Earlysurgical treatment of acu te coronary syndrome in patients with ST -segm ent elevation (at < h24), arrhy thm iccomp lications and severe mitral regu rgitation

Treatment outcomes of acute coronary syndrome in 108 patients with ST-segment elevation (after more than 24 hours) complicated by arrhythmias (atrial fibrillation and atrial flutter) and subsequently developed severe (degrees 2 and 3) mitral insufficiency were analyzed. We elaborated an algorithm for the sequence of interventions. All the patients had coronary angiography and stenting of the symptom-dependent artery during the first 2 days after the admission. Depending on the localization of the left ventricular myocardial infarction zone, the patients were divided into 3 groups: 68 (63%) patients with anterior wall and apex infarction; 23 (21.3%) patients with posterior wall infarction; 17 (15.7%) patients with lower wall infarction. It was revealed that patients, who had undergone revascularization in the early stages, had a statistically significant increase in the main indicators of myocardial contractility, in contrast to patients receiving only conservative therapy. In the observation group, sinus rhythm was restored in all patients 1–4 days after hospitalization. 12 patients underwent emergency electrical cardioversion on the day of admission. In 31 patients, sinus rhythm was restored within the first 24 hours during therapy prior to revascularization. In 39 patients, sinus rhythm was restored during therapy on days 3–5 after primary revascularization. In 26 patients, sinus rhythm was restored 2–4 days after complete revascularization. Based on the study, several conclusions can be drawn: in conditions of heart failure, revascularization is best to perform at the earliest possible stage. The optimal values of vital functions for performing revascularization can be considered: systolic blood pressure ≥ 80 mm Hg; heart rate ≤ 110 beats per minute. In primary surgical treatment, it is most optimal to revascularize only the symptom-dependent artery. Reintervention for complete revascularization is most effective and safe 10–14 days after the initial intervention. The use of emergency electrical cardioversion in those patients in the preoperative period is fully justified, despite the existing risks. Application of our algorithm helps to restore sinus rhythm, reduce the degree of mitral regurgitation and reduce mortality.

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Marijuana-induced acute myocardial infarction in a young adult male

BMJ Case Reports ◽

10.1136/bcr-2021-243335 ◽

2021 ◽

Vol 14 (7) ◽

pp. e243335

Author(s):

Aakash Verma ◽

Vivek Nanda ◽

Ankita Kabi ◽

Himanshi Baid

Keyword(s):

Interventricular Septum ◽

Tertiary Care ◽

Coronary Intervention ◽

Anterior Wall ◽

Acute Onset ◽

Left Ventricular ◽

Tertiary Care Centre ◽

Successful Resuscitation ◽

St Segment Elevation ◽

Coronary Syndrome

A 27-year-old man presented to the emergency department of a tertiary care centre with complaints of acute onset breathing difficulty and retrosternal chest discomfort of 6 hours’ duration. On primary survey, he was dyspnoeic with a room air saturation of 85% and a blood pressure of 80/50 mm Hg. A bedside ultrasound revealed an ejection fraction of around 40%, with hypokinesia of interventricular septum, left ventricular apex and anterior wall with bilateral multiple B lines in all lung zones. A 12 lead ECG showed ST segment elevation in leads V2-V6. He sustained a cardiac arrest. Return of spontaneous circulation was achieved following high-quality cardiopulmonary resuscitation. After successful resuscitation, the patient underwent primary percutaneous coronary intervention and recovered fully from the event. On further evaluation, an acute binge of marijuana smoking prior to the onset of symptoms was identified as the cause of the acute coronary syndrome.

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Analysis of risk factors for different subtypes of acute coronary syndrome

Journal of International Medical Research ◽

10.1177/03000605211008326 ◽

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.

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ACUTE CORONARY SYNDROME FOLLOWING INTRAVENOUS IMMUNOGLOBULIN THERAPY : A HIDDEN RISK

10.36106/ijar/3506061 ◽

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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Takotsubo Syndrome: Contemporary Views on the Pathogenesis, Prevalence and Prognosis

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2018-14-4-598-604 ◽

2018 ◽

Vol 14 (4) ◽

pp. 598-604 ◽

Cited By ~ 1

Author(s):

A. S. Shilova ◽

A. O. Shmotkina ◽

A. A. Yafarova ◽

M. Yu. Gilyarov

Keyword(s):

Genetic Predisposition ◽

Randomized Clinical Trials ◽

Myocardial Dysfunction ◽

Specific Treatment ◽

Left Ventricular ◽

Takotsubo Syndrome ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Reversible Left Ventricular Dysfunction

