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Sample records for acute anterior myocardial

  1. Frequency of left ventricular thrombus after anterior wall st-segment elevation acute myocardial infarction

    International Nuclear Information System (INIS)

    Iqbal, M.W.; Fayyaz, A.

    2014-01-01

    Left ventricular thrombus (LVT) formation is a well known complication seen in patients presenting with acute anterior wall ST-segment elevation myocardial infarction (STEMI). In previous studies the incidence of this complication, after acute myocardial infarction (AMI) has been reported to be 4% to 60% in large anterior wall STEMI, depending significantly upon the method as well as time of reperfusion therapy after STEMI. Objective: The objective of this descriptive case series study was to evaluate the frequency of left ventricular thrombus formation in patients after acute anterior wall ST-Segment elevation myocardial infarction. Methodology: In this study, 100 patients with anterior wall STEMI presenting to cardiac emergency or coronary care unit (CCU) of Cardiac complex, Gulab Devi Hospital, were selected on non-probability, purposive sampling meeting inclusion criteria, after taking written informed consent. All the patients were treated initially for management of acute STEMI, including use of thrombolytics where indicated. 2-D Transthoracic echocardiography (TTE) was performed during the same admission to assess presence of LV thrombus (LVT). Results: The mean age of the patients was 54.3 +- 11.4 years. There were 84(84%) male patients and 16 (16%) female patients. LVT was present in 28 (28%) patients on TTE. Among those, there were 23 (82.1%) male and 5 (17.9%) female patients. However, out of 84 male patients 27.4% develop LVT and among 16 female patients this ratio was 31.3%. The LV thrombus was independent of age and gender. LV thrombus was significantly less in thrombolytic group as compared to those who were not given this therapy, i.e. p value <0.05. Conclusion: Patients with anterior wall acute STEMI not infrequently develop the complication of development of LV thrombus. In this study the frequency of LV thrombus formation after anterior wall acute STEMI was 28%. (author)

  2. Hypertrophic Cardiomyopathy Mimicking Acute Anterior Myocardial Infarction Associated with Sudden Cardiac Death

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    Y. Daralammouri

    2012-01-01

    Full Text Available Hypertrophic cardiomyopathy is the most common genetic disease of the heart. We report a rare case of hypertrophic obstructive cardiomyopathy mimicking an acute anterior myocardial infarction associated with sudden cardiac death. The patient presented with acute ST elevation myocardial infarction and significant elevation of cardiac enzymes. Cardiac catheterization showed some atherosclerotic coronary artery disease, without significant stenosis. Echocardiography showed left ventricular hypertrophy with a left ventricular outflow tract obstruction; the pressure gradient at rest was 20 mmHg and became severe with the Valsalva maneuver (100 mmHg. There was no family history of sudden cardiac death. Six days later, the patient suffered a syncope on his way to magnetic resonance imaging. He was successfully resuscitated by ventricular fibrillation.

  3. Thallium-201 myocardial imaging in acute-myocardial infarction

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    Wackers, F.J.Th.; Lie, K.I.; Sokole, E.B.; Wellens, H.J.J.; Samson, G.; Schoot, J.B. van der

    1980-01-01

    Thallium-201 scintigraphy has proven to be an early and highly sensitive technique to detect myocardial perfusion abnormalities in patients with acute myocardial infarction. During the early phase of acute myocardial infarction, patients may be hemodynamically and electrically unstable. Therefore, scintigraphy is performed preferably at the bed side in the Coronary Care Unit using a mobile gamma camera. Additionally, in order to shorten imaging time in these often critically ill patients, the authors recommend injecting no less than 2 mCi of 201 Tl. Using this dosage, the imaging time per view will be approximately five minutes. Routinely, three views are taken: the first view is a supine 45 0 left-anterior-oblique view, followed by a supine anterior view and finally a left-lateral view, the latter with the patient turned on the right side. (Auth.)

  4. [Acute anterior myocardial infarction as presenting feature of antiphospholipid syndrome related lupus arthritis].

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    Capilla-Geay, E; Poyet, R; Brocq, F X; Pons, F; Kerebel, S; Foucault, G; Jego, C; Cellarier, G R

    2016-05-01

    Antiphospholipid syndrome is an autoimmune disorder causing venous and arterial thrombosis. Acute coronary complications are rare but potentially dramatic. We report a 39-year-old woman who presented with an acute anterior myocardial infarction after intravenous corticosteroids as part of the treatment of lupus arthritis and revealing antiphospholipid syndrome. Emergency coronary angiography was performed with drug-eluting stent angioplasty despite the need for anticoagulation and dual antiplatelet therapy. Antiplatelet and anticoagulant therapy management is pivotal in patients with antiphospholipid syndrome and acute coronary syndrome to prevent thrombosis recurrence. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  5. Localization and quantification of acute myocardial infarction by myocardial perfusion tomographic imaging

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    Lin Xiufang; Min Changgeng; Lin Zhihu; Ke Ruoyi

    1994-01-01

    The authors reported the result of the quantification and localization of 30 clinically confirmed acute myocardial infarction patients in comparison with that of ECG. A left ventricle model was used to correct the area calculated by the method of Bull's eye. The result indicated that the infarction area calculated by the corrected Bull's eye method correlated closely with that determined by the ECG QRS scoring method (r = 0.706, P<0.01). Myocardial infarctions of all 30 patients were detected by both ECG and myocardial perfusion tomographic imaging. The accuracy of localization of myocardial infarction by myocardial perfusion imaging was similar to that of ECG in the anterior wall, anterior septum, anterior lateral and inferior wall, but superior to that of ECG in the apex, posterior lateral, posterior septum, and posterior wall

  6. Characteristics of 201Tl myocardial SPECT and left ventriculography in patients with acute diagonal branch myocardial infarction

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    Tanaka, Takeshi; Aizawa, Tadanori; Katou, Kazuzo; Ogasawara, Ken; Kirigaya, Hajime

    1993-01-01

    Characteristics of 201 Tl myocardial SPECT and ventriculography were studied in 13 patients with acute diagonal branch myocardial infarction. Rest 201 Tl myocardial SPECT and left ventriculography were underwent in chronic phase. In 5 patients electrocardiogram (ECG) changes in acute phase were not definite. In 6 patients it was difficult to identify the obstructed coronary artery with coronary angiography in acute phase. Mean value of maximum creatine phosphokinese (CPK) was 854 (458-1,774) U/l. It seemed to be difficult to diagnose acute diagonal branch myocardial infarction with ECG and/or coronary angiography. In all patients defects were noted on 201 Tl SPECT. Defects were small and noted in the central anterior wall and not in the septum. In 2 patients defects were noted at apex. In left ventriculography dyskinetic motion was noted in 10 patients; one patient showed apical aneurysm and 3 patients showed anterior wall aneurysm. In 3 patients anterior wall showed akinesis. It was concluded that 201 Tl myocardial SPECT were useful for detecting diagonal branch lesion. In case of diagonal branch myocardial infarction size of defects were small and defects were not noted in the septum, however aneurysmal motion was frequently noted. (author)

  7. Effects of L-carnitine administration on left ventricular remodeling after acute anterior myocardial infarction: The L-carnitine Ecocardiografia Digitalizzata Infarto Miocardico (CEDIM) trial

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    S. Iliceto (Sabino); D. Scrutinio (Domenico); P. Bruzzi (P.); G. D'Ambrosio (Gaetano); A. Boni (Alejandro); M. Di Biase (Matteo); G. Biasco (Giuseppina); P.G. Hugenholtz (Paul); P. Rizzon (Paolo)

    1995-01-01

    textabstractObjectives. This study was performed to evaluate the effects of l-carnitine administration on long-term left ventricular dilation in patients with acute anterior myocardial infarction. Background. Carnitine is a physiologic compound that performs an essential role in myocardial energy

  8. Anterior ST segment depression in acute inferior myocardial infarction as a marker of greater inferior, apical, and posterolateral damage

    International Nuclear Information System (INIS)

    Ruddy, T.D.; Yasuda, T.; Gold, H.K.; Leinbach, R.C.; Newell, J.B.; McKusick, K.A.; Boucher, C.A.; Strauss, H.W.

    1986-01-01

    The clinical significance of anterior precordial ST segment depression during acute inferior myocardial infarction was evaluated in 67 consecutive patients early after onset of symptoms with gated blood pool scans, thallium-201 perfusion images, and 12-lead ECGs. Patients with anterior ST depression (n = 33) had depressed mean values for left ventricular ejection fraction (54 +/- 2% [mean +/- S.E.M.] vs 59 +/- 2%; p = 0.02), cardiac index (3.1 +/- 0.2 vs 3.6 +/- 0.2 L/m2; p = 0.03), and ratio of systolic blood pressure to end-systolic volume (2.0 +/- 0.1 vs 2.5 +/- 0.3 mm Hg/ml; p = 0.04) compared to patients with no anterior ST depression (n = 34). Patients with anterior ST depression had (1) lower mean wall motion values for the inferior, apical, and inferior posterolateral segments (p less than 0.05) and (2) greater reductions in thallium-201 uptake in the inferior and posterolateral regions (p less than 0.05). However, anterior and septal (1) wall motion and (2) thallium-201 uptake were similar in patients with and without ST depression. Thus, anterior precordial ST segment depression in patients with acute inferior wall myocardial infarction represents more than a reciprocal electrical phenomenon. It identifies patients with more severe wall motion impairment and greater hypoperfusion of the inferior and adjacent segments. The poorer global left ventricular function in these patients is a result of more extensive inferior infarction and not of remote septal or anterior injury

  9.  Effect of Thrombolytic Therapy on the Incidence of Early Left Ventricular Infarct Expansion in Acute Anterior Myocardial Infarction

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    Namir Ghanim Al-Tawil

    2011-11-01

    Full Text Available  Objectives: To determine the incidence of early left ventricular infarct expansion within five days after first anterior ST-segment elevation myocardial infarction and the effect of early thrombolytic therapy on the incidence of early infarct expansion compared with late thrombolytic therapy.Methods: In a prospective study of 101 patients (75males and 26 females, with the first attack of acute anterior myocardial infarction, their ages ranged from 40-80 years (mean age: 61.07±10.78 who had been admitted to the Coronary Care Unit of Hawler Teaching Hospital for the period from July 2007 through to September 2009. Those who received alteplase ≤3 hours of acute myocardial infarction were labelled as group-I (49 patients and those who received alteplase >3-12 hours were labelled as group-II (52 patients.Results: The incidence of early left ventricular infarct expansion was diagnosed by 2D-echocardiography and was found to be 17.8�20Group I patients had a lower incidence of early left ventricular infarct expansion (8.16�20compared with group-II (26.92�20 p=0.014. Patients with early left ventricular infarct expansion had a higher frequency rate of left ventricular systolic dysfunction (94.44�20compared to patients without early left ventricular infarct expansion (8.43�20p<0.001. There was a significant difference in the incidence of in-hospital mortality between the patients who developed early left ventricular infarct expansion (11.1�20compared with patients without early left ventricular infarct expansion (1.2�20p=0.025.Conclusion: Early reperfusion therapy in acute anterior myocardial infarction can decrease the incidence of early left ventricular infarct expansion, preserve left ventricular systolic function and decrease in-hospital mortality.

  10. Delayed ventricular septal rupture complicating acute inferior wall myocardial infarction

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    Cho, Jae Hyung; Sattiraju, Srinivasan; Mehta, Sanjay; Missov, Emil

    2013-01-01

    Background Ventricular septal rupture is a potentially fatal complication of acute myocardial infarction. Its incidence has declined with modern reperfusion therapy. In the era of percutaneous coronary interventions, it occurs a median of 18?24?hours after myocardial infarction and is most commonly associated with anterior myocardial infarction. We present a case of delayed ventricular septal rupture complicating acute inferior wall myocardial infarction. Case presentation A 53-year-old Cauca...

  11. Acute anterior myocardial infarction seen on conventional iodine-contrast CT

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    Christian Hagdrup, MD

    2017-09-01

    Full Text Available Diagnosis of acute myocardial infarction (AMI is based on clinical symptoms of chest pain and dyspnea in combination with electrocardiographic changes and a raise in myocardial-specific biomarkers. Imaging is by echocardiography and magnetic resonance. The preferred technique for identification of previous myocardial infarction (MI is magnetic resonance imaging with late gadolinium technique, but in the acute patient echocardiography is applied. In selected cases, important information can be obtained from other imaging modalities. We describe a case of a patient first suspected of an abdominal catastrophe in whom acute MI was diagnosed from a computerized tomography (CT scan with iodine contrast. Our case together with a few other cases reported in the literature demonstrate that contrast enhancement of the myocardium can be important to follow in the acute patient because the CT scans sometimes give a unique opportunity to recognize findings consistent with MI even though the CT scan was performed for another reason.

  12. Plasma bilirubin values on admission and ventricular remodeling after a first anterior ST-segment elevation acute myocardial infarction.

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    Miranda, Berta; Barrabés, José A; Figueras, Jaume; Pineda, Victor; Rodríguez-Palomares, José; Lidón, Rosa-Maria; Sambola, Antonia; Bañeras, Jordi; Otaegui, Imanol; García-Dorado, David

    2016-01-01

    Bilirubin may elicit cardiovascular protection and heme oxygenase-1 overexpression attenuated post-infarction ventricular remodeling in experimental animals, but the association between bilirubin levels and post-infarction remodeling is unknown. In 145 patients with a first anterior ST-segment elevation acute myocardial infarction (STEMI), we assessed whether plasma bilirubin on admission predicted adverse remodeling (left ventricular end-diastolic volume [LVEDV] increase ≥20% between discharge and 6 months, estimated by magnetic resonance imaging). Patients' baseline characteristics and management were comparable among bilirubin tertiles. LVEDV increased at 6 months (P bilirubin tertiles (10.8 [30.2], 10.1 [22.9], and 12.7 [24.3]%, P = 0.500). Median (25-75 percentile) bilirubin values in patients with and without adverse remodeling were 0.75 (0.60-0.93) and 0.73 (0.60-0.92) mg/dL (P = 0.693). Absence of final TIMI flow grade 3 (odds ratio 3.92, 95% CI 1.12-13.66) and a history of hypertension (2.04, 0.93-4.50), but not admission bilirubin, were independently associated with adverse remodeling. Bilirubin also did not predict the increase in ejection fraction at 6 months. Admission bilirubin values are not related to LVEDV or ejection fraction progression after a first anterior STEMI and do not predict adverse ventricular remodeling. Key messages Bilirubin levels are inversely related to cardiovascular disease, and overexpression of heme oxygenase-1 (the enzyme that determines bilirubin production) has prevented post-infarction ventricular remodeling in experimental animals, but the association between bilirubin levels and the progression of ventricular volumes and function in patients with acute myocardial infarction remained unexplored. In this cohort of patients with a first acute anterior ST-segment elevation myocardial infarction receiving contemporary management, bilirubin levels on admission were not predictive of the changes in left

  13. Effect of emergency PCI combined with rh-BNP therapy on neuroendocrine indicators and cardiac function in patients with acute anterior myocardial infarction

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    Yang Ji

    2016-06-01

    Full Text Available Objective: To analyze the effect of emergency PCI combined with rh-BNP therapy on neuroendocrine indicators and cardiac function in patients with acute anterior myocardial infarction. Methods: A total of 70 cases with acute anterior myocardial infarction who received emergency rescue in our hospital from February 2012 to September 2014 were included for study, and all included patients were divided into control group 38 cases who received emergency PCI treatment alone and observation group 32 cases who received emergency PCI combined with rh-BNP therapy. Differences in the values of neuroendocrine indicators, ventricular collagen remodeling-related indicators, cardiac function indicators, myocardial injury-related indicators and so on were compared between two groups after treatment. Results: Serum ET, PRA, ALD, AngII, NE and E values of observation group after treatment were significantly lower than those of control group (P<0.05; serum PⅠCP and PCⅢ values of observation group after treatment were lower than those of control group, and PⅠCP/ PCⅢ and TIMP-1 values were significantly higher than those of control group (P<0.05; examination of cardiac function by color Doppler ultrasound showed that LAD, LVEDD, LVESD, LVESV and LVEDV values of observation group were lower than those of control group, and LVEF and LVFS values were significantly higher than those of control group (P<0.05; serum CD14++CD2L+, hs-cTnT, HBDH and H-FABP values of observation group after treatment were significantly lower than those of control group, and CD14+CD2L- value was significantly higher than that of control group (P<0.05. Conclusions: Emergency PCI combined with rh-BNP therapy for patients with acute anterior myocardial infarction can significantly improve cardiac function and inhibit ventricular remodeling, and it has positive clinical significance.

  14. Right bundle branch block and anterior wall ST elevation myocardial infarction.

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    Trofin, Monica; Israel, Carsten W; Barold, S Serge

    2017-09-01

    We report the case of an acute anterior wall ST elevation myocardial infarction with new left anterior fascicular block and pre-existing right bundle branch block. Due to a wide right bundle branch block, no ST segment elevation was visible in lead V1. The left anterior fascicular block was caused by proximal occlusion of the left artery descending and disappeared after acute revascularization. However, also the R' of the right bundle branch block became significantly shorter after revascularization, dismanteling a minor ST segment elevation. The ST elevation in lead V1 in anterior wall infarction and right bundle branch block may merge with the R' and cause a further QRS widening as an "equivalent" to the ST elevation.

  15. Clinical implications of anterior S-T segment depression in patients with acute inferior myocardial infarction

    International Nuclear Information System (INIS)

    Croft, C.H.; Woodward, W.; Nicod, P.; Corbett, J.R.; Lewis, S.E.; Willerson, J.T.; Rude, R.E.

    1982-01-01

    To assess various factors associated with anterior S-T segment depression during acute inferior myocardial infarction, 47 consecutive patients with electrocardiographic evidence of a first transmural inferior infarction were studied prospectively with radionuclide ventriculography an average of 7.3 hours (range 2.9 to 15.3) after the onset of symptoms. Thirty-nine patients (Group I) had anterior S-T depression in the initial electrocardiogram and 8 (Group II) did not have such reciprocal changes. There was no difference between the two groups in left ventricular end-diastolic or end-diastolic volume index or left ventricular ejection fraction. Stroke volume index was greater in Group I than in Group II. There were no group differences in left ventricular total or regional wall motion scores. A weak correlation existed between the quantities (mV) or inferior S-T segment elevation and reciprocal S-T depression. No relation between anterior S-T segment depression and the left ventricular end-diastolic volume index could be demonstrated; the extent of left ventricular apical and right ventricular wall motion abnormalities, both frequently associated with inferior infarction, did not correlate with the quantity of anterior S-T depression. These data show that anterior S-T segment depression occurs commonly during the early evolution of transmural inferior infarction, is not generally a marker of functionally significant anterior ischemia and cannot be used to predict left ventricular function in individual patients. Anterior S-T segment depression may be determined by reciprocal mechanisms

  16. Assessment of mitral annular velocities by Doppler tissue imaging in predicting left ventricular thrombus formation after first anterior acute myocardial infarction

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    Ahmed Fathy

    2011-09-01

    Conclusion: From our study, we can conclude that TDE can be used for estimation of systolic and diastolic functions of LV and hence identification of patients at high risk for LV thrombus formation after first time acute anterior myocardial infarction and we recommend more studies to support our results about the importance of the role of oral anticoagulant after AMI.

  17. Myocardial infarct size vs duration of coronary artery occlusion in patients with acute anterior myocardial infarction. Assessment by thallium-201 emission tomography, gated cardiac pool study and CK-MB release

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    Tamaki, Shunichi; Kambara, Hirofumi; Kadota, Kazunori; Murakami, Tomoyuki; Suzuki, Yukisono [Kyoto Univ. (Japan). Faculty of Medicine

    1984-03-01

    Relationship between the duration of coronary artery occlusion and myocardial infarct size was investigated in 24 patients with acute anterior myocardial infarction associated with occlusion of the left anterior descending artery. The duration of coronary artery occlusion was divided into (A) 4 hours or less, (B) 4-10 hours, and (C) 10 hours or more. Defect score obtained by thallium-201 emission computed tomography was significantly greater, and left ventricular ejection fraction was significantly lower as the duration of coronary artery occlusion increased. Creatine kinase-MB (..sigma..CK-MB) was higher in cases of longer duration of occlusion. However, this was not significant between the groups A and B, suggesting the influence of reperfusion on the ..sigma..CK-MB release. The duration of coronary artery occlusion was considered to be an important factor to determine the infarct size, and significance of early reperfusion was suggested.

  18. Myocardial imaging in acute myocardial infarction using β-methyl-p-(123I)-iodophenylpentadecanoic acid

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    Naruse, Hitoshi; Itano, Midoriko; Kondo, Tomohiro

    1992-01-01

    Myocardial imaging using β-methyl-p-( 123 I)-iodophenylpentadecanoic acid (BMIPP) was performed in 11 patients with acute myocardial infarction. The left ventricular images were divided into 12 segments, and myocardial images with BMIPP were compared with coronary angiography (CAG), thallium-201 myocardial scintigraphy (Tl) and wall motion obtained by two-dimensional echocardiography (WM). When the culprit lesion was at the proximal point of the left anterior descending artery (LAD), all segments showed depressed uptake. In 3 cases with single vessel disease of the LAD, inferior wall of the basis showed reduced uptake of BMIPP despite the location of the culprit lesion. In cases with discordant uptake between the two tracers, BMIPP frequently showed more severely depressed uptake than Tl in the subacute phase, although the uptake of BMIPP correlated with that of Tl (τ=0.82, p<0.001). In such cases, the discordance was related to the improvement in WM from the acute phase to the convalescent phase. BMIPP uptake correlated with WM in the subacute phase (τ=0.50, p<0.001). BMIPP showed more severely depressed uptake while WM showed mild asynergy in most cases in which discordance was found between the BMIPP and WM findings. However, there was no correlation between the change in WM from the acute to subacute phases, or the uptakes of BMIPP and Tl alone. We concluded that the myocardial condition can be evaluated in detail in acute myocardial infarction by comparing the findings of BMIPP with those of Tl and WM. (author)

  19. Differential diagnosis at admission between Takotsubo cardiomyopathy and acute apical-anterior myocardial infarction in postmenopausal women.

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    Zorzi, Alessandro; Baritussio, Anna; ElMaghawry, Mohamed; Siciliano, Mariachiara; Migliore, Federico; Perazzolo Marra, Martina; Iliceto, Sabino; Corrado, Domenico

    2016-08-01

    Takotsubo cardiomyopathy (TTC) typically affects postmenopausal women and clinically presents with chest pain, ST-segment elevation, elevated cardiac enzymes and apical left ventricular (LV) wall motion abnormalities that mimic 'apical-anterior' acute myocardial infarction (AMI). This study assessed whether at-admission clinical evaluation helps in differential diagnosis between the two conditions. The study compared at-admission clinical, electrocardiographic (ECG) and echocardiographic findings of 31 women (median age 67 years, interquartile range (IQR) 62-76) with typical TTC and 30 women (median age 73 years, IQR 61-81) with apical-anterior AMI due to acute occlusion of the mid/distal left anterior descending coronary artery. Women with TTC significantly more often showed PR-segment depression (62% versus 3%, p<0.001), J-waves (26% versus 3%, p=0.03), maximum ST-segment elevation ⩽2 mm (84% versus 37%, p<0.001) and ST-segment elevation in lead II (42% versus 10%, p=0.01) than those with AMI. At multivariate analysis, PR-segment depression (odds ratio (OR)=37.2, 95% confidence interval (CI)=3.4-424, p=0.002) and maximum ST-segment elevation ⩽2 mm (OR=11.1, 95% CI=1.7-99.4, p=0.01) remained the only independent predictors of TTC and the co-existence of both parameters excluded AMI with a 100% specificity. The two groups did not differ with regard to age, first troponin-I value, echocardiographic LV ejection fraction and distribution of hypo/akinetic LV segments. At-admission electrocardiogram (but no clinical, laboratory and echocardiographic features) allows differential diagnosis between TTC and apical-anterior AMI in postmenopausal women. The combination of PR-segment depression and mild (⩽2 mm) ST-segment elevation predicted TTC with greater accuracy than traditional parameters such as localisation of ST-segment elevation and reciprocal ST-segment depression. © The European Society of Cardiology 2015.

  20. Acute myocardial infarction associated with intravenous dipyridamole for rubidium-82 PET imaging

    International Nuclear Information System (INIS)

    Marwick, T.H.; Hollman, J.

    1990-01-01

    This report describes the occurrence of chest pain and electrocardiographic features of acute myocardial infarction following intravenous dipyridamole-handgrip stress. Myocardial perfusion imaging (Rb-82 PET) demonstrated a stress-induced perfusion defect. Following failure to respond to medical therapy, urgent cardiac catheterization demonstrated total occlusion of the left anterior descending coronary artery. The vessel was revascularized, with limitation of myocardial damage evidenced by failure to develop anterior Q waves and only modest elevation of cardiac enzyme levels. Complications of intravenous dipyridamole stress are rare, this case constituting the first major problem in over 500 such procedures at this institution. However, this experience demonstrates the importance of vigilant observation during the performance of this technique

  1. Acute myocardial infarct imaging with indium-111-labeled monoclonal antimyosin Fab

    International Nuclear Information System (INIS)

    Khaw, B.A.; Yasuda, T.; Gold, H.K.; Leinbach, R.C.; Johns, J.A.; Kanke, M.; Barlai-Kovach, M.; Strauss, H.W.; Haber, E.

    1987-01-01

    Indium-111 monoclonal antimyosin Fab scintigraphy was used to detect myocardial necrosis in 52 of 54 patients (96.3%) with acute myocardial infarction. Infarcts were visualized when coronary arteries were persistently occluded (n = 10), became patent after thrombolysis (n = 33), or became patent after spontaneous reperfusion (n = 7). Posteroinferolateral visualizations were obtained in two patients with clinical and enzymatic evidence of infarction but normal electrocardiograms. Of the two patients in whom no infarcts were visualized, one had an anterior myocardial infarct. This patient underwent successful thrombolytic therapy, with attendant minimization of creatine kinase release. The other patient had a small, nonreperfused inferior myocardial infarct. Five patients with a history of remote infarction and acute necrosis showed antimyosin uptake only in regions concordant with the acute episodes of infarction, and radiolabeled antimyosin Fab localized in neither old infarcts nor normal, noninfarcted myocardium. Antimyosin Fab scintigraphy, thus, appears to be a highly specific means of delineating necrotic myocardium, at least in this limited and selected group of patients

  2. Magnetic resonance imaging of acute myocardial infarction in dextrocardia with situs solitus (dextroversion)

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    Salanitri, J.C.; Welker, M.; Pereles, F.S.

    2005-01-01

    The case report of an 88-year-old woman with dextroversion and acute anterior wall myocardial infarction is presented. The patient, who had been diagnosed with dextrocardia 3 years prior to this admission, presented with right-sided chest pain. Coronary angiography demonstrated an 80% proximal left anterior descending artery stenosis which was successfully stented. A cardiac MRI was performed to exclude a left atrial thrombus after an inconclusive echocardiogram. The MRI demonstrated findings consistent with dextroversion, with delayed contrast-enhanced viability sequences confirming a near transmural anterior wall myocardial infarct. To our knowledge, this is the first report illustrating the cardiac MRI findings in such a case. Copyright (2005) Blackwell Science Pty Ltd

  3. Three-dimension structure of ventricular myocardial fibers after myocardial infarction

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    Li Libin

    2010-11-01

    Full Text Available Abstract Background To explore the pathological changes of three-dimension structure of ventricular myocardial fibers after anterior myocardial infarction in dog heart. Methods Fourteen acute anterior myocardial infarction models were made from healthy dogs (mean weight 17.6 ± 2.5 kg. Six out of 14 dogs with old myocardial infarction were sacrificed, and their hearts were harvested after they survived the acute anterior myocardial infarction for 3 months. Each heart was dissected into ventricular myocardial band (VMB, morphological characters in infarction region were observed, and infarct size percents in descending segment and ascending segment were calculated. Results Six dog hearts were successfully dissected into VMB. Uncorresponding damages in myocardial fibers of descending segment and ascending segment were found in apical circle in anterior wall infarction. Infarct size percent in the ascending segment was significantly larger than that in the descending segment (23.36 ± 3.15 (SD vs 30.69 ± 2.40%, P = 0.0033; the long axis of infarction area was perpendicular to the orientation of myocardial fibers in ascending segment; however, the long axis of the infarction area was parallel with the orientation of myocardial fibers in descending segment. Conclusions We found that damages were different in both morphology and size in ascending segment and descending segment in heart with myocardial infarction. This may provide an important insight for us to understand the mechanism of heart failure following coronary artery diseases.

  4. Comparison of blood biochemics between acute myocardial infarction models with blood stasis and simple acute myocardial infarction models in rats

    International Nuclear Information System (INIS)

    Qu Shaochun; Yu Xiaofeng; Wang Jia; Zhou Jinying; Xie Haolin; Sui Dayun

    2010-01-01

    Objective: To construct the acute myocardial infarction models in rats with blood stasis and study the difference on blood biochemics between the acute myocardial infarction models with blood stasis and the simple acute myocardial infarction models. Methods: Wistar rats were randomly divided into control group, acute blood stasis model group, acute myocardial infarction sham operation group, acute myocardial infarction model group and of acute myocardial infarction model with blood stasis group. The acute myocardial infarction models under the status of the acute blood stasis in rats were set up. The serum malondialdehyde (MDA), nitric oxide (NO), free fatty acid (FFA), tumor necrosis factor-α (TNF-α) levels were detected, the activities of serum superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and the levels of prostacycline (PGI2), thromboxane A 2 (TXA 2 ) and endothelin (ET) in plasma were determined. Results: There were not obvious differences in MDA, SOD, GSH-Px and FFA between the acute myocardial infarction models with blood stasis in rats and the simple acute myocardial infarction models (P 2 and NO, and the increase extents of TXA 2 , ET and TNF-α in the acute myocardial infarction models in rats with blood stasis were higher than those in the simple acute myocardial infarction models (P 2 and NO, are significant when the acute myocardial infarction models in rats with blood stasis and the simple acute myocardial infarction models are compared. The results show that it is defective to evaluate pharmacodynamics of traditional Chinese drug with only simple acute myocardial infarction models. (authors)

  5. Myocardial Bridges and their Relationship to the Anterior Interventricular Branch of the Left Coronary Artery

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    Lima Vanildo Júnior de Melo

    2002-01-01

    Full Text Available OBJECTIVE: To analyze the relationship between myocardial bridges and the anterior interventricular branch (anterior descending of the left coronary artery. METHODS: The study was carried out with postmortem material, and methods of dissection and observation were used. We assessed the perimeter of the anterior interventricular branch of the left coronary artery using a pachymeter, calculated its proximal and distal diameters in relation to the myocardial bridge, and also its diameter under the myocardial bridge in 30 hearts. We also observed the position of the myocardial bridge in relation to the origin of the anterior interventricular branch. RESULTS: The diameters of the anterior interventricular branch were as follows: the mean proximal diameter was 2.76±0.76 mm; the mean diameter under the myocardial bridge was 2.08±0.54 mm; and the mean distal diameter was 1.98±0.59 mm. In 33.33% (10/30 of the cases, the diameter of the anterior interventricular branch under the myocardial bridge was lower than the diameter of the anterior interventricular branch distal to the myocardial bridge. In 3.33% (1/30 of the cases, an atherosclerotic plaque was found in the segment under the myocardial bridge. The myocardial bridge was located in the middle third of the anterior interventricular branch in 86.66% (26/30 of the cases. CONCLUSION: Myocardial bridges are more frequently found in the middle third of the anterior interventricular branch of the left coronary artery. The diameter of the anterior interventricular branch of the left coronary artery under the myocardial bridge may be smaller than after the bridge. Myocardial bridges may not provide protection against the formation of atherosclerotic plaque inside the anterior interventricular branch of the left coronary artery.

  6. Clinical usefulness of technetium-99m pyrophosphate and Tl-201 myocardial imaging for the estimation of myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Akio; Sato, Akihiko; Miyakoda, Hiroyuki; Watanabe, Toshiya; Itatsu, Hidetaka; Ueda, Osamu; Sakurai, Kuniteru; Kawai, Naoki; Sotobata, Iwao

    1985-04-01

    A correlative study was performed between the infarct size estimated by either technetium-99 pyrophosphate (Tc-PYP) or Tl-201 myocardial imaging, and the cumulative total creatinine phosphokinase activity (..sigma..CPK) or left ventricular ejection fraction (LVEF) in 40 patients with acute myocardial infarction. Tc-PYP infarct area (TcIA) and mean Tl-201 uptake ratio (MUR) were calculated as indices of myocardial infarct size. LVEF was evaluated by first pass method using Tc-PYP in the acute phase of myocardial infraction. In 23 patients with anterior myocardial infarction, a significant correlation was shown between either TcIA or anterior-wall MUR and ..sigma..CPK (r=0.81 and r=-0.69, respectively) and also between either TcIA or anterior-wall MUR and LVEF (r=-0.84 and r=0.80, respectively). In 17 patients with inferior myocardial infarction without additional involvement of right ventricular wall, inferior-wall MUR correlated with ..sigma..CPK (r=-0.74). No statically significant correlation was shown between TcIA and ..sigma..CPK, and also between either TcIA or inferior-wall MUR and LVEF. In conclusion, the infarct size estimated with Tc-PYP or Tl-201 myocardial imaging could be a useful clinical indicator of the severity of acute myocardial infarction especially in anterior wall. (author).

  7. Stress Induced Cardiomyopathy Triggered by Acute Myocardial Infarction: A Case Series Challenging the Mayo Clinic Definition.

    Science.gov (United States)

    Christodoulidis, Georgios; Kundoor, Vishwa; Kaluski, Edo

    2017-08-28

    BACKGROUND Various physical and emotional factors have been previously described as triggers for stress induced cardiomyopathy. However, acute myocardial infarction as a trigger has never been reported. CASE REPORT We describe four patients who presented with an acute myocardial infarction, in whom the initial echocardiography revealed wall motion abnormalities extending beyond the coronary distribution of the infarct artery. Of the four patients identified, the mean age was 59 years; three patients were women and two patients had underlying psychiatric history. Electrocardiogram revealed ST elevation in the anterior leads in three patients; QTc was prolonged in all cases. All patients had ≤ moderately elevated troponin. Single culprit lesion was found uniformly in the proximal or mid left anterior descending artery. Initial echocardiography revealed severely reduced ejection fraction with relative sparing of the basal segments, whereas early repeat echocardiography revealed significant improvement in the left ventricular function in all patients. CONCLUSIONS This is the first case series demonstrating that acute myocardial infarction can trigger stress induced cardiomyopathy. Extensive reversible wall motion abnormalities, beyond the ones expected from angiography, accompanied by modest elevation in troponin and marked QTc prolongation, suggest superimposed stress induced cardiomyopathy.

  8. Anterior ST depression with acute transmural inferior infarction due to posterior infarction. A vectorcardiographic and scintigraphic study

    International Nuclear Information System (INIS)

    Mukharji, J.; Murray, S.; Lewis, S.E.; Croft, C.H.; Corbett, J.R.; Willerson, J.T.; Rude, R.E.

    1984-01-01

    The hypothesis that anterior ST segment depression represents concomitant posterior infarction was tested in 49 patients admitted with a first transmural inferior myocardial infarction. Anterior ST depression was defined as 0.1 mV or more ST depression in leads V1, V2 or V3 on an electrocardiogram recorded within 18 hours of infarction. Serial vectorcardiograms and technetium pyrophosphate scans were obtained. Eighty percent of the patients (39 of 49) had anterior ST depression. Of these 39 patients, 34% fulfilled vectorcardiographic criteria for posterior infarction, and 60% had pyrophosphate scanning evidence of posterior infarction. Early anterior ST depression was neither highly sensitive (84%) nor specific (20%) for the detection of posterior infarction as defined by pyrophosphate imaging. Of patients with persistent anterior ST depression (greater than 72 hours), 87% had posterior infarction detected by pyrophosphate scan. In patients with inferior myocardial infarction, vectorcardiographic evidence of posterior infarction correlated poorly with pyrophosphate imaging data. Right ventricular infarction was present on pyrophosphate imaging in 40% of patients with pyrophosphate changes of posterior infarction but without vectorcardiographic evidence of posterior infarction. It is concluded that: 1) the majority of patients with acute inferior myocardial infarction have anterior ST segment depression; 2) early anterior ST segment depression in such patients is not a specific marker for posterior infarction; and 3) standard vectorcardiographic criteria for transmural posterior infarction may be inaccurate in patients with concomitant transmural inferior myocardial infarction or right ventricular infarction, or both

  9. Predictors of fatal outcome in acute myocardial infarction

    International Nuclear Information System (INIS)

    Qureshi, O.; Mughal, M.M.

    2008-01-01

    Myocardial infarction is one of the most common life threatening diagnoses in emergency hospital admissions. Most of the complications occur during the first few hours while the patients are likely to be in the hospital. Although the mortality rate after admission for myocardial infarction has declined significantly over the last two decades but it still remains high. Survival is markedly influenced by age of the patient, presence of different risk factors and complications that patients develop after myocardial infarction. We conducted a study at Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) to document the predictors of mortality in patients with acute myocardial infarction. Patients with first acute myocardial infarction admitted to the hospital from Feb. 2007 to June 2007 were included in the study. It was a descriptive case series study and data was collected on a pre-designed proforma with convenient sampling technique. Patients were assessed clinically with special emphasis on history of typical chest pain and physical examination. Relevant investigations were carried out to establish the diagnosis. Two hundred and fifty cases were assessed. Mean age was 57.94+-14.00 years. Males were 74.4% and Females were 25.6%. Overall in-hospital mortality was 9.2%. Females had a higher mortality (14.06%) as compared to males (7.52%). Mortality was also related with age of the patient and Diabetes Mellitus. Other features adversely affecting the in-hospital mortality included higher Killip class, anterior wall myocardial infarction and higher peak Creatine Kinase (CK) levels. Mortality was also higher in patients who did not receive thrombolytic therapy for different reasons. Patients with certain risk factors are more prone to develop complications and have a higher mortality rate. Identification of some of these risk factors and timely management of complications may reduce mortality. (author)

  10. Sgarbossa criteria and acute myocardial infarction.

    Science.gov (United States)

    Alang, Neha; Bathina, Jaya; Kranis, Mark; Angelis, Dimitrios

    2010-01-01

    Diagnosis of acute ST-elevation myocardial infarction in the presence of left bundle branch block is difficult. present a case of acute myocardial infarction with LBBB diagnosed and treated using the Sgarbossa criteria.

  11. [Myocardial imaging in acute myocardial infarction using beta-methyl-p-(123I)-iodophenylpentadecanoic acid: comparison with 201Tl imaging and wall motion].

    Science.gov (United States)

    Naruse, H; Itano, M; Kondo, T; Kogame, T; Yamamoto, J; Morita, M; Kawamoto, H; Fukutake, N; Ohyanagi, M; Iwasaki, T

    1992-01-01

    Myocardial imaging using beta-methyl-p-(123I)-iodophenylpentadecanoic acid (BMIPP) was performed in 11 patients with acute myocardial infarction. The left ventricular images were divided into 12 segments, and myocardial imagings with BMIPP were compared with coronary angiography (CAG), thallium-201 myocardial scintigraphy (TL) and wall motion obtained by two-dimensional echocardiography (WM). When the culprit lesion was at the proximal point of the left anterior descending artery (LAD), all segments showed depressed uptake. In 3 cases with single vessel disease of the LAD, inferior wall of the basis showed reduced uptake of BMIPP despite the location of the culprit lesion. In cases with discordant uptake between the two tracers, BMIPP frequently showed more severely depressed uptake than TL in the subacute phase, although the uptake of BMIPP correlated with that of TL (tau = 0.82, p less than 0.001). In such cases, the discordance was related to the improvement in WM from the acute phase to the convalescent phase. BMIPP uptake correlated with WM in the subacute phase (tau = 0.50, p less than 0.001). BMIPP showed more severely depressed uptake while WM showed mild asynergy in most cases in which discordance was found between the BMIPP and WM findings. However, there was no correlation between the change in WM from the acute to subacute phases, or the uptakes of BMIPP and TL alone. We concluded that the myocardial condition can be evaluated in detail in acute myocardial infarction by comparing the findings of BMIPP with those of TL and WM.

  12. Giant Coronary Artery Aneurysm Causing Acute Anterior Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Ahmet Yanık

    2016-01-01

    Full Text Available A 70-year-old man with hypertension was admitted to our coronary ICU with acute anterior MI. Emergent primary PCI was planned and coronary angiography was performed. LAD artery was totally occluded in the proximal segment just after a huge 32 × 26 mm sized aneurysm. Emergent CABG operation was performed in 75 minutes because of multivessel disease including the RCA and left circumflex artery. Aneurysm was ligated and coronary bypass was performed using LIMA and saphenous grafts. The postoperative course of the patient was uneventful. He was discharged with medical therapy including ASA, clopidogrel, and atorvastatin. He was asymptomatic at his polyclinic visit in the first month.

  13. Timing of ischemic onset estimated from the electrocardiogram is better than historical timing for predicting outcome after reperfusion therapy for acute anterior myocardial infarction: a DANish trial in Acute Myocardial Infarction 2 (DANAMI-2) substudy

    DEFF Research Database (Denmark)

    Sejersten, Maria; Ripa, Rasmus S; Grande, Peer

    2007-01-01

    BACKGROUND: Acute treatment strategy and subsequently prognosis are influenced by the duration of ischemia in patients with ST-elevation acute myocardial infarction (AMI). However, timing of ischemia may be difficult to access by patient history (historical timing) alone. We hypothesized that an ......BACKGROUND: Acute treatment strategy and subsequently prognosis are influenced by the duration of ischemia in patients with ST-elevation acute myocardial infarction (AMI). However, timing of ischemia may be difficult to access by patient history (historical timing) alone. We hypothesized...

  14. Low QRS Voltage on Presenting Electrocardiogram Predicts Multi-vessel Disease in Anterior ST-segment Elevation Myocardial Infarction.

    Science.gov (United States)

    Kobayashi, Akihiro; Misumida, Naoki; Aoi, Shunsuke; Kanei, Yumiko

    Low QRS voltage was reported to predict adverse outcomes in acute myocardial infarction in the pre-thrombolytic era. However, the association between low voltage and angiographic findings has not been fully addressed. We performed a retrospective analysis of patients with anterior ST-segment elevation myocardial infarction (STEMI). Low QRS voltage was defined as either peak to peak QRS complex voltage voltage. Patients with low voltage had a higher rate of multi-vessel disease (MVD) (76% vs. 52%, p=0.01). Patients with low voltage were more likely to undergo coronary artery bypass grafting (CABG) during admission (11% vs. 2%, p=0.028). Low voltage was an independent predictor for MVD (OR 2.50; 95% CI 1.12 to 6.03; p=0.032). Low QRS voltage was associated with MVD and in-hospital CABG in anterior STEMI. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Acute myocardial infarcts

    International Nuclear Information System (INIS)

    Just, H.

    1988-01-01

    Acute myocardial infarction is a major complication of stenosing coronary artery disease and constitutes the most frequent single cause of death. It is caused by thrombotic occlusion of one of the major epicardial coronary arterial branches in most cases. Sudden death due to ventricular fibrillation is responsible for the majority of early fatalities. In 60% of all fatal infarcts, death occurs within 1 h of the onset of pain. The final extension of myocardial necrosis is reached within 2-4 h. An integrated programme has therefore been developed for the supervision and treatment of patients suffering acute coronary attack; it has been shown that it can markedly lower infarct mortality. It includes mobile prehospital care, intensive care treatment in the hospital, and rehabilitative procedures for application during reconvalescence. Early antiarrhythmic treatment and myocardial reperfusion via fibrinolysis are the main therapeutic procedures in the earliest stage. In hospital an operating room and an operating team must be available round the clock for the performance of coronary angiography followed by percutaneous transluminal coronary angioplasty or bypass surgery, which can be safely carried out in the acute stage provided the indications are strictly observed. Mortality and morbidity can be significantly lowered and both life expectancy and quality of life can be remarkably improved. (orig.) [de

  16. Myocardial imaging in acute myocardial infarction using. beta. -methyl-p-( sup 123 I)-iodophenylpentadecanoic acid; Comparison with sup 201 Tl imaging and wall motion

    Energy Technology Data Exchange (ETDEWEB)

    Naruse, Hitoshi; Itano, Midoriko; Kondo, Tomohiro (Hyogo College of Medicine, Nishinomiya (Japan)) (and others)

    1992-01-01

    Myocardial imaging using {beta}-methyl-p-({sup 123}I)-iodophenylpentadecanoic acid (BMIPP) was performed in 11 patients with acute myocardial infarction. The left ventricular images were divided into 12 segments, and myocardial images with BMIPP were compared with coronary angiography (CAG), thallium-201 myocardial scintigraphy (Tl) and wall motion obtained by two-dimensional echocardiography (WM). When the culprit lesion was at the proximal point of the left anterior descending artery (LAD), all segments showed depressed uptake. In 3 cases with single vessel disease of the LAD, inferior wall of the basis showed reduced uptake of BMIPP despite the location of the culprit lesion. In cases with discordant uptake between the two tracers, BMIPP frequently showed more severely depressed uptake than Tl in the subacute phase, although the uptake of BMIPP correlated with that of Tl ({tau}=0.82, p<0.001). In such cases, the discordance was related to the improvement in WM from the acute phase to the convalescent phase. BMIPP uptake correlated with WM in the subacute phase ({tau}=0.50, p<0.001). BMIPP showed more severely depressed uptake while WM showed mild asynergy in most cases in which discordance was found between the BMIPP and WM findings. However, there was no correlation between the change in WM from the acute to subacute phases, or the uptakes of BMIPP and Tl alone. We concluded that the myocardial condition can be evaluated in detail in acute myocardial infarction by comparing the findings of BMIPP with those of Tl and WM. (author).

  17. Plain computed tomography for assessment of early coronary microcirculatory damage after revascularization therapy in acute myocardial infarction

    International Nuclear Information System (INIS)

    Kato, Masaya; Dote, Keigo; Sasaki, Shota

    2006-01-01

    Coronary microcirculatory damage is an important factor for the prognosis for acute myocardial infarction (MI) after revascularization. The myocardial enhancement area with contrast media infused during coronary revascularization therapy, detected by computed tomography (CT) just after revascularization, has been reported to correspond to the area of hemorrhagic infarction. The relationship between myocardial contrast enhancement and coronary microcirculatory damage was investigated in the present study. Thirteen patients with acute anterior MI underwent successful coronary revascularization within 6 h of symptom onset were enrolled. The coronary flow velocity pattern was measured using a Doppler guidewire and chest CT assessments were performed immediately after coronary revascularization. The ratio of mean CT number of the highest-enhanced myocardial area and the lumen of the left ventricle was defined as a relative CT number. The relative CT number significantly correlated with coronary diastolic deceleration time (r=-0.78, p<0.002) and coronary diastolic deceleration rate (r=0.74, p<0.04). It also correlated with peak myocardial enzyme release in plasma. Myocardial contrast enhancement detected using plain CT just after coronary reperfusion therapy implies coronary microcirculatory damage in acute MI. The relative CT number is useful in evaluating the impaired coronary microcirculatory state. (author)

  18. The effect of Valsartan and Captopril for the improvement of left ventricular systolic function after acute anterior myocardial infarction

    International Nuclear Information System (INIS)

    Liu Jun; Fu Xianghua; Xue Ling; Wu Weili; Li Shiqiang

    2010-01-01

    Objective: To compare the therapeutic effect of angiotensin II antagonist (Valsartan) and angiotension-converting enzyme inhibitor (Captopril) for the improvement of left ventricular systolic function (LVSF) after acute myocardial infarction (AMI) at anterior wall. Methods: A total of 75 patients with initial AMI at anterior wall were enlisted in the study. Patients were divided randomly into three groups: control group (n = 15), Captopril treated (n =30), and Valsartan treated (n =30). At 1 week and 28 weeks post AMI, the LVSF and left ventricular regional ejection fraction (LrEF) were measured by equilibrium radionuclide angiography (ERNA). The t-test was used to compare the dada. Results: (1) At 28 weeks, left ventricular ejection fraction (LVEF) and left ventricular peak ejection rate (LPER) in Valsartan treated group were significantly increased as compared with those of control: (59.4±8.6) % vs (44.9±8.4)%, t = 3.87, P 2 , LrEF 4 , LrEF 5 , LrEF-6: (71.6±18.8)% vs (57.0±11.4)%, t=2.11, P<0.05;(78.1±16.8)% vs (68.9±21.0)%, t =2.06, P<0.05; (70.5±16.9)% vs (59.9±23.4)%, t=1.99, P<0.05; and (58.1±9.0) % vs (46.0±18.9) %, t = 2.43, P<0.05, respectively. Conclusions: Valsartan and Captopril are effective for the improvement of LVEF after AMI at anterior wall. The effects of the two drugs are similar. (authors)

  19. Intravenous streptokinase therapy in acute myocardial infarction: Assessment of therapy effects by quantitative 201Tl myocardial imaging (including SPECT) and radionuclide ventriculography

    International Nuclear Information System (INIS)

    Koehn, H.; Bialonczyk, C.; Mostbeck, A.; Frohner, K.; Unger, G.; Steinbach, K.

    1984-01-01

    To evaluate a potential beneficial effect of systemic streptokinase therapy in acute myocardial infarction, 36 patients treated with streptokinase intravenously were assessed by radionuclide ventriculography and quantitative 201 Tl myocardial imaging (including SPECT) in comparison with 18 conventionally treated patients. Patients after thrombolysis had significantly higher EF, PFR, and PER as well as fewer wall motion abnormalities compared with controls. These differences were also observed in the subset of patients with anterior wall infarction (AMI), but not in patients with inferior wall infarction (IMI). Quantitative 201 Tl imaging demonstrated significantly smaller percent myocardial defects and fewer pathological stress segments in patients with thrombolysis compared with controls. The same differences were also found in both AMI and IMI patients. Our data suggest a favorable effect of intravenous streptokinase on recovery of left ventricular function and myocardial salvage. Radionuclide ventriculography and quantitative 201 Tl myocardial imaging seem to be reliable tools for objective assessment of therapy effects. (orig.)

  20. Deeply reinverted T wave at 14 days after the onset of first anterior acute myocardial infarction predicts improved left ventricular function at 6 months.

    Science.gov (United States)

    Yokoyama, Hiroaki; Tomita, Hirofumi; Nishizaki, Fumie; Hanada, Kenji; Shibutani, Shuji; Yamada, Masahiro; Abe, Naoki; Higuma, Takumi; Osanai, Tomohiro; Okumura, Ken

    2015-03-01

    Changes in electrocardiogram (ECG), especially in the ST segment and T wave, have been recognized as a noninvasive diagnostic tool for coronary flow or myocardial injury. A deeply inverted T wave at 14 days after successful percutaneous coronary intervention (PCI) in patients with ST-segment elevation acute myocardial infarction (STEMI) predicts improved left ventricular (LV) function at 6 months. We enrolled 112 consecutive patients (88 men, 63 ± 11 years) with first anterior STEMI who underwent successful PCI. A 12-lead ECG was recorded everyday from admission through 14 days. After PCI, the first T-wave inversion was observed within 2 days, and the second occurred at 14 days. We measured the maximum depth of the reinverted T wave (Neg-T) and divided the patients into 2 groups based on the median value of Neg-T: the deep group (≥0.6 mV, n = 62) and the nondeep group (wave in precordial leads at 6 months was more frequently observed in the deep than in the nondeep group (68% vs 46%, P = 0.02). Multivariate regression analysis showed that the Neg-T and max CPK-MB were independent contributors to LVEF at 6 months. A deeply reinverted T wave at 14 days after onset of first anterior STEMI can be a useful predictive marker for improved LV function at 6 months. © 2015 Wiley Periodicals, Inc.

  1. Evaluation of the differences of myocardial fibers between acute and chronic myocardial infarction: Application of diffusion tensor magnetic resonance imaging INA Rhesus monkey model

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yu Qing; Cai, Wei; Wang, Lei; Xia, Rui; Chen, Wei; Zheng, Jie [Dept. of Radiology, West China Hospital, Sichuan University, Sichuan (China); Gao, Fabao [Mallinckrodt Institute of Radiology, School of Medicine, Washington University, St. Louis (United States)

    2016-09-15

    To understand microstructural changes after myocardial infarction (MI), we evaluated myocardial fibers of rhesus monkeys during acute or chronic MI, and identified the differences of myocardial fibers between acute and chronic MI. Six fixed hearts of rhesus monkeys with left anterior descending coronary artery ligation for 1 hour or 84 days were scanned by diffusion tensor magnetic resonance imaging (MRI) to measure apparent diffusion coefficient (ADC), fractional anisotropy (FA) and helix angle (HA). Comparing with acute MI monkeys (FA: 0.59 ± 0.02; ADC: 5.0 ± 0.6 × 10{sup -4} mm{sup 2}/s; HA: 94.5 ± 4.4°), chronic MI monkeys showed remarkably decreased FA value (0.26 ± 0.03), increased ADC value (7.8 ± 0.8 × 10{sup -4} mm{sup 2}/s), decreased HA transmural range (49.5 ± 4.6°) and serious defects on endocardium in infarcted regions. The HA in infarcted regions shifted to more components of negative left-handed helix in chronic MI monkeys (-38.3 ± 5.0°–11.2 ± 4.3°) than in acute MI monkeys (-41.4 ± 5.1°–53.1 ± 3.7°), but the HA in remote regions shifted to more components of positive right-handed helix in chronic MI monkeys (-43.8 ± 2.7°–66.5 ± 4.9°) than in acute MI monkeys (-59.5 ± 3.4°–64.9 ± 4.3°). Diffusion tensor MRI method helps to quantify differences of mechanical microstructure and water diffusion of myocardial fibers between acute and chronic MI monkey's models.

  2. Evaluation of the differences of myocardial fibers between acute and chronic myocardial infarction: Application of diffusion tensor magnetic resonance imaging INA Rhesus monkey model

    International Nuclear Information System (INIS)

    Wang, Yu Qing; Cai, Wei; Wang, Lei; Xia, Rui; Chen, Wei; Zheng, Jie; Gao, Fabao

    2016-01-01

    To understand microstructural changes after myocardial infarction (MI), we evaluated myocardial fibers of rhesus monkeys during acute or chronic MI, and identified the differences of myocardial fibers between acute and chronic MI. Six fixed hearts of rhesus monkeys with left anterior descending coronary artery ligation for 1 hour or 84 days were scanned by diffusion tensor magnetic resonance imaging (MRI) to measure apparent diffusion coefficient (ADC), fractional anisotropy (FA) and helix angle (HA). Comparing with acute MI monkeys (FA: 0.59 ± 0.02; ADC: 5.0 ± 0.6 × 10 -4 mm 2 /s; HA: 94.5 ± 4.4°), chronic MI monkeys showed remarkably decreased FA value (0.26 ± 0.03), increased ADC value (7.8 ± 0.8 × 10 -4 mm 2 /s), decreased HA transmural range (49.5 ± 4.6°) and serious defects on endocardium in infarcted regions. The HA in infarcted regions shifted to more components of negative left-handed helix in chronic MI monkeys (-38.3 ± 5.0°–11.2 ± 4.3°) than in acute MI monkeys (-41.4 ± 5.1°–53.1 ± 3.7°), but the HA in remote regions shifted to more components of positive right-handed helix in chronic MI monkeys (-43.8 ± 2.7°–66.5 ± 4.9°) than in acute MI monkeys (-59.5 ± 3.4°–64.9 ± 4.3°). Diffusion tensor MRI method helps to quantify differences of mechanical microstructure and water diffusion of myocardial fibers between acute and chronic MI monkey's models

  3. Acute myocardial infarction in young adults with Antiphospholipid ...

    African Journals Online (AJOL)

    Abstract Acute myocardial infarction (AMI) is rarely associated with antiphospholipid syndrome. The treatment of these patients is a clinical challenge. We report the observations of 2 young adults (1 woman and 1 man), admitted in our acute care unit for acute myocardial infarction (AMI). A coagulopathy work-up concludes ...

  4. Does left ventricular function improve with L-carnitine after acute myocardial infarction?

    Directory of Open Access Journals (Sweden)

    Iyer R

    1999-04-01

    Full Text Available A double blind randomized placebo controlled clinical trial was carried out to assess the efficacy and safety of L-carnitine in patients suffering from acute anterior wall myocardial infarction with respect to left ventricular function. Sixty patients (34 men, 26 women, mean age 56+11 yr. with acute anterior wall myocardial infarction were randomized to placebo and L-carnitine. All the patients were given intravenous L-carnitine / placebo in the dose of 6gm/day for the first seven days followed by oral L-carnitine / placebo 3 gm/day in three divided doses for a period of three months. Echocardiography was performed for regional wall motion abnormality, left ventricular end systolic volume (ESV, end diastolic volume (EDV and ejection fraction (EF on admission, after seven days and after three months of the infarction. Forty-four patients completed the study. There were three deaths, two in the placebo and one in the L-carnitine group (p>0.05. Thirteen patients were lost to follow up. Echo parameters in both groups were comparable (p>0.05. The duration of chest pain prior to initiation of the I.V. L-carnitine was 7.5 + 5.2 hrs in the L-carnitine group and 7 + 4 hrs in the placebo group (p>0.05. There was no statistical difference in the EF, ESV and EDV on admission, at discharge and after three months in the L-carnitine and the placebo groups (p>0.05. No significant adverse effects were noted. L-carnitine, though a safe drug, does not affect the left ventricular function in patients with myocardial infarction.

  5. Pre-Hospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    James J McCarthy

    2011-05-01

    Full Text Available Introduction: Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI. Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI capability for the treatment of acute myocardial infarctions. Given the paucity of hospitals capable of PCI, early identification of more severe myocardial infarction may prompt emergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions. Methods: In a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings of proximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset. Results: In this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n¼35, the mean sum of ST elevation (STE in leads V1 through V6 plus ST depression (STD in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P¼0.007. A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n¼37, there was no significant difference in ST-segment deviation between the 2 groups. Conclusion: The sum STE (V1-V6 and STD (II

  6. Evaluation of the Differences of Myocardial Fibers between Acute and Chronic Myocardial Infarction: Application of Diffusion Tensor Magnetic Resonance Imaging in a Rhesus Monkey Model

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yuqing [Department of Radiology, West China Hospital, Sichuan University, Sichuan 610041 (China); CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology of China, Beijing 100190 (China); Cai, Wei [Department of Radiology, West China Hospital, Sichuan University, Sichuan 610041 (China); Department of Radiology, Beijing Jishuitan Hospital, 4th Clinical Medical College of Peking University, Beijing 100035 (China); Wang, Lei [Department of Radiology, West China Hospital, Sichuan University, Sichuan 610041 (China); Xia, Rui [Department of Radiology, West China Hospital, Sichuan University, Sichuan 610041 (China); Department of Radiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016 (China); Chen, Wei [Department of Radiology, West China Hospital, Sichuan University, Sichuan 610041 (China); Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Yunnan 650032 (China); Zheng, Jie [Mallinckrodt Institute of Radiology, School of Medicine, Washington University, St. Louis, MO 63110 (United States); Gao, Fabao [Department of Radiology, West China Hospital, Sichuan University, Sichuan 610041 (China)

    2016-11-01

    To understand microstructural changes after myocardial infarction (MI), we evaluated myocardial fibers of rhesus monkeys during acute or chronic MI, and identified the differences of myocardial fibers between acute and chronic MI. Six fixed hearts of rhesus monkeys with left anterior descending coronary artery ligation for 1 hour or 84 days were scanned by diffusion tensor magnetic resonance imaging (MRI) to measure apparent diffusion coefficient (ADC), fractional anisotropy (FA) and helix angle (HA). Comparing with acute MI monkeys (FA: 0.59 ± 0.02; ADC: 5.0 ± 0.6 × 10{sup -4} mm{sup 2}/s; HA: 94.5 ± 4.4°), chronic MI monkeys showed remarkably decreased FA value (0.26 ± 0.03), increased ADC value (7.8 ± 0.8 × 10{sup -4}mm{sup 2}/s), decreased HA transmural range (49.5 ± 4.6°) and serious defects on endocardium in infarcted regions. The HA in infarcted regions shifted to more components of negative left-handed helix in chronic MI monkeys (-38.3 ± 5.0°–11.2 ± 4.3°) than in acute MI monkeys (-41.4 ± 5.1°–53.1 ± 3.7°), but the HA in remote regions shifted to more components of positive right-handed helix in chronic MI monkeys (-43.8 ± 2.7°–66.5 ± 4.9°) than in acute MI monkeys (-59.5 ± 3.4°–64.9 ± 4.3°). Diffusion tensor MRI method helps to quantify differences of mechanical microstructure and water diffusion of myocardial fibers between acute and chronic MI monkey's models.

  7. Left anterior descending coronary artery myocardial bridging by multislice computed tomography: Correlation with clinical findings

    International Nuclear Information System (INIS)

    Jodocy, Daniel; Aglan, Iman; Friedrich, Guy; Mallouhi, Ammar; Pachinger, Otmar; Jaschke, Werner; Feuchtner, Gudrun M.

    2010-01-01

    Objective: To assess the relationship between left anterior descending (LAD) coronary artery myocardial bridging detected by 64-slice computed tomography (CT) and clinical findings. Methods: 221 consecutive patients were examined with coronary 64-slice CT angiography. 21 patients with coronary stenosis >50% were excluded. The length, depth, and luminal narrowing of LAD myocardial bridges during systole and diastole were measured. CT findings were compared with the treadmill ECG-stress test, and clinical symptoms. Results: Myocardial bridges of the LAD were found in 23% of patients (51/221) (length, 14.9 ± 6.5 mm; depth, 2.6 ± 1.6 mm). A significant difference was noted between the LAD luminal diameter before the intramyocardial course and intramyocardially, for both diastole and systole (p 50% was found in 3/25 (8%). 30/51 (59%) of bridges were 'deep' (>2 mm myocardial depth), 21/51 (41%) were 'superficial'. The prevalence of a positive ECG-stress tests for the anterior myocardial region was significantly higher in patients with LAD myocardial bridges (34/50; 68%) compared to those without (28/144; 19.4%) (p < 0.001). There was no difference between 'superficial' and 'deep' LAD myocardial bridges in regard to a positive treadmill ECG-stress test. Typical angina was rare with 6%. Conclusion: LAD myocardial bridges are common findings and can possibly explain a positive exercise ECG-stress test for anterior myocardial ischemia. Intramyocardial LAD segments show mild-to-moderate luminal narrowing at rest, which is higher during end-systolic phase.

  8. Scintigraphic demonstration of acute myocardial infarcts

    International Nuclear Information System (INIS)

    Holman, B.L.; Lesch, M.

    1976-01-01

    The feasibility of acute infarct scintigraphy for the clinical evaluation of patients with known or suspected acute myocardial infarction is established. Further development of this methodologic approach may result in even better agents for the visualization of infarcts. Radiotracers with high affinity for the infarct, rapid blood clearance, and low concentrations in surrounding organs, such as liver and bone, would be more suitable than available radiopharmaceuticals for acute myocardial infarct scintigraphy. Ultimately, labeling these tracers and ultra-short-lived radionuclides will enable rapid sequential imaging to assess changes in the extent of infarction and to determine the efficacy of therapies aimed at limiting infarct size

  9. Acute myocardial infarction mortality in Cuba, 1999-2008.

    Science.gov (United States)

    Armas, Nurys B; Ortega, Yanela Y; de la Noval, Reinaldo; Suárez, Ramón; Llerena, Lorenzo; Dueñas, Alfredo F

    2012-10-01

    Acute myocardial infarction is one of the leading causes of death in the world. This is also true in Cuba, where no national-level epidemiologic studies of related mortality have been published in recent years. Describe acute myocardial infarction mortality in Cuba from 1999 through 2008. A descriptive study was conducted of persons aged ≥25 years with a diagnosis of acute myocardial infarction from 1999 through 2008. Data were obtained from the Ministry of Public Health's National Statistics Division database for variables: age; sex; site (out of hospital, in hospital or in hospital emergency room) and location (jurisdiction) of death. Proportions, age- and sex-specific rates and age-standardized overall rates per 100,000 population were calculated and compared over time, using the two five-year time frames within the study period. A total of 145,808 persons who had suffered acute myocardial infarction were recorded, 75,512 of whom died, for a case-fatality rate of 51.8% (55.1% in 1999-2003 and 49.7% in 2004-2008). In the first five-year period, mortality was 98.9 per 100,000 population, falling to 81.8 per 100,000 in the second; most affected were people aged ≥75 years and men. Of Cuba's 14 provinces and special municipality, Havana, Havana City and Camagüey provinces, and the Isle of Youth Special Municipality showed the highest mortality; Holguín, Ciego de Ávila and Granma provinces the lowest. Out-of-hospital deaths accounted for the greatest proportion of deaths in both five-year periods (54.8% and 59.2% in 1999-2003 and 2004-2008, respectively). Although risk of death from acute myocardial infarction decreased through the study period, it remains a major health problem in Cuba. A national acute myocardial infarction case registry is needed. Also required is further research to help elucidate possible causes of Cuba's high acute myocardial infarction mortality: cardiovascular risk studies, studies of out-of-hospital mortality and quality of care

  10. An Unusual Complication Following Transarterial Chemoembolization: Acute Myocardial Infarction

    International Nuclear Information System (INIS)

    Lai Yiliang; Chang Weichou; Kuo Wuhsien; Huang Tienyu; Chu Hengcheng; Hsieh Tsaiyuan; Chang Weikuo

    2010-01-01

    Transarterial chemoembolization has been widely used to treat unresectable hepatocellular carcinoma. Various complications have been reported, but they have not included acute myocardial infarction. Acute myocardial infarction results mainly from coronary artery occlusion by plaques that are vulnerable to rupture or from coronary spasm, embolization, or dissection of the coronary artery. It is associated with significant morbidity and mortality. We present a case report that describes a patient with hepatocellular carcinoma who underwent transarterial chemoembolization and died subsequently of acute myocardial infarction. To our knowledge, there has been no previous report of this complication induced by transarterial chemoembolization for hepatocellular carcinoma. This case illustrates the need to be aware of acute myocardial infarction when transarterial chemoembolization is planned for the treatment of hepatocellular carcinoma, especially in patients with underlying coronary artery disease.

  11. Acute aortic dissection mimics acute inferoposterior wall myocardial infarction in a Marfan syndrome patient.

    Science.gov (United States)

    Phowthongkum, Prasit

    2010-01-01

    A 30-year old man with acute chest pain was diagnosed with acute inferoposterior wall myocardial infarction following electrocardiography. After a failed coronary angiography, an echocardiogram revealed an aortic intimal flap after which acute aortic dissection was diagnosed. The patient received a successful Bentall operation without immediate complication. Retrospective examination then confirmed the diagnosis of Marfan syndrome. This case demonstrates acute aortic dissection may mimic acute myocardial infarction.

  12. Precordial ST-segment depression during acute inferior myocardial infarction: clinical, scintigraphic and angiographic correlations

    International Nuclear Information System (INIS)

    Gibson, R.S.; Crampton, R.S.; Watson, D.D.; Taylor, G.J.; Carabello, B.A.; Holt, N.D.; Beller, G.A.

    1982-01-01

    The cause and associated pathophysiology of precordial ST-segment depression during acute inferior myocardial infarction (IMI) are controversial. To investigate this problem, electrocardiographic findings in 48 consecutive patients with acute IMI were prospectively compared with results of coronary angiography, submaximal exercise thallium-201 ( 201 Tl) scintigraphy and multigated blood pool imaging, all obtained 2 weeks after IMI, and with clinical follow-up at 3 months. Patients were classified according to the admission ECG obtained 3.3 +/- 3.1 hours after the onset of chest pain. Twenty-one patients (group A) had no or 201 Tl perfusion abnormalities (p 201 Tl defects or wall motion abnormalities in anterior or septal segments

  13. Gadolinium-enhanced magnetic resonance imaging in acute myocardial infarction

    International Nuclear Information System (INIS)

    Dijkman, P.R.M. van; Wall, E.E. van der; Roos, A. de; Doornbos, J.; Laarse, A. van der; Voorthuisen, A.E. van; Bruschke, A.V.G.; Rossum, A.C. van

    1990-01-01

    To evaluate he usefulness of the paramagnetic contrast agent Gadolinium-DTPA (diethylenetriaminepentaacetic acid) in Magnetic Resonance. Imaging of acute myocardial infarction, we studied a total of 45 patients with a first acute myocardial infarction by ECG-gated magnetic resonance imaging before and after intravenous administration of 0.1 mmol/kg Gadolinium-DTPA. All patients received thrombolytic treatment by intravenous streptokinase. The magnetic resonance imaging studies were preformed after a meam of 88 h (range 15-241) after the acute onset of acute myocardial infarction. Five patients without evidence of cardiac disease served as controls. Spin-echo measurements (TE 30 ms) were made using a Philips Gyroscan (0.5 Tesla) or a Teslacon II (0.6 Tesla). The 45 patients were divided into four groups of patients. In Group I( patients) Gadolinium-DTPA improved the detection of myocardial infarction by Gadolinium-DTPA. In Group II (20 patients) the magnetic resonance imaging procedure was repeated every 10 min for up to 40 min following administration of Gadolinium-DTPA. Optimal contrast enhancement was obtained 20-25 min after Gadolinium-DTPA. In Group III (27 patients) signal intensities were significantly higher in the patients who underwent the magnetic resonance imaging study more than 72 h (mean 120) after the acute event, suggesting increased acculumation of Gadolinium-DTPA in a more advanced stage of the infarction process. In Group IV (45 patients) Gadolinium-DTPA was administered in an attempt to distinguish between reperfused and nonreperfused myocardial areas after thrombolytic treatment for acute myocardial infarction. The signal intensities did not differ, but reperfused areas showed a more homogeneous aspect whereas nonreperfused areas were visualized as a more heterogeneous contrast enhancement. It is concluded that magnetic resonance imaging using the contrast agent Gadolinium-DTPA significantly improves the detection of infarcted myocardial areas

  14. Diabetes Mellitus and Cardiogenic Shock Complicating Acute Myocardial Infarction.

    Science.gov (United States)

    Echouffo-Tcheugui, Justin B; Kolte, Dhaval; Khera, Sahil; Aronow, Herbert D; Abbott, J Dawn; Bhatt, Deepak L; Fonarow, Gregg C

    2018-03-27

    Diabetes mellitus (diabetes) increases the risk of acute myocardial infarction, which can result in cardiogenic shock. Data on the relation of diabetes and the occurrence and prognosis of cardiogenic shock postacute myocardial infarction are scant. Among the National Inpatient Sample patients aged ≥18 years and hospitalized for acute myocardial infarction during the 2012-2014 period, we examined the association between diabetes and the incidence and outcomes of cardiogenic shock complicating acute myocardial infarction, using multivariable logistic and linear regression models. Of 1,332,530 hospitalizations for acute myocardial infarction, 72,765 (5.5%) were complicated by cardiogenic shock. In acute myocardial infarction patients, cardiogenic shock incidence was higher among those with vs without diabetes (5.8% vs 5.2%; adjusted odds ratio [aOR] 1.14; 95% confidence interval [CI], 1.11-1.19; P diabetes. Diabetic patients were less likely to undergo revascularization (percutaneous coronary intervention or coronary artery bypass grafting) (67.1% vs 68.7%; aOR 0.88; 95% CI, 0.80-0.96; P = .003). Diabetes was associated with higher in-hospital mortality in patients with acute myocardial infarction and cardiogenic shock (37.9% vs 36.8%; aOR 1.18; 95% CI, 1.09-1.28; P diabetes had a longer hospital stay (mean ± SEM: 11.6 ± 0.16 vs 10.9 ± 0.16 days; adjusted estimate 1.12; 95% CI, 1.06-1.18; P diabetes was associated with an increased risk of cardiogenic shock and worse outcomes in those with cardiogenic shock. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. Supine versus upright anterior images: comparison in T1-201 myocardial scintigraphy

    International Nuclear Information System (INIS)

    Jacobson, A.F.; Parker, J.A.; Royal, H.D.; Silverman, K.J.; Gervino, E.V.; Kolodny, G.M.

