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1.
Circulation ; 149(5): e274-e295, 2024 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-38112086

RESUMO

Out-of-hospital cardiac arrest is a leading cause of death, accounting for ≈50% of all cardiovascular deaths. The prognosis of such individuals is poor, with <10% surviving to hospital discharge. Survival with a favorable neurologic outcome is highest among individuals who present with a witnessed shockable rhythm, received bystander cardiopulmonary resuscitation, achieve return of spontaneous circulation within 15 minutes of arrest, and have evidence of ST-segment elevation on initial ECG after return of spontaneous circulation. The cardiac catheterization laboratory plays an important role in the coordinated Chain of Survival for patients with out-of-hospital cardiac arrest. The catheterization laboratory can be used to provide diagnostic, therapeutic, and resuscitative support after sudden cardiac arrest from many different cardiac causes, but it has a unique importance in the treatment of cardiac arrest resulting from underlying coronary artery disease. Over the past few years, numerous trials have clarified the role of the cardiac catheterization laboratory in the management of resuscitated patients or those with ongoing cardiac arrest. This scientific statement provides an update on the contemporary approach to managing resuscitated patients or those with ongoing cardiac arrest.


Assuntos
Reanimação Cardiopulmonar , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Adulto , Humanos , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/terapia , Coma/diagnóstico , Coma/etiologia , Coma/terapia , American Heart Association , Reanimação Cardiopulmonar/métodos , Cateterismo Cardíaco
2.
Circulation ; 149(22): e1223-e1238, 2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38660790

RESUMO

Tricuspid valve disease is an often underrecognized clinical problem that is associated with significant morbidity and mortality. Unfortunately, patients will often present late in their disease course with severe right-sided heart failure, pulmonary hypertension, and life-limiting symptoms that have few durable treatment options. Traditionally, the only treatment for tricuspid valve disease has been medical therapy or surgery; however, there have been increasing interest and success with the use of transcatheter tricuspid valve therapies over the past several years to treat patients with previously limited therapeutic options. The tricuspid valve is complex anatomically, lying adjacent to important anatomic structures such as the right coronary artery and the atrioventricular node, and is the passageway for permanent pacemaker leads into the right ventricle. In addition, the mechanism of tricuspid pathology varies widely between patients, which can be due to primary, secondary, or a combination of causes, meaning that it is not possible for 1 type of device to be suitable for treatment of all cases of tricuspid valve disease. To best visualize the pathology, several modalities of advanced cardiac imaging are often required, including transthoracic echocardiography, transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, to best visualize the pathology. This detailed imaging provides important information for choosing the ideal transcatheter treatment options for patients with tricuspid valve disease, taking into account the need for the lifetime management of the patient. This review highlights the important background, anatomic considerations, therapeutic options, and future directions with regard to treatment of tricuspid valve disease.


Assuntos
American Heart Association , Valva Tricúspide , Humanos , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/patologia , Estados Unidos , Doenças das Valvas Cardíacas/terapia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/terapia , Implante de Prótese de Valva Cardíaca
3.
Catheter Cardiovasc Interv ; 103(6): 1069-1073, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38584521

RESUMO

An 86-year-old female with history of surgical aortic valve replacement presented with clinical signs of heart failure. Echocardiography revealed a reduction in left ventricular systolic function and severe bioprosthetic aortic valve dysfunction. This is the first reported case of valve-in-valve transcatheter aortic valve replacement with concomitant undermining iatrogenic coronary obstruction with radiofrequency needle procedure in a surgical bioprosthetic valve.


