Dilceu Silveira Tolentino Júnior; Eliseu Miranda de Assis; Roberto Carlos de Oliveira
Abstract
Acute coronary syndrome (ACS) results from acute obstruction of a coronary artery which is responsible for a high mortality rate worldwide. The consequences depend on the degree and location of the obstruction and vary from unstable angina to non-ST segment elevation myocardial infarction (NSTEMI), ST-segment ...
Read More
Acute coronary syndrome (ACS) results from acute obstruction of a coronary artery which is responsible for a high mortality rate worldwide. The consequences depend on the degree and location of the obstruction and vary from unstable angina to non-ST segment elevation myocardial infarction (NSTEMI), ST-segment elevation myocardial infarction, and sudden cardiac death. The symptoms are similar in each of these syndromes (except for sudden death), involving chest discomfort with or without dyspnea, nausea, and diaphoresis. The diagnosis is possible; thanks to the electrocardiogram that is essential and the existence or absence of serological markers. In addition to these initial resources, other diagnostic methods are noteworthy, such as stress electrocardiogram, echocardiography, nuclear cardiology, computed tomography angiography, and exercise test. Other necessary measures are the stratification of the identified cases according to the degree of risk, availability of a coronary intensive care unit, and the establishment of the opportune treatment that consists of oxygen therapy, analgesia, sedation, antiplatelet, anticoagulants, nitrates, beta-blockers drugs, reperfusion of emergency with fibrinolytic drugs, percutaneous intervention or, occasionally, myocardial revascularization surgery to provide the recovery and consequently a better quality of life for the patient. This brief review aims to discuss the available diagnostic and therapeutic resources and the appropriate risk stratification for adequate care for the victims of acute coronary heart disease promptly in a hospital setting.
Ahmet Karabulut
Abstract
Introduction: Iatrogenic aortocoronary dissection (ACD) is a nightmare in interventional cardiology. Although ACD is rarely reported, the real-world prevalence is suspected of being higher due to unreported cases. The right coronary artery (RCA) ostium is involved in the majority of cases, and dissections ...
Read More
Introduction: Iatrogenic aortocoronary dissection (ACD) is a nightmare in interventional cardiology. Although ACD is rarely reported, the real-world prevalence is suspected of being higher due to unreported cases. The right coronary artery (RCA) ostium is involved in the majority of cases, and dissections are usually limited to the aortic sinus in half of the clinical presentations. There are different treatment strategies, including interventional approaches, surgery, and medical follow-up. Immediate stent deployment to the coronary osteum might be a life-saving procedure, and the surgical approach should be preferred in occasions of dissection extension beyond the sino-tubular junctions. Catheter trauma and subintimal progression of guidewires are major causes of ACD occurrence.Case Presentation: Herein presented is a case report of spontaneous ACD observed after contrast injection to the RCA ostium. Approximately 8 cc of radiocontrast agent was injected into the right coronary ostium. Antegrade and retrograde dissections which extended to the distal RCA and aortic root were observed. The right sinus of Valsalva was stained with contrast agent, and the border of the stained area was extended to the sinotubular junction. Medical follow-up was proposed by the heart team. Close follow-up with echocardiographic examination indicated the complete regression of the dissection.Conclusion: The authors consider conservative follow-up with echocardiogaphy rather than computed tomography and/or magnetic resonance to be the most appropriate imaging technique for use with stable patients.
Seyed Abbas Tavalaei; Shervin Assari; Vahid Tavalaei; Roghieh Nooripour
Abstract
Background: Hospitalization compared to outpatient care leads to better diagnosis. Stability of diagnosis varies among different psychiatric disorders and is associated with some demographic and mental health variables. Objective: The current study evaluated the stability of diagnosis in Baqiyatallah ...
Read More
Background: Hospitalization compared to outpatient care leads to better diagnosis. Stability of diagnosis varies among different psychiatric disorders and is associated with some demographic and mental health variables. Objective: The current study evaluated the stability of diagnosis in Baqiyatallah Hospital Psychiatric Ward. Methods: In this retrospective study, 908 inpatient records from the psychiatric ward of Baqiyatallah Hospital in the years 1997-2015 were randomly selected. Having primary and final diagnoses was the inclusion criterion. Demographic variables (age, sex, marital status, education, and employment) and mental health variables (primary and final psychiatric diagnoses, duration of hospitalization, psychiatric history, and medication history) were recorded. Ultimately, 429 cases were entered into the study. Results: The overall diagnostic stability rate was 57.6%. In mood, anxiety, psychotic, and personality disorders, the diagnostic stability rates were 84%, 63.8%, 46.3%, and 36.4%, respectively. For depressive and bipolar disorders, the stability of diagnosis rates were 85.5% and 86%, respectively. A significant relation between diagnosis axis, number of diagnoses, drug abuse and somatic disease history and diagnostic stability was seen (p<0.05). Conclusion: According to the present study, the maximum diagnostic stability rate was related to mood disorders with anxiety disorders ranking second. The minimum stability was related to personality disorders. Other studies have reported completely different results which may be due to different situations. Future studies in this field seem to be essential.
Reza Bidaki; Seyed Masood Moosavi