Vol 4-3 Review Article

Shockwave Coronary Lithoplasty for the Treatment of Under-Expanded Stent

Eliezer J. Tassone*, Cesare Tripolino, Gaetano Morabito, Placido Grillo, Bindo Missiroli

Department of Cardiac Surgery, Cardiology Unit, Sant’Anna Hospital-Catanzaro, Italy

The presence of coronary calcification is a hard challenge for the interventional cardiologist, as it is associated with incomplete stent expansion and frequently stent failure. In recent years, innovative techniques have been developed to treat coronary calcific lesions such as rotational atherectomy. However, many of them are burdened with an increased procedural risk. Recently, a new technique called “Shockwave Coronary Lithoplasty System”, also called lithotripsy, has been introduced in order to treat calcific coronary lesions with greater safety. Shockwave procedure allows treating the most calcific coronary lesions with simplicity and safety. This system employs the sound waves, similar to that used for treating kidney stones, in order to crush the calcific lesions. In this minireview, we explain the characteristics of the method and we provide a description of the technique in detail on the basis of the preliminary experience of the first cases. In particular, we will demonstrate that this technique is more effective and safer than traditional techniques employing atherectomy, also providing for the first time a therapeutic chance for the treatment of under-expanded stents in many clinical contexts.

DOI: 10.29245/2578-3025/2020/3.1202 View / Download Pdf
Vol 4-4 Review Article

Peripartum Cardiomyopathy: The Unknown is Known

Prasanna Karthik Suthakaran1, Jasima Nilofer2, Kothai Gnanamoorthy3, Mohammed Idhrees4*

1Professor, Department of General Medicine, Saveetha Medical College Hospital, Chennai, India

2Department of Pathology, Sree Balaji Medical College and Hospital, Chrompet, Chennai

3Associate Professor, Department of General Medicine, ESIC Medical College and PGIMSR, India

4Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, India

Peripartum cardiomyopathy is a idiopathy cardiomyopathy associated with heart failure towards the end of pregnancy or in the postpartum period. Various mechanisms like myocarditis, autoimmune response to pregnancy, viral infections, selenium deficiency, oxidative stress and prolonged tocolysis have been proposed as the etiology. The most common presentation is acute heart failure occurring usually within a few weeks after delivery with patients developing exertional breathlessness, orthopnea and paroxysmal nocturnal dyspnea. Cardiac Magnetic Resonance Imaging is useful in accurate measurement of chamber volumes and global and segmental myocardial function. The gold standard test for diagnosis of peripartum cardiomyopathy is Endomyocardial biopsy with the histological Dallas criteria. Most of these postpartum patients are managed medically. The risk of peripartum cardiomyopathy increases with increasing parity and outcomes in subsequent pregnancies was poor.

DOI: 10.29245/2578-3025/2020/4.1204 View / Download Pdf
Vol 4-2 Review Article

Diagnostic and Treatment Challenges in Acute Myocardial Infarction: Perspectives from a Community Hospital

François M.A. Paris1*, Gillian J. Jessurun2, Rutger L. Anthonio2, Massimo A. Mariani3

1House officer cardiology, Department of Cardiology, Treant Zorggroep Scheper Ziekenhuis Emmen, The Netherlands

2Intervention cardiologist, Department of Cardiology, Treant Zorggroep Scheper Ziekenhuis Emmen, The Netherlands

3Cardiothoracic surgeon Heart, Center University Medical Center Groningen, The Netherlands

One of the most important causes of death in Western society, following cancer, is myocardial infarction (MI). Although acute MI occurs at an older age, the incidence of acute MI in younger adults has increased.

Essentially, treatment of acute MI is reperfusion therapy, which should preferably be performed within 12 hours of onset of the symptoms. Time is imperative and shorter intervals between symptoms an reperfusion leads to lower mortality. Conversely, a longer interval results in higher mortality, more mechanical complications and morbidity.

At our institution, located in the middle of a thinly populated rural area, patients used to be treated with thrombolysis until 2005. The nearest centers for percutaneous coronary interventions (PCI) and cardiothoracic surgery, had a travelling distance of 60 minutes. Since the introduction of interventional cardiology in the province of Drenthe, we managed to reduce the symptom to needle time.

Recently, we have been confronted with the COVID-19 pandemic, led to an increase in patient’s and doctor’s delay. This unfolded new challenges in treating acute MI.

