Abstract：
:In Part 1 of this review, we discussed how plaque rupture is the most common underlying cause of most cases of unstable angina/non-ST-segment-elevation myocardial infarction (UA/NSTEMI) and how early risk stratification is vital for the timely diagnosis and treatment of acute coronary syndromes (ACS). Now, in Part 2, we focus on the medical therapies and treatment strategies (early conservative vs early invasive) used for UA/NSTEMI. We also discuss results from various large randomized controlled trials that have led to the contemporary standards of practice for, and reduced morbidity and death from, UA/NSTEMI. In summary, ACS involving UA/NSTEMI is associated with high rates of adverse cardiovascular events, despite recent therapeutic advances. Plaque composition and inflammation are more important in the pathogenesis of ACS than is the actual degree of arterial stenosis. As results from new trials challenge our current practices and help us develop the optimal treatment strategy for UA/NSTEMI patients, the cornerstones of contemporary treatment remain early risk stratification and aggressive medical therapy, supplemented by coronary angiography in appropriately selected patients. An early-invasive-treatment strategy is of most benefit to high-risk patients, whereas an early-conservative strategy is recommended for low-risk patients. Adjunctive medical therapy with acetylsalicylic acid, clopidogrel or another adenosine diphosphate antagonist, glycoprotein IIb/IIIa inhibitors, and either low-molecular-weight heparin or unfractionated heparin, in the appropriate setting, further reduces the risk of ischemic events secondary to thrombosis. Short- and long-term inhibition of platelet aggregation should be achieved by appropriately evaluating the risk of bleeding complications in these patients.
journal_name
Tex Heart Inst Jjournal_title
Texas Heart Institute journalauthors
Sami S,Willerson JTsubject
Has Abstractpub_date
2010-01-01 00:00:00pages
262-75issue
3eissn
0730-2347issn
1526-6702journal_volume
37pub_type
杂志文章,评审abstract：:A successful cardiac transplant starts with the selection of an appropriate donor. Once consent to organ donation has been obtained, the donor should be managed aggressively in order to maintain optimal organ function. In the case of multi-organ donation, the heart is the first organ to be prepared, as well as the fir...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：1987-12-01 00:00:00
abstract：:The efficiency and risks of a method that allows closed-chest decannulation of an intraoperatively inserted cardiac-assist balloon catheter are examined. The technique involves direct insertion of the balloon catheter into the ascending aorta under the protection of an indwelling silastic tourniquet. At the discretion...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：1992-01-01 00:00:00
abstract：:In our experience, single-stage open repair of descending thoracic or thoracoabdominal aortic aneurysms with concurrent aortic arch disease is technically feasible via a high left thoracotomy or a thoracolaparotomy. Distal aortic and antegrade brain perfusion, in combination with brain and spinal cord protection, seem...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：2010-01-01 00:00:00
abstract：:In recent years, researchers have investigated the relationship between biological markers of inflammation and prognosis in patients who experience acute coronary syndromes; however, the association between plasma fibrinogen and coronary heart disease is still not clear. We studied the prognostic value of fibrinogen, ...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：2010-01-01 00:00:00
abstract：:Contrast echocardiography is recognized to be a safe, effective technique for evaluating the endocardial border and left ventricular function in patients who have suboptimal non-contrast echocardiograms. However, its use in diagnosing right-heart conditions is less well established. Herein, we report our experience wi...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章,评审
doi：
更新日期：2008-01-01 00:00:00
abstract：:We report a case of an 11-year-old girl who presented with a slowly enlarging mass in the right posterolateral chest wall. Computed tomography showed a soft-tissue mass 8.5 × 7.5 × 5.5 cm in size, arising from the right posterolateral 9th, 10th, and 11th intercostal spaces. Magnetic resonance imaging confirmed a vascu...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：2010-01-01 00:00:00
abstract：:Atrial myxoma is the most common primary cardiac tumor. Patients with atrial myxoma typically present with obstructive, embolic, or systemic symptoms; asymptomatic presentation is very rare. To our knowledge, isolated association of atrial myxoma with hypertrophic cardiomyopathy has been reported only once in the Engl...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：2013-01-01 00:00:00
