Blood rheology and RBC aggregation in patients with angina pectoris and a prior history of myocardial infarction

Myxomas arising from the left ventricle (LV) are extremely rare and can be easily mistaken for a thrombus. We report a case of a 35-year-old man who presented with an acute cerebrovascular accident, having had a prior history of an anterior wall myocardial infarction 2 years back with an echocardiographic evaluation showing mild LV systolic dysfunction. His present prothrombotic workup revealed hyperhomocystinaemia and elevated levels of factor VIII. Present echocardiography revealed a mass arising from a scarred LV wall. Considering the possibility of a thrombus, he was initially started on parenteral anticoagulation. Unfortunately, consequent echocardiogram evaluation showed no reduction in size of the LV mass hence surgical removal was done. Histopathological evaluation unveiled the mass to be a myxoma.

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Impact of low v. moderate intakes of long-chain n-3 fatty acids on risk of coronary heart disease

British Journal Of Nutrition ◽

10.1017/s0007114511001644 ◽

2011 ◽

Vol 106 (8) ◽

pp. 1129-1141 ◽

Cited By ~ 43

Author(s):

Kathy Musa-Veloso ◽

Malcolm A. Binns ◽

Alexandra Kocenas ◽

Catherine Chung ◽

Harry Rice ◽

...

Keyword(s):

Myocardial Infarction ◽

Fatty Acids ◽

Cardiovascular Health ◽

Prior History ◽

History Of ◽

Coronary Events ◽

Meta Analyses ◽

Nested Case Control ◽

Fatal Myocardial Infarction ◽

Long Chain

The objective of the present study was to determine whether the consumption of ≥ 250 v. < 250 mg of the long-chain n-3 fatty acids (n-3 LCFA) per d is associated with a reduction in the risk of fatal and non-fatal CHD in individuals with no prior history of CHD. A comprehensive and systematic review of the published scientific literature resulted in the identification of eight prospective studies (seven cohorts and one nested case–control study) that met predefined inclusion criteria. Relative to the consumption of < 250 mg n-3 LCFA per d, the consumption of ≥ 250 mg/d was associated with a significant 35·1 % reduction in the risk of sudden cardiac death and a near-significant 16·6 % reduction in the risk of total fatal coronary events, while the risk of non-fatal myocardial infarction was not significantly reduced. In several meta-analyses, which were based on US studies, risk of CHD death was found to be dose-dependently reduced by the n-3 LCFA, with further risk reductions observed with intakes in excess of 250 mg/d. Prospective observational and intervention data from Japan, where intake of fish is very high, suggest that n-3 LCFA intakes of 900 to 1000 mg/d and greater may confer protection against non-fatal myocardial infarction. Thus, the intake of 250 mg n-3 LCFA per d may, indeed, be a minimum target to be achieved by the general population for the promotion of cardiovascular health.

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Clinical analysis of cardiac failure in post-myocardial infarction patients

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20182074 ◽

2018 ◽

Vol 5 (3) ◽

pp. 587

Author(s):

R. Jaya Prakash Reddy ◽

P. Vijaya Narasimha Reddy

Keyword(s):

Myocardial Infarction ◽

Cardiac Failure ◽

Clinical Analysis ◽

Cross Sectional Study ◽

Anterior Wall ◽

Prior History ◽

Medical Sciences ◽

Cross Sectional ◽

Number Of Patients ◽

History Of

Background: Cardiac failure is one of the common complications of Acute Myocardial Infarction. As CAD is the leading cause of death and post MI Cardiac failure also causing increase in rate of Mortality. It directs us to assess the complications of MI and to evaluate the precautionary & preventive steps of cardiac failure.Methods: The present study comprises of 50 cardiac failure patients with history of MI in the past and who presented with myocardial infarction with cardiac failure were included in this study. We excluded the patients who presented with Cardiac failure without Prior history of MI. This hospital based cross sectional study was conducted at Rajiv Gandhi Institute of Medical Sciences (RIMS), Ongole, Prakasam District, Andhra Pradesh. The study was carried out for a period of 1 year with informed consent.Results: In present study majority number of patients (33) show hypokinesia and 10 are found to have dyskinesia and only 4 are akinesia. In this study More than 50% patients are with history of anterior wall involvement. 36(72%) patients have elevated JVP, 34(68%) have cardiomegaly, 38 patients presented with PND. 29(58%) patients are DM and 35(70%) are HTN and only 6(12%) patients are neither DM, nor HTN.Conclusions: Cardiac failure is a common complication after MI. Most common presentations are breathlessness, chest pain, PND, JVP etc. Anterior wall MI on ECG either isolated or associated with other walls is the leading cause of post MI cardiac failure.

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P6529Safety of emergency pretreatment regimen for contrast allergy before percutaneous coronary intervention for ST-elevation myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehz746.1119 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Jha ◽

A Berger ◽

J Blankenship

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Medical Center ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Prior History ◽

