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Características diferenciales de los pacientes con síndrome coronario agudo sin elevación del segmento ST con respecto a los que tienen elevación transitoria del segmento ST Differential characteristics of patients with acute coronary syndrome without ST-segment elevation compared to those with transient ST-segment elevation
E. Arroyo úcar,A. Domínguez-Rodríguez,R. Juárez Prera,G. Blanco Palacios
Medicina Intensiva , 2011,
Abstract: Objetivo: Evaluar características diferenciales de los pacientes con síndrome coronario agudo (SCA) sin elevación del segmento ST en comparación con elevación transitoria del segmento ST. Dise o: Estudio prospectivo observacional. ámbito: Unidad coronaria de 12 camas. Pacientes: Enfermos consecutivos de SCA sin elevación persistente del segmento ST. Principales variables de interés La población se dividió en 2 grupos, en función de la presencia de elevación transitoria del segmento ST. Las variables de interés fueron: edad, factores de riesgos cardiovasculares, concentraciones de troponina I y glucemia al ingreso, anatomía coronaria, fracción de eyección del ventrículo izquierdo, mortalidad intrahospitalaria y fármacos intrahospitalarios. Resultados: Los pacientes identificados con SCA y elevación transitoria del segmento ST eran significativamente más jóvenes, fumadores y con predominio del sexo masculino. A su vez, presentaban una elevación pico de troponina I menor, mayor fracción de eyección y principalmente enfermedad coronaria de un vaso. Conclusiones: Los pacientes con SCA con elevación transitoria del segmento ST presentan diferencias en cuanto al tipo de población, da o miocárdico y resultados angiográficos con respecto a los pacientes con SCA sin elevación del segmento ST. Son necesarias más investigaciones para esclarecer si dichas diferencias implicarían un manejo terapéutico diferente. Objective: To evaluate different characteristics of patients with acute coronary syndrome (ACS) without ST-segment elevation compared with transient St-segment elevation. Design: An observational, prospective study. Setting: A 12-bed coronary care unit. Patients: Consecutive patients of ACS without persistent ST-segment elevation. Main variables of interest: The population was divided intro 2 groups according to the presence of transient ST-segment elevation. Variables of interest were age, cardiovascular risk factors, troponin I and glucose concentrations on admission, coronary anatomy, left ventricular ejection fraction, inhospital mortality and drugs. Results: Patients identified as ACS with transient ST-segment elevation were significantly younger, smokers and predominantly male. At the same time, they showed a minor peak elevation of troponin I, a higher ejection fraction and, mainly single-vessel coronary disease. Conclusions: Patients with ACS with transient ST-segment elevation differ in the type of population, myocardial damage and coronary angiographic results with respect to patients with ACS without ST-segment elevation. More research is needed to
Traumatic Tension Pneumopericardium  [cached]
Mahmut Tokur,Mehmet Ergin
Akademik Acil T?p Olgu Sunumlar? Dergisi (AKATOS) , 2012,
Abstract: Tension pneumopericardium is a rare and life threatening condition which results from either penetrating or blunt thorax trauma. A 44-year-old man, who fell from the fifth floor of a building, had major trauma that consisted with hemorrhagic shock, pneumothorax and pneumopericardium, retroperitoneal hemorrhage, pelvic and lower extremity fractures. Multiple costal fractures, sternal fracture, right hemopneumothorax, massive air in the pericardial sac and diffuse subcutaneous emphysema were reported in the chest computed tomography. Pneumopericardium is usually self–limited but can progress into tension pneumopericardium causing cardiac tamponade. The drainage of pneumothorax could be the initial procedure in case of pneumothorax associated with pneumopericardium. However, emergent pericardiocentesis can be required for patients with resistant hypotension. Emergency physicians should consider this rare entity for the differential diagnosis of thorax trauma with shock and be familiar with its treatment options.
