Cardiology clinics
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Triage of patients with acute, potentially life-threatening chest pain is one of the most daunting challenges currently facing emergency department physicians. Acute aortic syndrome and pulmonary embolism are two potentially underlying causes. For both, computed tomography has become the de facto clinical reference standard for diagnosis. This article discusses state-of-the-art computed tomography for the detection of these disorders, including recent advances and future perspectives.
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The recent, widespread success of mechanical circulatory support has prompted the development of numerous implantable devices to treat advanced heart failure. It is important to raise awareness of novel device systems, the mechanisms by which they function, and implications for patient management. ⋯ Implantation strategy, mechanism of action, durability, efficacy, hemocompatibility, and human factors are considered. The feasibility of novel strategies for unloading the failing heart is examined.
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Nonreversible failure of the right ventricle is seen in 0.04% to 0.1% of postcardiotomy cases. The incidence of right ventricular dysfunction after left ventricular assist device (LVAD) implantation that fails to resolve in the operating room is reported to be as frequent as 20% to 50% and imposes a considerable burden in terms of postoperative morbidity and mortality. Should this syndrome supervene, the mortality of an LVAD operation increases from 19% to 43%. Although most patients can be maintained with prolonged inotropic support, 10% to 15% may require implantation of a separate right ventricular support device.
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Cardiac catheterization historically has been the principal diagnostic modality for the evaluation of constrictive pericarditis, restrictive cardiomyopathy, and cardiac tamponade. In many instances, the hemodynamic consequences of these disorders can be accurately delineated with non-invasive methods. However, cardiac catheterization should be considered when there is a discrepancy between the clinical and non-invasive imaging data, and particularly may be required for the evaluation of patients with complex hemodynamic disorders. This report describes the methods and clinical utility of invasive hemodynamic catheterization for the evaluation of constriction, restriction, and cardiac tamponade.