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Many ST-segment elevation acute coronary syndrome (STEACS) patients fail to activate the Emergency Medical System (EMS), with possible dramatic consequences. Prior studies focusing on barriers to EMS activation included patients with any acute coronary syndrome (ACS) without representation of southern European populations. We aimed to investigate the barriers to EMS call for patients diagnosed for STEACS in Italy. A prospective, single-center, survey administered to all patients treated with primary percutaneous coronary intervention for STEACS in a tertiary hospital in northern Italy from 01/06/2018 to 31/05/2020. The questionnaire was filled out by 293 patients. Of these, 191 (65.2%) activated the EMS after symptoms onset. The main reasons for failing to contact EMS were the perception that the symptoms were unrelated to an important health problem (45.5%) and that a private vehicle is faster than EMS to reach the hospital (34.7%). Patients who called a private doctor after symptoms onset did not call EMS more frequently than those who did not and 30% of the patients who did not call the EMS would still act in the same way if a new episode occurred. Previous history of cardiovascular disease was the only predictor of EMS call. Information campaigns are urgently needed to increase EMS activation in case of suspected STEACS and should be primary focused on patients without cardiovascular history, on the misperception that a private vehicle is faster than EMS activation, and on the fact that cardiac arrest occurs early and may be prevented by EMS activation. Supplementary Information The online version contains supplementary material available at 10.1007/s11739-021-02894-7.

Purpose The intravitreal dexamethasone implant (DEX-I) is an alternative to anti-VEGF for the first-line treatment of diabetic macular oedema (DME). However, several questions remain regarding its routine use and its place in certain situations not always specified in current recommendations. A national consensus approach was, therefore, initiated by French retinal experts. Methods An iterative Delphi consensus approach was used. A steering committee (SC) of seven experts analysed data from the literature to formulate statements divided into five key areas of treatment. These statements were submitted to the independent and anonymous electronic vote of 87 French retina experts among whom 39 expressed their opinion and therefore constituted the voting panel. Results After two rounds of voting, 22 and 7 of 38 statements received a strong consensus and a good consensus, respectively. The consensus level was higher for statements regarding first-line indications and safety of DEX-I compared to those regarding efficacy assessment, reprocessing time or pathophysiological biomarkers. The panellists recommended the preferential use of DEX-I for patients with limited availability for multiple injections, those who needed to undergo cataract surgery or who had a recent cardiovascular history, and as a therapeutic alternative to anti-VEGF in patients with a history of vitrectomy, retinal serous detachment, hyper-reflective points or dry exudates in optical coherence tomography (OCT). However, some statements proposed by SC experts were not validated. Conclusion This study provides some key recommendations to clinicians treating diabetic macular oedema, which may be useful when using intravitreal dexamethasone implants in daily practice.

Resumen La infección es una complicación infrecuente de los aneurismas de la aorta abdominal. Campylobacter fetus tiene un especial tropismo por el endotelio vascular y ha sido reportado como causa de infección de aneurismas aórticos. Este tipo de infección es de alta mortalidad por lo que el reconocimiento temprano con el inicio precoz de terapia antibacteriana efectiva es clave. Además del tratamiento médico, puede requerirse cirugía, la que tiene una alta letalidad en pacientes inestables y con comorbilidades. Comunicamos el caso clínico de un adulto mayor con un aneurisma de aorta abdominal infectado por C. fetus. Dado su compromiso del estado general y antecedentes cardiovasculares se decidió tratamiento médico con imipenem, con una buena respuesta clínica y microbiológica, sin recurrencia de los síntomas. También se presenta una revisión de los casos publicados.

This study examined whether handgrip strength and thigh circumference are related to survival prognosis based on a 6-year follow-up period. Participants were 787 men (aged 69 ± 11 years) and 963 women (aged 69 ± 9 years) who took part in a Nomura cohort study and who continued with follow-ups for the subsequent 6 years (follow-up rate: 95.5%). We obtained adjusted relative hazards of all-cause mortality from the basic resident register. Thigh circumference and handgrip strength were useful predictors of death in Japanese community-dwelling men. Thigh circumference and handgrip strength can be considered an accurate and consistent predictor of all-cause mortality in adults. In addition to playing a critical role in cardiovascular health, muscle mass and strength independently impact aging-related health outcomes in adults. There are limited predictive data for all-cause mortality, particularly for community-dwelling persons in Japan. This study examined whether handgrip strength (HGS) and thigh circumference are related to survival prognosis based on a 6-year follow-up period. Participants were 787 men (aged 69 ± 11 years) and 963 women (aged 69 ± 9 years) who took part in a Nomura cohort study conducted in 2014 and who continued with follow-ups for the subsequent 6 years (follow-up rate: 95.5%). We obtained adjusted relative hazards of all-cause mortality from the basic resident register. The data were subjected to a Cox regression with age as the time variable and gender, age, anthropometric index, smoking habits, drinking habits, exercise habits, cardiovascular history, blood pressure, lipid levels, diabetes, renal function, and serum uric acid as risk factors. Of the 1750 participants, a total of 97 (5.5%) were confirmed to have died, of which 56 were men (7.1% of all male participants), and 41 were women (4.3% of all female participants). The multivariable Cox regression analysis revealed that smaller thigh circumference and lower HGS in men were found to predict 6-year all-cause mortality, but in women only baseline HGS was associated with all-cause mortality. Thigh circumference and HGS are useful predictors of death in Japanese community-dwelling men.

Authors review the safety and efficacy of romosozumab for the treatment of osteoporosis as demonstrated in three phase III clinical trials and offer insights into the potential cardiovascular risk associated with its use. Incidence of new vertebral fracture is dramatically reduced with 12 months of romosozumab use in comparison to both placebo and active bisphosphonate control groups in patients with postmenopausal osteoporosis. Significant non-vertebral anti-fracture benefit was also demonstrated in patients with more severe osteoporosis. Numerical increases in cardiovascular events call into question the safety of romosozumab use, particularly in patients with cardiovascular history or at high cardiovascular risk. Romosozumab has impressive anti-fracture effects in postmenopausal women with high risk for fragility fracture. Despite no significant differences in baseline cardiovascular risk factors between groups, a numerical increase in serious cardiovascular adverse events was demonstrated with romosozumab in randomized trials with no discernable etiology. Until more real-world evidence is available, romosozumab should not be used in patients with a recent cardiovascular event and should be used cautiously in patients with high cardiovascular risk. Romosozumab’s place in therapy is likely patients with severe postmenopausal osteoporosis and low cardiovascular risk.

Instruction Hyponatremia can be caused by various conditions such as Cerebral Salt Wasting Syndrome (CSWS), Inadequate Antidiuretic Hormone Secretion (SIADH), secondary adrenal dysfunction and thyroid dysfunction. However, each diagnosis has different treatment and inadequate treatment may increase mortality and morbidity, especially CSWS and SIADH. To the best of our knowledge, this case is considered rare clinical scenario and we would summarize some diagnostic criteria for these two diseases in this case report. Case presentation A 44-year-old Asian man was presented with cerebral salt wasting syndrome and elevated brain natriuretic peptide (BNP) after 2 weeks of a mild traumatic brain injury. Central nervous system examination revealed GCS 14 without neurological or neurosurgical deficit as well as cardiovascular history. CT scan showed right temporal hemorrhage #1.4 × 1.5 cm, scattered subarachnoid hemorrhages in the right hemisphere. The patient was treated in the direction of CSWS and symptoms of hyponatremia improved after 7 days. Re-examination after 3 months did not show any abnormal symptoms, sodium serum level returned to normal. Conclusion Hyponatremia caused by CSWS may occur in mild traumatic brain injury. Therefore, an accurate diagnosis and proper differentiation from SIADH is necessary to obtain an appropriate treatment with fluid and salt replacement. In this way, the patient morbidity and mortality can be reduced significantly.

