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Emergency cardiology

Mimi M Li, Mohamad S Hamady, Colin D Bicknell, Celia V Riga
Flexible robotic catheters are an emerging technology which provide an elegant solution to the challenges of conventional endovascular intervention. Originally developed for interventional cardiology and electrophysiology procedures, remotely steerable robotic catheters such as the Magellan system enable greater precision and enhanced stability during target vessel navigation. These technical advantages facilitate improved treatment of disease in the arterial tree, as well as allowing execution of otherwise unfeasible procedures...
March 19, 2018: Journal of Cardiovascular Surgery
Takayuki Warisawa, Christopher M Cook, Yoshihiro J Akashi, Justin E Davies
It is well known that the apparent significant coronary stenosis on angiography sometimes does not cause significant ischemia, and vice versa. For this reason, decision-making based on coronary physiology is becoming more and more important. Fractional flow reserve (FFR), which has emerged as a useful tool to determine which lesions need revascularization in the catheterization laboratory, now has a class IA indication in the European Society of Cardiology guidelines. More recently, the instantaneous wave-free ratio, which is considered easier to use than FFR, has been graded as equivalent to FFR...
March 15, 2018: Revista Española de Cardiología
Masaki Izumo, Yoshihiro J Akashi
Takotsubo cardiomyopathy (TTC) is newly-described secondary cardiomyopathy characterized by transient left ventricular (LV) dysfunction, which is increasingly recognized in the field of cardiology. TTC occurs in approximately 2% of the patients with acute coronary syndrome. Its onset is rare; however, its specific features play a crucial role in diagnosing the chest pain in clinical practice. TTC has generally favorable outcome with rapid recovery of LV function; however, an increasing evidence suggests that it should be regarded as a more serious acute cardiac disorder with a variety of complications...
February 2018: Cardiovascular Diagnosis and Therapy
Kazuaki Negishi
We are now entering the very exciting era of treatment and management of diabetes mellitus (DM) with the emergence of new therapeutic agents, including sodium-glucose cotransporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitor (DPP-4i). From a cardiology and echocardiography perspective, the existence of diabetic cardiomyopathy has been proven through over four decades of discussion. DM is highly prevalent in patients with heart failure (HF). Independent associations are found after adjusting for hypertension (HTN) and coronary artery disease (CAD)...
February 2018: Cardiovascular Diagnosis and Therapy
Emmanuel Teiger, Jean-Benoit Thambo, Pascal Defaye, Jean-Sylvain Hermida, Sélim Abbey, Didier Klug, Jean-Michel Juliard, Jean-Luc Pasquie, Gilles Rioufol, Antoine Lepillier, Meyer Elbaz, Jerome Horvilleur, Philippe Brenot, Bertrand Pierre, Philippe Le Corvoisier
BACKGROUND: Percutaneous left atrial appendage (LAA) closure is an emerging option for patients with atrial fibrillation at high risk for cerebrovascular events. The multicenter FLAAC registry (French Nationwide Observational LAA Closure Registry) was established to assess LAA closure outcomes in everyday practice. METHODS AND RESULTS: Four hundred thirty-six patients referred from April 2013 to September 2015 to 33 French interventional cardiology centers for percutaneous LAA closure were included prospectively in the FLAAC registry...
March 2018: Circulation. Cardiovascular Interventions
Aleksandar N Neskovic, Henry Skinner, Susanna Price, Gabriele Via, Stefan De Hert, Ivan Stankovic, Maurizio Galderisi, Erwan Donal, Denisa Muraru, Erik Sloth, Luna Gargani, Nuno Cardim, Alexandros Stefanidis, Matteo Cameli, Gilbert Habib, Bernard Cosyns, Patrizio Lancellotti, Thor Edvardsen, Bogdan A Popescu
There is a growing trend of using ultrasound examination of the heart as a first-line diagnostic tool for initial patient evaluation in acute settings. Focus cardiac ultrasound (FoCUS) is a standardized but restricted cardiac ultrasound examination that may be undertaken by a range of medical professionals with diverse backgrounds. The intention of this core curriculum and syllabus is to define a unifying framework for educational and training processes/programmes that should result in competence in FoCUS for various medical professionals dealing with diagnostics and treatment of cardiovascular emergencies...
