Aconitine intoxication mimicking acute myocardial infarction

Introduction: Cardiotoxicity in acute aconitine intoxication is well known; however, elevation of troponin I level and abnormal scintigraphy findings had not previously been reported. Case report: A 60-year-old man developed chest tightness, syncope and convulsion after ingesting processed Aconitum carmichaeli (Chuanwu) extract for treatment of headache. Electrocardiogram showed first degree atrioventricular (AV) block. Troponin I level was elevated at 14.8 ng/mL 13 hours post-ingestion. Creatine kinase was also increased to 414 U/L. However, echocardiography did not show any abnormal cardiac wall motion. Tc-99m-PYP scintigraphy revealed diffusely increased uptake in the myocardium, suggesting the presence of myocardial necrosis or myocarditis. Discussion: Aconitine poisoning can mimic acute myocardial infarction with chest tightness and elevated cardiac enzymes. Increased cardiac markers and myocardial insult seen in this patient were likely to be related to the toxicity of aconitine. Care should be taken in making the diagnosis in such instances. Management is primarily supportive.

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Association between the osmotic fragility of erythrocytes and the course of acute myocardial infarction

Complex Issues of Cardiovascular Diseases ◽

10.17802/2306-1278-2021-10-3-6-14 ◽

2021 ◽

Vol 10 (3) ◽

pp. 6-14

Author(s):

A. A. Garganeeva ◽

V. A. Aleksandrenko ◽

E. A. Kuzheleva ◽

V. V. Ryabov ◽

T. Yu. Rebrova ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Myocardial Contractility ◽

Myocardial Injury ◽

Creatine Phosphokinase ◽

Troponin I ◽

Osmotic Fragility ◽

Myocardial Necrosis ◽

Left Ventricular ◽

Erythrocyte Osmotic Fragility

Aim. To investigate the relationship between the osmotic fragility of erythrocytes and the course of acute myocardial infarction (MI).Methods. An analysis of the osmotic fragility of erythrocytes was conducted using beta-blocker-based osmotic fragility test in sixty-two patients within the first 6 hours after onset of MI symptoms.Results. The results revealed that the patients with increased erythrocyte osmotic fragility experienced more complications after acute MI, such as left ventricular failure and cardiac arrhythmias (ventricular extrasystoles and ventricular tachycardia) (p = 0.026). Moreover, these patients exhibited greater myocardial injury - the concentration of biomarkers of myocardial necrosis, such as creatine phosphokinase, creatine phosphokinase MB and Troponin I was increased - p = 0.009, p = 0.032 and p = 0.001, respectively. In addition to that, the patients with high osmotic fragility had a larger number of hypokinetic and akinetic segments, high impaired myocardial contractility index, and low ejection fraction. The impaired myocardial contractility index was significantly higher in patients with increased erythrocyte osmotic fragility (1.5 (1.22; 1.75) vs 1.12 (1.0; 1.56), U = 157.5, p = 0.032).Conclusion. Increased erythrocyte osmotic fragility in patients was associated with greater myocardial injury, manifesting through the higher concentration of biomarkers of myocardial necrosis in blood, as well as higher number of hypokinetic segments.

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High-sensitivity cardiac troponin assays and unstable angina

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872616658591 ◽

2016 ◽

Vol 7 (2) ◽

pp. 120-128 ◽

Cited By ~ 27

Author(s):

Yader Sandoval ◽

Fred S Apple ◽

Stephen W Smith

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Unstable Angina ◽

Cardiac Troponin ◽

Myocardial Injury ◽

Troponin I ◽

Myocardial Necrosis ◽

High Sensitivity ◽

Clinical Context ◽

Over Time

The term unstable angina has been conventionally applied to patients with myocardial ischemia without myocardial necrosis. However, while the clinical context has remained constant over time, the biomarkers of myocardial injury and acute myocardial infarction have evolved. High-sensitivity cardiac troponin assays have several key analytical differences from prior cardiac troponin assay generations, which may alter the diagnosis and frequency of unstable angina, as well as affect our understanding of previously developed risk stratification strategies. This document reviews the current challenges in regards to unstable angina when using high-sensitivity cardiac troponin I and T assays.

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The influence of stress hyperglycaemia on the prognosis of patients with acute myocardial infarction and temporary electrical cardiac pacing

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1008430s ◽

2010 ◽

Vol 138 (7-8) ◽

pp. 430-435 ◽

Cited By ~ 1

Author(s):

Aleksandar Stojkovic ◽

Goran Koracevic ◽

Zoran Perisic ◽

Nebojsa Krstic ◽

Milan Pavlovic ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Ejection Fraction ◽

Hospital Mortality ◽

Troponin I ◽

Myocardial Necrosis ◽

Cardiac Pacing ◽

St Segment Elevation ◽

Glucose Levels ◽

Stress Hyperglycaemia

Introduction. Elevated glucose levels on admission in many emergency conditions, including acute myocardial infarction (AMI), have been identified as a predictor of hospital mortality. Objective. Since there are no data in the literature related to stress hyperglycaemia (SH) in patients with both AIM and temporary electrical cardiac pacing, we aimed to investigate the influence of stress hyperglycaemia on the prognosis of patients with AMI and temporary electrical cardiac pacing. Methods. The prospective study included 79 patients with diagnosed AMI with ST-segment elevation (STEMI), admitted to the Coronary Care Unit of the Clinic for Cardiovascular Diseases, Clinical Centre Nis, from 2004 to 2007, who were indicated for temporary electrical cardiac pacing. The blood was sampled on admission for lab analysis, glucose levels were determined (as well as markers of myocardial necrosis - troponin I, CK-MB). Echocardiographic study was performed and ejection fraction was evaluated by using area length method. Results. The ROC analysis indicated that the best glycaemic level on admission, which could be used as a predictor of mortality, was 10.00 mmol/l, and the area under the curve was 0.82. In the group without SH, hospital mortality was 3-fold lower 11/48 (22.91%) compared to the group with SH 19/31 (61.29%), p<0.0001. Patients with SH were more likely to have higher troponin levels, Killip >1, lower ejection fraction and heart rate, as well as systolic blood pressure. Conclusion. The best cut-off value for SH in patients with AMI (STEMI) and temporary electrical cardiac pacing is 10 mmol/l (determined by ROC curve) and may be used in risk stratification; patients with glucose levels <10 mmol/l on admission are at 3-fold lower risk compared to those with glucose levels >10 mml/l. Our results suggest that SH is a more reliable marker of poor outcome in AMI patients with temporary pace maker, without previously diagnosed DM.

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