scholarly journals Assessment of arrhythmias in 50 patients of ST-elevation myocardial infarction after thrombolysis: a 24 hour Holter study

2017 ◽  
Vol 4 (3) ◽  
pp. 734 ◽  
Author(s):  
Rishi Rajhans ◽  
M. Narayanan
Keyword(s):  
Myocardial Infarction ◽  
Sinus Tachycardia ◽  
Anterior Wall ◽  
Warning Sign ◽  
Inferior Wall ◽  
Inclusion Criteria ◽  
Global Epidemic ◽  
Coronary Syndrome ◽  
Life Threatening ◽  
St Elevation

Background: Acute coronary syndrome represents a global epidemic. The purpose of this study was to evaluate the incidence of cardiac arrhythmias in acute myocardial infarction (AMI) in the first 24 hours of hospitalization post thrombolysis.Methods: 50 patients of AMI satisfying the inclusion criteria were included for this observational study. Philips Digitrak Holter was attached to the patient's chest for 24 hours and arrhythmias were noted.Results: In the study group 70% of cases were males, rest 30% females. Maximum incidence of AMI was seen between 4th and 7th decade of life. Incidence of diabetes and hypertension were 54% and 66% respectively either alone or in combination. Overall incidence of anterior wall was higher 56% than inferior wall which was 44%. Sinus tachycardia was seen in 54% of cases with higher incidence in anterior wall MI. Among the reperfusion arrhythmias incidence of frequent VPCs was highest with 66% followed by AIVR (42%) and NSVT (30%). AF was found in 3 cases i.e. 6% of which one died. One patient had VF to which she succumbed.Conclusions: It is a matter of debate whether arrhythmias being so common in AMI, should be considered under clinical spectrum or complication of AMI. An increasing belief that less serious arrhythmias may serve as a warning sign for potentially life threatening arrhythmias and timely intervention by drugs, D.C. shock or pacemakers can prevent mortality in these sets of patients.

scholarly journals Acute Myocardial Infarction Caused by an Anomalous Right Coronary Artery Occlusion Presenting with Precordial ST Elevation

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Bruno da Silva Matte ◽  
Alexandre Damiani Azmus
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Sinus Node ◽  
Artery Occlusion ◽  
Inferior Wall ◽  
St Segment Elevation ◽  
Right Ventricular Infarction ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Ventricular Infarction

Acute coronary syndrome with precordial ST segment elevation is usually related to left anterior descending artery occlusion, although isolated right ventricular infarction has been described as a cause of ST elevation in V1–V3 leads. We present a case of a patient with previous inferior wall infarction and new acute ST elevation myocardial infarction (STEMI) due to proximal right coronary thrombotic occlusion resulting in right ventricular infarction with precordial ST elevation and sinus node dysfunction. The patient was treated with successful rescue angioplasty achieving resolution of acute symptoms and electrocardiographic abnormalities.

scholarly journals The Pattern of Cardiac Arrhythmias in Acute ST Elevated Myocardial Infarction and their in-hospital Outcome

2020 ◽  
Vol 16 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Mohammad Khurshadul Alam ◽  
Manzoor Mahmood ◽  
Dipal Krishna Adhikary ◽  
Fakhrul Islam Khaled ◽  
Msi Tipu Chowdhury ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ventricular Tachycardia ◽  
Sinus Tachycardia ◽  
Sinus Bradycardia ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Av Block ◽  
Acute Stemi ◽  
Hospital Outcome

