Assuntos
Dor Abdominal/etiologia , Trombose Coronária/tratamento farmacológico , Dispneia/etiologia , Hiperglicemia/tratamento farmacológico , Pericardite/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Taquicardia Sinusal/etiologia , Abscesso/complicações , Abscesso/etiologia , Abscesso/terapia , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Cateterismo Cardíaco , Trombose Coronária/diagnóstico , Stents Farmacológicos , Eletrocardiografia , Evolução Fatal , Feminino , Coração/microbiologia , Humanos , Hiperglicemia/diagnóstico , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Insulina/administração & dosagem , Insulina/uso terapêutico , Pericardiocentese , Pericardite/complicações , Pericardite/terapia , Fator de Ativação de Plaquetas/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Infarto do Miocárdio com Supradesnível do Segmento ST/patologia , Taquicardia Sinusal/diagnóstico , Taquicardia Sinusal/tratamento farmacológico , Infecções Urinárias/tratamento farmacológicoAssuntos
Ponte de Artéria Coronária , Trombose Coronária/diagnóstico , Trombose Coronária/cirurgia , Vasos Coronários/patologia , Vasos Coronários/cirurgia , Intervenção Coronária Percutânea , Stents , Angiografia Coronária , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/patologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Intra-aortic balloon pump (IABP) use may be associated with complications; however, in certain patients with ST-elevation myocardial infarction (STEMI) with hemodynamic instability refractory to medical management its use may become necessary. METHODS: 36 STEMI patients with IABP placement for hemodynamic instability after percutaneous coronary intervention were studied. IABP duration ranged from one to seven days (median two days). Based on median time, patients were divided into two groups: IABP duration ≤ 2 days (n = 27) or > 2 days (n = 9). Vascular complications and incidence of bleeding were compared. RESULTS: Mean IABP duration was 1.4 ± 0.5 and 4.1 ± 1.3 days in ≤ 2 day and > 2 day groups, respectively (P < 0.01). Glycoprotein IIb/IIIa inhibitor and anti-coagulation use was not significantly different between groups. Mean duration of anti-coagulation was 1.9 ± 1.2 and 4.5 ± 1.3 days in ≤ 2 day and > 2 day groups, respectively (P < 0.05). Complications (vascular, access site bleeding, gastrointestinal bleeding) were significantly greater in > 2 day group (66%) compared to ≤ 2 day group (18%; P < 0.05). CONCLUSIONS: When an IABP was used for more than two days complications significantly increased. The clinical implications of the study will be strengthened if the findings are confirmed in a prospective study with a larger number of patients.
Assuntos
Hemorragia/etiologia , Balão Intra-Aórtico/efeitos adversos , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea , Doenças Vasculares/etiologia , Idoso , Eletrocardiografia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/fisiopatologia , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
Aneurysms of the coronary arteries are rare and are usually associated with atherosclerosis in adults. Mycotic coronary artery aneurysms are exceedingly uncommon and are typically associated with systemic bacteremia, endocarditis, or septic emboli. Literature and data describing the management of mycotic coronary artery aneurysms are limited. This case describes the successful diagnosis of a large right coronary artery aneurysm by transesophageal echocardiogram as well as the successful management of the aneurysm.
Assuntos
Aneurisma Infectado/diagnóstico , Aneurisma Roto/diagnóstico , Aneurisma Coronário/diagnóstico , Endocardite/diagnóstico , Adulto , Alcinos/uso terapêutico , Aneurisma Infectado/cirurgia , Aneurisma Roto/cirurgia , Bacteriemia/complicações , Cateterismo Cardíaco , Aneurisma Coronário/cirurgia , Vasos Coronários/diagnóstico por imagem , Ecocardiografia Transesofagiana , Endocardite/tratamento farmacológico , Átrios do Coração/diagnóstico por imagem , Cardiopatias/complicações , Cardiopatias/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Falência Renal Crônica/complicações , Masculino , Pericardite/etiologia , Peritonite/complicações , Doenças Raras , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/microbiologia , Trombose/complicações , Trombose/diagnóstico por imagemRESUMO
Hypertension is prevalent in the population at large and among hospitalized patients. Little has been reported regarding the attitudes and patterns of care of physicians managing nonemergent elevated blood pressure (BP) among inpatients. Resident physicians in internal medicine (IM), family medicine (FM), and surgery were surveyed regarding inpatient BP management. One hundred eighty-one questionnaires were completed across 3 sites. Respondents generally considered inpatient BP control a high priority. A majority of IM and FM residents indicated following the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) consensus guidelines for inpatients compared to 20% of surgery residents (P<.001). While trainees did not appear to strictly follow JNC 7 guidelines for goal BP of 140/90 mm Hg, they did report making frequent BP medication changes (â¼51% reported changing regimens for >50% of hypertensive patients). Overall â¼90% indicated that discharging a hypertensive patient on a drug regimen established during hospitalization is preferable to reverting to the regimen in place at the time of admission. Resident physicians regard elevated BP inpatient management as important, but attitudes and practice vary between specialties. JNC 7 guidelines may not be appropriate for inpatient use. Future research should focus on developing functional diagnostic criteria for hypertension in the inpatient setting and determining best practices inpatient BP management.