The Journal of invasive cardiology
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The activated clotting time (ACT) has been reported to be sensitive to the anticoagulant activity of the low-molecular weight heparin dalteparin following intravenous (IV) administration. ⋯ ACT-guided dose adjustment of intravenously administered dalteparin during PCI appears to constitute a feasible strategy.
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Atrial septal defect (ASD) closure reduces symptoms and prevents ongoing congestive heart failure. However, little is known about device closure in the elderly (age > 60 years) and whether it is a safe and effective treatment. In this study, we report our results with ASD transcatheter closure in the elderly patient > 60 years of age using the Amplatzer Septal Occluder (ASO) device. ⋯ In patients older than 60 years of age, device closure of ASDs is safe and an effective alternative to surgery. Right-heart remodeling can occur in patients > 60 years of age.
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Iatrogenic ostial coronary stenosis is a rare life-threatening complication of aortic valve replacement, usually presenting after 2-6 months. Although it is rarely reported, its incidence has been estimated at 0.3-5%. The most likely mechanism is posttraumatic fibrous intimal proliferation caused by coronary ostia cannulation for direct cardioplegia. We report a unique case of early occurrence of thrombotic obstruction of the left main stem following aortic valve replacement and its interventional management.
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We assessed the clinical, electrocardiographic (ECG) and angiographic characteristics of patients with acute coronary syndrome, increased troponin I (cTn-I) levels and normal creatine kinase levels. ⋯ Increased cTn-I levels in the presence of rest pain and normal creatine kinase is not a spurious finding, but may actually be a marker of advanced CAD. However, some of these patients may also have nonsignificant CAD.
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1) Describe a quality improvement (QI) process to decrease door-to-balloon time (D2B); 2) Explain implementation of evidence-based strategies to improve D2B. ⋯ Using QI methods of flow-charting, identifying bottlenecks, targeting strategies to bottleneck areas, and real-time monitoring with SPC and rapid-cycle feedback, D2B processes can be systematically redesigned for improvement. QI methods can be used by individual institutions to customize and implement strategies for their particular context.