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1
Durbin, Paul A. Asymptotic analysis of corona discharge from thin electrodes. Cleveland, Ohio: Lewis Research Center, 1986.
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2
United States. National Aeronautics and Space Administration. Scientific and Technical Information Branch., ed. Asymptotic analyses of corona discharge from thin electrodes. [Washington, D.C.]: National Aeronautics and Space Administration, Scientific and Technical Information Branch, 1987.
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3
IEEE Power Electronics Society. Electronics Transformers Technical Committee., ed. IEEE guide for making corona (partial discharge) measurements on electronics transformers. New York, NY, USA: Institute of Electrical and Electronics Engineers, 1991.
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4
Low current mode of negative corona: Investigation of initial stage of negative corona discharge in air at atmospheric pressure. Saarbrücken: VDM Verlag Dr. Müller, 2009.
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5
M, Dzhuvarly Ch. Koronnyĭ razri͡a︡d v ėlektrootrit͡s︡atelʹnykh gazakh. Baku: Izd-vo "Ėlm", 1988.
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6
Sahu, Ranjeet Kumar, and Somashekhar S. Hiremath. Corona Discharge Micromachining for the Synthesis of Nanoparticles. CRC Press, 2019. http://dx.doi.org/10.1201/9780429275036.
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7
Hiremath, Somashekhar S., and Ranjeet Kumar Sahu. Corona Discharge Micromachining for the Synthesis of Nanoparticles. Taylor & Francis Group, 2021.
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8
Hiremath, Somashekhar S., and Ranjeet Kumar Sahu. Corona Discharge Micromachining for the Synthesis of Nanoparticles. Taylor & Francis Group, 2019.
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9
Xiao, Gaozhi. Plasma and corona discharge pretreatment of polyetheretherketone for adhesive bonding. 1995.
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10
Institute Of Electrical and Electronics Engineers. IEEE Guide for Making Corona (Partial Discharge Measurements on Electronics Transformers). Institute of Electrical & Electronics Enginee, 1991.
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11
Hiremath, Somashekhar S., and Ranjeet Kumar Sahu. Corona Discharge Micromachining for the Synthesis of Nanoparticles: Characterization and Applications. Taylor & Francis Group, 2019.
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12
Hiremath, Somashekhar S., and Ranjeet Kumar Sahu. Corona Discharge Micromachining for the Synthesis of Nanoparticles: Characterization and Applications. Taylor & Francis Group, 2019.
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13
Hiremath, Somashekhar S., and Ranjeet Kumar Sahu. Corona Discharge Micromachining for the Synthesis of Nanoparticles: Characterization and Applications. Taylor & Francis Group, 2019.
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14
Corona Discharge Micromachining for the Synthesis of Nanoparticles: Characterization and Applications. Taylor & Francis Group, 2019.
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15
Feasibility of Cleaning PCB Contaminated Surfaces Using Pulsed Corona Discharges. Storming Media, 1999.
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16
Durand, Eric, Aures Chaib, and Nicolas Danchin. Chest pain and chest pain units. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0008.
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Patients presenting at the emergency department with acute chest pain and suspected to represent an acute coronary syndrome were classically admitted as routine to the cardiology department, resulting in expensive and time-consuming evaluations. However, 2-5% of patients with acute coronary syndromes were discharged home inappropriately, resulting in increased mortality. To address the inability to exclude the diagnosis of acute coronary syndrome, chest pain units were developed, particularly in the United States. These provided an environment where serial electrocardiograms, cardiac biomarkers, and provocative testing could be performed to rule out an acute coronary syndrome. Eligible candidates included the majority of patients with non-diagnostic electrocardiograms and normal troponin measurements. The results have been impressive; chest pain units have markedly reduced adverse events, while simultaneously increasing the rate of safe discharge by 36%. Despite evidence to suggest that care in chest pain units is more effective for such patients, the percentage of emergency or cardiology departments setting up chest pain units remains very low in Europe.
17
Durand, Eric, Aurès Chaib, Etienne Puymirat, and Nicolas Danchin. Chest pain and chest pain units. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0008_update_001.
