Towards the Provision of Palliative Care Services in the Intensive Coronary Care Units: Nurses' Knowledge, Training Needs, and Related-Barriers.

Despite the notable benefits of palliative care (PC) for patients with chronic diseases, its delivery to people with cardiac problems, particularly in the Middle East region (EMR), remains a critical issue. There is a scarcity of research assessing nursing staff's needs and knowledge in providing PC to cardiac patients in the EMR. This study aimed to assess the level of knowledge and needs of PC among nurses towards the provision of PC in intensive coronary care units (ICCUs) in the Gaza Strip, Palestine. It also identified the barriers to the provision of PC services in ICCUs in the Gaza Strip. A hospital-based descriptive quantitative cross-sectional design was adopted to collect data from 85 nurses working in ICCUs at four main hospitals in the Gaza Strip. Knowledge about PC was collected using a developed questionnaire based on the Palliative Care Quiz Nursing Scale (PCQN) and Palliative Care Knowledge Test (PCKT). PC training needs and barriers were assessed using the PC Needs Assessment instrument. Approximately two-thirds of nurses did not receive any PC educational or training programs, which contributed to their lack of PC knowledge. Most nurses would like to enroll in PC training programs, such as family support and communications skills courses. Nurses reported that there was a high demand for PC guidelines and discharge planning for patients with chronic illnesses. Insufficient healthcare professionals' knowledge about PC and a staff shortage were the main barriers to integrating PC into the Gaza healthcare system. This study suggests incorporating PC into nursing curricula and in-service training, and it covers both basic and advanced PC principles. Intensive coronary care unit nurses need knowledge and training about PC, guidance, and support to provide appropriate care to patients with cardiovascular issues.

Influenza as a threat to cardiovascular health and the role of vaccination in risk reduction / Az influenza mint kardiológiai rizikótényezo és a vakcináció szerepe a kockázat csökkentésében

The different types of cardiovascular diseases, including coronary heart disease, cardiac arrhythmias and heart failure are highly prevalent in the society. Cardiovascular diseases are the leading cause of mortality. Although the influenza is forced out from the mainstream of thinking nowadays because of the ongoing SARS-CoV-2 pandemic, it still has its serious epidemiological significance. The seasonal influenza epidemic often contributes to mortality mainly, but not exclusively among old, multi-morbid patients. There are a vast number of scientific publications and evidence which prove and emphasize the synergic health-destroying and mortality-increasing effect of co-existing cardiovascular disease and influenza. Moreover, the beneficial effect of vaccination against influenza infection and its major role in prevention is also well documented. The SARS-CoV-2 pandemic enforces the importance of influenza vaccination because both viruses can lead to severe or often fatal disease, especially among old and frail patients. In addition, the younger population can be far more vulnerable against the novel coronavirus in the case of a co-existing influenza infection. International guidelines recommend influenza vaccination for patients having heart disease, like for other high-risk populations. Despite the nationally reimbursed, cost-free vaccines, the influenza vaccination rate of the society is still low not just in Hungary but also internationally. The authors review the effect of influenza infection on heart diseases, and draw attention to the role of influenza vaccination in decreasing cardiovascular morbidity and mortality.

Clinical Significance of HSCARG for Atherosclerotic Coronary Heart Disease and Reduced ROS-Oxidative Stress in in Vivo and in Vitro Models via p47phox by NF-κB Activity

ABSTRACT Introduction: Coronary heart disease (CHD) is a dynamic process in which there are interactions between endothelial dysfunction, oxidative stress, and inflammatory responses. The aim of the present study was to investigate the function and mechanism of HSCARG in the treatment of CHD. Methods: Male apolipoprotein E/low-density lipoprotein receptor-deficient mice were given a high-fat diet with 21% fat and 0.15% cholesterol for the in vivo model. Human umbilical vein endothelial cells were incubated with angiotensin II for the in vitro model. HSCARG expression was inhibited in patients or mice with CHD. Results: HSCARG reduced oxidative stress in mice with CHD. HSCARG also reduced reactive oxygen species (ROS)-oxidative stress in the in vitro model. HSCARG induced p47phox expression in the in vitro model by NF-κB activity. The regulation of nuclear factor kappa B (NF-κB) activity or p47phox expression participates in the effects of HSCARG in CHD. Conclusion: Altogether, our data indicate that HSCARG reduced ROS-oxidative stress in in vivo and in vitro models of CHD via p47phox by NF-κB activity and may be a clinical target for CHD.

