scholarly journals The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kristijan B. Todoroski
Keyword(s):  
Acute Coronary Syndrome ◽  
Ecg Changes ◽  
Pain Experience ◽  
Coronary Syndrome ◽  
Pain Scores ◽  
Subjective Pain ◽  
Prospective Trials ◽  
National Emergency ◽  
Fast Acting ◽  
Current Guidelines

Abstract Background Both chewed aspirin and sublingual nitroglycerin are fast acting medications and reach therapeutic levels within a few minutes. Current guidelines for managing acute coronary syndrome (ACS) do not recognize the importance of the order or timing of administering aspirin and nitroglycerin. This retrospective study aimed to examine if there was any benefit to the timing of giving aspirin before or after nitroglycerin in cases of ACS. Methods From the large National Emergency Medical Services Information System (NEMSIS) 2017 Version database, 2594 patients with acute coronary syndrome were identified (based on chest pain and their ECG finding) that received aspirin plus nitroglycerin in prehospital settings. Based on which medication was given first, the patients were separated in 2 groups: an aspirin-first and a nitroglycerin-first group. The 2246 patients who received aspirin first were further stratified based on the time between administration of aspirin and the first dose of nitroglycerin. The other 348 patients who received nitroglycerin first were similarly stratified. Results In patients with STEMI ischemia, giving nitroglycerin 10 min after aspirin dosing (compared to giving them simultaneously) leads to a greater than 20% reduction in need for additional nitroglycerin, a greater than 7% decrease in subjective pain experienced by the patient and reduced need for additional opioids. The aspirin-first group in total, had a 39.6% decrease in subjective pain experience after giving additional nitroglycerin compared to nitroglycerin-first group. Conclusion In patients with ACS, this study found that giving nitroglycerin 10 min after aspirin was associated with a reduction in subjective pain scores, as well as a reduced need for additional nitroglycerin or opioids. Future prospective trials examining the timing of aspirin vs. nitroglycerin are needed to confirm these findings.

Bleeding with Tirofiban During Percutaneous Coronary Intervention

2021 ◽  
Vol 15 (10) ◽  
pp. 2833-2834
Author(s):  
Muhammad Waqas ◽  
Muhammad Shahzad Azeem ◽  
Muhammad Qasim Khan
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Continuous Infusion ◽  
Case Series ◽  
Coronary Intervention ◽  
Male Gender ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Modern Era ◽  
Current Guidelines

Objective: To determine the frequency of bleeding with Tirofiban during percutaneous coronary intervention Methodology: In this case series (Descriptive) at Mayo Hospital, Cardiology Deptt. Lahore during the year 2018 and 2019, we enrolled a total of 385 cases of either gender with acute coronary syndrome(ACS) and undergoing percutaneous coronary intervention(PCI)were included. Preloading with aspirin 300 mg and clopidogrel 600 mg was done. Intravenous Tirofiban was given keeping in mind the current guidelines. Tirofiban was given as I/V bolus of 0.25 mcg/kg over 5 minutes during/before the start of PCI. It was followed by a continuous infusion of 0.125 mcg/kg/min for up to eighteen hours. Bleeding during and within 24 hours of percutaneous coronary intervention was noted according to BARC bleeding type Results: Mean age was 50.750± 5.63years. Male gender was dominant i.e. 85.7% as compare to 14.3% females. Bleeding was observed in 3.9% patients Conclusion: In acute coronary syndrome patients undergoing PCI, Tirofiban use was associated with bleeding. In the modern era of PCI, the judicious use of Tirofiban is safe. Keywords: Percutaneous coronary intervention, Tirofiban, Bleeding, Acute coronary syndrome

scholarly journals To Perform Thrombolysis or Not: A Case of Acute Pancreatitis Presenting with Chest Pain and Transient Left Bundle Branch Block

