Journal Of Cardiovascular Emergencies最新文献

{"title":"Budget Impact of Intravenous Iron Therapy with Ferric Carboxymaltose in Patients with Chronic Heart Failure and Iron Deficiency in Romania","authors":"L. Lorenzovici, A. Székely, Szabolcs Farkas-Ráduly, Ciprian Jitaru, M. Csanádi","doi":"10.2478/jce-2019-0018","DOIUrl":"https://doi.org/10.2478/jce-2019-0018","url":null,"abstract":"Abstract Background: Ferric carboxymaltose (FCM) treatment in case of iron deficient (ID) patients with chronic heart failure (CHF) has shown great promise according to the findings of recent studies in improvement of symptoms and quality of life, New York Heart Association (NYHA) classification, and exercise capacity. Aim of the study: The purpose of the current study is to assess the budget impact of treating CHF patients with FCM in a sample of Romanian hospitals. Material and methods: Calculations have been based on the budget impact model developed by Theidel et al. The assumptions and clinical outcomes of the current study were based on a multivariate statistical approach used in the same German study. The predicted outcomes were based on data pooled from four double-blind randomized controlled trials. The time horizon of the model was 1 year. Budget impact calculations were performed from the public payer perspective. Two scenarios have been handled: one without applying the Clawback tax and one with applying the tax to the cost of medication. Results: The yearly budget impact of FCM vs. no iron-replacement treatment without applying the tax ranged between €678,383 and €641,588 for 1,000 patients, resulting in €37 of additional costs per patient per year. The yearly budget impact of FCM vs. no iron-replacement treatment with applying the tax ranged between €616,934 and €641,588 for 1,000 patients, resulting in €9 of cost reduction per patient per year. Key cost drivers included the cost of outpatient visits and the cost of hospitalization due to HF worsening. Sensitivity analysis for both scenarios proved the robustness of the results. Conclusions: The FCM treatment of CHF patients has a moderate budget impact. Moreover, this budget impact/saving translates into a reduction of the rate and length of hospitalization stay and a better symptomatic profile of the patients.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"1 1","pages":"131 - 139"},"PeriodicalIF":0.4,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88579993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern Management of Hypertensive Emergencies","authors":"Monica Marton-Popovici","doi":"10.2478/jce-2019-0020","DOIUrl":"https://doi.org/10.2478/jce-2019-0020","url":null,"abstract":"Abstract Hypertensive emergencies (HE) represent critical conditions in which extremely high blood pressure values are accompanied by acute hypertension-mediated organ damage. In this clinical setting, the main therapeutic goal is represented by the immediate reduction of blood pressure, in order to limit the extension or promote the regression of target organ damage. At present, HE are classified according to the condition or target organ involved, into: (1) malignant hypertension with or without thrombotic microangiopathy; (2) coronary ischemia or acute cardiogenic pulmonary edema; (3) acute stroke or hypertensive encephalopathy; (4) acute aortic dissection or aneurysm; and (5) eclampsia or severe preeclampsia/HELLP syndrome. The management of these conditions is different in relation to the complex pathophysiology involved in each of these types. This mini-review presents the main characteristics and management strategy for different forms of HE, revealing the particularities of management strategy for each of them.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"1 1","pages":"126 - 130"},"PeriodicalIF":0.4,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83043281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large-vessel Giant Cell Arteritis: A Rare Cause of Acute Upper Limb Ischemia – Case Presentation and Review of the Literature","authors":"K. Makó, C. Ureche, E. Horváth","doi":"10.2478/jce-2019-0017","DOIUrl":"https://doi.org/10.2478/jce-2019-0017","url":null,"abstract":"Abstract Introduction: Acute upper extremity ischemia is an uncommon vascular emergency due to a relatively rich collateral network and low workload of the upper limb. Its consequences depend on the site and etiology of the arterial occlusion. Case presentation: Aiming to emphasize the emerging role of Doppler ultrasound in the diagnosis of acute upper limb ischemia, we report the case of a 70-year-old female, with severe left arm resting pain and digital cyanosis. Due to the patient’s age and the presence of cardiovascular risk factors, cardioembolic or thrombotic arterial occlusion would have been the most likely diagnosis in this case, but the color Doppler ultrasound revealed severe left axillary arterial stenosis with hypoechoic wall swelling, being highly suggestive for arteritis. Temporal artery biopsy was performed, which confirmed giant cell arteritis. An excellent clinical response was obtained after initiation of treatment. Conclusion: In acute upper limb ischemia, color duplex ultrasound provides quick information about the etiology and localization of arterial lesions, offering characteristic findings in case of large-vessel giant cell arteritis.