[Coronary computed tomography and cardiac devices : Diagnostic results or nothing but artifacts?] / Koronare Computertomographie bei Device-Trägern : Sinnvolle Diagnostik oder nur Artefakt?

Coronary computed tomography (CT) angiography has become a major cornerstone in the diagnostic workup of cardiologic patients, particularly for evaluation of the coronary arteries and preprocedural planning of interventions for structural heart disease. Despite the possible problems that intensive electromagnetic radiation (including X­rays) might cause when directly impacting on implanted cardiac devices, cardiac CT is a safe diagnostic test and should not be withheld from patients with devices if properly indicated. Sufficient image quality is paramount for the evaluation; hence, special attention should be paid to a low heart rate (< 60 bpm) and sufficient compliance with breathing instructions. Furthermore, pacemaker or implantable cardioverter-defibrillator (ICD) leads may cause metal artifacts, especially around the lead tip. Their dense material causes beam hardening and streak artifacts which may result in reduced image quality and limited diagnostic assessability. The prevalence of such artifacts depends not only on lead material but also on lead positioning relative to the gantry plane. Metal artifacts are more frequent in patients with unipolar leads and shock coils, which can impair the assessment of coronary arteries, mainly of the right coronary artery (RCA). Artifacts caused by left ventricular (LV) leads of cardiac resynchronization therapy (CRT) systems tend to affect assessment of the left circumflex artery (LCX). By using dual energy CT and postprocessing algorithms, the impact of artifacts can be reduced and diagnostic image quality can be achieved in most cases. Unfortunately, the actual occurrence of such artifacts or the degree of impairment of image quality cannot be reliably predicted.

Clinical Significance of HSCARG for Atherosclerotic Coronary Heart Disease and Reduced ROS-Oxidative Stress in in Vivo and in Vitro Models via p47phox by NF-κB Activity.

INTRODUCTION: Coronary heart disease (CHD) is a dynamic process in which there are interactions between endothelial dysfunction, oxidative stress, and inflammatory responses. The aim of the present study was to investigate the function and mechanism of HSCARG in the treatment of CHD. METHODS: Male apolipoprotein E/low-density lipoprotein receptor-deficient mice were given a high-fat diet with 21% fat and 0.15% cholesterol for the in vivo model. Human umbilical vein endothelial cells were incubated with angiotensin II for the in vitro model. HSCARG expression was inhibited in patients or mice with CHD. RESULTS: HSCARG reduced oxidative stress in mice with CHD. HSCARG also reduced reactive oxygen species (ROS)-oxidative stress in the in vitro model. HSCARG induced p47phox expression in the in vitro model by NF-κB activity. The regulation of nuclear factor kappa B (NF-κB) activity or p47phox expression participates in the effects of HSCARG in CHD. CONCLUSION: Altogether, our data indicate that HSCARG reduced ROS-oxidative stress in in vivo and in vitro models of CHD via p47phox by NF-κB activity and may be a clinical target for CHD.

Acute Myocardial Infarction and Percutaneous Coronary Intervention: What does the Epidemiological Data of the Last Years Indicate?

Abstract Background: ST-segment elevation acute myocardial infarction (STEMI) is a pathological process that involves cardiac muscle tissue death. Intravenous thrombolysis with fibrinolytics or primary percutaneous coronary intervention (PCI), an invasive technique, can be performed for tissue revascularization. PCI has been preferred as compared to non-invasive methods, although few studies have described its use in Brazil. Objectives: The aim of the present study was to analyze data on the use of primary PCI and investigate the relevance of hospitalizations for the treatment of STEMI in the country. Methods: A descriptive, cross-sectional analysis of data from the Brazilian Unified Health system (SUS) Department of Informatics (DATASUS) from 2010 to 2019 was conducted. Results: Hospitalizations for STEMI represented 0.6% of all hospital admissions in Brazil in the analyzed period, 0.9% of hospital costs, and 2.1% of deaths. The number of hospitalizations due to STEMI was 659,811, and 82,793 for PCIs. Length of hospital stay was 36.0% shorter and mortality rate was 53.3% lower in PCI. The mean cost of PCI was 3.5-fold higher than for treatment of STEMI. Conclusions: Data on hospitalizations for STEMI treatment in Brazil revealed high hospitalization and mortality rates, elevated costs, and long hospital stay. Although primary PCI is a more expensive and less used technique than other methods, it can reduce the length of hospital stay and mortality in the treatment of STEMI.

