scholarly journals Dead man sign of ECG: An unique predicting sign of acute coronary syndrome

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Troponin I ◽  
Inferior Wall ◽  
Excessive Sweating ◽  
Common Cause ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Artery Disease ◽  
Dead Man

Coronary artery disease is the most common cause of morbidity and mortality worldwide. Acute coronary syndrome which includes STEMI, NSTEMI and unstable angina commonly diagnosed with the help of 12 lead in ECG in ER with or without elevated biomarkers. Inferior wall myocardial infarction is common cause of ST elevation myocardial infarction with low mortality rate. In this case report, we present a 52 years old male presented to ER with the complain of typical chest pain for more than 2 hours duration. Pain was in center of chest with radiation to back and left arm and associated with excessive sweating. Patient is a known smoker for past 10 years. At presentation Blood pressure was 110/70 mmHg and pulse rate of 55/min. Troponin I level was five times of upper normal limit. Basic investigations including ECG were done at presentation. ECG was showing typical changes of inferior wall myocardial infarction with infarction of right ventricle with hidden unique sign known as dead man sign commonly predict the location of obstruction and course of disease in the setting of acute coronary syndrome.

scholarly journals Coronary artery disease: Acute coronary syndrome

2010 ◽  
pp. 45-70
Author(s):  
Juan Carlos Kaski
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
St Elevation Myocardial Infarction ◽  
Atheromatous Plaque ◽  
Coronary Syndrome ◽  
Plaque Disruption ◽  
Prevention Therapy ◽  
St Elevation ◽  
Artery Disease

Background 46 Management of ST elevation myocardial infarction (STEMI) 48 Non-ST elevation myocardial infarction (NSTEMI) 52 Unstable angina 52 Therapeutic agents 56 Drugs for secondary prevention therapy after ACS 66 Further reading 70 Acute coronary syndrome (ACS) encompasses a spectrum of disorders resulting from severe acute myocardial ischaemia. The most common pathogenic mechanism is acute intracoronary thrombosis resulting from atheromatous plaque disruption or erosion. Platelet activation, thrombosis, and coronary vasoconstriction are all important pathogenic mechanisms in ACS....

scholarly journals N-Terminal Pro Brain Natriuretic Peptide in Assessment of Severity of Coronary Artery Disease in Patients with Non ST Elevation Acute Coronary Syndrome

2020 ◽  
Author(s):  
Hesham Mohammed El Ashmawy ◽  
Mohammed Ahmed Sadaka ◽  
Gehan Magdy Youssef ◽  
Abdulkarem Saeed Hassan
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Syntax Score ◽  
Gensini Score ◽  
Coronary Syndrome ◽  
St Elevation ◽  
The Mean ◽  
Artery Disease

Introduction: N-Terminal pro Brain Natriuretic Peptide (NT-pro BNP) is an important biomarker in the management of patients with heart failure. Several studies reported its importance as a predictor of morbidity and mortality in Acute Coronary Syndrome (ACS) patients. Aim: To compare serum NT-proBNP levels in Non ST Elevation Acute Coronary Syndrome (NSTE-ACS) patients and controls and to assess the relation between Nt-proBNP and the severity of Coronary Artery Disease (CAD) in patients with NSTE-ACS including unstable Angina (UA) and Non ST Elevation Myocardial Infarction (NSTEMI). Materials and Methods: Sixty NSTE-ACS patients and 20 matched control without significant obstructive CAD were included in the study. Cardiac enzymes, blood urea, serum creatinine, serum NT-proBNP were measured in all patients immediately before coronary angiography. Gensini score and Syntax score were calculated for all study patients. The NSTE-ACS patients were followed-up for six months for Major Adverse Cardiovascular Events (MACE) including mortality, myocardial infarction, heart failure, stroke, revascularisation by primary percutaneous coronary intervention or Coronary Artery Bypass Grafting (CABG). Results: The mean serum NT-proBNP in NSTE-ACS (UA and NSTEMI) patients was significantly higher (662.7±635.2) pg/mL than that in the control (102.3±96.4) pg/mL, p<0.001. The effective cut-off value for the diagnosis of CAD was 139 pg/mL, Area Under Curve (AUC)=0.950, 95% CI: 0.890-1.00). The serum NT-proBNP was correlated with the severity and complexity of CAD as measured by Gensini score (r=0.496, p<0.001) and Syntax score (r=0.443, p<0.001). The mean value of NT-proBNP in patients with six months MACE was insignificantly higher than in patients without six months MACE with Interquartile Range (IQR) of 418.5 (139-2037) vs. 366 (175-3237) pg/mL, p=0.970. Conclusion: NT-proBNP was correlated with the severity and complexity of CAD in NSTE-ACS with preserved left ventricular systolic function, but it has no impact on six months MACE.