Takotsubo syndrome (TTS) is a reversible left ventricular dysfunction characterized by local apical hypokinesia usually triggered by a physical or emotional stress. According to the last available data TTS may represent 2% of all admissions for acute coronary syndromes. Despite the reliable prevalence, diagnosis of TTS remains difficult. The initial presentation, both clinically and electrocardiographically, is similar to an acute myocardial infarction (AMI). The biomarker profile is also similar, although the peaks of troponin and creatinine kinase levels are lower, and brain natriuretic peptide levels are higher in patients with TTS compared with ST-segment elevation AMI. Modified Mayo diagnostic criteria are the most common for the diagnosis. Pathogenesis of TTS currently is not well understood. Catecholamines appear to play a central role in the pathophysiology of TTS. However, it is conceivable that some people have a genetic predisposition to stress-induced TTS. A genetic predisposition has been suggested based on the few familial TTS cases described. Despite reversible myocardial dysfunction, acute heart failure is the most common complication in the acute phase of TTS. In-hospital mortality rate is comparable to that of ST-segment elevation AMI. There are no randomized clinical trials to support specific treatment recommendations in TTS. It is believed that the tactics of managing patients with TTS hospitalized with suspicion of acute coronary syndrome should comply with the protocol of management of patients with AMI while acute coronary pathology is not excluded.

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Effects of Long-term Nonylphenol Exposure on Myocardial Fibrosis and Cardiac Function in Rats

10.21203/rs.3.rs-142059/v1 ◽

2021 ◽

Author(s):

Chao Liu ◽

Chengyu Ni ◽

Weichu Liu ◽

Xiaolian Yang ◽

Renyi Zhang ◽

...

Keyword(s):

Creatine Kinase ◽

Myocardial Fibrosis ◽

Posterior Wall ◽

Anterior Wall ◽

Left Ventricular ◽

Environmental Estrogens ◽

Control Group ◽

Cardiac Structure ◽

Collagen Iii

Abstract Background: Myocardial fibrosis is a critical pathological basis for the poor prognosis of cardiovascular diseases. Studies have found that myocardial fibrosis is closely associated with exposure to environmental estrogens such as nonylphenol (NP), as a representative of environmental estrogens. The aim of this study was to examine the effects of NP chronic exposure on myocardial fibrosis as well as cardiac structure and function. Forty Sprague Dawley rats were randomly divided into four groups (n = 10): control group (C), low NP dose (0.4 mg/kg, L), medium NP dose (4 mg/kg, M), and high NP dose (40 mg/kg, H) groups. The NP dose groups were gavaged with NP for 180 days. Results: The NP level in the heart of the NP groups was significantly higher than those in the control group (F = 43.658, P < 0.001). Serum aspartate aminotransferase (AST), creatine kinase (CK), creatine kinase isozyme (CK-MB), lactate dehydrogenase (LDH) and α-hydroxybutyrate dehydrogenase (α-HBDH) significantly increased in the NP groups compared with the control group (). Histopathological examination of the heart biopsy illustrates that in the medium and high NP groups, the fibrous connective tissue had a disordered and loose gridding shape, muscle fibers had fractured, and muscle fibers were loose with a widened gap. Extensive inflammatory cell infiltration and fibroblast proliferation in the myocardial interstitium were also found. With increasing NP dose, the degree of muscle fiber loosing and disorder became more significant in the NP treatment groups, and the collagen volume fraction (CVF) was higher than that in the control group (P < 0.01). Compared with the control group, the expression of collagen I and collagen III increased significantly in the medium and high NP groups (P < 0.05). The values of the systolic thickness of the left ventricular anterior wall (LVAWs), the diastolic thickness of the left ventricular posterior wall (LVPWd), the systolic thickness of the left ventricular posterior wall (LVPWs), and the left ventricular anterior wall (LVAWd) in the NP groups are were slightly lower than those in of the control group. The values of left ventricular end systolic dimensions (LVIDs) in the NP groups increased compared with the control group. Conclusions: Long-term NP exposure could lead to fibrosis in the rat myocardium, which is characterized by increased expressions of myocardial collagen I and collagen III, as well as elevated cardiac enzymes. In addition, the cardiac structure was affected and changes were observed in the thinner ventricular wall and as an enlarged ventricular cavity.

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Abstract 15692: Voltage Mapping in Atrial Fibrillation vs Sinus Rhythm: Results From the Mavs Study

Circulation ◽

10.1161/circ.142.suppl_3.15692 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Carola Gianni ◽

Jerri A Cunningham ◽

Sanghamitra Mohanty ◽

CHINTAN TRIVEDI ◽

Domenico G Della Rocca ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Low Voltage ◽