Renin Angiotensin Blockers and Cardiac Protection: From Basis to Clinical Trials.

Despite a similar beneficial effect on blood pressure lowering observed with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor (AT1R) blocker (ARBs), several clinical trials and meta-analyses have reported higher cardiovascular mortality and lower protection against myocardial infarction with ARBs when compared with ACEIs. The European guidelines for the management of coronary syndromes and European guidelines on diabetes recommend using ARBs in patients who are intolerant to ACEIs. We reviewed the main pharmacological differences between ACEIs and ARBs, which could provide insights into the differences in the cardiac protection offered by these 2 drug classes. The effect of ACEIs on the tissue and plasma levels of bradykinin and on nitric oxide production and bioavailability is specific to the mechanism of action of ACEIs; it could account for the different effects of ACEIs and ARBs on endothelial function, atherogenesis, and fibrinolysis. Moreover, chronic blockade of AT1 receptors by ARBs induces a significant and permanent increase in plasma angiotensin II and an overstimulation of its still available receptors. In animal models, AT4 receptors have vasoconstrictive, proliferative, and inflammatory effects. Moreover, in models with kidney damage, atherosclerosis, and/or senescence, activation of AT2 receptors could have deleterious fibrotic, vasoconstrictive, and hypertrophic effects and seems prudent and reasonable to reserve the use of ARBs for patients who have presented intolerance to ACE inhibitors.

Management of Cardiovascular Risk in Perimenopausal Women with Diabetes.

Cardiovascular disease is the primary cause of mortality in women and men with diabetes. Due to age and worsening of risk factors over the menopausal transition, risk of coronary heart disease events increases in postmenopausal women with diabetes. Randomized studies have conflicted regarding the beneficial impact of estrogen therapy upon intermediate cardiovascular disease markers and events. Therefore, estrogen therapy is not currently recommended for indications other than symptom management. However, for women at low risk of adverse events, estrogen therapy can be used to minimize menopausal symptoms. The risk of adverse events can be estimated using risk engines for the calculation of cardiovascular risk and breast cancer risk in conjunction with screening tools such as mammography. Use of estrogen therapy, statins, and anti-platelet agents can be guided by such calculators particularly for younger women with diabetes. Risk management remains focused upon lifestyle behaviors and achieving optimal levels of cardiovascular risk factors, including lipids, glucose, and blood pressure. Use of pharmacologic therapies to address these risk factors, particularly specific hypoglycemic agents, may provide some additional benefit for risk prevention. The minimal benefit for women with limited life expectancy and risk of complications with intensive therapy should also be considered.

Dissection of coronary artery: A clinical overview.

Spontaneous coronary artery dissection (SCAD) is a rare but life-threatening disorder. SCAD is gaining importance as an emerging cause of acute coronary syndrome (ACS), especially in otherwise healthy young women. While SCAD and ACS show similarity in presentation, the management of SCAD differs to that of ACS. If not managed properly SCAD can lead to sudden death. This review examines the pathophysiology, clinical presentation, diagnostic algorithms, and the current and future management of SCAD.

Perception of women with heart disease about their high-risk pregnancy / Percepción de mujeres cardíacas sobre su embarazo de alto riesgo / Percepção de mulheres com doenças cardíacas sobre sua gravidez de alto risco

Abstract: Framework: Although gestation marks some of the most important moments in a woman's life, it becomes complex when associated with the problems, limitations, and risks inherent in heart disease. Objective: to comprehend the meanings women with heart disease attribute to their high-risk pregnancy and to identify their perception of the risks to the mother-child binomial. Methodology: A quantiqualitative study involving 39 pregnant women with heart disease from a public university of an inland city of São Paulo, Brazil, was conducted. Data were collected through interviews with patients and analyzed using the Discourse of the Collective Subject. Results: This study showed high-risk gestation is a process linked to personal satisfaction and fulfillment of a dream, often associated with a lack of planning, uncertainties and fears. Some participants anchored in religion/spirituality to overcome difficulties, while others used self-reliance as a support. The risks are poorly understood and often underestimated. Conclusion: High-risk gestation is a process associated with personal satisfaction, fulfillment of a dream and even a common experience, often permeated by negative feelings about the inevitable risks to the mother-child binomial.

