scholarly journals Transient Myocardial Ischemia in a Case Post Intra-Muscular Adrenaline

2021 ◽  
pp. 36-40
Author(s):  
Nipun Bawiskar ◽  
Aamil Rasheed ◽  
Jahnabi Bhagawati ◽  
Sourya Acharya
Keyword(s):  
Case Report ◽  
Myocardial Ischemia ◽  
Troponin I ◽  
Fluid Challenge ◽  
Medical Emergency ◽  
Medical Attention ◽  
Acute Setting ◽  
St Segment ◽  
Creatine Kinase Mb ◽  
Transient Myocardial Ischemia

Background: Anaphylaxis is a medical emergency and requires immediate medical attention. Kounis syndrome is myocardial infarction or injury occurring in the setting of anaphylaxis and can also be due to the effects of epinephrine.  Adrenaline is a common drug in the management of anaphylaxis but the electrocardiographic consequences of its administration post an attack are seldomly seen. Vasospasm is generally the cause for myocardial injury in an acute setting following the administration of epinephrine. Case Presentation: A 21-year- old female developed sudden onset breathlessness and giddiness post vaccination with the oxford –AstraZeneca COVID -19 vaccine. She was administered 0.5 ml adrenaline (1:1000) intramuscularly on the lateral aspect of the left thigh, following which she complained of chest tightness and palpitations. This was accompanied by hypotension and global ST segment depression on her Electrocardiogram. The second electrocardiogram, done after 30 minutes showed a relative resolution in ST segment depressions with sinus rhythm in the one done at 16:00 hours. Creatine Kinase- MB and Troponin I were within normal limits and the patient experienced symptomatic improvement with normalization of blood pressure post fluid challenge. Conclusion: This case report highlights the case of a young female with no comorbidities who developed transient myocardial ischemia after administration of intramuscular adrenalin in therapeutic dose in view of an anaphylactic reaction. The probable action is alpha mediated coronary vasospasm. The potential adverse effects in an acute setting are hence outlined in this case report without discouraging its use given the potential benefits outweigh the risks.

Frequency and Outcomes of Transient Myocardial Ischemia in Critically Ill Adults Admitted for Noncardiac Conditions

2003 ◽  
Vol 12 (6) ◽  
pp. 508-517 ◽  
Author(s):  
Kathy J. Booker ◽  
Karyn Holm ◽  
Barbara J. Drew ◽  
Dorothy M. Lanuza ◽  
Frank D. Hicks ◽  
...  
Keyword(s):  
At Risk ◽  
Myocardial Ischemia ◽  
Critically Ill ◽  
Troponin I ◽  
Advanced Age ◽  
Elevated Troponin ◽  
Cardiac Events ◽  
Transient Myocardial Ischemia ◽  
Critically Ill Adults ◽  
Ill Adults

• Background Critically ill adults admitted for noncardiac conditions are at risk for acute myocardial ischemia.• Objectives To detect myocardial ischemia and injury in patients admitted for noncardiac conditions and to examine the relationship of myocardial ischemia, injury, and acuity to cardiac events.• Methods Transient myocardial ischemia, acuity, elevations in serum troponin I, and in-hospital cardiac events were examined in 76 consecutive patients. Transient myocardial ischemia, determined by using continuous electrocardiography, was defined as a 1-mm (0.1-mV) change in ST level from baseline to event in 1 or more leads lasting 1 or more minutes. Acuity was determined by scores on Acute Physiology and Chronic Health Evaluation II.• Results A total of 37 ischemic events were detected in 8 patients (10.5%); 32 (86%) were ST-segment depressions, and 35 (96%) were silent. Twelve patients (15.8%) had elevated levels of troponin I. Transient myocardial ischemia, elevated troponin I levels, and advanced age were significant predictors of cardiac complications (R2 = 0.387, F = 15.2, P < .001). Acuity correlated only modestly with increased length of stay in the intensive care unit (r = 0.26, P = .02) and elevated troponin I levels (r = 0.25, P = .03). Patients with transient myocardial ischemia had significantly higher rates of elevations in troponin I (P < .001) and cardiac events (P < .001) than did patients without.• Conclusions Transient myocardial ischemia and advanced age are predictors of cardiac events and may indicate patients at risk for cardiac events.