Full textAbstract:
Patients presenting at the emergency department with acute chest pain and suspected to represent an acute coronary syndrome were classically admitted as routine to the cardiology department, resulting in expensive and time-consuming evaluations. However, 2-5% of patients with acute coronary syndromes were discharged home inappropriately, resulting in increased mortality. To address the inability to exclude the diagnosis of acute coronary syndrome, chest pain units were developed, particularly in the United States. These provide an environment where serial electrocardiograms, cardiac biomarkers, and provocative testing can be performed to confirm or rule out an acute coronary syndrome. Eligible candidates include the majority of patients with non-diagnostic electrocardiograms. The results have been impressive; chest pain units have markedly reduced adverse events, while simultaneously increasing the rate of safe discharge by 36%. Despite evidence to suggest that care in chest pain units is more effective for such patients, the percentage of emergency or cardiology departments setting up chest pain units remains low in Europe.
18
Schennum, Steven Dean. The modeling of electromagnetic interference due to corona on electric power lines. 1992.
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19
Lee, Christoph I. CT Angiography for Discharge of Acute Coronary Syndrome. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190223700.003.0021.
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This chapter, found in the chest pain section of the book, provides a succinct synopsis of a key study examining the use of computed tomography (CT) angiography for discharging patients with acute coronary syndrome from the emergency department. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. The study showed that a negative coronary CT angiography examination can be used to safely expedite the discharge of low-to-intermediate risk patients who present to emergency department with possible acute coronary syndrome. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.
20
Bueno, Héctor, and José A. Barrabés. Non-ST-segment elevation acute coronary syndromes. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0046.
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Non-ST-segment elevation acute coronary syndromes are life-threatening disorders, usually caused by acute coronary thrombosis and subsequent myocardial ischaemia, presenting without persistent ST-segment elevation in the initial electrocardiogram. According to the occurrence of myocardial necrosis, non-ST-segment elevation acute coronary syndromes are divided into non-ST-segment myocardial infarction or unstable angina. The management of non-ST-segment elevation acute coronary syndromes requires an early diagnosis and risk stratification, urgent hospitalization, monitoring, and medical treatment, including antithrombotic therapy with dual antiplatelet therapy (aspirin plus one P2Y12 inhibitor) and parenteral anticoagulation, anti-ischaemic treatment, and preventative therapies. After the initial medical therapy is established, an invasive strategy, consisting of coronary angiography with coronary revascularization (either percutaneous coronary intervention or coronary bypass graft surgery), as appropriate, should be decided. The timing of the invasive strategy should be adjusted, according to the patient’s risk. Given the high event rate of patients with non-ST-segment elevation acute coronary syndromes after hospital discharge, an aggressive long-term preventative therapy should be put in place to improve prognosis.
21
Bueno, Héctor, and José A. Barrabés. Non-ST-segment elevation acute coronary syndromes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0046_update_001.
Full textAbstract:
Non-ST-segment elevation acute coronary syndromes are life-threatening disorders, usually caused by acute coronary thrombosis and subsequent myocardial ischaemia, presenting without persistent ST-segment elevation in the initial electrocardiogram. According to the occurrence of myocardial necrosis, non-ST-segment elevation acute coronary syndromes are divided into non-ST-segment myocardial infarction or unstable angina. The management of non-ST-segment elevation acute coronary syndromes requires an early diagnosis and risk stratification, urgent hospitalization, monitoring, and medical treatment, including antithrombotic therapy with dual antiplatelet therapy (aspirin plus one P2Y12 inhibitor) and parenteral anticoagulation, anti-ischaemic treatment, and preventative therapies. After the initial medical therapy is established, an invasive strategy, consisting of coronary angiography with coronary revascularization (either percutaneous coronary intervention or coronary bypass graft surgery), as appropriate, should be decided. The timing of the invasive strategy should be adjusted, according to the patient’s risk. Given the high event rate of patients with non-ST-segment elevation acute coronary syndromes after hospital discharge, an aggressive long-term preventative therapy should be put in place to improve prognosis.
