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1.
Int J Cardiol ; 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31761399

RESUMO

BACKGROUND: The optimal cutoff for systolic blood pressure (SBP) level to define high-risk pulmonary embolism (PE) remains to be defined. METHODS: To evaluate the relationship between SBP levels on admission and mortality in patients with acute symptomatic PE, the current study included 39,257 consecutive patients with acute symptomatic PE from the RIETE registry between 2001 and 2018. Primary outcomes included all-cause and PE-specific 30-day mortality. Secondary outcomes included major bleeding and recurrent venous thromboembolism (VTE). RESULTS: There was a linear inverse relationship between admission SBP and 30-day all-cause and PE-related mortality that persisted after multivariable adjustment. Patients in the lower SBP strata had higher rates of all-cause death (reference: SBP 110-129 mmHg) (adjusted odds ratio [OR] 2.9; 95% confidence interval [CI], 2.0-4.2 for SBP <70 mmHg; and OR 1.7; 95% CI, 1.4-2.1 for SBP 70-89 mmHg). The findings for 30-day PE-related mortality were similar (adjusted OR 4.4; 95% CI, 2.7-7.2 for SBP <70 mmHg; and OR 2.6; 95% CI, 1.9-3.4 for SBP 70-89 mmHg). Patients in the higher strata of SBP had significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR 0.7; 95% CI, 0.5-0.9 for SBP 170-190 mmHg; and OR 0.6; 95% CI, 0.4-0.9 for SBP >190 mmHg). Consistent findings were also observed for 30-day PE-related death. CONCLUSIONS: In patients with acute symptomatic PE, a low SBP portends an increased risk of all-cause and PE-related mortality. The highest mortality was observed in patients with SBP <70 mmHg.

2.
Arch Med Res ; 50(5): 257-258, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31593849

RESUMO

Acute pulmonary embolism remains a catastrophic acute cardiovascular event, and it is the leading cause of preventable mortality among hospitalized patients. Pulmonary embolism response teams have been designed to facilitate efficiency, streamline and improve quality of care in a timely manner for complex pulmonary embolism case scenarios with a multidisciplinary approach. Herein, we briefly describe and delineate the main goals and strategies on how to leverage the strengths from such pulmonary embolism response teams, with the aim to be adopted worldwide, improve survival, and change the paradigm in the care of a potentially deadly disease.

5.
Thromb Res ; 181 Suppl 1: S29-S32, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31477224

RESUMO

Acute pulmonary embolism (PE) represents the third most common cause of cardiovascular death worldwide. Clinical practice guidelines recommend prompt risk stratification of patients with acute PE. Prognostication may accurately identify: 1) hemodynamically unstable (i.e., high-risk) patients with PE, who might benefit from recanalization therapies (i.e., thrombolysis, embolectomy); 2) intermediate- to high-risk patients with PE, who might require monitoring and recanalization procedures if early hemodynamic decompensation occurs; and 3) low-risk patients with PE, who might benefit from an abbreviated hospital stay or outpatient therapy. A fourth group of patients should not undergo escalated or home therapy (intermediate- to low-risk PE). Studies of patients with proven acute PE have shown conflicting data regarding the association between sex and presentation and short-term clinical course in patients with acute symptomatic PE. Therefore, at this time sex differences should not dictate different approaches to prognostication and management.

10.
Clin Appl Thromb Hemost ; : 1076029618812954, 2018 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-30453745

RESUMO

Pulmonary embolism represents the third most common cause of cardiovascular death in the United States. Reperfusion therapeutic strategies such as systemic thrombolysis, catheter directed therapies, surgical pulmonary embolectomy, and cardiopulmonary support devices are currently available for patients with high- and intermediate-high-risk pulmonary embolism. However, deciding on optimal therapy may be challenging. Pulmonary embolism response teams have been designed to facilitate multidisciplinary decision-making with the goal to improve quality of care for complex cases with pulmonary embolism. Herein, we discuss the current role and strategies on how to leverage the strengths from pulmonary embolism response teams, its possible worldwide adoption, and implementation to improve survival and change the paradigm in the care of a potentially deadly disease.