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"46 1","pages":"148 - 153"},"PeriodicalIF":0.4,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73992602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Guitaring Technique with 035 Wire and Perforated Coronary Balloon for Thrombolysis in the Treatment of Acute Deep Vein Thrombosis","authors":"M. Arokiaraj","doi":"10.2478/jce-2019-0012","DOIUrl":"https://doi.org/10.2478/jce-2019-0012","url":null,"abstract":"Abstract A patient who underwent thrombolysis and inferior vena cava filter implantation for acute deep vein thrombosis treatment nine years before, presented with deep vein thrombosis on the other limb. The venous angiogram showed deep vein thrombosis in the ilio-femoral vessels. Through left femoral vein puncture, a 6F right Judkins diagnostic catheter was advanced up to the proximal iliac veins, and further advancement was not possible. Hence, a 035 hydrophilic wire was advanced, and through a guitaring technique, the clots were disrupted at the mid-thigh level. Through a 014 coronary wire, a punctured coronary balloon was placed at the distal mid-thigh level, and intravascular thrombolysis was performed for 12 hours, followed by removal of the balloon and the right coronary Judkins catheters. The leg swelling reduced in the first day, and subsequently, the patient was followed up for 7 months with anticoagulation and good resolution of the symptoms.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"23 1","pages":"104 - 107"},"PeriodicalIF":0.4,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73169120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Results of Thrombolytic Treatment in Patients With High-risk Pulmonary Embolism","authors":"A. Ataş, A. Sarac, A. Dirican, Nazlı Topbaşı, T. Uzar, Ladan Rastgar, P. Ekaterina, S. Ozkaya","doi":"10.2478/jce-2019-0013","DOIUrl":"https://doi.org/10.2478/jce-2019-0013","url":null,"abstract":"Abstract Background: Mortality rates due to massive pulmonary embolism (PE) are much higher than estimated. Although thrombolytic therapy is controversial, it can be a life-saving procedure and can be safely used in patients with massive PE. Study aim: We aimed to share the results of thrombolytic treatment in patients with massive PE. Material and methods: We retrospectively evaluated 72 patients with PE admitted between January 2010 and April 2018 to the Department of Pulmonary Medicine, VM Medicalpark Samsun Hospital, Samsun, Turkey. The data of patients who received thrombolytic treatment were retrospectively analyzed. Results: The female to male ratio was 24/48, with a mean age of 62.7 ± 12.6 (minimum 27, maximum 88) years. The diagnosis of massive PE was established with echocardiography in all patients and was confirmed via pulmonary CT angiography in 45 patients (62.5%) who presented an appropriate clinical status for this imaging technique. The most common symptoms were dyspnea (90.3%), chest pain (83.3%), and syncope (40.2%). The S1Q3T3 electrocardiography pattern was noted in 82% of patients, who rapidly recovered after thrombolytic therapy. Cardiopulmonary arrest was seen in 25 patients (37.2%), and thrombolytic treatment was administered during cardiopulmonary resuscitation in 18% (n = 13) of patients. The survival rate was 30.7% (n = 4) in patients with cardiopulmonary arrest who received thrombolytic treatment in the emergency room. The complications of rt-PA treatment included minor hemorrhages in 6.4% (n = 5), major hemorrhages in 2.7% (n = 2), and allergic reactions in 1.3% (n = 1) of patients. None of the patients had deceased as a complication of thrombolytic treatment. The overall mortality rate was 26.2% (n = 19), and 12.5% (n = 9) of the patients have died in first 24 hours after thrombolysis. Conclusions: We concluded that the risk factors, ECG, and echocardiography are key indicators for the suspicion of massive PE in patients with hemodynamic shock. Based on our experience, early thrombolytic therapy is a life-saving intervention in patients with diagnosed and/or suspected massive PE.