Atrial fibrillation, electroconvulsive therapy, stroke risk, and anticoagulation.

Background: Electroconvulsive therapy (ECT) is a therapy used to treat refractory mental health conditions, ranging from depression to catatonia, and it has gained renewed prominence in practice and the literature of late. Given that ECT involves the application of direct current to the body, there exists a risk of a change in cardiac rhythm during therapy. When atrial fibrillation is induced, ECT carries a potential risk of stroke.

A Meta-analysis of Clinical Trials Evaluating the Impact of Bivalirudin-based Anticoagulation for Primary Percutaneous Coronary on Long-Term Mortality.

Bivalirudin and heparin are the principal anticoagulants used during primary percutaneous coronary intervention (PCI) for patients experiencing ST-elevation myocardial infarctions. Based on previous meta-analyses, bivalirudin improves 30-day mortality rates compared with heparin, especially when vascular access is predominantly femoral. However, no meta-analysis has yet reported whether this mortality benefit with bivalirudin persists beyond 30 days.

The Pulmonary Complications of Paraneoplastic Autoimmune Vasculitis in a Patient With Myelodysplastic Syndrome.

Paraneoplastic autoimmune phenomena may occur in up to 30% of patients with myelodysplastic syndrome (MDS). We present the case of a patient with MDS who developed diffuse alveolar hemorrhage due to paraneoplastic autoimmune vasculitis. The patient was a 55-year-old male who had been referred for outpatient hematology/oncology evaluation by his primary care physician for incidentally discovered thrombocytopenia.

Action plan for improving cardiac rehabilitation-related outcomes in a university hospital based on a review of previous interventions.

Although referral to cardiac rehabilitation (CR) is considered the standard of care and demonstrably reduces both mortality rates and hospital admissions after cardiac events, rates of referral continue to be suboptimal. In fact, national reports reveal rates ranging from approximately 60% to 85% depending on the type of cardiac event. At an urban teaching hospital in Tennessee, efforts to increase referral rates were launched during the first quarter of 2018 as part of the Define, Measure, Analyze, Improve, Control (DMAIC) Project: Acute Myocardial Infarction (AMI) Transition of Care.

Intravenous cangrelor as a peri-procedural bridge with applied uses in ischemic events.

Cangrelor is a relatively new antiplatelet drug that has been approved for use as an adjunct therapy to percutaneous coronary intervention (PCI) to decrease peri-procedural myocardial infarction (MI), coronary revascularization, and stent thrombosis. Cangrelor is an adenosine triphosphate analogue with a pharmacokinetic mechanism based on a reversible, dose-dependent inhibition adenosine diphosphate (ADP)-induced platelet aggregation. This drug has lately been in the spotlight as a possible bridge therapy for anti-platelet medication prior to cardiac and non-cardiac surgeries.

Post-operative atrial fibrillation: should we anticoagulate?

The prevalence of atrial fibrillation (AF) is estimated to be 12 million by the year 2030. A subset of those patients fall into the category of post-operative atrial fibrillation (POAF) and either develop POAF after cardiac procedures [coronary artery bypass graft (CABG) and valvular procedures] or non-cardiac procedures. With the rise in surgical procedures, POAF represents a significant economic burden.

The dilemma of aspirin resistance in obese patients.

Aspirin resistance (AR) commonly refers to the concept of reduced aspirin efficacy in preventing cardiovascular disease and platelet inhibition. Obesity increases the risk of heart disease three- to four-fold and has been associated with AR. Aspirin is used as a tool for both primary and secondary prevention, but recent studies suggest that its lack of efficacy for primary prevention is partly attributable to obesity.

Chest X-Ray to Predict Difficult Right Transradial Cardiac Catheterization Due to Vascular Tortuosity: A Retrospective Study.

Tortuous brachiocephalic artery may lead to procedural difficulties among patients undergoing right transradial cardiac catheterization. By prospectively identifying patients with this anatomic barrier, operators may choose an alternate catheterization site to avoid complications from switching midway. To assess brachiocephalic artery tortuosity, 23 patients who underwent challenging diagnostic coronary angiography by right transradial access were compared to a control group of 29 patients who lacked brachiocephalic artery tortuosity.

Stroke Risk in Atrial Fibrillation: Beyond the CHADS-VASc Score.

Purpose Of Review: Stroke prevention is the cornerstone of atrial fibrillation (AF) management and the anticoagulation decision is currently based on CHADS-VASc risk score. We discuss several novel risk factors besides those included in CHADS-VASc score and alternative models for stroke prediction.

Recent Findings: Several clinical markers including obstructive sleep apnea and renal failure, laboratory markers like brain natriuretic peptide, imaging criteria including left atrial appendage morphology, spontaneous echo contrast, and coronary artery calcium score may predict stroke in AF patients.

Aortic Stenosis in African Americans: Focus On Disparities in Treatment and Outcomes.

Aortic stenosis (AS) is the third most common type of cardiovascular disease after hypertension and coronary artery disease, and it carries a high mortality rate when left untreated. Risk factors include male sex, hypertension, tobacco use, advanced age, elevated LDL cholesterol, and coronary atherosclerosis. Definitive treatment for AS includes valve repair, either percutaneously or surgically; however, in aging populations corrective surgery carries increased risk.

Misunderstood or Mistrusted? The Under-Utilization of the Wearable Cardioverter Defibrillator in Clinical Practice.

Annually in the United States, sudden cardiac death (including out-of-hospital cardiac arrests) is responsible for over 300,000 deaths, comprising 40%-50% of total mortality rates from cardiovascular disease. Among the highest-risk patients are those with ischemic and nonischemic cardiomyopathy who have a reduced left ventricular ejection fraction (≤ 35%-40%). However, not everyone is a candidate for an implantable cardioverter defibrillator.