A 68-year-old Caucasian man with a history of Waldenstrom macroglobulinemia (WM) on treatment with ibrutinib for 2 years presented with syncope. He had no prior cardiovascular history or risk factors. On the day of presentation, he had an episode of dizziness followed by a sudden loss of

Objectives To investigate the knowledge of radiologists on breast arterial calcifications (BAC) and attitude about BAC reporting, communication to women, and subsequent action. Methods An online survey was offered to EUSOBI members, with 17 questions focused on demographics, level of experience, clinical setting, awareness of BAC association with cardiovascular risk, mammographic reporting, modality of BAC assessment, and action habits. Descriptive statistics were used. Results Among 1084 EUSOBI members, 378 (34.9%) responded to the survey, 361/378 (95.5%) radiologists, 263 females (69.6%), 112 males (29.6%), and 3 (0.8%) who did not specify their gender. Of 378 respondents, 305 (80.7%) declared to be aware of BAC meaning in terms of cardiovascular risk and 234 (61.9%) to routinely include BAC in mammogram reports, when detected. Excluding one inconsistent answer, simple annotation of BAC presence was declared by 151/233 (64.8%), distinction between low versus extensive BAC burden by 59/233 (25.3%), and usage of an ordinal scale by 22/233 (9.5%) and of a cardinal scale by 1/233 (0.4%). Among these 233 radiologists reporting BAC, 106 (45.5%) declared to orally inform the woman and, in case of severe BAC burden, 103 (44.2%) to investigate cardiovascular history, and 92 (39.5%) to refer the woman to a cardiologist. Conclusion Among EUSOBI respondents, over 80% declared to be aware of BAC cardiovascular meaning and over 60% to include BAC in the report. Qualitative BAC assessment predominates. About 40% of respondents who report on BAC, in the case of severe BAC burden, investigate cardiovascular history and/or refer the woman to a cardiologist. Key Points • Of 1084 EUSOBI members, 378 (35%) participated: 81% of respondents are aware of breast arterial calcification (BAC) cardiovascular meaning and 62% include BAC in the mammogram report. • Of those reporting BAC, description of presence was declared by 65%, low versus extensive burden distinction by 25%, usage of an ordinal scale by 10%, and of a cardinal scale by 0.4%; 46% inform the woman and, in case of severe BAC burden, 44% examine cardiovascular history, and 40% refer her to a cardiologist. • European breast radiologists may be ready for large-scale studies to ascertain the role of BAC assessment in the comprehensive framework of female cardiovascular disease prevention.

A 61-year-old woman diagnosed with chronic myeloid leukemia (CML) (Sokal intermediate risk) was treated with the tyrosine kinase inhibitor (TKI) nilotinib 600 mg/day. The patient was a nonsmoker and had no cardiovascular history, diabetes, or other relevant diseases. Blood tests revealed

Introduction: Pulmonary embolism and aortic dissection are two formidable cardiovascular emergencies. Their exceptional association has a poor prognosis with very high mortality. The aim of our study was to report the case of a 31-year-old patient with pulmonary embolism associated with De Bakey’s type I aortic dissection, admitted to the cardiology department of Kati University Hospital. Case Presentation: We report the case of a young patient of 31 with no known cardiovascular history, on estrogen-progestogen contraception for 10 years, who consults for a left basal thoracic pain of increasing intensity, a whitish productive cough, hemoptysis and dyspnea stage III. She was admitted to the cardiology department, transthoracic cardiac ultrasound objectified aortic insufficiency, dissection of the aorta, the presence of the intimal flap, the false and the true channel, dilation of the right cavities with HTAP. The chest CT scan revealed bilateral lobar and segmental pulmonary embolism, De Bakey’s type I aortic dissection. Medical treatment was instituted for hemodynamic stabilization at the end of sending her to a center specializing in cardiovascular surgery for better management; unfortunately she succumbed before the preparations for her evacuation were finished. Conclusion: The pulmonary embolism associated with aortic dissection constitutes a medical emergence of rare incidence in a cardiological environment;if the diagnosis was quickly made in our patient, the lack of technical platform made management difficult.

This report describes a 61-year-old female with no previous cardiovascular history presented with acute heart failure. Clinical, laboratory, and imaging findings suggested the diagnosis of pneumococcal invasive disease with concomitant purulent pericarditis. Prompt pharmacological and operatory treatment with both pericardiocentesis and further fenestration brought to a complete recovery.

Cardiovascular risk management of patients with systemic lupus erythematosus (SLE) is medically relevant. The objectives were to estimate the cardiovascular risk by different strategies in patients with SLE, analyzing which proportion of patients would be candidates to receive statin therapy, and identify how many patients with statin indication received such drugs.A cross-sectional study was performed from a secondary database. Following the recommendations of National Institute for Health and Care Excellence (NICE) guidelines and the Argentine Consensus, the QRISK-3 and the adjusted Framingham (multiplying factor × 2) scores were calculated in primary prevention subjects. The indications for statin therapy according to these recommendations were analyzed.In total, 110 patients were included. Regarding patients without previous cardiovascular history, the median adjusted Framingham score was 12.8% (4.1-21.9), and 45.2%, 22.6%, and 32.2% of them were classified at low, moderate, or high risk. The median QRISK-3 score was 6.0% (2.1-14.1) and 42.1% of subjects were classified "at risk". Only 60% of subjects in secondary prevention received statins, although no patient received the recommended doses. Analyzing patients in primary prevention who did not receive statins (87%), 43.4% and 45.2% of the patients were eligible for statin therapy according to NICE guidelines and Argentine Consensus, respectively.Our findings showed that a large proportion of patients with SLE have a considerable cardiovascular risk and many of them would be eligible for statin therapy. However, the statin use observed was low.Key Points• A large proportion of patients with lupus have a considerable cardiovascular risk, explained in part by dyslipidemia.• Many patients with SLE would be eligible for statin therapy according to risk stratification based on conventional risk factors.• The use of statins in this population is inadequate.

The treatment of cardiovascular disease in patients with diabetes has seen a sea change in recent years with the development of novel antihyperglycemic agents. The impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs), two medication classes introduced in the United States in the wake of increased scrutiny by the US Food and Drug Administration on cardiovascular disease and antihyperglycemic agents, highlight this progression. In recent trials, SGLT2 inhibitors have demonstrated significant reductions in admissions for heart failure in patients with established cardiovascular disease and those at risk of cardiovascular disease, as well as significant reductions in major adverse cardiovascular events for those with established cardiovascular disease. GLP-1 RAs have exhibited consistent reductions in major adverse cardiovascular events for patients with established cardiovascular disease. These developments have led the 2019 American Diabetes Association guidelines to recommend considering each patient’s cardiovascular history when selecting antihyperglycemic agents. The goal of this article is to review recent updates and provide relevant strategies for providers on SGLT2 and GLP-1 RAs in treating cardiovascular disease in patients with diabetes.