    1987-01-01

    In patients undergoing exercise thallium-201 myocardial scintigraphy, activity in the inferior wall on anterior images may appear diminished when the standard supine view is used, but normal when the view is acquired with the patient upright. To determine the clinical significance of this observation, the distribution of thallium-201 activity was semiquantitatively assessed in supine and upright anterior images obtained immediately after exercise in 93 patients (65 men, 28 women). The presence of inferior wall and coronary artery disease was established with coronary angiography or from documentation of previous myocardial infarction. Supine and upright images were compared with use of receiver operating characteristic curves. In male patients diagnostic accuracy for identification of both inferior wall and coronary artery disease was improved through the use of the upright anterior image. In women, there was no significant difference in reader performance with upright and supine images. Upright anterior images should be routinely obtained in men in order to reduce the frequency of false-positive identification of inferior wall defects

  16. Left anterior descending coronary artery myocardial bridging by multislice computed tomography: Correlation with clinical findings

    Energy Technology Data Exchange (ETDEWEB)

    Jodocy, Daniel; Aglan, Iman [Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck (Austria); Friedrich, Guy [Clinical Department of Cardiology, Innsbruck Medical University, Innsbruck (Austria); Mallouhi, Ammar [Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck (Austria); Pachinger, Otmar [Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck (Austria); Clinical Department of Cardiology, Innsbruck Medical University, Innsbruck (Austria); Jaschke, Werner [Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck (Austria); Feuchtner, Gudrun M. [Clinical Department of Radiology II, Innsbruck Medical University, Innsbruck (Austria)], E-mail: gudrun.feuchtner@i-med.ac.at

    2010-01-15

    Objective: To assess the relationship between left anterior descending (LAD) coronary artery myocardial bridging detected by 64-slice computed tomography (CT) and clinical findings. Methods: 221 consecutive patients were examined with coronary 64-slice CT angiography. 21 patients with coronary stenosis >50% were excluded. The length, depth, and luminal narrowing of LAD myocardial bridges during systole and diastole were measured. CT findings were compared with the treadmill ECG-stress test, and clinical symptoms. Results: Myocardial bridges of the LAD were found in 23% of patients (51/221) (length, 14.9 {+-} 6.5 mm; depth, 2.6 {+-} 1.6 mm). A significant difference was noted between the LAD luminal diameter before the intramyocardial course and intramyocardially, for both diastole and systole (p < 0.001); with a higher diameter reduction of 27% for end-systole compared to end-diastole with 15% (p = 0.006). Systolic LAD intramyocardial luminal narrowing >50% was found in 3/25 (8%). 30/51 (59%) of bridges were 'deep' (>2 mm myocardial depth), 21/51 (41%) were 'superficial'. The prevalence of a positive ECG-stress tests for the anterior myocardial region was significantly higher in patients with LAD myocardial bridges (34/50; 68%) compared to those without (28/144; 19.4%) (p < 0.001). There was no difference between 'superficial' and 'deep' LAD myocardial bridges in regard to a positive treadmill ECG-stress test. Typical angina was rare with 6%. Conclusion: LAD myocardial bridges are common findings and can possibly explain a positive exercise ECG-stress test for anterior myocardial ischemia. Intramyocardial LAD segments show mild-to-moderate luminal narrowing at rest, which is higher during end-systolic phase.

  17. Unexpected Coexisting Myocardial Infarction Detected by Delayed Enhancement MRI

    Directory of Open Access Journals (Sweden)

    Edouard Gerbaud

    2009-01-01

    Full Text Available We report a case of an unexpected coexisting anterior myocardial infarction detected by delayed enhancement MRI in a 41-year-old man following a presentation with a first episode of chest pain during inferior acute myocardial infarction. This second necrotic area was not initially suspected because there were no ECG changes in the anterior leads and the left descending coronary artery did not present any significant stenoses on emergency coronary angiography. Unrecognised myocardial infarction may carry important prognostic implications. CMR is currently the best imaging technique to detect unexpected infarcts.

  18. Thrombolytic therapy of acute myocardial infarction alters collagen metabolism

    DEFF Research Database (Denmark)

    Høst, N B; Hansen, S S; Jensen, L T

    1994-01-01

    The objective of the study was to monitor collagen metabolism after thrombolytic therapy. Sequential measurements of serum aminoterminal type-III procollagen propeptide (S-PIIINP) and carboxyterminal type-I procollagen propeptide (S-PICP) were made in 62 patients suspected of acute myocardial.......05). A less pronounced S-PIIINP increase was noted with tissue-plasminogen activator than with streptokinase. Thrombolytic therapy induces collagen breakdown regardless of whether acute myocardial infarction is confirmed or not. With confirmed acute myocardial infarction collagen metabolism is altered...... for at least 6 months. Furthermore, fibrin-specific and nonspecific thrombolytic agents appear to affect collagen metabolism differently....

  19. The Influence of findings of coronary artery on myocardial salvage in acute myocardial infarction

    International Nuclear Information System (INIS)

    Itano, Midoriko; Naruse, Hitoshi; Morita, Masato; Kawamoto, Hideo; Yamamoto, Juro; Fukutake, Naoshige; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Fukuchi, Minoru

    1992-01-01

    201 Tl stress myocardial scintigraphy was performed in convalescent patients with acute myocardial infarction, to evaluate the influence of stenosis and collateral circulation of coronary artery in acute phase, on myocardial salvage in chronic phase. In 14 cases of unsuccessful coronary revascularization (complete occlusion), a complete defect of thallium imaging in chronic phase was seen in only one case of four cases with good collateral circulation, while eight of 10 cases with poor collateral circulation. In 16 cases with collateral circulation, six cases showed a complete defect, although the target vessel had improved to less than 75% of stenosis. However, in cases of good collateral circulation, no case showed a complete defect when the target vessel had improved to less than 75% of stenosis. The myocardial salvage is quite possible (p<0.05), when the coronary angiography in acute phase showed the forward flow (99% or 90% of stenosis) before coronary revascularization and/or good collateral circulation (Rentrop 2deg or 3deg). (author)

  20. Gadolinium-DTPA-enhanced magnetic resonance imaging and functional outcome in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Kitamura, Jun; Shimada, Toshio; Murakami, Yo; Ochiai, Koichi; Inoue, Shin-ichi; Ishibashi, Yutaka; Kinoshita, Yoshihisa; Sano, Kazuya; Murakami, Rinji

    1999-01-01

    This study was designed to test the hypothesis that Gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced magnetic resonance images (MRI) reflect the severity of ischemic injury during the acute and chronic phases of myocardial infarction (MI). Twenty-nine patients with their first acute MI underwent Gd-DTPA-enhanced MRI in the first week (4.2±0.3 days) and at 1 month after onset. Pairs of left ventriculograms were compared with Gd-DTPA-enhanced magnetic resonance images, classified into 3 pattern groups: hyper-enhancement, with and without a central hypo-enhanced region (P1 and P2, respectively), and non-enhancement (P3). In the acute phase of MI, P1 was found in 10, P2 in 11, and P3 in 8 patients. One month later, the image pattern had changed from P1 to P2 in a single patient, from P2 to P3 in 4 patients, and had remained identical in the others. Patients with P3 showed improvement of anterior wall motion in the 1-month follow-up study, and had higher TIMI flow grades and lower peak creatine kinase values than those without recovery. Thus, Gd-DTPA-enhanced magnetic resonance images, closely reflecting the severity of myocardial injury, are useful in predicting myocardial functional recovery after MI. (author)

  1. Assessment of myocardial viability using multidetector computed tomography in patients with reperfused acute myocardial infarction

    International Nuclear Information System (INIS)

    Kim, T.; Choi, B.J.; Kang, D.K.; Sun, J.S.

    2012-01-01

    Aim: To assess the prognostic value of 64-section multidetector computed tomography (MDCT) to predict follow-up myocardial dysfunction and functional recovery after reperfusion therapy in patients with acute myocardial infarction (MI) as defined by echocardiography. Materials and methods: After reperfusion therapy for acute MI, 71 patients underwent two-phase contrast-enhanced MDCT and follow-up echocardiography. MDCT findings were compared with echocardiographic findings using kappa statistics. The areas under the receiver operating characteristic curves (AUCs) and the odds ratios (ORs) of early perfusion defects (EPD), delayed enhancement (DE), and residual perfusion defects (RPD) for predicting follow-up myocardial dysfunction and functional recovery were calculated on a segmental basis. Results: The presence of transmural EPD (EPD TM ) or RPD showed good agreement (k = 0.611 and 0.658, respectively) with follow-up myocardial dysfunction, while subendocardial EPD (EPD sub ) or subendocardial DE (DE sub ) showed fair agreement with follow-up myocardial dysfunction (k = 0.235 and 0.234, respectively). The AUC of RPD (0.796) was superior (p TM (0.761) and DE TM (0.771). The presence of EPD TM , DE TM , and RPD were significant, independent positive predictors of follow-up myocardial dysfunction (OR = 6.4, 1.9, and 9.8, respectively). EPD TM was a significant, independent negative predictor of myocardial functional recovery (OR = 0.13). Conclusion: Abnormal myocardial attenuation on two-phase MDCT after reperfusion therapy may provide promising information regarding myocardial viability in patients with acute MI.

  2. Clinical evaluation of myocardial involvement in acute myopericarditis in young adults.

    Science.gov (United States)

    Saricam, Ersin; Saglam, Yasemin; Hazirolan, Tuncay

    2017-05-22

    Myocardial involvement in young adults has various causes. Acute myopericarditis is one of the myocardial involvements in young adults. It is easy to confuse with acute ST-elevation myocardial infarction because of the electrocardiographic features. This study aims to investigate a number of imaging techniques and clinical features for acute myopericarditis in young adults (defined as myocardial brightness in the left ventricle regions, especially in posterior and lateral wall. Focal echobright was observed in the 75 of 77 cases of acute myopericarditis in transthoracic echocardiogram. This sign was confirmed by cardiac magnetic resonance imaging. Focal echobright sensitivity was 95%; its specificity was 93%; its predictive was 95.2%. Pericardial effusion (83%) was observed in group I behind posterior wall. Its specificity was 81%; its sensitivity was 65%; predictivity was 73%. Pericardial effusion and myocardial focal echobright in echocardiography can be quite sensitive indicators for acute myopericarditis in young adults.

  3. Neural Mechanisms and Delayed Gastric Emptying of Liquid Induced Through Acute Myocardial Infarction in Rats

    Energy Technology Data Exchange (ETDEWEB)

    Nunez, Wilson Ranu Ramirez; Ozaki, Michiko Regina; Vinagre, Adriana Mendes; Collares, Edgard Ferro; Almeida, Eros Antonio de, E-mail: erosaa@cardiol.br [Universidade Estadual de Campinas, Campinas, SP (Brazil)

    2015-02-15

    In pathological situations, such as acute myocardial infarction, disorders of motility of the proximal gut can trigger symptoms like nausea and vomiting. Acute myocardial infarction delays gastric emptying (GE) of liquid in rats. Investigate the involvement of the vagus nerve, α 1-adrenoceptors, central nervous system GABA{sub B} receptors and also participation of paraventricular nucleus (PVN) of the hypothalamus in GE and gastric compliance (GC) in infarcted rats. Wistar rats, N = 8-15 in each group, were divided as INF group and sham (SH) group and subdivided. The infarction was performed through ligation of the left anterior descending coronary artery. GC was estimated with pressure-volume curves. Vagotomy was performed by sectioning the dorsal and ventral branches. To verify the action of GABA{sub B} receptors, baclofen was injected via icv (intracerebroventricular). Intravenous prazosin was used to produce chemical sympathectomy. The lesion in the PVN of the hypothalamus was performed using a 1mA/10s electrical current and GE was determined by measuring the percentage of gastric retention (% GR) of a saline meal. No significant differences were observed regarding GC between groups; vagotomy significantly reduced % GR in INF group; icv treatment with baclofen significantly reduced %GR. GABA{sub B} receptors were not conclusively involved in delaying GE; intravenous treatment with prazosin significantly reduced GR% in INF group. PVN lesion abolished the effect of myocardial infarction on GE. Gastric emptying of liquids induced through acute myocardial infarction in rats showed the involvement of the vagus nerve, alpha1- adrenergic receptors and PVN.

  4. Neural Mechanisms and Delayed Gastric Emptying of Liquid Induced Through Acute Myocardial Infarction in Rats

    International Nuclear Information System (INIS)

    Nunez, Wilson Ranu Ramirez; Ozaki, Michiko Regina; Vinagre, Adriana Mendes; Collares, Edgard Ferro; Almeida, Eros Antonio de

    2015-01-01

    In pathological situations, such as acute myocardial infarction, disorders of motility of the proximal gut can trigger symptoms like nausea and vomiting. Acute myocardial infarction delays gastric emptying (GE) of liquid in rats. Investigate the involvement of the vagus nerve, α 1-adrenoceptors, central nervous system GABA B receptors and also participation of paraventricular nucleus (PVN) of the hypothalamus in GE and gastric compliance (GC) in infarcted rats. Wistar rats, N = 8-15 in each group, were divided as INF group and sham (SH) group and subdivided. The infarction was performed through ligation of the left anterior descending coronary artery. GC was estimated with pressure-volume curves. Vagotomy was performed by sectioning the dorsal and ventral branches. To verify the action of GABA B receptors, baclofen was injected via icv (intracerebroventricular). Intravenous prazosin was used to produce chemical sympathectomy. The lesion in the PVN of the hypothalamus was performed using a 1mA/10s electrical current and GE was determined by measuring the percentage of gastric retention (% GR) of a saline meal. No significant differences were observed regarding GC between groups; vagotomy significantly reduced % GR in INF group; icv treatment with baclofen significantly reduced %GR. GABA B receptors were not conclusively involved in delaying GE; intravenous treatment with prazosin significantly reduced GR% in INF group. PVN lesion abolished the effect of myocardial infarction on GE. Gastric emptying of liquids induced through acute myocardial infarction in rats showed the involvement of the vagus nerve, alpha1- adrenergic receptors and PVN

  5. Neural Mechanisms and Delayed Gastric Emptying of Liquid Induced Through Acute Myocardial Infarction in Rats

    Directory of Open Access Journals (Sweden)

    Wilson Ranu Ramirez Nunez

    2015-02-01

    Full Text Available Background: In pathological situations, such as acute myocardial infarction, disorders of motility of the proximal gut can trigger symptoms like nausea and vomiting. Acute myocardial infarction delays gastric emptying (GE of liquid in rats. Objective: Investigate the involvement of the vagus nerve, α 1-adrenoceptors, central nervous system GABAB receptors and also participation of paraventricular nucleus (PVN of the hypothalamus in GE and gastric compliance (GC in infarcted rats. Methods: Wistar rats, N = 8-15 in each group, were divided as INF group and sham (SH group and subdivided. The infarction was performed through ligation of the left anterior descending coronary artery. GC was estimated with pressure-volume curves. Vagotomy was performed by sectioning the dorsal and ventral branches. To verify the action of GABAB receptors, baclofen was injected via icv (intracerebroventricular. Intravenous prazosin was used to produce chemical sympathectomy. The lesion in the PVN of the hypothalamus was performed using a 1mA/10s electrical current and GE was determined by measuring the percentage of gastric retention (% GR of a saline meal. Results: No significant differences were observed regarding GC between groups; vagotomy significantly reduced % GR in INF group; icv treatment with baclofen significantly reduced %GR. GABAB receptors were not conclusively involved in delaying GE; intravenous treatment with prazosin significantly reduced GR% in INF group. PVN lesion abolished the effect of myocardial infarction on GE. Conclusion: Gastric emptying of liquids induced through acute myocardial infarction in rats showed the involvement of the vagus nerve, alpha1- adrenergic receptors and PVN.

  6. Acute myocardial infarction in a young adult with myocardial bridging and normal coronary arteries

    Directory of Open Access Journals (Sweden)

    Moris Chansky

    2004-09-01

    Full Text Available The authors present a case of a young adult with acute myocardialinfarction, attended at the Emergency Department of HospitalIsraelita Albert Einstein. Acute myocardial infarction caused bymyocardial bridge (intramyocardial tunneled coronary artery is arare clinical entity. The finding of this condition in patients withnormal arteries (non-obstructed vessels is uncommon; it isusually associated with extracardiac triggering factors. The casereported presented an acute myocardial infarction caused by amyocardial bridge as demonstrated in the clinical picture, ECGprogression, enzyme pattern (troponin, CKMB, TGO and LD andventriculography.

  7. Adenosine as an adjunct to thrombolytic therapy for acute myocardial infarction: results of a multicenter, randomized, placebo-controlled trial: the Acute Myocardial Infarction STudy of ADenosine (AMISTAD) trial.

    Science.gov (United States)

    Mahaffey, K W; Puma, J A; Barbagelata, N A; DiCarli, M F; Leesar, M A; Browne, K F; Eisenberg, P R; Bolli, R; Casas, A C; Molina-Viamonte, V; Orlandi, C; Blevins, R; Gibbons, R J; Califf, R M; Granger, C B

    1999-11-15

    The Acute Myocardial Infarction STudy of ADenosine (AMISTAD) trial was designed to test the hypothesis that adenosine as an adjunct to thrombolysis would reduce myocardial infarct size. Reperfusion therapy for acute myocardial infarction (MI) has been shown to reduce mortality, but reperfusion itself also may have deleterious effects. The AMISTAD trial was a prospective, open-label trial of thrombolysis with randomization to adenosine or placebo in 236 patients within 6 h of infarction onset. The primary end point was infarct size as determined by Tc-99 m sestamibi single-photon emission computed tomography (SPECT) imaging 6+/-1 days after enrollment based on multivariable regression modeling to adjust for covariates. Secondary end points were myocardial salvage index and a composite of in-hospital clinical outcomes (death, reinfarction, shock, congestive heart failure or stroke). In all, 236 patients were enrolled. Final infarct size was assessed in 197 (83%) patients. There was a 33% relative reduction in infarct size (p = 0.03) with adenosine. There was a 67% relative reduction in infarct size in patients with anterior infarction (15% in the adenosine group vs. 45.5% in the placebo group) but no reduction in patients with infarcts located elsewhere (11.5% for both groups). Patients randomized to adenosine tended to reach the composite clinical end point more often than those assigned to placebo (22% vs. 16%; odds ratio, 1.43; 95% confidence interval, 0.71 to 2.89). Many agents thought to attenuate reperfusion injury have been unsuccessful in clinical investigation. In this study, adenosine resulted in a significant reduction in infarct size. These data support the need for a large clinical outcome trial.

  8. Acute Carbon Monoxide Poisoning Resulting in ST Elevation Myocardial Infarction: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Po-Chao Hsu

    2010-05-01

    Full Text Available Acute carbon monoxide (CO poisoning with cardiac complications is well documented in the literature. However, ST segment elevation is a rare presentation, and most of these cases with ST elevation have revealed non-occlusive or normal coronary arteries. We report a case of CO poisoning complicated with ST elevation myocardial infarction. Emergency coronary angiography revealed total occlusion of the left anterior descending artery and primary percutaneous coronary intervention was performed. This report of a rare case should remind physicians that cardiovascular investigations, including electrocardiography, must be performed in cases with CO poisoning because mortality might increase if reperfusion therapy or appropriate medical treatments are not performed in patients with acute coronary artery occlusion.

  9. Perfusion scintigraphy in acute myocardial infarction

    International Nuclear Information System (INIS)

    Schricke, U.; Schwaiger, M.; Kastrati, A.; Schoemig, A.

    1999-01-01

    The Tc-99m sestamibi perfusion SPECT scintigraphy in acute myocardial infarction is a feasible method to assess the size of area at risk and the residual blood flow to this area as the most important determinants of final infarct size without any delay in treatment. In combination with a follow-up study final infarct size as well as myocardial salvage can be quantified. Clinical indications for the use of Tc-99m sestamibi scintigraphy are the noninvasive identification of arterial occlusion in patients suspected to acute myocardial infarction without electrocardiographic ST-elevation and the assessment of reperfusion success. In clinical trials Tc-99m sestamibi scintigraphy has proven to be a useful method to assess the impact of varying reperfusion therapies. The present review article discusses the indication, the study protocol, the interpretation of results and the clinical and scientifically importance of this method. (orig.) [de

  10. Pharmacological prevention of reperfusion injury in acute myocardial infarction. A potential role for adenosine as a therapeutic agent.

    Science.gov (United States)

    Quintana, Miguel; Kahan, Thomas; Hjemdahl, Paul

    2004-01-01

    last years, three relatively large placebo-controlled clinical trials have been conducted: Acute Myocardial Infarction Study of Adenosine Trial (AMISTAD) I and II and Attenuation by Adenosine of Cardiac Complications (ATTACC). In the AMISTAD trials, the final infarct size was reduced and the LV systolic function was improved by adenosine treatment, mainly in patients with anterior MI localization. However, morbidity and mortality were not affected. In the ATTACC study, the LV systolic function was not affected by adenosine, however, trends towards improved survival were observed in patients with anterior MI localization. The possibility of obtaining a Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow in the infarct-related artery in up to 95% of patients with acute MI (increasing the occurrence of reperfusion injury) has turned back the interest towards the protection of myocardial cells from the impending ischemic and reperfusion injury in which adenosine alone or together with other cardio-protective agents may exert important clinical effects.

  11. Sensitivity of {sup 99m}Tc-pyrophosphate scintigraphy in diagnosis of acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seong Hee; Park, Tai Que; Chae, Yoo Soon; Kim, Yang Sook [Maryknoll Hospital, Busan (Korea, Republic of)

    1991-01-15

    To assess the difference of the diagnostic sensitivity of {sup 99m}Tc-Pyrophosphate (PYP) myocardial scintigraphy in acute transmural infarction and acute subendocardial infarction, we analyzed 38 patients with a confirmed transmural infarct, 10 with a subendocardial infarct, 2 with old myocardial infarct, and 10 with other cardiovascular disease (2 unstable angina, 6 stable angina, 1 Prinzmetal angina, and 1 atrial fibrillation) according to Berman's criteria for scintigraphic assessment and then come to conclusion; When only focal myocardial uptake wa used as a criteria for positivity, the diagnostic sensitivity of {sup 99m}Tc-PYP scintigraphy in acute subendocardial myocardial infarction was only 40% (4/10) compared with 86.8% (33/38) of acute transmural myocardial infarction. There was no case that was interpreted as focal myocardial uptake in 2 old myocardial infarction and 10 other cardiovascular disease. The incidence of complication was higher in doughnut pattern of myocardial uptake 50% (3/6) than in non-doughnut focal patterns 19.4% (6/31). It is concluded that focal myocardial uptake is a sensitive indicator suggesting acute myocardial necrosis and that {sup 99m}Tc-PYP myocardial scintigraphy is a sensitive technique for diagnosing acute transmural myocardial infarction, but a insensitive method in acute subendocardial infarction, and that the doughnut pattern of myocardial uptake an provide clues to the patient's future course.

  12. Use of copeptin for rapid rule-out of acute myocardial infarction

    DEFF Research Database (Denmark)

    Mueller, Christian; Möckel, Martin; Giannitsis, Evangelos

    2017-01-01

    Copeptin is currently understood as a quantitative marker of endogenous stress. It rises rapidly in multiple acute disorders including acute myocardial infarction. As a single variable, it has only modest diagnostic accuracy for acute myocardial infarction. However, the use of copeptin within a d...

  13. [Acute myocardial infarction in Morocco: FES-AMI registry data].

    Science.gov (United States)

    Akoudad, H; El Khorb, N; Sekkali, N; Mechrafi, A; Zakari, N; Ouaha, L; Lahlou, I

    2015-12-01

    Acute myocardial infarction is the most dangerous complication of coronary atherothrombosis. There are several disparities in regard to its management around the world. The aim of this study is to analyze the specificities of management of acute myocardial infarction in Morocco. FES-AMI (Fès Acute Myocardial Infarction) is a prospective monocentric registry conducted in cardiology department of Hassan II university hospital in Fès. In this registry, we enrolled patients with acute myocardial infarction who presented within 5 days after symptom onset. From January 2005 to August 2015, we enrolled 1835 patients. Seventy-five percent of patients were males and mean age was 60 years old. Fifty-one percent of patients were smokers, 27% were hypertensives and 14% were diabetics. Sixty-six percent of patients had more than 2 risk factors. Time from symptom onset to hospital admission was less than six hours for 40% of the patients. Thirty-six percent of patients were admitted more than twelve hours after the onset of chest pain. Only 37% of patients received reperfusion therapy, 31% with in-hospital thrombolysis and 6% with primary angioplasty. In-hospital mortality was 7.6%. The patients enrolled in our registry have late presentation of acute myocardial infarction and less rate of reperfusion therapy. Furthermore, the majority of our patients have multiple risk factors and this result underlines the failure of preventive interventions. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. Role of myocardial perfusion imaging in evaluating thrombolytic therapy for acute myocardial infarction

    International Nuclear Information System (INIS)

    Beller, G.A.

    1987-01-01

    Myocardial thallium-201 scintigraphy is being increasingly employed as a method for assessing the efficacy of coronary reperfusion in acute myocardial infarction. New thallium uptake after intracoronary tracer administration after successful recanalization indicates that nutrient blood flow has been successfully restored. One may also presume that some myocardial salvage occurred if thallium administered in this manner is transported intracellularly by myocytes with intact sarcolemmal membranes. However, if one injects thallium by way of the intracoronary route immediately after reperfusion, the initial uptake of thallium in reperfused myocardium may predominantly represent hyperemic flow and regional thallium counts measured may not be proportional to the mass of viable myocytes. When thallium is injected intravenously during the occlusion phase the degree of redistribution after thrombolysis is proportional to the degree of flow restoration and myocardial viability. When thallium is injected for the first time intravenously immediately after reperfusion, an overestimation of myocardial salvage may occur because of excess thallium uptake in the infarct zone consequent to significant hyperemia. Another approach to myocardial thallium scintigraphy in patients undergoing thrombolytic therapy is to administer two separate intravenous injections before and 24 hours or later after treatment. Finally, patients with acute myocardial infarction who receive intravenous thrombolytic therapy are candidates for predischarge exercise thallium-201 scintigraphy for risk stratification and detection of residual ischemia

  15. Acute myocardial infarction: 'telomerasing' for cardioprotection

    OpenAIRE

    Sanchís-Gomar, Fabián; Lucía Mulas, Alejandro

    2015-01-01

    Reactivating the telomerase gene through gene therapy after acute myocardial infarction (AMI) has been recently reported to improve survival in mice. Given that regular physical exercise also activates this gene, therapeutic and lifestyle interventions targeting telomerase need to be explored as possible additions to the current armamentarium for myocardial regeneration. 9.292 JCR (2015) Q1, 17/289 Biochemistry & mollecular biology, 17/187 Cell biology, 8/124 Medicine, research & experimen...

  16. Acute myocardial infarction in infectious endocarditis. Report of one case

    International Nuclear Information System (INIS)

    Parietti, G; Artucio, C.; Fernandez, A; Areco, D.; Mallo, D; Lluberas, R.

    2012-01-01

    The acute myocardial infarction is a rare complication in the course of an acute endocarditis. It takes place in the first weeks infection. Although is not associated with any particular microorganism it has been associated with virulent microorganism and is common in aortic valve endocarditis insufficiency. This report is a case of a patient who suffered a myocardial infarction during a acute endocarditis of native valve

  17. Does overprotection cause cardiac invalidism after acute myocardial infarction?

    Science.gov (United States)

    Riegel, B J; Dracup, K A

    1992-01-01

    To determine if overprotection on the part of the patient's family and friends contributes to the development of cardiac invalidism after acute myocardial infarction. Longitudinal survey. Nine hospitals in the southwestern United States. One hundred eleven patients who had experienced a first acute myocardial infarction. Subjects were predominantly male, older-aged, married, caucasian, and in functional class I. Eighty-one patients characterized themselves as being overprotected (i.e., receiving more social support from family and friends than desired), and 28 reported receiving inadequate support. Only two patients reported receiving as much support as they desired. Self-esteem, emotional distress, health perceptions, interpersonal dependency, return to work. Overprotected patients experienced less anxiety, depression, anger, confusion, more vigor, and higher self-esteem than inadequately supported patients 1 month after myocardial infarction (p Overprotection on the part of family and friends may facilitate psychosocial adjustment in the early months after an acute myocardial infarction rather than lead to cardiac invalidism.

  18. Early spontaneous intermittent myocardial reperfusion during acute myocardial infarction is associated with augmented thrombogenic activity and less myocardial damage

    NARCIS (Netherlands)

    Haider, A.W.; Andreotti, F.; Hackett, D.R.; Tousoulis, D.; Kluft, C.; Maseri, A.; Davies, G.J.

    1995-01-01

    Objectives. This study investigated the influence of early spontaneous intermittent reperfusion on the extent of myocardial damage and its relation to endogenous hemostatic activity, Background. In the early phase of acute myocardial infarction coronary occlusion is often intermittent, even before

  19. Amphetamine Containing Dietary Supplements and Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Julio Perez-Downes

    2016-01-01

    Full Text Available Weight loss is one of the most researched and marketed topics in American society. Dietary regimens, medications that claim to boost the metabolism, and the constant pressure to fit into society all play a role in our patient’s choices regarding new dietary products. One of the products that are well known to suppress appetite and cause weight loss is amphetamines. While these medications suppress appetite, most people are not aware of the detrimental side effects of amphetamines, including hypertension, tachycardia, arrhythmias, and in certain instances acute myocardial infarction. Here we present the uncommon entity of an acute myocardial infarction due to chronic use of an amphetamine containing dietary supplement in conjunction with an exercise regimen. Our case brings to light further awareness regarding use of amphetamines. Clinicians should have a high index of suspicion of use of these substances when young patients with no risk factors for coronary artery disease present with acute arrhythmias, heart failure, and myocardial infarctions.

  20. Risk profile in young patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Safdar, M.H.K.; Fazal, I.; Ejaz, A.; Awan, Z.I.

    2010-01-01

    The objective of this study was to determine the frequency of risk factors in young patients with acute myocardial infarction and thus with ischemic heart disease (IHD), aged 20 to 40 years, in our population. All patients who fulfilled the inclusion criteria who presented to emergency reception of the hospital with a diagnosis of Acute MI were included. The patients were admitted to coronary care unit (CCU) and were managed for Acute myocardial infarction (MI). Their detailed history was then taken including symptoms at presentation and their risk factors were assessed with the help of history and laboratory investigations. A total of 137 patients were included during the study period. Mean age was 36 years (SD=3.67). Majority of patients were males. Smoking was the major risk factor (64.2%) followed by family history of IHD (30.7%). Most frequent risk factor for Acute myocardial infarction (MI) at young age is smoking followed by family history. (author)

  1. Pigment dispersion syndrome masquerading as acute anterior uveitis.

    Science.gov (United States)

    Gonzalez-Gonzalez, Luis Alonso; Rodríguez-García, Alejandro; Foster, C Stephen

    2011-06-01

    Signs and symptoms of pigment dispersion may be confused with those of acute anterior uveitis. This case series is intended to aid the ophthalmologist in the clinical differentiation between these two disorders. The authors present a series of 6 patients with pigment dispersion who were initially diagnosed as having acute anterior uveitis and treated with anti-inflammatory medication, including corticosteroids. The patients were referred for a second opinion due to poor or no response to therapy and were found to have pigment dispersion instead of uveitis. Symptoms of pigment dispersion may consist of blurred vision, redness, ocular pain, and photophobia, all of which are also symptoms of acute anterior uveitis. These symptoms, plus the fact that pigment floating in the aqueous humor can be mistaken for inflammation, make diagnosis challenging. Moreover, the possible co-existence of true anterior uveitis and pigment dispersion makes the diagnosis and treatment more difficult.

  2. Serum aminoterminal type III procollagen peptide reflects repair after acute myocardial infarction

    DEFF Research Database (Denmark)

    Jensen, L T; Hørslev-Petersen, K; Toft, P

    1990-01-01

    similar to changes observed during wound healing in humans. PIIINP is cleaved off procollagen type III during the biosynthesis of type III collagen, which characterizes the early stages of repair and inflammation. Our findings suggest that serum PIIINP reflects the repair processes and scar formation...... following acute myocardial infarction. The serum PIIINP alterations in acute myocardial infarction differ essentially from the changes in myocardial enzymes reflecting myocardial injury. Serum PIIINP may therefore provide new and clinically relevant information on the healing of myocardial infarction....

  3. Hemodynamic effects of acute digitalization several months after acute myocardial infarction.

    Science.gov (United States)

    Ressl, J; Jandová, R; Jebavý, P; Kasalický, J; Widimský, J

    1975-01-01

    Left ventricular function was investigated at rest and during exercise by heart catheterization in 15 patients 3-5 months after acute myocardial infarction. The effect of 1 mg digoxin i.v. in ten patients was correlated to placebo (saline solution) in five patients. A significant decrease of the left ventricular enddiastolic pressure, increase of left ventricular systolic ejection fraction and a shift of the left ventricular function curve to left upwards was found after digoxin with no changes in the placebo group. This beneficial effect of acute digitalization in patients convalescing from uncomplicated myocardial infarction without clinical signs of manifest heart failure could have therapeutic implication.

  4. Clinical Manifestation of Acute Myocardial Infarction in the Elderly

    Directory of Open Access Journals (Sweden)

    Miftah Suryadipradja

    2003-12-01

    Full Text Available A retrospective study were performed in patients with acute myocardial infarction (AMI that hospitalized in ICCU Cipto Mangunkusumo hospital, Jakarta during the period of January 1994 until Decmber 1999. There were 513 patients hospitalized with MCI, 227 patients (44.2% were classified as elderly, and 35.2% of them were female. Most of the elderly AMI patients reported typical chest pain just like their younger counterparts. Elderly AMI patients tend to come later to the hospital, and more Q-wave myocardial infarction were identified compared to non- Q-wave myocardial infarction. Risk factors of diabetes mellitus and hypertension were more common among the elderly. The prevalence of atrial fibrillation and the mortality rate were higher among elderly AMI patients. (Med J Indones 2003; 12: 229-35 Keywords: clinical manifestation, acute myocardial infarction, elderly

  5. MANAGEMENT OF DIABETES IN ACUTE MYOCARDIAL INFARCTION IN CELJE GENERAL HOSPITAL IN 1999

    Directory of Open Access Journals (Sweden)

    Gregor Veninšek

    2001-12-01

    Full Text Available Background. DIGAMI study showed that intrahospital mortality and mortality at one year after myocardial infarction can be significantly reduced in diabetics treated in acute phase of myocardial infarction by GI infusion and afterwards for at least three months with intensive insulin treatment. Mortality can be reduced for more than 50% in a subgroup of patients younger than 70 years, without congestive heart failure, with first myocardial infarction, not treated with insulin or digitalis. In this perspective we reviewed treatment of diabetics with acute myocardial infarction in 1999 in Celje General Hospital.Methods. We reviewed documentation of treatment of all diabetics with acute myocardial infarction treated in Celje General Hospital in 1999. We collected data on number of newly discovered diabetes, on previous treatment of diabetes, on treatment of diabetes during hospitalization and at discharge, on drugs used for treatment of diabetes and on mortality during hospitalization.Results. Diabetics presented 20% of all patients with acute myocardial infarction treated in Celje General Hospital in 1999. None of patients received GI infusion, none had intensively managed blood sugar. 24% of patients were treated with sulfonylureas in acute phase of myocardial infarction. 33% of patients were discharged from hospital with insulin therapy. Intrahospital mortality was 9%, comparable with patients without diabetes.Conclusions. In 1999 was intrahospital treatment of diabetics with acute myocardial infarction in Celje General Hospital successful as their intrahospital mortality equaled non-diabetics. Treatment of diabetes itself, during hospitalization and after discharge, on the other hand, in 1999 had not been up to date according to results of recent studies. In our opinion, it is mandatory for diabetologist to make part of the team that treats diabetic with acute myocardial infarction

  6. Acute myocardial infarction: Can it be a complication of acute organophosphorus compound poisoning?

    Directory of Open Access Journals (Sweden)

    P Joshi

    2013-01-01

    Full Text Available Organophosphorus compounds are used as pesticides and represent a common cause of poisoning in developing countries including India due to their widespread availability and use. Toxicity due to these agents can affect many organs including heart. Here, we report a case of acute organophosphorus poisoning (parathion, followed by acute myocardial infarction; documented by clinical features, electrocardiographic changes, and elevated cardiac enzymes. Myocardial infarction has been rarely reported with organophosphorus compounds exposure, thus awareness of this complication can reduce morbidity and mortality.

  7. [Interventional therapy of acute myocardial infarction].

    Science.gov (United States)

    Zahn, R; Zeymer, U

    2008-09-01

    Currently an acute myocardial infarction has to be differentiated into ST-elevation myocardial infarction (STEMI) or non ST-elevation myocardial infarction (NSTEMI). However, there exists another definition of acute coronary syndromes (ACS), which is more important in clinical practice, for all recommendations from the guidelines of the cardiac societies concerning the invasive strategies rely on this one. Here one has to differentiate an ACS with ST-elevation (STE-ACS = STEMI) from an ACS without ST-elevation (NSTE-ACS). The last one is further divided into an NSTE-ACS with or without high risk. In patients with an NSTE-ACS with high risk an early invasive strategy is recommended within 72 h after the diagnosis. In patients with an NSTE-ACS without high risk a more conservative approach can be pursued. In STE-ACS patients primary angioplasty is the reperfusion therapy of choice, if it can be performed in a timely fashion within 2 h after diagnosis at an interventional centre with experienced interventionalists and short "door-to-balloon" times. In Germany this goal is achievable almost everywhere. Therefore it is currently the most important task to establish local networks to reach this goal.

  8. Acute myocardial infarcts. A changing clinical picture

    Energy Technology Data Exchange (ETDEWEB)

    Just, H.

    1988-09-01

    Acute myocardial infarction is a major complication of stenosing coronary artery disease and constitutes the most frequent single cause of death. It is caused by thrombotic occlusion of one of the major epicardial coronary arterial branches in most cases. Sudden death due to ventricular fibrillation is responsible for the majority of early fatalities. In 60% of all fatal infarcts, death occurs within 1 h of the onset of pain. The final extension of myocardial necrosis is reached within 2-4 h. An integrated programme has therefore been developed for the supervision and treatment of patients suffering acute coronary attack; it has been shown that it can markedly lower infarct mortality. It includes mobile prehospital care, intensive care treatment in the hospital, and rehabilitative procedures for application during reconvalescence. Early antiarrhythmic treatment and myocardial reperfusion via fibrinolysis are the main therapeutic procedures in the earliest stage. In hospital an operating room and an operating team must be available round the clock for the performance of coronary angiography followed by percutaneous transluminal coronary angioplasty or bypass surgery, which can be safely carried out in the acute stage provided the indications are strictly observed. Mortality and morbidity can be significantly lowered and both life expectancy and quality of life can be remarkably improved.

  9. Relation between electrocardiographic and enzymatic methods of estimating acute myocardial infarct size.

    Science.gov (United States)

    Hindman, N; Grande, P; Harrell, F E; Anderson, C; Harrison, D; Ideker, R E; Selvester, R H; Wagner, G S

    1986-07-01

    The extent of initial acute myocardial infarction (AMI) and subsequent patient prognosis were studied using 2 independent indicators of AMI size. Two inexpensive, readily available techniques, the complete Selvester QRS score from the standard 12-lead electrocardiogram and the peak value of the isoenzyme MB of creatine kinase (CK-MB), were evaluated in 125 patients with initial AMI. The overall correlation between peak CK-MB and QRS score was fair (0.57), with marked difference according to anterior (0.72) or inferior (0.35) location. The prognostic capabilities of each measurement varied. Peak CK-MB provided significant information concerning hospital morbidity or early mortality (within 30 days) for both anterior (chi 2 = 9.83) and inferior (chi 2 = 7.68) AMI locations; however, the QRS score was significant only for anterior AMI (chi 2 = 9.50). For total 24-month mortality, the QRS score alone provided the most information (chi 2 = 10.0, p = 0.0016), which was not improved with the addition of CK-MB (chi 2 = 0.07, p = 0.79). This study shows a good relation between these 2 independent estimates of AMI size for patients with anterior AMI location. Both QRS and CK-MB results are significantly related to early morbidity and mortality; however, only the QRS score is related to total 24-month prognosis.

  10. Utility of lead aVR for identifying the culprit lesion in acute myocardial infarction

    DEFF Research Database (Denmark)

    Kühl, Jørgen Tobias; Berg, Ronan M G

    2009-01-01

    BACKGROUND: Lead aVR is a neglected, however, potentially useful tool in electrocardiography. Our aim was to evaluate its value in clinical practice, by reviewing existing literature regarding its utility for identifying the culprit lesion in acute myocardial infarction (AMI). METHODS: Based...... on a systematic search strategy, 16 studies were assessed with the intent to pool data; diagnostic test rates were calculated as key results. RESULTS: Five studies investigated if ST-segment elevation (STE) in aVR is valuable for the diagnosis of left main stem stenosis (LMS) in non-ST-segment AMI (NSTEMI......). The studies were too heterogeneous to pool, but the individual studies all showed that STE in aVR has a high negative predictive value (NPV) for LMS. Six studies evaluated if STE in aVR is valuable for distinguishing proximal from distal lesions in the left anterior descending artery (LAD) in anterior ST...

  11. Severe Hyperthyroidism Presenting with Acute ST Segment Elevation Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Dayan Zhou

    2015-01-01

    Full Text Available Introduction. Acute myocardial infarction is life-threatening. A cardiac troponin rise accompanied by typical symptoms, ST elevation or depression is diagnostic of acute myocardial infarction. Here, we report an unusual case of a female who was admitted with chest pain. However, she did not present with a typical profile of an acute myocardial infarction patient. Case Presentation. A 66-year-old Han nationality female presented with chest pain. The electrocardiogram (ECG revealed arched ST segment elevations and troponin was elevated. However, the coronary angiography showed a normal coronary arterial system. Thyroid function tests showed that this patient had severe hyperthyroidism. Conclusion. Our case highlights the possibility that hyperthyroidism may cause a large area of myocardium injury and ECG ST segment elevation. We suggest routine thyroid function testing in patients with chest pain.

  12. The myocardial perfusion imaging of bone marrow mesenchymal stem cell transplantation treated acute myocardial infarction in pig

    International Nuclear Information System (INIS)

    He Miao; Hou Xiancun; Li Yaomei; Zhou Peng; Qi Chunmei; Wu Weihuan; Li Li

    2006-01-01

    Objective: To evaluate the clinical value of bone marrow mesenchymal stem cell transplantation on acute myocardial infarction in pig with myocardial perfusion imaging. Methods: Acute myocardial infarction models were established by 21 minitype Chinese pigs and were divided into two groups. After 10 days, experimental group (n=11) was transplanted with bone marrow mesenchymal stem cell at the infarct areas, and the control group (n=10) with incubation solution. Before and eight weeks after transplantation, both groups were examined by 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging and with semi-quantitative analysis. Besides, echocardiogram and immunohistochemistry were also performed. Results: There was significant difference of total myocardial perfusion abnormal segments (46 vs 26), infarct areas [(34±12)% vs (21±10)%] and myocardial ischemia score [(20.0±4.3) vs (12.1±3.6)] between two groups (P<0.05). Also, there were accordant results with echocardiogram and immunohistochemistry findings. Conclusions: Bone marrow mesenchymal stem cell transplantation may improve blood perfusion and viability of the ischemic areas: Myocardial perfusion imaging can accurately observe the survival of bone marrow mesenchymal stem cell transplanted at the infarct areas. (authors)

  13. Multislice coronary computed tomographic angiography in emergency department presentations of unsuspected acute myocardial infarction.

    Science.gov (United States)

    Hecht, Harvey S; Bhatti, Tandeep

    2009-01-01

    Coronary computed tomographic angiography (CCTA) is not indicated in the setting of acute myocardial infarction in the emergency department (ED). Nonetheless, acute coronary syndromes may have atypical presentations, and CCTA may be inadvertently performed in this setting. This study was designed to determine the frequency and characteristics of CCTA imaging of unsuspected acute myocardial infarction in the ED. All CCTAs performed in the ED at Lenox Hill Hospital were reviewed for clinical indications and subsequent course; patients with documented acute myocardial infarction were identified. Of the 500 CCTAs performed on ED patients in the Lenox Hill laboratory, 5 patients (1%) were imaged during the initial phase of an unsuspected acute myocardial infarction; in all cases the CCTAs were key to the diagnosis. The imaging characteristics were (1) total or subtotal occlusion and (2) transmural hypodensity in the infarct area. Although acute myocardial infarction on CCTA in ED patients is an infrequent event, proper and prompt recognition is critical for appropriate patient care, particularly as applications to the ED increase.

  14. Value of the Doppler index of myocardial performance in the early phase of acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, S H; Jensen, S E; Tei, C

    2000-01-01

    Prospective assessment of a nongeometric Doppler-derived index of combined systolic and diastolic myocardial performance was performed in 64 patients with acute myocardial infarction (MI) within 1 hour after their arrival to the hospital and in 39 age-matched healthy subjects. The index is defined...

  15. Acute myocardial infarction after heart irradiation in young patients with Hodgkin's disease

    International Nuclear Information System (INIS)

    Joensuu, H.

    1989-01-01

    Forty-seven patients younger than 40 years at the time of the diagnosis, and irradiated to the mediastinum for Hodgkin's disease at Turku University Central Hospital from 1977 to 1982, were regularly followed for 56 to 127 months after therapy. Two patients developed an acute myocardial infarction ten and 50 months after cardiac irradiation at the age of only 28 and 24 years, respectively. None of the patients died from lymphoma within five years from the diagnosis, but one of the infarctions was eventually fatal. Since acute myocardial infarction is rare in this age group, the result suggests strongly that prior cardiac irradiation is a risk factor for acute myocardial infarction. The possibility of radiation-induced myocardial infarction should be taken into account both in treatment planning and follow-up of patients with Hodgkin's disease

  16. Feature-tracking myocardial strain analysis in acute myocarditis. Diagnostic value and association with myocardial oedema

    Energy Technology Data Exchange (ETDEWEB)

    Luetkens, Julian A.; Schlesinger-Irsch, Ulrike; Kuetting, Daniel L.; Dabir, Darius; Homsi, Rami; Schmeel, Frederic C.; Sprinkart, Alois M.; Naehle, Claas P.; Schild, Hans H.; Thomas, Daniel [University of Bonn, Department of Radiology, Bonn (Germany); Doerner, Jonas [University Hospital Cologne, Department of Radiology, Cologne (Germany); Fimmers, Rolf [University of Bonn, Department of Medical Biometry, Informatics, and Epidemiology, Bonn (Germany)

    2017-11-15

    To investigate the diagnostic value of cardiac magnetic resonance (CMR) feature-tracking (FT) myocardial strain analysis in patients with suspected acute myocarditis and its association with myocardial oedema. Forty-eight patients with suspected acute myocarditis and 35 control subjects underwent CMR. FT CMR analysis of systolic longitudinal (LS), circumferential (CS) and radial strain (RS) was performed. Additionally, the protocol allowed for the assessment of T1 and T2 relaxation times. When compared with healthy controls, myocarditis patients demonstrated reduced LS, CS and RS values (LS: -19.5 ± 4.4% vs. -23.6 ± 3.1%, CS: -23.0 ± 5.8% vs. -27.4 ± 3.4%, RS: 28.9 ± 8.5% vs. 32.4 ± 7.4%; P < 0.05, respectively). LS (T1: r = 0.462, P < 0.001; T2: r = 0.436, P < 0.001) and CS (T1: r = 0.429, P < 0.001; T2: r = 0.467, P < 0.001) showed the strongest correlations with T1 and T2 relaxations times. Area under the curve of LS (0.79) was higher compared with those of CS (0.75; P = 0.478) and RS (0.62; P = 0.008). FT CMR myocardial strain analysis might serve as a new tool for assessment of myocardial dysfunction in the diagnostic work-up of patients suspected of having acute myocarditis. Especially, LS and CS show a sufficient diagnostic performance and were most closely correlated with CMR parameters of myocardial oedema. (orig.)

  17. Feature-tracking myocardial strain analysis in acute myocarditis. Diagnostic value and association with myocardial oedema

    International Nuclear Information System (INIS)

    Luetkens, Julian A.; Schlesinger-Irsch, Ulrike; Kuetting, Daniel L.; Dabir, Darius; Homsi, Rami; Schmeel, Frederic C.; Sprinkart, Alois M.; Naehle, Claas P.; Schild, Hans H.; Thomas, Daniel; Doerner, Jonas; Fimmers, Rolf

    2017-01-01

    To investigate the diagnostic value of cardiac magnetic resonance (CMR) feature-tracking (FT) myocardial strain analysis in patients with suspected acute myocarditis and its association with myocardial oedema. Forty-eight patients with suspected acute myocarditis and 35 control subjects underwent CMR. FT CMR analysis of systolic longitudinal (LS), circumferential (CS) and radial strain (RS) was performed. Additionally, the protocol allowed for the assessment of T1 and T2 relaxation times. When compared with healthy controls, myocarditis patients demonstrated reduced LS, CS and RS values (LS: -19.5 ± 4.4% vs. -23.6 ± 3.1%, CS: -23.0 ± 5.8% vs. -27.4 ± 3.4%, RS: 28.9 ± 8.5% vs. 32.4 ± 7.4%; P < 0.05, respectively). LS (T1: r = 0.462, P < 0.001; T2: r = 0.436, P < 0.001) and CS (T1: r = 0.429, P < 0.001; T2: r = 0.467, P < 0.001) showed the strongest correlations with T1 and T2 relaxations times. Area under the curve of LS (0.79) was higher compared with those of CS (0.75; P = 0.478) and RS (0.62; P = 0.008). FT CMR myocardial strain analysis might serve as a new tool for assessment of myocardial dysfunction in the diagnostic work-up of patients suspected of having acute myocarditis. Especially, LS and CS show a sufficient diagnostic performance and were most closely correlated with CMR parameters of myocardial oedema. (orig.)

  18. [Acute myocardial infarction in Djibouti: 2-year prospective study].

    Science.gov (United States)

    Maurin, O; Massoure, P L; de Regloix, S; Topin, F; Sbardella, F; Lamblin, G; Kaiser, E

    2012-01-01

    Acute myocardial infarction (AMI) is a life-threatening emergency. In Africa, the increasing prevalence of cardiovascular risk factors is leading to an epidemiological transition. No data have yet been reported about AMI in Djibouti. This study prospectively included all patients with acute coronary syndrome and persistent ST segment elevation admitted to the emergency department of Bouffard Military Hospital in Djibouti from January 2009 through December 2010. It analyzed their clinical data and management. The study included 35 patients. Their mean age was 52 ± 11 years [range: 29-76]. The sex ratio was 7.7 (men/women). Cardiovascular risk factors were: hypercholesterolemia (83%), tobacco use (60%), khat chewing (57%), diabetes (49%), hypertension (46%), and heredity (20%). AMI was anterior in 40% of cases. Fifteen patients (43%) arrived within 12 hours after the onset of symptoms (average 5 hours); thrombolysis was successful for 11 of them (73%). Seven patients (20%) died over the entire follow-up (11.3 ± 9 months), 5 within the first month. Mortality was significantly associated with diabetes (pDjibouti are 10 to 15 years younger than in Western countries. Their high level of cardiovascular risk is remarkable. Khat use did not significantly affect prognosis. The high mortality rate was similar to rates reported before the percutaneous coronary angioplasty era.

  19. Acute aortic dissection mimics acute inferoposterior wall myocardial infarction in a Marfan syndrome patient

    OpenAIRE

    Phowthongkum, Prasit

    2010-01-01

    A 30-year old man with acute chest pain was diagnosed with acute inferoposterior wall myocardial infarction following electrocardiography. After a failed coronary angiography, an echocardiogram revealed an aortic intimal flap after which acute aortic dissection was diagnosed. The patient received a successful Bentall operation without immediate complication. Retrospective examination then confirmed the diagnosis of Marfan syndrome. This case demonstrates acute aortic dissection may mimic acut...

  20. Clinical Significance of Reverse Redistribution Phenomenon on Delayed Tc-99m Tetrofosmin Myocardial Perfusion Imaging in Patients with Acute Myocardial Infarction

    International Nuclear Information System (INIS)

    Park, Soon Ah; Kim, Dae Weung; Kim, Chang Guhn; Jeong, Jin Won; Kim, Nam Ho; Yun, Kyeong Ho

    2009-01-01

    This study was performed to investigate the clinical significance of reverse redistribution (RR) phenomenon detected on delayed Tc-99m tetrofosmin myocardial single photon emission computed tomography (SPECT) in patients with acute myocardial infarction after revascularization. A Tc-99m tetrofrosmin myocardial SPECT was performed in 67 consecutive patients after revascularization for acute myocardial infarction. Myocardial SPECT imaging was performed for early imaging at 40 min and for delayed imaging at 180 min after reinjection at myocardial stress. Regional myocardial uptakes were scored by 4-point scoring in the left ventricular wall divided into 17 segments. Reverse redistribution was defined as an increase of more than 2 point in the activity score on the delayed image. Follow-up myocardial SPECT and coronary angiography (CAG) were performed 9 months later. On myocardial SPECT performed following revascularization, RR was observed in 100 of all 319 segments (31%) and in 43 patients (64%). The abnormalities of perfusion and regional wall motion were more severe in the patients with RR compared to those without RR (p<0.05). On follow-up myocardial SPECT, the myocardial perfusion, regional wall motion, and myocardial thickness were significantly improved in the patients with RR (p<0.05) however, these changes were not significant in those without RR. There was no significant difference between the patients with RR and those without RR in the occurrence of restenosis on CAG. In patients with acute myocardial infarction, the regions showing the RR phenomenon on delayed Tc-99m tetrofosmin SPECT may reflect viable myocardium and indicate recovery of salvaged myocardium

  1. Alcohol drinking triggers acute myocardial infarction in a case of hypertrophic obstructive cardiomyopathy

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    Po-Chao Hsu

    2011-05-01

    Full Text Available Alcohol ingestion–related increased left ventricular outflow tract (LVOT pressure gradient in hypertrophic obstructive cardiomyopathy (HOCM has been reported in the literature; however, acute myocardial infarction (AMI after alcohol drinking in this patient group is rarely reported. Herein, we report a 68-year-old man with chronic alcoholism suffering from AMI after alcohol drinking. Electrocardiography revealed complete left bundle branch block, and chest X-ray showed acute pulmonary edema. Intubation was done for respiratory failure and intra-aortic balloon pump was also inserted for unstable hemodynamics. However, emergent coronary angiography revealed normal coronary arteries. HOCM was diagnosed by a high pressure gradient over LVOT and systolic anterior motion of mitral valve by echocardiography. This patient became stable under intensive care and medical treatment. This case reminds physicians that alcohol ingestion might cause AMI in HOCM patients because of increased LVOT pressure gradient and decreased coronary perfusion despite normal coronary arteries.

  2. [Reduction of in-hospital mortality and improved secondary prevention after acute myocardial infarction. First results from the registry of secondary prevention after acute myocardial infarction (SAMI)].

    Science.gov (United States)

    Tebbe, U; Messer, C; Stammwitz, E; The, G S; Dietl, J; Bischoff, K-O; Schulten-Baumer, U; Tebbenjohanns, J; Gohlke, H; Bramlage, P

    2007-07-30

    In hospital mortality of acute myocardial infarction (AMI) has been reduced due to the availability of better therapeutic strategies. But there is still a gap between mortality rates in randomised trials and daily clinical practice. Thus, it was aim of the present registry to document the course and outcome of patients with AMI and to improve patient care by implementing recent guidelines. In a nationwide registry study in hospitals in Germany with a cardiology unit or an internal medicine department data on consecutive patients were recorded for six to twelve months at admission, discharge and during a follow-up of one year. From 02/2003 until 10/2004 a total of 5,353 patients with acute myocardial infarction (65.7 % male, mean age of 67.6 +/- 17.7 years; 55.1 % of them with ST elevation myocardial infarction (STEMI) were included in the registry. Of the patients with STEMI, 76.6 % underwent acute intervention, 37.1 % had thrombolysis, 69.7 % percutaneous transluminal coronary angioplasty (PTCA). 40.0 % of those with non-Stemi (NSTEMI) had an acute intervention, 6.6 % thrombolysis, 73.5 % PTCA. Recommended secondary prevention consisted of ASS (93.2 %), beta-blockers (93.0 %), CSE-inhibitors (83.5 %), ACE-inhibitors (80.9 %) and clopidogrel (74.0 %). In-hospital mortality was 10.5 % (STEMI) and 7.4 % (NSTEMI). The 9 % mortality among patients with acute myocardial infarction treated in the hospitals participating in the SAMI registry is low compared to that in similar collectives. The high number of patients who had thrombofibrinolysis and coronary interventions as well as the early initiation of drug therapy contributed to these results. Medical treatment in the prehospital phase of these patients remains still insufficient and to a substantial extent contributes to the mortality of acute myocardial infarction.

  3. Accuracy of localization of acute myocardial infarction by 12 lead electrocardiography

    International Nuclear Information System (INIS)

    Yasuda, T.; Ribeiro, L.G.; Holman, B.L.; Alpert, J.S.; Maroko, P.R.

    1982-01-01

    Until recently, ECG accuracy in localizing acute myocardial infarction (AMI) could be assessed only by comparing the ECGs with autopsy findings. This approach, however, preselected patients, including only those who died. It is possible that this postmortem group of patients would be different from the whole population of patients with AMI. Myocardial imaging with 99 mTc-pyrophosphate offers the advantage of directly localizing the region of injured myocardium in the acute phase of AMI. In 34 patients with confirmed AMI and focal uptake of 99 mTc-pyrophosphate, serial ECGs were obtained and interpreted by two independent observers. The sensitivity and specificity of serial ECGs in determining the location of AMI in the five left ventricular (LV) wall segments were determined: (1) in the anterior wall sensitivity was 86.7% and specificity was 89.5%; (2) in the lateral wall sensitivity was 73.7% and specificity was 80.0%; (3) in the high lateral wall sensitivity was 80.0% and specificity was 87.5%; (4) in the inferior wall sensitivity was 87.5% and specificity was 100%; (5) in the true posterior wall sensitivity was 83.3% and specificity was 86.4%. Overall, in the 170 LV wall segments (five per patient) examined, scans localized with a sensitivity of 81.9% and a specificity of 88.8%. After four patients with LBBB were excluded, sensitivity increased to 87.1%. Overall, localization of AMI by serial ECG was accurate in 85.9% of the 34 patients included in the study

  4. THE SPEKL-TREKING PREDICTIVE VALUE OF THE ECHOCARDIOGRAPHY AT THE ACUTE MYOCARDIAL INFARCTION

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    N. A. Kosheleva

    2016-01-01

    Full Text Available Speckle-tracking echocardiography is a non-invasive method  for assessment of myocardial deformation, which is closely associated with its regional and global function. Although it is not yet introduced into clinical practice, deformation parameters are actively studied in different clinical conditions, particularly in acute myocardial infarction. Numerous studies show deformation  impairment may have important prognostic value at patients with a acute myocardial infarction.

  5. The electrocardiogram in acute myocardial infarction

    International Nuclear Information System (INIS)

    Lorenzo, R

    2013-01-01

    In 2006, 94 years after Eindhoven W. performed the first electrocardiogram (ECG) three derivations, J. Willis Hurst said: T he treatment of acute coronary syndrome is based entirely on electrocardiogram a normalities. Therefore, the correct interpretation of the electrocardiogram is needed now more than ever in the history of medicine.This article will address those aspects of the subject that we consider most useful for clinical cardiologists should assist patients with acute myocardial infarction (AMI) in the crucial first minutes or hours of their evolution

  6. Follow-up of regional myocardial T2 relaxation times in patients with myocardial infarction evaluated with magnetic resonance imaging

    International Nuclear Information System (INIS)

    Krauss, X.H.; Wall, E. van der; Laarse, A. van der; Dijkman, P.R.M. van; Bruschke, A.V.G.; Doornbos, J.; Roos, A. de; Voorthuisen, A.E. van

    1990-01-01

    Multi-echo spin-echo cardiac magnetic resonance imaging studies (echo times 30, 60, 90 and 120 ms) were performed in 19 patients with a 7-14-day (mean 10) old myocardial infarction and were repeated in 13 patients 4-7 months (mean 6) later. Also, 10 normal subjects were studied with magnetic resonance imaging. T2 relaxation times of certain left ventricular segments were calculated from the signal intensities at echo times of 30 and 90 ms. Compared to normal individuals, the mean T2 values on the early magnetic resonance images of the patients with inferior infarction showed significantly prolonged T2 times in the inferiorly localized segments, while on the follow-up magnetic resonance images the T2 times had almost returned to the normal range. Also the patients with anterior infarction showed significantly prolonged T2 times in the anteriorly localized segments on the early nuclear magnetic resonance images, but the T2 times remained prolonged at the follow-up magnetic resonance images. For every patient a myocardial damage score was determined, which was defined as the sum of the segmental T2 values in the patients minus the upper limit of normal T2 values obtained from the normal volunteers (= mean normal+2SD). The damage score on both the early and late magnetic resonance imaging study correlated well with the infarction size determined by myocardial enzyme release. Only the patients with an inferior infarction showed a significant decrease in damage score at follow-up magnetic resonance imaging. It is concluded that the regional T2 relaxation times are increased in infarcted myocardial regions and may remain prolonged for at least up to 7 months after the acute event, particularly in patients with an anterior infarction. These findings demonstrate the clinical potential of T2-weighted magnetic resonance imaging studies for detecting myocardial infarction, and estimating infarct size for an extended period after acute myocardial infarction. (author). 29 refs

  7. Frequency of adverse outcomes of acute myocardial infarction in patients with stress hyperglycem)a

    International Nuclear Information System (INIS)

    Shah, S.T.; Shah, C.F.A.; Shah, I.; Khan, S.B.; Hadi, A.; Gul, A.M.; Hafizullah, M.

    2012-01-01

    Objective: To determine the frequency of in-hospital adverse outcomes of acute myocardial infarction in patients with stress hyperglycemia. Methodology: This was a descriptive cross sectional study conducted from August 2010 to January 2011 in Cardiology department, Lady Reading Hospital, Peshawar. Patients of age 25-70 years, of either gender, non-diabetic with acute myocardial infarction with stress hyperglycemia were included. Random blood sugar >144 mg/dl was taken as stress hyperglycemia for patients at presentation of acute myocardial infarction. Patients were monitored for electrical complications such as atrial fibrillation, ventricular tachycardia, ventricular fibrillation and complete heart block and mechanical complications such as cardiac pulmonary edema and cardiogenic shock during hospital stay. The statistical analysis was performed using the statistical package for social sciences (SPSS Ver. 15.0). Results: A total of 341 patients having acute myocardial infarction with stress hyperglycemia were studied. The mean age was 56.35 +- 9.748 (95% CI 57.39 - 55.31). Male were 58.1% (n=198). The frequency of various major in-hospital electrical adverse outcomes of acute myocardial infarction with stress hyperglycemia were atrial fibrillation (AF) 15.8%, ventricular tachycardia (VT) 11.7%, ventricular fibrillation (VF) 10.9% and complete heart block (CHB) 6.7%, while mechanical adverse outcomes were cardiac pulmonary edema (CPE) 7.9% and cardiogenic shock (CS) 11.7%. Conclusion: Stress hyperglycemia has adverse impact on outcomes of patients presenting with acute myocardial infarction. Among electrical and mechanical complications of acute myocardial infarction in patients with stress hyperglycemia, the two most frequent in-hospital adverse outcomes were atrial fibrillation and cardiogenic shock, respectively. (author)

  8. Early detection of myocardial infarction following blunt chest trauma by computed tomography: a case report.

    Science.gov (United States)

    Lee, Thung-Lip; Hsuan, Chin-Feng; Shih, Chen-Hsiang; Liang, Huai-Wen; Tsai, Hsing-Shan; Tseng, Wei-Kung; Hsu, Kwan-Lih

    2017-02-10

    Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy. Here we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting. Perfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation.

  9. Acute Myocardial Infarction: The First Manifestation of Ischemic Heart Disease and Relation to Risk Factors

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    Manfroi Waldomiro Carlos

    2002-01-01

    Full Text Available OBJECTIVE: To assess the association between cardiovascular risk factors and acute myocardial infarction as the first manifestation of ischemic heart disease, correlating them with coronary angiographic findings. METHODS: We carried out a cross-sectional study of 104 patients with previous acute myocardial infarction, who were divided into 2 groups according to the presence or absence of angina prior to acute myocardial infarction. We assessed the presence of angina preceding acute myocardial infarction and risk factors, such as age >55 years, male sex, smoking, systemic arterial hypertension, lipid profile, diabetes mellitus, obesity, sedentary lifestyle, and familial history of ischemic heart disease. On coronary angiography, the severity of coronary heart disease and presence of left ventricular hypertrophy were assessed. RESULTS: Of the 104 patients studied, 72.1% were males, 90.4% were white, 73.1% were older than 55 years, and 53.8% were hypertensive. Acute myocardial infarction was the first manifestation of ischemic heart disease in 49% of the patients. The associated risk factors were systemic arterial hypertension (RR=0.19; 95% CI=0.06-0.59; P=0.04 and left ventricular hypertrophy (RR=0.27; 95% CI=0,.8-0.88; P=0.03. The remaining risk factors were not statistically significant. CONCLUSION: Prevalence of acute myocardial infarction as the first manifestation of ischemic heart disease is high, approximately 50%. Hypertensive individuals more frequently have symptoms preceding acute myocardial infarction, probably due to ventricular hypertrophy associated with high blood pressure levels.

  10. Usefulness of BMIPP SPECT to evaluate myocardial viability, contractile reserve and coronary stenotic progression after reperfusion in acute myocardial infarction

    International Nuclear Information System (INIS)

    Katsunuma, Eita; Kurokawa, Shingo; Takahashi, Motoi; Fukuda, Naoto; Kurosawa, Toshiro; Izumi, Tohru

    2001-01-01

    Using combined 123 I-BMIPP (BMIPP), 201 Tl (Tl) and 99m Tc-PYP (PYP) myocardial SPECT imaging, risk areas of acute myocardial infarction were documented in the acute stage, and then these images were evaluated for how well they reflected muscle viability, contractile reserve and coronary stenotic progression subsequent to reperfusion therapy. Patients who only experienced a first attack of myocardial infarction were enrolled. In total, 36 cases who had had the occluded artery successfully reperfused were examined during the past year. They had no significant vessel disease except for the culprit single artery. The patients were comprised of 32 men and 4 women. The mean age was 59.5 years. All patients underwent coronary angiography and left ventricular (LV) angiography in the emergency room. BMIPP/Tl and PYP myocardial SPECT were conducted in the acute stage and chronic stage. In the chronic stage LV angiography was repeated to assess the improvement of LV wall motion. The response to postextrasystolic potentiation (PESP) testing was performed to estimate myocardial contractile reserve. The risk area of acute myocardial infarction (AMI) was documented by reduced BMIPP accumulation. The size of reduced BMIPP accumulation was larger than that of PYP accumulation. A BMIPP/Tl discrepancy and PYP accumulation were documented to assess myocardial viability. Both improvement in LV wall motion and augmentation of PESP response were more closely related to a BMIPP/Tl discrepancy in the presence or absence of PYP accumulation. Therefore, it would be possible to evaluate myocardial viability and contractile reserve by the BMIPP/Tl discrepancy. In patients with good viability, it is important to predict whether there is coronary stenotic progression or not. In this study, we demonstrated that most patients with improved BMIPP images had no significant progression at the site of intervention. Serial observation of BMIPP images from the acute stage to the chronic stage might

  11. Implantation of stem cells in the treatment of acute myocardial infarction

    International Nuclear Information System (INIS)

    Obregon Santos, Angel; Wilford de Leon, Mario; Aroche Aportela, Ronald; Isla Garcia, Rosa; Conde Cerdeira, Hector; Vila Garcia, Elena

    2007-01-01

    A lot of investigations demonstrate the possibility of regeneration of the cardiomiocity from stem cells. A longitudinal, prospective, observational study was conducted in patients with acute myocardial infarction in CIMEQ'S hospital since January 2004 up to January 2007 with the purpose to evaluate the security and efficacy of the intracoronary transfer of autologous bone-marrow-cells during acute myocardial infarction. Patients within seven days of the onset of symptoms of a first ST-segment elevation myocardial infarction, and between 18 and 70 years old. The patients are evaluated previous to apply the procedure and 6 months for clinic, electrocardiography, echocardiography, ergometry and coronariography. The drug eluting stent is placed on the culprit lesion and the bone marrow is stimulated with granulocyte colony-stimulating factor (G-CSF). The mononuclear's cells which are obtained have been implanted using the intracoronary way. The implantation by means of the intracoronary way of stem cells, after of stimulation of bone marrow during acute myocardial infarction demonstrated to be an effective and safety procedure

  12. Histochemical and immunohistochemical analyses of the myocardial scar fallowing acute myocardial infarction

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    Tatić Vujadin

    2012-01-01

    Full Text Available Background/Aim. The heart has traditionally been considered as a static organ without capacity of regeneration after trauma. Currently, the more and more often asked question is whether the heart has any intrinsic capacities to regenerate myocytes after myocardial infarction. The aim of this study was to present the existence of the preserved muscle fibers in the myocardial scar following myocardial infarction as well as the presence of numerous cells of various size and form that differently reacted to the used immunohistochemical antibodies. Methods. Histological, histochemical and immunohistochemical analyses of myocardial sections taken from 177 patients who had died of acute myocardial infarction and had the myocardial scar following myocardial infarction, were carried out. More sections taken both from the site of acute infarction and scar were examined by the following methods: hematoxylin-eosin (HE, periodic acid schiff (PAS, PAS-diastasis, Masson trichrom, Malory, van Gieson, vimentin, desmin, myosin, myoglobin, alpha actin, smoth muscle actin (SMA, p53, leukocyte common antigen (LCA, proliferating cell nuclear antigen (PCNA, Ki-67, actin HHF35, CD34, CD31, CD45, CD45Ro, CD8, CD20. Results. In all sections taken from the scar region, larger or smaller islets of the preserved muscle fibers with the signs of hypertrophy were found. In the scar, a large number of cells of various size and form: spindle, oval, elongated with abundant cytoplasm, small with one nucleus and cells with scanty cytoplasm, were found. The present cells differently reacted to histochemical and immunohistochemical methods. Large oval cells showed negative reaction to lymphocytic and leukocytic markers, and positive to alpha actin, actin HHF35, Ki-67, myosin, myoglobin and desmin. Elongated cells were also positive to those markers. Small mononuclear cells showed positive reaction to lymphocytic markers. Endothelial and smooth muscle cells in the blood vessel walls

  13. Right Ventricular Involvement in either Anterior or Inferior Myocardial Infarction

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    Firoozeh Abtahi

    2016-06-01

    Full Text Available Background: Unlike left ventricular function, less attention has been paid to Right Ventricular (RV function after Myocardial Infarction (MI. Objectives: The current study aimed to compare RV function in patients with inferior and anterior MI. Patients and Methods: During the study period, 60 patients consecutively presented to the Emergency Department with chest pain were divided into two groups based on their electrocardiographic findings. Accordingly, 25 patients had inferior MI (IMI group and 35 ones had anterior MI (AMI group. Echocardiography was performed 48 hours after starting the standard therapy. Conventional echocardiographic parameters and Tissue Doppler Imaging (TDI measurements were acquired from the standard views. Student t-test and the chi-square test were respectively used for comparisons of the normally distributed continuous and categorical variables in the two groups. Besides, P < 0.05 was considered to be statistically significant.

  14. Simultaneous right coronary artery spasm in a patient with Anterior ST-Segment Elevation Myocardial Infarction: a case report

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    Zhiva Taherpour

    2013-05-01

    Full Text Available Please cite this article as: Taherpour Z, Seyedian M, Alasti M. Simultaneous right coronary artery spasm in a patient with Anterior ST-Segment Elevation Myocardial Infarction: a case report. Novel Biomed 2013;1:29-33.Simultaneous occlusion of two vessels causing infarction at different territories is an uncommon finding. We report simultaneous right ventricular and anterior ST-segment elevation myocardial infarction in a previously healthy young man.The angiographic results demonstrated the simultaneous occlusion of the right and left coronary arteries because of simultaneous occlusion of left anterior descending artery (LADA and spasm of right coronary artery (RCA. In this patient, we found simultaneous ST elevations in right and precordial leads so everyone should be careful about all leads of the surface electrocardiogram for decision making in the management of a patient.

  15. Inferior ST-Elevation Myocardial Infarction Associated with Takotsubo Cardiomyopathy

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    Oliver Koeth

    2010-01-01

    Full Text Available Takotsubo cardiomyopathy (TCM is usually characterized by transient left ventricular apical ballooning. Due to the clinical symptoms which include chest pain, electrocardiographic changes, and elevated myocardial markers, Takotsubo cardiomyopathy is frequently mimicking ST-elevation myocardial infarction in the absence of a significant coronary artery disease. Otherwise an acute occlusion of the left anterior descending coronary artery can produce a typical Takotsubo contraction pattern. ST-elevation myocardial infarction (STEMI is frequently associated with emotional stress, but to date no cases of STEMI triggering TCM have been reported. We describe a case of a female patient with inferior ST-elevation myocardial infarction complicated by TCM.

  16. Effects on infarct size and left ventricular function of early intravenous injection of anistreplase in acute myocardial infarction. The APSIM Study Investigators.

