scholarly journals Left bundle branch block and Wavy triple sign (Yasser’s sign) intertwining COVID-19 Pneumonia with Renal Impairment; defective Sgarbosa criteria for Thrombolytic: A Case Report in Cardiology, Infectious Diseases, Nephrology and Critical Care Medicine

2021 ◽  
Vol 2 (1) ◽  
pp. 01-05
Author(s):  
Yasser Elsayed
Keyword(s):  
Myocardial Infarction ◽  
Renal Impairment ◽  
Left Bundle Branch Block ◽  
Blood Gases ◽  
Current Case ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Arterial Blood ◽  
St Segment

Rationale: Left bundle branch block is a diagnostic utility for ST-segment elevation myocardial infarction equivalent. Consequently, administration of thrombolytic is a pivotal step. Emergent Sgarbosa criteria and their modification are considered helpful guide keys. Wavy triple an electrocardiographic sign (Yasser Sign) is a novel diagnostic sign in hypocalcemia. Interestingly, the presentation of COVID-19 pneumonia with an intertwining left bundle branch block, renal impairment, and hypocalcemia has a risk impact on both morbidity and mortality of COVID-19 patients. Patient concerns: An elderly carpenter male COVID-19 patient was admitted to intensive care unit with COVID-19 pneumonia with interlacing left bundle branch block, renal impairment, and Wavy triple sign (Yasser’s sign). Diagnosis: Left bundle branch block and Wavy triple sign (Yasser’s sign) intertwining COVID-19 pneumonia with renal impairment. Interventions: Arterial blood gases, chest CT scan, electrocardiography, oxygenation, and echocardiography. Outcomes: Gradual dramatic clinical, electrocardiographic, and radiological improvement had happened. Lessons: The triage of the left bundle branch block with the COVID-19 patient is highly significant for both diagnosis of acute myocardial infarction and giving thrombolytic. The combination of left bundle branch block, renal impairment, and hypocalcemia COVID-19 pneumonia signifies the risk in the current case study.

scholarly journals Differences in presentation and clinical outcomes between left or right bundle branch block and ST segment elevation in patients with acute myocardial infarction

2020 ◽  
Vol 9 (8) ◽  
pp. 848-856
Author(s):  
Matthias R Meyer ◽  
Dragana Radovanovic ◽  
Giovanni Pedrazzini ◽  
Hans Rickli ◽  
Marco Roffi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Right Bundle Branch Block ◽  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Cerebrovascular Events ◽  
St Segment ◽  
Ischaemic Attack

Background: In patients with acute myocardial infarction, the presence of a left bundle branch block or right bundle branch block may be associated with worse prognosis compared to isolated ST segment elevation. However, specificities in clinical presentation and outcomes of acute myocardial infarction patients with left bundle branch block or right bundle branch block are poorly characterized. Methods: We analysed acute myocardial infarction patients with left bundle branch block ( n=880), right bundle branch block ( n=732) or ST segment elevation without bundle branch block ( n=15,852) included in the Acute Myocardial Infarction in Switzerland-Plus registry between 2008–2019. Results: Acute myocardial infarction patients with bundle branch block were older and had more pre-existing cardiovascular conditions compared to ST segment elevation. Pulmonary oedema and cardiogenic shock were most frequent in patients with left bundle branch block (18.8% vs 12.0% for right bundle branch block and 7.9% for ST segment elevation, p<0.001). Acute myocardial infarction patients with bundle branch block had more three-vessel (40.6% vs 25.3%, p<0.001 vs ST segment elevation) and left main disease (5.6% vs 2.0%, p<0.001 vs ST segment elevation). Major adverse cardiac and cerebrovascular events, a composite of reinfarction, stroke/transient ischaemic attack, and death during hospitalization, were highest in acute myocardial infarction patients with left bundle branch block (13.9% vs 9.9% for right bundle branch block and 6.7% for ST segment elevation, p<0.05), which was driven by hospital mortality. After multivariate adjustment, however, mortality was similar in patients with left bundle branch block and lower in patients with right bundle branch block, respectively, when compared to ST segment elevation. Mortality was only increased when a right bundle branch block with concomitant STE was present (odds ratio 1.77, 95% confidence interval 1.19–2.64, p<0.01 vs ST segment elevation). Conclusions: Compared to ST segment elevation, an isolated bundle branch block reflects high-risk clinical characteristics but does not independently determine increased hospital mortality in acute myocardial infarction.

scholarly journals Electrocardiographic signs of acute myocardial infarction in left bundle branch block

2013 ◽  
Vol 66 (11-12) ◽  
pp. 503-506
Author(s):  
Igor Ivanov ◽  
Sonja Bugarski ◽  
Jadranka Dejanovic ◽  
Anastazija Stojsic-Milosavljevic ◽  
Jasna Radisic-Bosic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Sensitivity And Specificity ◽  
Left Bundle Branch Block ◽  
Bundle Branch Block ◽  
Duration Of Symptoms ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Introduction. Acute myocardial infarction is characterized by typical chest pain, electrocardiographic changes in terms of lesion and/or myocardial ischemia and increased cardiac enzymes. It is often difficult to make diagnosis in the presence of non-specific chest pain, the short duration of symptoms and electrocardiographic signs of a complete left bundle branch block. Literature Review. Many authors have tried to set the electrocardiographic criteria that can increase the possibility of correct diagnosis of acute myocardial infarction in such situations. The most widely used and recognized criterion is Sgarbossa scoring system that includes concordant ST segment elevation > 1 mm ST segment, disconcordant denivelation of ST segment > 1 mm in the leads V1-V3 and disconcordant ST segment elevation > 5 mm with acceptable sensitivity and specificity. In subsequent studies, the sensitivity and specificity increased by replacing the third criterion with ST/S ratio < -0.25. Conclusion. The knowledge of certain electrocardiographic signs in patients with acute coronary syndrome and left bundle branch block increases the chances of early diagnosis and the possibility of better and timely treatment.