Pneumopericardium should be considered with electrocardiogram changes after blunt chest trauma: a case report
Arjan JM Konijn, Peter HM Egbers, Micha?l A Kuiper
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-100
Abstract: We report a rare case of pneumopericardium with extreme ECG abnormalities after blunt chest trauma in a 22-year-old male. The diagnosis was confirmed using computed tomography (CT) scanning. The case is discussed, together with its differential diagnosis and the aetiology of pneumopericardium and tension pneumopericardium.Pneumopericardium should be distinguished from other pathologies such as myocardial contusion and myocardial infarction because of the possible development of tension pneumopericardium. Early CT scanning is important in the evaluation of blunt chest trauma.When an electrocardiogram (ECG) is obtained during the diagnostic processing and evaluation of a trauma patient (as in the present case), it is important to realize that ECG findings in patients with cardiac trauma are diverse and non-specific. These findings may be non-specific ST-segment or T-wave changes, axis deviation and dysrhythmias, such as premature atrial contractions, bundle branch blocks and ventricular fibrillation [1]. Diagnostic considerations in a patient with blunt chest trauma and ECG abnormalities include, amongst others, myocardial contusion and myocardial ischaemia. Other causes involve the presence of air in thoracic structures that do not normally contain air, for example pneumothorax, pneumomediastinum and pneumopericardium. These options are discussed in a stepwise manner and related to the patient in this case report.A 22-year-old male, with no previous medical history, was admitted to the intensive care unit (ICU) at our hospital with blunt thoracic trauma and near-drowning after a high-energy trauma. The man had been driving a car when, for no apparent reason, he lost control and drove into a ditch filled with water.The patient consequently aspirated water, but managed to reach solid ground. He was transported by ambulance to the hospital emergency unit, where he was found to be in respiratory failure, probably as a result of severe lung contusion. He was subsequently
Acute ST segment elevation MI with Normal Coronaries  [PDF]
M Barakoti,SC Jha,SM Acharya,CM Paudel
Nepalese Heart Journal , 2011, DOI: 10.3126/njh.v8i1.8335
Abstract: A 45 year-old man with no history of cardiac disease presented to the emergency department with typical angina chest pain of >24 hours duration. He was not thormbolyzed due to late presentation. Having elevated troponin and CK-MB levels and an electrocardiogram demonstrating anterolateral ST segment elevation and persistent of angina pain prompted coronary angiography which could be done only after 3 weeks of symptom onset due to financial constraint; which revealed coronary vessels free of significant disease. An echocardiogram showed dilatation of all cardiac chambers with hypokinesia of anterior wall and mid-septum and akinesia of apex. There was moderate mitral regurgitation and moderate tricuspid regurgitation and moderate systolic dysfunction. A number of conditions can lead to ST segment elevation MI with normal epicardial coronary anatomy. We report a case possibly due to autothrombolysis. Treatment to such cases would be symptomatic drug therapy with reassurance and risk factor reduction. DOI: http://dx.doi.org/10.3126/njh.v8i1.8335 Nepalese Heart Journal Vol.8(1) 2011 pp.33-36
ST Segment Elevation in aVR: Clinical Significance in Acute Coronary Syndrome
Antoine Kossaify
Clinical Medicine Insights: Case Reports , 2012, DOI: 10.4137/CCRep.S11261
Abstract: A 59-year-old-male patient with no previous medical history presented with oppressive chest pain; initial electrocardiogram showed ST segment elevation in aVR and V1, with intermittent right bundle branch block. Emergent coronary angiogram showed a proximal sub-occlusive stenosis of the left anterior descending artery, and the patient was hemodynamically unstable during the first 72 hours. Insights into the significance of ST segment elevation in aVR are presented and discussed in light of the current medical data.
Pneumopericardium: reports and a review
F Visser, M Heine, A.I Levin, A.R Coetzee
Southern African Journal of Anaesthesia and Analgesia , 2008,
Abstract: Pneumopericardium, and especially tension pneumopericardium, are relatively rare consequences of penetrating, blunt or iatrogenic injury. Despite its rarity and the compressibility of air, pneumopericardium can result in life threatening cardiac tamponade. We present two recent cases of this rare condition with divergent aetiologies from which lessons can be learned. The pathophysiology, diagnosis and treatment of pneumopericardium are reviewed.
