cardiovascular-agents and Emergencies

Hypertensive urgencies and emergencies are common situations in clinical practice. Hypertensive urgencies are characterized by acute elevation of blood pressure without target organ damage. Hypertensive emergencies are life-threatening situations characterized by acute elevation of blood pressure and target organ damage. The aims of blood pressure control, antihypertensive drugs to use and route of administration will depend on the presence or absence of target organ damage and individual patient characteristics. The correct diagnosis and treatment of these situations are essential for patient prognosis. © 2017 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.

Topics: Acute Disease; Ambulatory Care; Antihypertensive Agents; Aortic Dissection; Cardiovascular Agents; Cardiovascular Diseases; Catecholamines; Emergencies; Hospitalization; Humans; Hypertension, Malignant; Hypertensive Encephalopathy; Stress, Psychological

Topics: Angioplasty, Balloon, Coronary; Biomarkers; Cardiovascular Agents; Coronary Artery Bypass; Coronary Artery Disease; Coronary Thrombosis; Creatine Kinase, MB Form; Defibrillators; Diagnostic Imaging; Electrocardiography; Emergencies; Extracorporeal Circulation; Humans; Myocardial Infarction

Atrial fibrillation is the most common cardiac arrhythmia managed by emergency and acute general physicians. There is increasing evidence that selected patients with acute atrial fibrillation can be safely managed in the emergency department without the need for hospital admission. Meanwhile, there is significant variation in the current emergency management of acute atrial fibrillation. This review discusses evidence based emergency management of atrial fibrillation. The principles of emergency management of acute atrial fibrillation and the subset of patients who may not need hospital admission are reviewed. Finally, the need for evidence based guidelines before emergency department based clinical pathways for the management of acute atrial fibrillation becomes routine clinical practice is highlighted.

Topics: Ambulatory Care; Atrial Fibrillation; Cardiovascular Agents; Clinical Protocols; Electric Countershock; Emergencies; Emergency Service, Hospital; Hospitalization; Humans; Patient Selection; Recurrence

Topics: Acute Disease; Cardiovascular Agents; Combined Modality Therapy; Critical Care; Emergencies; Heart Failure; Humans; Shock, Cardiogenic

Ischemic heart disease and contributing risk factors such as the hyperlipoproteinemic states affect a great percentage of the general population. Because these disease processes can effectively place patients at risk for a life-threatening event, every health care provider must be knowledgeable, disciplined to take a thorough medical history, and prepared for emergency situations that may arise in the clinical practice of dentistry. A proactive approach to identification of risk factors and to primary prevention of ischemic heart disease not only helps to lengthen and improve the quality of patient's lives, but also ensures that necessary modifications of treatment reflect each patient's medical and pharmacologic status.

Topics: Cardiovascular Agents; Dental Care for Chronically Ill; Emergencies; Humans; Hyperlipoproteinemias; Hypolipidemic Agents; Medical History Taking; Myocardial Ischemia; Quality of Life; Risk Factors

Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cardiovascular Agents; Emergencies; Heart Failure; Hemodynamics; Humans; Shock, Cardiogenic

Topics: Angioplasty, Balloon, Coronary; Cardiovascular Agents; Contraindications; Emergencies; First Aid; Humans; Monitoring, Physiologic; Myocardial Infarction; Thrombolytic Therapy; Time Factors

Treatment strategies in acute myocardial infarction are directed toward limitation of infarct size and reduction of frequency of complications. This goal is best achieved by early reperfusion of ischemic myocardium. All trials comparing thrombolytic treatment in acute myocardial infarction indicate that either streptokinase, APSAC, or rtPA reduce mortality significantly. Particularly patients at high risk (old patients, women) benefit most from thrombolytic treatment. Although, conservation of left ventricular function and risk reduction is best achieved by very early treatment, a reduction of mortality has even been shown if thrombolytic agents are if given before 12 hours after onset of symptoms. Primary PTCA is an attractive alternative to thrombolytic therapy particularly in patients with anterior wall myocardial infarction or cardiogenic shock. Routine PTCA early or late after thrombolytic treatment however does not alter the outcome of the patients. The value of rescue PTCA remains to be settled. Heparin as an adjunctive treatment of rtPA improves patency of the coronary arteries and reduces mortality. Newer anti-thrombotic agents like hirudin, argotraban, or monoclonal antibody 7E3 are even more promising for prevention of reocclusion after thrombolytic treatment. Of the conservative medical treatment aspirin, beta-blockade, nitrates, and magnesium all have been shown reduce mortality. Similar effects could not be proven for calcium antagonists or routine antiarrhythmic drugs. ACE-inhibitors are of value if given 3 days after onset of symptoms.

