RESUMO
Cardiovascular emergencies represent life-threatening conditions requiring a high index of clinical suspicion. In an emergency scenario, a simple stepwise biomarker/imaging diagnostic algorithm may help prompt diagnosis and timely treatment along with related improved outcomes. This article describes several clinical cases of cardiovascular emergencies, such as coronary stent thrombosis-restenosis, takotsubo syndrome, acute myocarditis, massive pulmonary embolism, type A acute aortic dissection, cardiac tamponade, and endocarditis.
Assuntos
Técnicas de Imagem Cardíaca/métodos , Doenças Cardiovasculares , Emergências/classificação , Tratamento de Emergência/métodos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , HumanosRESUMO
Acute heart failure (AHF) is the most frequent cause of unplanned hospital admission in patients of >65 years of age and it is associated with significantly increased morbidity, mortality, and healthcare costs. Different AHF classification criteria have been proposed, mainly reflecting the clinical heterogeneity of the syndrome. Regardless of the underlying mechanism, peripheral and/or pulmonary congestion is present in the vast majority of cases. Furthermore, a marked reduction in cardiac output with peripheral hypoperfusion may occur in most severe cases. Diagnosis is made on the basis of signs and symptoms, laboratory, and non-invasive tests. After exclusion of reversible causes, AHF therapeutic interventions mainly consist of intravenous (IV) diuretics and/or vasodilators, tailored according to the initial hemodynamic status with the addition of inotropes/vasopressors and mechanical circulatory support if needed. The aim of this review is to discuss current concepts on the diagnosis and management of AHF in order to guide daily clinical practice and to underline the unmet needs. Preventive strategies are also discussed.
RESUMO
We describe the case of a 60-year-old man with prior rotational atherectomy and drug-eluting stent to the left anterior descending artery (LAD) who presented with shortness of breath and chest pain 8 weeks after stent placement. Further workup revealed a large pericardial effusion with gram stain positive for methicillin-resistant Staphylococcus aureus. Subsequently, this was shown to be related to an aneurysm at the site of the prior LAD stent. This case demonstrated coronary stent infection with mycotic aneurysm and purulent pericardial effusion as an extremely rare but serious complication of percutaneous coronary intervention.