RESUMO
BACKGROUND: Little is known about patients admitted with chest pain to inpatient telemetry units directly from an emergency department. METHODS: We analyzed data from 105 consecutive patients who presented with chest pain to an emergency department and who were hospitalized in an inpatient telemetry unit but who were at low risk for a coronary event. RESULTS: Telemetry yielded no information which was used to manage any patient. None of the 105 patients (0%) developed a myocardial infarction or died during hospitalization. At 4.8-year follow-up, 8 of 105 patients (8%) died. Significant risk factors for long-term mortality were age (p < .001), prior coronary artery disease (p < .05), and diabetes (p < .02). CONCLUSIONS: Inpatient telemetry was of no value in predicting short-term coronary events or mortality or long-term mortality in low-risk patients hospitalized with chest pain.
Assuntos
Dor no Peito/diagnóstico , Dor no Peito/mortalidade , Mortalidade Hospitalar/tendências , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Telemetria/normas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/terapia , Feminino , Seguimentos , Avaliação Geriátrica , Hospitalização , Humanos , Pacientes Internados , Masculino , Infarto do Miocárdio/terapia , Probabilidade , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Telemetria/tendênciasRESUMO
Randomized, double-blind, placebo-controlled trials have demonstrated that intracoronary brachytherapy is more efficacious than placebo in reducing death, myocardial infarction, and target vessel revascularization at long-term follow up of patients with in-stent restenosis. Intracoronary brachytherapy is efficacious in treating totally occluded in-stent restenotic lesions, in treating de novo and in-stent restenotic lesions in saphenous vein grafts, in treating diffuse in-stent restenosis, in treating native coronary ostial in-stent restenotic lesions, in treating patients with diabetes with in-stent restenosis, in treating patients at high-risk for recurrence of restenosis, in treating elderly patients, and in treating patients who failed intracoronary radiation. Beta and gamma intracoronary brachytherapy are equally effective in treating in-stent restenosis. Long-term aspirin and clopidogrel should be administered for at least 1 year to reduce late vessel thrombosis. Inadequate radiation may cause edge stenosis.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Braquiterapia/métodos , Reestenose Coronária/radioterapia , Estenose Coronária/terapia , Radioisótopos de Irídio/uso terapêutico , Radiografia Intervencionista/métodos , Angioplastia Coronária com Balão/métodos , Ensaios Clínicos Controlados como Assunto , Angiografia Coronária , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/mortalidade , Estenose Coronária/diagnóstico , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Sensibilidade e Especificidade , Taxa de Sobrevida , Grau de Desobstrução Vascular/fisiologiaRESUMO
Percutaneous transluminal coronary angioplasty (PTCA) was performed in all 1,050 patients hospitalized within 24 hours of symptoms of documented acute myocardial infarction (AMI) from 1998 to 2002. Hospital mortality was similar in women and men who underwent PTCA for AMI but was higher in patients aged 75 to 95 years (10%) than in patients aged 21 to 50 (2.1%, p <0.001), 51 to 64 (2.3%, p <0.001), and 65 to 74 years (4%, p <0.02). Hospital mortality was higher in patients who had PTCA for AMI during off-normal (5.8%) than normal hours (3.2%, p <0.05).
Assuntos
Angioplastia Coronária com Balão/mortalidade , Mortalidade Hospitalar , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Resultado do Tratamento , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , New York/epidemiologia , Radiografia , Fatores Sexuais , Carga de TrabalhoRESUMO
The authors investigated the association of transesophageal echocardiographic findings with the site of arterial occlusion in patients who underwent transesophageal echocardiography because of thromboembolic stroke and in whom the site of arterial occlusion was diagnosed by computerized axial tomography. The study population included 101 patients (mean age 59 +/- 15 years) with thromboembolic stroke and 101 randomly selected age-matched and sex-matched control without stroke. Transesophageal echocardiographic findings that were significantly higher in the patients with thromboembolic stroke than in the control group were vegetations on the aortic or mitral valve (9% versus 1%, P < 0.01), left atrial or left atrial thrombus or spontaneous echocardiographic contrast (20% versus 6%, P < 0.005), thrombus on a prosthetic valve or in the left ventricle (4% versus 0%, P < 0.05), and atherosclerosis in the thoracic aorta (37% versus 21%, P < 0.02). A higher prevalence of atherosclerosis in the thoracic aorta was found in patients with lacunar infarction compared with patients with middle cerebral artery occlusion (67% versus 25%, P < 0.02), as well as a higher prevalence of vegetations on the aortic or mitral valve in patients with occlusion of 2 arteries compared with patients with vertebrobasilar artery occlusion (28% versus 0%, P < 0.05).
Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Ecocardiografia Transesofagiana , Acidente Vascular Cerebral/etiologia , Tromboembolia/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tromboembolia/complicações , Tomografia Computadorizada por Raios XRESUMO
Penetrating aortic ulcers (PAUs) are rare exotic pathological entities, classically located in the descending thoracic aorta. Their association with syphilis has never been reported. We describe a first case of a patient with cardiovascular syphilis presenting as PAU in the ascending aorta.