The coronavirus disease outbreak in 2019 (COVID-19) reached devastating pandemic proportions, still representing a challenge for all healthcare workers. Furthermore, the social environment underwent significant changes and healthcare facilities were overwhelmed by COVID-19 patients. The purpose of our study was to compare the prevalence, characteristics and outcomes of 234 patients presenting with pulmonary embolism diagnosed by computed tomography pulmonary angiography (CTPA) during the COVID-19 pandemic, to patients presenting with PE one year before, aiming to assess differences and similarities between these patients. Or main findings were: patients with PE had worse survival during the pandemic, there was an increased incidence of PE among hospitalizations in our cardiology unit during the COVID-19 pandemic, and patients hospitalized with PE during the pandemic were more likely to be obese, allowing us to infer that weight control can have a positive impact on preventing PE. Future research should establish optimal therapeutic, epidemiological and economical strategies for non-COVID patients, as the pandemic continues to put significant burden on the healthcare systems worldwide.
We present the case of a 74 y.o. woman with multiple cardiovascular risk factors, admitted for worsening angina over the past three weeks. On admission she had no significant electrocardiographic and echocardiographic changes and a negative Troponin test. Coronary angiography revealed single vessel disease: severe stenosis of the right coronary artery (RCA) ostium (difficult to assess visually), 50% mid-vessel and 60% distal segment. The left anterior descending artery and circumflex artery had non-significant stenoses. Fractional flow reserve technique (FFR) was used to evaluate the RCA ostial lesion which proved to be significant, therefore angioplasty with three drug-eluting stents was performed for all three lesions of the right coronary artery, starting from the ostium. Due to its location, minimal aortic protrusion of the first stent occluded a small ostial branch which proved to be the conus artery and the patient developed mild transient angina during the procedure, but with good outcome regarding the intracoronary flow. After the angioplasty the patient presented anterior leads ST-elevation and developed mild chest pain with an increase in cardiac enzymes (CK-MB peak 39 U/L). Later on, she had two episodes of ventricular fibrillation with rapid defibrillation to sinus rhythm, with no further events or echocardiographic changes and no recurrent angina. The patient was started on amiodarone to prevent ventricular arrhythmias and continued double antiplatelet therapy with aspirin and clopidogrel. She was discharged six days later. In conclusion, although the conus branch is a small artery, its acute occlusion can have significant life-threatening complications.
Background Data regarding cardiac damage in Romanian hypertensive adults are scarce. Our aim was to assess hypertension-mediated subclinical and clinical cardiac damage using a post-hoc echocardiographic analysis of a national epidemiological survey. Methods A representative sample of 1477 subjects was included in the SEPHAR IV (Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk in an Adult Population in Romania) survey. We retrieved echocardiographic data for 976 subjects, who formed our study group. Cardiac damage included left ventricular (LV) hypertrophy (defined as an LV mass > 95 g/m2 in females and > 115 g/m2 in males), coronary artery disease (CAD), and LV diastolic and systolic dysfunction. Results Hypertension prevalence was 46.0% in SEPHAR IV and 45.3% in our study subgroup. Hypertensives had a higher prevalence of LV hypertrophy, CAD, diastolic dysfunction (p<0.001 for all) and systolic dysfunction (p=0.03) than normotensives. Age (OR=1.05;95% CI,1.03–1.08;p<0.001), female sex (OR=2.07;95% CI,1.24–3.45;p=0.006), and systolic blood pressure (OR=1.02;95% CI,1.01−1.04;p=0.026) were independent predictors of LVH in hypertensives. Age was a predictor of diastolic dysfunction (OR=1.04;95% CI,1.02−1.06;p<0.001), and female sex was a protective factor against systolic dysfunction (OR=0.26;95% CI,0.10–0.71;p=0.009). Age (OR=1.05;95% CI,1.02−1.07;p<0.001) and dyslipidemia (OR=1.89;95% CI,1.20–3.00;p=0.007) were independent determinants of CAD in hypertensives. Conclusion The prevalence of cardiac damage in Romanian hypertensives is high. Both non-modifiable risk factors (such as age and gender) and modifiable (such as dyslipidemia and systolic blood pressure) risk factors are independent predictors of cardiac damage in hypertensives.