scholarly journals Peripheral Artery Disease in Patients Presenting with Acute Coronary Syndrome in Hill Population of Northern India

2020 ◽  
Author(s):  
Nagaraju Naik Banavath ◽  
Mohd Iqbal Dar ◽  
Mohd Iqbal Wani ◽  
Aamir Rashid ◽  
Khursheed A Khan
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Ct Angiography ◽  
Lower Limb ◽  
Peripheral Artery ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
Northern India ◽  
St Elevation ◽  
Artery Disease

Introduction: Acute Coronary Syndrome (ACS) and Peripheral Artery Disease (PAD) represent the serious presentations of the atherosclerotic disease spectrum. PAD due to atherosclerotic disease can lead to significant morbidity and mortality with significant medical and economic burden. Aim: To study the prevalence of PAD in patients presenting with ACS in the Hill population of Northern India. Materials and Methods: Patients presenting with ACS, with acute chest pain, Electrocardiogram (ECG) changes and elevated troponins were enrolled in the study. The presence of PAD was assessed with MESI Ankle Branchial Measuring Device (MESI ABPI MD® Slovenia EU) system which uses plethysmographic sensors with an inbuilt software that automatically calculates ABI with accuracy. Patients with ABI <0.91 were further evaluated by Computed Tomography (CT) Angiography of lower limb vessels. Results: A total of 288 patients were included in the study. There were 238 (82.6%) males and 50 (17.4%) females. Majority of patients had hypertension (214, 74.3%) as the risk factor. ST-Elevation Myocardial Infarction (STEMI) was seen in 197 (68.4%) and Non-ST Elevation Myocardial Infarction (NSTEMI) in 91 (31.6%). Coronary angiography was done in 240 patients. Single vessel disease was seen in 135 (56.2%), double vessel disease in 69 (28.8%) and triple vessel disease in 36 (15%) cases. Out of overall 288 patients 9 (3.12%) had borderline ABI (ABI- >0.9 and ≤1.0) and 4 (1.38%) had abnormal ABI (ABI <0.9). CT angiography of 3 out of 4 patients with ABI <0.9 showed significant atherosclerosis of lower limb vessels. Conclusion: There was very low prevalence of PAD with ACS in this study population.

scholarly journals THE DIAGNOSTIC VALUE OF HEART-TYPE FATTY ACID BINDING PROTEIN (h-FABP) RAPID TEST RELATED TO CARDIAC TROPONIN I IN NON ST ELEVATION MYOCARDIAL INFARCTION (NSTEMI)

2018 ◽  
Vol 17 (2) ◽  
pp. 67
Author(s):  
F.R. Marpaung ◽  
Sidarti Soehita SFHS ◽  
Yogiarto Yogiarto ◽  
Yusri Yusri
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Predictive Value ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Rapid Test ◽  
Diagnostic Value ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
St Elevation

