Myocardial infarction with non-obstructive coronary arteries: A comprehensive review and future research directions

Acute coronary syndromes constitute a variety of myocardial injury presentations that include a subset of patients presenting with myocardial infarction with non-obstructive coronary arteries (MINOCA). This acute coronary syndrome differs from type 1 myocardial infarction (MI) regarding patient characteristics, presentation, physiopathology, management, treatment, and prognosis. Two-thirds of MINOCA subjects present ST-segment elevation; MINOCA patients are younger, are more often female and tend to have fewer cardiovascular risk factors. Moreover, MINOCA is a working diagnosis, and defining the aetiologic mechanism is relevant because it affects patient care and prognosis. In the absence of relevant coronary artery disease, myocardial ischaemia might be triggered by an acute event in epicardial coronary arteries, coronary microcirculation, or both. Epicardial causes of MINOCA include coronary plaque disruption, coronary dissection, and coronary spasm. Microvascular MINOCA mechanisms involve microvascular coronary spasm, takotsubo syndrome (TTS), myocarditis, and coronary thromboembolism. Coronary angiography with non-significant coronary stenosis and left ventriculography are first-line tests in the differential study of MINOCA patients. The diagnostic arsenal includes invasive and non-invasive techniques. Medical history and echocardiography can help indicate vasospasm or thrombosis, if one finite coronary territory is affected, or specify TTS if apical ballooning is present. Intravascular ultrasound, optical coherence tomography, and provocative testing are encouraged. Cardiac magnetic resonance is a cornerstone in myocarditis diagnosis. MINOCA is not a benign diagnosis, and its polymorphic forms differ in prognosis. MINOCA care varies across centres, and future multi-centre clinical trials with standardized criteria may have a positive impact on defining optimal cardiovascular care for MINOCA patients

Фразеологические единицы микрополя "счастье" в составе фразеосемантического поля "эмоциональные состояния человека"

yesАнализ фразеологизмов французского языка, выражающих эмоциональное состояние "счастье", с точки зрения их места в моделируемом автором фразеосемантическом поле "эмоциональные состояния человека"Белгородский государственный университе

Longer-term results of a Universal Electronic Consultation Program at the Cardiology Department of a Galician Healthcare Area

Background: Telemedicine models play a key role in organizing the growing demand for care and healthcare accessibility, but there are not described longer-term results in health care. Our objective is to assess the longer-term results (delay time in care, accessibility and hospital admissions) of an electronic consultation (e-consultation) outpatient care management program. Methods: Epidemiological and clinical data were obtained from the 41,258 patients referred by primary care to the cardiology department from January 1, 2010, to December 31, 2019. Until 2012, all patients were attended in an in-person-consultation (2010-2012). In 2013, we instituted an e-consultation program (2013-2019) for all primary care referrals to cardiologists that preceded patients’ in-person consultations when considered. We used an interrupted time series regression approach to investigate the impact of the e-consultation program on i) delay time (days) in care and ii) hospital admissions. We also analyzed iii) total number and referral rate (population adjusted referred rate) in both periods (in-person consultation and e-consultation); and iv) the accessibility was measured as number of consultations and variation according to distance from municipality and reference hospital center. Results: During the e-consultation period, the demand for cardiology care increased (7.2 ±2.4% vs. 10.1 ±4.8% per 1,000 inhabitants, p<0.001) and referrals from different areas were equalized. The reduction in delay to consultation during the in-person consultation (-0.96, 95%CI [-0.951, -0.966], p<0.001) was maintained with e-consultations (-0.064, 95%CI [0.043, 0.085], p<0.001). After the implementation of e-consultation, we observed that the increasing of hospital admission observed in the in-person consultation (IRR: 1,011;95% CI [1,003-1,018]), was stabilized (IRR:1,000; 95% CI [0.985, 1.015]; p=0.874). Conclusions: Implementing e-consultations in the outpatient management model may improve accessibility of care for patients furthest from the referral hospital. After e-consultations were implemented, the upward trend of hospital admissions observed during the in-person consultation period was stabilized with a slight downward trend