Lateral Wall ◽

Posterior Wall ◽

Anterior Wall ◽

Inferior Wall ◽

Voltage Mapping ◽

First Time ◽

Mapping Catheter

Background: Left atrial (LA) scar can be identified with bipolar voltage mapping during sinus rhythm (SR). It is not clear whether the same voltage criteria can be applied during atrial fibrillation (AF). Objective: Aim of this study was to compare voltage maps performed in the same patient both in AF and SR. Methods: Voltage mapping was performed using a 10-pole circular mapping catheter in patients with non-paroxysmal AF undergoing first time RF ablation. For descriptive purposes, the LA was divided in 6 regions: septum, posterior wall (PW), inferior wall (IW), lateral wall, anterior wall, and roof. The threshold for low voltage was <0.5 mV (with a color range setting 0.2-0.5 mV). Mild “scar” was defined as an area low voltage 5-20%, moderate 20-35% and severe as >35%. Results: 16 patients (62% persistent AF, 38% longstanding persistent AF) were included in the study. The map density was comparable during AF and SR (mean points per map 551 vs 547, paired t test P = NS). 2 patients displayed normal voltage during both AF and SR. 14 patients showed areas of low voltage during AF, which were still present during SR in 8. All patients with mild “scarring” during AF (n = 4), showed normal voltage during SR. Of the 7 patients with moderate “scarring”, 2 patients showed normal voltage during SR, while in the remaining 5 “scarring” was only mild during SR. 3 patients showed extensive “scarring” during AF, which was only moderate during SR. During AF, areas of low voltage were more commonly observed in the PW (12/14) followed by the IW (6/14) and antero-septum (4/14); while in SR, in the antero-septum (4/8), PW (3/8) and IW (3/8). Interestingly, in all patients both the PW/IW and (less dramatically) the antero-septum showed more “scarring” during AF as compared to SR. Conclusion: Areas of low voltage are more severe and diffuse during AF when compared to SR. When areas of low voltage are detected during AF, they are more commonly seen in the PW, IW and antero-septal areas.

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Takotsubo Cardiomyopathy and Non-ST-Segment Elevation Myocardial Infarction: Predictors of Left Ventricular Dysfunction

Clinical Medicine Insights Cardiology ◽

10.1177/1179546817716103 ◽

2017 ◽

Vol 11 ◽

pp. 117954681771610

Author(s):

Andrew Hinojos ◽

Thomas E Vanhecke ◽

Susan Enright ◽

Nathan Elg ◽

Kristina Gifft ◽

...

Keyword(s):

Myocardial Infarction ◽

Left Ventricular ◽

Retrospective Case ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Segment Elevation Myocardial Infarction ◽

Lv Dysfunction ◽

St Segment ◽

Artery Disease ◽

Control Study

Background: Acute coronary syndrome (ACS) from non-ST-segment elevation myocardial infarction (NSTEMI) and Takotsubo (TK) cardiomyopathy present with similar initial clinical features and can result in left ventricular (LV) dysfunction and acute heart failure. Methods: This study was a retrospective case-control study that identified patients aged 18 years and older who presented with ACS and underwent cardiac catheterization. Results: There were a total of 321 patients in the TK group and 1031 patients in the NSTEMI group. There was significantly worse LV dysfunction in the TK group with average ejection fraction (EF) of 44.35% (±15.11%) versus NSTEMI with an average EF of 47.36% (±13.5%) ( P < .001). The presence of TK yielded of an odds ratio (OR) of 2.373 (95% confidence interval [CI]: 1.165-3.618) and presence of peripheral artery disease (PAD) yielded an OR of 2.053 (95% CI: 1.165-3.618). Conclusions: The presence of TK cardiomyopathy and PAD were independent predictors of patients who had LVEF of <35% and elevated B-type natriuretic peptide levels.

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Analysis of ticagrelor’s cardio-protective effects on patients with ST-segment elevation acute coronary syndrome accompanied with diabetes

Open Medicine ◽

10.1515/med-2019-0017 ◽

2019 ◽

Vol 14 (1) ◽

pp. 234-240 ◽

Cited By ~ 1

Author(s):

Dong-Tao Li ◽

Shun-Bao Li ◽

Jian-Yong Zheng ◽

Hai-hong Tang ◽

Yi-Gang Qiu ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Adverse Reactions ◽

Left Ventricular ◽

Control Group ◽

Observation Group ◽

Protective Effects ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Elevation Acute Coronary Syndrome

AbstractBackgroundTo analyze the cardio-protective effects of ticagrelor in patients with acute coronary syndrome with S-T segment elevation.MethodsThe sample was 200 patients who had been diagnosed with acute coronary syndrome accompanied by diabetes Mellitus type II. Only patients having ST segment elevation before the treatment were included. Then, the subjects were further randomly divided into an observation group and a control group. The control group of 100 patients received clopidogrel; the observation group of 100 patients of ticagrelor. The serous creatine kinase CK-MB, functional cardiac indexes of left ventricular end diastolic diameter (LVDD), cardiac troponin I, ventricular ejection fraction, and relevant major adverse cardiovascular events (MACE) were compared between the two groups.ResultsOne month after a percutaneous coronary intervention (PCI) the observation group showed better results against angina, stent thrombosis, and all-cause mortality compared with those of the control subjects. Six months after treatment, both groups suffered adverse reactions. The number of patients who suffered adverse reactions in respiratory tract in the observation group was higher than in the control group. The inhibition of platelet aggregation IPA of ticagrelor was found to be significantly higher than clopidogrel, having a significant p value.ConclusionTicagrelor can effectively protect myocardial function for patients with ST-segment elevation acute coronary syndrome accompanied by diabetes and can reduce the incidence of adverse reactions..

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