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https://www.readbyqxmd.com/read/26439395/acute-coronary-syndrome-inpatient-management
#1
Brian Veauthier, Karlynn Sievers, Jaime Hornecker
The first step in inpatient management of acute coronary syndrome (ACS) is determining whether the patient has ST-segment elevation myocardial infarction (STEMI). For STEMI, the initial approach to management is cardiac catheterization with percutaneous coronary intervention (PCI) to reperfuse the blocked artery; PCI should take place within 120 minutes of first medical contact. However, if no contraindications are present, fibrinolytic therapy is preferred if PCI will take more than 120 minutes. In ACS without STEMI, cardiac catheterization with PCI is the recommended approach for patients who are unstable, and for stable patients with high risk assessment scores, diabetes or renal insufficiency, stent placement within the past 6 months, or prior bypass surgery...
October 2015: FP Essentials
https://www.readbyqxmd.com/read/26439394/acute-coronary-syndrome-emergency-department-evaluation-and-management
#2
Brian Veauthier, Karlynn Sievers, Jaime Hornecker
Patients with chest pain who present to emergency departments have a significantly higher incidence of acute coronary syndrome (ACS) than patients with chest pain presenting to outpatient settings, so emergency department clinicians should have a lower threshold for considering ACS as an etiology. Evaluating patients with suspected ACS in the emergency department involves obtaining a history, physical examination, electrocardiograms (ECGs), and cardiac troponin measurements in conjunction with risk calculators...
October 2015: FP Essentials
https://www.readbyqxmd.com/read/25789580/acute-phase-treatment-of-venous-thromboembolism-advanced-therapy-systemic-fibrinolysis-and-pharmacomechanical-therapy
#3
Stavros V Konstantinides, Simone Wärntges
Venous thromboembolism, which encompasses deep-vein thrombosis and acute pulmonary embolism (PE), represents a major contributor to global disease burden worldwide. For patients who present with cardiogenic shock or persistent hypotension (acute high-risk PE), there is consensus that immediate reperfusion treatment applying systemic fibrinolysis or, in the case of a high bleeding risk, surgical or catheter-directed techniques, is indicated. On the other hand, for the large, heterogeneous group of patients presenting without overt haemodynamic instability, the indications for advanced therapy are less clear...
June 2015: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/25612280/-pulmonary-embolism
#4
Gerold Söffker, Stefan Kluge
Acute pulmonary embolism is an important differential diagnosis of acute chest pain. The clinical signs are often non-specific. However, diagnosis and therapy must be done quickly in order to reduce morbidity and mortality. The new (2014) European guidelines for acute pulmonary embolism (PE) focus on risk-adapted diagnostic algorithms and prognosis adapted therapy concepts. According to the hemodynamic presentation the division in a high-risk group (unstable patient with persistent hypotension or shock) or in non-high-risk groups (hemodynamically stable) was proposed...
January 2015: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/25205632/usefulness-of-the-chads2-score-for-prognostic-stratification-of-patients-with-acute-myocardial-infarction
#5
COMPARATIVE STUDY
Shao-Sung Huang, Ying-Hwa Chen, Wan-Leong Chan, Po-Hsun Huang, Jaw-Wen Chen, Shing-Jong Lin
The Thrombolysis In Myocardial Infarction (TIMI) score and Global Registry of Acute Coronary Events (GRACE) score have been validated as predictors of major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI). This study was undertaken to determine whether the CHADS2 score had good accuracy for predicting clinical outcome in patients with AMI and to compare the discriminatory performance of the 3 risk scores (RSs). We calculated the TIMI RS, GRACE RS, and CHADS2 score for 747 consecutive patients with AMI...
November 1, 2014: American Journal of Cardiology
https://www.readbyqxmd.com/read/25177884/-functional-state-of-right-ventricular-myocardium-in-patients-with-acute-pulmonary-embolism-before-and-after-thrombolytic-therapy
#6
A A Karpenko, Iu E Klevanets, S P Mironenko, A N Shilova, N V Matveeva
We present in this paper results of assessment of functional state of right ventricular (RV) myocardium in 38 patients with acute pulmonary embolism (PE) before and after endovascular recanalization of pulmonary arteries supplemented with thrombolytic therapy. According to echocardiography data RV dysfunction was detected in 60.5% of cases, while an elevated concentration of brain natriuretic peptide (BNP) in blood plasma was observed in all patients. None of the patients had elevated level of troponin I. An increased concentration of BNP in blood plasma with normal troponin level in patients with acute PE was indicative of a hidden RV dysfunction due to its dilatation, acute volume or pressure overload without evidence of myocardial damage...
