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Background: Cardiac biomarkers, such as high-sensitivity cardiac troponin (hs-cTn) and brain natriuretic peptide (BNP) or N‑terminal prohormone of brain natriuretic peptide (NT-proBNP) are measured perioperatively to improve the prognosis and risk prediction. The European Society of Cardiology (ESC), European Society of Anesthesiology and Intensive Care (ESAIC) and the German Society of Anesthesiology and Intensive Care Medicine (DGAI) have recently published guidelines on the use of cardiac biomarkers prior to surgery. Objective/research question: This article provides an overview of the available evidence on perioperative troponin and BNP/NT-proBNP measurements. Current guideline recommendations are presented and discussed. Material and methods: MEDLINE, Cochrane and google.scholar were searched for relevant keywords. Titles and abstracts of identified papers were checked for relevance and published results were summarized. Guideline recommendations from the ESC, ESAIC and DGAI are presented, compared and evaluated based on the available literature. In addition, the significance of new perioperative cardiac biomarkers is discussed based on the existing evidence. Results: The definitions, diagnosis and management of cardiovascular events in the perioperative context differ from those in the nonsurgical setting. The evidence for the measurement of hs-cTn and BNP/NT-proBNP is evaluated differently in the guidelines and the resulting recommendations are partly contradictory. In particular, recommendations for changes in perioperative management based on biomarker measurements diverge. The ESC guidelines propose an algorithm that uses preoperative biomarkers as the basis for additional cardiac investigations. In particular, invasive coronary angiography is recommended for patients with stable chronic coronary syndrome who have no preoperative cardiac symptoms but elevated biomarkers. In contrast, the ESAIC guidelines emphasize that the available evidence is not sufficient to use perioperative biomarker measurements as a basis for a change in perioperative management. Discussion: Treating physicians should coordinate interdisciplinary (surgery, anesthesiology, cardiology) recommendations for clinical practice based on the aforementioned guidelines. If cardiac biomarkers are routinely determined in high-risk patients, this should be done in accordance with the ESC algorithm. [ABSTRACT FROM AUTHOR]

In Switzerland, about 20 000 people experience an acute coronary syndrome (ACS) event each year. Acute coronary syndromes comprise ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina. The diagnosis is made based on the clinical presentation, a rise in cardiac biomarkers, and ischemic ECG changes. In patients with acute STEMI, urgent coronary angiography with primary percutaneous coronary intervention (PCI) to open the occluded artery is indicated. In patients with NSTEMI and unstable angina, the timing of coronary angiography and PCI is based on the clinical presentation and on a comprehensive and individualized risk stratification. Optimal secondary prevention and aggressive cardiovascular risk factor control are important following the acute event. [ABSTRACT FROM AUTHOR]

A randomized clinical study in the USA examined the effects of pharmacogenetic testing on medication selection and symptom remission in severe depressive disorders. The results showed that the use of these tests reduced the prescription of antidepressants with known gene-drug interactions. However, the effects on symptom remission did not persist over time. The study had advantages and disadvantages, and it was found that pharmacogenetic testing is only beneficial for about 20% of those affected overall. A study from Sweden and Norway examined the effects of early introduction of potentially allergenic foods on the development of food allergies in infants. The risk of food allergies was significantly reduced in the group with early introduction of complementary foods compared to the group without intervention. Another study examined the effects of ezetimibe and PCSK9 inhibitors on cardiovascular risk. The study shows that adding ezetimibe to the maximum tolerated statin dose reduces the risk of myocardial infarction and stroke. [Extracted from the article]

The article discusses the current guidelines for the management of atrial fibrillation (AF) according to the guidelines of the European Society of Cardiology (ESC). It presents significant changes in the guidelines since August 2020, including a new diagnostic algorithm and a treatment algorithm called "CC to ABC". Catheter ablation is recommended as a first-line therapy for individuals with AF and a high likelihood of tachycardia-induced cardiomyopathy. The risk of AF increases with comorbidities such as hypertension, heart failure, and coronary artery disease/myocardial infarction. The symptoms of AF can vary and range from palpitations and chest pain to dizziness and exercise intolerance. Various indications and treatment options for patients with atrial fibrillation are presented, including catheter ablation as a first-line therapy. The ablation aims to completely electrically isolate the pulmonary veins as triggers of AF. The success rates of ablation are around 80% for paroxysmal AF, while they are significantly lower for persistent AF due to extrapulmonary triggers. Anticoagulation before and after ablation, as well as follow-up care, are also discussed. [Extracted from the article]