Background: Acute myocardial infarction (AMI) is a major cause of death worldwide with arrhythmia being the most common determinant in the post-infarction period. Identification and management of arrhythmias at an early period of acute MI has both short term and long term significance. Objective: The aim of the study is to evaluate the pattern of arrhythmias in acute STEMI in the first 48 hours of hospitalization and their inhospital outcome. Methods: A total of 50 patients with acute STEMI were included in the study after considering the inclusion and exclusion criteria. The patients were observed for the first 48 hours of hospitalization for detection of arrhythmia with baseline ECG at admission and continuous cardiac monitoring in the CCU. The pattern of the arrhythmias during this period & their in-hospital outcome were recorded in predesigned structured data collection sheet. Result: The mean age was 53.38 ± 10.22 years ranging from 29 to 70 years. Most of the patients were male 42(84%). Majority of the patients had anterior wall ( anterior, antero-septal & extensive anterior) myocardial infarction (54%). Sinus tachycardia in isolation was the most common arrhythmia observed in 36.8% of patients followed by sinus bradycardia (22.8%), ventricular tachycardia (19.3%), ventricular ectopic (12.3%),first degree AV block (5.3%), complete heart block and atrial ectopic 1.7% each. Tachyarrhythmias were more common in anterior wall myocardial infarction, whereas bradyarrhythmias were more common in inferior wall myocardial infarction. Among studied patients, 72% had favourable outcome , followed by acute left ventricular failure 10%, cardiogenic shock & lengthening of hospital stay 8% each and death 2%. Conclusion: The commonest arrhythmias encountered were sinus tachycardia followed by sinus bradycardia, ventricular tachycardia, ventricular ectopic, AV block and atrial ectopic. The incidence of mortality was 2%. University Heart Journal Vol. 16, No. 1, Jan 2020; 16-21

scholarly journals SUN-924 Functioning Abdominal Paraganglioma Presenting as Acute ST-Elevation Myocardial Infarction

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jaruwan Kongkit ◽  
Meythee Leelaprute ◽  
Natnicha Houngngam ◽  
Thiti Snabboon
Keyword(s):  
Myocardial Infarction ◽  
Imaging Study ◽  
Celiac Trunk ◽  
Signs And Symptoms ◽  
Inferior Wall ◽  
Unusual Manifestation ◽  
Coronary Syndrome ◽  
Wide Range ◽  
History Of ◽  
St Elevation

Abstract Background: Functioning paraganglioma is a rare catecholamine-producing tumor that arises in the sympathetic nervous system. It usually presents with sustained or paroxysmal hypertension accompanied by episodes of its classic triad of headache, palpitation, and diaphoresis. However, a wide range of signs and symptoms may be present. We report an unusual manifestation as acute myocardial infarction, which accidentally diagnosed by the trigger response from metoclopramide injection. Case presentation A 66-year-old woman with medical history of well-control hypertension, dyslipidemia and type 2 diabetes mellitus for 8 years presented with typical angina pain for 1 hour. She denied history of chest pain or triad symptoms of pheochromocytoma/paraganglioma (PCC/PGL). Her physical examination was unremarkable except severe hypertension, 206/89 mmHg, and occasional sinus tachycardia. Acute inferior wall myocardial infarction was proposed by an electrocardiogram study, acute ST elevation in lead II, III and aVF, and highly elevated cardiac enzymes. Echocardiogram and coronary angiography showed preserved left ventricle function (LV ejection fraction 70%) without regional wall motion abnormality. No evidence of coronary artery disease was found. During the catheterization, the cardiologist raised the possibility of the presence of PCC/PGL from her fluctuating blood pressure, 73/42 to 206/113 mmHg, after 10-mg metoclopramide injection to control her vomiting. Computer tomography of the abdomen showed a lobulated heterogeneous enhancing left para-aortic mass with internal necrosis, 6.1x4.9x4.1 cm in size, abutting left anterolateral aortic wall and encasing celiac trunk, superior mesenteric artery, and left renal arterial wall. Her hormonal study showed 24-hour urine fractionated metanephrine/normetanephrine levels of 2,924 nmol (<1,777 nmol)/4,328 nmoL(< 3,279 nmol), respectively, and plasma free metanephrine/normetanephrine levels of 93.66 pg/mL (0-96.6 pg/mL)/233.61 pg/mL (0-163.05 pg/mL). She underwent surgical tumor removal with uneventful outcome and the pathology confirmed the diagnosis of functioning PGL. During 2-years follow-up, the patient remained asymptomatic and her hormonal and functioning imaging study showed no recurrence. The genetic testing for PCC/PGL panel was negative. Conclusion: We present an unusual manifestation of PCC/PGL as acute coronary syndrome. The clinician should remind this tumor as the differential diagnosis, especially in a patient with negative coronary angiogram.

