By Aung Myat, Shouvik Haldar, Simon Redwood
This case-based studying e-book information 25 difficult situations in cardiovascular drugs protecting all subspecialty parts of cardiology. it's designed for use by way of trainees yet every one case is supported by means of the observation of a popular professional within the box, permitting readers to enhance their very own administration of those patients.
As the reader works via each one case there are 'Clinical Tips', 'Learning issues' and 'Landmark Trial Summaries' to augment the educational approach in addition to the 'Expert Commentary', offering an within song on how the specialists technique a majority of these difficult cases.
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Additional resources for Challenging Concepts in Cardiovascular Medicine: Cases with Expert Commentary
26 Daemen J, Kuck KH, Macaya C, et al. Multivessel coronary revascularization in patients with and without diabetes mellitus. 3-year follow-up of the ARTS II trial. J Am Coll Cardiol 2008; 52: 1957–1967. 27 Serruys PW, Morice M-C, Kappetein AP, et al. for the SYNTAX Investigators. Percutaneous coronary intervention vs coronary artery bypass grafting for severe coronary artery disease. N Engl J Med 2009; 360: 961–972. 28 Sianos G, Morel M-A, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease.
Clinical tip A negative 12-hour troponin and normal resting ECG do not equate to low risk When assessing patients with probable cardiac chest pain, it is essential to take every facet of the history, examination, observations, and investigations into consideration. It is clear from the history that this patient has presented with a troponin-negative unstable angina (UA) and has at least three risk factors for the development of signiﬁcant CHD. Ensure you document the use of established therapeutic decisionmaking tools such as the TIMI or GRACE risk scores.
Furthermore, in the six trials (AWESOME, BARI, EAST, ERACI II, MASS II, and RITA) that reported outcome data on a diabetic subgroup, CABG did not confer an overall survival advantage over PCI. This is in contrast to the individual BARI trial findings [15,16], which have been the cause of much debate and have ultimately led to the initiation of ongoing RCTs comparing CABG to PCI in diabetics. Diabetic patients tend to be associated with smaller vessel calibre, greater plaque burden, longer lesion lengths, and possibly a different restenotic cascade when compared to non-diabetic patients.