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Cardiac troponin (cTn) is mainly used to diagnose acute coronary syndrome (ACS). However, cTn can also be elevated in critically ill patients secondary to demand ischemia or myocardial injury. The impact of cardiology consultation on the clinical outcomes of patients admitted to medical intensive care unit (ICU) with elevated cTn is unclear.A retrospective analysis of medical ICU patients with elevated cTn without evidence of ACS between January 2013 through December 2018. Patients were stratified based on documentation of cardiology consultation. The primary outcome was 1-year mortality. Secondary outcomes were in-hospital and 30-day mortality, the length of stay (LOS), further cardiac testing, 30-day readmission rate, new prescription of cardiac medications, and the predictors of a cardiology consultation.Of 846 patients screened, 766 patients were included, of whom 63.2% had cardiology consultation. Cardiology consultation group had longer median LOS (7 vs. 5 days, P = 0.007), additional cardiac testing (90.3% vs. 67.7%, P 0.001), and more new cardiac medications (52.1% vs. 16.3%, P 0.001). No difference was noted in-hospital mortality (adjusted odds ratio [aOR], 0.6, 95% CI, 0.4-1.1, P = .117), 30-day mortality (aOR = 0.8, 95% CI, 0.5-1.4, P = .425), 1- year mortality (aOR, 1.4, 95% CI, 0.9-2.2, P = .193), or cardiac-specific 30-day readmission rate (aOR, 7.0, 95% CI, 0.7-14.9, P = .137). History of coronary artery disease (CAD) was the most independent predictor for a cardiology consult (aOR, 2.2, 95% CI, 1.3-3.8, P .001).Cardiology consultation for elevated cTn in medical ICU patients was associated with increased cardiac testing and LOS, without significant impact on mortality.

Background There is limited data on the efficacy of direct oral anticoagulants (DOACs) for the treatment of left ventricular thrombus. Currently, vitamin K antagonists (VKAs) remain the preferred oral anticoagulant for left ventricular thrombus. In this retrospective study, we assessed the safety and efficacy of DOACs in comparison to VKAs in patients with a new diagnosis of left ventricular thrombus. Methods We retrospectively identified all patients admitted to the 5 Catholic Health Initiative Omaha hospitals with a diagnosis of left ventricular thrombus between January 2012 and March 2019 and were discharged on oral anticoagulants. Patients were stratified into 2 groups: VKAs or DOACs and followed for up to 1 year. We compared the outcomes of ischemic stroke, bleeding, and echocardiographic resolution of left ventricular thrombus between the 2 groups. Results A total of 99 patients were included in this study (mean age: 61 years, 29% females). Of these, 80 (81%) were discharged on VKAs and 19 (19%) on DOACs. Stroke within 1 year of diagnosis occurred in 2 patients in the VKA group and none in the DOAC group (P = 0.49). Bleeding events were observed in 5 patients (4 in the VKA group and 1 in the DOAC group; P = 0.96). Ninety patients had follow-up echocardiogram; resolution of left ventricular thrombus was similar between the 2 groups (VKAs vs DOACs: 81% vs 80%; P = 0.9). Conclusion In patients with left ventricular thrombus, DOACs and VKAs had similar rates of stroke and bleeding. These findings need confirmation in randomized clinical trials.

Radiation induces complicated vascular occlusions due to scarring, adventitial fibrosis, elastic degeneration, and accelerated atherosclerosis. Such occlusions were typically treated by vascular surgery bypassing the stenosis. However, minimally invasive percutaneous transluminal angioplasty (PTA)

Cardiac troponin (T) is used to diagnose acute coronary syndrome. However, T can also be elevated in critically ill patients secondary to demand ischemia or myocardial injury. The impact of routine cardiology consultation on the clinical outcomes of critically ill patients with elevated T is unclear

Randomized controlled trials have reported 10% to 23% prevalence of anemia in patients undergoing percutaneous coronary interventions (PCI). Current clinical guidelines fail to offer recommendations for its concurrent management in such patients. We conducted meta-analysis to review impact of

Chiropractic therapy (CPT) is a popular physical therapy. Cerebrovascular accidents were reported with neck manipulation (NM), mainly due to vertebral artery dissection. However, it is unclear whether NM could be associated with internal carotid artery atherosclerosis (ICAAS). We present a case of

Contrast induced Nephropathy (CIN) has been associated with morbidity and mortality. Oxidative stress play a major role in development of CIN. Increased Red cell Distribution Width(RDW) has been associated with an inflammatory state and poor outcomes in coronary artery disease (CAD) patients.

Percutaneous intervention in coronary chronic total occlusion (CTO) is generally faced with lots of difficulties and requires special equipment and skills. Among tools that can be utilized during CTO intervention is mechanical atherectomy devices. We systematically searched Pubmed, MEDLINE