The Canadian journal of cardiology
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Approximately 2% to 4% of patients undergo urgent or emergency coronary artery bypass grafting (CABG) for complications of percutaneous coronary intervention (PCI) after treatment with glycoprotein (GP) IIb/IIIa inhibitors. The pharmacokinetic and pharmacodynamic properties of GP IIb/IIIa inhibitors play a large role in determining the safety of their use in the setting of urgent or emergency CABG procedures. ⋯ Limited data for tirofiban show that bleeding is not increased when compared with acetylsalicylic acid or heparin. Eptifibatide and tirofiban appear to have favourable safety profiles compared with abciximab in the setting of emergency or urgent CABG after failed PCI.
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Review Case Reports
Impending paradoxical embolus: a case report and review of the literature.
A case of a 43-year-old man with impending paradoxical embolism (IPE) is described. The patient initially presented with pulmonary embolism and was diagnosed with an IPE on transthoracic and transesophageal echocardiography. ⋯ This report discusses the main clinical features, the diagnostic role of echocardiography and the outcome of medical and surgical treatment strategies in patients with IPE. Based on the literature to date, we recommend that patients with impending paradoxical embolism be treated with initial systemic heparinization followed by emergent surgical embolectomy if the surgical risks are acceptable.
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Cardiologists' expertise in managing traumatic heart disease will be increasingly sought as the incidence of both firearm and motor vehicle accidents soars. Knowledge of mechanisms of injury, as well as appropriate use of diagnostic tools, will aid in rapid recognition of complications related to cardiac injury.
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Review
Cardiovascular adverse effects of herbal medicines: a systematic review of the recent literature.
Herbal medicines are popular but health care professionals often feel uncertain about their risks. This article summarizes recent evidence regarding the serious or potentially serious cardiovascular adverse effects of herbal medicines. Five electronic literature databases were searched. ⋯ Because of the anecdotal nature of the evidence, it is impossible to estimate the incidence of adverse effects. In conclusion, herbal medicinal products are regularly associated with serious cardiovascular adverse events but the size of this problem cannot be estimated at present. Vigilance and research seem to be the best way forward.
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Review Practice Guideline Guideline
The 2000 Canadian recommendations for the management of hypertension: part two--diagnosis and assessment of people with high blood pressure.
To provide updated, evidence-based recommendations for the diagnosis and assessment of high blood pressure in adults. ⋯ These recommendations are endorsed by the Canadian Hypertension Society, The Canadian Coalition for High Blood Pressure Prevention and Control, The College of Family Physicians of Canada, The Heart and Stroke Foundation of Canada, The Adult Disease Division and Bureau of Cardio-Respiratory Diseases and Diabetes at the Centre for Chronic Disease Prevention and Control of Health Canada.