In acute cardiac care, the timely initiation of life-saving measures proved to be life-saving and requires many organizational and logistic measures. One of such measures is represented by the development and implementation of a regional network dedicated for the treatment of major cardiovascular emergencies, a strategy that proved to significantly reduce mortality rates on short and long term. This review aims to describe the current status in the development of regional networks in three of the main cardiovascular emergencies: acute myocardial infarction, out-of-hospital cardiac arrest, and acute stroke. The concepts demonstrating the utility of such networks, together with their results in reducing cardiac events, are presented in this paper.

The aim of this study was to demonstrate that the transluminal contrast attenuation gradient (TAG), a new CT imaging-derived marker of functional significance of a coronary stenosis, is directly associated with the vulnerability degree of atheromatous coronary plaques. Material and methods: This is a prospective study on 21 patients with 30 atheromatous plaques in the coronary arteries, who underwent cardiac computed tomography angiography (CCTA) for assessment of coronary plaques. Results: Twelve plaques were classified as vulnerable (40%) and 18 plaques (60%) as non-vulnerable. Plaques associated with a TAG value above 10 HU exhibited in a significantly higher proportion CCTA markers of plaque vulnerability, as compared to plaques in which the attenuation gradient was below 10 HU. TAG values >10 HU were associated with a higher amount of plaque volume (107.4 ± 91.2 mm3 vs. 56.0 ± 37.5 mm3, p = 0.009), necrotic core (32.5 ± 36.9 mm3 vs. 3.1 ± 3.2 mm3, p = 0.0003), and fibro-fatty tissue (17.7 ± 16.3 mm3 vs. 4.0 ± 2.6 mm3, p = 0.0002), as compared to those lesions with TAG values below 10 HU. Linear regression analysis revealed a significant correlation between TAG values and CCTA features of plaque instability: necrotic core (r = −0.73, p <0.0001), fibrofatty tissue (r = −0.63, p = 0.0002), and plaque volume (r = −0.48, p = 0.006). Conclusions: In patients with coronary artery disease, contrast attenuation gradient along the coronary plaques, determined by CCTA, correlates with CT markers of plaque vulnerability. Vulnerable coronary plaques are associated with a higher functional significance than the stable ones with a similar anatomic profile.

Background: Critical coarctation of the aorta is the most common congenital heart disease with ductal-dependent systemic circulation. In severe forms, this disease represents a critical condition, which can become life-threatening. The aim of this study was to evaluate the usefulness of different echocardiographic parameters in the prediction of aortic coarctation in newborns. Material and method: This is a retrospective study performed by reviewing echocardiographic images of both pre-term and full-term newborns presented with aortic coarctation to the emergency room of a clinic of pediatric cardiology. Based on echocardiographic measurements, both the common carotid artery-subclavian artery index (CSAi) and the aortic isthmus-descending aorta index (I/D) were calculated. Results: Fifty-two newborns presented in acute settings with aortic coarctation and were included in the study, divided into: subgroup 1 (n = 26) – ductal-dependent aortic coarctation; subgroup 2 (n = 2) – non-ductaldependent aortic coarctation; and subgroup 3 (n = 24) – unconfirmed aortic coarctation. ROC analysis identified a cutoff value of 1.37 for the CSAi index and a cutoff value of 0.46 for the I/D index as being associated with the highest predictive power for the diagnosis of aortic coarctation. Conclusions: The CSAi and I/D indices are simple and accessible echocardiographic parameters that can provide supplemental information for the pediatric cardiologist in acute cases of newborns with suspicion of aortic coarctation. These new indices can contribute to the decision-making process in case of pre-term and full-term newborns with suspicion of coarctation of the aorta, independent of the presence of persistent ductus arteriosus.

Pulmonary embolism (PE) is one of the most severe conditions encountered in the emergency department (ED) and one of the leading causes of cardiovascular morbidity and mortality, especially in patients presenting with hemodynamic instability, right ventricular dysfunction, or necessitating cardiopulmonary resuscitation. The early recognition and treatment of PE is essential, as many studies demonstrated that mortality rates drop significantly if adequate therapy is administered from the early stages. The aim of this update is to summarize the various patterns of PE presentations in the ED.

Truncus arteriosus (TA) or common arterial trunk is a rare malformation, accounting for 0.21 to 0.34% of congenital heart diseases, which, if left untreated, leads to increased mortality rates. The condition is characterized by the presence of a unique arterial trunk that overrides the interventricular septum. Despite an overall poor outcome, few subjects present in emergency settings with signs suggestive for pulmonary arterial hypoplasia and associated heart failure. We report the case of a 31-year-old female patient who had been previously diagnosed with pulmonary atresia and severe scoliosis as an infant, presenting in the emergency department with clinical sings of decompensated heart failure which were demonstrated to be attributable to the severe cyanogenic heart malformation and were reversible after initiation of appropriate therapeutic measures.