ABSTRACT
This case illustrates a potential complication of the retrograde approach using epicardial collaterals for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Hypotension post CTO PCI in a patient who has undergone previous cardiac surgery can have multiple causes, one of which is chamber compression from a localized hematoma due to coronary perforation as occurred in this case. This report is the first description of successful nonsurgical management of a left atrial hematoma causing cardiovascular collapse with percutaneous drainage.
Subject(s)
Heart Atria/injuries , Heart Atria/surgery , Heart Injuries/etiology , Heart Injuries/surgery , Hematoma/etiology , Hematoma/surgery , Percutaneous Coronary Intervention/adverse effects , Aged , Chronic Disease , Coronary Angiography , Drainage , Drug-Eluting Stents , Echocardiography , Humans , Male , Radiography, Interventional , Tomography, X-Ray ComputedABSTRACT
Patients with chronic heart failure due to left ventricular systolic dysfunction of ischemic or nonischemic etiology have shown improvement in morbidity and mortality with carvedilol therapy. In patients with symptomatic (New York Heart Association class II-IV) heart failure, carvedilol improves left ventricular ejection fraction and clinical status, and slows disease progression, reducing the combined risk of mortality and hospitalization. Despite the overwhelming evidence for their benefit, there continues to be a large treatment gap between those who would derive benefit and those who actually receive the drug. In this article, the pharmacology, clinical trial evidence, and the potential differences between carvedilol and other beta blockers are discussed. Carvedilol provides powerful therapy in the treatment of chronic heart failure caused by a variety of etiologies and in a wide array of clinical settings.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Carbazoles/therapeutic use , Heart Failure/drug therapy , Propanolamines/therapeutic use , Ventricular Dysfunction, Left/drug therapy , Adrenergic beta-Antagonists/pharmacology , Carbazoles/pharmacology , Carvedilol , Heart Failure/etiology , Heart Failure/mortality , Hemodynamics/drug effects , Humans , Propanolamines/pharmacology , Stroke Volume/drug effects , Treatment Outcome , Ventricular Dysfunction, Left/complications , Ventricular Function, Left/drug effectsSubject(s)
Heart Failure/physiopathology , Neurotransmitter Agents/pharmacology , Ventricular Dysfunction, Left/pathology , Ventricular Remodeling/drug effects , Adrenergic beta-Antagonists/pharmacology , Apoptosis , Biomechanical Phenomena , Heart/drug effects , Heart Failure/pathology , Humans , Myocardium/cytology , Receptors, Adrenergic/physiology , Ventricular Dysfunction, Left/physiopathologyABSTRACT
Angiotensin-converting enzyme (ACE) inhibitors were introduced in the early 1980s as a novel class of agents to treat hypertension. Since that time, they have been proven to be a powerful tool in the treatment of symptomatic left ventricular systolic dysfunction. In this article we will summarize the results from clinical trials using ACE inhibitors in the treatment of heart failure and after myocardial infarction. We will discuss some of the mechanisms postulated to account for the beneficial effects associated with ACE inhibitor treatment. Finally, we will highlight some recent controversies in the use of ACE inhibitors.