This overview addresses the general clinical approach of acute MI and highlights the diagnostic approach and treatment options of both premature atherosclerosis and non-atherosclerotic causes of MI from our clinical perspective. We would like to argue that a personalized clinical approach remains of utmost importance in each patient treated by protocolized medicine.

DOI: 10.29245/2578-3025/2020/2.1200 View / Download Pdf
Vol 4-4 Original Research Article

What are Adults’ Illness Representations, Mood and Quality of Life after Myocardial Infarction?

Elizabeth Tolmie, Grace M Lindsay*, Philip Belcher

College of Nursing, Umm Al-Qura University Makkah, Kingdom of Saudi Arabia

Background: Survival after myocardial infarction (MI) is improving leading to increasing numbers of people dealing with heart health recovery, readjustment and re-investment in their future wellbeing and that of their family. Cardiac Rehabilitation (CR) aims to improve outcome by ensuring patients adopt recommended health maintenance strategies. This study explored the health maintenance needs of adults one to three years after an MI. The theoretical framework guiding the study was Leventhal’s Self Regulation Model. Data from the completion of different measures of health and illness representation are presented and the potential for measuring current health status and their explanatory factors is illuminated.

Aims: To identify the longer-term health needs of adults who have suffered an acute MI.

Methods: A mixed method design was used to explore respondents’ illness representations and the factors believed to be impacting on their longer-term health and health behaviour. A sample of 73 adults completed 3 questionnaires to assess their illness perceptions, mood and quality of life (QoL) 1 to 3 years after discharge from hospital. A sub-sample (n=30) participated in an interview, underwent a brief clinical assessment, and completed a small task. Data analysis used StatsDirect and Nudist 5.

Results: One to three years post-discharge, Personal and Treatment control belief scores of 22.6 ± 4.3 and 17.6 ± 4.3 respectively were strong, but perceived consequences high (20.6 ± 4.9). Many respondents were experiencing low energy (92%), breathlessness (67%) and chest pain (53%), and many reported a sense of loss that affected their ability to sustain health and positive health behaviour. Those with the poorest attendance at CR had poorer QoL, anxiety, and depression scores, and women had poorer outcomes than men in many of the indices assessed (p<0.05). Initial compliance with prescribed drug regimens and lifestyle recommendations (self-report) was not maintained.

Conclusion: This preliminary study supports the notion that there is a largely unmet and persistent health need among adults diagnosed with MI, and that more consideration needs to be paid to its longer-term effects and the needs of women. Combining surveys with interview methods and tools such as the PRISM+ provide an opportunity to understand the complexity of patients’ health evaluation.

DOI: 10.29245/2578-3025/2020/4.1205 View / Download Pdf
Vol 4-4 Original Research Article

Dilemma During the Pandemic- Hickam’s Dictum or Occam’s Razor?

Akanksha Agrawal1*, Deepanshu Jain2, Jefferson Baer1, Michael McDaniel1

1Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

2Center for Interventional Endoscopy, AdventHealth, Orlando, FL, USA

Coronavirus Disease 2019 (COVID-19) is a primary respiratory illness with various cardiac manifestations. This case describes a patient presenting as acute myocardial infarction (AMI) with cardiogenic shock and acute hypoxic respiratory failure secondary to COVID-19 complicated by acute embolic stroke.

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Vol 5-1 Commentary

Commentary: The Effects of Different Fluorescent Indicators in Observing the Changes of The Mitochondrial Membrane Potential During Oxidative Stress-Induced Mitochondrial Injury of Cardiac H9c2 Cells

Yanyi Tian1,4,5, Wei Tian2,4,5, Ting Li3, Jingman Xu1,4,5*

1Heart Institute, School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China

2Analysis and Test Center, North China University of Science and Technology, Tangshan, Hebei, China

3College of Foreign Language, North China University of Science and Technology, Tangshan, Hebei, China

4Hebei Province Key Laboratory of Organ Fibrosis, Tangshan, Hebei, China

5International Scientific and Technological Cooperation Base of Geriatrics Medicine, Tangshan, Hebei, China

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Vol 5-1 Commentary

Commentary: Description of the Position and Performance of an Echocardiogram by Subcostal View During the Prone Position in A Patient with Severe Pneumonia Caused by COVID-19

César Del Castillo Gordillo1,2*, Mario Alfaro Diaz1

1Cardiovascular center, San Borja Arriaran Hospital, Santiago, Chile

2Cardiovascular center, DIPRECA Hospital, Santiago, Chile

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