Coronary artery disease (CAD) is the first cause of morbidity and mortality worldwide. An important goal is to diagnose patients in early stages, in order to reduce acute cardiovascular events. The angiotensin-converting enzyme (ACE) is an important element for the cardiovascular system, through its actions on hydro-salin balance and vascular tone. ACE polymorphism consists of insertions (I)/deletions (D) and there are 3 genotypes: II, ID, DD. It is speculated that the DD genotype may be a genetic basis for severe CAD, while the II genotype may have a protective effect on the coronary arteries. The present study included 154 patients with acute coronary syndroms admitted to the Institute for Cardiovascular Disease 'George I.M. Georgescu', Iasi. The patients underwent coronary angiography in order to assess the severity of the lesions and the ACE genotypes were determined for each patient. The genotypes were correlated with the severity of the vessel-disease and the exposure to classic risk factors. It was concluded that the D-allele is associated with a greater risk for acute coronary events and severe coronary stenosis, especially when risk genotype and risk phenotype interact.
What started with 41 hospitalized patients identified as having laboratory-confirmed coronavirus disease 2019 in Wuhan, China, by January 2, 2020, turned into an unprecedented pandemic with more than 113 million confirmed cases and a mortality exceeding 2.5 million deaths worldwide by the beginning of March 2021. Although the course of the disease is uneventful in most cases, there is a percentage of patients who become critically ill and need admission in the intensive care unit for severe respiratory failure. Numerous of these patients undergo invasive mechanical ventilation and have an extremely high mortality rate. For these patients, extracorporeal membrane oxygenation (ECMO) has emerged as a last standing resource. In the present study, the literature was reviewed to evaluate the worldwide data regarding the use of ECMO in the management of critically ill COVID-19 patients. ISI Thomson Web of Science was searched for articles with English language abstracts from inception to March 1, 2021, with 'ECMO in COVID-19' as key words. A total of 214 abstracts were screened (case reports, guidelines, reviews) and the most relevant articles were included in the present review. The use of ECMO in the management of critically ill patients with COVID-19-induced acute respiratory distress syndrome refractory to conventional mechanical invasive ventilation is increasing. By increasing the survival rate from less than 20% to more than 50%, ECMO proved to be a valuable resource in the management of the most challenging critically ill COVID-19 patients. Contents 1. Introduction 2. Worldwide data regarding the critically ill COVID-19 patients 3. Rational for extracorporeal membrane oxygenation (ECMO) use in the management of critically ill COVID-19 patients 4. ECMO use in the management of critically ill COVID-19 patients: Current guidelines 5. Worldwide data regarding ECMO-supported COVID-19 patients 6. Discussion 7. Conclusions
Venous thromboembolism (VTE) is a major healthcare problem due to its high incidence, significant mortality rate from pulmonary embolism, high recurrence rate and morbidity from long-term complications. After a first episode of VTE all patients must receive anticoagulant treatment for 3 months. Further anticoagulation is recommended in patients without transient risk factors for VTE or patients with active cancer, if they are not at a high risk for bleeding. The VTE-BLEED risk score was created with the purpose of enabling a better stratification of the bleeding risk during stable anticoagulation after a first VTE. Currently, it is the most validated risk score in VTE settings (selected and non-selected cohorts). It has a good prediction power for major bleeding events in patients receiving any of the currently available classes of oral anticoagulants, and it can identify patients at risk of intracranial and fatal bleeding events. The aim of our review was to highlight the strengths of the VTE-BLEED risk score, to acknowledge its weak points and to properly position its use in current medical practice. Contents 1. Introduction 2. Premises for a new bleeding risk score 3. Development and internal validation of the VTE-BLEED risk score 4. External validation of the VTE-BLEED risk score 5. VTE-BLEED risk score performance in identifying patients at high risk of severe major bleedings 6. VTE-BLEED risk score performance in practice-based conditions 7. VTE-BLEED risk score performance in predicting in-hospital major bleedings 8. Conclusions
Atrial septal defects represent an abnormal communication between the left and the right atria. Some patients may experience dyspnoea, fatigue, others may suffer directly from complications, like arrhythimias, paradoxal embolisation, resulting in stroke, but some remain asymptomatic until adulthood. When possible, the gold standard treatment is percutaneous closure with nitinol messh occluder. We are presenting the case of a 50-year-old patient with an acute anterior myocardial infarction, whose echocardiography showed akinesia of the left ventricular apex and anterior wall, as well as a surprise element, not connected to the myocardial infarction, a 22 mm atrial defect, with a shunt ratio higher than 1.5. Our first concern was the cardiovascular emergency. The coronarography revealed a critical stenosis of the proximal left anterior descendent and we introduced a stent. In a second phase,we evaluated the atrial septal defect. Since it had indication for percutaneous closure, we decided to use an Amplatzer occluder. The intervention was a success, with no residual shunt. The patient�s follow up was good, with no cardiovascular events. Most of time, cardiovascular diseases are not isolated, but come together, related or not to one another. An adequate management implies treating the cardiovascular emergency first and solving the associated lesions in a second phase.
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