Essential hypertension (HTN) has a complex spectrum of pathophysiological determinants and current guidelines provide limited information on high-risk groups that should be targeted for its primary prevention. The objective of our research was to identify clusters of social and metabolic factors associated with prevalent HTN in men and women from a population-based survey in Romania. Of the 1477 participants in the main study, 798 with complete data were analyzed here. Using two-step cluster analysis, one high-risk cluster in women and two high and intermediate risk for prevalent HTN in men were identified. Older age, rural area, lower education, and higher burden of metabolic factors characterized clusters with higher risk, while intermediate risk in men was characterized by a more metabolically healthy phenotype in younger individuals. In logistic regression, men in Cluster 1 vs. those in Cluster 3 had an odds ratio (OR) of 9.6 (95%CI: 4.6; 20.0), p < 0.001 for prevalent HTN, while OR for Cluster 2 vs. Cluster 3 was 3.2 (95%CI: 1.4; 7.4), p = 0.005. In women, the OR for HTN was 10.2 (95%CI: 5.7; 18.5) if assigned to Cluster 2 vs. Cluster 1, p < 0.001. These results pointed out the subgroups and communities that the primary prevention of HTN should be prioritized in.
Ischemic heart disease is one of the most prevalent diseases with a high impact on mortality and morbidity. The main process implicated in acute coronary syndromes (ACS) including its most severe form, the ST elevation myocardial infarction (STEMI), is the development of thrombosis subsequently of plaque erodation or rupture. The thrombus is formed by aggregates of platelets that furthermore drive the process of coagulation, that in this turn stimulates platelet aderation and aggregation, causing a vicious circle. From these physiopathological mechanims derive the indication and role of antiplatelets and anticoagulation in STEMI. Antiplatelets and anticoagulants play a central role in the therapeutic management of STEMI along with the interventional therapy. Correctly conducted by all physicians involved in the management of patients with STEMI, it reduces the area of ischemia, as well as mortality and other major adverse cardiovascular events. The following article will review the antithrombotic treatment adjuvant to the interventional treatment and the evidence based indications for treatment in STEMI. RezumatBoala cardiacă ischemică este una dintre cele mai prevalente boli cu un impact major asupra mortalităţii și morbidităţii. Principalul proces implicat în sindroamele coronariene acute (SCA), incluzând forma sa cea mai severăinfarctul miocardic acut cu supradenivelare de segment ST (STEMI), este tromboza ce urmează în general erodării sau rupturii plăcii de aterom. Trombul este format din agregate plachetare care mai departe activează calea coagulării, care la rândul său stimulează aderarea și agregarea plachetară creând un cerc vicios cu potenţare reciprocă. Din aceste mecanisme fi ziopatologice derivă indicaţia și rolul tratamentelor antiagregante și anticoagulante în STEMI, terapia antiagregantă împreună cu cea antiacogulantă jucând un rol central în managementul STEMI alături de terapia intervenţională. Un tratament corect administrat de către toţi medicii implicaţi ajută la reducerea ariei de ischemie, precum și la scăderea mortalităţii și a celorlalte evenimente adverse cardiovasculare majore. Articolul reprezintă o revizuire a tratamentului antitrombotic premergător terapiei de reperfuzie intervenţionale, precum și a indicaţiilor de ghid bazate pe dovezi pentru tratamentul STEMI. Cuvinte cheie: sindroame coronariene acute, STEMI, antiagregante, anticoagulante, ghiduri, balanţa risc-benefi ciu, risc ischemic, angioplastie primară. REVIEWVlad BATAILA et al. Modern Medicine | 2019, Vol. 26, No. 3 112 ADP-receptor inhibitors ClopidogrelClopidogrel is a second-generation irreversible inhibitor of P2Y12 receptor protein from the family of thienopyridines. It was patented in 1982 and approved for medical use in 1998 being currently on the WHO list of the safest and most eff ective drugs 9 . Clopidogrel followed ticlopidine, the fi rst member of the thienopyridine family, but with a much faster onset of acti-
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