International journal of cardiology
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The aim of this study was to evaluate the clinical utility of serum pregnancy associated plasma protein-A (PAPP-A) levels in assisting triage of an intermediate to high-risk patient presenting with chest pain in the Emergency Department and no definite evidence of an acute coronary syndrome. ⋯ Elevated serum PAPP-A levels were predictive of a diagnosis of acute coronary syndrome in intermediate- to high-risk patients presenting to the Emergency Department with chest pain and no definite evidence of an acute coronary syndrome. Thus, serum PAPP-A may be valuable as an adjunct, minimally invasive marker to improve risk stratification in chest pain patients.
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There are a number of definitions available for the diagnosis of the metabolic syndrome (MetS). The MetS-associated increase in cardiovascular disease (CVD) risk may depend on the definition used. ⋯ CVD prevalence was increased in the presence of MetS irrespective of the definition used. However, this increase was more pronounced when the NCEP-ATP-III and AHA/NHLBI criteria were implemented compared with the IDF definition. Furthermore, the IDF definition included a large proportion of subjects who did not have increased CVD prevalence compared with the whole study population. These findings may have implications regarding which definition should we use to diagnose the MetS.
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Letter Case Reports
Neonatal life-threatening arrhythmia responding to lidocaine, a probable LQTS3.
Intrauterine and neonatal manifestations of congenital long QT syndrome (LQTS) are associated with a high cardiac risk. We present a newborn, with antecedents of intrauterine premature ventricular contractions, showing in his surface electrocardiogram (ECG): a QTc of 0.69 ms, 2:1 atrioventricular block, autolimited episodes of ventricular tachycardia and Torsade de Pointes. ⋯ Lidocaine was substituted for oral mexiletine, and esmolol for propranolol. During the follow-up the patient has remained asymptomatic under therapy with propranolol and mexiletine.
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Letter Case Reports
Permanent pacemaker lead implantation via azygous vein in a patient with silent superior vena cava syndrome.
Occlusion of the superior vena cava is a rare but serious complication of transvenous endocardial pacing. We describe an unusual approach for permanent pacemaker implantation using the azygous vein in a patient with occlusion of the bilateral total subclavian and innominate veins after previous bilateral pectoral pacemaker implantation. Endocardial pacing using the azygous vein with minimal invasive thoracotomy may be a good option for patients with inaccessible subclavian route.
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The partial pressure of end-tidal carbon dioxide production (P(ET)CO2) at ventilatory threshold (VT) has been shown to be strongly correlated with cardiac output during exercise in patients with heart failure (HF), but few data are available regarding its prognostic utility. ⋯ These results indicate that P(ET)CO2 during CPX is a significant predictor of cardiac-related events in patients with HF. Clinical assessment of this variable in patients with HF undergoing CPX may therefore be warranted.