Cardiovascular Medicine

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Swiss Cooperative Study Acute Coronary Syndromes and Inflammation: A success story supported by the Swiss National Science Foundation

by Christian M. Matter, Stephan Windecker, François Mach, Nicolas Rodondi and Thomas F. Lüscher

Cardiovasc. Med. 2011, 14(5), 167; https://doi.org/10.4414/cvm.2011.01587 - 25 May 2011

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Aschenputtel

by Maria Isbary, Christoph Schreen and Stefan Christen

Cardiovasc. Med. 2011, 14(5), 165; https://doi.org/10.4414/cvm.2011.01592 - 25 May 2011

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Ein 72-jähriger Patient wurde uns via Notfallpraxis mit der Verdachtsdiagnose Pneumonie zugewiesen. Klinisch präsentierte sich der Patient afebril [...] Full article

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2 pages, 720 KB

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Diastolic Mitral Regurgitation in Complete Atrioventricular Block

by Alexander Breitenstein, Bernhard Herzog and Patric Biaggi

Cardiovasc. Med. 2011, 14(5), 163; https://doi.org/10.4414/cvm.2011.01586 - 25 May 2011

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Abstract

A 75-year-old woman was admitted to our hospital with progressive dyspnea and fever due to an acute, community-acquired pneumonia. On examination, the heart rate was irregular and slow (43 beats per minute), and there was a soft end-diastolic and a somewhat louder systolic [...] Read more.

A 75-year-old woman was admitted to our hospital with progressive dyspnea and fever due to an acute, community-acquired pneumonia. On examination, the heart rate was irregular and slow (43 beats per minute), and there was a soft end-diastolic and a somewhat louder systolic murmur over the apex [...] Full article

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Open AccessCase Report

Unkonventionelle «Hybrid-Intervention» bei Etabliertem Vorhof-Flimmern

by Philipp Wagdi and Robert Siebenmann

Cardiovasc. Med. 2011, 14(5), 159; https://doi.org/10.4414/cvm.2011.01590 - 25 May 2011

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A 71-year-old woman suffered a symptomatic cerebrovascular accident with hemiplegia and dysphasia. Work up revealed a patent foramen ovale which was occluded percutaneously after excluding relevant atherosclerosis of intra- and extracranial cerebral vessels, aortic plaque, atrial fibrillation and intracardiac thrombi. Four months later, [...] Read more.

A 71-year-old woman suffered a symptomatic cerebrovascular accident with hemiplegia and dysphasia. Work up revealed a patent foramen ovale which was occluded percutaneously after excluding relevant atherosclerosis of intra- and extracranial cerebral vessels, aortic plaque, atrial fibrillation and intracardiac thrombi. Four months later, the patient developed persistent atrial fibrillation. Because she was asymptomatic, she declined cardioversion and Amiodarone therapy. During the following year, she underwent repeated surgery for recurrent bleeding from diverticulosis under oral anticoagulation. After minimal-invasive surgical exclusion of the left atrial appendage and biatrial radiofrequency ablation, oral anticoagulation and all antiarrhythmics could be stopped and a stable low atrial rhythm established and maintained. Full article

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7 pages, 258 KB

Open AccessArticle

Quality of Lipid Management in Patients with a History of Myocardial Infarction in General Practice in Graubuenden, Switzerland

by Oliver Sears, Walter H. Reinhart and Piero O. Bonetti

Cardiovasc. Med. 2011, 14(5), 152; https://doi.org/10.4414/cvm.2011.01588 - 25 May 2011

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Objective: Lipid lowering therapy represents a cornerstone of secondary prevention in patients with coronary heart disease (CHD). Current national and international guidelines on the use of lipid lowering therapy recommend a low density lipoprotein cholesterol (LDL-C) target level of less than 2.6 [...] Read more.

Objective: Lipid lowering therapy represents a cornerstone of secondary prevention in patients with coronary heart disease (CHD). Current national and international guidelines on the use of lipid lowering therapy recommend a low density lipoprotein cholesterol (LDL-C) target level of less than 2.6 mmol/l in patients with CHD. The aim of the present survey was to assess whether lipid management is performed according to current guidelines in outpatients with CHD and prior myocardial infarction in Graubuenden, Switzerland. Patients and methods: In the summer of 2009, a questionnaire regarding lipid management was sent to all office-based general practitioners/internists in Graubuenden, caring for any of the 389 patients who had suffered from an acute myocardial infarction and had been treated at the Kantonsspital Graubuenden in the years 2006–2009. In autumn 2009, we sent a reminder letter to those general practitioners/internists who had not yet replied to our first letter. Results: At least one questionnaire was returned by 114 of 128 contacted general practitioners/internists. Completed questionnaires were available for 313 of the 389 patients (80%). Of these, 231 (74%) were men and 82 (26%) were women. A total of 287 (92%) patients were prescribed a lipid lowering drug. Of these, 284 patients (91% of the study population) were treated with a statin. An LDL-C level <2.6 mmol/l was reached in 75% of the patients. No difference in the prescription rate of lipid lowering drugs and the achievement of target lipid levels was observed between men and women. Conclusions: The results of our representative survey demonstrate that the majority of patients with CHD and prior myocardial infarction in Graubuenden are treated according to current guidelines. However, despite these encouraging results, target lipid levels are still not reached in about one fourth of all patients, suggesting a potential for further improvement of lipid management in patients with CHD and a history of myocardial infarction. Full article

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Open AccessArticle

Long-Term Follow-Up of Patients with AAI Pacemakers for Sick Sinus Syndrome: System Upgrades and Changes in Wenckebach Block Point Behaviour

by Hannah Bussell, Michael Kühne, Stefan Osswald, Christian Sticherling and Beat Schaer

Cardiovasc. Med. 2011, 14(5), 148; https://doi.org/10.4414/cvm.2011.01589 - 25 May 2011

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Aims: Though indicated in guidelines, AAI1 pacemakers are scarcely used in patients with sick sinus syndrome (SSS) due to fear of AV block during follow-up, necessitating device upgrade. The Wenckebach block point (WBP) is often used to determine AV nodal conduction at [...] Read more.