Clots Kill: Hematologic Pharmacology for ST-Segment Elevation Myocardial Infarction

2012 ◽  
Vol 32 (6) ◽  
pp. 35-41
Author(s):  
Stacy H. James
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Agents ◽  
Thrombin Inhibitors ◽  
Fibrinolytic Agents ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Drugs that work on the hematologic system play an important role in helping to limit the morbidity and mortality that can be associated with an acute coronary syndrome. The pharmacology of the fibrinolytic agents, thrombin inhibitors, and antiplatelet agents is described. A case study of a woman having an ST-segment elevation myocardial infarction is reviewed to highlight the importance of drugs that work on the hematologic system.

scholarly journals Viscose and thrombocytic-aggregation disorders on patients with myocardial infarction with stable elementation of ST segment

2021 ◽  
Vol 2 (16) ◽  
pp. 25-31
Author(s):  
D.U. Uzun ◽  
V.V. Lazoryshynets ◽  
K.S. Uzun
Keyword(s):  
Myocardial Infarction ◽  
Platelet Aggregation ◽  
Blood Viscosity ◽  
The State ◽  
St Segment Elevation ◽  
Arterial Blood ◽  
St Segment ◽  
Lower Amplitude ◽  
Medical Diagnostic ◽  
Aggregation Parameters

Abstract. Clinical studies indicate a significant role in the pathogenesis of acute myocardial infarction, the functional state of platelet aggregation and blood viscosity, which determine the nature of blood flow in the vessels at the level of macro– and microcirculation. The aim of the study was to analyze changes in viscosity and platelet-aggregation disorders under the influence of different tactical, diagnostic and interventional approaches in patients with myocardial infarction and stable elevation of the ST segment in the presence of multivascular coronary artery disease. The study used 4 tactical and treatment-diagnostic approaches during the year of observation. Patients with myocardial infarction with persistent ST-segment elevation were found to have hyperviscosity and hypercoagulability syndromes, manifested in the first weeks by a compensatory increase in platelet count, blood viscosity, fibrinogen levels, and an increase in platelet aggregation. Carrying out additional in-depth examination of coronary circulation (coherent tomography and intravascular sonography) as the main methods of detailed assessment of atheromatous process and further application of delayed stenting of infarct-independent arteries in group 1, contributed to lower amplitude of fluctuations, due to the systemic step-by-step improvement of arterial blood supply, to optimize the state of viscosity and processes of adhesion / aggregation of platelets. Traditional tactical and medical-diagnostic principles of this category of patients do not allow to fundamentally improve the state of viscosity and coagulation-aggregation parameters, even with the use of dual antiplatelet therapy.

scholarly journals Viscose and Thrombocytic-Aggrega-Tion Disorders On Patients With Myocardial Infarction With Stable Elementation of ST Segment

2021 ◽  
Keyword(s):  
Myocardial Infarction ◽  
Platelet Aggregation ◽  
Blood Viscosity ◽  
The State ◽  
St Segment Elevation ◽  
Arterial Blood ◽  
St Segment ◽  
Lower Amplitude ◽  
Medical Diagnostic ◽  
Aggregation Parameters

Abstract. Clinical studies indicate a significant role in the pathogenesis of acute myocardial infarction, the functional state of platelet aggregation and blood viscosity, which determine the nature of blood flow in the vessels at the level of macro- and microcirculation. The aim of the study was to analyze changes in viscosity and platelet-aggregation disorders under the influence of different tactical, diagnostic and interventional approaches in patients with myocardial infarction and stable elevation of the ST segment in the presence of multivascular coronary artery disease. Materials and methods. The study used 4 tactical and treatment-diagnostic approaches during the year of observation. Results. Patients with myocardial infarction with persistent ST-segment elevation were found to have hyperviscosity and hypercoagulability syndromes, manifested in the first weeks by a compensatory increase in platelet count, blood viscosity, fibrinogen levels, and an increase in platelet aggregation. Conclusions. Carrying out additional in-depth examination of coronary circulation (coherent tomography and intravascular sonography) as the main methods of detailed assessment of atheromatous process and further application of delayed stenting of infarct-independent arteries in group 1, contributed to lower amplitude of fluctuations, due to the systemic step-by-step improvement of arterial blood supply, to optimize the state of viscosity and processes of adhesion / aggregation of platelets. Traditional tactical and medical-diagnostic principles of this category of patients do not allow to fundamentally improve the state of viscosity and coagulation-aggregation parameters, even with the use of dual antiplatelet therapy.

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