abstract：:We discuss the case of a 38-year-old black man who presented at our hospital with his first episode of syncope, recently developed atrial arrhythmias refractory to pharmacologic therapy, and a left atrial thrombus. He was diagnosed with primary cardiac sarcoidosis characterized by predominant involvement of the epicar...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章,评审
doi：10.14503/THIJ-14-4792
更新日期：2016-06-01 00:00:00
abstract：:We report the case of a 65-year-old man who presented with an infrarenal aortic aneurysm in association with a congenital right pelvic kidney vascularized by 2 aortic arteries, 1 of which arose from the aneurysmal aorta and the other from the common right iliac artery. Successful surgery consisted of excising the aneu...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章,评审
doi：
更新日期：1997-01-01 00:00:00
abstract：:Understanding plaque formation in patients at risk for coronary artery disease-the leading cause of morbidity and death in the world-enables physicians to better determine whether and how to treat these individuals. We used computed tomographic angiography to quantitatively evaluate the progression of nonculprit coron...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：10.14503/THIJ-16-5805
更新日期：2017-10-01 00:00:00
abstract：:Alternans of the ST segment is sometimes observed in experimental studies but is rarely seen in the clinical setting. Described is a case of exercise-induced ST segment elevation alternans that was successfully treated with transluminal coronary artery angioplasty. Theories regarding the cause and mechanism of this ph...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：1983-06-01 00:00:00
abstract：:The Bentall procedure is the standard operation for patients who have lesions of the ascending aorta associated with aortic valve disease. In many cases, however, mechanical prosthetic conduits are not suitable. There are few reports in the English-language medical literature concerning the mid- to long-term outcome o...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：2004-01-01 00:00:00
abstract：:Lyme disease is the most prevalent tick-borne disease in the United States. It is caused by the spirochete Borrelia burgdorferi. Cardiac involvement is seen in 4% to 10% of patients with Lyme disease. The principal manifestation of Lyme carditis is self-limited conduction system disease, with predominant involvement o...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：10.14503/THIJ-14-4126
更新日期：2015-06-01 00:00:00
abstract：:This report describes the case of a 61-year-old woman who presented with dyspnea, aortic stenosis, and coronary artery disease-typical side effects of radiation therapy for Hodgkin lymphoma. A poor candidate for surgery, she underwent successful high-risk percutaneous coronary intervention and subsequent transcatheter...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：10.14503/THIJ-16-5806
更新日期：2016-08-01 00:00:00
abstract：:A simple technique of controlling a bleeding aortic cannulation site employing autogenous tissue is described in which 3-0 Prolene suture is placed through the lateral pericardial tissue on both sides of the aortotomy closure in a horizontal mattress fashion. This technique is advantageous because of the availability ...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：1986-06-01 00:00:00
abstract：:The clinical presentation of the bronchogenic cyst is variable, from respiratory distress at birth to late appearance of symptoms. In order to determine clinical features and treatments, we retrospectively studied the medical records and pathology reports of all patients with bronchogenic cysts (n = 22) referred to ou...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：2003-01-01 00:00:00
abstract：:Matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) are thought to be associated with coronary artery disease. The association of these markers with incident coronary artery disease has not been well described. Using a case-cohort design, we selected 216 individuals who had inci...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：2008-01-01 00:00:00
abstract：:From March 2004 through October 2007, we prospectively evaluated the benefits of cardiac resynchronization therapy as an adjunct to conventional procedures in patients who were undergoing surgery for heart failure.Twenty severely symptomatic patients (14 men and 6 women, with a mean age of 70 +/- 8 years) who displaye...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：2008-01-01 00:00:00