Assuntos
Estenose da Valva Aórtica , Valva Aórtica , Bioprótese , Próteses Valvulares Cardíacas , Doença Iatrogênica , Desenho de Prótese , Substituição da Valva Aórtica Transcateter , Humanos , Idoso de 80 Anos ou mais , Feminino , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Resultado do Tratamento , Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Ablação por Cateter/efeitos adversos , Falha de Prótese , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/efeitos adversos , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/terapia , Agulhas , Função Ventricular Esquerda , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/etiologia , Oclusão Coronária/terapia , Oclusão Coronária/fisiopatologia , Angiografia Coronária
4.
Curr Cardiol Rep ; 21(10): 113, 2019 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-31471758

RESUMO

PURPOSE OF REVIEW: Chronic kidney disease (CKD) is a highly prevalent condition that increases the incidence and complexity of acute coronary syndrome (ACS). The purpose of this review is to summarize current evidence, uncertainties, and opportunities in the management of patients with CKD and ACS, with a focus on revascularization. RECENT FINDINGS: Patients with CKD have been systematically under-represented or excluded from clinical trials in ACS. Available data, however, demonstrates that although patients with CKD and ACS benefit from revascularization, they are also less likely to receive recommended medical and revascularization therapies when compared to patients with normal kidney function. Despite the increased short-term risk of major morbidity and mortality, patients with CKD and ACS should be considered for an early invasive strategy while also trying to mitigate the risks of procedural related complications. Until evidence emerges from randomized clinical trials, the decision about revascularization strategy should involve multi-disciplinary collaboration, heart team consensus, and patient shared decision-making.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Ponte de Artéria Coronária , Intervenção Coronária Percutânea , Insuficiência Renal Crônica/cirurgia , Síndrome Coronariana Aguda/complicações , Humanos , Insuficiência Renal Crônica/complicações , Resultado do Tratamento
5.
Radiology ; 282(3): 892-902, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27732159

RESUMO

Purpose To determine how close to the heart pulmonary microwave ablation can be performed without causing cardiac tissue injury or significant arrhythmia. Materials and Methods The study was performed with approval from the institutional animal care and use committee. Computed tomographic fluoroscopically guided microwave ablation of the lung was performed in 12 swine. Antennas were randomized to either parallel (180° ± 20°) or perpendicular (90° ± 20°) orientation relative to the heart surface and to distances of 0-10 mm from the heart. Ablations were performed at 65 W for 5 minutes or until a significant arrhythmia (asystole, heart block, bradycardia, supraventricular or ventricular tachycardia) developed. Heart tissue was evaluated with vital staining and histologic examination. Data were analyzed with mixed effects logistic regression, receiver operating characteristic curves, and the Fisher exact test. Results Thirty-four pulmonary microwave ablations were performed with the antenna a median distance of 4 mm from the heart in both perpendicular (n = 17) and parallel (n = 17) orientation. Significant arrhythmias developed during six (18%) ablations. Cardiac tissue injury occurred with 17 ablations (50%). Risk of arrhythmia and tissue injury decreased with increasing antenna distance from the heart with both antenna orientations. No cardiac complication occurred with a distance of greater than or equal to 4.4 mm from the heart. The ablation zone extended to the pleural surface adjacent to the heart in 71% of parallel and 17% of perpendicular ablations performed 5-10 mm from the heart. Conclusion Microwave lung ablations performed more than or equal to 5 mm from the heart were associated with a low risk of cardiac complications. © RSNA, 2016.


Assuntos
Técnicas de Ablação/instrumentação , Técnicas de Ablação/métodos , Cardiopatias/etiologia , Coração/efeitos da radiação , Pulmão/efeitos da radiação , Órgãos em Risco/efeitos da radiação , Técnicas de Ablação/efeitos adversos , Animais , Modelos Animais de Doenças , Feminino , Micro-Ondas , Suínos
6.
Vasc Med ; 19(5): 407-14, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25161213

