scholarly journals Effect of short-acting b--blockers on heart rate and blood pressure in patients with acute coronary syndrome during percutaneous and coronary intervention

2021 ◽  
Vol 4 (2) ◽  
pp. 36-44
Author(s):  
L Rasputina ◽  
D Didenko ◽  
A Solomonchyk
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Heart Rate Reduction ◽  
Rate Reduction ◽  
Coronary Syndrome ◽  
History Of

Background. The use of b- blockers in acute coronary syndrome (ACS) is recommended for all patients, who has not contraindications. The study of the effects of esmolol during percutaneous coronary intervention (PCI) remains relevant. Objective. To evaluate the features of the effect of esmolol (Biblock, “YURiA-PHARM”) on heart rate and blood pressure in patients with ACS during PCI.Materials and methods. The study included 30 patients, 15 men and 15 women, who were hospitalized in a specialized cardiology department with ACS with elevation of the ST segment. All patients underwent a general clinical examination, ECG recording in 12 leads, PCI according to the standard protocol with ECG and blood pressure monitoring. All patients were given infusion of esmolol before the standard therapy. The level of heart rate reduction, systolic blood pressure (SBP), diastolic blood pressure (DBP), the correlation of heart rate reduction during esmolol infusion with the clinical and functional parameters of patients and the degree of coronary artery (CA) damage were analyzed.Results. Decreased heart rate and blood pressure during infusion of esmolol in all patients. Before the infusion, the heart rate av-eraged (109.8 ± 4.0) beats per minute. After the infusion – (92.8 ± 3.2) beats per minute, (p < 0.001) with an average duration of infusion (18.2 ± 2.3) minutes. The decrease in SBP levels during infusion occurred on average by (22.8 ± 2.5) mm Hg, DBP – by (16.0 ± 2.1) mm Hg, no patient had hypotension. According to the results of correlation analysis, it was found that the decrease in heart rate with the use of esmolol has a correlation with the average age of patients (r = -0.47, p = 0.0012), with the presence of multivascular coronary artery disease (r = -0.38, p = 0.002). Weaker negative correlation was found with the initial level of SBP (r = -0.28, p = 0.015), the presence of a history of myocardial infarction (r = -0.27, p = 0.005), the presence of signs of left ventricular hypertrophy (LVH) on the ECG (r = -0.22, p = 0.008), and a history of arterial hypertension that was not treated according to current recommendations (r = -0.21, p = 0.032).Conclusions. The use of esmolol solution in patients with ACS who have supraventricular tachycardia and elevated blood pressure during PCI can improve control of heart rate, SBP and DBP, a significant decrease is observed after 10 minutes of dose titration. Careful titration of esmolol solution and monitoring of ECG and blood pressure revealed no side effects, including bradycardia and hypotension, which indicates a high safety profile of the drug.

scholarly journals Cardiorehabilitation of Patients with Acute Coronary Syndrome Who Were Performed Coronary Arteries Revascularization

2017 ◽  
Vol 24 (4) ◽  
Author(s):  
Mykola Shved ◽  
Lesja Tsuglevych ◽  
Iryna Kyrychok ◽  
Tetiana Boiko ◽  
Larysa Levutska
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Cardiac Rehabilitation ◽  
Rehabilitation Program ◽  
Left Ventricular ◽  
Cardiac Rehabilitation Program ◽  
Coronary Artery Revascularization ◽  
Coronary Syndrome

