RESUMEN
PURPOSE OF REVIEW: To identify and address the challenges associated with the care of ACS patients during the coronavirus 2019 pandemic. RECENT FINDINGS: The COVID-19 pandemic has had a considerable global impact with over 2.0 million deaths worldwide so far. There has been considerable evidence suggesting that COVID-19 increases the risk of acute coronary syndromes (ACS). We propose characterizing ACS patients into 3 distinct categories to better assist in appropriate triage and management: critically ill patients, non-critically ill ST elevation myocardial infarction (STEMI) patients, and non-critically ill non-ST elevation myocardial infarction (NSTEMI)/unstable angina (UA) patients. We thoroughly review treatments strategies, management considerations, and current consensus statements for the care of COVID-19 patients with ACS. As we continue to gain more experience with management of COVID-19 in ACS patients and as health-care workers and patients continue to get vaccinated, we must continue to adapt our strategies to treat this high-risk group of patients.
Asunto(s)
Síndrome Coronario Agudo , COVID-19 , Infarto del Miocardio sin Elevación del ST , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/terapia , Humanos , Pandemias , SARS-CoV-2RESUMEN
Platypnea-orthodeoxia syndrome, a rare condition characterized by posture-related dyspnea, is usually caused by an intracardiac shunt, hepatopulmonary syndrome, or shunting resulting from severe pulmonary disease. We report the case of a 33-year-old woman who presented with increasing dyspnea and oxygen desaturation when she sat up or arose. Our diagnosis was platypnea-orthodeoxia syndrome. A lead of a previously implanted pacemaker exacerbated a severe tricuspid regurgitant jet that was directed toward the patient's intra-atrial septum. Percutaneous closure of a small secundum atrial septal defect eliminated right-to-left shunting and substantially improved the patient's functional status. In addition to this case, we discuss this unusual condition.
Asunto(s)
Disnea/etiología , Defectos del Tabique Interatrial/complicaciones , Hipoxia/etiología , Adulto , Cateterismo Cardíaco/métodos , Ecocardiografía Transesofágica , Femenino , Defectos del Tabique Interatrial/diagnóstico , Humanos , SíndromeRESUMEN
Coronavirus Disease 2019 (COVID-19) has infected more than 3.0 million people worldwide and killed more than 200,000 as of April 27, 2020. In this White Paper, we address the cardiovascular co-morbidities of COVID-19 infection; the diagnosis and treatment of standard cardiovascular conditions during the pandemic; and the diagnosis and treatment of the cardiovascular consequences of COVID-19 infection. In addition, we will also address various issues related to the safety of healthcare workers and the ethical issues related to patient care in this pandemic.
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Betacoronavirus , Enfermedades Cardiovasculares/epidemiología , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , COVID-19 , Comorbilidad , Salud Global , Humanos , Incidencia , SARS-CoV-2RESUMEN
We present a systematic review and meta-analysis comparing efficacy and safety outcomes between single procedure multivessel revascularization (MVR) and culprit vessel only revascularization in patients presenting with non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). NSTE-ACS is the most common form of acute coronary syndrome (ACS), and multivessel disease is common. There is no consensus on the most efficacious single procedure revascularization strategy for patients undergoing percutaneous coronary intervention not meeting coronary artery bypass grafting criteria. Studies in PubMed and EMBASE databases were systematically reviewed, and 15 studies met criteria for inclusion in the meta-analysis. Baseline characteristics between the groups were similar. A random effects model was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity of studies was assessed using Cochrane's Q and Higgins I2 tests. For short-term outcomes, patients who underwent MVR had higher rates of major adverse cardiac events (OR 1.14; 95% CI 1.01 to 1.29; pâ¯=â¯0.03); and stroke (OR 1.94; 95% CI 1.01 to 3.72; pâ¯=â¯0.05), but lower rates of urgent or emergent coronary artery bypass grafting (OR 0.35; 95% CI 0.29 to 0.43; p <0.00001). In the long-term, MVR patients had less frequent major adverse cardiac events (OR 0.76; 95% CI 0.61-0.93; pâ¯=â¯0.009), all-cause death (OR 0.83; 95% CI 0.71 to 0.97; pâ¯=â¯0.03), and repeat revascularization, (OR 0.62; 95% CI 0.42 to 0.90; pâ¯=â¯0.01). MVR following NSTE-ACS was associated with higher short-term risk, but long-term benefit. In conclusion, these results support the use of single procedure multivessel revascularization for NSTE-ACS patients who are suitable candidates at the time of percutaneous coronary intervention.
Asunto(s)
Síndrome Coronario Agudo/cirugía , Vasos Coronarios/cirugía , Electrocardiografía , Revascularización Miocárdica/métodos , Síndrome Coronario Agudo/diagnóstico , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , HumanosAsunto(s)
Fibrilación Atrial/terapia , Electrocardiografía , Atrios Cardíacos/fisiopatología , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Anciano , Fibrilación Atrial/diagnóstico , Estimulación Cardíaca Artificial/efectos adversos , Diagnóstico Diferencial , Humanos , Masculino , Taquicardia por Reentrada en el Nodo Atrioventricular/etiología , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatologíaRESUMEN
Neuroendocrine carcinoma of the thymus, previously termed thymic carcinoid, is a rare clinical entity. Rarer still are such cases presenting with endocrinopathies. We report a case of thymic neuroendocrine carcinoma presenting with ectopic adrenocorticotroic hormone production and resultant Cushing's syndrome.
Asunto(s)
Hormona Adrenocorticotrópica/biosíntesis , Carcinoma Neuroendocrino/complicaciones , Carcinoma Neuroendocrino/metabolismo , Síndrome de Cushing/etiología , Neoplasias del Timo/complicaciones , Neoplasias del Timo/metabolismo , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Proteomic profiling by mass spectrometry has tremendous potential for identifying disease biomarkers. A key limitation of mass spectrometry is that the information provided on the abundance of the various peptides is only relative. Thus, normalization is typically employed. Several normalization methods have been proposed and implemented in the literature. However, it is not clear if there is any reason to prefer one method over another. The goal of this study was to investigate the effect of normalization strategy on the identification of putative biomarkers from MALDI-TOF and SELDI-TOF mass spectra. Our results demonstrate that many of the putative biomarkers identified by mass spectrometry will be the same regardless of which data normalization scheme is applied. However, there can be substantial differences in the m/z values identified as being most discriminatory based on choice of normalization method. As there is no consistent pattern as to which normalization method yields the most promising targets for follow up study, we recommend that investigators routinely repeat their analysis with multiple normalization methods and consider the top several candidates identified in each case.