Topics: Aged; Angioplasty, Balloon, Coronary; Aspirin; Cardiovascular Agents; Combined Modality Therapy; Emergencies; Female; Humans; Male; Myocardial Infarction; Survival Rate; Thrombolytic Therapy

The first part of this two-part article discussed the equipment needed for pediatric resuscitations and the techniques used for cardiopulmonary assessment, airway securance, circulatory maintenance and intravascular access. In this second part, additional life support measures are reviewed, including fluid therapy, resuscitation medications and the management of cardiac rhythm disturbances.

Topics: Arrhythmias, Cardiac; Bereavement; Cardiovascular Agents; Child; Child, Preschool; Diagnosis, Differential; Electrocardiography; Emergencies; Family; Fluid Therapy; Humans; Infant; Infant, Newborn; Life Support Care; Pediatrics; Respiration, Artificial; Resuscitation

Topics: Cardiovascular Agents; Electric Countershock; Emergencies; Humans; Mobile Health Units; Myocardial Infarction; Resuscitation; Transportation of Patients

Topics: Cardiovascular Agents; Cardiovascular Diseases; Dose-Response Relationship, Drug; Emergencies; Humans

To describe the prevalence, types, and consequences of adverse drug events (ADEs) in older outpatients with polypharmacy.. A cohort study.. General Medicine Clinic at the Durham Veterans Affairs Medical Center.. A total of 167 high risk (taking > or = 5 scheduled medications) ambulatory older veterans who participated in a year long health service intervention trial.. Potential ADEs were identified by asking patients during closeout interviews whether, in the past year, they had experienced any side effects, unwanted reactions, or other problems from any medication. All reported medications and corresponding adverse experiences were assessed for plausibility by a research clinical pharmacist using two standard pharmacological textbooks and categorized by predictability, therapeutic class, and organ system.. Eighty self-reported ADEs involving 72 medications taken by 58 (35%) of 167 patients were textbook confirmed. Seventy-six of 80 (95%) ADEs were classified as Type A (predictable) reactions. Cardiovascular (33.3%) and central nervous system (27.8%) medication classes were most commonly implicated. Gastrointestinal (30%) and central nervous system (28.8%) ADE symptoms were common. Sixty-three percent of patients with ADEs required physician contacts, 10% emergency room visits, and 11% hospitalization. Twenty percent of medications implicated with ADEs required dosage adjustments, and 48% of ADE-related medications were discontinued. No significant differences (P > .05) were observed when ADE reporters (n = 58) and nonreporters (n = 109) were compared.. Predictable ADEs are common in high risk older outpatients, resulting in considerable medication modification and substantial healthcare utilization.

Topics: Aged; Ambulatory Care; Cardiovascular Agents; Central Nervous System Agents; Cohort Studies; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Emergencies; Follow-Up Studies; Forecasting; Gastrointestinal Agents; Hospitalization; Humans; Longitudinal Studies; Pharmaceutical Preparations; Polypharmacy; Prevalence; Risk Factors

Management of uncomplicated type B aortic dissection (TBAD) has traditionally been aggressive medical therapy. Recent studies brought about a paradigm shift with evidence to suggest benefits from early endovascular intervention to a high risk subgroup of acute uncomplicated TBAD patients.. We aim to review the effects of aortic remodeling in Asian patients with TBAD with and without endovascular intervention, including maximal aortic diameter, true lumen diameter, and false lumen thrombosis.. This is a single-center retrospective study of a prospective database. Patients who presented to our institution with acute TBAD from January 2008 to December 2015 (n = 44) were evaluated. Eighteen percent (8 patients) presented with complicated TBAD and underwent emergency thoracic endovascular aortic repair (TEVAR) while the remaining 82% (36 patients) were treated with optimal medical therapy (OMT).. Six patients under the conservative arm crossed over to elective TEVAR after 6 weeks because of interval radiological progression of disease. There was no significant difference in the baseline demographics of the TEVAR group and the OMT group. At 24 months, mean maximal aortic diameter difference was -7.7 mm and +1.9 mm (P = 0.077), mean true lumen diameter difference was +10.0 mm and +2.6 mm (P = 0.049), and false lumen thrombosis was 100% and 20% (P = 0.012) for TEVAR and OMT, respectively. Kaplan-Meier analysis showed no significant difference in mortality between the 2 groups at 30 days and 2 years.. Within an Asian population with TBAD, TEVAR with OMT has a significant positive effect on aortic remodeling, compared with OMT-only management.