22
Bueno, Héctor, and José A. Barrabés. Non-ST-segment elevation acute coronary syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0046_update_002.
Full textAbstract:
Non-ST-segment elevation acute coronary syndromes are life-threatening disorders, usually caused by acute coronary thrombosis and subsequent myocardial ischaemia, presenting without persistent ST-segment elevation in the initial electrocardiogram. According to the occurrence of myocardial necrosis, non-ST-segment elevation acute coronary syndromes are divided into non-ST-segment myocardial infarction or unstable angina. The management of non-ST-segment elevation acute coronary syndromes requires an early diagnosis and risk stratification, urgent hospitalization, monitoring, and medical treatment, including antithrombotic therapy with dual antiplatelet therapy (aspirin plus one P2Y12 inhibitor) and parenteral anticoagulation, anti-ischaemic treatment, and preventative therapies. After the initial medical therapy is established, an invasive strategy, consisting of coronary angiography with coronary revascularization (either percutaneous coronary intervention or coronary bypass graft surgery), as appropriate, should be decided. The timing of the invasive strategy should be adjusted, according to the patient’s risk. Given the high event rate of patients with non-ST-segment elevation acute coronary syndromes after hospital discharge, an aggressive long-term preventative therapy should be put in place to improve prognosis.
23
Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0049.
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Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
24
Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0049_update_001.
Full textAbstract:
Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
25
Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0049_update_002.
Full textAbstract:
Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
26
Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0049_update_003.
Full textAbstract:
Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
27
Kočka, Viktor, Steen Dalby Kristensen, William Wijns, Petr Toušek, and Petr Widimský. Percutaneous coronary interventions in acute coronary syndromes. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0047.
Full textAbstract:
Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following:All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hoursPatients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groupsOther patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentationLow-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testingStents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settingsTriple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk
28
Kočka, Viktor, Steen Dalby Kristensen, William Wijns, Petr Toušek, and Petr Widimský. Percutaneous coronary interventions in acute coronary syndromes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0047_update_001.
Full textAbstract:
Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following:All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hoursPatients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groupsOther patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentationLow-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testingStents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settingsTriple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk
29
Kočka, Viktor, Steen Dalby Kristensen, William Wijns, Petr Toušek, and Petr Widimský. Percutaneous coronary interventions in acute coronary syndromes. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0047_update_002.
Full textAbstract:
Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following: All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hours. Patients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groups. Other patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentation. Low-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testing. Stents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settings. Triple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk.
30
Kočka, Viktor, Steen Dalby Kristensen, William Wijns, Petr Toušek, and Petr Widimský. Percutaneous coronary interventions in acute coronary syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0047_update_003.
Full textAbstract:
Three different guidelines of the European Society of Cardiology cover the field of percutaneous coronary interventions. Their main recommendations are the following: All patients with an ST-segment elevation myocardial infarction should undergo immediate coronary angiography and percutaneous coronary intervention as soon as possible after the first medical contact. Thrombolysis can be used as an alternative reperfusion therapy if the time delay to primary percutaneous coronary intervention is more than 2 hours. Patients with very high-risk non-ST-segment elevation acute coronary syndromes (recurrent or ongoing chest pain, profound or dynamic electrocardiogram changes, major arrhythmias, or haemodynamic instability) should undergo urgent coronary angiography within less than 2 hours after the initial hospital admissionAll moderate- to high-risk (GRACE score >140 or at least one primary high-risk criterion) non-ST-segment elevation acute coronary syndromes patients should undergo coronary angiography before discharge; the ideal timing is within 24 hours after admission for high-risk groups, and within 72 hours for moderate-risk groups. Other patients with recurrent symptoms or at least one high-risk criterion should undergo coronary angiography within 72 hours of first presentation. Low-risk non-ST-segment elevation acute coronary syndromes may be treated conservatively, and the indication for an invasive evaluation can be done, based on the evidence of ischaemia during exercise stress testing. Stents should be used during all percutaneous coronary intervention procedures, whenever technically feasible. Second-generation drug-eluting stents do not increase stent thrombosis and can be safely used in the ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome settings. Triple pharmacotherapy, consisting of aspirin, thienopyridine antiplatelet agent, and anticoagulation with heparin or bivalirudin, should be used in all percutaneous coronary intervention procedures, with glycoprotein IIb/IIIa inhibitors added in patients with a high thrombus burden and low bleeding risk.
