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Prognostic Importance of ST-Segment Resolution in Acute Myocardial Infarction
Ero?lu M et al.
Konuralp Tip Dergisi , 2011,
Abstract: Some factors may affect prognosis and may be used to determine long term life duration after myocardial infarction. Hence, risk classification after myocardial infarction is of great importance. Coronary reperfusion following fibrinolytic therapy may be detected invasively and non-invasively in myocardial infarction with ST-segment elevation. ST-segment resolution, which is one of non-invasive reperfusion criteria, might be used to determine prognosis, since it reflects myocardial microcirculatory circulation better, and it is an easy, simple, and inexpensive parameter used in clinical practice. In the present study, we evaluated the prognostic importance of ST-segment resolution degree.
Septal rupture with right ventricular wall dissection after myocardial infarction
Carlos J Soriano, José L Pérez-Boscá, Sergio Canovas, Francisco Ridocci, Pau Federico, Ildefonso Echanove, Rafael Paya
Cardiovascular Ultrasound , 2005, DOI: 10.1186/1476-7120-3-33
Abstract: We present a case of a 59-year-old man who had a septal rupture with right ventricular wall dissection after inferior and right ventricular myocardial infarction. Transthoracic echocardiography, as first line examination, established the diagnosis, and prompt surgical repair allowed long-term survival in our patient.Outcomes after right ventricular intramyocardial dissection following septal rupture related to myocardial infarction has been reported to be dismal. Early recognition of this complication using transthoracic echocardiography at patient bedside, and prompt surgical repair are the main factors to achieve long-term survival in these patients.The occurrence of ventricular septal rupture after acute myocardial infarction is an uncommon complication in the reperfusion era [1], however, this condition implies a high mortality rate, even after surgical repair [2]. In patients with inferior myocardial infarction, septal rupture generally involves basal inferoposterior septum, and the communicating tract between left and right ventricle is often serpiginous with a variable degree of right ventricular wall extension [3]. Right ventricular wall dissection following septal rupture related to previous myocardial infarction has been reported in a very few cases [4-6], in many of them this condition has been diagnosed in post-mortem studies [4]. In a recent report long-term survival has been achieved after promptly echocardiographic diagnosis and surgical repair [6].A 59-year-old man was admitted to Coronary Care Unit because of suspected ST-segment-elevation myocardial infarction. The patient was complaining of typical coronary chest pain during the last twelve hours. He had a history of dyslipidemia, type 2 diabetes mellitus, smoking habit and a transient ischemic attack without any sensitive or motor squele one year ago. On admission, his blood pressure was 100/60 and heart rate was 110 beats per minute. Cardiac examination revealed jugular vein distension, and no s
Correlation between delayed-enhancement magnetic resonance and nitrate myocardial Tc-99m tetrofosmin scintigraphy in myocardial infarction: a case report
Mauro Feola, Gian Rosso, Alberto Biggi, Stephane Chauvie, Giovanni Leonardi, Franca Margaria, Maurizio Grosso, Valeria Ferrero
Journal of Medical Case Reports , 2007, DOI: 10.1186/1752-1947-1-120
Abstract: We describe a case of a 71-year-old man admitted for ischemic-like chest pain in which DE-MRI and post-nitrate 99mTc-tetrofosmin myocardial scintigraphy equally contributed to the diagnosis of previous lateral myocardial infarction.In this patient with coronary artery disease, the absence of uptake of tracer at myocardial scintigraphy appeared to be closely correlated to DE-MRI data. Cardiologists can use SPECT or DE-MRI to obtain similar information about myocardial viability.Delayed-enhancement magnetic resonance imaging (DE-MRI) is a highly accurate method for the non-invasive estimation of infarct size and location in acute or chronic myocardial infarction [1-3]. Cardiac MRI can also be used to detect the chronic consequence of myocardial infarction using its high degree of image definition [4]. It has recently been proposed as an alternative tool for the assessment of myocardial necrosis. Diagnostic methods for assessing myocardial viability, such as positron-emission tomography, single-photon-emission computed tomography (SPECT) and dobutamine echocardiography all have demonstrated limits in identifying the transmural extension of necrosis and/or viability of the ventricular wall [5-7].Previous studies [1,8,9] have documented the comparable efficacy of myocardial SPECT (using either thallium 201 or 99mTc-tetrofosmin) and DE-MRI in the evaluation of the presence, location, and transmural extension of myocardial necrosis. Furthermore, DE-MRI is a diagnostic method that is characterized by superior spatial resolution and the absence of ionizing radiation.In this case report we describe the case of a man with a previous lateral myocardial infarction, in which MRI showed a DE in the lateral wall according to the result of post-nitrate 99mTc-tetrofosmin imaging.A 71-year-old man was admitted for ischemic-like chest pain occurring 10 days prior to the hospital admission. The ECG showed ST-T segment elevation without a q wave in the infero-lateral leads (figure 1) tha