    Science.gov (United States)

    Bassand, J P; Bernard, Y; Lusson, J R; Machecourt, J; Cassagnes, J; Borel, E

    1990-03-01

    A total of 231 patients suffering from a first acute myocardial infarction were randomly allocated within 4 hours following the onset of symptoms either to anistreplase or anisoylated plasminogen streptokinase activator complex (APSAC), 30 U over 5 minutes, or to conventional heparin therapy, 5000 IU in bolus injection. Heparin was reintroduced in both groups 4 h after initial therapy at a dosage of 500 IU/kg per day. A total of 112 patients received anistreplase and 119 received heparin within a mean period of 188 +/- 62 min following the onset of symptoms. Infarct size was estimated from single photon emission computerized tomography and expressed in percentage of the total myocardial volume. The patency rate of the infarct-related artery was 77% in the anistreplase group and 36% in the heparin group (p less than 0.001). Left ventricular ejection fraction determined from contrast angiography was significantly higher in the anistreplase group than in the heparin group (6 absolute percentage point difference). A significant 31% reduction in infarct size was found in the anistreplase group (33% for the anterior wall infarction subgroup [p less than 0.05] and 16% for the inferior wall infarction subgroup, NS). A close inverse relation was found between the values of left ventricular ejection fraction and infarct size (r = -.73, p less than 0.01). In conclusion, early infusion of anistreplase in acute myocardial infarction produced a high early patency rate, a significant limitation of infarct size, and a significant preservation of left ventricular systolic function, mainly in the anterior wall infarctions.

  17. Protective effect of active perfusion in porcine models of acute myocardial ischemia

    Science.gov (United States)

    Feng, Zanxiang; Mao, Zhifu; Dong, Shengjun; Liu, Baohui

    2016-01-01

    Mortality rates associated with off-pump coronary artery bypass (CAB) are relatively high, as the majority of patients requiring CAB are at a high risk for cardiac events. The present study aimed to establish porcine models of acute myocardial ischemia, and evaluate the protective role of shunt and active perfusion. A total of 30 pigs were randomly assigned to five groups, as follows: i) Sham (control); ii) A1 (shunt; stenosis rate, 55%); iii) A2 (shunt; stenosis rate, 75%); iv) B1 (active perfusion; stenosis rate, 55%); and v) B2 (active perfusion; stenosis rate, 75%) groups. Aortic pressure (P0), left anterior descending coronary pressure (P1), and coronary effective perfusion pressure (P1/P0) were measured. The expression levels of tumor necrosis factor-α (TNF-α), cardiac troponin (cTnI), creatine kinase-myocardial band (CK-MB), interleukin (IL)-6, IL-10, B-cell lymphoma 2 (Bcl-2), and caspase-3 were detected using enzyme-linked immunosorbent assay or western blotting. The myocardial apoptosis rate was determined using the terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Ischemia models with stenosis rates of 55 and 75% were successfully constructed following suturing of the descending artery. Compared with the control, the 55 and 75% stenosis groups demonstrated significantly decreased P1/P0, increased expression levels of TNF-α, cTnI, CK-MB, IL-6, IL-10 and caspase-3, an increased rate of myocardial apoptosis, and a decreased expression level of anti-apoptotic protein, Bcl-2. At 30 min following successful establishment of the model (ST segment elevation to 1 mm), group B demonstrated significantly increased P1/P0, decreased expression levels of TNF-α, cTnI, CK-MB, IL-6, IL-10 and caspase-3, a decreased rate of myocardial apoptosis, and an increased expression level of anti-apoptotic protein, Bcl-2. Furthermore, the current study indicated that active perfusion was more efficacious in maintaining myocardial perfusion and alleviating

  18. Comparison between young males and females with acute myocardial infarction

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    Ricardo Augusto Slaibi Conti

    2002-11-01

    Full Text Available OBJECTIVE: To assess the differences between young males and females after acute myocardial infarction. METHODS: We retrospectively studied 236 patients (54 females and 182 males after acute myocardial infarction and during hospital stay assessed the following parameters: risk factors; the treatment used; the pattern of coronary artery obstruction; left ventricular ejection fraction; complications; and, using a logistic regression model, the factors related to the occurrence of reinfarction and death. RESULTS: No significant difference was observed between the sexes in risk factors, pattern of coronary artery obstruction, and left ventricular function. The time interval between symptom onset and treatment was longer in females (p=0.03, who underwent thrombolysis (p=0.01 and angioplasty (p=0.03 less frequently than males did, but not myocardial revascularization. Female sex (OR = 5.98 and diabetes (OR = 14.52 were independent factors related to the occurrence of reinfarction and death. CONCLUSION: Young males and females after acute myocardial infarction did not differ in coronary risk factors, and clinical and hemodynamic characteristics. Females had their treatment started later, and they underwent chemical thrombolysis and angioplasty less frequently than males did. Female sex and diabetes were related to the occurrence of reinfarction and death.

  19. Changes of blood and myocardial tissue contents of IGF-I after development of acute myocardial infarction in rat models

    International Nuclear Information System (INIS)

    Cao Heng; Wei Youquan

    2006-01-01

    Objective: To study the changes of IGF-I contents in blood and myocardium after experimental acute myocardial infarction in rat models. Methods: Rat models of acute myocardial infarction were prepared with intraperitoneal injection of isoproterenol. Eight models were sacrificed 48h later and another 8 models were sacrificed 14 days after preparation. Serum and myocardium homogenate contents of IGF-I were measured with RIA in these models as well as 8 control rats. Results: The serum and myocardial contents of IGF-I increased in the models sacrificed at 48h, but were not significantly higher than those in the controls (P>0.05). At 14 th day, the levels were significantly higher than those in controls and at 48h (both P<0.05). The serum and myocardial contents of IGF-I were mutually correlated in the controls and 14 day models (r=0.9987, r=0.9992; P<0.01). Conclusion After myocardial infarction, the serum and myocardial IGF-I contents increased along with the course of disease in the rat models. (authors)

  20. A CLINICAL CASE OF ACUTE ALLERGIC MYOCARDITIS SIMULATING MYOCARDIAL INFARCTION

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    N. A. Shostak

    2015-01-01

    Full Text Available Objective: to describe a clinical case of evolving acute eosinophilic myocarditis simulating coronary heart disease. Subjects and methods. Patient B. aged 62 years was admitted to Intensive Care Unit Fifteen, N.I. Pirogov First Moscow City Clinical Hospital, by being transferred from Thailand with a referral diagnosis of acute myocardial infarction made on November 1, 2012, with complaints of pressing and aching heart pains. At a Phuket hospital, his electrocardiogram recorded atrial fibrillation; indirect cardiac massage, electric pulse therapy, and mechanical ventilation were performed. After being admitted to the N.I. Pirogov First Moscow City Clinical Hospital, the patient underwent examination: estimation of laboratory indicators over time, electrocardiography (ECG, echocardiography, Holter ECG monitoring, and myocardial scintigraphy. Results. The patient had a history of an allergic reaction as urticaria to the ingestion of fish products. His examination showed practically all diagnostic criteria for allergic myocarditis: hypereosinophilia (the admission level of eosinophils was 9% with their further normalization; the characteristic clinical presentation of myocarditis (pressing retrosternal pain; elevated levels of cardiac specific enzymes (creatinine phosphokinase-MB, lactate dehydrogenase, troponin T; ECG changes – myocardial hypokinesis in the acute period, followed by its pattern normalization. of the pattern. Myocardial scintigraphy (by taking into account the fact that the patient had had a new allergic reaction episode, the investigators decided not to perform coronary angiography revealed decreased radiopharmaceutical accumulation in the lower left ventricular wall in the right coronary arterial bed; perfusion remained in the other myocardial walls. Conclusion. This clinical case reflects the specific features of the course of and difficulties in the diagnosis of acute allergic myocarditis that, in most cases, has no specific

  1. Monitoring of myocardial edema following acute myocardial infarction

    International Nuclear Information System (INIS)

    Tahir, E.; Sinn, M.; Avanesov, M.; Wien, J.; Saering, D.; Stehning, C.; Radunski, U. K.; Muellerleile, K.; Adam, G.; Lund, G. K.

    2015-01-01

    Full text: Currently, myocardial edema monitoring after acute myocardial infarction (AMI) is based on visualization of the region with increased signal-intensity on T2-weighted images. Native T1 and T2 mapping are promising novel MRI techniques to quantitatively assess myocardial edema. The purpose of the study was to quantitatively evaluate resorption of myocardial edema following AMI by native T1 and T2 -mapping cardiac magnetic resonance imaging (CMR). CMR (1.5 Tesla Philips Achieva) was performed in 30 patients four times after reperfused AMI at baseline (BL) at 9±6 days after infarction and at 7±1 weeks (follow-up 1, FU1), 3.6±0.5 months (FU2) and 6.5±0.7 months (FU3), respectively. Edema sensitive black-blood T2-weighted (T2w) STIR CMR was performed on end-diastolic LV short-axes. A free-breathing, navigatorgated multi-echo sequence was used for short-axis T2 mapping. T1 mapping was performed using the modified look-locker inversion recovery (MOLLI) sequence. T2 maps were calculated from nine and T1 maps from eight echoes using a dedicated plug-in written for OsiriX software. Two experienced observers independently evaluated T2w-CMR as well as T1 and T2 mapping using the HeAT-Software applying a threshold method. Size of edema and prolongation of the native T1- or T2-time was measured using a cutoff >2SD of remote normal myocardium. Edema size continuously decreased from BL with 32.8 %LV to 24.6 %LV at FU1, to 19.1 %LV at FU2 and to 16.4 %LV at FU3 using T2w-CMR. An almost identical decrease of edema size was observed using native T1 and T2 - mapping. T2 times only decreased between BL from 79±5 ms to 73±2 ms at FU1 (P<0.05), but no further change was observed at later time points with 70±5 ms at FU2 and 70±6 ms at FU3. At all time points the T2 times of remote normal myocardium were about 50±2 ms and significantly lower compared to the edema zone. Also native T1 time within the edema was with 1253 ±103 ms significantly increased compared to remote

  2. Abrupt opium discontinuation has no significant triggering effect on acute myocardial infarction.

    Science.gov (United States)

    Masoomi, Mohammad; Zare, Jahangir; Nasri, Hamidreza; Mirzazadeh, Ali; Sheikhvatan, Mehrdad

    2011-04-01

    A deleterious effect of withdrawal symptoms due to abrupt discontinuation of opium on the cardiovascular system is one of the recent interesting topics in the cardiovascular field. The current study hypothesized that the withdrawal syndrome due to discontinuing opium might be an important trigger for the appearance of acute myocardial infarction. Eighty-one opium-addicted individuals who were candidates for cardiovascular clinical evaluation and consecutively hospitalized in the coronary care unit (CCU) ward of Shafa Hospital in Kerman between January and July 2009 were included in the study and categorized in the case group, including patients experiencing withdrawal symptoms within 6-12 h after the reduced or discontinued use of opium according to the Diagnostic and Statistical Manual of Mental Disorders-revised IV version (DSM-IV-R) criteria for opium dependence and withdrawal, and the control group, without opium withdrawal symptoms. The appearance of acute myocardial infarction was compared between the two groups using multivariable regression models. Acute myocardial infarction occurred in 50.0% of those with withdrawal symptoms and in 45.1% of patients without evidence of opium withdrawal (P = 0.669). Multivariable analysis showed that opium withdrawal symptoms were not a trigger for acute myocardial infarction adjusting for demographic characteristics, marital status, education level and common coronary artery disease risk profiles [odds ratio (OR) = 0.920, 95% confidence interval (CI) = 0.350-2.419, P = 0.866]. Also, daily dose of opium before reducing or discontinuing use did not predict the appearance of myocardial infarction in the presence of confounder variables (OR = 0.975, 95% CI = 0.832-1.143, P = 0.755). Withdrawal syndrome due to abrupt discontinuation of opium does not have a triggering role for appearance of acute myocardial infarction.

  3. Geographic variation in the treatment of acute myocardial infarction in the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial

    DEFF Research Database (Denmark)

    Reed, Shelby D; McMurray, John J V; Velazquez, Eric J

    2006-01-01

    BACKGROUND: The VALIANT trial compared the efficacy and safety of captopril, valsartan, and their combination in patients with left ventricular systolic dysfunction, heart failure, or both after acute myocardial infarction (MI). By examining this international trial population of high-risk patients...

  4. Impact of obesity on long-term prognosis following acute myocardial infarction

    DEFF Research Database (Denmark)

    Kragelund, Charlotte; Hassager, Christian; Hildebrandt, Per

    2005-01-01

    diabetes and hypertension. In both men and women, there was no association between obesity assessed as BMI and mortality [men: adjusted RR=0.99 (0.85-1.14, p=0.3); women: adjusted RR=0.90 (0.74-1.10, p=0.2)]. Men with WHR in the upper quartile had an increased mortality [adjusted RR=1.21 (1.07-1.37, p....01)]. Increasing WHR in women showed a trend of increased mortality, although this was not significant [adjusted RR=1.13 (0.95-1.34, p=0.2)]. CONCLUSION: In patients with acute myocardial infarction overall obesity as assessed by body mass index is inversely related to mortality. However, abdominal obesity appears......OBJECTIVE: To evaluate the impact of obesity on mortality in patients with acute myocardial infarction. METHODS: This study comprises 6676 consecutive patients with acute myocardial infarction screened for entry into the Danish Trandolapril Cardiac Evaluation (TRACE) study. At baseline, body mass...

  5. Lipoprotein lipase gene variants: Association with acute myocardial ...

    African Journals Online (AJOL)

    Mahyar Bahrami

    2015-05-13

    May 13, 2015 ... ated with acute myocardial infarction but with triglyceride levels. У 2015 The ... C) and low levels of high-density lipoprotein cholesterol. (HDL-C) are .... relationship between LDL, HDL, cholesterol and TG levels with LPL ...

  6. DISFUNCIÓN DIASTÓLICA EN EL INFARTO AGUDO DE MIOCARDIO / Diastolic dysfunction in acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Norge Ramón Lara Pérez

    2010-03-01

    Full Text Available Introduction and objectives: Ischemic heart disease is among the first causes of disability and death in the world. The acute myocardial infarction alters considerably the myocardial relaxation. The echocardiogram is a useful, economic and harmless method to assess diastolic function in these patients; that is why the aim of the study was to characterize the behavior of this left ventricular function by means of an echocardiography. Methods: an observational descriptive study was carried out with 91 patients with myocardial infarction who were hospitalized at the Cardiology Ward of the Arnaldo Milian Castro Provincial University Hospital in Santa Clara during 2008. An echocardiogram was performed between the fifth and the seventh day of evolution, and the patterns of diastolic function were compared with other variables. Results: There was a prevalence of the male sex (74,7 %, the infarctions without ST segment elevation were more frequent (83,1 % – which showed a bigger alteration of the relaxation, much more when the anterior and lateral walls of the left ventricle were involved. The presence of complications was linked to a bigger alteration of the relaxation, and the most associate ones were the contractile dysfunction and malignant arrhythmias. The decrease of the ejection fraction was linked to (p = 0,000 the prolongation of the relaxation. Conclusions: There was a prevalence of the infarction without ST segment elevation. It was more frequent in the male sex and it was associated with a higher level of alteration of the relaxation. The infarctions with anterior or lateral location, and those which caused complications, presented a higher level of this alteration. All patients with a reduced ejection fraction had relaxation disorders.

  7. Correlation between Left Ventricular Global and Regional Longitudinal Systolic Strain and Impaired Microcirculation in Patients with Acute Myocardial Infarction

    DEFF Research Database (Denmark)

    Løgstrup, Brian B; Høfsten, Dan Eik; Christophersen, Thomas Brøcher

    2012-01-01

    investigated if LRS and GLS imaging is superior to conventional measures of left ventricle (LV) function. Methods: In a consecutive population of first time AMI patients, who underwent successful revascularization, we performed comprehensive TTE. GLS and LRS were obtained from the three standard apical views...... elevation myocardial infarction. The GLS was -15.2 [-19.3;-10.1]% in the total population of 183 patients. Total wall motion score index (WMSI) in the population was 1.19 [1;1.5]. Eighty-five patients suffered from culprit lesion in left anterior descending artery (LAD). The CFR in these patients was 1......Objectives: We investigated the correlation between left ventricular global and regional longitudinal systolic strain (GLS and LRS) and coronary flow reserve (CFR) assessed by transthoracic echocardiography (TTE) in patients with a recent acute myocardial infarction (AMI). Furthermore, we...

  8. Exosomes Derived from Human Umbilical Cord Mesenchymal Stem Cells Relieve Acute Myocardial Ischemic Injury

    Directory of Open Access Journals (Sweden)

    Yuanyuan Zhao

    2015-01-01

    Full Text Available This study is aimed at investigating whether human umbilical cord mesenchymal stem cell- (hucMSC- derived exosomes (hucMSC-exosomes have a protective effect on acute myocardial infarction (AMI. Exosomes were characterized under transmission electron microscopy and the particles of exosomes were further examined through nanoparticle tracking analysis. Exosomes (400 μg protein were intravenously administrated immediately following ligation of the left anterior descending (LAD coronary artery in rats. Cardiac function was evaluated by echocardiography and apoptotic cells were counted using TUNEL staining. The cardiac fibrosis was assessed using Masson’s trichrome staining. The Ki67 positive cells in ischemic myocardium were determined using immunohistochemistry. The effect of hucMSC-exosomes on blood vessel formation was evaluated through tube formation and migration of human umbilical vein endothelial cells (EA.hy926 cells. The results indicated that ligation of the LAD coronary artery reduced cardiac function and induced cardiomyocyte apoptosis. Administration of hucMSC-exosomes significantly improved cardiac systolic function and reduced cardiac fibrosis. Moreover, hucMSC-exosomes protected myocardial cells from apoptosis and promoted the tube formation and migration of EA.hy926 cells. It is concluded that hucMSC-exosomes improved cardiac systolic function by protecting myocardial cells from apoptosis and promoting angiogenesis. These effects of hucMSC-exosomes might be associated with regulating the expression of Bcl-2 family.

  9. Scintigraphic evaluation of suspected acute myocardial infarction

    International Nuclear Information System (INIS)

    Kan, M.K.; Hopkins, G.B.; Carroll, C.F.X.

    1977-01-01

    Ninety-one patients with chest pain suggestive of acute myocardial infarction were studied by static technetium /sup 99m/Tc stannous pyrophosphate scintigraphy and dynamic sodium pertechnetate /sup 99m/Tc cardioangiography. Twenty-three of 26 patients (88%) with acute transmural infarcts and 12 of 17 patients (71%) with nontransmural infarcts had abnormal static studies. In 45 patients with negative scintigrams, ECG or serum enzyme changes consistent with acute infarction failed to develop. Three false-positive static studies (6%) were recorded. Twenty of 43 (47%) patients with acute infarction had hemodynamic or structural abnormalities identified by cardioangiography. The dynamic study also proved helpful in localizing the site of infarction and in ruling out certain causes of false-positive static scintigrams

  10. Differential expression of myocardial heat shock proteins in rats acutely exposed to fluoride.

    Science.gov (United States)

    Panneerselvam, Lakshmikanthan; Raghunath, Azhwar; Perumal, Ekambaram

    2017-09-01

    Acute fluoride (F - ) toxicity is known to cause severe cardiac complications and leads to sudden heart failure. Previously, we reported that increased myocardial oxidative damage, apoptosis, altered cytoskeleton and AMPK signaling proteins associated with energy deprivation in acute F - induced cardiac dysfunction. The present study was aimed to decipher the status of myocardial heat shock proteins (Hsps-Hsp27, Hsp32, Hsp40, Hsp60, Hsp70, Hsp90) and heat shock transcription factor 1 (Hsf1) in acute F - -intoxicated rats. In order to study the expression of myocardial Hsps, male Wistar rats were treated with single oral doses of 45 and 90 mg/kg F - for 24 h. The expression levels of myocardial Hsps were determined using RT-PCR, western blotting, and immunohistochemical studies. Acute F - -intoxicated rats showed elevated levels of both the transcripts and protein expression of Hsf1, Hsp27, Hsp32, Hsp60, and Hsp70 when compared to control. In addition, the expression levels of Hsp40 and Hsp90 were significantly declined in a dose-dependent fashion in F - -treated animals. Our result suggests that differential expression of Hsps in the rat myocardium could serve as a balance between pro-survival and death signal during acute F - -induced heart failure.

  11. Comparison of two surgical techniques for creating an acute myocardial infarct in rats

    Directory of Open Access Journals (Sweden)

    Luiz Guilherme Achcar Capriglione

    2014-12-01

    Full Text Available Objective: To perform a comparative assessment of two surgical techniques that are used creating an acute myocardial infarc by occluding the left anterior descending coronary artery in order to generate rats with a left ventricular ejection fraction of less than 40%. Methods: The study was completely randomized and comprised 89 halothane-anaesthetised rats, which were divided into three groups. The control group (SHAM comprised fourteen rats, whose left anterior descending coronary artery was not occluded. Group 1 (G1: comprised by 35 endotracheally intubated and mechanically ventilated rats, whose left anterior descending coronary artery was occluded. Group 2 (G2: comprised 40 rats being manually ventilated using a nasal respirator whose left anterior descending coronary artery was occluded. Other differences between the two techniques include the method of performing the thoracotomy and removing the pericardium in order to expose the heart, and the use of different methods and suture types for closing the thorax. Seven days after surgery, the cardiac function of all surviving rats was determined by echocardiography. Results: No rats SHAM group had progressed to death or had left ventricular ejection fraction less than 40%. Nine of the 16 surviving G1 rats (56.3% and six of the 20 surviving G2 rats (30% had a left ventricular ejection fraction of less than 40%. Conclusion: The results indicate a tendency of the technique used in G1 to be better than in G2. This improvement is probably due to the greater duration of the open thorax, which reduces the pressure over time from the surgeon, allowing occlusion of left anterior descending coronary artery with higher accuracy.

  12. PSYCHOLOGICAL REACTIONS AND HEALTH BEHAVIOR FOLLOWING ACUTE MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    Tatjana Milenković

    2011-06-01

    Full Text Available Psychological reactions, risk health behavior and cardiac parameters can influence rehospitalization after acute myocardial infarction.The aim of the paper was to determine the presence of psychological reactions and risk health behavior in patients with acute myocardial infarction on admission as well as the differences after six months.The research included thirty-trhee patients of both sexes, who were consecutively hospitalized due to acute myocardial infarction. A prospective clinical investigation involved the following: semi-structured interview, Mini International Neuropsychiatric Interview (M.I.N.I for pcychiatric disorders, Beck Anxiety Inventory (BAI for measuring the severity of anxiety, Beck Depression Inventory (BDI for measuring the severity of depression, KON-6 sigma test for aggression, Holms-Rahe Scale (H-R for exposure to stressful events, and Health Behavior Questionnaire: alcohol consumption, cigarette smoking, lack of physical activity. Measurement of the same parameters was done on admission and after six months. The differences were assessed using the t-test and chi-square test for p<0.05.On admission, anxiety (BAI=8.15±4.37 and depression (BDI=8.67±3.94 were mild without significant difference after six months in the group of examinees. Aggression was elevated and significantly lowered after six monts (KON-6 sigma =53,26±9, 58:41,42±7.67, t=2,13 for p<0.05. Exposure to stressful events in this period decreased (H-R=113.19±67.37:91,65±63,81, t=3,14 for p<0.05; distribution of physical activity was significantly higher compared to admission values (54.83%: 84.84%. χ2=5.07 for p<0.01.In the group of examinees with acute myocardial infarction in the period of six months, anxiety and depression remained mildly icreased, while the levels of aggression and exposure to stressful events were lowered. Risk health behavior was maintained, except for the improvement in physical activity. In the integrative therapy and

  13. Acute myocardial infarction after mediastinal radiotherapy

    International Nuclear Information System (INIS)

    Gagliardi, Juan; Tezanos Pinto, Miguel; Avalos, Adolfo; Sarubbi, Augusto; Padilla, Lucio; Espinosa, Daniel

    2004-01-01

    Mediastinal radiotherapy can affect the heart and great vessels to different degrees. It may turn up as coronary heart disease and less frequently as acute myocardial infarction. We report the case of a patient without coronary risk factors and an antecedent of mediastinal radiotherapy for Hodgkin's lymphoma. Considerations about mediastinal radiation as a risk factor for early development of coronary heart diseases are exposed. (author) [es

  14. Comparison of anxiety between smokers and nonsmokers with acute myocardial infarction.

    Science.gov (United States)

    Sheahan, Sharon L; Rayens, Mary K; An, Kyungeh; Riegel, Barbara; McKinley, Sharon; Doering, Lynn; Garvin, Bonnie J; Moser, Debra K

    2006-11-01

    Increased anxiety correlates with increased complications after acute myocardial infarction. Anxiety levels and use of anxiolytic agents have not been compared between smokers and nonsmokers hospitalized because of acute myocardial infarction. To compare anxiety level, sociodemographic factors, and clinical variables between smokers and nonsmokers hospitalized with acute myocardial infarction and to examine predictors of use of beta-blockers and anxiolytic agents among smokers and nonsmokers. Secondary data analysis of a prospective multisite study on anxiety in 181 smokers and 351 nonsmokers with acute myocardial infarction. Anxiety was measured by using the State Trait Anxiety Inventory and the anxiety subscale of the Basic Symptom Inventory within 72 hours of admission. Smokers reported higher anxiety levels than nonsmokers reported on both anxiety scales. Female smokers reported the highest anxiety and peak pain levels of all, yet women were the least likely to receive anxiolytic agents. Smoking status was not a predictor for anxiety level when sex, peak pain, use of beta-blockers in the hospital, and age were controlled for. However, smokers were twice as likely as nonsmokers to receive an anxiolytic agent and 60% more likely to receive a beta-blocker in the emergency department, and smokers were 80% more likely than nonsmokers to receive an anxiolytic agent during hospitalization when these variables were controlled. Older female smokers are at risk for complications because they are older than their male counterparts and less likely to receive beta-blockers and antianxiety medications in the emergency department.

  15. A Case of Post Myocardial Infarction Papillary Muscle Rupture.

    Science.gov (United States)

    Anuwatworn, Amornpol; Milnes, Christopher; Kumar, Vishesh; Raizada, Amol; Nykamp, Verlyn; Stys, Adam

    2016-06-01

    Papillary muscle rupture is a rare, life-threatening post myocardial infarction mechanical complication. Without surgical intervention, prognosis is very poor. Clinicians need to recognize this complication early, as prompt therapy is crucial. We present a case of inferior ST elevation myocardial infarction complicated by posteromedial papillary muscle rupture resulting in severe acute mitral regurgitation (flail anterior mitral leaflet), acute pulmonary edema and cardiogenic shock. In our patient, a new mitral regurgitation murmur suggested this mechanical complication. Complete disruption of papillary muscle was visualized by transesophageal echocardiography. This case illustrates the importance of good physical examination for early diagnosis of papillary muscle rupture, so that life-saving treatment can be administered without delay.

  16. Creatine kinase radioimmunoassay and isoenzyme electrophoresis compared in the diagnosis of acute myocardial infarction

    International Nuclear Information System (INIS)

    Homburger, H.A.; Jacob, G.L.

    1980-01-01

    We compared, in 116 patients, the relative usefulness of results of tests for creatine kinase B-isoenzymes, as measured by radioimmunoassay, and the MB isoenzyme, as measured by electrophoresis, in diagnosis of acute myocardial infarction. The radioimmunoassay was specific for isoenzymes of creatine kinase containing the B subunit. All patients with acute transmural infarcts had positive test results by both techniques, but concentrations of B-isoenzymes were more frequently above normal than were MB bands in the case of patients with acute subendocardial infarcts and in the case of all patients with acute myocardial infarcts from whom sera were collected more than 24 h after onset of chest pain. Concentrations of B-isoenzymes also were increased, even when MB bands were not electrophoretically detectable in specimens from several patients without documented acute myocardial infarcts. These abnormal results presumably were caused by increased concentrations of the BB isoenzyme in serum. Accordingly, an increased concentration of B-isoenzymes had less diagnostic specificity and predictive value for acute myocardial infarction than did a detectable MB band. Results of isoenzyme electrophoresis were more reliable for establishing this diagnosis, but the results of radioimmunoassay were more reliable for excluding it in patients with chest pain as the primary symptom

  17. Newly diagnosed and previously known diabetes mellitus and 1-year outcomes of acute myocardial infarction: the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial

    DEFF Research Database (Denmark)

    Aguilar, David; Solomon, Scott D; Køber, Lars

    2004-01-01

    cardiovascular events associated with previously known and newly diagnosed diabetes by studying 14,703 patients with acute MI enrolled in the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial. Patients were grouped by diabetic status: previously known diabetes (insulin use or diagnosis of diabetes before...

  18. Significant improvement in statin adherence and cholesterol levels after acute myocardial infarction

    DEFF Research Database (Denmark)

    Brogaard, Hilde Vaiva Tonstad; Køhn, Morten Ganderup; Berget, Oline Sofie

    2012-01-01

    Not all patients recovering from acute myocardial infarction (AMI) are optimally treated with statin, and their adherence to statin treatment may be inadequate. We set out to describe changes in statin treatment adherence and cholesterol values over time.......Not all patients recovering from acute myocardial infarction (AMI) are optimally treated with statin, and their adherence to statin treatment may be inadequate. We set out to describe changes in statin treatment adherence and cholesterol values over time....

  19. Approach to chest pain and acute myocardial infarction | Pandie ...

    African Journals Online (AJOL)

    Approach to chest pain and acute myocardial infarction. ... Patient history, physical examination, 12-lead electrocardiogram (ECG) and cardiac biomarkers ... Essential adjunctive therapies include antiplatelet therapy (aspirin, P2Y12 inhibitors), ...

  20. Myocardial stress in patients with acute cerebrovascular events

    DEFF Research Database (Denmark)

    Jespersen, C.M.; Hansen, J.F.

    2008-01-01

    Signs of myocardial involvement are common in patients with acute cerebrovascular events. ST segment deviations, abnormal left ventricular function, increased N-terminal pro-brain natriuretic peptide (NT-proBNP), prolonged QT interval, and/or raised troponins are observed in up to one third...

  1. Acute perimyocarditis mimicking transmural myocardial infarction

    Directory of Open Access Journals (Sweden)

    Omar Hesham R

    2009-12-01

    Full Text Available Abstract Although acute pericarditis has charachteristic electrocardiographic (ECG findings that differentiate it from acute ST segment elevation myocardial infarction (MI; in certain cases diagnosis is somewhat difficult especially when the ECG reveals focal instead of diffuse changes and moreover when pericarditis is associated with an underlying myocarditis causing elevation of the cardiac biomarkers therefore increasing the difficulty in differentiating between both enteties. This is especially important because adverse lethal side effect can occur if thrombolytic therapy is administered for a patient with acute pericarditis, or if a diagnosis of transmural MI is missed. In this case report we are describing an 18 year old male patient who presented with an acute onset of severe chest pain associated with focal ECG changes and elevated cardiac enzymes mimicking transmural MI. This report aims to sensitize readers to this debate and create awareness among cardiologists and intensivists with both presentations and how to reach an accurate diagnosis.

  2. Thrombolysis significantly reduces transient myocardial ischaemia following first acute myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H; Pless, P; Nielsen, J R

    1992-01-01

    In order to investigate whether thrombolysis affects residual myocardial ischaemia, we prospectively performed a predischarge maximal exercise test and early out-of-hospital ambulatory ST segment monitoring in 123 consecutive men surviving a first acute myocardial infarction (AMI). Seventy......-four patients fulfilled our criteria for thrombolysis, but only the last 35 patients included received thrombolytic therapy. As thrombolysis was not available in our Department at the start of the study, the first 39 patients included were conservatively treated (controls). No significant differences...... in baseline clinical characteristics were found between the two groups. In-hospital atrial fibrillation and digoxin therapy was more prevalent in controls (P less than 0.05). During exercise, thrombolysed patients reached a higher maximal work capacity compared with controls: 160 +/- 41 vs 139 +/- 34 W (P...

  3. Myocardial imaging with 99mTc-2-methoxyisobutilisonitrile in the assessment of reperfusion after intravenous thrombolytic treatment for acute myocardial infarction

    International Nuclear Information System (INIS)

    Vattimo, A.; Favilli, R.; Bertelli, P.; Burroni, L.; Gaddi, R.; Ferretti, A.; Baldi, L.

    1989-01-01

    The effect of reperfusion with intravenous streptokinase for acute myocardial infarction (AMI) was assessed by myocardial scintigraphy in 6 patients using 99m Tc-MIBI injected before and 48 hours after the thrombolysis. All patients showed 3 to 4 segmental defects consistent for AMI in the baseline study. The post-thrombolytic study showed an intense reperfusion in 3 patients, a moderate reperfusion in 2 patients and absence of reperfusion in one patient. These findings indicate that the dual imaging strategy with 99m Tc-MIBI is an effective non-invasive technique to assess the effectiveness of reperfusion in acute myocardial infarcted areas. (orig.) [de

  4. A simple slide test to assess erythrocyte aggregation in acute ST-elevated myocardial infarction and acute ischemic stroke: Its prognostic significance

    Directory of Open Access Journals (Sweden)

    Atla Bhagya Lakshmi

    2011-01-01

    Full Text Available A simple slide test and image analysis were used to reveal the presence of an acute-phase response and to determine its intensity in subjects of acute myocardial infarction and acute ischemic stroke. Erythrocytes tend to aggregate during an inflammatory process. Evaluation of erythrocyte adhesiveness/aggregation is currently available to the clinicians indirectly by erythrocyte sedimentation rate (ESR, but ESR correlates poorly with erythrocyte aggregation, hence a simple slide technique using citrated blood was used to evaluate erythrocyte aggregation microscopically and also by using image analysis. Aims: (1 To study erythrocyte aggregation/adhesiveness by a simple slide test in subjects with acute ST-elevated myocardial infarction (STEMI, acute ischemic stroke and healthy controls. (2 To study the prognostic significance of ESR and erythrocyte aggregation/adhesiveness test (EAAT in predicting the outcome after 1 week in subjects of acute myocardial infarction and acute ischemic stroke. Patients and Methods: Three groups of subjects were included in the study; 30 patients of acute STEMI, 30 patients of acute ischemic stroke, and 30 subjects with age- and gender-matched healthy controls. Citrated blood was subjected to simple slide test and ESR estimation by Westergren′s method. Stained smears were examined under 400Χ and graded into four grades. Images were taken from nine fields; three each from head, body, and tail of the smear. The degree of erythrocyte aggregation was quantified using a variable called erythrocyte percentage (EP, by using the software MATLAB Version 7.5. A simple program was used to count the number of black and white pixels in the image by selecting a threshold level. Results: The mean ESR of the subjects with acute myocardial infarction (29 + 17.34 was significantly higher (P = 0.001 than the mean ESR of the control group (15.5 + 12.37. The mean EP of the subjects with acute myocardial infarction (69.91 + 13.25 was

  5. Improving acute and long-term myocardial infarction care : bridging the gap between science and practice

    NARCIS (Netherlands)

    Liem, Su-San

    2009-01-01

    The main topic of this thesis was the design, implementation and subsequent evaluation of an all-phases integrated care program for patients with acute myocardial infarction: the MISSION! protocol. The aim of MISSION! was to improve daily care for patients with an acute myocardial infarction by

  6. Magnetic resonance imaging in patients with unstable angina: comparison with acute myocardial infarction and normals

    International Nuclear Information System (INIS)

    Ahmad, M.; Johnson, R.F. Jr.; Fawcett, H.D.; Schreiber, M.H.

    1988-01-01

    The role of magnetic resonance imaging in characterizing normal, ischemic and infarcted segments of myocardium was examined in 8 patients with unstable angina, 11 patients with acute myocardial infarction, and 7 patients with stable angina. Eleven normal volunteers were imaged for comparison. Myocardial segments in short axis magnetic resonance images were classified as normal or abnormal on the basis of perfusion changes observed in thallium-201 images in 22 patients and according to the electrocariographic localization of infarction in 4 patients. T2 relaxation time was measured in 57 myocardial segments with abnormal perfusion (24 with reversible and 33 with irreversible perfusion changes) and in 25 normally perfused segments. T2 measurements in normally perfused segments of patients with acute myocardial infarction, unstable angina and stable angina were within normal range derived from T2 measurements in 48 myocardial segments of 11 normal volunteers (42 +/- 10 ms). T2 in abnormal myocardial segments of patients with stable angina also was not significantly different from normal. T2 of abnormal segments in patients with unstable angina (64 +/- 14 in reversibly ischemic and 67 +/- 21 in the irreversibly ischemic segments) was prolonged when compared to normal (p less than 0.0001) and was not significantly different from T2 in abnormal segments of patients with acute myocardial infarction (62 +/- 18 for reversibly and 66 +/- 11 for irreversibly ischemic segments). The data indicate that T2 prolongation is not specific for acute myocardial infarction and may be observed in abnormally perfused segments of patients with unstable angina

  7. Prognostic usefulness of repeated echocardiographic evaluation after acute myocardial infarction. TRACE Study Group. TRAndolapril Cardiac Evaluation

    DEFF Research Database (Denmark)

    Korup, E; Køber, L; Torp-Pedersen, C

    1999-01-01

    The prognostic value of repeated echocardiographic measurement of left ventricular function after acute myocardial infarction was evaluated. We found that repeated measurements of wall motion index in survivors of acute myocardial infarction, with no reinfarction, provide important prognostic...

  8. Treatment for acute anterior cruciate ligament tear

    DEFF Research Database (Denmark)

    Frobell, Richard B; Roos, Harald P; Roos, Ewa M

    2013-01-01

    To compare, in young active adults with an acute anterior cruciate ligament (ACL) tear, the mid-term (five year) patient reported and radiographic outcomes between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL...

  9. Evaluation of the severity of anterior myocardial infarction (single-vessel disease) by stress myocardial scanning

    International Nuclear Information System (INIS)

    Kobayashi, Mitsuru; Nishimura, Tsunehiko; Uehara, Toshiisa; Hayashida, Kohei; Hayashi, Makoto; Saito, Muneyasu; Sumiyoshi, Tetsuya

    1986-01-01

    Stress thallium-201 scanning was performed in 57 patients with ≥ 75 % stenosis in the left anterior descending artery. The ratio of lung uptake to heart uptake was defined as lung thallium uptake. For quantitative assessment of infarct size and the severity of ischemia, defect score and ischemic score were derived, respectively, from circumferential profile analysis. Lung thallium uptake at stress tended to increase with an increase in both defect and ischemic scores. The increase in lung thallium uptake also tended to be associated with a decrease in LVEF as determined by cardiac catheterization. The results indicate that stress thallium scanning is of value in the evaluation of the severity of myocardial infarction. (Namekawa, K.)

  10. Pseudo-acute myocardial infarction due to transient apical ventricular dysfunction syndrome (Takotsubo syndrome).

    Science.gov (United States)

    Maciel, Bruno Araújo; Cidrão, Alan Alves de Lima; Sousa, Italo Bruno Dos Santos; Ferreira, José Adailson da Silva; Messias Neto, Valdevino Pedro

    2013-03-01

    Takotsubo syndrome is characterized by predominantly medial-apical transient left ventricular dysfunction, which is typically triggered by physical or emotional stress. The present article reports the case of a 61-year-old female patient presenting with dizziness, excessive sweating, and sudden state of ill feeling following an episode involving intense emotional stress. The physical examination and electrocardiogram were normal upon admission, but the troponin I and creatine kinase-MB concentrations were increased. Acute myocardial infarction without ST segment elevation was suspected, and coronary angiography was immediately performed, which showed severe diffuse left ventricular hypokinesia, medial-apical systolic ballooning, and a lack of significant coronary injury. The patient was referred to the intensive care unit and was successfully treated with supportive therapy. As this case shows, Takotsubo syndrome might simulate the clinical manifestations of acute myocardial infarction, and coronary angiography is necessary to distinguish between both myocardial infarction and myocardial infarction in the acute stage. The present patient progressed with spontaneous resolution of the ventricular dysfunction without any sequelae.

  11. [Effect of puerarin in myocardial protection in rats with acute and chronic alcoholism].

    Science.gov (United States)

    Cui, Shu-qin

    2011-12-01

    To investigate the protective effect of puerarin on the myocardium of rats with acute and chronic alcoholism. In acute alcoholism experiment, normal male SD rats were randomly divided into the control group, alcoholism group and puerarin group (n=8), and high- and low-dose puerarin was administered. In chronic alcoholism experiment, increasing puerarin doses were given. Serum and myocardial levels of spartate aminotransferase (AST) and creatine phosphokinase (CPK) were determined using enzymatic methed, and superoxide dismutase (SOD), malondialdehyde (MDA), Ca(2+)-Mg(2+)-ATPase, and Na(+)-K(+)-ATPase in the myocardium were assayed with colorimetric method. HE staining was used to observe the microscopic changes of the myocardium. Compared with alcoholism group, puerarin-treated groups showed significantly lowered myocardial contents of MDA, CPK and AST and serum levels of AST and CPK (P0.05). HE staining of the myocardium showed cell swelling and obscure cell boundaries in alcoholism group, especially in chronic alcoholism group. The myocardial structure in puerarin group remained clear and regular. Puerarin can protect from myocardial injuries induced by acute and chronic alcoholism in rats.

  12. Acute myocarditis mimicking myocardial infarction can misdirect the diagnostic approach

    Directory of Open Access Journals (Sweden)

    Erkan Yildirim

    2016-03-01

    Full Text Available Acute myocarditis is a well-recognized but rare manifestation of mostly viral infections. It can present with various clinical manifestations and may mimic myocardial infarction (MI since patients usually present with chest pain, and the electrocardiographic changes similar to those observed in acute ST-elevation MI. We, herein, present such an extreme case of acute myocarditis characterized by dynamic ST segment elevation with reciprocal changes in the electrocardiogram.

  13. Mortality and morbidity remain high despite captopril and/or valsartan therapy in elderly patients with left ventricular systolic dysfunction, heart failure, or both after acute myocardial infarction - Results from the Valsartan in Acute Myocardial Infarction Trial (VALIANT)

    NARCIS (Netherlands)

    White, HD; Aylward, PEG; Huang, Z; Dalby, AJ; Weaver, WD; Barvik, S; Marin-Neto, JA; Murin, J; Nordlander, RO; van Gilst, WH; Zannad, F; McMurray, JJV; Califf, RM; Pfeffer, MA

    2005-01-01

    Background - The elderly constitute an increasing proportion of acute myocardial infarction patients and have disproportionately high mortality and morbidity. Those with heart failure or impaired left ventricular left ventricular function after acute myocardial infarction have high complication and

  14. Right ventricular function after acute myocardial infarction: dependence upon infarct related coronary artery

    International Nuclear Information System (INIS)

    Cho, Ihn Ho; Chun, Kyung A; Won, Kyu Chang; Lee, Hyung Woo; Hong, Geu Ru; Park, Jong Seon; Shin, Dong Gu; Kim, Young Jo; Shim, Bong Sub

    2004-01-01

    We studied to know the relation between right ventricular function and infarct-related artery after acute myocardial infarction. The right and left ventricular function after a first myocardial infarction was assessed ECG-gated blood pool single photon emission computed tomography (GBPS) algorithms (Cedars-Sinai Medical Center, Los Angels, Calif) (12 after LAD related infarction (group 1) and 15 after RCA related infarction (group 2)). The left ventricular ejection fraction, end-diastolic volume and end-systolic volume did not differ significantly between two groups( group 1 vs 2 :LVEF 50.8% vs 55.1%. LVEDV=73.2 vs 79.7 ml, LVESV=38 vs 44 ml : P>0.05), but right ventricular ejection fraction, end-diastolic volume and end-systolic volume were significantly different after anterior myocardial infarction between two groups( group 1 vs 2 : RVEF=57.3% vs 46.3%. RVEDV=56.4 vs 95.1 ml, RVESV=25.6 vs 54.6ml : P<0.05). There was evidence of right ventricular dilatation in the group with RCA related infarction. Six with inferior infarction had abnormal right ventricular ejection fractions (< 40%). The relation between right and left ventricular ejection fractions was markedly different in the two groups. In the group with RCA related infarction there was a significant linear relation between right and left ventricular ejection fraction(R=0.5). Whereas in the group with LAD related infarction there was not (R=-0.3). Thus right ventricular dysfunction commonly occurs after RCA related infarction. Right ventricular impairment is related after RCA related infarction, but are independent after LAD related infarction. Finally, the different effects of LAD and RCA related infarction on right ventricular function may be explained by site of the myocardial wall involvement after infarction

  15. Dilemma in Timing of Delivery in a Patient with an Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Laura M. Héman

    2015-01-01

    Full Text Available Introduction. Acute myocardial infarction (AMI in a pregnant woman is rare. When occurring, AMI is a major cause of maternal and neonatal death. By presenting the following case we describe the dilemma concerning the timing of delivery. Case. A 36-year-old, multiparous women, at 35 6/7 weeks of gestation, suffered from an AMI due to an acute blockage of the left anterior descending artery (LAD. This was treated by angiographic thrombosuction and biodegradable stent placement. Within 5 hours after this procedure, a cesarean section (CS was performed because of a nonreassuring fetal condition. A healthy son with an Apgar score of 9/10 was born. The patient’s postoperative course was complicated by a big wound hematoma, a hemoglobin drop, and heart failure. Discussion. In case of AMI during pregnancy, the cardiological management has absolute priority. The obstetrical management is not outlined. In a nonreassuring fetal condition, delivery is indicated after stabilization of the mother. However, delivery after recent AMI and angiography will bring new risks of cardiologic stress and bleeding complications. The limited literature available tends to an expectant obstetrical management, but this case emphasizes the difficulty of waiting in suspected fetal distress.

  16. Ischemic preconditioning effect of prodromal angina is attenuated in acute myocardial infarction patients with hypertensive left ventricular hypertrophy

    International Nuclear Information System (INIS)

    Takeuchi, Toshiharu; Kikuchi, Kenjiro; Hasebe, Naoyuki; Ishii, Yoshinao

    2011-01-01

    Several animal experiments on acute myocardial infarction (AMI) have shown that the cardioprotective effects of ischemic preconditioning are more significant in hypertensive subjects. However, because there are no clinical data on the impact of hypertension on ischemic preconditioning in patients with AMI, whether clinical ischemic preconditioning of prodromal angina was beneficial in AMI patients with hypertension was investigated in the present study. 125 patients with a first anterior AMI who had undergone successful reperfusion therapy were divided into 2 groups, with or without hypertension, and into 2 further subgroups based on the presence or absence of prodromal angina. Dual-isotope (thallium-201(TL)/Tc-99m pyrophosphate) single-photon emission computed tomography (SPECT) was performed within 1 week of reperfusion therapy. Left ventricular (LV) function and LV mass index (LVMI) were measured by left ventriculography and echocardiography, respectively. In patients without hypertension, prodromal angina resulted in significantly less myocardial damage on TL-SPECT, better LV ejection fraction and a greater myocardial blush grade compared to patients without prodromal angina. However, these cardioprotective effects of prodromal angina were significantly diminished in hypertensive patients. Importantly, the myocardial salvage effects of prodromal angina showed a significant negative correlation with LVMI, which was significantly greater in hypertensive patients. The cardioprotective effects of prodromal angina were attenuated in patients with hypertension. Hypertensive LV hypertrophy may crucially limit the effects of ischemic preconditioning in AMI. (author)

  17. Combination nivolumab- and cabiralizumab-associated acute bilateral anterior and posterior scleritis and anterior uveitis

    Directory of Open Access Journals (Sweden)

    John A. Gonzales

    2018-06-01

    Full Text Available Purpose: To report on a case of uveitis and scleritis resulting as an immune-mediated side effect of cancer immunotherapy with nivolumab and cabiralizumab. Observations: Bilateral anterior nongranulomatous anterior uveitis and bilateral diffuse anterior and posterior scleritis occurred following the use of combination cancer immunotherapy. The uveitis and scleritis resolved following temporary discontinuation of nivolumab and cabiralizumab as well as systemic prednisone. Conclusions and importance: Ophthalmologists should be aware of the possibility of acute ocular inflammation developing with cancer immunotherapy. Systemic corticosteroids play a first-line role in managing such immune-mediated side effects. Keywords: Uveitis, Scleritis, Cancer immunotherapy, Side effects, Nivolumab, Cabiralizumab

  18. Myocardial imaging with sup 99m Tc-2-methoxyisobutilisonitrile in the assessment of reperfusion after intravenous thrombolytic treatment for acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Vattimo, A.; Favilli, R.; Bertelli, P.; Burroni, L.; Gaddi, R.; Ferretti, A.; Baldi, L. (Siena Univ. (Italy). Nuclear Medicine Unit)

    1989-08-01

    The effect of reperfusion with intravenous streptokinase for acute myocardial infarction (AMI) was assessed by myocardial scintigraphy in 6 patients using {sup 99m}Tc-MIBI injected before and 48 hours after the thrombolysis. All patients showed 3 to 4 segmental defects consistent for AMI in the baseline study. The post-thrombolytic study showed an intense reperfusion in 3 patients, a moderate reperfusion in 2 patients and absence of reperfusion in one patient. These findings indicate that the dual imaging strategy with {sup 99m}Tc-MIBI is an effective non-invasive technique to assess the effectiveness of reperfusion in acute myocardial infarcted areas. (orig.).

  19. Cancer risk of patients discharged with acute myocardial infarct

    DEFF Research Database (Denmark)

    Dreyer, L; Olsen, J H

    1998-01-01

    We studied whether common shared environmental or behavioral risk factors, other than tobacco smoking, underlie both atherosclerotic diseases and cancer. We identified a group of 96,891 one-year survivors of acute myocardial infarct through the Danish Hospital Discharge Register between 1977...... and 1989. We calculated the incidence of cancer in this group by linking it to the Danish Cancer Registry for the period 1978-1993. There was no consistent excess over the expected figures for any of the categories of cancer not related to tobacco smoking. Specifically, the rates of colorectal cancer...... in acute myocardial infarct patients were similar to those of the general population, as were the rates for hormone-related cancers, including endometrial and postmenopausal breast cancers. We found a moderate increase in the risk for tobacco-related cancers, which was strongest for patients with early...

  20. Measurement of acute Q-wave myocardial infarct size with single photon emission computed tomography imaging of indium-111 antimyosin.

    Science.gov (United States)

    Antunes, M L; Seldin, D W; Wall, R M; Johnson, L L

    1989-04-01

    Myocardial infarct size was measured by single photon emission computed tomography (SPECT) following injection of indium-111 antimyosin in 27 patients (18 male and 9 female; mean age 57.4 +/- 10.5 years, range 37 to 75) who had acute transmural myocardial infarction (MI). These 27 patients represent 27 of 35 (77%) consecutive patients with acute Q-wave infarctions who were injected with indium-111 antimyosin. In the remaining 8 patients either tracer uptake was too faint or the scans were technically inadequate to permit infarct sizing from SPECT reconstructions. In the 27 patients studied, infarct location by electrocardiogram was anterior in 15 and inferoposterior in 12. Nine patients had a history of prior infarction. Each patient received 2 mCi of indium-111 antimyosin followed by SPECT imaging 48 hours later. Infarct mass was determined from coronal slices using a threshold value obtained from a human torso/cardiac phantom. Infarct size ranged from 11 to 87 g mean 48.5 +/- 24). Anterior infarcts were significantly (p less than 0.01) larger (60 +/- 20 g) than inferoposterior infarcts (34 +/- 21 g). For patients without prior MI, there were significant inverse correlations between infarct size and ejection fraction (r = 0.71, p less than 0.01) and wall motion score (r = 0.58, p less than 0.01) obtained from predischarge gated blood pool scans. Peak creatine kinase-MB correlated significantly with infarct size for patients without either reperfusion or right ventricular infarction (r = 0.66). Seven patients without prior infarcts had additional simultaneous indium-111/thallium-201 SPECT studies using dual energy windows.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. [Acute stent thrombosis and reverse transient left ventricular dilatation after performing a single-photon emission computed tomography myocardial perfusion].

    Science.gov (United States)

    Miranda, B; Pizzi, M N; Aguadé-Bruix, S; Domingo, E; Candell-Riera, J

    2015-01-01

    A 63-year-old male patient with a history of stent implantation in the left anterior descending three months before. Due to the presentation of vegetative symptoms, he was referred for gated-SPECT myocardial perfusion. During acquisition of the resting images he presented chest pain and ST segment elevation, so that urgent cardiac catheterization was performed, showing stent thrombosis. Rest perfusion imaging showed a defect in anterior and apical perfusion, more severe and extensive than in the stress images, with striking left ventricular dilatation and a fall in the ejection fraction related to the acute ischemia phenomenon. Intense exercise is associated with a transient activation of the coagulation system and hemodynamic changes that might induce thrombosis, especially in recently implanted coronary stents that probably still have not become completely endothelialized. Copyright © 2014 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  2. Effect of loading-dose ticagrelor on coronary blood flow, left ventricular remodeling and myocardial enzyme spectrum in patients with acute myocardial infarction after interventional therapy

    Directory of Open Access Journals (Sweden)

    Xiao-Rui Xie

    2016-12-01

    Full Text Available Objective: To study the effect of loading-dose ticagrelor on coronary blood flow, left ventricular remodeling and myocardial enzyme spectrum in patients with acute myocardial infarction after interventional therapy. Methods: A total of 86 patients with acute myocardial infarction who received emergency PCI in our hospital between May 2013 and May 2016 were selected and randomly divided into two groups, ticagrelor group received perioperative ticagrelor therapy and clopidogrel group received perioperative clopidogrel therapy. After PCI, coronary blood flow reperfusion was evaluated, serum myocardial remodeling indexes and myocardial enzymes were determined, and cardiac color Doppler ultrasonography was conducted to determine the cardiac function indexes. Results: TIMI grading and TMPG grading of ticagrelor group after PCI were significantly higher than those of clopidogrel group; serum MMP9, BNP, CITP, PICP, PIIINP, CK, CK-MB, cTnI and cTnT content of ticagrelor group 24h after operation were significantly lower than those of clopidogrel group; LVEDD, LVSED and LVMI of ticagrelor group 2 weeks after operation were significantly lower than those of clopidogrel group while LVEF was significantly higher than that of clopidogrel group. Conclusion: Peri-PCI loading-dose ticagrelor can improve coronary blood perfusion and reduce ventricular remodeling and myocardial injury in patients with acute myocardial infarction.

  3. Pertinence between the tombstoning electrocardiographic pattern of ST-segment change and infarcted artery orientation in acute myocardial infarction

    International Nuclear Information System (INIS)

    Deng Min; Ma Qianjun; Song Jianping

    2005-01-01

    Objective: The aim of this study is to address the pertinence between the tombstoning electrocardiographic pattern of ST-segment change and infracted artery orientation in acute myocardial infarction. Methods: The study investigated 104 patients with AMI, who subsequently underwent angiography. In this population, 19 patients had a definite tombstoning pattern on their admission ECG. Results: Between tombstoning ECGs and non-tombstoning, campared CAG, the results were as follows: tombstoning ECGs were more strongly associated with anterior infarction and significantly influence the left anterior descending (LAD) artery (P<0.001); LAD occlusions were significantly more severe, mostly proximal (P<0.05, P<0.01); tombstoning ECGs were significantly greater incidence of occlusion of multivessel coronary artery (P<0.05). Conclusions: Although tombstoning ECGs correlates with the occlusion of a high-grade stenosis of the proximal LAD and severe abnormal ventricle wall motion, it is still greatly necessary to reperfuse and revascularize so as to ameliorate the prognosis. (authors)

  4. Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation

    Energy Technology Data Exchange (ETDEWEB)

    Tountopoulou, Argyro; Ahl, Bjoern; Weissenborn, Karin [Hannover Medical School, Department of Neurology and Clinical Neurophysiology, Hannover (Germany); Becker, Hartmut; Goetz, Friedrich [Hannover Medical School, Department of Neuroradiology, Hannover (Germany)

    2008-01-15

    The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation. We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication. Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge. The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid, 44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline CT scan. Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor affecting its efficacy. (orig.)

  5. Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation

    International Nuclear Information System (INIS)

    Tountopoulou, Argyro; Ahl, Bjoern; Weissenborn, Karin; Becker, Hartmut; Goetz, Friedrich

    2008-01-01

    The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation. We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication. Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge. The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid, 44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline CT scan. Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor affecting its efficacy. (orig.)

  6. Treatment for acute anterior cruciate ligament tear

    DEFF Research Database (Denmark)

    Frobell, Richard B; Roos, Harald P; Roos, Ewa M

    2015-01-01

    STUDY QUESTION: In young active adults with an acute anterior cruciate ligament (ACL) rupture, do patient reported or radiographic outcomes after five years differ between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed AC...... AND WHAT THIS PAPER ADDS: The relative efficacy of surgical reconstruction and rehabilitation for short and long term outcomes of ACL rupture is debated. Clinicians and young active adult patients should consider rehabilitation as a primary treatment option following an acute ACL tear....

  7. Thrombolysis in acute myocardial infarction : factors determining its efficacy

    NARCIS (Netherlands)

    Brügemann, Johannes

    1994-01-01

    Insight in the mechanisms leading to acute myocardial infarction (MI) has resulted in the administration of exogenous plasminogen activator, later called thrombolytic therapy. This treatment was associated with a significant reduction in mortality and morbidity. However, success has not always been

  8. Emotions delay care-seeking in patients with an acute myocardial infarction.

    Science.gov (United States)

    Nymark, Carolin; Mattiasson, Anne-Cathrine; Henriksson, Peter; Kiessling, Anna

    2014-02-01

    In acute myocardial infarction the risk of death and loss of myocardial tissue is at its highest during the first few hours. However, the process from symptom onset to the decision to seek medical care can take time. To comprehend patients' pre-hospital delay, attention must be focused on the circumstances preceding the decision to seek medical care. To add a deeper understanding of patients' thoughts, feelings and actions that preceded the decision to seek medical care when afflicted by an acute myocardial infarction. Fourteen men and women with a first or second acute myocardial infarction were interviewed individually in semi-structured interviews. Data were analysed by qualitative content analysis. Four themes were conceptualized: 'being incapacitated by fear, anguish and powerlessness', 'being ashamed of oneself', 'fear of losing a healthy identity' and 'striving to avoid fear by not interacting with others'. Patients were torn between feelings such as anguish, fear, shame and powerlessness. They made an effort to uphold their self-image as being a healthy person thus affected by an unrecognized discomfort. This combined with a struggle to protect others from involvement, strengthened the barriers to seeking care. The present study indicates that emotional reactions are important and influence patients' pre-hospital behaviour. Being ashamed of oneself stood out as a novel finding. Emotions might be an important explanation of undesired and persisting patient delays. However, our findings have to and should be evaluated quantitatively. Such a study is in progress.

  9. Dexrazoxane Shows No Protective Effect in the Acute Phase of Reperfusion during Myocardial Infarction in Pigs.

    Science.gov (United States)

    Kamat, Pranitha; Vandenberghe, Stijn; Christen, Stephan; Bongoni, Anjan K; Meier, Bernhard; Rieben, Robert; Khattab, Ahmed A

    2016-01-01

    Calcium and iron overload participate in the mechanisms of ischemia/reperfusion (I/R) injury during myocardial infarction (MI). Calcium overload induces cardiomyocyte death by hypercontraction, while iron catalyses generation of reactive oxygen species (ROS). We therefore hypothesized that dexrazoxane, an intracellular metal chelator, would attenuate I/R injury. MI was induced in pigs by occlusion of the left anterior descending artery for 1 hour followed by 2 hours reperfusion. Thirty minutes before reperfusion either 5 mg/ml dexrazoxane (n = 5) or saline (n = 5) was infused intravenously. Myocardial necrosis as percentage of the area at ischemic risk was found to be similar in both groups (77.2 ± 18% for dexrazoxane and 76.4 ± 14% for saline group) as determined by triphenyl tetrazolium chloride staining of the ischemic myocardium. Also, serum levels of troponin-I were similar in both groups. A conductance catheter was used to measure left ventricular pressure and volume at all times. Markers for tissue damage due to ROS (HNE), endothelial cell activation (CD31) and inflammation (IgG, C3b/c, C5b9, MCP-1) were assessed on tissue and/or in serum. No significant differences were observed between the groups for the parameters analyzed. To conclude, in this clinically relevant model of early reperfusion after acute myocardial ischemia, dexrazoxane lacked attenuating effects on I/R injury as shown by the measured parameters.

  10. Contribution of contractile state of the non-infarcted area to global ventricular performance after acute myocardial infarction

    International Nuclear Information System (INIS)

    Nishimura, Tsunehiko; Yasuda, Tsunehiro; Gold, H.K.; Leinbach, R.C.; Boucher, C.A.; McKusick, K.A.; Strauss, H.W.

    1986-01-01

    To evaluate the regional contractile state of the non-infarcted zone and to determine the contribution of this area to left ventricular (LV) performance, 112 patients (42 anterior and 70 inferior infarction) with their first acute myocardial infarction were investigated by radionuclide ventriculography at admission and 10 days after admission. Wall motion at the non-infarcted area was defined as hyperkinetic, normal, or hypokinetic, if radial chord shortening had above normal, normal, or below normal values, respectively, by quantitative wall motion analysis. Hyperkinetic, normal, and hypokinetic wall motion of the non-infarcted area were observed in three (7 %), 12 (29 %), and 27 (64 %) patients in anterior infarction and 14 (20 %), 28 (40 %), and 28 (40 %) in inferior infarction, respectively. In the patients with hypokinetic wall motion at the non-infarcted area, the infarct involved more than 30 % of the left ventricle manifesting akinetic contractile segment (ACS), radial chord shortening in the infarcted area was severely depressed, and the incidence of multi-vessel involvement was higher compared with those with hyperkinetic or normal wall motion. In serial measurements, radial chord shortening in the infarcted and non-infarcted area, percent ACS, left ventricular ejection fraction, and left ventricular end-diastolic volume index did not change significantly from acute to follow-up study in any group. In conclusion, our data indicated that the non-infarcted area following acute infarction had various contractile states and these conditions were determined primarily by the severity and extent of infarct and underlying coronary artery disease. Furthermore, the contractile state of the non-infarcted area has a supplemental role in determination of LV function following acute infarction. (author)

  11. The Olson method for detection of acute myocardial ischemia in patients with coronary occlusion.

    Science.gov (United States)

    Lindow, Thomas; Olson, Charles W; Swenne, Cees A; Man, Sumche; Pahlm, Olle

    An automated ECG-based method may provide diagnostic support in the management of patients with acute coronary syndrome. The Olson method has previously proved to accurately identify the culprit artery in patients with acute coronary occlusion. The Olson method was applied to 360 patients without acute myocardial ischemia and 52 patients with acute coronary occlusion. This study establishes the normal variation of the Olson wall scores in patients without acute myocardial ischemia, which provides the basis for implementation of the Olson method for triage of patients with acute coronary syndrome. All patients with acute occlusion had Olson wall scores above the upper limit of normal. The Olson method can be used for ischemia detection with very high sensitivity. Future studies are needed to explore specificity in patients with non-ischemic ST elevation. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Effects of Chronic and Acute Zinc Supplementation on Myocardial Ischemia-Reperfusion Injury in Rats.

    Science.gov (United States)

    Ozyıldırım, Serhan; Baltaci, Abdulkerim Kasim; Sahna, Engin; Mogulkoc, Rasim

    2017-07-01

    The present study aims to explore the effects of chronic and acute zinc sulfate supplementation on myocardial ischemia-reperfusion injury in rats. The study registered 50 adult male rats which were divided into five groups in equal numbers as follows: group 1, normal control; group 2, sham; group 3, myocardial ischemia reperfusion (My/IR): the group which was fed on a normal diet and in which myocardial I/R was induced; group 4, myocardial ischemia reperfusion + chronic zinc: (5 mg/kg i.p. zinc sulfate for 15 days); and group 5, myocardial ischemia reperfusion + acute zinc: the group which was administered 15 mg/kg i.p. zinc sulfate an hour before the operation and in which myocardial I/R was induced. The collected blood and cardiac tissue samples were analyzed using spectrophotometric method to determine levels of MDA, as an indicator of tissue injury, and GSH, as an indicator of antioxidant activity. The highest plasma and heart tissue MDA levels were measured in group 3 (p zinc administration and markedly by chronic zinc supplementation.

  13. Anticoagulants for secondary prevention after acute myocardial infarction: lessons from the past decade

    NARCIS (Netherlands)

    Atar, D.; Bode, C.; Stuerzenbecher, A.; Verheugt, F.W.A.

    2014-01-01

    The impact of an acute coronary syndrome (ACS) event, such as an acute myocardial infarction (MI), is not limited to the acute management phase; patients face an elevated risk of residual atherothrombotic events that commonly requires chronic management for months or even years. Significant advances

  14. Acute Stress Decreases but Chronic Stress Increases Myocardial Sensitivity to Ischemic Injury in Rodents.

    Science.gov (United States)

    Eisenmann, Eric D; Rorabaugh, Boyd R; Zoladz, Phillip R

    2016-01-01

    Cardiovascular disease (CVD) is the largest cause of mortality worldwide, and stress is a significant contributor to the development of CVD. The relationship between acute and chronic stress and CVD is well evidenced. Acute stress can lead to arrhythmias and ischemic injury. However, recent evidence in rodent models suggests that acute stress can decrease sensitivity to myocardial ischemia-reperfusion injury (IRI). Conversely, chronic stress is arrhythmogenic and increases sensitivity to myocardial IRI. Few studies have examined the impact of validated animal models of stress-related psychological disorders on the ischemic heart. This review examines the work that has been completed using rat models to study the effects of stress on myocardial sensitivity to ischemic injury. Utilization of animal models of stress-related psychological disorders is critical in the prevention and treatment of cardiovascular disorders in patients experiencing stress-related psychiatric conditions.

  15. Acute Stress Decreases but Chronic Stress Increases Myocardial Sensitivity to Ischemic Injury in Rodents

    Science.gov (United States)

    Eisenmann, Eric D.; Rorabaugh, Boyd R.; Zoladz, Phillip R.

    2016-01-01

    Cardiovascular disease (CVD) is the largest cause of mortality worldwide, and stress is a significant contributor to the development of CVD. The relationship between acute and chronic stress and CVD is well evidenced. Acute stress can lead to arrhythmias and ischemic injury. However, recent evidence in rodent models suggests that acute stress can decrease sensitivity to myocardial ischemia–reperfusion injury (IRI). Conversely, chronic stress is arrhythmogenic and increases sensitivity to myocardial IRI. Few studies have examined the impact of validated animal models of stress-related psychological disorders on the ischemic heart. This review examines the work that has been completed using rat models to study the effects of stress on myocardial sensitivity to ischemic injury. Utilization of animal models of stress-related psychological disorders is critical in the prevention and treatment of cardiovascular disorders in patients experiencing stress-related psychiatric conditions. PMID:27199778

  16. [Clinical demonstrations: Heart rupture in acute myocardial infarct. Infectious endocarditis. Wolff-Parkinson-White syndrome].

    Science.gov (United States)

    Nager, F

    1984-12-08

    This clinical demonstration includes three topics of clinical cardiology: myocardial rupture in acute myocardial infarction, infective endocarditis, and WPW-syndrome with paroxysmal supraventricular tachycardia. In the first part three cases with septal perforation or papillary muscle rupture are demonstrated. Our experience with myocardial rupture (free wall, septum, papillary muscle) during the last six years is summarized with special reference to the significance and the differential diagnosis of systolic regurgitant murmurs after myocardial infarction. Special features of acute mitral incompetence (papillary muscle dysfunction) in myocardial infarction are outlined and diagnostic guidelines for differentiation between septal perforation and papillary muscle rupture are discussed. In the second part two patients with aortic (e.g. mitral) valve rupture in the course of infective endocarditis are presented. The synoptic comparison of these two patients is related to the results of our own clinical studies on the changing pattern of infective endocarditis (epidemiologically, clinically) during the last three decades. The clinical picture of acute aortic valve rupture is outlined and the bedside signs indicating catastrophic complications of infective endocarditis are summarized. In the third part the odyssey of a patient with WPW-syndrome and consecutive paroxysmal supraventricular tachycardia is described. Progress in electrophysiological analysis of the re-entry circles in preexcitation syndromes is outlined.

  17. Plasma Ceramides as Prognostic Biomarkers and Their Arterial and Myocardial Tissue Correlates in Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Leonardo P. de Carvalho, MD, PhD

    2018-04-01

    Full Text Available Summary: We identified a plasma signature of 11 C14 to C26 ceramides and 1 C16 dihydroceramide predictive of major adverse cardiovascular events in patients with acute myocardial infarction (AMI. Among patients undergoing coronary artery bypass surgery, those with recent AMI, compared with those without recent AMI, showed a significant increase in 5 of the signature’s 12 ceramides in plasma but not simultaneously-biopsied aortic tissue. In contrast, a rat AMI model, compared with sham control, showed a significant increase in myocardial concentrations of all 12 ceramides and up-regulation of 3 ceramide-producing enzymes, suggesting ischemic myocardium as a possible source of this ceramide signature. Key Words: acute coronary syndrome, ceramides, dihydroceramides, major adverse cardiovascular and cerebrovascular events, prognosis, risk prediction

  18. The Role of Echocardiography in Coronary Artery Disease and Acute Myocardial Infarction

    Science.gov (United States)

    Esmaeilzadeh, Maryam; Parsaee, Mozhgan; Maleki, Majid

    2013-01-01

    Echocardiography is a non-invasive diagnostic technique which provides information regarding cardiac function and hemodynamics. It is the most frequently used cardiovascular diagnostic test after electrocardiography and chest X-ray. However, in a patient with acute chest pain, Transthoracic Echocardiography is essential both for diagnosing acute coronary syndrome, zeroing on the evaluation of ventricular function and the presence of regional wall motion abnormalities, and for ruling out other etiologies of acute chest pain or dyspnea, including aortic dissection and pericardial effusion. Echocardiography is a versatile imaging modality for the management of patients with chest pain and assessment of left ventricular systolic function, diastolic function, and even myocardial and coronary perfusion and is, therefore, useful in the diagnosis and triage of patients with acute chest pain or dyspnea. This review has focused on the current applications of echocardiography in patients with coronary artery disease and myocardial infarction. PMID:23646042

  19. Effect of collateral circulation on myocardial protection in patients with acute myocardial infarction. Comparison of technetium-99m-tetrofosmin myocardial single photon emission computed tomography and coronary angiography

    International Nuclear Information System (INIS)

    Yoshida, Michi; Kondo, Makoto; Abe, Yoshiteru; Kubota, Tomoyuki; Matsuoka, Ryota; Araki, Makoto; Tanio, Hitoshi; Doyama, Kiyoshi

    2006-01-01

    Evaluation of myocardial blood flow from collateral vessels into the infarct area has been estimated by coronary angiography. In patients with acute myocardial infarction with Thrombolysis in Myocardial Infarction (TIMI) 0 flow, myocardial tracer uptake on single photon emission computed tomography (SPECT) images can predict the collateral blood flow in the infarct area if technetium (Tc)-99m-tetrofosmin was administered before recanalization. The present study investigated whether collateral blood flow evaluated by myocardial scintigraphy is a good predictor of myocardial salvage in patients with acute myocardial infarction. The study group consisted of 30 patients (mean age 65±14 years, 23 males, 7 females) with first acute myocardial infarction and coronary angiography evidence of total occlusion (TIMI 0) within 12 hr after the onset. All patients had one vessel disease related to infarction and TIMI 3 flow after percutaneous coronary intervention (PCI). Tc-99m-tetrofosmin was injected intravenously before the PCI. The regional severity score index (RSSI) was obtained from SPECT using the 17 segment method with the four-point scoring system. Myocardial viability was evaluated by the RSSI obtained from thallium-glucose-insulin infusion SPECT after 1 week and regional wall motion score index obtained from echocardiography during the chronic phase. The patients were divided into two groups according to the angiographic collateral finding. There were no differences in RSSI on thallium-glucose-insulin SPECT and regional wall motion score between the good collateral group (n=8) and poor collateral group (n=22). Myocardial Tc-99m-tetrofosmin RSSI was similar in these groups. On the other hand, the patients were divided according to Tc-99m-tetrofosmin scintigraphic evaluation before PCI. RSSI on thallium-glucose-insulin SPECT was significantly greater (0.7±0.5 vs 1.5±0.4, p<0.01) and regional wall motion score was significantly less (1.46±0.50 vs 2.08±0.78, p<0

  20. Acute myocardial infarction in young adults with Antiphospholipid syndrome: report of two cases and literature review

    OpenAIRE

    Abid, Leila; Frikha, Faten; Bahloul, Zouhir; Kammoun, Samir

    2011-01-01

    Abstract Acute myocardial infarction (AMI) is rarely associated with antiphospholipid syndrome. The treatment of these patients is a clinical challenge. We report the observations of 2 young adults (1 woman and 1 man), admitted in our acute care unit for acute myocardial infarction (AMI). A coagulopathy work-up concludes the existence of antiphospholipid syndrome (APS) in the 2 cases. APS syndrome was considered primary in 2 cases. All patients presented an intense inflammatory syndrome (high...

