RESUMO
The increasing rate of cardiovascular diseases, the improved survival after the acute phase, the aging of the population and the implementation of primary prevention caused an exponential increase in outpatient cardiac performance, thereby making it difficult to maintain a balance between the citizen-patient request and the economic sustainability of the healthcare system. On the other side, the prescription of many diagnostic tests with a view to defensive medicine and the related growth of patients' expectations, has led several scientific societies to educational campaigns highlighting the concept that "less is more".The present document is aimed at providing the general practitioner with practical information about a prompt diagnosis of signs/symptoms (angina, dyspnea, palpitations, syncope) of the major cardiovascular diseases. It will also provide an overview about appropriate use of diagnostic exams (echocardiogram, stress test), about the appropriate timing of their execution, in order to ensure effectiveness, efficiency, and equity of the health system.
Assuntos
Assistência Ambulatorial/métodos , Cardiopatias/terapia , Pacientes Ambulatoriais , Algoritmos , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/normas , Fármacos Cardiovasculares/uso terapêutico , Tomada de Decisão Clínica , Técnicas de Diagnóstico Cardiovascular , Gerenciamento Clínico , Dispneia/etiologia , Dispneia/terapia , Seguimentos , Prioridades em Saúde , Cardiopatias/complicações , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Guias de Prática Clínica como Assunto , Avaliação de Sintomas , Fatores de TempoRESUMO
Although it is well recognized that warfarin dramatically reduces the risk for ischemic stroke, its use for stroke prevention in patients with atrial fibrillation is often inadequate. Even among patients with other known risk factors for stroke (e.g., high blood pressure) and no contraindications to warfarin, warfarin therapy is prescribed in less than 60% of cases. In addition, safety and efficacy of warfarin therapy depend on adequate anticoagulation effect, but time in therapeutic range is 63%. Notably, major bleeding and intracranial hemorrhage represent a feared, though infrequent, complication. Aspirin monotherapy for stroke prevention in patients with atrial fibrillation should be discouraged, as it does not provide adequate protection against stroke and is associated with a significant increase in bleeding complications. New oral anticoagulants have a favorable risk-benefit profile, resulting in significant reductions in stroke, intracranial hemorrhage and mortality, with similar rates of major bleeding compared to warfarin but increased risk for gastrointestinal bleeding. The present review describes the new oral anticoagulants dabigatran, rivaroxaban, apixaban and edoxaban with a focus on the results from major randomized clinical trials and meta-analyses. It also provides practical suggestions for their use in daily clinical practice, introducing a dedicated, novel application for smartphones and tablets.
Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Hemorragia/induzido quimicamente , Humanos , Hemorragias Intracranianas/induzido quimicamente , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Acidente Vascular Cerebral/etiologiaRESUMO
The number of percutaneous coronary interventions (PCI) is increasing worldwide. Follow-up strategies after PCI are extremely heterogeneous and can greatly affect the cost of medical care. Of note, clinical evaluations and non-invasive exams are often performed to low risk patients. In the present consensus document, practical advises are provided with respect to a tailored follow-up strategy on the basis of patients' risk profile. Three strategies follow-up have been defined and types and timing of clinical and instrumental evaluations are reported. Clinical and interventional cardiologists, cardiac rehabilitators, and general practitioners, who are in charge to manage post-PCI patients, equally contributed to the creation of the present document.
Assuntos
Cardiologia , Consenso , Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea/normas , Cuidados Pós-Operatórios/normas , Guias de Prática Clínica como Assunto/normas , Sociedades Médicas , Seguimentos , Humanos , ItáliaRESUMO
Mediastinitis is a serious complication of cardiac surgical procedures, with high rates of morbidity and mortality. We describe a new simple surgical technique to treat deep sternal infection based on the removal of all wires and deep sutures, and reapproximation of the sternum with four external plates without rewiring. Fourteen patients were treated with this technique. No complications related to the procedure occurred, the infection was successfully treated in all patients, and only 1 patient underwent vacuum treatment to obtain healing of the wound.