scholarly journals MODERN METHODS TO DIFFERENTIATE BETWEEN CHEST PAIN AND CARDIAC ISCHEMIA

2020 ◽  
Vol 49 (06) ◽  
pp. 43-43
Author(s):  
Giorgi Javakhishvili ◽  
Rusudan Sujashvili
Keyword(s):  
Acute Coronary Syndrome ◽  
Acute Coronary Syndromes ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
T Wave ◽  
Fibrous Cap ◽  
St Segment ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Acute coronary syndrome (ACS) is a group of conditions which often present with similar signs and symptoms while having different outcomes and complications. Therefore it is essential to differentiate between them as soon as possible and provide appropriate management. Acute coronary syndromes are classified into two categories: STE-ACS (ST segment Elevation Acute Coronary Syndrome) and NSTE-ACS (Non ST segment Elevation Acute Coronary Syndrome). STE-ACS stands for ST Elevation Acute Coronary Syndrome all of which demonstrate significant ST elevations on ECG due to complete blockage of artery by thrombus, while NSTE-ACS is due to partial occlusion of artery which exhibit ST segment depression and/or T wave inversions. Patients with NSTE-ACS who do not develop infarction are diagnosed with unstable angina, which itself is a precursor of myocardial infarction. Acute coronary syndromes are considered multifactorial and risk factors most commonly associated with development of acute coronary syndromes include: hypertension, smoking, diabetes, obesity, sedentary life-style, hereditary conditions etc. Chronic stress to the coronary endothelium eventually leads to inflammation and atherosclerotic plaque formation. Plaque at some point with additional stress will rupture and trigger thrombus formation. Probability of plaque rupture depends on its composition: stable plaques contain small fatty core and thick fibrous cap, unstable plaque have larger fatty cores and thin fibrous cap. Patients with acute coronary syndromes present with chest pain and/or discomfort and may experience tightness and pressure sensation; pain may radiate to left or both arms, jaw, back or stomach, sweating, dyspnea and dizziness are also common complaints. Whenever we suspect ACS first diagnostic tests is always ECG (Electrocardiography). If ST segment is persistently elevated STEMI (ST Elevation Myocardial Infarction) can be diagnosed and reperfusion therapy is indicated; but if ST segment is depressed and/or T wave inversion is present laboratory tests are necessary for diagnosis. Cardiac biomarkers mainly used in the clinic are Troponins and CK-MB (Creatine Kinase MB), yet LDH (lactate dehydrogenase), B-type natriuretic peptide and C-reactive protein can be used additionally. Several studies have been conducted in hopes to find other myocardial markers useful for diagnosis of ACS, one of which tested candidate biomarkers such as hFABP (Heart-type fatty acid binding protein), GPBB (Glycogen Phosphorylase Isoenzyme BB), S100, PAPP-A (Pregnancy-associated plasma protein A), TNF (Tumor Necrosis Factor), IL6 (Interleukin 6), IL18 (Interleukin 18), CD40 (Cluster of differentiation 40) ligand, MPO (Myeloperoxidase), MMP9 (Matrix metallopeptidase 9), cell-adhesion molecules, oxidized LDL (Low Density Lipoprotein), glutathione, homocysteine, fibrinogen, and D-dimer, procalcitonin. The idea of this study was to estimate usefulness of combining enzymatic markers with nonenzymatic ones in the clinical settings.

scholarly journals Significance of ST Segment Elevation in Lead aVR in Patients with Non-ST Elevation Acute Coronary Syndrome