2014: Kardiologiia
https://www.readbyqxmd.com/read/25115211/-thrombolysis-not-always-necessary-in-patients-with-acute-pulmonary-embolism
#7
Menno V Huisman, Anne J Fogteloo, Frederikus A Klok
International guidelines suggest that patients presenting with acute pulmonary embolism should be given routine thrombolysis on top of heparin. There is debate as to whether patients with acute pulmonary embolism who present in a haemodynamically stable condition, yet have signs of right ventricular dysfunction and increased troponin, actually need thrombolytic therapy. The results of the Pulmonary Embolism Thrombolysis study (PEITHO) show that in this particular patient group routine thrombolysis led to less haemodynamic decompensation or collapse, but that this advantage came with significantly higher incidences of haemorrhagic stroke and major extracranial bleeding...
2014: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/24916050/aborted-myocardial-infarction-in-st-elevation-myocardial-infarction-insights-from-the-strategic-reperfusion-early-after-myocardial-infarction-trial
#8
RANDOMIZED CONTROLLED TRIAL
Neda Dianati Maleki, Frans Van de Werf, Patrick Goldstein, Jennifer A Adgey, Yves Lambert, Vitaly Sulimov, Fernando Rosell-Ortiz, Anthony H Gershlick, Yinggan Zheng, Cynthia M Westerhout, Paul W Armstrong
BACKGROUND: We evaluated the prespecified endpoint, aborted myocardial infarction (AbMI), according to the use of a pharmacoinvasive (PI) strategy versus primary percutaneous coronary intervention (PCI) in 1754 patients randomised within 3 h of symptom onset in the STrategic Reperfusion Early After Myocardial infarction (STREAM) trial. METHODS: Based on sequential ECG's and biomarkers, AbMI was defined as ST-elevation resolution ≥50% (90 min posttenecteplase (TNK) in the PI arm or 30 min postprimary PCI) with minimal biomarker rise...
October 2014: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/24814115/study-of-clinical-profile-and-management-of-patients-with-pulmonary-embolism-single-center-study
#9
S Calwin Davidsingh, Narayanan Srinivasan, P Balaji, U Kalaichelvan, Ajit Sankaradas Mullasari
OBJECTIVE: To study the clinical profile, diagnostic methods and management in patients with symptomatic pulmonary embolism (PE). METHODS: Retrospective assessment of clinical features and management of patients presenting with symptomatic pulmonary embolism from January 2005 to March 2012. RESULTS: 35 patients who were newly diagnosed to have pulmonary embolism with a mean age of 52.1 years were included in the study. Dyspnea (91.4%) and syncope (22...
March 2014: Indian Heart Journal
https://www.readbyqxmd.com/read/24716681/fibrinolysis-for-patients-with-intermediate-risk-pulmonary-embolism
#10
RANDOMIZED CONTROLLED TRIAL
Guy Meyer, Eric Vicaut, Thierry Danays, Giancarlo Agnelli, Cecilia Becattini, Jan Beyer-Westendorf, Erich Bluhmki, Helene Bouvaist, Benjamin Brenner, Francis Couturaud, Claudia Dellas, Klaus Empen, Ana Franca, Nazzareno Galiè, Annette Geibel, Samuel Z Goldhaber, David Jimenez, Matija Kozak, Christian Kupatt, Nils Kucher, Irene M Lang, Mareike Lankeit, Nicolas Meneveau, Gerard Pacouret, Massimiliano Palazzini, Antoniu Petris, Piotr Pruszczyk, Matteo Rugolotto, Aldo Salvi, Sebastian Schellong, Mustapha Sebbane, Bozena Sobkowicz, Branislav S Stefanovic, Holger Thiele, Adam Torbicki, Franck Verschuren, Stavros V Konstantinides
BACKGROUND: The role of fibrinolytic therapy in patients with intermediate-risk pulmonary embolism is controversial. METHODS: In a randomized, double-blind trial, we compared tenecteplase plus heparin with placebo plus heparin in normotensive patients with intermediate-risk pulmonary embolism. Eligible patients had right ventricular dysfunction on echocardiography or computed tomography, as well as myocardial injury as indicated by a positive test for cardiac troponin I or troponin T...
