Progress in cardiovascular diseases
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Massive pulmonary embolism carries a high mortality rate as a result of right ventricular failure. In addition to anticoagulation, systemic thrombolysis is the standard first line of therapy for patients with life-threatening massive pulmonary embolism. ⋯ Surgical embolectomy is not without inherent risk and limitations. Although there is a paucity of large clinical trials, available data suggests catheter-based treatment of massive pulmonary embolism restores hemodynamic stability and thus is an alternative to surgical therapy.
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Prog Cardiovasc Dis · Jan 2010
ReviewPeripartum cardiomyopathy in Africa: challenges in diagnosis, prognosis, and therapy.
Peripartum cardiomyopathy (PPCM) is a form of heart failure affecting women of childbearing age, which can be associated with considerable mortality and chronic debilitating disease. Most patients present with acute postpartal heart failure that resembles the clinical presentation of idiopathic dilated cardiomyopathy. ⋯ Beyond any potentially inherent factors contributing to poorer outcomes of patients with PPCM in developing societies, prognosis in these settings will continue to lag behind as the challenges faced to optimizing diagnosis remain immense. New insights into the role of inflammatory, apoptotic, and other genetic pathways may improve prognosis through the early detection and more targeted treatment of PPCM.
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Cardiac sarcoidosis is an underdiagnosed disease that may be present in as many as 25% of patients with systemic sarcoidosis. Although most commonly recognized in patients with other manifestations of sarcoidosis, it may occur in isolation and its presence is often not appreciated. ⋯ Although untested in clinical trials, early use of high-dose steroid therapy may halt or reverse cardiac damage. This article reviews the clinical manifestations, diagnosis and treatment of sarcoidosis, with an emphasis on new imaging techniques and therapies.
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Mild therapeutic hypothermia (32 degrees C-34 degrees C) is the only therapy that improved neurological outcome after cardiac arrest in a randomized, controlled trial. Induced hypothermia after successful resuscitation leads to one additional patient with intact neurological outcome for every 6 patients treated. It protects the brain after ischemia by reduction of brain metabolism, attenuation of reactive oxygen species formation, inhibition of excitatory amino acid release, attenuation of the immune response during reperfusion, and inhibition of apoptosis. ⋯ Mild hypothermia is a safe and effective therapy after cardiac arrest, even in hemodynamically compromised patients and in patients undergoing percutaneous coronary intervention. Its use is recommended by the American Heart Association and the International Liaison Committee on Resuscitation for unconscious adult patients with spontaneous circulation after out-of-hospital ventricular fibrillation cardiac arrest. Further research is needed to maximize its potential benefits.
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Rheumatic heart disease is the most serious sequelae of rheumatic fever occurring in approximately 30% of rheumatic fever patients. Patients with acute rheumatic fever may develop varying degrees of pancarditis with associated valve disease, heart failure, and pericarditis. ⋯ Involvement of the mitral valve results in mitral regurgitation and/or stenosis. Where surgery is indicated, mitral valve replacement is usually necessary although in some cases, mitral valve repair is possible.