RESUMO
Cardiogenic shock continues to be the most common cause of death in patients hospitalized with acute myocardial infarction. It has also been frequently associated with ST-segment elevation myocardial infarction (STEMI) and patients with co-morbidities. Cardiogenic shock presents with low systolic blood pressure and clinical signs of hypoperfusion. Rapid diagnosis and supportive therapy in the form of medications, airway support and intra-aortic balloon counterpulsation is required. Initial stabilization can be followed by reperfusion by fibrinolytic therapy, emergent percutaneous intervention (PCI) or coronary artery bypass grafting (CABG). The latter two have been found to decrease mortality in the long term. Research is being carried out on the role of inflammatory mediators in the clinical manifestation of cardiogenic shock. Mechanical support devices also show promise in the future.
RESUMO
Acute vertebrobasilar artery occlusion is a life-threatening event, even after thrombolytic treatment with local intraarterial (IA) recombinant tissue plasminogen activator. We report a 70-year-old man with acute vertebral artery occlusion in which IA thrombolysis resulted in partial recanalisation and revealed pre-existing severe stenosis as the underlying cause. Stenosis was managed with stenting with excellent long-term clinical as well as angiographical outcomes.
Assuntos
Stents , Trombose/etiologia , Insuficiência Vertebrobasilar/cirurgia , Idoso , Artéria Basilar/diagnóstico por imagem , Angiografia Cerebral , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Terapia Trombolítica , Trombose/tratamento farmacológico , Ativador de Plasminogênio Tecidual/uso terapêutico , Insuficiência Vertebrobasilar/complicaçõesAssuntos
Antibacterianos/efeitos adversos , Claritromicina/efeitos adversos , Digoxina/efeitos adversos , Pneumonia Bacteriana/tratamento farmacológico , Anticoagulantes/efeitos adversos , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Interações Medicamentosas , Quimioterapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Pneumonia Bacteriana/complicações , Varfarina/efeitos adversosRESUMO
Two patients with symptomatic fast/slow pathway double responses were evaluated with electrophysiology studies. Chronic palpitations were resistant or worsened by medical therapy. No reentry tachycardias were induced. A nonreentrant paroxysmal supraventricular tachycardia was documented. Radiofrequency ablation of the slow pathway was safely and successfully performed. Patients remain asymptomatic for 16-18 months. Ablation of the slow pathway for this substrate is a viable option.
Assuntos
Ablação por Cateter , Eletrocardiografia , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia Paroxística/cirurgia , Adulto , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Nó Atrioventricular/fisiopatologia , Nó Atrioventricular/cirurgia , Estimulação Cardíaca Artificial , Eletrocardiografia Ambulatorial , Feminino , Seguimentos , Humanos , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia Paroxística/diagnóstico , Taquicardia Paroxística/fisiopatologia , Resultado do TratamentoRESUMO
A retrospective analysis of 60 consecutive patients who underwent outpatient transseptal radiofrequency ablation of left sided accessory pathways at Westchester County Medical Center/New York Medical College from September 1994 to December 1997 was performed. Patients were followed for a mean duration of 22 months. No complications either local or related to the transseptal method were observed. All patients had successful ablation of the accessory pathway. One patient had a recurrence of symptoms. This study suggests transseptal radiofrequency ablation of the left sided accessory pathways to be safe, feasible and an effective procedure when performed in an outpatient setting. These results were obtained at a high volume center with experience using the transseptal technique.
Assuntos
Assistência Ambulatorial , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/cirurgia , Nó Atrioventricular/fisiopatologia , Ablação por Cateter , Sistema de Condução Cardíaco/fisiopatologia , Sistema de Condução Cardíaco/cirurgia , Adulto , Feminino , Septos Cardíacos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Segurança , Resultado do TratamentoRESUMO
Long-term clinical outcome after use of stents in primary and rescue coronary angioplasty for treatment of acute myocardial infarction has not been described in detail. This study was conducted to evaluate long-term (more than one year) outcome in patients treated for acute myocardial infarction with stents. Between January 1, 1997 and September 1997, 101 consecutive patients had coronary artery stents implanted either for primary treatment of myocardial infarction or after failed thrombolytic therapy. Medical records of these patients were reviewed and telephone follow-up was performed using a standard questionnaire. Mean duration of follow-up was 17.8 +/- 1.7 months. During initial hospitalization only one patient had emergent percutaneous transluminal coronary angioplasty due to stent thrombosis (1%); two patients underwent emergent coronary artery bypass surgery (2%) and two patients died (2%). During the follow-up period, ten patients (10%) had recurrent angina, eight patients were treated medically (8%), two required repeat angioplasty (2%), two patients died (2%), and three patients (3%) were lost to follow-up. Stenting of the culprit vessel during acute myocardial infarction appears to be a safe and effective treatment associated with favorable in-hospital and long-term outcomes.