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
S. Ullah ◽  
S. Mehmood ◽  
H. A. Chatha ◽  
A. Mahmood
Keyword(s):  
Acute Pancreatitis ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Serum Amylase ◽  
Suspected Case ◽  
Ecg Changes ◽  
Bundle Branch Block ◽  
Coronary Syndrome ◽  
Laboratory Results ◽  
New Onset

A suspected case of acute coronary syndrome presented with new-onset left bundle branch and first-degree heart blocks. The decision to thrombolyse was reverted as ECG changes proved to be transient within fifteen minutes of presentation. Later on the patient was diagnosed with acute pancreatitis based on laboratory results of serum amylase, confirmed on radiological investigations.

scholarly journals Acute “Pseudoischemic” ECG Abnormalities after Right Pneumonectomy

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Nada Vasic ◽  
Sanja Dimic-Janjic ◽  
Ruza Stevic ◽  
Branislava Milenkovic ◽  
Verica Djukanovic
Keyword(s):  
Acute Coronary Syndrome ◽  
Myocardial Ischemia ◽  
Heart Rhythm ◽  
Diagnostic Procedures ◽  
Final Diagnosis ◽  
Acute Myocardial Ischemia ◽  
Ecg Changes ◽  
Postpericardiotomy Syndrome ◽  
Coronary Syndrome ◽  
Ecg Abnormalities

New onset of electrocardiographic (ECG) abnormalities can occur after lung surgery due to the changes in the position of structures and organs in the chest cavity. The most common heart rhythm disorder is atrial fibrillation. So-called “pseudoischemic” ECG changes that mimic classic ECG signs of acute myocardial ischemia are also often noticed. We report the case of a 68-year-old male, with no prior cardiovascular disease, who underwent extensive surgical resection for lung cancer. On a second postoperative day, clinical and electrocardiographic signs of acute myocardial ischemia occurred. According to clinical course, diagnostic procedures, and therapeutic response, we excluded acute coronary syndrome. We concluded that physical lesion of the pericardium, caused by extended pneumonectomy with resection of the pericardium, provoked the symptoms and ECG signs that mimic acute coronary syndrome. Our final diagnosis was postpericardiotomy syndrome after extended pneumonectomy and further treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) was recommended. It is necessary to consider possibility that nature of ECG changes after extended pneumonectomy could be “pseudoischemic.”

scholarly journals Severe Hypokalemia ECG Changes Mimicking Those of Acute Coronary Syndrome (ACS) in Patient with Underlying Ischaemic Heart Disease: A Case Review

2020 ◽  
Vol 08 (02) ◽  
pp. 53-58
Author(s):  
C. Sethuraman ◽  
S. F. Mohd ◽  
S. Govindaraju ◽  
W. J. Tiau ◽  
N. D. Mohamad Farouk ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Case Review ◽  
Ecg Changes ◽  
Coronary Syndrome

scholarly journals Antiplatelet and anticoagulation pretreatment in acute coronary syndrome: current guidelines and unresolved issues.

2016 ◽  
Vol 11 (3-4) ◽  
pp. 106-106
Author(s):  
Irzal Hadzibegovic ◽  
Deiti Prvulovic ◽  
Kresimir Gabaldo ◽  
Ognjen Cancarevic ◽  
Bozo Vujeva
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Syndrome ◽  
Current Guidelines

Abstract 221: Prognostic Role of elevated Myeloperoxidase in Patients with Acute Coronary Syndrome: A Systemic Review and Meta-Analysis.