Comparative effect of streptokinase and alteplase on electrocardiogram and angiogram signs of myocardial reperfusion in ST segment elevation acute myocardial infarction
Toma?evi? Miloje,Kosti? Tomislav,Apostolovi? Svetlana,Peri?i? Zoran
Srpski Arhiv za Celokupno Lekarstvo , 2008, DOI: 10.2298/sarh0810481t
Abstract: INTRODUCTION Modern pharmacological reperfusion in ST segment elevation acute myocardial infarction means the application of fibrin specific thrombolytics combined with modern antiplatelets therapy dual antiplateles therapy, acetylsalicylic acid and clopidogrel, and enoxaparin. The contribution of each agent has been widely examined in large clinical studies, but not sufficiently has been known about the effects of a combined approach, where the early angiography and percutaneous coronary intervention is added during hospitalization, if necessary. OBJECTIVE The aim of the paper is to compare the effects of streptokinase and alteplase, together with the standard modern adjuvant antiplatelets and anticoagulation therapy (aspirin, clopidogrel, enoxaparin) in patients with ST segment elevation acute myocardial infarction, on electrocardiographic and angiographic signs of the achieved myocardial reperfusion. METHOD The prospective study included 127 patients with the first ST segment elevation acute myocardial infarction who were treated with a fibrinolytic agent in the first 6 hours from the chest pain onset. The examined group included 40 patients on the alteplase reperfusion therapy, while the control 87 patients were on the streptokinase therapy. All the patients received the same adjuvant therapy and all were examined by coronary angiography on the 3rd to 10th day of hospitalization. Reperfusion effects were estimated on the basis of the following: ST segment resolution at 60, 90 and 120 minutes, the appearance of reperfusion arrhythmias at the electrocardiogram, percentage of residual stenosis at the 'culprit' artery, TIMI coronary flow at the 'culprit' artery and the appearance of new major adverse coronary events in the 6-month-follow-up period. RESULTS By analysing the resolution of the sum of ST segment elevation in infarction leading 60 minutes after the beginning of the medication application, we received a statistically significantly higher resolution of ST segment in the group of patients who received alteplase (p<0.05). 60 minutes after the application of thrombolytics, 64% of patients at streptokinase showed the absence of ST segment resolution (<30%), and 32% of patients at alteplase (p<0.0001). Reperfusion arrhythmias as the sign of successful myocardial reperfusion were present in 62.5% of patients at alteplase and in 57.4% of patients at streptokinase, but the difference is not statistically significant. There was no statistically significant difference in the degree of residual stenosis at the 'culprit' artery in the compared groups of p
Tomislav Kosti?,Zoran Peri?i?,Sonja ?alinger Martinovi?,Svetlana Apostolovi?
Acta Medica Medianae , 2009,
Abstract: Sudden cardiac death poses an immense problem in the middle and highly developed countries because its first expression is at the same time the last one. Ventricle tachycardia, the monomorphous and the polymorphous ones, and ventricular fibrillation are rhythm disorders that are most frequently associated with the phenomenon of sudden cardiac death. Ventricular fibrillation is the most common cause of sudden cardiac death within the first hours of the acute myocardial infarction. A 60-year-old man was admitted to our Clinic from a local hospital due to acute onset of chest pain and ECG signs of anterior ST segment elevation myocardial infarction. He had severe rhythm disturbances, about 70 epizodes of ventricular fibrilation (VF). Due to rhytmical instability of the patient, we decided that along with PCI it was necessary to implant ICD twenty-two days after the first acute coronary event.The ICD implantation ensures the best prevention against sudden cardiac death (secondary and primary) in selected high-risk patients and has no alternative for any medicine known so far. It is significant that, lately, the field of application has extended to indication areas of primary prevention of sudden cardiac death, and especially to development of resynchronization implantable cardioverter defibrillator in the heart failure therapy.