31
Lee, Christoph I. Coronary CT Angiography in Acute Chest Pain. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190223700.003.0022.
Full textAbstract:
This chapter, found in the chest pain section of the book, provides a succinct synopsis of a key study examining the use of computed tomography (CT) angiography for triaging patients with acute chest pain. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. The study showed that for patients presenting to the emergency department with symptoms suggesting acute coronary syndromes, incorporating early coronary CT angiography into the triage strategy improves diagnostic efficiency, with more direct discharges from the emergency department and shorter lengths of stay for those admitted. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.
32
de Graaf, Michiel A., Arthur JHA Scholte, Lucia Kroft, and Jeroen J. Bax. Computed tomography angiography and other applications of computed tomography. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0022.
Full textAbstract:
Patients presenting with acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computed tomography for non-invasive visualization of coronary artery disease in patients presenting with acute chest pain to the emergency department; particularly the subset of patients who are suspected of having an acute coronary syndrome, but without typical electrocardiographic changes and with normal troponin levels at presentation. As a result of rapid developments in coronary computed tomography angiography technology, high diagnostic accuracies for excluding coronary artery disease can be obtained. It has been shown that these patients can be discharged safely. The accuracy for detecting a significant coronary artery stenosis is also high, but the presence of coronary artery atherosclerosis or stenosis does not imply necessarily that the cause of the chest pain is related to coronary artery disease. Moreover, the non-invasive detection of coronary artery disease by computed tomography has been shown to be related with an increased use of subsequent invasive coronary angiography and revascularization, and further studies are needed to define which patients benefit from invasive evaluation following coronary computed tomography angiography. Conversely, the implementation of coronary computed tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computed tomography is an excellent modality in patients whose symptoms suggest other causes of acute chest pain such as aortic aneurysm, aortic dissection, or pulmonary embolism. Furthermore, the acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computed tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as the evaluation of coronary artery plaque composition, myocardial function and perfusion, or fractional flow reserve, are currently being developed and may also become valuable in the setting of acute chest pain in the future.
33
de Graaf, Michiel A., Arthur JHA Scholte, Lucia Kroft, and Jeroen J. Bax. Computed tomography angiography and other applications of computed tomography. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0022_update_001.
Full textAbstract:
Patients presenting with acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computed tomography for non-invasive visualization of coronary artery disease in patients presenting with acute chest pain to the emergency department; particularly the subset of patients who are suspected of having an acute coronary syndrome, but without typical electrocardiographic changes and with normal troponin levels at presentation. As a result of rapid developments in coronary computed tomography angiography technology, high diagnostic accuracies for excluding coronary artery disease can be obtained. It has been shown that these patients can be discharged safely. The accuracy for detecting a significant coronary artery stenosis is also high, but the presence of coronary artery atherosclerosis or stenosis does not imply necessarily that the cause of the chest pain is related to coronary artery disease. Moreover, the non-invasive detection of coronary artery disease by computed tomography has been shown to be related with an increased use of subsequent invasive coronary angiography and revascularization, and further studies are needed to define which patients benefit from invasive evaluation following coronary computed tomography angiography. Conversely, the implementation of coronary computed tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computed tomography is an excellent modality in patients whose symptoms suggest other causes of acute chest pain such as aortic aneurysm, aortic dissection, or pulmonary embolism. Furthermore, the acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computed tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as the evaluation of coronary artery plaque composition, myocardial function and perfusion, or fractional flow reserve, are currently being developed and may also become valuable in the setting of acute chest pain in the future.
34
de Graaf, Michiel A., Arthur JHA Scholte, Lucia Kroft, and Jeroen J. Bax. Computed tomography angiography and other applications of computed tomography. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0022_update_002.