Robustness of the Drosophila segment polarity network to transient perturbations  [PDF]
Kartik Subramanian,Chetan Gadgil
Quantitative Biology , 2009,
Abstract: Continuous and Boolean models for the Drosophila segment polarity network have shown that the system is able to maintain the wild-type pattern when subjected to sustained changes in the interaction parameters and initial conditions. Embryo development is likely to occur under fluctuating environmental conditions. We use a well-established Boolean model to explore the ability of the segment polarity network to resist transient changes. We identify paths along which alternate unviable states are reached, and hence critical nodes whose state changes lead the system away from the wild-type state. We find that the system appears to be more sensitive to changes that involve activation of normally inactive nodes. Through a simulation of the heat shock response, we show how a localized perturbation in one parasegment is more deleterious than a global perturbation affecting all parasegments. We identify the sequence of events involved in the recovery of the system from a global transient heat shock condition. Finally we discuss these results in terms of the robustness of the system response.
Reperfusion therapy in acute coronary syndrome with ST segment elevation  [cached]
A.L. Alyavi,B.A. Alyavi
Rational Pharmacotherapy in Cardiology , 2009,
Abstract: Aim. To compare effect of percutaneous balloon angioplasty (PCA) and a systemic thrombolysis (STL) on the central and intracardiac hemodynamics in patients with acute coronary syndrome (ACS) with ST segment elevation.Material and methods. 80 patients with ACS with ST segment elevation were included in the study. Patients were split into 2 groups depending on reperfusion strategy. PCA was performed in 55 patients (first group). 25 patients of the second group had STL with Streptokinase, i/v, 1 500 000 units per hour. Echocardiography was performed in all patients at admission and after 3 and 7 days of treatment to evaluate intracardiac hemodynamics.Results. Both reperfusion methods significantly increase of ejection fraction (EF) and maximal output speed of left ventricle (LV). Increase of LV EF in patients after PCA was higher than this in patients after STL. PCA improved LV diastolic function; STL did not change this characteristic. After PCA working diagnosis of ACS was transformed to the following final diagnosis: acute myocardial infarction (AMI) with Q, AMI without Q and unstable angina in 37,5, 30,4 and 32,1% of patients, respectively. After STL diagnosis of AMI with Q was defined in all patients.Conclusion. PCA in patients with ACS with ST segment elevation results in fast improvement of global systolic and diastolic LV function. Besides, PCA prevents AMI with Q in a half of these patients.
Takotsubo cardiomyopathy mimicking acute ST-segment elevation myocardial infarction in a 28-year-old woman  [PDF]
Laxman Dubey,Sanjib Kumar Sharma,Samir Gautam,Sachin Dhungel,Shankar Laudari
Journal of Advances in Internal Medicine , 2014, DOI: 10.3126/jaim.v3i1.10703
Abstract: DOI Takotsubo cardiomyopathy is a rare type of nonischemic cardiomyopathy accompanied by a transient ballooning and akinesis of the apical segment of left ventricle. Here, we report a 28-year-old woman who presented with acute chest pain after an emotional stress. Electrocardiography showed STsegment elevation in leads II, III, aVF, V3-V6. Echocardiography, coronary angiography and left ventriculography showed typical features of Takotsubo cardiomyopathy. DOI: http://dx.doi.org/10.3126/jaim.v3i1.10703 ? Journal of Advances in Internal Medicine 2014;03(01):38-41
Coronary artery anomalies presenting with ST-segment elevation myocardial infarction  [cached]
Jlenia Marchesini,Gianluca Campo,Riccardo Righi,Giorgio Benea
Clinics and Practice , 2011, DOI: 10.4081/cp.2011.e107
Abstract: ST-segment elevation MI (STEMI) is a rare presentation in patients with coronary artery anomalies. In these patients, the identification of the culprit lesion and its treatment may be difficult, particularly in the emergency setting of primary percutaneous coronary intervention (PCI). From January 2008 to April 2011, 1015 STEMI patients received coronary artery angiography and primary PCI in our centre. Of these, 5 (0.4%) patients showed a coronary artery anomaly. In this paper we reported two rare cases: i) the first is a single coronary artery originating from right sinus of Valsalva; ii) the second is a separate origin of 3 coronary arteries originating from the right sinus of Valsalva. In conclusion, coronary artery anomalies presenting with STEMI are really uncommon, but often are a challenge. The integration between traditional coronary artery angiography and multidetector computerized tomography is crucial to optimize the interventional and medical management of these patients
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