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Myocardial Infarction Stabilization

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3081. Intracoronary thermography for detection of high-risk vulnerable plaques. Full Text available with Trip Pro

Intracoronary thermography for detection of high-risk vulnerable plaques. Up to two-thirds of acute myocardial infarctions develop at sites of culprit lesions without a significant stenosis. New imaging techniques are needed to identify those lesions with an increased risk of developing an acute complication in the near future. Inflammation is a hallmark feature of these vulnerable/high-risk plaques. We have shown that inflamed atherosclerotic plaques are hot and their surface temperature (...) correlates with an increased number of macrophages and decreased fibrous-cap thickness. Multiple animal and human experiments have shown that temperature heterogeneity correlates with arterial inflammation in vivo. Several coronary temperature mapping catheters are currently being developed and studied. These thermography methods can be used in the future to detect vulnerable plaques, potentially to determine patients' prognosis, and to study the plaque-stabilizing effects of different medications.

2006 Journal of the American College of Cardiology

3082. Antiatherosclerotic and antithrombotic effects of omega-3 fatty acids. (Abstract)

. Epidemiologic studies show more consistent reductions in the incidence of nonfatal myocardial infarction and ischemic stroke than do the clinical trials of increased omega-3 fatty acid intake, which suggests important confounding factors in observational studies. Ongoing clinical trials may clarify the non-antiarrhythmic benefits of omega-3 fatty acid supplementation. (...) published through August 2005 shows that omega-3 fatty acids of marine origin consistently lower elevated plasma triglyceride levels in a dose-dependent fashion, with greater efficacy at higher triglyceride levels. Smaller effects on lowering blood pressure, improving endothelial function, and increasing plasma levels of high-density lipoprotein cholesterol were also found. No consistent effects on other lipid, hemostatic, inflammatory, glucose tolerance, or plaque stabilization parameters were found

2006 American Journal of Cardiology

3083. Secondary prevention of coronary artery disease with omega-3 fatty acids. (Abstract)

Secondary prevention of coronary artery disease with omega-3 fatty acids. Omega-3 fatty acid therapy is a promising intervention for the secondary prevention of coronary artery disease (CAD). Omega-3 fatty acids have properties that promote atherosclerotic plaque stability and decrease the incidence of ischemia-driven cardiac arrhythmias. A large number of clinical trials conducted in patients with CAD or prior myocardial infarction (MI) have examined hard cardiovascular end points, including (...) a strong role for omega-3 fatty acids derived from fish oil in secondary prevention through a presumptive role as an antiarrhythmic agent and through an ability to promote plaque stabilization.

2006 American Journal of Cardiology

3084. Usefulness of preoperative intraaortic balloon pump therapy during off-pump coronary artery bypass grafting in high-risk patients. (Abstract)

stability, especially in high-risk patients.One hundred thirty-three consecutive patients who underwent OPCABG through sternotomy between April 2000 and July 2003 were studied. We compared the clinical results of 32 patients who underwent preoperative IABP placement (group 1) with those of 101 patients who did not have IABP placement (group 2). Of the 32 patients satisfying the insertion criteria, 15 had critical left main artery disease, 20 had unstable angina, 5 had acute myocardial infarction, and 5

2004 Annals of Thoracic Surgery

3085. Intercontinental LVAS patient transport. (Abstract)

(WorldHeart Corp, Ottawa, Canada). While in Japan, the Canadian patient suffered a myocardial infarction and despite coronary artery bypass grafting, the patient remained in a low cardiac output state. After implantation of the left ventricular assist system in Japan, the patient was stabilized and transported by a commercial airline to Canada where he underwent successful heart transplantation. (...) Intercontinental LVAS patient transport. Mechanical circulatory support is currently indicated for patients with cardiac insufficiency as a bridge to transplantation or as a bridge to recovery. These systems continue to evolve and improve, and many patients (after they are stabilized) are now able to be discharged from the hospital. This article reports our experience with the intercontinental transportation of a patient while being supported with a Novacor left ventricular assist system

2004 Annals of Thoracic Surgery

3086. First-year outcomes of beating heart coronary artery bypass grafting using proximal mechanical connectors. (Abstract)

connector (St Jude Medical Anastomotic Technology Group, St. Paul, MN). Follow-up for major adverse cardiac events (MACEs), which is defined as cardiac mortality, myocardial infarction, or revascularization of a previous target vessel, was obtained on 162 patients (97.6%). A control group of 159 patients was identified from a cohort of patients having beating heart surgery with one or more sutured proximal vein graft anastomosis in the preceding year. The MACE follow-ups were obtained in 136 patients (...) (85.6%) by direct telephone contact.Patients with connectors showed an accelerated number of MACEs beginning approximately 180 days from the time of surgery and stabilizing at approximately 300 days. Logistic regression analysis identified the presence of diabetes as a significant preoperative risk factor predisposing patients to earlier onset of MACEs (p = 0.03) with an odds ratio of 2.9 (95% confidence interval, 1.1 to 7.6). Insulin dependent diabetics showed no differences between connector