RESUMO

Retroperitoneal fibrosis (RPF) is a rare disease that is marked by systemic inflammation and the development of a periaortic fibroinflammatory mass. The fibroinflammatory infiltration can encase the abdominal aorta, ureters, and other abdominal organs. The clinical presentation often includes constitutional symptoms, abdominal pain, and signs of renal insufficiency or renal failure related to ureteral obstruction. Less frequently, RPF may present with vascular complications, such as venous thrombosis or claudication. The idiopathic form of RPF is most common but secondary forms have been described and are associated with malignancy and a variety of different medications. The pathophysiology is uncertain, but RPF has been linked with periaortitis and IgG4-related disease. Treatment centers on the relief of symptoms and complications associated with mass effects. Corticosteroids and other immunosuppressant therapies can improve constitutional symptoms, reduce infiltrate mass, and achieve disease remission, but a chronic relapsing course is not uncommon.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Prednisona/uso terapêutico , Intensificação de Imagem Radiográfica , Fibrose Retroperitoneal/diagnóstico por imagem , Fibrose Retroperitoneal/patologia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Arteriopatias Oclusivas/tratamento farmacológico , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/patologia , Meios de Contraste , Feminino , Seguimentos , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/etiologia , Pessoa de Meia-Idade , Doenças Raras , Fibrose Retroperitoneal/complicações , Fibrose Retroperitoneal/tratamento farmacológico , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
7.
J Vasc Surg Cases Innov Tech ; 5(4): 467-471, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31763500

RESUMO

Aortocaval fistula (ACF) is an uncommon condition that can result in a number of adverse clinical sequelae. We describe a case of an ACF that occurred several years after open repair of a penetrating injury of the abdominal aorta and inferior vena cava. Whereas ACF can have sudden and catastrophic presentations, our patient had a subacute presentation of high-output heart failure. We were able to fully correct the vascular injury and heart failure physiology and symptoms with endovascular therapy.

8.
Circ Cardiovasc Interv ; 11(9): e000035, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30354598

RESUMO

Transradial artery access for percutaneous coronary intervention is associated with lower bleeding and vascular complications than transfemoral artery access, especially in patients with acute coronary syndromes. A growing body of evidence supports adoption of transradial artery access to improve acute coronary syndrome-related outcomes, to improve healthcare quality, and to reduce cost. The purpose of this scientific statement is to propose and support a "radial-first" strategy in the United States for patients with acute coronary syndromes. This document also provides an update to previously published statements on transradial artery access technique and best practices, particularly as they relate to the management of patients with acute coronary syndromes.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/terapia , American Heart Association , Cateterismo Periférico/normas , Angiografia Coronária/normas , Intervenção Coronária Percutânea/normas , Artéria Radial , Síndrome Coronariana Aguda/mortalidade , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/mortalidade , Tomada de Decisão Clínica , Consenso , Angiografia Coronária/efeitos adversos , Angiografia Coronária/mortalidade , Hemorragia/etiologia , Humanos , Seleção de Pacientes , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Valor Preditivo dos Testes , Punções , Fatores de Risco , Resultado do Tratamento , Estados Unidos
10.
Circulation ; 109(13): 1623-9, 2004 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-15023883

RESUMO

BACKGROUND: In apparently healthy people, the relation between blood pressure and risk of subsequent cardiovascular disease (CVD) is linear. In persons with CVD, the relation is uncertain. METHODS AND RESULTS: We conducted a prospective study of 5218 older women with CVD who reported their blood pressure at baseline in the Women's Antioxidant Cardiovascular Study (WACS), an ongoing double-blind, placebo-controlled secondary prevention trial of the benefits and risks of antioxidant vitamins, folic acid, vitamin B6, and vitamin B12 among women with CVD or > or =3 coronary risk factors. A total of 661 confirmed CVD events (nonfatal myocardial infarction, nonfatal stroke, coronary artery bypass graft procedure, percutaneous coronary angioplasty, or CVD death) occurred during a median follow-up of 6.5 years. After controlling for age, randomized treatment assignment, antihypertensive medication use, and coronary risk factors, we found that systolic blood pressure (SBP) was a strong predictor of CVD events and that the relation between SBP and CVD risk was positive, continuous, and linear (P for linear trend=0.001). For each 10-mm Hg increment in SBP, there was a 9% (95% CI 4% to 15%) increase in risk of secondary CVD events. Diastolic blood pressure, mean arterial pressure, and pulse pressure were weaker predictors of CVD risk in this cohort, and joint consideration of SBP and diastolic blood pressure found that only SBP significantly predicted risk. Use of antihypertensive medication did not modify the relationship of SBP with CVD events. CONCLUSIONS: In this population of women with CVD, we observed a strong, continuous, and linear association between SBP and risk of secondary CVD events. SBP was the blood pressure measure most strongly related to CVD risk.


