Hypertension and emergency medicine: an update

The objective of this paper is to evaluate the correct management of hypertension in emergency departments. Studies were identified searching PubMed up to April 30, 2012, combining the terms 'HYPERTENSIVE EMERGENCY' and 'HYPERTENSIVE URGENCY'. The search strategy was limited to English and Italian language papers on adult and pediatric patients. Hypertensive crises are commonly found in emergency departments. A range of pharmacological options are available in this setting, but each physician should tailor theoretical principles to the individual patient according to his or her clinical parameters

Il paziente a rischio di nefropatia da mezzi di contrasto iodati

Summary Subjects with hypovolemia and/or dehydration and pre-existing renal failure are considered at highest risk for radiocontrast-medium-induced acute kidney injury (RCI-AKI), and this risk increases in the presence of glomerular filtration rate or creatinine clearance rates lower than 60 mL/min (stage 3-5 chronic kidney disease according to the National Kidney Foundation). The authors critically review the evidence-based literature on RCI-AKI, its diagnosis, epidemiological aspects, predisposing conditions, and markers of risk, including advanced age. Procedures requiring the use of iodinated contrast media are increasingly performed in patients over 70 years of age, and there is no definitive consensus regarding the role of advanced age as a marker of risk for RCI-AKI

Rare but possible: clopidogrel-induced pancytopenia

We present the case of an 84-year-old female patient admitted to the Internal Medicine Ward for atypical chest pain and laboratory findings of severe pancytopenia. Past medical history was remarkable for an episode of myocardial infarction approximately 4 weeks prior to the current hospitalization which had required angioplasty + drug-eluting stent and dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. Some rare cases of clopidogrel-induced pancytopenia are described in scientific literature, therefore, after excluding infectious, vitamin deficiencies, and autoimmune causes, we modified the antiplatelet therapy by replacing clopidogrel with ticagrelor, obtaining complete leukocyte recovery within a few days. Since clopidogrel is an antiplatelet drug still used in clinical cardiological practice, the knowledge of this rare side effect may lead the clinician to suspect hematological toxicity which, if recognized promptly, may suggest modification of antiplatelet therapy and limit any possible infectious complications for the care of the patient

Patients at risk for contrast-induced acute kidney injury

Subjects with hypovolemia and/or dehydration and pre-existing renal failure are considered at highest risk for radiocontrast-medium-induced acute kidney injury (RCI-AKI), and this risk increases in the presence of glomerular filtration rate or creatinine clearance rates lower than 60 mL/min (stage 3-5 chronic kidney disease according to the National Kidney Foundation). The authors critically review the evidence-based literature on RCI-AKI, its diagnosis, epidemiological aspects, predisposing conditions, and markers of risk, including advanced age. Procedures requiring the use of iodinated contrast media are increasingly performed in patients over 70 years of age, and there is no definitive consensus regarding the role of advanced age as a marker of risk for RCI-AKI

Individual exposure to particulate matter and the short-term arrhythmic and autonomic profiles in patients with myocardial infarction

Aims Epidemiological studies show that peak exposure to air pollution is associated with increased morbidity and mortality from cardiovascular events. Panel and controlled exposure studies show that particulate matter (PM) may influence the parasympathetic regulation of the heart. The aim of this study was to concurrently measure individual exposure to PM of various sizes, heart rate variability (HRV), and electrical instability in patients with myocardial infarction. Methods and results Personal exposures to PM10, PM2.5, and PM0.25 was measured over 24 h in 39 patients (36 males, 3 females; mean age 60.3 years) with prior myocardial infarction (>6 months). Simultaneously, a 24 h ECG was recorded and then analysed for HRV and ventricular arrhythmias. Breath condensate and blood samples also were collected at the end of monitoring to measure several indexes of inflammation. Negative correlation was found between HRV and exposure to PM0.25 in a group of patients not taking \u3b2-blockers. More severe ventricular arrhythmias were observed at the highest concentrations of PM10 and PM2.5. Indexes of inflammation in either breath condensate or blood did not correlate with PM exposures. Conclusion Our study shows that exposure to ultrafine particles is associated with autonomic dysregulation in selected patients with myocardial infarction. More severe arrhythmias occur at the highest exposures to larger particles. Nevertheless, the underlying mechanisms remain hypothetical because inflammation may be evoked by PM or be related to the disease itself