2014 ◽  
Vol 115 (suppl_1) ◽  
Author(s):  
Andrew R Kolodziej ◽  
Charles L Campbell ◽  
Richard Charnigo ◽  
Raphael Twerenbold ◽  
Christian Mueller ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Meta Analysis ◽  
Systemic Review ◽  
Major Adverse Cardiovascular Events ◽  
Poor Prognostic Factor ◽  
Coronary Syndrome ◽  
Prospective Trials ◽  
Long Term Prognosis

BACKGROUND: It has been shown that Myeloperoxidase (MPO) is intimately involved in pathogenesis of atherosclerosis and Acute Coronary Syndrome (ACS). Small studies have shown that high levels of MPO are a poor prognostic factor in patients presenting with ACS. However, due to the small nature of these studies, the relationship between MPO and outcomes has not been confirmed. Here we aimed to examine the prognostic value of MPO in patients with ACS. METHODS: We performed a meta-analysis to compare the long-term prognosis of ACS patients with high MPO and low MPO levels. The literature was retrieved by formal searches of electronic databases (PubMed, EMBASE, Medline, OVID, and web of knowledge) from inception to November 2013. A total of 16 trials were included in this meta-analysis involving 10572 patients. Data were analyzed using random-effects model and study quality was assessed using appropriate scales. RESULTS: High MPO group was associated with overall worse outcomes than low MPO group in terms of recurrent myocardial infarction (9% [211 of 2336] vs. 7.7% [240 of 3101], odds ratio [OR] 1.4, 95% confidence interval [CI]: 0.92-2.15, p 0.11); all cause mortality (8% [236 of 2920] vs. 5% [209 of 4263], OR 1.83, 95% CI: 1.31-2.54, p <0.0004) and Major Adverse Cardiovascular Events (MACE) (24% [334 of 1400] vs. 14% [133 of 949], OR 2.04, 95% CI: 1.46-2.85, p< 0.0001) (Figure). CONCLUSIONS: In this meta-analysis examining the long-term outcomes in ACS patients, high MPO levels were associated with worse outcomes. These observations support prospective trials tailoring more aggressive therapy to patients with suspected worse prognosis.

Comparative Prospective Study of the Performance of Chest Pain Scores and Clinical Assessment in an Emergency Department Cohort in Singapore

2020 ◽  
Author(s):  
Ng Mingwei ◽  
Hong Jie Gabriel Tan ◽  
Fei Gao ◽  
Jack Wei Chieh Tan ◽  
Swee Han Lim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Clinical Assessment ◽  
Clinical Judgment ◽  
Low Risk ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome ◽  
Pain Scores ◽  
Pain Patients

Abstract Background Chest pain scores allow emergency physicians to identify low-risk patients for whom discharge can be safely expedited. While their utility have been extensively studied and validated in Western cohorts, data in patients of Asian heritage is lacking. This study aimed to determine the accuracy of HEART, EDACS and GRACE in risk-stratifying which emergency patients with chest pain or angina-equivalent symptoms are at risk of major adverse cardiovascular events (MACE) within 30 days (composite of all-cause mortality, acute myocardial infarction, and coronary revascularization). This single-centre prospective cohort-study enrolling 1200 patients was conducted by a large urban tertiary centre in Singapore. The chest pain scores were reported prior to disposition by research assistants blinded to the physician’s clinical assessment. Outcome adjudication was performed by an independent blinded cardiologist and emergency physician, while a second cardiologist adjudicated in the case of discrepancies. \Results Of 1200 patients enrolled, 5 withdrew consent and were excluded from analyses. 135 patients (11.3%) suffered MACE within 30 days. HEART, which ruled-out acute coronary syndrome in 52.8% of patients with 88.1% sensitivity, and EDACS, which ruled-out acute coronary syndrome in 57.5% of patients with 83.7% sensitivity, proved comparable to clinical judgment which ruled-out acute coronary syndrome in 73.0% of patients with 85.5% sensitivity. GRACE was weaker – ruling-out acute coronary syndrome in 79.2% of patients but with a dismal sensitivity of 45.0%. The correlation-statistic for HEART (79.4%) was also superior to EDACS (69.9%) and GRACE (69.2%). Conclusions HEART more accurately identified low-risk chest pain patients in an Asian emergency department who were suitable for expedited discharge and demonstrated comparable performance characteristics to clinical judgment. This has major implications on the use of chest pain scores to safely expedite disposition decisions for low-risk chest pain patients in the emergency department.

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