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BACKGROUND: Breast implants interfere may interfere with surface ECG recording. The goal of this study was to evaluate if the presence of breast implants can lead to abnormal electrocardiogram (ECG) using a large database in adults. METHODS: Using ICD 10 codes for breast implants and abnormal ECG, we evaluated any association between abnormal ECG coding in adult women with breast implants compared to women without breast implants utilizing the National Inpatient Sample (NIS) database. Using different age cutoffs showed similar results. RESULTS: A total of 252,200 women in the NIS database had coding for abnormal EKG over age 18. There were no differences in the presence of abnormal EKG in women with or without breast implants (0.28% vs 0.3%, P = 0.64, OR: 1.02, CI: 0.72-1.32, p = 0.89). After multivariate adjustment for age, baseline characteristics, and comorbid conditions, women with or without breast implants had similar rates of abnormal ECG. CONCLUSION: Using a large database, we could not find any effect of breast implants on ECG recording suggesting that breast implant has no significant interference with ECG.
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Implantes de Mama , Eletrocardiografia , Humanos , Feminino , Pessoa de Meia-Idade , Implantes de Mama/efeitos adversos , Adulto , Estados Unidos/epidemiologia , Fatores de Risco , Artefatos , IdosoRESUMO
An acute migraine attack is a very painful condition and can be difficult to treat. Pharmacological treatments are limited by significant side effects and limited efficacy. There are anecdotal reports suggesting that acute migraine attacks could be treated using pressure point stimulation between the thumb and index fingers. There are no scientific published data to evaluate the effectiveness of this trigger point. Using rhythmic pressure applied to the trigger point between the index finger and thumb, we report the effectiveness of this method in 6 of 7 cases. This technique can effectively break acute migraine attacks in a matter of minutes. The pressure must be applied in a rhythmic cycle without causing significant pain. A detailed description of this technique in successfully treated cases is described in this manuscript.
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Transtornos de Enxaqueca , Polegar , Humanos , Transtornos de Enxaqueca/tratamento farmacológico , Dor/tratamento farmacológico , Administração Oral , Resultado do TratamentoRESUMO
Platelets play an integral role in the pathogenesis of acute coronary syndrome (ACS). The purpose of this study was to investigate any correlation between immune thrombocytopenia (ITP) and non-ST segment elevation myocardial infarction (NTSEMI), a common presentation of ACS. Using the large Nationwide Inpatient Sample (NIS) database, we studied any correlation between NSTEMI and ITP utilizing ICD-9 codes. We performed uni- and multivariate analysis adjusting for risk factors from the years 2002-2011. Data was extracted from 106,653 ITP patients and 79,636,090 controls. In multiple years of the study period (2002-2011), NSTEMI incidence was significantly higher in ITP patients when compared with non-ITP patients in the univariate analysis (odds ratio average 1.226). However, no significant association was found after adjusting for additional risk factors in multivariate analysis. Based on our large database study, ITP is not independently associated with NSTEMI incidence after adjusting for comorbidity.
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Infarto do Miocárdio sem Supradesnível do Segmento ST/etiologia , Púrpura Trombocitopênica Idiopática/complicações , Feminino , Humanos , Incidência , Masculino , Análise Multivariada , Fatores de RiscoRESUMO
Reduction in X-ray exposure during cardiac catheterization is important to reduce radiation risks to operators and personnel. Reducing scattered radiation from the patient can achieve this goal. The goal of this study was to evaluate the reduction in radiation using simple partial shielding of patients undergoing cardiac catheterization. By putting a lead-based apron on the lower extremities of patients undergoing cardiac catheterization, we analyzed the reduction in total radiation dose with and without this shielding. One hundred and twelve patients were divided into two groups. In one group, the protective lead-based apron was put on the lower extremities of patients. Another group did not have any shielding. Total duration of angiography was 332 minutes and 45 seconds in the first group and 269 minutes and 10 seconds in the second group. The total radiation exposure was 33 µGy in the first group vs 606 µGy in the second group. Despite higher exposure time, total radiation dose was 22 times lower in the simple shielded group. Our simple method without any additional cost can significantly reduce radiation exposure in the cardiac catheterization laboratory.
