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Coronary Artery Disease
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Acute coronary syndromes are outcomes of acute coronary artery obstruction. Severity is based on the location of the obstruction and its degree. Uncontrolled angina can occur, as well as various types of MI, or sudden cardiac death. Diabetes mellitus is a major risk factor. All acute coronary syndromes involve acute coronary ischemia. They are identified by their symptoms, ECG results, and cardiac biomarkers. The uncontrolled angina subtype involves acute coronary insufficiency, preinfarction angina, and is an intermediate syndrome. The cardiac biomarkers do not meet the criteria for MI. There is resting angina longer than 20 minutes, new-onset angina of at least class 3 severity, and increasing angina that becomes more regular, severe, longer lasting, or that increases quickly from class 1 to class 3 or higher. With non-ST-segment elevation MI (NSTEMI, also called subendocardial MI), there is myocardial necrosis with no acute ST-segment elevation. There may be ST-segment depression, T-wave inversion, or both.
Weaning from Mechanical Ventilation
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
The barriers to weaning that we observe frequently include: inadequate MV, cardiac disease, infection, fluid overload, nutritional deficiency, and neurological dysfunction. Mechanical ventilation that is not set appropriately for the patient, particularly for tidal volume and inspiratory flow rate, may lead to persisting respiratory muscle fatigue due to continued activation and strain of those muscles. Cardiac disease can take the form of either coronary ischemia that occurs as a result of stress due to the resumption of breathing activity or left ventricular pump failure that can lead to inadequate blood flow to the respiratory muscles. Infection can be pulmonary or non-pulmonary in origin and can raise the metabolic rate and produce circulating cytokines that adversely affect muscle function. Fluid overload may worsen oxygenation and decrease lung compliance. Nutritional deficiency may weaken the respiratory muscles and reduce their work capacity. Neurological dysfunction can take the form of neuromuscular abnormalities including critical illness neuromyopathy or altered mental status including but not limited to sedative effects.
Congenital Heart Disease in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Due to the late complications of the atrial switch operation, it was eventually developed and first performed successfully in 1975 by Jatene and associates [20]. However, due to early operative complications with coronary ischemia, the arterial switch operation was not performed routinely until the early 1990s. In the arterial switch operation, the aorta and pulmonary artery are transected above the sinuses, and the coronary arteries are disconnected from the native aorta. The great arteries are then re-anastomosed in a “switched” manner, with the aorta now surgically anastomosed to the native pulmonary root (which arises from the left ventricle), and the pulmonary artery now surgically anastomosed anteriorly to the native aortic root (which arises from the right ventricle). The coronary arteries are implanted into the new constructed aortic (“neoaortic”) root. Long-term sequelae of the arterial switch operation include ventricular dysfunction and risk for myocardial ischemia, particularly due to the reimplantation of the coronary arteries. Neoaortic dilation and neoaortic valve regurgitation may also occur.
Treatment patterns and clinical outcomes among Medicare beneficiaries using antipsychotic medications for FDA-approved indications before and after transitioning from the community to a nursing home
Published in Current Medical Research and Opinion, 2023
Kyle Pérez, Michele Berrios, Bruce Pyenson, Heidi C. Waters
The acute clinical events and other medications of interest included in our analysis (hypnotics, antidepressants, antiepileptics, medications for treatment of dementia, benzodiazepines, and opioids) have been linked to AP use or identified as potential substitutions when AP use decreases5,8–11,14,16. Acute events (see Appendix E-1, Supplemental File) required identification either via an outpatient emergency department visit (Part B claims data) or inpatient acute admission (Part A claims data) and were identified using ICD-10-CM diagnosis codes. Skeletal events excluded bone fractures associated with a high-impact event (e.g. a car crash) occurring in the prior 7 days. Coronary artery events included both myocardial infarctions and acute coronary ischemia. Cerebrovascular events included both transient ischemic attacks and acute strokes. The bivariate descriptive statistics analysis measured acute events based on a normalized per-1,000 patients annually calculation, which accounted for variable lengths of NH exposure. For the logistic regression analysis of event risks, one or more acute events were considered Boolean events. Acute events occurring within the context of a SNF stay during a patient’s NH experience were included in both calculations.
Aiming toWards Evidence baSed inTerpretation of Cardiac biOmarkers in patients pResenting with chest pain-the WESTCOR study: study design
Published in Scandinavian Cardiovascular Journal, 2019
Hilde L. Tjora, Ole-Thomas Steiro, Jørund Langørgen, Rune Bjørneklett, Ottar K. Nygård, Renate Renstrøm, Øyvind Skadberg, Vernon V. S. Bonarjee, Bertil Lindahl, Paul Collinson, Torbjørn Omland, Kjell Vikenes, Kristin M. Aakre
The first challenge is that patients with myocardial ischemia without necrosis (UAP) cannot be accurately identified using troponin measurement or the ECG alone or in combination. The second challenge is that troponin is not a specific marker of ischemic myocardial injury. Stable increases are seen in chronic diseases like kidney disease and multi-morbid conditions. Transient increases are seen in a range of conditions including atrial fibrillation, exacerbation of chronic obstructive pulmonary disease, sepsis, acute stroke, burn injury and strenuous physical activity [27]. Many of these conditions have clinical symptoms resembling acute coronary ischemia. Consequently, large proportions of patients are in need of additional investigations (often imaging) to distinguish NSTE-ACS from non-coronary chest pain or non-coronary myocardial injury [28,29]. The last challenge is that although troponins are specific for myocyte necrosis in the clinical setting of coronary ischemia, they provide no information of the underlying pathophysiology causing ischemia and necrosis. Even in NSTEMI patients, troponins cannot distinguish between atherosclerosis, and other often more rare causes of ischemia like spontaneous coronary dissection, coronary spasm or oxygen supply/demand imbalance as the cause of the MI. Improved knowledge of the underling mechanisms for ischemia in general and atherosclerosis in particular is necessary to develop new and targeted treatments for both acute and stable coronary artery disease.
Elevated serum YKL40 level is a predictor of MACE during the long-term follow up in hypertensive patients
Published in Clinical and Experimental Hypertension, 2020
Mustafa Çetin, Turan Erdoğan, Tuncay Kırış, Savaş Özer, Göksel Çinier, Nadir Emlek, Hüseyin Durak, Ömer Şatıroğlu
Patients were excluded from the study if any of the following conditions were present; secondary HT, malignancy, fever, infection, chronic inflammatory disease, autoimmune disease, endocrine disorder, coronary artery disease (CAD), HF, structural heart disease, atrial fibrillation (AF), eGFR < 30 mL/min/1.73 m2, peripheral artery disease, prior cerebrovascular event, liver disease, and the presence of typical symptoms for coronary ischemia. In addition, patients whose clinical follow-up data could not be obtained were excluded from the study.