摘要:

The diagnosis and management of acute myocardial infarction and unstable angina pectoris are frequent challenges for emergency department staff. Strategies must quickly and accurately identify all patients requiring admission, monitoring, and reperfusion therapy to maximize outcomes without overdiagnosing. The Acute Cardiac Ischemia Time-Insensitive Predictive Instrument and the Thrombolytic Predictive Instrument are two decision-support tools designed to address this need. The instruments have been shown to improve some measures of the appropriateness of and time to emergency department triage. Prospective trials will be completed soon that will examine their effects on morbidity and mortality.

ISSN:0889-4655    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The American Heart Association has been the recognized source for Advanced Cardiac Life Support (ACLS) education for the past three decades. Since the first ACLS course, numerous revisions have been made to the management algorithms based on evolving scientific evidence. The last revisions made in August 2000 were the first international guidelines published. These guidelines reflect the intense review and analysis of scientific work and emphasize the importance of evidence-based therapies. This article outlines the major changes to ACLS guidelines for dysrhythmias, acute coronary syndromes, and acute stroke management.

ISSN:0889-4655    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Syncope may be related to a large spectrum of medical and psychologic disorders, yet the precise etiology is often difficult to determine. Although the evaluation of syncope involves extensive testing, nearly 50% of these individuals remain without definitive diagnosis. Because of the infrequent and unpredictable nature of syncope, many ambulatory screening techniques are not suited to diagnose syncope. The use of an implantable loop recording device provides continuous monitoring of heart rate and rhythm during syncopal events and may help clinicians arrive at a more precise diagnosis in a more timely manner. The Reveal Plus implantable loop recorder (ILR) (Medtronic USA, Minneapolis, Minn) has demonstrated its clinical utility in evaluating syncope and drug-refractory seizure disorders.

ISSN:0889-4655    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Ventricular assist devices (VADs) have made it possible for patients with end-stage heart failure to survive until a donor heart is available. In addition to serving as a bridge to transplantation, evolving indications for VADs include bridge to recovery and destination therapy. There are many VAD programs, but in the majority of programs only a small number of devices are implanted each year. Low volume poses a challenge in terms of provision of comprehensive education and training for nurses who will care for patients with VADs and in terms of maintaining competency to care for these patients. This article briefly addresses current VAD technology and VAD program development. The major focus is on the education and competency challenges and solutions the authors have experienced as infrequent users of VAD technology.

ISSN:0889-4655    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Technological advances have increased life expectancy and improved quality of life for patients with heart disease. A new device, called the wearable defibrillator, is designed to provide monitoring and defibrillation capability for patients who have had an infarct and those awaiting heart transplantation. These two populations of patients are at increased risk of sudden cardiac death. This external wearable apparatus continuously monitors a patient's heart rhythm. The monitor is programmed to recognize the individual's heart rhythm. If the heart rhythm changes and meets criteria for a lethal dysrhythmia, the monitor will provide a series of alarms to the patient and bystanders. If the patient fails to respond to the alarms, because of loss of consciousness, the system delivers a shock to treat the life-threatening dysrhythmia. Although still in the investigational phase, this device holds promise as temporary protection for patients at risk for sudden cardiac death.

ISSN:0889-4655    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Sudden cardiac death (SCD) remains a significant problem despite an overall reduction in other cardiac related deaths in recent years. Research supports the use of the implantable cardioverter defibrillator (ICD) as an effective means of treating dangerous ventricular tachydysrhythmias to prevent SCD. The issue that demands increasing attention is the psychologic experience of ICD recipients. Although the ICD is clearly a technological success, there is evidence that recipients experience strong physical and emotional reactions to the device. Such quality of life issues are worthy of a multidisciplinary effort directed at facilitating patient acceptance and adaptation to technology that although potentially life-saving, may also be unpredictable and anxiety provoking.

ISSN:0889-4655    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Effective management of patients with heart failure is guided by hemodynamic indices that may provide more objective evidence of cardiovascular status than physical signs and symptoms and the chest radiograph. Quantitative hemodynamic data obtained without the need for hospitalization supplements physical assessment findings, daily weights, and functional status classification and provides objective data for optimization of therapies and prevention or reduction of hospitalizations. The current health care climate is characterized by shrinking health care reimbursement and increased emphasis on patient-centered care focused on enhancing quality of life and patient satisfaction. In this climate, devices such as an implantable right ventricular hemodynamic monitor and impedance cardiography may improve nursing and medical management, promote appropriate use of resources, and contribute to enhanced quality of care and patient quality of life.

ISSN:0889-4655    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Congestive heart failure (CHF) is a clinical syndrome that affects more than 4 million people in the United States. The grim prognosis for this population has led to a search for new therapies to treat CHF. Resynchronization of the ventricles is one such therapy. The pathophysiology associated with conduction defects and the evolution of the use of pacing technologies for this patient population will be discussed. Early data have been encouraging, suggesting that patients may gain important hemodynamic, functional, and quality-of-life improvements with biventricular pacing.

ISSN:0889-4655    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The epidemic of heart failure and its subsequent effect on public health policy is escalating. Cardiac transplantation continues to be limited by the shortage of donor organs, and the current generation of mechanical circulatory support devices has not yet approached the goal of destination therapy. A better understanding of the role of left ventricular remodeling in the development of heart failure has resulted in novel surgical therapies and devices that may reverse or retard the remodeling process.

ISSN:0889-4655    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0889-4655    

出版商:OVID    

年代:2002

数据来源: OVID