Acute coronary syndrome is the most common reason for the deployment of emergency medical services in Germany. Approximately 20–25% of all medical emergencies result from the indications for the suspicion of acute coronary syndrome. A substantial proportion of the total mortality rate is observed in the preclinical phase. Consequently, targeted diagnostics and treatment are of particular importance in this early phase. This article provides recommendations for the approach to patients with acute coronary syndrome in the prehospital phase and in the emergency department. [ABSTRACT FROM AUTHOR]

We report the case of a male athlete with a myocardial infarction caused by intracoronary thrombus formation, which was associated with prior cannabis consumption. Cannabis is a rare cause of myocardial infarction and is poorly recognized as a cardiovascular risk factor. Because of the ongoing process of marijuana legalization in many countries, there is concern about an increasing number of cannabis-related myocardial infarctions especially in young patients. Several pathophysiological mechanisms have been proposed and warrant further investigation. [ABSTRACT FROM AUTHOR]

Bei Personen, die an Marathonläufen teilnehmen, ist im Anschluss an die sportliche Belastung die Troponin-Konzentration im Blut häufig erhöht. Fachleute diskutieren, ob es sich hierbei um physiologische oder pathologische Veränderungen handelt. Bei den meisten Athlet:innen liegen die Troponinwerte nach 48 Stunden wieder im Refe)renzbereich, bei einigen hält die Erhöhung aber länger als 72 Stunden. [ABSTRACT FROM AUTHOR]

Despite an increasing number of patients suffering from an acute coronary syndrome under novel oral anticoagulant therapy, specific treatment recommendations for anticoagulation are still lacking. For this reason, the German Society of Cardiology and the German Association of Interdisciplinary Intensive Care and Emergency Medicine developed a consensus statement for the treatment of these patients with the aim to summarize the current evidence and to increase the safety of this special patient group. [ABSTRACT FROM AUTHOR]

Background: Despite an increasing incidence of patients suffering from acute coronary syndrome (ACS) under simultaneous treatment with direct oral anticoagulants (DOAC), neither sufficient scientific data nor uniform guidelines for the anticoagulation treatment of these patients are currently available.Objective: The aim of this study was to determine the current practice of preclinical treatment of ACS in patients under DOAC treatment.Material and Methods: An internet and paper-based survey of emergency physicians, specialists of internal medicine, anesthesiologists, emergency and intensive care physicians was performed concerning the prehospital treatment of ACS in patients under long-term DOAC treatment.Results: Overall, 284 questionnaires were answered. Substantial differences in the current treatment of ACS under long-term DOAC therapy were identified. While 39% of the respondents stated that they administer a combination treatment of heparin and acetylsalicylic acid (ASA), 36% renounced the administration of heparin. If a dose reduction was performed, 71% answered that they reduce the heparin dosage. Also, in cases of ST-segment elevation myocardial infarction 48% of the physicians renounced the administration of heparin.Conclusion: In Germany there is currently a heterogeneous practice of emergency treatment of ACS patients under DOAC therapy with respect to the administration of heparin and ASA. Therefore, guidelines of the specialist medical societies should address the prehospital emergency anticoagulation management of ACS in patients under therapy with DOAC, which correspond to the needs of patients and emergency physicians. [ABSTRACT FROM AUTHOR]

Because of new surgical techniques, advanced monitoring modalities and improvements in perioperative care, perioperative mortality and morbidity have been significantly reduced in the last decades; however, patients still suffer from high perioperative mortality and morbidity, especially those with pre-existing cardiovascular diseases. Not only perioperative myocardial infarction but also myocardial injury after non-cardiac surgery, which presents without clinical symptoms, is associated with an adverse outcome. Patients at risk require particular interdisciplinary attention throughout the perioperative phase. The premedication visit is of particular importance. In addition to a thorough patient medical history and physical assessment, the perioperative handling of the patient's pre-existing medication and possible necessity for further preoperative tests should be verified. If necessary and where possible, optimization of the patient's state of health can be planned together with other disciplines. It is the anesthesiologist's responsibility to optimally guide and support patients with pre-existing cardiovascular diseases through the entire surgical procedure. This review summarizes perioperative interventions that have an influence on patient mortality and morbidity and evaluates the underlying evidence. This covers the perioperative handling of cardioprotective medication, choice of the anesthetic regimen, blood pressure management and transfusion regimens. Furthermore, this review highlights recent findings, e.g. perioperative reloading with statins and short-term preoperative initiation of beta blockers. The pros and cons of thoracic epidural anesthesia in patients with an elevated cardiovascular risk are discussed. Not only intraoperative hypotension should be of concern to anesthesiologists but also postoperative hypotension can have a deleterious impact on the outcome. This is relevant in the time period when a significant proportion of patients have already left the monitoring ward. The recently published recommendations by the World Health Organization concerning perioperative hyperoxia might not be beneficial for patients with an elevated cardiovascular risk. Finally, the treatment options for perioperative cardiovascular events are explained and an algorithm for handling of patients with perioperative myocardial injury without clinical ischemic symptoms is suggested (myocardial injury after non-cardiac surgery). [ABSTRACT FROM AUTHOR]

