Rev Cardiovasc Med
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Approximately 6 million patients are evaluated annually in US emergency departments for acute chest pain. The delineation of the presence or absence of acute coronary syndromes in these patients must be accurate and efficient in order to prevent missed diagnoses. Coronary computed tomography angiography has great promise as a tool to expedite the triage of patients with acute chest pain to early discharge or further inpatient diagnosis and treatment.
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Obesity is a known risk factor for developing cardiovascular disease, including heart failure. However, the impact of obesity on patients with heart failure is unclear. ⋯ Even more, increases of weight in cachectic heart failure patients might improve survival, although patients with heart failure who are overweight or mildly to moderately obese have better outcomes than patients with heart failure who are at ideal or normal weight. In heart failure patients, weight reduction through diet regulation, moderate exercise, and bariatric surgery can improve quality of life and New York Heart Association functional class, but it is yet unclear if these measures will improve survival.
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Cardiocerebral resuscitation is a new approach to patients with primary cardiac arrest that has been shown to dramatically increase survival. The term cardiocerebral is used to stress that the issue is immediate and effective support of the central circulation. Cardiocerebral resuscitation consists of continuous chest compressions--without mouth-to-mouth ventilations--administered by bystanders, and a new algorithm for emergency medical services that consists of sets of 200 chest compressions before and immediately after electrocardiographic analysis and, if indicated, a single shock. ⋯ Early establishment of intravenous or intraosseous access for epinephrine is emphasized. Postresuscitation care for comatose patients includes early coronary intervention and 24 hours of mild hypothermia. Studies show marked improvement in prehospital cardiac arrest patients with return of spontaneous circulation who subsequently received specialized postresuscitation care.
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A mainstay of therapy for congestive heart failure has been the use of potent diuretic agents, such as furosemide, that target the kidney to enhance sodium and water excretion. Although furosemide is widely used to treat the symptoms of acute decompensated heart failure (ADHF), the consequent activation of the renin-angiotensin-aldosterone system may limit the natriuretic response by reducing the glomerular filtration rate. ⋯ In order to preserve and/or enhance renal function in ADHF, especially with agents such as conventional diuretics and vasodilators, an understanding of intrarenal factors that may protect the kidney may provide a direction for optimal use of current therapies and also lead to newer therapeutic strategies. Vasodilators, especially those that are linked to cGMP activation, may provide an alternative approach.
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Review Case Reports
Treatment of intractable angina pectoris utilizing spinal cord stimulation.
Intractable angina pectoris affects approximately 5% to 15% of patients with ischemic heart disease. Current treatment options for refractory angina can be divided into 3 groups: pharmacological, nonpharmacological noninvasive, and invasive. The newest pharmacological treatment option for intractable angina pectoris is ranolazine. ⋯ Spinal cord stimulation (SCS) as a palliative intervention for refractory angina has been underutilized in the United States. This case review describes application of SCS in a 43-year-old woman with a 10-year history of symptomatic ischemic heart disease who was unresponsive to all available treatment options for intractable severe chest pain. Following spinal cord stimulator placement, the patient reported no further angina, discontinued nitroglycerine, had improved sleep quality, and resumed full-time employment.