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Emergency cardiology

Steven R Steinhubl, Jill Waalen, Alison M Edwards, Lauren M Ariniello, Rajesh R Mehta, Gail S Ebner, Chureen Carter, Katie Baca-Motes, Elise Felicione, Troy Sarich, Eric J Topol
Importance: Opportunistic screening for atrial fibrillation (AF) is recommended, and improved methods of early identification could allow for the initiation of appropriate therapies to prevent the adverse health outcomes associated with AF. Objective: To determine the effect of a self-applied wearable electrocardiogram (ECG) patch in detecting AF and the clinical consequences associated with such a detection strategy. Design, Setting, and Participants: A direct-to-participant randomized clinical trial and prospective matched observational cohort study were conducted among members of a large national health plan...
July 10, 2018: JAMA: the Journal of the American Medical Association
Francesco Burzotta, Giulio Russo, Eloisa Basile, Cristina Aurigemma, Antonio Maria Leone, Giampaolo Niccoli, Italo Porto, Piergiorgio Bruno, Massimo Massetti, Filippo Crea, Carlo Trani
The use of percutaneous mechanical circulatory support systems in the setting of both high-risk percutaneous coronary intervention (PCI) and cardiogenic shock is an emerging, controversial issue in contemporary clinical cardiology. The most common devices are the intra-aortic balloon pump (IABP), the Impella and the extracorporeal membrane oxygenator (ECMO). Technical progress, equipment improvement and growing cath-lab team expertise are allowing to offer critical patients different levels of assistance according to the selected device...
June 2018: Giornale Italiano di Cardiologia
Nivaldo Menezes Filgueiras Filho, Gilson Soares Feitosa Filho, Davi Jorge Fontoura Solla, Felipe Coelho Argôlo, Patrícia Oliveira Guimarães, Ivan de Mattos Paiva Filho, Larissa Gordilho Mutti Carvalho, Larissa Silva Teixeira, Marcos Nogueira de Oliveira Rios, Sergio Figueiredo Câmara, Victor Oliveira Novais, Leonardo de Souza Barbosa, Constance Silva Ballalai, Carolina Vitoria De Lúcia, Christopher B Granger, L Kristin Newby, Renato D Lopes
BACKGROUND: Few data exist on regional systems of care for the treatment of ST-segment-elevation myocardial infarction (STEMI) in developing countries. Our objective was to describe temporal trends in 30-day mortality and identify predictors of mortality among STEMI patients enrolled in a prospective registry in Brazil. METHODS AND RESULTS: From January 2011 to June 2013, 520 patients who received initial STEMI care at 23 nonspecialized public health units or hospitals, some of whom were transferred to a public cardiology referral center, were identified through a regional STEMI network supported by telemedicine and the local prehospital emergency medical service...
July 6, 2018: Journal of the American Heart Association
Zhe Li, Xin Ding
BACKGROUND: Emerging evidence demonstrate that frailty measures can predict adverse outcomes after cardiac procedures. Our objective was to examine whether the inclusion of frailty measures adds incremental predictive value on existing surgical risk prediction models in patients undergoing cardiac surgery, and evaluate the reporting and methods of studies that investigated the prediction of frailty measures in cardiology. HYPOTHESIS: The inclusion of frailty measures adds incremental predictive value on existing perioperative risk scoring systems...
July 5, 2018: Clinical Cardiology
Nathan R Riding, Jonathan A Drezner
To assess the accuracy of interpreting the athlete's ECG both pre and post a series of online training modules among a range of healthcare professionals. 10 512 healthcare professionals from 138 different nations commenced the online course. These were primarily doctors (43%), nurses (18.4%) and other healthcare professionals (3.9%). The users came from 102 different specialities, with General Practice/Family Medicine (24.5%), Cardiology (10.6%), Emergency Medicine (8.7%) and Sports Medicine (6.6%) predominating...
July 4, 2018: Heart: Official Journal of the British Cardiac Society
Marco Bobbo, Stefano Amoroso, Gianluca Tamaro, Valentina Gesuete, Biancamaria D'agata Mottolese, Egidio Barbi, Alessandro Ventura
AIM: This retrospective study reviewed the prevalence and long-term prognosis of children aged 0-18 with palpitations who were admitted to the emergency department of an Italian paediatric hospital. METHODS: We examined all admissions to the emergency department of the IRCCS Burlo Garofolo between January 2009 and December 2015 by selecting triage diagnoses of palpitations. The hospital discharge cards were reviewed to assess vital parameters, physical examinations, diagnostic tests, cardiology consultations and final diagnoses...
