RESUMO
BACKGROUND: Implantable loop recorders (ILRs) are a central tool in the evaluation of unexplained syncope. These devices record and store electrocardiograms, both automatically and on patient-dependent activation. Therefore, obtaining optimal diagnostic results relies on a patient's comprehension and collaboration. OBJECTIVES: To evaluate the effect of ethnic background and mother-tongue language on the diagnostic yield (DY) of ILRs. METHODS: Patients at two medical centers in Israel, who had ILRs as part of syncope workup were included. Inclusion criteria were age over 18 years and an ILR for at least one year (or less if the cause of syncope was detected). Patient demographics, ethnic background, and previous medical history were recorded. All findings from ILR recordings, activation mode (manual vs. automatic), and treatment decisions (none, ablation, device implantation) were collected. RESULTS: The study comprised 94 patients, 62 Jews (i.e., ethnic majority) and 32 non-Jews (i.e., ethnic minority). While baseline demographic characteristics, medical history, and drug therapy were similar in both groups, Jewish patients were significantly older at the time of device implantation: 64.3 ± 16.0 years of age vs. 50.6 ± 16.9, respectively; (P < 0.001). Arrhythmias recorded in both groups as well as treatment decisions and device activation mode were similar. Total follow-up time from device implantation was longer in the non-Jewish vs. the Jewish group (17.5 ± 12.2 vs. 24.0 ± 12.4 months, respectively; P < 0.017). CONCLUSIONS: The DY of ILR implanted for unexplained syncope did not seem to be influenced by patient's mother-tongue language or ethnicity.
Assuntos
Etnicidade , Grupos Minoritários , Humanos , Adolescente , Judeus , Judaísmo , Síncope/diagnóstico , Síncope/etiologiaRESUMO
OBJECTIVE: Activated clotting time (ACT)-based heparin dosing during percutaneous intervention (PCI) is recommended by Society guidelines. However, the relationship between ACT and outcome in the setting of elective PCI has not been sufficiently studied. We sought to evaluate the in-hospital outcome of patients undergoing elective PCI while receiving fixed-dose heparin without ACT measurement versus those with ACT-guided management. METHODS: This retrospective study included consecutive patients undergoing elective PCI in a single-center between 11/2015 and 12/2018. Patients were divided into two groups, depending on whether ACT was measured. Heparin-only anticoagulation and non-femoral procedures were allowed. Patient demographics, procedural data and in-hospital outcomes were collected. The primary outcome was in-hospital major adverse cardiovascular events (MACE), secondary (safety) outcomes were in-hospital definite stent thrombosis, Bleeding Academic Research Consortium bleeding, access-related complications (any) as well as peri-procedural complications. RESULTS: In total, 500 procedures were included in the study, 151 ACT and 349 fixed-dose. Patient demographics and medical history in both groups were well balanced, but those having ACTs were younger (63.2 ± 10.9 vs. 66.5 ± 11.3; P = 0.003) and less likely to have a history of coronary artery disease (74 vs. 82%; P = 0.032) or kidney failure. Procedural data were similar; however, total heparin dose and procedure length were higher in the ACT group (6232 ± 1388 vs.5032 ± 417 units; P < 0.001; 40.1 ± 14.0 vs. 30.3 ± 12.7 min; P < 0.001). Primary and secondary outcome events were rare and similar (MACE 1.1 vs. 1.3%; P = 0.86). CONCLUSIONS: A fixed-dose heparin injection (5000 IU) approach for elective PCI while omitting ACT offers slightly shortened procedural time and similar in-hospital safety profile.
Assuntos
Testes de Coagulação Sanguínea , Doença da Artéria Coronariana/cirurgia , Heparina/administração & dosagem , Heparina/farmacocinética , Intervenção Coronária Percutânea , Idoso , Anticoagulantes/administração & dosagem , Anticoagulantes/farmacocinética , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Amiodarone can induce TdP; therefore, it should be avoided as a first choice for therapy in patients without heart disease. Careful QT interval monitoring, especially during intravenous use, can prevent development of this life-threatening arrhythmia.
RESUMO
BACKGROUND: The first complete ban on indoor smoking in all public spaces (including bars and restaurants) occurred in 1994 in Israel, because of clear scientific evidence that SHS (Second Hand Smoking) is dangerous to non-smokers. Despite the smoking-ban law warning about the dangers of smoking, SHS remains in houses. The role of cigarette smoking on cardiac arrhythmia is less clearly defined and secondhand smoke (SHS) impact on the risk of atrial fibrillation (AF) remains unknown. The aim of this study was to evaluate the relationship between SHS and AF risk in Israeli women. METHODS: This was a population-based case-control study consisting of never-smoking women aged 30-80 from Israel: 102 cases (diagnosed) of AF and 109 population- based controls. All participants were interviewed using a socio-demographic questionnaire that also related to past and current exposure to SHS. RESULTS: SHS was associated with AF risk with adjusted odds ratio (OR) of 3.81 (95% confidence interval, CI 2.02-7.18). Higher exposure to SHS was associated with higher risk of AF compared to never-exposed women. Those exposed to SHS during one, two, or three life-periods (childhood, adolescence or adulthood) had an OR of 1.71 (95% CI 0.76-3.86), 2.87 (95% CI 1.25-6.56), and 9.14 (95% CI 4.09-20.44), respectively. Moreover, exposure to one pack/day increased the risk of AF by 2.89 times compared to 'never exposed' (95% CI 2.05-4.09). CONCLUSIONS: SHS exposure in women who never smoked is associated with increased risk for AF.