April 10, 2014: New England Journal of Medicine
https://www.readbyqxmd.com/read/24617753/a-clinical-audit-of-thrombolytic-therapy-in-patients-with-normotensive-pulmonary-embolism-and-intermediate-risk
#11
Carla Nobre, Dinis Mesquita, Boban Thomas, Teresinha Ponte, Luis Santos, João Tavares
INTRODUCTION: There is considerable debate regarding the use of thrombolytic therapy in patients with pulmonary embolism, normal blood pressure and intermediate clinical risk, as defined by right ventricular dysfunction on transthoracic echocardiography or elevated serum markers of cardiac necrosis. AIMS AND OBJECTIVES: A clinical audit of normotensive patients diagnosed with acute pulmonary embolism using multi- detector computerized tomography pulmonary angiography (MDCTPA) and intermediate risk, was conducted to determine clinical outcomes at 30 days...
June 2014: Acute Cardiac Care
https://www.readbyqxmd.com/read/24585265/no-post-conditioning-in-the-human-heart-with-thrombolysis-in-myocardial-infarction-flow-2-3-on-admission
#12
RANDOMIZED CONTROLLED TRIAL
F Roubille, N Mewton, M Elbaz, O Roth, F Prunier, T T Cung, C Piot, J Roncalli, G Rioufol, E Bonnefoy-Cudraz, J Y Wiedemann, A Furber, L Jacquemin, S Willoteaux, W Abi-Khallil, I Sanchez, G Finet, F Sibellas, S Ranc, I Boussaha, P Croisille, M Ovize
AIMS: Proof-of-concept evidence suggests that mechanical ischaemic post-conditioning (PostC) reduces infarct size when applied immediately after culprit coronary artery re-opening in ST-elevation myocardial infarction (STEMI) patients with thrombolysis in myocardial infarction 0-1 (TIMI 0-1) flow grade at admission. Whether PostC might also be protective in patients with a TIMI 2-3 flow grade on admission (corresponding to a delayed application of the post-conditioning algorithm) remains undetermined...
July 1, 2014: European Heart Journal
https://www.readbyqxmd.com/read/24492356/blunted-inflammatory-response-in-stemi-patients-timely-reperfused
#13
Natale Daniele Brunetti, Michele Correale, Luisa De Gennaro, Andrea Cuculo, Pier Luigi Pellegrino, Matteo Di Biase
BACKGROUND: Acute coronary syndrome is characterized by an acute inflammatory systemic response. We investigated whether timely reperfusion could reduce the inflammatory response in patients with ST-elevation acute myocardial infarction (STEMI). METHODS: Forty-seven consecutive patients with STEMI eligible for fibrinolysis and admitted to a coronary care unit were enrolled in the study and reperfused with tenecteplase; 33 patients admitted 6 h after the onset of chest pain (late comers), who therefore underwent delayed coronary angioplasty, acted as controls...
January 2014: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/24226808/high-sensitivity-troponin-i-for-risk-assessment-in-patients-with-atrial-fibrillation-insights-from-the-apixaban-for-reduction-in-stroke-and-other-thromboembolic-events-in-atrial-fibrillation-aristotle-trial
#14
RANDOMIZED CONTROLLED TRIAL
Ziad Hijazi, Agneta Siegbahn, Ulrika Andersson, Christopher B Granger, John H Alexander, Dan Atar, Bernard J Gersh, Puneet Mohan, Veli-Pekka Harjola, John Horowitz, Steen Husted, Elaine M Hylek, Renato D Lopes, John J V McMurray, Lars Wallentin
BACKGROUND: High-sensitivity troponin-I (hs-TnI) measurement improves risk assessment for cardiovascular events in many clinical settings, but the added value in atrial fibrillation patients has not been described. METHODS AND RESULTS: At randomization, hs-TnI was analyzed in 14 821 atrial fibrillation patients in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial comparing apixaban with warfarin. The associations between hs-TnI concentrations and clinical outcomes were evaluated by using adjusted Cox analysis...
February 11, 2014: Circulation
https://www.readbyqxmd.com/read/23922509/almanac-2011-acute-coronary-syndromes-the-national-society-journals-present-selected-research-that-has-driven-recent-advances-in-clinical-cardiology
#15
Charles Knight, Adam D Timmis
This overview highlights some recent advances in the epidemiology, diagnosis, risk stratification and treatment of acute coronary syndromes. The sheer volume of new studies reflects the robust state of global cardiovascular research but the focus here is on findings that are of most interest to the practising cardiologist. Incidence and mortality rates for myocardial infarction are in decline, probably owing to a combination of lifestyle changes, particularly smoking cessation, and improved pharmacological and interventional treatment...
