Kardiol Pol
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Therapeutic hypothermia is currently the best-documented method of improving neurological outcomes in patients after cardiac arrest and successful resuscitation. There is a variety of methods for lowering body temperature. However, there are no data showing that any specific method of cooling improves the results or increases survival. A simple method involving surface cooling and ice-cold intravenous fluids, as well as more technologically advanced methods, are used in clinical practice. One of the more advanced methods is intravascular hypothermia, during which cooling is carried out with the use of a special catheter located in the central vein. ⋯ The presented technique of intravascular hypothermia provides more precise temperature control in comparison with the traditional method.
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Wellens syndrome is characterised by negative or biphasic T waves in V2-V4 leads and critical stenosis of proximal part of the left descending coronary artery. These ECG changes without atherosclerotic changes in coronary angiography, i.e. coronary artery spasm are called pseudo-Wellens syndrome. We describe a patient with acute coronary syndrome and pseudo-Wellens syndrome as a cause of vasospastic angina. These ECG abnormalities need differentiation with acute pulmonary embolism.
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Reperfusion therapy is the primary treatment for acute myocardial infarction. Its infarct-limiting effectiveness is, however, limited by so called reperfusion-induced myocardial injury likely related to reperfusion-mediated opening of the mitochondrial permeability transition pore (mPTP). ⋯ In this context, a clinical exploitation of endogenous cardioprotective mechanisms, known as ischaemic preconditioning and ischaemic postconditioning, emerges as an attractive therapeutic alternative. This is particularly so because ischaemic pre- and post-conditionig seem to afford cardioprotection by preventing reperfusion-induced deleterious opening of mPTP.
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Comparative Study
Successful primary coronary angioplasty improves early and long-term outcomes in ST segment elevation acute coronary syndromes in patients above 80 years of age.
ST segment elevation myocardial infarction (STEMI) in patients above 80 years of age continues to be a therapeutic challenge. Patients in this age group are rarely included in randomised clinical trials. ⋯ Successful primary PCI in STEMI patients above 80 years of age resulted in a reduction of early and long-term mortality compared to the medically treated patients. The benefits of PCI treatment accrued during the follow-up. In patients treated in the tertiary reference centre in whom PCI was not successful or was not deemed feasible, prognosis was similar to that in the medically treated patients. The latter patients rarely received thrombolytic treatment.
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Cardiac surgery is associated with ischaemic and reperfusion injury to the myocardium. It seems natural to seek a possibility of inducing the natural endoprotective mechanisms known as myocardial conditioning, including preconditioning, postconditioning, and remote conditioning. Still, in spite of almost 20 years of research in the field, we are far from routine widespread usage of these methods, with published reports describing quite various, and often contradictory results. Current review summarises the trials of using the conditioning in cardiac surgical practice including pharmacological manipulations to induce resistance to ischaemia-reperfusion.