The metabolic syndrome combines morphological, physiological and biochemical abnormalities that evolve over time, predisposing the affected person to atherosclerosis and its complications. The purpose of our work was to determine the clinical and biological profile of metabolic syndrome in patients received for medical examination according to WHO criteria. This was a retrospective study over a 1-year period: from January 1st, 2018 to December 31st, 2018. The information collected was clinical (sociodemographic characteristics, anthropometric data, initial blood pressure, cardiovascular history) and biological data (fasting blood glucose level, lipid test). Two thousand six hundred and two patients visited during the study period, including 291 patients (11.18%) for a reason that may evoke the metabolic syndrome but 115 files were retained for this study. The age of the patients was 58.39 ± 10.02 years with extremes ranging from 32 to 81 years old. Metabolic syndrome was found in 77 patients, or 66.9% of patients who had consulted for a reason that might suggest this diagnosis. 44.3% had 3 criteria for definition; 19.1% had 4 criteria and 3.5% had 5 criteria. All patients have benefited a mono, bi or antihypertensive therapy associated with antidiabetic or hypolipemic treatment. Metabolic syndrome better predicts cardiovascular risk than analysis of individual risk factors. Its prevention involves diet which must be hyposodium, hypolipidic, without fast sugar and daily physical activities.

Despite improvement in the prognosis of ANCA-associated vasculitides (AAVs), increased mortality, mainly from a cardiovascular origin, persists. We aimed to determine the role of cardiovascular risk factors (CVRFs) on the occurrence of major cardiovascular events (MACEs) in AAVs. Patients with AAVs were successively included in a prospective cohort study, which assessed CVRFs (defined by age &gt, 50 years in men and &gt, 60 years in women, personal history of cardiovascular disease, smoking status, obesity, diabetes, dyslipidemia, hypertension, and sedentary lifestyle), the use of glucocorticoids and immunosuppressive agents at baseline and during follow-up, and the occurrence of MACEs. One hundred and three patients were included, with a median follow-up time of 3.5 years. In the glucocorticoids and cyclophosphamide adjusted multivariate analysis, the occurrence of MACEs was associated with older age (p = 0.001, OR = 14.71, 95% CI (confidence interval) = 2.98–72.68), cardiovascular history (p = 0.007, OR (odds ratio) = 6.54, 95% CI = 1.66–25.71), sedentary lifestyle (p = 0.011, OR = 4.50, 95% CI = 1.42–14.29), hypertension (p = 0.017, OR = 5.04, 95% CI = 1.33–19.12), and dyslipidemia (p = 0.03, OR = 3.86, 95% CI = 1.14–13.09). The occurrence of MACEs was associated with the number of CVRFs (p &lt, 0.001), but not with the use of glucocorticoids or cyclophosphamide (p = 0.733 and p = 0.339, respectively). The implementation of a screening and management program for modifiable CVRFs, particularly hypertension, sedentary lifestyle, and dyslipidemia, may be beneficial for AAV patients in order to reduce their cardiovascular risk.

Background During COVID-19 pandemic, elective invasive cardiac procedures (ICP) have been frequently cancelled or postponed. Consequences may be more evident in patients with diabetes. Objectives The objective was to identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome. Methods We included 2,158 patients in whom an elective ICP was cancelled or postponed during COVID-19 pandemic in 37 hospitals in Spain. Among them, 700 (32.4%) were diabetics. Patients with and without diabetes were compared. Results Patients with diabetes were older and had a higher prevalence of other cardiovascular risk factors, previous cardiovascular history and co-morbidities. Diabetics had a higher mortality (3.0% vs. 1.0%; p = 0.001) and cardiovascular mortality (1.9% vs. 0.4%; p = 0.001). Differences were especially important in patients with valvular heart disease (mortality 6.9% vs 1.7% [p Conclusion Among patients in whom an elective invasive cardiac procedure is cancelled or postponed during COVID-19 pandemic, mortality and cardiovascular mortality is higher in patients with diabetes, irrespectively on other clinical conditions. These procedures should not be cancelled in patients with diabetes.

Introduction: The use of vitamin K antagonists (VKAs) in non-valvular atrial fibrillation (NVAF) is complicated due to the narrow therapeutic margin they present and their unpredictable dose–response relationship. Most studies are based on warfarin, with the results being extrapolated to acenocoumarol. However, studies comparing the two treatments in terms of the degree of anticoagulation control are scarce, justifying the present study. Main factors associated with poor control of time in therapeutic range (TTR) of anticoagulated patients are also studied. Methods: Cross-sectional study, with real-world data from patients treated in primary care (PC). Data were obtained from the System for the Improvement of Research in PC (SIDIAP) database, covering 60,978 NVAF-anticoagulated patients from 287 PC centres in 2018. Descriptive statistics were derived, and odds ratios were estimated by multivariate logistic regression. Results: 41,430 patients were considered: 93% were being treated with acenocoumarol and 7% with warfarin. There was no difference in poor control of TTR between the two types of VKA treatment, acenocoumarol and warfarin (38.9 vs. 38.4, p = 0.610). Poor anticoagulation control was mainly associated with advanced alcoholism (OR = 1.38), liver failure (OR = 1.37) and intracranial haemorrhage (OR = 1.35) as well as female sex, age &lt, 60 years, cardiovascular history, diabetes mellitus and other variables. Conclusions: There is no association between poor anticoagulation control and the type of VKA treatment administered. Factors associated with poor control of TTR must be considered in clinical practice to improve control and decision-making.

The cardiovascular history and physical examination are considered essential components of the preparticipation screening of competitive athletes. They are specifically incorporated into recommendations for the overall cardiovascular screening of athletes by all major North American and European medical societies. This chapter reviews the rationale, organizational aspects, and specific elements of the history and the exam. Limitations of the history and exam, as well as issues related to clearance for participation, are also discussed.

The cerebrovascular accident or stroke represents the third cause of mortality in Uruguay and the world, as well as the first cause of disability.Its treatment with acupuncture is very effective especially if started early and mainly in those of ischemic nature.We report the case of a patient with a cardiovascular history who suffered an ischemic stroke, who was treated with craniopuncture, with a very successful response.