February 26, 2018: European Heart Journal Cardiovascular Imaging
Christopher W Baugh, Carol L Clark, Jason W Wilson, Ian G Stiell, Abraham G Kocheril, Krista K Luck, Troy D Myers, Charles V Pollack, Steven K Roumpf, Gery F Tomassoni, James M Williams, Brian B Patel, Fred Wu, Jesse M Pines
Atrial fibrillation and flutter (AF) is a common condition among emergency department (ED) patients in the United States (US). Traditionally, ED care for primary complaints related to AF focus on rate control, and patients are often admitted to an inpatient setting for further care. Inpatient care may include further telemetry monitoring and diagnostic testing, rhythm control, a search for identification of AF etiology, and stroke prophylaxis. However, many patients are eligible for safe and effective outpatient management pathways...
March 10, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Amy C Arnold, Jessica Ng, Satish R Raj
Postural tachycardia syndrome (POTS) is a heterogeneous clinical syndrome that has gained increasing interest over the past few decades due to its increasing prevalence and clinical impact on health-related quality of life. POTS is clinically characterized by sustained excessive tachycardia upon standing that occurs in the absence of significant orthostatic hypotension and other medical conditions and or medications, and with chronic symptoms of orthostatic intolerance. POTS represents one of the most common presentations of syncope and presyncope secondary to autonomic dysfunction in emergency rooms and in cardiology, neurology, and primary care clinics...
February 28, 2018: Autonomic Neuroscience: Basic & Clinical
Brent A Becker, Barbara A Stahlman, Nathaniel McLean, Erik I Kochert
OBJECTIVE: The study sought to evaluate changes in mortality and resource utilization in patients with low level troponin elevations following a reduction in the cutoff for normal troponin I (TnI) from 0.5 ng/mL to the 99th percentile (0.06 ng/mL). METHODS: This was an interrupted time series comparing emergency department (ED) patients with possible acute coronary syndrome (ACS) and TnI values 0.06-0.5 ng/mL before and after an institutional decrease in the TnI cutoff...
February 3, 2018: American Journal of Emergency Medicine
Nivethitha Ilangkovan, Christian Backer Mogensen, Hans Mickley, Annmarie Touborg Lassen, Jess Lambrechtsen, Niels Peter Ronnow Sand, Rasmus Albiniussen, Jørgen Byg, Flemming Hald, Mette Hjortdal Grønhøj, Axel Diederichsen
OBJECTIVES: To examine and compare the prevalence of coronary artery calcification (CAC) and the frequency of cardiac events in a background population and a cohort of patients with non-specific chest pain (NSCP) who present to an emergency or cardiology department and are discharged without an obvious reason for their symptom. DESIGN: A double-blinded, prospective, observational cohort study that measures both CT-determined CAC scores and cardiac events after 1 year of follow-up...
March 3, 2018: BMJ Open
Lane M Smith, Chadwick D Miller
Acute aortic dissection (AAD) sits at the intersection of rare, deadly, and expensive to diagnose conditions. It is a disease that every emergency physician (EP) considers on a daily basis, but encounters only a handful during a career. Considerable attention has been given to this disease after the American Heart Association, American College of Cardiology, and 10 cosponsoring professional societies published the 2010 thoracic aortic disease guidelines to improve the missed or delayed treatment of AAD (1)...
March 2, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Syed Rafay Ali Sabzwari, Zoltan Varga, Khurram Butt, Nimra Khan
Vasospastic angina (VSA), also known as variant or Prinzmetal's angina, is a relatively uncommon cause of retrosternal chest pain with transient ST segment elevation, mainly due to vasospasm in the coronary arteries. This is a case of 37-year-old female who presented with chest pain and syncope. Her initial workup, including echocardiogram, was negative. Subsequently, she was sent home with an event monitor. During the next two weeks, she continued to have recurrent episodes of similar chest pains and presented to her cardiology appointment with a heart rate of 45 bpm and blood pressure of 100/60 mmHg and was taken to hospital emergency department...
December 16, 2017: Curēus
Sharonne N Hayes, Esther S H Kim, Jacqueline Saw, David Adlam, Cynthia Arslanian-Engoren, Katherine E Economy, Santhi K Ganesh, Rajiv Gulati, Mark E Lindsay, Jennifer H Mieres, Sahar Naderi, Svati Shah, David E Thaler, Marysia S Tweet, Malissa J Wood
Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction...