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"32 1","pages":"92 - 98"},"PeriodicalIF":0.4,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84230804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mobilization of Patients Suffering from Acute Myocardial Infarction – When Is It Too Early?","authors":"D. Opincariu, R. Hodaș","doi":"10.2478/jce-2019-0014","DOIUrl":"https://doi.org/10.2478/jce-2019-0014","url":null,"abstract":"Abstract The significant raise in the number of patients surviving an acute myocardial infarction (AMI) has increased the burden of morbidity and disability due to acute coronary events. This has led to an increasing awareness on the need to develop specific rehabilitation programs, both during the acute phase, as well as in out-patient settings. In the pre-revascularization era, AMI was treated in bed. Regardless of the known therapeutic benefits of bed rest, there are scarce data regarding a standardized protocol for the early rehabilitation of patients with AMI. An extensive group of AMI patients are still exposed to prolonged immobilization, with current data showing a disparity in the length of post-MI bed rest, with a time of immobilization reported to be from 2 to 12 days and 2 to 28 days. The growing body of evidence on the effects of early cardiac rehabilitation programs following an AMI suggests that early mobilization after the index event could improve the inflammatory response and further modulate the ventricular remodeling process. The timing, duration, and intensity of cardiac mobilization has not yet been established, and further research on the effects of mobilization as early as the first 12 to 24 hours after the acute event could be beneficial for both short- and long-term outcomes, inflammation, and ventricular remodeling with subsequent heart failure.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"48 1","pages":"103 - 99"},"PeriodicalIF":0.4,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89985380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombocytopenia and Coronary Artery Disease, the Existing Dilemmas","authors":"I. Davarashvili, T. Hasin, E. Asher","doi":"10.2478/jce-2019-0011","DOIUrl":"https://doi.org/10.2478/jce-2019-0011","url":null,"abstract":"Abstract Background: Platelets play a pivotal role in the pathogenesis of acute coronary syndrome (ACS) and acute or chronic complications following percutaneous coronary intervention (PCI) as well. Platelet inhibition is a cornerstone treatment in the management of these patients. Thrombocytopenia in patients with ACS is uncommon. Idiopathic thrombocytopenic purpura (ITP) is a rare phenomenon; nevertheless, some case series presenting concomitant ACS and ITP have been described in the literature. The safety of antiplatelet therapy and PCI in patients who have ACS and thrombocytopenia is limited. Case summary: We present a case of a 60-year-old patient with ITP who was admitted with unstable angina pectoris. On admission, the platelet count was 23 × 109/L. Coronary CT angiography revealed severe stenosis in the mid portion of RCA. After one-week treatment with high-dose Prednisolone, the platelet count recovered, and coronary catheterization was performed. Successful PCI to the RCA with drug-eluting stent was performed. The patient was discharged on dual antiplatelet therapy. Conclusion: The case suggests that PCI is a suitable treatment for ITP patients with ACS. Hemostasis is the major concern in managing these patients. The treatment strategy may be based on platelet function rather than platelet count alone. Further analysis of antiplatelet therapies as mono or dual therapy are needed.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"39 1","pages":"108 - 111"},"PeriodicalIF":0.4,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84435415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MINOCA Today – Are We There Yet?","authors":"A. Mester","doi":"10.2478/jce-2019-0015","DOIUrl":"https://doi.org/10.2478/jce-2019-0015","url":null,"abstract":"In the last few years, the concept of myocardial infarction with non-obstructive coronary artery disease (MINOCA) has been one of the emerging hot topics in the field of cardiovascular medicine. The most recent studies in this field, focused on multiple approaches including invasive and noninvasive imaging techniques or various laboratory biomarkers, did not succeed to completely elucidate this frequent cause of acute myocardial infarction (AMI). The consensus papers published by the working groups of the European Society of Cardiology (ESC) have established the diagnostic criteria for MINOCA, defined as the absence of stenosis higher than 50% in an epicardial coronary artery at coronary angiography, in the clinical context of an AMI. At the same time, the Fourth Universal Definition of Myocardial Infarction, published in 