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Nurse-led distal radial access: efficacy, learning curve, and perspectives of an increasingly popular access. Does learning by doing apply to both the doctor and the nurse?

BACKGROUND: The distal radial represents an evolution of the standard radial approach. Distal radial arterial access (DRA) in the so-called "anatomical snuffbox" is technically more difficult but offers potential advantages for patients. Moreover, the use of the distal radial would preserve the proximal radial from the risk of arterial occlusion after interventional procedures performed through the radial artery. METHODS: We enrolled 100 consecutive elective patients undergoing cardiac catheterization (diagnostic or procedural). Arterial access to the distal radial was entirely managed by nur

Evaluation of Hepatic Hemodynamics (Hepatic Venous Pressure Gradient) During Right Heart Catheterization: A Comprehensive Review.

Centers for the research of patients with pulmonary hypertension (PH) usually perform right cardiac catheterization (RHC) to document this hemodynamic condition; traditionally, the procedure is performed by the interventional cardiologist, while the interventional radiologist generally conducts the study of hepatic hemodynamics. In our center, where the leading cause of catheterization of the hepatic veins is orthotopic liver transplantation, the cardio-pulmonologist performs the procedure to diagnose the possibility of porto-pulmonary hypertension and its implications. Routine measurement of

Pulmonary Embolism and Cardiac Tamponade in Critical Care Patients with COVID-19; Telemedicine's Role in Developing Countries: Case Reports and Literature Review.

INTRODUCTION: In this study, two cases that demonstrate the importance of bedside echocardiography and hands-off telemedicine technology for diagnosis and intervention in patients with coronavirus disease 2019 (COVID-19) are discussed. CASE PRESENTATION: We report two cases of cardiac emergency associated with COVID-19. Case 1 is a 50-year-old female patient with chronic hypertension and chronic renal failure. Case 2 is a 64-year-old female with atrial fibrillation and recent stroke. Both were admitted to an isolation intensive care unit that was designated specifically to patients with COVID

Consensus on the management of hyperkalemia in patients with heart failure: Recommendations from the SEC-SEMI.

Use of renin-angiotensin-aldosterone system inhibitors (RAASi) in patients with heart failure (HF) and reduced ejection fraction is associat … xperts and reviewed by a panel of another ten specialists in the treatment of patients with HF (ten cardiologists and ten internists in total). This document has been endorsed by the Spanish Society of Cardiology (SEC, for its initials in Spanish) and the Spanish Society of Internal Medicine (SEMI, for its initials in Spanish).

Long-term outcome of fetus with ameliorated cystic hygroma.

OBJECTIVE: Cystic hygroma often ameliorates or disappears with pregnancy progression. Fetuses/neonates with amelioration, when without chromosomal or major structural abnormality, generally show a favorable outcome at birth. The present study was aimed to clarify the short/long-term outcomes of fetuses/neonates with the amelioration of cystic hygroma during pregnancy. MATERIAL AND METHODS: This was a retrospective observational study. We focused on fetuses with cystic hygroma managed in our institute between January 2006 and June 2019. The infants were followed by pediatricians (neonatologist

Massive gallstone in an asymptomatic Indigenous Canadian male: Case report and literature review.

INTRODUCTION: Gallstones are present in 10-15% of North Americans, but only 20% become symptomatic. This case report describes a patient with a 7.5 cm gallstone detected incidentally while being investigated for cardiac pathology. This is the first report in the English literature of a stone this size that has remained clinically asymptomatic. This work is reported in line with the SCARE criteria. CASE REPORT: The patient was a 71-year-old Indigenous Canadian male, with atrial fibrillation. His cardiologist ordered a CT scan of his chest, which incidentally identified a large gallstone. He wa

Multidisciplinary rounds in prevention of 30-day readmissions and decreasing length of stay in heart failure patients: A community hospital based retrospective study.

To assess the impact of multidisciplinary rounds (MDR) on 30-day readmissions and length of stay in hospitalized patients with a diagnosis of congestive heart failure in a community teaching hospital.Patients with primary admission diagnosis of congestive heart failure (CHF) were included. A before and after retrospective study was conducted once the intervention was implemented in 2014. The before and after study periods were each of 1-year duration and included 181 and 151 patients, respectively. Our multidisciplinary heart failure rounding team consisted of a staff cardiologist, case manage

Joining Forces: Establishing a Cardio-oncology Clinic.

