Volume 8 • Issue 4 • December 2022 – JCE – Journal of Cardiovascular Emergencies

Self-Care Behaviors in Patients with Hypertension to Prevent Hypertensive Emergencies: a Qualitative Study Based on the Theory of Planned Behavior

Tue, 21 Feb 2023 05:21:47 +0000

ABSTRACT
Background: Hypertension is a crucial general health issue. Severe and acute hypertension needs urgent medical intervention. Self-care behaviors can help patients with hypertension in controlling blood pressure and preventing hypertensive emergencies. This study aimed to determine the perception of hypertension towards self-care behaviors using constructs of the theory of planned behavior (TPB) in critically ill patients with hypertension to prevent hypertensive emergencies. Material and Methods: This study was conducted based on the directed qualitative content analysis of 33 critically ill patients with hypertension who participated in semi-structured interviews and focus group discussions. Results: The data were analyzed based on the four main categories of TPB. The attitude category consisted of positive and negative subcategories. The subjective norms category consisted of authority of healthcare staff, family support and approval, and influence of friends subcategories. The perceived behavioral control category included discipline, self-control, receiving consultation, individual concerns, financial problems, access to medicine, food culture, and coronavirus limitations subcategories. The behavioral intention category had intention to perform the behavior and intention to continue a behavior subcategories. Conclusion: The results revealed the requirement for a multidimensional approach to improve attitude, subjective norms, and behavioral control for performing self-care behaviors to reduce the number of hypertensive emergencies in critically ill patients with hypertension. Factors affecting self-care included socioeconomic status, family support, governmental organizations, and participants’ health condition.

Neutrophil-to-lymphocyte Ratio and Systemic Inflammation Index as Predictors of Poor Outcome in Patients with Critical Limb Ischemia Treated with Remote Endarterectomy

Sat, 21 Jan 2023 05:22:10 +0000

ABSTRACT
Introduction: Severe ischemia occurring in the lower limbs represents the advanced stage of peripheral artery disease (PAD). Atherosclerosis and inflammatory markers have been intensively studied to identify prognostic tools with a role in the evolution of patients with PAD. The aim of this study is to demonstrate the predictive value of systemic inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and the systemic inflammation index (SII) in the prognosis of patients diagnosed with critical leg ischemia (CLI) undergoing infrainguinal surgical revascularization with remote endarterectomy. Materials and methods: This retrospective study included all patients admitted to the Vascular Surgery Clinic of the County Emergency Clinical Hospital of Târgu Mureș, Romania between January 2018 and December 2021, who had critical limb ischemia Leriche-Fontaine stage III and were treated with endarterectomy. Patients were divided into two groups based on the presence or absence of patency in the lower limbs at 12 months. Results: There was a higher baseline value of neutrophil count (p <0.0001), platelet count (p = 0.006), NLR and SII value (p <0.0001), as well as a lower value of lymphocyte count (p = 0.001) in the group without patency at 12 months. The ROC curve analysis showed that the NLR and SII were associated with the risk of major amputation and primary patency failure at 12 months, while multivariate analysis has shown that arterial hypertension (OR 3.63, p = 0.04), history of myocardial infarction (OR 2.93, p = 0.009), diabetes mellitus (OR 2.20; p = 0.04) and smoking (OR 3.48, p <0.0001) were also predictors of primary patency failure. Conclusions: The results of this study demonstrated the predictive role of NLR and SII regarding poor outcomes among patients with CLI Leriche-Fontaine stage III undergoing infrainguinal surgical revascularization with remote endarterectomy.

Arterial Embolic Complications in a Patient with Acute Heart Failure

Annamária Magdás, Andreea Ciacâru, Zsuzsánna Ágnes Szász, Cristian Podoleanu — Thu, 19 Jan 2023 20:05:14 +0000

ABSTRACT
Introduction: In acute heart failure patients, the prothrombotic state is likely due to arterial and venous endothelial dysfunction. Decompensated heart failure appears to also be associated with increased levels of prothrombotic molecules, such as fibrinogen and von Willebrand factor, which also contribute to the prothrombotic state. Case presentation: We present the case of a 72-year-old male patient, admitted for signs of acute heart failure with bilateral ankle edema. Laboratory data showed D-dimer level >5 μg/mL, which raised the suspicion of pulmonary embolism secondary to deep vein thrombosis. Doppler ultrasound performed to exclude a deep vein thrombosis revealed a total occlusion of the superficial femoral artery on the lower left limb and an abdominal aorta with a lumen diameter of 35 mm and a true lumen of 18.6 mm with circular isoechoic material on the aortic wall. The computed tomography angiography described an aneurysm of the abdominal aorta with mural thrombosis extending to the bifurcation level. Conclusion: In patients with acute heart failure, a comprehensive vascular assessment is also needed. The therapeutic management of these patients varies from conservative to endovascular or surgical therapy, but revascularization therapy should be considered based on the patient’s medical condition.

Focal Atrial Tachycardia as Presenting Feature of Left Atrial Myxoma

Hendrianus, Susetyo Atmojo, Rarsari Soerarso Dian Yaniarti Hasanah — Mon, 09 Jan 2023 16:46:04 +0000