In the future an increasing number of older patients with significant comorbidities will have to undergo major surgical procedures. Perioperative cardiovascular events account for many major complications and even fatalities. While perioperative myocardial infarction (PMI) is a generally well-known and recognized complication, the less severe myocardial injury after non-cardiac surgery (MINS) has not gained widespread scientific attention until recently; however, two large observational trials (VISION 1 and VISION 2) have shown a significantly increased mortality after MINS with even subtle increases in troponin T being associated with an increased risk of death. This review summarizes the current knowledge pertaining to PMI and MINS and proposes a diagnostic and therapeutic framework for optimally guiding patients at risk through the perioperative period. [ABSTRACT FROM AUTHOR]

The study compares the effectiveness of chlorthalidone and hydrochlorothiazide as first-line medications for the treatment of hypertension. The results show that both medications are equally effective in terms of the primary outcome. Individuals with a history of stroke or myocardial infarction had a better primary outcome in the chlorthalidone group, while the hydrochlorothiazide group performed better in participants without stroke or myocardial infarction. Side effects such as hypokalemia occurred more frequently in the chlorthalidone group. The study investigates whether the benefits of both medications in reducing the risk of cardiovascular diseases are different. [Extracted from the article]

The study compares the outcome of patients with stable angina pectoris who received either a computed tomography (CT) or a coronary angiography. CT is an accurate and non-invasive alternative to coronary angiography to determine if there is a relevant narrowing of the coronary arteries. In more than half of the patients who received a coronary angiography, no relevant stenosis was found. The study shows that the primary endpoint (death due to cardiovascular disease, non-fatal heart attack, non-fatal stroke) was similar in both groups, but complications were higher in the coronary angiography group compared to the CT group. There was no difference in quality of life between the two groups. [Extracted from the article]

Background: The Westpfalz is a mainly rural region in the southwestern part of the German state of Rhineland-Palatinate with 527,000 inhabitants and demonstrates a higher than average cardiovascular mortality compared to the rest of Germany. The reasons are not known. Our study attempted to investigate whether significant deficits in knowledge of the population on cardiovascular emergencies, the accessibility of emergency medical services (EMS) or the different responsibilities and abilities of the medical facilities could be held responsible for this. These factors are of the utmost importance for the timely initiation and administration of curative therapeutic strategies.Methods: We conducted standardized telephone interviews with 1126 inhabitants of Westpfalz as a representative sample of the population in the study area. The interviewees were asked about demographic data, participation in first aid courses, knowledge of emergency telephone numbers and the different responsibilities of preclinical emergency physicians which are a part of the EMS and the doctor-on-call system for non-life-threatening conditions (ÄBD). Moreover, we asked about the leading symptoms of myocardial infarction and stroke. Finally, we enquired how the respondents would react in fictitious cardiovascular emergencies.Results: Of the participants 651 (57.8%) were female and 475 (42.2%) male. The mean age in our study was 51 ± 18 years and 1002 of the participants (89%) had some formal first aid training. The current telephone number of the EMS system (112) was known to 29.5% of the interviewees and 15.4% could only recall the old number (19222) which is no longer in use. In the case of participants who gave the correct telephone number the first aid course took place 10 years ago (median), whereas for participants who did not know the correct number, the course dated back 15 years (median, p < 0.01). The telephone number 116117 of the ÄBD, usually a family physician, was familiar to only 23 of the people interviewed (2.0%). The basic differences in the functions and responsibilities of the ÄBD and the emergency physician within the EMS were known to only 235 participants (20.2%), 231 (20.5%) were not able to name a single leading symptom of a myocardial infarction and 354 did not know a leading symptom (31.4%) of stroke. In the fictitious case report of an unconscious patient with respiratory arrest (as a sign of cardiac arrest) 96.8% of the interviewees would have correctly informed the EMS, for patients with acute coronary syndrome 81.8% and for a stroke patient 76.8% (cardiac arrest vs. acute coronary syndrome: p < 0.001, cardiac arrest vs. stroke: p < 0.001, acute coronary syndrome vs. stroke: p = 0.005).Conclusion and Recommendations: A large proportion of the population were found to be ignorant about the telephone numbers for medical emergency calls and the different functions of the ÄBD and emergency physicians within the EMS. Moreover, our results indicate that a significant percentage of the population would neither be in a position to recognize a stroke or myocardial infarction in an emergency situation nor be informed enough to communicate with the correct part of the emergency system. The association of these deficits with the time elapsed since the last first aid course should be reason enough to continuously motivate the population, especially at risk patients and their relatives, to repeat such courses several times. Furthermore, digital media should be used more intensively in providing first aid instructions. In our opinion, this study clearly shows that in Germany a uniform number for medical emergency calls is mandatory. [ABSTRACT FROM AUTHOR]