Topics: Aged; Aorta, Thoracic; Aortic Aneurysm; Aortic Dissection; Asian People; Cardiovascular Agents; Databases, Factual; Emergencies; Endovascular Procedures; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Singapore; Time Factors; Treatment Outcome; Vascular Remodeling

Topics: Adenoviridae Infections; Adult; Biopsy; Cardiovascular Agents; Combined Modality Therapy; Defibrillators; Disease Progression; Emergencies; Female; Fever; Heart-Assist Devices; Hemodynamics; Humans; Myocarditis; Myocardium; Parvoviridae Infections; Pericarditis; Shock, Cardiogenic; Spironolactone; Ventricular Dysfunction, Left

We aimed to identify factors easily collected at admission in patients with transient ischemic attack (TIA) that were associated with early recurrence, so as to guide clinicians' decision-making about hospitalization in routine practice. From September 2011 to January 2013, all TIA patients who were referred to the University Hospital of Dijon, France, were identified. Vascular risk factors and clinical information were collected. The etiology of the TIA was defined according to the results of complementary examinations performed at admission as follows: large artery atherosclerosis (LAA-TIA) TIA, TIA due to atrial fibrillation (AF-TIA), other causes, and undetermined TIA. Logistic regression analyses were performed to identify factors associated with any recurrence at 48 hours (stroke or TIA). Among the 312 TIA patients, the etiology was LAA-TIA in 33 patients (10.6%), AF-TIA in 57 (18.3%), other causes in 23 (7.3%), and undetermined in 199 (63.8%). Early recurrence rates were 12.1% in patients with LAA-TIA, 5.3% in patients with AF-TIA, 4.3% in patients with another cause of TIA, and 1.0% in patients with undetermined TIA. In multivariable analysis, the LAA etiology was independently associated with early recurrence (odds ratio [OR]: 12.03; 95% confidence interval [CI]: 1.84-78.48, p=0.009). A non-significant trend was also observed for AF-TIA (OR: 3.82; 95% CI: 0.40-36.62, p=0.25) and other causes (OR: 3.73; 95% CI: 0.30-46.26, p=0.31). A simple initial assessment of TIA patients in the emergency room would be helpful in targeting those with a high risk of early recurrence and who therefore need to be hospitalized.

Topics: Aged; Aged, 80 and over; Atherosclerosis; Atrial Fibrillation; Cardiovascular Agents; Coronary Disease; Diabetes Mellitus; Diagnostic Imaging; Emergencies; Female; France; Humans; Hypercholesterolemia; Hypertension; Ischemic Attack, Transient; Length of Stay; Male; Middle Aged; Patient Admission; Recurrence; Risk Factors; Smoking

The results of emergency coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) are less than satisfactory, and readmission for cardiac events is common.. 105 patients underwent emergency CABG for AMI. We examined the long-term results of emergency CABG for AMI from the viewpoints of preoperative, intraoperative, and postoperative factors. The operative mortality rate was 11.4%. Risk factors for early death were age ≥80 years, shock, veno-arterial bypass, creatine kinase isoenzyme Mb ≥100 U/L, non-use of a left internal thoracic artery graft and an extracorporeal circulation time ≥120 min. Risk factors for late cardiac events were ejection fraction <40%, non-use of human atrial natriuretic peptide (hANP) therapy, angiotensin II receptor blockers (ARB) and aldosterone blockers, and a 3-month postoperative brain natriuretic peptide level ≥200 pg/ml.. Early results of this study are similar to those seen in previous reports, whereas late phase results yield some new and interesting findings. We suggest that intraoperative hANP, and postoperative aldosterone blocker and ARB, following CABG for AMI, will, through control of the renin-angiotensin-aldsterone system, inhibit left ventricular remodelling, reduce the extent of infarction, and improve cardiac function, yielding a favourable long-term prognosis.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Biomarkers; Cardiovascular Agents; Coronary Artery Bypass; Creatine Kinase, MB Form; Disease-Free Survival; Emergencies; Extracorporeal Membrane Oxygenation; Female; Hospital Mortality; Humans; Intraoperative Care; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Natriuretic Peptide, Brain; Postoperative Care; Recovery of Function; Retrospective Studies; Risk Assessment; Risk Factors; Stroke Volume; Time Factors; Treatment Outcome; Ventricular Function, Left; Ventricular Remodeling

Topics: Capillary Leak Syndrome; Cardiovascular Agents; Combined Modality Therapy; Diagnosis, Differential; Emergencies; Fatal Outcome; Female; Fluid Therapy; Humans; Hypotension, Orthostatic; Middle Aged; Monoclonal Gammopathy of Undetermined Significance; Multiple Myeloma; Pasteurella Infections; Pasteurella multocida; POEMS Syndrome; Respiration, Artificial; Shock, Septic; Skin Diseases, Bacterial; Ventricular Dysfunction, Left

Metformin is an antihyperglycemic agent commonly used in diabetic patients. It is very effective and is able to reduce the plasma glucose and HbA1C. However, in some patients, specially those with comorbidities, metformin can provoke severe lactic acidosis with high morbimortality. Treatment of the lactic acidosis induced by metformin is based on the use of supportive general measures; in severe cases, procedures of extrarrenal purification like hemodialysis or continuous hemodiafiltration have been successfully used.

