How to Do It: Transbrachial Impella Placement to Facilitate Percutaneous Coronary Intervention.

A 64-year-old man with diffusely diseased iliofemoral vessels and an ejection fraction of 20% to 25% presented with a non-ST elevation myocardial infarction and proximal left anterior descending (LAD) and left circumflex (LCx) coronary artery disease, with a chronically occluded right coronary artery. The iliofemoral system was not suitable for Impella placement, and bilateral axillary arteries were heavily calcified. The proximal left brachial artery was chosen for placement of both an Impella CP (Abiomed, Danvers, MA, USA) and percutaneous coronary intervention (PCI) sheath through a graft sewn to the brachial artery in this single-access technique.

Thrombolysis After Protamine Reversal of Heparin for Acute Ischemic Stroke After Cardiac Catheterization: Case Report and Literature Review.

Background: Patients with an acute ischemic stroke (AIS) following cardiac catheterization (CC) generally do not receive intravenous thrombolysis [intravenous tissue plasminogen activator (IV-tPA)] as it is contraindicated due to the coagulopathy related to the heparin used during the procedure. We report a case of AIS successfully treated with IV thrombolysis following protamine reversal of heparin effect.

Case Report: An 87-year-old man with diabetes mellitus, hypertension, neurofibromatosis, and hyperlipidemia underwent elective transradial CC following an abnormal stress test.

Acute and Subacute Triggers of Cardiovascular Events.

Inability to predict short-term cardiovascular (CV) events and take immediate preemptive actions has long been the Achilles heel of cardiology. However, certain triggers of these events have come to light. Although these triggers are nonspecific and are part of normal life, studying their temporal relationship with the onset of CV events provides an opportunity to alert high-risk atherosclerotic patients who may be most vulnerable to such triggers, the "vulnerable patient".

Relation of Total and Cardiovascular Death Rates to Climate System, Temperature, Barometric Pressure, and Respiratory Infection.

A distinct seasonal pattern in total and cardiovascular death rates has been reported. The factors contributing to this pattern have not been fully explored. Seven locations (average total population 71,354,000) were selected where data were available including relatively warm, cold, and moderate temperatures.

Super Bowl outcome's association with cardiovascular death.

Background: A previous analysis from Los Angeles showed that death rates increased among hometown fans after losing the Super Bowl in 1980 and decreased after a win in 1984. Data are unavailable in the era of drug-eluting stents, dual antiplatelet therapy, statins, and modern medical therapy.

Methods: Two high drama and intense Super Bowls were analyzed: NYC beat New England (Massachusetts) in 2008 and Pittsburgh defeated Arizona in 2009.

Phosphodiesterase type 5 inhibitors improve endothelial function and may benefit cardiovascular conditions.

The effects of phosphodiesterase type 5 inhibitors on vasodilation mediated via nitric oxide-cyclic guanosine monophosphate are well described. Less is known about other mechanisms through which phosphodiesterase type 5 inhibitors benefit endothelial function, including normalization of serum biomarkers, increased levels of endothelial progenitor cells, ischemia-reperfusion protection mechanisms, and other actions specific to patients with diabetes. These various mechanisms are reviewed.

Treating peripheral arterial disease percutaneously with atherectomy.

Purpose: To determine clinical outcomes of patients who underwent percutaneous revascularization (PR) with multiple devices.

Methods: PR cases at a private, tertiary referral hospital were reviewed retrospectively. Limb salvage and patency rates were calculated by the Kaplan Meier method.

Therapeutic hypothermia for acute myocardial infarction and cardiac arrest.

This report focuses on cardioprotection and describes the advantages and disadvantages of various methods of inducing therapeutic hypothermia (TH) with regard to neuroprotection and cardioprotection for patients with cardiac arrest and ST-segment elevation myocardial infarction (STEMI). TH is recommended in cardiac arrest guidelines. For patients resuscitated after out-of-hospital cardiac arrest, improvements in survival and neurologic outcomes were observed with relatively slow induction of TH.