scholarly journals Dead man sign of ECG: An unique predicting sign of acute coronary syndrome

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Troponin I ◽  
Inferior Wall ◽  
Excessive Sweating ◽  
Common Cause ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Artery Disease ◽  
Dead Man

Coronary artery disease is the most common cause of morbidity and mortality worldwide. Acute coronary syndrome which includes STEMI, NSTEMI and unstable angina commonly diagnosed with the help of 12 lead in ECG in ER with or without elevated biomarkers. Inferior wall myocardial infarction is common cause of ST elevation myocardial infarction with low mortality rate. In this case report, we present a 52 years old male presented to ER with the complain of typical chest pain for more than 2 hours duration. Pain was in center of chest with radiation to back and left arm and associated with excessive sweating. Patient is a known smoker for past 10 years. At presentation Blood pressure was 110/70 mmHg and pulse rate of 55/min. Troponin I level was five times of upper normal limit. Basic investigations including ECG were done at presentation. ECG was showing typical changes of inferior wall myocardial infarction with infarction of right ventricle with hidden unique sign known as dead man sign commonly predict the location of obstruction and course of disease in the setting of acute coronary syndrome.

scholarly journals ACUTE STEMI

2018 ◽  
Vol 25 (05) ◽  
pp. 759-763
Author(s):  
Raj Kumar Sachdewani ◽  
Lal Chand Dingra ◽  
Aijaz Hussain Memon
Keyword(s):  
Myocardial Infarction ◽  
Diabetes Type 2 ◽  
Cross Sectional Study ◽  
Anterior Wall ◽  
Inferior Wall ◽  
Chi Square ◽  
Cross Sectional ◽  
Chi Square Test ◽  
Study Population ◽  
St Elevation

Objectives: To find a relationship between acute ST elevation myocardialinfarction (STEMI) and two major risk factors i.e. diabetes type 2 and hypertension in adultpatients admitted in cardiology department of Ghulam Muhammad Mahar Medical CollegeSukkur. Study Design: Cross-sectional study. Study Setting: Department of Cardiology,Ghulam Muhammad Mahar Medical College Sukkur. Period: October 2016 to March 2017. 6months. Material and Methods: Total of 764 patients aged 18-80 years were included in thestudy population on bases of history of chest discomfort and sudden ST elevation MI (STEMI).Those patients with unstable angina and those cases which presented with Q waves wereexcluded from study population. Blood pressure and blood sample were taken and analyzedin the institution laboratory. Results: Off 764 anterior wall Myocardial infarction (includingextensive) was seen in 367(48%) while inferior wall Myocardial infarction (including RV andposterior) was recorded in 397(52%) of the study population. 118 (15.44%) were hypertensiveand also had diabetes off which 8.11% were female and chi square test reveals a relationshipbetween sex and diabetes and hypertension in the study population. Conclusion: A relationshipof hypertension and diabetes with STEMI is there. Primary prevention and proper screenprogram needs to be in place to identify the submerge part of the iceberg.

Prevalence of cardiovascular risk factors and management practices of acute coronary syndrome in a tertiary care hospital

2015 ◽  
Vol 26 (6) ◽  
Author(s):  
Chandrasekhar Dilip ◽  
Shinu Cholamugath ◽  
Molniya Baby ◽  
Danisha Pattani
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Tertiary Care ◽  
Inclusion Criteria ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Β Blocker

