Polycythemia Vera Presenting as Cardiac Arrest: Novel Management Strategies.

Acute coronary syndromes (ACS) usually occur in patients with multiple cardiac risk factors. In young adults, drug use and hypercoagulable states are common causes for ACS presentations. We report a case of a man in his early 30s who was diagnosed with polycythemia vera (PV) and had a cardiac arrest due to an anterolateral ST elevation myocardial infarction. We discuss his unique management and review the evidence on the management of arterial thromboembolism in PV patients.

Effectiveness of renal denervation therapy for resistant hypertension: a systematic review and meta-analysis.

OBJECTIVES: This study sought to determine the current effectiveness and safety of sympathetic renal denervation (RDN) for resistant hypertension. BACKGROUND: RDN is a novel approach that has been evaluated in multiple small studies. METHODS: We performed a systematic review and meta-analysis of published studies evaluating the effect of RDN in patients with resistant hypertension. Studies were stratified according to controlled versus uncontrolled design and analyzed using random-effects meta-analysis models. RESULTS: We identified 2 randomized controlled trials, 1 observational study with a control group, and 9 observational studies without a control group. In controlled studies, there was a reduction in mean systolic and diastolic blood pressure (BP) at 6 months of -28.9 mm Hg (95% confidence interval [CI]: -37.2 to -20.6 mm Hg) and -11.0 mm Hg (95% CI: -16.4 to -5.7 mm Hg), respectively, compared with medically treated patients (for both, p < 0.0001). In uncontrolled studies, there was a reduction in mean systolic and diastolic BP at 6 months of -25.0 mm Hg (95% CI: -29.9 to -20.1 mm Hg) and -10.0 mm Hg (95% CI: -12.5 to -7.5 mm Hg), respectively, compared with pre-RDN values (for both, p < 0.00001). There was no difference in the effect of RDN according to the 5 catheters employed. Reported procedural complications included 1 renal artery dissection and 4 femoral pseudoaneurysms. CONCLUSIONS: RDN resulted in a substantial reduction in mean BP at 6 months in patients with resistant hypertension. The decrease in BP was similar irrespective of study design and type of catheter employed. Large randomized controlled trials with long-term follow-up are needed to confirm the sustained efficacy and safety of RDN.