abstract：:Newer generations of assist devices for postcardiotomy support in patients with ventricular failure have eliminated bearings and incorporated suspended impellers, smaller cannulae and hardware, and simplified insertion techniques. We describe the use of a surgically implanted, percutaneous, continuous-flow centrifugal...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：2007-01-01 00:00:00
abstract：:Most reports of coronary artery bypass grafting in adult patients with dextrocardia have focused on the surgeon's position with respect to the operating table. Herein, we describe the cases of 2 patients with dextrocardia who underwent surgery at our own institution, then discuss preoperative evaluation, surgical appr...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：2010-01-01 00:00:00
abstract：:Using continuous-wave Doppler echocardiography, we evaluated the mitral flow velocity pattern in 30 ventricular septal defect patients, 11 of whom had severe pulmonary vascular obstructive disease (Group I); 10 of whom had severe pulmonary hypertension without pulmonary vascular obstructive disease (Group II); and 9 o...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：1989-01-01 00:00:00
abstract：:Disease or dysfunction of the aortic valve in pediatric patients presents a substantial challenge. Valve preservation, even if not the definitive solution, is always optimal. Successful repair will enable somatic growth and avoid repeated valve replacement and the need for systemic anticoagulation. When repair of the ...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：2010-01-01 00:00:00
abstract：:Serial measurements of coronary plaque volume have been used to evaluate drug efficacy in atherosclerotic progression. However, the usefulness of computed tomography for this purpose is unknown. We investigated whether the change in total plaque volume on coronary computed tomographic angiography is associated with th...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：10.14503/THIJ-15-5212
更新日期：2018-04-07 00:00:00
abstract：:Tricuspid regurgitation secondary to percutaneous lead extraction is uncommon, and it rarely requires surgical intervention. Most tricuspid regurgitation occurs during the implantation of tined leads, which can be entrapped in the tricuspid valve apparatus and may require immediate withdrawal. Severe tricuspid regurgi...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章,评审
doi：
更新日期：2011-01-01 00:00:00
abstract：:Pseudoaneurysms of the ascending aorta after the original inclusion/wrap technique of the Bentall procedure present a difficult surgical management problem and are associated with substantial morbidity and mortality. Patients with Marfan syndrome frequently develop aneurysms and dissections that involve multiple aorti...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：2003-01-01 00:00:00
abstract：:The central question that faces coronary laser investigators is whether interaction between laser energy and target tissues can be controlled in a dynamic in vivo environment. In considering this question, the author reviews the in vitro and in vivo experiments that his center carried out before it began using laser a...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：1989-01-01 00:00:00
abstract：:Hemangiomas of the heart are extremely rare. The prognosis is quite variable, because this benign tumor may grow, involute, or stop growing; therefore, resection is usually the treatment of choice. In patients with tumors of the left atrium, percutaneous balloon mitral valvulotomy is generally contraindicated. Yet for...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：2010-01-01 00:00:00
abstract：:Three patients with ventricular septal defect and coarctation of the aorta were treated successfully by simultaneous correction of both anomalies through a single incision via a left transsternal anterolateral thoracotomy. (Texas Heart Institute Journal 1994; 21:158-60) ...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：1994-01-01 00:00:00
abstract：:To evaluate the possibility of providing, in vitro, an endothelial lining for artificial hearts, we cultivated adult autologous endothelial cells on two polyurethane and two silicone rubber surfaces. Over the ensuing 11-day period, we investigated the resulting cell proliferation and morphology by means of scanning el...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：
更新日期：1987-06-01 00:00:00
abstract：:We reviewed the cases of 100 patients (mean age, 73 ± 10 yr; 64 men) who had mitral valve replacement with a Medtronic Mosaic porcine bioprosthesis from 1995 through 2011. The mean New York Heart Association (NYHA) class was 3 ± 0.7, and 52 patients were in atrial fibrillation. Prosthetic sizes were chiefly 27 mm (50 ...
journal_title：Texas Heart Institute journal
pub_type： 杂志文章
doi：10.14503/THIJ-14-4407
更新日期：2016-02-01 00:00:00
