European heart journal
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European heart journal · Jun 1998
Delays in thrombolytic therapy for acute myocardial infarction in Finland. Results of a national thrombolytic therapy delay study. Finnish Hospitals' Thrombolysis Survey Group.
To determine lengths and causes of pre- and in-hospital delays in thrombolytic treatment. ⋯ Only 38% of the patient received thrombolysis within 2 h of onset of symptoms. Patient-related delay before they sought help accounted for the major portion of the total treatment delay. Thus the findings emphasize the importance of prompt action when people are confronted with an acute heart attack. Reorganizing the emergency medical service and emergency department routines is also a necessary target to shorten thrombolysis delays. The delay attributable to transporting patients could be shortened by initiating thrombolytic treatment in the pre-hospital setting. In Finnish hospitals, door-to-needle delay was acceptable in cases with clear indications for thrombolysis. However, emergency physicians often had diagnostic difficulties, which led to remarkably longer in-hospital delays.
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European heart journal · Jun 1998
Direct percutaneous transluminal coronary angioplasty in acute myocardial infarction. Predictors of short-term outcome and the impact of coronary stenting. Study Group of The Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK).
Direct percutaneous transluminal coronary angioplasty (PTCA) is widely accepted in the treatment of acute myocardial infarction since excellent results had been reported from several small randomized trials. Less favourable results were observed in large-scale registries. In particular, the use of stents in acute myocardial infarction has become common practice without documented evidence of clinical efficacy. ⋯ Direct percutaneous transluminal coronary angioplasty is a valuable treatment strategy in acute myocardial infarction, although the results are less exceptional than reported from some highly specialized centres. Failed percutaneous transluminal coronary angioplasty seems to be harmful, thus outweighing much of the benefit from successful procedures. Stents did not improve the clinical outcome significantly, despite technically successful placement in 98%. Mortality from cardiogenic shock continues to be excessively high despite direct PTCA.
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Patients who have an accessory pathway (AP) of atrioventricular (AV) conduction may develop circus movement tachycardia otherwise known as atrioventricular re-entrant tachycardia (AVRT). Orthodromic AVRT is the most common form. It occurs as a result of antegrade conduction through the normal AV conduction system and retrograde conduction to the atria via the AP. ⋯ No class of drug stands out as 'therapy of choice', and physician preference, pro-arrhythmic effects and associated conditions need to be taken into account such that an individual choice can be made in each patient. The management of patients with AVRT has been revolutionized in recent years with the advent of catheter-based techniques for their cure. Whilst this method of treatment is highly effective and has low complication rates, pathways in particular locations such as the septal region remain challenging.
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European heart journal · May 1998
Prediction of behavioural and emotional problems in children and adolescents with operated congenital heart disease.
The aim of the present study was to determine which medical variables were predictors of long-term behavioural/emotional outcome after surgical correction for congenital heart disease in infancy and childhood. ⋯ Several medical variables were significant predictors and can be used to identify those congenital heart disease children who are at risk of long-term behavioural/emotional maladjustment.
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European heart journal · May 1998
Non-invasive assessment of inspiratory muscle performance during exercise in patients with chronic heart failure.
The aim of this study was to assess inspiratory performance at rest and during exercise in patients with chronic heart failure in comparison with healthy controls using a non-invasive index: the tension-time index of inspiratory muscles (TTMUS). ⋯ This study shows that the determination of TTMUS at rest and during exercise allows the observation of alterations in inspiratory muscle performance as a result of both reduced inspiratory strength, as measured by the maximal inspiratory pressure, and increased ventilatory drive, as reflected by the mouth occlusion pressure in patients with chronic heart failure. The non-invasiveness of this new index is an additional argument for its use in a clinical setting.