July 4, 2018: Acta Paediatrica
Nicola Benjamin, Alberto Maria Marra, Christina Eichstaedt, Ekkehard Grünig
Within the last years, exercise training and rehabilitation as add-on to medical treatment has become an emerging field in pulmonary hypertension. Owing to the beneficial effects of exercise training in pulmonary hypertension, the new European Respiratory Society/European Society of Cardiology guidelines for pulmonary hypertension recommended a supervised and closely monitored exercise and respiratory training/rehabilitation as add-on to medical therapy (class IIa, level of evidence B). In this article, different training modalities, effects of exercise training, possible pathobiological mechanisms of action, and future research questions are discussed...
July 2018: Heart Failure Clinics
Sahithi Sharma, Shubhatara Swamy, Anupam Bhambhani, Pratibha Nadig
Introduction: This study was carried out to collect and analyze the adverse drug reactions (ADRs) reported with use of anticoagulants, heparin and fondaparinux. These drugs are vital in the treatment of unstable coronary artery diseases and emergencies. Materials and Methods: A cross-sectional study with active reporting of ADRs from cardiology and medicine department was conducted. The type of reaction was assessed by Rawlins and Thomson criteria, causality by Naranjo probability scale, severity by modified Hartwig criteria, and preventability by Schumock and Thornton criteria...
April 2018: Journal of Pharmacy & Bioallied Sciences
Siavash Foroughi, Hui-Li Wong, Lucy Gately, Margaret Lee, Koen Simons, Jeanne Tie, Antony Wilks Burgess, Peter Gibbs
Substantial progress has recently been made in optimizing the management of cancer patients, resulting in major gains in survival and quality of life. Much of this progress has resulted from the serial testing of promising treatment strategies, typically using prospective randomized controlled trials to compare outcomes achieved with the new approach versus the current standard(s) of care. However, there is an ever-expanding list of important questions that are difficult to investigate, particularly with respect to determining the optimal sequencing and combination of proven active agents...
June 26, 2018: Asia-Pacific Journal of Clinical Oncology
Anna S M Dobbe, Renate Stolmeijer, Jan C Ter Maaten, Jack J M Ligtenberg
BACKGROUND: Liberal use of oxygen in an emergency situation is common. Today, most health care professionals do not adjust the amount of oxygen given when a saturation of 100% or a PaO2 which exceeds the normal range is reached- which may result in hyperoxia. There is increasing evidence for the toxic effects of hyperoxia. Therefore, it seems justified to aim for normoxia when giving oxygen. This study evaluates whether it is feasible to aim for normoxia when giving oxygen therapy to patients at the emergency department (ED)...
June 26, 2018: BMC Emergency Medicine
Muhammad Ammad Abbasi, Saqib Malik, Khurshid Ali
BACKGROUND: The long-term cardiovascular health risks associated with cigarette smoking are well established. It is a major risk factor for all manifestations of coronary artery disease, stroke, and peripheral vascular disease. Patients with acute coronary syndrome, who quit smoking, reduce their risk of cardiovascular events immediately and significantly when compared to those who continue smoking. The study was conducted to determine the frequency of smoking cessation after counselling in patients presenting with acute coronary syndrome (ACS)...
April 2018: Journal of Ayub Medical College, Abbottabad: JAMC
Efi Aggelopoulou, Stavros Tzortzis, Fotini Tsiourantani, Ioannis Agrios, Kyriakos Lazaridis
OBJECTIVE: The aim of this report is to describe a case of atrial fibrillation and shock precipitated by deliberate self-poisoning with theophylline. CLINICAL PRESENTATION AND INTERVENTION: An 85-year-old male with severe theophylline intoxication in a suicide attempt was admitted with severe cardiac arrhythmia and shock; despite poor prognosis, he fully recovered gradually after proper diagnosis and treatment. Theophylline is a rather forgotten medication; thus, intoxication is not usually considered among the etiologies of potentially treatable cardiologic emergencies, especially when its use is intentionally concealed...
June 22, 2018: Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre
Dhaval Kolte, Sahil Khera, Sreekanth Vemulapalli, Dadi Dai, Stephan Heo, Andrew M Goldsweig, Herbert D Aronow, Sammy Elmariah, Ignacio Inglessis, Igor F Palacios, Vinod H Thourani, Barry L Sharaf, Paul C Gordon, J Dawn Abbott
OBJECTIVES: The authors sought to examine outcomes and identify independent predictors of mortality among patients undergoing urgent/emergent transcatheter aortic valve replacement (TAVR). BACKGROUND: Data on urgent/emergent TAVR as a rescue therapy for decompensated severe aortic stenosis (AS) are limited. METHODS: The Society of Thoracic Surgeons and the American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry linked with Centers for Medicare & Medicaid Services claims was used to identify patients who underwent urgent/emergent versus elective TAVR between November 2011 and June 2016...