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Exposição à Radiação , Proteção Radiológica , Cateterismo Cardíaco/efeitos adversos , Redução da Medicação , Humanos , Doses de Radiação , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controleRESUMO
Objective: The study objective was to determine if peri-operative bridging anticoagulation in patients with atrial fibrillation is beneficial or harmful.Design: Systematic review and meta-analysis.Setting: Inpatient or in-hospital setting.Participants: Adults with atrial fibrillation having a CHADS2 score >1 undergoing elective surgical procedure on anticoagulation.Methods: A systemic search of multiple databases (Cochrane, Medline, PubMed) was performed regarding studies conducted on efficacy and safety of perioperative bridging anticoagulation in patients with atrial fibrillation. Studies identified were reviewed by two authors individually before inclusion. The results were then pooled using Review Manager to determine the combined effect. Stroke/systemic embolism was considered as the primary efficacy outcome. Major bleeding was the primary safety outcome.Results: The systematic search revealed 108 potential articles. The full texts of 28 articles were retrieved for assessment of eligibility. After full text review, 25 articles were excluded. Three articles met inclusion criteria. No significant difference in stroke/systemic embolism with bridging anticoagulation was noted (risk ratio, 1.25-95% confidence interval [CI], 0.55-2.85). Bridging was associated with significantly higher risk of major bleeding (risk ratio, 3.29-95% CI, 2.25-4.81).Conclusion: An individualized approach is required when initiating peri-operative bridging anticoagulation. There is certainly a higher risk of bleeding with bridging anticoagulation and no difference in stroke/systemic embolism. However, the results cannot be extrapolated to patients who have valvular atrial fibrillation or CHADS2 score of 5 or greater.
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Fibrilação Atrial , Acidente Vascular Cerebral , Adulto , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Procedimentos Cirúrgicos Eletivos , Hemorragia , Humanos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , VarfarinaRESUMO
Aortic valve disease (AVD) has similarities to atherosclerosis in the case of aortic stenosis. The important role of platelet in the pathogenesis of atherosclerosis is known. The goal of this study is to evaluate whether platelet disorders play any role in aortic valve disease. We used patients with idiopathic thrombocytopenic purpura (ITP) for this study. We evaluated any association between ITP and AVD using a large inpatient database. The International Classification of Diseases, Ninth Revision, and Clinical Modification (ICD-9-CM) codes for ITP and AVD from the Nationwide Inpatient Sample (NIS) database were used for this study. Uni- and multivariate analyses were performed on data from 2002 to 2011 to evaluate any association between ITP and AVD. In the 2002 database, AVD was present in 1.73% of ITP patients versus 1.12% in the control population (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.34-1.81; p < 0.001). In the 2011 database, AVD was present in 1.96% of ITP patients versus 1.33% in the control population (OR, 1.48; 95% CI, 1.30-1.68; p < 0.001). ITP remained independently associated with AVD following a multivariate logistic regression analysis adjusting for age, gender, diabetes mellitus, hypertension, and hyperlipidemia in 2002 (OR, 1.35; 95% CI, 1.16-1.57; p < 0.001) with a trend of this association in 2011 (OR, 1.12; 95% CI, 0.98-1.27; p = 0.096). ITP was strongly associated with AVD over the 10-year period analyzed in a large inpatient database. The reason for this association is not known warranting further investigations.