Posttraumatic stress disorder (PTSD) was previously thought to be a psychological reaction precipitated by exposure to war, sexual and physical violence; however, PTSD is also prevalent after life-threatening medical events, such as stroke and myocardial infarction. After such events PTSD is often underdiagnosed despite the fact that it is clearly associated with adverse clinical outcomes including recurrence of cardiac events and increased mortality. Moreover, PTSD increases the risk of vascular events. This review summarizes the bidirectional relationship between PTSD and vascular diseases and outlines current knowledge regarding clinical features, prevalence and the putative underlying pathophysiological mechanisms. [ABSTRACT FROM AUTHOR]

A 32-year-old woman at 32 weeks gestation presented with cardiac arrest due to ventricular tachycardia following acute chest pain at home. After immediate defibrillation with return of spontaneous circulation (ROSC), an ST segment elevation myocardial infarction due to coronary artery dissection was confirmed. Two drug-eluting stents were implanted and she was placed on dual antiplatelet therapy (DAPT). The echocardiogram showed akinesis of the apex and anterior wall. The patients risk for stent thrombosis was considered high and therefore DAPT was continued until cesarean section at 35 weeks gestation. Intraoperatively she received two units of packed red blood cells, one platelet concentrate, 4 g fibrinogen and 2 g tranexamic acid. Left ventricular ejection fraction deteriorated 8 days after delivery and the patient developed congestive heart failure. [ABSTRACT FROM AUTHOR]

Survivors of a myocardial infarction are at increased risk for future cardiac events, including recurrent infarction, heart failure, arrhythmia, stroke, and sudden cardiac death. The primary care physician needs to be aware of the potential risks and complications facing these patients. Secondary preventive measures after myocardial infarction include an optimal medical therapy (dual antiplatelet therapy, Statin, ACE-inhibitor, and in most cases a beta-blocker) and life style modifications (quit smoking, regular physical activity, Mediterranean-style diet). Patients should be informed about how to recognize and react to cardiac symptoms. [ABSTRACT FROM AUTHOR]

Sleep-related breathing disorders (SRBD) and coronary artery disease (CAD) are common disorders in the industrial countries. There is no doubt that SRBD contribute to cardiovascular risk and clinical course of CAD. Epidemiologic and clinical studies suggest that nocturnal breathing disorders promote the progression of CAD. In this regard it has been shown that obstructive sleep apnea syndrome is associated with an increase in coronary plaque-burden, endothelial dysfunction, and a worse course outcome after percutaneous coronary intervention. Consequently, SRBD should be included in the diagnostic work up of patients with CAD and myocardial infarction. [ABSTRACT FROM AUTHOR]

The prevalence of a major depressive disorder in patients after myocardial infarction is 20%. Depression is a risk factor for incident coronary heart disease and poor prognosis after myocardial infarction. Poor lifestyle habits and adherence to cardiac therapy as well as metabolic and pathophysiologic changes may partially explain this link. The threatening experience of an acute coronary event and immune and inflammatory changes may be unique features contributing to incident depression after myocardial infarction. While psychotherapy, antidepressants, and physical exercise may alleviate depressive symptoms in patients with coronary heart disease, cardiac rehabilitation additionally reduces mortality risk. Attempts are being undertaken to identify the cardiotoxic characteristics of depression to develop even more effective therapies in the future. [ABSTRACT FROM AUTHOR]

Background: Only randomized clinical trials can improve the outcome of life-threatening injuries or diseases but observations from England and North America suggest that the number of such randomized clinical trials is decreasing. In this study contributions from German speaking countries with regards to randomized clinical trials in emergency medicine over the last 22 years were investigated. Methods: The Medline database was searched from January 1990 to December 2012 for prospective randomized clinical trials in the prehospital setting using the criteria 'cardiac arrest', 'cardiopulmonary resuscitation', 'multiple trauma', 'hemorrhagic shock', 'head trauma', 'stroke' as well as myocardial infarction and emergency medical service. Only studies originating from Germany, Austria or Switzerland were included. Results: A total of 474 studies were found and 25 studies (5.3 %) fulfilled the inclusion criteria. In the last 22 years German speaking countries have published approximately one prospective, randomized, clinical trial per year on prehospital emergency medicine. The median number of patients included in the trials was 159 (minimum 16, maximum 1,219). Most (80 %) studies originated from Germany and most (64 %) studies were conducted by anesthesiology departments. Cardiac arrest was the most frequent subject of the investigated studies. Approximately 50 % of the studies had financial support from industrial companies. Conclusion: A significant increase or decrease in the number of prospective randomized clinical trials in the out-of-hospital setting could not be found in German speaking countries despite the fact that the absolute numbers of studies had increased. Only about one prospective, randomized clinical trial with an emergency medicine core tracer diagnosis originated from Germany, Austria and Switzerland per year. [ABSTRACT FROM AUTHOR]