June 25, 2018: JACC. Cardiovascular Interventions
William Brady, Katya de Souza
Chest pain is one of the most common, potentially serious presenting complaints for adult emergency department (ED) visits. The challenge of acute coronary syndrome (ACS) identification with appropriate disposition is quite significant. Many of these patients are low risk and can be managed non-urgently in the outpatient environment; other patients, however, are intermediate to high risk for ACS and should be managed more aggressively, likely with inpatient admission and cardiology consultation. The HEART score, a recently derived clinical decision rule aimed at the identification of risk in the undifferentiated chest pain patient, is potentially quite useful as an adjunct to physician medical decision-making...
June 2018: Turkish Journal of Emergency Medicine
Carsten W Israel
Transient loss of consciousness represents one of the most frequent reasons for patients to present in the emergency room. Already at the very beginning, the diagnostic work-up is faced with fundamental questions: (1) Was it really a loss of consciousness? (2) Which department (neurology, cardiology, or others) should check the patient? (3) Is an in-hospital diagnostic work-up required? These questions can be answered from a meticulous patient history which needs to be adjusted to the individual case but also has to systematically go through a list of questions...
June 2018: Herzschrittmachertherapie & Elektrophysiologie
Stephanie K Mueller, Evan Shannon, Anuj Dalal, Jeffrey L Schnipper, Patricia Dykes
OBJECTIVES: Although existing data suggest marked variability in interhospital transfer (IHT), little is known about specific factors that may impact the quality and safety of this care transition. We aimed to explore transferred patients' and involved physicians' experience with IHT to better understand the components of the transfer continuum and identify potential targets for improvement. METHODS: We performed a qualitative study using individual interviews of adult patients recently transferred to cardiology, general medicine, and oncology services at a tertiary care academic medical center, as well as their transferring physician, accepting attending physician, and accepting/admitting resident physician...
June 12, 2018: Journal of Patient Safety
Gheorghe-Andrei Dan, Konstantinos Iliodromitis, Daniel Scherr, Francisco Marín, Radoslaw Lenarczyk, Heidi L Estner, Marcin Kostkiewicz, Nikolaos Dagres, Gregory Y H Lip
Despite the huge progress made in the both understanding the mechanisms and the management of atrial fibrillation (AF) this arrhythmia still represents an important health and social burden. Atrial fibrillation is increasing in frequency and is a major cause of death, stroke, heart failure, cognitive decline, and hospitalizations. New data have emerged emphasizing the multidisciplinary approach to better management of this common arrhythmia. Despite the availability of AF management guidelines, practice among European centres may differ from the current guideline recommendations...
June 8, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Geetanjali Rangnekar, Celine Gallagher, Geoffrey R Wong, Simon Rocheleau, Anthony G Brooks, Jeroen M L Hendriks, Melissa E Middeldorp, Adrian D Elliott, Rajiv Mahajan, Prashanthan Sanders, Dennis H Lau
INTRODUCTION: Recent registry data suggests oral anticoagulation (OAC) usage remains suboptimal in atrial fibrillation (AF) patients. The aim of our study was to determine if rates of appropriate use of OAC in individuals with AF differs between the emergency department (ED) and cardiac outpatient clinic (CO). METHODS: This was a retrospective study of consecutive AF patients over a 12-month period. Data from clinical records, discharge summaries and outpatient letters were independently reviewed by two investigators...
April 4, 2018: Heart, Lung & Circulation
Yohan Chacko, Rushi V Parikh, Jennifer A Tremmel
Women undergoing cardiac catheterization, percutaneous coronary intervention, transcatheter aortic valve replacement, and other structural heart interventions have a significantly higher risk of vascular complications and bleeding than men, leading to significant morbidity and mortality. This review highlights the importance of recognizing female sex as a specific and independent risk factor, and focuses on mechanisms of increased risk and strategies to minimize that risk. Smaller caliber peripheral vessels, low body weight, variations in platelet reactivity, and inappropriate dosing of anticoagulant and antiplatelet agents are the currently identified mechanisms for elevated bleeding and vascular complication risk in women...
June 8, 2018: Current Atherosclerosis Reports
Sophie Mavrogeni, Lambros Fotis, Loukia Koutsogeorgopoulou, Vasiliki Vartela, Vana Papaevangelou, Genovefa Kolovou
Juvenile idiopathic arthritis (JIA) is the commonest rheumatic disease in childhood and presents several subtypes according to the ILAR classification. JIA, specifically in its systemic form, may seriously damage various structures of the cardiovascular system. Other JIA phenotypes are also of interest, as cardiovascular disease (CVD) is underestimated and understudied, but chronic systemic inflammation and risk factors remained important contributors for CVD development. The currently applied non-invasive modalities, although they are important for the initial evaluation of JIA patients, frequently fail to detect the silent, subclinical forms of CVD...
June 6, 2018: Rheumatology International
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