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Insuficiência da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/epidemiologia , Púrpura Trombocitopênica Idiopática/epidemiologia , Idoso , Insuficiência da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/diagnóstico , Bases de Dados Factuais/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/tendências , Prevalência , Púrpura Trombocitopênica Idiopática/diagnóstico , Estudos RetrospectivosRESUMO
OBJECTIVE: Acute coronary syndrome is frequently complicated by rhythm disturbances, yet any association between high-density lipoprotein (HDL) cholesterol levels and arrhythmias in the setting of non-ST-segment elevation myocardial infarction (non-STEMI) is uncertain. The goal of this study was to evaluate any association between HDL-cholesterol levels and arrhythmias in the setting of non-STEMI. METHODS: Retrospective data from Phoenix Veterans Affair Medical Center records were utilized for our study. A total of 6881 patients were found who presented during 2000 to 2003 with non-STEMI with available fasting lipid panels collected within the first 24 hours of admission. Patients were followed for the development of rhythm disturbances up to 6 years after initial presentation, with a mean follow up of 1269 days. RESULTS: We found that high triglycerides/HDL and low-density lipid/HDL ratios were predictive of arrhythmias. However, low HDL levels had strongest association with highest odds ratio (OR) for development of arrhythmias (for HDL <31 mg/dL, OR = 3.72, 95% confidence interval [CI] = 2.55-5.44, P < .05) in patients with diabetes and (for HDL < 31 mg/dL, OR = 3.69, 95% CI = 2.85-4.71, P < .05) in patients without diabetes. Using multivariate analysis adjusting for comorbidities, low HDL level remained independently associated with arrhythmias. CONCLUSIONS: Patients with low HDL levels during hospitalization with non-STEMI have a greater risk of developing cardiac rhythm disturbances independent of other risk factors. These data suggest a possible protective role of HDL in preventing arrhythmias in the setting of acute coronary syndrome.
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Síndrome Coronariana Aguda/sangue , Arritmias Cardíacas/etiologia , Fibrilação Atrial/etiologia , HDL-Colesterol/sangue , Síndrome Coronariana Aguda/complicações , Idoso , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Lipoproteínas LDL/sangue , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Triglicerídeos/sangueRESUMO
Statins are currently the primary treatment for hyperlipidemia, particularly for the treatment of high levels of low-density lipoprotein cholesterol (LDL-C), as many studies have proven benefit in a variety of populations. The benefits of statin treatment for high cholesterol have been proven in many trials. Forefront among different adverse events is statin-induced myopathy, which still eludes complete understanding, and may range anywhere from muscle soreness or fatigue to potentially extremely rare occurrence of rhabdomyolysis.As most adverse events are rare and not life-threatening, in high-risk patients, a high-dose statin should be started initially as data suggests that clinicians rarely up titrate statin therapy after initial prescription leading to under-treatment of many patients requiring high-dose statin therapy. As we will discuss in this paper, musculoskeletal side effects are the main concern and reason for discontinuing statin therapy. The occurrence and true association of other adverse events in patients on statin such as new onset of diabetes, hepatic toxicity, or cognitive impairment are rare, controversial, and not proven. In placebo-controlled studies, abnormal liver function occurs to a similar degree in statin- and placebo-treated patients. This led to FDA removal of the requirement to monitor liver function tests in patients on statin therapy.The combination of statins with other compounds such as ezetimibe or PCSK9 inhibitors has shown some additional benefits in the treatment of hypercholesterolemia. The goal of this manuscript is to conduct a comprehensive review about most commonly used statins and compare data on their history, structures, benefits, adverse effects, and clinical outcomes.
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LDL-Colesterol/sangue , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Animais , Biomarcadores/sangue , Regulação para Baixo , Quimioterapia Combinada , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hipercolesterolemia/sangue , Hipercolesterolemia/diagnóstico , Rabdomiólise/induzido quimicamente , Medição de Risco , Fatores de Risco , Resultado do TratamentoAssuntos
Infarto do Miocárdio sem Supradesnível do Segmento ST , Inibidores da Agregação Plaquetária , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Hemorragia/induzido quimicamente , Hemorragia/prevenção & controle , Cateterismo Cardíaco/efeitos adversos , Endoscopia , Resultado do TratamentoRESUMO
The use of atrial septal device occluders can lead to device embolization. This major complication can occur due to loose margins, deficient aorta, or thin and floppy posterior rim. Device embolization most often occurs after device release, and retrieval is essential. Many devices, including snare and bioptome, have been utilized for retrieval. However, performing these procedures can be difficult and time consuming. Failure to retrieve the embolized device requires open heart surgery. We report a novel and easy to perform method, "coronary wire trap technique," in the event of retrieval failure using conventionally available devices and snare, thereby preventing open-heart surgery. © 2017 Wiley Periodicals, Inc.
