简介：BackgroundThevideo-assistedthoracoscopicsurgicaltechniquesarewidelyusedinthetreatmentofpatientswithcongenitalheartdiseaseswithgoodoutcomes.However,thefeasibilityandsignificanceofnursebasedearlycardiacrehabilitationincardiacintensivecareunit(ICU)forpatientswithtotallythoracoscopiccardiacoperationhasbeenseldomstudied.MethodsThirty-sixpatientswithtotallythoracoscopiccardiacoperationundertheconditionofthecardiacICUinGuangdongGeneralHospitalwererandomallocatedtotheinterventiongroupandthecontrolgroupbetweenJanuary2012toDecember2014.Thecontrolgroupreceivedstandardnursingcare,andtheinterventiongroupreceivedearlycardiacrehabilitationnursingcareinadditiontostandardcare.Theoutcomemeasuresincludedtheoxygensaturation(SpO2%),vitalcapacity,forcedexpiratoryvolumein1second(FEV1),andpaininthethoracicwound(visualanaloguescale,VAS),whichweremeasuredatthebaselineandwithin2-dayafter4-weeknursingcare.Forsafetyreason,wealsomonitoredtherateofperceivedexertion(RPE),heartrate,systemicbloodpressure.ResultsTherewerenon-significantdifferencesbetweenthegroupsinage,sex,totalnumberofcomorbidconditions,totalnumberofmedications,surgicaltime,andanesthetictime(P>0.05).Following4weekstreatment,thecardiopulmonaryfunctionsandVASscorewereimproved(P<0.05)inallgroups.Inaddition,theimprovementsweremoreintheearlycardiacrehabilitationnursecaregroupthaninthecontrolgroup(P<0.05).ConclusionTheearlycardiacrehabilitationnursingcareincardiacICUissafe,feasibleandbeneficialforpatientswithtotallythoracoscopiccardiacoperation.

简介：Over20yearsofresearchhasledtothenowwidelyacceptedroleofcardiacresynchronizationtherapy(CRT)inmedicallyrefractory,mildtoseveresystolicheartfailure(HF)withincreasedQRSduration.Inadditiontoconferringamortalitybenefit,CRThasbeenshowntoreduceHFhospitalizationratesandimprovefunctionalstatusinthispopulation.However,notallpatientsconsistentlydemonstrateapositiveresponsetoCRT.EffortstoimproveresponsetoCRThavefocusedonimprovingpatientselectionandoptimizingdeviceimplantationandfollow-up,therebycorrectingelectricalandmechanicaldyssynchrony.Inthisarticlewereviewthepathobiologyofcardiacdyssynchrony,therationalefortheuseofCRT,thehistoryandthestateoftheartofCRT,andguidelinesandrecommendationsforCRT,whilealsofocusingontheareasofcontroversyandpotentialfutureapplications.

简介：BackgroundBasedonpreviousstudies,afragmentedQRS(fQRS)complex,asapredictivebiomarkerofmyocardialscarringcondition,couldbeusedtopredicttheoutcomesofcardiacresynchronizedtherapy(CRT).However,thisconclusionisstilldebatable.MethodsFiftyischemicornon-ischemiccardiomyopathypatientsfailure(aged65±10yrs,34males,16females)withrefractoryheart,diagnosedbythecriteriaofNewYorkHeartAssociationreceivedCRT.TheECGsof18patientswithafQRScomplex(dividedbyDas)werecomparedwiththoseof32patientswithoutafQRScomplex,whowereevaluatedby12-leadECGbeforeCRT.Thepatientswerefollowedupforsixmonths,and12-leadECGandechocardiographywerereviewed.Atleast15%reductionintheleftventricularend-systolicvolume(LVESV)wasdefinedasrespondersaccordingtothedataobtainedforbetween-groupandintra-groupanalysis.ResultsSixpatients(33.3%)inthefQRSgroupand24patients(75%)inthenon-fQRSgrouprespondedwell.Inaddition,comparisonsofindicatorsfromsurfaceECGandechocardiography6monthsafterCRTshowedthatthenon-fQRSgroupbenefitedfromCRTsignificantlymorethanthefQRSgroup.ConclusionsThefQRScomplexhasgoodpredictivevalueforresponsivenesstoCRT.Non-fQRScomplexpatientswithrefractoryheartfailuremaybenefitmorefromCRT,andthesepatientsneedtoreceivethistreatmentasearlyaspossible.

简介：Sarcoidosisisarareconditionofgranulomatousinfiltrationofmanytissuesofthebody,includingtheheart.Cardiacsarcoidosishasbeenchallengingtostudy,asitisoftenasymptomatic,althoughtheinitialpresentationcanbesuddencardiacdeath.Theincidenceandprevalencerateshavebeendifficulttoestablishandnoexpertagreeduponguidelinesfordiagnosisandmanagementofcardiacsarcoidosisexist,andclinicalmanifestationsarevaried.Thepathophysiologyofgranulomaformationinthemyocardiumaswellasothertissuesisgovernedbyimmuneresponsetosomeenvironmentalantigen.Geneticsisalsothoughttoplayarole,althoughgenealterationshavenotbeenextensivelystudied,andnospecificsetofgeneticmutationshasbeenidentifiedtoaidinidentificationofindividualsatriskofdevelopingdisease.Epigeneticfactorslikelyplayasignificantroleinmodulationofgeneexpressionwithrespecttoimmuneresponse.Thereisnostandardizedscreeningtoolfortheidentificationofcardiacsarcoidosis.Thepresenceofsystemicsarcoidosisandnew-onsetthird-degreeheartblockorventriculararrhythmiaswarrantsfurtherinvestigationforcardiacsarcoidosis.MRIandPETareusefulinhelpingtoidentifycardiacsarcoidosisbutarenotstand-alonetests.Endomyocardialbiopsyisthegoldstandardbuthasalowyieldowingtothepatchynatureofgranulomaformationinthemyocardium.Therapyshouldbeinstitutedearlyandinvolvesimmunosuppressivetherapywithpredominantuseofcorticosteroids.Arrhythmias,eitherventricularorhigh-gradeheartblocks,aremanagedwithdevicetherapy.Clinicalpresentationmaywarrantuseofantiarrhythmicagentsand/orcatheterablation.Survivalanddiseaseprognosisaredependentonearlydiagnosisandtreatment.Thisreviewdetailsthecurrentunderstandingofcardiacsarcoidosisandhighlightsdiagnosticstrategiesandtreatmentwiththeaimofguidingthecliniciantoearlyidentificationofpatientsandimplementationofappropriatemanagementinthisraredi