ABSTRACT
Recent advances in interventional cardiology, pharmacotherapeutics and modern surgical management in tertiary cardiac care centers have tremendously improved the present treatment of Pulmonary Embolism (PE). CT pulmonary angiography (CTPA), nuclear lung scan (V/Q scan), D-dimer test and modern echocardiography have revolutionized the diagnostic methodology and risk assessment criteria. Cardiogenic shock or systolic hypotension (BP < 90 mmHg) and presence of right ventricular dysfunction (or failure) are two principal criteria which govern the severity of pulmonary embolism. While all patients of pulmonary embolism require anticoagulation, systemic thrombolytic therapy is the mainstay of initial treatment in massive and submassive pulmonary embolism. When thrombolysis is contraindicated or has failed, urgent surgical embolectomy or catheter embolectomy may be life saving procedures in severe pulmonary embolism.
Subject(s)
Acute Disease , Angiography/instrumentation , Antifibrinolytic Agents/therapeutic use , Embolectomy/methods , Fibrinolytic Agents/therapeutic use , Humans , Pulmonary Embolism/diagnosis , Streptokinase/therapeutic use , Thrombolytic Therapy , Tissue Plasminogen Activator/therapeutic use , Tomography, X-Ray Computed/instrumentation , Urokinase-Type Plasminogen Activator/therapeutic useABSTRACT
Coronary artery bypass surgery (CABG) is the treatment of choice in unprotected left main coronary artery disease (ULMCA). However drug eluting stent (DES) implantations in ULMCA have ushered a revolution in the field of percutaneous coronary interventions (PCI) for left main coronary artery (LMCA) by reducing peri-procedural mortality and incidence of major adverse cardiac events (MACE). More randomized trials and follow-up studies are required before PCI with DES can be chosen as alternative to CABG.
Subject(s)
Coronary Artery Bypass , Coronary Disease/surgery , Coronary Restenosis/prevention & control , Drug Delivery Systems , Humans , Stents , Vascular PatencyABSTRACT
Metabolic syndrome is a complex constellation of risk factors which predispose to diabetes and coronary heart disease. Various components of the metabolic syndrome are: abdominal obesity, impaired glucose regulation, dyslipidemias and hypertension. Insulin resistance and obesity are characteristics of metabolic syndrome. The risk factors predispose to the development of type 2 diabetes and atherosclerosis. Changes in the life style, reduction of obesity and food habits are fundamental in reducing the risk factors. Some patients may, however, require pharmacological intervention for the control of hyperglycemia, obesity, hypertension and dyslipidemias.