  1. Scuba diving, acute left anterior descending artery occlusion and normal ECG

    Science.gov (United States)

    Doll, Sébastien Xavier; Rigamonti, Fabio; Roffi, Marco; Noble, Stéphane

    2013-01-01

    We report the case of an acute proximal occlusion of the left anterior descending coronary (LAD) artery following a scuba diving decompression accident and associated with normal ECG. Following uneventful thromboaspiration and coronary stenting, the patient was discharged on day  4 with secondary preventative therapies. A transthoracic echocardiography performed at this point showed a complete recovery compared with an initial localised akinesia involving the anterior and apical portion of the left ventricle upon admission. This case highlights that significant acute coronary lesions involving the LAD can occur without any ECG anomaly. The presence of acute and persistent angina associated with troponin elevation should prompt physicians to consider coronary angiography without delay, independently of the ECG results. PMID:23376677

  2. Acute myocardial infarction in very young adults: A clinical presentation, risk factors, hospital outcome index, and their angiographic characteristics in North India-AMIYA Study.

    Science.gov (United States)

    Sinha, Santosh Kumar; Krishna, Vinay; Thakur, Ramesh; Kumar, Ashutosh; Mishra, Vikas; Jha, Mukesh Jitendra; Singh, Karandeep; Sachan, Mohit; Sinha, Rupesh; Asif, Mohammad; Afdaali, Nasar; Mohan Varma, Chandra

    2017-03-01

    India is currently in the fourth stage of epidemiological transitions where cardiovascular disease is the leading cause of mortality and morbidity. Purpose of the present study was to assess the risk factors, clinical presentation, angiographic profile including severity, and in-hospital outcome of very young adults (aged ≤ 30 years) with first acute myocardial infarction (AMI). Total of 1,116 consecutive patients with ST-segment elevation acute myocardial infarction (STEMI) were studied between March 2013 and February 2015 at LPS Institute of Cardiology, Kanpur, Uttar Pradesh, India. Mean age of the patients was 26.3 years. Risk factors were smoking (78.5%), family history of premature coronary artery disease (CAD) (46.8%), obesity (39.1%), physical inactivity (38.7%) and stressful life events (29.6%). The most common symptom and presentation was chest pain and anterior wall myocardial infarction (AWMI) in 94.8% and 58.8%, respectively. About 80.6% of patients had obstructive CAD with single vessel disease (57.6%), double-vessel disease (12.9%) and left main involvement (3.2%). Left anterior descending (LAD) was commonest culprit artery (58.1%) followed by right coronary artery in 28.2%. In-hospital mortality was 2.8%. Percutaneous coronary intervention was performed in 71.6% of patients. Median number and length of stent were 1.18 and 28 ± 16 mm, respectively. AMI in very young adult occurred most commonly in male. Smoking was the most common risk factor. AWMI owing to LAD artery involvement was the most common presentation. Mean time of presentation after symptom onset was 16.9 hours. In contrast to western population, it is characterised by earlier onset, delayed presentation, more severity, diffuse disease, and more morbidity but with favourable in-hospital mortality.

  3. Lipid paradox in acute myocardial infarction-the association with 30-day in-hospital mortality.

    Science.gov (United States)

    Cheng, Kai-Hung; Chu, Chih-Sheng; Lin, Tsung-Hsien; Lee, Kun-Tai; Sheu, Sheng-Hsiung; Lai, Wen-Ter

    2015-06-01

    Elevated low-density lipoprotein cholesterol and triglycerides are major risk factors for coronary artery disease. However, fatty acids from triglycerides are a major energy source, low-density lipoprotein cholesterol is critical for cell membrane synthesis, and both are critical for cell survival. This study was designed to clarify the relationship between lipid profile, morbidity as assessed by Killip classification, and 30-day mortality in patients with acute myocardial infarction. A noninterventional observational study. Coronary care unit in a university hospital. Seven hundred twenty-four patients with acute myocardial infarction in the coronary care program of the Bureau of Health Promotion were analyzed. None. Low-density lipoprotein cholesterol and triglyceride levels were significantly lower in high-Killip (III+IV) patients compared with low-Killip (I+II) patients and in those who died compared with those who survived beyond 30 days (both pvalues for predicting 30-day mortality and were associated with hazard ratios of 1.65 (95% CI, 1.18-2.30) and 5.05 (95% CI, 1.75-14.54), and the actual mortality rates were 23% in low low-density lipoprotein, 6% in high low-density lipoprotein, 14% in low triglycerides, and 3% in high triglycerides groups, respectively. To test the synergistic effect, high-Killip patients with triglycerides less than 62.5 mg/dL and low-density lipoprotein cholesterol less than 110 mg/dL had a 10.9-fold higher adjusted risk of mortality than low-Killip patients with triglycerides greater than or equal to 62.5 mg/dL and low-density lipoprotein cholesterol greater than or equal to 110 mg/dL (pparadox also improved acute myocardial infarction short-term outcomes prediction on original Killip and thrombolytic in myocardial infarction scores. Low low-density lipoprotein cholesterol, low triglycerides, and high Killip severity were associated with significantly higher 30-day in-hospital mortality in patients presenting with acute myocardial

  4. Quality indicators for acute myocardial infarction: A position paper of the Acute Cardiovascular Care Association.

    Science.gov (United States)

    Schiele, Francois; Gale, Chris P; Bonnefoy, Eric; Capuano, Frederic; Claeys, Marc J; Danchin, Nicolas; Fox, Keith Aa; Huber, Kurt; Iakobishvili, Zaza; Lettino, Maddalena; Quinn, Tom; Rubini Gimenez, Maria; Bøtker, Hans E; Swahn, Eva; Timmis, Adam; Tubaro, Marco; Vrints, Christiaan; Walker, David; Zahger, Doron; Zeymer, Uwe; Bueno, Hector

    2017-02-01

    Evaluation of quality of care is an integral part of modern healthcare, and has become an indispensable tool for health authorities, the public, the press and patients. However, measuring quality of care is difficult, because it is a multifactorial and multidimensional concept that cannot be estimated solely on the basis of patients' clinical outcomes. Thus, measuring the process of care through quality indicators (QIs) has become a widely used practice in this context. Other professional societies have published QIs for the evaluation of quality of care in the context of acute myocardial infarction (AMI), but no such indicators exist in Europe. In this context, the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA) has reflected on the measurement of quality of care in the context of AMI (ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI)) and created a set of QIs, with a view to developing programmes to improve quality of care for the management of AMI across Europe. We present here the list of QIs defined by the ACCA, with explanations of the methodology used, scientific justification and reasons for the choice for each measure.

  5. Discharge Policy and Reperfusion Therapy in Acute Myocardial Infarction

    NARCIS (Netherlands)

    M.J. van der Vlugt (Maureen)

    2007-01-01

    textabstractTreatment of patients with acute myocardial infarction (MI) has improved over time and the duration of hospital stay has considerably decreased. Early hospital discharge after MI has been promoted for over 25 years. However, the meaning of “early” evolved over time. In the early

  6. Intracoronary and systemic melatonin to patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Halladin, Natalie L; Busch, Sarah Ekeløf; Jensen, Svend Eggert

    2014-01-01

    INTRODUCTION: Ischaemia-reperfusion injury following acute myocardial infarctions (AMI) is an unavoidable consequence of the primary percutaneous coronary intervention (pPCI) procedure. A pivotal mechanism in ischaemia-reperfusion injury is the production of reactive oxygen species following...

  7. Serial Holter ST-segment monitoring after first acute myocardial infarction. Prevalence, variability, and long-term prognostic importance of transient myocardial ischemia

    DEFF Research Database (Denmark)

    Mickley, H; Nielsen, J R; Berning, J

    1998-01-01

    Based on serial Holter monitoring performed 7 times within 3 years after a first acute myocardial infarction, we assessed the prevalence, variability and long-term clinical importance of transient myocardial ischemia (TMI) defined as episodes of ambulatory ST-segment depression. In all, 121...... consecutive male patients variability was found within and between patients...

  8. Influence of high energy phosphate metabolism in postischemic myocardial dysfunction using magnetic resonance spectroscopy; Influencia dos fosfatos de alta energia na funcao ventricular em pacientes com infarto do miocardio avaliada pela resonancia magnetica

    Energy Technology Data Exchange (ETDEWEB)

    Kalil Filho, Roberto [Sao Paulo Univ., SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

    1998-05-01

    The recovery of left ventricular function after reperfusion is delayed in general by several hours, days or weeks and this phenomenon is known as myocardial stunning. One of the theories to explain the pathogenesis of this postischemic myocardial dysfunction is the production of not enough energy by mitochondria, leading to decreased adenosine-triphosphate (ATP) levels. We evaluated the influence of high energy phosphate metabolism in postischemic myocardial dysfunction, using magnetic resonance spectroscopy in patients with acute anterior wall myocardial infarction, successfully reperfused, within the first six hours from the onset of the symptoms. Twenty-nine patients were studied in the acute phase (on average four days after the onset of myocardial infarction) and 21 repeated the examination in the follow-up phase (average 39 days). Regional left ventricular function was evaluated by cine-resonance and high energy phosphate metabolism by phosphorus-31 spectroscopy, using the phosphocreatine {beta} ATP (P Cr/{beta}ATP) ratio. The existence of myocardial stunning was suggested by the improvement of the related regional contractility during the follow-up. The contractility improved in the septal wall from 2.46{+-} 0.68 to 1.54 {+-} 0.78 (p<0.001), in the anteroseptal wall from 2.0 {+-} 0.89 to 1.40 {+-} 0.75 (p<0.001) and in the anterior wall from 2.37 {+-} 0.71 to 1.41 {+-} 0.59 (p<0.001). The P Cr/{beta}ATP ratio did not change from acute to follow-up phase (1.51 {+-} 0.17 vs. 1.53 {+-} 0.17; p = 0.6). This study suggests that decreased high energy phosphate metabolism after reperfusion does not have an important role in the genesis of the myocardial stunning in patients with acute anterior wall myocardial infarction. (author) 25 refs., 9 figs., 1 tab.

  9. Acute stress decreases but chronic stress increases myocardial sensitivity to ischemic injury in rodents

    Directory of Open Access Journals (Sweden)

    Eric D Eisenmann

    2016-04-01

    Full Text Available Cardiovascular disease is the largest cause of mortality worldwide, and stress is a significant contributor to the development of cardiovascular disease. The relationship between acute and chronic stress and cardiovascular disease is well-evidenced. Acute stress can lead to arrhythmias and ischemic injury. However, recent evidence in rodent models suggests that acute stress can decrease sensitivity to myocardial ischemia-reperfusion injury. Conversely, chronic stress is arrythmogenic and increases sensitivity to myocardial ischemia-reperfusion injury. Few studies have examined the impact of validated animal models of stress-related psychological disorders on the ischemic heart. This review examines the work that has been completed using rat models to study the effects of stress on myocardial sensitivity to ischemic injury. Utilization of animal models of stress-related psychological disorders is critical in the prevention and treatment of cardiovascular disorders in patients experiencing stress-related psychiatric conditions.

  10. Serum uric acid level in hypertensive patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Burki, L.; Mehmood, A.

    2013-01-01

    To estimate serum uric acid level in hypertensive patients with acute myocardial infarction and hypertensive patients without myocardial infarction. Study Design Cross-sectional study. Setting Department of Medicine, Mayo Hospital, Lahore. Duration of study with dates Study was carried over a period of six months from 01-01-2007 to 30-06-2007. Subjects and methods Eighty hypertensive patients were included in the study out of which 40 patients with acute myocardial infarction were put in MI group and 40 patients without any history of myocardial infarction were labeled as non-MI group. Results Mean age of the patients in MI group and non-MI was found to be 50.0+-12.4 and 51.8+-10.1 years, respectively. Results of Serum uric acid level in MI group were 6.9+-1.0 mg/dl (0.407 +- 0.059 mmol/L ) and in non-MI group were 5.8+-1.5 mg/dl (0.342 +- 0.088 mmol/L) (p<0.001). (where 1 mmol/L = 16.78 mg/dl or 1 mg/dl = 0.059 mmol/L). Conclusion The present study proved that raised serum uric acid level can cause hypertension and further rise can lead to MI. (author)

  11. Acute myocardial infarction and stress cardiomyopathy following the Christchurch earthquakes.

    Science.gov (United States)

    Chan, Christina; Elliott, John; Troughton, Richard; Frampton, Christopher; Smyth, David; Crozier, Ian; Bridgman, Paul

    2013-01-01

    Christchurch, New Zealand, was struck by 2 major earthquakes at 4:36 am on 4 September 2010, magnitude 7.1 and at 12:51 pm on 22 February 2011, magnitude 6.3. Both events caused widespread destruction. Christchurch Hospital was the region's only acute care hospital. It remained functional following both earthquakes. We were able to examine the effects of the 2 earthquakes on acute cardiac presentations. Patients admitted under Cardiology in Christchurch Hospital 3 week prior to and 5 weeks following both earthquakes were analysed, with corresponding control periods in September 2009 and February 2010. Patients were categorised based on diagnosis: ST elevation myocardial infarction, Non ST elevation myocardial infarction, stress cardiomyopathy, unstable angina, stable angina, non cardiac chest pain, arrhythmia and others. There was a significant increase in overall admissions (pearthquake. This pattern was not seen after the early afternoon February earthquake. Instead, there was a very large number of stress cardiomyopathy admissions with 21 cases (95% CI 2.6-6.4) in 4 days. There had been 6 stress cardiomyopathy cases after the first earthquake (95% CI 0.44-2.62). Statistical analysis showed this to be a significant difference between the earthquakes (pearthquake triggered a large increase in ST elevation myocardial infarction and a few stress cardiomyopathy cases. The early afternoon February earthquake caused significantly more stress cardiomyopathy. Two major earthquakes occurring at different times of day differed in their effect on acute cardiac events.

  12. Clinical and angiographic characteristics of young adult patients recovered from acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Miljković Dušan

    2015-01-01

    Full Text Available Introduction. Occurrence of acute myocardial infarction in young adults is a relatively rare. In majority of the studies, age of 45 years is used as cut-off line in definition of the young patients with coronary artery disease or myocardial infarction. Studies have shown that younger population aged less than 40 years represents only 2-8% of all patients with myocardial infarction. Objective. The aim of this study was to examine the specificities of clinical and angiographic characteristics of the patients recovered from acute myocardial infarction, younger than 45 years at the moment of attack, by comparing their clinical and angiographic characteristics with those of patients older than 65 years, who recovered from acute myocardial infarction. Method. The study included 78 patients recovered from acute myocardial infarction, 33 patients were younger than 45 years (40.7 ± 3.9 years, 25 (75.7% men and eight (24.2% female, and 45 patients were older than 65 years (68.2 ± 4.2 years, 32 (71.3% men and 13 women. Detailed history taking, physical examination, permanent ECG monitoring, laboratory analyses, X-ray examination, echocardiography and selective coronarography of all patients were performed. Results. Patients younger than 45 years had a significantly higher incidence of STEMI (p 0.05 Multivessel disease existed at 54.5% under the age of 45 and 77.8% older than 65 years (p0.05. The disease of left main coronary artery had 6.1% of patients younger than 45 and 22.2% of patients older than 65 years (p0.05 Were without significant coronary artery stenosis Comparing risk factors for coronary artery disease in patients younger than 45 years and older than 65 years, we find: hypertension in 48.5% vs. 88.9% (p0.05, diabetes mellitus in 21.2% vs. 55.5% (p 0.05, and stress in 18.2% vs. 2.2% (p <0.01. Conclusion. Patients with myocardial infarction younger than 45 years are predominantly male and have a significantly higher incidence of infarction

  13. The prognostic significance of early and late right precordial lead (V4 R) ST-segment elevation in patients with acute anterior myocardial infarction.

    Science.gov (United States)

    Keskin, Muhammed; Uzun, Ahmet Okan; Börklü, Edibe Betül; Hayıroğlu, Mert İlker; Türkkan, Ceyhan; Tekkeşin, Ahmet İlker; Kozan, Ömer

    2018-03-01

    The predictive significance of ST-segment elevation (STE) in lead V 4 R in patients with anterior ST-segment elevation myocardial infarction (STEMI) has not been well-understood. In this study, we evaluated the prognostic value of early and late STE in lead V 4 R in patients with anterior STEMI. A total 451 patients with anterior STEMI who treated with primary percutaneous coronary intervention (PPCI) were prospectively enrolled in this study. All patients were classified according to presence of STE (>1 mm) in lead V 4 R at admission and/or 60 min after PPCI. Based on this classification, all patients were divided into three subgroups as no V 4 R STE (Group 1), early but not late V 4 R STE (Group 2) and late V 4 R STE (Group 3). In-hospital mortality had higher rates at group 2 and 3 and that had 2.1 and 4.1-times higher mortality than group 1. Late V 4 R STE remained as an independent risk factor for cardiogenic shock (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.9-4.3; p < .001) and in-hospital mortality (OR 2.3; 95% CI 1.8-4.1; p < .001). The 12-month overall survival for group 1, 2, and 3 were 91.1%, 82.4%, and 71.4% respectively. However, the long-term mortality also had the higher rate at group 3; late V 4 R STE did not remain as an independent risk factor for long-term mortality (OR 1.5; 95% CI 0.8-4.1; p: .159). Late V 4 R STE in patients with anterior STEMI is strongly associated with poor prognosis. The record of late V 4 R in patients with anterior STEMI has an important prognostic value. © 2017 Wiley Periodicals, Inc.

  14. Emission tomography with sup(99m)Tc-pyrophosphate in the diagnosis of acute myocardial infarction

    International Nuclear Information System (INIS)

    Poeyhoenen, L.; Uusitalo, A.; Virjo, A.

    1985-01-01

    Electrocardiograms (ECG) and enzyme criteria are usually used to confirm the diagnosis of acute myocardial infarction in the case of chest pain. However, ECG is not always diagnostic. Elevated enzyme values may be due to causes other than myocardial infarction. In uncertain cases, the ECG and enzyme criteria can be supplemented by emission tomography, performed with technetium pyrophosphate that will accumulate in the site of infarction. Twenty-nine patients with suspected acute myocardial infarction were studied with emission tomography. Of these 12 had acute transmural infarction. Both enzyme tests and ECG were diagnostic in only 7 of these 12 cases, 4 had positive enzyme tests but a nondiagnostic ECG and in one case neither enzymes nor ECG were diagnostic. In 11 patients the infarcted myocardial area was detected with emission tomography. Six patients had acute nontransmural infarction. Only 2 of these had positive emission tomography. The chest pain was not due to infarction in 11 patients. All these patients had negative emission tomography. The sensitivity of emission tomography was 92% and specificity 100% in transmural acute infarction. In nontransmural infarction the specificity was only 33%. Emission tomography is a valuable diagnostic tool. It may be the decisive method when ECG and enzymes are not diagnostic. Emissin tomography also shows the localization and size of the infarcted area in the myocardium. (orig.)

  15. [Myocardial bridge as the only cause of acute coronary syndrome among the young patients].

    Science.gov (United States)

    Miakinkova, Liudmila O; Teslenko, Yurii V; Tsyhanenko, Irina V

    2018-01-01

    Introduction: Myocardial bridge is an inborn anomaly of coronary artery development, when a part of it is submerged in a myocard, which is pressing the coronary artery to a systola and restrains coronary blood circulation. Generally this feature of coronary blood circulation does not cause any clinical symptoms because the 85% of coronary blood stream of the left ventricle is provided by diastolic filling. Hemodynamic changes in atherosclerosis, tahicardie, hypertrophie of myocard are leading to the manifestation of clinical symptoms of ischemia. The aim: The purpose of the investigation was to discover the features of clinical development of acute coronary syndrome caused by myocardial bridge of young patients without the features of atherosclerotical harm of coronary arteries. Materials and methods: Eight causes of acute coronary syndrome among patients of 28±8,5 years with myocardial bridge which was revealed during coronary angiography, were investigated. Standardized examination and conservative treatment of patients was held, except for three who have got interventional therapy. Results: According to our investigation, myocardial bridge of all investigated patients was located in the middle of the third front interventricular branch of the left coronary artery. Causes of acute coronary syndrome manifestation were tahicardia, spasms of coronary artery, inducted by iatrogenic factors hypertrophie of myocard, hypertrophic cardiomyopatie. Connection between the manifestation of clinical symptoms and length of tunneled segment which did not depend on the level of systolic compres was discovered. The results of conservative and interventional treatment were analyzed. Conclusions: Myocardial bridge can be the cause of myocardial ischemia among patients without signs of coronary atherosclerosis with additional hemodynamic risk facts such as tahicardia, spasms of coronary artery, hypertrophie of myocard. Clinical symptomatology of the acute coronary syndrome is more

  16. Electrocardiographic changes of acute lateral wall myocardial infarction: a reappraisal based on scintigraphic localization of the infarct

    International Nuclear Information System (INIS)

    Movahed, A.; Becker, L.C.

    1984-01-01

    To determine how often acute lateral myocardial infarcts may be electrocardiographically silent, a new approach was utilized in which subjects were selected by admission thallium scintigraphy. Thirty-one patients with their first infarction were identified with moderate to severe perfusion defects of the lateral and posterolateral walls, persistent over 7 days and associated with severe wall motion abnormalities. Patients with involvement of the anterior, septal or inferior regions were not included. In nine patients, the perfusion defect extended to the anterolateral wall: all developed ST elevation and Q waves in at least one of the lateral leads (I, aVL or V6) but none showed changes in the inferior leads (II, III or aVF). In the other 22 patients, the perfusion defect was limited to the lateral and posterolateral walls: only 12 showed ST elevations (inferior leads only in 7, lateral leads only in 2, both leads in 3) and only 9 developed Q waves (inferior in all). In 8 of these 22 patients, the infarct was silent in the sense that no ST segment elevation or Q waves were seen, although ST depressions or T wave inversions, or both, in all but one patient were compatible with subendocardial infarction. The results indicate that the standard electrocardiogram is insensitive to changes in the lateral and posterolateral regions. Additional diagnostic studies are needed for proper localization and sizing of acute myocardial infarcts

  17. Quality of health information on acute myocardial infarction and stroke in the world wide web.

    Science.gov (United States)

    Bastos, Ana; Paiva, Dagmara; Azevedo, Ana

    2014-01-01

    The quality of health information in the Internet may be low. This is a concerning issue in cardiovascular diseases which warrant patient self-management. We aimed to assess the quality of Portuguese websites as a source of health information on acute myocardial infarction and stroke. We used the search terms 'enfarte miocardio' and 'acidente vascular cerebral' (Portuguese terms for myocardial infarction and stroke) on Google(®), on April 5th and 7th 2011, respectively, using Internet Explorer(®). The first 200 URL retrieved in each search were independently visited and Portuguese websites in Portuguese language were selected. We analysed and classified 121 websites for structural characteristics, information coverage and accuracy of the web pages with items defined a priori, trustworthiness in general according to the Health on the Net Foundation and regarding treatments using the DISCERN instrument (48 websites). Websites were most frequently commercial (49.5%), not exclusively dedicated to acute myocardial infarction/ stroke (94.2%), and with information on medical facts (59.5%), using images, video or animation (60.3%). Websites' trustworthiness was low. None of the websites displayed the Health on the Net Foundation seal. Acute myocardial infarction/ stroke websites differed in information coverage but the accuracy of the information was acceptable, although often incomplete. The quality of information on acute myocardial infarction/ stroke in Portuguese websites was acceptable. Trustworthiness was low, impairing users' capability of identifying potentially more reliable content.

  18. Do diabetes mellitus and systemic hypertension predispose to left ventricular free wall rupture in acute myocardial infarction?

    DEFF Research Database (Denmark)

    Melchior, T; Hildebrant, P; Køber, L

    1997-01-01

    Diabetes and systemic hypertension had no influence on left ventricular free wall rupture complicating acute myocardial infarction. Age <65 years and a history of coronary artery disease offers some protection from protection.......Diabetes and systemic hypertension had no influence on left ventricular free wall rupture complicating acute myocardial infarction. Age

  19. Effect of coronary artery recanalization on right ventricular function in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Verani, M.S.; Tortoledo, F.E.; Batty, J.W.; Raizner, A.E.

    1985-01-01

    The effects of coronary artery recanalization by intracoronary administration of streptokinase on left ventricular function during acute myocardial infarction have received increasing attention in recent years. Although myocardial dysfunction is often more pronounced in the right ventricle than in the left ventricle in patients with acute inferior wall myocardial infarction, the effect of coronary artery recanalization on right ventricular dysfunction has not been previously addressed. Accordingly, in this investigation, 54 patients who participated in a prospective, controlled, randomized trial of recanalization during acute myocardial infarction were studied. Among 30 patients with inferior wall infarction, 19 had right ventricular dysfunction on admission; 11 of these 19 had positive uptake of technetium-99m pyrophosphate in the right ventricle, indicative of right ventricular infarction. Patients with successful recanalization exhibited improved right ventricular ejection fraction from admission to day 10. However, control patients and patients who did not undergo recanalization also exhibited improvement. These data indicate that the right ventricular dysfunction commonly associated with inferior wall infarction is often transient, and improvement is the rule, irrespective of early recanalization of the infarct vessel

  20. Dexrazoxane Shows No Protective Effect in the Acute Phase of Reperfusion during Myocardial Infarction in Pigs.

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    Pranitha Kamat

    Full Text Available Calcium and iron overload participate in the mechanisms of ischemia/reperfusion (I/R injury during myocardial infarction (MI. Calcium overload induces cardiomyocyte death by hypercontraction, while iron catalyses generation of reactive oxygen species (ROS. We therefore hypothesized that dexrazoxane, an intracellular metal chelator, would attenuate I/R injury. MI was induced in pigs by occlusion of the left anterior descending artery for 1 hour followed by 2 hours reperfusion. Thirty minutes before reperfusion either 5 mg/ml dexrazoxane (n = 5 or saline (n = 5 was infused intravenously. Myocardial necrosis as percentage of the area at ischemic risk was found to be similar in both groups (77.2 ± 18% for dexrazoxane and 76.4 ± 14% for saline group as determined by triphenyl tetrazolium chloride staining of the ischemic myocardium. Also, serum levels of troponin-I were similar in both groups. A conductance catheter was used to measure left ventricular pressure and volume at all times. Markers for tissue damage due to ROS (HNE, endothelial cell activation (CD31 and inflammation (IgG, C3b/c, C5b9, MCP-1 were assessed on tissue and/or in serum. No significant differences were observed between the groups for the parameters analyzed. To conclude, in this clinically relevant model of early reperfusion after acute myocardial ischemia, dexrazoxane lacked attenuating effects on I/R injury as shown by the measured parameters.

  1. Increased risk of sudden and non-sudden cardiovascular death in patients with atrial fibrillation/flutter following acute myocardial infarction

    DEFF Research Database (Denmark)

    Pedersen, Ole Dyg; Abildstrøm, Steen Z; Ottesen, Michael M

    2005-01-01

    AIMS: Atrial fibrillation (AF) is a common complication in patients with acute myocardial infarction and is associated with an increase in the risk of death. The excess mortality associated with AF complicating acute myocardial infarction has not been studied in detail. Observations indicate...... that AF facilitates induction of ventricular arrhythmias, which may increase the risk of sudden cardiovascular death (SCD). A close examination of the mode of death could potentially provide useful knowledge to guide further investigations and treatments. METHODS AND RESULTS: We analysed the relation...... between AF/atrial flutter (AFL) and modes of death in 5983 consecutive patients discharged alive after an acute myocardial infarction screened in the TRAndolapril Cardiac Evaluation registry. This cohort of patients with an enzyme-verified acute myocardial infarction was admitted to 27 centres in 1990...

  2. Risk Stratification and Effects of Pharmacotherapy in Patients with Acute Myocardial Infarction (AMI) based on data from Pilot AMI Registry

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Grünfeldová, H.; Monhart, Z.; Faltus, Václav; Tomečková, Marie; Ryšavá, D.; Velimský, T.; Ballek, L.; Hubač, J.; Charalampidi, K.; Jánský, P.

    2007-01-01

    Roč. 30 (2007), s. 367-367 ISSN 1420-4096. [Central European Meeting on Hypertension and Cardiovascular Disease Prevention. 11.10.2007-13.10.2007, Kraków] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : pilot registry of acute myocardial infarction * risk stratification in acute myocardial infarction * effects of pharmacotherapy in acute myocardial infarction Subject RIV: FA - Cardiovascular Disease s incl. Cardiotharic Surgery

  3. Transient coronary vasodilatory impairment after direct PTCA in acute myocardial infarction

    International Nuclear Information System (INIS)

    Yamabe, Hiroshi; Kim, Susik; Hashimoto, Yasunori; Fujita, Hideki; Yano, Takashi; Iwahashi, Masanori; Maeda, Kazumi; Yokoyama, Mitsuhiro

    1995-01-01

    To determine whether transient impairment in coronary artery reserve may occur after acute percutaneous transluminal coronary angioplasty (PTCA) and may be related with myocardial stunning in acute myocardial infarction (MI), 14 paients were examined by dipyridamole (dip) thallium-201 scintigraphy. Of these patients, 13 patients had recanalization after PTCA and one had spontaneous recanalization. Eight and 6 patients were classified as the 'fill-in phenomenon' and as no 'fill-in phenomenon', respectively, on reinjection thallium-201 images after delayed imaging. In the group of 'fill-in phenomenon', thallium uptake was significantly increased both on early images in chronic MI and on reinjection images, as compared with that on early images in acute MI. In the group of 'no fill-in phenomenon', on the contrary, thallium uptake was significantly decreased. An increase of thallium-201 uptake from early images in acute MI to reinjection images was positively correlated with changes in thallium-201 uptake on early images from acute to chronic MI. There was a positive correlation between the arteriographic improvement of wall motion abnormality in the infart zones and % thallium-201 uptake. These data indicate that transient functional impairment may occur not only in the myocardium but also in coronary fine vessels in MI patients successfully treated with direct PTCA. (N.K.)

  4. Dipyridamole induced directory disfunction of infarcted vessel, and estimation of patients with acute myocardial infarction and successful PTCA

    International Nuclear Information System (INIS)

    Hashimoto, Yasunori; Yamabe, Hiroshi; Kim, Sushik; Yano, Takashi; Fujita, Hideki; Kakimoto, Tetsuya; Namura, Hiroyuki; Maeda, Kazumi; Yokoyama, Mitsuhiro

    1993-01-01

    The purpose of this study was to determine whether transient disturbance of vascular dilation in the peripheral coronary vessels in patients with myocardial infarction in whom coronary recanalization was successfully attained in the acute stage. The subjects were 6 patients with acute myocardial infarction in whom recanalization was successfully attained without a significant coronary stenosis by emergency percutaneous transluminal coronary angioplasty (PTCA). Dipyridamole-loaded thallium-201 myocardial scintigraphy was undertaken during the acute stage (an average of 5 days after PTCA) and during convalescent stage (an average 24 days after PTCA). Defect was seen in the infarcted areas on early images during the acute stage in all 6 patients, and Tl uptake in the infarcted areas was improved during the convalescent stage in 2 of the 6 patients. In these two patients, fill-in phenomenon was seen in the infarcted area during acute stage when images were acquired after re-injection of Tl-201. These findings suggested that transient disturbance of vascular dilation may occur in the peripheral coronary artery vessels in the infarcted area where recanalization was successfully attained in patients with acute myocardial infarction. (N.K.)

  5. Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: Initial results

    Energy Technology Data Exchange (ETDEWEB)

    Weininger, Markus [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC (United States); Ramachandra, Ashok [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Fink, Christian [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany); Rowe, Garrett W.; Costello, Philip [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Henzler, Thomas [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany)

    2012-12-15

    Purpose: Recent innovations in CT enable the evolution from mere morphologic imaging to dynamic and functional testing. We describe our initial experience performing myocardial stress perfusion CT in a clinical population with acute chest pain. Methods and materials: Myocardial stress perfusion CT was performed on twenty consecutive patients (15 men, 5 women; mean age 65 ± 8 years) who presented with acute chest pain and were clinically referred for stress/rest SPECT and cardiac MRI. Prior to CT each patient was randomly assigned either to Group A or to Group B in a consecutive order (10 patients per group). Group A underwent adenosine-stress dynamic real-time myocardial perfusion CT using a novel “shuttle” mode on a 2nd generation dual-source CT. Group B underwent adenosine-stress first-pass dual-energy myocardial perfusion CT using the same CT scanner in dual-energy mode. Two experienced observers visually analyzed all CT perfusion studies. CT findings were compared with MRI and SPECT. Results: In Group A 149/170 myocardial segments (88%) could be evaluated. Real-time perfusion CT (versus SPECT) had 86% (84%) sensitivity, 98% (92%) specificity, 94% (88%) positive predictive value, and 96% (92%) negative predictive value in comparison with perfusion MRI for the detection of myocardial perfusion defects. In Group B all myocardial segments were available for analysis. Compared with MRI, dual-energy myocardial perfusion CT (versus SPECT) had 93% (94%) sensitivity, 99% (98%) specificity, 92% (88%) positive predictive value, and 96% (94%) negative predictive value for detecting hypoperfused myocardial segments. Conclusion: Our results suggest the clinical feasibility of myocardial perfusion CT imaging in patients with acute chest pain. Compared to MRI and SPECT both, dynamic real-time perfusion CT and first-pass dual-energy perfusion CT showed good agreement for the detection of myocardial perfusion defects.

  6. Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: Initial results

    International Nuclear Information System (INIS)

    Weininger, Markus; Schoepf, U. Joseph; Ramachandra, Ashok; Fink, Christian; Rowe, Garrett W.; Costello, Philip; Henzler, Thomas

    2012-01-01

    Purpose: Recent innovations in CT enable the evolution from mere morphologic imaging to dynamic and functional testing. We describe our initial experience performing myocardial stress perfusion CT in a clinical population with acute chest pain. Methods and materials: Myocardial stress perfusion CT was performed on twenty consecutive patients (15 men, 5 women; mean age 65 ± 8 years) who presented with acute chest pain and were clinically referred for stress/rest SPECT and cardiac MRI. Prior to CT each patient was randomly assigned either to Group A or to Group B in a consecutive order (10 patients per group). Group A underwent adenosine-stress dynamic real-time myocardial perfusion CT using a novel “shuttle” mode on a 2nd generation dual-source CT. Group B underwent adenosine-stress first-pass dual-energy myocardial perfusion CT using the same CT scanner in dual-energy mode. Two experienced observers visually analyzed all CT perfusion studies. CT findings were compared with MRI and SPECT. Results: In Group A 149/170 myocardial segments (88%) could be evaluated. Real-time perfusion CT (versus SPECT) had 86% (84%) sensitivity, 98% (92%) specificity, 94% (88%) positive predictive value, and 96% (92%) negative predictive value in comparison with perfusion MRI for the detection of myocardial perfusion defects. In Group B all myocardial segments were available for analysis. Compared with MRI, dual-energy myocardial perfusion CT (versus SPECT) had 93% (94%) sensitivity, 99% (98%) specificity, 92% (88%) positive predictive value, and 96% (94%) negative predictive value for detecting hypoperfused myocardial segments. Conclusion: Our results suggest the clinical feasibility of myocardial perfusion CT imaging in patients with acute chest pain. Compared to MRI and SPECT both, dynamic real-time perfusion CT and first-pass dual-energy perfusion CT showed good agreement for the detection of myocardial perfusion defects.

  7. Myocardial revascularization with coronary endarterectomy. Stratification of risk factors for early mortality

    Directory of Open Access Journals (Sweden)

    Atik Fernando Antibas

    2000-01-01

    Full Text Available OBJECTIVE: To determine the risk factors for mortality related to myocardial revascularization when performed in association with coronary endarterectomy. METHODS: We assessed retrospectively 353 patients who underwent 373 coronary endarterectomies between January '89 and November '98, representing 3.73% of the myocardial revascularizations in this period of time. The arteries involved were as follows: right coronary artery in 218 patients (58.45%; left anterior descending in 102 patients (27.35%; circumflex artery in 39 patients (10.46%; and diagonal artery in 14 patients (3.74%. We used 320 (85.79% venous grafts and 53 (14.21% arterial grafts. RESULTS: In-hospital mortality among our patients was 9.3% as compared with 5.7% in patients with myocardial revascularizations without endarterectomy (p=0.003. Cause of death was related to acute myocardial infarction in 18 (54.55% patients. The most significant risk factors for mortality identified were as follows: diabetes mellitus (p=0.001; odds ratio =7.168, left main disease (<0.001; 9.283, female sex (0.01; 3.111, acute myocardial infarction (0.02; 3.546, ejection fraction <35% (<0.001; 5.89, and previous myocardial revascularization (<0.001; 4.295. CONCLUSION: Coronary endarterectomy is related to higher mortality, and the risk factors involved are important elements of a poor outcome.

  8. Use of orbital atherectomy in acute myocardial infarction via the transradial approach

    Science.gov (United States)

    Mowakeaa, Samer; Snyder, Branden; Kakouros, Nikolaos

    2016-01-01

    Severe coronary artery calcifications pose an ongoing challenge when performing percutaneous coronary interventions, resulting in an increased likelihood of procedural complications. Orbital atherectomy (OA) has emerged as a promising technology that helps improve outcomes in this complex patient population. Its safety and efficacy are yet to be demonstrated in the setting of acute myocardial infarction. We present a case of a patient with acute ST-elevation myocardial infarction (STEMI) evaluated with emergent transradial coronary angiography. The culprit lesion was a severely stenotic, heavily calcified, segment of the right coronary artery. The use of OA facilitated lesion expansion and implantation of a drug-eluting stent. Although OA should be considered as contraindicated for the management of soft-ruptured plaque, which accounts for the majority of STEMI presentations, it may be well applied to the small subset of patients with calcified nodule pathology, even in the acute setting. PMID:28180008

  9. Technetium-99m pyrophosphate myocardial scintigraphy in the diagnosis of acute rheumatic carditis

    International Nuclear Information System (INIS)

    Malhotra, A.; Radhakrishnan, S.; Reddy, K.S.; Gopinath, P.G.; Bhatia, M.L.

    1989-01-01

    Rheumatic fever (RF) and rheumatic heart disease (RHD) are major health problems in India. The most difficult decision to make in such a setting is whether a patient of acute rheumatic fever has acute rheumatic carditis or not. Physical signs such as a new cardiac murmur, cardiac enlargement, congestive cardiac failure although quoted as pointers to carditis are non-specific specially if the attack is superimposed on pre-existing RHD. Any investigation which will provide an answer to this problem would be very welcome. sup(99m)Tc pyrophosphate (Tc PYP) is a very sensitive indicator of myocardial necrosis in acute myocardial infarction. A study to determine the usefulness of this technique in diagnosis of rheumatic carditis in patients with unequivocal clinical evidence of myocarditis was undertaken. Results are reported. (author). 14 refs

  10. Microvascular obstruction after successful fibrinolytic therapy in acute myocardial infarction. Comparison of reteplase vs reteplase+abciximab: A cardiovascular magnetic resonance study

    Directory of Open Access Journals (Sweden)

    Tiziano Gherli

    2010-05-01

    Full Text Available Background. About one third of patients with TIMI 3 after reperfusion have evidence of microvascular obstruction (MO which represents an independent predictor of myocardial wall rupture. This explains all efforts made to prevent MO. Magnetic resonance imaging (MRI has proved to be particularly useful in detecting MO. The aim of this study was to evaluate with MRI if different fibrinolytic regimens in acute myocardial infarction display different effects on left ventricle (LV volumes and ejection fraction (EF, as well as on myocardial infarct size (MIsz and MO. Methods. Twenty male patients, mean age 58 years, affected by acute myocardial infarction, ten anterior and ten inferior, were treated with: full dose reteplase in ten, and half dose reteplase plus full dose abciximab (R+Abcx in the other ten patients. In the fourth day after hospital admission, MRI STIR T2 images were used to quantify MIsz, while 2dflash cineloops were used after the injection of gadolinium, to quantify LV volumes, EF and to detect MO. Results. LV EF was higher in R+Abcx 51±10 than in reteplase 41±8. MIsz was similar in both treatment groups: however a close relationship was present between MIsz and EF in the reteplase group indicating that the greater the MIsz the lower the EF. In R+Abcx this relationship was no longer present, suggesting a protective effect of the drug on microcirculation. In fact extensive MO was present in 25% of all cases, 80% of which in the reteplase group while only 20% in R+Abcx. Conclusion. R+Abcx prevents MO: compared to traditional fibrinolytic therapy it allows better LV function and most likely improved long term survival.

  11. Acute myocardial infarction in young adults with Antiphospholipid syndrome: report of two cases and literature review

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    Leila Abid

    2011-02-01

    Full Text Available Acute myocardial infarction (AMI is rarely associated with antiphospholipid syndrome. The treatment of these patients is a clinical challenge. We report the observations of 2 young adults (1 woman and 1 man, admitted in our acute care unit for acute myocardial infarction (AMI. A coagulopathy work-up concludes the existence of antiphospholipid syndrome (APS in the 2 cases. APS syndrome was considered primary in 2 cases. All patients presented an intense inflammatory syndrome (high level of CRP. Anticardiolipine was present in the 2 cases. However, anti B2 glycoprotein I antibodies were detected in only one case. Emergency percutaneous transluminal coronary angioplasty (PTCA with direct stenting had been performed successfully only in the first case, and the follow-up was uncomplicated. Thereafter, long-term oral anticoagulant appeared to be effective. The last patient was admitted because of peripheral acute ischemia of legs. Standard electrocardiogram showed signs of previous silent anteroseptal wall myocardial infarction confirmed by echocardiography. The latter revealed an apical thrombus and a very low left ventricular ejection fraction. Amputation of the right leg was necessary because of consultation occurred too late. However, he died four weeks later. Primary antiphospholipid syndrome should be considered as a cause of acute myocardial infarction in young adults, and PTCA with anticoagulant treatment is effective for initial treatment of this complication

  12. Fasa Registry on Acute Myocardial Infarction (FaRMI: Feasibility Study and Pilot Phase Results.

    Directory of Open Access Journals (Sweden)

    Ehsan Bahramali

    Full Text Available Myocardial infarction (MI is the leading cause of death in Iran. Every attempt to improve treatment patterns and patient outcomes needs a surveillance system to both consider the efficacy and safety measures. Fasa Registry on Myocardial Infarction (FaRMI is the first population-based registry for acute MI in Iran targeted to provide meticulous description of patients' characteristics, to explore the management patterns of these patients, to discover the degree of adherence to the practice guidelines, and to investigate the determinants of poor in-hospital and later outcomes.A diagnosis of acute MI (type I, II and III was made upon the accepted criteria by the attending cardiologists and types IV and V MI were excluded. Two registrar nurses gathered data on demographics, place of residence and ethnicity, past medical history, risk factors, and the clinical course. Management patterns in the pre-hospital setting, during the hospital stay and at the discharge time were recorded. Routine laboratory results and cardiac biomarkers on three consecutive days were registered.pilot phase included the first 95 patients, 63.5% of whom were men and 31.5% were women. With a mean age of 62.89±13.75 years among participants, the rate of premature MI was 31.8%. ST segment elevation MI accounted for 68.2% cases and inferior wall was the most prevalent region involved followed by anterior and posterior walls.Obtained data on the characteristics of patients suffering an MI event revealed the major determinants of delay in initiation of therapies and contributors of poor outcome. Completeness of data was guaranteed upon involvement of multiple checkpoints and data quality was secured by means of automatic validation processes in addition to weekly physicians' roundups.Execution of FaRMI in the form presented is feasible and it will build up a comprehensive population-based registry for MI in the region.

  13. Evolutionary changes in left and right ventricular function in acute myocardial infarction

    International Nuclear Information System (INIS)

    Ohsuzu, Fumitaka; Yasuda, Tsunehiro; Gold, H.K.; Leinbach, R.C.; Rosenthal, S.V.; Alpert, N.M.; Boucher, C.A.; McKusick, K.A.; Strauss, H.W.

    1987-01-01

    To determine the evolutionary changes in right and left ventricular function in acute myocardial infarction, 3 serial gated blood pool scans were performed in 76 patients within 24 hours (24 H), at 10 days (10 D) and 3 months (3 M) following the onset of myocardial infarction. The patients were divided into 3 groups: ANT (anterior MI), INF (inferior MI without right ventricular dysfunction) and RVF (inferior MI with right ventricular dysfunction). LVEF in ANT was significantly lower than that of INF and RVF at 24 H, 10 D and 3 M. The ratio of right ventricular volume to LV volume (RVV/LVV) was compared among 3 groups. The mean values of RVV/LVV in RVF were 1.3 through 24 H and 3 M and they were significantly higher than the other two groups. The RVV/LVV in ANT and INF were around 1.0. LVEDVI in RVF was rather smaller than that of ANT and INF. LVESVI in ANT at 24 H was significantly larger than that of INF and RVF and the mean value of LVESVI in ANT were around 60 ml/M 2 from 24 H to 3 M. LVEF in ANT, RVF and INF did not increase significantly during peak exercise at 3 M. However, quantitative regional wall motion analysis revealed that regional wall motion of R2 (posterolateral wall motion) in ANT and R5 (septal wall motion) in INF decreased significantly during peak exercise. These impairments in regional wall motion might be due to the exacerbation of ischemia of non-infarcted area. (author)

  14. Evolutionary changes in left and right ventricular function in acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Ohsuzu, Fumitaka; Yasuda, Tsunehiro; Gold, H K; Leinbach, R C; Rosenthal, S V; Alpert, N M; Boucher, C A; McKusick, K A; Strauss, H W

    1987-09-01

    To determine the evolutionary changes in right and left ventricular function in acute myocardial infarction, 3 serial gated blood pool scans were performed in 76 patients within 24 hours (24 H), at 10 days (10 D) and 3 months (3 M) following the onset of myocardial infarction. The patients were divided into 3 groups: ANT (anterior MI), INF (inferior MI without right ventricular dysfunction) and RVF (inferior MI with right ventricular dysfunction). LVEF in ANT was significantly lower than that of INF and RVF at 24 H, 10 D and 3 M. The ratio of right ventricular volume to LV volume (RVVLVV) was compared among 3 groups. The mean values of RVVLVV in RVF were 1.3 through 24 H and 3 M and they were significantly higher than the other two groups. The RVVLVV in ANT and INF were around 1.0. LVEDVI in RVF was rather smaller than that of ANT and INF. LVESVI in ANT at 24 H was significantly larger than that of INF and RVF and the mean value of LVESVI in ANT were around 60 mlM/sup 2/ from 24 H to 3 M. LVEF in ANT, RVF and INF did not increase significantly during peak exercise at 3 M. However, quantitative regional wall motion analysis revealed that regional wall motion of R2 (posterolateral wall motion) in ANT and R5 (septal wall motion) in INF decreased significantly during peak exercise. These impairments in regional wall motion might be due to the exacerbation of ischemia of non-infarcted area

  15. [Diagnostics of acute myocardial infarction in elderly patients].

    Science.gov (United States)

    Bahrmann, P; Heppner, H J; Bahrmann, A; Christ, M; Bertsch, T; Sieber, C C

    2011-06-01

    The early diagnosis of an acute myocardial infarction (MI) is improved by the introduction of novel high-sensitivity troponin assays. These assays can measure low level myocardial injury not detectable by standard troponin assays. Especially in older patients who appear to have a higher basal troponin level, the results must always be judged in the context of the medical history, physical examination, electrocardiogram (ECG) and any further findings. Even small increases in high-sensitivity troponin indicate increased risk for death or MI during follow-up. In the case of MI an invasive strategy results in better survival rates compared with conservative therapy but at the expense of an increased risk of bleeding in elderly patients. This article provides an overview on the diagnosis of MI in elderly patients.

  16. Impact of metabolic syndrome on ST segment resolution after thrombolytic therapy for acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Ayşe Saatçı Yaşar

    2010-09-01

    Full Text Available 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:1.248-5.179Conclusion: 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.

  17. Mortality after acute myocardial infarction according to income and education

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe Nørgaard; Rasmussen, Søren; Gislason, Gunnar H

    2006-01-01

    OBJECTIVE: To study how income and educational level influence mortality after acute myocardial infarction (AMI). DESIGN AND SETTING: Prospective analysis using individual level linkage of registries in Denmark. PARTICIPANTS: All patients 30-74 years old hospitalised for the first time with AMI i...... that both educational level and income substantially and independently affect mortality after AMI, indicating that each indicator has specific effects on mortality and that these indicators are not interchangeable.......OBJECTIVE: To study how income and educational level influence mortality after acute myocardial infarction (AMI). DESIGN AND SETTING: Prospective analysis using individual level linkage of registries in Denmark. PARTICIPANTS: All patients 30-74 years old hospitalised for the first time with AMI...... in Denmark in 1995-2002. MAIN OUTCOME MEASURES: Relative risk (RR) of 30 day mortality and long term mortality (31 days until 31 December 2003) associated with income (adjusted for education) or educational level (adjusted for income) and further adjusted for sex, age, civil status, and comorbidity. RESULTS...

  18. Acute anterior uveitis following intravitreal bevacizumab but not subsequent ranibizumab

    Directory of Open Access Journals (Sweden)

    Antonopoulos C

    2011-11-01

    Full Text Available Christina Antonopoulos1, Maxwell Stem2, Grant M Comer21Department of Ophthalmology, Boston University, Boston, MA, USA; 2WK Kellogg Eye Center, Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USAPurpose: Previous reports have identified noninfectious uveitis as a potential sequela following both intravitreal bevacizumab and ranibizumab injections. We present two unique cases of acute anterior uveitis following intravitreal bevacizumab that did not occur with subsequent ranibizumab injections.Methods: Case report.Conclusion: These cases may reflect differences in the etiology of anterior uveitis following intravitreal bevacizumab and ranibizumab. Given these differences, it may be reasonable to offer ranibizumab to patients who have experienced presumed bevacizumab-induced anterior uveitis.Keywords: adverse effect, age-related macular degeneration, anterior uveitis, bevacizumab, ranibizumab, uveitis

  19. Long-term mortality in patients with diabetes mellitus type 2 after acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Miljković Dušan

    2014-01-01

    Full Text Available Introduction. Myocardial infarction is the most common cause of death in patients with diabetes, and several studies have shown that people with diabetes have twice the risk of dying from a heart attack compared to non diabetics. Objective. The aim of this study was to determine the mortality of patients that have survived acute myocardial infarction, in population of patients with diabetes mellitus and without diabetes. Method. The study included 135 patients recovered from myocardial infarction, of whom 51 (37.8% had type 2 diabetes mellitus, and 84 (62.2% were without diabetes, mean age 55,4±9,6 years. All patients underwent a complete cardiac and hemodynamic testing, cardiac catheterization with selective coronary angiography, and in most patients the aortocoronary bypass revascularization or percutaneous coronary intervention. Start of follow-up was the date of acute myocardial infarction. The study included only patients who survived at least one month after acute myocardial infarction. All patients with diabetes and without diabetes were monitored for an average of 84 months, i.e. 7 years. Results. The average age of patients with diabetes and myocardial infarction was 57.1±8.7 years, and of patients with myocardial infarction without diabetes 54.5 ± 9.6 years (t=1.62; p>0.05. Among patients with diabetes 14 (27.5% were women and 37 (72.5% were men, and in non-diabetics 15 (17.9% were women and 69 (82.1% were men (χ2=1.66; p>0.05. In the follow-up period died 15 (29.4% patients with diabetes, and 7 (8.3% patients without diabetes. Mortality in patients with diabetes and myocardial infarction was significantly higher than the mortality of patients with myocardial infarction without diabetes (χ2=11.2; p0.05. In the group of 27 patients who were treated with insulin, died five (18.5% and in the group of 24 patients on oral therapy died 10 (41.7%. There was no significant difference in mortality in patients with diabetes treated with

  20. Atrial fibrillation and acute myocardial infarction without significant coronary stenoses associated with subclinical hyperthyroidism and erythrocytosis.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo

    2010-11-05

    Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. It has been reported that sub-clinical hyperthyroidism is not associated with CHD or mortality from cardiovascular causes but is sufficient to induce arrhythmias including atrial fibrillation and atrial flutter. Moreover increased factor X activity in patients with subclinical hyperthyroidism represents a potential hypercoagulable state. It has been also reported an acute myocardial infarction with normal coronary arteries associated with iatrogenic hyperthyroidism and with a myocardial bridge too. It has been also reported an acute myocardial infarction without significant coronary stenoses associated with subclinical hyperthyroidism. Furthermore it has been reported that at highly increased hematocrit levels patients may experience hyperviscosity symptoms. We present a case of atrial fibrillation and acute myocardial infarction without significant coronary stenoses associated with subclinical hyperthyroidism and erythrocytosis. Also this case focuses attention on the importance of a correct evaluation of subclinical hyperthyroidism. Copyright © 2008 Elsevier Ireland Ltd. All rights reserved.

  1. Age-related in-hospital mortality among patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Abid, A.R.; Rafique, S.; Ahmed, R.Z.; Anjum, A.H.; Tarin, S.M.A.

    2004-01-01

    Objective: To evaluate the in-hospital mortality of acute myocardial infarction among different age groups. Subjects and Methods: The subjects were 460 admitted patients of acute myocardial infarction who fulfilled our inclusion criteria. Patients were divided into four age groups. Group-I included patients in 20-40 years, group-II (41-50 years), group-III (51-60 years) and group-IV (>60 years). Mortality was compared between different age groups by Chi-square and linear-regression models. Results: The total in-hospital mortality was 16.7%. It gradually increased from 5.6% in group-I (20-40 years) patients to 21% in group-IV (>60 years) patients. While mortality in groups group-II (41-50 years) and group-III (51-60 years) patients was 16.7% and 18.6% respectively. A marked increase in mortality was noted with increase in age. Group- IV (>60 years) patients presented 2 hours late to the hospital than the group-I (20-40 years) patients. There was no statistical difference in site of infarction in different age groups. Old age (group-IV i.e. >60 years old) was more associated with heart failure (higher Killip class) on presentation. Lesser number of patients in group-IV received thrombolytic therapy than group-I. Only 31.09% patients in group-IV and 62.5% patients in group-I received streptokinase therapy respectively. Conclusion: In patients with acute myocardial infarction age was a powerful independent predictor of in-hospital mortality and complications. (author)

  2. Lingual Haematoma due to Tenecteplase in a Patient with Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Muhlis Bal

    2013-01-01

    Full Text Available The use of intravenous thrombolytic agents has revolutionised the treatment of acute myocardial infarction. However, the improvement in mortality rate achieved with these drugs is tempered by the risk of serious bleeding complications, including intracranial haemorrhage. Tenecteplase is a genetically engineered mutant tissue plasminogen activator. Haemorrhagic complications of tissue plasminogen activator (tPA are well known. Compared to other tPAs, tenecteplase use leads to lower rates of bleeding complications. Here, we report a case of unusual site of spontaneous bleeding, intralingual haematoma during tenecteplase therapy following acute myocardial infarction, which caused significant upper airway obstruction and required tracheotomy to maintain the patient’s airway. Clinical dilemmas related to securing the airway or reversing the effects of tissue plasminogen activator are discussed.

  3. Follow-up of acute myocardial infarction with Gd-DTPA-enhanced MR image

    International Nuclear Information System (INIS)

    Matheijssen, N.A.A.; Dijkman, P.; Rossum, A.C. van der; Laarse, A. van der; Voorthuisen, A. van; Bruschke, A.

    1990-01-01

    MR imaging with Gd-DTPA has been shown to be useful in the identification of acutely infarcted myocardium. The purpose of this paper is to assess the influence of Gd-DTPA on myocardial signal intensity (SI) at different intervals after acute myocardial infarction (SMI). The authors used Gd-DTPA-enhanced MR imaging to study 84 patients at different intervals after AMI. A total of 109 T1-weighted MR studies were performed with a Philips Gyroscan magnet (0.5T) before and 20 minutes after Gd-DTPA (0.15 mmol/kg given intravenously). Four groups were studied. Group 1 underwent MR imaging less than 1 week after AMI; group 2, 1-3 weeks; group 3, 3-6 weeks; and group 4, over 6 weeks after AMI

  4. Quantification of myocardial infarct size by technetium-99m pyrophosphate single photon emission computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Hiromichi; Fukuyama, Takaya; Aoki, Makoto; Inou, Tetsuji; Ashihara, Toshiaki; Nabeyama, Shyohzou; Yamamoto, Yuhsuke

    1989-04-01

    Myocardial infarct size in 41 patients with the first attack of acute transmural myocardial infarction (MI) was assessed by technetium-99m pyrophosphate single photon emission computed tomography (/sup 99m/TcPYP-SPECT). A ratio of the number of voxels of /sup 99m/TcPYP uptake into the infarct area to that into the thorax was calculated as a parameter of MI size. The ratio was positively correlated with both peak CPK activity (r=0.53, p<0.005, n=24) and extent score in /sup 201/Tl-SPECT (r=0.70, p<0.005, n=14) significantly in patients with anterior MI but not in patients with inferior MI. There was also significant negative correlation between the ratio and the left ventricular ejection fraction (LVEF) measured by RI angiography in both acute (r=-0.67, p<0.005, n=18) and chronic (r=-0.75, p<0.005, n=25) phases in patients with anterior MI. Recovery in LVEF at chronic phase was noted in patients with small anterior MI but not with large anterior MI. Eight of 14 patients with inferior MI had right ventricular MI, that might have affected evaluation of MI size and resulted in no correlation between variables. It was suggested that /sup 99m/TcPYP-SPECT was a useful method to evaluate MI size and to predict prognosis of cardiac function in patients with anterior MI but not in patients with inferior MI. (author).

  5. Clinical analysis of acute anterior uveitis in 215 cases

    Directory of Open Access Journals (Sweden)

    Xue-Wei Zhou

    2013-11-01

    Full Text Available AIM: To analyze the etiology, therapeutic effects,risk of relapse and prognosis of acute anterior uveitis.MEHTODS: Medical history of 215 patients with acute anterior uveitis who underwent treatment in Department of Ophthalmology, People's Hospital of Fenghua was collected, together with results of clinical examinations and auxiliary examinations. The data were studied in terms of therapeutic effects, etiological factors, prognosis and relapse rate. RESULTS: In 85 cases(39.5%, the cause was identified, and among the among the most frequent causes were traumatic or surgical injury, viral infection and glaucomatocyclitic crisis. After treatment, the best corrected visual acuity was no less than 1.0 in 153 cases(71.2%, between 0.5 and 1.0 in 55 cases(25.6%, between 0.3 and 0.5 in 4 cases(1.9%, between 0.05 and 0.3 in 2 cases(0.9%, and less than 0.05 in 1 case(0.5%. During the follow-up of more than 6 months, relapse occurred in 4 cases(1.9%during 4-6 months, in 7 cases(3.2%during 7-12 months, in 10 cases(4.7%during 13-24 months, and in 3 cases(1.4%during 25-60 months. CONCLUSION: The etiology of acute anterior uveitis is complicated and mostly idiopathic. Vision prognosis is good after treatment, but therelapse rate is high and can cause visual impairment, so better understanding should be gained of its relapse and its prevention and early treatment should be emphasized.

  6. Approach to chest pain and acute myocardial infarction.

    Science.gov (United States)

    Pandie, S; Hellenberg, D; Hellig, F; Ntsekhe, M

    2016-03-01

    Patient history, physical examination, 12-lead electrocardiogram (ECG) and cardiac biomarkers are key components of an effective chest pain assessment. The first priority is excluding serious chest pain syndromes, namely acute coronary syndromes (ACSs), aortic dissection, pulmonary embolism, cardiac tamponade and tension pneumothorax. On history, the mnemonic SOCRATES (Site Onset Character Radiation Association Time Exacerbating/relieving factor and Severity) helps differentiate cardiac from non-cardiac pain. On examination, evaluation of vital signs, evidence of murmurs, rubs, heart failure, tension pneumothoraces and chest infections are important. A 12-lead ECG should be interpreted within 10 minutes of first medical contact, specifically to identify ST elevation myocardial infarction (STEMI). High-sensitivity troponins improve the rapid rule-out of myocardial infarction (MI) and confirmation of non-ST elevation MI (NSTEMI). ACS (STEMI and NSTEMI/unstable anginapectoris (UAP)) result from acute destabilisation of coronary atheroma with resultant complete (STEMI) or subtotal (NSTEMI/UAP) thrombotic coronary occlusion. The management of STEMI patients includes providing urgent reperfusion: primary percutaneous coronary intervention(PPCI) if available, deliverable within 60 - 120 minutes, and fibrinolysis if PPCI is not available. Essential adjunctive therapies include antiplatelet therapy (aspirin, P2Y12 inhibitors), anticoagulation (heparin or low-molecular-weight heparin) and cardiac monitoring.

  7. [An analysis of the prognostic factors of acute myocardial infarction in different gender].

    Science.gov (United States)

    Wang, Chun-Mei; Wu, Xue-Si; Han, Zhi-Hong; Zhang, Qian

    2009-02-01

    To analyse the prognostic factors of ST-elevation acute myocardial infarction men and women. The data of 904 in-hospital patients with ST-elevation myocardial infarction were collected from the database of our hospital during 2003 - 2004 and 728 of them were followed-up. The patients were divided into groups of male and female. Women had more accompanying diseases such as diabetes mellitus (DM) and hypertension than men; left ventricular ejection fraction (LVEF) was lower in female. The rate of successful reperfusion was lower in women than men (P different between two groups during follow-up. In the female group, LVEF was lower significantly and the rate of readmission for heart failure and myocardial infarction as well as that of mortality was higher (P difference was an independent risk factor for in-hospital mortality (OR = 2.130, 95% CI 0.954 - 4.754, P = 0.045), but not for mortality in the followed-up period and readmission. There are many factors leading to the poor prognosis of ST-elevation acute myocardial infarction in women. It is essential to pay more attention to its clinical characteristics and begin intervention of the risk factors earlier so as to improve the prognosis.

  8. "DETERMINANTS OF PREHOSPITAL DELAY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION"

    Directory of Open Access Journals (Sweden)

    M. Alidoosti

    2004-05-01

    Full Text Available Determination of pre-hospital delay time of patients with acute myocardial infarction and seeking ways of speeding up the time for reperfusion is an important factor to lower mortality in these patients. This is a cross-sectional study to determine pre-hospital delay time, its components, and related causes and conditions, obtained in 375 patients with prolonged chest pain referred to four hospitals of Tehran University of Medical Sciences. Means of transport to hospital, reasons of ambulance disuse, decision time by the patient and finally the entire time of pre-hospital delay were specified. Suspected factors related to delays of more than 2 and 6 h were scrutinized with chi-square test. Rate of ambulance utility (18.9% directly correlated with age of patients (P<0.05. Principal motives to disuse ambulance insuccession were unrememberance (33.7%, access to private vehicle (32.8% and supposition of sufficient speed of personal reference (18.9%. Pre-hospital delay time was 8.1 ± 9.1 h (mean ± SD in whole patients and 7.6 ± 9.1 h in those with acute myocardial infarction. Delays of more than 2 and 6 hoccurred in 67.5% and 33.6% of patients, respectively. Decision time constitute three fourth of whole pre-hospital delay and was correlated with female gender, older age, history of diabetes, lower level of literacy and nocturnal onset of symptoms. In conclusion, a significant number of patients with acute myocardial infarction have pre-hospital delay of more than 2 and even 6 h, when golden time for thrombolytic therapy has already been elapsed.

  9. Evaluation of heart perfusion in patients with acute myocardial infarction using dynamic contrast-enhanced magnetic resonance imaging

    DEFF Research Database (Denmark)

    Nielsen, Gitte; Fritz-Hansen, Thomas; Dirks, Christina G

    2004-01-01

    with acute transmural myocardial infarction were studied using a Turbo-fast low angle shot (FLASH) MRI sequence to monitor the first pass of an extravascular contrast agent (CA), gadolinium diethylene triamine pentaacetic acid (Gd-DTPA). Quantitation of perfusion, expressed as Ki (mL/100 g/minute), in five......PURPOSE: To investigate the diagnostic ability of quantitative magnetic resonance imaging (MRI) heart perfusion in acute heart patients, a fast, multislice dynamic contrast-enhanced MRI sequence was applied to patients with acute myocardial infarction. MATERIALS AND METHODS: Seven patients...

  10. Diagnosis of acute myocardial infarction in patients undergoing open heart surgery: a comparison of serial myocardial imaging with cardiac enzymes, electrocardiography, and vectocardiography

    International Nuclear Information System (INIS)

    Lowenthal, I.S.; Parisi, A.F.; Tow, D.E.; Barsamian, E.M.; Sasahara, A.A.; McCaughan, D.; Clemson, H.C.

    1977-01-01

    In 44 consecutive patients undergoing elective open heart surgery (OHS), serial electrocardiograms (ECG), vectorcardiograms (VCG), serum CPK, cardiac isoenzymes (CPKMB), and myocardial images using Tc-99m pyrophosphate were obtained, before and after the operation, for the detection of acute myocardial infarction (AMI). Twenty-nine patients developed one or more positive tests postoperatively. Two patients had positive myocardial scintiscans; both had other evidence of infarction. Conversely, the appearance of CPKMB, or new ECG and VCG changes, occurred frequently without evidence of infarction, and were not associated with the development of a positive scintiscan. The results show that false-negative results are infrequent in patients imaged early after OHS, and that cardiac surgical procedures do not cause a high incidence of false-positive scintigrams. Consequently, radionuclide imaging for AMI offers an important adjunct for excluding acute infarction following open heart surgery

  11. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock

    NARCIS (Netherlands)

    Thiele, Holger; Akin, Ibrahim; Sandri, Marcus; Fuernau, Georg; de Waha, Suzanne; Meyer-Saraei, Roza; Nordbeck, Peter; Geisler, Tobias; Landmesser, Ulf; Skurk, Carsten; Fach, Andreas; Lapp, Harald; Piek, Jan J.; Noc, Marko; Goslar, Tomaž; Felix, Stephan B.; Maier, Lars S.; Stepinska, Janina; Oldroyd, Keith; Serpytis, Pranas; Montalescot, Gilles; Barthelemy, Olivier; Huber, Kurt; Windecker, Stephan; Savonitto, Stefano; Torremante, Patrizia; Vrints, Christiaan; Schneider, Steffen; Desch, Steffen; Zeymer, Uwe; Tebbe, Ulrich; Wöhrle, Jochen; Pachinger, Otmar; Busch, Clemens; Pfeiffer, Nathalie; Neumer, Alexander; Ouarrak, Taoufik; Reimer, Thomas; Lober, Christiane; Clemmensen, Peter; Follath, Ferenc; Wegscheider, Karl; Zeitouni, M.; Overtchouk, P.; Guedeney, P.; Hage, G.; Hauguel-Moreau, N. N.; Eitel, Ingo; Weinschenk, Sabrina; Borggrefe, Martin; Neumann, Franz-Josef; Ferenc, Miroslaw; Olbrich, Hans-Gerd; Hopf, Hans-Bernd; Kastrati, Adnan; de Waha, Antoinette; Schunkert, Heribert; Richardt, Gert; Schwarz, Bettina; Abdel-Wahab, Mohamed; Toelg, Ralph; Geist, Volker; Bahnsen-Maaß, Monika; Hennersdorf, Marcus; Graf, Jochen; Riemann, Urs; Scharpf, Dominik; Empen, Klaus; Busch, Mathias C.; Werdan, Karl; Nuding, Sebastian; Hambrecht, Rainer; Fiehn, Eduard; Gitt, Anselm K.; Mark, Bernd; Winkler, Ralph; Lauer, Bernward; Möbius-Winkler, Sven; Schulze, Christian; Minden, Hans-Heinrich; Braun-Dullaeus, Rüdiger C.; Schmeißer, Alexander; Strasser, Ruth H.; Ebner, Bernd; Ertl, Georg; Mudra, Harald; Hug, Martin; Endemann, Dierk; Hamm, Christian; Walther, Claudia; Liebetrau, Christoph; Menck, Niels; Mehilli, Julinda; Orban, Martin; Hausleiter, Jörg; Massberg, Steffen; Prondzinsky, Roland; Gielen, Stephan; Gawaz, Meinrad; Pauschinger, Matthias; Ademaj, Fadil; Bode, Christoph; Nickenig, Georg; Fichtlscherer, Stephan; Zeiher, Andreas; Viertel, Achim; Kelm, Malte; Jung, Christian; Sydow, Carsten; Karakas, Mahir; Rudolph, Volker; Baldus, Stephan; Jacobshagen, Claudius; Hasenfuß, Gerd; Pfeiffer, Dietrich; Buchter, Björn; Hügl, Burkhard; Nef, Holger; Dörr, Oliver; Reinig, Karsten; Kuck, Karl Heinz; Ghanem, Alexander; Katus, Hugo; Gori, Tommaso; Münzel, Thomas; Schnupp, Steffen; Brachmann, Johannes; Ferrari, Markus; Achenbach, Stephan; Carrié, Didier; Henry, Patrick; Manzo-Silberman, Stephane; Ledermann, Bertrand; Cayla, Guillaume; Bonnet, Jean-Louis; Windecker, Stefan; Frenk, André; Jeger, Raban; Eeckhout, Eric; Henriques, Jose P.; van Geuns, Robert-Jan; Voskuil, Michiel; Bax, M.; van der Harst, Pim; Serpytis, Rokas; Jarasuniene, Dalia; Lang, Irene Marthe; Pichler, Philipp; Weidinger, Franz; Zaruba, Marc-Michael; Dudek, Darius; Depukat, Rafal; Witkowski, Adam; Milewski, Krzysztof; Prokopczuk, Janusz; Gąsior, Mariusz; Gorycki, Bogdan; Ochała, Andrzej; Piatti, Luigi; Galvani, Marcello; Bossi, Irene; Emilia, Reggio; Pignatelli, Gianluca; Greenwood, John; Lockie, Tim; Mamas, Mamas

    2017-01-01

    In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether PCI should be

  12. The value of radionuclide angiography for risk assessment of patients following acute myocardial infarction

    International Nuclear Information System (INIS)

    Morris, K.G.

    1985-01-01

    Radionuclide angiography (RNA) is an accurate noninvasive method for the evaluation of left ventricular function at rest and exercise. Both the change in ejection fraction from rest to exercise and the exercise ejection fraction correlate with the severity of coronary artery disease and are more sensitive than ST-segment changes for detecting abnormalities due to exercise-induced myocardial ischemia. The amount of left ventricular dysfunction produced acutely by myocardial ischemia appears to vary linearly with the severity of ischemia produced. Thus rest and exercise RNA provide information noninvasively regarding both the severity of left ventricular dysfunction and the amount of potentially ischemic myocardium, two of the three major pathophysiologic mechanisms related to prognosis. It is reasonable to hypothesize that rest and exercise RNA may provide useful prognostic information concerning subsequent mortality and morbidity in survivors of acute myocardial infarction

  13. Analysis of acute myocardial infarction occurance in Saratov region using GIS-technologies and prognostic modeling

    Directory of Open Access Journals (Sweden)

    SokolovI.M.

    2012-09-01

    Full Text Available

     

    The research objective: To find estimation tools of incidence of acute myocardial infarction at the regional level and to optimize organization of medical assistance to patients with acute coronary pathology. Materials. With the use of statistics of territorial distribution of acute myocardial infarction incidence in the region and GIS-TECHNOLOGIES the statistical analysis and mathematical modelling of the spatially-organizational data has been carried out. Results. On the basis of the received results the prognostic model of development of acute coronary pathology has been generated. Measures on optimization of organization of medical assistance to patients with an acute coronary pathology have been stated. Conclusion. Methods of intellectual support of the doctor may become effective in formation of organizational structure of the system of stage-by-stage qualified and specialized aid to patients with acute coronary syndrome.

  14. A Case Report of Acute Myocardial Infarction in a Young Woman with Severe Mitral Stenosis and OCP Use

    Directory of Open Access Journals (Sweden)

    Leili Iranirad

    2013-03-01

    Full Text Available Background and Objectives: Acute Myocardial Infarction is a rare complication of Mitral Stenosis, which in rare cases occurs following the use of oral contraceptive pills.Case Report: A 28-year-old woman was admitted to emergency ward with complaint of severe chest pain typical of is chemia. Electrocardiogram showed ST segment elevation in leads II, III, avf, and ST depression in anterior leads. Also, Troponin I level elevated to 16µg/l. Diagnosis of MI of the inferior and lateral walls was established. The patient reported a history of breathlessness after physical activity over the last 2 years, and was aware of her mitral disease. Also, the patient stated that she had been taking oral contraceptive pills over the past 3 months. Transthorasic echocardiography showed severe mitral stenosis (mitral valve area<1cm, and severe hypokinesia of inferior and laterel walls. Coronary arteries were normal in cardiac angiography. It seemed that acute MI in this patient with valvular heart disease, history of OCP use, and normal angiogram was due to thromboembolism from left atrial thrombus.

  15. Changing circadian variation of transient myocardial ischemia during the first year after a first acute myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H; Pless, P; Nielsen, J R

    1992-01-01

    In a consecutive series of 123 men (aged 55 +/- 8 years) with a recent first acute myocardial infarction (AMI), 24-hour ambulatory ST-segment monitoring was performed early after discharge (day 11 +/- 5), 6 months (day 185 +/- 6) and 1 year (day 368 +/- 8) after AMI. No difference in the prevalen...

