Acute Myocardial Infarction with an Initially Non–Diagnostic Electrocardiogram – Clinical Intuition is Crucial for Decision Making

2014 ◽  
Vol 31 (3) ◽  
pp. 201-206
Author(s):  
Dejan Petrović ◽  
Marina Deljanin Ilić ◽  
Sanja Stojanović ◽  
Viktor Stoičkov
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Work ◽  
Coronary Intervention ◽  
Rehabilitation Program ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Positive Effects ◽  
Coronary Syndrome ◽  
Cardiovascular Rehabilitation

Summary Acute myocardial infarction (AMI) is a common cause of reduced cardiac capacity and functional status of a patient. Successful primary percutaneous coronary intervention (pPCI) in acute coronary syndrome and appropriate, complex cardiovascular rehabilitation play a major role in preserving left ventricular function and improvement of prognosis and quality of patient’s life. The aim of this paper was to present a clinical course in a patient with acute myocardial infarction who did not have a classic ECG presentation in the form of ST-segment elevation. We showed that in everyday clinical work it is essential to timely recognize the symptoms of acute myocardial infarction, make the proper diagnosis and perform right treatment strategy. The next step is cardiovascular rehabilitation program, which positive effects, in our patient, was achieved through the retrieval of functional capacity and correction of risk factors.

scholarly journals Clinical examples of microcirculation disorders in acute myocardial infarction

2016 ◽  
Vol 15 (1) ◽  
pp. 56-64
Author(s):  
K. A. Kireev ◽  
A. V. Krasnopeev
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Fatal Outcome ◽  
Reperfusion Therapy ◽  
Left Ventricular ◽  
Early Postoperative Period ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Angiographic Result

Objective. To improve the results of acute myocardial infarction (AMI) treatment. Material and methods. We have analyzed 2 clinical cases of unfavorable course of AMI. Results. The middle aged patient who had ST segment elevation acute coronary syndrome received immediate full reperfusion therapy (thrombolysis and stenting). It was performed early in the course of the disease and demonstrated good angiographic result. Postoperatively there were no typical evolution of ECG signs of AMI. By the end of the first day we registered stent thrombosis with fatal outcome. Cause of death: acute left ventricular failure. The area of infarcted cardiac muscle was about 40 %, in the projection of the apex of the left ventricle the acute aneurysm was formed. Perhaps this situation has been associated with disorders of microcirculation in the infarcted area, which can be potentially neutralized by inhibitors 2b/3a receptors of platelets. This drug was given to this patient too late (during rethrombosis). In another observation (with the same circumstances) the inhibitor of IIb/IIIa GP receptors was given during the early postoperative period, what was followed by the natural course of AMI. Conclusion. These examples demonstrate the need of additional antiplatelet support (inhibitor IIb/IIIa GP receptors) in such clinical situations.

scholarly journals Acute Coronary Syndromes in the Elderly: Impact of Age on Diagnosis and Terapeutic Management

2019 ◽  
Vol 16 (1) ◽  
pp. 59-66
Author(s):  
Pașc Priscilla ◽  
Ioana Alexandra Coţe ◽  
Mircea Ioachim Popescu
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Epigastric Pain ◽  
Coronary Intervention ◽  
The Elderly ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Atypical Symptoms ◽  
Ischemic Coronary Artery Disease ◽  
Artery Disease

AbstractCardiovascular pathology in the elderly is a topic of particular interest because it is themain cause of morbidity and mortality in this segment of the population, but also because in the last century the population over 60 years (this is the arbitrary limit from which a person is considered to be elderly) has doubled and is estimated to increase 2-3 times during the first century of this millennium. With the aging of the population, the number of associated diseases increases, but also the complexity of treatment for these diseases and the cost of hospitalization. Ischemic coronary artery disease has an increased incidence in the elderly population.Acute myocardial infarction (AMI) with ST segment elevation is manifested relatively frequently with atypical symptoms at onset - dyspnea, diaphoresis, nausea, confusion, epigastric pain, syncope. The influence of age on diagnosis and therapeutic management. There are no electrical changes in 40% of the elderly with acute myocardial infarction. Statistics show that 50% of patients addmited for AMI are elderly and 80% of acute myocardial infarction deaths occur in the elderly, due to both greater risk of post-treatment complications (eg left ventricular rupture after fibrinolysis) and general suboptimal treatment in the eldery, either due to age, comorbidities and atypical presentation delaying the diagnosis. Generally, outcomes of patients undergoing percutaneous coronary intervention are better compared to patients treated with fibrinolysis, the invasive strategy being thus preferred in these patients.

scholarly journals Analysis of risk factors for different subtypes of acute coronary syndrome

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110083
Author(s):  
Lei Zhang ◽  
Juledezi Hailati ◽  
Xiaoyun Ma ◽  
Jiangping Liu ◽  
Zhiqiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Brain Natriuretic Peptide ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Amino Terminal ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Aims To investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS). Methods A total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed. Results Univariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602). Conclusion Different subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.

ACUTE CORONARY SYNDROME FOLLOWING INTRAVENOUS IMMUNOGLOBULIN THERAPY : A HIDDEN RISK

2021 ◽  
pp. 78-79
Author(s):  
Karthikkeyan Rajachandran ◽  
Giphy Susan Varghese
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Intravenous Immunoglobulin ◽  
Ivig Therapy ◽  
Immunoglobulin Therapy ◽  
Left Ventricular ◽  
Intravenous Immunoglobulin Therapy ◽  
Severe Left Ventricular Dysfunction ◽  
St Segment Elevation ◽  
Coronary Syndrome

Intravenous immunoglobulin (IVIG) is one of the main line modalities of therapy for chronic inammatory demyelinating polyneuropathy (CIDP). We hereby, report an incidence of acute myocardial infarction probably induced by IVIG during the treatment of CIDP. A 76 year old female with no history suggestive of cardiovascular disease, developed an acute Non ST Segment Elevation Myocardial Infarction (NSTEMI) and severe left ventricular dysfunction after receiving three doses of IVIG. Since hypercoagulability is a concern with IVIG therapy, it was discontinued. Hence, we highlight the importance of cardiac evaluation before initiation and during the course of IVIG therapy in elderly patients as well as in patients with known risk factors for cardiovascular disease and thrombotic events.

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