Italian heart journal : official journal of the Italian Federation of Cardiology
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Although automated external defibrillators (AEDs) have been available for adults for more than 20 years, their use in children under 8 years of age has been approved by the International Liaison Committee on Resuscitation (ILCOR) as recently as June 2003. The following concerns about AEDs limited their use in children: amount of delivered energy, effect of biphasic waveforms in children, pad size, and capacity of detecting pediatric shockable and non-shockable rhythms. ⋯ This perspective briefly describes the main advances which heralded the new recommendations of ILCOR. Randomized clinical trials are now needed to identify whether these new pediatric devices can improve the outcome of pediatric cardiac arrest.
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5-Fluorouracil, a widely used drug in cancer treatment, is known to have cardiotoxic effects: chest pain with ECG changes, arrhythmias, arterial hypertension or hypotension, myocardial infarction, cardiogenic shock and sudden death have been described in the literature. Coronary artery vasospasm is the pathogenetic mechanism hypothesized in most cases, but mechanisms other than myocardial ischemia had been advocated in some patients. The approach to the patient with persistent chest pain, despite therapy and persistent ST-segment elevation mimicking an acute myocardial infarction, has not been well addressed, and the appropriate diagnostic and therapeutic pathways have not yet been defined. ⋯ One patient was treated with systemic fibrinolysis, and coronary angiography was performed 6 days later; the other was submitted to urgent coronary angiography shortly after admission. In both cases the ECG and echocardiographic abnormalities were transient and normalized within a few days, the serum markers of myocardial necrosis were persistently in the normal range and the coronary artery trees were normal. The diagnostic and therapeutic approach to patients with this unusual clinical presentation is also discussed.
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We report a case of a 22-year-old Ethiopian female presenting with multiple rheumatic valve disease. She was admitted to hospital because of dyspnea at rest. She underwent open mitral commissurotomy associated with splitting of the postero-medial papillary muscle, aortic right-coronary-left coronary commissural resuspension with resection of fibrous tissue from the free-edge cusps and open tricuspid commissurotomy of all three commissures completed with chordal shortening of the anterior leaflet. ⋯ The patient was asymptomatic without recurrence of symptoms at 2 months. Echocardiography confirmed the satisfactory outcome of the multiple repair with no residual insufficiency. Multiple repair is advisable for patients living in many areas of the Third World, where the safety of long-term anticoagulation cannot be assured.
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Multicenter Study Comparative Study
Treatment modalities of non-ST-elevation acute coronary syndromes in the real world. Results of the prospective R.OS.A.I.-2 registry.
Despite advances in the treatment of non-ST-elevation acute coronary syndromes (ACS) based on randomized studies and published guidelines, the extent to which such treatments are applied in daily clinical practice remains elusive. The R.OS.A.I.-2 registry was undertaken to assess the modalities of the treatment of non-ST-elevation ACS, both in terms of the use of drugs, with particular attention to glycoprotein IIb/IIIa inhibitors and clopidogrel, as well as type of strategy, aggressive versus conservative, in a consecutive series of patients admitted to 76 coronary care units (CCU) in Italy. ⋯ The R.OS.A.I.-2 registry confirms that the population admitted to the CCU with non-ST-elevation ACS has a higher risk profile than that included in recent clinical trials. The aggressive approach is still more dependent on the cath lab availability than on a risk stratification process. Conservatively treated patients have worse clinical features and short-term prognosis. Applying an invasive approach to higher risk groups might further improve the global outcome of non-ST-elevation ACS.
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Transesophageal echocardiography (TEE) is the method of choice for the evaluation of the left atrium and of left atrial appendage (LAA) thrombosis. However, the anatomy of the left appendage is complex and reverberations from anatomical structures may create images and ghosting which mimic left atrial thrombosis. The purpose of this study was to investigate whether a systematic approach through TEE may facilitate the recognition of LAA anatomical variants and artifacts. ⋯ A systematic approach with multiplane TEE facilitates the evaluation of the LAA anatomy and the recognition of artifacts, thus reducing the likelihood of false positive or negative diagnoses of left appendage thrombi.