  16. High-sensitivity troponin assays for the early rule-out or diagnosis of acute myocardial infarction in people with acute chest pain: A systematic review and cost-effectiveness analysis

    NARCIS (Netherlands)

    M. Westwood (Marie); T. van Asselt (Thea); B.L.T. Ramaekers (Bram); P. Whiting (Penny); P. Thokala (Praveen); M.A. Joore (Manuela); N. Armstrong (Nigel); J. Ross (Janine); J.L. Severens (Hans); J. Kleijnen (Jos)

    2015-01-01

    textabstractBackground The primary indication for this assessment is the early rule-out of acute myocardial infarction (AMI) in people presenting with acute chest pain and suspected, but not confirmed, non-ST segment elevation myocardial infarction (NSTEMI). Cardiac troponins (cTns) I and T are used

  17. Applications of radionuclide myocardial perfusion imaging in acute coronary syndrome

    International Nuclear Information System (INIS)

    Han Pingping; Tian Yueqin

    2008-01-01

    In recent years, acute coronary syndrome(ACS) has been getting more and more attentions. Radionuclide myocardial perfusion imaging (MPI) can make a quick accurate diagnosis for patients with acute chest pain who cann't be diagnosed by conventional methods. The sensitivity and negative predictive value of MPI are relatively high. Besides, MPI can be applicated in the detection of ischemic and infarct size and degree, the risk stratification and the assessment of prognosis of the patients with ACS, and the appraisal of the effect of strategies. (authors)

  18. [Effectiveness of combined use of kontrykal and nitroglycerin in the acute period of myocardial infarction].

    Science.gov (United States)

    Lazutin, V K; Broun, D K; Barashkov, M I; Kuparev, I I; Kibalova, G A; Samorukova, N T; Zapevalov, M V

    1990-04-01

    The natural history and extension of myocardial infarction were studied from parameters of precordial ECG in 35 leads and central hemodynamic findings in 100 patients with acute myocardial infarction. The least extension of myocardial lesion areas and better central hemodynamic parameters and a sharp reduction in the frequency of complications and hospital mortality in patients receiving a combined therapy with contrykal and nitroglycerin as a continuous long-term infusion within the first 24 hours of myocardial infarction as compared with the controls and in those having these agents alone.

  19. SIGNIFICANCE OF LABORATORY PARAMETERS IN PROGNOSIS OF OUTCOMES OF ACUTE MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    I. E. Belaya

    2017-01-01

    Full Text Available The study objective is to validate a mathematical model for prognosis of progression of the acute period of myocardial infarction.Materials and methods. We examined 135 patients with acute Q-wave myocardial infarction of the left ventricle aged between 34 and 88 years (mean age 66, standard deviation 12 years, among them 64 women and 71 men. For prognosis of the outcome of the acute period of myocardial infarction we used an approach based on intellectual data analysis (data mining in combination with mathematical methods based on decision trees.Results. Using decision tree algorithms, we singled out laboratory parameters (attributes which were subsequently used as input. Adequacy of classification of these attributes was determined by a contingency table. Accuracy of the obtained calculation results was 95.56 % demonstrating good agreement between the model and observed data. In a decision tree visualization, the most significant 8 laboratory parameters were determined. Significance of NO2  metabolite was 24.9 %, triglycerides – 16.7 %, urea – 14.8 %, erythrocytes – 11.2 %, alanine aminotransferase – 9.4 %, very low density lipoproteins – 9.4 %, creatinine – 8.5 %, prothrombin index – 5.1 %. In the Rules tab, only rules 4 and 9 can be used with confidence, because their confidence level approaches 100 %, and effect cost for the fact of death was 33.59 % and 32.03 %, respectively.Conclusion. Using a decision tree algorithm, we determined prognostically significant factors for progression of acute myocardial infarction. The following set of parameters predicts unfavorable outcome (death with 95.56 % accuracy: NO2  < level 22.755 mmol/l, triglycerides ≥ 1.565 mmol/l, erythrocytes < 4.91 M/uL, alanine aminotransferase < 1.23 mmol/l, urea < 7.05 mmol/l, very low-density lipoproteins < 0.965 mmol/l, creatinine ≥ 91.55 µmol/l, NO2 level ≥ 22.755 mmol/l predicts a favorable outcome with 95.56 % accuracy. 

  20. Acute Myocardial Infarction Due to Spontaneous Dissection of the Right Coronary Artery in a Young Male

    International Nuclear Information System (INIS)

    Papadopoulos, Dimitris P.; Moyssakis, Ioannis; Perakis, Alexandros; Athanasiou, Andreas; Anagnostopoulou, Sophia; Benos, Ioannis; Votteas, Vassilios E.

    2004-01-01

    Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction. We report a case of a 33-year-old male who presented with an acute inferior myocardial infarction. Coronary arteriography performed 3 hours after the episode revealed a dissection involving the middle segment of right coronary artery. Because of a spiral form of dissection and the TIMI 3 flow grade, our patient was treated medically and repeat coronary angiography 6 months later was decided

  1. Rapid Rule-Out of Acute Myocardial Injury Using a Single High-Sensitivity Cardiac Troponin I Measurement.

    Science.gov (United States)

    Sandoval, Yader; Smith, Stephen W; Shah, Anoop S V; Anand, Atul; Chapman, Andrew R; Love, Sara A; Schulz, Karen; Cao, Jing; Mills, Nicholas L; Apple, Fred S

    2017-01-01

    Rapid rule-out strategies using high-sensitivity cardiac troponin assays are largely supported by studies performed outside the US in selected cohorts of patients with chest pain that are atypical of US practice, and focused exclusively on ruling out acute myocardial infarction (AMI), rather than acute myocardial injury, which is more common and associated with a poor prognosis. Prospective, observational study of consecutive patients presenting to emergency departments [derivation (n = 1647) and validation (n = 2198) cohorts], where high-sensitivity cardiac troponin I (hs-cTnI) was measured on clinical indication. The negative predictive value (NPV) and diagnostic sensitivity of an hs-cTnI concentration rules out acute myocardial injury, regardless of etiology, with an excellent NPV and diagnostic sensitivity, and identifies patients at minimal risk of AMI or cardiac death at 30 days. ClinicalTrials.gov Identifier: NCT02060760. © 2016 American Association for Clinical Chemistry.

  2. Radioimmunoassay of creatine kinase-B isoenzyme in human sera: results in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Willerson, J.T.; Stone, M.J.; Ting, R.; Mukherjee, A.; Gomez-Sanchez, C.E.; Lewis, P.; Hersh, L.B.

    1977-01-01

    A radiommunoassay was developed to measure serum levels of the B isoenzyme of creatine kinase (ATP: creatine N-phosphotransferase, EC 2.7.3.2) (CPK) in order to evaluate the time course and frequency of MB isoenzyme elevation in patients with acute myocardial infarction. The method can identify as little as 0.2 ng of the B portion of the CPK-MB isoenzyme, does not significantly crossreact with CPK-MM isoenzyme, and is not affected by storage of serum at -20 0 . CPK isoenzyme containing B subunits was detected in 48 out of 51 sera from normal adults; serum levels in these individuals ranged between 1.2 and 12.5 ng/ml[mean +- SEM was 2.7 +- 0.30 ng/ml]. The mean serum level of CPK-B isoenzyme in a pool of sera obtained from 100 normal subjects was 2.9 +- 0.35 ng/ml; two patients with rhabdomyolysis that were studied had serum CPK-B isoenzyme levels of 2.5 and 3.5 ng/ml, respectively. In contrast, serum levels of the CPK-B isoenzyme were markedly elevated in sera from 18 patients with acute myocardial infarcts when obtained within 12 hr after hospital admission; the mean +- SEM concentration was 56 +- 7.8 ng/ml. We performed serial determinations on 14 patients with acute myocardial infarcts and demonstrated that maximal serum CPK-B levels occurred within the first 12 hr after admission and were lower thereafter. The serum concentration of B-containing CPK isoenzyme in 19 additional patients admitted with chest pain but without acute myocardial infarction was 3.4 +- 0.50 ng/ml. Thus, radioimmunoassay measurement of CPK-B isoenzyme appears to be a useful and sensitive test for the detection of acute myocardial infarcts in patients

  3. Radioimmunoassay of human cardiac tropomyosin in acute myocardial infarction

    International Nuclear Information System (INIS)

    Cummins, P.; McGurk, B.; Littler, W.A.

    1981-01-01

    Tropomyosin was prepared from fresh human myocardium and antisera raised in rabbits. A sensitive radioimmunoassay was developed for the detection of human cardiac 125 I-labelled tropomyosin in human sera down to levels of 1 ng/ml. Values for human cardiac tropomyosin in normal patients ranged from less than 1 to 3 ng/ml. In 18 patients with acute myocardial infarction all had elevated tropomyosin levels ranging from 41 to above 200 ng/ml with a mean peak level of 101 ng/ml. In this study there were no false positive or false negative results. In the initial stages of infarction the time course of appearance and peak levels of cardiac tropomyosin, total creatine kinase and creatine kinase MB isoenzyme were similar. Although total creatine kinase and creatine kinase MB isoenzyme levels were normal after 72 h in patients with single, uncomplicated infarction, cardiac tropomyosin levels were still significantly elevated above normal after this time, being 30-60% of peak values. Radioimmunoassay of human cardiac tropomyosin may prove useful in the diagnosis and in the management of patients with acute myocardial infarction, particularly in the long-term postinfarction period. (author)

  4. Stem cell mobilization by granulocyte colony-stimulating factor for myocardial recovery after acute myocardial infarction: a meta-analysis

    DEFF Research Database (Denmark)

    Zohlnhofer, D.; Dibra, A.; Koppara, T.

    2008-01-01

    OBJECTIVES: The objective of this meta-analysis was to evaluate the effect of stem cell mobilization by granulocyte colony-stimulating factor (G-CSF) on myocardial regeneration on the basis of a synthesis of the data generated by randomized, controlled clinical trials of G-CSF after acute...

  5. Electrocardiographic scores of severity and acuteness of myocardial ischemia predict myocardial salvage in patients with anterior ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Fakhri, Yama; Sejersten, Maria; Schoos, Mikkel Malby

    2018-01-01

    inferior infarct locations. METHODS: In STEMI patients, the severity and acuteness scores were obtained from the admission ECG. Based on the ECG patients were assigned with severe or non-severe ischemia and acute or non-acute ischemia. Cardiac magnetic resonance (CMR) was performed 2-6days after primary...

  6. Stimulation of ganglionated plexus attenuates cardiac neural remodeling and heart failure progression in a canine model of acute heart failure post-myocardial infarction.

    Science.gov (United States)

    Luo, Da; Hu, Huihui; Qin, Zhiliang; Liu, Shan; Yu, Xiaomei; Ma, Ruisong; He, Wenbo; Xie, Jing; Lu, Zhibing; He, Bo; Jiang, Hong

    2017-12-01

    Heart failure (HF) is associated with autonomic dysfunction. Vagus nerve stimulation has been shown to improve cardiac function both in HF patients and animal models of HF. The purpose of this present study is to investigate the effects of ganglionated plexus stimulation (GPS) on HF progression and autonomic remodeling in a canine model of acute HF post-myocardial infarction. Eighteen adult mongrel male dogs were randomized into the control (n=8) and GPS (n=10) groups. All dogs underwent left anterior descending artery ligation followed by 6-hour high-rate (180-220bpm) ventricular pacing to induce acute HF. Transthoracic 2-dimensional echocardiography was performed at different time points. The plasma levels of norepinephrine, B-type natriuretic peptide (BNP) and Ang-II were measured using ELISA kits. C-fos and nerve growth factor (NGF) proteins expressed in the left stellate ganglion as well as GAP43 and TH proteins expressed in the peri-infarct zone were measured using western blot. After 6h of GPS, the left ventricular end-diastolic volume, end-systolic volume and ejection fraction showed no significant differences between the 2 groups, but the interventricular septal thickness at end-systole in the GPS group was significantly higher than that in the control group. The plasma levels of norepinephrine, BNP, Ang-II were increased 1h after myocardial infarction while the increase was attenuated by GPS. The expression of c-fos and NGF proteins in the left stellate ganglion as well as GAP43 and TH proteins in cardiac peri-infarct zone in GPS group were significantly lower than that in control group. GPS inhibits cardiac sympathetic remodeling and attenuates HF progression in canines with acute HF induced by myocardial infarction and ventricular pacing. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro

    Directory of Open Access Journals (Sweden)

    Claudia Caminha Escosteguy

    Full Text Available CONTEXT: International studies have shown a large variation in the utilization patterns of interventions, in acute myocardial infarction. OBJECTIVE: To analyze utilization patterns of pharmacological interventions in acute myocardial infarction and their corresponding effects on hospital mortality. DESIGN: Cross-sectional study. LOCAL: Hospitals of the Brazilian National Health System (SUS in the municipal district of Rio de Janeiro. SAMPLE: A stratified hospital sample of 391 medical records selected from the 1,936 admissions registered in the SUS Hospital Information System (SIH/SUS with a main diagnosis of acute myocardial infarction, in the studied district in 1997. MAIN MEASUREMENTS: Sex, age, time to treatment, risk factors, severity factors, diagnosis confirmation, use of pharmacological interventions, hospital death, contraindication of the use of thrombolytic therapy, contraindication of aspirin use. RESULTS: We reviewed 98.2% of the sampled medical records. Acute myocardial infarction diagnosis was confirmed in 91.7% (95% CI 88.3 to 94.2. 61.5% were men and 38.5% women, with an average age of 60.2 years (SD 2.4. The median time interval between symptom onset and hospital admission was 11 hours. Hospital mortality was 20.6% (95% CI 16.7 to 25.0. Intravenous thrombolytic therapy was used in 19.5% (95% CI 15.8 to 23.9 of the cases; aspirin in 86.5% (95% CI 82.5 to 89.6; beta-blockers in 49.0% (95% CI 43.8 to 54.1; angiotensin-converting enzyme (ACE inhibitors in 63.3% (95% CI 58.2 to 68.1; nitrates in 82.0% (95% CI 82.4 to 89.6; heparin in 81.3% (95% CI 76.9 to 85.0; calcium antagonists in 30.5% (95% CI 26.0 to 35.4. There was a significant variation in the use of thrombolytic therapy, beta-blockers, ACE inhibitors, calcium antagonists and heparin among hospitals of different juridical nature. CONCLUSIONS: There was underutilization of some interventions with well-established efficacy (thrombolytic therapy, aspirin, beta-blockers and

  8. Crise de feocromocitoma simulando um infarto agudo do miocárdio em paciente com artérias coronárias normais Pheochromocytoma-induced segmental myocardial dysfunction mimicking an acute myocardial infarction in a patient with normal coronary arteries

    Directory of Open Access Journals (Sweden)

    Eduardo S. Darzé

    2004-02-01

    Full Text Available Relatamos o caso de um paciente com alterações eletrocardiográficas e disfunção miocárdica segmentar induzidas por feocromocitoma, simulando infarto agudo do miocárdio. A angiografia coronariana foi normal e houve normalização completa do eletrocardiograma e ecocardiograma, após terapia com um bloqueador alfa-adrenérgico e ressecção do tumor. Espasmo coronariano foi o provável mecanismo envolvido na produção dessas alterações, ilustrando a importância de manter um alto grau de suspeição clínica em pacientes com evento miocárdico inesperado em meio a uma crise hipertensiva.We report a case of pheochromocytoma-induced segmental myocardial dysfunction and electrocardiographic abnormalities mimicking an acute anterior myocardial infarction, probably due to coronary spasm. Coronary angiography showed normal coronaries, and the electrocardiographic and echocardiographic changes resolved completely after therapy with an alpha-adrenergic blocker and tumor removal. Our case illustrates the importance of maintaining a high index of suspicion in patients presenting with an unexpected myocardial event and a hypertensive crisis.

  9. Justification for intravenous magnesium therapy in acute myocardial infarction

    DEFF Research Database (Denmark)

    Rasmussen, H S

    1988-01-01

    Recent studies have shown that patients with acute myocardial infarction (AMI) are magnesium-deficient and develop an additional transient decrease in serum magnesium concentrations (S-Mg c) during the acute phase of the infarct. Animal experiments, as well as studies on humans, have indicated.......v. magnesium therapy on mortality and incidence of arrhythmias in patients with AMI has been evaluated. Magnesium treatment more than halved the acute mortality and incidence of arrhythmias requiring treatment in three of the four intervention studies. The mechanisms behind the beneficial effect of magnesium...... therapy are probably multifactorial; a direct depressive effect on the cardiac conducting system; a peripheral dilatory effect on the arteries, reducing the afterload on the myocardium; a reduced infarct size; an ion-stabilizing effect, maintaining stable intra and extracellular concentrations...

  10. HEMOSTATIC SYSTEM CONDITION AND HEART REMODELING IN PATIENTS WITH Q-WAVE MYOCARDIAL INFARCTION WITH ACUTE ANEURYSMS AND LEFT VENTRICLE THROMBUS

    Directory of Open Access Journals (Sweden)

    V. D. Syvolap

    2014-02-01

    Full Text Available Introduction. Worldwide myocardial infarction (MI is one of the main causes of morbidity and mortality. Thanks to advances in modern cardiology we achieved a significant reduction in mortality and the incidence of fatal complications of acute Q-wave MI. However, keeping in mind the pathogenetic features of myocardial defeat of the left ventricle (LV cavity dilation and thinning at the focus of myocardial infarction, which increase the risk of left ventricular aneurysm development and parietal thrombus formation, it is impossible to reduce significantly the risk of these serious complications development. Post-infarction left ventricular aneurysm, extremely unfavorable prognostic factor complicates the course of Q-wave myocardial infarction in 30% of cases. The likelihood of parietal clot development in the anterior apical localization of aneurysms is 32%. The reasons of parietal clot formation are varied and are not fully disclosed, that is responsible for the relevance of this study. Aim: to investigate the serum level of protein C, von Willebrand factor, the expression of vascular adhesion molecules sVCAM-1, platelet aggregation properties and to evaluate their relationship with the structural and functional performance of the heart in patients with acute Q-wave myocardial infarction with aneurysm and parietal thrombus of LV. Methods. 110 patients (67 men and 43 women, mean age - 63,2 ± 5,7 years, with a diagnosis of acute Q-wave myocardial infarction were involved into the study. The first group included 72 patients with postinfarction left ventricular aneurysm, the second - 38 patients with postinfarction aneurysm and parietal thrombus of LV. Serum levels of protein C, von Willebrand factor, the expression of vascular adhesion molecules sVCAM-1, platelet aggregation properties were studied and their relationship with the structural and functional performance of the heart were evaluated. Results. There were revealed high activity of the key

  11. System delay and timing of intervention in acute myocardial infarction (from the Danish Acute Myocardial Infarction-2 [DANAMI-2] trial)

    DEFF Research Database (Denmark)

    Nielsen, Peter Haubjerg; Terkelsen, Christian Juhl; Nielsen, Torsten Toftegård

    2011-01-01

    The interval from the first alert of the healthcare system to the initiation of reperfusion therapy (system delay) is associated with mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention (pPCI). The importance of system delay...... in patients treated with fibrinolysis versus pPCI has not been assessed. We obtained data on system delay from the Danish Acute Myocardial Infarction-2 study, which randomized 1,572 patients to fibrinolysis or pPCI. The study end points were 30-day and 8-year mortality. The short system delays were associated...... with reduced absolute mortality in both the fibrinolysis group (3 hours, 11.5%; test for trend, p = 0.08) and pPCI group (3 hours, 7.7%; test for trend, p = 0.02). The lowest 30-day mortality was obtained with pPCI and a system delay of 1 to 2 hours (vs fibrinolysis within 3 hours was associated with a similar...

  12. The nursing care of nausea and vomiting occurred in interventional treatment for acute myocardial infarction

    International Nuclear Information System (INIS)

    Meng Qing'na; Li Guoqing; Bai Xiaodong

    2011-01-01

    Objective: To investigate the effective nursing measures of nausea and vomiting occurred in percutaneous coronary intervention for acute myocardial infarction. Methods: During the period from Jan. 2010 to Feb. 2011, percutaneous coronary intervention was carried out in 109 patients with acute myocardial infarction. Among the 109 patients, 21 developed nausea, 83 developed vomiting one to three times and 5 developed projectile vomiting for 4-5 times. For these patients the nursing assessment was conducted, while proper psychological care, symptomatic nursing, psychosomatic relaxation, guidance for vomiting posture, vomiting nursing, balanced replenishment of fluid, etc. were carried out in order to ensure the accomplishment of percutaneous coronary intervention. Results: After the employment of nursing measures, no recurrence of vomiting was seen in 21 patients, the percutaneous coronary intervention was uninterruptedly completed in 83 patients, and in five patients with severe vomiting the procedure was eventually accomplished. Conclusion: The effective nursing care of nausea and vomiting plays an important auxiliary role in performing percutaneous coronary intervention for acute myocardial infarction. (authors)

  13. Myocardial enhancement pattern in patients with acute myocardial infarction on two-phase contrast-enhanced Ecg-gated multidetector-row computed tomography

    International Nuclear Information System (INIS)

    Ko, S.M.; Seo, J.B.; Hong, M.K.; Do, K.H.; Lee, S.H.; Lee, J.S.; Song, J.W.; Park, S.J.; Park, S.W.; Lim, T.H.

    2006-01-01

    Aim: To evaluate the myocardial enhancement pattern of the left ventricle on two-phase contrast-enhanced electrocardiogram (ECG)-gated multidetector computed tomography (MDCT) images in patients with acute myocardial infarction (AMI). METHODS: Two-phase contrast-enhanced ECG-gated MDCT examinations were performed in 16 patients with AMI. The presence, location and pattern of myocardial enhancement were evaluated. MDCT findings were compared with the catheter angiographic results. RESULTS: Subendocardial (n=9) or transmural (n=6) area of early perfusion defects of the myocardium was detected in 15 of 16 patients (94%) on early-phase CT images. Variable delayed myocardial enhancement patterns on late-phase CT images were observed in 12 patients (75%): (1) subendocardial residual perfusion defect and subepicardial late enhancement (n=6); (2) transmural late enhancement (n=1); (3) isolated subendocardial late enhancement (n=1); and (4) isolated subendocardial residual perfusion defect (n=2). On catheter angiography, 14 of 15 corresponding coronary arteries showed significant stenosis. CONCLUSION: Variable abnormal myocardial enhancement pattern was seen on two-phase, contrast-enhanced ECG-gated MDCT in patients with AMI. Assessment of myocardial attenuation on CT angiography gives additional information of the location and extent of infarction

  14. [Myocardial ultrastructural changes in rats following different levels of acute +Gz exposure].

    Science.gov (United States)

    Zheng, Jun; Liu, Cheng-gang; Ren, Li; Xiao, Xiao-guang; Xu, Shu-xuan; Wang, Ping; Ji, Gui-ying

    2004-06-01

    To observe the effects of different levels of acute +Gz exposure on myocardial ultrastructure of rats and provide experimental basis for further development of anti-G measures. Twenty male Wistar rats were randomly divided into 4 groups (n=5): normal control group, +20 Gz group, +10 Gz group and +5 Gz group. Profile of the centrifuge +Gz exposure was trapezoidal, in which +20 Gz lasted for 30 s, +10 Gz for 1.5 min. +5 Gz exposure was repeated for 3 times with 30 min interval and each for 1.5 min. Myocardial tissue of left ventricle was sampled for transmission electron microscopy 5 h after exposure. +20 Gz and +10 Gz exposure caused obvious edema of myocardial and endothelial cells, myofibril disorder and injuries of mitochondria and nucleus. Breaks of myocardial fiber, formation of contraction bands and rupture of mitochondria were also observed in +20 Gz group. In +5 Gz group, there was still slight edema of myocardial and endothelial cells, while organic changes of myocardial ultrastructure were not observed. High +Gz exposure can cause myocardial ultrastructural injury in rats. Slight reversible injured response can also be observed in myocardial cell after repeated moderate level of +Gz exposure. This indicates that attention should be paid to the study of the effect of high +Gz on heart in pilots.

  15. Vitamin D Deficiency in Patients with Acute Myocardial Infarction: An Italian Single-Center Study.

    Science.gov (United States)

    Aleksova, Aneta; Belfiore, Rita; Carriere, Cosimo; Kassem, Salam; La Carrubba, Salvatore; Barbati, Giulia; Sinagra, Gianfranco

    2015-01-01

    Hypovitaminosis D is a vitamin deficiency that has been increasing in developed countries; it was also suggested as an emerging risk factor for developing of atherosclerosis and acute myocardial infarction. The primary source of vitamin D is its cutaneous synthesis under exposure to sunlight. It has been suggested that 30 min of sun exposure twice weekly leads to sufficient vitamin D synthesis. The residents of Trieste (Italy) are well-known for their high exposure to sunlight in all seasons. We aimed to investigate the vitamin D status in subjects with acute myocardial infarction living in this area. Vitamin D status was identified in 478 subjects diagnosed with acute myocardial infarction. The median serum 25-hydroxyvitamin D concentration was 14.5 [7.8 - 22.7] ng/mL. Vitamin D deficiency and insufficiency were present in 324 (68 %) and 107 (22 %) subjects, respectively. Vitamin D deficiency was less frequent among subjects enrolled in the period from July to the end of September (p female gender (p = 0.002), higher body mass index (p = 0.05), autumn/winter sampling (p < 0.001), increased parathyroid hormone (p = 0.03) and alkaline phosphatase (p = 0.003). We observed very high prevalence of vitamin D deficiency among subjects with myocardial infarction in all seasons of enrollment. However, it was lower in the summer when sun exposure is higher. The exposure to sunlight may be a cost-saving therapeutic strategy for the management of vitamin D deficiency.

  16. Cells involved in extracellular matrix remodeling after acute myocardial infarction

    International Nuclear Information System (INIS)

    Garcia, Larissa Ferraz; Mataveli, Fábio D’Aguiar; Mader, Ana Maria Amaral Antônio; Theodoro, Thérèse Rachell; Justo, Giselle Zenker; Pinhal, Maria Aparecida da Silva

    2015-01-01

    Evaluate the effects of VEGF_1_6_5 gene transfer in the process of remodeling of the extracellular matrix after an acute myocardial infarct. Wistar rats were submitted to myocardial infarction, after the ligation of the left descending artery, and the left ventricle ejection fraction was used to classify the infarcts into large and small. The animals were divided into groups of ten, according to the size of infarcted area (large or small), and received or not VEGF_1_6_5 treatment. Evaluation of different markers was performed using immunohistochemistry and digital quantification. The primary antibodies used in the analysis were anti-fibronectin, anti-vimentin, anti-CD44, anti-E-cadherin, anti-CD24, anti-alpha-1-actin, and anti-PCNA. The results were expressed as mean and standard error, and analyzed by ANOVA, considering statistically significant if p≤0.05. There was a significant increase in the expression of undifferentiated cell markers, such as fibronectin (protein present in the extracellular matrix) and CD44 (glycoprotein present in the endothelial cells). However, there was decreased expression of vimentin and PCNA, indicating a possible decrease in the process of cell proliferation after treatment with VEGF_1_6_5. Markers of differentiated cells, E-cadherin (adhesion protein between myocardial cells), CD24 (protein present in the blood vessels), and alpha-1-actin (specific myocyte marker), showed higher expression in the groups submitted to gene therapy, compared to non-treated group. The value obtained by the relation between alpha-1-actin and vimentin was approximately three times higher in the groups treated with VEGF_1_6_5, suggesting greater tissue differentiation. The results demonstrated the important role of myocytes in the process of tissue remodeling, confirming that VEGF_1_6_5 seems to provide a protective effect in the treatment of acute myocardial infarct

  17. Cells involved in extracellular matrix remodeling after acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, Larissa Ferraz [Faculdade de Medicina do ABC, Santo André, SP (Brazil); Mataveli, Fábio D’Aguiar [Universidade Federal de São Paulo, São Paulo, SP (Brazil); Mader, Ana Maria Amaral Antônio; Theodoro, Thérèse Rachell [Faculdade de Medicina do ABC, Santo André, SP (Brazil); Justo, Giselle Zenker; Pinhal, Maria Aparecida da Silva [Universidade Federal de São Paulo, São Paulo, SP (Brazil)

    2015-07-01

    Evaluate the effects of VEGF{sub 165} gene transfer in the process of remodeling of the extracellular matrix after an acute myocardial infarct. Wistar rats were submitted to myocardial infarction, after the ligation of the left descending artery, and the left ventricle ejection fraction was used to classify the infarcts into large and small. The animals were divided into groups of ten, according to the size of infarcted area (large or small), and received or not VEGF{sub 165} treatment. Evaluation of different markers was performed using immunohistochemistry and digital quantification. The primary antibodies used in the analysis were anti-fibronectin, anti-vimentin, anti-CD44, anti-E-cadherin, anti-CD24, anti-alpha-1-actin, and anti-PCNA. The results were expressed as mean and standard error, and analyzed by ANOVA, considering statistically significant if p≤0.05. There was a significant increase in the expression of undifferentiated cell markers, such as fibronectin (protein present in the extracellular matrix) and CD44 (glycoprotein present in the endothelial cells). However, there was decreased expression of vimentin and PCNA, indicating a possible decrease in the process of cell proliferation after treatment with VEGF{sub 165}. Markers of differentiated cells, E-cadherin (adhesion protein between myocardial cells), CD24 (protein present in the blood vessels), and alpha-1-actin (specific myocyte marker), showed higher expression in the groups submitted to gene therapy, compared to non-treated group. The value obtained by the relation between alpha-1-actin and vimentin was approximately three times higher in the groups treated with VEGF{sub 165}, suggesting greater tissue differentiation. The results demonstrated the important role of myocytes in the process of tissue remodeling, confirming that VEGF{sub 165} seems to provide a protective effect in the treatment of acute myocardial infarct.

  18. Statin use after acute myocardial infarction: a nationwide study in Denmark

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe Nørgaard; Gislason, Gunnar H; Abildstrom, Steen Z

    2005-01-01

    AIMS: To study outpatient statin use after first acute myocardial infarction (AMI) in Denmark between 1995 and 2002 and to determine the predictors of statin use. METHODS: This is a nationwide population-based study using administrative registries. Patients with first AMI between 1995 and 2002 ol...

  19. The effects of compound danshen dripping pills and human umbilical cord blood mononuclear cell transplant after acute myocardial infarction.

    Science.gov (United States)

    Jun, Yi; Chunju, Yuan; Qi, Ai; Liuxia, Deng; Guolong, Yu

    2014-04-01

    The low frequency of survival of stem cells implanted in the myocardium after acute myocardial infarction may be caused by inflammation and oxidative stress in the myocardial microenvironment. We evaluated the effects of a traditional Chinese medicine, Compound Danshen Dripping Pills, on the cardiac microenvironment and cardiac function when used alone or in combination with human umbilical cord blood mononuclear cell transplant after acute myocardial infarction. After surgically induced acute myocardial infarction, rabbits were treated with Compound Danshen Dripping Pills alone or in combination with human umbilical cord blood mononuclear cell transplant. Evaluation included histology, measurement of left ventricular ejection fraction and fractional shortening, leukocyte count, count of green fluorescent protein positive cells, superoxide dismutase activity, and malondialdehyde content. Combination treatment with Compound Danshen Dripping Pills and human umbilical cord blood mononuclear cell transplant significantly increased the survival of implanted cells, inhibited cardiac cell apoptosis, decreased oxidative stress, decreased the inflammatory response, and improved cardiac function. Rabbits treated with either Compound Danshen Dripping Pills or human umbilical cord blood mononuclear cells alone had improvement in these effects compared with untreated control rabbits. Combination therapy with Compound Danshen Dripping Pills and human umbilical cord blood mononuclear cells may improve cardiac function and morphology after acute myocardial infarction.

  20. Feelings of being disabled as a risk factor for mortality up to 8 years after acute myocardial infarction

    DEFF Research Database (Denmark)

    van der Vlugt, Maureen J; van Domburg, Ron T; Pedersen, Susanne S.

    2005-01-01

    We examined the independent prognostic value of the four subscales of the Heart Patients Psychological Questionnaire (HPPQ) on mortality in acute myocardial infarction (AMI) survivors up to 8 years after the event.......We examined the independent prognostic value of the four subscales of the Heart Patients Psychological Questionnaire (HPPQ) on mortality in acute myocardial infarction (AMI) survivors up to 8 years after the event....

  1. Clinical presentation, diagnosis and management of acute mitral regurgitation following acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Rengin Çetin Güvenç

    2016-03-01

    Full Text Available Acute mitral regurgitation (MR is a frequent complication of acute myocardial infarction, with a variable presentation depending on the severity of MR and the integrity of the subvalvular apparatus. While most cases are asymptomatic or have mild dyspnea, rupture of chordae tendinea or papillary muscles are catastrophic complications that may rapidly lead to cardiogenic shock and death. Despite the presence of pulmonary edema and/or cardiogrenic shock, the murmur of acute MR is usually subtle due to rapid equalization of left atrial and left ventricular pressure gradient, and therefore misleading. Echocardiography is the definite diagnostic modality, allowing quantification of the severity of MR and the structural abnormalities within the subvalvular apparatus. Severe MR accompanied by rupture of chordae or papillary muscles should be managed with temporary stabilization with medical treatment or with mechanical circulatory support, with subsequent surgical intervention to repair or replace the valve.

  2. Intravenous Administration of Lycopene, a Tomato Extract, Protects against Myocardial Ischemia-Reperfusion Injury.

    Science.gov (United States)

    Tong, Chao; Peng, Chuan; Wang, Lianlian; Zhang, Li; Yang, Xiaotao; Xu, Ping; Li, Jinjin; Delplancke, Thibaut; Zhang, Hua; Qi, Hongbo

    2016-03-03

    Oral uptake of lycopene has been shown to be beneficial for preventing myocardial ischemia-reperfusion (I/R) injury. However, the strong first-pass metabolism of lycopene influences its bioavailability and impedes its clinic application. In this study, we determined an intravenous (IV) administration dose of lycopene protects against myocardial infarction (MI) in a mouse model, and investigated the effects of acute lycopene administration on reactive oxygen species (ROS) production and related signaling pathways during myocardial I/R. In this study, we established both in vitro hypoxia/reoxygenation (H/R) cell model and in vivo regional myocardial I/R mouse model by ligating left anterior artery descending. TTC dual staining was used to assess I/R induced MI in the absence and presence of acute lycopene administration via tail vein injection. Lycopene treatment (1 μM) before reoxygenation significantly reduced cardiomyocyte death induced by H/R. Intravenous administration of lycopene to achieve 1 μM concentration in circulating blood significantly suppressed MI, ROS production, and JNK phosphorylation in the cardiac tissue of mice during in vivo regional I/R. Elevating circulating lycopene to 1 μM via IV injection protects against myocardial I/R injury through inhibition of ROS accumulation and consequent inflammation in mice.

  3. Comparison of initial and delayed myocardial imaging with beta-methyl-p-[123I]-iodophenylpentadecanoic acid in acute myocardial infarction

    International Nuclear Information System (INIS)

    Naruse, Hitoshi; Yoshimura, Noriko; Yamamoto, Juro; Morita, Masato; Fukutake, Naoshige; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Fukuchi, Minoru

    1994-01-01

    Myocardial imaging using β-methyl-p-[ 123 I]-iodophenylpentadecanoic acid (BMIPP) of 15 patients with acute myocardial infarction was performed to assess 'fill-in' and 'washout' defects in the delayed myocardial image. The initial and delayed images were evaluated by a visual and quantitative washout rate method. Visual judgement found 8/180 (4%) segments showed 'fill-in' defects, and 24/180 segments (13%) showed 'washout' defects. There was no relationship between days from onset to the study and the frequency of fill-in and washout defects. The mean washout rate in the segments with 'fill-in' defects was 9.0±16.6%, and that of 'washout' defects was 24.9±18.1% which was significantly higher than in controls (8.7±15.4%, p<0.05). There was no correlation between mean washout rate and total blood lipids, total cholesterol, triglyceride and HDL-cholesterol. Therefore, neither time from onset nor blood lipids level was related to changes from the initial image to the delayed image. These changes may be due to relative (false) findings due to changes in circumference, and may be based on myocardial characteristics after myocardial infarction and/or reperfusion. (author)

  4. [Comparison of initial and delayed myocardial imaging with beta-methyl-p-[123I]-iodophenylpentadecanoic acid in acute myocardial infarction].

    Science.gov (United States)

    Naruse, H; Yoshimura, N; Yamamoto, J; Morita, M; Fukutake, N; Ohyanagi, M; Iwasaki, T; Fukuchi, M

    1994-01-01

    Myocardial imaging using beta-methyl-p-[123I]-iodophenylpentadecanoic acid (BMIPP) of 15 patients with acute myocardial infarction was performed to assess "fill-in" and "washout" defects in the delayed myocardial image. The initial and delayed images were evaluated by a visual and quantitative washout rate method. Visual judgement found 8/180 (4%) segments showed "fill-in" defects, and 24/180 segments (13%) showed "washout" defects. There was no relationship between days from onset to the study and the frequency of fill-in and washout defects. The mean washout rate in the segments with "fill-in" defects was 9.0 +/- 16.6%, and that of "washout" defects was 24.9 +/- 18.1% which was significantly higher than in controls (8.7 +/- 15.4%, p < 0.05). There was no correlation between mean washout rate and total blood lipids, total cholesterol, triglyceride and HDL-cholesterol. Therefore, neither time from onset nor blood lipids level was related to changes from the initial image to the delayed image. These changes may be due to relative (false) findings due to changes in circumference, and may be based on myocardial characteristics after myocardial infarction and/or reperfusion.

  5. Non-invasive assessment of the effects of drugs on acute myocardial infarct size in man

    Energy Technology Data Exchange (ETDEWEB)

    Maclean, D [Ninewells Hospital and Medical School, Dundee (UK)

    1979-06-01

    The amount of necrotic myocardium following acute coronary artery occlusion influences both the early and long-term consequences of myocardial infarction. Experiments, however, indicate that several drugs given early after the occlusion can substantially alter final infarct size. Clinical assessment of the effects of these drugs poses difficulties and an awareness of the limitations of existing methods is essential for their successful application. This discussion is restricted largely to the advantages and disadvantages of the three main methods currently used for assessing acute myocardial infarct size:-praecordial electrocardiographic mapping, serial estimates of serum creatine kinase activity, and radionuclide scintigraphy.

  6. Clinical Characteristics and Findings of 99mTc-MIBI Heart SPECT in Patients with Acute Myocardial Infarction with Normal Coronary Arteriography

    International Nuclear Information System (INIS)

    Park, Myung Jae; Choi, Tae Youl; Kim, Deong Yoon; Kang, Heung Sun; Choue, Chung Whee; Kim, Kwon Sam; Kim, Kwang Won; Kim, Myung Shick; Song, Jung Sang; Bae, Jong Hoa

    1993-01-01

    Among 64 patients with acute myocardial infarction who underwent coronary angiography, 7 patients (10.9%)showed normal coronary artery. Six patients were men and 1 patient was female. The mean age of patients were 31.1 ± 3.9 years. Among the risk factors of coronary heart disease, smoking was most probable factor in patients with acute myocardial infarction with normal coronary angiography. 99m Tc-MIBI heart SPECT performed 5 of 7 patients and showed that it could be used in diagnosis, localization, extent of infarct area in patients with acute myocardial infarction with normal coronary angiography. But follow up 99m Tc-MIBI heart SPECT study will be needed to define the ability of myocardial viability in this patients.

  7. Thrombus aspiration combined with intra-coronary injection of Tirofiban for acute ST-segment elevation myocardial infarction: its influence on myocardial reperfusion

    International Nuclear Information System (INIS)

    Yin Da; Zhu Hao; Zhou Xuchen; Huang Rongchong; Zhang Bo; Wang Shaopeng; Zhang Yousheng; Jia Yuqing; Sun Menghan; Cui Hashen

    2011-01-01

    Objective: To explore the influence of thrombus aspiration combined with intra-coronary administration of the glycoprotein Ⅱ b/Ⅲ a inhibitor, Tirofiban, on myocardial microcirculation when percutaneous coronary intervention (PCI) is employed for the treatment of acute ST-segment elevation myocardial infarction. Methods: During the period from April 2008 to June 2010, percutaneous coronary interventional was performed in 184 consecutive patients with acute ST-segment elevation myocardial infarction. The patients were randomly divided into study group (n=78) and control group (n=106). Thrombus aspiration combined with intra-coronary administration of Tirofiban was used in patients of study group, while routine PCI together with intravenous administration of Tirofiban was adopted in patients of control group. Clinical features, TIMI grade, myocardial blush grade, ratio of ST falling >70% at 24 hours after treatment, incidence of massive haemorrhage, hospitalization, days, major adverse cardiac event within 30 days were observed, and the results were compared between two groups. Results: The incidence of no reflow phenomenon in study group was markedly lower than that in control group (5.67% vs. 21.14%, P=0.011), while the myocardial blush grade was much higher in study group than that in control group (2.03±0.32 vs. 1.12±0.47, P=0.021). The ratio of ST falling > 70% at 24 hours after treatment in study group was increased (94% vs. 85%, P=0.003), and the occurrence of perioperative massive haemorrhage was lower (9% vs. 4%, P=0.03). The incidence of major adverse cardiac event within 30 days was distinctly decreased although it was quite similar in both groups (5.5% vs. 6.1%, P=0.786). Conclusion: Thrombus aspiration combined with intra-coronary administration of Tirofiban is superior to conventional PCI in effectively improving the reperfusion of myocardial microcirculation and in reliably reducing perioperative risk. (authors)

  8. Acute and chronic tears of anterior cruciate ligament : role of gadolinium-enhanced MR imaging

    International Nuclear Information System (INIS)

    Lee, Eun Jung; Jee, Won Hee; Im, Soo A; Chun, Ho Jong; Jung, Hyun Seouk; Kim, Soo Young; Kwon, Tae An; Song, Sun Wha; Choi, Kyu Ho

    1998-01-01

    To evaluate the efficacy of fat-suppressed gadolinium-enhanced MR imaging in differentiating acute from chronic ligament tears of anterior cruciate ligament. Materials and Methods : MR images of 22 patients with arthroscopically proven complete tear of the anterior cruciate ligament were retrospectively reviewed. The interval between injury and MR examination was one day to seven years. When ligament tear was detected on MR image with three months of injury, the case was considered acute;if detected after three months had elapsed, it was judged to be chronic. The extent of contrast enhancement was graded as 1, 2 or 3; grade 1, enhancement was confined to the expected ligament region; grade 2, enhancement extended to the joint capsule; grade 3, enhancement extended beyond the joint capsule. The grades of contrast enhancement correlated with the acute and chronic stages of ligament tears. Associated bone bruise and/or adjacent soft tissue edema were also evaluated. Results : Among 15 patients with acute ligament tear, nine (60%) showed grade 3 enhancement; among seven in whom tearing was chronic, four (57%) showed grade 1 enhancement. Bone bruising was present in 100% of acute tears (15/15) and 29 % of chronic tears (2/7). Soft tissue edema was associated in 87% of acute tears (13/15) and 29% of chronic tears(2/7). Conclusion : Fat-suppressed gadolinium-enhanced MR imaging could help differentiate acute from chronic tears of anterior cruciate ligament, as well as bone bruising and tissue edema

  9. Detection of periodontal bacteria in thrombi of patients with acute myocardial infarction by polymerase chain reaction.

    Science.gov (United States)

    Ohki, Takahiro; Itabashi, Yuji; Kohno, Takashi; Yoshizawa, Akihiro; Nishikubo, Shuichi; Watanabe, Shinya; Yamane, Genyuki; Ishihara, Kazuyuki

    2012-02-01

    Numerous reports have demonstrated that periodontal bacteria are present in plaques from atherosclerotic arteries. Although periodontitis has recently been recognized as a risk factor for coronary artery disease, the direct relationship between periodontal bacteria and coronary artery disease has not yet been clarified. It has been suggested that these bacteria might contribute to inflammation and plaque instability. We assumed that if periodontal bacteria induce inflammation of plaque, the bacteria would be released into the bloodstream when vulnerable plaque ruptures. To determine whether periodontal bacteria are present in thrombi at the site of acute myocardial infarction, we tried to detect periodontal bacteria in thrombi of patients with acute myocardial infarction by polymerase chain reaction (PCR). We studied 81 consecutive adults with ST-segment elevation acute myocardial infarction who underwent primary percutaneous coronary intervention (PCI). All patients underwent removal of thrombus with aspiration catheters at the beginning of percutaneous coronary intervention, and a small sample of thrombus was obtained for PCR. The detection rates of periodontal bacteria by PCR were 19.7% for Aggregatibacter actinomycetemcomitans, 3.4% for Porphyromonas gingivalis, and 2.3% for Treponema denticola. Three species of periodontal bacteria were detected in the thrombi of patients with acute myocardial infarction. This raises the possibility that such bacteria are latently present in plaque and also suggests that these bacteria might have a role in plaque inflammation and instability. Copyright © 2012 Mosby, Inc. All rights reserved.

  10. The effects of escitalopram on myocardial apoptosis and the expression of Bax and Bcl-2 during myocardial ischemia/reperfusion in a model of rats with depression.

    Science.gov (United States)

    Wang, Yiming; Zhang, Hongming; Chai, Fangxian; Liu, Xingde; Berk, Michael

    2014-12-04

    Major depressive disorder (MDD) is an independent risk factor for coronary heart disease (CHD), and influences the occurrence and prognosis of cardiovascular events. Although there is evidence that antidepressants may be cardioprotective after acute myocardial infarction (AMI) comorbid with MDD, the operative pathophysiological mechanisms remain unclear. Our aim was therefore to explore the molecular mechanisms of escitalopram on myocardial apoptosis and the expression of Bax and Bcl-2 in a rat model of depression during myocardial ischemia/reperfusion (I/R). Rats were divided randomly into 3 groups (n = 8): D group (depression), DI/R group (depression with myocardial I/R) and escitalopram + DI/R group. The rats in all three groups underwent the same chronic mild stress and separation for 21 days, at the same time, in the escitalopram + DI/R group, rats were administered escitalopram by gavage (10 mg/kg/day). Ligation of the rat's left anterior descending branch was done in the myocardial I/R model. Following which behavioral tests were done. The size of the myocardial infarction was detected using 1.5% TTC dye. The Tunel method was used to detect apoptotic myocardial cells, and both the Rt-PCR method and immunohistochemical techniques were used to detect the expression of Bcl-2 and Bax. Compared with the D and DI/R groups, rats in Escitalopram + DI/R group showed significantly increased movements and sucrose consumption (P escitalopram + DI/R group was significantly decreased (P escitalopram + DI/R groups (P escitalopram + DI/R group were significantly decreased (P escitalopram + DI/R group (P escitalopram. This suggests that clinically escitalopram may have a direct cardioprotective after acute myocardial infarction.

  11. Exclusion of acute myocardial infarction. The value of measuring creatine kinase slope

    NARCIS (Netherlands)

    Bakker, A. J.; Koelemay, M. J.; van Vlies, B.; Gorgels, J. P.; Smits, R.; Tijssen, J. G.; Haagen, F. D.

    1995-01-01

    For the exclusion (and diagnosis) of acute myocardial infarction, we studied timed sequential (slope) measurements of creatine kinase and creatine kinase-MB catalytic activity concentration, creatine kinase-MB mass concentration, troponin T and myoglobin, using data from 242 patients consecutively

  12. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction

    NARCIS (Netherlands)

    M.L. Simoons (Maarten); E.J. Topol (Eric); R.M. Califf (Robert); F.J.J. van de Werf (Frans); P.W. Armstrong (Paul); P.E. Aylward (Philip Edmund); G.I. Barbash; E.R. Bates (Eric); A. Betriu; J.H. Chesebro (James); J.J. Col (Jacques); D.P. de Bono (David); J.M. Gore (Joel); A.D. Guerci (Alan); J.R. Hampton (John)

    1993-01-01

    textabstractBACKGROUND: The relative efficacy of streptokinase and tissue plasminogen activator and the roles of intravenous as compared with subcutaneous heparin as adjunctive therapy in acute myocardial infarction are unresolved questions. The current trial was designed to compare new, aggressive

  13. Usefulness of contrast enhanced cardiac computed tomography in myocardial infarction

    International Nuclear Information System (INIS)

    Morooka, Nobuhiro; Yamada, Zenju; Watanabe, Shigeru

    1982-01-01

    Contrast enhanced cardiac computed tomography (CECT) was performed in 33 patients with transmural myocardial infarction. The anterior wall thickness assessed by CECT was well correlated with that by left ventriculography in RAO projection. When the septal wall thickness was compared between ECG gated and non-gated CECT images, the septal wall thickness by non-gated CECT showed a close coincidence with the diastolic wall thickness by ECG gated CECT. In all patients, the thickness of the septal, anterior and postero-lateral walls was measured. The mean wall thickness in patients of antero-septal infarction was 9.0 +- 1.9 mm for the septal wall, 6.3 +- 1.3 mm for the anterior wall, and 10.0 +- 2.1 mm for the postero-lateral wall. In patients of infero-lateral infarction, the mean wall thickness was 12.2 +- 1.7 mm for the septal wall, 10.8 +- 1.6 mm for the anterior wall and 8.9 +- 1.2 mm for the postero-lateral wall. A filling defect was revealed in the infarcted area when CECT was performed in patients with acute myocardial infarction within 1 week from the onset, and late enhancement was demonstrated by plain CT performed 10 min later. Left ventricular aneurysms were noted in 16 of 23 patients of anteroseptal infarction, and 8 of these 16 had mural thrombi in the left ventricle. Coronary artery calcification was found in 11 of 33 myocardial infarction patients. In patients with aortocoronary bypass graft, the sequential scan (dynamic scan) was shown to be a useful non-invasive method because it showed whether the graft was patent or not. (J.P.N.)

  14. Early Cessation of Adenosine Diphosphate Receptor Inhibitors Among Acute Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention

    DEFF Research Database (Denmark)

    Fosbøl, Emil L; Ju, Christine; Anstrom, Kevin J

    2016-01-01

    BACKGROUND: Guidelines recommend the use of adenosine diphosphate receptor inhibitor (ADPri) therapy for 1 year postacute myocardial infarction; yet, early cessation of therapy occurs frequently in clinical practice. METHODS AND RESULTS: We examined 11 858 acute myocardial infarction patients tre...

  15. Radioimmunoassay determination of factor 4 platelets (PF4) in acute myocardial infarction patients

    International Nuclear Information System (INIS)

    Leon Herrejon, Ma. de L.; Graef S, A.; Altamirano B, P.; Ramos C, M.A.

    1985-01-01

    From a pathological standpoint an increase in the Factor 4 platelet has been observed in various abnormal states including myocardial infarction, diabetes mellitus, diffuse intravascular coagulation and renal insufficiency among others. Eighty subjects were studied at rest: 40 normal and under no medication, and 40 myocardial infarction patients in the acute phase and with added pathology. All were under the same therapeutic regimen. Results obtained between both groups were statistically significant with a P > 0.01. (author)

  16. Predictive value of c-reactive protein for thrombolytic therapy in acute myocardial infarction

    International Nuclear Information System (INIS)

    Majeed, N.; Bashir, F.

    2014-01-01

    The serum levels of C-reactive protein on admission may predict the efficacy of reperfusion in patients with acute myocardial infarction. Objectives: This study was conducted to know the predictive value of CRP for success of thrombolysis and to know the prognostic value of C-reactive protein in patients having acute myocardial infarction. Study Design: It was single center, open labeled cross sectional study. Materials and Methods: Sixty patients of acute myocardial infarction diagnosed on clinical and ECG criteria, who received thrombolytic therapy with strepto- kinase, were included in the study. The diagnosis of acute rnyocardial infarction was made on clinical para meters and ECG criteria. The ECG changes were noted before starting thrombolysis. The baseline sample for C-reactive protein (CRP,) was taken before starting thrombolysis. The time duration between onset of symptoms and start of thrombolysis was also noted. The thrombolysis was done with streptokinase infusion, 1.5 million units diluted in 100ml normal saline, intravenously over one hour. The ECG was repeated after six hours of completion of thrombolysis and, changes were noted and compared with ECG changes before thrombolysis. Now second sample for C-reactive protein (CRP2) was taken after six hours of completion of thrombolysis. CRP was measured by a high sensitivity assay which can accurately measure basal levels of CRP throughout the currently accepted cardiovascular risk assessment range (0.20 - 10.0 mg/L). According to ECG findings after thrombolysis, all patients were divided into two groups. Group A was considered as successful group to thrombolysis, in whom ECG changes were settled. Group B was considered as unsuccessful group to thrombolysis, in whom ECG changes remained same as before thrombolysis. Both values of C-reactive protein, CRP, and CRP2 were compared in both groups group A and group B. Results: Plasma CRP values before and after thrombolysis had strong predictive value for

  17. Acute myocardial infarction with a non-diagnostic electrocardiogram. Case presentation and overview

    Energy Technology Data Exchange (ETDEWEB)

    Przybojewski, J Z; Gilburt, S G.M. [Tygerberg Hospital, Stellenbosch (South Africa). Dept. of Internal Medicine

    1983-12-17

    The clinical presentation of a young hypertensive White man with acute high lateral non-transmural myocardial infarction (MI) is documented. This diagnosis was established on the grounds of a history of chest pain, elevated serial serum enzyme levels, technetium-99m pyrophosphate ('hot-spot') scintigraphy, exercise thallium-201 ('cold-spot') scanning, left ventricular cine angiography and selective coronary arteriography. Daily resting 12-lead ECGs failed to demonstrate unequivocal features of acute non-transmural subendocardial MI. The diagnostic difficulties facing the clinician in a case of acute MI associated with a non-diagnostic ECG are stressed, and the ECG features of acute subendocardial MI are reviewed.

  18. Acute Stress Decreases but Chronic Stress Increases Myocardial Sensitivity to Ischemic Injury in Rodents

    OpenAIRE

    Eisenmann, Eric D.; Rorabaugh, Boyd R.; Zoladz, Phillip R.

    2016-01-01

    Cardiovascular disease is the largest cause of mortality worldwide, and stress is a significant contributor to the development of cardiovascular disease. The relationship between acute and chronic stress and cardiovascular disease is well-evidenced. Acute stress can lead to arrhythmias and ischemic injury. However, recent evidence in rodent models suggests that acute stress can decrease sensitivity to myocardial ischemia-reperfusion injury. Conversely, chronic stress is arrythmogenic and incr...

  19. Urinary albumin excretion and history of acute myocardial infarction in a cross-sectional population study of 2,613 individuals

    DEFF Research Database (Denmark)

    Jensen, J S; Borch-Johnsen, K; Feldt-Rasmussen, B

    1997-01-01

    BACKGROUND: Preliminary studies have suggested that microalbuminuria--a slightly increased urinary excretion of albumin--is a risk factor for atherosclerosis. The aim of this study was to examine whether an association exists between urinary excretion of albumin and a history of acute myocardial...... measurement of urinary albumin excretion rate, acquisition of information regarding previous acute myocardial infarction (verified by the Danish Hospital Register) and tobacco and alcohol consumption, 12-lead resting electrocardiogram, and measurement of blood pressure, body mass index, waist:hip ratio......, plasma concentrations of total cholesterol, HDL cholesterol and fibrinogen, serum albumin concentration and glomerular filtration rate. RESULTS: Among the participants, 3.6% presented with a history of acute myocardial infarction. There was a positive association between urinary albumin excretion rate...

  20. [Unilateral acute pulmonary edema and ischemic myocardial process: a case report].

    Science.gov (United States)

    Bentaleb, A; Tagu, P; Vascaut, L

    2008-08-01

    Unilateral acute pulmonary oedema (APO) is a rare radioclinical finding. It occurs secondary to multiple specific and rare pathological processes. Functional ischemic mitral regurgitation (FIMR) secondary to myocardial necrosis is one of the rare aetiologies involved in its pathogenesis. This concerns a 94-year-old male patient with a history of myocardial infarction who presented with a clinical picture of unilateral APO secondary to functional mitral regurgitation as a complication of myocardial necrosis. In addition to the clinical presentation and unilateral radiological findings, the diagnosis was based essentially on the electrocardiographic tracing, as well as changes in cardiac enzyme levels and transthoracic echocardiogram coupled with Doppler tissue imaging. This resulted after ruling out many differential diagnoses. Unilateral APO secondary to functional mitral regurgitation often presents diagnostic challenges and problems of initial management for the clinician. There are multiple aetiologies of acute unilateral pulmonary oedema, namely mechanical (re-expansion), lesional, vascular, bronchial obstructions, as well as iatrogenic causes, as is the case with some lung transplantations. As with all cases of APO, the treatment is based mainly on diuretics with high-flow oxygen therapy in association with an anticoagulant, which is usually effectively combined with a platelet aggregation inhibiting drug and sometimes with vasodilators and beta-blockers. Surgical treatment with valvuloplasty or valvular replacement appears to be the most effective means for preventing relapse.

  1. Confluence of depression and acute psychological stress among patients with stable coronary heart disease: effects on myocardial perfusion.

    Science.gov (United States)

    Burg, Matthew M; Meadows, Judith; Shimbo, Daichi; Davidson, Karina W; Schwartz, Joseph E; Soufer, Robert

    2014-10-30

    Depression is prevalent in coronary heart disease (CHD) patients and increases risk for acute coronary syndrome (ACS) recurrence and mortality despite optimal medical care. The pathways underlying this risk remain elusive. Psychological stress (PS) can provoke impairment in myocardial perfusion and trigger ACS. A confluence of acute PS with depression might reveal coronary vascular mechanisms of risk. We tested whether depression increased risk for impaired myocardial perfusion during acute PS among patients with stable CHD. Patients (N=146) completed the Beck Depression Inventory-I (BDI-I), a measure of depression linked to recurrent ACS and post-ACS mortality, and underwent single-photon emission computed tomography myocardial perfusion imaging at rest and during acute PS. The likelihood of new/worsening impairment in myocardial perfusion from baseline to PS as a function of depression severity was tested. On the BDI-I, 41 patients scored in the normal range, 48 in the high normal range, and 57 in the depressed range previously linked to CHD prognosis. A BDI-I score in the depressed range was associated with a significantly greater likelihood of new/worsening impairment in myocardial perfusion from baseline to PS (odds ratio =2.89, 95% CI: 1.26 to 6.63, P=0.012). This remained significant in models controlling ACS recurrence/mortality risk factors and medications. There was no effect for selective serotonin reuptake inhibitor medications. Depressed patients with CHD are particularly susceptible to impairment in myocardial perfusion during PS. The confluence of PS with depression may contribute to a better understanding of the depression-associated risk for ACS recurrence and mortality. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  2. Comparison of coronary angiography and early oral dipyridamole thallium-201 scintigraphy in patients receiving thrombolytic therapy for acute myocardial infarction

    International Nuclear Information System (INIS)

    Jain, A.; Hicks, R.R.; Myers, G.H.; McCarthy, J.J.; Perry, J.R.; Adams, K.F.

    1990-01-01

    We evaluated 50 consecutive patients who received thrombolytic therapy for acute myocardial infarction using thallium-201 single photon emission computed tomography in combination with oral dipyridamole to assess the frequency of residual myocardial ischemia. Thallium studies were performed early after myocardial infarction at a mean of 4.6 days. The time from the onset of chest pain to the administration of thrombolytic therapy was 2.6 hours (range 0.5 to 5.5). Q wave myocardial infarction was evident in 46 patients; four patients had a non-Q wave infarction (anterior infarction in 31 patients and inferior infarction in 19 patients). The serum mean peak creatinine kinase was 1503 IU/L (range 127 to 6500). Coronary angiography was performed in all patients at a mean of 3.1 days (range 2 to 10) and revealed the infarct-related vessel to be patent in 36 patients (72%). The ejection fraction was 48% (range 26% to 67%). After dipyridamole administration, 13 patients (26%) developed angina that was easily reversed with the administration of intravenous aminophylline. Systolic blood pressure decreased from 122 to 115 mm Hg (p less than 0.05) and the heart rate increased from 76 to 85 beats/min (p less than 0.05). None of the patients had significant hypotension, arrhythmias, or evidence of infarct extension. Perfusion abnormalities were present on the initial thallium images in 48 patients. Redistribution suggestive of ischemia was present in 36 patients (72%). Ischemia confined to the vascular distribution of the infarct vessel was evident in 22 patients. Seven patients had ischemia in the infarct zone as well as in a remote myocardial segment. Thus 29 patients (58%) had ischemia in the distribution of the infarct vessel. Ischemia in the infarct zone was evident in 19 of 36 patients with open infarct vessels and in 10 of 14 patients with occluded infarct vessels

  3. Discharge Policy and Reperfusion Therapy in Acute Myocardial Infarction

    OpenAIRE

    Vlugt, Maureen

    2007-01-01

    textabstractTreatment of patients with acute myocardial infarction (MI) has improved over time and the duration of hospital stay has considerably decreased. Early hospital discharge after MI has been promoted for over 25 years. However, the meaning of “early” evolved over time. In the early eighties, before the widespread introduction of reperfusion therapy, patients were hospitalised for approximately 3 weeks and early discharge implemented a reduction to 7 days. Nowadays, the average hospit...

  4. MR Assessment of Acute Pathologic Process after Myocardial Infarction in a Permanent Ligation Mouse Model: Role of Magnetic Nanoparticle-Contrasted MRI

    Directory of Open Access Journals (Sweden)

    Cheongsoo Park

    2017-01-01

    Full Text Available We evaluated the relationship between myocardial infarct size and inflammatory response using cardiac magnetic resonance imaging (CMR in an acute myocardial infarction (AMI mouse model. Myocardial infarction (MI was induced in 14 mice by permanent ligation of the left anterior descending artery. Late gadolinium enhancement (LGE, manganese-enhanced MRI (MEMRI, and magnetofluorescent nanoparticle MRI (MNP-MRI were performed 1, 2, and 3 days after MI, respectively. The size of the enhanced lesion was quantitatively determined using Otsu’s thresholding method in area-based and sector-based approaches and was compared statistically. Linear correlation between the enhanced lesion sizes was evaluated by Pearson’s correlation coefficients. Differences were compared using Bland-Altman analysis. The size of the inflammatory area determined by MNP-MRI (57.1 ± 10.1% was significantly larger than that of the infarct area measured by LGE (40.8 ± 11.7%, P<0.0001 and MEMRI (44.1 ± 14.9%, P<0.0001. There were significant correlations between the sizes of the infarct and inflammatory lesions (MNP-MRI versus LGE: r=0.3418, P=0.0099; MNP-MRI versus MEMRI: r=0.4764, P=0.0002. MNP-MRI provides information about inflammatory responses in a mouse model of AMI. Thus, MNP-MRI associated with LGE and MEMRI may play an important role in monitoring the disease progression in MI.

  5. Comparative study of body surface isopotential map, left ventriculogram and thallium-201 myocardial scintigram in patients with old lateral myocardial infarction

    International Nuclear Information System (INIS)

    Matsumoto, Naoyuki

    1988-01-01

    In 16 patients with old lateral myocardial infarction, body surface isopotential maps and 12 lead electrocardiograms were compared with left ventriculographic findings. In addition 8 of these subjects were performed thallium-201 myocardial scintigraphy in order to determine the location and extent of myocardial necrosis. Common 12 lead electrocardiographic findings of the subjects were initial Q waves more than 30 msec and inverted T waves in only aVL lead. The patients were classified into 4 groups according to the location and extent of ventricular wall motion abnormalities group I (6 cases) showed hypokinesis in the anterior segment, group II (5 cases): akinesis in the anterior segment and hypokinesis in the seg. 6, group III (4 cases): hypokinesis in the anterior segment and seg. 7, group IV (1 case): hypokinesis in the anterior segment and seg. 4, 7. And each of the 4 groups demonstrated characteristic findings of surface isopotential maps. Group II with coexisting hypokinesis in the seg. 6 showed surface isopotential maps additional pattern of anterior myocardial infarction, and group III with coexisting hypokinesis in the seg. 7 showed additional patterns of posterior myocardial infarction. The classification according to the abnormality of ventricular wall motion was also conformed with the thallium-201 myocardial scintigraphic findings except one case. These results suggest that body surface isopotential map is more useful than the 12 lead electrocardiogram in detecting the location and extent of left ventricular wall motion abnormality in patients with old lateral myocardial infarction. (author) 53 refs

  6. 3D cardiac wall thickening assessment for acute myocardial infarction

    Science.gov (United States)

    Khalid, A.; Chan, B. T.; Lim, E.; Liew, Y. M.

    2017-06-01

    Acute myocardial infarction (AMI) is the most severe form of coronary artery disease leading to localized myocardial injury and therefore irregularities in the cardiac wall contractility. Studies have found very limited differences in global indices (such as ejection fraction, myocardial mass and volume) between healthy subjects and AMI patients, and therefore suggested regional assessment. Regional index, specifically cardiac wall thickness (WT) and thickening is closely related to cardiac function and could reveal regional abnormality due to AMI. In this study, we developed a 3D wall thickening assessment method to identify regional wall contractility dysfunction due to localized myocardial injury from infarction. Wall thickness and thickening were assessed from 3D personalized cardiac models reconstructed from cine MRI images by fitting inscribed sphere between endocardial and epicardial wall. The thickening analysis was performed in 5 patients and 3 healthy subjects and the results were compared against the gold standard 2D late-gadolinium-enhanced (LGE) images for infarct localization. The notable finding of this study is the highly accurate estimation and visual representation of the infarct size and location in 3D. This study provides clinicians with an intuitive way to visually and qualitatively assess regional cardiac wall dysfunction due to infarction in AMI patients.

  7. Handheld echocardiography during hospitalization for acute myocardial infarction.

    Science.gov (United States)

    Cullen, Michael W; Geske, Jeffrey B; Anavekar, Nandan S; Askew, J Wells; Lewis, Bradley R; Oh, Jae K

    2017-11-01

    Handheld echocardiography (HHE) is concordant with standard transthoracic echocardiography (TTE) in a variety of settings but has not been thoroughly compared to traditional TTE in patients with acute myocardial infarction (AMI). Completed by experienced operators, HHE provides accurate diagnostic capabilities compared with standard TTE in AMI patients. This study prospectively enrolled patients admitted to the coronary care unit with AMI. Experienced sonographers performed HHE with a V-scan. All patients underwent clinical TTE. Each HHE was interpreted by 2 experts blinded to standard TTE. Agreement was assessed with κ statistics and concordance correlation coefficients. Analysis included 82 patients (mean age, 66 years; 74% male). On standard TTE, mean left ventricular (LV) ejection fraction was 46%. Correlation coefficients between HHE and TTE were 0.75 (95% confidence interval: 0.66 to 0.82) for LV ejection fraction and 0.69 (95% confidence interval: 0.58 to 0.77) for wall motion score index. The κ statistics ranged from 0.47 to 0.56 for LV enlargement, 0.55 to 0.79 for mitral regurgitation, and 0.44 to 0.57 for inferior vena cava dilatation. The κ statistics were highest for the anterior (0.81) and septal (0.71) apex and lowest for the mid inferolateral (0.36) and basal inferoseptal (0.36) walls. In patients with AMI, HHE and standard TTE demonstrate good correlation for LV function and wall motion. Agreement was less robust for structural abnormalities and specific wall segments. In experienced hands, HHE can provide a focused assessment of LV function in patients hospitalized with AMI; however, HHE should not substitute for comprehensive TTE. © 2017 Wiley Periodicals, Inc.

  8. Myocardial Bridging

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    2016-02-01

    Full Text Available Abstract Myocardial bridging is rare. Myocardial bridges are most commonly localized in the middle segment of the left anterior descending coronary artery. The anatomic features of the bridges vary significantly. Alterations of the endothelial morphology and the vasoactive agents impact on the progression of atherosclerosis of myocardial bridging. Patients may present with chest pain, myocardial infarction, arrhythmia and even sudden death. Patients who respond poorly to the medical treatment with β-blockers warrant a surgical intervention. Myotomy is a preferred surgical procedure for the symptomatic patients. Coronary stent deployment has been in limited use due to the unsatisfactory long-term results.

  9. Very late coronary spasm inducing acute myocardial infarction in a heart transplant recipient.

    Science.gov (United States)

    Santoro, Francesco; Lopizzo, Agostino; Centola, Antonio; Cuculo, Andrea; Ruggiero, Antonio; Di Biase, Matteo; Brunetti, Natale Daniele

    2016-12-01

    : We report coronary angio findings of very late (10-year) coronary spasm inducing acute myocardial infarction with typical chest pain in a heart transplant recipient. Coronary spasm was promptly relieved by intra-coronary infusion of nitrates.

  10. Effects of hyper- and hypo- thyroidism on oxidative stress of the eye in experimental acute anterior uveitis.

    Science.gov (United States)

    Bilgihan, K; Bilgihan, A; Diker, S; Ataoglu, O; Dolapci, M; Akata, F; Hasanreisôglu, B; Turkozkan, N

    1996-02-01

    Glutathione peroxidase activities and malondialdehyde levels were measured in the homogenated anterior segment of rat eyes with endotoxin induced acute anterior uveitis in euthyroid, hyperthyroid and hypothyroid rats. Malondialdehyde concentrations were found to be significantly increased (p 0.05). These results suggest that excess or deficiency of the thyroid hormones cause alterations in the malondialdehyde levels and glutathione peroxidase activities of the rat eyes in endotoxin induced uveitis, and hyperthyroidism may increase the oxidative stress in endotoxin induced acute anterior uveitis.

  11. Acute myocardial infarction associated with blood transfusion: case report and literature review.

    Science.gov (United States)

    Velibey, Yalcin; Erbay, Aliriza; Ozkurt, Enver; Usta, Emrah; Akin, Filiz

    2014-04-01

    A 62-year old patient with a history of chronic anemia associated with malabsorption secondary to short gut syndrome, experienced acute chest pain the second hour after the transfusion of a crossmatch-compatible erythrocyte suspension. His electrocardiogram (ECG) revealed widespread ST-segment depressions and he had an elevated troponin level. Laboratory findings and physical examination did not indicate the presence of immunological or non-immunological blood transfusion reactions. Cardiac catheterization was performed and showed angiographically non-obstructive, atherosclerotic plaques and the absence of vasospasm or thrombus formation. Following antiischemic therapy his symptoms resolved completely. The ECG obtained 24 hours after the emergence of chest pain demonstrated normal sinus rhythm with no ST-T wave changes. We present a rare case of acute myocardial infarction induced following a blood transfusion. To the best of our knowledge, a few cases of acute myocardial infarction associated with blood transfusion have been formally recorded in the medical literature and the clinical experience regarding such cases is indeed quite limited. The present case is reviewed in the context of the relevant literature as a practical resource for clinical practice. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  12. Acute Respiratory Distress Syndrome after Early Successful Primary Percutaneous Coronary Intervention Therapy in Acute Myocardial Infarction: A Case Report

    Directory of Open Access Journals (Sweden)

    Ho-Ming Su

    2005-02-01

    Full Text Available Acute respiratory distress syndrome (ARDS is characterized by acute-onset dyspnea, diffuse bilateral pulmonary infiltration, low pulmonary capillary wedge pressure (PCWP, and an arterial oxygen tension/ inspired oxygen fraction (PaO2/FiO2 ratio of less than 200 mmHg. Acute myocardial infarction (AMI, whether complicated by circulatory arrest, cardiogenic shock, and hypotension or not, was reported as an etiologic factor in the development of ARDS in the prethrombolytic era. In the thrombolytic era, two cases of AMI complicated with ARDS have been reported. ARDS in these two patients resulted from anaphylactic reaction to the thrombolytic agent and not from the hemodynamic consequences of AMI. Development of ARDS during the AMI period has not been reported after early successful primary percutaneous coronary intervention (PCI. Herein, we report a 61-year-old male patient with persistent chest pain who was diagnosed with Killip II anterior ST-segment elevation AMI. He was treated successfully with primary PCI 2.5 hours after the onset of chest pain. Unfortunately, on the third hospital day, acuteonset dyspnea (respiratory rate, 33 beats/min, fever (38.5°C, leukocytosis (white blood cell count, 18,360/μL, and diffuse bilateral pulmonary infiltration were noted. ARDS was diagnosed from the low PCWP (8 mmHg and a PaO2/FiO2 of less than 200 mmHg (160 mmHg. No usual causes of ARDS such as infection, aspiration, trauma, shock, or drug reactions were noted. We assumed that, in this particular patient, the systemic inflammatory response syndrome frequently induced by AMI might have caused this episode of ARDS. This may imply that AMI itself is a possible etiology of ARDS.