Full textAbstract:
Patients presenting with acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computed tomography for non-invasive visualization of coronary artery disease in patients presenting with acute chest pain to the emergency department; particularly the subset of patients who are suspected of having an acute coronary syndrome, but without typical electrocardiographic changes and with normal troponin levels at presentation. As a result of rapid developments in coronary computed tomography angiography technology, high diagnostic accuracies for excluding coronary artery disease can be obtained. It has been shown that these patients can be discharged safely. The accuracy for detecting a significant coronary artery stenosis is also high, but the presence of coronary artery atherosclerosis or stenosis does not imply necessarily that the cause of the chest pain is related to coronary artery disease. Moreover, the non-invasive detection of coronary artery disease by computed tomography has been shown to be related with an increased use of subsequent invasive coronary angiography and revascularization, and further studies are needed to define which patients benefit from invasive evaluation following coronary computed tomography angiography. Conversely, the implementation of coronary computed tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computed tomography is an excellent modality in patients whose symptoms suggest other causes of acute chest pain such as aortic aneurysm, aortic dissection, or pulmonary embolism. Furthermore, the acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computed tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as the evaluation of coronary artery plaque composition, myocardial function and perfusion, or fractional flow reserve, are currently being developed and may also become valuable in the setting of acute chest pain in the future.
35
de Graaf, Michiel A., Arthur JHA Scholte, Lucia Kroft, and Jeroen J. Bax. Computed tomography angiography and other applications of computed tomography. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0022_update_003.
Full textAbstract:
Patients presenting with acute chest pain constitute a common and important diagnostic challenge. This has increased interest in using computed tomography for non-invasive visualization of coronary artery disease in patients presenting with acute chest pain to the emergency department; particularly the subset of patients who are suspected of having an acute coronary syndrome, but without typical electrocardiographic changes and with normal troponin levels at presentation. As a result of rapid developments in coronary computed tomography angiography technology, high diagnostic accuracies for excluding coronary artery disease can be obtained. It has been shown that these patients can be discharged safely. The accuracy for detecting a significant coronary artery stenosis is also high, but the presence of coronary artery atherosclerosis or stenosis does not imply necessarily that the cause of the chest pain is related to coronary artery disease. Moreover, the non-invasive detection of coronary artery disease by computed tomography has been shown to be related with an increased use of subsequent invasive coronary angiography and revascularization, and further studies are needed to define which patients benefit from invasive evaluation following coronary computed tomography angiography. Conversely, the implementation of coronary computed tomography angiography can significantly reduce the length of hospital stay, with a significant cost reduction. Additionally, computed tomography is an excellent modality in patients whose symptoms suggest other causes of acute chest pain such as aortic aneurysm, aortic dissection, or pulmonary embolism. Furthermore, the acquisition of the coronary arteries, thoracic aorta, and pulmonary arteries in a single computed tomography examination is feasible, allowing ‘triple rule-out’ (exclusion of aortic dissection, pulmonary embolism, and coronary artery disease). Finally, other applications, such as the evaluation of coronary artery plaque composition, myocardial function and perfusion, or fractional flow reserve, are currently being developed and may also become valuable in the setting of acute chest pain in the future.
36
Soman, Prem, and James E. Udelson. Imaging Patients with Chest Pain in the Emergency Department. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199392094.003.0019.
Full textAbstract:
The six-to-eight million people who present to emergency departments (EDs) across the U.S. each year for the evaluation of chest pain present a unique challenge to physicians.(1) Less than a third of these patients are eventually diagnosed with coronary artery disease (CAD).(2,3) However, a small percentage of patients with acute cardiac ischemia and an acute coronary syndrome (ACS) are inadvertently discharged, with potential adverse consequences.(2,4-6) Concerns about patient safety and malpractice litigation has resulted in the adoption of a practice paradigm that involves observation and testing that is associated with high cost. In this chapter we review the current approaches to risk stratification of chest pain patients, the utility of myocardial perfusion imaging for this purpose and, the ongoing investigation of potential new approaches in this area.
37
Pisinger, Charlotta, and Serena Tonstad. Smoking. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0010.