Topics: Acidosis, Lactic; Acute Kidney Injury; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Antidepressive Agents; Cardiovascular Agents; Cardiovascular Diseases; Coma; Diabetes Mellitus, Type 2; Drug Synergism; Drug Therapy, Combination; Emergencies; Fatal Outcome; Female; Humans; Hypoglycemic Agents; Ibuprofen; Male; Metformin; Middle Aged; Nephrology; Physician's Role; Polypharmacy

With the advent of new therapeutic options for acute ischemic stroke, expeditious evaluation of patients with suspected stroke has become imperative. Goals of the initial evaluation are to determine the time of symptom onset, severity of the neurologic deficit, and to exclude intracranial hemorrhage and other mimics of acute ischemic stroke. CT and MRI perfusion studies may demonstrate the presence of an ischemic penumbra and aid in identification of patients who may benefit from thrombolysis. Intravenous recombinant tissue plasminogen activator (IV rtPA) remains the gold standard for acute ischemic stroke treatment, and the therapeutic time window recently has been extended to 4.5 h in certain patients. Catheter-based intra-arterial thrombolysis is being used increasingly as "rescue therapy" after IV rtPA and as primary therapy in select patients who are ineligible for intravenous therapy. Trials investigating the efficacy and safety of intra-arterial therapy are ongoing.

Topics: Brain Ischemia; Cardiovascular Agents; Emergencies; Fibrinolytic Agents; Humans; Stroke; Telemedicine; Tissue Plasminogen Activator

Modern dental offices must be equipped to initiate prompt emergency care should the sudden need arise. With the elderly population in dental practices increasing, these emergencies will undoubtedly occur. This article discusses the basic emergency equipment the average dental office should possess to allow for an adequate initial response. It also discusses the policies and personnel needed for dealing with emergencies. Among the basic emergency equipment, an office should have syringes, an Ambu bag, a portable oxygen system, a sphygmomanometer (child and adult sizes), and an EKG/defibrillator. Emergency drugs that should be stocked include aromatic ammonia, aspirin, and nitroglycerine. The dentist should also develop a protocol and policy for his/her staff to follow when a medical emergency arise.

Topics: Adult; Cardiovascular Agents; Child; Defibrillators; Dental Offices; Dental Staff; Emergencies; Emergency Treatment; Hematologic Agents; Humans; Organizational Policy; Respiration, Artificial; Respiratory System Agents; Sphygmomanometers; Syringes

The Oxford Record Linkage Study (ORLS; an epidemiological database) was used to examine relationships between intercurrent cardiovascular drug therapy and cardiac death within 30 days of elective or emergency/urgent surgery under general anaesthesia. Cases identified from the ORLS were paired with matched control patients. Clinical details were obtained from the patients' medical notes. In elective surgical patients, there was no effect of beta-adrenoceptor or calcium entry channel blockade, diuretics or digoxin on cardiac death after adjusting for confounding variables. Use of nitrates was associated with an odds ratio of 4.79 [95% confidence interval (CI) 1.01-22.72] for cardiac death after adjustment for confounding by a history of angina and residual age difference. In emergency/urgent patients, there were significant univariate associations with cardiac death for intercurrent use of angiotensin converting enzyme (ACE) inhibitors (odds ratio 1.18) and diuretics (odds ratio 4.95; 95% CI 1.82-13.46). However, neither maintained significance after adjustment for the confounding effect of cardiac failure. We conclude that, with the possible exception of the use of nitrates in elective surgical patients, chronic intercurrent drug treatment alone does not significantly affect the odds of cardiac death within 30 days of surgery.

