European heart journal
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We would advocate 3 weeks of anticoagulation prior to, and 4 weeks post-cardioversion (either electrical or chemical) for patients in chronic atrial fibrillation or flutter. In selected cases it seems reasonable to use transoesophageal echocardiography to exclude preformed thrombus and negate the need for 3 weeks of prior anticoagulation. ⋯ Oral anticoagulation should be continued for 4 weeks post-procedure. If transoesophageal echocardiography is not readily available an alternative strategy would be to anticoagulate the patient for 3 weeks and thereafter readmit them for elective cardioversion, continuing the anticoagulation for a further 4 weeks after the procedure.
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The coronary circulation is controlled by the central nervous system, circulating hormones and local vascular mechanisms. The importance of local regulatory mechanisms has only recently been recognized. The endothelium is in a strategical anatomical position within the blood vessel wall located between the circulating blood and vascular smooth muscle cells. ⋯ Nitrates substitute in part for deficient endogenous nitric oxide, while angiotensin converting enzyme inhibitors increase the bradykinin induced nitric oxide and prostacyclin production. The newly developed endothelin antagonists allow specific blocking of the effects of endothelin. Pharmacological correction of endothelial dysfunction may be important to treat coronary artery disease and its complications.