Acute coronary syndrome (ACS) is caused by atherosclerotic plaque rupture and microembolization which lead to decreased oxygensupply into the myocardium. Generally, ACS includes an unstable angina (UA), non ST elevation myocardial infarction (NSTEMI) andST elevation myocardial infarction. ACS may lead to ST elevation Myocardial Infarction (STEMI) and finally a sudden death. Cardiactroponin is used routinely for diagnosing acute coronary syndrome (ACS); however, troponin is not elevated in the initial hours ofACS—precluding their usefulness in the early diagnosis. The aim of this study is to determine the diagnostic value of h-FABP Rapid testin relation to Cardiac Troponin I in NSTEMI. Seventy five patients with ACS were enrolled in this study. All patients presented symptomswithin six hours of the onset and suffered typical chest pain. Blood samples were obtained for rapid test h-FABP (cardiodetect) andTroponin I (tropospot). The h-FABP showed a 93.5% sensitivity, 95% CI: 81.1–98.3 and 82.8% specificity, 95% CI: 63.5–93.5, PositivePredictive Value 89.6%, 95% CI: 76.6–96.1, Negative Predictive Value 88.9%, 95% CI: 69.7–97.1, respectively in the first six hours.Troponin I had a 60.9% sensitivity, 95% CI: 45.4–74.5 and 96.6% specificity, 95% CI: 80.4–99.8, Positive Predictive Value 96.6%,95% CI: 80.4–99.8, Negative Predictive Value 60.9%, 95% CI: 45.4–74.5, respectively in the first six hours. Based on this study resulton patients with Non ST Elevation Myocardial Infarction (NSTEMI), it is suggested to determine the h-FABP as well. For this purpose,point-of-care h-FABP test can be utilized, as it has the advantage of highly sensitivity and specificity, beside it can carry on a bedsidetesting and show a rapid test results as well.

scholarly journals Clinical characteristics, risk factors and angiographic profile of acute coronary syndrome patients in a tertiary care center of Nepal.

2019 ◽  
Vol 16 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Abhishesh Shakya ◽  
Sunil Chandra Jha ◽  
Ratna Mani Gajurel ◽  
Chandra Mani Poudel ◽  
Ravi Sahi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
St Elevation ◽  
Artery Disease

Background and Aims: Acute coronary syndrome (ACS) refers to a group of clinical symptoms consistent with new onset or worsening ischemic symptoms. ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) are the three types of ACS. The objectives were to study the risk factors prevalence, angiographic distribution and severity of coronary artery stenosis in ACS among patients admitted in Cardiology Department of Manmohan Cardiothoracic Vascular and Transplant Center (MCVTC). Methods: This is a restrospective study of 419 ACS patients admitted and treated in MCVTC from November 2017 to October 2018. Patients were divided into STEMI, NSTEMI and UA then analyzed for various risk factors, angiographic patterns and severity of coronary artery disease. Results: Mean age of presentation was 59.3Å}12.8 years. Majority were male 317(75.7%). Most patients had STEMI 252 (60.1%) followed by NSTEMI 98 (23.4%) and UA 69 (16.5 %). Risk factors: smoking was present in 241 (57.5%), hypertension in 212 (50.6%), diabetes in 144 (34.4%), dyslipidemia in 58 (13.8%). Single-vessel disease was present in 34.6 % patients, double- vessel disease was present in 27.44 % patients and triple vessel disease was present in 26.3 % patients, left main disease in 1.4 % patients. Normal coronaries were present in 6.4% patients and minor coronary artery disease in 3.8 % patients. Conclusions: STEMI was the most common presentation. Three quarters of ACS were male patients. Smoking was most prevalent risk factor. Single vessel involvement was the most common CAG finding in all spectrum of ACS. Diabetic patients had more multivessel disease.

scholarly journals Free vs Total Pregnancy-Associated Plasma Protein A (PAPP-A) as a Predictor of 1-Year Outcome in Patients Presenting with Non–ST-Elevation Acute Coronary Syndrome

2010 ◽  
Vol 56 (7) ◽  
pp. 1158-1165 ◽  
Author(s):  
Juha Lund ◽  
Saara Wittfooth ◽  
Qiu-Ping Qin ◽  
Tuomo Ilva ◽  
Pekka Porela ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Plasma Protein ◽  
Troponin I ◽  
Protein A ◽  
Free Fraction ◽  
Prognostic Information ◽  
Reactive Protein ◽  
Coronary Syndrome ◽  
St Elevation

