Clinical outcomes of fibrinolytic therapy for prehospital treatment of acute myocardial infarction

Fibrinolytic Therapy (FT) is an important form of treatment for cases of Acute Myocardial Infarction (AMI), especially in those places where Primary Percutaneous Coronary Intervention (PPCI) is not available, which is the main form of treatment and can be used even in the prehospital care. Aimed to describe the clinical outcomes of the use of FT in prehospital care for treating patients with AMI. This research covered a total of 53 patients and was carried out from march to october 2017, referring to the care provided from january 2015 to december 2016 in two stages, in which the first occurred with the Mobile Emergency Service (SAMU) and Walk-in Emergency Care Units (UPA), and the second in the referenced hospital services as gateways to those units. Data were collected from secondary sources. The clinical outcomes of FT considered in the form of absolute and relative frequencies and measures of central tendency were considered. The main signs and symptoms at admission were chest pain (84.62%), sweating (36.54%), dyspnea (26.92%), hypertension (19.23%), nausea (17.31%), malaise (17.31%) and emesis (13.46%). The main characteristic of chest discomfort was chest pain (70.45%). The FT drug administered in all patients was tenecteplase. The median time from symptom-to-door was 180 minutes, while symptom-reperfusion was 300 minutes and door-to-needle 160 minutes. Regarding the outcome, 74.47% had clinical improvement, 19.15% died, 4.25% had refractory AMI and 2.13% had reinfarction. The main characteristic of clinical improvement was the reversal of chest pain (68.57%), characterized as myocardial reperfusion criteria. The present study presented the main outcomes of FT use with improvement of those patients who were treated with it, and shorter times related to chest discomfort and the administration of FT were responsible for increasing the outcomes of clinical improvement and decreasing the outcome of death.

Ocular manifestations and clinical profile of multisystemic inflammatory syndrome in children during COVID-19 pandemic

Background: Multisystemic inflammatory syndrome in children (MIS-C) is a new childhood disease, which is associated with Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). To evaluate ocular manifestations and clinical characteristics of MIS-C during COVID-19 pandemic.Methods: A cross-sectional observational study was conducted among 48 MIS-C patients (≤19 years) at Burdwan Medical college and hospital in West Bengal, India from April 2021 to June 2021. History taking, clinical examination and necessary investigations of all the patients were done.Results: Out of 48 patients, 18 patients (37.5%) presented with conjunctivitis, 4 (8.3%) with eyelid swelling, 2 (4.2%) with episcleritis, 2 (4.2%) with papilledema, 1 (2.1%) with subconjunctival haemorrhage, 1 (2.1%) with uveitis, 1 (2.1%) with retinitis and 4 (8.3%) with decreased vision. Other clinical manifestations included fever, skin rash, loose stool, vomiting, abdominal pain, cough, peripheral oedema, myalgia, breathlessness, altered sensorium, cervical lymphadenopathy, shock, oliguria, chest discomfort and joint swelling. Serum inflammatory, coagulation and cardiac markers were deranged.Conclusions: Ocular and other clinical manifestations in MIS-C were due to post-COVID immuno-dysregulation resulting in “cytokine storm” and hyper-inflammatory response. Conjunctivitis was the most common ocular manifestation. There was a positive correlation between severity of the conjunctival hyperaemia and level of serum inflammatory markers.

Amphotericin B Induced Anaphylactic Reaction and Electrolyte Imbalance: A Case Report

Amphotericin B, a polyene antifungal antibiotic derived from a strain of Streptomyces nodosus. It acts by binding to sterols in the cell membrane of susceptible fungi, with a resultant change in the permeability of the membrane. Amphotericin B can cause allergic reactions, electrolyte imbalance and severe side effects, such as chest discomfort accompanied by dyspnea, flushing, agitation, tachypnea, tachycardia, hypoxemia, hypotension, or hypertension, are likely to develop following the injection of Amphotericin B. Anaphylaxis, cardiac toxicity and respiratory failure have also been associated to different formulations of Amphotericin B as life-threatening acute events. This case report is on a 57-year-old male patient who was admitted with a condition of left diabetic foot with non-healing medial supra heel ulcer and fungal infection on the site of wound. The patient was given Amphotericin B in emulsion form due to the high priority of fungal infection and the need for antifungal medicine, which led to anaphylactic reaction and electrolyte imbalance, which were treated immediately and the same preparation was continued with a low infusion rate. When infusion is discontinued, antihistamines can assist to alleviate the symptoms. In this case, it is recommended that the patient's condition and clinical parameters should be closely followed after the medicine has been administered.

Assessment Screening of Chest Pain in Primary Setting: A Review

Chest pain can be caused by a variety of illnesses, ranging from benign and self-limiting to significant or life-threatening. Before a doctor examines more benign reasons, a workup must focus on ruling out significant pathology. The words "dull," "deep," "pressure," and "squeezing" are commonly used to describe visceral discomfort. Visceral pain generally has a diffuse distribution pattern, making it difficult for the patient to pinpoint a precise location. chest discomfort accounts for 1.5 percent of all consultations in primary care. The age group 45 to 64 years has the highest prevalence of chest pain consultations. Patients with suspected Acute coronary syndrome (ACS) should be diagnosed and treated as soon as feasible. While most patients are sent to the hospital, an electrocardiogram (ECG) is the sole examination necessary in primary care. In this review we will be looking at chest pain incident in primary care, and also we’ll be making overview to the etiology and diagnosis of the disease.

