bluuebunny/crossref_metadata_2025_split huggingface dataset:
NURSING COUNSELING FOR THE OPTIMIZATION OF THE REMOTE MANAGEMENT OF PATIENTS WITH ILR AFTER CRYPTOGENIC STROKE
Authors: Bruno R , De Marco G , Affuso N , Chiarello O , De Fazio D , Mazzei E , Fortuna C , Tomaselli C , Talarico A , Quirino G 
Published: May 2024

Abstract

Background
ILR is a device used to diagnose and document cardiac rhythm disorders in various clinical contexts including syncope and CS. The ILRs can be remotely monitored through a dedicated system consisting of a fully automatic home monitor or, in the latest generation devices, throughan APP that can be downloaded by the patient on his mobile phone. ILR remote monitoring can be performed by the nurse after acquiring the necessary skills on system functioning and knowledge about heart rhythm disorders.

Methods
Since 2017, a collaboration between Cardiologists and Neurologists has been established at our hospital providing a shared protocol for the management of patients with CS implanted with an ILR to detect asymptomatic AF. All CS patients referred for ILR implantation at our center received a MEDTRONIC ILR and were equipped with a remote monitoring system. ILR management protocol includes a first phase after the implant, where the nurse carries out patient training and counseling; enters all data in the Medtronic Carelink website, provides the patient with the home monitor, clearly explaining its use at home and, finally, obtains patient informed. Second phase of the protocol includes patient FU management, where the nurse reviews all remote transmissions, identifies any arrhythmic events and contacts by phone the patient to evaluate symptoms and, in case,establish the date for FU.

Results
Since 2017, 70 pz with CS (mean age:65±9 years,67.24% with CHADS2–VASc Score &gt;=4) underwent ILR implantation.ILR remote monitoring allowed the diagnosis of AF in 27% pz (asymptomatic in 72%), of bradyarrhythmia in 4% and VT in 2%. Patients with arrhythmic diagnoses were contacted for FU in H to set up appropriate intervention. In described care pathway, the training and counselling carried out by nurses after the implant was crucial to establish the relationship of trust between patient and nurse, which significantly improved patient compliance.

Conclusions
The use of ILR has allowed to detect arrhythmias, even when asymptomatic, in patients affected by CS. In our experience, remote monitoring managed by trained nurses was crucial for the early diagnosis of AF. However, since technology is rapidly evolving, training updates to nurse staff regarding remote monitoring systems are essential to improve the counselling. Teamwork and constant cardiologist–nurse communication proved to be fundamental in offering the best care to these patients.
WHAT IS THE EXPERIENCE OF CARDIAC SURGERY PATIENTS REGARDING THE NURSING CARE THEY RECEIVE? SCOPING REVIEW
Authors: Ulisse A , Moro A , Magon G , Cislaghi A , Stella M , Bonino E , Caccamo D , Dimito M , Adamini L 
Published: May 2024

Abstract

Introduction
The patient experience is recognized as a key indicator of the quality of healthcare. Patients‘ expectations and experiences significantly influence health outcomes, including the effects of treatments in specialized settings, such as cardiac surgery. Cardiovascular disease is one of the world‘s major public health problems, and people who survive a heart attack become ‘chronically ill‘, resulting in economic costs to society.

Aim
The aim of this scoping review is to investigate and highlight the experiences of patients undergoing cardiac surgery, identifying which factors are considered significant and which have led to patient discomfort, in order to improve nursing care.

Methods
A scoping review was conducted in June and July 2023 and the scoping followed the guidelines outlined by Joanna Briggs Institute. The drafted review protocol is aligned with the PRISMA guidelines. The search for relevant articles was conducted using 6 databases (PubMed, Cinahl, Web of Science, PsycInfo, Scopus, Embase), and articles extracted from secondary bibliographies were also considered. All paper with a qualitative approach, as this is the methodology that provides the best understanding of the patient experiences about nursing care, written in Italian or in English, in the field of cardiac surgery and referring to the review question were included.

