Outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have improved because of advancements in equipment and techniques. With global collaboration and knowledge sharing, we have identified 7 common principles that are widely accepted as best practices for CTO-PCI. 1. Ischemic symptom improvement is the primary indication for CTO-PCI. 2. Dual coronary angiography and in-depth and structured review of the angiogram (and, if available, coronary computed tomography angiography) are key for planning and safely performing CTO-PCI. 3. Use of a microcatheter is essential for optimal guidewire manipulation and exchanges. 4. Antegrade wiring, antegrade dissection and reentry, and the retrograde approach are all complementary and necessary crossing strategies. Antegrade wiring is the most common initial technique, whereas retrograde and antegrade dissection and reentry are often required for more complex CTOs. 5. If the initially selected crossing strategy fails, efficient change to an alternative crossing technique increases the likelihood of eventual PCI success, shortens procedure time, and lowers radiation and contrast use. 6. Specific CTO-PCI expertise and volume and the availability of specialized equipment will increase the likelihood of crossing success and facilitate prevention and management of complications, such as perforation. 7. Meticulous attention to lesion preparation and stenting technique, often requiring intracoronary imaging, is required to ensure optimum stent expansion and minimize the risk of short- and long-term adverse events. These principles have been widely adopted by experienced CTO-PCI operators and centers currently achieving high success and acceptable complication rates. Outcomes are less optimal at less experienced centers, highlighting the need for broader adoption of the aforementioned 7 guiding principles along with the development of additional simple and safe CTO crossing and revascularization strategies through ongoing research, education, and training.
Patient: Male, 38-year-old Final Diagnosis: COVID 19 infection • pneumonia Symptoms: Dyspnea • fever Medication: — Clinical Procedure: — Specialty: Cardiology • Infectious Diseases Objective: Unusual clinical course Background: Since the initial COVID-19 cases in 2019, the pandemic has expanded globally. Clinical data showed that dexamethasone treatment at a dose of 6 mg daily for up to 10 days in hospitalized patients with COVID-19 who were receiving respiratory support decreased 28-day mortality in COVID-19 patients. Recent reports, on the other hand, have indicated that both steroid resistance and rebound events occur. We report a case of rebound inflammation after the termination of dexamethasone medication in a 38-year-old man with severe COVID-19 pneumonia, which improved after the reintroduction of dexamethasone. Case Report: A 38-year-old male patient with no past medical history of note presented with new onset of dyspnea. He was subsequently diagnosed with severe coronavirus disease 2019 (COVID-19). Initially, the patient was clinically improved following a 3-day course of 16 mg of dexamethasone daily. Shortly after discontinuing corticosteroids, the patient’s clinical condition deteriorated, necessitating increased oxygen support. Following the rein-troduction of corticosteroids, the patient gradually improved and responded favorably in terms of respiratory function, symptoms, and imaging, after which he was successfully discharged. Conclusions: This case exemplifies the previously observed rebound effects of discontinuing dexamethasone medication in individuals with severe COVID-19 pneumonia. The timing and length of dexamethasone medication should be tailored to the individual patient. In addition, monitoring lung function should be part of the gradual withdrawal of dexamethasone to avoid rebound lung inflammation and the long-term effects of increasing lung fibrosis.
Background. Olanzapine is a second-generation antipsychotic drug commonly prescribed for certain mental/mood conditions such as schizophrenia and bipolar disorders. This agent has been considered a precipitating factor for venous thromboembolism formation. Most of the cases previously reported were associated with high-dose olanzapine therapy or in patients with high-risk factors for the development of thromboembolism. Case Presentation. We report a patient who developed pulmonary embolism after a long course of low-dose olanzapine. A 66-year-old female patient suffering from insomnia had been prescribed olanzapine 2.5 mg and paroxetine 10 mg for two years. The patient suddenly developed a syncopal episode at home and was immediately brought to the hospital. The diagnosis of pulmonary embolism was made by chance during the computerized tomography of coronary arteries. The patient made a full recovery under conventional treatment and was discharged in stable condition. The thoracic computed tomography taken two months after discharge showed a completely normal pulmonary arterial tree. Conclusion. Olanzapine-associated pulmonary embolism is a rare entity and might be missed if the physician in charge is not vigilant and well informed. Even low-dose olanzapine can be associated with pulmonary embolism in patients with low classic risk factors if the treatment is prolonged. Pulmonary embolism should be sought in patients taking olanzapine even though the presenting manifestations are nonspecific.
Patient: Female, 38-year-old Final Diagnosis: COVID 19 infection • myocarditis Symptoms: Dyspnea • hypotension Medication: — Clinical Procedure: — Specialty: Cardiology • Critical Care Medicine • Infectious Diseases Objective: Rare coexistence of disease or pathology Background: COVID-19 is a pandemic caused by a coronavirus that has only recently been discovered. The disorder is characterized by persistent respiratory system malfunction, which can range from modest difficulty breathing to potentially lethal complications such as acute respiratory distress syndrome. Additional organs are affected as a result of its presence. An adverse impact of COVID-19 infection is myocarditis, which is a condition that affects the heart muscle. Case Report: We describe the case of a 38-year-old woman who was hospitalized at University Medical Center Ho Chi Minh City following a 15-day fever, a 3-day bout of dyspnea, and a positive nasal PCR SAR-CoV-2 test. The Lake Louise criteria were used to determine that the patient had a high probability of having myocarditis. She was then treated with oxygen treatment, vasoconstrictor medicines, inotropic therapy, and cornerstone heart failure medications, and was discharged 2 weeks later after a complete recovery. Conclusions: Myocarditis has been identified as a cause of death in COVID-19, although it is not known how common the ailment is in the general population. Early detection and complete treatment, which should include support for the cardiovascular system, are consequently critical for successful outcomes. Magnetic resonance imaging (MRI) of the cardiovascular system (cardiac MRI) is the most important noninvasive method for diagnosing myocarditis.
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