Full textAbstract:
Smoking causes all forms of cardiovascular disease (CVD): there is no safe level of smoking. The health benefits of quitting smoking are immediate. In patients with coronary heart disease smoking cessation results in a dramatic decline in future cardiovascular events and reduces cardiovascular death; it is the most effective and cheapest treatment for preventing new or recurrent CVD. Tobacco dependence should be regarded as a chronic disease with a lifelong risk of relapse. Making treatment readily available and reducing barriers to treatment increase the likelihood that smokers will accept treatment. Medication and follow-up should be arranged for all smokers upon hospital discharge and in outpatient settings. High priority should be given to identification and documentation of the smoking status of all patients, and systematic provision of cessation support. Clinicians should also ask about exposure to second-hand smoke and should play an active role in advocating for stronger tobacco controls.
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Pisinger, Charlotta, and Serena Tonstad. Smoking. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199656653.003.0010_update_001.
Full textAbstract:
Smoking causes all forms of cardiovascular disease (CVD): there is no safe level of smoking. The health benefits of quitting smoking are immediate. In patients with coronary heart disease smoking cessation results in a dramatic decline in future cardiovascular events and reduces cardiovascular death; it is the most effective and cheapest treatment for preventing new or recurrent CVD. Tobacco dependence should be regarded as a chronic disease with a lifelong risk of relapse. Making treatment readily available and reducing barriers to treatment increase the likelihood that smokers will accept treatment. Medication and follow-up should be arranged for all smokers upon hospital discharge and in outpatient settings. High priority should be given to identification and documentation of the smoking status of all patients, and systematic provision of cessation support. Clinicians should also ask about exposure to second-hand smoke and should play an active role in advocating for stronger tobacco controls.
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Corrà, Ugo, and Bernhard Rauch. Acute care, immediate secondary prevention, and referral. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656653.003.0021.
Full textAbstract:
Preventive cardiology (PC), as performed in various cardiac rehabilitation (CR) settings, is effective in reducing recurrent cardiovascular events after both acute coronary syndromes or myocardial revascularization. However, the need for newly structured PC programmes and processes to provide a continuum of care and surveillance from the acute to post-acute phases is evident. Phase I CR serves as a bridge between acute therapeutic interventions and phase II CR. After clinical stabilization, phase I CR ideally provides a multifaceted and multidisciplinary intervention, including post-acute clinical evaluation and risk assessment, general counselling, supportive counselling, early mobilization, discharge planning, and referral to phase II CR. All these are important and contribute to achieving the preventive target. All the interventions within phase I CR should be supervised and provided in a comprehensive manner involving several healthcare professionals. For explanatory purposes this chapter analyses and describes these components separately.
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DeAugustinas, M., and A. Kiely. Periocular Infections. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0015.
Full textAbstract:
Periocular Infections occur when there is inflammation of the conjunctiva. Uncomplicated viral infections can usually be managed with careful hand hygiene and lubrication of the eye with artificial tears. More severe infections are notable for purulent discharge, membrane formation, and scarring, and can lead to corneal change. For suspected bacterial conjunctivitis, empiric therapy begins with broad spectrum antibiotic eye drops or ointment, which are supplemented with oral antibiotics in cases associated with pharyngitis and in children with H. influenzae infection. For gonococcal conjunctivitis, systemic ceftriaxone is recommended for both adults and children (including neonates) due to the increasing prevalence of penicillin-resistant N. gonorrhoeae. If the cornea is not involved and the patient is extremely reliable, next day referral to an ophthalmologist in addition to management with IM ceftriaxone is sufficient. Otherwise, admission for IV therapy is advised. Copious, repeated irrigation is also advised to remove inflammatory mediators and debris that can contribute to corneal melting.
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Farmakis, Dimitrios, John Parissis, George Papingiotis, and Gerasimos Filippatos. Acute heart failure. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0051_update_001.