Objectives: Type 2 diabetes mellitus(T2DM) can accelerate the clinical process of atherosclerosis(AS). Dipeptidyl peptidase-4 inhibitors(DPP-4Is) have potential anti-AS effects. And, we completed a meta-analysis of the changes in carotid intima-media thickness(CIMT), flow-mediated dilation(FMD), and pulse wave velocity(PWV) of DPP-4Is to research the effect of DPP-4Is in the progression of AS in T2DM patients. Materials and methods: We included RCTs that evaluated the impact of DPP-4Is on CIMT, FMD, and PWV compared to other treatments from PubMed, Cochrane trials, and Embase database before October 31, 2020. We selected the random-effect model and calculated the weighted mean difference(WMD) to evaluate the effect of CIMT, FMD, and PWV in T2DM patients. Results：Through the meta-analysis, we found that DPP-4Is can significantly reduce CIMT in T2DM patients(WMD =-0.036, 95% CI:-0.055 to-0.017; p≤0.001). Based on the subgroup analysis, we found that CIMT was significantly decreased in patients with greater than 12 months of intervention and without cardiovascular diseases. Besides, we also found that DPP-4Is had a not significant efficacy on the improvement of FMD in T2DM patients(WMD=0.635, 95% CI: -0.112 to 1.383, p= 0.097). Our subgroup analysis showed that for T2DM patients who have cardiovascular diseases, DPP-4Is can significantly increase their FMD. In addition, we also found that DPP-4Is had an insignificant influence on PWV in T2DM patients(WMD= 0.424, 95% CI: -0.198 to 1.046, p= 0.18). but SGLT2 inhibitors may reduce the PWV of T2DM patients. Conclusions: DPP-4Is can alleviate the development of AS in T2DM patients to a certain extent by reducing CIMT. And, we believe that long-term use of DPP-4Is may be more helpful to alleviate the atherosclerotic development of T2DM without obvious cardiovascular history.

Objectives Type 2 diabetes mellitus (T2DM) can accelerate the clinical process of atherosclerosis (AS). Dipeptidyl peptidase-4 inhibitors (DPP-4Is) have potential anti-AS effects. And, we completed a meta-analysis of the changes in carotid intima-media thickness (CIMT), flow-mediated dilation (FMD) and pulse wave velocity (PWV) of DPP-4Is to research the effect of DPP-4Is in the progression of AS in T2DM patients. Materials and methods We included RCTs that evaluated the impact of DPP-4Is on CIMT, FMD and PWV compared to other treatments from PubMed, Cochrane trials and Embase database before October 31, 2020. We selected the random-effect model and calculated the weighted mean difference (WMD) to evaluate the effect of CIMT, FMD and PWV in T2DM patients. Results Through the meta-analysis, we found that DPP-4Is can significantly reduce CIMT in T2DM patients (WMD = -0.036, 95% CI:-0.055 to-0.017; P ≤ .001). Based on the subgroup analysis, we found that CIMT was significantly decreased in patients with greater than 12 months of intervention and without cardiovascular diseases. Besides, we also found that DPP-4Is had a no significant efficacy on the improvement of FMD in T2DM patients (WMD = 0.635, 95% CI: -0.112 to 1.383, P = .097). Our subgroup analysis showed that for T2DM patients who have cardiovascular diseases, DPP-4Is can significantly increase their FMD. In addition, we also found that DPP-4Is had an insignificant influence on PWV in T2DM patients (WMD = 0.424, 95% CI: -0.198 to 1.046, P = .18), but SGLT2 inhibitors may reduce the PWV of T2DM patients. Conclusions DPP-4Is can alleviate the development of AS in T2DM patients to a certain extent by reducing CIMT. And, we believe that long-term use of DPP-4Is may be more helpful to alleviate the atherosclerotic development of T2DM without obvious cardiovascular history.

Los aneurismas del seno de Valsalva son anomalías poco frecuentes que pueden ser de carácter congénito o adquirido, y pueden ser intervenibles o no acorde con la presentación clínica. Se expone el caso de un paciente joven sin antecedentes cardiovasculares de importancia, que consulta por cuadro de dolor torácico y en quien se documenta de manera temprana aneurisma del seno de Valsalva asociado con insuficiencia mitral. Se intervino quirúrgicamente y fue dado de alta a los 90 días de la cirugía con evolución clínica favorable y remisión de la sintomatología cardiovascular.

Background Different strategies have been proposed for the cardiovascular risk management of patients with rheumatoid arthritis (RA). Objectives (1) To estimate the cardiovascular risk by different strategies in RA patients, analyzing which proportion of patients would be candidates to receive statin therapy; (2) to identify how many patients meet the recommended lipid goals. Methods A cross-sectional study was performed from a secondary database. The QRISK-3 score, the Framingham score (adjusted for a multiplying factor × 1.5), the ASCVD calculator and the SCORE calculator were estimated. The indications for statin therapy according to NICE, Argentine Consensus, ACC/AHA, and new European guidelines were analyzed. The recommended LDL-C goals were analyzed. Results A total of 420 patients were included. In total, 24.7% and 48.7% of patients in primary and secondary prevention were receiving statins, respectively. Only 19.4% of patients with cardiovascular history received high intensity statins. Applying the ACC/AHA guidelines (based on ASCVD score), the Argentine Consensuses (based on adjusted Framingham score), the NICE guidelines (based on QRISK-3) and European recommendations (based on SCORE), 26.9%, 26.5%, 41.1% and 18.2% of the population were eligible for statin therapy, respectively. Following the new European recommendations, 50.0%, 46.2% and 15.9% of the patients with low-moderate, high or very high risk achieved the suggested lipid goals. Conclusion Applying four strategies for lipid management in our population, the cardiovascular risk stratification and the indication for statins were different. A significant gap was observed when comparing the expected and observed statin indication, with few patients achieving the LDL-C goals.

A 71-year-old woman without a cardiovascular history was transferred from a nearby hospital to our catheterization laboratory in cardiogenic shock on vasopressors following a very late presentation anterior ST-segment elevation myocardial infarction (STEMI) ([Figure 1A][1]). She reported avoiding

This study aimed to clarify the association of post-percutaneous coronary intervention (PCI) acute heart failure (AHF) with all-cause long-term mortality in patients with chronic kidney disease (CKD).In this prospective, observational study, 610 patients with CKD and coronary artery disease (CAD) undergoing PCI were included in the final analysis. Patients were divided to the non post-PCI AHF group (n = 557) and the post-PCI AHF group (n = 53). The diagnosis of post-PCI AHF was based on symptoms, prior cardiovascular history, and potential cardiac and noncardiac precipitants.The overall incidence of post-PCI AHF was 53/610 (8.7%). The incidence of all-cause long-term mortality was significantly higher in the post-PCI AHF group than in the non post-PCI AHF group (50.9% vs 23.2%, P .01). The median follow-up period was 7.3 years (interquartile range: 3.7-8.4). After adjusting for left ventricular ejection fraction40% at discharge, CKD stage, acute myocardial infarction, age and smoking, post-PCI AHF was the strongest predictor of all-cause long-term mortality (hazard ratio: 8.08; 95% CI: 3.04-21.48; P .01).In patients with CKD and CAD undergoing PCI, post-PCI AHF is the strongest predictor of all-cause long-term mortality.

Objective The objective of this study was to analyze the effects of obesity on postoperative complications and patient and graft survival after kidney transplantation. Methods We retrospectively included 506 patients who received a kidney transplant in our center during eleven years. Obesity was defined by a body mass index ≥ 30 kg/m2 based on World Health Organization criteria. Using univariate and multivariate analyses, we evaluated the impact of obesity on surgical complications according to the Clavien-Dindo classification up to 30 days after surgery. The impact of obesity on graft and patient survival was assessed using a Cox proportional regression model. Results Seventy-one patients were obese (14%), and mean follow-up was 63.1 months (59.7-66.5). By multivariable analysis, obesity was associated with delayed graft function (hazard ratio [HR] = 2.60 [1.31-5.02], P = .004). Obesity was not associated with surgical complications, but cardiovascular history was (HR = 1.68 [1.09-2.99], P = .048). By Cox regression analysis, obesity was significantly associated with a higher risk of graft loss (HR = 1.55 [1.06-2.99], P = .042) but not with patient survival (HR = 1.82 [0.88-3.79], P = .106). Conclusion Obesity was associated with delayed graft function and graft loss. However, it was not associated with surgical complications. Kidney transplantation remains the best therapy for obese patients suffering from end-stage renal disease, despite shorter graft survival.

