Safety and efficacy of aminophylline in the prevention of bradyarrhythmia during coronary atherectomy.

Coronary calcified lesions are commonly encountered and coronary atherectomy is commonly used for lesion modification during percutaneous coronary interventions (PCI). The release of adenosine during atherectomy can result in bradyarrhythmias and aminophylline is commonly used to prevent this reaction. We identified 138 patients to evaluate the safety and efficacy of intravenous (IV) aminophylline administration prior to coronary atherectomy.

Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention of the Left Anterior Descending Artery.

The left anterior descending artery (LAD) subtends a large myocardial territory. The outcomes of LAD chronic total occlusion (CTO) percutaneous coronary intervention (PCI) have received limited study. We performed a retrospective analysis of all patients who underwent LAD CTO PCI at a high-volume single center.

Sex differences in outcomes of transcatheter edge-to-edge repair with MitraClip: A meta-analysis.

Background: Transcatheter edge-to-edge repair (TEER) with MitraClip improves outcomes among select patients with moderate-to-severe and severe mitral regurgitation; however, data regarding sex-specific differences in the outcomes among patients undergoing TEER are limited.

Methods: An electronic search of the PubMed, Embase, Central, and Web of Science databases for studies comparing sex differences in outcomes among patients undergoing TEER was performed. Summary estimates were primarily conducted using a random-effects model.

2021 Update for the Diagnosis and Management of Acute Coronary Syndromes for the Perioperative Clinician.

In this review, recent key publications related to acute coronary syndrome (ACS) are summarized and placed into context of contemporary practice. Landmark trials examining vascular access in ST-elevation myocardial infarction, the management of multivessel disease, acute myocardial infarction and cardiac arrest are discussed. An update in pharmacology for ACS provides updates in major trials relating to P2Y12 inhibitor initiation, deescalation, and use in special populations.

Snare-Assisted Valve Positioning of Self-Expanding Valves for Transcatheter Aortic Valve Replacement.

We describe 4 cases in which technical challenges were anticipated in delivering a self-expanding TAVR valve due to challenging aortic anatomy or a previous placed surgical aortic valve. An upfront snare strategy is described which facilitates valve centralization and atraumatic valve delivery. ().

Management of Cardiogenic Shock in Patients with Acute Myocardial Infarction.

Acute myocardial infarction and cardiogenic shock (AMI-CS) is associated with significant morbidity and mortality. Early mechanical revascularization improves survival, and development of STEMI systems of care has increased the utilization of revascularization in AMI-CS from 19% in 2001 to 60% in 2014. Mechanical circulatory support devices are increasingly used to support and prevent hemodynamic collapse.

Antegrade versus retrograde techniques for Chronic Total Occlusions (CTO): a review and comparison of techniques and outcomes.

: As the field of chronic total occlusion percutaneous coronary intervention has evolved, technical approaches have evolved and been refined.: In this review, we discuss the major techniques utilized in modern CTO PCI including antegrade wiring, antegrade dissection reentry, retrograde wiring, and retrograde dissection reentry. Retrograde techniques have been extensively studied in comparison to antegrade techniques.

Vein Graft Coil Embolization and Successful Retrieval With a Micro-Snare.

Following successful retrograde CTO PCI via a degenerating saphenous vein graft, persistent TIMI II flow was noted in the graft. Given increased risk of target vessel failure in the presence of significant competitive flow from a saphenous vein graft, the SVG underwent coil embolization with two 4 mm × 6 cm detachable coils. Follow up angiography with forceful contrast injection resulted in embolization of the coils into the patient's two remaining patent grafts.

Mechanical Circulatory Support in High-Risk Percutaneous Coronary Intervention.

The use of mechanical circulatory devices to support high-risk elective percutaneous coronary intervention (PCI) has become more common as the group of patients considered inoperable or high risk for surgical revascularization has grown. Most of the data examining outcomes in high-risk PCI are observational and retrospective. Limited prospective randomized studies have been unable to show improved clinical outcomes with routine mechanical circulatory support (MCS) in patients with a high burden of coronary artery disease and reduced ejection fraction.

Papillary Muscle Rupture Due to Delayed STEMI Presentation in a Patient Self-Isolating for Presumed COVID-19.

A 57-year-old man acutely developed chest tightness and dyspnea. Given concern that his symptoms were consistent with COVID-19, the patient self-isolated. After 1 week of worsening symptoms, the patient presented with hypoxia and hypotension.

Usefulness of Noninvasively Measured Pulse Amplitude Changes During the Valsalva Maneuver to Identify Hospitalized Heart Failure Patients at Risk of 30-Day Heart Failure Events (from the PRESSURE-HF Study).

The pulse amplitude ratio (PAR), the ratio of pulse pressure at the end of the Valsalva maneuver to before the onset, correlates with cardiac filling pressure. We have developed a handheld device that uses finger photoplethysmography to measure PAR and estimate left ventricular end diastolic pressure (LVEDP). Patients hospitalized with heart failure (HF) performed three 10-second trials of a standardized Valsalva maneuver (at 20 mm Hg measured via pressure transducer), while photoplethysmography waveforms were recorded, at admission and discharge.

Racial/Ethnic Differences in Left Ventricular Structure and Function in Chronic Kidney Disease: The Chronic Renal Insufficiency Cohort.

Background: Chronic kidney disease (CKD) is associated with increased risk of cardiovascular disease (CVD) and it is especially common among Blacks. Left ventricular hypertrophy (LVH) is an important subclinical marker of CVD, but there are limited data on racial variation in left ventricular structure and function among persons with CKD.

Methods: In a cross-sectional analysis of the Chronic Renal Insufficiency Cohort Study, we compared the prevalence of different types of left ventricular remodeling (concentric hypertrophy, eccentric hypertrophy, and concentric remodeling) by race/ethnicity.

Safe-haven laws focus on abandoned newborns and their mothers.

In the United States, 47 states have safe-haven laws that allow a mother to relinquish her newborn infant at a hospital emergency department or a manned fire station and maintain her anonymity. In addition to anonymity, immunity from prosecution is given to the mother, provided the relinquished newborn is unharmed and meets the age specified by the state's law. This article describes safe-haven laws and how they developed, barriers to successful use, nursing implications, and the nurse's role in increasing public awareness and influencing legislative policy.