Circulation journal : official journal of the Japanese Circulation Society
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Although cardiac output index (CI), stroke volume index (SVI), and total systemic vascular resistance (TSVR) are important hemodynamic parameters for the prognosis of chronic heart failure (CHF), they are difficult to measure in an outpatient setting. Whole body bioimpedance monitoring using a Non-Invasive Cardiac System (NICaS) allows for easy, non-invasive estimation of these parameters. Here, whether NICaS-derived hemodynamic parameters are clinically significant was investigated by relating them to other conventional cardiovascular functional indices, and by evaluating their predictive accuracy for CHF readmission. ⋯ Hemodynamic parameters derived by NICaS are applicable for the non-invasive assessment of cardiac function in outpatient CHF follow up.
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Mechanical circulatory support has been used to treat graft failure after heart transplantation, but in patients who needed mechanical circulatory support because of chronic rejection, we have suffered from the treatment because its outcome was catastrophic. Multiple organ failure was often caused by the addition of or increase in immunosuppressive medications, and it is known as a cause of the poor outcomes. ⋯ The patient underwent re-heart transplantation, with a good result. This is a new therapeutic technique for chronic graft rejection.
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A 35-year-old man was referred to the emergency department after having a short syncopal episode while waiting for a Doppler scan of the lower extremities for a 4-week history of a painful right leg. He had no significant past medical history and was a non-smoker. On presentation he had severe chest pain and dyspnea associated with diaphoresis, and was hemodynamically unstable. ⋯ However, the angiography showed the coronary arteries were normal and the right main pulmonary artery was partially occluded by large pulmonary emboli. The ECG changes were recorded in detail which also pointed to the diagnosis of pulmonary embolism (PE). This case shows how a PE can mimic an anteroseptal myocardial infarction on ECG, and the physiopathology of the ST elevation in PE was discussed.
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In patients with non-ST-segment elevation acute coronary syndromes, early risk stratification is crucial for appropriate management of this condition and for deciding whether early invasive strategies should be adopted. The electrocardiogram (ECG) has been extensively used for risk stratification, and the presence of ST-segment depression is an especially strong predictor of poor outcomes. ⋯ ST-segment elevation in lead a V(R) in addition to ST-segment depression in other leads is a very valuable marker of left main and/or 3-vessel disease. This review explores the clinical importance of the ECG in the current interventional era.