Introduction Inflight medical incapacitations are rare events that can result in the loss of lives and aircraft. The potential for an in-flight medical event deserves the attention of certification authorities. Cardiac emergencies are among the most common serious events. The primary focus of this study was to examine whether the proportions of pilots with reported cardiac conditions could be used to identify those who had inflight medical incapacitations. Methods The Civil Aerospace Medical Institute Inflight Incapacitation Registry was searched to identify airline pilots with a cardiac history and an inflight medical event between 1995 and 2015. The Federal Aviation Administration's Decision Support System was searched for airline pilots without an inflight medical event. The cardiovascular history of incapacitated pilots was then compared to that of airline pilots without incapacitation events. Results Although a significantly greater proportion of airline pilots with cardiac events had pacemakers than a control group with the same cardiac history who did not have inflight events, no significant difference was found in the proportions of other markers of cardiac health. Conclusion The proportions of airline pilots with identified cardiac conditions could not be reliably used to identify which pilots had inflight incapacitations.DeJohn CA, Mills WD, Hathaway W, Larcher J. Cardiac inflight incapacitations of U.S. airline pilots: 1995-2015. Aerosp Med Hum Perform 2018; 89(9):837-841.

Background Although combined changes in eating habits and physical activity are pivotal to hypercholesterolemia management and the prevention of cardiovascular disease, little is known about the factors influencing the adoption of both behaviors by adults with hypercholesterolemia. The goal of this study was to identify psychological factors that predict a combined adoption of dietary modification and physical activity among adults with hypercholesterolemia. Methods We recruited a sample of 1100 adults with hypercholesterolemia (56.9% male, mean age = 56.5 years) through a nationally representative online panel. Participants reported their physical activity using the International Physical Activity Questionnaire (IPAQ) and their eating habits using a Food-Frequency Questionnaire (FFQ). We assessed a comprehensive set of psychological variables, including hypercholesterolemia knowledge and perception, patient's cardiovascular history, doctor–patient relationship, social-cognitive beliefs, and personality traits. Based on IPAQ and FFQ scores, we classified participants into four groups (dietary modification plus physical exercise, dietary modification, physical exercise, passive). Results Our analysis showed that subjective hypercholesterolemia knowledge, beliefs about the effects of hypercholesterolemia, external locus of control (other people and chance), nutrition and physical exercise self-efficacy, and trait self-control significantly influenced the simultaneous adoption of physical exercise and dietary modification. Conclusions This study highlights the importance of psychological factors in predicting the combined adoption of physical exercise and dietary modification among adults with hypercholesterolemia. Addressing these factors could help improve hypercholesterolemia prevention strategies.

Objectives Approximately 25% of the Australian population are hypertensive, contributing 5% to the total burden of disease in Australia. The measurement of blood pressure (BP) and management of hypertension is relatively straightforward, and is a modifiable risk factor for cardiovascular disease. Given the prevalence of hypertension in the community, osteopaths are in a position to be able to measure BP and do so in routine practice. The present study sought to identify the frequency of blood pressure measurement of patients attending a student-led osteopathy clinic. Method New patients attending the Victoria University (VU) Osteopathy Clinic between March and June 2016 completed a demographic and health information questionnaire prior to their initial consultation. During the initial consultation students are asked to measure the patients BP and record this in the clinical history, this is a routine part of their standard osteopathy consultation. Results BP measurements were available for 31.2% (n = 129) of new patients attending the VU Osteopathy Clinic, 68.8% of new patients did not have BP measurements recorded. Of those patients whose blood pressure was recorded, approximately 25% were classified as hypertensive. Age, gender and cardiovascular history did not appear to influence whether BP was recorded. Conclusions Nearly 70% of patients did not have their BP recorded. Future research should evaluate the reasons for student osteopaths not measuring and/or recording new patients BP, and whether these reasons are modifiable. Changes in the curricula and training of clinical educators may be required to increase the clinical practice of measuring BP in student-led clinics.

Introduction: The hypercoagulability state induced by COVID-19 has been well established and various forms of subsequent thromboembolic events have been reported throughout literature including multiple cases of intracardiac thrombi, four of which in our center alone, this case being the fifth. Case report: We report the case of a 38-year-old male with no prior cardiovascular history who -subsequently to a COVID-19 infection-developped a right atrial thrombosis associated to a pulmonary embolism, and in whom cardiography revealed an interatrial communication. Management relied upon curative doses of low molecular weight heparin (LMWH) with favourable outcome. Discussion: In our discussion, we lay out the various physiopathological mechanisms incriminated throughout literature in the genesis of a hypercoagulability state distinctive of COVID-19, before highlighting the incidence of an interatrial communication (whether a Potent Foramen Ovale or Atrial Septal Defect) discovered in patients with COVID-19, and the potential paradoxical embolization risks they imply as well as reported cases. A mention of hemostatic parameters monitored was also warranted. Finally we discuss the guidelines in terms of prophylactic and therapeutic anticoagulation in hospitalized patients before discussing cardiac thrombosis's therapeutic options. Conclusion: Our case highlights various key points which could change the prognosis of COVID-19 patients, whether related to the underdiagnosis of interatrial abnormalities or with regards to the diagnosis to thromboembolic events, but also the indisputable place of anticoagulation in COVID-19 management.

ObjectivesThere is minimal literature examining the association of sepsis with out-of-hospital cardiac arrest (OHCA). Using a large national database, we aimed to quantify the risk of OHCA among sepsis patients after hospital discharge.DesignPopulation-based cohort study.SettingNationwide sepsis cohort retrieved from the National Health Insurance Research Database of Taiwan between 2000 and 2013.ParticipantsWe included 17 304 patients with sepsis. After hospital discharge, 144 patients developed OHCA within 30 days and 640 between days 31 and 365.Primary and secondary outcome measuresThe main outcomes were OHCA events following hospital discharge for sepsis. To evaluate the independent association between sepsis and OHCA after a sepsis hospitalisation, we constructed two non-sepsis comparison cohorts using risk set sampling and propensity score matching techniques (non-infection cohort, non-sepsis infection cohort). We plotted the daily number and daily risk of OHCA within 1 year of hospital discharge between sepsis and matched non-sepsis cohorts. We used Cox regression to evaluate the risk of early and late OHCA, comparing sepsis to non-sepsis patients.ResultsCompared with non-infected patients, sepsis patients had a higher rate of early (HR 1.66, 95% CI: 1.27 to 2.16) and late (HR 1.19, 95% CI: 1.06 to 1.33) OHCA events. This association was independent of age, sex or cardiovascular history. Compared with non-sepsis patients with infections, sepsis patients had a higher rate of both early (HR 1.28, 95% CI: 1.00 to 1.63) and late (HR 1.13, 95% CI: 1.01 to 1.27) OHCA events, especially among patients with cardiovascular disease (OR 1.35, 95% CI: 1.01 to 1.81).ConclusionsSepsis patients had increased risk of OHCA compared with matched non-sepsis controls, which lasted up to 1 year after hospital discharge.