Abstract Background: The free fraction of pregnancy-associated plasma protein A (FPAPP-A) was found to be the PAPP-A form released to the circulation in acute coronary syndrome (ACS). We estimated the prognostic value of FPAPP-A vs total PAPP-A (TPAPP-A) concentrations in forecasting death and nonfatal myocardial infarction (combined endpoint) in patients with non–ST-elevation ACS. Methods: We recruited 267 patients hospitalized for symptoms consistent with non–ST-elevation ACS and followed them for 12 months. FPAPP-A, TPAPP-A, C-reactive protein (CRP), and cardiac troponin I (cTnI) were measured at admission; cTnI was also measured at 6–12 h and 24 h. Because of the recently shown interaction between PAPP-A and heparin, we excluded patients treated with any heparin preparations before the admission blood sampling. Results: During the follow-up, 57 (21.3%) patients met the endpoint (22 deaths and 35 nonfatal myocardial infarctions). According to FPAPP-A (&lt;1.27, 1.27–1.74, &gt;1.74 mIU/L) and TPAPP-A (&lt;1.98, 1.98–2.99, &gt;2.99 mIU/L) tertiles, this endpoint was met by 12 (13.5%), 18 (20.2%), 27 (30.3%) (P = 0.02), and 17 (19.1%), 17 (19.1%), 23 (25.8%) (P = 0.54) patients, respectively. After adjusting for age, sex, diabetes, previous myocardial infarction, and ischemic electrocardiogram (ECG) findings, FPAPP-A &gt;1.74 mIU/L [risk ratio (RR) 2.0; 95% CI 1.0–4.1, P = 0.053), increased cTnI, and CRP ≥2.0 mg/L were independent predictors of an endpoint. The prognostic performance of TPAPP-A was inferior to that of FPAPP-A. Conclusions: FPAPP-A seems to be superior as a prognostic marker compared to TPAPP-A, giving independent and additive prognostic information when measured at the time of admission in patients hospitalized for non–ST-elevation ACS.

scholarly journals Etiology of Acute Coronary Syndrome after Noncardiac Surgery

2018 ◽  
Vol 128 (6) ◽  
pp. 1084-1091 ◽  
Author(s):  
Mohammad A. Helwani ◽  
Amit Amin ◽  
Paul Lavigne ◽  
Srikar Rao ◽  
Shari Oesterreich ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Noncardiac Surgery ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Artery Disease

Abstract Background The objective of this investigation was to determine the etiology of perioperative acute coronary syndrome with a particular emphasis on thrombosis versus demand ischemia. Methods In this retrospective cohort study, adult patients were identified who underwent coronary angiography for acute coronary syndrome within 30 days of noncardiac surgery at a major tertiary hospital between January 2008 and July 2015. Angiograms were independently reviewed by two interventional cardiologists who were blinded to clinical data and outcomes. Acute coronary syndrome was classified as ST–elevation myocardial infarction, non–ST–elevation myocardial infarction, or unstable angina; myocardial infarctions were adjudicated as type 1 (plaque rupture), type 2 (demand ischemia), or type 4b (stent thrombosis). Results Among 215,077 patients screened, 146 patients were identified who developed acute coronary syndrome: 117 were classified as non–ST–elevation myocardial infarction (80.1%); 21 (14.4%) were classified as ST–elevation myocardial infarction, and 8 (5.5%) were classified as unstable angina. After coronary angiography, most events were adjudicated as demand ischemia (type 2 myocardial infarction, n = 106, 72.6%) compared to acute coronary thrombosis (type 1 myocardial infarction, n = 37, 25.3%) and stent thrombosis (type 4B, n = 3, 2.1%). Absent or only mild, nonobstructive coronary artery disease was found in 39 patients (26.7%). In 14 patients (9.6%), acute coronary syndrome was likely due to stress-induced cardiomyopathy. Aggregate 30-day and 1-yr mortality rates were 7 and 14%, respectively. Conclusions The dominant mechanism of perioperative acute coronary syndrome in our cohort was demand ischemia. A subset of patients had no evidence of obstructive coronary artery disease, but findings were consistent with stress-induced cardiomyopathy.

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