In patients with acute coronary syndrome who were performed coronary arteries’ revascularization, in the postoperative period disorders of hemodynamics and heart rate variability often develop. The aim of our work was to optimize the cardiac rehabilitation of such patients by individualization of physical activity depending on the state of systolic and diastolic left ventricular dysfunction and heart rate variability.                 40 patients with acute coronary syndrome and coronary artery revascularization were included into the experimental group. The control group consisted of 20 patients of the same age, clinical and laboratory manifestations of ACS who were treated according to the protocol of Ministry of Health of Ukraine. In both groups of patients clinical efficacy of cardiac rehabilitation process was evaluated according to the dynamics of clinical symptoms, systolic and diastolic left ventricular function and heart rate variability.                 In patients with acute coronary syndrome and coronary artery revascularization in the initial state the clinical and laboratory signs of myocardial ischemia disappear, but subclinical and clinical manifestations of heart failure remain.                 During the first month of training, the original accelerated cardiac rehabilitation program leads to the decrease of systolic and diastolic signs of cardiac dysfunction and improves heart rate variability, which significantly improves the quality of life of these patients.                 For monitoring the efficacy and safety of the performance of cardiac rehabilitation program in patients with acute coronary syndrome and coronary artery revascularization, in addition to conventional methods (determination of heart rate, blood pressure, 6-minute test), it is useful to diagnose subclinical stage of heart failure by examination of systolic, diastolic function and vegetative regulation.

scholarly journals 346 Baroreflex sensitivity and autonomic function in Takotsubo syndrome long after the acute phase

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Martina Zinelli ◽  
Davide Lazzeroni ◽  
Luca Moderato ◽  
Claudio Stefano Centorbi ◽  
Matteo Bini ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Acute Phase ◽  
Baroreflex Sensitivity ◽  
Autonomic Function ◽  
Left Ventricular ◽  
Sympathetic Tone ◽  
Coronary Syndrome ◽  
History Of ◽  
Acute Event

Abstract Aims Takotsubo Syndrome (TS) occurs as an acute coronary syndrome (ACS) characterized by severe left ventricular (LV) dysfunction that typically recovers spontaneously within days or weeks and in the absence of obstructive coronary artery disease. Although during the acute phase it is well documented that an exaggerated sympathetic tone plays a central role in the development of TS, whether an impaired sympatho-vagal balance may persist long after the acute phase, despite the recovery of left ventricular function, is still an open issue. Interestingly, recent evidences suggest that an impairment in central autonomic network not only persist long after the acute event but also may be pre-existent before the acute onset of TS. The Aim of the study was to investigate whether an impairment of the autonomic function is still present long after a TS event. Methods and results We evaluated 67 patients (91% female, mean age 66 ± 8 years) divided into three groups: 24 with a history of TS (1 year after acute event), 21 subjects with a previous history of acute coronary syndrome (ACS) and complete LV ejection fraction recovery (1 year after acute event) and 22 age- and gender-matched healthy subjects. All patients underwent a non-invasive beat-to-beat arterial blood pressure and heart rate recording (short term: 5 min), after at least 3 days of β-blockers wash-out, to obtain heart rate variability (HRV) and spontaneous baroreflex sensitivity (sBRS) data. An overall autonomic dysfunction was found in both TS and ACS groups compared to controls. In particular, a lower heart rate variability, expressed as lower SDNN, has been found in TS and ACS groups compared to controls (31 ± 12 vs. 25 ± 11 vs. 41 ± 22; P = 0.006—Figure A) as a consequence of blunted vagal tone, expressed as lower RMSSD (20 ± 12 vs. 19 ± 11 vs. 40 ± 37; P = 0.007—Figure B) and higher sympathetic tone, expressed as higher LF/HF ratio (P = 0.007 Figure C) which was found to be higher in TS even when compared to ACS (TS: 3.5 ± 2.5 vs. ACS: 2.1 ± 1.7; P = 0.011). Moreover, fractal analysis of HRV showed higher complexity of heart rate regulation, expressed as higher fractal dimension (DFA 1.48 ± 0.06 vs. 1.53 ± 0.05 vs. 1.40 ± 0.10; P &lt; 0.0001—Figure D), in both TS and ACS compared to controls. Interestingly, spontaneous BRS showed the lowest values in the TS group (sSBP: 5.6 ± 2.6 vs. 7.5 ± 3.0 vs. 12.1 ± 11.9; P = 0.027—Figure E), associated with highest levels of sympathetic peripheral control of systolic blood pressure (SBP), expressed as LF-BRS (13.7 ± 9.6 vs. 8.3 ± 5.2 ± 6.8 ± 5.8; P = 0.008—Figure F). Conclusions An autonomic dysfunction, characterized by a hyper-sympathetic tone, reduced baroreflex sensitivity and increased peripheral adrenergic control of blood pressure, persists in TS patients long after the acute phase.