Dysphagia is not a normal process of aging. Dysphagia aortica refers to external compression of the distal esophagus from an enlarged, ectatic or aneurysmal thoracic aorta leading to mechanical obstruction of the food bolus. It is a rare cause of dysphagia seen in the older population and predisposing risk factors include female gender, short stature, and kyphosis. We selected the case of an octogenarian with a significant cardiovascular history presenting with dysphagia where the diagnosis of dysphagia aortica was delayed but ultimately identified. Although rare, we urge and remind a high index of suspicion for clinicians treating this patient population.

To construct a sudden death risk score specifically for hypertension (HYSUD) patients with or without cardiovascular history.Data were collected from six randomized controlled trials of antihypertensive treatments with 8044 women and 17 604 men differing in age ranges and blood pressure eligibility criteria. In total, 345 sudden deaths (1.35%) occurred during a mean follow-up of 5.16 years. Risk factors of sudden death were examined using a multivariable Cox proportional hazards model adjusted on trials. The model was transformed to an integer system, with points added for each factor according to its association with sudden death risk.Antihypertensive treatment was not associated with a reduction of the sudden death risk and had no interaction with other factors, allowing model development on both treatment and placebo groups. A risk score of sudden death in 5 years was built with seven significant risk factors: age, sex, SBP, serum total cholesterol, cigarette smoking, diabetes, and history of myocardial infarction. In terms of discrimination performance, HYSUD model was adequate with areas under the receiver operating characteristic curve of 77.74% (confidence interval 95%, 74.13-81.35) for the derivation set, of 77.46% (74.09-80.83) for the validation set, and of 79.17% (75.94-82.40) for the whole population.Our work provides a simple risk-scoring system for sudden death prediction in hypertension, using individual data from six randomized controlled trials of antihypertensive treatments. HYSUD score could help assessing a hypertensive individual's risk of sudden death and optimizing preventive therapeutic strategies for these patients.

Nurse practitioners frequently manage patients who have cardiac risks and need further evaluation before their elective surgery. Cardiac stress testing can provide important needed data. Cardiac stress testing includes exercise treadmill testing; echocardiography, with exercise or pharmacologically; myocardial perfusion stress testing; and magnetic resonance angiography. Although a number of factors need to be considered, including prior cardiovascular history and type of surgical risk, a nurse practitioner's selection of the appropriate cardiac stress test needs to include the benefit-risk ratio and the level of evidence supporting the clinical decision-making process.

A 71-year-old woman without a cardiovascular history was transferred to our hospital with persistent hypotension days following an inferior ST-segment elevation myocardial infarction (STEMI). Urgent coronary angiography for refractory shock showed a proximal occlusion of the right coronary artery (

Arteriovenous fistulas (AVFs) are preferred vascular access in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). However, AVFs, can occasionally lead to clinically significant complications. Of these, cardiovascular complications have been well described in the literature. In this report, we describe a case of a 78-year-old Caucasian male with ESRD who presented with severe debilitating dizziness and orthostatic hypotension that started soon after the creation of left brachiobasilic AVF. The patient had no significant cardiovascular history apart from essential hypertension. His symptoms persisted despite extensive evaluation and interventions, and abated only after banding of the AVF. This report describes the timeline of the patient's clinical course beginning from the day of creation of his AVF, through the course of his hospitalization leading to AVF banding and ending with postoperative recovery phase with resolution of symptoms. We will also review the pathophysiologic effects of AVF on cardiovascular system, as well as the potential causes of our patient's clinical presentation.

Background Copeptin, a marker for vasopressin, is related to advanced cardiovascular disease such as myocardial infarction. Purpose The aim of the present investigation was to assess whether copeptin is associated with the different atherosclerotic plaque stages expressed by coronary artery calcium scores (CAC score). Methods Copeptin and CAC score were studied in 677 participants in the ICELANDIC MI cohort without a history of a myocardial infarction at baseline. The Agatston method was used to measure coronary artery calcification visualized by means of computed tomographic scans. The CAC score was categorized into four classes: 0, 1–99, 100–399, and ≥400. Correlations between the CAC score and copeptin were assessed using Spearman's Rank Correlation while the predictive value of copeptin and CAC score were evaluated with Cox proportional Hazard regression analysis (unadjusted and adjusted for age groups, serum creatinine, gender, hypertension and type 2 diabetes mellitus). The primary outcome was cardiovascular events (CVE) while total mortality served as secondary outcome. Results The median copeptin level was 6.4 pmol/L and the median CAC score 227.0 (IQR: 48.3–692.4) for the total cohort. The highest copeptin level was seen in people with a CAC score ≥400. Copeptin predicted total mortality in the unadjusted analysis and the CAC score predicted both outcomes. Only the CAC score that predicted outcome following adjustments (CVE: HR 1.35, 95% CI 1.23–1.48; p Figure 1 Conclusion In this cohort of elderly individuals without a previous MI a high CAC score was as a significant predictor of future cardiovascular events. People with high a CAC score had elevated copeptin levels but copeptin did not serve as a prognostic indicator. This suggests that copeptin elevation in people with CAD is an expression for the general state of disease rather than an indicator of a pathophysiological role of vasopressin in this context.

Background Clinical-epidemiological research has advanced our knowledge on the negative impact of lupus nephritis (LN) on systemic lupus erythematosus (SLE) outcomes. Impaired renal function at LN diagnosis and failure to normalize renal function upon aggressive immunosuppressive therapy are associated with a very poor long-term renal outcome. Most reports on that field are however based on tertiary care data of limited sample size that impede the ability to generalize the findings. In order to measure the impact of renal function impairment on clinical outcome such as death or cardiovascular events effectively, updated comprehensive information at national level is needed. Objectives We conducted an analysis of a French nationwide database to assess the characteristics associated with the presence of CKD (i.e. eGFR Methods Characteristics of all admitted SLE patients experiencing CKD in France from 2009 to 2015 were analyzed through the French medico-administrative database. Factors associated with CKD and major clinical outcomes such as end-stage renal disease (ESRD), cardiovascular event (CVE), septic shock and death were assessed. We used a multivariate Cox proportional hazard model and subdistribution hazard models to analyze survival without major clinical events according to the presence of CKD. Results From 2009 to 2015, 26 320 SLE patients were hospitalized in France. Among them, 6 439 (86.5% women; mean age 45.7 [16.5] years old) had a baseline stay in 2009 during which CKD was reported in 428 (6.7%) cases. Multivariate analysis showed that lupus nephritis (OR 6.6 [5.2-8.4]), high blood pressure (OR 3.5 [2.8-4.5]), septic shock (OR 3.2 [1.7-6.0]) and past cardiovascular history (OR 1.4 [1.0-2.0]) were associated with CKD status. From 2009 to 2015, ESRD, CVE, septic shock, and death occurred in 4.0%, 14.4%, 6.3% and 9.6% of the 6 439 SLE patients. CKD at baseline was independently and strongly associated with the occurrence of ESRD (sdHR 15.9 [11.6-21.9]), CVE (sdHR 1.7 [1.4-2.2]), septic shock (sdHR 2.1 [1.5-2.8]) and death (HR 1.7 [1.3-2.2]) during the follow up Conclusion CKD is a major risk factor for overall morbidity and mortality in SLE patients, highlighting the need for early pre-CKD lupus nephritis diagnosis and treatment Disclosure of Interests: Arthur Mageau: None declared, Jean-Francois Timsit: None declared, Anne Perozziello: None declared, Benedicte Giroux Leprieur: None declared, Stephane Ruckly : None declared, Claire Dupuis: None declared, Lila Bouadma: None declared, Thomas Papo: None declared, karim sacre Grant/research support from: GSK

