Aspirin, Plavix, and Other Antiplatelet Medications: What the Oral and Maxillofacial Surgeon Needs to Know.

Most patients with coronary artery disease and peripheral vascular disease are on long-term antiplatelet therapy and dual therapy. Achieving a balance between ischemic and bleeding risk remains an important factor in managing patients on antiplatelet therapy. For most outpatient surgical procedures, maintenance and continuation of this therapy are recommended.

Prospective chest pain evaluation in the emergency department with use of high-sensitivity C-reactive protein (PROCEED-CRP study).

We evaluated the clinical value of a single measurement of high-sensitivity C-reactive protein (hs- CRP) in patients presenting to the emergency department with chest pain. We screened 408 consecutive patients of whom 292 comprised the final cohort for this study. Hs-CRP measured in the emergency department (ED) in patients presenting with chest pain and admitted for evaluation of acute myocardial infarction was neither sensitive nor specific in predicting acute myocardial infarction, myocardial ischemia on SPECT imaging, need for coronary revascularization, or cardiovascular or all-cause rehospitalization at 30 days.

Long-term outcome of Tako-tsubo cardiomyopathy.

Background: Current data suggest an excellent outcome for patients with Tako-tsubo cardiomyopathy (TC). The objectives of this study were to evaluate the long-term outcome and the prognostic implication of thrombolysis in myocardial infarction myocardial perfusion grade (TMPG) in patients with TC.

Methods: Retrospective analysis of all patients diagnosed with TC at our hospital between 2003 and 2008.

Papillary fibroelastoma arising from the pulmonary valve associated with pulmonary embolization.

Cardiac papillary fibroelastomas are rare, usuallybenign tumors that can be detected at autopsy, during open-heart surgery, or with echocardiography. They usually arise from the cardiac valves and more commonly are found on the left side of the heart. Embolization of left-sided and tricuspid valve tumors has been well documented.

Caseous calcification of the mitral valve ring.

Mitral annular calcification (MAC) is found in 10% of patients older than 50 years of age, and represents deposition of calcium between the basal infero-lateral ventricular wall and the posterior leaflet of the mitral valve. Caseous calcification, formed from a mixture of calcium, cholesterol and fatty acids, is an uncommon variant found on echocardiography in 0.6% of patients with MAC.

Intraaortic balloon pump insertion through the subclavian artery. Subclavian artery insertion of IABP.

The intraaortic balloon pump (IABP) is frequently used in the management of cardiac failure in the setting of myocardial infarction or as a bridge for coronary revascularisation surgery. The IABP is usually inserted through the femoral artery. Occasionally severe aorto-iliac occlusive disease prevents the retrograde passage of the balloon, in which case an anterograde route, usually through the ascending aorta is used.

Intramural hematoma of the descending thoracic aorta.

Aortic intramural hematoma (AIH) is part of the acute aortic syndrome together with aortic dissection and penetrating aortic ulcer. AIH represents up to 12% of acute aortic syndrome cases and has a clinical presentation indistinguishable from that of classic aortic dissection. A patient with AIH is presented and the diagnostic, prognostic and therapeutic implications of the disease are discussed.

Patterns of anticoagulation in patients hospitalized with atrial fibrillation: warfarin is underused in paroxysmal atrial fibrillation.

Paroxysmal atrial fibrillation (PAF) has a similar stroke risk when compared with chronic atrial fibrillation (CAF). Our study sought to define the incidence of warfarin use at time of admission and discharge in patients hospitalized with PAF and CAF. Anticoagulation rates upon hospital admission were 89% in the patients with CAF and 38% in patients with PAF, and increased to 100% for patients with CAF and 81% for patients with PAF at the time of hospital discharge.