scholarly journals NON-ST-ELEVATION ACUTE CORONARY SYNDROME DUE TO A TOTALLY OCCLUDED CORONARY ARTERY: A HISTORY OF TWO TWIN BROTHERS

2020 ◽  
Vol 73 (1) ◽  
pp. 201-202
Author(s):  
Adam Kern ◽  
Krystian Bojko ◽  
Ewa Sienkiewicz ◽  
Artur Zarzecki ◽  
Jacek Bil
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
The Other ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
History Of ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

We present the image of two twin brothers aged 53. Within 18 months they both underwent acute coronary syndrome treated with percutaneous coronary intervention (PCI). This story shows that both twins had similar comorbidities (hypercholesterolemia and hypothyroidism) as well as the course of the acute coronary syndrome. Although in both cases the coronary artery was totally occluded (in one case – fresh occlusion, in the other – CTO), no STEMI presentation was observed. Therefore, thorough investigation is warranted in twins after the acute coronary syndrome in of them, even in case of no evident ischemia symptoms.

scholarly journals Selective Heart Rate Reduction With Ivabradine Increases Central Blood Pressure in Stable Coronary Artery Disease

Hypertension ◽  
2016 ◽  
Vol 67 (6) ◽  
pp. 1205-1210 ◽  
Author(s):  
Stefano F. Rimoldi ◽  
Franz H. Messerli ◽  
David Cerny ◽  
Steffen Gloekler ◽  
Tobias Traupe ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Heart Rate ◽  
Coronary Artery ◽  
Stable Coronary Artery Disease ◽  
Central Blood Pressure ◽  
Heart Rate Reduction ◽  
Rate Reduction ◽  
Artery Disease

scholarly journals Clinical impact of peripheral artery disease on acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Fonseca Goncalves ◽  
S.C Borges ◽  
J.J Monteiro ◽  
P.S Mateus ◽  
J.I Moreira
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Peripheral Artery Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Peripheral Artery ◽  
Coronary Syndrome ◽  
History Of ◽  
Artery Disease

Abstract Introduction Peripheral artery disease (PAD) and acute coronary syndrome (ACS) are two diseases with high morbidity and mortality and, sometimes, may be present simultaneously, making patient management more complex. Purpose This study sought to characterize and evaluate the prognostic impact of PAD in patients with an ACS. Methods This was a retrospective study of patients admitted with an ACS, periodically included in a national multicenter registry, between October 2010 and September 2019. Results Of a total of 26036 patients, 1429 had previous history of PAD. This group had a higher predominance of men (79,5% vs 72,0%, p&lt;0,001) and was older (71±11 years vs 66±14 years, p&lt;0,001). Besides having a higher burden of cardiovascular risk factors, they also had more past history of myocardial infarction (MI), stroke and chronic kidney disease. In patients with PAD, non-ST segment elevation MI was the most frequent type of MI (58,6% vs 45,0%, p&lt;0,001) and left ventricular ejection fraction assessed during hospitalization was lower (49±13% vs 51±12%, p&lt;0,001). These patients were submitted less frequently to a coronary angiography (74,0% vs 85,2%, p&lt;0,001) and, when performed, more cases of multivessel coronary artery disease were found (70,6% vs 50,4%, p&lt;0,001). Nevertheless, they were less likely to undergo revascularization, with fewer angioplasties performed (47,8% vs 64,7%, p&lt;0,001), despite the greater number of coronary artery bypass grafting (9,0% vs 6,0%, p&lt;0,001). Both during hospitalization and at discharge, ticagrelor, beta-blockers and ACE inhibitors were less prescribed in the PAD group. Statins prescription was also lower, but only at discharge. In a multivariate regression analysis, we found that, during hospitalization, the presence of PAD was associated with a significant higher risk of myocardial reinfarction (OR 1,90 (CI 1,18–3,06)) and death (OR 1,43 (CI 1,03–2,00)). In addition, there was a tendency for more strokes (OR 1,88 (CI 0,98–3,61)). During a 1-year follow-up, PAD was also independently associated with a significant increase in mortality (HR 1,50 (CI 1,16–1,95)). Conclusions PAD is a disease present in patients with a higher number of comorbidities and is associated with more severe coronary events. Nevertheless, these patients seem to receive less evidence-based therapy. In this study, PAD was independently associated with a significant increase in short and medium-term major adverse events. Kaplan-Meier curves of 1-year follow-up Funding Acknowledgement Type of funding source: None