2004 Annals of Thoracic Surgery

3087. Midterm outcomes using the physio ring in mitral valve reconstruction: experience in 492 patients. (Abstract)

(3.0%) commissurotomy. Overall hospital mortality was 3.5% (17 of 492). Postoperative complications included respiratory insufficiency in 55 patients (11.2%), low cardiac output in 13 (2.6%), stroke in 14 (2.8%), reoperation for bleeding in 13 (2.6%), renal insufficiency in 21 (4.3%), and myocardial infarction in 5 (1.0%), and new onset of atrial fibrillation in 74 patients (15.0%). The cumulative follow-up for the series was 1,522.9 patient years and ranged from 1 to 101.0 months (mean, 38.5 (...) Midterm outcomes using the physio ring in mitral valve reconstruction: experience in 492 patients. Mitral valve reconstruction using standardized Carpentier techniques is the treatment of choice for most patients with regurgitant lesions. Demonstrated predictability and stability make it an attractive alternative to valve replacement. The Physio Ring's inherent flexibility provides a viable alternative in the application of remodeling techniques and appears to be physiologically superior

2005 Annals of Thoracic Surgery

3088. Postinfarction ventricular septal defect with pseudoaneurysm repair after failed percutaneous closure. (Abstract)

Postinfarction ventricular septal defect with pseudoaneurysm repair after failed percutaneous closure. Ventricular septal defect with intramyocardial dissection of the ventricular free wall is a rare complication of myocardial infarction associated with poor prognosis. We describe a patient who developed a ventricular septal defect with intramyocardial dissection of the right ventricular free wall. Initially the patient was successfully stabilized by the placement of a percutaneous closure

2005 Annals of Thoracic Surgery

3089. Percutaneous intervention versus coronary bypass surgery for patients older than 70 years of age with high-risk unstable angina. (Abstract)

factor for an adverse outcome with bypass. Both the randomized trial and the registry demonstrated comparable 3-year survival. The purpose of this study was to compare bypass and percutaneous intervention survival of AWESOME patients who were older than 70 years of age.Over a 5-year period (1995 to 2000), 2,431 patients with medically refractory myocardial ischemia and at least one of the following five risk factors (prior heart surgery, myocardial infarction within 7 days, left ventricular ejection (...) Percutaneous intervention versus coronary bypass surgery for patients older than 70 years of age with high-risk unstable angina. The Angina With Extremely Serious Operative Mortality Evaluation (AWESOME) study was a multicenter Veterans Affairs randomized trial and registry that compared long-term survival of percutaneous coronary intervention with coronary artery bypass graft surgery for the treatment of patients with medically refractory myocardial ischemia and at least one additional risk

2005 Annals of Thoracic Surgery

3090. Prediction of short- and long-term outcomes by electrocardiography in survivors of out-of-hospital cardiac arrest. (Abstract)

(seven died in the emergency department prior to admission) and 79 (40%) were discharged. The QRS duration (141 +/- 41ms in nonsurvivors, 123 +/- 35 in survivors, P = 0.004) was predictive of short-term mortality in patients who did not survive to hospital discharge. The ventricular rate, PR interval, presence of right or left bundle branch block, QTc, ST elevation myocardial infarction, and atrial fibrillation/flutter were nonpredictive. The average length of follow up for hospital dismissal (...) )] were predictive of long-term mortality and ICD shocks.Careful evaluation of the admitting and discharge ECG provides prognostic information for in-hospital and long-term outcomes, respectively in this cohort of out-of-hospital cardiac arrest survivors. The QRS duration on the dismissal ECG following VF OHCA provides prognostic information which might be useful to identify those at highest risk long-term, and who would benefit from more aggressive antiarrhythmic therapy and cardiac stabilization.