Creatine kinase-MB release during pacing-induce transient myocardial ischemia

1992 ◽  
Vol 3 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Y. Vijaya Chandra ◽  
Y. Chandrashekhar ◽  
Nalini Kaul ◽  
Nirmal K. Ganguly ◽  
Inder S. Anand
Keyword(s):  
Creatine Kinase ◽  
Myocardial Ischemia ◽  
Creatine Kinase Mb ◽  
Transient Myocardial Ischemia

scholarly journals Pneumopericardium after Laparoscopic Hernia Repair Presents with ST-segment Changes: A Case Report

2021 ◽  
Vol 2 (5) ◽  
pp. 178-181
Author(s):  
Demi Galindo ◽  
Emily Martin ◽  
Douglas Franzen
Keyword(s):  
Pulmonary Embolism ◽  
Case Report ◽  
Chest Pain ◽  
Myocardial Ischemia ◽  
Hernia Repair ◽  
Laparoscopic Hernia Repair ◽  
T Wave ◽  
St Segment ◽  
Electrocardiogram Ecg ◽  
Unnecessary Intervention

Introduction: Although rare, iatrogenic cases of pneumopericardium have been documented following laparoscopic surgery and mechanical ventilation. Electrocardiogram (ECG) changes, including ST-segment depressions and T-wave inversions, have been documented in cases of pneumopericardium, and can mimic more concerning causes of chest pain including myocardial ischemia or pulmonary embolism. Case Report: This unique case describes a patient who presented with chest pain and ST-segment changes on ECG hours after a laparoscopic inguinal hernia repair and who was found to have pneumopericardium. Conclusion: While iatrogenic pneumopericardium is often self-limiting and rarely requires intervention, it is critical to differentiate pneumopericardium from other etiologies of chest pain, including myocardial ischemia and pulmonary embolism, to prevent unnecessary intervention.

scholarly journals A Strategy for Optimizing the Combination of Active Components Based on Chinese Medicinal Formula Sheng-Mai-San for Myocardial Ischemia

2018 ◽  
Vol 45 (4) ◽  
pp. 1455-1471 ◽  
Author(s):  
Fang Li ◽  
Xiao-Xue Fan ◽  
Chun Chu ◽  
Yu Zhang ◽  
Jun-Ping Kou ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Protective Effect ◽  
Infarct Size ◽  
Troponin I ◽  
Serum Lactate Dehydrogenase ◽  
Chinese Drug ◽  
Myocardial Infarct Size ◽  
Effective Components ◽  
Creatine Kinase Mb ◽  
Further Development

Background/Aims: Traditional Chinese medicine (TCM) has been used in clinical practice for thousands of years and has accumulated considerable knowledge concerning the in vivo efficacy of targeting complicated diseases. TCM formulae are a mixture of hundreds of chemical components with multiple potential targets, essentially acting as a combination therapy of multi-component drugs. However, the obscure substances and the unclear molecular mechanisms are obstacles to their further development and internationalization. Therefore, it is necessary to develop new modern drugs based on the combination of effective components in TCM with exact clinical efficacy. In present study, we aimed to detect optimal ratio of the combination of effective components based on Sheng-Mai-San for myocardial ischemia. Methods: On the basis of preliminary studies and references of relevant literature about Sheng-Mai-San for myocardial ischemia, we chose three representative components (ginsenoside Rb1 (G), ruscogenin (R) and schisandrin (S)) for the optimization design studies. First, the proper proportion of the combination was explored in different myocardial ischemia mice induced by isoproterenol and pituitrin based on orthogonal design. Then, the different proportion combinations were further optimized through uniform design in a multi-model and multi-index mode. Finally, the protective effect of combination was verified in three models of myocardial ischemia injured by ischemia/reperfusion, chronic intermittent hypoxia and acute infarction. Results: The optimized combination GRS (G: 6 mg/kg, R: 0.75 mg/kg, S: 6 mg/kg) obtained by experimental screening exhibited a significant protective effect on myocardial ischemia injury, as evidenced by decreased myocardium infarct size, ameliorated histological features, decreased myocardial myeloperoxidase (MPO) and malondiadehyde (MDA), calcium overload, and decreased serum lactate dehydrogenase (LDH), creatine kinase MB isoenzyme (CK-MB), cardiac troponin I (cTn-I) activity. In addition, the interactions of three components in combination GRS were also investigated. The combination, compared to G, R and S, could significantly reduce the concentration of serum CK-MB and cTn-I, and decrease myocardial infarct size, which demonstrated the advantages of this combination for myocardial ischemia. Conclusion: Our results demonstrated that the optimized combination GRS could exert significant cardioprotection against myocardial ischemia injury with similar effect compared to Sheng Mai preparations, which might provide some pharmacological evidences for further development of new modern Chinese drug for cardiovascular diseases basing on traditional Chinese formula with affirmative therapeutic effect.

