International journal of cardiology
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Comment Letter
The use of vasopressors in Takotsubo cardiomyopathy: impact on neurological practice.
Takotsubo has been reported in a wide range of clinical conditions. The choice of vasopressors in such situations needs careful consideration. This is highlighted in the management of status epilepticus where hemodynamic compromise is often iatrogenic though this may not be the case in the presence of concomitant Takotsubo cardiomyopathy.
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Further efforts in controlling blood pressure are warranted in patients with hypertension. Office blood pressure measurements, 24-h ambulatory blood pressure monitoring and home blood pressure monitoring are synergic techniques. But, according to available evidence about efficacy and cost-effectiveness of all these techniques, it is likely that for a better blood pressure management, office blood pressure measurements and home blood pressure monitoring could be extended to most of the hypertensive population in daily clinical practice, and limit the use of the 24-h ambulatory blood pressure monitoring just to the current indications.
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We have followed 6 pregnancies in women affected by idiopathic pericarditis from 2002 to 2008, the largest reported clinical series. Four women were treated with aspirin 800 mg three times daily; in 3 women aspirin was gradually stopped at 20 weeks gestation, while in one case aspirin was continued till delivery. All the women were treated with prednisone, at low to moderate doses: 4 women with prednisone 10-2.5 mg daily during all the pregnancy, and 2 with prednisone starting from 25 mg daily only during the III trimester. ⋯ Five pregnancies were uneventful, while HELLP syndrome developed in the mother in which high-dose aspirin was continued till delivery, with rapid improvement after delivery. All the infants had a good outcome. No recurrences occurred during the pregnancies, while one mother had a recurrence 12 months after delivery, during a mean follow up of 21 months.
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Randomized Controlled Trial Multicenter Study Comparative Study
Atrial septal defects versus ventricular septal defects in BREATHE-5, a placebo-controlled study of pulmonary arterial hypertension related to Eisenmenger's syndrome: a subgroup analysis.
Eisenmenger's syndrome (ES) is the most advanced form of pulmonary arterial hypertension related to congenital heart disease. Evolution of pulmonary vascular disease differs markedly between patients with atrial septal defects (ASD) versus ventricular septal defects (VSD), potentially affecting response to treatment. We compared the effects of bosentan and placebo in patients with isolated ASD (ASD subgroup) versus patients with isolated VSD or both defects (VSD subgroup). ⋯ Improvements in exercise capacity and cardiopulmonary hemodynamics, without desaturation, were observed in ES patients with both ASDs and VSDs. Although not reaching statistical significance, improvements were similar to those in the BREATHE-5 analyses, suggesting that the location of septal defects is not a key determinant of treatment response. These data further support the use of bosentan for the treatment of ES, independent of shunt location.