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1.
Catheter Cardiovasc Interv ; 99(3): 772-776, 2022 02.
Article in English | MEDLINE | ID: mdl-34551189

ABSTRACT

OBJECTIVES: To demonstrate the feasibility and safety of performing elective percutaneous coronary intervention (PCI) during contrast reaction producing severe hypotension. BACKGROUND: The development of profound hypotension due to a contrast reaction requires emergency treatment and usually signals procedure termination. METHODS AND RESULTS: We report successful completion of planned PCI with blood pressure support with vasopressors during contrast-induced hypotension in nine procedures in three patients with previously known contrast reaction causing hypotension. CONCLUSIONS: This case series provides support for the feasibility and safety of performing successful planned PCI under blood pressure support in patients with contrast reaction causing severe hypotension. A management approach for considering intervention in the setting of contrast-induced hypotension is provided.


Subject(s)
Hypotension, Controlled , Percutaneous Coronary Intervention , Elective Surgical Procedures , Humans , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , Treatment Outcome
2.
Cardiol Res ; 10(4): 249-252, 2019 Aug.
Article in English | MEDLINE | ID: mdl-31413784

ABSTRACT

Direct oral anticoagulants (DOACs) are used for many conditions where anticoagulation is needed such as non-valvular atrial fibrillation, deep vein thrombosis (DVT) and pulmonary embolism (PE). These novel agents have become popular since they do not require monitoring of therapeutic levels and there is a lower risk of certain bleeding complications when compared to warfarin. However, the efficacy and side effect profile of these agents have not been widely studied in certain patient cohorts, namely cancer patients and patients on immunomodulators or hormone analogs. We present a case of a patient with a history of malignancy and autoimmune disease who developed pericardial and pleural effusions shortly after initiating apixaban for treatment of a PE. In addition, we aim to increase awareness of the role that the newly available reversal agents for anticoagulants would offer in the acute management of hemorrhagic pericardial and pleural effusions caused by DOACs in patients with and without malignancy.

3.
Eur Heart J Cardiovasc Pharmacother ; 2(3): 175-84, 2016 Jul.
Article in English | MEDLINE | ID: mdl-27533759

ABSTRACT

D-dimers have been discovered as by-products of fibrinolysis. In situations where the fundamental pathology is associated with increased thrombolytic activity, D-dimer assays could serve an integral role in the clinical workup, and have an already established role in the diagnosis of clinical disorders of venous thromboembolism, and disseminated intravascular coagulation. However, there is growing literature suggesting that this is not the only clinical scenario where D-dimers may be of significance. They may also become an important biomarker in coronary and carotid artery atherosclerosis and aortic diseases. Being a non-invasive and quick means of diagnosis, D-dimers are a cost-effective tool used for diagnosing diseases. With the future being steered in the direction of preventive cardiology, it is imperative for clinicians to understand how to effectively utilize biomarkers in order to diagnose disorders. In this context, we review D-dimer's origin, current clinical utility, and potential future applications.


Subject(s)
Acute Coronary Syndrome/diagnosis , Fibrin Fibrinogen Degradation Products/analysis , Acute Coronary Syndrome/blood , Animals , Biomarkers , Humans
4.
Cardiovasc Revasc Med ; 17(6): 424-7, 2016 Sep.
Article in English | MEDLINE | ID: mdl-27396606

ABSTRACT

History of prior coronary artery bypass surgery (CABG) is a frequent scenario encountered in patients with severe symptomatic aortic stenosis deemed inoperable and referred for transcatheter aortic valve replacement (TAVR). Aside from indices of frailty and other comorbidities, these patients remain at higher risk for peri-operative mortality and morbidity compared to their counterparts without prior CABG. Presence of concomitant peripheral arterial disease and patent left internal mammary artery (LIMA) graft pose further access related challenges. We present a case of an 84-year-old female with prior CABG and severe PAD who underwent transapical TAVR for severe symptomatic AS sustaining an acute myocardial injury from damage to her apical epicardial collateral circulation. The case entails the importance of recognition of epicardial coronary collateralization where a transapical approach is best avoided or further aided by utilization of peri-procedural angiographic/fluoroscopy guidance to avoid epicardial vascular injury.


Subject(s)
Aortic Valve Stenosis/therapy , Cardiac Catheterization/adverse effects , Heart Valve Prosthesis Implantation/adverse effects , Medical Futility , Patient Selection , Aged, 80 and over , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/physiopathology , Cardiac Catheterization/instrumentation , Collateral Circulation , Coronary Angiography , Coronary Artery Bypass/adverse effects , Coronary Circulation , Electrocardiography , Fatal Outcome , Female , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/instrumentation , Humans , Myocardial Infarction/etiology , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/physiopathology , Risk Assessment , Risk Factors , Severity of Illness Index , Time Factors , Treatment Outcome
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