February 22, 2018: Circulation
Wadi Mawad, Luc L Mertens
Cardiac imaging is central to today's pediatric cardiology practice not only to diagnose structural congenital defects and delineate cardiac and extracardiac anatomy but also for determining the hemodynamic impact of the structural defects and acquired pediatric diseases. Not so long ago, clinicians had to heavily rely on angiography as the main cardiac imaging modality to visualize the heart. Particularly, the development of echocardiography in the 1970s and 1980s together with the development of magnetic resonance imaging (MRI) and computed tomography (CT) resulted in a non-invasive diagnostic revolution with diagnostic catheterization becoming obsolete apart for very specific indications...
February 21, 2018: Current Treatment Options in Cardiovascular Medicine
Christos P Kotanidis, Maria-Anna Bazmpani, Anna-Bettina Haidich, Charalambos Karvounis, Charalambos Antoniades, Theodoros D Karamitsos
OBJECTIVES: The purpose of this systematic review was to explore the diagnostic accuracy of various cardiovascular magnetic resonance (CMR) index tests for the diagnosis of acute myocarditis in adult patients. BACKGROUND: Acute myocarditis remains one of the most challenging diagnoses in cardiology. CMR has emerged as the diagnostic tool of choice to detect acute myocardial injury and necrosis in patients with suspected myocarditis. METHODS: We considered all diagnostic cohort and case-control studies...
February 9, 2018: JACC. Cardiovascular Imaging
Anjan Tibrewala, Arif Jivan, William J Oetgen, Neil J Stone
Lipid treatment guidelines have continued to evolve as new evidence emerges. We sought to review similarities and differences of 5 lipid treatment guidelines from the American College of Cardiology/American Heart Association, Canadian Cardiovascular Society, European Society for Cardiology/European Atherosclerosis Society, U.S. Preventive Services Task Force, and U.S. Veterans Affairs/Department of Defense. All guidelines utilize rigorous evidentiary review, highlight statin therapy for primary and secondary prevention of atherosclerotic cardiovascular disease, and emphasize a clinician-patient risk discussion...
February 20, 2018: Journal of the American College of Cardiology
Adelina-Mihaela Sorescu, Tudor Enache, Suzana Guberna
Background and aims: Few studies discuss the prevalence of oral anticoagulation therapy (OAT) in clinical practice, despite their increasing use worldwide. In America, studies established that 20% to 80% of the patients with indication benefit from OAT. In Romania, there is no data regarding the utilization of oral anticoagulants. Thus, this study aims to determine the trends of OAT. Methods: We designed a cross-sectional study of the patients admitted to the Cardiology Department of the "Bagdasar-Arseni" Clinical Emergency Hospital, Bucharest, from the 1st of November 2016 until the 31st of January 2017...
2018: Clujul Medical (1957)
Mohammad Amin Kashef, Jane Garb, Aaron Kugelmass, Amir Lotfi
BACKGROUND: Most of the patients presenting to emergency department with chest pain are at low risk of adverse events. Identifying high-risk patients can be challenging and resource intensive. METHODS: We created a protocol to assist early discharge of low-risk adults with chest pain from emergency department. Also a chest pain clinic (CPC) was started for cardiology follow-up within 72 hours. In a retrospective cohort study, primary outcome of major adverse cardiac events (MACEs) of death, myocardial infarction, or revascularization was compared between CPC patients and those hospitalized for observation...
March 2018: Critical Pathways in Cardiology
Naureen Farook, L Cochon, A D Bode, B P Langer, A A Baez
BACKGROUND: Accurate identification of patients at risk of major adverse cardiac events (MACE) places a substantial burden on emergency physicians (EPs). Bayesian nomogram for risk stratification in low- to intermediate-risk cardiovascular patients has not been investigated previously. OBJECTIVE: The objective of this study was to develop a comparative diagnostic model using Bayesian statistics for exercise treadmill test (ETT) and stress echocardiogram (ECHO) to calculate post-test diagnostic risk of MACE using HEART (history, electrocardiogram, age, risk factors, and troponin) risk score as predictor of pretest probability...
February 2018: Journal of Emergency Medicine
Shaili K Patel, Samir M Kacheriwala, Dipesh D Duttaroy
Objective: The objective of this study was to conduct an audit of Surgical Intensive Care Unit (SICU) for identifying the admission risk factors and evaluating the outcomes of postoperative surgical patients. Design: This was a prospective, observational study. Setting: This study was conducted at SICU of a 1500-bedded tertiary care university hospital in Western India. Subject and Methods: Two hundred and forty patients admitted to the SICU postoperatively over a period of 15 months...
January 2018: Indian Journal of Critical Care Medicine
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