Aims: Though indicated in guidelines, AAI1 pacemakers are scarcely used in patients with sick sinus syndrome (SSS) due to fear of AV block during follow-up, necessitating device upgrade. The Wenckebach block point (WBP) is often used to determine AV nodal conduction at implant. Our aims were therefore to determine the upgrade rate of AAI pacemakers over time and to study both the stability of WBP over time and its usefulness as a predictor for upgrades. Methods: In this single-centre study, patients with AAI pacemakers were followed regarding need for upgrade and predictors were explored. An AAI system was implanted in patients with SSS without evidence of conduction delay in the His-Purkinje system. WBP was measured at implant and at every follow-up visit. Changes in WBP during long-term follow-up were studied in patients with complete data. Results: We included 140 patients, 87 patients (62%) were female and age at implantation was 74 ± 13 years. Mean follow-up was 3.6 ± 3.3 years. Intraoperative WBP was 134 ± 16 bpm, for patients with complete follow-up it was 129 ± 18 bpm. Mean WBP remained stable during long-term follow-up within a range of 120 to 140 bpm. No changes in WBP behaviour were seen with increasing age. System upgrade was performed in 8 patients (5.7%) mainly due to higher degree AV block. The annual upgrade rate was 1.6%. None of intraoperative WBP, age at implant, presence of atrial fibrillation at implant and gender were predictive for future upgrade. Conclusion: AAI pacemakers evince a very reasonable long-term performance in patients with SSS, with very few patients needing an upgrade. WBP is stable during long-term follow-up and well into old age. No predictors for the development of higher-degree AV block were found. Thus AAI pacemakers may be considered more frequently in patients with SSS and without signs of atrioventricular conduction disease. Full article

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7 pages, 167 KB

Open AccessArticle

Single-Vessel Versus Multivessel PCI in Patients with Acute Coronary Syndrome and Multivessel Coronary Artery Disease

by Marino Quarella, Stefan Toggweiler, Dominic J. Müller, Christophe A. Wyss, Roberto Corti and Thomas F. Lüscher

Cardiovasc. Med. 2011, 14(5), 141; https://doi.org/10.4414/cvm.2011.01593 - 25 May 2011

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Aims: Optimal management of patients with acute coronary syndromes (ACS) presenting with multivessel coronary artery disease (CAD) is controversial. We compared the outcome of three different treatment strategies: single-vessel (SV) PCI of the infarct-related artery only, multivessel PCI during the index procedure [...] Read more.

Aims: Optimal management of patients with acute coronary syndromes (ACS) presenting with multivessel coronary artery disease (CAD) is controversial. We compared the outcome of three different treatment strategies: single-vessel (SV) PCI of the infarct-related artery only, multivessel PCI during the index procedure (MV_index) and staged multivessel PCI (MV_staged). Methods and results: Between July 2007 and December 2008, 387 patients presented with ACS and multivessel CAD. In-hospital mortality was 2.4% for SV PCI, 1.9% for MVindex PCI and 0.8% for MV_staged PCI (p = 0.566). The in-hospital rate of myocardial infarction, acute stent thrombosis, cerebrovascular accident and unplanned revascularisation did not differ. MV_index PCI was associated with a higher rate of inguinal haematoma (0.5%, 9.4%, and 2.4% for SV PCI, MV_indexPCI and MV_staged PCI respectively, p = 0.001). After 1 year death had occurred in 4.6% with SV PCI, in 4.0% with MV_index PCI and in 4.9% of the patients with MV_staged PCI (p = 0.966). Rates for major cardiovascular events including death, myocardial infarction, cerebrovascular accident and unplanned revascularisation were 13.1%, 12.1% and 13.4%, for SV PCI, MV_index PCI and MV_staged PCI respectively (p = 0.981). Conclusion: Multivessel coronary artery PCI performed during the index procedure on presentation of the ACS was associated with a higher rate of inguinal haematoma. Long-term outcome of the three treatment strategies did not differ. Revascularisation of the infarct-related artery only might provide equal benefit to multivessel revascularisation, but needs to be determined prospectively in a larger patient population. Full article

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2 pages, 95 KB

Open AccessCommunication

Zum Abschied von Prof. Dr. med. Otto Martin Hess

by Bernhard Meier

Cardiovasc. Med. 2011, 14(5), 139; https://doi.org/10.4414/cvm.2011.01591 (registering DOI) - 25 May 2011

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Otto Hess hat uns verlassen, und wir können es noch nicht fassen [...] Full article

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Cardiovasc. Med., Volume 14, Issue 5 (05 2011) – 8 articles

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