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Aorta Torácica , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/métodos , Cateteres Cardíacos , Remoção de Dispositivo/instrumentação , Forame Oval Patente/terapia , Migração de Corpo Estranho/terapia , Artéria Pulmonar , Dispositivo para Oclusão Septal , Adulto , Aorta Torácica/diagnóstico por imagem , Cateterismo Cardíaco/efeitos adversos , Feminino , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/cirurgia , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Pessoa de Meia-Idade , Desenho de Prótese , Artéria Pulmonar/diagnóstico por imagem , Radiografia Intervencionista , Resultado do TratamentoRESUMO
A single left coronary artery is a rare coronary anomaly. In such situations, the right coronary artery arises from the left anterior descending artery and traverses an unusual proximal course between the aorta and pulmonary trunk. There are only 10 such reported cases in the medical literature to date. After a detailed risk-to-benefit consideration, the decision was made for conservative management. In this report, we describe this rare case with a detailed review of the literature.
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Limitations of current antiplatelet therapies have led to the discovery of new antiplatelet agents with new modes of action. Vorapaxar has been developed as a thrombin receptor antagonist. This drug works against the protease-activated receptor 1 (PAR1) and inhibits platelet aggregation mediated by PAR1. This article reviews this new class of antiplatelet therapy in detail with an acute focus on the TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) and TRA 2°P-TIMI 50 (Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients With Atherosclerosis-Thrombolysis In Myocardial Infarction 50) trials. Vorapaxar has proven to be beneficial when administered to stable atherosclerotic patients. However, it has been shown to increase risk of intracranial hemorrhage in patients with known, previous history of cerebrovascular incidence. Despite these limitations, TRA 2°P-TIMI 50 results showed that vorapaxar appears to have a definitive therapeutic benefit when administered alongside aspirin or when it is used as an addition to dual antiplatelet therapy for patients with stable atherosclerosis.
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More than 1 million cardiac catheterizations are performed every year in the United States, and incur substantial risk of access site bleeding. Furthermore, insertion of central venous catheters and performance of pericardio- or pleurocentesis are common practice, also with substantial risk of vascular or organ injury. One of the major risks for access site bleeding is multiple or posterior arterial puncture with a large needle. Using a very small needle to obtain initial access to vessels or organ cavities has the potential to reduce the risk of bleeding or organ injury. Multiple unsuccessful attempts to achieve vascular access are more forgiving, and accidental organ injury during pericardio- or pleurocentesis is less traumatic when using a small micropuncture needle. This article reviews the use of micropuncture technique for vascular or organ cavity access, a technique that has the potential to decrease vascular access site complications and organ injury.
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BACKGROUND: Early detection and follow-up of abdominal aortic aneurysm (AAA) are important and can be lifesaving. The goal of this study was to evaluate if routine abdominal aorta screenings during echocardiograms can be helpful in detecting asymptomatic abdominal aortic aneurysm. METHODS: We retrospective studied consecutive patients who were sent for outpatient routine echocardiograms for various clinical reasons in 2015-2017 until we reached a total of 1000 patients. Starting from the subcostal and then proceeding to the abdomen, a long-axis screening of the abdominal aorta was attempted on all of the patients after the echocardiogram was completed. No patient preparation was given. Imaging began from the subcostal view and proceeded caudally with images obtained every 1-2 cm. Measurement of the aortic diameter was performed from the longitudinal plane using the leading-edge-to-leading-edge method. RESULTS: The age range was 33-96 years with a median age of 72.4. A total of 273 (27.3%) patients did not have an appropriate window to evaluate AAA. Among the remaining 727 screenings, 18 (2.4%) had dilatation of abdominal aorta or AAA. The dilatation and aneurysms ranged between 2.5 and 4.5 cm in size. Abnormal aortic diameters were as follows: 5 (27.7%) were between 2.5 and 2.9 cm, 6 (33.3%) between 3 and 3.4 cm, 1 (5.5%) between 3.5 and 3.9, 5 (27.7%) between 4.0 and 4.4 cm, and 1 (5.5%) between 4.5 and 4.9 cm. CONCLUSIONS: Performing routine abdominal aortic examinations during routine echocardiographic exams can detect a significant amount of abdominal aortic aneurysm which can be lifesaving. We suggest adding abdominal aortic assessment to routine echocardiographic examination.
