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  • ISSN: 2333-6676
    Volume 2, Issue 3
    Editorial
    Yavuzer Koza*
    Atrial Fibrillation (AF) is the most common sustained cardiac arrhytmia with a high prevalence in the elderly population [1]. AF is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism [2].
    Gulsin GS*, Clement KD and Anglim N
    The Diagonal Ear Lobe Crease (DELC), or Frank's sign, has long been recognised as a potential marker of coronary artery disease (CAD). Despite its identification over forty years ago [1], few clinicians are aware of the relevance of Frank's sign as a cutaneous indicator of coronary atherosclerosis. In this article, we aim to highlight evidence linking the DELC with CAD. We argue that this easily identifiable yet easily missed sign provides a valuable contribution to the practitioner in his assessment of patients at risk of ischaemic heart disease.
    Case Report
    Nicola Alessandri*, Claudia Iannone, Angela Dei Giudici, Emiliano Coletta, Antonella Maddaluno, Flavia Tersigni, Michela D'Ascanio, Flavio Moscariello, Fabrizio Tufano and Bich Lien Nguyen
    Abstract: In this article are reported hypokinetic arrhytmias (asystole or AVB 3°) arising after several months from ablation procedure that needed definitive pacemaker implantation. These events, coming in patients submitted to ablation of left atrial roof and cavotricuspid isthmus area could be considered, primarily, complications of ablation. However, their appearance long time after the RF-TCA let us to consider them autonomic and independent events.
    The observation of these events opens a patho-physiological discussion in relation to current knowledge and we suggest these three hypothesis: a) "Electric remodelling as a result of ablation procedure"; b) "Development of the natural history of AF"; c) "Random observation".
    Review Article
    Joel M Kupfer*
    Abstract: Oral Anticoagulation (OAC) therapy is an effective medical therapy to reduce the risk of cardioembolic strokes related to atrial fibrillation. However, OAC therapy has limitations that include poor follow-up and pharmacotherapy monitoring, bleeding complications, or a reluctance to continue with therapy because of concerns with the potential risk of bleeding. The majority of strokes in atrial fibrillation are believed to arise from thrombi originating within the Left Atrial Appendage (LAA). Therefore, devices that occlude or ligate the LAA is one potential strategy to offer patients an alternative to chronic OAC therapy. The focus of this review is on surgical techniques and percutaneous methods for closing the LAA. Particular emphasize is the evidence of efficacy of these procedures compared to dose-adjusted warfarin. The limitations of the available evidence are critically reviewed.
    Ângela Martins1, Lia Marques2* and Paulo Batista2
    Abstract:
    Introduction: A Thoracic Aortic Aneurysm (TAA) is a condition with a high mortality rate, which is associated with atherosclerosis, age, infection, inflammation, trauma, congenital abnormality or degeneration. The main treatment is conventional Surgery and there is an emerging technique, Thoracic Endovascular Aortic Repair (TEVAR). The latter is a non-invasive procedure, quickly adopted by clinicians for the endovascular treatment of TAA.
    Purpose: The purpose of this review article is to highlight the advantages and the appropriateness of the use of Doppler ultrasound in the early detection and follow-up of endoleaks after TEVAR compared with other imaging techniques.
    Methods: We conducted a review of the literature, based on the keywords: aneurysm, TEVAR, endoleak, follow-up, imaging techniques, Doppler ultrasound. We used PubMed and B-on data, where 48 articles were selected, 27 of these were analyzed because they corresponded to the keywords above.
    Development: The main complication inherent in TEVAR, is the formation of endoleaks. Thus, it is extremely important to employ different imaging techniques. Computerized tomography (CT) is the Gold Standard in the detection and identification of endoleaks. Doppler ultrasound has been recognized as a good choice for this technique due to its low cost, easy interpretation and implementation and lack of exposure to any type of radiation.
    Conclusion: Doppler ultrasound is an imaging technique of high quality and comparable to CT in the measurement of aneurysm, endoleak after TEVAR identification and can be used for surveillance and follow-up.
    Research Article
    Maria Maiello, Annapaola Zito, Marco Matteo Ciccone and Pasquale Palmiero*
    Abstract:
    Objectives: Our study describes the prevalence of co-morbidity and clinical coexisting conditions in a population of post-menopausal women, partially affected by Coronary Artery Disease (CAD), with the specific purpose to lead to think over modifying clinical decision-making and potentially informing on the management of women on CAD affected by co-morbidity.
    Patients and Methods: Among 8555 consecutive women, 6535(76,4%) were on menopause, clinical history was collected by trained nurses. Conditions that are likely to affect the clinical course or ability to treat CAD were considered, focusing on that which is relevant when making decisions related to prescribing medications or other treatments or achieving adherence. They were grouped into chronic disease as Congestive Heart Failure (CHF), stroke and Chronic Lower Respiratory Tract Disease (CRD); and clinical coexisting conditions as hypertension, diabetes mellitus, dizziness or falls, low Glomerular Filtration Rate (GFR), assumption of more than 4 medications, urinary incontinence and warfarin use. The diseases here studied are leading causes of death or morbidity and interacts with CAD, CAD treatments or their treatments interacts with CAD. About clinical conditions they may affect function and quality of life, affect a person's ability to adhere to therapy, and are often caused by several processes in post-menopausal women.
    Results: 528 women (8,1%) were affected by CAD,6007 were not. People with CAD were more likely to be slightly older, but not in a statistical significant way. All co-morbid chronic diseases and two of clinical conditions considered were statistically significant and more prevalent for women with CAD than for their counterparts without CAD. The prevalence of diseases in postmenopausal women with CAD was for: CHF 9,1%(p<0,02); stroke 6% (p<0,01) and CRD 6,5%(p<0,04); the prevalence of coexisting clinical conditions, was for: hypertension 58.9% (p<0,5); diabetes 32,4%(p<0,1); dizziness or falls 0,6 (p<0,02); low GFR 0,9%(p<0,004); use of more than four medications 73,4%(p<0,2); urinary incontinence 17%(p<0,2) and for use of warfarin 2,3%(p<0,01). 99 women affected by CAD had at least one more chronic disease (18,1%).
    Conclusion: Complexity of clinical management for postmenopausal women with CAD is an ongoing rule. Guidelines focused on single diseases do not apply well to those with co-morbidity. Our findings support the idea that the complexity of a persons' health status can be better understood using a framework that incorporates all diseases paying attention to co-morbidities. Understanding how to, best care for women with CAD , in terms of all of their health needs, may lead to improvements in quality of life, use of health care, safety, morbidity, and mortality.
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