scholarly journals Association of Factor II G20210A, Factor V G1691A and methylenetetrahydrofolate reductase C677T gene polymorphism with different forms of myocardial infarction: ST segment elevation and non-ST segment elevation

2020 ◽  
Vol 77 (10) ◽  
pp. 1041-1047
Author(s):  
Milica Cucuz-Jokic ◽  
Vesna Ilic ◽  
Bojana Cikota-Aleksic ◽  
Slobodan Obradovic ◽  
Zvonko Magic
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Methylenetetrahydrofolate Reductase ◽  
Mthfr C677t ◽  
Factor V ◽  
St Segment Elevation ◽  
St Segment ◽  
Factor Ii ◽  
Factor V G1691a ◽  
St Elevation

Background/Aim. Coagulation Factor II G20210A and Factor V G1691A variants are moderately associated with coronary artery disease. Polymorphism of methylenetetrahydrofolate reductase (MTHFR) gene C677T is associated with myocardial infarction (MI) in some ethnical groups. At the present time there are rare studies which try to differentiate two forms of MI, ST-elevation MI (STEMI) and non ST-elevation MI (NSTEMI) according to the genetic background. The aim of the study was investigate the association of polymorphisms of Factor II G20210A, Factor V G1691A and MTHFR C677T with different forms of MI: STEMI and NSTEMI. Methods. The study included 82 patients, divided into two cohorts: patients with STEMI (49 patients) and NSTEMI (33 patients). Genetic factors that would be different in those two entities, included in response to plaque rupture and occlusion of coronary artery, were examined. The peripheral blood lymphocytes were used as DNA source. Genotypes were determined on the polymerase chain reaction (PCR) based methodology. Results. The frequency of MTHFR C677T CT genotype was higher in the patients with NSTEMI in comparison with the patients with STEMI [odds ratio (OR) 3.33; 95% confidence interval (CI) 1.22?9.15; p = 0.02]. Logistic regression analysis shows MTHFR CT genotype as an independent prognostic factor for development of NSTEMI (OR 3.15; 95% CI 1.20?8.29; p = 0.02). There were no differences between two patients groups in frequency of Factor II G20210A and Factor V G1691A gene polymorphism. Conclusion. MTHFR C677T CT genotype was significantly associated with the NSTEMI development examined patients.

scholarly journals Microfistulas Causing Diverse Regional Ischemia: Consecutive Inferior and Lateral ST-Elevation Myocardial Infarction

2020 ◽  
Vol 23 (10) ◽  
pp. 704-706
Author(s):  
Tufan Çınar ◽  
Yavuz Karabağ ◽  
İbrahim Rencuzogullari ◽  
Metin Cağdaş
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
St Elevation Myocardial Infarction ◽  
Type I ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Artery Fistulas ◽  
Clinical Consequences ◽  
Electrocardiographic Changes ◽  
St Elevation

Coronary artery fistulas (CAFs) are described as abnormal communications between a coronary artery and cardiac chambers, or other vascular structures. The two types of CAFs are defined as type I (singular fistula) and type II (microfistulas). Even though various electrocardiographic changes have been previously described in CAF patients, coronary-artery microfistulas causing ST-segment elevation in diverse locations have not been reported. We describe a case report of an adult patient who presented with acute inferior myocardial infarction due to coronary-artery microfistulas. During the hospital stay, the patient re-experienced chest pain, and control electrocardiography revealed ST-segment elevation in the I and AVL leads along with reciprocal ST-segment depression in the inferior precordial leads. Although CAFs are clinically rare, they can have important clinical consequences. Microfistulas should be kept in mind as a cause of ST elevation myocardial infarction in some patients.

scholarly journals Correlation of ECG Changes with Coronary Angiographic Findings in Acute Inferior Myocardial Infarction

2017 ◽  
Vol 29 (2) ◽  
pp. 33-37 ◽  
Author(s):  
Kazi Shamim Al Mamun ◽  
Anisul Awal ◽  
AKM Manzur Murshed
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Inferior Myocardial Infarction ◽  
Significant Stenosis ◽  
St Segment Elevation ◽  
St Segment ◽  
Infarct Related Artery ◽  
St Elevation ◽  
Acute Inferior Myocardial Infarction