We report the case of a 58 year old man with unspecific lower abdominal pain, respiratory failure and shock. An acute aortic syndrome and a massive pulmonary embolism were excluded, and a coronary angiography for suspected acute myocardial infarction was performed, with detection of a high-grade stenosis of the left main coro nary artery. A percutaneous coronary intervention was needed. We discuss the difficulty to distinguish an acute aortic syndrome, an acute coronary syndrome, and a massive pulmonary embolism in the emergency situation. In addition we discuss the difficulty of detecting a left main coronary artery stenosis in the ECG. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases represent the major cause of mortality in the western world. The concept of regenerative medicine has been repeatedly suggested to be an innovative approach to repair and regenerate the diseased myocardium after acute myocardial infarction and chronic ischemic cardio-myopathy. However, while numerous experimental and preclinical studies using various types of stem and progenitor cells have shown promising results, the outcomes of first clinical pilot trials have only shown marginal effects with regards to the improvement of cardiac performance after cell-based therapies. Current meta-analyses demonstrate a mean of only 3% improvement of cardiac function. The reasons for the ineffective translation into the clinical setting are related to many unanswered key questions comprising the ideal cell type, the mode of delivery, the optimal timing, the application format (2D versus 3D) and the definition of effective study endpoints. Furthermore, advanced, non-invasive imaging techniques as well as the development of appropriate animal models are mandatory for the assessment of cell based-therapies and represent the key requisite for a safe translation into the clinical setting. Future cell-based therapy concepts need to be optimized to achieve long-term efficiency and in particular the clinical potential of novel pluripotent stem cells such as induced pluripotent cells (IPS) needs to be addressed. In addition, recent experimental studies demonstrate the principal feasibility of direct reprogramming of myocardial fibroblasts into functional cardiomyocytes in vitro and in-vivo what may represent a novel myocardial regenerative strategy without the direct necessity of stem cells. [ABSTRACT FROM AUTHOR]

A 63-year-old man was admitted with fever and bilateral pulmonary infiltrates accompanied by pleural effusion a few days after ST-segment elevation myocardial infarction treated with primary angioplasty and stent implantation. The diagnosis of early postmyocardial infarction syndrome (Dressler's syndrome) with pulmonary infiltrates was made after ruling out possible differential diagnosis such as pneumonia and congestive heart failure. Infiltrates and markers of inflammation resolved rapidly with systemic steroid therapy. Etiology, diagnosis and treatment of this immunological reaction with inflammation of pericardium, pleur and often pulmonary parenchyma are discussed. [ABSTRACT FROM AUTHOR]

This article reports the case of a patient who developed acute coronary syndrome while receiving postoperative pain treatment via an epidural catheter (EC). Platelet function testing was performed before removal of the EC to assess the bleeding risk under ongoing dual antiplatelet therapy. Platelet function testing showed low responsiveness to clopidogrel and acetylsalicylic acid (ASS). The EC was removed uneventfully and clopidogrel was subsequently replaced by prasugrel and platelet function showed improved depression of thrombocyte aggregation. Possible reasons for low responsiveness to clopidogrel and ASS, such as drug-drug interactions with proton pump inhibitors and genetic factors are discussed. [ABSTRACT FROM AUTHOR]

The article reports on a conference in Zürich, Switzerland, from March 8-10, 2012, which focused on the historical evolution of the notion of stress in European medical discourses and society in the twentieth century. Topics discussed included the contribution of futurologists like American author Alvin Toffler to increased popular interest in stress, heart attacks in German literature, and the impact of technological innovations on the experience of stress.

