scholarly journals Staged medical aid in acute myocardial infarction management as a key for successful treatment of elderly patients with severe comorbidities

2014 ◽  
Vol 95 (4) ◽  
pp. 593-596
Author(s):  
I F Yakupov ◽  
A S Galyavich ◽  
K V Korchagina
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Mitral Regurgitation ◽  
Elderly Patients ◽  
Successful Treatment ◽  
Bypass Graft ◽  
Stable Condition

During the recent years, since the start of coronary artery stent era not only coronary artery bypass graft surgery, but percutaneous transluminal angioplasty became common in patients with left main coronary artery stenosis. Mechanical complications of myocardial infarction, such as ventricular septal rupture, left ventricle free wall rupture and mitral regurgitation due to papillary muscle rupture, are straight indications for cardiac surgery. However, studies show that the age of over 70 years is a high-risk factor for cardiac surgery. In elderly patients, the duration of cardiopulmonary bypass and aortic cross-clamping time have a major impact on the surgery outcome. Therefore, strategies aimed at reducing the volume of cardiac surgery, should be more successful in elderly patients. On the other hand, elderly patients should be well prepared for surgery, and it should be performed when concomitant diseases are compensated. A case of 82-year patient admitted to the intensive care unit with acute myocardial infarction and chord papillary muscles partial rupture associated with severe mitral regurgitation, is presented. Due to the progression of pulmonary edema, mechanical ventilation was started and emergency percutaneous intervention was administered as a life-saving measure. Stents were placed in obtuse marginal branch, circumflex artery and anterior interventricular artery. Because of existing mitral regurgitation of 3-4 grade, after 2 weeks the patient was re-evaluated ex consilio. Considering relatively stable condition, mitral valve replacement with cardiopulmonary bypass was administered, which was successfully done. The successful treatment of this patient was possible because of the proper and timely staging of the patient’s management.

scholarly journals Risk of Ischemic Stroke After Acute Myocardial Infarction in Patients Undergoing Coronary Artery Bypass Graft Surgery

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
André Åström ◽  
Lars Söderström ◽  
Thomas Mooe
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Incidence Rates ◽  
P2y12 Inhibitors ◽  
Over Time

AbstractOnly sparse epidemiological data are available regarding the risk of ischemic stroke (IS) after coronary artery bypass surgery (CABG). Here we aimed to describe the incidence and predictors of IS associated with CABG performed after acute myocardial infarction (AMI), as well as trends over time. We analyzed data for 248,925 unselected AMI patients. We separately analyzed groups of patients who underwent CABG early or late after the index infarction. IS incidence rates per year at risk were 15.8% (95% confidence interval, 14.5–17.1) and 10.9% (10.6–11.2), respectively, among patients with and without CABG in the early cohort, and 4.0% (3.5–4.5) and 2.3% (2.2–2.3), respectively, among patients with and without CABG in the late cohort. Predictors of post-AMI IS included prior IS, CABG, prior atrial fibrillation, prior hemorrhagic stroke, heart failure during hospitalization, older age, diabetes mellitus, and hypertension. Reduced IS risk was associated with use of statins and P2Y12 inhibitors. IS incidence markedly decreased among patients who did not undergo CABG, while no such reduction over time occurred among those who underwent CABG. This emphasizes the need to optimize modifiable risk factors and to consistently use treatments that may reduce IS risk among CABG patients.

scholarly journals Clinical Study on Characteristics and Risk Factors of Coronary Artery Lesions in Young Patients with Acute Myocardial Infarction

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Hua Liu ◽  
Jiangang Zhang ◽  
Zengcai Ma ◽  
Zesheng Xu
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Collateral Circulation ◽  
Young Patients ◽  
Coronary Artery Lesions ◽  
Dominant Type ◽  
Factors Affecting

Epidemiological evidence suggests that the incidence of acute myocardial infarction (AMI) among people under 40 years of age has an increasing trend in recent years. Smoking, hypertension, diabetes mellitus, family history, and gender (male) are considered as classic risk factors for CHD, but the pathogenesis of CHD in young people is not exactly the same. Moreover, the relationship between the pattern of coronary artery disease and risk factors in young patients with acute myocardial infarction is inconclusive. In this study, we retrospectively studied the clinical data of 150 AMI patients treated in our hospital from January 2020 to May 2021. The patients were divided into the young group and elderly group according to the difference in age. The number of coronary artery lesions, the degree of coronary artery stenosis, the distribution dominance typing, the position of the lesions, and the presence of collateral circulation were observed and compared between the two groups. Multivariate logistic regression analysis was used to investigate the risk factors affecting coronary artery lesions in young patients with AMI. The results showed that the number of coronary lesions in young patients with AMI was mainly single-vessel, and the dominant type of distribution was mainly right dominant type. The stenosis degree is lighter than that of elderly patients, and the incidence of collateral circulation is lower than that of elderly patients, but the position of the lesions has no obvious regular. Smoking, staying up late, HDL-C, and LDL-C/ApoB were independent factors affecting the number of coronary artery lesions, and the changes of HDL-C and LDL-C/ApoB had an important influence on the degree of coronary stenosis in young patients. This provides a new idea for clinical treatment.

Use of Aprotinin in the Control of Bleeding During Cardiopulmonary Bypass Surgery: Current Status

1998 ◽  
Vol 4 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Roque Pifarrè
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Bypass Surgery ◽  
Whole Body ◽  
Current Status ◽  
Blood Transfusions ◽  
Donor Blood ◽  
Excessive Bleeding

Excessive bleeding is one of the major complica tions of cardiac surgery with cardiopulmonary bypass (CPB). This complication is related to the operation and the defects in hemostasis induced by extracorporeal circulation. The system atic effects of CPB are called whole body inflammatory reac tion. Heparin, platelet dysfunctions, and fibrinolysis are the major causes of bleeding problems associated with CPB. Dif ferent pharmacological approaches have been used to reduce bleeding and the need for blood transfusions in patients under going cardiac surgery. The most effective is aprotinin, a serum protease inhibitor that is an antifibrinolytic with a platelet- preserving action. It inhibits the activation of the intrinsic co agulation system. Aprotinin therapy effectively reduces blood loss and donor blood requirements. According to most reports, it does not increase the risk of acute myocardial infarction, renal dysfunction, and mortality.

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