The determination of infarct related artery in acute inferior myocardial infarction is extremely important for the prediction the amount of myocardium at risk and guide decisions regarding urgency of revascularization. Urgent decision may facilitate management and prevention of complication. Our objective was to Identification of the infarct related artery involving either right coronary artery (RCA) or left circumflex artery (LCX) in acute inferior wall myocardial infarction using electrocardiographic criteria and comparing with angiographic finding. This prospective, observational study was done in Chittagong Medical College Hospital from June 2013 to May 2014. A total of 112 Patients with acute inferior myocardial infarction were included in this study. The electrocardiogram of these patients evaluated for ST segment elevation in lead III exceeding that in lead II (i.e. a ratio of ST elevation in lead III/elevation in lead II > 1) and S/R wave ratio > 0.33 plus ST segment depression > 1 mm in lead aVL as a prediction for right coronary artery occlusion. If criteria are negative, LCX obstruction is likely. Coronary angiogram was done within 2-6 weeks in cath lab, department of cardiology, CMCH to identify the culprit artery. The infarct related artery (IRA) was identified from total occlusion or significant stenosis (> 70%) of the RCA or LCX or their major branches, or from arteriographic evidence of intraluminal thrombosis. To minimize the chance of misclassifying the culprit artery, patients with significant stenosis of both the RCA and the LCX were excluded from the study. The study population consisted of 112 patients (94 male and 18 female) with a mean ± SD age of 51 ± 8.6 years. On coronary angiography, the culprit artery was shown to be the RCA in 92 patients and the LCX in 20 patients. It was evident that the degree of ST segment elevation in lead III was significantly higher in right coronary artery group (92 patients) vs left circumflex group (20 patients) 3.16±1.14mm vs 1.35±0.24mm (p<0.001) respectively. While its comparable in lead II 2.18±0.95mm vs 1.7±0.34mm (p>0.05). In respect to leads AVL, we found that deeper ST segment depression was in right coronary artery group as compared to left circumflex group 1.11±0.25mm vs 0.2 ±0.34mm (p<0.001). ECG parameters for implicating the RCA were a higher ST elevation in lead III than lead II (specificity 98%, sensitivity 97%) and an S/R wave ratio > 0.33 plus ST segment depression > 1 mm in lead aVL (specificity 96%, sensitivity 95%). Absence of these criteria was associated with LCX occlusion (specificity 100%, sensitivity 85%). It is possible to predict the culprit artery whether right coronary artery or left circumflex by examining the surface electrocardiography in patients with acute inferior myocardial infarction.Medicine Today 2017 Vol.29(2): 33-37

scholarly journals Correlation of Severity of ST Segment Elevation with Respect to the Site of Right Coronary Artery Lesion

2013 ◽  
Vol 52 (191) ◽  
Author(s):  
Rabindra Simkhada
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Inferior Wall ◽  
St Segment Elevation ◽  
St Segment ◽  
Infarct Related Artery ◽  
St Elevation ◽  
The Mean ◽  
St Segments ◽  
Lesion Severity

Introduction: Electrocardiogram a widely available tool may predict infarct related artery in acute inferior wall myocardial infarction. Severity of ST segment elevation may correlate with proximity of lesion in right coronary artery.Methods: Patient with acute ST segment elevation inferior wall myocardial infarction who underwent coronary angiogram was studied. Differences in electrocardiogram among right coronary and left circumflex groups were evaluated. Severity of ST segments elevation in relation to site of lesion in right coronary was studied.Results: The mean age of presentation was 59.52 ± 11.01 years. Total 36 (72%) were men. A total of 42 (84%) had lesion in right and 8 (16%) in left circumflex. Age, sex,diabetes,hypertension, smoking, dyslipidemia and physical activity showed no correlation with lesion in right or circumflex coronary artery. ST segment elevation in III>II (P=0.01), ST segment depression in AVL> I (P<0.01) and ST elevation in V4R (P=0.04), correlated with right coronary lesion. Sum of ST elevation in inferior leads were 10.90 ±1.30 mm for proximal, 7.38±1.19 mm for mid and 5.50± 0.53 mm for distal right coronary with significant correlation (P<0.01).Conclusions: Electrocardiogram was reliable tool to difference right and left circumflex lesion. Severity of sum of ST segment elevations in inferior leads correlated with the proximity of lesion in right coronary._______________________________________________________________________________________Keywords: acute inferior myocardial infarction; electrocardiogram; infarct related artery._______________________________________________________________________________________