Cardiogenic shock is most commonly a complication of acute myocardial infarction. The ischemic loss of functional myocardium triggers distinct cardiovascular responses which can deteriorate to global pump failure with a mortality rate of more than 50%. Causes of cardiogenic shock beyond myocardial ischemia are very diverse. Decisive management with rapid evaluation, identification of the underlying disease and urgent initiation of supportive measures as well as definitive therapy is of prognostic value. Causal treatment of the cardiac disease is crucial but has to be weighed against the specific surgical circumstances of perioperative patients, particularly concerning anticoagulation, platelet inhibition and bleeding risks. Hemodynamic stabilization is achieved by pharmacological support of myocardial function, control of arrhythmia and volume load. Prevention and intensive care of shock-related multiorgan failure is of pivotal importance in the successful management of cardiogenic shock. [ABSTRACT FROM AUTHOR]

Cardiac damage after an accident mostly occurs in connection with penetrating or blunt chest trauma and is often decisive for the prognosis of a patient. It is known that an emotional trauma can also lead to acute cardiac disease, the so-called stress-induced cardiomyopathy, however this condition is ill-defined. We present two cases with symptoms of an acute myocardial infarction occurring directly after an emotional trauma at work or while travelling to work. Diagnostic procedures defined the cardiac disease as takosubo cardiomyopathy without coronary occlusion but with a typical dysfunction of the left ventricle. Legal and assessment aspects concerning the accident insurance are discussed. [ABSTRACT FROM AUTHOR]

Background: Thoracic epidural analgesia (EDA) is thought to provide cardioprotective effects in patients undergoing noncardiac surgery. The results of two previous meta-analysis showed controversial conclusions regarding the impact of EDA on perioperative survival. The purpose of the present meta-analysis was to evaluate, whether thoracic EDA has the potential to reduce perioperative cardiac morbidity or mortality on the basis of available randomized controlled trials. Patients and methods: A systematic literature search was conducted in medical databases ( Med-Line, EBM-Reviews, Embase, Biosis and Biological Abstracts) and relevant clinical trials including patients undergoing noncardiac surgery were evaluated by two independent investigators. All randomized controlled trials investigating the effects of thoracic EDA on perioperative outcome, published from 1980 up to the end of 2008 were included into this quantitative systematic review. Calculations were performed using the statistics program Review Manager 4.1 using a fixed-effects model. Results: Nine studies with a total of 2,768 patients were included in the meta-analysis. Thoracic EDA did not reduce perioperative mortality [odds ratio (Peto OR): 1.08; 95% confidence interval (CI) 0.74-1.58]. Patients receiving thoracic EDA demonstrated a tendency to a lower rate of perioperative myocardial infarction. However, this effect of thoracic EDA did not reach statistical significance (Peto OR: 0.65; 95% CI 0.4-1.05). Conclusions: The present meta-analysis did not prove any positive influence of thoracic EDA on perioperative in-hospital mortality in patients undergoing noncardiac surgery. Furthermore, it remains questionable if thoracic EDA has the potential to reduce the rate of perioperative myocardial infarction. [ABSTRACT FROM AUTHOR]

According to most studies, persons living or being born at higher altitude have a lower risk of fatal myocardial infarction or stroke than lowlanders. The altitude effect is more pronounced for myocardial infarction than for stroke and generally stronger in men than in women. Possibly, exposure to a certain altitude impacts on cardiovascular risk for the entire life span. It is unlikely that classical cardiovascular risk factors substantially influence the altitude effect. In contrast, environmental conditions that depend on altitude could play a role. [ABSTRACT FROM AUTHOR]

Perioperative detection of cardiac biomarkers may help to identify patients at risk. Whether detection of these markers will be recommended in the preoperative setting for patients with cardiac diseases in the future has to be discussed as large prospective trials on this topic are missing. For preoperative evaluation of cardiac insufficiency quantification of brain natriuretic peptide (BNP) and amino-terminal pro-brain natriuretic peptide (NT-proBNP) are useful markers. Troponin is the marker of choice for detection of myocardial ischemia/infarction in the postoperative setting. In unstable patients coronary angiography and/or percutaneous coronary intervention (PCI) are indicated. However, in stable patients the decision for coronary angiography and/or PCI has to be made in each patient individually after interdisciplinary discussion between anesthesiologists, cardiologists and surgeons. [ABSTRACT FROM AUTHOR]