Resumen: Marco contextual: Aunque la gestación marca algunos de los momentos más importantes en la vida de una mujer, se vuelve compleja cuando se asocia con los problemas, las limitaciones y los riesgos inherentes a la enfermedad cardíaca. Objetivo: entender los significados que las mujeres con enfermedad cardíaca atribuyen a embarazos de alto riesgo e identificar su percepción de los riesgos para el binomio madre-hijo. Metodología: Fue desarrollado un estudio cuanti-cualitativo con 39 embarazadas cardíacas en una universidad pública en el interior de São Paulo, Brazil. Los datos fueron recolectados mediante entrevistas con pacientes y analizados mediante el Discurso del Sujeto Colectivo. Resultados: Este estudio reveló que el embarazo de alto riesgo es un proceso vinculado a satisfacción personal y cumplimiento de un sueño, muchas veces asociado con una falta de planificación, incertidumbres y miedos. Algunas participantes se apoyaron en la religión/espiritualidad para superar dificultades, mientras otras utilizaron la autoconfianza como apoyo. Hay poca comprensión y muchas veces subestimación de los riesgos. Conclusión: El embarazo de alto riesgo es un proceso asociado con satisfacción personal, cumplimiento de un sueño e incluso con una experiencia común, muchas veces permeada por sentimientos negativos sobre los riesgos inevitables para el binomio madre-hijo.

Resumo: Marco contextual: Embora a gestação marque alguns dos momentos mais importantes na vida de uma mulher, ela se torna complexa quando associada aos problemas, limitações e riscos inerentes às doenças cardíacas. Objetivo: compreender os significados que mulheres cardiopatas atribuem à gravidez de alto risco e identificar sua percepção sobre os riscos para o binômio mãe-filho. Metodologia: Foi realizado um estudo quantitativo com 39 gestantes cardiopatas de uma universidade pública de uma cidade do interior de São Paulo, Brasil. Os dados foram coletados por meio de entrevista com os pacientes e analisados por meio do Discurso do Sujeito Coletivo. Resultados: Este estudo mostrou que a gestação de alto risco é um processo atrelado à satisfação pessoal e realização de um sonho, muitas vezes associado à falta de planejamento, incertezas e medos. Alguns participantes se ancoraram na religião / espiritualidade para superar as dificuldades, enquanto outros usaram a autossuficiência como suporte. Os riscos são mal compreendidos e frequentemente subestimados. Conclusão: A gestação de alto risco é um processo associado à satisfação pessoal, realização de um sonho e até mesmo uma experiência comum, muitas vezes permeada por sentimentos negativos sobre os riscos inevitáveis para o binômio mãe-filho.

Evaluation on left ventricular volume and systolic function with three-dimensional echocardiographic automated algorithm in patients with coronary heart disease after percutaneous coronary intervention / 中国医学影像技术

Objective: To evaluate left ventricular systolic function in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI) with three-dimensional echocardiographic automated algorithm (3DEA). Methods: Fifty patients with CHD were enrolled. Left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV) and ejection fraction (LVEF) were measured before PCI and 1 month and 3 months after PCI by using 3DEA and two-dimensional biplane Simpson's (2DBP) methods. Results: LVEDV,LVESV and LVEF measured with 3DEA significantly correlated with those with 2DBP (r=0.92, 0.90, 0.84). Compared with measurements before PCI, LVEDV and LVESV measured with 3DEA and 2DBP methods decreased, while LVEF increased 1 month and 3 months after PCI (all P0.05). The time of 3DEA was short, and the reproducibility was higher than that of 2DBP (both P<0.05). Conclusion: 3DEA method is rapid and highly reproducible and highly correlated with 2DBP, therefore may be a useful technique in serially following patients with CHD and assessing responses to PCI.

