The left bundle-branch block puzzle in the 2013 ST-elevation myocardial infarction guideline: from falsely declaring emergency to denying reperfusion in a high-risk population. Are the Sgarbossa Criteria ready for prime time?

Prompt and accurate identification of ST-elevation myocardial infarction (STEMI) in the presence of left bundle-branch block (LBBB) remains difficult. The 2004 STEMI guideline recommended emergent reperfusion therapy to patients with suspected ischemia and new or presumably new LBBB. These recommendations have led to frequent false catheterization laboratory activation and inappropriate fibrinolytic therapy because most patients with suspected ischemia and new or presumably new LBBB do not have acute coronary artery occlusion on angiography.

Postcardiac injury syndrome following transvenous pacer or defibrillator insertion: CT imaging and review of the literature.

Postcardiac injury syndrome (PCIS) is a frequent clinical entity developing as a complication of cardiac procedures. Some of these may be only minor procedures, such as the insertion of permanent pacer or defibrillator devices. The purpose of this article is to review and illustrate its common imaging findings.

Localization-delocalization transition for disordered cubic harmonic lattices.

We study numerically the disorder-induced localization-delocalization phase transitions that occur for mass and spring constant disorder in a three-dimensional cubic lattice with harmonic couplings. We show that, while the phase diagrams exhibit regions of stable and unstable waves, the universality of the transitions is the same for mass and spring constant disorder throughout all the phase boundaries. The combined value for the critical exponent of the localization lengths of ν = 1.

Abdominal aortic aneurysm screening during transthoracic echocardiography: Cardiologist and vascular medicine specialist interpretation.

Aim: To study the interobserver variability between a cardiologist and vascular medicine specialist in the screening of the abdominal aorta during transthoracic echocardiography (TTE).

Methods: Consecutive patients, > 55 years of age, underwent abdominal aortic imaging following standard TTE. Two cardiologists and one vascular medicine specialist performed a blinded review of the images.

Acute morbidity and complications of thigh compartment syndrome: A report of 26 cases.

Background: To describe the patient population, etiology, and complications associated with thigh compartment syndrome (TCS). TCS is a rare condition, affecting less than 0.3% of trauma patients, caused by elevated pressure within a constrained fascial space which can result in tissue necrosis, fibrosis, and physical impairment in addition to other complications.

Cardiovascular emergencies in cruise ship passengers.

More than 10 million people, many elderly and likely to harbor cardiovascular (CV) disease, embark on cruise ship travel worldwide every year. The clinical presentation and outcome of CV emergencies presenting during cruise ship travel remain largely unknown. Our department provides contracted cardiology consultations to several large cruise lines.

Lower extremity compartment syndrome in the acute care surgery paradigm: safety lessons learned.

Background: Prompt diagnosis and decompression of acute lower extremity compartment syndrome (LECS) in the multisystem injured patient is essential to avoid the devastating complications of progressive tissue necrosis and amputation. Despite collaborative trauma and orthopedic management of these difficult cases, significant delays in diagnosis and treatment occur. Periodic system review of our trauma and orthopedic data for complications of LECS led us to hypothesize that delayed diagnosis and limb loss were potentially preventable events in our trauma center.

Meta-analysis comparing reported frequency of atrial fibrillation after acute coronary syndromes in Asians versus whites.

The development of atrial fibrillation (AF) in cardiac patients is multifactorial, including not well defined genetic factors. To determine if Asian ethnicity is associated with the development of AF in patients with coronary disease, a meta-analysis was conducted of patient-level data from 7 prospective randomized clinical trials that prospectively collected information on the development of AF: 3 trials in patients with ST-elevation myocardial infarction (Global Use of Strategies to Open Occluded Coronary Arteries [GUSTO] I, GUSTO III, and GUSTO V), 3 trials in patients with non-ST-elevation acute coronary syndromes (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy [PURSUIT], Integrilin to Minimize Platelet Aggregation and Coronary Thrombosis-II [IMPACT II], and Platelet IIb/IIIa Antagonist for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network [PARAGON A]), and 1 trial in patients with both conditions (GUSTO IIb). A total of 94,785 patients were identified (93,050 white, 1,735 Asian).

Use of the prehospital ECG improves door-to-balloon times in ST segment elevation myocardial infarction irrespective of time of day or day of week.

Background: The use of the prehospital electrocardiogram (ECG) to identify patients with ST-segment elevation myocardial infarction (STEMI), coupled with a centralised system to alert the cardiac catheterisation team in preparation for prompt intervention, has been shown to reduce door-to-balloon times (DBT) effectively. A confounding variable in prolonging the recommended 90 min DBT is the time of day or day of the week of patient presentation. We postulated that use of the prehospital ECG, coupled with an emergency department initiated "Cath Alert" system, could neutralise DBT delays related to time of day or day of week.

Spondyloarthropathy-associated aortitis and massive thickening of the aortic-mitral curtain: diagnosis by echocardiography.

Cardiac involvement in reactive arthritis is well-recognized, and usually results in aortic regurgitation, proximal aortitis, and conduction system abnormalities. Aortitis is usually recognized in conjunction with aortic regurgitation, but can be diagnosed in isolation as aortic root thickening and subaortic fibrous ridging. We report a case of spondyloarthropathy-associated aortitis diagnosed by transesophageal echocardiography.

Cardiac pacing: the state of the art.

Permanent cardiac pacing remains the only effective treatment for chronic, symptomatic bradycardia. In recent years, the role of implantable pacing devices has expanded substantially. At the beginning of the 21st century, exciting developments in technology seem to happen at an exponential rate.

Twelve-lead electrocardiogram: the advantages of an orderly frontal lead display including lead -aVR.

Background: It is possible that efforts in ECG review by both young experienced clinicians are currently discouraged-and risk to be completely dismissed-by the conventional (ie, disorderly) display of the frontal plane leads, with lead aVR at -150 degrees.

Methods: We reviewed studies on the usefulness of leads aVR and -aVR as well as on the history of the frontal leads in electrocardiography.

Results: Lead aVR and particularly, lead -aVR, provide useful information when systematically analyzed.

What is the minimal pacing rate that prevents torsades de pointes? Insights from patients with permanent pacemakers.

In the acquired long QT syndrome, torsades de pointes (TP) is invariably preceded by pauses or bradycardia. Thus, it has been proposed that out-of-hospital initiation of drugs that prolong repolarization should be safe in patients with permanent pacemakers. However, a minimal protective pacing rate has not been identified.

Cost-effectiveness of the implantable cardioverter-defibrillator versus antiarrhythmic drugs in survivors of serious ventricular tachyarrhythmias: results of the Antiarrhythmics Versus Implantable Defibrillators (AVID) economic analysis substudy.

Background: The implantable cardioverter-defibrillator (ICD) is an effective but expensive device. We used prospectively collected data from a large randomized clinical trial of secondary prevention of life-threatening ventricular arrhythmias to determine the cost-effectiveness of the ICD compared with antiarrhythmic drug (AAD) therapy, largely with amiodarone.

Methods And Results: Charges for initial and repeat hospitalizations, emergency room, and day surgery stays and the costs of antiarrhythmic drugs were collected on 1008 patients.