Clinical cardiology
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Clinical cardiology · Apr 1998
Review Case ReportsTiclopidine-induced neutropenia mimicking sepsis early after intracoronary stent placement.
We report a case of ticlopidine-induced profound neutropenia early in the course of therapy, which was manifest as a febrile systemic illness mimicking sepsis. This clinical presentation was potentially indicative of a contaminated intracoronary stent. The patient's signs and symptoms of illness promptly resolved with removal of ticlopidine, and no infection was documented. Review of indications for ticlopidine use, potential adverse effects, and monitoring recommendations are discussed.
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Clinical cardiology · Nov 1997
ReviewEndothelial function, fibrinolysis, and angiotensin-converting enzyme inhibition.
Experimental and clinical studies with angiotensin-converting enzyme (ACE) inhibitors have suggested that these agents may reduce the risk of atherothrombotic events. Recent studies have identified the role of angiotensin II and ACE in the regulation of fibrinolysis. There is now substantial evidence that the renin-angiotensin system (RAS) plays an important role in the regulation of vascular fibrinolytic balance. This recently recognized relationship may contribute to the vasculoprotective effects of ACE inhibitors.
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The term torsade de pointes refers to polymorphic ventricular tachycardia that occurs in the setting of an abnormally long QT interval. While the most common cause is treatment with QT prolonging drugs, torsade de pointes also occurs in the congenital long QT syndromes and in the setting of acquired heart block or severe electrolyte disturbance, notably hypokalemia. ⋯ Treatment consists of recognition of the syndrome, correction of underlying electrolyte abnormalities, and withdrawal of any offending drugs. Magnesium, isoproterenol, or cardiac pacing provides specific antiarrhythmic therapy in torsade de pointes.
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Noncardiac chest pain is a common costly phenomenon in the cardiology setting. Recent research suggests that panic disorder, a highly distressful yet treatable anxiety disorder, occurs in a significant proportion of noncardiac chest pain patients. This article reviews research on the prevalence of panic disorder in patients seen in cardiology settings for unexplained chest pain. ⋯ Panic disorder and the potential consequences of its nonrecognition by physicians are examined. Current psychological and pharmacologic treatments are reviewed. Recommendations on the management of panic patients in the cardiology setting are provided.
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Clinical cardiology · Mar 1997
ReviewDepression and coronary heart disease: a review for cardiologists.
Major depression is a common comorbid condition in patients with coronary heart disease (CHD). Although mild emotional distress may be a normal reaction to myocardial infarction or other manifestations of CHD, major depression should not be considered a normal reaction, nor should it be ignored. ⋯ Fortunately, it is one that can be successfully treated in the majority of cases. The purpose of this review is to present the evidence for the negative prognostic effects of depression in cardiac patients and to discuss methods for assessing and treating depression in these patients.