Results
The analysis of the qualitative data extracted from the 43 articles identified 4 themes – communication, perceived professionalism, nurse–patient relationship, patient needs, and criticality – and 43 subthemes, which were differentiated into 16 "positive" and 27 "negative" subthemes, depending on the meaning reported by patients. For each subtheme, the frequency of recurrence was calculated since they do not all have the same weight and recurrence.

Conclusions
This review has extrapolated from the patient experience which areas of nursing care are considered significant by patients and which need improvement and more attention. In order to increase personalized and patient–centered nursing care, it is now necessary to consider the experiences, and emotions of patients undergoing cardiac surgery to nip worries and anxieties in the bud, promote rapid recovery in the postoperative period, and foster improvement in the quality of nursing care.
MYOCARDIAL INFARCTION DUE TO LEFT CIRCUMFLEX ARTERY OCCLUSION: A SUBTLE TROJAN HORSE
Authors: Ottaviani A , Foglietta M , Ricci F , Zimarino M , Renda G , Gallina S 
Published: May 2024

Abstract
A 47–year–old man presented to the emergency department complaining of recurrent chest pain (CP) since the previous day. His medical history included active smoking and dyslipidemia. The ECG revealed sinus bradycardia (56 bpm) with widespread ST elevation, consistent with benign early repolarization, and hyperacute and broad–based T waves in V2–V3 (Fig. A). The echocardiography showed normal left and right ventricular systolic function and no valvular abnormalities. A low but abnormal initial high–sensitivity cardiac troponin I value (40 pg/mL, normal range: 1.7– 34,2 pg/mL) and a slightly and early increase after two hours (52 pg/ml) were seen. Therefore, the patient was admitted to our intensive cardiac care unit (ICCU) with a working diagnosis of non–ST–segment elevation myocardial infarction (NSTEMI). No sign or symptoms of heart failure on physical examination were recorded. GraceScore 2.0 was calculated as 68 points and coronary angiography was organized within 24h. Two hours after admission to the ICCU, the patient experienced a new episode of CP. Consequently, ECG and echo were repeated. Compared to the previous results, ECG showed dynamic changes in V2–V3, with the resolution of hyperacute T waves (Fig B); bedside echo remained unchanged. Considering the unresponsiveness to nitrate therapy, the cath lab was activated for a time–dependent coronary angiography. The exam showed an acute total thrombotic occlusion of the mid–segment of the circumflex branch (LCx) in the setting left–sided dominant circulation. A drug eluting stent was deployed into the culprit lesion (Fig. C), and the coronary flow was restored completely (TIMI Flow 3). The subsequent hospital stay proceeded without complications. The peak troponin level was 60’000 pg/ml. The patient was discharged on the fifth day, asymptomatic and hemodynamically stable, with instructions to continue dual antiplatelet therapy. The case report focuses on the electrocardiographic and angiographic expression of LCx total occlusion. Despite acute myocardial infarction (AMI) size was large, as confirmed by the abnormal troponin I values and the angiographic total occlusion, the first and the repeated ECGs showed only vague repolarization changes without clear ST–segment modifications. LCx occlusion is often characterized by the absence of significant ST–elevation, therefore categorized as NSTEMI. Greater awareness of the presentation of LCx–related AMI can be crucial to avoid delays in reperfusion.
HOSPITAL READMISSION PREVENTION IN PEOPLE WITH HEART FAILURE: NURSING EDUCATIONAL INTERVENTION USING GORDON‘S FUNCTIONAL HEALTH PATTERNS
Authors: Feletto E , Mazzariol E , Moschetta S 
Published: May 2024

Abstract

Background
Heart failure (HF) is a complex clinical syndrome that combines common characteristics that manifest differently in each patient. A personalized educational intervention is essential at the time of discharge to the home to identify the educational needs and resources of the person. It is, therefore, necessary to start from an organized and precise collection of data to adapt the intervention to the needs of the patients, guarantee a good quality of life, and prevent the relapses of chronic pathology.

Objective
The research aims to describe the best educational nursing strategies relating to Gordon‘s Functional Health Patterns for patients with HF upon discharge to prevent readmission.

Methods
A narrative review of the literature was conducted by consulting the MEDLINE (via Pubmed) and Cumulative Index of Nursing and Allied Health Literature (CINHAL) databases, inserting free and MeSH terms. Twenty–eight articles were included in the literature.

