RESUMO
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.
Assuntos
Doença Aguda , Angiografia/instrumentação , Antifibrinolíticos/uso terapêutico , Embolectomia/métodos , Fibrinolíticos/uso terapêutico , Humanos , Embolia Pulmonar/diagnóstico , Estreptoquinase/uso terapêutico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Tomografia Computadorizada por Raios X/instrumentação , Ativador de Plasminogênio Tipo Uroquinase/uso terapêuticoRESUMO
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.
Assuntos
Ponte de Artéria Coronária , Doença das Coronárias/cirurgia , Reestenose Coronária/prevenção & controle , Sistemas de Liberação de Medicamentos , Humanos , Stents , Grau de Desobstrução VascularRESUMO
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.