Patients have been surviving cancer diagnoses at a steadily increasing rate over the past few decades. Despite the encouraging decline in cancer morbidity, the cardiovascular effect of some chemotherapy medications is concerning. Moreover, even though there is extensive knowledge of the pathophysiology and increased risk of cardiotoxicity, there is a lack of specific guidelines and adequate cardio-oncology programs focused on reducing cardiovascular risks or disease in patients undergoing cancer treatment. The high incidence of both cardiovascular disease (CVD) and cancer warrants the collabor

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… The initiation and growth of the program was well supported by the administrators and the other cardiologists in the group. … The cardiologist had been practicing in his specialty and the Hudson Valley region for 3 years and the APRN had experience working in cardiology for 9 years. …

When a Diuretic Causes Pulmonary Oedema.

BACKGROUND: Hydrochlorothiazide (HCTZ) is one of the most popular drugs for the treatment of hypertension and heart failure. Most of its side effects are harmless and predictable, but some studies report a few life-threatening reactions to this drug, one of the most dangerous being acute pulmonary oedema. CASE REPORT: A 73-year-old woman was admitted to the Emergency Department with acute respiratory failure due to pulmonary oedema. Her past medical history included long-lasting hypertension with permanent atrial fibrillation and mitral stenosis. Her blood pressure control had been suboptimal

A 52-year-old woman with ventricular tachycardia.

CLINICAL INTRODUCTION: A 52-year-old woman with shortness of breath and palpitations was referred to a cardiologist. A 24-hour Holter demonstrated high density (37%) of ventricular premature beats (VPBs) and long runs of non-sustained (eventually sustained) monomorphic ventricular tachycardia (VT) with the same morphology as several VPBs detected in a 12-lead ECG (figure 1A). A transthoracic echocardiogram was performed, and the patient's evaluation was completed with a functional and gadolinium-enhanced cardiovascular MR (CMR) study (figure 1B,C) to assess structural heart disease. In a follo

Antithrombotic Treatment Management in Patients with Intracerebral Hemorrhage: Reversal and Restart.

BACKGROUND: Intracerebral hemorrhage is the pathological accumulation of blood within the brain. It is a type of stroke more likely to be lethal or to severely disable the patient and results from a wide variety of causes. On the other hand antithrombotic therapy is used for the prevention or/and the therapy of thromboembolic episodes. Antithrombotic drugs are very effective in reducing risk or mortality rate after a thromboembolic event, yet they are associated with significant hemorrhages. OBJECTIVE: The aim of this article is to review current literature for intracerebral hemorrhage and an

Bloodless Repair for a 3.6 Kilogram Transposition of the Great Arteries with Jehovah's Witness Faith.

Achieving pediatric cardiac surgery using cardiopulmonary bypass (CPB) without allogeneic blood transfusion is challenging. There are many clinical and economic factors that point to the importance of avoiding blood transfusions. In some instances, honoring patients or parents beliefs may be the reason for avoiding blood transfusions. For example, patients or parents of the Jehovah's Witness faith refuse blood transfusion based on their religious beliefs. Over the last decade, our institution has seen a steady increase in our pediatric Jehovah's Witness patient population. Caring for these pat

Relationship between perfusion index and patent ductus arteriosus in preterm infants.

BACKGROUND: Perfusion index (PI) is a noninvasive measure of perfusion. ΔPI (difference between pre- and postductal PI) may identify hemodynamically significant PDA. However, studies are limited to brief and intermittent ΔPI sampling. Our objective is to assess the value of continuous high resolution ΔPI monitoring in the diagnosis of PDA. METHODS: Continuous ΔPI monitoring in preterm infants was prospectively performed using two high-resolution pulse oximeters. Perfusion Index measures (ΔPI mean and variability, pre- and postductal PI) were analyzed over a 4-h period prior to echocardiograph

Miocarditis inducida por clozapina durante la evaluación observacional, transversal y ongitudinal: comparación con otros antipsicóticos en ambientes naturalísticos.

