807 Wellens syndrome: a rare entity not to underestimate

Aims Abrupt oppressive chest pain is a common reason of emergency department’s access. An accurate assessment of the clinical setting is needed to ensure the patient the correct management. This includes a good anamnesis, physical examination, electrocardiogram (ECG) and cardiac biomarkers evaluation. Wellens syndrome is a clinical entity characterized by acute chest pain, normal or minimal elevation of cardiac biomarker, specific ECG changes with no ST elevation or Q-waves. The ECG modifications contemplate: biphasic T waves in lead V2 and V3 (type A) initially positive and subsequent negative or deep and symmetrically inverted T waves in anterior leads (Type B, more often V1–V4). Recognizing these patterns can be so challenging for physician in emergency departments, especially in Type A, and failure in diagnosis can lead to deleterious outcomes. In fact, Wellens syndrome can be considered as a pre-infarction state that needs immediate intervention: if not treated appropriately, about 75% of patients can suffer anterior myocardial infarction due to a stenosis of left anterior descending (LAD) artery. Methods A 55-year-old male with hyperlipidaemia and a family history of cardiovascular disease, presented to emergency department with abrupt oppressive chest pain after mild physical effort. At presentation he presented a typical ECG of Wellens syndrome type A with negative cardiac biomarkers. His GRACE (Global Registry of Acute Coronary Events) score was 72 and his thrombolysis in myocardial infarction (TIMI) was 2. At second blood sample cardiac biomarkers was mildly higher than upper limit of normal. Results Despite low grade on risk stratification he immediately underwent coronary angiography, who resulted in a subocclusive stenosis from ostium to the medium tract of LAD. PCI was subsequently taken with implantation of TWO drug eluting stent (DES). After 3 days he was discharged asymptomatic and in optical medical therapy. Conclusions Wellens syndrome is a rare clinical entity that must be considered as a pre- infarction state difficult to individuate. Conventional management in these patients utilizing typical risk stratification scores may not be appropriate. In this context an early diagnosis of ECG patterns it’s crucial, in order to provide an urgent percutaneous intervention. Failure in recognition of signs and symptoms of Wellens syndrome can lead to disastrous outcome due to a critical, vulnerable, stenosis on proxymal LAD and to a possible imminent large anterior myocardial infarction.

Asymptomatic takotsubo syndrome occurring during Holter monitoring

Asymptomatic takotsubo syndrome was observed during periodic Holter monitoring in a man in his 60s undergoing maintenance dialysis. No emotional or physical stress was noticed. The electrocardiographic changes at onset were determined, and repeated ST elevation and progressive formation of giant negative T waves were recorded.

De Winter ECG Pattern Can Be A Temporary ECG Phenomenon Related To Severe Stenosis of The Left Circumflex Coronary Artery: A Case Report

The de Winter ECG pattern consisting of ST-segment depression and tall symmetrical T waves on ECG, known as an ST elevation equivalent, accounts for approximately 2% of patients with occlusion of the proximal left anterior descending coronary artery (LAD). These patterns are considered static and persistent and are, on average, recorded 1.5 hours after onset. Here, we describe a case of the de Winter ECG pattern as a temporary ECG phenomenon associated with left circumflex coronary artery (LCX) stenosis.

Study on the Effects of Kuanxiong Aerosol on the Isolated Artery and Rabbits Acute Myocardial Ischemia Model

Background: Kuan xiong aerosol (KXA) is a kind of Chinese herbal compound used to regulating qi-flowing for relieving pain and improving angina. However, little pharmacological study of this traditional Chinese medicine preparation has been reported to confirm these activities. Objective: This article aims to observe the effect of resisting acute myocardial ischemia (AMI) in vivo and dilating vessel in vitro of KXA. Materials: The AMI model involves intravenously injecting pituitary (2 U.kg-1) into the ear of rabbits. Electrocardiograph (ECG) T waves were then recorded after administration and the falling range was calculated. Following this, the level of serum Cardiac troponin T (cTn-T) and the histopathology of the cardiac muscle tissue was evaluated. In vitro, the effect of KXA on vasodilation of isolated aortic rings that had been pre-contracted with KCl (30 mM) was observed. Results: It was found KXA reduced ECG ST-T waves and serum cTn-T in the rabbit AMI model, protected myocardial tissue from fracturing and loss of myocardial fibers, and inhibited inflammatory cell infiltration, cavitation degeneration and karyopyknosis of the myocardial matrix. Furthermore, the administration of 0.215, 1.075 and 2.150 mg.mL-1 KXA resulted in significant relaxation of the aortic rings at a rate of 69.63 %, 90.14 % and 118.72 % (p < 0.01) of the untreated ones, and a second shrinkage ratio of 20.17 %, 4.29 %, and 4.54 % (p < 0.01) of the untreated ones, respectively. Conclusions: these results suggest KXA protects against AMI, contributes to dilation of blood vessels and has long-acting effectiveness.

Noncontact ECG Monitoring by Capacitive Coupling of Textiles in a Chair

Some patients are uncomfortable with being wired to a device to have their heart activity measured. Accordingly, this study adopts a noncontact electrocardiogram (ECG) measurement system using coupled capacitance in a conductive textile. The textiles can be placed on a chair and are able to record some of the patient’s heart data. Height and distance between the conductive textile electrodes were influential when trying to obtain an optimal ECG signal. A soft and highly conductive textile was used as the electrode, and clothing was regarded as capacitance insulation. The conductive textile and body were treated as the two electrode plates. This study found that placing the two conductive textiles at the same height provided better data than different heights. The system also enabled identifying the P, Q, R, S, and T waves of the ECG signal and eliminated unnecessary noise successfully.