Impact of metabolic syndrome on ST segment resolution after thrombolytic therapy for acute myocardial infarction  [PDF]
Ay?e Saat?? Ya?ar,Nurcan Ba?ar,Ahmet Kasapkara,?sa ?ner Yüksel
Dicle Medical Journal , 2010,
Abstract: Objectives: It has been shown that metabolic syndrome is associated with poor short-term outcome and poor long-term survival in patients with acute myocardial infarction. We aimed to investigate the effect of metabolic syndrome on ST segment resolution in patients received thrombolytic therapy for acute myocardial infarction.Materials and methods: We retrospectively analyzed 161 patients, who were admitted to our clinics with acute ST-elevated-myocardial infarction and received thrombolytic therapy within 12 hours of chest pain. Metabolic syndrome was diagnosed according to National Cholesterol Education Program Adult Treatment Panel III criteria. Resolution of ST segment elevation was assessed on the baseline and 90-minute electrocardiograms. ST segment resolution ≥70% was defined as complete resolution.Results: Metabolic syndrome was found in 56.5% of patients. The proportion of patients with metabolic syndrome who achieved complete ST segment resolution after thrombolysis was significantly lower than that of patients without metabolic syndrome (32.9% versus 58.6%, p=0.001). On multivariate analysis metabolic syndrome was the only independent predictor of ST segment resolution (p=0.01, Odds ratio=2.543, %95 CI:1.248-5.179)Conclusion: The patients with metabolic syndrome had lower rates of complete ST segment resolution after thrombolytic therapy for acute myocardial infarction. This finding may contribute to the higher morbidity and mortality of patients with metabolic syndrome.
An unusual case of ST-segment elevation myocardial infarction following a late bare-metal stent fracture in a native coronary artery: a case report
Giovanni Minardi, Paolo G Pino, Marco Nazzaro, Herribert Pavaci, Martina Sordi, Cesare Greco, Carlo Gaudio
Journal of Medical Case Reports , 2009, DOI: 10.1186/1752-1947-3-9296
Abstract: We present, to the best of our knowledge, the first documented case of ST-segment elevation myocardial infarction in a patient following a late bare-metal stent fracture and thrombosis in a native coronary artery. The patient, a 51-year-old Caucasian man, was treated successfully with primary percutaneous coronary intervention and a new stent implantation.A coronary stent fracture is a rare complication that has been described in venous bypass grafts deploying either a drug-eluting stent or a bare-metal stent. Stent fractures rarely occur in coronary arteries. In light of the non-specific presentation of stent fracture, it is also an easily missed complication. Patients may present with a non-specific symptom of angina. The angina could either be stable or unstable as a result of restenosis or in-stent thrombosis, or both. Our case demonstrates the most severe consequences of a bare-metal stent fracture (sudden coronary thrombosis and subsequent myocardial infarction) in a native coronary artery. It was diagnosed angiographically and treated early and effectively.A bare-metal stent (BMS) fracture as a cause of acute coronary thrombosis and consequently of acute coronary syndrome (ACS) is a rare clinical event that, to the best of our knowledge, has previously not been reported.A stent fracture is a rare complication of percutaneous coronary intervention (PCI). Drug-eluting stent (DES) fractures have an estimated incidence of 2.7% [1], and a BMS fracture in a saphenous vein graft has recently been described [2]. A late BMS fracture has also been reported, which was detected by 64-slice multidetector computed tomography (MDCT) [3].A 51-year-old Caucasian man who smoked and was afflicted with dyslipidemia presented at our emergency department complaining of typical angina and shortness of breath. He had a family history of coronary artery disease. He had been successfully treated with coronary angioplasty 12 years before presentation. A 4.0/16.0 mm AVE Micro stent (AVE
A case report of type VI dual left anterior descending coronary artery anomaly presenting with non-ST-segment elevation myocardial infarction
Lee Yonggu,Lim Young-Hyo,Shin Jinho,Kim Kyung-Soo
BMC Cardiovascular Disorders , 2012, DOI: 10.1186/1471-2261-12-101
Abstract: Background Type VI dual left anterior descending artery (LAD) is a rare coronary anomaly, the first case of which has recently been described. This is the first report of type VI dual LAD anomaly in which the patient presented with non-ST-segment elevation myocardial infarction and percutaneous coronary intervention was performed in the anomalously originating LAD. Case presentation A 52-year-old man with diabetes, hypertension and hyperlipidemia presented with chest pain without ST elevation on EKG, although the patient’s troponin I level was elevated. Coronary angiography revealed a short LAD originating from the left main coronary artery and a long LAD originating from the proximal portion of the right coronary artery (RCA). Three-dimensional reconstruction of computed tomography of images revealed that the long LAD originated from the proximal RCA and coursed between the right ventricular outflow tract (RVOT) and the aortic root before entering the mid anterior interventricular groove. The high take-off RCA originated underneath the RVOT, pointing downwards and forming an acute angle with the proximal portion of the long LAD. The anomalous long LAD displayed significant stenosis. We performed successful percutaneous coronary intervention (PCI) in the anomalous artery. Conclusion With accurate understanding of the coronary anatomy and appropriate hardware selection, successful PCI can be performed in the in the long LAD in patients with type VI dual LAD anomaly.
