RESUMO
In patients with short episodes of clinical, non-triggered AF is the evidence for long-term anticoagulation based on the CHA2DS2-VASc score strong. In situations where a temporary trigger for AF is observed (e.g. after surgery or an infection), or when AF is only detected on a cardiac implantable electronic device (CIED) or smartwatch, the evidence for anticoagulation is less well established. Despite the short duration of the AF episode(s), both patients with subclinical or triggered AF are often at an inherently increased risk of stroke or thromboembolism. In some of these cases long-term anticoagulation can be considered, especially when other cardiovascular risk factors are present. Important considerations when deciding to start with long-term anticoagulation are the individually estimated risk of thrombosis and bleeding, the implementation of shared decision making, and the optimization of the overall cardiovascular risk management.
Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Humanos , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/complicações , Fatores de Risco , Anticoagulantes/efeitos adversos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Hemorragia/induzido quimicamente , Medição de RiscoRESUMO
For decades beta-blockers have been used in the treatment of patients after a myocardial infarction (MI). Current guidelines on the use of beta-blockers after myocardial infarction are based on studies that date back to 3 decades ago. Since then advances in the treatment of myocardial infarction have been made, thanks to the implementation of percutaneous coronary intervention, statins and ACE-inhibitors. This has resulted in increased survival and lower rates of post-MI heart failure. Long-term beta-blocker treatment is a cornerstone for treatment in patients with decreased left ventricular systolic function. However, the efficacy of the long-term treatment in post-MI patients with preserved ventricular function is unknown. Side-effects of beta-blockers can considerably impact patient's quality-of-life. This contribution reviews available data on the efficacy and possibilities for discontinuation of treatment with beta-blockers.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Infarto do Miocárdio/tratamento farmacológico , Antagonistas Adrenérgicos beta/efeitos adversos , Humanos , Tempo , Resultado do Tratamento , Suspensão de TratamentoRESUMO
Background. Patients with coronary artery disease are at high risk of coronary events and death, but effective secondary prevention can reduce this risk. There is a gap between guidelines on secondary prevention and the implementation of these measures, which could potentially be reduced by nurse led prevention clinics (NLPC).Objectives. The aim of the current study is to quantify the impact of NLPC on the risk of cardiovascular events in patients with established coronary artery disease.Methods. A randomised, multicentre clinical trial of NLPC in addition to usual care or usual care alone in post-acute coronary syndrome patients. (Neth Heart J 2009;17:322-8.).
RESUMO
A 62-year-old man was brought into the intensive care unit because of a cardiac arrest. After extensive resuscitation, including defibrillation, sinus bradycardia occurred with marked QT prolongation, followed by recurrent episodes of torsade de pointes. Hetero-anamnestic data revealed a suicide attempt with sotalol. Treatment consisted largely of temporary pacing using an external transvenous overdrive pacemaker and administration of glucagon, milrinon and norepinephrine. Eventually, the patient was discharged in good condition. A suicide attempt with sotalol is a rare intoxication with considerable morbidity and mortality. Treatment is primarily based upon counteracting the proarrhythmic effects of sotalol. However, even when therapeutic levels of this drug are used, proarrhythmic effects can occur.
Assuntos
Parada Cardíaca/induzido quimicamente , Marca-Passo Artificial , Sotalol/efeitos adversos , Tentativa de Suicídio , Taquicardia/induzido quimicamente , Parada Cardíaca/terapia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia/terapiaRESUMO
OBJECTIVE: To evaluate the addition of ezetimibe or placebo to on-going simvastatin treatment on attaining the LDL-C treatment target of = 2.60 mmol/L (100 mg/dL) in coronary heart disease (CHD) patients with hypercholesterolemia. METHODS: Patients with documented CHD were recruited if they were on a stable dose of simvastatin 10 mg or 20 mg for at least 6 weeks, had LDL-C > 2.60 mmol/L and = 4.20 mmol/L (> 100 mg/dL and = 160 mg/dL), triglycerides = 4.00 mmol/L (355 mg/dL) and hepatic transaminases and creatine kinase = 50% above the upper limit of normal. After a 4-week placebo and diet run-in period, eligible patients were randomized to a double-blind, placebo-controlled comparative study with ezetimibe 10mg co-administered with on-going simvastatin 10mg or 20 mg (n = 208) versus placebo to match ezetimibe co-administered with simvastatin 10mg or 20mg for 6 weeks (n = 210). RESULTS: When ezetimibe was added to on-going simvastatin therapy, a significantly greater percentage of patients attained the LDL-C target of = 2.60 mmol/L after 6 weeks of treatment compared to placebo added to on-going simvastatin (80.4% vs. 17.4%, respectively;p = 0.001). When co-administered with on-going simvastatin therapy, mean percentage reduction in LDL-C from baseline was significantly larger in the ezetimibe group compared to placebo (27.1% vs. 4.1%, respectively; p = 0.001). The co-administration of ezetimibe or placebo to on-going simvastatin treatment was generally well tolerated. CONCLUSIONS: Ezetimibe co-administered with on-going simvastatin 10 mg or 20 mg treatment enabled more CHD patients with hypercholesterolemia to attain the LDL-C treatment target of = 2.60 mmol/L.
Assuntos
Anticolesterolemiantes/uso terapêutico , Azetidinas/uso terapêutico , LDL-Colesterol/sangue , LDL-Colesterol/efeitos dos fármacos , Doença das Coronárias/complicações , Hipercolesterolemia/tratamento farmacológico , Sinvastatina/uso terapêutico , Administração Oral , Idoso , Método Duplo-Cego , Quimioterapia Combinada , Ezetimiba , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placebos , Resultado do TratamentoRESUMO
Anomalous origin of the left coronary artery connected to the pulmonary artery (ALCAPA) is a rare congenital defect with a high mortality rate in infancy if left untreated. It may cause myocardial ischaemia and can lead to myocardial infarction, mitral dysfunction, cardiac arrhythmias, heart failure and sudden death. Without operation, survival into adulthood is rare. We report clinical findings, diagnostic characteristics and therapy in a 31-year-old woman with ALCAPA and preserved left ventricular function.
RESUMO
We report the case of a 37-year-old female with a complex manifestation of serogroup C meningococcal disease. The patient presented with symptoms and signs of pneumonia, sepsis and diffuse intravascular coagulation. Moreover, she suffered from a culture-proven pyogenic pericarditis that deteriorated into cardiac tamponade. Immediate pericardiocentesis was successful and eventually the patient recovered.