Assuntos
Pressão Sanguínea , Doenças Cardiovasculares/epidemiologia , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Antioxidantes/uso terapêutico , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Método Duplo-Cego , Feminino , Ácido Fólico/uso terapêutico , Seguimentos , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Sístole , Vitamina B 12/uso terapêutico , Vitamina B 6/uso terapêutico
11.
Am J Cardiol ; 96(10): 1365-9, 2005 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-16275179

RESUMO

The application of soluble CD40 ligand (sCD40L) as a biomarker has garnered great scientific and clinical interest. However, there are many uncertainties with regard to the biology of sCD40L. Although presumed to be a marker of platelet activation, relative levels in plasma, serum, and platelet expression are unknown, as is the optimal method for its measurement. We measured CD40L from serum, platelet-poor plasma, and platelet surface in adults who had stable cardiovascular disease (CVD) and those who had unstable CVD (n = 40). Plasma sCD40L did not differ significantly between groups. Serum sCD40L was significantly lower (1.4 +/- 1.3 vs 5.2 +/- 3.7 ng/ml, p <0.001) and platelet membrane CD40L expression was higher (1.4 +/- 0.7% vs 0.9 +/- 0.6%, p = 0.03) in unstable compared with stable CVD. When the 2 groups were considered together, there was a significant correlation between plasma and serum sCD40L levels (rho = 0.4, p = 0.02) and negative correlations between plasma (rho = -0.3, p = 0.04) and serum (rho = -0.4, p = 0.01) sCD40L levels with platelet membrane CD40L expression. In unstable CVD, the correlation between sCD40L measurements was poor. Consistent with enhanced platelet activation, there was a positive correlation between platelet aggregation and surface CD40L expression (rho = 0.5, p = 0.02) and between platelet expression of CD40L and P-selectin (rho = 0.4, p = 0.05) in unstable CVD. There was no correlation between CD40L and platelet count or C-reactive protein. Only surface expression of CD40L compared with platelet-derived (plasma) or total (serum) CD40L level proved a reliable marker of platelet function in patients who had stable CVD and those who had unstable CVD. In conclusion, our data demonstrate the complex nature of CD40L and highlight the distinct processes of expression, shedding, and clearance of this ligand in patient populations.


Assuntos
Plaquetas/metabolismo , Ligante de CD40/sangue , Doenças Cardiovasculares/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Pressão Sanguínea/fisiologia , Proteína C-Reativa/metabolismo , Doenças Cardiovasculares/fisiopatologia , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ativação Plaquetária/fisiologia , Contagem de Plaquetas , Testes de Função Plaquetária , Tromboxano B2/metabolismo
12.
Rev Cardiovasc Med ; 5(3): 156-63, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15346099

RESUMO

Aspirin is an effective antiplatelet agent with proven benefit in the prevention of atherothrombotic complications of cardiovascular disease. The antithrombotic effects of aspirin, however, are variable among individuals and this might explain, in part, why the absolute risk of recurrent vascular events in patients receiving aspirin therapy remains relatively high (8% - 18% after 2 years). Although formal diagnostic criteria are lacking, aspirin resistance generally describes the failure of aspirin to produce an expected biological response or the failure of aspirin to prevent atherothrombotic events. Aspirin resistance has been reported to occur in 5% to 45% of the general population; therefore, its detection is potentially of clinical importance. The biological mechanisms, population prevalence, laboratory methods for detection, and clinical relevance of aspirin resistance are discussed in this review.