scholarly journals The type 2 myocardial infarction following hypertension:a case report

2021 ◽  
Author(s):  
rui xu ◽  
yan zhang ◽  
Yanping Bi ◽  
yan wang
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Chest Pain ◽  
Myocardial Injury ◽  
Troponin I ◽  
T Wave ◽  
Wave Dynamic ◽  
St Segment

A 60-years-old patient with sustained chest pain was referred to hypertension.The tertiary Troponin-I concentrations,namely the biomarker of myocardial injury,were 0.19ng per milliliter,1.288ng per milliliterand 16.698ng per milliliter,respectively.Electrocardiogram showed ST-segment and T wave dynamic changes.Type 2 MI was confirmed.

scholarly journals Subarachnoid haemorrhage mimicking unstable angina: a case report

2020 ◽  
Vol 8 (10) ◽  
pp. 3732
Author(s):  
Subhash Chand ◽  
Subhash Chander ◽  
Gaveshna Gargi ◽  
Tarun Sharma ◽  
Rittin Sharma
Keyword(s):  
Myocardial Ischemia ◽  
Subarachnoid Haemorrhage ◽  
Medical Emergency ◽  
Qtc Interval ◽  
Neck Stiffness ◽  
Coronary Syndrome ◽  
St Segment ◽  
Ct Head ◽  
Electrocardiogram Ecg ◽  
The Brain

Subarachnoid haemorrhage (SAH) is medical emergency caused by bleeding into the subarachnoid space. It is caused by rupture of an aneurysm or arteriovenous malformations (AVM). Symptoms of SAH are severe headache, nausea, vomiting, impaired consciousness and seizures. Neck stiffness and neck pain are relatively uncommon. Risk factors are high blood pressure, smoking, family history, alcoholism and even cocaine use. Diagnosis is mainly made by CT scan of head which should be done within six hours of the onset of symptoms and occasionally lumber puncture can also be done. An electrocardiogram (ECG) of all patients with subarachnoid should be done because patient with SAH can have myocardial ischemia due to increased level of circulating catecholamines or due to autonomic stimulation of the brain. ECG changes associated with SAH primarily reflect repolarisation abnormalities involving ST segment, T wave, U wave and QTc interval. Myocardial ischemia or infarction is often suspected in patients with SAH. Even troponin levels may be raised in these patients. However, suspicion of SAH is a contraindication for thrombolytic and anticoagulant therapy. This is a case of SAH which was initially treated for acute coronary syndrome (ACS) on the basis of symptoms and gradually changing ECG findings but on CT Head, patient was having SAH.