  13. Diagnostic usefulness of the oedema-infarct ratio to differentiate acute from chronic myocardial damage using magnetic resonance imaging

    International Nuclear Information System (INIS)

    Yamada, Kiyoyasu; Suzuki, Susumu; Kinoshita, Kousuke; Yokouchi, Kazuhiko; Iwata, Hirokazu; Sawada, Ken; Isobe, Satoshi; Ohshima, Satoru; Murohara, Toyoaki; Hirai, Makoto

    2012-01-01

    To differentiate acute from chronic damage to the myocardium in patients with myocardial infarction (MI) using DE and T2w MR. Short-axis T2w and DE MR images were acquired twice after the onset of MI in 36 patients who successfully underwent emergency coronary revascularisation. The areas of infarct and oedema were measured. The oedema-infarct ratio (O/I) of the left ventricular area was calculated by dividing the oedema by the infarct area. The oedema size on T2w MR was significantly larger than the infarct size on DE MR in the acute phase. Both the oedema size on T2w MR and the infarct size on DE MR in the acute phase were significantly larger than those in the chronic phase. The O/I was significantly greater in the acute phase compared with that in the chronic phase (P < 0.05). An analysis of relative cumulative frequency distributions revealed an O/I of 1.4 as a cut-off value for differentiating acute from chronic myocardial damage with the sensitivity, specificity, and accuracy of 85.1%, 82.7% and 83.9%, respectively. The oedema-infarct ratio may be a useful index in differentiating acute from chronic myocardial damage in patients with MI. (orig.)

  14. Correlation between Stress Hyperglycemia and Short-Term Prognosis in non Diabetic Patients with Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Rafighdoust Amirhossein

    2009-03-01

    Full Text Available Background: Abnormal hyperglycemia is a common finding in early phase of acute myocardial infarction that is named as stress hyperglycemia. In this study we have evaluated primary blood sugar of non-diabetic patients with acute myocardial infarction at the time of admission to compare the early complications between patients with high or normal blood sugar. We aimed to find any relation between primary blood sugar and post MI complication rate. Materials and Methods: One hundred non-diabetic patients with acute myocardial infarction who were referred to heart emergency ward of Imam Reza Hospital (Mashhad, Iran were included in this study. According to primary blood glucose level, 50 patients with blood glucose > 126 mg/dl were compared with 50 patients with normal blood glucose level. All patients were evaluated during hospitalization and daily clinical examinations laboratory tests, and routine non-invasive assessments were done. The results were analyzed by SPSS software and the level of signification difference was described as p<0.05.Results: Sinus tachycardia, atrial fibrillation, bundle branch block, ventricular extrasystole, prolonged PR-interval and heart failure according to Klip classification and also according to echocardiographic index (EF<50 were statistically significant and more common in hyperglycemic patients (P<0.05. Thromboembolic and mechanical complications (papillary muscle dysfunction, pericarditis, phlebitis and angina were also more common in hyperglycemic group although the differences were not significant statistically. Conclusion: It seems that high rate of early complications in non-diabetic patients with acute myocardial infarction is directly related to primary hyperglycemia (stress hyperglycemia.

  15. The impact of winter cold weather on acute myocardial infarctions in Portugal

    International Nuclear Information System (INIS)

    Vasconcelos, João; Freire, Elisabete; Almendra, Ricardo

    2013-01-01

    Mortality due to cardiovascular diseases shows a seasonal trend that can be associated with cold weather. Portugal is the European country with the highest excess winter mortality, but nevertheless, the relationship between cold weather and health is yet to be assessed. The main aim of this study is to identify the contribution of cold weather to cardiovascular diseases within Portugal. Poisson regression analysis based on generalized additive models was applied to estimate the influence of a human-biometeorological index (PET) on daily hospitalizations for myocardial infarction. The main results revealed a negative effect of cold weather on acute myocardial infarctions in Portugal. For every degree fall in PET during winter, there was an increase of up to 2.2% (95% CI = 0.9%; 3.3%) in daily hospital admissions. This paper shows the need for public policies that will help minimize or, indeed, prevent exposure to cold. -- Highlights: ► We model the relationship between daily hospitalizations due to myocardial infarctions and cold weather in Portugal. ► We use Physiological Equivalent temperature (PET) as main explanatory variable. ► We adjust the models to confounding factors such as influenza and air pollution. ► Daily hospitalizations increased up to 2.2% per degree fall of PET during winter. ► Exposure to cold weather has a negative impact on human health in Portugal. -- There is an increase of up to 2.2% in daily hospitalizations due to acute myocardial infarctions per degree fall of thermal index during the winter months in Portugal

  16. The clinical application value of myocardial perfusion imaging in evaluating coronary artery myocardial bridge patients with symptoms

    International Nuclear Information System (INIS)

    Wang Yuetao; Fu Ning; Ding Xuemei; Lu Cunzhi; Zhu Feng; Wang Guanmin; Huang Yijie; Wang Linguang

    2008-01-01

    Objective: Myocardial bridge is a common inborn coronary artery anomaly, myocardial bridge may be associated with myocardial ischemia. Only a few patients with coronary artery myocardial bridge were evaluated with nuclear medicine techniques. The aim of this study was to investigate the role of nuclear cardiology with myocardial perfusion technique in symptomatic myocardial bridge patients. Methods Nineteen myocardial bridge patients with the symptoms of chest pain and chest distress were analyzed retrospectively. 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion images (both exercise and rest) were performed in all. Imaging results were compared with the results of movement electrocardiogram (ECG) and coronary arteriography. The t test or χ 2 test was used to statistically analyze the data with Stata 7.0 software. Results: Of the 19 patients, 18 patients had myocardial bridge locating at the left anterior descending artery, 1 patient at the left anterior descending and left circumflex artery, the mean angiographic systolic occlusion within the myocardial bridge was (65.4 ± 22.1)%. Of these 19 patients, Exercise-rest 99 Tc m -MIBI myocardial perfusion imaging defined positive myocardial ischemia in 10 and negative in 9 patients. Of the 10 patients with 99 Tc m -MIBI myocardial perfusion imaging defined myocardial ischemia, 8 had reversible radioactive defect of partial anterior wall and (or) apex, 1 had reversible defect of post lateral wall and post septal wall, and 1 had reversible defect of inferior wall. The positive predictive value of myocardial perfusion imaging was 52.6% (10/19), which was higher than movement ECG [21.1% (4/19), χ 2 = 4.07, P 99 Tc m -MIBI myocardial periusion imaging defined myocardial ischemia. Six cases with Grade II stenosis, two were 99 Tc m -MIBI myocardial perfusion imaging defined myocardial ischemia. Eight cases with Grade III stenosis, seven were 99 Tc m -MIBI myocardial perfusion imaging defined myocardial

  17. Prognostic value of intravenous dipyridamole thallium scintigraphy after an acute myocardial ischemic event

    International Nuclear Information System (INIS)

    Younis, L.T.; Byers, S.; Shaw, L.; Barth, G.; Goodgold, H.; Chaitman, B.R.

    1989-01-01

    Seventy-seven patients recovering from an acute coronary event were studied by intravenous dipyridamole thallium scintigraphy to evaluate the prognostic value and safety of the test in this patient subset. Forty-four patients (58%) had unstable angina and 33 (42%) had an acute myocardial infarction. One death occurred within 24 hours of testing. Sixty-eight patients were followed for an average of 12 months; 25, 31 and 23% had a fixed, reversible or combined thallium defect on their predischarge thallium scan. During follow-up, 10 patients died or had a nonfatal myocardial infarction; in each case, a reversible or combined myocardial thallium defect was present. Univariate analysis of 17 clinical, scintigraphic and angiographic variables showed that a reversible thallium defect and the angiographically determined extent of coronary artery disease were predictors of future cardiac events. The extent of coronary disease and global left ventricular ejection fraction were predictors of subsequent reinfarction or death. Logistic regression analyses revealed that a reversible thallium defect (p less than 0.001) and the extent of coronary disease (p less than 0.009) were the only significant predictors of a cardiac event. When death or reinfarction were the outcome variables, the extent of coronary disease (p less than 0.02) and left ventricular ejection fraction (p less than 0.06) were the only variables selected. Thus, intravenous dipyridamole thallium scintigraphy after an acute coronary ischemic syndrome is a useful and relatively safe noninvasive test to predict subsequent cardiac events

  18. Silent ischemia in patients after the acute myocardial infarction

    International Nuclear Information System (INIS)

    Samarzija, M.

    1991-01-01

    The purpose of this study was to determine the frequency and importance of silent ischemia in patients (pts) after acute myocardial infarction (AMI) as well as to establish diagnostic and prognostic values of exercise stress test (EST), Holter (H) monitoring and thallium-201 (Tl) scintigraphy. All the tests were performed 2-4 months following the AMI. The criterion for diagnostic myocardial ischemia on EST and H is 1 mm or more of horizontal or down-sloping ST depression. Additional criteria for Holter imply that the ischemic episode should last one minute and be separated from other episodes by at least one minute. Planar thallium images were performed 5-10 minutes after the stress test; the delayed images were obtained after 3-6 hours. Visual and quantitative methods were employed in the analysis of Tl-scintigraphy. Scintigraphy was considered positive if exercise-induced perfusion defects showed redistribution. The study included 74 asymptomatic patients after the AMI. The patients were divided into two groups by results of quantitative Tl-scintigraphy: Group I - 44 pts with silent ischemia, Group II - 30 pts without ischemia. In Group I, out of 44 pts, 9 had a positive exercise stress test, 4 showed a painless ST depression on Holter and 7 had both tests positive, whereas 24 pts had only scintigraphy positive. In Group II one patient had positive EST and H. Sensitivity and specificity were determined by results of coronary arteriography performed on 33 pts: EST (Se=40%, Sp=80%), H (Se=21%, Sp=100%) and scintigraphy (Se=93%, Sp=80%). During the follow-up period lasting at least 12 months, in Group I 3 pts died, 1 developed a new myocardial infarction and 15 pts had painful ischemic occurrences. In Group II only 3 pts developed symptoms of angina pectoris. Tl-scintigraphy was the only non-invasive test showing significant correlation with the follow-up outcomes. The diagnostic and prognostic superiority of Tl-scintigraphy justifies its value as an initial

  19. Botulinum toxin-induced acute anterior uveitis in a patient with Behçet's disease under infliximab treatment: a case report.

    Science.gov (United States)

    Sasajima, Hirofumi; Yagi, Syunsuke; Osada, Hiromu; Zako, Masahiro

    2017-05-04

    Injections of lipopolysaccharide in animal models generate acute anterior uveitis (also known as endotoxin-induced uveitis), but the effects of lipopolysaccharide injection are unknown in humans. We describe an unusual case in which acute anterior uveitis was dramatically activated subsequent to botulinum toxin injection in a patient with Behçet's disease but the acute anterior uveitis was satisfactorily attenuated by infliximab. A 53-year-old Japanese man had normal ocular findings at his regularly scheduled appointment. He had been diagnosed as having incomplete-type Behçet's disease 11 years before. Three years after the diagnosis he was given systemic infusions of 5 mg/kg infliximab every 8 weeks and he had not experienced a uveitis attack for 8 years with no treatment other than infliximab. Two days after the eye examination, he received intracutaneous botulinum toxin injections to treat axillary hyperhidrosis on both sides. Three hours after the injections, he noted rapidly increasing floaters in his right eye. Four days after the injections, his right eye showed severe acute anterior uveitis with deteriorated aqueous flare and anterior vitreous opacity. He received his scheduled infliximab injection, and the right acute anterior uveitis immediately attenuated. Botulinum toxin may have clinical effects similar to those of lipopolysaccharide in endotoxin-induced uveitis models. To the best of our knowledge, this is the first report to suggest that botulinum toxin may trigger acute anterior uveitis, although the precise mechanism is still unclear.

  20. Acute Myocardial Infarction: Changes in Patient Characteristics, Management, and 6-Month Outcomes Over a Period of 20 Years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015.

    Science.gov (United States)

    Puymirat, Etienne; Simon, Tabassome; Cayla, Guillaume; Cottin, Yves; Elbaz, Meyer; Coste, Pierre; Lemesle, Gilles; Motreff, Pascal; Popovic, Batric; Khalife, Khalife; Labèque, Jean-Noel; Perret, Thibaut; Le Ray, Christophe; Orion, Laurent; Jouve, Bernard; Blanchard, Didier; Peycher, Patrick; Silvain, Johanne; Steg, Philippe Gabriel; Goldstein, Patrick; Guéret, Pascal; Belle, Loic; Aissaoui, Nadia; Ferrières, Jean; Schiele, François; Danchin, Nicolas

    2017-11-14

    ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction (NSTEMI) management has evolved considerably over the past 2 decades. Little information on mortality trends in the most recent years is available. We assessed trends in characteristics, treatments, and outcomes for acute myocardial infarction in France between 1995 and 2015. We used data from 5 one-month registries, conducted 5 years apart, from 1995 to 2015, including 14 423 patients with acute myocardial infarction (59% STEMI) admitted to cardiac intensive care units in metropolitan France. From 1995 to 2015, mean age decreased from 66±14 to 63±14 years in patients with STEMI; it remained stable (68±14 years) in patients with NSTEMI, whereas diabetes mellitus, obesity, and hypertension increased. At the acute stage, intended primary percutaneous coronary intervention increased from 12% (1995) to 76% (2015) in patients with STEMI. In patients with NSTEMI, percutaneous coronary intervention ≤72 hours from admission increased from 9% (1995) to 60% (2015). Six-month mortality consistently decreased in patients with STEMI from 17.2% in 1995 to 6.9% in 2010 and 5.3% in 2015; it decreased from 17.2% to 6.9% in 2010 and 6.3% in 2015 in patients with NSTEMI. Mortality still decreased after 2010 in patients with STEMI without reperfusion therapy, whereas no further mortality gain was found in patients with STEMI with reperfusion therapy or in patients with NSTEMI, whether or not they were treated with percutaneous coronary intervention. Over the past 20 years, 6-month mortality after acute myocardial infarction has decreased considerably for patients with STEMI and NSTEMI. Mortality figures continued to decline in patients with STEMI until 2015, whereas mortality in patients with NSTEMI appears stable since 2010. © 2017 American Heart Association, Inc.

  1. Optic neuritis and acute anterior uveitis associated with influenza A infection: a case report

    Directory of Open Access Journals (Sweden)

    Nakagawa H

    2017-01-01

    Full Text Available Hayate Nakagawa, Hidetaka Noma, Osamu Kotake, Ryosuke Motohashi, Kanako Yasuda, Masahiko Shimura Department of Ophthalmology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan Background: A few reports have described ocular complications of influenza A infection, such as impaired ocular movement, parasympathetic ocular nerve, keratitis, macular lesion, and frosted branch angiitis. We encountered a rare case of acute anterior uveitis and optic neuritis associated with influenza A infection. Case presentation: A 70-year-old man presented with symptoms of upper respiratory tract infection. A rapid diagnostic test showed a positive result for influenza A. At the same time, he developed ocular symptoms including blurred vision with optic disk edema and hemorrhage in the left eye, and bilateral red eyes. Multiplex polymerase chain reaction performed on aqueous humor sample detected no viral infection. Visual field testing with a Goldmann perimeter showed central and paracentral scotomas in the left eye. In addition to antiviral agent (oseltamivir phosphate 75 mg, the patient was prescribed topical prednisolone acetate ophthalmic suspension eye drops every 5 hours and high-dose intravenous methylprednisolone 1,000 mg daily for 3 days. Two months later, his best-corrected visual acuity improved to 20/50 with regression of visual field defects in his left eye. Conclusion: We report a case of bilateral acute anterior uveitis and unilateral optic neuritis concomitant with influenza A infection. Topical and systemic corticosteroids were effective to resolve acute anterior uveitis and neuritis. Analysis of aqueous humor sample suggested that acute anterior uveitis and optic neuritis in this case were not caused by influenza A virus infection per se but by autoimmune mechanism. Keywords: optic neuritis, anterior uveitis, influenza virus, multiplex polymerase chain reaction

  2. Income inequality and 30 day outcomes after acute myocardial infarction, heart failure, and pneumonia: retrospective cohort study.

    Science.gov (United States)

    Lindenauer, Peter K; Lagu, Tara; Rothberg, Michael B; Avrunin, Jill; Pekow, Penelope S; Wang, Yongfei; Krumholz, Harlan M

    2013-02-14

    To examine the association between income inequality and the risk of mortality and readmission within 30 days of hospitalization. Retrospective cohort study of Medicare beneficiaries in the United States. Hierarchical, logistic regression models were developed to estimate the association between income inequality (measured at the US state level) and a patient's risk of mortality and readmission, while sequentially controlling for patient, hospital, other state, and patient socioeconomic characteristics. We considered a 0.05 unit increase in the Gini coefficient as a measure of income inequality. US acute care hospitals. Patients aged 65 years and older, and hospitalized in 2006-08 with a principal diagnosis of acute myocardial infarction, heart failure, or pneumonia. Risk of death within 30 days of admission or rehospitalization for any cause within 30 days of discharge. The potential number of excess deaths and readmissions associated with higher levels of inequality in US states in the three highest quarters of income inequality were compared with corresponding data in US states in the lowest quarter. Mortality analyses included 555,962 admissions (4348 hospitals) for acute myocardial infarction, 1,092,285 (4484) for heart failure, and 1,146,414 (4520); readmission analyses included 553,037 (4262), 1,345,909 (4494), and 1,345,909 (4524) admissions, respectively. In 2006-08, income inequality in US states (as measured by the average Gini coefficient over three years) varied from 0.41 in Utah to 0.50 in New York. Multilevel models showed no significant association between income inequality and mortality within 30 days of admission for patients with acute myocardial infarction, heart failure, or pneumonia. By contrast, income inequality was associated with rehospitalization (acute myocardial infarction, risk ratio 1.09 (95% confidence interval 1.03 to 1.15), heart failure 1.07 (1.01 to 1.12), pneumonia 1.09 (1.03 to 1.15)). Further adjustment for individual income

  3. Recognizing Wellens’ syndrome, a warning sign of critical proximal LAD artery stenosis and impending anterior myocardial infarction

    Directory of Open Access Journals (Sweden)

    Laura Hollar

    2015-10-01

    Full Text Available Wellens’ syndrome, also known as LAD coronary T-wave syndrome or the ‘widow maker’, is a pre-infarction syndrome with non-classical ischemic ECG changes and unremarkable cardiac biomarkers. This syndrome continues to be a ‘can't miss’ for the clinician as delay in urgent angiography and intervention can result in anterior myocardial infarction, left ventricular dysfunction, arrhythmias, and death. We describe a case followed by a discussion of identification criteria and clinical implications.

  4. [Takotsubo cardiomiopathy. A rare cause of cardiogenic shock simulating acute myocardial infarction].

    Science.gov (United States)

    Vasconcelos, Jayro Thadeu Paiva de; Martins, Sebastião; Sousa, João Francisco de; Portela, Antenor

    2005-08-01

    Takotsubo Cardiomiopathy is a rare cause of acute left ventricular aneurysm, in the absence of coronariopathy, only recently described in world literature. Symptoms may be similar to those from acute myocardial infarction with typical thoracic pain. The image of dumbbell or Takotsubo (a device used in Japan to capture octopus) suggestive ventricular ballooning is characteristic of that new syndrome and there is usually the disappearing of dyskinetic movement up to the 18th day from the beginning of the symptoms, in average.

  5. The effect of optimal medical therapy on 1-year mortality after acute myocardial infarction.

    Science.gov (United States)

    Bramlage, P; Messer, C; Bitterlich, N; Pohlmann, C; Cuneo, A; Stammwitz, E; Tebbenjohanns, J; Gohlke, H; Senges, J; Tebbe, U

    2010-04-01

    Five drug classes have been shown to improve the prognosis of acute myocardial infarction in clinical trials: aspirin, beta-blockers, statins, renin angiotensin system (RAS) blockers and thienopyridines. We aimed to assess whether the benefits of combining these drugs (termed optimal medical therapy, OMT), will result in a reduction of mortality in clinical practice. Nationwide registry Hospitals with a cardiology unit or internal medicine department. 5353 patients with acute myocardial infarction. At hospital discharge 89% received aspirin, 90% beta-blockers, 84% statins, 81% RAS blockers, 70% a thienopyridine and 46.2% OMT. Pharmacotherapy OR with 95% CI for mortality from myocardial infarction were calculated and adjusted for patient risk at baseline. Total mortality was reduced by 74% in patients receiving OMT (adj OR 0.26; 95% CI 0.18 to 0.38) versus patients receiving one or no drug. This was consistent in subgroups defined by STEMI/NSTEMI, diabetes and gender. Mortality was also reduced in patients receiving 2-4 drugs (adj OR 0.49; 95% CI 0.35 to 0.68), diabetic patients being the only subgroup with no significant effect. Analyses on the relative importance of either component revealed that withdrawal of beta-blockers (adj OR 0.63; 95% CI 0.34 to 1.16) and/or a combination of aspirin/clopidogrel (adj OR 0.59; 95% CI 0.20 to 1.17) abolished the risk reduction conferred by OMT. OMT over 1 year was associated with a significantly lower mortality of patients with acute myocardial infarction in clinical practice. However OMT is provided to less than half of eligible patients leaving room for substantial improvement.

  6. Biphasic thallium 201 SPECT-imaging for the noninvasive diagnosis of myocardial perfusion abnormalities in a child with Kawasaki disease--a case report

    International Nuclear Information System (INIS)

    Hausdorf, G.; Nienaber, C.A.; Spielman, R.P.

    1988-01-01

    The mucocutaneous lymph node syndrome (Kawasaki disease) is of increasing importance for the pediatric cardiologist, for coronary aneurysms with the potential of thrombosis and subsequent stenosis can develop in the course of the disease. The authors report a 2 1/2-year-old female child in whom, fourteen months after the acute phase of Kawasaki disease, myocardial infarction occurred. Biphasic thallium 201 SPECT-imaging using dipyridamole depicted anterior wall ischemia and inferolateral infarction. This case demonstrates that noninvasive vasodilation-redistribution thallium 201 SPECT-imaging has the potential to predict reversible myocardial perfusion defects and myocardial necrosis, even in small infants with Kawasaki disease

  7. ACUTE MYOCARDIAL INFARCTION- AN UNUSUAL PRESENTATION OF A MASS IN LEFT VENTRICLE AND RIGHT VENTRICLE

    Directory of Open Access Journals (Sweden)

    Sunil Pisharadi

    2010-11-01

    Full Text Available Acute Myocardial infarction is not a rare finding in patients with a history of carcinoma with second aries. We report a case of a 38-year old man who presented with symptoms of acute MI. The echocardiography showed a rare finding of a mass in both right and left ventricle

  8. Anterior Z-plate and titanic mesh fixation for acute burst thoracolumbar fracture.

    Science.gov (United States)

    Xu, Jian-Guang; Zeng, Bing-Fang; Zhou, Wei; Kong, Wei-Qing; Fu, Yi-Shan; Zhao, Bi-Zeng; Zhang, Tao; Lian, Xiao-Feng

    2011-04-01

    A retrospective study. To evaluate the clinical outcome, effectiveness, and security of the surgical management of acute thoracolumbar burst fracture with corpectomy, titanic mesh autograft, and Z-plate fixation by anterior approach. Many surgical methods were adopted to treat acute burst thoracolumbar fracture. But the optimal surgical management remains controversial. A retrospective review of a consecutive series of 48 patients with thoracolumbar burst fracture treated with anterior corpectomy, titanic mesh autograft, and Z-plate internal fixation was carried out. Preoperative clinical and radiographic data of all cases were originally collected. Surgical indications were motor neurologic deficit and thoracolumbar column instability. Twenty-two patients (45.8%) with acute thoracolumbar burst fractures presented with a neurologic deficit. The postoperative recovery of neural function, restoration of anterior cortex collapse, kyphotic angle, and spinal canal compromise were observed. The preoperative kyphotic angle was improved to a mean of 5.6°, radiographic height restored to 95.8% of the adjacent normal levels, and canal compromise was 0%. None of the patients had neurologic deterioration. Mean follow-up time was 32.4 months (range, 24-47 months). All 22 patients with neurologic deficit demonstrated at least one Frankel grade improvement on final observation, with 16 (73%) patients had accomplished complete neurologic recovery. Forty-six (96%) patients reported minimal or no pain at final follow-up observation, and 40 (83%) patients who had been working before injury returned to original work. The authors considered spinal cord decompression with anterior corpectomy and stability reconstruction with titanic mesh autograft and Z-plate fixation at same time in one incision as an effective technique for unstable thoracolumbar burst fracture with and without neurologic deficit.

  9. MR imaging of acute myocardial infarction

    International Nuclear Information System (INIS)

    Revel, D.; Dandis, G.; Pichard, J.B.; Ovize, M.; DeLorgeril, M.; Amiel, M.

    1990-01-01

    This paper reports on superparamagnetic iron oxide particles (AMI-25) evaluated in comparison with paramagnetic Gd-DOTA for the MR evaluation of acute myocardial infarct size. Twelve openchest dogs underwent 2 hours of LAD occlusion followed by 6 hours of reperfusion. AMI-25 and Gd-DOTA were intravenously injected 1 hour and 10 minutes before euthanasia, respectively, in two groups of six dogs. Gradient-echo and T1- and T2-weighted spin-echo images were obtained in six AMI-25-injected excised hearts, and T1- and T2-weighted images in six Gd-DOTA injected excised hearts. Infarct size was evaluated by planimetry of each 8-mm-thick transverse slice after ex vivo double staining and correlated with the planimetry of each 8-mm-thick transverse MR section

  10. Myocardial infarction among women with early-stage breast cancer treated with conservative surgery and breast irradiation

    International Nuclear Information System (INIS)

    Rutqvist, Lars E.; Liedberg, Anette; Hammar, Niklas; Dalberg, Kristina

    1998-01-01

    Purpose: To assess the possible impact of the irradiation on the risk of acute myocardial infarction among breast cancer patients treated with conservative surgery and postoperative radiation therapy. Methods and Materials: The incidence of and mortality from acute myocardial infarction was assessed in a group of 684 women with early-stage breast cancer diagnosed during 1976-1987 who had been treated with breast conserving surgery plus postoperative radiation therapy given with tangential photon fields. In 94% of the patients the total dose was between 48-52 Gy given with 2 Gy daily fractions 5 days per week for a total treatment period of about 4 (1(2)) - 5 (1(2)) weeks. In 88% of the patients the target volume included the breast parenchyma alone. In the remaining patients regional nodal areas were also irradiated. A concurrent group of 4,996 breast cancer patients treated with mastectomy without postoperative radiation therapy was used as a reference. Results: After a median follow-up of 9 years (range: 5-16 years) 12 conservatively treated patients (1.8%) had developed an acute myocardial infarction and 5 (0.7%) had died due to this disease. The age-adjusted relative hazard of acute myocardial infarction for the conservative group vs. the mastectomy group was 0.6 (95% C.I.: 0.4-1.2) and for death due to this disease 0.4 (0.2-1.1). The incidence of acute myocardial infarction among the conservatively treated women was similar irrespective of tumor laterality. Conclusions: There was no indication of an increased risk of acute myocardial infarction with the radiation therapy among the women treated with conservative surgery. However, due to the small number of events the study could not exclude the possibility that cardiac problems may arise in some patients with left-sided cancers who have their heart located anteriorly in the mediastinum. Individual, three-dimensional dose planning represents one method to identify such patients and is basic to technical changes

  11. Acute myocardial infarction in a young bodybuilder taking anabolic androgenic steroids: A case report and critical review of the literature.

    Science.gov (United States)

    Christou, Georgios A; Christou, Konstantinos A; Nikas, Dimitrios N; Goudevenos, John A

    2016-11-01

    We describe a case report of a 30-year-old bodybuilder suffering acute myocardial infarction (AMI). He had been taking stanozolol and testosterone for two months. The coronary angiogram showed high thrombotic burden in the left anterior descending artery without underlying atherosclerosis. Few case reports of AMI in athletes taking anabolic androgenic steroids (AASs) have been reported so far. AAS-related AMI is possibly underreported in the medical literature due to the desire of the affected individuals to hide AAS use. Physicians should always consider the possibility of AAS abuse in the context of a young athlete suffering AMI. AASs can predispose to AMI through the acceleration of coronary atherosclerosis. Additionally, thrombosis without underlying atherosclerosis or vasospasm is highly possible to cause AMI in AAS users. Complications after AMI may be more frequent in AAS users. © The European Society of Cardiology 2016.

  12. Management and outcomes of acute ST-segment-elevation myocardial infarction at a tertiary-care hospital in Sri Lanka: an observational study

    OpenAIRE

    Bandara, Ruwanthi; Medagama, Arjuna; Munasinghe, Ruwan; Dinamithra, Nandana; Subasinghe, Amila; Herath, Jayantha; Ratnayake, Mahesh; Imbulpitiya, Buddhini; Sulaiman, Ameena

    2015-01-01

    Background Sri Lanka is a developing country with a high rate of cardiovascular mortality. It is still largely dependent on thrombolysis for primary management of acute myocardial infarction. The aim of this study was to present current data on the presentation, management, and outcomes of acute ST-segment-elevation myocardial infarction (STEMI) at a tertiary-care hospital in Sri Lanka. Methods Eighty-one patients with acute STEMI presenting to a teaching hospital in Peradeniya, Sri Lanka, we...

  13. Roxicam pharmacological modulation of the prostacyclin-thromboxane system in heart failure-complicated acute myocardial infarction

    International Nuclear Information System (INIS)

    Shushlyapin, O.I.; Shelest, A.N.; Khossejn Shakhavat, A.F.M.

    1991-01-01

    The prostaglandin-thromboxane system, platelet hemostasis and central hemodynamics were evaluated in 51 patients with heart failure-complicated acute myocardial infarction. The concentration of active metabolites of thromboxane-prostacyclin system was determined by means of radioimmunoassay. The new non-steroidal antiinflammatory agent roxicam was shown to selectively inhibit thromboxane, without affecting prostacyclin levels. The agent may be use in therapy in patients with myocardial infarction concurrent with heart failure

  14. Comparison of initial and delayed myocardial imaging with beta-methyl-p-[[sup 123]I]-iodophenylpentadecanoic acid in acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Naruse, Hitoshi; Yoshimura, Noriko; Yamamoto, Juro; Morita, Masato; Fukutake, Naoshige; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Fukuchi, Minoru (Hyogo Coll. of Medicine, Nishinomiya (Japan))

    Myocardial imaging using [beta]-methyl-p-[[sup 123]I]-iodophenylpentadecanoic acid (BMIPP) of 15 patients with acute myocardial infarction was performed to assess 'fill-in' and 'washout' defects in the delayed myocardial image. The initial and delayed images were evaluated by a visual and quantitative washout rate method. Visual judgement found 8/180 (4%) segments showed 'fill-in' defects, and 24/180 segments (13%) showed 'washout' defects. There was no relationship between days from onset to the study and the frequency of fill-in and washout defects. The mean washout rate in the segments with 'fill-in' defects was 9.0[+-]16.6%, and that of 'washout' defects was 24.9[+-]18.1% which was significantly higher than in controls (8.7[+-]15.4%, p<0.05). There was no correlation between mean washout rate and total blood lipids, total cholesterol, triglyceride and HDL-cholesterol. Therefore, neither time from onset nor blood lipids level was related to changes from the initial image to the delayed image. These changes may be due to relative (false) findings due to changes in circumference, and may be based on myocardial characteristics after myocardial infarction and/or reperfusion. (author).

  15. VALsartan In Acute myocardial iNfarcTion (VALIANT) trial: baseline characteristics in context

    DEFF Research Database (Denmark)

    Velazquez, Eric J; Pfeffer, Marc A; McMurray, John V

    2003-01-01

    BACKGROUND: The VALsartan In Acute myocardial iNfarcTion (VALIANT) trial compared outcomes with: (1) angiotensin-converting enzyme inhibition (ACEI) with the reference agent captopril; (2) angiotensin-receptor blockade (ARB) with valsartan; or (3) both in patients with heart failure (HF) and...

  16. HDL function is impaired in acute myocardial infarction independent of plasma HDL cholesterol levels

    NARCIS (Netherlands)

    Annema, Wijtske; Willemsen, Hendrik M.; de Boer, Jan Freark; Dikkers, Arne; van der Giet, Markus; Nieuwland, Wybe; Muller Kobold, Anna; van Pelt, L. Joost; Slart, Riemer H. J. A.; van der Horst, Iwan C. C.; Dullaart, Robin P. F.; Tio, Rene A.; Tietge, Uwe J. F.

    2016-01-01

    BACKGROUND: High-density lipoproteins (HDLs) protect against the development of atherosclerotic cardiovascular disease. HDL function represents an emerging concept in cardiovascular research. OBJECTIVE: This study investigated the association between HDL functionality and acute myocardial infarction

  17. Relationship between the mismatch of 123I-BMIPP and 201Tl myocardial single-photon emission computed tomography and autonomic nervous system activity in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Yamanaka, Hiroyuki; Suzuki, Takeshi; Kishida, Hiroshi; Nagasawa, Koichi; Takano, Teruo

    2006-01-01

    The purpose of this study was to elucidate the relationship between the mismatch of thallium-201 (Tl) and iodine-123-beta-methyl-iodophenyl-pentadecanoic acid (BMIPP) myocardial single-photon emission computed tomography (SPECT) and autonomic nervous system activity in myocardial infarction (MI) patients. The subjects were 40 patients (34 males, 6 females) who underwent examinations by 123 I-BMIPP and 201 Tl myocardial SPECT imaging and 24-hour Holter monitoring within a 3-day period 3 weeks after the onset of their first MI. R-R intervals were analyzed every hour over a period of 24 hours by fast Fourier transformation (FFT). High frequency (HF) and low frequency (LF) were defined as markers of cardiac vagal activity in the former and the LF/HF ratio as sympathetic activity. Greater or more extensive decreases in the BMIPP image than that in the Tl image were defined as a positive mismatch. Patients were divided into positive and negative mismatch groups of 20 patients each. There were no significant differences between the 2 groups in age, sex, site of infarction, max CK (creatine kinase), max CK-MB, or left ventricular ejection fraction. The incidences of clinical signs suggesting residual myocardial ischemia were significantly greater in the positive than in the negative mismatch group (P 123 I-BMIPP and 201 Tl myocardial SPECT 3 weeks after a first acute myocardial infarction with uncomplicated moderate or severe heart failure and decreased heart rate variability are related to residual myocardial ischemia. A combined assessment of heart rate variability in 24 hour Holter electrocardiogram (ECG) monitoring and perfusion-metabolism mismatch in 123 I-BMIPP and 201 Tl myocardial SPECT is useful for determining residual myocardial ischemia in the follow-up of those with acute myocardial infarction. (author)

  18. ?Spice? (Synthetic Marijuana) Induced Acute Myocardial Infarction: A Case Series

    OpenAIRE

    Ul Haq, E.; Shafiq, A.; Khan, A. A.; Awan, A. A.; Ezad, S.; Minteer, W. J.; Omar, B.

    2017-01-01

    Marijuana is the most widely abused “recreational” substance in the United States, with highest prevalence in young adults. It is reported to cause ischemic strokes, hepatitis, anxiety, and psychosis. Although it is associated with dose dependent tachycardia and can lead to coronary vasospasm, it has not been directly related to acute myocardial infarction (AMI). Marijuana induced coronary vasospasm can result in endothelial denudation at the site of a vulnerable atherosclerotic plaque in res...

  19. Meta-analysis of cell-based CaRdiac stUdiEs (ACCRUE) in patients with acute myocardial infarction based on individual patient data

    DEFF Research Database (Denmark)

    Gyöngyösi, Mariann; Wojakowski, Wojciech; Lemarchand, Patricia

    2015-01-01

    RATIONALE: The meta-Analysis of Cell-based CaRdiac study is the first prospectively declared collaborative multinational database, including individual data of patients with ischemic heart disease treated with cell therapy. OBJECTIVE: We analyzed the safety and efficacy of intracoronary cell...... therapy after acute myocardial infarction (AMI), including individual patient data from 12 randomized trials (ASTAMI, Aalst, BOOST, BONAMI, CADUCEUS, FINCELL, REGENT, REPAIR-AMI, SCAMI, SWISS-AMI, TIME, LATE-TIME; n=1252). METHODS AND RESULTS: The primary end point was freedom from combined major adverse.......1), end-diastolic volume, or systolic volume were observed compared with controls. These results were not influenced by anterior AMI location, reduced baseline ejection fraction, or the use of MRI for assessing left ventricular parameters. CONCLUSIONS: This meta-analysis of individual patient data from...

  20. Evaluation of the NICE mini-GRACE risk scores for acute myocardial infarction using the Myocardial Ischaemia National Audit Project (MINAP) 2003-2009: National Institute for Cardiovascular Outcomes Research (NICOR).

    Science.gov (United States)

    Simms, Alexander D; Reynolds, Stephanie; Pieper, Karen; Baxter, Paul D; Cattle, Brian A; Batin, Phillip D; Wilson, John I; Deanfield, John E; West, Robert M; Fox, Keith A A; Hall, Alistair S; Gale, Christopher P

    2013-01-01

    To evaluate the performance of the National Institute for Health and Clinical Excellence (NICE) mini-Global Registry of Acute Coronary Events (GRACE) (MG) and adjusted mini-GRACE (AMG) risk scores. Retrospective observational study. 215 acute hospitals in England and Wales. 137 084 patients discharged from hospital with a diagnosis of acute myocardial infarction (AMI) between 2003 and 2009, as recorded in the Myocardial Ischaemia National Audit Project (MINAP). Model performance indices of calibration accuracy, discriminative and explanatory performance, including net reclassification index (NRI) and integrated discrimination improvement. Of 495 263 index patients hospitalised with AMI, there were 53 196 ST elevation myocardial infarction and 83 888 non-ST elevation myocardial infarction (NSTEMI) (27.7%) cases with complete data for all AMG variables. For AMI, AMG calibration was better than MG calibration (Hosmer-Lemeshow goodness of fit test: p=0.33 vs pModel performance was reduced in patients with NSTEMI, chronic heart failure, chronic renal failure and in patients aged ≥85 years. The AMG and MG risk scores, utilised by NICE, demonstrated good performance across a range of indices using MINAP data, but performed less well in higher risk subgroups. Although indices were better for AMG, its application may be constrained by missing predictors.

  1. Epidemiology and genetics of ventricular fibrillation during acute myocardial infarction

    DEFF Research Database (Denmark)

    Glinge, Charlotte; Sattler, Stefan; Jabbari, Reza

    2016-01-01

    of a family member is a risk factor for SCD and VF during acute myocardial infarction (MI), independent of traditional risk factors including family history of MI, suggesting a genetic component in the susceptibility to VF. To prevent SCD and VF due to MI, we need a better understanding of the genetic...... and molecular mechanisms causing VF in this apparently healthy population. Even though new insights and technologies have become available, the genetic predisposition to VF during MI remains poorly understood. Findings from a variety of different genetic studies have failed to reach reproducibility, although...... several genetic variants, both common and rare variants, have been associated to either VF or SCD. For this review, we searched PubMed for potentially relevant articles, using the following MeSH-terms: "sudden cardiac death", "ventricular fibrillation", "out-of-hospital cardiac arrest", "myocardial...

  2. Changes in somatotropic hormone secretion in patients with acute myocardial infarct

    International Nuclear Information System (INIS)

    Milanov, S.; Milkov, V.; Atanasov, I.; Sotirov, I.; Kamenova, Ts.

    1982-01-01

    Secretion of somatotropic hormone (STH) was estimated by radioimmunoassay during intravenous glucose-tolerance test (IGTT) in 17 patients with acute myocardial infarct (AMI) and 10 patients with chronic ischemic heart disease, without evidence of recent myocardial infarct. In both groups of patients the basal STH levels were elevated, as compared to those in normal individuals, with statistical significance (p<0.001). During the IGTT, somatotropic hormone in AMI patients was slightly reduced, which was out of proportion to the blood glucose changes. During IGTT in patients with chronic ischemic heart disease, the somatotropic hormone secretion, though increased, followed the blood glucose changes. These changes in STH secretion during IGTT in AMI patients are indicative of impaired hypothalamo-pituitary interrelations mediated by central nervous route. (author)

  3. Effection of percutaneous coronary intenvention compared with intravenous thrombolysis therapy of acute myocardial infarction

    International Nuclear Information System (INIS)

    Lu Jianhui; Hong Xiaosu; Xu Weiting

    2006-01-01

    Objective: To evaluate the curative effect of the two successful therapeatic methods on myocardial infarction in the acute and long-term stage: percutaneous coronary intenvention(PCI) and intravenous thrombolysis therapy. Methods: Fifty-six patients of acute myocardial infarction were studied. There was no record of heart failure occurence in the case history for all of them. We randomly assigned them to receive PCI or intravenous thrombolysis therapy, and all of them are treated successfully. Left ventricule ejection fraction (LVEF) and left ventricule end diastole diameter(LVEDD) measured by echocardiography were analyzed. Clinical information about death caused by cardial origin problems were collected and the mean survival days of the patients were 548.7 ± 48.9. Results: The total of 27 patients were assigned to undergo PCI and 29 patients received intravenous thrombolysis therapy. LVEF patients with PCI were 57.6% ± 2.3%, and patients with intravenous thrombolysis therapy were 49.9% ± 1.9%. There were significant difference between the two groups(P 0.5). 548.7 ± 48.9 days survival was accounted for 85.2% in the PCI group, and 79.3% in the intravenous thrombolysis therapy (P>0.5). Multivariate analysis showed that older age, LVEF, were related to 548.7 ± 48.9 days mortality. Conclusion: The results of this study show more acute stage benefit patients treated with PCI using bare stant than those treated with intravenous thrombolysis therapy; But it indicates that there is no more long-term survival for patients treated with PCI by using bare stant compared with those who received intravenous thrombolysis therapy in the patients with light or medium acute myocardial infarction. (authors)

  4. Detection and differentiation of early acute and following age stages of myocardial infarction with quantitative post-mortem cardiac 1.5T MR.

    Science.gov (United States)

    Schwendener, Nicole; Jackowski, Christian; Persson, Anders; Warntjes, Marcel J; Schuster, Frederick; Riva, Fabiano; Zech, Wolf-Dieter

    2017-01-01

    Recently, quantitative MR sequences have started being used in post-mortem imaging. The goal of the present study was to evaluate if early acute and following age stages of myocardial infarction can be detected and discerned by quantitative 1.5T post-mortem cardiac magnetic resonance (PMCMR) based on quantitative T1, T2 and PD values. In 80 deceased individuals (25 female, 55 male), a cardiac MR quantification sequence was performed prior to cardiac dissection at autopsy in a prospective study. Focal myocardial signal alterations detected in synthetically generated MR images were MR quantified for their T1, T2 and PD values. The locations of signal alteration measurements in PMCMR were targeted at autopsy heart dissection and cardiac tissue specimens were taken for histologic examinations. Quantified signal alterations in PMCMR were correlated to their according histologic age stage of myocardial infarction. In PMCMR seventy-three focal myocardial signal alterations were detected in 49 of 80 investigated hearts. These signal alterations were diagnosed histologically as early acute (n=39), acute (n=14), subacute (n=10) and chronic (n=10) age stages of myocardial infarction. Statistical analysis revealed that based on their quantitative T1, T2 and PD values, a significant difference between all defined age groups of myocardial infarction can be determined. It can be concluded that quantitative 1.5T PMCMR quantification based on quantitative T1, T2 and PD values is feasible for characterization and differentiation of early acute and following age stages of myocardial infarction. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Diagnostic performance of dark-blood T2-weighted CMR for evaluation of acute myocardial injury.

    Science.gov (United States)

    Srichai, Monvadi B; Lim, Ruth P; Lath, Narayan; Babb, James; Axel, Leon; Kim, Daniel

    2013-01-01

    We compared the image quality and diagnostic performance of 2 fat-suppression methods for black-blood T2-weighted fast spin-echo (FSE), which are as follows: (a) short T1 inversion recovery (STIR; FSE-STIR) and (b) spectral adiabatic inversion recovery (SPAIR; FSE-SPAIR), for detection of acute myocardial injury. Edema-sensitive T2-weighted FSE cardiac magnetic resonance (CMR) imaging is useful in detecting acute myocardial injury but may experience reduced myocardial signal and signal dropout. The SPAIR pulse aims to eliminate artifacts associated with the STIR pulse. A total of 65 consecutive patients referred for CMR evaluation of myocardial structure and function underwent FSE-STIR and FSE-SPAIR, in addition to cine and late gadolinium enhancement (LGE) CMR. T2-weighted FSE images were independently evaluated by 2 readers for image quality and artifacts (Likert scale of 1-5; best-worst) and presence of increased myocardial signal suggestive of edema. In addition, clinical CMR interpretation, incorporating all CMR sequences available, was recorded for comparison. Diagnostic performance of each T2-weighted sequence was measured using recent (T2, and wall motion. There was a statistically significant difference in sensitivity between the clinical interpretation and each of the T2-weighted sequences but not between each T2-weighted sequence. Although FSE-SPAIR demonstrated significantly improved image quality and decreased artifacts, isolated interpretations of each T2-weighted technique demonstrated high specificity but overall low sensitivity for the detection of myocardial injury, with no difference in accuracy between the techniques. However, real-world interpretation in combination with cine and LGE CMR methods significantly improves the overall sensitivity and diagnostic performance.

  6. Value of planar 201Tl imaging in risk stratification of patients recovering from acute myocardial infarction

    International Nuclear Information System (INIS)

    Gibson, R.S.; Watson, D.D.

    1991-01-01

    Although exercise ECG testing has been shown to have important prognostic value after acute myocardial infarction, exercise 201Tl scintigraphy offers several potential advantages, including: (1) increased sensitivity for detecting residual myocardial ischemia; (2) the ability to localize ischemia to a specific area or areas subtended by a specific coronary artery; (3) the ability to identify exercise-induced left ventricular dysfunction, which is manifested by increased lung uptake or transient left ventricular dilation; and (4) more reliable risk stratification of individual patients. The more optimal prognostic efficiency of 201Tl scintigraphy partially results from the fact that the error rate in falsely classifying patients as low risk is significantly smaller with 201Tl scintigraphy than with stress ECG. Because of these substantial advantages, there seems to be adequate rationale for recommending exercise perfusion imaging rather than exercise ECG alone as the preferred method for evaluating mortality and morbidity risks after acute myocardial infarction

  7. Role of myocardial perfusion imaging in acute coronary syndrome

    International Nuclear Information System (INIS)

    Aleem, M.

    2007-01-01

    Full text: In the cardiac emergency department, a number of patients present with acute chest pain. In case of non diagnostic ECG and enzymes, accurately categorizing the patient in high and low probability is difficult. Aim of study was to evaluate the role of resting myocardial perfusion imaging (MPI) in patients with acute coronary syndrome (ACS) and then to compare the results with subsequent stress imaging. Material and Methods. A total of 34 patients were selected for the study, which were divided into three groups on the basis of respective probabilities of having ACS. This probability was decided on the basis of nature of chest pain, ECG findings, enzymes levels, and age and sex. Arbitrary score was given to patient's condition. This score ranged from 1 to 14. Patients with score between 1-6 were assigned low probability, from 7-10 were assigned intermediate probability and patients having score greater than 11 were placed in high probability groups. Patients in the low and intermediate probability groups were injected with Tc 99 m- MIBI within 6 hours of onset of chest pain and were undergone resting myocardial perfusion imaging (MPI) 3 to five hours after injection.. Imaging in high probability group was performed at discharge. Four weeks after the acute event all the patients underwent stress myocardial perfusion imaging. Results: All patients (100%) with low probability of ACS (n=10) showed negative resting scans. On stress MPI two patients (20%) showed new defects. Patient with high probability of ACS (n=12), all were positive 100% on resting MPI. On stress MPI, three showed (25%) no change from rest MPI, while nine patients (75%) showed augmentation of defects and four out of these nine patients (33%) also showed new perfusion defects. Patients with intermediate probability of ACS (n=12), three showed positive rest MPI (25%). On stress MPI out of these three cases, one showed (8%) no change from rest MPI and two showed (17%) augmentation of defect

  8. Arthroscopic repair of acute traumatic anterior shoulder dislocation in young athletes.

    Science.gov (United States)

    Larrain, M V; Botto, G J; Montenegro, H J; Mauas, D M

    2001-04-01

    To compare the results of arthroscopic repair in acute anterior shoulder traumatic dislocation with those of nonoperative treatment. A prospective nonrandomized study was performed. Between August 1989 and April 1997, 46 patients were seen after a first episode of traumatic anterior shoulder dislocation. The average age was 21 years (range, 17 to 27 years). Most dislocations were in rugby players (36 patients). There were 18 patients treated by nonoperative methods and 28 patients treated by acute arthroscopic repair; 22 patients using transglenoid suture and 6 patients with bone anchor suture fixation. Of the patients treated nonoperatively, 94.5% suffered a redislocation between 4 and 18 months (average, 6 months). In the operative group, 96% of the patients (27) obtained excellent results according to the Rowe scale. Only 1 patient suffered a redislocation 1 year after surgery. Three different types of lesions were found during surgery: group I, capsular tear with no labrum lesion (4%); group II, capsular tear with partial labrum detachment (32%); and group III, capsular tear and full anterior labrum detachment (64%). The average follow-up was 67.4 months (range, 28 to 120). There were no surgical complications. The operative group obtained 96% excellent results, but the nonoperative group only obtained 5.5% excellent results, according to the Rowe scale. The nonoperative group showed a high incidence of redislocation (94.5%) compared with the operative group (4%). Based on the findings of this study, we recommend using an arthroscopic evaluation and repair after an initial anterior traumatic shoulder dislocation in young athletes.

  9. Scintigraphy of sacroiliac joints in acute anterior uveitis. A study of thirty patients.

    Science.gov (United States)

    Russell, A S; Lentle, B C; Percy, J S; Jackson, F I

    1976-11-01

    HLA-B27 is a transplantation antigen found in a high proportion of patients with ankylosing spondylitis. Recently, an association has been shown to exist between HLA-B27 and acute uveitis, even in the absence of ankylosing spondylitis. We have examined the HLA antigen profile of 45 patients with acute nongranulomatous anterior uveitis and have confirmed this relation. In addition, using 90mtechnetium stannous pyrophosphate we have been able to demonstrate abnormal bone scan in 19 of 30 patients studied. Such abnormalities are limited to the sacroiliac joints but are otherwise the same as those seen in overt ankylosing spondylitis. Seven of the 19 patients did not have HLA-B27. These factors suggest that acute anterior uveitis may often represent a manifestation of a spondylitic diathesis even in the complete absence of any suggestive symptomatic or radiologic change and, in some cases, even though the antigenic marker HLA-B27 may be absent.

  10. Scintigraphy of sacroliac joints in acute anterior uveitis. A study of thirty patients

    International Nuclear Information System (INIS)

    Russell, A.S.; Lentle, B.C.; Percy, J.S.; Jackson, F.I.

    1976-01-01

    HLA-B27 is a transplantation antigen found in a high proportion of patients with ankylosing spondylitis. Recently, an association has been shown to exist between HLA-B27 and acute uveitis, even in the absence of ankylosing spondylitis. We have examined the HLA antigen profile of 45 patients with acute nongranulomatous anterior uveitis and have confirmed this relation. In addition, using 90m technetium stannous pyrophosphate we have been able to demonstrate abnormal bone scan in 19 of 30 patients studied. Such abnormalities are limited to the sacroiliac joints but are otherwise the same as those seen in overt ankylosing spondylitis. Seven of the 19 patients did not have HLA-B27. These factors suggest that acute anterior uveitis may often represent a manifestation of a spondylitic diathesis even in the complete absence of any suggestive symptomatic or radiologic change and, in some cases, even through the antigenic marker HLA-B27 may be absent

  11. Clinical Characteristics and Risk Factors of Left Ventricular Thrombus after Acute Myocardial Infarction: A Matched Case-control Study

    Directory of Open Access Journals (Sweden)

    Yue-Xin Jiang

    2015-01-01

    Conclusions: This study indicated that lower LVEF, extensive anterior myocardial infarction, severe RWMA, and left ventricular aneurysm were independent risk factors of LVT after AMI. It also suggested that further efforts are needed for the LVT diagnosis after AMI in clinical practice.

  12. The effects of different remedies on acute myocardial infarction

    International Nuclear Information System (INIS)

    Lu Zhigang; Wei Meng; Pan Jingwei; Ma Shixin; Hang Jingyu; Wei Junbo; Ke Jun; Pan Lijian; Fan Shougen; Xue Shaoping

    2007-01-01

    Objective: To investigate the different treatment effects of intravenous thrombolysis vs primary coronary angioplasty and interhospital transfer for primary coronary angioplasty in acute myocardial infarction within 12 hours after onset. Methods: During January 2004 to December 2005, 63 consecutive patients with acute myocardial infarction admitted directly for primary PCI and 25 patients transferred from other hospitals for primary. PCI were compared with 32 patients treated with intravenous thrombolysis. Each patients arrived at hospital within 12 h from chest pain onset. T-test and Chi-square test were used to analyze the rate of mortality, re-infarction, heart failure in-hospital and 1-year latter. Results: Among the 3 groups, for group of intravenous thrombolysis, time interval from arriving to having reflow was the shortest (1.1 ± 0.2 h vs 2.3 ± 1.0 h vs 2.1 ± 1.1 h, P < 0.01), the mortalities in hospital (6.3% vs 3.2% vs 4.0%) and 1-year follow up (12.5% vs 4.8% vs 8.0%)were highest in spite of no statistic difference. After 1 year, the rate of reinfarction in intravenous thrombolysis group is higher than that in PCI group (18.8% vs 4.5%, P < 0.05). Conclusions: The key point of AMI remedy is to open the criminal vessel as fast as possible. Interhospital transfer for PCI is feasible and safe. (authors)

  13. Sibutramine-induced acute myocardial infarction in a young lady.

    Science.gov (United States)

    Yim, Kin-Ming Anfernee; Ng, Hon Wah; Chan, Chi-Kin; Yip, Gabriel; Lau, Fei Lung

    2008-11-01

    Sibutramine is an amphetamine-like drug used for its weight reducing effect. Sibutramine-induced acute coronary syndrome has rarely been reported. We report a case of myocardial infarction associated with the use of sibutramine. A 37-year-old woman presented to an Emergency Department (ED) with intermittent retrosternal chest pain, nausea, and sweating for 3 days. She reported taking one sibutramine tablet each day for 3 days. Blood pressure was 128/89 mm Hg and pulse 66 beats/min. An electrocardiogram revealed ST elevation over the inferior leads and ST depression over leads AVR and V1, the other leads were normal. Serum troponin T was 0.65 microg/L, and sibutramine was identified in her urine. Echocardiography revealed mild hypokinesia over the inferior wall without evidence of acute aortic dissection. The ST segment changes resolved spontaneously within 24 h of cardiac care unit (CCU) admission, a coronary angiogram performed 1 week later was unremarkable, and echocardiography performed 4 weeks after the event showed normal resting regional wall motion. Seventeen medications containing sibutramine as an active ingredient were registered in Hong Kong in 2007. Sibutramine was introduced in the United States in 1997 and in Australia, United Kingdom, and Italy in 2001. Hypertension, tachycardia, dry mouth, and headache are the most commonly reported adverse reactions. Cardiovascular toxicities include tachycardia, palpitation, hypertension, and tachyarrhythmia. We postulate that the myocardial infarction was the result of coronary vasospasm associated with the therapeutic use of sibutramine-containing slimming pills.

  14. Clinical significance of technetium-99m stannous pyrophosphate myocardial scintigrams in patients with acute and old myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Kanazawa, Ikuo; Eno, Shin; Takeuchi, Masaaki

    1987-08-01

    Seventy-five consecutive patients with acute (43) or old (32) myocardial infarction (AMI, OMI) have been examined by myocardial scintiscanning with technetium-99m stannous pyrophosphate (PYP). Using Parker's classification, the PYP scans were graded as positive in 56 % of the AMI patients; in restricting to the PYP scans obtained within the first 3 days after the onset, the positive rate was 86 %. Positive or negative PYP scans for the AMI patients were independent of maximum creatine phosphokinase and infarct site. For OMI patients, the PYP scans were positive in 41 %, with decreased left ventricular function being more common than those having negative PYP scans. In the group of positive scans, clinical manifestations tended to be remarkable, which were likely due to persistent cardiac ischemia during chronic stage. (Namekawa, K.).

  15. Augmented healing process in female mice with acute myocardial infarction.

    Science.gov (United States)

    Wang, Fangfei; Keimig, Thomas; He, Quan; Ding, Jennifer; Zhang, Zhenggang; Pourabdollah-Nejad, Siamak; Yang, Xiao-Ping

    2007-09-01

    It is well established that premenopausal women are protected from cardiovascular disease. This gender difference in favor of females is also demonstrated in animal studies. Our research group previously found that female mice had much lower incidence of cardiac rupture and mortality than did males during the acute phase of myocardial infarction (MI); however, the mechanisms responsible for such protection are not fully understood. The aim of this study was to determine whether the favorable cardiac effect observed in female mice with MI is due to an augmented healing process that includes less inflammation, reduced matrix degradation, and enhanced neovascularization. Twelve-week-old male and female C57BL/6J mice were subjected to MI by ligating the left anterior descending coronary artery and then euthanized at 1, 4, 7, or 14 days post-MI. Inflammatory cell infiltration and myofibroblast transformation, matrix metalloproteinase (MMP)-2 and MMP-9 activity, tissue inhibitor of metalloproteinase (TIMP)-I expression, and neovascularization were examined by immunohistochemistry, zymography, Western blot, and laser scanning confocal microscopy, respectively. Cardiac function was evaluated by echocardiography on day 14. We found that: (1) neutrophil infiltration during the early phase of MI (1-4 days) was much lower in females than in males and was associated with lower MMP-9 activity and higher TIMP-1 protein expression, indicating less-exaggerated inflammation and extracellular matrix degradation in females; (2) myofibroblast transformation, as indicated by expression of alpha-smooth muscle actin, was significantly greater in females than in males at day 7 of MI (Pvascular area in the infarct border) was markedly increased in females, and was associated with better preserved cardiac function and less left ventricular dilatation. Our data suggest that less-exaggerated early inflammation and augmented reparative fibrotic response, indicated by enhanced myofibroblast

  16. The role of ECToolbox software in evaluating bio-therapeutic effect on acute myocardial infarct of pig modal

    International Nuclear Information System (INIS)

    Zou Renjian; Meng Shu; Fu Hongliang; Wu Jingchuan; Wang Hui

    2009-01-01

    Objective: The aim of this study was to estimate the role of ECToolbox software in evaluating the bio-therapeutic effect on acute myocardial infarction of pig model by angiopoietin-related protein 2 (Ad. ARP2). Methods: Sixteen acute myocardial infarction pigs were divided into groups A and B. Group A was intra-myocardial injected with Ad. ARP2 gene and group B was control with intra-myocardial injected of saline. Gated myocardial perfusion imaging was performed one and four weeks after the injection. To evaluate the bio-therapeutic effect, data was acquired and analyzed qualitatively and quantitatively with ECToolbox to observe the territory, extent and severity of myocardial defect. SPSS 10.0 was used for the statistical analysis. By applying the scoring system for each segment of the 20-segments model to the myocardial perfusion images, a mean score could be derived. Comparisons for the data of one and four weeks after the injection in the same group were made with the paired t-test, and for the data of different groups were made with t-test. Results: (1) The mean score of ischemic lateral wall was 1.99±0.85 and 1.71±0.85 respectively at one and four weeks after the injection. The mean score of ischemic inferior wall was 1.86±0.67 and 1.65±0.73 respectively. (2) The radioactivity ratios of defect area to the whole left ventricle in the first week and the fourth week were 25.75±7.16 and 31.57±5.64 on the short axis (t=3.83, P<0.01), 30.55±4.80 and 36.03± 6.27 on the vertical long axis (t=3.71, P<0.01), 25.03±2.65 and 27.42±3.48 on horizontal long axis (t= 2.88, P<0.01). (3) Polar maps showed myocardial defect extent of the fourth week was smaller than that of the first week. The percentage of defect area to the whole left ventricle in the first and fourth week was (16.58±5.78)% and (12.66±4.90)%. (4) Mean left ventricular eject fraction (LVEF) of group A was (43.99±5.96)% and (61.03±8.74)% respectively after one and four weeks. Conclusions: Bio

  17. Effect of Tumor Necrosis Factor-α on Neutralization of Ventricular Fibrillation in Rats with Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Yu Chen

    2011-01-01

    Full Text Available The purpose of this study was to explore the effects of tumor necrosis factor-α (TNF-α on ventricular fibrillation (VF in rats with acute myocardial infarction (AMI. Rats were randomly classified into AMI group, sham operation group and recombinant human tumor necrosis factor receptor:Fc fusion protein (rhTNFR:Fc group. Spontaneous and induced VFs were recorded. Monophasic action potentials (MAPs among different zones of myocardium were recorded at eight time points before and after ligation and MAP duration dispersions (MAPDds were calculated. Then expression of TNF-α among different myocardial zones was detected. After ligation of the left anterior descending coronary artery, total TNF-α expression in AMI group began to markedly increase at 10 min, reached a climax at 20–30min, and then gradually decreased. The time-windows of VFs and MAPDds in the border zone performed in a similar way. At the same time-point, the expression of TNF-α in the ischemia zone was greater than that in the border zone, and little in the non-ischemia zone. Although the time windows of TNF-α expression, the MAPDds in the border zone and the occurrence of VFs in the rhTNFR:Fc group were similar to those in the AMI group, they all decreased in the rhTNFR:Fc group. Our findings demonstrate that TNF-α could enlarge the MAPDds in the border zone, and promote the onset of VFs.

  18. Anabolic steroids, acute myocardial infarction and polycythemia: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Kathleen Stergiopoulos

    2008-12-01

    Full Text Available Kathleen Stergiopoulos1, Joseph J Brennan2, Robin Mathews1, John F Setaro2, Smadar Kort11Division of Cardiovascular Medicine, Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA; 2Division of Cardiovascular Medicine, Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT, USAAbstract: The association between testosterone-replacement therapy and cardiovascular risk remains unclear with most reports suggesting a neutral or possibly beneficial effect of the hormone in men and women. However, several cardiovascular complications including hypertension, cardiomyopathy, stroke, pulmonary embolism, fatal and nonfatal arrhythmias, and myocardial infarction have been reported with supraphysiologic doses of anabolic steroids. We report a case of an acute ST-segment elevation myocardial infarction in a patient with traditional cardiac risk factors using supraphysiologic doses of supplemental, intramuscular testosterone. In addition, this patient also had polycythemia, likely secondary to high-dose testosterone. The patient underwent successful percutaneous intervention of the right coronary artery. Phlebotomy was used to treat the polycythemia acutely. We suggest that the chronic and recent “stacked” use of intramuscular testosterone as well as the resultant polycythemia and likely increased plasma viscosity may have been contributing factors to this cardiovascular event, in addition to traditional coronary risk factors. Physicians and patients should be aware of the clinical consequences of anabolic steroid abuse.Keywords: acute myocardial infarction, anabolic steroid use, polycythemia

  19. Potential cost effectiveness of intravenous tissue plasminogen activator versus streptokinase for acute myocardial infarction.

    Science.gov (United States)

    Goel, V; Naylor, C D

    1992-01-01

    An economic evaluation of the potential incremental benefits of intravenous tissue plasminogen activator (tPA) versus streptokinase (SK) for treatment of acute myocardial infarction. Cost effectiveness analysis from a third-party payer perspective (Ontario Ministry of Health). ECONOMIC INPUTS: Fully allocated costs for cardiovascular procedures and hospitalization for myocardial infarction were obtained anonymously for four Ontario teaching hospitals and converted to 1988 Canadian dollars. Professional charges were taken from the provincial health insurance fee schedule and drug costs obtained from the manufacturers. CLINICAL INPUTS: The baseline analysis was for nonelderly patients with uncomplicated myocardial infarctions; sensitivity analyses allowed extrapolation to higher risk subgroups. Short and longer term mortality and short term invasive procedure rates were estimated using data from clinical trials. If tPA achieves a 1% short term mortality advantage over SK with no advantages for other survivors, cost per life-year gained can be comparable to other cardiovascular interventions at $58,600. In the absence of immediate survival advantages, but assuming greater left ventricular preservation, the constant annual hazard rate advantage must be about 0.5% per year for competitive cost effectiveness ratios. A full range of projections is presented to help guide the policy decisions that will arise in the wake of the Global Utilization of SK and tPA for Occluded Coronary Arteries (GUSTO) trial. The analysis also illustrates the general importance of considering longer term effects of in-hospital therapies for acute myocardial infarction.

  20. Value of admission electrocardiogram in predicting outcome of thrombolytic therapy in acute myocardial infarction

    NARCIS (Netherlands)

    F.W.H.M. Bär (Frits); C. de Zwaan (Chris); S.H. Braat (Simon); M.L. Simoons (Maarten); W.T. Hermens (Wim); A. van der Laarse (Arnoud); W.T. Wellens; M. Ramentol; F.W.A. Verheugt (Freek); F. Vermeer (Frank); X.H. Krauss

    1987-01-01

    textabstractTo determine the value of the admission 12-lead electrocardiogram to predict infarct size limitation by thrombolytic therapy, data were analyzed in 488 of 533 patients with acute myocardial infarction (AMI) from a randomized multicenter study. All patients had typical

  1. The incidence and prognostic significance of new-onset atrial fibrillation in patients with acute myocardial infarction and left ventricular systolic dysfunction: a CARISMA substudy

    DEFF Research Database (Denmark)

    Jons, Christian; Jacobsen, Uffe G; Joergensen, Rikke Moerch

    2011-01-01

    The incidence and risk associated with new-onset atrial fibrillation (AF) occurring after discharge in patients with acute myocardial infarction (MI) remains unknown.......The incidence and risk associated with new-onset atrial fibrillation (AF) occurring after discharge in patients with acute myocardial infarction (MI) remains unknown....

  2. Evaluation of myocardial sympathetic nerve function in patients with mitral valve prolapse using iodine-123-metaiodobenzylguanidine myocardial scintigraphy

    International Nuclear Information System (INIS)

    Kishi, Fumiko; Nomura, Masahiro; Yukinaka, Michiko

    1996-01-01

    Mitral valve prolapse (MVP) is closely related to myocardial sympathetic nerve function. This study evaluated the presence of impaired myocardial sympathetic nerve function by Iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy in nine patients with MVP. For comparison, 15 healthy subjects without heart disease were investigated (control group). Single photon emission computed tomography (SPECT) and anterior planar myocardial scintigraphy were performed 15 min (initial images) and 3 hours (delayed images) after injection of MIBG (111 MBq). The location and degrees of reduced tracer uptake were evaluated. Myocardial MIBG uptake was quantified by uptake ratio of the heart (H) to upper mediastinum (M) on the anterior planar images (H/M). Percentage washout of MIBG in nine sectors of all oblique slices along the short-axis was calculated. The washout rates were higher at the inferoposterior and septal segments in patients with anterior leaflet prolapse, and at inferoposterior and lateral segments in patients with posterior leaflet prolapse. The bull's eye map showed increased washout rate in the apical and posteroseptal basal segments. There was no significant difference in the H/M ratio between MVP patients and the control group. These results indicate that MIBG can be used to evaluate localized myocardial sympathetic nerve function in MVP. (author)

  3. Evaluation of initial uptake and redistribution on stress thallium-201 myocardial perfusion images in patients with myocardial infarction

    International Nuclear Information System (INIS)

    Watanabe, Yoshihiko; Tonooka, Ichiroh; Kanaya, Tohru; Tsuiki, Kai; Yasui, Shouji.

    1984-01-01

    Stress thallium-201 myocardial perfusion imaging was performed on 29 patients with previous myocardial infarction and 29 patients with angina pectoris at exercise to evaluate thallium-201 kinetics in ischemic heart disease. Four views of thallium-201 images (right anterior oblique, antero-posterior, left anterior oblique and left lateral views) were obtained at 5 min after treadmill exercise with administration of 2 mCi of thallium-201 chloride (initial image) and at 3 hours later (delayed image). Myocardial images were divided into 6 segments (anterior, lateral, inferior, posterior, apical and septal segments) and initial uptake (IU) and redistribution index (RDI, the ratio of the maximal washout rate to a washout rate in each segment) were calculated in order to assess the relations of thallium-201 kinetics to wall motion abnormality and coronary artery stenosis. In myocardial infarction, IU and RDI were decreased in proportion to the severity of wall motion abnormality and coronary artery stenosis. Contrarily, in angina pectoris, IU was decreased but RDI was increased proportionally to the severity of coronary arterial stenosis. In conclusion, IU and redistribution of thallium-201 were affected essentially by both the grade of coronary arterial stenosis and the amount of residual viable heart muscle in patients with ischemic myocardial disease. (author)

  4. Right Ventricular Function After Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention : (from the Glycometabolic Intervention as Adjunct toPrimary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction III Trial)

    NARCIS (Netherlands)

    Gorter, Thomas M; Lexis, Chris P H; Hummel, Yoran M; Lipsic, Erik; Nijveldt, Robin; Willems, Tineke P; van der Horst, Iwan C C; van der Harst, Pim; Melle, van J.P.; van Veldhuisen, Dirk J

    2016-01-01

    Right ventricular (RV) dysfunction is a powerful risk marker after acute myocardial infarction (MI). Primary percutaneous coronary intervention (PCI) has markedly reduced myocardial damage of the left ventricle, but reliable data on RV damage using cardiac magnetic resonance imaging (MRI) are

  5. [Markers for early detection of alterations in carbohydrate metabolism after acute myocardial infarction].

    Science.gov (United States)

    de Gea-García, J H; Benali, L; Galcerá-Tomás, J; Padilla-Serrano, A; Andreu-Soler, E; Melgarejo-Moreno, A; Alonso-Fernández, N

    2014-03-01

    Undiagnosed abnormal glucose metabolism is often seen in patients admitted with acute myocardial infarction, although there is no consensus on which patients should be studied with a view to establishing an early diagnosis. The present study examines the potential of certain variables obtained upon admission to diagnose abnormal glucose metabolism. A prospective cohort study was carried out. The Intensive Care Unit of Arrixaca University Hospital (Murcia), Spain. A total of 138 patients admitted to the Intensive Care Unit with acute myocardial infarction and without known or de novo diabetes mellitus. After one year, oral glucose tolerance testing was performed. Clinical and laboratory test parameters were recorded upon admission and one year after discharge. Additionally, after one year, oral glucose tolerance tests were made, and a study was made of the capacity of the variables obtained at admission to diagnose diabetes, based on the ROC curves and multivariate analysis. Of the 138 patients, 112 (72.5%) had glucose metabolic alteration, including 16.7% with diabetes. HbA1c was independently associated with a diagnosis of diabetes (RR: 7.28, 95%CI 1.65 to 32.05, P = .009), and showed the largest area under the ROC curve for diabetes (0.81, 95%CI 0.69 to 0.92, P = .001). In patients with acute myocardial infarction, HbA1c helps identify those individuals with abnormal glucose metabolism after one year. Thus, its determination in this group of patients could be used to identify those subjects requiring a more exhaustive study in order to establish an early diagnosis. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  6. Acute myocardial infarction

    International Nuclear Information System (INIS)

    RISCHPLER, Christoph

    2016-01-01

    Inflammatory processes after myocardial infarction have gained major interest in recent cardiovascular research. It is believed that not only the degree of cell recruitment to the heart plays a pivotal role in the quality of wound healing after myocardial infarction, but also the balance between different types or even subtypes of cells. It is also this balance which is thought to control key processes in tissue repair, such as apoptosis and neoangiogenesis. In this paper, we aim to review imaging strategies (with a special focus on nuclear molecular imaging strategies) that target cells and processes involved in postischemic inflammation and that have a high potential to be translated into clinic or that are already being used and evaluated in humans.

  7. Delayed percutaneous coronary intervention in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Zhu Weiming; Tian Fang; Shi Li; Lan Xi

    2004-01-01

    Objective: To observe the clinical effects, safeness and prognosis of delayed percutaneous coronary intervention (PCI) for infarct related artery (IRA) in post-infarct patients. Methods: In total 53 patients with acute myocardial infarction (AMI) underwent delayed PCI within 5-15 days after the acute event. Conventional treatment (including thrombolytic therapy) was given in all patients as they were admitted. Results: Intervention was performed in 68 branches of IRA were, including 64 cases of PTCA followed by stent implantation and 4 cases of direct stent implantation. In total 68 stents were implanted. The TIMI classification was improved from the pre-PCI 0-2 to post-PCI 3. No patient died during the treatment. No repeated AMI, post-infarct angina and repeated recanalization happened in the hospitalization. A 5-48 month follow up showed there was 1 death (1.9%), 1 case of repeated myocardial infarction (1.9%), 3 cases of unstable angina (5.7%), 2 cases of repeated PCI and 1 case of CABG. The rate of repeated recanalization was 5.7%. Seven patients (13.2%) were admitted for the second time, who survived 6-48 months after the intervention. Conclusion: Delayed PCT can obviously improve the short and long term prognosis as well as the life quality of patients with AMI, which is a safe interventional procedure

  8. [Myocardial infarction related to sport. Acute clinical and coronary angiographic characteristics in 16 cases].