11.
Proc (Bayl Univ Med Cent) ; 31(1): 67-69, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29686558

RESUMO

Patent foramen ovale (PFO) occurs in 25% of people. The decision on whether to close the PFO found after myocardial infarction and specifically right ventricular infarction is debated, with no solid guidelines addressing this subject. Here we present the case of a 59-year-old man who presented with a myocardial infarction and was found to have PFO. He was treated with revascularization of the culprit artery, followed by supportive care.

14.
Angiology ; 68(6): 494-501, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27609936

RESUMO

Intermediate-risk pulmonary embolism (PE), also known as submassive PE, occurs in a substantial group of patients and carries a significant mortality risk. With adequate risk stratification, catheter-directed techniques could be used as a therapeutic approach in the intermediate-risk PE. Ultrasound-assisted catheter-directed thrombolysis (UCDT) represents a novel endovascular technique with good clinical and safety outcomes. Ultrasound-assisted catheter-directed thrombolysis can achieve reduction in the thrombus burden and improvement of pulmonary hemodynamics and right ventricular (RV) dysfunction and/or dilatation, without major procedure-related complications, major bleeding, or hemorrhagic strokes. This narrative review will focus on the major studies involving the efficacy and safety of UCDT in the intermediate-risk PE population. Prospective, randomized clinical trials with long-term follow-up and a large sample size are needed for further evaluation of mortality benefit and to further define which subgroup of patients may benefit from this novel endovascular technique.


Assuntos
Cateterismo Periférico , Procedimentos Endovasculares/métodos , Fibrinolíticos/administração & dosagem , Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica/métodos , Ultrassonografia de Intervenção , Humanos , Medição de Risco , Fatores de Risco
15.
Case Rep Neurol ; 8(2): 102-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27403130

RESUMO

Neuromyelitis optica (NMO) is a rare disease, common in white females and rarely reported in Hispanic males. It is usually associated with recurrent demyelinating spectrum that is autoimmune in nature. The diagnosis is usually confirmed by antibody biomarkers; however, they can be negative and lead to more dilemma in diagnosis. Furthermore, the course of disease and prognosis are different in seronegative as compared to seropositive NMO. Treatment is similar in both subgroups with new approaches under investigation for seronegative NMO patients. We present an interesting case of a 37-year-old Hispanic male who presented with sudden onset of lower extremity weakness, numbness, blurry vision, and urinary retention. Magnetic resonance imaging (MRI) of the thoracic spine showed multiphasic demyelinating process involving the thoracic spinal cord. His brain MRI also revealed changes suggesting optic neuritis. The patient met the criteria for diagnosis of NMO by having optic neuritis and myelitis by imaging studies despite having negative aquaporin-4 antibodies (AQP4-Ab). His condition improved after plasma exchange. NMO can be difficult to distinguish from acute multiple sclerosis in the early stages of the disease. Having AQP4-Ab testing is important for diagnosis with imaging studies; however, negative antibody results cannot exclude the diagnosis, but rather group it in seronegative subtype. Ongoing studies and research suggest that seronegative NMO might have a different pathophysiology, manifestation, and prognosis.

16.
Case Rep Pulmonol ; 2016: 2359437, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27190667

RESUMO

Acute pulmonary toxicity associated with brentuximab appears to be a rare but serious adverse effect that can be potentially fatal. We report the case of a twenty-nine-year-old female with Hodgkin's lymphoma who was treated with brentuximab and later presented with severe acute pulmonary toxicity; she improved after the discontinuation of brentuximab and administration of antibiotics and glucocorticoid therapy. Currently there is very little data in the literature in regard to the clinical manifestations and characteristics of patients taking brentuximab and the potential development of acute severe pulmonary toxicity, as well as the appropriate therapeutic approach, making this particular case of successful treatment and resolution unique.