2019 ◽  
Vol 14 (2) ◽  
pp. 71-76
Author(s):  
Pritam Kumar Gachchhadar ◽  
Manzoor Mahmood ◽  
Dipal Krishna Adhikary ◽  
MSI Tipu Chowdhury ◽  
Md Ashraf Uddin Sultan ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Area Under The Curve ◽  
Left Main ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Triple Vessel Disease ◽  
St Segment ◽  
Lead Avr ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Background: As acute occlusion of the left main (LM) artery causes life-threatening hemodynamic deterioration and malignant arrhythmias, resulting in an adverse outcome, a rapid diagnosis and subsequent urgent revascularization with percutaneous coronary intervention (PCI) or coronary bypass surgery is very important in this subset of patients. The 12-lead electrocardiogram (ECG) is a crucial tool in the diagnosis and risk stratification of acute coronary syndrome (ACS). Unlike other 11 leads, lead aVR has been long neglected until recent years. Objective: To determine the accuracy of 12-lead electrocardiography in predicting left main and/or triplevessel disease in patients with non-ST elevation acute coronary syndrome (NSTE- ACS). Methodology: This cross sectional observational study carried out among patients presenting with non-ST elevation acute coronary syndrome at Cardiac Emergency Department or CCU of BSMMU. This study was conducted from May 2017 to April 2018. A total of 36 patients meeting the eligibility criteria were consecutively included. Data collection was carried out by using a questionnaire. Informed written consent was obtained from the hospital authority. Analysis of data was finally done with Statistical Package for Social Science program 17 version of computer on the basis of different variables. Result: As ST-segment elevation in lead aVR is a continuous variable, a suitable cut-off for ST- elevation in lead aVR was found out for diagnosing LM and/or triple vessel disease (TVD) using ROC curve. The cut-off value was 0.75 mm which gave us an optimum sensitivity of 88.5% and a specificity of 80% with an area under the curve being 0.892(95% CI = 0.785-1.000), p < 0.001. The area under the curve demonstrated that 89.2% of the LM and/or TVD were correctly diagnosed with ST elevation e” 0.75 mm in lead aVR in patients with non-ST segment elevation acute coronary syndrome. The positive predictive value was commendably high (92%) and negative predictive value was no less (72.7%) with an overall diagnostic accuracy of 86%. Conclusion: From the findings of the study it can be concluded that ST- segment elevation e”0.75 mm in lead aVR in patients of non-ST segment elevation acute coronary syndrome had optimum sensitivity and specificity with an appreciably high overall diagnostic accuracy. The ST- segment elevation e”0.75 mm in lead aVR in patients with non-STE-ACS can differentiate LM and/or triple vessel disease with fair degree of accuracy. University Heart Journal Vol. 14, No. 2, Jul 2018; 71-76

scholarly journals Diabetes mellitus and acute coronary syndromes

2021 ◽  
Vol 17 (4) ◽  
pp. 346-360
Author(s):  
V.A. Serhiyenko ◽  
A.A. Serhiyenko
Keyword(s):  
Diabetes Mellitus ◽  
Acute Coronary Syndrome ◽  
Acute Coronary Syndromes ◽  
Left Ventricular ◽  
Assessment Tools ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Patients With Diabetes ◽  
Coronary Syndromes

This review article summarizes the existing literature on the current state of the problem of diabetes mellitus and acute coronary syndromes. In particular, the issues are analyzed related to the etiology, epidemiology, main pathophysiological features, classification of acute coronary syndromes, acute coronary syndromes without persistent ST-segment elevation on the electrocardiogram, acute coronary syndromes with ST-segment elevation, non-athe­rosclerotic causes of acute coronary syndrome, laboratory and instrumental diagnostic tests. Issues were analyzed related to the main approaches to the treatment of acute coronary syndromes, management of patients with diabetes mellitus and acute coronary syndromes, recommendations for secondary prevention. Initial treatment with corticosteroids includes acetylsalicylic acid, bolus heparin and intravenous heparin infusion (in the absence of contraindications). Antiplatelet therapy with ticagrelor or clopidogrel is also recommended. Pain is controlled using morphine/fentanyl and oxygen in case of hypoxia. Nitroglycerin can also be used sublingually or by infusion to relieve pain. Continuous monitoring of myocardial activity for arrhythmia is required. The choice of reperfusion strategy in patients with diabetes mellitus should be based on many factors, including assessment of clinical status (hemodynamic/electrical instability, prolonged ischemia), complications of chronic coronary syndrome, ischemic load, echocardiography, assessment of left ventricular function and any other comorbidities. In addition, various methods for assessing coronary artery disease and predicting mortality due to surgery are needed to make a final decision. Advances in the sensitivity of cardiac biomarkers and the use of risk assessment tools now enable rapid diagnosis within a few hours of symptom onset. Advances in the invasive management and drug therapy have resulted in improved clinical outcomes with resultant decline in mortality associated with acute coronary syndrome.

scholarly journals Usefulness of ECG to differentiate apical hypertrophic cardiomyopathy from non-ST elevation acute coronary syndrome