    Science.gov (United States)

    Halna du Fretay, X; Akoudad, H; Nejjari, M; Benamer, H

    2013-12-01

    Determination of clinical and angiographic characteristics of myocardial infarctions related to sport. Retrospective study of acute coronary syndromes with ST elevation related to sport treated with interventional cardiology from 2006 to 2013. Sixteen patients were included. They are mostly men (15/16), aged 24-65 years (over 35 years old in 13 cases) with few cardiovascular risk factors, most frequently heredity or smoking. Myocardial infarctions usually occur during the practice of sports (13/16), with serious rhythmic complications in three of the cases. On angiography, most patients have single vessel disease (12/16). Myocardial infarction related to sports affects a male population aged over 35 years old with few cardiovascular risk factors, most often single vessel disease, making the preventative screening uneasy. Other studies investigating larger populations, assessing previous clinical events (symptoms, results of stress tests), evaluating the impact of competition and integrating sudden deaths would improve the screening and the treatment of sport-related myocardial infarctions. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  9. Chronic obstructive pulmonary disease is an independent predictor of death but not atherosclerotic events in patients with myocardial infarction: analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT)

    DEFF Research Database (Denmark)

    Hawkins, Nathaniel M; Huang, Zhen; Pieper, Karen S

    2009-01-01

    ) events associated with chronic obstructive pulmonary disease in 14 703 patients with acute MI enrolled in the Valsartan in Acute Myocardial Infarction (VALIANT) trial. Cox proportional hazards models were used to evaluate the relationship between chronic obstructive pulmonary disease and CV outcomes...

  10. Effect of thrombolytic therapy on exercise response during early recovery from acute myocardial infarction

    DEFF Research Database (Denmark)

    Svendsen, J H; Madsen, J K; Saunamäki, K I

    1992-01-01

    Several studies have shown that infarct size is reduced following thrombolytic treatment in patients with acute myocardial infarction. Exercise test variables, such as an impaired heart rate response during exercise, are known to be related to left ventricular function and patient prognosis follo...

  11. New application of myocardial infarct map using a dual isotope single photon emission computed tomography (SPECT) of [99mTc]pyrophosphate and [201Tl]chloride in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Hiroe, Michiaki; Muramatsu, Yasuji; Sugimoto, Keiichi; Tsujino, Motoyoshi; Maejima, Michihiro; Miyahara, Yasuhiro; Taniguchi, Koichi; Matsui, Susumu; Mizukawa, Katsumi.

    1988-01-01

    In 12 patients with acute myocardial infarction, a dual isotope SPECT was applied to describe a myocardial infarct map for detecting the site and the extent of the infarct. Threshold cut-off level was determined as 55 % for [ 99m Tc] and 35 % for [ 201 Tl] according to cardiac phantom studies. Multiple cardiac tomograms showed two different uptakes of the isotopes in indentical slices and regions. Then, color tomograms were described on the red and green image for [ 99m Tc] and for [ 201 Tl], respectively, and Bulls eye map was drawn in the two colored fashion as the myocardial infarct map. In all patients, the infarct map was successful to determine the exact site of the infarct and the overlapped area by the viable myocardium. In conclusion, this functional map of acute myocardial infarction may be useful for understanding three dimensional area of the infarct and the viable myocardium easily and exactly. (author)

  12. Acute Myocardial Infarction Patients

    Directory of Open Access Journals (Sweden)

    Bruce Ovbiagele

    2011-01-01

    Full Text Available Background. Diabetes mellitus (DM confers high vascular risk and is a growing national epidemic. We assessed clinical characteristics and prevalence of diagnosed DM among patients hospitalized with acute myocardial infarction (AMI in the US over the last decade. Methods. Data were obtained from all states within the US that contributed to the Nationwide Inpatient Sample. All patients admitted to hospitals between 1997 and 2006 with a primary discharge diagnosis of AMI were included. Time trends in the proportion of these patients with DM diagnosis were computed. Results. The portion of patients with comorbid diabetes among AMI hospitalizations increased substantially from 18% in 1997 to 30% in 2006 (<.0001. Absolute numbers of AMI hospitalizations in the US decreased 8% (from 729, 412 to 672, 243, while absolute numbers of AMI hospitalizations with coexisting DM rose 51% ((131, 189 to 198, 044, both (<.0001. Women with AMI were significantly more likely to have DM than similarly aged men, but these differences diminished with increasing age. Conclusion. Although overall hospitalizations for AMI in the US diminished over the last decade, prevalence of diabetes rose substantially. This may have important consequences for the future societal vascular disease burden.

  13. Cardioprotective Effect of the Compound Yangshen Granule in Rat Models with Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Xie Ming

    2012-01-01

    Full Text Available The protective effect of Compound Yangshen Granules was observed in myocardial infarction rat model. Rats were randomly divided into 6 groups: the model group, the control group (sham operated, the positive drug group, and small, medium, and large dosage of the Yangshen granule groups, respectively. The rats in the 3 Yangshen granule groups were orally administrated with 0.7 g/kg, 1.4 g/kg, and 2.8 g/kg for 7 consecutive days, whereas the rats of the positive drug group treated with 0.14 g/kg of Danshen Dropping Pills, and rats in the control and model groups orally administrated with saline. The rat model of acute myocardial infarction was established with ligation of coronary artery. Electrocardiograms at different time points, the blood rheology, myocardial enzymes, infarct size, and myocardial morphologic changes were measured. The results demonstrated that the granules could improve blood rheology, decrease st-segment of electrocardiograms and the activities of LDH and CK in serum, reduce myocardial infarction size, and alleviate myocardial histopathologic changes. In addition, the effect of the granules depended on the dose administrated orally. The results suggest that the Yangshen granules could produce cardioprotection effect and have potential benefits in the prevention of ischemic heart disease.

  14. Acute Thrombotic Coronary Occlusion in a Patient with Coronary Artery Anomaly

    Directory of Open Access Journals (Sweden)

    Beganu Elena

    2017-09-01

    Full Text Available Patients with coronary artery anomalies are more susceptible to develop acute thrombotic coronary occlusions due to the abnormal anatomy of these arteries and the disturbance of the pathophysiological mechanisms that lead to an accelerated atherosclerosis development. The following article presents the case of a 64-year-old female patient diagnosed with anterior ST-segment elevation myocardial infarction. The patient underwent primary percutaneous coronary intervention, which revealed the absence of the right coronary artery and separated origins of the left anterior descending artery and the left circumflex artery from the aorta.

  15. Comparison of primary coronary percutaneous coronary intervention between Diabetic Men and Women with acute myocardial infarction.

    Science.gov (United States)

    Liu, Heng-Liang; Liu, Yang; Hao, Zhen-Xuan; Geng, Guo-Ying; Zhang, Zhi-Fang; Jing, Song-Bin; Ba, Ning; Guo, Wei

    2015-01-01

    This study aimed to explore the short-term efficacy and safety of primary percutaneous coronary intervention (PCI) in female diabetic patients complicated with acute myocardial infarction (AMI). A total of 169 diabetic patients with AMI who underwent primary PCI were selected and divided into group A (52 females) and group B (117 males). The clinical data, characteristics of coronary artery lesions, lengths of hospital stay, and incidences of complications were then compared between two groups. The average age, history of hyperlipidemia, double branch lesions, triple branch lesions, and left main lesions were significantly higher in group A than in group B (P paid to the therapy of diabetic women with acute myocardial infarction as well as the control of risk factors.

  16. Clinical characteristics and outcomes of acute coronary syndrome patients with left anterior hemiblock.

    Science.gov (United States)

    Zhang, Hanfei; Goodman, Shaun G; Steg, Gabriel P; Budaj, Andrzej; Lopez-Sendon, Jose; Dorian, Paul; Huynh, Thao; Mangat, Iqwal; Wong, Graham C; Spencer, Frederick A; Yan, Andrew T

    2014-09-15

    We aimed to study the relationships between left anterior hemiblock (LAHB) and the patient characteristics, management, and clinical outcomes in the setting of acute coronary syndromes (ACS). Admission ECGs of patients enrolled in the Global Registry of Acute Coronary Events (GRACE) ECG substudy, and the Canadian ACS Registry I, were analysed independently at a blinded core laboratory. Multivariable logistic regression analysis was performed to assess the independent associations between LAHB on the admission ECG and in-hospital and 6-month mortality. Of the 11 820 eligible ACS patients, 692 (5.9%) patients had LAHB. The presence of LAHB on admission was associated with older age, male sex, prior myocardial infarction, prior heart failure, worse Killip class, higher creatinine level, and higher GRACE risk score (all pcoronary revascularisation or reperfusion therapy (all p<0.05). The LAHB group had higher in-hospital (6.9% vs 3.9%, p<0.001) and 6-month mortality (12.5% vs 7.7%, p<0.001). However, after adjusting for the known predictors of mortality in the GRACE risk models, LAHB was not independently associated with in-hospital death (OR 1.07, 95% CI 0.76 to 1.52, p=0.70), or death at 6 months (OR 1.00, 95% CI 0.75 to 1.34, p=0.99). Across the broad spectrum of ACS, LAHB was associated with significant comorbidities, high-risk clinical features on presentation, and worse unadjusted outcomes. However, LAHB was not an independent predictor of in-hospital and 6-month mortality and did not carry incremental prognostic value beyond the known prognosticators in the GRACE risk models. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Standardised pre-hospital care of acute myocardial infarction patients: MISSION! guidelines applied in practice

    NARCIS (Netherlands)

    Atary, J. Z.; de Visser, M.; van den Dijk, R.; Bosch, J.; Liem, S. S.; Antoni, M. L.; Bootsma, M.; Viergever, E. P.; Kirchhof, C. J.; Padmos, I.; Sedney, M. I.; van Exel, H. J.; Verwey, H. F.; Atsma, D. E.; van der Wal, E. E.; Jukema, J. W.; Schalij, M. J.

    2010-01-01

    Background. To improve acute myocardial infarction (AMI) care in the region 'Hollands-Midden' (the Netherlands), a standardised guideline-based care program was developed (MISSION!). This study aimed to evaluate the outcome of the pre-hospital part of the MISSION! program and to study potential

  18. Increased incidence and clinical correlation of persistently abnormal technetium pyrophosphate myocardial scintigrams following acute myocardial infarction in patients with diabetes mellitus

    International Nuclear Information System (INIS)

    Nicod, P.; Lewis, S.E.; Corbett, J.C.; Buja, L.M.; Henderson, G.; Raskin, P.; Rude, R.E.; Willerson, J.T.

    1982-01-01

    Persistently abnormal /sup 99m/Tc stannous pyrophosphate myocardial scintigrams (PPi+) appear to be associated with a relatively poor prognosis after acute myocardial infarction (AMI). To assess the incidence and implications of PPi+, we performed a retrospective analysis in 29 patients with and 25 patients without diabetes mellitus who had abnormal myocardial scintigrams within 4 days of AMI and who had follow-up scintigrams at least 3 months after hospital discharge. There were no significant differences between patients with and without diabetes as regards age, incidence of transmural or nontransmural AMI, or degree of left ventricular dysfunction after AMI. Persistently abnormal PPi+ occurred more commonly in patients with diabetes than in nondiabetic patients (18 of 29, 62%, compared to 3 of 25, 12%; p less than 0.001). Patients with chronic PPi+ had more frequent cardiac complications following hospital discharge (p less than 0.005) including death, recurrent AMI, unstable angina, and intractable congestive heart failure. Postmortem analysis in two patients with diabetes and chronic PPi+ revealed marked myocytolysis. Thus, patients with diabetes mellitus have an increased incidence of post-AMI persistently abnormal technetium (PPi+) scintigrams and relatively poor prognosis following myocardial infarction

  19. Acute Myocardial Infarction with Simultaneous Gastric Perforation

    Directory of Open Access Journals (Sweden)

    Alon Kaplan

    2017-05-01

    Full Text Available Acute myocardial infarction and perforated peptic ulcer disease with associated peritonitis are both medical emergencies requiring urgent intervention. This patient presented with both emergencies simultaneously. Current literature is devoid of guidance as to which should be addressed initially. A multidisciplinary discussion was conducted leading to a unanimous decision for initiating percutaneous coronary intervention (PCI. After successful PCI, the patient was immediately taken to the operating room for laparoscopic repair of the perforated viscous. Subsequent to the operative repair, the patient became hemodynamically unstable and a repeat electrocardiogram demonstrated complete right coronary occlusion. Shock ensued and the patient died in the intensive care unit despite this plan of care. It is our opinion that this case reveals the need for expert panels to devise decision algorithms for concomitant presentations of life-threatening diseases.

  20. Acute anterior uveitis as the initial presentation of alkaptonuria.

    Science.gov (United States)

    John, S S; Padhan, P; Mathews, J V; David, S

    2009-01-01

    Alkaptonuria is a rare autosomal recessive metabolic disorder that may present with multi-system involvement such as ochronotic arthropathy, renal, urethral and prostatic calculi, cardiac valvular lesions and pigmentation of the skin, sclera, cartilage and other connective tissues. An association of the disease with uveitis has never been reported. We report the first case of alkaptonuria with ochronotic arthropathy presenting with recurrent acute anterior uveitis as the initial manifestation. The possible common link with the HLA-B27 gene is discussed.

  1. Evaluation of left ventricular function in patient with old myocardial infarction by 201-thallium myocardial scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Kanji; Shimohara, Yasuaki; Ito, Misao; Okada, Keisei [Kure Kyosai Hospital, Hiroshima (Japan); Kodama, Kazunori

    1984-08-01

    Correlation between the ratio of myocardial defect calculated by 201-thallium myocardial scintigraphy and the left ventricular ejection fraction (LVEF) obtained by gated blood pool scintigraphy and the maximum level of creatine phosphokinase (CPK) was studied in 70 patients with old myocardial infarction. There was a significant correlation between the defect ratio and the LVEF or CPK level in patients with anterior or septal myocardial infarction. In all patients with inferior myocardial infarction in whom no defect was seen, the LVEF was more than 40%. However, no distinct correlation between the defect ratio and the LVEF or CPK level was obtained in cases of inferior myocardial infarction.

  2. Comparison of two-dimensional echocardiography with gated radionuclide ventriculography in the evaluation of global and regional left ventricular function in acute myocardial infarction

    International Nuclear Information System (INIS)

    Van Reet, R.E.; Quinones, M.A.; Poliner, L.R.; Nelson, J.G.; Waggoner, A.D.; Kanon, D.; Lubetkin, S.J.; Pratt, C.M.; Winters, W.L. Jr.

    1984-01-01

    Two-dimensional echocardiography and gated radionuclide ventriculography were performed in 93 patients (66 men, 27 women; mean age 61 years) with 95 episodes of acute myocardial infarction within 48 hours and at 10 days after infarction. Abnormal motion of an inferior or posterior wall segment was seen in 91% of inferoposterior infarctions by echocardiography versus 61% seen by radionuclide ventriculography. Ejection fractions determined by echocardiography and radionuclide ventriculography correlated well (r . 0.82) and did not change from the first 48 hours to 10 days after infarction (0.48 +/- 0.14). Similarly, wall motion score showed minimal change from the first 48 hours to 10 days. In-hospital mortality was 37 and 42% in patients with an ejection fraction of 0.35 or less by echocardiography and radionuclide ventriculography, respectively. No mortality was seen in patients with an ejection fraction above 0.40 by either test. The echocardiographic wall motion score was also predictive of mortality (40 versus 2%; score less than or equal to 0.50 versus greater than 0.50). The 1 year mortality rate in the 81 short-term survivors was 17%. Mortality was lowest in patients with an ejection fraction above 0.49 or wall motion score above (0.79 (2 to 5%) and worse in those with an ejection fraction below 0.36 or wall motion score below 0.51 (36 to 63%) by either technique. Thus in acute myocardial infarction, echocardiography and radionuclide ventriculography provide a comparable assessment of left ventricular function and wall motion in anterior infarction. Echocardiography appears more sensitive in detecting inferoposterior wall motion abnormalities. Both techniques are capable of identifying subgroups of patients with a high risk of death during the acute event and with an equally high mortality rate over a 1 year follow-up period

  3. Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

    Science.gov (United States)

    Mandurino-Mirizzi, Alessandro; Crimi, Gabriele; Raineri, Claudia; Pica, Silvia; Ruffinazzi, Marta; Gianni, Umberto; Repetto, Alessandra; Ferlini, Marco; Marinoni, Barbara; Leonardi, Sergio; De Servi, Stefano; Oltrona Visconti, Luigi; De Ferrari, Gaetano M; Ferrario, Maurizio

    2018-05-01

    Elevated serum uric acid (eSUA) was associated with unfavorable outcome in patients with ST-segment elevation myocardial infarction (STEMI). However, the effect of eSUA on myocardial reperfusion injury and infarct size has been poorly investigated. Our aim was to correlate eSUA with infarct size, infarct size shrinkage, myocardial reperfusion grade and long-term mortality in STEMI patients undergoing primary percutaneous coronary intervention. We performed a post-hoc patients-level analysis of two randomized controlled trials, testing strategies for myocardial ischemia/reperfusion injury protection. Each patient underwent acute (3-5 days) and follow-up (4-6 months) cardiac magnetic resonance. Infarct size and infarct size shrinkage were outcomes of interest. We assessed T2-weighted edema, myocardial blush grade (MBG), corrected Thrombolysis in myocardial infarction Frame Count, ST-segment resolution and long-term all-cause mortality. A total of 101 (86.1% anterior) STEMI patients were included; eSUA was found in 16 (15.8%) patients. Infarct size was larger in eSUA compared with non-eSUA patients (42.3 ± 22 vs. 29.1 ± 15 ml, P = 0.008). After adjusting for covariates, infarct size was 10.3 ml (95% confidence interval 1.2-19.3 ml, P = 0.001) larger in eSUA. Among patients with anterior myocardial infarction the difference in delayed enhancement between groups was maintained (respectively, 42.3 ± 22.4 vs. 29.9 ± 15.4 ml, P = 0.015). Infarct size shrinkage was similar between the groups. Compared with non-eSUA, eSUA patients had larger T2-weighted edema (53.8 vs. 41.2 ml, P = 0.031) and less favorable MBG (MBG < 2: 44.4 vs. 13.6%, P = 0.045). Corrected Thrombolysis in myocardial infarction Frame Count and ST-segment resolution did not significantly differ between the groups. At a median follow-up of 7.3 years, all-cause mortality was higher in the eSUA group (18.8 vs. 2.4%, P = 0.028). eSUA may affect myocardial

  4. Apical ballooning syndrome complicated by acute severe mitral regurgitation with left ventricular outflow obstruction – Case report

    Directory of Open Access Journals (Sweden)

    Celermajer David S

    2007-02-01

    Full Text Available Abstract Background Apical ballooning syndrome (or Takotsubo cardiomyopathy is a syndrome of transient left ventricular apical ballooning. Although first described in Japanese patients, it is now well reported in the Caucasian population. The syndrome mimicks an acute myocardial infarction but is characterised by the absence of obstructive coronary disease. We describe a serious and poorly understood complication of Takotsubo cardiomyopathy. Case Presentation We present the case of a 65 year-old lady referred to us from a rural hospital where she was treated with thrombolytic therapy for a presumed acute anterior myocardial infarction. Four hours after thrombolysis she developed acute pulmonary oedema and a new systolic murmur. It was presumed she had acute mitral regurgitation secondary to a ruptured papillary muscle, ischaemic dysfunction or an acute ventricular septal defect. Echocardiogram revealed severe mitral regurgitation, left ventricular apical ballooning, and systolic anterior motion of the mitral valve with significant left ventricular outflow tract gradient (60–70 mmHg. Coronary angiography revealed no obstructive coronary lesions. She had an intra-aortic balloon pump inserted with no improvement in her parlous haemodynamic state. We elected to replace her mitral valve to correct the outflow tract gradient and mitral regurgitation. Intra-operatively the mitral valve was mildly myxomatous but there were no structural abnormalities. She had a mechanical mitral valve replacement with a 29 mm St Jude valve. Post-operatively, her left ventricular outflow obstruction resolved and ventricular function returned to normal over the subsequent 10 days. She recovered well. Conclusion This case represents a serious and poorly understood association of Takotsubo cardiomyopathy with acute pulmonary oedema, severe mitral regurgitaton and systolic anterior motion of the mitral valve with significant left ventricular outflow tract obstruction. The

  5. G-CSF in acute myocardial infarction - experimental and clinical findings.

    Science.gov (United States)

    Ince, Hüseyin; Petzsch, Michael; Rehders, Tim C; Dunkelmann, Simone; Nienaber, Christoph A

    2006-09-01

    Early data from clinical studies suggest that intracoronary injection of autologous progenitor cells may beneficially affect postinfarction remodeling and perfusion. Beyond intracoronary infusion of autologous bone marrow mononuclear CD34+ cells (MNCCD34+), mobilization of stem cells by G-CSF has recently attracted attention because of various advantages such as the noninvasive nature of MNCCD34+ mobilization by subcutaneous injections. It is the aim of the present work to give an overview about the current experimental and clinical findings of G-CSF treatment in acute myocardial infarction.

  6. Anterior ischemic optic neuropathy precipitated by acute primary angle closure

    Directory of Open Access Journals (Sweden)

    Choudhari Nikhil

    2010-01-01

    Full Text Available A 59-year-old man with a history of longstanding systemic hypotension developed asymmetric non-arteritic anterior ischemic optic neuropathy (NAION apparently precipitated by bilateral sequential acute primary angle closure. NAION is very rarely reported in association with raised intraocular pressure. In contrast to optical coherence tomography, the failure of scanning laser polarimetry to detect axonal swelling was another interesting finding. Possible reasoning for these observations is discussed.

  7. The impact of the Danish smoking ban on hospital admissions for acute myocardial infarction

    DEFF Research Database (Denmark)

    Christensen, Tabita Maria; Møller, Lisbeth; Jørgensen, Torben

    2014-01-01

    Background: Exposure to secondhand smoke is associated with an increased risk of acute myocardial infarction (AMI). The positive impact of a smoking ban on AMI hospitalization rates has been demonstrated both inside and outside Europe. A national smoking ban (SB) was implemented in Denmark on 15...

  8. Scintigraphic diagnosis of acute nontransmural myocardial infarction using sup(99m)Tc-labelled pyrophosphate

    Energy Technology Data Exchange (ETDEWEB)

    Duska, F; Novak, J; Vizda, J; Kafka, P; Kubicek, J; Veverkova, O [Karlova Univ., Hradec Kralove (Czechoslovakia). Lekarska Fakulta

    1980-04-01

    In 10 patients with acute non-transmural myocardial lesion, the heart muscle was examined by scintigraphy. The scan was negative in 4 patients, positive in 6. No obvious relationship was observed between the degree and character of sup(99m)Tc-pyrophosphate cumulation in the myocardial lesion and the results of other laboratory tests. The actual site of non-transmural lesion cannot be determined by scan. Although scintigraphy alone cannot decide whether a non-transmural necrosis or mere ischemic heart disease is involved, the method is a valuable addition to other diagnostic techniques presently in use.

  9. Increased mortality associated with low use of clopidogrel in patients with heart failure and acute myocardial infarction not undergoing percutaneous coronary intervention: a nationwide study

    DEFF Research Database (Denmark)

    Bonde, Lisbeth; Sorensen, Rikke; Fosbøl, Emil Loldrup

    2010-01-01

    We studied the association of clopidogrel with mortality in acute myocardial infarction (AMI) patients with heart failure (HF) not receiving percutaneous coronary intervention (PCI).......We studied the association of clopidogrel with mortality in acute myocardial infarction (AMI) patients with heart failure (HF) not receiving percutaneous coronary intervention (PCI)....

  10. Sex differences in perceived stress and early recovery in young and middle-aged patients with acute myocardial infarction.

    Science.gov (United States)

    Xu, Xiao; Bao, Haikun; Strait, Kelly; Spertus, John A; Lichtman, Judith H; D'Onofrio, Gail; Spatz, Erica; Bucholz, Emily M; Geda, Mary; Lorenze, Nancy P; Bueno, Héctor; Beltrame, John F; Krumholz, Harlan M

    2015-02-17

    Younger age and female sex are both associated with greater mental stress in the general population, but limited data exist on the status of perceived stress in young and middle-aged patients presenting with acute myocardial infarction. We examined sex difference in stress, contributing factors to this difference, and whether this difference helps explain sex-based disparities in 1-month recovery using data from 3572 patients with acute myocardial infarction (2397 women and 1175 men) 18 to 55 years of age. The average score of the 14-item Perceived Stress Scale at baseline was 23.4 for men and 27.0 for women (Pstress in women was explained largely by sex differences in comorbidities, physical and mental health status, intrafamily conflict, caregiving demands, and financial hardship. After adjustment for demographic and clinical characteristics, women had worse recovery than men at 1 month after acute myocardial infarction, with mean differences in improvement score between women and men ranging from -0.04 for EuroQol utility index to -3.96 for angina-related quality of life (Pstress reduced these sex-based differences in recovery to -0.03 to -3.63, which, however, remained statistically significant (Pstress at baseline was associated with significantly worse recovery in angina-specific and overall quality of life, as well as mental health status. The effect of baseline stress on recovery did not vary between men and women. Among young and middle-aged patients, higher stress at baseline is associated with worse recovery in multiple health outcomes after acute myocardial infarction. Women perceive greater psychological stress than men at baseline, which partially explains women's worse recovery. © 2015 American Heart Association, Inc.

  11. Educational attainment and differences in relative survival after acute myocardial infarction in Norway: a registry-based population study.

    Science.gov (United States)

    Klitkou, Søren Toksvig; Wangen, Knut R

    2017-08-28

    Although there is a broad societal interest in socioeconomic differences in survival after an acute myocardial infarction, only a few studies have investigated how such differences relate to the survival in general population groups. We aimed to investigate education-specific survival after acute myocardial infarction and to compare this with the survival of corresponding groups in the general population. Our study included the entire population of Norwegian patients admitted to hospitals for acute myocardial infarction during 2008-2010, with a 6- year follow-up period. Patient survival was measured relative to the expected survival in the general population for three educational groups: primary, secondary and tertiary. Education, sex, age and calendar year-specific expected survival were obtained from population life tables and adjusted for the presence of infarction-related mortality. Six-year patient survivals were 56.3% (55.3-57.2) and 65.5% (65.6-69.3) for the primary and tertiary educational groups (95% CIs), respectively. Also 6-year relative survival was markedly lower for the primary educational group: 70.2% (68.6-71.8) versus 81.2% (77.4-84.4). Throughout the follow-up period, patient survival tended to remain lower than the survival in the general population with the same educational background. Both patient survival and relative survival after acute myocardial infarction are positively associated with educational level. Our findings may suggest that secondary prevention has been more effective for the highly educated. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Usefulness of rest-redistribution on thallium myocardial scintigraphy in patients with acute myocardial infarction by SPECT; Analysis by bull's eye and unfolded map images

    Energy Technology Data Exchange (ETDEWEB)

    Tahara, Yorio; Taya, Makoto; Sasaki, Akira; Nishimura, Tooru; Shimoyama, Katsuya; Mizuno, Haruyoshi; Ono, Akifumi; Okada, Michio; Ishikawa, Kyozo (Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine)

    1990-01-01

    The purpose of this study was to clarify the clinical significance of rest-redistribution in myocardial scintigraphy (SPECT) in acute myocardial infarction (AMI). 30 patients with AMI within one week after the onset of attack were studied. SPECT images were obtained 10 min and 3hrs after injection of {sup 201}Tl. Bull's eye images and unfolded map images were prepared. A {sup 201}Tl uptake was studied at the infarct and non-infarct sites. Exercise SPECT and radionuclide angiography were performed in all patients one month after the onset of AMI, and the findings were compared with clinical and coronary angiographic (CAG) findings. Redistribution of Tl at rest was observed at the infarct sites in 9 of the 30 patients. Redistribution at rest was observed at the non-infarct sites in 8 patients. Redistribution at rest was observed during exercise SPECT one month after the onset of AMI in patients with redistribution at rest in the acute phase. In patients with redistribution at rest at the infarct site, left ventricular ejection fraction (EF) improved one month after the onset of AMI ({Delta}EF>5%), but it decreased slightly during exercise. Wall motion at the infarct site was not much impaired in patients who showed redistribution at rest at the infarct site. Angina pectoris and recurrence of myocardial infarction were observed more frequently on SPECT, but no characteristic findings were obtained on CAG in those with redistribution at rest. In conclusion, cardiac function and wall motion at the infarct site are better preserved in patients with redistribution of Tl at rest on SPECT in the acute stage of myocardial infarction, as compared with patients having fixed defects, but the EF decrease slightly during exercise and the frequency of post-infarction angina is greater in those patients. Resting SPECT in AMI is considered to provide useful information for predicting cardiac function and the clinical course following myocardial infarction. (author).

  13. The evaluation of usefulness of quantitative analysis method with {sup 99m}Tc-tetrofosmin on effective dicision of reperfusion therapy to acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Takagi, Hitoshi; Sone, Takahito [Ogaki Municipal Hospital, Gifu (Japan)

    1998-01-01

    SPECT on acute and chronic period of {sup 99m}Tc-tetrofosmin on 46 patients with acute myocardial infarction were analyzed to evaluate about usefulness of quantitative analysis method used by unfolding image that was gotten by Bull`s eye analysis on reperfusion therapy in acute myocardial infarction, and we could get undermentioned results. 60% black out area in resional of interested was best on the obstacle myocardium using analysis of unfolding image. Significantly betterment from acute to chronic phase on the obstacle area of myocardium and the mean uptake ratio of the obstacle area was confirmed by this method. The relation between myocardial salvage and factors of myocardial damage, for example reperfusion time TIMI grade, rentrop grade and reperfusion phenomenon could be analyzed by this method. This method was suspected to underestimate the areas of obstacle myocardium on the cases of defect of apex. Error of analysis was suspected on the case of accumulation of TF to other than myocardium. The problems were minimised by some techniques mention in this paper. (author)

  14. Results of the Croatian Primary Percutaneous Coronary Intervention Network for patients with ST-segment elevation acute myocardial infarction.

    Science.gov (United States)

    Nikolić Heitzler, Vjeran; Babic, Zdravko; Milicic, Davor; Bergovec, Mijo; Raguz, Miroslav; Mirat, Jure; Strozzi, Maja; Plazonic, Zeljko; Giunio, Lovel; Steiner, Robert; Starcevic, Boris; Vukovic, Ivica

    2010-05-01

    The Republic of Croatia, with a gross domestic product per capita of US$11,554 in 2008, is an economically less-developed Western country. The goal of the present investigation was to prove that a well-organized primary percutaneous coronary intervention network in an economically less-developed country equalizes the prospects of all patients with acute ST-segment elevation myocardial infarction at a level comparable to that of more economically developed countries. We prospectively investigated 1,190 patients with acute ST-segment elevation myocardial infarction treated with primary PCI in 8 centers across Croatia (677 nontransferred and 513 transferred). The postprocedural Thrombolysis In Myocardial Infarction flow, in-hospital mortality, and incidence of major adverse cardiovascular events (ie, mortality, pectoral angina, restenosis, reinfarction, coronary artery bypass graft, and cerebrovascular accident rate) during 6 months of follow-up were compared between the nontransferred and transferred subgroups and in the subgroups of older patients, women, and those with cardiogenic shock. In all investigated patients, the average door-to-balloon time was 108 minutes, and the total ischemic time was 265 minutes. Postprocedural Thrombolysis In Myocardial Infarction 3 flow was established in 87.1% of the patients, and the in-hospital mortality rate was 4.4%. No statistically significant difference was found in the results of treatment between the transferred and nontransferred patients overall or in the subgroups of patients >75 years, women, and those with cardiogenic shock. In conclusion, the Croatian Primary Percutaneous Coronary Intervention Network has ensured treatment results of acute ST-segment elevation myocardial infarction comparable to those of randomized studies and registries of more economically developed countries. Copyright 2010 Elsevier Inc. All rights reserved.

  15. Diagnostic significance of gadolinium-DTPA (diethylenetriamine penta-acetic acid) enhanced magnetic resonance imaging in thrombolytic treatment for acute myocardial infarction: its potential in assessing reperfusion.

    Science.gov (United States)

    van der Wall, E E; van Dijkman, P R; de Roos, A; Doornbos, J; van der Laarse, A; Manger Cats, V; van Voorthuisen, A E; Matheijssen, N A; Bruschke, A V

    1990-01-01

    The diagnostic value of gadolinium-DTPA (diethylenetriamine penta-acetic acid) enhanced magnetic resonance imaging in patients treated by thrombolysis for acute myocardial infarction was assessed in 27 consecutive patients who had a first acute myocardial infarction (14 anterior, 13 inferior) and who underwent thrombolytic treatment and coronary arteriography within 4 hours of the onset of symptoms. Magnetic resonance imaging was performed 93 hours (range 15-241) after the onset of symptoms. A Philips Gyroscan (0.5 T) was used, and spin echo measurements (echo time 30 ms) were made before and 20 minutes after intravenous injection of 0.1 mmol/kg gadolinium-DTPA. In all patients contrast enhancement of the infarcted areas was seen after Gd-DTPA. The signal intensities of the infarcted and normal values were used to calculate the intensity ratios. Mean (SD) intensity ratios after Gd-DTPA were significantly increased (1.15 (0.17) v 1.52 (0.29). Intensity ratios were higher in the 17 patients who underwent magnetic resonance imaging more than 72 hours after the onset of symptoms than in the 10 who underwent magnetic resonance imaging earlier, the difference being significantly greater after administration of Gd-DTPA (1.38 (0.12) v 1.61 (0.34). When patients were classified according to the site and size of the infarcted areas, or to reperfusion (n = 19) versus non-reperfusion (n = 8), the intensity ratios both before and after Gd-DTPA did not show significant differences. Magnetic resonance imaging with Gd-DTPA improved the identification of acutely infarcted areas, but with current techniques did not identify patients in whom thrombolytic treatment was successful. Images PMID:2310640

  16. Significance of a negative exercise thallium test in the presence of a critical residual stenosis after thrombolysis for acute myocardial infarction

    International Nuclear Information System (INIS)

    Sutton, J.M.; Topol, E.J.

    1991-01-01

    After thrombolytic therapy for acute myocardial infarction, increasing emphasis is placed on early submaximal exercise testing, with further intervention advocated only for demonstrable ischemia. Although significant residual coronary artery lesions after successful thrombolysis are common, many patients paradoxically have no corresponding provokable ischemia. The relation between significant postthrombolytic residual coronary artery disease and a negative early, submaximal exercise thallium-201 tomogram was studied among 101 consecutive patients with uncomplicated myocardial infarction and at least 70% residual stenosis of the infarct artery. A negative test occurred in 49 (48.5%) patients with a mean 88% residual infarct artery stenosis. Further characteristics of the group were as follows: mean time to treatment was 3.1 hours; mean age was 54 +/- 10 years; 80% were male; 47% had anterior infarction; 39% had multivessel disease; mean left ventricular ejection fraction was 53 +/- 14%; and mean peak creatine kinase level was 3,820 +/- 3,123 IU/ml. A similar group of 52 (51.5%) patients, treated within 3.3 hours from symptom onset, with a mean postthrombolysis stenosis of 90%, had a positive exercise test. Characteristics of this group were as follows: age was 58 +/- 10 years; 92% were male; 56% had anterior infarction; 40% had multivessel disease; and mean left ventricular ejection fraction was 54 +/- 15%. The peak creatine kinase level associated with the infarction, however, was lower: 2,605 +/- 1,805 IU/ml (p = 0.04). There was no difference in performance at exercise testing with respect to peak systolic pressure, peak heart rate, or time tolerated on the treadmill between the two groups. By multivariate logistic regression, only peak creatine kinase level predicted a negative stress result in the presence of a significant residual stenosis

  17. Long-term clinical outcomes of the left ventricular thrombus in patients with ST elevation anterior myocardial infarction

    Directory of Open Access Journals (Sweden)

    Mahmoud Ebrahimi

    2015-01-01

    Full Text Available BACKGROUND: This study was performed to determine the size of left ventricular thrombus (LVT, risk of systemic embolization and response to medical treatment during 18 months of follow up in the patients with anterior-ST elevation myocardial infarction (aSTEMI. METHODS: This cross-sectional study was performed on thirty-five patients with anterior myocardial infarction (MI, in Emam Reza Hospital and Ghaem Hospital, Mashhad, Iran, from August 2008 to January 2011. Warfarin was prescribed for all the patients. Transthoracic echocardiographic study was performed on the 1st, 2nd, 4th, 6th, 12th and 18th months. Outcomes included rate of death, MI, stroke, systemic embolization, major bleeding and change in thrombus size following treatment. RESULTS: The resolve rate of clot on the 2nd, 4th, 6th, 12th and 18th months was 64.7, 86.6, 81.4, 81.4 and 100 percent, respectively. In five patients with complete clot resolution, clot reformation occurred after warfarin discontinuation. In these patients, left ventricular ejection fraction (LVEF improvement was poor. During the study period, five patients died due to severe heart failure. One patient developed hematuria whereas non-experienced thromboembolic events. The mean LVEF at study initiation was 30.8 ± 0.92%, which improved to 42 ± 0.84% (P < 0.05 at the end. CONCLUSION: All LVT was resolved with a combination therapy of antiplatelet and warfarin without any thromboembolic event. In patients with a poor improvement in the LV function, due to the risk of LVT reformation, lifelong warfarin therapy was recommended. 

  18. Myocardial perfusion SPECT imaging in patients with myocardial bridging

    International Nuclear Information System (INIS)

    Fang Wei; Qiu Hong; Yang Weixian; Wang Feng; He Zuoxiang

    2008-01-01

    Objective: Stress myocardial perfusion SPECT imaging was used to assess myocardial ischemia in patients with myocardial bridging. Methods: Ninety-six patients with myocardial bridging of the left anterior descending artery documented by coronary angiography were included in this study. All under- went exercise or pharmacological stress myocardial perfusion SPECT assessing myocardial ischemia. None had prior myocardial infarction. One year follow-up by telephone interview was performed in all patients. Results The mean stenotic severity of systolic phase on angiography was (65 ± 19)%. In the SPECT study, 20 of 96 (20.8%) patients showed abnormal perfusion. This percentage was significantly higher than that of stress electrocardiogram (ECG). The higher positive rate of SPECT perfusion images was showed in the group of patients with severe systolic narrowing (≥75%) than that with mild-to-moderate systolic narrowing (50% vs 6.3%, P<0.001). The prevalence of abnormal image was significantly higher in ELDERLY PEOPLE; patients with STT change on rest ECG than in those with normal rest ECG (54.2% vs 9.7%, P<0.001). During follow-up, one patient with abnormal SPECT perfusion image sustained angina and accepted percutaneous coronary intervention, and no cardiac event occurred in patients with normal images. Conclusions: Stress myocardial perfusion SPECT imaging can be used effectively for assessing myocardial ischemia and has potential prognostic value for patients with myocardial bridging. (authors)

  19. Changing paradigms in thrombolysis in acute myocardial infarction.

    Science.gov (United States)

    Gotsman, M S; Rozenman, Y; Admon, D; Mosseri, M; Lotan, C; Zahger, D; Weiss, A T

    1997-05-23

    Acute myocardial infarction occurs when a ruptured coronary artery plaque causes sudden thrombotic occlusion of a coronary artery and cessation of coronary artery blood flow. This paper reviews the underlying coronary pathology in progressive coronary atherosclerosis, mechanisms of plaque rupture and arterial occlusion and the time relationship between coronary occlusion and myocardial necrosis. Reperfusion can be achieved by chemical thrombolysis with different thrombolytic agents. Early lysis is achieved best by prehospital administration, a transtelephonic monitor, a mobile intensive care unit, active general practitioner treatment or by warning the emergency room of impending arrival of a patient. Thrombolytic therapy may be unsuccessful and not achieve Grade III TIMI flow in less than 4 h (or even 2 h) due to inadequate or intermittent perfusion or reocclusion. Adjuvant therapy includes aspirin and platelet receptor antagonists. Bleeding is a constant danger. Direct percutaneous transluminal coronary angioplasty (PTCA) may be as effective or better than chemical thrombolysis. Reperfusion protects the myocardium and salvages viable tissue. It also improves mechanical remodelling of the ventricle. Long-term follow-up has shown that quantum leaps of fresh coronary occlusion causes step-wise progression in patient disability and that further early, prompt reperfusion can salvage myocardium and prevent this inexorable progress of the disease.

  20. In-hospital outcome of acute myocardial infarction in correlation with 'thrombolysis in myocardial infarction' risk score

    International Nuclear Information System (INIS)

    Masood, A.; Naqvi, M.A.; Jafar, S.S.

    2009-01-01

    Effective risk stratification is integral to management of acute coronary syndromes (ACS). The Thrombolysis in Myocardial Infarction (TIMI) risk score for ST-segment elevation myocardial infarction (STEMI) is a simple integer score based on 8 high-risk parameters that can be used at the bedside for risk stratification of patients at presentation with STEMI. To evaluate the prognostic significance of TIMI risk score in a local population group of acute STEMI. The study included 160 cases of STEMI eligible for thrombolysis. TIMI risk score was calculated for each case at the time of presentation and were then followed during their hospital stay for the occurrence of electrical and mechanical complications as well as mortality. The patients were divided into three risk groups, namely 'low risk', 'moderate-risk' and 'high-risk' based on their TIMI scores (0-4 low-risk, 5-8 moderate-risk, 9-14 high risk). The frequencies of complications and deaths were compared among the three risk groups. Post MI arrhythmias were noted in 2.2%, 16% and 50%; cardiogenic shock in 6.7%, 16% and 60%; pulmonary edema in 6.7%, 20% and 80%; mechanical complications of MI in 0%, 8% and 30%; death in 4.4%, 8%, and 60% of patients belonging to low-risk, moderate-risk and high-risk groups respectively. Frequency of complications and death correlated well with TIMI risk score (p=0.001). TIMI risk score correlates well with the frequency of electrical or mechanical complications and death after STEMI. (author)

  1. Impact of endothelial dysfunction on left ventricular remodeling after successful primary coronary angioplasty for acute myocardial infarction. Analysis by quantitative ECG-gated SPECT

    International Nuclear Information System (INIS)

    Matsuo, Shinro; Nakae, Ichiro; Matsumoto, Tetsuya; Horie, Minoru

    2006-01-01

    We hypothesized that endothelial cell integrity in the risk area would influence left ventricular remodeling after acute myocardial infarction. Twenty patients (61±8 y.o.) with acute myocardial infarction underwent 99m Tc-tetrofosmin imaging in the sub-acute phase and three months after successful primary angioplasty due to myocardial infarction. All patients were administered angiotensin-converting enzyme inhibitor after revascularization. Cardiac scintigraphies with quantitative gated SPECT were performed at the sub-acute stage and again 3 months after revascularization to evaluate left ventricular (LV) remodeling. The left ventricular ejection fraction (EF) and end-systolic and end-diastolic volume (ESV, EDV) were determined using a quantitative gated SPECT (QGS) program. Three months after myocardial infarction, all patients underwent cardiac catheterization examination with coronary endothelial function testing. Bradykinin (BK) (0.2, 0.6, 2.0 μg/min) was administered via the left coronary artery in a stepwise manner. Coronary blood flow was evaluated by Doppler flow velocity measurement. Patients were divided into two groups by BK-response: a preserved endothelial function group (n=10) and endothelial dysfunction group (n=10). At baseline, both global function and LV systolic and diastolic volumes were similar in both groups. However, LV ejection fraction was significantly improved in the preserved-endothelial function group, compared with that in the endothelial dysfunction group (42±10% to 48±9%, versus 41±4% to 42±13%, p<0.05). LV volumes progressively increased in the endothelial dysfunction group compared to the preserved-endothelial function group (123±45 ml to 128±43 ml, versus 111±47 ml to 109±49 ml, p<0.05). In re-perfused acute myocardial infarction, endothelial function within the risk area plays an important role with left ventricular remodeling after myocardial infarction. (author)

  2. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock.

    Science.gov (United States)

    Thiele, Holger; Akin, Ibrahim; Sandri, Marcus; Fuernau, Georg; de Waha, Suzanne; Meyer-Saraei, Roza; Nordbeck, Peter; Geisler, Tobias; Landmesser, Ulf; Skurk, Carsten; Fach, Andreas; Lapp, Harald; Piek, Jan J; Noc, Marko; Goslar, Tomaž; Felix, Stephan B; Maier, Lars S; Stepinska, Janina; Oldroyd, Keith; Serpytis, Pranas; Montalescot, Gilles; Barthelemy, Olivier; Huber, Kurt; Windecker, Stephan; Savonitto, Stefano; Torremante, Patrizia; Vrints, Christiaan; Schneider, Steffen; Desch, Steffen; Zeymer, Uwe

    2017-12-21

    In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether PCI should be performed immediately for stenoses in nonculprit arteries is controversial. In this multicenter trial, we randomly assigned 706 patients who had multivessel disease, acute myocardial infarction, and cardiogenic shock to one of two initial revascularization strategies: either PCI of the culprit lesion only, with the option of staged revascularization of nonculprit lesions, or immediate multivessel PCI. The primary end point was a composite of death or severe renal failure leading to renal-replacement therapy within 30 days after randomization. Safety end points included bleeding and stroke. At 30 days, the composite primary end point of death or renal-replacement therapy had occurred in 158 of the 344 patients (45.9%) in the culprit-lesion-only PCI group and in 189 of the 341 patients (55.4%) in the multivessel PCI group (relative risk, 0.83; 95% confidence interval [CI], 0.71 to 0.96; P=0.01). The relative risk of death in the culprit-lesion-only PCI group as compared with the multivessel PCI group was 0.84 (95% CI, 0.72 to 0.98; P=0.03), and the relative risk of renal-replacement therapy was 0.71 (95% CI, 0.49 to 1.03; P=0.07). The time to hemodynamic stabilization, the risk of catecholamine therapy and the duration of such therapy, the levels of troponin T and creatine kinase, and the rates of bleeding and stroke did not differ significantly between the two groups. Among patients who had multivessel coronary artery disease and acute myocardial infarction with cardiogenic shock, the 30-day risk of a composite of death or severe renal failure leading to renal-replacement therapy was lower among those who initially underwent PCI of the culprit lesion only than among those

  3. Acute anterior uveitis as the initial presentation of alkaptonuria

    Directory of Open Access Journals (Sweden)

    Padhan P

    2009-01-01

    Full Text Available Alkaptonuria is a rare autosomal recessive metabolic disorder that may present with multi-system involvement such as ochronotic arthropathy, renal, urethral and prostatic calculi, cardiac valvular lesions and pigmentation of the skin, sclera, cartilage and other connective tissues. An association of the disease with uveitis has never been reported. We report the first case of alkaptonuria with ochronotic arthropathy presenting with recurrent acute anterior uveitis as the initial manifestation. The possible common link with the HLA-B27 gene is discussed.

  4. Clinical correlations, lactate extraction, coronary venous bloodflow and Thallium-201 myocardial imaging in patients with isolated left anterior descending muscle brigdes: Normal variant or obstruction

    International Nuclear Information System (INIS)

    Voss, H.; Kupper, W.; Hanrath, P.; Mathey, D.; Montz, R.; Buecking, J.; Hamburg Univ.; Hamburg Univ.

    1980-01-01

    In 848 coronary arteriograms performed in a two-years period 21 patients (2.5%) showed a myocardial bridging of the left anterior descending artery. Resting- and/or stress-ECG were abnormal in half of the patients. Regional lactate-metabolism measured in the great cardiac vein at rest and during maximal atrial pacing was normal (29 +- 12 resp. 24 +- 9%). Thermodilution of great cardiac vein bloodflow at rest and during atrial pacing also demonstrated normal values (94 +- 33 resp. 138 +- 30 ml/min). Biphasic 201-Thallium myocardial imaging revealed no case of reversible perfusion defect, but surprisingly frequent (5 of 16 patients) clearly irreversible defects limited to the interventricular septum. We conclude that muscle bridges do not cause myocardial ischemia at rest or during exercice. (orig.) [de

  5. Development and validation of an instrument to assess patients' appraisal, emotions and action tendencies preceding care-seeking in acute myocardial infarction: The PA-AMI questionnaire.

    Science.gov (United States)

    Nymark, C; Saboonchi, F; Mattiasson, A-C; Henriksson, P; Kiessling, A

    2017-03-01

    Reducing patient delay for patients afflicted by an acute myocardial infarction is a task of great complexity, which might be alleviated if more factors that influence this delay could be identified. Although a number of self-reported instruments associated with patient delay exist, none of these taps the content of the appraisal process related to patients' subjective emotions. The aim of this study was to develop and validate a questionnaire aimed at assessing patients' appraisal, emotions and action tendencies when afflicted by an acute myocardial infarction. An item pool was generated based on themes conceptualized in a recent qualitative study of acute myocardial infarction patients' thoughts, feelings and actions preceding the decision to seek medical care. The 'Think-Aloud Protocol' and test-retest analysis at item level were performed. The modified item pool was administered to 96 patients when treated for acute myocardial infarction. Explorative factor analysis and principal component analysis with the non-linear iterative partial least squares algorithm were performed to examine the underlying factor structure of the items. The findings indicated three core dimensions corresponding to three subscales, namely, 'symptom appraisal'; 'perceived inability to act'; 'autonomy preservation'. The results demonstrated acceptable measures of reliability and validity Conclusions: The PA-AMI questionnaire demonstrated satisfactory psychometric properties. Assessment of the included core dimensions may contribute to greater understanding of the appraisal processes for patients afflicted by an acute myocardial infarction.

  6. Evaluation of myocardial involvement in Duchenne progressive muscular dystrophy with thallium-201 myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Kawai, Naoki; Yamamoto, Shuhei; Okada, Mitsuhiro

    1983-01-01

    Myocardial involvement in progressive muscular dystrophy of the Duchenne type was evaluated in 19 patients using thallium-201 myocardial perfusion imaging. The qualitative analysis was performed in anterior, 3 left anterior oblique and left lateral projection images by three experienced physicians. Distinct perfusion defects were shown in 13 patients, especially in LV posterolateral or posterior walls (11 patients). There was no significant relationship between the presence of perfusion defects and the skeletal muscle changes or thoracic deformities assessed by transmission computed tomography. Slightly increased thallium-201 activity in RV free wall and lungs was shown in nine and one patient, respectively. The extensive perfusion defects were shown in 2 patients who died of congestive heart failure 1 to 2 years after the scintigraphic study. The myocardial scintigraphic changes were considered to be minimal in 7 of 9 patients who underwent two serial scintigraphic studies in 2 to 3 years. It was concluded that the thallium myocardial perfusion imaging was a useful clinical technique to evaluate the cardiomyopathy in Duchenne progressive muscular dystrophy. (author)

  7. Evaluation of myocardial involvement in Duchenne progressive muscular dystrophy with thallium-201 myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kawai, Naoki; Yamamoto, Shuhei; Okada, Mitsuhiro (Nagoya Univ. (Japan). Faculty of Medicine)

    1983-12-01

    Myocardial involvement in progressive muscular dystrophy of the Duchenne type was evaluated in 19 patients using thallium-201 myocardial perfusion imaging. The qualitative analysis was performed in anterior, 3 left anterior oblique and left lateral projection images by three experienced physicians. Distinct perfusion defects were shown in 13 patients, especially in LV posterolateral or posterior walls (11 patients). There was no significant relationship between the presence of perfusion defects and the skeletal muscle changes or thoracic deformities assessed by transmission computed tomography. Slightly increased thallium-201 activity in RV free wall and lungs was shown in nine and one patient, respectively. The extensive perfusion defects were shown in 2 patients who died of congestive heart failure 1 to 2 years after the scintigraphic study. The myocardial scintigraphic changes were considered to be minimal in 7 of 9 patients who underwent two serial scintigraphic studies in 2 to 3 years. It was concluded that the thallium myocardial perfusion imaging was a useful clinical technique to evaluate the cardiomyopathy in Duchenne progressive muscular dystrophy.

  8. Intracoronary thallium-201 scintigraphy after thrombolytic therapy for acute myocardial infarction compared with 10 and 100 day intravenous thallium-201 scintigraphy

    International Nuclear Information System (INIS)

    Heller, G.V.; Parker, J.A.; Silverman, K.J.; Royal, H.D.; Kolodny, G.M.; Paulin, S.; Braunwald, E.; Markis, J.E.

    1987-01-01

    Thallium-201 imaging has been utilized to estimate myocardial salvage after thrombolytic therapy for acute myocardial infarction. However, results from recent animal studies have suggested that as a result of reactive hyperemia and delayed necrosis, thallium-201 imaging may overestimate myocardial salvage. To determine whether early overestimation of salvage occurs in humans, intracoronary thallium-201 scans 1 hour after thrombolytic therapy were compared with intravenous thallium-201 scans obtained approximately 10 and 100 days after myocardial infarction in 29 patients. In 10 patients with angiographic evidence of coronary reperfusion, immediate improvement in thallium defects and no interim clinical events, there was no change in imaging in the follow-up studies. Of nine patients with coronary reperfusion but no initial improvement of perfusion defects, none showed worsening of defects in the follow-up images. Six of these patients demonstrated subsequent improvement at either 10 or 100 days after infarction. Seven of 10 patients with neither early evidence of reperfusion nor improvement in perfusion defects had improvement of infarct-related perfusion defects, and none showed worsening. In conclusion, serial scanning at 10 and 100 days after infarction in patients with no subsequent clinical events showed no worsening of the perfusion image compared with images obtained in acute studies. Therefore, there is no evidence that thallium-201 imaging performed early in patients with acute myocardial infarction overestimates improvement

  9. Cardiac MRI. T2-mapping versus T2-weighted dark-blood TSE imaging for myocardial edema visualization in acute myocardial infarction

    International Nuclear Information System (INIS)

    Nassenstein, K.; Nensa, F.; Schlosser, T.; Umutlu, L.; Lauenstein, T.; Bruder, O.; Maderwald, S.; Ladd, M.E.

    2014-01-01

    Purpose: To assess the diagnostic accuracy of T2 mapping for the detection of myocardial edema in acute myocardial infarction (AMI), and to compare this diagnostic accuracy with that of the current standard for myocardial edema imaging, which is T2w dark-blood TSE imaging. Materials and Methods: 29 patients with AMI were examined at 1.5 T. For the visualization of myocardial edema, T2 maps, calculated from three T2w SSFP images, and T2w dark-blood TSE images were acquired in standard short- and long-axis views. Cine SSFP images were acquired for the analysis of left ventricular (LV) function and late gadolinium enhancement images (LGE) for the visualization of myocardial necrosis. The T2 maps as well as the T2w dark-blood TSE images were evaluated twice independently from the cine SSFP and LGE images. The presence or absence of myocardial edema was rated visually for each LV segment. As the standard of reference, the infarct zone was defined based on the cine SSFP and the LGE images. Results: In this segment-based analysis, T2 mapping showed a sensitivity of 82 % and a specificity of 94 % for the detection of edema in the infarct zone. T2w dark-blood TSE imaging revealed a sensitivity of 50 % and a specificity of 98 %. T2 mapping showed a higher intra-rater agreement compared to T2w dark-blood TSE imaging (κ: 0.87 vs. 0.76). Conclusions: T2 mapping allows for the visualization of myocardial edema in AMI with a high sensitivity and specificity, and features better diagnostic accuracy in terms of a higher sensitivity compared to T2w dark-blood TSE imaging. (orig.)

  10. Characteristics and prognostic importance of ST-segment elevation on Holter monitoring early after acute myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H; Nielsen, J R; Berning, J

    1995-01-01

    The correlation between episodes of ST-segment elevation on Holter monitoring, clinical characteristics, left ventricular function, exercise testing, and long-term prognosis was determined in 123 consecutive patients 55 +/- 8 years old (mean +/- SD) with a first acute myocardial infarction (AMI...... +/- 11% (p = 0.0001). All episodes of ST-segment elevation were asymptomatic and did not correlate with different indicators of myocardial ischemia. Indeed, exercise-induced ST-segment depression was more prevalent in group 2 than in group 1: 57 vs 18% (p

  11. The Frequency of Cerebral Microembolism in Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Masoud Mehrpour

    2010-11-01

    Full Text Available ABSTRACT Introduction: Stroke is more common in patients with cerebral microembolisms. Frequency of cerebral microembolisms (high intensity transient signals, HITS in acute myocardial infarction has been reported about 17%. The factors that influence on microembolism after myocardial infarction (MI are not definitive. Type of MI, Ejection fraction, Hx of Streptokinase is the factors that were studied. Methods: During three years we studied the frequency of cerebral microembolisms in AMI patients, we studied forty patients with microembolism as a case group and ninety patients without microembolism as a control group. We detected microembolism in patients by transcranial doppler study within 72 houre after myocardial infarction. Two-dimensional echocardiogram was performed for all patients during hospitalization. Excluding criteria were prosthetic heart valves, carotid stenosis >50% and poor window for TCD monitoring. Results: number of patients who had history of receiving SK were significantly more common in case group in comparison to control group. OR 2.4 CI(1.1-5.2 The frequency was more prevalent in anterolateral MI in comparison to inferior MI.OR=3.3 CI(1.4-7.4. Ejection fraction has no significant effect on frequency of microembolism. OR 0.5 CI(0.2-1.3.Hypokinesia is also a risk factor for increasing risk of microembolism. OR 4.5 CI(1.4.13.8 Discussion: frequency of microembolism has been increased in patients with history of streptokinase or in the type of Anterolateral MI or wall motion abnormality, so we should be careful for risk of microembolism in this groups.

  12. Microvascular resistance of the culprit coronary artery in acute ST-elevation myocardial infarction

    Science.gov (United States)

    Carrick, David; Haig, Caroline; Carberry, Jaclyn; McCartney, Peter; Welsh, Paul; Ahmed, Nadeem; McEntegart, Margaret; Petrie, Mark C.; Eteiba, Hany; Lindsay, Mitchell; Hood, Stuart; Watkins, Stuart; Rauhalammi, Samuli M.O.; Mordi, Ify; Ford, Ian; Radjenovic, Aleksandra; Sattar, Naveed; Oldroyd, Keith G.

    2016-01-01

    BACKGROUND. Failed myocardial reperfusion is common and prognostically important after acute ST-elevation myocardial infarction (STEMI). The purpose of this study was to investigate coronary flow reserve (CFR), a measure of vasodilator capacity, and the index of microvascular resistance (IMR; mmHg × s) in the culprit artery of STEMI survivors. METHODS. IMR (n = 288) and CFR (n = 283; mean age [SD], 60 [12] years) were measured acutely using guide wire–based thermodilution. Cardiac MRI disclosed left ventricular pathology, function, and volumes at 2 days (n = 281) and 6 months after STEMI (n = 264). All-cause death or first heart failure hospitalization was independently adjudicated (median follow-up 845 days). RESULTS. Myocardial hemorrhage and microvascular obstruction occurred in 89 (42%) and 114 (54%) patients with evaluable T2*-MRI maps. IMR and CFR were associated with microvascular pathology (none vs. microvascular obstruction only vs. microvascular obstruction and myocardial hemorrhage) (median [interquartile range], IMR: 17 [12.0–33.0] vs. 17 [13.0–39.0] vs. 37 [21.0–63.0], P < 0.001; CFR: 1.7 [1.4–2.5] vs. 1.5 [1.1–1.8] vs. 1.4 [1.0–1.8], P < 0.001), whereas thrombolysis in myocardial infarction blush grade was not. IMR was a multivariable associate of changes in left ventricular end-diastolic volume (regression coefficient [95% CI] 0.13 [0.01, 0.24]; P = 0.036), whereas CFR was not (P = 0.160). IMR (5 units) was a multivariable associate of all-cause death or heart failure hospitalization (n = 30 events; hazard ratio [95% CI], 1.09 [1.04, 1.14]; P < 0.001), whereas CFR (P = 0.124) and thrombolysis in myocardial infarction blush grade (P = 0.613) were not. IMR had similar prognostic value for these outcomes as <50% ST-segment resolution on the ECG. CONCLUSIONS. IMR is more closely associated with microvascular pathology, left ventricular remodeling, and health outcomes than the angiogram or CFR. TRIAL REGISTRATION. NCT02072850. FUNDING. A

  13. Myocardial oxygenation and transmural lactate metabolism during experimental acute coronary stenosis in pigs.

    Science.gov (United States)

    Gonschior, P; Gonschior, G M; Conzen, P F; Hobbhahn, J; Goetz, A E; Peter, K; Brendel, W

    1992-01-01

    Measurement of surface tissue pO2 (ptO2) with surface electrodes is increasingly applied in experimental medicine. Its use on the beating heart may seem to be problematic because transmural gradients of tissue pO2 would reduce the validity of pO2 determinations in the epicardial layers. This study attempted to determine whether ptO2 may be a valid and sensitive indicator of transmural myocardial oxygenation. In order to measure ptO2, two eight-channel Clark-type electrodes were placed on a beating porcine left ventricle (n = 13). Measurements were made at different degrees of acute stenosis of the left anterior descending artery (LAD). A 24-F cannula was inserted into the great cardiac vein, draining the poststenotic myocardium to obtain coronary venous blood samples. Transmural metabolic changes were detected simultaneously by coronary venous blood gas parameters and lactate levels. Epicardial tissue pO2 was 49 +/- 2 mm Hg (mean +/- SEM) before stenosis and decreased to a mean value of 25 +/- 2 mm Hg during stenosis. Different degrees of LAD stenosis (ptO2 range: 12-35 mm Hg) were substantial enough to alter arterio-coronary venous lactate difference (avd lactate) from +0.31 +/- 0.07 mmol/l (control) to -0.62 +/- 0.15 mmol/l (stenosis). A significant linear correlation between changes of ptO2 (delta ptO2) and changes of avd lactate (delta avd lactate) resulted (y = 0.59 + 0.62x; r = 0.86; p less than or equal to 0.001). However, linear regression analysis between delta ptO2 correlated with the corresponding data from coronary venous pO2 (delta pO2cv) oxygen content (delta O2contcv), and oxygen saturation (delta O2satcv) showed no significant correlations. We conclude that measurement of ptO2 is a sensitive and valuable indicator of transmural oxygenation in ischemic myocardium, whereas pO2cv, O2contcv and O2satcv do not seem to be valid predictors of ischemia in myocardial oxygenation.

  14. Women's experiences and behaviour at onset of symptoms of ST segment elevation acute myocardial infarction

    DEFF Research Database (Denmark)

    Herning, Margrethe; Hansen, Peter R; Bygbjerg, B

    2011-01-01

    BACKGROUND: Minimizing time from onset of symptoms to treatment (treatment delay) is crucial for patients with ST segment elevation acute myocardial infarction (STEMI), and one of the great challenges is to reduce the delay relating to the prehospital behaviour of the patient (patient delay...

  15. Myocardial Hemorrhage After Acute Reperfused ST-Segment–Elevation Myocardial Infarction

    Science.gov (United States)

    Carrick, David; Haig, Caroline; Ahmed, Nadeem; McEntegart, Margaret; Petrie, Mark C.; Eteiba, Hany; Hood, Stuart; Watkins, Stuart; Lindsay, M. Mitchell; Davie, Andrew; Mahrous, Ahmed; Mordi, Ify; Rauhalammi, Samuli; Sattar, Naveed; Welsh, Paul; Radjenovic, Aleksandra; Ford, Ian; Oldroyd, Keith G.

    2016-01-01

    Background— The success of coronary reperfusion therapy in ST-segment–elevation myocardial infarction (MI) is commonly limited by failure to restore microvascular perfusion. Methods and Results— We performed a prospective cohort study in patients with reperfused ST-segment–elevation MI who underwent cardiac magnetic resonance 2 days (n=286) and 6 months (n=228) post MI. A serial imaging time-course study was also performed (n=30 participants; 4 cardiac magnetic resonance scans): 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. Myocardial hemorrhage was taken to represent a hypointense infarct core with a T2* value of hemorrhage 2 days post MI was associated with clinical characteristics indicative of MI severity and inflammation. Myocardial hemorrhage was a multivariable associate of adverse remodeling (odds ratio [95% confidence interval]: 2.64 [1.07–6.49]; P=0.035). Ten (4%) patients had a cardiovascular cause of death or experienced a heart failure event post discharge, and myocardial hemorrhage, but not microvascular obstruction, was associated with this composite adverse outcome (hazard ratio, 5.89; 95% confidence interval, 1.25–27.74; P=0.025), including after adjustment for baseline left ventricular end-diastolic volume. In the serial imaging time-course study, myocardial hemorrhage occurred in 7 (23%), 13 (43%), 11 (33%), and 4 (13%) patients 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. The amount of hemorrhage (median [interquartile range], 7.0 [4.9–7.5]; % left ventricular mass) peaked on day 2 (Phemorrhage and microvascular obstruction follow distinct time courses post ST-segment–elevation MI. Myocardial hemorrhage was more closely associated with adverse outcomes than microvascular obstruction. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850. PMID:26763281

  16. Gingival crevicular fluid MMP-8-concentrations in patients after acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Münzel Thomas

    2011-01-01

    Full Text Available Abstract Background The aim of this study was to determine the presence of matrix metalloproteinase-8 in the gingival crevicular fluid (GCF of patients after acute myocardial infarction (AMI. Methods A total of 48 GCF samples from 20 AMI patients, hospitalized at the Department of Cardiology and Angiology of the Johannes Gutenberg University Mainz, were investigated. Besides the myocardial infarction all patients suffered from chronic periodontal disease. Fifty-one GCF samples from 20 healthy age matched individuals with similar periodontal conditions served as controls. The dental examination included the assessment of oral hygiene, gingival inflammation, probing pocket depth, clinical attachment level and X-ray examination. The study was only carried out after the positive consent of the regional ethic commission. A quantitative assessment of aMMP-8 levels in the gingival crevicular fluid was performed with the help of the DentoAnalyzer (Dentognostics GmbH, Jena, Germany, utilising an immunological procedure. Results The aMMP-8 concentrations found in the gingival crevicular fluid of the AMI patients significantly differed (p = 0.001; mean value 30.33 ± 41.99 ng/ml aMMP-8 from the control group (mean value 10.0 ± 10.7 ng/ml aMMP-8. These findings suggest that periodontal inflammation in AMI patients might be associated with higher MMP-8-values compared to the healthy controls. Conclusions The acute myocardial infarction seems to influence the degree of periodontal inflammation, thus the measurement of the gingival crevicular fluid MMP8 levels seems to be a helpful biochemical test to obtain information about the severity of the periodontal disease.

  17. Acute Embolic Myocardial Infarction in a Patient with Paroxysmal Atrial Fibrillation Receiving Direct-current Cardioversion

    Directory of Open Access Journals (Sweden)

    Tung-Chao Lin

    2009-03-01

    Full Text Available Coronary embolism with acute myocardial infarction (MI following direct-current (DC cardioversion of atrial fibrillation (AF has rarely been reported. We present the case of a 34-year-old female with severe aortic regurgitation and highly symptomatic paroxysmal AF. Acute embolic MI occurred 4 days after DC cardioversion of AF, although there was no left atrial thrombus detected before this procedure. Insufficient anticoagulation therapy during the post-cardioversion period was the cause, leading to embolic MI.

  18. Intra-articular lignocaine as a means of analgesia during manual reduction of acute anterior shoulder dislocation

    Directory of Open Access Journals (Sweden)

    Manoj Kadel

    2016-11-01

    Full Text Available Background & Objectives: Acute anterior shoulder dislocation needs prompt reduction of the dislocation. The ideal reduction method should be simple, fast, effective and non- traumatic, with minimal pain, and should not cause further injury to the affected shoulder. Intra-articular local lignocaine injection is a means of achieving analgesia with less complication, and allowing prompt patient discharge of patient after reduction. The study was conducted with objective to evaluate the effectiveness of intra-articular lignocaine for reduction of acute anterior shoulder dislocation.Materials & Methods: Twenty- one cases of acute anterior shoulder dislocation were reduced using intra-articular local lignocaine injection as a method of analgesia by modified Hippocrates method.Results: The mean age was 44.71 years ± SD 20.14 while 11 cases were reduced with one to six hours of injury. Pain assessed through application of a visual analogue scale during the maneuver revealed scores ranging from two to eight with mean score of 4.29 ± SD 1.55.Conclusion: This method is not only safe and effective but also reduces hospital stay and has negligible adverse effects making it a popular choice for most orthopedists.

  19. Effect of coronary occlusion site on angiographic and clinical outcome in acute myocardial infarction patients treated with early coronary intervention

    NARCIS (Netherlands)

    Elsman, P; van't Hof, AWJ; Hoorntje, JCA; de Boer, MJ; Borm, GF; Suryapranata, H; Ottervanger, JP; Gosselink, AM; Zijlstra, F; Dambrink, Jan Hendrik Everwijn

    2006-01-01

    In acute myocardial infarction that is treated with thrombolysis, proximal coronary artery occlusion is associated with worse prognosis, irrespective of the infarcted artery. Primary percutaneous coronary intervention (PCI) is currently the treatment of choice for ST-segment elevation acute

  20. ECG and enzymatic indicators of therapeutic success after intravenous streptokinase for acute myocardial infarction

    DEFF Research Database (Denmark)

    Clemmensen, P; Grande, P; Pedersen, F

    1990-01-01

    Thrombolytic therapy has been documented to result in reperfusion of jeopardized myocardium and reduction in the size of the acute myocardial infarction (AMI). The effect of intravenous streptokinase on a creatine kinase-MB (CK-MB) reperfusion index and an ECG estimate of myocardial salvage...... was therefore studied in 65 patients with a first AMI, randomized to treatment with streptokinase (n = 33) or placebo (control group, n = 32). Reperfusion was defined as a CK-MB appearance rate constant (k1) greater than 0.185. The final AMI size was first predicted from the admission standard ECG by previously...... developed formulas based on ST segment elevation. The final AMI size was estimated from the QRS score on the predischarge ECG. Myocardial salvage was defined as a greater than or equal to 20% decrease from predicted to final AMI size. The k1 value in the control group was significantly lower than...

  1. Myocardial perfusion assessed by contrast echocardiography and single photon emission computed tomography in the evaluation of patients with acute chest pain and normal electrocardiogram

    International Nuclear Information System (INIS)

    Soares, J. Jr.; Ferreira, S.M.A.; Matias, W. Jr.; Giorgi, M.C.P.; Izaki, M.; Luz, P.L.; Ramires, J.A.F.; Meneghetti, J.C.

    2002-01-01

    Aim : Evaluation of diagnostic accuracy of myocardial contrast echocardiography (MCE) in comparison with single-photon emission computed tomography (SPECT) for the detection of myocardial ischemia in patients with acute chest pain. Material and Methods : Eighteen patients (pts) with chest pain lasting ≥30 minutes, occurring within 6 hours of emergency room presentation and a normal or no diagnostic electrocardiogram were studied. Pts underwent rest MCE and SPECT. For both exams myocardial perfusion was assessed in the same 7 segments (apical, anterior, inferior, anteroseptal, inferoseptal, lateral and posterior) of left ventricle. A total of 126 segments were analyzed. Images were classified as positive for ischemia if they had a perfusion defect. Coronary angiography was performed if MCE or SPECT images were classified as positive for ischemia or by clinical indication. Otherwise the patients underwent stress SPECT. Significant coronary artery disease (CAD) was defined as ≥70% stenosis in a major coronary artery or its branches. Final diagnosis of an acute coronary event (ACE) was established in the presence of positive findings in MCE or SPECT in addition to significant CAD in the corresponding territory. Kappa statistics were calculated to evaluate the concordance between MCE and SPECT. κ values of ≤0.4, >0.4 and >0.7 indicate fair, good and excellent agreement, respectively. Results: Thirteen out of 18 pts underwent coronary angiography (seven pts had positive findings on SPECT, 2 on MCE, 2 on both exams and 1 had clinical indication). Significant CAD was detected on six. Five pts underwent stress SPECT and no perfusion defect was detected. Therefore, six pts (33.3%) had an ACE and 12 (66.6%) had not. There were no statistical differences between groups according to age, gender, duration of pain, free pain interval, presence of risk factors and antecedents. Concordance between MCE and SPECT for evaluation of perfusion defects showed a ? coefficient of 0

  2. Stress thallium-201 myocardial scintigraphy for the detection of individual coronary arterial lesions in patients with and without previous myocardial infarction

    International Nuclear Information System (INIS)

    Rigo, P.; Bailey, I.K.; Griffith, L.S.; Pitt, B.; Wagner, H.N. Jr.; Becker, L.C.