scholarly journals Association between gender and short-term outcome in patients with ST elevation myocardial infraction participating in the international, prospective, randomised Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery (ATLANTIC) trial: a prespecified analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e015241 ◽  
Author(s):  
Dimitrios Venetsanos ◽  
Sofia Sederholm Lawesson ◽  
Joakim Alfredsson ◽  
Magnus Janzon ◽  
Angel Cequier ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Independent Predictor ◽  
Female Gender ◽  
Short Term ◽  
St Segment Elevation ◽  
Timi Flow ◽  
St Segment ◽  
St Elevation ◽  
Catheterisation Laboratory

ObjectivesTo evaluate gender differences in outcomes in patents with ST-segment elevation myocardial infarction (STEMI) planned for primary percutaneous coronary intervention (PPCI).SettingsA prespecified gender analysis of the multicentre, randomised, double-blind Administration of Ticagrelor in the catheterisation Laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery.ParticipantsBetween September 2011 and October 2013, 1862 patients with STEMI and symptom duration <6 hours were included.InterventionsPatients were assigned to prehospital versus in-hospital administration of 180 mg ticagrelor.OutcomesThe main objective was to study the association between gender and primary and secondary outcomes of the main study with a focus on the clinical efficacy and safety outcomes. Primary outcome: the proportion of patients who did not have 70% resolution of ST-segment elevation and did not meet the criteria for Thrombolysis In Myocardial Infarction (TIMI) flow 3 at initial angiography. Secondary outcome: the composite of death, MI, stent thrombosis, stroke or urgent revascularisation and major or minor bleeding at 30 days.ResultsWomen were older, had higher TIMI risk score, longer prehospital delays and better TIMI flow in the infarct-related artery. Women had a threefold higher risk for all-cause mortality compared with men (5.7% vs 1.9%, HR 3.13, 95% CI 1.78 to 5.51). After adjustment, the difference was attenuated but remained statistically significant (HR 2.08, 95% CI 1.03 to 4.20). The incidence of major bleeding events was twofold to threefold higher in women compared with men. In the multivariable model, female gender was not an independent predictor of bleeding (Platelet Inhibition and Patient Outcomes major HR 1.45, 95% CI 0.73 to 2.86, TIMI major HR 1.28, 95% CI 0.47 to 3.48, Bleeding Academic Research Consortium type 3–5 HR 1.45, 95% CI 0.72 to 2.91). There was no interaction between gender and efficacy or safety of randomised treatment.ConclusionIn patients with STEMI planned for PPCI and treated with modern antiplatelet therapy, female gender was an independent predictor of short-term mortality. In contrast, the higher incidence of bleeding complications in women could mainly be explained by older age and clustering of comorbidities.Clinical trial registrationNCT01347580;Post-results.

scholarly journals Posterior myocardial infarction with isolated ST elevations in V8 and V9: Is this an “ST elevation MI”?

CJEM ◽  
2003 ◽  
Vol 5 (02) ◽  
pp. 115-118
Author(s):  
Lance Brown ◽  
Jessica Sims ◽  
Alessandra Conforto
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Artery Occlusion ◽  
Primary Angioplasty ◽  
Artery Occlusion ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation ◽  
Artery Disease ◽  
Electrocardiogram Ecg

ABSTRACT We report a case of a 53-year-old man whose first manifestation of coronary artery disease was an acute isolated posterior myocardial infarction (IPMI). Acute IPMI is relatively uncommon and predominantly due to occlusion of the left circumflex coronary artery. IPMI is challenging to diagnose due to the absence of ST segment elevation on a standard 12-lead electrocardiogram (ECG) even in the setting of total coronary artery occlusion and transmural (Q-wave) infarct. We discuss the diagnostic implications of the absence of tall R waves in leads V1 and V2 on this patient’s ECG. The utility of posterior leads (V7 through V9) is demonstrated. The controversy surrounding the use of thrombolytic therapy or primary angioplasty in the setting of acute IPMI without ST segment elevation on a standard 12-lead ECG is reviewed.

scholarly journals Role of Coronary Prognostic Index, and Thrombolysis, in ST Segment Elevation Myocardial Infarction

