Diabetes mellitus (DM) is a leading cause of mortality in the world, mainly on account of cardiovascular diseases. At present we know that not only DM but also other hyperglycemic states are a risk factor for coronary arterial disease. In the context of acute coronary syndromes, DM determines a worst prognosis, either in short- or long-term outcomes. Since the absolute risk of death is greater among diabetic patients when compared to non-diabetic patients, therapeutical interventions have a greater impact in terms of benefits to these patients as well. Strategies such as strict control of hyperglycemia during hospitalization, acute reperfusion management (either by thrombolysis or by percutaneous coronary intervention), use of platelet glycoprotein IIb/IIIa inhibitors and angiotensin-converting enzyme (ACE)-inhibitors have recently proven to be of greater benefit for diabetics over non-diabetic patients. Meanwhile, in spite of all proven benefits of the use of evidence-based interventions to the treatment of acute coronary syndromes on diabetic patients, there is still an under utilization of these measures. Therefore, taking into account the predictions of an increasing number of diabetics in the world for the future years, and the fact that acute coronary syndromes will be the leading cause of death among them, it becomes increasingly necessary for both cardiologists and endocrinologists to work together in order to reduce the unfavorable outcomes that are expected to arise.
BACKGROUND AND OBJECTIVES: Acute coronary syndromes (ACS) are one of the most common causes of ICU admissions. New drugs have been developed for management of ACS. These drugs reduced morbidity and mortality; however their adverse effects or their incorrect use may cause excessive bleeding. The objective of this review is to present the principal peculiarities, doses, and indications of these drugs in ACS settings.
Introduction:
In-hospital cardiopulmonary arrest (CPA-IH) is a public health problem with high worldwide morbidity and mortality. Cases of non-shockable CPA rhythms, such as asystole and pulseless electrical activity (PEA), have remained unchanged over the last 30 years. Despite updates to resuscitation guidelines every five years, we have not been successful in increasing patient survival. Prognostic and diagnostic factors during CPA are necessary to increase survival among these patients and optimise available resources. Transthoracic echocardiography (TTE) provides valuable information about diagnosis and perhaps prognosis, through real-time images.
Hypothesis:
This study describes the use of TTE in patients with CPA with non-shockable rhythms in an intensive care unit (ICU), evaluating the prognostic factor of myocardial contractility in the return of spontaneous circulation (ROSC) and differential diagnoses
Methods:
This was a prospective cohort study conducted in an ICU of a university hospital with patients in CPA with asystole or PEA as their initial rhythm.
Results:
TTE performed by doctors highly trained in the method was included in the treatment protocol. In total, 49 patients were included in the study, 32 in PEA and 17 in asystole, of whom 27 patients in PEA had myocardial contractility. During the examination, the patients in PEA were subclassified into pseudo electromechanical dissociation (EMD) and true EMD. Of the 49 patients, 24 had ROSC, and two had survival > 360 days. The pseudo-EMD patients (contractility present and without central pulse) had a survival rate odds ratio of 2.99 (1.22 to 7.29; p = 0.016) compared with the other groups.
Conclusions:
Therefore, the presence of myocardial contractility may be a short- and long-term prognostic factor during CPA.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.