Results
The results obtained from the analysis of the materials were divided into two macro areas: the first concerns aspects relating to nursing education according to Gordon‘s Functional Health Patterns; the second concerns the effects of education on hospital readmissions. Compared to Functional Health Patterns, the literature pays little attention to the educational aspects of Sexuality and Reproduction and Values and Beliefs. Although other health problems can be considered a priority, these two elements can be regarded as relevant for the patient to live with the pathology and maintain psychological and relational well–being during treatment and rehabilitation. Furthermore, the literature has underlined how a personalized educational process at discharge helps prevent hospital readmissions due to disease exacerbation within 30 days.

Conclusions
According to Gordon‘s Functional Health Patterns, the organization of nursing data can help the professional plan an effective educational intervention. Furthermore, this last moment of care is crucial in preventing hospital readmissions and guaranteeing the person‘s well–being at home.
CARDIAC CONTRACTILITY MODULATION: AN OPTION FOR CHRONIC HEART FAILURE; A CASE REPORT
Authors: Lamaida N , Cerciello A 
Published: May 2024

Abstract

Introduction
Cardiac resynchronization therapy (CRT) reduces hospitalizations and mortality in patients with advanced heart failure and prolonged QRS duration. In patients with a narrow QRS complex, CRT has failed to reduce the rate of death or hospitalization. Thus, there is an alternative device–based treatment for patients with persistent symptoms despite best medical therapy (BMT). Cardiac Contractility Modulation (CCM) is a relatively new electrical device–based technique proposed for enhancing ventricular contractile strength of the failing myocardium independent of the synchrony of myocardial contraction. In this work, we show the use of CCM therapy in an older patient with non–ischemic dilated cardiomyopathy without indication to CRT, demonstrating the clinical benefit of this novel HF device–based therapy.

Case Report
We present a 72–year–old patient successfully implanted with a cardiac contractility modulation (CCM) system. The patient had arterial hypertension, and a history of chronic heart failure (HF) due to non–ischaemic cardiomyopathy with severe systolic dysfunction (left ventricular ejection fraction [LVEF] 30 %). Due to persistent severe HF symptoms (NYHA class III/IV) despite BMT (bisoprolol 5 mg/die, sacubitril/valsartan 49/51 mg bis in die, SLGT2 inhibitors and eplerenone 25 mg/die), the NT–proBNP value was 1300 pg/mL, and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) score was 80 points. The patient was referred for implantation of a CCM system as a first–line cardiac device treatment. The patient did not fit the criteria for cardiac resynchronization therapy (CRT) due to narrow QRS. At 3–month follow–up, the patient already experienced significant improvements in terms of quality of life with an MLWHFQ score of 20 and a decrease in BNP to 600 pg/mL In addition, no HF–related hospitalizations was observed. At 12–month follow–up, no HF–rehospitalizations occurred and the patient had stable NYHA class II, an LVEF of 40% (an increase in systolic function of the left ventricle using the Simpson biplane method) an MLWHFQ score of 6, an NT–proBNP value of 300 pg/m and stable renal function.

Conclusions
in this report, CCM proves to be an useful and safe HF device therapy for HFrEF not eligible for CRT implantation, led to improved quality of life and a reduction in HF–related hospitalizations in an older patient with HFrEF due to non–ischemic dilated cardiomyopathy.
PERCUTANEOUS MITRAL PLICATION FOR WEANING BY VA–ECMO IN PATIENT WITH OBSTRUCTIVE SAM ASSOCIATED WITH PRECLINICAL PHENOTYPE OF HYPERTROPHIC CARDIOMYOPATHY AND STEMI COMPLICATED BY CARDIOGENIC SHOCK
Authors: Rende G , De Rosa M , Perfetti M , Di Fulvio M , Giuliani L , Rossi S , Aquilani R , Di Pace G , Ricci F , Gallina S , Zimarino M , Appignani M 
Published: May 2024

