrome (ACS) may be triggered by external activities; however, their frequency, predictors, and significance are uncertain. We evaluated data from the National Israel Survey of Acute Coronary Syndromes, which was conducted in 2004 (February to March) in all 25 coronary care units and cardiac wards in Israel. Demographic and clinical data were recorded for consecutive participants, including potential triggers and time of symptom onset of ACS. Among the 1,849 patients who completed the trigger question, 1/4 (25...
May 15, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28337699/lung-ultrasound-is-comparable-with-chest-roentgenogram-for-diagnosis-of-community-acquired-pneumonia-in-hospitalised-children
#20
Krishna Kumar Yadav, Shally Awasthi, Anit Parihar
OBJECTIVE: To evaluate the accuracy of lung ultrasound (LUS) in comparison to chest roentgenogram (CXR) in hospitalised children with community-acquired pneumonia (CAP). METHODS: This study was a hospital based prospective observational study, conducted between January 2014 and December 2014. Hospitalised children aged 2 to 59 mo with community-acquired pneumonia were included in the study. The informed written consent was taken from parents (or legal guardian) before recruitment...
March 24, 2017: Indian Journal of Pediatrics
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