Perioperative Myocardial Ischemia and Infarction

2002 ◽  
Vol 96 (2) ◽  
pp. 264-270 ◽  
Author(s):  
Giora Landesberg ◽  
Morris Mosseri ◽  
Yehuda Wolf ◽  
Yellena Vesselov ◽  
Charles Weissman
Keyword(s):  
Myocardial Ischemia ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Electrocardiographic Monitoring ◽  
St Segment ◽  
On Line ◽  
Cardiac Outcome ◽  
Electrocardiographic Leads ◽  
Ischemic Events

Background Perioperative myocardial ischemia is conventionally monitored using five electrocardiographic leads, with only one precordial lead placed at V5. This is based on studies from more than a decade ago. The authors reassessed this convention by analyzing data obtained from continuous on-line 12-lead electrocardiographic monitoring. Methods One hundred eighty-five consecutive patients undergoing vascular surgery were monitored by continuous 12-lead ST-trend analysis during and for 48-72 h after surgery. Cardiac troponin I was measured in the first 3 postoperative days, and cardiac outcome was prospectively recorded. Ischemia was defined as ST deviation, relative to the reference preanesthesia electrocardiogram, of 0.2 mV or more in one lead or 0.1 mV or more in two contiguous leads, lasting more than 10 min. Results During 11,132 patient-hours of monitoring, 38 patients (20.5%) had 66 transient ischemic events, with all but one denoted by ST-segment depression. Twelve patients (6.5%) sustained postoperative infarction (cardiac troponin I > 3.1 ng/ml). Among the 38 patients with ischemia, lead V3 most frequently (86.8%) demonstrated ischemia, followed by V4 (78.9%) and V5 (65.8%). Among the 12 patients with infarction, V4 was most sensitive to ischemia (83.3%), followed by V3 and V5 (75% each). Combining two precordial leads increased the sensitivity for detecting ischemia (97.4% for V3 + V5 and 92.1% for either V4 + V5 or V3 + V4) and infarction (100% for V4 + V5 or V3 + V5 and 83.3% for V3 + V4). On average, baseline preanesthesia ST was above isoelectric in V1 through V3 and below isoelectric in V5 through V6. Lead V4 was closest to the isoelectric level on the baseline electrocardiogram, rendering it most suitable for ischemia monitoring. Conclusions As a single lead, V4 is more sensitive and appropriate than V5 for detecting prolonged postoperative ischemia and infarction. Two precordial leads or more are necessary so as to approach a sensitivity of greater than 95% for detection of perioperative ischemia and infarction.

scholarly journals Lactic acidosis following intentional overdose by inhalation of salmeterol and fluticasone

CJEM ◽  
2012 ◽  
Vol 14 (06) ◽  
pp. 378-381 ◽  
Author(s):  
Alessandro Manara ◽  
Philippe Hantson ◽  
Dominique Vanpee ◽  
Frédéric Thys
Keyword(s):  
Lactic Acidosis ◽  
Troponin I ◽  
Chronic Obstructive ◽  
Laboratory Findings ◽  
Obstructive Pulmonary Disease ◽  
St Segment ◽  
Creatine Kinase Mb ◽  
High Doses ◽  
Long Acting ◽  
Adrenergic Receptor Agonist

ABSTRACT Salmeterol, a long-acting β2-adrenergic receptor agonist used for the treatment of asthma and chronic obstructive pulmonary disease, has an adverse effects profile that is similar to that of salbutamol and other β2-agonists. We report a sympathomimetic syndrome with metabolic acidosis and hyperlactatemia after intentional inhalation of salmeterol in a suicide attempt. A 16-year-old female patient was admitted to the emergency department approximately 2 hours after having inhaled 60 puffs of a combination of salmeterol xinafoate 25 μg and fluticasone propionate 50 μg. She presented in an anxious state with complaints of palpitations and chest pain. The electrocardiogram demonstrated sinus tachycardia and ST-segment depression in the inferior and anterolateral leads. Laboratory findings showed hypokalemia, hypophosphatemia, and lactic acidosis. Cardiac troponin I and creatine kinase MB remained within the normal range. Treatment was supportive and included intravenous fluids and cautious potassium supplementation. The next day, electrocardiographic and laboratory findings returned to normal. We hypothesize that stimulation of β2-adrenergic receptors by inhalation of salmeterol caused this patient's lactic acidosis. This observation is consistent with the hypothesis that the hyperlactatemia observed during asthma attacks is due in part to the administration of high doses of β2-agonists. Salmeterol overdose by inhalation appears to be sufficient to cause lactic acidosis.

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