Full textAbstract:
Acute heart failure is defined as the rapid development or change of symptoms and signs of heart failure that requires urgent medical attention and usually hospitalization. Acute heart failure is the first reason for hospital admission in individuals aged 65 or more and accounts for nearly 70% of the total health care expenditure for heart failure. It is characterized by an adverse prognosis, with an in-hospital mortality rate of 4–7%, a 2–3-month post-discharge mortality of 7–11%, and a 2–3-month readmission rate of 25–30%. The majority of patients have a previous history of heart failure and present with normal or increased blood pressure, while about half of them have preserved left ventricular ejection fraction. A high prevalence of cardiovascular or non-cardiovascular comordid conditions is further observed, including coronary artery disease, arterial hypertension, atrial fibrillation, diabetes mellitus, renal dysfunction, chronic lung disease, and anaemia.
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Nolan, Jerry P. Advanced life support. Edited by Neil Soni and Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0091.
Full textAbstract:
Anaesthetists have a central role in cardiopulmonary resuscitation (CPR). The incidence of treated out-of-hospital cardiopulmonary arrest is 40 per 100 000 population and is associated with a survival rate to hospital discharge of 8–10%. The incidence of in-hospital cardiac arrest (IHCA) is 1–5 per 1000 admissions and is associated with a survival rate to hospital discharge of 13–17%. The most effective strategy for reducing mortality from IHCA is to prevent it occurring by detecting and treating those at risk or to identify in advance those with no chance of survival and to make a decision not to attempt resuscitation. The European Resuscitation Council and the Resuscitation Council (UK) publish guidelines for CPR every 5 years and the evidence supporting these is described in the international consensus on CPR science. The advanced life support algorithm forms the core of the guidelines but the precise interventions depend on the circumstances of the cardiac arrest and the skills of the healthcare providers. High-quality CPR with minimal interruptions will optimize survival rates. Shockable rhythms are treated with defibrillation while minimizing the pause in chest compressions. Although adrenaline (epinephrine) is used in most cardiac arrests, no studies have shown that it improves long-term outcome. The post-cardiac arrest syndrome is common and requires multiple organ support in an intensive care unit. Therapy in this phase is aimed at improving neurological (e.g. targeted temperature management) and myocardial (e.g. percutaneous coronary intervention) outcomes. Based on standard outcome measurements (e.g. cerebral performance category), 75–80% of survivors will have a ‘good’ neurological outcome, but many of these will have subtle neurocognitive deficits.
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Farmakis, Dimitrios, John Parissis, and Gerasimos Filippatos. Acute heart failure: epidemiology, classification, and pathophysiology. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0051.
Full textAbstract:
Acute heart failure is defined as the rapid development or change of symptoms and signs of heart failure that requires urgent medical attention and usually hospitalization. Acute heart failure is the first reason for hospital admission in individuals aged 65 or more and accounts for nearly 70% of the total health care expenditure for heart failure. It is characterized by an adverse prognosis, with an in-hospital mortality rate of 4-7%, a 2-3-month post-discharge mortality of 7-11%, and a 2-3-month readmission rate of 25-30%. The majority of patients have a previous history of heart failure and present with normal or increased blood pressure, while about half of them have a preserved left ventricular ejection fraction. A high prevalence of cardiovascular or non-cardiovascular comordid conditions is further observed, including coronary artery disease, arterial hypertension, atrial fibrillation, diabetes mellitus, renal dysfunction, chronic lung disease, and anaemia. Different classification systems have been proposed for acute heart failure, reflecting the clinical heterogeneity of the syndrome; the categorization to acutely decompensated chronic heart failure vs de novo acute heart failure and to hypertensive, normotensive, and hypotensive acute heart failure are among the most widely used and clinically relevant classifications. The pathophysiology of acute heart failure involves several pathogenetic mechanisms, including volume overload, pressure overload, myocardial loss, and restrictive filling, while several cardiovascular and non-cardiovascular causes or precipitating factors lead to acute heart failure through a single of these mechanisms or a combination of them. Regardless of the underlying mechanism, peripheral and/or pulmonary congestion is the hallmark of acute heart failure, resulting from fluid retention and/or fluid redistribution. Myocardial injury and renal dysfunction are also involved in the precipitation and progression of the syndrome.