Depression is considered an independent risk factor for coronary artery disease (CAD) and other vascular conditions. Moreover, comorbid depressive disorder in CAD patients carries an increased risk of cardiac events and mortality. Among survivors of acute myocardial infarction, up to 20% meet diagnostic criteria for major depression, the presence of which carries a fivefold increased risk of cardiac death within 6 months. Heart patients with depressive comorbidity require particular care for both adequate treatment of their affective disorder and reduction of their cardiac risk. Antidepressant treatment must follow established guidelines; special care is needed to avoid cardiac side effects. In this review, we discuss the pathophysiological and prognostic significance of comorbid depression in CAD and weigh risks and benefits of available treatment options - particularly different drug classes and psychotherapy - in light of recent study results. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine documentation quality in physician staffed emergency medical services (EMS). This study compared simulated on-site care with the associated patient records written by EMS physicians. Methods: For this study two standardized simulated case scenarios, ST segment elevation myocardial infarction (STEMI) and major trauma with traumatic brain injury were designed by an expert committee. Overall 29 EMS teams each consisting of 1 EMS physician and 2 paramedics ran through the scenarios on high fidelity patient simulators and each scenario was videotaped. The scenarios were stopped after 12 min for STEMI and after 14 min for major trauma independent of the actions carried out and each EMS physician then had 10 min to document this initial phase on standardized protocol sheets. The videotaped scenarios were analyzed by two independent investigators. Documentation of predefined contents and all drug dosages were checked against the simulated on-site care. The data were evaluated and classified as correct, incorrect or missing documentation although action performed. Results: Written consent for data analysis was provided by 28 teams. Overall 20 parameters and actions in the STEMI scenario and 16 in the major trauma scenario as well as all drug dosages were evaluated. For the scenario STEMI 469 actions were analyzed of which 271 (58%) were correct, 94 (20%) incorrect and 104 (22%) had missing documentation. A total of 140 medications were administered of which 31 (22%) were documented incorrectly and 14 (10%) were not documented. For major trauma 401 actions were analyzed of which 244 (61%) were correct, 101 (25%) incorrect and 56 (14%) had missing documentation. In this scenario the teams administered 138 medications of which 31 (22%) were documented incorrectly and 16 (12%) were not documented. Infused amounts of crystalloids and colloids were mostly documented correctly in this case (35 correct /6 incorrect/8 not documented). Documentation of several clinical parameters was carried out predominantly correctly, e.g. initial blood pressure (STEMI: 25/2/1, major trauma: 21/4/2) and initial ECG rhythm (STEMI: 27/0/1, major trauma: 26/0/1). Documentation of other clinically relevant parameters was often performed incorrectly: 12-lead ECG in STEMI (5/9/12) and capnometry in major trauma (9/4/7). No team used a pain scale to assess the level of pain in the STEMI scenario but 12 EMS physicians documented an accordant value (numerical rating scale) on the patient records. Furthermore some parameters could be identified where documentation was mostly missing although they were measured, e.g. onset of symptoms in STEMI (5/4/15) and reduced level of consciousness and bradypnea in major trauma (9/2/17). Conclusion: Patient safety can be reduced if relevant preclinical data are not transmitted correctly to the admitting hospital. Therefore there is a need to improve documentation quality in EMS. Electronic documentation, training of EMS staff and quality management programs might offer solutions. Because of the small sample size further studies are needed to evaluate the validity of these results. [ABSTRACT FROM AUTHOR]

Tako-tsubo cardiomyopathy (TK) is an acutely appearing myocardial disease leading to impaired cardiac function, which can barely be distinguished clinically from an acute myocardial infarction. It occurs mainly in postmenopausal women and usually has a good prognosis. The pathophysiology of TK still remains to be elucidated but the favoured hypothesis is myocardial damage induced by catecholamine excess. Various acute diseases, emotional stress, surgical procedures and anaesthesia have been described as possible causes for TK. Little is known about the optimal therapy, however, there might be potential differences in the therapy of TK compared to contemporary therapy algorithms for heart failure. Knowledge of TK as a differential diagnosis for acute myocardial infarction is necessary to avoid incorrect treatment. [ABSTRACT FROM AUTHOR]

The obstructive sleep apnoea syndrome (OSAS) is a highly prevalent sleep related breathing disorder associated with hypopnoea/apnoea, arousals and increased daytime sleepiness. OSAS has been shown to have damaging acute effects on the cardiovascular system and thus has been postulated to represent an independent cardiovascular risk factor. A causal relationship between OSAS and cardiovascular disease has currently only been established for hypertension and heart failure. Evidence that OSAS indeed plays a key role in the pathogenesis of heart attacks and stroke and that therapy of OSAS reduces cardiovascular morbidity and mortality is currently limited. The results of multiple ongoing international multi-centre studies investigating the effects of OSAS therapy on cardiovascular event rate and mortality are thus anxiously awaited. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is associated with atherosclerosis and its consequences including myocardial infarction and stroke. The pathophysiological interactions comprise neural, vascular, mechanical, inflammatory, and metabolic mechanisms, which are caused by repetitive hypoxemia and contribute to cardiovascular disease progression. In mostly observational, albeit valuable studies, treatment with CPAP (continuous positive airway pressure) has been shown to exert several beneficial effects on cardiovascular disease and prognosis; however, evaluation of the data as well as a definitive therapeutic strategy is limited by lack of prospective, randomized data. [ABSTRACT FROM AUTHOR]