Research status and progresses of ultrasonic observation of cardiac function changes after percutaneous coronary intervention / 中国医学影像技术

With the aging of social structure, the incidence of cardiovascular disease is increasing. Timely percutaneous coronary intervention (PCI) is an important method to treat acute coronary syndrome (ACS) and improve prognosis. Echocardiography has a prominent advantage in evaluating the ischemic myocardium and cardiac function in patients with ACS, therefore is of great significance in judging the development and prognosis. The applications of echocardiography in evaluating cardiac function changes after PCI were reviewed in this article.

Percentage of attenuation drop of intra-mural coronary segment at diastolic phase coronary CTA in prediction of significant systolic compression of myocardial bridge / 中国医学影像技术

Objective To explore the diagnostic value of the percentage of attenuation drop measured by diastolic phase coronary CTA (CCTA) in identifying significant dynamic compression of myocardial bridge (MB).Methods Totally 135 patients with MB confirmed by CCTA were enrolled.The CT value of MB segment and proximal MB segment was measureed respectively.Attenuation of mural coronary artery(％) =(CT value of proximal MB segment-CT value of MB segment)/CT value of MB segment × 100 ％.Systolic compression ≥50 ％ was considered significant.The percentage of attenuation drop of MB vessel,length and depth of MB were measured and correlated with the presence and degree of dynamic compression.Results Attenuation drop of mural coronary artery(％),length of MB in MB patients with significant systolic compression,slight systolic compression and without systolic compression had significant statistical differences (all P＜0.05).ROC curve showed the percentage of attenuation had the best accuracy of 73.3％ in diagnosis of MB with significant systolic compression with the cutoff value of 15％ and the area under the curve (AUC) of 0.75 (95％ CI [0.67,0.82],P＜0.01).Conclusion Attenuation drop of MB segment has relationship with the extent of dynamic compression of MB and it has value to identify significant dynamic compression of MB.

Study of efficacy and safety of Paclitaxel drug coated balloon in elderly patients with de novo coronary disease / 中华老年医学杂志

Objective To evaluate the efficacy and safety of Paclitaxel drug coated balloon (DCB) (SeQuent Please) in an elderly patients with de novo coronary disease.Methods We performed a retrospective study of 158 consecutive patients (63 patients aged ≥65 yrs and 95 patients aged ＜65 yrs) received DCB therapy in Cath Lab of Beijing Hospital.Clinical characteristic was recorded and coronary angiography was analyzed with quantitative coronary angiography (QCA) software.Results In elderly group,more patients have hypertension (65.1％ vs.56.8％),atrial fibrillation (7.9％ vs.2.1％),previous percutaneous coronary intervention (PCI) history (44.4％ vs.23.2％,P＜0.01) and non ST-elevated myocardial infarction (NSTEMI) (14.3％ vs.4.2％,P ＜0.05).In non-elderly group,more patients were male (71.6％ vs.50.8％,P＜0.05) and current smoker (52.3％ vs.30.2％,P＜ 0.01).Old patients had more complicated lesions,especially calcified lesions (36.8％ vs.14.0％,P＜0.01).Despite of that,our study showed a higher success rate of PCI in elderly group.Both groups of patients showed significant acute gain in minimal lumen diameter (MLD) after DCB released.At 4 days post-operation,there was one case that underwent acute myocardial infarction requiring emergent target lesion revascularization (TLR) in non-elderly group.No major adverse cardiac event (MACE) was observed in the elderly group during hospitalization.Twenty-one patients underwent coronary angiographic followed up at average 9 months post PCI.The QCA analysis showed that MLD of lesions treated with DCB had mildly increased [(2.00±0.67) mm vs.(1.91 ± 0.47) mm,P＞0.05],the late lumen loss (LLL) was (-0.09±0.50) mm.At 9 months follow-up,the MACE rate in the elderly group was 1.6％ and 1.1％ in non-elderly group,with TLR rates at 0.0％ and 1.1％ respectively (both P＞0.05).No death was observed in either group.Conclusions The efficacy and safety of DCB on the elderly patients with de novo lesions is as good as non-elderly patients despite more complex anatomy and comorbidities.