Recent Advances in the Treatment of ST-Segment Elevation Myocardial Infarction  [PDF]
Mun K. Hong
Scientifica , 2012, DOI: 10.6064/2012/683683
Abstract: ST-segment elevation myocardial infarction (STEMI) represents the most urgent condition for patients with coronary artery disease. Prompt diagnosis and therapy, mainly with primary angioplasty using stents, are important in improving not only acute survival but also long-term prognosis. Recent advances in angioplasty devices, including manual aspiration catheters and drug-eluting stents, and pharmacologic therapy, such as potent antiplatelet and anticoagulant agents, have significantly enhanced the acute outcome for these patients. Continuing efforts to educate the public and to decrease the door-to-balloon time are essential to further improve the outcome for these high-risk patients. Future research to normalize the left ventricular function by autologous stem cell therapy may also contribute to the quality of life and longevity of the patients surviving STEMI. 1. Introduction ST-segment elevation myocardial infarction (STEMI) accounts for approximately 30–45% of an estimated 1.5 million hospitalizations for acute coronary syndromes annually in the USA [1]. STEMI results primarily from sudden-onset plaque rupture and complete occlusion of a coronary artery [2]. Therefore, STEMI represents the most severe form of acute coronary syndromes and requires immediate therapy. There have been many recent advances in the treatment of STEMI, ranging from pharmacologic to device therapy. These advances have resulted in improved outcomes for the patients experiencing STEMI [3, 4]. In-hospital mortality from STEMI decreased steadily in the USA in all groups between 1997 and 2006, except for men <55 years of age [4]. Thus, there is still much more work to be done, especially the prevention of its occurrence in young men due to the unpredictable timing and relatively high risk of sudden death [5]. In addition, complete myocardial perfusion to improve left ventricular function and survival is essential but may not be achieved in many patients due to multifactorial reasons [6–12] and needs continued research for better long-term outcome. 2. Reperfusion Therapies The most important therapy for STEMI patients is the prompt reestablishment of antegrade flow. The earlier and the more complete the reperfusion, the greater the myocardial salvage and preservation of left ventricular function, the most important prognostic factor for long-term survival. There are pharmacologic and mechanical reperfusion therapies. Randomized trials have conclusively established primary angioplasty with stents as the optimal therapy for these patients, as primary percutaneous coronary
Acute Myocardial Infarction Caused by Filgrastim: A Case Report  [PDF]
Cemil Bilir,Hüseyin Engin,Yasemin Bakkal Temi,Bilal Toka,Turgut Karaba?
Case Reports in Oncological Medicine , 2012, DOI: 10.1155/2012/784128
Abstract: Common uses of the granulocyte-colony stimulating factors in the clinical practice raise the concern about side effects of these agents. We presented a case report about an acute myocardial infarction with non-ST segment elevation during filgrastim administration. A 73-year-old man had squamous cell carcinoma of larynx with lung metastasis treated with the chemotherapy. Second day after the filgrastim, patient had a chest discomfort. An ECG was performed and showed an ST segment depression and negative T waves on inferior derivations. A coronary angiography had showed a critical lesion in right coronary arteria. This is the first study thats revealed that G-CSF can cause acute myocardial infarction in cancer patients without history of cardiac disease. Patients with chest discomfort and pain who are on treatment with G-CSF or GM-CSF must alert the physicians for acute coronary events. 1. Introduction Granulocyte-colony stimulating factors (G-CSF) are commonly used in patients with chemotherapy-induced neutropenia. Recently G-CSF has been used in clinical trials to research neovascularization and/or to reduce the damaged size of infarct. Common uses of the granulocyte-colony stimulating factors in the clinical practice raise the concern about side effects of these agents. Studies showed that nearly 5% of patients undergoing peripheral blood stem cell mobilization with G-CSF developed venous thromboembolic events (VTEs) [1]. In addition an early dose escalation study for G-CSF revealed that 5/39 patients had chest pain and 1/39 patient had abnormal ST segment depression [2]. We also presented a case about an acute myocardial infarction with non-ST segment elevation during filgrastim administration. 2. Case Report A 73-year-old man had squamous cell carcinoma of larynx with lung metastasis treated with the chemotherapy including the docetaxel, cisplatin, and fluorouracil regimen. The patient was admitted to the hospital for pneumonia after the 3rd course of chemotherapy. Piperacillin tazobactam of ?gr per day was given. On the 4th day of the treatment of antibiotic, patients become neutropenic without fever, and then filgrastim 5?mcg/kg/day was administered. Patient had a chest discomfort on the second day of filgrastim administration. An ECG was performed, and ST segment depression with negative T waves on inferior derivations of the ECG had been determined (Figure 1). Patient’s ECG was normal on admission to the hospital. Cardiac enzymes analysis were elevated, and value of troponin I was 1,9?ng/mL and value of CK-MB was 7,3(5,5)?ng/mL. Filgrastim was
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