2011: Materia Socio-medica
https://www.readbyqxmd.com/read/23892824/successful-treatment-of-mobile-right-atrial-thrombus-and-acute-pulmonary-embolism-with-intravenous-tissue-plasminogen-activator
#16
R Bajaj, Ajay Ramanakumar, Suresh Mamidala, Deepti Kumar
An 89-year-old woman came with symptoms of progressively worsening dyspnoea at rest over the preceding week. She was normotensive, had elevated jugular venous pressure and clear lungs. ECG revealed atrial fibrillation with the rapid ventricular rate. Labs were significant for markedly elevated pro-brain natriuretic peptide of 43,000 pg/mL and troponin-T of 1 ng/mL. An urgent 2D echocardiogram was obtained, which revealed the severely dilated right atrium and a large linear mobile mass in the right atrium consistent with a thrombus...
2013: BMJ Case Reports
https://www.readbyqxmd.com/read/23835298/management-of-right-heart-thrombi-associated-with-acute-pulmonary-embolism-a-retrospective-single-center-experience
#17
Hakan Akıllı, Enes Elvin Gül, Alpay Arıbaş, Kurtuluş Özdemir, Mehmet Kayrak, Halil Ibrahim Erdoğan
OBJECTIVE: The mortality of right heart thrombi (RHT) associated with pulmonary embolism (PE) is increased about three to four times. The most devastating scenario is fragmentation of RHT and occurrence of recurrent PE. The reports regarding the management of RHT complicated with PE are very scarce in the current literature. Therefore, we report a single-center experience in this paper. METHODS: From January 2006 to December 2011, data of all patients diagnosed with acute PE were analyzed retrospectively...
September 2013: Anadolu Kardiyoloji Dergisi: AKD, the Anatolian Journal of Cardiology
https://www.readbyqxmd.com/read/23354859/thrombolysis-in-submassive-pulmonary-embolism-prudent-or-puerile
#18
Aamer Rehman, Shafaq Yousaf, Atul Chugh
Pulmonary embolism (PE) remains one of the leading causes of cardiovascular mortality. The safety and efficacy of thrombolytic therapy using tissue-type plasminogen activator (tPA) for acute PE in clinical practice remain unclear. We describe a case of life-threatening submassive PE causing extreme refractory hypoxaemia, where thrombolysis was successfully administered. Current consensus suggests that patients with features of hemodynamic instability as a result of an acute PE, that is, massive PE, should receive thrombolysis...
2013: BMJ Case Reports
https://www.readbyqxmd.com/read/23337923/pulmonary-embolism-hotline-2012-recent-and-expected-trials
#19
REVIEW
S Konstantinides, M Lankeit
Management of acute pulmonary embolism (PE) has advanced considerably in the past year, and progress is expected to continue in 2013. To help determine the optimal management strategy for normotensive patients with intermediate-risk PE, the Pulmonary Embolism Thrombolysis (PEITHO) study completed enrolment of 1006 patients with evidence of right ventricular dysfunction (by echocardiography or computed tomography) plus a positive troponin test. Patients have been randomised to thrombolytic treatment with tenecteplase versus placebo, and the effects on clinical end points (death or haemodynamic collapse) assessed at 7 and 30 days...
2013: Hämostaseologie
https://www.readbyqxmd.com/read/23152490/predictors-of-mortality-in-6975-patients-with-chronic-heart-failure-in-the-gruppo-italiano-per-lo-studio-della-streptochinasi-nell-infarto-miocardico-heart-failure-trial-proposal-for-a-nomogram
#20
RANDOMIZED CONTROLLED TRIAL
Simona Barlera, Luigi Tavazzi, Maria Grazia Franzosi, Roberto Marchioli, Elena Raimondi, Serge Masson, Renato Urso, Donata Lucci, Gian Luigi Nicolosi, Aldo P Maggioni, Gianni Tognoni
BACKGROUND: We developed a prognostic model to assess the risk of all-cause mortality in patients with chronic heart failure. METHODS AND RESULTS: We examined 6975 patients with chronic heart failure enrolled in the Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure (GISSI-HF) trial (3.9 years follow-up). Multivariable Cox regression models were developed to predict mortality (1969 deaths). By stepwise selection, the full final model included 25 predictors...
January 2013: Circulation. Heart Failure
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