Supraventricular Tachycardia Ablation and Effects on Anxiety Medications

Background: Patients with true paroxysmal supraventricular tachycardia (SVT) are frequently misdiagnosed with panic or anxiety disorders due to similar symptoms of palpitations, light-headedness, dyspnea, or chest discomfort. Unrecognized SVT can lead to unnecessary management with anxiety medications. Treatment of SVT with catheter ablation may lead to reduction in anxiety medications. Methods: A total of 175 patients underwent successful SVT ablation between January 1, 2010 and December 31, 2020. We examined symptoms at presentation, psychiatric medications prior to SVT ablation, comorbidities, and psychiatric medications at 3 months post-ablation. Results: 15% of patients who underwent successful SVT ablation were being treated with psychiatric medications and were included in the final study population. The most common symptoms were palpitations (80.77%), followed by dizziness (42.31%), and shortness of breath (34.62%). The average number of medications prior to ablation was 1.42 and decreased down to 1.08 at 3 months post-ablation (p = 0.04). The average number of SSRIs, SNRIs, and other anxiolytics were also decreased but were not statistically significant. Conclusion: In patients with anxiety and paroxysmal supraventricular tachycardia, catheter ablation is associated with reduced average number of psychiatric medications.

Aorto-oesophageal fistula: rarest cause of haematemesis - is it salvageable?

A 60-year-old man presented with severe abdominal pain, two episodes of massive haematemesis and chest discomfort. CT angiography showed a saccular aneurysm of the juxtaphrenic aorta with possible oesophageal erosion. Upper GI endoscopy revealed external compression of the lower oesophagus—near total luminal obstruction with impending rupture of the aortic aneurysm. Emergency aneurysmal repair by interposition grafting using 20 mm Dacron graft with oesophageal–gastric reconstruction done. Postoperative period was uneventful

An Algorithmic Approach Is Superior to the 99th Percentile Upper Reference Limits of High Sensitivity Troponin as a Threshold for Safe Discharge from the Emergency Department

Background and Objectives: High-sensitivity cardiac troponin I (hs-TnI) is an important indicator of acute myocardial infarction (AMI) among patients presenting with chest discomfort at the emergency department (ED). We aimed to determine a reliable hs-TnI cut-off by comparing various values for a baseline single measurement and an algorithmic approach. Materials and Methods: We retrospectively reviewed the hs-TnI values of patients who presented to our ED with chest discomfort between June 2019 and June 2020. We evaluated the diagnostic accuracy of AMI with the Beckman Coulter Access hs-TnI assay by comparing the 99th percentile upper reference limits (URLs) based on the manufacturer’s claims, the newly designated URLs in the Korean population, and an algorithmic approach. Results: A total of 1296 patients who underwent hs-TnI testing in the ED were reviewed and 155 (12.0%) were diagnosed with AMI. With a single measurement, a baseline hs-TnI cut-off of 18.4 ng/L showed the best performance for the whole population with a sensitivity of 78.7%, specificity of 95.7%, negative predictive value (NPV) of 97.1%, and positive predictive value (PPV) of 71.3%. An algorithm using baseline and 2–3 h hs-TnI values showed an 100% sensitivity, 97.7% specificity, an NPV of 100%, and a PPV of 90.1%. This algorithm used a cut-off of <4 ng/L for a single measurement 3 h after symptom onset or an initial level of <5 ng/L and a change of <5 ng/L to rule a patient out, and a cut-off of ≥50 ng/L for a single measurement or a change of ≥20 ng/L to rule a patient in. Conclusions: The algorithmic approach using serial measurements could help differentiate AMI patients from patients who could be safely discharged from the ED, ensuring that patients were triaged accurately and did not undergo unnecessary testing. The cut-off values from previous studies in different countries were effective in the Korean population.

Percutaneous Closure of Post Myocardial Infarction Ventricular Septal Rupture in an Unstable Hemodynamic State, Using an Unconventional Internal Jugular venous access;

We report a 56-year-old woman with multiple cardiovascular risk factors who initially present with chest discomfort. She underwent successful primary percutaneous coronary intervention (PCI) on left anterior descending and right coronary artery . Few hours later and after the hemodynamic deterioration of patient,

An unruptured “Pocket – Like” giant apical pseudoaneurysm of the left ventricle: A case report

Cardiac pseudoaneurysm is rare and appears mostly as tardive complication of Acute Myocardial Infarct (AMI). Its apical localization is also scarce as it is usually described in posterior or lateral wall of left ventricle. Its diagnosis is based on cardiac imaging. We report a case of a hypertensive, diabetic and smoking 64-year-old man with a past history of anterior AMI. He was symptomatic of chest discomfort. Physical examination indicates an apical murmur, his electrocardiogram showed a regular sinus rhythm and a complete left branch block. The Transthoracic (TTE) echocardiography revealed a giant apical pocketlike aneurysm lined with a clot. Cardiac Magnetic Resonance Imaging (CMRI) confirmed the diagnosis of an apical pseudoaneurysm due to ischemic heart disease in the stage of severe heart failure.