Abstract
A 53–year–old man with a history of hypertrophic obstructive cardiomyopathy with a preclinical phenotype, classified at low risk of sudden cardiac death (HCM–SCD risk score 2.98%), and cardiac arrest (OHCA) in the absence of a shockable rhythm. The patient underwent cardiopulmonary resuscitation for more than 30 minutes before the diagnosis of complete atrioventricular block, masked by concomitant atrial stand–still, resolved after transcutaneous pacing. After temporary trans–venous cardiac pacing was obtained, the electrocardiogram revealed signs of an extensive anterolateral occlusive infarction (OMI), treated with primary angioplasty during percutaneous ventricular support (Impella CP). The ICU course was characterized by several ineffective attempts to wean from mechanical assistance to the circulation finally made possible by correction of outflow obstruction from mitral SAM, achieved by percutaneous mitral plication with MitraClip system. This case, in addition to suggesting an alternative strategy of weaning from mechanical assistance to the circulation in patients with a similar hemodynamic profile (SCAI D stage cardiogenic shock by dual mechanism: pump dysfunction and outflow obstruction), offers important insights into the management of OCHA in the absence of a shockable rhythm.
ECG SCREENING, HEART RATE VARIABILITY AND SUDDEN CARDIAC DEATH PREVENTION IN ENDURANCE ATHLETES
Authors: Crispino E , Ricciardi D , Liporace P , Sanasi L , Loiacono G , Italiano E , D‘Amore M , Sposito E , Marchi F , Picarelli F , Gioia F , Calabrese V , Ussia G , Grigioni F 
Published: May 2024

Abstract

Introduction
Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. Identifying non–invasive and repeatable risk markers during annual athletes screening remains a goal for the scientific community for the prevention of SCD. The Heart Rate Variability (HRV) has been shown to be an independent predictor of mortality in populations with CVD, but its relationship with SCD has been little explored in those at low risk, including athletes. This study aims to use a 5 minute ECG screening in athletes practicing endurance sports and evaluate its clinical role. The aim of the study is to assess whether morphological and spectral ECG analysis in endurance athletes by the 5–minute ECG screening can add information to periodic screening for the prevention of SCD.

Methods
The study population were selected from Endurance Marathon athletes. A control group was also collected for comparison. The 5 minutes ECG was recorded at rest with the Kardia Mobile 6L. HRV indices were obtained using the Kubios software. A morphological analysis was performed and the HRV parameters were analyzed in the time and frequency domains.

Results
A total of 554 subjects (220 athletes and 334 controls, 325 male and 229 women) were analyzed. A higher incidence of arrhythmic and morphological abnormalities in athletes compared to controls was observed (p&lt;0.05). Athletes had a significantly shorter QTc than the control group, a finding suggestive of greater protection from episodes of malignant ventricular arrhythmias. Th PNS and SNS indices were respectively higher and lower in the athlete group than in the controls, suggestive for higher vagal tone. Given the absence of a normality range of standard HRV parameters in the athlete population, values in the normal range of the 5th to 95th percentile were extrapolated in the whole population for the main HRV parameters. The project, therefore, is to evaluate patients with HRV values higher or lower than 5–95 percentile to identify those deserving further clinical investigations and closer follow–up for suspected increased risk of CVD and SCD.

Conclusions
The 5–minute ECG screening allows a greater number of static and dynamic alterations to be detected; moreover, the analysis of HRV could provide more information, such that it could be considered as a complementary tool during the athlete‘s follow–up. Further long–term prospective studies are needed to correlate alterations in HRV and clinical events.
VAI OF MARSHALL ETHANOL INFUSIONE: SOMETIMES, LESS CAN BE MORE. A CASE REPORT OF SAFETY WITHOUT DECEASING EFFICACY
Authors: Magnano M , Oriente D , Abdirashid M , Rametta F 
Published: May 2024