2004 Resuscitation

3091. Do metalloproteinases destabilize vulnerable atherosclerotic plaques? (Abstract)

Do metalloproteinases destabilize vulnerable atherosclerotic plaques? Atherosclerotic plaque rupture and thrombosis underlie most myocardial infarctions. Matrix metalloproteinases are a family of enzymes that remodel the extracellular matrix. Metalloproteinases could stabilize rupture-prone plaques by promoting smooth muscle cell migration and proliferation. Alternatively, metalloproteinases could destabilize vulnerable plaques by promoting matrix destruction, angiogenesis, leucocyte (...) . Overexpression studies in mice or rabbits show that high activities of matrix metalloproteinase 9 and 12 decrease stability. Biomarker and human genetic studies demonstrate that increased metalloproteinase activity is associated with vascular repair or myocardial infarction.Recent studies reinforce evidence for a dual role of matrix metalloproteinases in plaque stabilization and rupture, which probably depends on the stage, site, and severity of disease. Dysregulated metalloproteinase activity in end-stage

2006 Current Opinion in Lipidology

3092. One-year survival following early revascularization for cardiogenic shock. (Abstract)

One-year survival following early revascularization for cardiogenic shock. Cardiogenic shock (CS) is the leading cause of death for patients hospitalized with acute myocardial infarction (AMI).To assess the effect of early revascularization (ERV) on 1-year survival for patients with AMI complicated by CS.The SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) Trial, an unblinded, randomized controlled trial from April 1993 through November 1998.Thirty-six (...) referral centers with angioplasty and cardiac surgery facilities.Three hundred two patients with AMI and CS due to predominant left ventricular failure who met specified clinical and hemodynamic criteria.Patients were randomly assigned to an initial medical stabilization (IMS; n = 150) group, which included thrombolysis (63% of patients), intra-aortic balloon counterpulsation (86%), and subsequent revascularization (25%), or to an ERV group (n = 152), which mandated revascularization within 6 hours

2001 JAMA Controlled trial quality: predicted high

3093. Long-term treatment with a platelet glycoprotein-receptor antagonist after percutaneous coronary revascularization. EXCITE Trial Investigators. Evaluation of Oral Xemilofiban in Controlling Thrombotic Events. (Abstract)

Long-term treatment with a platelet glycoprotein-receptor antagonist after percutaneous coronary revascularization. EXCITE Trial Investigators. Evaluation of Oral Xemilofiban in Controlling Thrombotic Events. When administered intravenously at the time of percutaneous coronary revascularization, glycoprotein IIb/IIIa receptor antagonists decrease the incidence of death and nonfatal myocardial infarction and the need for urgent revascularization. We hypothesized that long-term administration (...) . There were two primary composite end points: one was death, nonfatal myocardial infarction, or urgent revascularization at 182 days, and the other was death or nonfatal myocardial infarction at 182 days.Death, myocardial infarction, or urgent revascularization occurred within 182 days in 324 patients who received placebo (Kaplan-Meier cumulative event rate, 13.5 percent), 332 who received 10 mg of xemilofiban (13.9 percent, P=0.82 for the comparison with placebo), and 306 who received 20 mg

2000 NEJM Controlled trial quality: predicted high

3094. Obstructive sleep apnoea. (Abstract)

(increased neck circumference), but overnight polysomnography is needed to confirm presence of the disorder. Repetitive pharyngeal collapse causes recurrent arousals from sleep, leading to sleepiness and increased risk of motor vehicle and occupational accidents. The surges in hypoxaemia, hypercapnia, and catecholamine associated with this disorder have now been implicated in development of hypertension, but the association between obstructive sleep apnoea and myocardial infarction, stroke (...) Obstructive sleep apnoea. Obstructive sleep apnoea is a disease of increasing importance because of its neurocognitive and cardiovascular sequelae. Abnormalities in the anatomy of the pharynx, the physiology of the upper airway muscle dilator, and the stability of ventilatory control are important causes of repetitive pharyngeal collapse during sleep. Obstructive sleep apnoea can be diagnosed on the basis of characteristic history (snoring, daytime sleepiness) and physical examination

2002 Lancet

3095. Diuretics

with acute LVF. Higher doses may be necessary if the patient has been taking large doses over the longer term. The rapid initial action is due to pulmonary vasodilation rather than the later diuretic effect. Eplerenone is licensed for use as an adjunct in LVF following myocardial infarction [ , ] . Chronic heart failure [ ] Use the lowest dose of diuretic necessary to relieve fluid overload and breathlessness and adjust following the addition of other heart failure therapies. Patients on long-term (...) . ; The effects of eplerenone on length of stay and total days of heart failure hospitalization after myocardial infarction in patients with left ventricular systolic dysfunction. Am Heart J. 2009 Sep158(3):437-43. doi: 10.1016/j.ahj.2009.07.003. ; Eplerenone survival benefits in heart failure patients post-myocardial infarction are independent from its diuretic and potassium-sparing effects. Insights from an EPHESUS (Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study