AbstractA prospective study of patients with acute coronary syndrome (ACS), who met the inclusion criteria, was carried out. It was conducted in the cardiology department of tertiary care referral hospital in Kerala. An attempt was made to identify and determine the prevalence of cardiovascular risk factors in patients presenting with ACS and to evaluate the current treatment practice pattern of ACS and to compare it with standard treatment guidelines, thereby improving the quality of life of patients.Data of patients who met the inclusion criteria were collected in specially designed data collection form. The form included the patient data such as demographics, risk factors, procedures performed during the hospital stay, and in-hospital and discharge drug therapy. Patients with ACS included those with ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina (UA). Descriptive statistics were performed. All statistical analysis was done using Statistical Package for Social Sciences (SPSS) software version 16.0.A total of 100 patients were studied having mean age of 62.57 years±12.18 years. Fifty-one percent were having NSTEMI, 33% were having STEMI, and 16% were having UA. Hypertension (63%) and diabetes (51%) were more prevalent in both men and women. Smoking among males was consistently high (48.6%), being highest among adults. Cardiac procedures performed include percutaneous transluminal coronary angioplasty (PTCA) in 45%, coronary angiogram (CAG) in 20%, and coronary artery bypass graft surgery (CABG) in 7%. In-hospital medications were antiplatelets (100%), thrombolytics (28%), statins (97%), anticoagulants (80%), nitrates (73%), β-blocker (32%), angiotensin-converting enzyme inhibitor (6%), angiotensin receptor blocker (9%), potassium opener (7%), vasodilator (1%), calcium channel blocker (9%), α-blocker (7%), and α+β blocker (7%).The contemporary profile of treatment patterns for patients with ACS indicates an improved adherence to the guidelines. The alarmingly high rate of modifiable risk factors remains a cause of concern and a challenge that needs to be tackled, as better control of cardiovascular risk factors is expected to have a favorable impact on the incidence of ACS.

scholarly journals A clinical study of arrhythmias associated with acute myocardial infarction and thrombolysis

2016 ◽  
Vol 5 (1) ◽  
pp. 335 ◽  
Author(s):  
Mayuri A. Mhatre ◽  
Freston M. Sirur ◽  
Deepali R. Rajpal ◽  
Manhar R. Shah
Keyword(s):  
Myocardial Infarction ◽  
Sinus Tachycardia ◽  
Sinus Bradycardia ◽  
Anterior Wall ◽  
Inferior Wall ◽  
Cardiac Enzymes ◽  
Reperfusion Arrhythmias ◽  
Bundle Branch Block ◽  
Patients With Diabetes ◽  
Type Relation

Background: Arrhythmias are a common occurrence in ACS. This study was undertaken to analyze the incidence, frequency and type of arrhythmias in relation to the site of infarction to aid in timely intervention to modify the outcome in MI and to study the significance of Reperfusion arrhythmias.Methods: 100 patients were evaluated. ECG and cardiac enzymes were studied. Arrhythmias complicating AMI in terms of their incidence, timing, severity, type, relation, reperfusion and results were studied.Results: Of the 100 cases, 74% were males and 26% females of which incidence being common between 4th to 7th decades of life. AMI was common in patients with Diabetes and Hypertension (23% each). Incidence of AWMI (58%) is higher than IWMI (40%). Out of all arrhythmias, Ventricular Tachycardia was seen in 24% cases with 50% mortality and preponderance to Antero Lateral Myocardial Infarction. Sinus Tachycardia was seen in 23% of cases with preponderance to Antero Lateral Myocardial Infarction and persistence of Sinus Tachycardia was a prognostic sign, mortality being 22%. Complete Heart Block and Sinus Bradycardia were seen with IWMI, incidence being 53.8% and 100% respectively. Bundle Branch Block was common in AWMI (31%) than IWMI (10%). Among 64 thrombo-lysed cases, 21 had Reperfusion Arrhythmias without any mortality, whereas remaining 43 without Reperfusion Arrhythmias had mortality of 18.6%.Conclusions: According to the study, Tachy-arrhythmias are common with Anterior Wall Myocardial Infarction and Brady-arrhythmias in Inferior Wall Myocardial Infarction. Reperfusion Arrhythmias are a benign phenomenon and good indicator of successful reperfusion.

scholarly journals Clinical profile of ST-elevation myocardial infarction patients from a tertiary care hospital in Northern India

2021 ◽  
Author(s):  
Prakhar Kumar ◽  
Shazia Durdana
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Left Ventricular Ejection ◽  
Inferior Wall ◽  
Care Hospital ◽  
Coronary Syndrome ◽  
Northern India ◽  
St Elevation