Assuntos
Aspirina/farmacologia , Resistência a Medicamentos/efeitos dos fármacos , Inibidores da Agregação Plaquetária/farmacologia , Aspirina/farmacocinética , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/fisiopatologia , Fibrinolíticos/farmacocinética , Fibrinolíticos/farmacologia , Humanos , Ativação Plaquetária/efeitos dos fármacos , Adesividade Plaquetária/efeitos dos fármacos , Agregação Plaquetária/efeitos dos fármacos , Inibidores da Agregação Plaquetária/farmacocinética
13.
Surg Clin North Am ; 93(4): 761-78, vii, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23885930

RESUMO

Atherosclerotic lower extremity peripheral arterial disease (PAD) is a highly prevalent condition associated with a significant increase in risk of all-cause mortality and cardiovascular morbidity and mortality. PAD is underdiagnosed and undertreated. Treatment is focused on (1) lowering cardiovascular risk and cardiovascular disease event rates and (2) improvement in symptoms and quality of life. Multidisciplinary and intersociety guidelines guide optimal medical therapy. Substantial evidence supports implementation of tobacco cessation counseling and pharmacotherapy to help achieve tobacco abstinence, antiplatelet therapy, HMG-CoA reductase inhibitors (statins) therapy, and antihypertensive therapy for the purpose of lowering cardiovascular event rates and improving survival.


Assuntos
Aterosclerose/terapia , Doenças Vasculares Periféricas/terapia , Anti-Hipertensivos/uso terapêutico , Aterosclerose/diagnóstico , Aterosclerose/etiologia , Angiopatias Diabéticas/etiologia , Angiopatias Diabéticas/prevenção & controle , Diagnóstico Precoce , Terapia por Exercício , Humanos , Hiperlipidemias/complicações , Hiperlipidemias/prevenção & controle , Hipertensão/complicações , Hipertensão/prevenção & controle , Hipolipemiantes/uso terapêutico , Estilo de Vida , Doenças Vasculares Periféricas/diagnóstico , Doenças Vasculares Periféricas/etiologia , Inibidores da Agregação Plaquetária/uso terapêutico , Guias de Prática Clínica como Assunto , Fatores de Risco , Fumar/efeitos adversos , Abandono do Hábito de Fumar
14.
J Am Coll Cardiol ; 46(6): 986-93, 2005 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-16168280

RESUMO

Acute coronary syndromes and other manifestations of atherothrombotic disease are primarily caused by atherosclerotic plaque rupture or fissuring and subsequent occlusive or subocclusive thrombus formation. Platelets play a critical role in the pathophysiology of atherothrombotic disease, and aspirin is the most commonly used antiplatelet agent. Clinical trials have demonstrated the efficacy of aspirin in both primary and secondary prevention of myocardial infarction, stroke, and cardiovascular death. Despite its proven benefit, the absolute risk of recurrent vascular events among patients taking aspirin remains relatively high, an estimated 8% to 18% after two years. Therapeutic resistance to aspirin might explain a portion of this risk. Although formal diagnostic criteria and a validated method of measurement are lacking, aspirin resistance may affect between 5% and 45% of the population. Given the prevalence of cardiovascular disease, the potential impact of aspirin resistance is large. Currently, however, there are many unanswered questions regarding the biological mechanism, diagnosis, population prevalence, clinical relevance, and optimal therapeutic intervention for aspirin resistance.


Assuntos
Aspirina/uso terapêutico , Aterosclerose/complicações , Aterosclerose/tratamento farmacológico , Trombose/complicações , Trombose/tratamento farmacológico , Aspirina/farmacologia , Resistência a Medicamentos , Humanos , Ativação Plaquetária/efeitos dos fármacos
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