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Aneurisma da Aorta Abdominal , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/epidemiologia , Ecocardiografia , Aorta Abdominal/diagnóstico por imagemRESUMO
BACKGROUND: The prevalence of hypertrophic cardiomyopathy (HCM) can be silent and can present with sudden death as the first manifestation of this disease. The goal of this study was to evaluate any association between reported physical symptoms with the presence of suspected HCM. METHOD: The Anthony Bates Foundation has been performing screening echocardiography across the United States for prevention of sudden death since 2001. A total of 4120 subjects between the ages of 4 and 79 underwent echocardiographic screening. We evaluated any association between various symptoms and suspected HCM defined as any left ventricular wall thickness³ ≥15 mm. RESULTS: The total prevalence of suspected HCM in the entire study population was 1.1%. The presence of physical symptoms was not associated with HCM (chest pain in 4.3% of participants with HCM vs. 9.9% of the control, P = 0.19, palpitation in 4.3% of participants with HCM vs. 7.3% of the control, P = 0.41, shortness of breath in 6.4% of participant with HCM vs. 11.7% of the control, P = 0.26, lightheadedness in 4.3% of participant with HCM vs. 13.1% of the control, P = 0.07, ankle swelling in 2.1% of participant with HCM vs. 4.0% of the control, P = 0.52, dizziness in 8.5% of participant with HCM vs. 12.2% of the control, P = 0.44). CONCLUSIONS: Echocardiographic presence of suspected HCM is not associated with a higher prevalence of physical symptoms in the participants undergoing screening echocardiography.
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Cardiomiopatia Hipertrófica , Ecocardiografia , Programas de Rastreamento , Humanos , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/epidemiologia , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Masculino , Feminino , Ecocardiografia/métodos , Pessoa de Meia-Idade , Idoso , Adulto , Adolescente , Programas de Rastreamento/métodos , Adulto Jovem , Prevalência , Estados Unidos/epidemiologia , Criança , Pré-Escolar , Dor no Peito/etiologia , Dor no Peito/epidemiologia , Dor no Peito/diagnósticoRESUMO
INTRODUCTION: Coronary perforation is one of the major complications of percutaneous coronary intervention (PCI). The goal of this study was to evaluate adverse outcomes and mortality in patients suffering from coronary perforation during PCI above the age of 30. METHODS: The National Inpatient Sample (NIS) database, years 2016-2020, was studied using ICD 10 codes. Patients suffering from perforation were compared to patients without perforation during PCI. RESULTS: PCI was performed in a weighted total of 10,059,269 patients. Coronary perforation occurred in 11,725 (0.12 %) of all PCI performed. The mortality rate of patients with perforations was very high in comparison to patients without perforations. (12.9% vs 2.5%, OR: 5.6, CI:5-6.3 p<0.001). Furthermore, patients with coronary perforations had much higher rates of urgent coronary bypass surgery, tamponade, cardiac arrest, and major cardiovascular outcomes. Mortality remained high and over 10% in the 5-year study period. CONCLUSION: Using a large national inpatient database, all-cause inpatient mortality in patients with coronary perforation is very high (over 10%) with persistently high mortality rates over the years study suggesting that treatment of perforations needs further improvement.