Background: Our aim was to the study clinical and epidemiological profile of patients presenting with ST-elevation myocardial infarction (STEMI).Methods: We did a single centre cross-sectional observational study of 200 patients presented with STEMI to a tertiary referral centre in Northern India from January 2016 to November 2017. All patients above 18 years of age admitted with diagnosis of STEMI were included in the study.Results: The mean age of study population was 55.75±12.5. The most common chief compliant was chest pain (95.1%). The anterior wall myocardial infarction (AWMI) accounted for 60.5% of all STEMI patients. The median duration from onset of symptoms to presentation to hospital was 7.93±6.58 hours. Cardiogenic shock was observed in 10.5% patients. Most common risk factor noted was smoking (63%). Mean left ventricular ejection fraction (LVEF) was less in AWMI (47±9.09) as compared to inferior wall myocardial infarction (IWMI) (50.72±7.14) (p<0.05). Among 200 cases studied, 11.5% cases developed post MI-Angina. Among arrhythmic complications, sinus bradycardia was most common (17.5%).Conclusions: Our study represents the predominance of AWMI as the initial acute coronary syndrome (ACS) presentation with a considerable delay in first medical contact. Complications like cardiogenic shock, arrhythmia were frequently observed. The biggest barrier to uniform STEMI care in developing nations is nonexistence of regional systems of care and this need to be improved.

scholarly journals Circulating Levels of Dephosphorylated-Uncarboxylated Matrix Gla Protein in Patients with Acute Coronary Syndrome

Molecules ◽  
2021 ◽  
Vol 26 (4) ◽  
pp. 1108
Author(s):  
Admira Bilalic ◽  
Tina Ticinovic Kurir ◽  
Marko Kumric ◽  
Josip A. Borovac ◽  
Andrija Matetic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
High Risk ◽  
Hospital Mortality ◽  
Vascular Calcification ◽  
Matrix Gla Protein ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
St Elevation

Vascular calcification contributes to the pathogenesis of coronary artery disease while matrix Gla protein (MGP) was recently identified as a potent inhibitor of vascular calcification. MGP fractions, such as dephosphorylated-uncarboxylated MGP (dp-ucMGP), lack post-translational modifications and are less efficient in vascular calcification inhibition. We sought to compare dp-ucMGP levels between patients with acute coronary syndrome (ACS), stratified by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) status. Physical examination and clinical data, along with plasma dp-ucMGP levels, were obtained from 90 consecutive ACS patients. We observed that levels of dp-ucMGP were significantly higher in patients with NSTEMI compared to STEMI patients (1063.4 ± 518.6 vs. 742.7 ± 166.6 pmol/L, p < 0.001). NSTEMI status and positive family history of cardiovascular diseases were only independent predictors of the highest tertile of dp-ucMGP levels. Among those with NSTEMI, patients at a high risk of in-hospital mortality (adjudicated by GRACE score) had significantly higher levels of dp-ucMGP compared to non-high-risk patients (1417.8 ± 956.8 vs. 984.6 ± 335.0 pmol/L, p = 0.030). Altogether, our findings suggest that higher dp-ucMGP levels likely reflect higher calcification burden in ACS patients and might aid in the identification of NSTEMI patients at increased risk of in-hospital mortality. Furthermore, observed dp-ucMGP levels might reflect differences in atherosclerotic plaque pathobiology between patients with STEMI and NSTEMI.

scholarly journals Management of ST Elevation Myocardial Infarction (STEMI) in Different Settings

2021 ◽  
Author(s):  
Rod Partow-Navid ◽  
Narut Prasitlumkum ◽  
Ashish Mukherjee ◽  
Padmini Varadarajan ◽  
Ramdas G. Pai
Keyword(s):  
Myocardial Infarction ◽  
Treatment Strategies ◽  
Management Process ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Multiple Factors ◽  
St Segment ◽  
Threatening Condition ◽  
Life Threatening ◽  
St Elevation

AbstractST-segment elevation myocardial infarction (STEMI) is a life-threatening condition that requires emergent, complex, well-coordinated treatment. Although the primary goal of treatment is simple to describe—reperfusion as quickly as possible—the management process is complicated and is affected by multiple factors including location, patient, and practitioner characteristics. Hence, this narrative review will discuss the recommended management and treatment strategies of STEMI in the circumstances.

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