2021 ◽  
Vol 10 (29) ◽  
pp. 2212-2216
Author(s):  
Amol Andhale ◽  
Anuj Varma ◽  
Sourya Acharya ◽  
Samarth Shukla ◽  
Anuj Chaturvedi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Coronary Artery ◽  
Prognostic Index ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
St Elevation

Angioplasty is considered superior to fibrinolytic therapy in acute myocardial infarction (AMI) if the patient receives it within the therapeutic window. It is unclear if such advantages are available for patients who need to travel from a community hospital to a facility where invasive care is available, since primary thrombolysis often re-establishes coronary artery blood flow in patients with ST elevation acute myocardial infarction (STEMI). At the most severe end of the range of acute coronary syndromes is ST - segment elevation myocardial infarction (STEMI), which generally occurs when a fibrin-rich thrombus fully occludes an epicardial coronary artery. The diagnosis of STEMI is based on clinical features and persistent ST-segment elevation as evidenced by 12 - lead electrocardiography. Patients with STEMI should have a quick reperfusion treatment evaluation and a reperfusion strategy should be performed immediately following contact with the system. All patients with AMI who had chest pain within 12 hours were evaluated. The detailed history of chest pain, character, and radiation, had been taken in terms of duration from the beginning of chest pain in minutes. After 10 minutes, patients were given 10 mg of sublingual isosorbide dinitrate and repeated ECG. Patients were excluded if chest pain or ST elevation was resolved after 10 minutes of nitrate administration. In the analysis only those cases in which chest pain and ST shift were not resolved following sublingual nitrates. Serum CKMB estimates have been performed. All patients were treated with 1.5 million IU streptokinase in 100 ml of normal saline for more than 45 minutes. Clinical assessment for 2 hours every half hour was done to evaluate: 1. Chest pain reduction in a subjective scale percentage and to assess changes in the Killip class. 2. Continuous ECG monitoring of reperfusion rhythm occurrences. Patients are assessed at the end of 2 hours of follow-up for: a. Percentage reduction in subjective chest pain a. A 12 lead ECG to identify changes in the ST height c. Repeat CK-MB estimate. Patients with thrombolysis were classified into two classes on the basis of presence or absence of SCR at the end of two hours of initiation. Those with successful reperfusion were grouped into the SCR Group and into the SCR (negative) Group without successful reperfusion. Coronary prognostic index is a set of questionnaires which prognosticate the outcome in AMI. This review describes the role of Coronary Prognostic Index and thrombolysis in patients of STEMI. KEY WORDS ECG, AMI, STEMI, Angioplasty

scholarly journals A rare cause of acute ST-elevation myocardial infarction: a case of coronary embolism secondary to calcified bicuspid aortic valve

2021 ◽  
Vol 31 (1) ◽  
pp. 116-121
Author(s):  
Anda Bularga ◽  
Andrew R Chapman ◽  
John Hung ◽  
Nicholas L. Mills ◽  
Marc R. Dweck
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Acute Onset ◽  
St Elevation Myocardial Infarction ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation ◽  
Coronary Embolism

Coronary embolism is an uncommon cause of acute myocardial infarction, which can have a similar clinical presentation to a plaque rupture event with acute onset of ischaemic symptoms, ST segment elevation on electrocardiogram (ECG) and signifi cant elevation in cardiac troponin, requiring immediate intervention. We report the case of a middle-aged female with a background history of previous non-ST elevation myocardial infarction, bicuspid aortic valve with severe stenosis and metastatic breast cancer. The patient underwent emergency coronary angiography following acute onset central chest pain and evidence of anterior ST segment elevation on ambulance 12-lead ECG. The procedure revealed complete occlusion of the mid left anterior descending coronary artery with immediate fl ow restoration following embolus aspiration and subsequent normal appearance of the left anterior descending coronary artery. Gross examination of the aspirated specimen resembled a calcified hard lump, which was further confirmed on microscopic examination revealing calcified fibrous tissue most likely an embolus from the calcified bicuspid aortic valve. The patient had evidence of near transmural myocardial infarction in the distribution of the left anterior descending coronary on cardiac magnetic resonance imaging (MRI). She made full recovery and was discharged on short-term dual antiplatelet therapy followed by lifelong aspirin and further assessment for aortic stenosis management.

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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