Cardiol J
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The identification of a good prognostic factor of neurological outcome after cardiac arrest is needed. S-100B protein seems to be a promising early predictor of brain damage. Yet it is necessary to reach a consensus on cut-off values, time of blood sampling and the predictive accuracy of S-100B protein. The present review summarizes the data about the clinical implications of S-100B protein after brain injury, especially in patients after cardiac arrest.
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Methadone is increasingly prescribed for chronic pain, yet the associated mortality appears to be rising disproportionately relative to other opioid analgesics. We review the available evidence on methadone-associated mortality, and explore potential pharmacokinetic and pharmacodynamic explanations for its greater apparent lethality. While methadone shares properties of central nervous system and respiratory depression with other opioids, methadone is unique as a potent blocker of the delayed rectifier potassium ion channel (IKr). ⋯ Predicting an individual's propensity for methadone-induced TdP is difficult at present given the inherent limitations of the QT interval as a risk-stratifier combined with the multifactorial nature of the arrhythmia. Consensus recommendations have recently been published to mitigate the risk of TdP until further studies better define the arrhythmia risk factors for methadone. Studies are needed to provide insights into the clinical covariates most likely to result in methadone-associated arrhythmia and to assess the feasibility of current risk mitigation strategies.
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Digoxin remains one of the most frequently prescribed drugs in the management of atrial fibrillation. The main indications for digoxin in atrial fibrillation are restoration of sinus rhythm, prevention of recurrence and slowing of the ventricular rate. ⋯ In addition, recent reports suggest increased mortality in patients with atrial fibrillation without heart failure taking digoxin. The aim of this article is to review the role of digoxin in atrial fibrillation without heart failure.
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At present there is consent that patients with acute pulmonary embolism (APE) and hemodynamic instability have poor prognosis and benefit from thrombolytic therapy or embolectomy, whereas hemodynamically stable patients without echocardiographic signs of right ventricular overload/dysfunction (RVO) have good prognosis and should be treated with anticoagulation alone. The optimal treatment for stable APE patients with RVO remains a challenge, and cardiac biomarkers can probably add to risk stratification and therapeutic decision making. Troponins are indicators of irreversible cardiac cell injury, and in patients with APE even a moderate rise of the blood troponin level correlates with RVO, hemodynamic instability and cardiogenic shock. ⋯ There are some proposals of algorithms that combine both biomarkers and echocardiography for risk stratification. The principal aim of ongoing studies is to find patients with hemodynamically stable APE who can be candidates for thrombolytic therapy. The usefulness of biomarkers in long-term prognosis and their value to identify APE patients in whom chronic thromboembolic pulmonary hypertension can develop should also be confirmed.