Tenecteplase for ST-elevation myocardial infarction in a patient treated with drotrecogin alfa (activated) for severe sepsis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Drotrecogin alfa (activated) (DrotAA), an activated protein C, promotes fibrinolysis in patients with severe sepsis. There are no reported cases or studies that address the diagnosis and treatment of myocardial infarction in septic patients treated with DrotAA.</p> <p>Case presentation</p> <p>A 59-year-old Caucasian man with septic shock secondary to community-acquired pneumonia treated with DrotAA, subsequently developed an ST-elevation myocardial infarction 12 hours after starting DrotAA. DrotAA was stopped and the patient was given tenecteplase thrombolysis resulting in complete resolution of ST-elevation and no adverse bleeding events. DrotAA was restarted to complete the 96-hour course. The sepsis resolved and the patient was discharged from hospital.</p> <p>Conclusion</p> <p>In patients with severe sepsis or septic shock complicated by myocardial infarction, it is difficult to determine if the myocardial infarction is an isolated event or caused by the sepsis process. The efficacy and safety of tenecteplase thrombolysis in septic patients treated with DrotAA need further study.</p

European cardiac resynchronization therapy survey: rationale and design

AIMS: The European cardiac resynchronization therapy (CRT) Survey is a joint initiative taken by the Heart Failure Association (HFA) and European Heart Rhythm Association (EHRA) of the European Society of Cardiology. The primary objective is to describe the current European practice and routines associated with CRT/CRT-D implantations based on a wide range of sampling in 13 countries. METHODS AND RESULTS: The data collected should provide useful information, including demographics and clinical characteristics, diagnostic criteria, implantation routines and techniques, short-term outcomes, adverse experience, and assessment of adherence to guideline recommendations

Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association.

Cardiac pacing as an adjunct therapy for heart failure began to be the subject of scientific research at the start of the 1990s. The first pacing modality to be examined was dual-chamber pacing with a short atrioventricular (AV) delay, in patients with heart failure but without the classical bradyarrhythmic indications for pacing. The first studies in this area gave promising results. Acute and short-term improvements resulted from the optimization of left ventricular (LV) filling and a reduction in pre-systolic mitral regurgitation. Unfortunately, the initial results were not confirmed by subsequent studies and the early hopes raised by dual-chamber pacing with a short AV delay for heart failure patients were not fulfilled. In contrast, atrio-biventricular pacing for patients with symptomatic heart failure and intra- or interventricular conduction disturbances has proved beneficial. During the last decade, a number of studies have established a theoretical basis for this new therapy and have drawn related conclusions regarding the importance of resynchronization in terms of improving symptoms, morbidity, and mortality in these patients. This document presents the recommendations of the committee concerning indications for CRT based on the most recent studies

Guidelines cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association.

Cardiac pacing has been used in the treatment of bradyarrhythmias for more than 50 years and during that time both clinical practice and an impressive body of research have proved its effectiveness objectively, in terms of parameters that includes the patient's quality of life, morbidity, and mortality. There can also be no doubt that the related technology has made great strides over the same period. The guidelines for the appropriate use of pacemaker devices presented in this document, a joint European Society of Cardiology (ESC) and EHRA initiative, aim to provide for the first time in Europe an up-to-date specialists’ view of the field. The guidelines cover two main areas: the first includes permanent pacing in bradyarrhythmias, syncope, and other specific conditions, whereas the second refers to ventricular resynchronization as an adjunct therapy in patients with heart failure

Guidelines for cardiac pacing and cardiac resynchronization therapy

As Orientações e os documentos de consenso dos especialistas sintetizam e avaliam todas as evidências actualmente disponíveis sobre uma determinada questão, com o objectivo de auxiliar o médico na selecção das estratégias de tratamento que melhor se adequam a determinado doente com uma doença específica, tendo em conta não só o impacto no resultado final mas também a relação risco-benefício de um diagnóstico ou procedimento terapêutico específico. As Orientações não pretendem ser substitutos para os manuais. As implicações legais das Orientações médicas foram previamente discutida

Guidelines in cardiac pacing and resynchronization therapy.

Cardiac pacing as an adjunct therapy for heart failure began to be the subject of scientific research at the start of the 1990s. The first pacing modality to be examined was dual-chamber pacing with a short atrioventricular (AV) delay, in patients with heart failure but without the classical bradyarrhythmic indications for pacing. The first studies in this area gave promising results. Acute and short-term improvements resulted from the optimization of left ventricular (LV) filling and a reduction in pre-systolic mitral regurgitation. Unfortunately, the initial results were not confirmed by subsequent studies and the early hopes raised by dual-chamber pacing with a short AV delay for heart failure patients were not fulfilled. In contrast, atrio-biventricular pacing for patients with symptomatic heart failure and intra- or interventricular conduction disturbances has proved beneficial. During the last decade, a number of studies have established a theoretical basis for this new therapy and have drawn related conclusions regarding the importance of resynchronization in terms of improving symptoms, morbidity, and mortality in these patients. This document presents the recommendations of the committee concerning indications for CRT based on the most recent studies