Primarily a consequence of sedentary lifestyle, atherosclerosis has already reached pandemic proportions, and with every year the burden of it is only increasing. As low-density lipoprotein ...cholesterol (LDL-C) represents a crucial factor in atherosclerosis formation and progression, stringent lipid-lowering therapy could conceivably be the key to preventing the unfavorable outcomes that arise as a consequence of atherosclerosis. The use of statins in lipid-lowering is often burdened by adverse events or is insufficient to prevent cardiovascular events as a monotherapy. Therefore, in the present review, the authors aimed to discuss the underlying mechanisms of dyslipidemia and associated atherosclerotic cardiovascular disease (ASCVD) and preclinical and clinical trials of novel therapeutic approaches to its treatment, some of which are still in the early stages of development. Apart from novel therapies, a novel change in perspective is needed. Specifically, the critical objective in the future management of ASCVD is to embrace emerging evidence in the field of atherosclerosis, because clinicians are often burden by common practice and personal experience, both of which have so far been shown to be futile in the setting of atherosclerosis.
A spontaneous coronary artery dissection (SCAD) during the postpartum period is a serious medical emergency and the most important non-atherosclerotic cause of coronary artery disease (CAD) in this ...population. While conservative management is recommended in most SCAD scenarios, cases complicated by hemodynamic instability or cardiogenic shock are particularly challenging and might be amenable only with invasive percutaneous or cardiothoracic surgical management. Herein, we present a case of a 35-year-old otherwise healthy woman that suffered an intense emotional stress event and was subsequently admitted with crushing chest pain to the emergency department. The initial electrocardiogram showed dynamic changes suggesting anterolateral ST-elevation myocardial infarction. She gave birth to a healthy child 3 months before the current presentation. Diagnostic angiography found no occlusive CAD but instead an extensive intramural hematoma originating from the left main artery dissection and extending to the whole left coronary circulation was observed. Hemodynamic instability and hypotension soon followed, and the patient went into cardiogenic shock. The heart team opted for conservative and supportive intensive care management without surgical or percutaneous intervention. This decision ultimately led to the successful extubation of the patient and the achievement of hemodynamic stability. The patient was eventually safely discharged home without any permanent disability.
Proximal venous approaches (femoral or jugular) for catheter-directed thrombolysis (CDT) of acute pulmonary embolism (PE) dominate in clinical practice.
We investigated the feasibility and safety of ...CDT in acute PE by using the superficial cubital venous approach.
All patients with acute PE received intravenous unfractionated heparin plus CDT. CDT included mechanical thrombus fragmentation and the local application of adjuvant thrombolytic therapy through the pigtail catheter - alteplase administered as 2.5 mg bolus in each main branch of the pulmonary artery plus adjuvant 25 mg for 12 h in the more severely affected branch of the pulmonary artery.
Twenty-seven consecutive patients presenting with acute massive (high risk) PE (
= 10) or submassive (intermediate risk) PE (
= 17) were enrolled in the study. The mean age of the enrolled cohort was 60.6 (14.1) years and most patients were female (
= 14, 52%). The procedural success of CDT application through the cubital vein was achieved in all patients. After the procedure, the systolic pulmonary artery pressure decreased from 61.4 (18.3) to 35.8 (12.3) mm Hg (
< 0.001) while the mean pulmonary artery pressure decreased from 35.7 (10.8) to 21.1 (6.5) mm Hg (
< 0.001). Similarly, the mean arterial pressure increased from 81.9 (12.8) to 89.0 (10.3) mm Hg (
= 0.031). Miller angiographic obstruction score and Miller index decreased significantly after the CDT intervention (
< 0.001). There were no deaths, major bleeding events, or hemorrhagic strokes.
CDT by using the cubital approach is a simple, safe, and feasible treatment option for PE. This approach was associated with significant improvement in hemodynamic parameters without fatal outcomes or major periprocedural complications.
Limited information exists concerning arterial blood pressure (BP) changes in underwater breath-hold diving. Simulated chamber dives to 50 m of freshwater (mfw) reported very high levels of invasive ...BP in two divers during static apnea (SA), whereas a recent study using a noninvasive subaquatic sphygmomanometer reported unchanged or mildly increased values at 10 m SA dive. In this study we investigated underwater BP changes during not only SA but, for the first time, dynamic apnea (DA) and shortened (SHT) DA in 16 trained breath-hold divers. Measurements included BP (subaquatic sphygmomanometer), ECG, and pulse oxymetry (arterial oxygen saturation, SpO₂, and heart rate). BP was measured during dry conditions, at surface fully immersed (SA), and at 2 mfw (DA and SHT DA), whereas ECG and pulse oxymetry were measured continuously. We have found significantly higher mean arterial pressure (MAP) values in SA (∼40%) vs. SHT DA (∼30%). Postapneic recovery of BP was slightly slower after SHT DA. Significantly higher BP gain (mmHg/duration of apnea in s) was found in SHT DA vs. SA. Furthermore, DA attempts resulted in faster desaturation vs. SA. In conclusion, we have found moderate increases in BP during SA, DA, and SHT DA. These cardiovascular changes during immersed SA and DA are in agreement with those reported for dry SA and DA.
Aim of the study was to estimate the in-hospital mortality and death rate in patients with AMI according to gender and location of infarction during 5 years before and after the introduction of ...percutaneous coronary intervention (PCI) procedures in Split University Hosptial Center, Croatia. The hospitalized patients were divided in two groups, from 2000 to 2004 and from 2005 to 2009. The analysis included total mortality and mortality according to gender and location of AMI. The location of infarction was detected toward typical ECG changes. The analysis included the model of death in patients with AMI and in-hospital mortality of patients undergoing the PCI procedures. The patients in the first group were treated with the standard medication therapy, and the patients in the second group were treated with PCI. The number of hospitalized patients with AMI, in ten years, increased from 475 to 652. A total of 5339 patients with AMI were hospitalized, and included 67.5% males and 32.5% females. The first group included 2336 patients (68% males and 32% females). The second group included 2973 patients (67% males and 33% females). Male patients in average were 5 years younger than female patients. A total in-hospital mortality was significantly higher in the first group (13.5 vs. 7.6%). The mortality in the first group was significantly higher in females (22.7 vs. 12%) and in males (9 vs. 5.5%) comparing with second group. In-hospital mortality in the patients with STEMI was significantly higher in the first group (16.6 vs. 9%). Among the patients with NSTEMI there were no significantly differences in the in-hospital mortality (4 vs. 2.5%). The most frequent trigger of death in males were ventricular fibrillation in both groups such as heart failure in females. Cx occlusion is more often among the male patients treated with PCI. In-hospital mortality in patients with STEMI treated with PCI was 5.7%. A in-hospital mortality in the patients with AIM after PCI was almost halved. Females had two times higher in-hospital mortality before and after PCI introduction.
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