Assuntos
COVID-19 , Cardiologia , Ablação por Cateter , COVID-19/epidemiologia , Grécia/epidemiologia , Humanos , Pandemias , Sistema de RegistrosAssuntos
Cardioversão Elétrica/métodos , Insuficiência Cardíaca Sistólica/terapia , Doença Crônica , Eletrocardiografia , Insuficiência Cardíaca Sistólica/diagnóstico , Insuficiência Cardíaca Sistólica/fisiopatologia , Humanos , Índice de Gravidade de Doença , Resultado do Tratamento , Função Ventricular Esquerda/fisiologiaRESUMO
A case of sustained monomorphic ventricular tachycardia underdetected by a single chamber implantable cardioverter defibrillator because of RR interval irregularity is presented. The programmed stability criterion is responsible for the underdetection. Special attention must be paid when it comes to programming this detection parameter.
Assuntos
Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Desfibriladores Implantáveis , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/fisiopatologia , Falha de Equipamento , Humanos , Masculino , Taquicardia Ventricular/tratamento farmacológicoRESUMO
The elderly constitute an increasingly important sector of patients with acute coronary syndromes (ACS), although they have been under-represented in many therapeutic trials. Elderly patients with ACS usually have more complex co-morbidities and worse outcomes than their younger counterparts, and they are less likely to undergo revascularisation or to receive short- and long-term evidence-based medications. The most common ACS in the elderly is non-ST-segment elevation myocardial infarction (STEMI), which is associated with high mortality. For this reason, elderly patients with non-STEMI and unstable angina should be treated invasively early in the course of the episode. In elderly patients with STEMI, primary angioplasty seems to be more effective than fibrinolysis, and in patients aged >85 years a more conservative approach to fibrinolysis is also warranted because of the higher risk for cerebral haemorrhage. Therefore, angioplasty should be preferred when feasible, although more trials are needed before this strategy can definitely be documented as the preferred option. Drug-eluting stents afford greater benefit than bare metal stents in elderly patients and are more cost effective. After fibrinolysis, low-molecular-weight heparin appears to be superior to unfractionated heparin in elderly patients with STEMI but major bleeding and intracranial haemorrhages occur more frequently, especially in women aged >75 years. It is very important to understand that the elderly with ACS constitute a subgroup of atherosclerotic patients for whom decision making must be guided by the patients''physiological age' (determined by their physical condition and other co-morbidities) and not strictly by their 'chronological age'.