Myocarditis occurs more frequently during clozapine (CLZ) administration than during treatment with other antipsychotic drugs (APs). In this observational study, we transversally screened outpatients for myocarditis by comparing a CLZ group of 132 subjects, with a non-CLZ group taking other APs (n = 371) only, and in 21 CLZ-treated patients and 18 subjects treated with other APs who had been followed for more than one year. The protocol included a) assessment of symptoms such as dyspnea, tachycardia, chest discomfort, fever, cough, and edema, b) blood pressure and heart auscultation; c) a stan

[Sudden cardiovascular death in adults: Study of 361 autopsy cases].

AIMS OF THE STUDY: To describe epidemiological aspects of sudden cardiovascular death and to specify the etiopathogenic characteristics. PATIENTS AND METHOD: Our study is retrospective and descriptive. It included 361 cases of sudden cardiovascular death, which underwent autopsy in forensic medicine department of Monastir during eight years, from 1st January 2004 to 31st December 2011. RESULTS: The incidence of sudden cardiovascular death was 9 per 100,000 person. A marked male predominance was noted. The mean age was 55.75 years. In our series, myocardial infarction represents the leading c

[Intraoperative asystole in a patient with concealed sick sinus syndrome: a case report].

We report a patient with concealed sick sinus syndrome who developed intraoperative bradycardia and asystole. An 81-year-old man was scheduled to undergo total gastrectomy under general and epidural anesthesia. There was no history of syncope, and preoperative 12-lead ECG showed normal sinus rhythm. Anesthesia was induced with propofol and remifentanil, maintained with sevoflurane, remifentanil and thoracic epidural infusion of lidocaine, fentanyl and levobupivacaine. Bradycardia was detected on ECG 110 minutes after the start of surgery. Intravenous atropine (0.5 mg, repeated up to a total do

Vivax malaria in an Amazonian child with dilated cardiomyopathy.

A child living in the Brazilian Amazon region who had had vivax malaria at the age of 11 months was admitted three months later with a history of progressive dyspnoea and fever, which culminated in respiratory distress and severe dilated cardiomyopathy at hospital admission in a malaria-free area. She received treatment for cardiac insufficiency and was tested for malaria with two thick blood smears, which were negative. There was general improvement of cardiorespiratory function in the next two weeks, but in the third week of hospital admission, there was re-appearance of fever, severe anaemi

Marfan's syndrome and pregnancy: a good maternal and fetal outcome.

INTRODUCTION: this case report highlights the important role of a multidisciplinary team's task in the care of pregnant women with Marfan's syndrome (MFS), a systemic disorder of connective tissue that is transmitted as an autosomal dominant trait. CASE: a 42 year-old italian pregnant woman with Marfan's syndrome and degenerative heart disease (aneurysmatic dilatation of the aortic root, mitral regurgitation and prosthetic mitralic valve) was clinically assessed jointly by an obstetrician and a cardiologist, 'the obstetric team specialised in management of high risk pregnancy', every 2-3 week

Ocular ischemic syndrome - a systematic review.

Ocular ischemic syndrome is a rare condition, which is caused by ocular hypoperfusion due to stenosis or occlusion of the common or internal carotid arteries. Atherosclerosis is the major cause of changes in the carotid arteries. Ocular ischemic syndrome is manifested as visual loss, orbital pain and, frequently, changes of the visual field, and various anterior and posterior segment signs. Anterior segment signs include iris neovascularization and secondary neovascular glaucoma, iridocyclitis, asymmetric cataract, iris atrophy and sluggish reaction to light. Posterior eye segment changes are

[Transposition of the great arteries: a curable congenital heart defect?].

Transposition of the great arteries (TGA) is a common congenital heart malformation, involving the inversion of both great vessels (aorta and pulmonary artery). It is not compatible with life in the absence of surgical treatment. The prognosis of this malformation has been transformed by the development of neonatal cardiac surgery. "Anatomic" repair has been introduced in the 80s; its goal is to provide near-normal cardiac anatomy. The mid-term results of anatomic repair of TGA can be summarized as follows: overall mortality is 5% (most deaths occur during the first postoperative year and are