Treating Refractory Cardiogenic Shock With the TandemHeart and Impella Devices: A Single Center Experience.

Background: Patients with cardiogenic shock (CS) are routinely treated with intra-aortic balloon pumps (IABPs). The utility of 2 new percutaneous left ventricular assist devices (PLVADs), the Impella and TandemHeart, is unknown. The objective of this study was to describe the use of PLVADs for patients with CS at our institution.

How the 2008 stock market crash and seasons affect total and cardiac deaths in Los Angeles County.

Various stressors trigger cardiac death. The objective was to investigate a possible relation between a stock market crash and cardiac death in a large population within the United States. We obtained daily stock market data (Dow Jones Industrial Average Index), death certificate data for daily deaths in Los Angeles County (LA), and annual LA population estimates for 2005 through 2008.

Impella-assisted balloon aortic valvuloplasty.

The Impella LP 2.5 left ventricular assist device (Abiomed) is safe and effective for assisting high-risk percutaneous interventions. A 77-year-old woman with severe aortic stenosis, severe coronary artery disease, an ejection fraction of 20%, severe peripheral vascular disease, and other comorbidities presented to a private, tertiary referral hospital with shortness of breath that had been worsening over 2 weeks.

Cardiac uses of phosphodiesterase-5 inhibitors.

Phosphodiesterase-5 inhibitors (PDE5Is) improve erectile function by enhancing nitric oxide availability in the penis and its supplying vasculature, resulting in vasodilation and increased blood flow. PDE5Is might benefit cardiovascular diseases because phosphodiesterase-5 is also located elsewhere in the body, including the pulmonary and systemic vasculature and in hypertrophied myocardium. PDE5Is are approved for pulmonary arterial hypertension, given that they improved several hemodynamic and clinical parameters in large randomized trials.

High-risk percutaneous coronary intervention with the TandemHeart and Impella devices: a single-center experience.

Background: Intra-aortic balloon pumps (IABPs) are indicated during high-risk percutaneous coronary intervention (HR-PCI) to reduce major procedural complications. The clinical utility of the newer Impella and TandemHeart devices is not clear. This study determined the baseline characteristics, hemodynamics, and outcomes of patients treated with prophylactic percutaneous left ventricular assist devices (PLVADs) during HR-PCI.

Coronary no reflow.

The no-reflow phenomenon has been studied extensively in the basic science laboratory and has entered the clinical arena. No-reflow, which develops largely within the first 2h of reperfusion, is primarily the result of ischemic endothelial cell injury that obstructs the capillary lumen. Additional contributing mechanisms in experimental models include neutrophil accumulation, reactive oxygen species, and the coagulation cascade.

Rotational atherectomy in the drug-eluting stent era: a single-center experience.

Background: In heavily calcified lesions, rotational atherectomy (RA) improves procedural success and facilitates stent deployment. Reports on RA in the drug-eluting stent (DES) era are limited. The objective of this study was to determine the presenting characteristics, procedural and in-hospital clinical outcomes of patients who underwent RA at our institution in the DES era.

Review of vascular closure devices.

Vascular access-site complications are an important cause of morbidity following catheterization procedures. Manual compression is the "gold standard" in achieving hemostasis of an arteriotomy site; however, manual compression is limited by the need to interrupt anticoagulation, prolonged bed rest, patient discomfort and time demands for healthcare providers. Vascular closure devices (VCDs) improve patient comfort, free medical staff resources and shorten the time needed for hemostasis, ambulation and discharge.

Sporting events affect spectators' cardiovascular mortality: it is not just a game.

Physiologic and clinical triggers, including mental stress, anxiety, and anger, often precipitate acute myocardial infarction and cardiovascular death. Sporting events can acutely increase cardiovascular event and death rates. A greater impact is observed in patients with known coronary artery disease and when stressful features are present, including a passionate fan, a high-stakes game, a high-intensity game, a loss, and a loss played at home.