The most feared complication after coronary stent implantation is the acutely occurring stent thrombosis, which usually leads to a myocardial infarction with its relatively high mortality. Dual antiplatelet therapy with acetylsalicylic acid and clopidogrel is currently the standard therapy after coronary stent implantation to prevent a life-threatening stent thrombosis. Surgery appears to increase the risk of stent thrombosis, myocardial infarction, and death, particularly when patients undergo surgery early after stent implantation. The incidence of complications is further increased when dual-antiplatelet therapy is discontinued preoperatively. This article reviews the current data of perioperative problems in patients after percutaneous coronary intervention. [ABSTRACT FROM AUTHOR]

Perioperative myocardial damage occurs with a high incidence depending on the operative procedure and the patients examined and is considered to be among the most relevant risk factors for increased perioperative morbidity and mortality in patients undergoing non-cardiac surgery. The pathophysiology of myocardial damage in the perioperative period is still not well understood. Both ischemia with and without acute coronary occlusion and non-ischemic stimuli can put a substantial strain on the heart in the perioperative period. However, in many cases the clinical presentation does not allow a clear differentiation between ischemic and non-ischemic myocardial damage. In the majority of cases perioperative myocardial infarctions occur with only mild or even without any clinical symptoms. This is probably due to a considerable difference in phenotype and pathophysiology between perioperative and non-perioperative myocardial infarctions. As a result of this unexplained etiology of perioperative myocardial infarction it remains an open question whether the contemporary diagnostic and therapeutic recommendations for the acute coronary syndrome can be extrapolated to the perioperative situation. The present review reflects the current state of knowledge and presents an optional approach to the diagnosis and therapy of perioperative myocardial injury. [ABSTRACT FROM AUTHOR]

The aim of regenerative medicine is the reconstitution of the physiological structure of critically damaged organs. Bone marrow derived stem cells (BMDCs) show promising therapeutic potential. BMDCs are already used in oncology and are ideally suited for regenerative medicine due to their regenerative potential and safety profile. A variety of cells have been contemplated in cardiology, and there is emerging preclinical and clinical data on the feasibility and safety of different cell lines in the setting of acute myocardial infarction and chronic heart failure. In this review, the various concepts and cells will be discussed in further detail. [ABSTRACT FROM AUTHOR]

Logistic regression is a model used for prediction of an event (e.g. heart attack: yes/no) using several predictor variables whereas the output is confined to values between 0 and 1. The regression coefficients describe the size of the contribution of the risk factor. In this short introduction an example is used to explain the basic principle and the advantages of the logistic regression. [ABSTRACT FROM AUTHOR]

BNP and NT-proBNP are new markers with potential applications for the diagnosis and management of patients with cardiovascular diseases. In patients with acute dyspnea, these markers might strengthen the clinical suspicion of decompensated congestive heart failure. Vice versa, below-threshold marker concentrations allow to virtually exclude significant left ventricular dysfunction in symptomatic patients. Furthermore, BNP and NT-proBNP are predictors of morbidity and mortality in patients with heart failure, but also in acute coronary syndrome, myocardial infarction, pulmonary embolism and other cardiovascular diseases. The markers therefore appear suitable for additional risk stratification. Independently from the clinical application, however, it is important to note that extracardiac variables may affect marker concentrations and need to be considered when marker concentrations are interpreted. Due to their diagnostic and prognostic value, the cardiac markers BNP and NT-proBNP have a clear potential to further improve the care of patients with cardiovascular diseases. [ABSTRACT FROM AUTHOR]

In 19219 individuals (45.4% male, 54.6% female) with an age range from 10 to 95 years average body weight, body mass index (BMI), serum cholesterol and arterial blood pressure showed typical age-dependent changes. In the middle-aged between 45 and 65 years the high percentage of total cholesterol levels over 200 mg/dl (male: 58.3%; female 70.7%) seems alarming. In very old persons over 80 years the predictive value of those cardiovascular risk factors for increased mortality might be reversed, since in several epidemiological observations higher total cholesterol values and a high systolic blood pressure were associated with a longer survival. Average random blood glucose concentration is steadily rising with age. In good comparison with results from US American and European studies the age-matched relative risk for known myocardial infarction and stroke is twice to four times higher in individuals with known diabetes mellitus than in those without. These findings underline the urgent need for broadly based screening programs looking for metabolic and cardiovascular risk factors and for early disturbances of carbohydrate metabolism particularly in middle-aged groups, and for manifest diabetes mellitus in persons over 65 years of age. [ABSTRACT FROM AUTHOR]