Assuntos
Fibrilação Atrial , Poluição por Fumaça de Tabaco , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Estudos de Casos e Controles , Feminino , Humanos , Israel/epidemiologia , Pessoa de Meia-Idade , Fumar/efeitos adversos , Fumar/epidemiologia , Poluição por Fumaça de Tabaco/efeitos adversosRESUMO
BACKGROUND: Red cell distribution width (RDW) is a measure of the size variation of erythrocytes. Its prognostic value has been described in a variety of cardiac and noncardiac diseases. Implantable cardioverter defibrillator (ICD) is useful in preventing sudden cardiac death in high-risk patients, but many of these patients continue to survive without needing ICD therapy. We sought to examine whether RDW, with its prognostic values, can benefit in risk stratification of patients with ICD by predicting death and ICD therapy, and thus help in the selection of patients who will benefit the most from ICD, and minimizing its implantation in others at low risk of death and arrhythmias. METHODS: In a retrospective study, we enrolled patients with ICD implanted for both primary and secondary prevention of sudden cardiac death. Baseline RDW values, demographics, and clinical characteristics, as well as the occurrence of death or first appropriate ICD therapy in postimplantation follow-up were collected. We examined whether RDW can predict higher-risk ICD-implanted patients prone to death and first appropriate ICD therapy (the combined outcome). RESULTS: Final population included 432 patients. Compared to others, patients in the upper RDW tertile were older and had more comorbidities and outcomes. In multivariate analysis including RDW, age, gender, and ejection fraction, RDW was the only predictor of the combined outcome. CONCLUSION: RDW may be useful in risk stratification of patients selected for ICD implantation. But larger prospective randomized trials are needed.
Assuntos
Arritmias Cardíacas/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Índices de Eritrócitos , Seleção de Pacientes , Idoso , Arritmias Cardíacas/complicações , Morte Súbita Cardíaca/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de RiscoAssuntos
Angina Pectoris/etiologia , Angioplastia Coronária com Balão , Aneurisma Coronário , Estenose Coronária , Stents Farmacológicos/efeitos adversos , Sirolimo/análogos & derivados , Implantes Absorvíveis/efeitos adversos , Angina Pectoris/diagnóstico , Angina Pectoris/fisiopatologia , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Antibióticos Antineoplásicos/farmacologia , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/etiologia , Aneurisma Coronário/fisiopatologia , Angiografia Coronária/métodos , Estenose Coronária/complicações , Estenose Coronária/diagnóstico , Estenose Coronária/fisiopatologia , Estenose Coronária/cirurgia , Vasos Coronários/patologia , Vasos Coronários/fisiopatologia , Vasos Coronários/cirurgia , Ecocardiografia sob Estresse/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Inibidores da Agregação Plaquetária/uso terapêutico , Sirolimo/farmacologia , Resultado do TratamentoAssuntos
Adenosina/análogos & derivados , Bloqueio Atrioventricular/induzido quimicamente , Estimulação Cardíaca Artificial/métodos , Eletrocardiografia/efeitos dos fármacos , Síndrome Coronariana Aguda/tratamento farmacológico , Adenosina/efeitos adversos , Adenosina/uso terapêutico , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , TicagrelorRESUMO
BACKGROUND: Myocarditis is an inflammation of the myocardium. It is potentially life-threatening, with a wide range of clinical presentations and most often it is caused by various viral, bacterial or fungal infections. CASE PRESENTATION: A 27 year-old man, previously hospitalized due to streptococcal tonsillitis, was admitted to ED because of chest pain. He presented with pain, tightness irradiating to both shoulders and arms and associated sweating and vomiting. The ECG revealed ST elevations on Leads: V5-V6, V7-V9, II, III, AVF and ST depressions on Leads V1-V3. Laboratory results showed elevated Liver enzymes, and positive troponin-5.766 ng/mL The patient showed clinical improvement with NSAIDs and was diagnosed with myocarditis. His brother was admitted to the hospital a year earlier with a sore throat accompanied by chest pain and was diagnosed with perimyocarditis. CONCLUSIONS: The family history of myocarditis after a streptococcal infection, affecting two brothers a year apart from each other, raises the possibility that there is a genetic component responsible for an individuaLs susceptibility to develop myocarditis.
Assuntos
Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor no Peito/diagnóstico , Miocardite , Irmãos , Infecções Estreptocócicas , Tonsilite , Doença Aguda , Adulto , Dor no Peito/etiologia , Diagnóstico Diferencial , Suscetibilidade a Doenças , Eletrocardiografia/métodos , Saúde da Família , Humanos , Masculino , Miocardite/diagnóstico , Miocardite/tratamento farmacológico , Miocardite/etiologia , Miocardite/fisiopatologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Tonsilite/complicações , Tonsilite/diagnóstico , Tonsilite/tratamento farmacológico , Resultado do TratamentoAssuntos
Fístula Arteriovenosa , Cateterismo Cardíaco , Complicações Pós-Operatórias , Artéria Radial , Ultrassonografia Doppler/métodos , Veias , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/fisiopatologia , Fístula Arteriovenosa/cirurgia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodos , Fármacos Cardiovasculares/uso terapêutico , Feminino , Mãos/irrigação sanguínea , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/terapia , Inibidores da Agregação Plaquetária/uso terapêutico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Artéria Radial/cirurgia , Fluxo Sanguíneo Regional , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos , Veias/diagnóstico por imagem , Veias/fisiopatologia , Veias/cirurgiaRESUMO
We describe a case of hemoptysis as a rare complication of pacemaker lead insertion via the axillary approach in a patient with difficult chest anatomy.