Percutaneous Coronary ◽

History Of ◽

St Elevation ◽

Contrast Allergy

Abstract Background Primary percutaneous coronary intervention (PPCI) is the best treatment for ST-elevation myocardial infarction (STEMI). However, patients with prior contrast reactions may not receive PCI due to concern over a recurrent contrast reaction. Purpose To determine the clinical efficacy of emergency pretreatment regimens for contrast allergy in STEMI patients undergoing PPCI. Methods We retrospectively identified all individuals with a history of contrast allergy who presented with STEMI, were pretreated for contrast allergy, and underwent PPCI at our medical center between January 2005 to May 2018. Emergency pretreatment regimen included a combination of intravenous (IV) steroid, IV famotidine and IV diphenhydramine administered immediately before PCI. Laboratory records, inpatient notes, and discharge summaries were reviewed to confirm the severity of the original contrast allergy and identify any allergic breakthrough reaction after pretreatment with an emergency regimen. Reactions were characterized as mild, moderate, severe, or of unknown severity. Results During the study period 15,712 individuals underwent PCI, of which 176 patients presented with STEMI, had confirmed contrast allergy, and were pretreated before undergoing PCI. No patient with a history of contrast allergy underwent PPCI without pre-treatment. Mean age was 64 years, with 52% males, and all individuals were white. The majority had hypertension (77%), 67% had dyslipidemia, 29% had diabetes mellitus, and 20% patients had a prior history of MI. Intravenous steroids used in the emergency regimen included methylprednisone (n=100), hydrocortisone (n=70), and dexamethasone (n=6). The original allergic response to ICM was mild in 59% patients, moderate in 15%, severe in 20% and of unknown severity in 13% patients. Of the 176 patients only 10 (5.6%) developed a breakthrough reaction. Most of which were mild; none was fatal. Median length of hospital stays was three days and nine patients (10.8%) passed away within 30 days of hospital admission. Conclusions Patients with prior contrast allergy presenting with STEMI can safely undergo PPCI after emergency pretreatment. Breakthrough reactions are infrequent and mild.

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PRIMARY XANTHOMA TUBEROSUM IN CHILDREN

PEDIATRICS ◽

10.1542/peds.23.1.67 ◽

1959 ◽

Vol 23 (1) ◽

pp. 67-75

Author(s):

Jack E. McCleary ◽

Louis A. Brunsting ◽

Roger L. J. Kennedy

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Angina Pectoris ◽

Cardiac Disease ◽

Blood Lipids ◽

Close Relative ◽

History Of ◽

Coronary Blood Vessels ◽

The One

A brief classification of xanthomatoses is presented. In an attempt to remove some of the confusion contributed by the several different meanings for the term "hyperlipemia," the term "hyperneutralipemia" is introduced to indicate an elevation of the concentrations of neutral fat in the serum. The term "hyperlipemia" is retained to mean an elevation of values for any of the blood lipids. The term "primary xanthoma tuberosum" designates the classic idiopathic form of xanthoma tuberosum associated with hypercholesteremia and without hyperneutralipemia. The primary purpose of this paper is to review the outcome of 11 cases of primary xanthoma tuberosum in children seen at the Mayo Clinic. Five of the eleven are known to be dead from cardiovascular disease, and one other is presumed to be dead. In five of the six patients angina pectoris developed before death. Two patients who are still living have angina pectoris, one having suffered myocardial infarction. Necropsy of four patients showed atheromatous involvement of the coronary blood vessels to be a prominent finding. Three of the patients died before they reached the age of 15 years. Two of the patients were brother and sister. Of the remaining nine patients, four gave a family history of cardiac disease occurring in a close relative early in life and five patients had relatives with cutaneous xanthomas. In the one family studied, all five members had hypercholestenemia.

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Real-world evidence on short- and long-term outcomes for acute coronary syndrome patients with a prior history of atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehaa946.1662 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Gouda ◽

A Savu ◽

K Bainey ◽

R Welsh ◽

R.K Sandhu

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Prior History ◽

Long Term Outcomes ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

History Of ◽

Short And Long Term

Abstract Background Acute coronary syndromes (ACS) are often complicated by new-onset atrial fibrillation (AF), which is associated with higher short-term mortality. It is unknown whether a prior history of AF affects outcomes beyond in-hospital mortality in a real-world setting. Purpose To assess (i) the prevalence of prior AF in patients with ACS, including unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI); (ii) clinical characteristics of ACS patients with and without AF; and (iii) in-hospital mortality and long-term outcomes in the presence of prior AF. Methods We used linked administrative health databases to identify patients hospitalized with a primary diagnosis of ACS and prior history of non-valvular AF (ICD-9 code 427.3 and ICD-10 code 148), which was defined as 1 hospitalization or 1 emergency department visit or 2 outpatient visits at least 30 days apart in 1 year in any position, between April 2002 and March 2016 in Alberta, Canada. Outcomes included in-hospital mortality, long-term mortality and a composite of all-cause mortality, hospitalisation for myocardial infarction (MI) or stroke over 3 years. Kaplan-Meier curves were constructed for mortality and the composite outcome according to presence of prior AF and ACS type. Results Of 31,056 presenting with an ACS, 4,173 (13.4%) had a prior history of AF. Compared to patients without prior AF, patients with AF were older (75.7 versus 64.7 years), female (35.5% versus 29.9%), with a higher comorbidity burden (Charlson Comorbidity Index 1.7 versus 1.1). Patient with AF more often presented with NSTEMI (57.7% versus 48.2%) and UA (17.1% versus 16.4%) compared to STEMI (25.2% versus 35.4%). In-hospital mortality was higher for ACS patients in the presence of prior AF (8.1% versus 3.3%; p<0.0001). Mortality and the composite endpoint were also significantly higher in patients with prior AF compared to those without AF (Panel A and B) over the 3-year period. A worse prognosis was observed for STEMI and NSTEMI patients with prior AF compared to any other group (panel C and D). Conclusion In this large, population-based study, we found that a history of AF is common in patients presenting with an ACS. In the presence of AF, short- and long-term prognosis is poor particularly for STEMI and NSTEMI patients. Aggressive modification of shared risk factors and use of evidence-based therapies to improve outcomes is needed in this high-risk population. Outcomes by presence of AF and ACS type Funding Acknowledgement Type of funding source: None

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