17.
Ther Adv Cardiovasc Dis ; 10(2): 103-10, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26864121

RESUMO

Submassive (intermediate risk) pulmonary embolism (PE) continues to be a significantly morbid disease process that remains unrecognized, inadequately risk stratified and suboptimally treated. Appropriate early clinical and imaging-based risk stratification represents the cornerstone for adequate therapeutic decision making, particularly for the selection of candidates who may benefit the most from systemic thrombolysis. The relevance of estimating clinical prognostic scores, in combination with imaging data, for accurate assessment of right ventricular function and laboratory biomarkers, indicative of myocardial injury for identification of normotensive patients at intermediate risk for an adverse short-term outcome are emphasized in this review. Recent clinical trials have demonstrated improvement in hemodynamics and mortality with the use of systemic thrombolysis among intermediate risk patients; however, it came at the cost of a significantly increased risk of major bleeding. Catheter-based therapies have garnered considerable clinical interest in recent years; of particular note is the ultrasound accelerated catheter-directed thrombolysis which has emerged as a novel and attractive alternative therapeutic modality with an increasing number of single center studies and ongoing randomized trials. Our review focuses on the major trials and studies involved in submassive PE in the recent literature including the role of thrombolytic therapy. We include major trials with reasonable sample size and extensive review of the potential side effects, such as major bleeding.


Assuntos
Fibrinolíticos/administração & dosagem , Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica/métodos , Doença Aguda , Cateterismo/métodos , Fibrinolíticos/efeitos adversos , Hemorragia/induzido quimicamente , Humanos , Seleção de Pacientes , Embolia Pulmonar/patologia , Fatores de Risco , Terapia Trombolítica/efeitos adversos
18.
Curr Cardiol Rep ; 18(2): 13, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26768739

RESUMO

Increase in heart rate represents a significant contribution in the pathophysiology of coronary artery disease and heart failure, by promoting atherosclerotic process and endothelial dysfunction. Thus, it negatively influences cardiovascular risk in the general population. The aim of this review is to analyze the current, controversial, and future role of ivabradine as an anti-anginal agent in the setting of coronary artery disease without heart failure. Ivabradine represents a selective heart rate-lowering agent that increased diastolic perfusion time and improving energetics in the ischemic myocardium.


Assuntos
Angina Estável/tratamento farmacológico , Benzazepinas/uso terapêutico , Fármacos Cardiovasculares/uso terapêutico , Doença da Artéria Coronariana/tratamento farmacológico , Frequência Cardíaca/efeitos dos fármacos , Angina Estável/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Humanos , Ivabradina , Fatores de Risco , Resultado do Tratamento
19.
Proc (Bayl Univ Med Cent) ; 28(3): 350-2, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26130886

RESUMO

Pulmonary veno-occlusive disease (PVOD) represents a rare form of precapillary pulmonary arterial hypertension. We present a young patient hospitalized with progressive dyspnea, with initial workup suggestive of pulmonary hypertension and unexplained noncardiogenic pulmonary edema. His subsequent clinical course was consistent with the diagnosis of PVOD.

20.
Proc (Bayl Univ Med Cent) ; 28(2): 188-90, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25829649

RESUMO

Acute myocarditis can be induced by various concomitant disease processes including infections. Most of these cases are viral in origin; however, bacterial infections are also implicated to a lesser degree. Group A streptococcus is a frequent culprit in bacterial-induced myocarditis. Its diagnosis is suspected by the presence of signs and symptoms of rheumatic fever as established by the Jones criteria. The development and refinement of current diagnostic tools has improved our ability to identify specific pathogens. It has been found that group A streptococcus may be responsible for more cases of infection-induced acute myocarditis than previously thought, and often without the clinical features of rheumatic fever. We present the case of a 43-year-old man hospitalized with chest pain that was initially diagnosed as an acute ST-elevation myocardial infarction. Further evaluation confirmed that his chief complaint was due to acute nonrheumatic streptococcal myocarditis.

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