Background Cardiovascular risk is not uncommon in patients with chronic inflammatory rheumatism. Objectives The objective: To evaluate the interest of systematic electrocardiogram (ECG) as a tool for detecting cardiac abnormalities during spondyloarthropathies (SA) and rheumatoid arthritis (SA). Methods Consecutive patients suffering from SA, RA, hospitalized during the period from 2016 to 2017 and free from cardiovascular events were included. An ECG - 12-lead - was performed and interpreted by a cardiologist without the diagnosis. Results A total of 44 patients with SA were included (average duration 9 ± 8 years), 56 patients with RA (average duration 11 ± nine years). They were all asymptomatic on the cardiac level and without a cardiovascular history. The population was homogeneous, concerning the presence of the cardiovascular risk factors, except for the diabetes, more frequent in the RA groups. The proportions of extra systoles, atrioventricular blocks (2.2% in the SA group, 1.4% in the RA group), complete or incomplete left branch block (respectively: 0.7%, 0.6%), complete right limb block or left branch block (respectively: 0.8%, 2.7%) and abnormality suggestive of myocardial ischemia (5.2%, 10.8%) Conclusion In patients with no history of cardiovascular disease who are asymptomatic, performing a systematic ECG does not reveal the increased risk of specific cardiac complications related to these conditions in patients with SA and RA. References [1] Danesh J, Whincup P, Walker M, et al. Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses. BMJ2000;321:199–204. [2] Bulkley BH, Roberts WC. Ankylosing spondylitis and aortic regurgitation. Circulation 1973;48:1014–27: [3] Nitter Hauge S, Otterstad JE. Characteristics of atrioventricular conduction disturbances in ankylosing spondylitis. Acta Med Scand 1981;210:197–200. [4] Brunner F, Kunz A, Weber U, et al. Ankylosing spondylitis and heart abnormalities. Clin Rheumatol 2006;25:24–9. [5] Yildirir A, Aksoyek S, Calguneri M, et al. QT dispersion as a predictor ofarrhythmic events in patients with ankylosing spondylitis. Rheumatology 2000;39:875–9 Disclosure of Interests None declared

The history of the recognition and surgical treatment of lower limb ischemia dates back to the Middle Ages. The twin Saints Comas and Damian were ascribed to have saved a gangrenous limb in the 13th century and became patrons of future surgeons. The physicians that followed developed the theories of blood flow, anatomy of the arterial circulation, and recognition that occlusive disease was the cause of limb ischemia and gangrene. Innovative physicians developed the techniques of arterial surgery and bypass grafting to restore limb blood flow and allow healing of lesions. In the 1960s, the era of endovascular intervention by the pioneering work of Charles Dotter, who developed techniques to image diseased arteries during a recanalization procedure. The development of guide wires, angioplasty balloons, and stents quickly followed. Management of lower limb ischemia and the diabetic foot will continue to evolve, building on the history and passion of preceding physicians and surgeons.

International audience; Purpose: To measure subfoveal choroidal thickness (SFCT) in the elderly and to determine the associations among SFCT, cardiovascular history, and the 10-year risk of fatal cardiovascular disease (CVD). Methods: We conducted a population-based study, the Montrachet (Maculopathy Optic Nerve, nuTRition neurovAsCular, and HEarT disease) study, in subjects older than 75 years. SFCT was measured with spectral-domain optical coherence tomography (SD-OCT) with enhanced-depth mode imaging. Participants underwent a comprehensive eye examination. The history of CVD, CVD risk factors, and a score-based estimation of their 10-year risk of cardiovascular mortality (Heart Score) were collected. Results: Overall, 764 participants were retained for analysis. The mean SFCT was 206.4 +/- 83.0 mum. The mean age was 81.9 +/- 3.6 years. After a multivariable analysis, older age (beta = -32.56 mum, P < 0.001) and longer axial length (beta = -20.71 mum, P < 0.001) were independently associated with thinner SFCT. SFCT was not significantly associated with sex, cardiovascular history, classical CVD risk factors, or prognostic risk score. Conclusions: This study confirms that longer axial length and older age are associated with thinner SFCT. However, SFCT does not appear to be a biomarker for cardiovascular history in this study.

The review discusses literature data describing patients without cardiovascular comorbidity with mild to moderate novel coronavirus infection (COVID-19) at risk of developing COVID-19-associated viral myocardial damage. The search for data was carried out using the keywords «COVID-19, myocarditis, cardiomyopathy, myocarditis, and cardiomyopathy» for the period from February 2020 to February 2021 in the open sources PubMed and eLIBRARY. Patients who have undergone mild COVID-19 and, therefore, have not undergone hospitalization in specialized hospitals and receive treatment at the outpatient stage are at risk for the development of cardiovascular complications, in particular myocarditis, since they are not under the supervision of specialists and are not start treatment of complications in a timely manner. In addition, the current guidelines for the group of outpatients with COVID-19 do not prescribe diagnostic markers to identify and/or establish the degree of myocardial damage while clinical manifestations in the form of complaints of cardiovascular symptoms occur already at the initial manifestation COVID-19. The article proposes to discuss the issues of diagnosis of acute myocardial injury in an outpatient group of patients with COVID-19 in order to stratify the risk of developing cardiovascular complications in young patients with no history of previous cardiovascular events. (English) [ABSTRACT FROM AUTHOR] В обзоре обсуждаются данные литературы, описывающие пациентов без сопутствующей сердечно-сосудистой патологии с легким или среднетяжелым течением новой коронавирусной инфекции (COVID-19), подверженных риску развития ассоциированного с COVID-19 вирусного повреждения миокарда. Поиск данных осуществлялся по ключевым словам «COVID-19, myocarditis, cardiomyopathy, миокардит, кардиомиопатия» за период с февраля 2020 г. по февраль 2021 г. в открытых источниках PubMed и eLIBRARY. Пациенты, перенесшие COVID-19 в легкой форме и, следовательно, не подвергшиеся госпитализации в специализированные стационары и получающие лечение на амбулаторно-поликлиническом этапе, являются группой риска по развитию сердечно-сосудистых осложнений, в частности миокардита, поскольку не находятся под наблюдением специалистов и не начинают лечение осложнений своевременно. Кроме того, в имеющихся на сегодняшний день методических рекомендациях в отношении группы амбулаторных пациентов с COVID-19 не прописаны диагностические маркеры для выявления и/или установления степени миокардиального повреждения, тогда как клинические проявления в виде жалоб на сердечно-сосудистые симптомы отмечаются уже при первоначальном проявлении COVID-19. В статье предложены к обсуждению вопросы диагностики острого миокардиального повреждения у амбулаторной группы больных COVID-19 с целью стратификации риска развития сердечно-сосудистых осложнений у молодых пациентов, не имеющих в анамнезе предшествующих сердечно-сосудистых событий. (Russian) [ABSTRACT FROM AUTHOR] Copyright of Profilakticheskaya Meditsina is the property of Media Sphere Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives To assess the effect of 25 or 50 mg mirabegron on cardiovascular end-points and adverse drug reactions in real-world Japanese patients with overactive bladder and cardiovascular disease. Methods Participants had overactive bladder, a history of/coexisting cardiovascular disease and a 12-lead electrocardiogram carried out ≤7 days before initiating 4 weeks of mirabegron treatment. Patients with “serious cardiovascular disease” (class III or IV on the New York Heart Association functional classification and further confirmed by expert analysis) were excluded. Patient demographics, physical characteristics and cardiovascular history were recorded. After 4 weeks, patients underwent another electrocardiogram. Incidence of cardiovascular adverse drug reactions and change from baseline in electrocardiogram parameters (RR, PR, QRS intervals, Fridericia's corrected QT and heart rate) were assessed. Results Of 316 patients registered, 236 met criteria and had baseline/post-dose electrocardiograms: 61.9% male; 60.2% aged ≥75 years; 93.6% with coexisting cardiovascular disease, notably, arrhythmia (67.8%) and angina pectoris (19.1%). Starting mirabegron daily doses were 25 mg (19.9%) or 50 mg (80.1%). The incidence of cardiovascular adverse drug reactions was 5.51%. After 4 weeks, the mean heart rate increased by 1.24 b.p.m. (statistically significant, but clinically acceptable as per previous trials). No significant changes were observed in PR, QRS or Fridericia's corrected QT. No significant correlations in the total population or age-/sex-segregated subgroups were observed between baseline Fridericia's corrected QT and change at 4 weeks. No correlation for heart rate versus change from baseline heart rate with treatment was observed. Conclusions Mirabegron was well tolerated in real-world Japanese patients with overactive bladder and coexisting cardiovascular disease. No unexpected cardiovascular safety concerns were observed.