2018, acknowledges this condition as a separate entity.1,2","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"6 5 1","pages":"89 - 91"},"PeriodicalIF":0.4,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80202046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrical Storm Due to Active Myocardial Ischemia in the Right Coronary Artery Territory – Case Report","authors":"D. Păsăroiu, Z. Parajkó, N. Mitra, D. Opincariu","doi":"10.2478/jce-2019-0009","DOIUrl":"https://doi.org/10.2478/jce-2019-0009","url":null,"abstract":"Abstract Electrical storm is defined by at least three episodes of sustained ventricular tachyarrhythmias or appropriate shocks given by implantable cardiac defibrillator devices (ICD), occurring within a period of 24 hours. In the present manuscript, we present the case of a 69-year-old female patient with previous aortocoronary bypass, who was admitted from the Emergency Department after presenting several episodes of syncope in prehospital settings and presented 4 episodes of sustained ventricular tachycardia which required electrical cardioversion. The arrhythmia disappeared after percutaneous revascularization of a chronic occlusion in the right coronary artery. In this case, the implantation of an ICD was avoided, as a reversible cause of ES has been identified and treated.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"54 1","pages":"72 - 77"},"PeriodicalIF":0.4,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88691138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Multivessel Coronary Artery Disease on Long Term Prognosis in Patients with ST-segment Elevation Myocardial Infarction","authors":"L. Savic, I. Mrdovic, M. Ašanin, S. Stanković, G. Krljanac, R. Lasica","doi":"10.2478/jce-2019-0006","DOIUrl":"https://doi.org/10.2478/jce-2019-0006","url":null,"abstract":"Abstract Background: A significant proportion of patients with ST-segment elevation myocardial infarction (STEMI) have multivessel coronary artery disease (MVD), and they are at high risk for recurrent cardiac events. The aim of the present study was to analyze the impact of MVD on long-term cardiovascular mortality in STEMI patients treated with primary percutaneous coronary intervention (pPCI). Method: This study included 3,115 consecutive STEMI patients hospitalized in the Coronary Care Unit of the Clinical Centre of Serbia, between November 2005 and January 2012. Patients were divided in two groups: MVD and no MVD. MVD disease was defined as stenosis greater than 50% by visual assessment in more than one major coronary artery. Primary PCI was limited to the infarct-related artery (IRA). Cardiovascular mortality was defined as any death from cardiovascular reason (myocardial reinfarction, low-output heart failure, and sudden death). Patients presenting with cardiogenic shock were excluded. Patients were followed-up for 6 years after enrollment. Results: Among 3,115 analyzed patients, 1,352 (43.4%) patients had no MVD and 1,763 (56.6%) had MVD; among patients with MVD, 926 (52.6%) had two-vessel disease and 837 (47.4%) had three-vessel disease. Compared with patients with single-vessel disease, patients with MVD were older, had longer pain duration, and presented more often with heart failure; they were more likely to have previous coronary artery disease, diabetes, hypertension, and chronic kidney disease; post-procedural flow TIMI <3 was more frequently observed in patients with MVD than in patients with no MVD (5.9% vs. 3.1%, p <0.001). Patients with MVD had lower left ventricular ejection fraction than patients with single-vessel disease: 45% (interquartile range [IQR] 40¬–55%) vs. 50% (IQR 43–55%), p <0.001. Revascularization of non-IRA lesions was performed at index hospitalization in 1,075 (61%) patients, and in 602 (34.1%) patients revascularization was performed in the first few months after pPCI (median 1.5 months, IQR 1–2.5 months); coronary artery bypass grafting was performed in 291 (18.4%) patients and PCI (with stent implantation) in 1,368 (81.6%) patients. Six-year cardiovascular mortality was significantly higher in patients with MVD than in patients with single-vessel disease (10.4% vs. 4.6%, p <0.001). In multivariate Cox regression analysis, MVD remained an independent predictor for 6-year cardiovascular mortality (HR 1.55, 95% CI 1.11–2.06, p = 0.041). Conclusion: In STEMI patients treated with pPCI, the presence of MVD remained an independent predictor for higher long-term cardiovascular mortality despite early revascularization of the remaining stenosis in non-IRA.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"28 1","pages":"66 - 71"},"PeriodicalIF":0.4,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90624645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}