2020 ◽  
Author(s):  
Yirao Tao ◽  
Jing Xu ◽  
Samira Yerima Bako ◽  
Xiaobo Yao ◽  
Donghui Yang
Keyword(s):  
Acute Coronary Syndrome ◽  
Hypertrophic Cardiomyopathy ◽  
Maximal Amplitude ◽  
Apical Hypertrophic Cardiomyopathy ◽  
Coronary Syndrome ◽  
T Wave ◽  
St Segment ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome ◽  
T Waves

Abstract Objective: Apical hypertrophic cardiomyopathy (ApHCM) is a phenotypic variant of nonobstructive HCM. ApHCM is characterized by left ventricular hypertrophy involve the distal apex. The electrocardiographic character of ApHCM can mimic non-ST elevation acute coronary syndrome (NSTEACS) which triggers a series of studies and treatments that may be unnecessary. This study aimed to clarify the ECG differences between the two diseases.Methods: Initial electrocardiogram (ECG) recordings of 41 patients with ApHCM and 72 patients with NSTEACS were analyzed retrospectively. We analyzed the voltage of negative T (neg T) wave, R wave and the change of ST-segment in the 12-lead ECGs as well as the number of leads with neg T waves.Results: Across the 12-lead ECGs, the magnitude of R wave significantly differed between ApHCM and NSTEACS in 10 leads excluding leads aVR and V1. ApHCM was associated with a greater maximal amplitude of R wave in lead V5 (3.13±1.08 vs. 1.38±0.73, P=0.000). The magnitude of T wave significantly differed between ApHCM and NSTEACS in 10 leads excluding leads II and V1. ApHCM was associated with a greater maximal amplitude of neg T wave in lead V4 (0.85±0.69 vs. 0.35±0.23, P=0.000). The frequency of giant neg T (1mv or more) wave was higher in ApHCM (36.5% vs. 0%, P=0.000). The magnitude of ST-segment deviation significantly differed between ApHCM and NSTEACS in 10 leads excluding leads aVF and V2. ApHCM was associated with a greater maximal amplitude of ST-segment depression in lead V5 (0.19±0.07 vs. 0.03±0.06, P=0.000). The number of leads with neg T waves also differed between ApHCM and NSTEACS (6.75±1.42 vs. 6.08±1.51, P=0.046). The sum of R wave in lead V5, neg T wave in lead V6 and ST-segment depression in lead V4>2.585 mV identified ApHCM with 90.2% sensibility and 87.5% specificity, representing the highest diagnostic accuracy.Conclusions: Compared with NSTEACS patients, ApHCM patients presented higher R waves and neg T wave voltage as well as a greater ST-segment depression in the 12-lead ECGs.

scholarly journals The Bleeding Safety of Ticagrelor in Patients With ST-Elevation Acute Coronary Syndrome Treated With Fibrinolytic Therapy

Kardiologiia ◽  
2020 ◽  
Vol 60 (6) ◽  
pp. 92-95
Author(s):  
A. V. Bocharov ◽  
D. V. Sidorov
Keyword(s):  
Acute Coronary Syndrome ◽  
Treatment Group ◽  
Fibrinolytic Therapy ◽  
Intracranial Hemorrhages ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Aim      To compare hemorrhagic safety of ticagrelor and clopidogrel in patients with ST-segment elevation acute coronary syndrome (STEACS) after thrombolytic therapy (TLT).Material and methods  This nonrandomized study included 183 patients followed up for 30 days. Hemorrhagic safety was compared in a group of patients with STEACS (n=71) after a thrombolytic treatment with alteplase and early ticagrelor treatment (180 mg followed by switching to 90 mg twice daily) and in a group of patients (n=112) with STEACS receiving TLT with alteplase and clopidogrel (loading dose, 600 mg followed by switching to 75 mg daily). Primary endpoint was hemorrhage associated with TLT; patients were followed up for 30 days.Results During the follow-up period, TLT-associated hemorrhages were observed in 11.3% of patients in the ticagrelor treatment group and in 10.7% of patients in the clopidogrel treatment group (p=0.9; odds ratio, 1.06 at 95 % confidence interval, from 0.41 to 2.73). Intracranial hemorrhages and fatal hemorrhages were absent in both groups.Conclusion      There were no significant differences in hemorrhagic safety between patients with STEACS after the TLT treatment with alteplase and early treatment with ticagrelor or clopidogrel.

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