scholarly journals ROLE OF HEART RATE REDUCTION WITH IVABRADINE IN LEFT VENTRICULAR FAILURE

2020 ◽  
Vol 70 (6) ◽  
pp. 1839-42
Author(s):  
Safia Batool ◽  
Jamal Waris ◽  
Muhammad Usman Sajid ◽  
Shazia Nisar ◽  
Imran Khan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Placebo Group ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Left Ventricular ◽  
Left Ventricular Failure ◽  
Heart Rate Reduction ◽  
Rate Reduction ◽  
Ventricular Failure

Objective: To compare mean heart rate reduction in Ivabradine and placebo group in left ventricular failurepatients. Study Design: Quasi experimental study. Place and Duration of Study: Study was conducted at CMH, Kharian, from Jul 2018 to Dec 2018. Methodology: 64 patients participated in the study. They were randomly divided into two groups of 32each. One group was given Tab Ivabradine (10 mg twice a day) while second group received a placebo for aperiod of 4 weeks. After 4 weeks each patient was evaluated and heart rate, systolic and diastolic blood pressure were recorded. Mann-whitney U test selected to compare heart rate and ages of both groups t- test used to compare systolic and diastolic blood pressure among both groups. Chi-square test used to determine the association of heart rate between two groups. A p-value ≤0.05 was considered significant. Results: Median (IQR) heart rate was significantly lower in Ivabradine group 58.3 (4) as compared to placebo64.1(1) (p<0.01). Systolic blood pressure (132.8 ± 3.6) was significantly lower in ivabradine group as comparedto placebo group (137.1 ± 4.5) (p<0.01). Difference in diastolic blood pressure was insignificant in both groups (p=0.55). There was a significant association between heart rate of 55-60 beats per minute and ivabradine use(p<0.01). Conclusion: Ivabradine is safe and efficative drug in reducing heart rate and systolic blood pressure for patients suffering from left ventricular failure. Early detection and management of left ventricular failure with ivabradine use leads to better prognosis of the disease.

An Atypical Presentation of Acute Coronary Syndrome

2012 ◽  
Vol 8 (1) ◽  
pp. 67
Author(s):  
Syed Khurram Mushtaq Gardezi ◽  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Systolic Function ◽  
Artery Bypass ◽  
Left Ventricular Systolic Function ◽  
Regional Wall Motion ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
Coronary Syndrome

A 61-year-old man was admitted to hospital with severe occipital headache and weakness and numbness of the left arm. His electrocardiograms showed changes hinting at acute coronary syndrome (ACS). However, in view of his clinical presentation, he underwent tests for likely subarachnoid haemorrhage, but this was ruled out. The next day, he was referred to cardiology. A transthoracic echocardiogram showed reduced left ventricular systolic function along with regional wall motion abnormalities involving inferoposterior walls. The patient was treated as per the protocol for ACS. A dobutamine stress echocardiogram confirmed inferior myocardial infarction with evidence of myocardial viability in the affected left ventricular segments. Subsequent investigations confirmed three-vessel coronary artery disease and reduced left ventricular systolic function. The patient underwent successful coronary artery bypass grafting.

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