Breaking the code: What is the best post‐PCI MI definition?

• Various definitions of post‐PCI MI have been recommended by different professional societies and studies.
• This present study suggests that the troponin‐based 3rd universal definition of post‐PCI MI has prognostic value for recurrent MI but not mortality alone, unlike the CK‐MB based SCAI definition.
• Absent a consensus on the best definition, clinical trials should report outcomes based on multiple definitions of post‐PCI MI.

     

“Typical symptoms in the atypical patient? Consider SCAD!”

• Consider SCAD as a potential etiology of cardiac ischemia in young, otherwise healthy patients
• Cardiac biomarker testing should be included in the initial evaluation of young patients who present with possible cardiac symptoms
• If unstable symptoms/ongoing ischemia are present, cardiac catheterization should be considered to diagnose and treat CAD regardless of etiology

     

Controlling hypertension and reducing its associated morbidity and mortality in the Caribbean: implications of race and ethnicity

Cardiovascular diseases and stroke, especially hypertension, represent a significant global disease burden for both morbidity and mortality, with a disproportionately higher impact in vulnerable low‐ to middle‐income countries. International initiatives such as the Centers for Disease and Prevention and the Pan American Health Organization Standardized Hypertension Treatment Project have been developed to address this burden on the Caribbean and Latin America populations. The disparity in disease burden observed in low‐ to middle‐income countries is explained, in part, by differences in disease risks for different racial and ethnic groups with high blood pressure more prevalent and hypertension‐related morbidity significantly higher in men and women of African heritage. In addition to the race and ethnic differences in indicators of socioeconomic status, access to care and health service delivery, the physiologic mechanism of high blood pressure including salt‐sensitivity, may also play a significant role in the disparities in hypertension and hypertension‐related outcomes. This article focuses on potential racial and ethnic differences in influences on the pathophysiology of hypertension in the Caribbean region of the world. The identification of such differences may be used in the development of population hypertension control strategies and treatment approach that address the excess disease burden in these populations. The consideration of strategies, such as salt reduction and hypertension awareness and treatment, are particularly relevant to the high‐risk Caribbean region.     

Addressing Gaps in Cardiopulmonary Resuscitation Education: Training Middle School Students in Hands‐Only Cardiopulmonary Resuscitation

BACKGROUND

Training middle school students to perform hands‐only cardiopulmonary resuscitation (HOCPR) is a potential method to increase overall rates of bystander cardiopulmonary resuscitation (CPR). We aimed to examine the feasibility of teaching this population CPR using teacher‐implemented education sessions guided by American Heart Association (AHA) training kits and resources.

METHODS

We conducted a national HOCPR training campaign in middle schools during the 2014‐2015 school year. Participating schools utilized AHA CPR training kits to train seventh and eighth grade students. We assessed pretest/posttest knowledge and comfort in performing HOCPR.

RESULTS

We recruited 1131 schools and trained approximately 334,610 students in HOCPR. The average pretest score on knowledge questions was 50% and the average posttest score was 84%. Most students (76%) felt comfortable performing HOCPR after the education session. Overall, 98% of teachers said they would continue to implement CPR training in the future.

CONCLUSIONS

Large‐scale, teacher‐implemented CPR education sessions in the middle school setting are a successful approach to increase middle school student's knowledge and comfort in performing HOCPR and to increase overall bystander CPR rates.

     

Prognosis, risk stratification,and management of asymptomatic individuals with Brugada syndrome: A systematic review

Brugada syndrome (BrS) is a primary electrical disease associated with increased risk of sudden cardiac death due to polymorphic ventricular arrhythmias. The prognosis, risk stratification, and management of asymptomatic individuals remain the most controversial issues in BrS. Furthermore, the decision to manage asymptomatic patients with an implantable cardioverter‐defibrillator should be made after weighing the potential individual risk of future arrhythmic events against the risk of complications associated with the implant and follow‐up of patients living with such devices, and the accompanying impairment of the quality of life. Several clinical, electrocardiographic, and electrophysiological markers have been proposed for risk stratification of subjects with BrS phenotype, but the majority have not yet been tested in a prospective manner in asymptomatic individuals. Recent data suggest that current risk factors are insufficient and cannot accurately predict sudden cardiac death events in this setting. This systematic review aims to discuss contemporary data regarding prognosis, risk stratification, and management of asymptomatic individuals with diagnosis of Brugada electrocardiogram pattern and to delineate the therapeutic approach in such cases.