Background Obstructive sleep apnea syndrome (OSAS) is a sleep breathing disorder with episodes of upper airway obstructions. Patients with cardiovascular diseases such as myocardial infarction and stroke show a high prevalence of OSAS. Several studies focus on stroke and not on transient ischemic attack (TIA), suggesting it could be a symptom after stroke. We analyzed the occurrence of OSAS in high-risk patients with TIA. Methods There were 555 patients suspected for TIA by the general practitioner who were referred to our TIA daycare clinic. They were screened for OSAS using 3 screening factors: snoring (yes/no), body mass index greater than or equal to 30, and Epworth Sleepiness Score greater than 10. When 2 out of 3 were positive, patients received a polysomnography. An apnea–hypopnea index (AHI) of 5-15 is defined as mild OSAS, AHI 15-30 as moderate OSAS, and AHI greater than 30 as severe OSAS. Results Seventy-seven patients received a polysomnography. Twenty-five patients had a diagnosis of TIA and 18 had a diagnosis of cerebral ischemia, whereas 34 had other diagnoses. Twenty of the 25 (80%) TIA patients had OSAS, compared to 16 of the 34 (47%) patients without a vascular diagnosis (P = .010). When excluding patients with a cardiovascular history, we found 15 of the 20 patients with OSAS, compared to 14 out of 30 patients (P = .047). Conclusions There is a significant higher occurrence of OSAS in TIA patients compared to patients without a vascular diagnosis, even after excluding patients with a history of cardiovascular events.

Enquadramento: A cefaleia é um sintoma comum nos cuidados de saúde primários (CSP). Pode ter características sugestivas de uma cefaleia secundária grave, devendo o médico de família (MF) estar atento aos sinais de alarme. Sendo assim, perante um sintoma inespecífico, as competências nucleares do MF capacitam-no para gerir a incerteza, facilitando a gestão das várias possibilidades. Descrição de caso: Sexo feminino, 21 anos, antecedentes de disseção aórtica aos nove anos, sem MF na Unidade Funcional. A 01/09 recorre a consulta de intersusbstituição (CIS), grávida de 12 semanas, por cefaleias com 2,5 semanas, holocranianas e quase diárias. Foi-lhe indicado paracetamol em SOS. Por antecedentes cardiovasculares importantes foi referenciada a consulta hospitalar de obstetrícia. A 14/09 recorre a CIS por manter cefaleias holocranianas de predomínio frontal, de caráter pulsátil, com fonofobia, fotofobia e osmofobia, sem cedência ao analgésico. É encaminhada para o serviço de urgência (SU), onde foi observada por neurologia que considerou tratar-se de uma enxaqueca sem aura. A 01/10 teve consulta de obstetrícia, referindo novamente cefaleias intensas com reforço da toma de analgésico. A 07/10, agora com 17 semanas de gestação, recorre a CIS por manter cefaleias frontais. Por quadro arrastado, com recurso a múltiplas consultas com médicos diferentes, opta-se por contactar telefonicamente o neurologista de urgência. No SU, a angio-ressonância magnética (RM) revelou trombose venosa cerebral do seio lateral esquerdo. Foi internada na Unidade de Cuidados Intermédios Polivalentes e iniciou terapêutica com enoxaparina 12/12h. Discussão: A prevalência das cefaleias nos CSP é alta e, na maioria dos casos, sem sinais de alarme. A continuidade de cuidados, abordagem abrangente, modelação holística e a capacidade de gestão de cuidados - características da medicina geral e familiar -, são essenciais na avaliação destes utentes e conferem ao MF clara vantagem sobre os restantes especialistas na resolução de problemas complexos ou indiferenciados. Este caso vem demonstrar, uma vez mais, a importância de todos terem um MF Background: Headache is a common symptom encountered in primary health care. However, it may have features that suggest serious causes. The family doctor should be aware of this risk when faced with a patient with nonspecific symptom. The core competencies of family medicine should allow the doctor to manage uncertainty and to acknowledge various possibilities when faced with a pregnant patient with headache. Case description: A 21 years old patient with a history of aortic dissection at age 9 years presented to a health care center at 12 weeks of gestation complaining of daily headaches. She did not have her own family physician previously. Paracetamol was prescribed for use as needed. Due to her cardiovascular history, she was referred for obstetric consultation at a local hospital. Two weeks later she returned to the health centre without an appointment complaining of severe pulsatile headache, with phonophobia, photophobia, osmophobia, and without improvement with analgesics. The patient was referred to the local hospital emergency department, where she was examined by a neurologist, who diagnosed migraine without aura. Two weeks later, she had a follow-up consultation at the hospital for the pregnancy. She complained of severe headache again and was prescribed analgesics. One week later she returned to the health centre without an appointment (at 17 weeks gestation) because of persistence of the headache. Due to the long course without improvement and multiple consultations with different doctors, contact was made with the neurologist on call at the local hospital and an emergency consultation was arranged. A magnetic resonance angiogram revealed a left lateral sinus cerebral venous thrombosis. She was admitted to the intensive care unit and was treated with enoxaparin. Conclusion: Continuous, comprehensive care and the ability to manage health care resources gave the family physician an advantage in the management of this challenging case. This case highlights the importance of a family doctor for every patient