2008 Mentor

3096. Coronary Revascularisation

infarction or episode of unstable angina : recent coronary events increase procedural risk. Unfavourable coronary anatomy : extensive disease in the distal parts of coronary arteries reduces the likely benefits of intervention. Results of pre-intervention tests : eg, myocardial perfusion scanning or cardiac MRI. Presence of chronic kidney disease: CABG is superior to PCI where the eGFR is between 30-90 mL/min/1.73 m 2 . In severe chronic kidney disease and end-stage kidney disease or haemodialysis (...) greater clarity is needed around the balance of risks and benefits for this group of people. Revascularisation in ST-segment elevation myocardial infarction [ ] Primary PCI in dedicated centres should be undertaken if possible in ST-segment elevation myocardial infarction. If this cannot occur within 120 minutes of the ECG diagnosis then immediate fibrinolysis should be performed and if this is successful, PCI should be undertaken within 24 hours. If, however, fibrinolysis is unsuccessful then rescue

2008 Mentor

3097. Acute Coronary Syndromes (ACS)

and persistent (>20 minutes) ST-segment elevation. Most of these patients will develop an ST-elevation myocardial infarction (STEMI). Non-ST-elevation ACS (NSTE-ACS): patients present with acute chest pain but without persistent ST-segment elevation. The ECG shows persistent or transient ST-segment depression or T-wave inversion, flat T waves, pseudo-normalisation of T waves, or no ECG changes at presentation. NSTE-ACS is further divided into: Unstable angina: normal troponin levels. Non-ST-elevation (...) myocardial infarction (NSTEMI): a rise in troponin levels. This article refers mainly to unstable angina and NSTEMI. STEMI is discussed in the separate , , and articles. There is also a separate article. Epidemiology See also separate article. The diagnosis of NSTEMI is more difficult to establish than STEMI and therefore its prevalence is harder to estimate. [ ] Coronary heart disease is the single biggest cause of death in the UK as well as being a major cause of premature mortality. [ ] Risk factors

2008 Mentor

3098. Ventricular Fibrillation

. Epidemiology VF is the most commonly identified arrhythmia in cardiac arrest patients. The incidence of VF parallels the incidence of ischaemic heart disease, with a peak incidence of VF occurring in people aged 45-75 years. Risk factors VF is most often associated with coronary artery disease and as a terminal event. VF may be due to acute myocardial infarction (MI) or ischaemia, or occur because of a chronic infarction scar. When electrocardiogram documentation is available, it often shows that rapid VT (...) forms of congenital heart disease. Management See the separate articles on and . Medical stabilisation Patients who survive the initial episode of VF require a full evaluation of left ventricular function, myocardial perfusion and electrophysiological stability. Careful post-resuscitation care is essential to survival because recurrence rates average at about 50%. Treatment of myocardial ischaemia, heart failure and electrolyte disturbances. Empirical beta-blockers are often given. Most survivors

2008 Mentor

3099. General Anaesthesia

GA. Consideration of these factors and the requirements of the particular operation requires a systematic approach to assessment of the patient. This is achieved through careful history, examination and, if necessary, further investigation. History Pre-existing conditions affecting operation and anaesthesia. For example: Heart disease (including recent myocardial infarction, heart failure and hypertension). Liver disease. Blood disorders (for example, anaemia and coagulopathy). Diabetes mellitus (...) amnesia. New methods for monitoring anaesthesia are being devised. [ ] See also separate article. Recovery The time of recovery is a time of risk. All patients are observed on a one-to-one basis by an anaesthetist or recovery nurse until they have regained airway control and cardiovascular stability and are able to communicate. [ ] Patients are kept under clinical observation at all times and all measurements recorded: Level of consciousness. Oxygen saturation and oxygen administration. Blood pressure

2008 Mentor

3100. Flying with Medical Conditions

[ ] : Uncomplicated myocardial infarction within seven days (exercise testing to show that there is no residual ischaemia or symptoms is not mandatory before travel). Complicated myocardial infarction within 4-6 weeks. Unstable angina. Decompensated congestive cardiac failure. Uncontrolled hypertension. Coronary artery bypass graft within 10 days. Cerebrovascular accident within three days. Uncontrolled cardiac arrhythmia. Severe symptomatic valvular heart disease. Uncomplicated percutaneous coronary (...) [ ] . Risk category Relevant risk factors Suggested prophylaxis Minimal risk Age <40; otherwise fit and healthy. General advice. Low risk Age >40; obesity; active inflammation; minor surgery within 3 days. As above ± graduated compression stockings. Moderate risk Varicose veins; poorly controlled heart failure; myocardial infarction within six weeks; oestrogen therapy (including oral contraception); polycythaemia; pregnancy/puerperium; lower limb paralysis/trauma within six weeks. Consider aspirin

2008 Mentor

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