Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

The goal of therapy for bradycardia or tachycardia is to rapidly identify and treat patients who are hemodynamically unstable or symptomatic due to the arrhythmia. Drugs or, when appropriate, pacing may be used to control unstable or symptomatic bradycardia. Cardioversion or drugs or both may be used to control unstable or symptomatic tachycardia. ACLS providers should closely monitor stable patients pending expert consultation and should be prepared to aggressively treat those with evidence of decompensation.

The reperfusion era. Strategies for establishing or maintaining coronary patency.

Only 3 decades ago, controversy existed over the origin of the thrombus that occluded coronary arteries during myocardial infarction (MI). Then, the acute clinical angiographic studies of DeWood butterssed new pathological and experimental evidence that the thrombus was the proximate cause of MI and unstable angina. The remaining years of the 20th century saw an explosion of knowledge delineating a spectrum of related disorders now collectively called acute coronary syndromes (ACS). The clinician managing patients is confronted with an array of evidence as more than 75,000 patients worldwide have been randomized to clinical trials in ACS. This article reviews key pathophysiological concepts, presents an initial strategy for triage of patients, and summarizes evidence-based medicine guiding therapy for acute coronary lesions.

Update on cardiac resuscitation for sudden death: International Guidelines 2000 on Resuscitation and Emergency Cardiac Care.

Cardiopulmonary resuscitation developed over the past one half century largely from empiric science and consensus opinions and recommendations. Treatment algorithms and protocols were originally developed to summarize existing recommendations for systematic and regimented use by a heterogenous group of health care providers. Now, resuscitation science and health care teams are focusing on major issues and continuing questions as sudden death rates remain undaunted and the population at risk is rapidly increasing. For the first time, the international resuscitation community has developed an international consensus on Guidelines for Resuscitation and Emergency Cardiac Care. More than 400 basic scientists, clinical trial investigators, and educators defined common priority and scientific areas during the Evidence Evaluation International Meeting in 1999. The science of resuscitation and emergency cardiac care was reviewed for evidence-based support in randomized clinical trials. In 2000, this review was used as a foundation to structure international guidelines. The participants from seven resuscitation councils and foundations realized that regional differences in systems may exist, but the underlying science should be the same. Presented in this article are some of the major issues and controversies discussed in adult advanced cardiac life support, primarily focusing on the major problem of prehospital adult cardiac arrest.

Cardiac catheterization in morbidly obese patients.

The safety and findings of cardiac catheterization and coronary angiography in morbidly obese patients with suspected coronary heart disease (CHD) have not been fully examined in the modern era. From a database of 4,978 patients undergoing diagnostic cardiac catheterization, we identified 110 with morbid obesity (body mass > or = 145 kg and body mass index > or = 40 kg/m(2)). Relative to all the other patients in this database, morbidly obese patients had a lower prevalence of CHD (45% vs. 72%; P < 0.05), reflecting a higher prevalence of false positive noninvasive tests. Overall, noninvasive tests were only 75% sensitive and 39% specific for CHD in this group. Use of radial access (66%) and femoral closure devices (24%) was much more frequent in the morbidly obese cohort. Complications were no more frequent in the morbidly obese group, with major (0 vs. 0.9%) and minor (4.7% vs. 3.5%) adverse outcomes being similar to the rest of the database. We conclude that cardiac catheterization using the radial artery or a femoral closure device is a safe and effective method of evaluating CHD in morbidly obese patients. In contrast, noninvasive testing is frequently not definitive and may be misleading.