Abstract
Vein of Marshall ethanol infusion (VoM–EI) is a new therapeutic option effective for decreasing the likelihood of atrial tachyarrhythmias in patients with persistent atrial fibrillation (PAF). Complications related to retrograde EI described in the literature are rare but can have grave consequences for the patient. Our clinical case shows how a careful evaluation of the anatomy of the left atrium venous circulation can significantly reduce the risk of serious adverse events (SAEs). A 64–year–old man underwent a second ablation for symptomatic PAF with VoM–EI. Selective angiography (Fig.1) showed a particular anatomical variant: the VoM (antero–lateral) and a vein of the interatrial septum (postero–medial direction) originated from a posterior and proximal common trunk (CT). A limited perforation of the CT with the wire occurred as shown by the iodine extravasation into the pericardial space: this condition significantly increases the risk of delayed tamponade (DT), the most frequent SAEs related to this procedure. Furthermore, a rare SAEs observed in the literature is the appearance of complete atrioventricular block and has been correlated to the presence of septal collateral branches of VoM with particularly proximal origin (like that of our patient). Then, we decided to exclude the septal branch and VoM perforation from the EI area: an over–the–wire balloon was used to a selective EI in the antero–lateral branch of the CT distal to the perforation (Fig.3). As desired, only the VoM area was involved in the ethanol–related endocardial scarring, but its ventricular aspect was excluded (Fig.2): endocardial and within the coronary sinus RF delivery was therefore necessary to achieve complete conduction block at the mitral isthmus. No conduction disturbances appeared after EI. The patient was discharged 48 hours after the procedure and a weekly echocardiographic control in the month following discharge excluded DT. In conclusion, careful analysis of the anatomy in selected cases must guide the choice of the site of VoM–EI: excluding its most proximal portion can limit the extension of the scar, but can also significantly reduce the risk of severe complications.
BETWEEN SCYLLA AND CHARYBDIS: MULTIPLE LEFT ATRIAL THROMBI DESPITE ORAL ANTICOAGULATION AND ANTIPLATELET THERAPY IN A PATIENT CANDIDATE FOR LEFT ATRIAL APPENDAGE OCCLUSION
Authors: De Marchi A , Raccis M , Sanna G , Decandia F , Navarese E , Casu G 
Published: May 2024

Abstract

Introduction
Left atrial (LA) thrombosis usually occurs in patients affected by atrial fibrillation (AF), generally involving the left atrial appendage (LAA). We present the unexpected echocardiographic finding of multiple LA thrombi despite an adequate antithrombotic strategy.

Case Presentation
A 76–year–old lady underwent transesophageal echocardiographic examination (TOE) to assess eligibility for percutaneous LAA occlusion (LAAO) procedure due to high bleeding risk. Her medical history included AF and a recent percutaneous coronary revascularization; therefore, her antithrombotic therapy included apixaban 2.5 mg bid and clopidogrel 75 mg od. The TOE showed LA structural and functional remodeling with spontaneous echo contrast and multiple thrombi involving the LAA (one [12 x 9 mm] overflowing the orifice and attached to the Coumadin Ridge and the second [12 x 7 mm] attached and arising from the tunnel of patent foramen ovale). Mitral valve stenosis was excluded (Fig.1). Due to TOE findings, the patient was not considered eligible for percutaneous LAAO. Due to the concomitant very high thromboembolic risk, despite the previous intracranial bleeding, we decided to stop apixaban and to start parenteral anticoagulation for 3 weeks with low–molecular weight heparin (100 UI/kg bid) followed by the switch to a vitamin k antagonist (VKA). We also prescribed a hematological evaluation to exclude a hypercoagulability disorder. Our patient’s daughter was a carrier of a mutation in both the methylenetetrahydrofolatereductase and Thrombin genes. A TOE after 30 days showed the persistence of LA thrombi, although with significantly reduced size and mobility (Fig.2). The follow–up was clinically uneventful. We suggested to continue anticoagulation therapy with VKA, and we planned a new TOE after 4 weeks.

Discussion
Although proper anticoagulation decreases cardioembolic risk in patients with AF, atrial thrombosis may occur due to LA remodeling, high CHA2DS2–VASc score and other factors, including hypercoagulability disorders. The presence of multiple LA thrombi represents a challenge for clinicians, especially in case of concomitant high thromboembolic and bleeding risk. However, the best treatment strategies for these extreme conditions are not defined, so far. Therefore, the therapeutic choice is often tailored to the single patient and based on the clinical judgment, bearing in mind that avoiding Charybdis means passing to close to Scylla and vice versa.