Topics: Adrenergic beta-Antagonists; Adult; Aged; Aged, 80 and over; Anesthesia, General; Calcium Channel Blockers; Cardiovascular Agents; Cardiovascular Diseases; Case-Control Studies; Elective Surgical Procedures; Emergencies; England; Female; Humans; Male; Medical Record Linkage; Middle Aged; Nitrates; Odds Ratio; Postoperative Complications

Topics: Adult; Anuria; Bradycardia; Cardiovascular Agents; Cold Temperature; Coma; Combined Modality Therapy; Drug Overdose; Electric Countershock; Emergencies; Extracorporeal Membrane Oxygenation; Female; Frostbite; Humans; Hypotension; Hypothermia; Intermittent Positive-Pressure Ventilation; Psychotropic Drugs; Resuscitation; Suicide, Attempted; Ventricular Fibrillation

Topics: Angina, Unstable; Cardiovascular Agents; Electrocardiography; Emergencies; Humans; Male

From the International Registry on Cardiac Transplantation we can not infer a higher mortality in urgent or emergent Cardiac Transplantation. The data in the Spanish Registry and in the literature show that the risk is higher in these patients compared to non urgent transplantation, implying ethical considerations which are discussed in the article. A different approach to urgent transplantation could be based on previous circulatory support, or heart assist systems as a bridge to transplantation.

Topics: Assisted Circulation; Cardiovascular Agents; Emergencies; Heart Transplantation; Heart, Artificial; Humans; Intra-Aortic Balloon Pumping; Middle Aged; Registries; Risk Factors; Spain

Topics: Cardiovascular Agents; Critical Care; Emergencies; Heart Diseases; Humans

Topics: American Heart Association; Cardiopulmonary Resuscitation; Cardiovascular Agents; Clinical Protocols; Emergencies; Heart Arrest; Humans; Life Support Care

Cardiac transplantation can only be performed in a few patients with severe congestive heart failure (CHF), due to the shortage of donor hearts. The efficacy of current medical therapy tailored for severe CHF, which has not previously been determined for transplant candidates, is of particular importance in patients considered for urgent cardiac transplantation. In this study, 50 consecutive in-patients transferred from other hospitals for urgent transplantation underwent intensive afterload reduction therapy, initially with intravenous and subsequently with oral vasodilators and diuretics tailored to hemodynamic goals. Oral regimens allowed hospital discharge without surgery for 40 of 50 patients. Nineteen of these patients had arrived on inotropic infusions and 32 had received oral vasodilators in the previous month. Cardiac index increased from 1.9 +/- 0.6 to 2.8 +/- 0.7 liters/min/m2, while pulmonary capillary wedge pressure decreased from 30 +/- 8 to 15 +/- 4 mm Hg and systemic vascular resistance decreased from 1,800 +/- 800 to 1,100 +/- 200 dynes-s-cm-5. Despite poor initial hemodynamics, ejection fraction 16 +/- 4%, serum sodium 131 +/- 6 mEq/liter, and apparent failure of previous medical therapy, actuarial survival for 24 discharged patients receiving sustained medical therapy alone was 67% at 1 year, with 67% of survivors employed full- or part-time, and 14 of 16 (88%) discharged transplant candidates survived until transplantation. By decreasing the need for transplantation to be performed urgently, increased emphasis on the design of medical therapy may allow more effective distribution of limited donor hearts.

Topics: Actuarial Analysis; Adolescent; Adult; Aged; Cardiovascular Agents; Combined Modality Therapy; Drug Therapy, Combination; Emergencies; Female; Furosemide; Heart Failure; Heart Transplantation; Hemodynamics; Humans; Male; Metolazone; Middle Aged; Vasodilator Agents

Topics: Cardiovascular Agents; Emergencies; Humans

Topics: Adult; Cardiovascular Agents; Child; Emergencies; Humans; Infusions, Intravenous; Mathematics

Highly efficient medicaments like catecholamines, vasodilators and antiarrhythmics require exact and safe application. So far, however, we have not been able to meet this requirement in our medical emergency service, as the appropriate dispensing equipment has not been available. Nevertheless, today potent medication must be administered during preclinical emergency care. A case report is given that shows the advantages of the use of an electronically controlled injection pump (IVAC 700) for dispensing highly efficient medicaments in emergency medicine.

Topics: Adult; Ambulances; Cardiovascular Agents; Emergencies; Female; Heart Failure; Hemodynamics; Humans; Perfusion

Topics: Cardiovascular Agents; Emergencies; First Aid; Humans

Topics: Analgesics; Antidotes; Cardiovascular Agents; Drug Therapy; Emergencies; Humans; Hypnotics and Sedatives; Internal Medicine; Respiratory Tract Diseases; Shock

Topics: Cardiovascular Agents; Drug-Related Side Effects and Adverse Reactions; Emergencies; Humans; Nursing Care; Pharmaceutical Preparations

Topics: Animals; Cardiovascular Agents; Dog Diseases; Dogs; Emergencies; Heart Arrest; Heart Diseases; Heart Failure; Resuscitation; Shock