    1981-01-01

    The value of stress thallium-201 scintigraphy for detecting individual coronary arterial stenoses was analyzed in 141 patients with angiographically proved coronary artery disease, 101 with and 40 without a previous myocardial infarction. In patients without infarction, the sensitivity for detecting greater than 50 percent narrowing in the left anterior descending, the right and the left circumflex coronary artery was 66, 53 and 24 percent, respectively. In those with a previous infarction, the sensitivity for demonstrating disease in the artery corresponding to the site of infarction was 100 percent for the left anterior descending, 79 percent for the right and 63 percent for the left circumflex coronary artery. In patients with a prior anterior infarction, concomitant right or left circumflex coronary arterial lesions were detected in only 1 of 12 cases, whereas in those with previous inferior or inferolateral infarction, the sensitivity for left anterior descending coronary artery disease was 69 percent. Because of the reasonably high sensitivity for detecting left anterior descending arterial disease, irrespective of the presence and location of previous infarction, myocardial scintigraphy was useful in identifying multivessel disease in patients with a previous inferior infarction. However, because of its relative insensitivity for right or left circumflex coronary artery disease, scintigraphy proved to be a poor predictor of multivessel disease in patients with a prior anterior infarction and in patients without previous myocardial infarction

  3. Assessment of myocardial viability using 123I-labeled iodophenylpentadecanoic acid at sustained low flow or after acute infarction and reperfusion.

    Science.gov (United States)

    Yang, J Y; Ruiz, M; Calnon, D A; Watson, D D; Beller, G A; Glover, D K

    1999-05-01

    123I-labeled iodophenylpentadecanoic acid (IPPA) is a synthetic fatty acid that may be useful for determination of myocardial viability. We investigated the uptake and clearance kinetics of this tracer in canine models of ischemia and infarction. In protocol 1, 185 MBq (5 mCi) 123I-IPPA were injected intravenously in 19 dogs with 50% left anterior descending artery (LAD) flow reduction. In 9 dogs, 201TI was coinjected. In protocol 2, 5 dogs underwent LAD occlusion for 3 h, and 123I-IPPA was injected 60 min after reperfusion. All dogs had flow measured by microspheres, regional systolic thickening by ultrasonic crystals and measurements of postmortem risk area and infarct size. Tracer activities were quantified by gamma well counting and by serial imaging. In protocol 1 dogs with sustained low flow (50% +/- 4%) and absence of systolic thickening (-3.2% +/- 1%), 123I-IPPA defect magnitude (LAD/left circumflex artery [LCX] count ratios) decreased from 0.65 +/- 0.02 to 0.74 +/- 0.02 at 30 min and to 0.84 +/- 0.03 at 2 h (P < 0.01), indicative of rest redistribution. Final transmural 123I-IPPA LAD/LCX activity ratio (0.99 +/- 0.05) was significantly greater than the flow ratio (0.53 +/- 0.04) at injection, confirming complete rest redistribution. The final 123I-IPPA activity ratio was significantly greater than the 201TI ratio over the 2-h period (P < 0.01). In protocol 2 dogs that underwent 3 h of total LAD occlusion and reflow (infarct size = 51% +/- 13% of risk area), viability was overestimated with 123I-IPPA, because uptake averaged 64% of normal in the central necrotic region, where flow averaged < 10% of normal. These findings suggest that serial 123I-IPPA imaging may be useful for assessing myocardial viability under conditions of sustained low flow and myocardial asynergy, such as appears to exist in patients with chronic coronary artery disease and depressed left ventricular function. In contrast, 123I-IPPA given early after reperfusion following prolonged

  4. Statin therapy and clinical outcomes in myocardial infarction patients complicated by acute heart failure : insights from the EPHESUS trial

    NARCIS (Netherlands)

    Dobre, Daniela; Rossignol, Patrick; Murin, Jan; Parkhomenko, Alexander; Lamiral, Zohra; Krum, Henry; van Veldhuisen, Dirk J.; Pitt, Bertram; Zannad, Faiez

    Several clinical trials have shown that in patients with acute myocardial infarction (MI), statin therapy improves cardiovascular (CV) outcomes, but in these trials patients with acute heart failure (HF) were excluded or only a few were included. In patients with chronic HF, statin therapy does not

  5. Interventional therapy for acute myocardial infarction associated with postinfarction ventricular septal rupture: report of 6 cases

    International Nuclear Information System (INIS)

    Zhou Ling; Xie Dujiang; Dong Jing; Wu Chengquan; Tian Nailiang; Li Xiaobo; Wang Rong; Chen Shaoliang

    2014-01-01

    Objective: To evaluate the curative effect of interventional therapy in treating acute myocardial infarction (AMI) associated with postinfarction ventricular septal rupture (VSR). Methods: Transcatheter closure was performed in 6 patients with VSR which was caused by AMI. Percutaneous coronary intervention (PCI) was also carried out according to patient's clinical condition. The results were analyzed. Results: The interval between the occurrence of VSR and the performance of transcatheter closure ranged from 3 to 30 days. Of the six patients, transcatheter closure failed in two, who died from cardiogenic shock during hospitalization. The remaining 4 patients experienced a successful transcatheter closure procedure, and their cardiac function was improved during the follow-up period lasting for 0.5-4 years. Conclusion: Interventional transcatheter treatment is safe and feasible for acute myocardial infarction complicated by postinfarction ventricular septal rupture. (authors)

  6. Acute myocardial ischemia after aortic valve replacement: A comprehensive diagnostic evaluation using dynamic multislice spiral computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Lembcke, Alexander [Department of Radiology, Charite-Universitaetsmedizin Berlin, Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Berlin (Germany)]. E-mail: alexander.lembcke@gmx.de; Hein, Patrick A. [Department of Radiology, Charite-Universitaetsmedizin Berlin, Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Berlin (Germany); Enzweiler, Christian N.H. [Department of Radiology, Charite-Universitaetsmedizin Berlin, Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Berlin (Germany); Hoffmann, Udo [Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Klessen, Christian [Department of Radiology, Charite-Universitaetsmedizin Berlin, Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Berlin (Germany); Dohmen, Pascal M. [Department of Cardiovascular Surgery, Charite-Universitaetsmedizin Berlin, Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Berlin (Germany)

    2006-03-15

    We describe the case of a 72-year-old man presenting with endocarditis and clinical signs of acute myocardial ischemia after biological aortic valve replacement. A comprehensive cardiac dynamic multislice spiral computed tomography demonstrated: (1) an endocarditic vegetation of the aortic valve; (2) a subvalvular leakage feeding a paravalvular pseudoaneurysm based on an aortic root abscess with subsequent compromise of the systolic blood flow in the left main coronary artery and the resulting myocardial perfusion deficit.

  7. Acute myocardial ischemia after aortic valve replacement: A comprehensive diagnostic evaluation using dynamic multislice spiral computed tomography

    International Nuclear Information System (INIS)

    Lembcke, Alexander; Hein, Patrick A.; Enzweiler, Christian N.H.; Hoffmann, Udo; Klessen, Christian; Dohmen, Pascal M.

    2006-01-01

    We describe the case of a 72-year-old man presenting with endocarditis and clinical signs of acute myocardial ischemia after biological aortic valve replacement. A comprehensive cardiac dynamic multislice spiral computed tomography demonstrated: (1) an endocarditic vegetation of the aortic valve; (2) a subvalvular leakage feeding a paravalvular pseudoaneurysm based on an aortic root abscess with subsequent compromise of the systolic blood flow in the left main coronary artery and the resulting myocardial perfusion deficit

  8. "Spice" (Synthetic Marijuana) Induced Acute Myocardial Infarction: A Case Series.

    Science.gov (United States)

    Ul Haq, E; Shafiq, A; Khan, A A; Awan, A A; Ezad, S; Minteer, W J; Omar, B

    2017-01-01

    Marijuana is the most widely abused "recreational" substance in the United States, with highest prevalence in young adults. It is reported to cause ischemic strokes, hepatitis, anxiety, and psychosis. Although it is associated with dose dependent tachycardia and can lead to coronary vasospasm, it has not been directly related to acute myocardial infarction (AMI). Marijuana induced coronary vasospasm can result in endothelial denudation at the site of a vulnerable atherosclerotic plaque in response to hemodynamic stressors, potentially causing an AMI. Spice refers to herbal mixture with composition and effects similar to that of marijuana and therefore is referred to as "synthetic marijuana." Herein, we report 3 cases of spice induced ST-segment elevation myocardial infarction. All patients were relatively young and had few or absolutely no risk factors for cardiovascular disease. All patients underwent emergent coronary angiography, with two needing stent placement and the third requiring only aspiration thrombectomy. Our case series emphasizes the importance of suspecting and investigating synthetic marijuana use in low risk young adults presenting with AMI.

  9. Regional myocardial extraction of a radioiodinated branched chain fatty acid during right ventricular pressure overload due to acute pulmonary hypertension

    International Nuclear Information System (INIS)

    Hurford, W.; Lowenstein, E.; Zapol, W.; Barlai-Kovach, M.; Livni, E.; Elmaleh, D.R.; Strauss, H.W.

    1985-01-01

    To determine whether branched chain fatty acid extraction is reduced during right ventricular (RV) dysfunction due to acute pulmonary artery hypertension, studies were done in 6 anesthetized dogs. Regional branched chain fatty acid extraction was measured by comparing the myocardial uptake of I-125 labeled 15-[p-(iodophenyl)]-3-methylpentadecanoic acid (I-PDA) to myocardial blood flow. Acute pulmonary hypertension was induced by incremental intravenous injection of 100 micron diameter glass beads into six pentobarbital anesthetized, mechanically ventilated dogs. Myocardial blood flow was measured by radiolabeled microspheres both under baseline conditions and during pulmonary hypertension. Mean RV pressure rose from 12 +- 2 (mean +- SEM) to 30 +-3mmHg resulting in a 225 +- 16% increase in RV stroke work. RV ejection fraction, as assessed by gated blood pool scans fell from 39 +- 2 to 18 +- 2%. Left ventricular (LV) pressures, stroke work and ejection fraction were unchanged. Myocardial blood flow increased 132 + 59% in the RV free wall and 67 +- 22% in the RV septum. LV blood flow was unchanged. Despite increased RV work and myocardial blood flow, no differences were noted in the branched chain fatty acid extraction ratios among LV or RV free walls or septum. The authors conclude that early RV dysfunction associated with pulmonary artery hypertension is not due to inadequate myocardial blood flow or branched chain fatty acid extraction

  10. Immediate rule-out of acute myocardial infarction using electrocardiogram and baseline high-sensitivity troponin I

    DEFF Research Database (Denmark)

    Neumann, Johannes Tobias; Sörensen, Nils Arne; Ojeda, Francisco

    2017-01-01

    AIMS: Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG...

  11. Impact of congestive heart failure and left ventricular systolic function on the prognostic significance of atrial fibrillation and atrial flutter following acute myocardial infarction

    DEFF Research Database (Denmark)

    Pedersen, Ole Dyg; Bagger, Henning; Køber, Lars

    2005-01-01

    fibrillation in acute myocardial infarction patients that might explain previous discrepancies. METHODS: The study population was 6676 patients consecutively admitted to hospital with acute myocardial infarction. Information on the presence of atrial fibrillation/flutter, left ventricular systolic function......BACKGROUND: Reports on the prognostic importance of atrial fibrillation following myocardial infarction have provided considerable variation in results. Thus, this study examined the impact of left ventricular systolic function and congestive heart failure on the prognostic importance of atrial...... and congestive heart failure were prospectively collected. Mortality was followed for 5 years. RESULTS: In patients with left ventricular ejection fraction

  12. What is new HLA-B27 acute anterior uveitis?

    Science.gov (United States)

    Wakefield, Denis; Chang, John H; Amjadi, Shahriar; Maconochie, Zoe; Abu El-Asrar, Ahmed; McCluskey, Peter

    2011-04-01

    Acute anterior uveitis (AAU) is the most common form of uveitis, accounting for approximately 90% of all cases. Half of all cases of AAU are HLA-B27 positive. The disease is typically acute in onset, unilateral, nongranulomatous inflammation involving the iris and ciliary body, with a tendency to recurrent attacks. Approximately 50% of all patients with HLA-B27 AAU develop an associated seronegative arthritis (SNA), while approximately 25% of the patients initially diagnosed with HLA-B27 SNA develop AAU. Environmental factors play a critical role in the pathogenesis of AAU; in particular, bacterial triggers have been strongly implicated in the development of this disease. Topical corticosteroids and cycloplegic agents remain the cornerstones of treatment for AAU. Salazopirine and methotrexate are effective in decreasing recurrent attacks. Biological agents such as anti-TNF and anti-CD20 therapy may be effective in refractory severe AU but are rarely required.

  13. Acute Aortic Dissection Mimicking STEMI in the Catheterization Laboratory: Early Recognition Is Mandatory

    Directory of Open Access Journals (Sweden)

    Alessio Arrivi

    2012-01-01

    Full Text Available Coronary malperfusion due to type A aortic dissection is a life-threatening condition where timely recognition and treatment are mandatory. A 77-year-old woman underwent an acute evolving type A aortic dissection mimicking acute myocardial infarction. Two pathophysiologic mechanisms are discussed: either thrombosis migrating from a previously treated giant aneurism of proximal left anterior descending or a local arterial complication due to left main stenting. Recognition of these occurrences in the catheterization laboratory is important to look immediately for surgery.

  14. Myocardial imaging. Coxsackie myocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Wells, R.G.; Ruskin, J.A.; Sty, J.R.

    1986-09-01

    A 3-week-old male neonate with heart failure associated with Coxsackie virus infection was imaged with Tc-99m PYP and TI-201. The abnormal imaging pattern suggested myocardial infarction. Autopsy findings indicated that the cause was myocardial necrosis secondary to an acute inflammatory process. Causes of abnormal myocardial uptake of Tc-99m PYP in pediatrics include infarction, myocarditis, cardiomyopathy, bacterial endocarditis, and trauma. Myocardial imaging cannot provide a specific cause diagnosis. Causes of myocardial infarction in pediatrics are listed in Table 1.

  15. Myocardial imaging. Coxsackie myocarditis

    International Nuclear Information System (INIS)

    Wells, R.G.; Ruskin, J.A.; Sty, J.R.

    1986-01-01

    A 3-week-old male neonate with heart failure associated with Coxsackie virus infection was imaged with Tc-99m PYP and TI-201. The abnormal imaging pattern suggested myocardial infarction. Autopsy findings indicated that the cause was myocardial necrosis secondary to an acute inflammatory process. Causes of abnormal myocardial uptake of Tc-99m PYP in pediatrics include infarction, myocarditis, cardiomyopathy, bacterial endocarditis, and trauma. Myocardial imaging cannot provide a specific cause diagnosis. Causes of myocardial infarction in pediatrics are listed in Table 1

  16. Sex Differences in Financial Barriers and the Relationship to Recovery After Acute Myocardial Infarction

    OpenAIRE

    Beckman, Adam L.; Bucholz, Emily M.; Zhang, Weiwei; Xu, Xiao; Dreyer, Rachel P.; Strait, Kelly M.; Spertus, John A.; Krumholz, Harlan M.; Spatz, Erica S.

    2016-01-01

    Background Financial barriers to health care are associated with worse outcomes following acute myocardial infarction (AMI). Yet, it is unknown whether the prevalence of financial barriers and their relationship with post?AMI outcomes vary by sex among young adults. Methods and Results We assessed sex differences in patient?reported financial barriers among adults aged

  17. Is it possible to differentiate between Takotsubo cardiomyopathy and acute anterior ST-elevation myocardial infarction?

    DEFF Research Database (Denmark)

    Vervaat, Fabienne E; Christensen, Thomas E; Smeijers, Loes

    2015-01-01

    . The latter group was divided into the following subgroups: 46 patients with proximal, 47 with mid and 10 with distal LAD occlusion. Three ST-segment based ECG features were investigated: (1) Existing criterion for differentiating anterior STEMI from TC: ST-segment depression >0.5mm in lead aVR...

  18. A rare case of gestational thyrotoxicosis as a cause of acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Varalaxmi Bhavani Nannaka

    2016-11-01

    Full Text Available Angina pectoris in pregnancy is unusual and Prinzmetal’s angina is much rarer. It accounts for 2% of all cases of angina. It is caused by vasospasm, but the mechanism of spasm is unknown but has been linked with hyperthyroidism in some studies. Patients with thyrotoxicosis-induced acute myocardial infarction are unusual and almost all reported cases have been associated with Graves’ disease. Human chorionic gonadotropin hormone-induced hyperthyroidism occurs in about 1.4% of pregnant women, mostly when hCG levels are above 70–80 000 IU/L. Gestational transient thyrotoxicosis is transient and generally resolves spontaneously in the latter half of pregnancy, and specific antithyroid treatment is not required. Treatment with calcium channel blockers or nitrates reduces spasm in most of these patients. Overall, the prognosis for hyperthyroidism-associated coronary vasospasm is good. We describe a very rare case of an acute myocardial infarction in a 27-year-old female, at 9 weeks of gestation due to right coronary artery spasm secondary to gestational hyperthyroidism with free thyroxine of 7.7 ng/dL and TSH <0.07 IU/L.

  19. Frequency of dyslipidaemia in young patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Zaman, Q.U.; Fazal, I.F.; Ali, A.; Satti, L.

    2012-01-01

    Objective: To study the frequency of dyslipidaemia in young patients aged between 20-40 years, with Acute Myocardial Infarction in our population. Study design: Descriptive study Place and duration of Study: Coronary Care Unit (CCU) of Armed Forces Institute of Cardiology (AFIC) National Institute of Heart Diseases (NIHD), Rawalpindi from December 2008 to May 2009. Subjects and Methods: One hundred patients of acute myocardial infarction (AMI) fulfilling the World Health Organization (WHO) diagnostic criteria of AMI, having ages between 20-40 years, were included in the study after full informed consent using non-probability consecutive sampling. Blood samples for serum lipid profile were taken after 12 hours fasting (within 24 hours of presentation), and analyzed in laboratory of AFIC. Individual patients' results were compiled with respect to age, gender, serum total cholesterol, serum triglycerides, serum low density lipoprotein (LDL) cholesterol, serum very low density lipoprotein (VLDL) cholesterol and serum high density lipoprotein (HDL) cholesterol. The data was entered in SPSS (version 11.0) and analyzed. Results: Of the 100 patients with AMI, 47 were found to have dyslipidaernia. Hypertriglyceridaernia was the most common lipid abnormality as it was found in 32 (68.1 %) patients; followed by raised serum VLDL, hypercholesterolemia, raised serum LDL and low serum HDL found in 25 (53.2%), 16 (34.0%), 4 (8.5%) and 2 (4.3%) patients respectively. Out of 47 patients with dyslipidaemia, 28 (59.6%) had more than one lipid abnormality. Conclusion: Frequency of dyslipidaemia in young patients with AMI in our population is high. (author)

  20. Technetium-99m-pyrophosphate myocardial imaging in unstable angina

    International Nuclear Information System (INIS)

    Willerson, J.T.; Parkey, R.W.; Lewis, S.E.; Buja, L.M.; Bonte, F.J.

    1980-01-01

    The authors have found that approximately one third of patients with the syndrome of unstable angina pectoris have abnormal 99mTc-pyrophosphate myocardial scintigrams even in the absence of abnormal enzymes and electrocardiographic confirmation of the presence of acute myocardial necrosis. Thus, 99mTc-pyrophosphate myocardial imaging technique appears to represent a sensitive means to detect acute multicellular injury associated with the clinical syndrome of unstable angina pectoris even when cardiac enzymes are normal and the electrocardiogram does not definitively document the presence of acute myocardial necrosis. (Auth.)

  1. Regional left ventricular myocardial contraction abnormalities and asynchrony in patients with hypertrophic cardiomyopathy evaluated by magnetic resonance spatial modulation of magnetization myocardial tagging

    International Nuclear Information System (INIS)

    Mishiro, Yuichiro; Oki, Takashi; Iuchi, Arata

    1999-01-01

    Global left ventricular (LV) pump function is generally preserved in patients with hypertrophic cardiomyopathy (HCM). However, it is unknown whether regional myocardial contractility is impaired, especially in nonhypertrophied regions. The purpose of this study was to evaluate regional LV myocardial contraction in patients with HCM using magnetic resonance (MR) spatial modulation of magnetization (SPAMM) myocardial tagging. The study group comprised 20 patients with asymmetric septal hypertrophy (HCM group) and 16 age-matched normal patients (control group), and data were collected using transthoracic M-mode and 2-dimensional echocardiography, and MR SPAMM myocardial tagging. The systolic strain ratio, maximum systolic strain velocity, and time from end-diastole to maximum systolic strain (ΔT) in the anterior, ventricular septal, inferior and lateral regions for 2 LV short-axis sections at the levels of the chordae tendineae and papillary muscles were measured at 50-ms intervals by MR myocardial tagging. The end-diastolic anterior and ventricular septal wall thicknesses and LV mass index were significantly different between the HCM and control groups. The systolic strain ratio for all 4 walls, particularly the anterior and ventricular septal regions, was significantly lower in the HCM group. In the HCM group, the maximum systolic strain velocity was significantly lower and ΔT was significantly shorter for all 4 walls, particularly the anterior and ventricular septal regions. The standard deviation for the ΔT, calculated from the ΔT for the 8 regions of the 2 LV short-axis sections, was significantly greater in the HCM group. In conclusion, regional LV myocardial contraction is impaired in both hypertrophied and nonhypertrophied regions, and systolic LV wall asynchrony occurs in patients with HCM. (author)

  2. [Digitalization for acute myocardial infarction: haemodynamic changes in patients with heart failure at rest (author's transl)].

    Science.gov (United States)

    Bachour, G; Hochrein, H

    1975-11-21

    Haemodynamic changes after intravenous administration of 0.4 mg beta-methyldigoxin or 0.4 mg digoxin daily were measured on the first to fourth day in 42 patients in heart failure after onset of transmural myocardial infarction. Regular reduction in filling pressure and increased stroke volume while arterial blood pressure remained unaltered pointed to improved contractility. Digitalization in the first few days after infarction achieved sustained tendency towards improved haemodynamics. It is concluded that early digitalization is indicated in patients with acute myocardial infarction if there are signs of heart failure.

  3. Determinants of delay between symptoms and hospital admission in 5978 patients with acute myocardial infarction. The TRACE Study Group. Trandolapril Cardiac Evaluation

    DEFF Research Database (Denmark)

    Ottesen, M M; Køber, L; Jørgensen, S

    1996-01-01

    of 6676 consecutive patients with enzyme-confirmed acute myocardial infarction, admitted alive to 27 Danish hospitals over a 26 month period from 1990 to 1992, were studied. Due to missing information on delay or in-hospital acute myocardial infarction 698 patients were excluded, leaving 5978 patients...... associated with male gender (odds ratio (OR) = 0.809, P = 0.003), increased age (P = 0.0001), diabetes mellitus (OR = 1.269, P = 0.03), left ventricular systolic function (wall motion index) (P = 0.02), onset from midnight to 0600h (OR = 1.434, P = 0.0001), onset on a weekday (OR = 0.862, P = 0.04), history...... depressions (OR = 0.847, P = 0.01). All these variables, except history of diabetes mellitus, angina pectoris, and chest pain as an initial symptom were also associated with a delay of more than 6 h. Thrombolytic therapy was administered to 55.8% of patients admitted within 2 h of an acute myocardial...

  4. Prognostic implications of left ventricular mass and geometry following myocardial infarction: the VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study

    DEFF Research Database (Denmark)

    Verma, Anil; Meris, Alessandra; Skali, Hicham

    2008-01-01

    associated with RWT was independent of LVMi. CONCLUSIONS: Increased baseline LV mass and abnormal LV geometry portend an increased risk for morbidity and mortality following high-risk myocardial infarction. Concentric LV hypertrophy carries the greatest risk of adverse cardiovascular events including death...... cardiovascular events. METHODS: Quantitative echocardiographic analyses were performed at baseline in 603 patients from the VALIANT (VALsartan In Acute myocardial iNfarcTion) echocardiographic study. The left ventricular mass index (LVMi) and relative wall thickness (RWT) were calculated. Patients were...... classified into 4 mutually exclusive groups based on RWT and LVMi as follows: normal geometry (normal LVMi and normal RWT), concentric remodeling (normal LVMi and increased RWT), eccentric hypertrophy (increased LVMi and normal RWT), and concentric hypertrophy (increased LVMi and increased RWT). Cox...

  5. Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction - Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year.

    Science.gov (United States)

    Cuenin, Léo; Lamoureux, Sophie; Schaaf, Mathieu; Bochaton, Thomas; Monassier, Jean-Pierre; Claeys, Marc J; Rioufol, Gilles; Finet, Gérard; Garcia-Dorado, David; Angoulvant, Denis; Elbaz, Meyer; Delarche, Nicolas; Coste, Pierre; Metge, Marc; Perret, Thibault; Motreff, Pascal; Bonnefoy-Cudraz, Eric; Vanzetto, Gérald; Morel, Olivier; Boussaha, Inesse; Ovize, Michel; Mewton, Nathan

    2018-04-25

    Up to 25% of patients with ST elevation myocardial infarction (STEMI) have ST segment re-elevation after initial regression post-reperfusion and there are few data regarding its prognostic significance.Methods and Results:A standard 12-lead electrocardiogram (ECG) was recorded in 662 patients with anterior STEMI referred for primary percutaneous coronary intervention (PPCI). ECGs were recorded 60-90 min after PPCI and at discharge. ST segment re-elevation was defined as a ≥0.1-mV increase in STMax between the post-PPCI and discharge ECGs. Infarct size (assessed as creatine kinase [CK] peak), echocardiography at baseline and follow-up, and all-cause death and heart failure events at 1 year were assessed. In all, 128 patients (19%) had ST segment re-elevation. There was no difference between patients with and without re-elevation in infarct size (CK peak [mean±SD] 4,231±2,656 vs. 3,993±2,819 IU/L; P=0.402), left ventricular (LV) ejection fraction (50.7±11.6% vs. 52.2±10.8%; P=0.186), LV adverse remodeling (20.1±38.9% vs. 18.3±30.9%; P=0.631), or all-cause mortality and heart failure events (22 [19.8%] vs. 106 [19.2%]; P=0.887) at 1 year. Among anterior STEMI patients treated by PPCI, ST segment re-elevation was present in 19% and was not associated with increased infarct size or major adverse events at 1 year.

  6. Study progress of cardiac MRI technology in assessment of myocardial viability after myocardial infarction

    International Nuclear Information System (INIS)

    Wang Jing; Zhang Hao

    2013-01-01

    Acute myocardial infarction (AMI) is one of the most common diseases that cause disability and death around the world. Correctly and effectively assessing the myocardial viability after myocardial infarction can reduce the disabled rate and mortality rate. At present, many methods could be used to assess myocardial viability. The cardiac magnetic resonance imaging (CMR) technology has a lot of advantages compared to other methods. In this paper, we reviewed the research progress of CMR in assessment of myocardial viability after myocardial infarction, and compared CMR with other technologies. (authors)

  7. The relationship between myocardial blood flow and myocardial viability after reperfusion. Myocardial viability assessed by 15O-water-PET

    International Nuclear Information System (INIS)

    Tsukagoshi, Joichi

    1994-01-01

    The purpose of this study was to examine the relationship between myocardial blood flow and myocardial viability in the ischemic canine myocardium after reperfusion. Transient ischemia was induced by 60-, 90-, and 180-minute occlusion of the left anterior descending coronary artery. Myocardial blood flow (MBF) was measured in the areas in which regional contractility was severely impaired (ehocardiographically akinetic or dyskinetic) in the early reperfusion period by 15 O-water positron emission tomography (PET) 12 hours and 4 weeks after reperfusion. An MBF ratio of ischemic to nonischemic regions 12 hours after reperfusion was inversely correlated with the amount of histologically determined tissue necrosis (r=-0.74). The regional contractility recovered 4 weeks later in the areas where an MBF ratio was 0.48 or greater, but did not recover in the areas with a lower MBF ratio. Thus, myocardial viability can be appropriately predicted in the early phase of myocardial perfusion by PET with 15 O-water even in the absence of metabolic imaging. (author)

  8. Impact of aspirin and statins on long-term survival in patients hospitalized with acute myocardial infarction complicated by heart failure

    DEFF Research Database (Denmark)

    Lewinter, Christian; Bland, John M; Crouch, Simon

    2014-01-01

    AIMS: Aspirin and statins are established therapies for acute myocardial infarction (MI), but their benefits in patients with chronic heart failure (HF) remain elusive. We investigated the impact of aspirin and statins on long-term survival in patients hospitalized with acute MI complicated by HF...

  9. Sex disparities in acute myocardial infarction incidence : Do ethnic minority groups differ from the majority population?

    NARCIS (Netherlands)

    Van Oeffelen, Aloysia A M; Vaartjes, Ilonca; Stronks, Karien; Bots, Michiel L.; Agyemang, Charles

    2015-01-01

    Background: The incidence of acute myocardial infarction (AMI) in men exceeds that in women. The extent of this sex disparity varies widely between countries. Variations may also exist between ethnic minority groups and the majority population, but scientific evidence is lacking. Methods: A

  10. Rapid estimation of left ventricular ejection fraction in acute myocardial infarction by echocardiographic wall motion analysis

    DEFF Research Database (Denmark)

    Berning, J; Rokkedal Nielsen, J; Launbjerg, J

    1992-01-01

    Echocardiographic estimates of left ventricular ejection fraction (ECHO-LVEF) in acute myocardial infarction (AMI) were obtained by a new approach, using visual analysis of left ventricular wall motion in a nine-segment model. The method was validated in 41 patients using radionuclide...

  11. Mitochondrial Membrane Permeability Inhibitors in Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Cory Trankle, MD

    2016-10-01

    Full Text Available Despite therapeutic advances, acute myocardial infarction (AMI remains a leading cause of morbidity and mortality worldwide. One potential limitation of the current treatment paradigm is the lack of effective therapies to optimize reperfusion after ischemia and prevent reperfusion-mediated injury. Experimental studies indicate that this process accounts for up to 50% of the final infarct size, lending it importance as a potential target for cardioprotection. However, multiple therapeutic approaches have shown potential in pre-clinical and early phase trials but a paucity of clear clinical benefit when expanded to larger studies. Here we explore this history of trials and errors of the studies of cyclosporine A and other mitochondrial membrane permeability inhibitors, agents that appeared to have a promising pre-clinical record yet provided disappointing results in phase III clinical trials.

  12. Long-term prognosis after acute myocardial infarction in patients with a history of arterial hypertension. TRACE study group

    DEFF Research Database (Denmark)

    Gustafsson, F; Køber, L; Torp-Pedersen, C

    1998-01-01

    AIMS: The objective of the study was to investigate the influence of a history of arterial hypertension on long-term prognosis after an acute myocardial infarction in a representative population, and secondly to assess the impact on prognosis of left ventricular systolic function in hypertensives......%) of the patients had a history of arterial hypertension. During the time of observation 763 (50.6%) hypertensives and 2253 (43.7%) normotensives died, corresponding to a risk ratio for death in hypertensives of 1.23 (1.13-1.33, P .... CONCLUSION: A history of arterial hypertension is a moderate risk factor for mortality after an acute myocardial infarction in patients aged 65 years or less. This excess risk is present at all levels of left ventricular systolic function....

  13. Cardioprotective Effects of LCZ696 (Sacubitril/Valsartan After Experimental Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Masanobu Ishii, MD

    2017-12-01

    Full Text Available LCZ696 (sacubitril/valsartan can lower the risk of cardiovascular events in chronic heart failure. However, it is unclear whether LCZ696 can improve prognosis in patients with acute myocardial infarction (MI. The present study shows that LCZ696 can prevent cardiac rupture after MI, probably due to the suppression of pro-inflammatory cytokines, matrix metalloproteinase-9 activity and aldosterone production, and enhancement of natriuretic peptides in mice. These findings suggest the mechanistic insight of cardioprotective effects of LCZ696 against acute MI, resulting in the belief that LCZ696 might be useful clinically to improve survival after acute MI.

  14. Impact of time to therapy and reperfusion modality on the efficacy of adenosine in acute myocardial infarction: the AMISTAD-2 trial.

    Science.gov (United States)

    Kloner, Robert A; Forman, Mervyn B; Gibbons, Raymond J; Ross, Allan M; Alexander, R Wayne; Stone, Gregg W

    2006-10-01

    The purpose of this analysis was to determine whether the efficacy of adenosine vs. placebo was dependent on the timing of reperfusion therapy in the second Acute Myocardial Infarction Study of Adenosine (AMISTAD-II). Patients presenting with ST-segment elevation anterior AMI were randomized to receive placebo vs. adenosine (50 or 70 microg/kg/min) for 3 h starting within 15 min of reperfusion therapy. In the present post hoc hypothesis generating study, the results were stratified according to the timing of reperfusion, i.e. > or = or < the median 3.17 h, and by reperfusion modality. In patients receiving reperfusion < 3.17 h, adenosine compared with placebo significantly reduced 1-month mortality (5.2 vs. 9.2%, respectively, P = 0.014), 6-month mortality (7.3 vs. 11.2%, P = 0.033), and the occurrence of the primary 6-month composite clinical endpoint of death, in-hospital CHF, or rehospitalization for CHF at 6 months (12.0 vs. 17.2%, P = 0.022). Patients reperfused beyond 3 h did not benefit from adenosine. In this post hoc analysis, 3 h adenosine infusion administered as an adjunct to reperfusion therapy within the first 3.17 h onset of evolving anterior ST-segment elevation AMI enhanced early and late survival, and reduced the composite clinical endpoint of death or CHF at 6 months.

  15. The relationship between coronary stenosis severity and compression type coronary artery movement in acute myocardial infarction.

    Science.gov (United States)

    Chan, Kim H; Chawantanpipat, Chirapan; Gattorna, Tim; Chantadansuwan, Thamarath; Kirby, Adrienne; Madden, Ann; Keech, Anthony; Ng, Martin K C

    2010-04-01

    Acute myocardial infarction is thought to occur at sites of minor coronary stenosis. Recent data challenge this and also propose a role for coronary artery movement (CAM) in plaque instability. We examined the relationship between coronary stenosis severity, CAM pattern, and infarct-related lesions (IRLs) in acute myocardial infarction. We investigated 203 consecutive patients with ST-segment elevation myocardial infarction after successful fibrinolysis. Quantitative coronary angiography, CAM pattern, and extent score (atheroma burden) analysis was performed for each coronary artery segment. The IRL stenosis was at least moderate (>50%) and severe (>70%) in 78% and 31% of patients, respectively. Culprit arteries were associated with higher atheroma extent scores (25.2 vs 21.6, P 70% vs Compression CAM was also strongly associated with culprit segments (OR 3.4, 95% CI 2.6-4.5, P compression CAM and stenosis severity were strongly correlated, with the likelihood of a coronary segment having compression CAM progressively increasing with worsening stenosis (OR 56.4, 95% CI 37.9-83.8, P 70% vs relationship between stenosis severity and IRLs. Our study also raises the hypothesis that compression CAM may accelerate atherosclerosis and predispose to plaque vulnerability. Copyright 2010 Mosby, Inc. All rights reserved.

  16. Off-pump supra-arterial myotomy for myocardial bridging.

    Science.gov (United States)

    Crespo, Alejandro; Aramendi, José I; Hamzeh, Gadah; Voces, Roberto

    2008-09-01

    We report the results of surgery and midterm outcome in two patients with symptomatic myocardial bridging who underwent off-pump supra-arterial myotomy. Both patients were operated upon through a median sternotomy. The anterior wall of the heart was exposed in the same manner as in off-pump CABG. The left anterior descending coronary artery is unroofed from its myocardial bridge with the aid of a heart stabilizer and a blower. Neither heparin nor blood transfusion was required. Both patients survived the operation and are asymptomatic. Postoperative coronary angiogram showed good resolution of the muscle bridge in one patient. We conclude that in symptomatic patients with myocardial bridging despite medical therapy, surgical myotomy can be considered an adequate therapy. It can be safely done off-pump.

  17. Limitation of myocardial infarct size and preservation of left ventricular function by early administration of APSAC in myocardial infarction.

    Science.gov (United States)

    Bassand, J P; Machecourt, J; Cassagnes, J; Lusson, J R; Borel, E; Schiele, F

    1989-07-05

    In cases of acute myocardial infarction (MI), it has been shown that preserving left ventricular function and limiting infarct size with early reperfusion of the occluded artery by means of a thrombolytic agent could eventually result in a reduced mortality rate. The aim of the APSIM study (anisoylated plasminogen streptokinase activator complex [APSAC] dans l'infarctus du Myocarde) was to demonstrate that early administration of APSAC in patients with recent acute MI could limit the infarct size and preserve left ventricular systolic function. In all, 231 patients with a first acute MI were randomly allocated to either APSAC (30 U over 5 minutes) or to conventional heparin therapy (5,000 IU in bolus injection) within 5 hours of the onset of symptoms. Of these patients, 112 received APSAC and 119 received heparin within a mean period of 188 +/- 62 minutes after the onset of symptoms. The patency rate of the infarct-related artery was 77% in the APSAC group and 36% in the heparin group (p less than 0.001). Left ventricular ejection fraction determined from contrast angiography was significantly higher in the APSAC than in the heparin group. This was true for the entire population (0.53 +/- 0.13 vs 0.47 +/- 0.13, p = 0.002) as well as for the subgroups of anterior and inferior wall infarctions (0.47 +/- 0.13 vs 0.4 +/- 0.16, p = 0.004 and 0.56 +/- 0.11 vs 0.51 +/- 0.09, p = 0.02). At 3 weeks, the difference remained significant for patients with anterior MI.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Evaluation of effects of early intravenous thrombolytic therapy in acute myocardial infarction with 99mTc-MIBI tomography imaging

    International Nuclear Information System (INIS)

    Zhang Zhongzheng; Xue Zheng; Qin Fuzhong

    1997-01-01

    PURPOSE: To evaluate the effects of early intravenous thrombolytic therapy in acute myocardial infarction (AMI) with 99m Tc-MIBI tomography imaging. METHODS: 22 patients with AMI were observed using 99m Tc-MIBI rest myocardial tomography imaging. The semiquantitative score of myocardial 99m Tc-MIBI uptake was expressed with a four point scoring system. RESULTS: The findings showed in patients in whom reperfusion was achieved, mean scores decreased from 9.1 +- 3.3 before thrombolytic therapy to 3.7 +- 2.2 (t 4.085, P 99m Tc-MIBI perfusion defect segments correlated with that of the ECG-determined infarct site. The comparison between the first and the second myocardial imaging in the non-thrombolytic-treatment group was statistically insignificant. CONCLUSION: The potential advantages of rest myocardial imaging in AMI before and after thrombolytic therapy not only provide an information for assessing the extent of improvement of myocardial ischemia but also provide an imaging basis for determining coronary artery reperfusion

  19. Sex disparities in acute myocardial infarction incidence: do ethnic minority groups differ from the majority population?

    NARCIS (Netherlands)

    van Oeffelen, Aloysia A. M.; Vaartjes, Ilonca; Stronks, Karien; Bots, Michiel L.; Agyemang, Charles

    2015-01-01

    The incidence of acute myocardial infarction (AMI) in men exceeds that in women. The extent of this sex disparity varies widely between countries. Variations may also exist between ethnic minority groups and the majority population, but scientific evidence is lacking. A nationwide register-based

  20. Depressive symptoms in younger women and men with acute myocardial infarction : Insights from the VIRGO Study

    NARCIS (Netherlands)

    Smolderen, Kim G.; Strait, Kelly M.; Dreyer, Rachel P.; D'Onofrio, Gail; Zhou, Shengfan; Lichtman, Judith H.; Geda, Mary; Bueno, Hector; Beltrame, John; Safdar, Basmah; Krumholz, Harlan M.; Spertus, John A.

    2015-01-01

    Background Depression was recently recognized as a risk factor for adverse medical outcomes in patients with acute myocardial infarction (AMI). The degree to which depression is present among younger patients with an AMI, the patient profile associated with being a young AMI patient with depressive

  1. Improvement of exercise capacity and left ventricular diastolic function with metoprolol XL after acute myocardial infarction

    DEFF Research Database (Denmark)

    Poulsen, S H; Jensen, S E; Egstrup, K

    2000-01-01

    dysfunction after acute myocardial infarction were given metoprolol XL (n = 29) or placebo (n = 30). The effects of metoprolol XL on exercise capacity in relation to effects on LV diastolic filling were studied. Two-dimensional Doppler echocardiography and maximal symptom limited bicycle test were performed...

  2. Myocardial scintigraphy

    International Nuclear Information System (INIS)

    Bunko, Hisashi; Hisada, Kinichi

    1982-01-01

    Among the various methods of image diagnosis of the cardiovascular disorder, nuclear cardiology provides noninvasive means for evaluation of myocardial perfusion as well as morphological and functional informations. In this article, clinical application and image diagnosis of myocardial scintigraphy including Tl-201 myocardial perfusion scintigraphy, single photon emission computed tomography with Tl-201, acute myocardial infarction scintigraphy with Tc-99m-pyrophosphate and Ga-67 imaging of the heart, were discussed. Multiplanar imaging of the heart with Tl-201 after stress and at redistribution was the accepted method for detection and evaluation of the ischemic heart disease. Although it achieved high sensitivity and specificity for ischemic heart disease, detection of the small ischemia and quantation of the regional Tl-201 accumulation were difficult with conventional multiplanar imaging. Application of emission computed tomography improved detectability and quantitativity of the ischemia. However, 7-pinhole tomography did not increase the diagnostic accuracy significantly. It had limited clinical applicability due to poor quantitativity in spite of improved image contrast and its tomographic nature. Advantage and limitation of these tomographic imaging and multiplanar imaging were discussed. Problems and prognostic significance of pyrophosphate imaging of the acute myocardial infarction were also discussed. Visualization of the heart with Ga-67 was helpful for identification of the tumor or inflammation of the heart as well as evaluation of the effect of the therapy. (author)

  3. Prevention of subsequent exercise-induced periinfarct ischemia by emergency coronary angioplasty in acute myocardial infarction: comparison with intracoronary streptokinase

    International Nuclear Information System (INIS)

    Fung, A.Y.; Lai, P.; Juni, J.E.; Bourdillon, P.D.; Walton, J.A. Jr.; Laufer, N.; Buda, A.J.; Pitt, B.; O'Neill, W.W.

    1986-01-01

    To compare the efficacy of emergency percutaneous transluminal coronary angioplasty and intracoronary streptokinase in preventing exercise-induced periinfarct ischemia, 28 patients presenting within 12 hours of the onset of symptoms of acute myocardial infarction were prospectively randomized. Of these, 14 patients were treated with emergency angioplasty and 14 patients received intracoronary streptokinase. Recatheterization and submaximal exercise thallium-201 single photon emission computed tomography were performed before hospital discharge. Periinfarct ischemia was defined as a reversible thallium defect adjacent to a fixed defect assessed qualitatively. Successful reperfusion was achieved in 86% of patients treated with emergency angioplasty and 86% of patients treated with intracoronary streptokinase (p = NS). Residual stenosis of the infarct-related coronary artery shown at predischarge angiography was 43.8 +/- 31.4% for the angioplasty group and 75.0 +/- 15.6% for the streptokinase group (p less than 0.05). Of the angioplasty group, 9% developed exercise-induced periinfarct ischemia compared with 60% of the streptokinase group (p less than 0.05). Thus, patients with acute myocardial infarction treated with emergency angioplasty had significantly less severe residual coronary stenosis and exercise-induced periinfarct ischemia than did those treated with intracoronary streptokinase. These results suggest further application of coronary angioplasty in the management of acute myocardial infarction

  4. Acute myocardial infarction and pulmonary embolism in a young man with pernicious anemia-induced severe hyperhomocysteinemia

    Directory of Open Access Journals (Sweden)

    Hofmann Marion A

    2009-05-01

    Full Text Available Abstract A 27 year-old man who presented to the hospital with progressive lower extremity weakness, developed an acute ST elevation myocardial infarction on his second hospital day. Primary angioplasty to the left anterior descending coronary artery was performed. Due to persistent dyspnea, the patient underwent a diagnostic chest computed tomography which confirmed multiple small pulmonary emboli. Laboratory analysis revealed a megaloblastic anemia with a reduced vitamin B12 level and positive titers for antibodies against intrinsic factor, establishing a diagnosis of pernicious anemia. Screening for hypercoaguable markers documented an isolated severely elevated homocysteine levels (105 μmol/l. No other significant risk factors for coronary artery disease including a family history of premature atherosclerosis were identified. This case illustrates the importance of testing for hyperhomocysteinemia as part of a workup for atherothrombotic disease, especially in patients without other significant risk factors. The severity of hyperhomocysteinemia found in our patient is unusual for patients with vitamin B12 malabsorption and raises the question of whether the widely practiced folic acid fortification in the United States may mask or even worsen vitamin B12 deficiency over time, leading to more severe cases of vitamin B12 deficiency and hyperhomocysteinemia than seen in the past.

  5. Coronary Emboli in a Young Patient with Mechanical Aortic Valve: A Rare Cause of Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Arash Gholoobi

    2016-03-01

    Full Text Available Coronary artery embolism is an uncommon cause of Acute Myocardial Infarction (AMI. Herein, we reported a 24-year-old male who was admitted with acute infero-posterior myocardial infarction and cerebral Transient Ischemic Attack (TIA. He had undergone mechanical Aortic Valve Replacement (AVR surgery 6 years ago. Surprisingly, the patient had decided to stop taking his medication (warfarin 20 days earlier without any medical advice. Coronary angiography revealed a thrombus located at the distal part of the left circumflex artery. Discontinuation of anticoagulant therapy in the presence of mechanical valve prosthesis, clinical evidence of coincidental TIA, and lack of atherosclerotic risk factors were highly suggestive of coronary thromboembolism as the cause of AMI. Overall, this case report emphasized the necessity of continuous education in patients with mechanical heart valves to prevent such undesired events.

  6. The importance of systematic inquiry in nursing research: An example; women and recovery from acute myocardial infarction.

    Science.gov (United States)

    Hamilton, G A

    1991-01-01

    A review of the literature related to recovery from acute myocardial after discharge from the hospital revealed that very little is known about the recovery period in women. The recovery period has been studied in men with the major focus on cardiac rehabilitation, return to work, and sexual activity. In this descriptive exploratory study women were compared to men in these three areas of recovery within 3 to 9 months after discharge from the hospital. There were statistically significant differences in the following areas: marital status, more women were widowed or single; women had more responsibility for household duties after acute myocardial infarction, a decrease in frequency of sexual activity, and more reports of chest pain during sexual activity. Subjects reported little or no counselling by nurses with regard to cardiac rehabilitation, return to work or household duties, and resumption of sexual activity.

  7. Prognostic implications of left ventricular mass and geometry following myocardial infarction: the VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study.

    Science.gov (United States)

    Verma, Anil; Meris, Alessandra; Skali, Hicham; Ghali, Jalal K; Arnold, J Malcolm O; Bourgoun, Mikhail; Velazquez, Eric J; McMurray, John J V; Kober, Lars; Pfeffer, Marc A; Califf, Robert M; Solomon, Scott D

    2008-09-01

    This study sought to understand prognostic implications of increased baseline left ventricular (LV) mass and geometric patterns in a high risk acute myocardial infarction. The LV hypertrophy and alterations in LV geometry are associated with an increased risk of adverse cardiovascular events. Quantitative echocardiographic analyses were performed at baseline in 603 patients from the VALIANT (VALsartan In Acute myocardial iNfarcTion) echocardiographic study. The left ventricular mass index (LVMi) and relative wall thickness (RWT) were calculated. Patients were classified into 4 mutually exclusive groups based on RWT and LVMi as follows: normal geometry (normal LVMi and normal RWT), concentric remodeling (normal LVMi and increased RWT), eccentric hypertrophy (increased LVMi and normal RWT), and concentric hypertrophy (increased LVMi and increased RWT). Cox proportional hazards models were used to evaluate the relationships among LVMi, RWT, LV geometry, and clinical outcomes. Mean LVMi and RWT were 98.8 +/- 28.4 g/m(2) and 0.38 +/- 0.08. The risk of death or the composite end point of death from cardiovascular causes, reinfarction, heart failure, stroke, or resuscitation after cardiac arrest was lowest for patients with normal geometry, and increased with concentric remodeling (hazard ratio [HR]: 3.0; 95% confidence interval [CI]: 1.9 to 4.9), eccentric hypertrophy (HR: 3.1; 95% CI: 1.9 to 4.8), and concentric hypertrophy (HR: 5.4; 95% CI: 3.4 to 8.5), after adjusting for baseline covariates. Also, baseline LVMi and RWT were associated with increased mortality and nonfatal cardiovascular outcomes (HR: 1.22 per 10 g/m(2) increase in LVMi; 95% CI: 1.20 to 1.30; p independent of LVMi. Increased baseline LV mass and abnormal LV geometry portend an increased risk for morbidity and mortality following high-risk myocardial infarction. Concentric LV hypertrophy carries the greatest risk of adverse cardiovascular events including death. Higher RWT was associated with an

  8. Unilateral Acute Anterior Ischemic Optic Neuropathy in a Patient with an Already Established Diagnosis of Bilateral Optic Disc Drusen

    Directory of Open Access Journals (Sweden)

    Ziya Ayhan

    2015-01-01

    Full Text Available Optic disc drusen (ODD are calcific deposits that form in the optic nerve head secondary to abnormalities in axonal metabolism and degeneration. Anterior ischemic optic neuropathy, central retinal artery, and vein occlusion are among the rare vascular complications of disc drusen. We reported the clinical course of a 51-year-old patient with a unilateral acute nonarteritic anterior ischemic optic neuropathy (NAION who received the diagnosis of bilateral optic disc drusen five years earlier and thereby reiterated the association of ODD and acute NAION.

  9. Early intervention in acute myocardial infarction: significance for myocardial salvage of immediate intravenous streptokinase therapy followed by coronary angioplasty

    International Nuclear Information System (INIS)

    Miller, H.I.; Almagor, Y.; Keren, G.

    1987-01-01

    Sixteen patients with acute myocardial infarction underwent treatment with streptokinase up to 3 hours after the onset of chest pain. Nine patients (group I) received streptokinase within 1 hour of the onset of pain, and seven patients (group II) received it within 2 to 3 hours. All underwent multigated radionuclide ventriculography after streptokinase therapy and 1 week later. Percutaneous transluminal coronary angioplasty of the infarct artery was performed within 24 hours in all patients. An effort-limited treadmill stress test was performed before discharge. There was no mortality or serious complication. Mean peak total creatine kinase was 521 +/- 289 mU/ml in group I, and 1,614 +/- 709 mU/ml in group II (p less than 0.05). The mean initial left ventricular ejection fraction was 47 +/- 11% in group I and 37 +/- 10% in group II. After early angioplasty (within 24 hours) and at 1 week recovery, left ventricular ejection fraction increased to 53 +/- 9% in group I (p less than 0.05) and to 40 +/- 7% in group II (p = NS). Seven of the nine patients in group I had normal radionuclide ventriculograms at discharge compared with none of the seven patients in group II. Thrombolytic therapy administered less than 1 hour after the onset of symptoms of acute myocardial infarction followed by angioplasty of the infarct artery results in preservation of left ventricular function, whereas therapy given after 2 hours has only a limited effect

  10. Role of redistribution and 24 hour reinjection images to assess myocardial viability in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Yoon, Seok Nam; Pai, Moon Sun; Park, Chan H.; Yoon, Myung Ho; Choi, Byung Il

    1998-01-01

    We evaluated the importance of redistribution and 24 hour reinjection images in Tl-201 SPECT assessment of myocardial viability after acute myocardial infarction (AMI). We performed dipyridamole stress-4 hour redistribution-24 hour reinjection Tl-201 SPECT in 43 patients with recent AMI (4-16 days). The myocardium was divided into 16 segments and perfusion grade was measured visually with 4 point score from 0 to 3 (absent uptake to normal uptake). A perfusion defect with stress score 2 was considered moderate. A defect was considered severe if the stress score was 0 or 1 (absent uptake or severe perfusion decrease). Moderate defect on stress image were considered viable and and segments with severe defect were considered viable if they showed improvement of 1 score or more on redistribution or reinjection images. We compared the results of viability assessment in stress-redistribution and stress-reinjection images. On visual analysis, 344 of 688 segments (50%) had abnormal perfusion. Fify two (15%) had moderate perfusion defects and 292 (85%) had severe perfusion defects on stress image. Of 292 severe stress defects, 53 were irreversible on redistribution and reversible on reinjection images, and 15 were reverseble on redistribution and irreversible on reinjection images. Two hundred twenty four of 292 segments (76.7%) showed concordant results on stress-redistribution and stress- reinjection images. Therefore 24 hour reinjection image changed viability status from necrotic to viable in 53 segments of 292 severe stress defect (18%). However, myocardial viability was underestimated in only 5% (15/292) of severe defects by 24 hour reinjection. The 24 hour reinjection imaging is useful in the assessment of myocardial viability. It is more sensitive than 4 hour redistribution imaging. However, both redistribution and reinjection images are needed since they complement each other

  11. Myocardial scintigraphy with gallium-67 in the detection of cardiac acute rejection

    International Nuclear Information System (INIS)

    Meneguetti, J.C.

    1990-01-01

    In order to evaluate the myocardial scintigraphy with Gallium-67 potentiality in the detection of acute rejection phenomenon, 105 studies were performed in 20 patients after they had a heart transplantation. The scintigraphic images were obtained by a conventional camera-computer system. These images were acquired 48 hours after all the patients were given an intravenous injection of 111 MBq of Gallium-67 Citrate. The biopsies were done according to the Mason technique and the histological analysis followed the Billingham standards. (author)

  12. Autonomic responses during acute myocardial infarction in the rat model: implications for arrhythmogenesis.

    Science.gov (United States)

    Kolettis, Theofilos M; Kontonika, Marianthi; Lekkas, Panagiotis; Vlahos, Antonios P; Baltogiannis, Giannis G; Gatzoulis, Konstantinos A; Chrousos, George P

    2018-04-10

    Autonomic responses participate in the pathophysiology of acute myocardial infarction, but their precise time course remains unclear. Here, we investigated the autonomic activity and ventricular tachyarrhythmias in conscious, unrestrained rats post-infarction. The left coronary artery was ligated in 12 Wistar rats, and six rats were sham operated, followed by 24-h electrocardiographic recording via implanted telemetry transmitters. Sympathetic activity was assessed by detrended fluctuation analysis and vagal activity by time- and frequency-domain analysis of heart rate variability. The duration of the ventricular tachyarrhythmias was measured, and voluntary motion served as a marker of heart failure. In sham-operated rats, heart rate and sympathetic activity remained low, whereas vagal activity rose progressively after the fourth hour. Post-ligation, medium-sized antero-septal necrosis was observed, reaching ~20% of the left ventricular volume; tachyarrhythmias were frequent, displaying a bimodal curve, and motion counts were low. Vagal activity decreased early post-ligation, coinciding with a high incidence of tachyarrhythmias, but tended to rise subsequently in rats with higher motion counts. Sympathetic activity increased after the third hour, along with a second tachyarrhythmia peak, and remained elevated throughout the 24-h period. Vagal withdrawal, followed by gradual sympathetic activation, may participate in arrhythmogenesis during acute myocardial infarction.

  13. Sleep impairment and prognosis of acute myocardial infarction

    DEFF Research Database (Denmark)

    Clark, Alice; Lange, Theis; Hallqvist, Johan

    2014-01-01

    STUDY OBJECTIVES: Impaired sleep is an established risk factor for the development of cardiovascular disease, whereas less is known about how impaired sleep affects cardiovascular prognosis. The aim of this study is to determine how different aspects of impaired sleep affect the risk of case fata...... assessment that could benefit secondary cardiovascular prevention. CITATION: Clark A, Lange T, Hallqvist J, Jennum P, Rod NH. Sleep impairment and prognosis of acute myocardial infarction: a prospective cohort study. SLEEP 2014;37(5):851-858....... registries. In women, disturbed sleep showed a consistently higher risk of long-term cardiovascular events: AMI (hazard ratio [HR] = 1.69; 95% confidence interval [CI] 0.95-3.00), stroke (HR = 2.61; 95% CI: 1.19-5.76), and heart failure (HR = 2.43; 95% CI: 1.18-4.97), whereas no clear effect of impaired...

  14. Acute coronary care: Principles and practice

    International Nuclear Information System (INIS)

    Califf, R.M.; Wagner, G.S.

    1985-01-01

    This book contains 58 chapters. Some of the chapter titles are: Radionuclide Techniques for Diagnosing and Sizing of Myocardial Infarction; The Use of Serial Radionuclide Angiography for Monitoring Function during Acute Myocardial Infarction; Hemodynamic Monitoring in Acute Myocardial Infarction; and The Valve of Radionuclide Angiography for Risk Assessment of Patients following Acute Myocardial Infarction

  15. Neuromodulation therapy does not influence blood flow distribution or left-ventricular dynamics during acute myocardial ischemia.

    Science.gov (United States)

    Kingma, J G; Linderoth, B; Ardell, J L; Armour, J A; DeJongste, M J; Foreman, R D

    2001-08-13

    Electrical stimulation of the dorsal aspect of the upper thoracic spinal cord is used increasingly to treat patients with angina pectoris refractory to conventional therapeutic strategies. The purpose of this study was to determine whether spinal cord stimulation (SCS) in dogs affects regional myocardial blood flow and left-ventricular (LV) function before and during transient obstruction of the left anterior descending coronary artery (LAD). In anesthetized dogs, regional myocardial blood flow distribution was determined using radiolabeled microspheres and left-ventricular function was measured by impedance-derived pressure-volume loops. SCS was accomplished by stimulating the dorsal T1-T2 segments of the spinal cord using epidural bipolar electrodes at 90% of motor threshold (MT) (50 Hz, 0.2-ms duration). Effects of 5-min SCS were assessed under basal conditions and during 4-min occlusion of the LAD. SCS alone evoked no change in regional myocardial blood flow or cardiovascular indices. Transient LAD occlusion significantly diminished blood flow within ischemic, but not in non-ischemic myocardial tissue. Left ventricular pressure-volume loops were shifted rightward during LAD occlusion. Cardiac indices were altered similarly during LAD occlusion and concurrent SCS. SCS does not influence the distribution of blood flow within the non-ischemic or ischemic myocardium. Nor does it modify LV pressure-volume dynamics in the anesthetized experimental preparation.

  16. Prognostic Impact of In-Hospital and Postdischarge Heart Failure in Patients With Acute Myocardial Infarction

    DEFF Research Database (Denmark)

    Sulo, Gerhard; Igland, Jannicke; Nygård, Ottar

    2017-01-01

    Background: Heart failure (HF) is a serious complication of acute myocardial infarction (AMI). We explored the excess mortality associated with HF as an early or late complication of AMI and describe changes over time in such excess mortality. Methods and Results: All patients hospitalized with a...... or late complication of AMI—has a negative impact on patients' survival. Changes in the excess mortality associated with HF are driven by modest improvements in survival among AMI patients with HF as compared to those without HF.......Background: Heart failure (HF) is a serious complication of acute myocardial infarction (AMI). We explored the excess mortality associated with HF as an early or late complication of AMI and describe changes over time in such excess mortality. Methods and Results: All patients hospitalized...... with an incident AMI and without history of prior HF hospitalization were followed up to 1 year after AMI discharge for episodes of HF. New HF episodes were classified as in‐hospital HF if diagnosed during the AMI hospitalization or postdischarge HF if diagnosed within 1 year after discharge from the incident AMI...

  17. Prognostic implications of stress hyperglycemia in acute ST elevation myocardial infarction. Prospective observational study.

    Science.gov (United States)

    Sanjuán, Rafael; Núñez, Julio; Blasco, M Luisa; Miñana, Gema; Martínez-Maicas, Helena; Carbonell, Nieves; Palau, Patricia; Bodí, Vicente; Sanchis, Juan

    2011-03-01

    In patients with acute myocardial infarction, elevation of plasma glucose levels is associated with worse outcomes. The aim of this study was to evaluate the association between stress hyperglycemia and in-hospital mortality in patients with acute myocardial infarction with ST-segment elevation (STEMI). We analyzed 834 consecutive patients admitted for STEMI to the Coronary Care Unit of our center. Association between admission glucose and mortality was assessed with Cox regression analysis. Discriminative accuracy of the multivariate model was assessed by Harrell's C statistic. Eighty-nine (10.7%) patients died during hospitalization. Optimal threshold glycemia level of 140mg/dl on admission to predict mortality was obtained by ROC curves. Those who presented glucose ≥140mg/dl showed higher rates of malignant ventricular tachyarrhythmias (28% vs. 18%, P=.001), complicative bundle branch block (5% vs. 2%, P=.005), new atrioventricular block (9% vs. 5%, P=.05) and in-hospital mortality (15% vs. 5%, PStress hyperglycemia on admission is a predictor of mortality and arrhythmias in patients with STEMI and could be used in the stratification of risk in these patients. Copyright © 2010 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  18. Intracranial hemorrhage complicating thrombolytic therapy for acute myocardial infarction

    International Nuclear Information System (INIS)

    Uglietta, J.P.; Boyko, O.B.; O'Connor, C.M.; Aldrich, H.; Massey, E.W.; Heinz, E.R.

    1990-01-01

    This paper determines the incidence and types of intracranial hemorrhage (ICH) in 1,696 patients treated with thrombolytic therapy for acute myocardial infarction (AMI). Thirteen of 1,696 patients experienced ICH, and their nonenhanced brain CT scans were reviewed. Their mean age was 62 years (range, 53-74 years), and nine of 13 were male. Six patients received tissue plasminogen activator (tPA), four streptokinase, two urokinase, and one tPA and urokinase. The hemorrhages were classified according to CT location: intraparenchymal (IPH), subarachnoid (SAH), subdural (SDH), and intraventricular (IVH). The incidence of ICH was 0.76%. There were 31 hemorrhages in 13 patients. Twelve hemorrhages were IPH, 10 were SDH, seven were SAH, and two were IVH. Excluding IVH, 24 of 29 hemorrhages (83%) were supratentorial

  19. The value of right lateral decubitus position to decrease artificial defect of cardiac anterior wall in 99Tcm-MIBI SPECT myocardial perfusion imaging for women

    International Nuclear Information System (INIS)

    Huang Kemin; Feng Yanlin; Wen Guanghua; Liang Weitang; Yu Fengwen; Liu Dejun

    2013-01-01

    Objective: To explore the value of right lateral decubitus position MPI for differentiating myocardial perfusion defect from cardiac anterior wall attenuation artificial defect, caused by breast of woman. Methods: Forty-nine patients(average age (61.5±8.4) years) who had low likelihood of coronary artery disease and had perfusion defect in the anterior wall after exercise stress 99 Tc m -MIBI MPI were included. All underwent supine and right lateral decubitus position during resting SPECT images. The myocardial perfusion SPECT images at left ventricle were reconstructed and were measured by Bull's-eye, based on the counts. Results from both supine position imaging and right lateral decubitus position imaging were compared. Paired t test was used to statistically analyse the data by SPSS 13.0. Results: Compared with supine position, the counts of the anterior, inferior, apex and lateral wall in right lateral decubitus position were significantly higher: (71.30±3.53)% vs (66.50±3.85)%, (70.06±4.45)% vs (65.44±4.16)%, (77.90±3.00)% vs (75.81±4.08)%,(79.30±2.26)% vs (72.60±3.87)% (t=6.731, 5.286, 3.555, 10.885, all P<0.01). The counts of septal wall were significantly lower ((66.60±3.98)% vs (70.06±4.51)%, t=-4.625, P<0.01) in right lateral decubitus position than that in supine position. Among the different regions of anterior wall, the counts of the anterior-middle ((76.40 ± 3.80)% vs (68.60 ± 4.76)%) and anterior-apex region ((77.10±3.24)% vs (69.00±3.54)%) were significantly higher (t=9.916, 8.870, both P<0.01) in right lateral decubitus position than those in supine position, but there was insignificance ((56.94±6.06)% vs (58.50±4.98)%, t=-1.493, P>0.05) at anterior-basal region. The artificial defect of different degrees in anterior wall was observed in all patients in supine position, 23 cases (46.9%, 23/49) showed artificial defect in the anterior-middle region and 16 cases (32.7%, 16/49) in the anterior-apex region. All artificial defect

  20. Myocardial and Peripheral Ischemia Causes an Increase in Circulating Pregnancy-Associated Plasma Protein-A in Non-atherosclerotic, Non-heparinized Pigs.

    Science.gov (United States)

    Steffensen, Lasse Bach; Poulsen, Christian Bo; Shim, Jeong; Bek, Marie; Jacobsen, Kevin; Conover, Cheryl A; Bentzon, Jacob Fog; Oxvig, Claus

    2015-12-01

    The usefulness of circulating pregnancy-associated plasma protein-A (PAPP-A) as a biomarker for acute coronary syndrome (ACS) is widely debated. We used the pig as a model to assess PAPP-A dynamics in the setting of myocardial ischemia. Induction of myocardial ischemia by ligation of the left anterior descending (LAD) coronary artery caused a systemic rise in PAPP-A. However, the ischemic myocardium was excluded as the source of PAPP-A. Interestingly, induction of ischemia in peripheral tissues by ligation of the left femoral artery caused a systemic rise in PAPP-A originating from the left hind limb. This is the first study to demonstrate PAPP-A elevations in the absence of atherosclerosis or heparin during myocardial ischemia. Our findings thus add to the current discussion of the usefulness of PAPP-A as a biomarker for ACS.

  1. Usefulness of intra-aortic balloon pump counterpulsation in patients with cardiogenic shock from acute myocardial infarction

    NARCIS (Netherlands)

    Cheng, Jin M.; Valk, Suzanne D. A.; den Uil, Corstiaan A.; van der Ent, Martin; Lagrand, Wim K.; van de Sande, Meike; van Domburg, Ron T.; Simoons, Maarten L.

    2009-01-01

    Although intra-aortic balloon pump (IABP) counterpulsation is increasingly being used for the treatment of patients with cardiogenic shock from acute myocardial infarction, data on the long-term outcomes are lacking. The aim of the present study was to evaluate the 30-day and long-term mortality and

  2. Recovery from Hospital-Acquired Anemia after Acute Myocardial Infarction and Effect on Outcomes

    OpenAIRE

    Salisbury, Adam C.; Kosiborod, Mikhail; Amin, Amit P.; Reid, Kimberly J.; Alexander, Karen P.; Spertus, John A.; Masoudi, Frederick A.

    2011-01-01

    New onset, hospital-acquired anemia (HAA) during acute myocardial infarction (AMI) is independently associated with poor outcomes. Patterns of recovery from HAA after AMI and their association with mortality and health status are unknown. In the prospective 24-center TRIUMPH registry, we identified 530 AMI patients with HAA (defined as normal hemoglobin at admission with development of anemia by discharge) who had repeat, protocol-driven hemoglobin measurement 1 month after discharge. The 1-m...

  3. “Spice” (Synthetic Marijuana Induced Acute Myocardial Infarction: A Case Series

    Directory of Open Access Journals (Sweden)

    E. Ul Haq

    2017-01-01

    Full Text Available Marijuana is the most widely abused “recreational” substance in the United States, with highest prevalence in young adults. It is reported to cause ischemic strokes, hepatitis, anxiety, and psychosis. Although it is associated with dose dependent tachycardia and can lead to coronary vasospasm, it has not been directly related to acute myocardial infarction (AMI. Marijuana induced coronary vasospasm can result in endothelial denudation at the site of a vulnerable atherosclerotic plaque in response to hemodynamic stressors, potentially causing an AMI. Spice refers to herbal mixture with composition and effects similar to that of marijuana and therefore is referred to as “synthetic marijuana.” Herein, we report 3 cases of spice induced ST-segment elevation myocardial infarction. All patients were relatively young and had few or absolutely no risk factors for cardiovascular disease. All patients underwent emergent coronary angiography, with two needing stent placement and the third requiring only aspiration thrombectomy. Our case series emphasizes the importance of suspecting and investigating synthetic marijuana use in low risk young adults presenting with AMI.

  4. Determination of infarct size of acute myocardial infarction in dogs by magnetic resonance imaging and gadolinium-DTPA: Comparison with indium-111 antimyosin imaging

    International Nuclear Information System (INIS)

    Nishimura, T.; Yamada, Y.; Hayashi, M.; Kozuka, T.; Nakatani, T.; Noda, H.; Takano, H.

    1989-01-01

    Acute myocardial infarctions were produced in nine dogs by ligation of the left anterior descending coronary artery. Twenty-four hours after ligation, 0.5 mM/kg of gadolinium (Gd)-DTPA was injected intravenously, followed by cardiectomy 30 min later. Indium-111 antimyosin was administered intravenously 6 hr before cardiectomy to compare the infarct size with Gd-DTPA contrast enhancement. Areas of Gd-DTPA contrast enhancement were closely correlated with those of indium-111 antimyosin uptake (r = .86), although the former showed slightly greater than the latter. Partial and complete enhancements were observed in three and six dogs, respectively. In the T1 and T2 maps, T1 relaxation times of the infarcted area showed greater T1 shortening compared with normal myocardium, whereas T2 relaxation times were not different between infarcted and normal myocardium. Thus, Gd-DTPA showed significant contrast enhancement of the infarcted area because of greater T1 shortening and the extent of Gd-DTPA contrast enhancement expressed the infarct size precisely

  5. Assessment of Takotsubo (ampulla) cardiomyopathy using 99mTc-tetrofosmin myocardial SPECT. Comparison with acute coronary syndrome

    International Nuclear Information System (INIS)

    Ito, Kazuki; Katoh, Shuji

    2003-01-01

    We assessed Takotsubo (ampulla) cardiomyopathy compared with acute coronary syndrome (ACS) using two-dimensional echocardiography and 99m Tc-tetrofosmin myocardial SPECT. We examined 10 patients with Takotsubo cardiomyopathy and 16 with ACS at the time of emergency admission (acute phase), at three to nine days after the attack (subacute phase) and at one month after the attack (chronic phase). The left ventricle was divided into nine regions on echocardiograms and SPECT images, and the degree of abnormalities in each region was scored in five grades from normal (0) to severely abnormal (4). Coronary angiography revealed total or subtotal occlusion in patients with ACS but no stenotic legions in those with Takotsubo cardiomyopathy. The amount of ST segment elevation (mm) was 7.9±3.4 in patients with Takotsubo cardiomyopathy and 7.3±3.7 in those with ACS (N.S.). Abnormal wall motion scores on echocardiograms were 13.8±4.4, 4.4±3.8 and 1.8±2.3 during the acute, subacute and chronic phases in patients with Takotsubo cardiomyopathy, and 13.9±4.0, 11.7±3.7, 7.6±4.2, respectively in patients with ACS. The value of MB fraction of creatine phosphokinase (IU/l) was 34±23 in patients with Takotsubo cardiomyopathy and 326±98 in those with ACS (p 99m Tc-tetrofosmin myocardial SPECT were 11.4±3.2, 3.2±3.3 and 0.7±1.1 during the acute, subacute and chronic phases respectively, in patients with Takotsubo cardiomyopathy, and 15.8±4.1, 13.5±4.4, 8.2±4.4, respectively, in those with ACS. The numbers of myocardial segments that did not uptake 99m Tc-tetrofosmin during the acute phase were 0.5±0.8 and 3.6±2.8 in patients with Takotsubo cardiomyopathy and ACS, respectively. Impaired coronary microcirculation might be a causative mechanism of Takotsubo cardiomyopathy. (author)

  6. Comparison of radiological and morphologic assessments of myocardial bridges.

    Science.gov (United States)

    Ercakmak, Burcu; Bulut, Elif; Hayran, Mutlu; Kaymaz, Figen; Bilgin, Selma; Hazirolan, Tuncay; Bayramoglu, Alp; Erbil, Mine

    2015-09-01

    In this study we aimed to compare the findings of coronary dual-source computed tomography angiography of myocardial bridges with cadaveric dissections. Forty-one isolated, non-damaged fresh sheep hearts were used in this study. Myocardial bridges of the anterior interventricular branch of the left coronary artery were demonstrated and analyzed by a coronary dual-source computed tomography angiography. Dissections along the left anterior interventricular branch of the left coronary artery were performed by using Zeiss OPMI pico microscope and the length of the bridges were measured. The depths of the myocardial bridges were measured from the stained sections by using the light microscope (Leica DM 6000B). MBs were found in all 41 hearts (100%) during dissections. Dual-source computed tomography angiography successfully detected 87.8% (36 of the 41 hearts) of the myocardial bridges measured on left anterior interventricular branch of left coronary artery. The lengths of the myocardial bridges were found 5-40 and 8-50 mm with dissection and dual-source computed tomography angiography, respectively. And the depths were found 0.7-4.5 mm by dual-source computed tomography angiography and 0.745-4.632 mm morphologically. Comparison of the mean values of the lengths showed statistically significantly higher values (22.0 ± 8.5, 17.7 ± 7.7 mm, p = 0.003) for the dissections. Radiological assessment also effectively discriminated complete bridges from incomplete ones. Our study showed that coronary computed tomography angiography is reliable in evaluating the presence and depth of myocardial bridges.

  7. Comparison of exercise ECG and radionuclide ventriculography in the assessment of myocardial ischemia in patients with isolated stenoses of the left anterior descending artery

    International Nuclear Information System (INIS)

    Klepzig, H. Jr.; Mildenberger, D.; Kaltenbach, M.; Standke, R.; Baum, R.P.; Tezak, S.; Maul, F.D.; Hoer, G.

    1988-01-01

    21 patients with LAD-stenoses of at least 70% and 21 patients with LAD-stenoses and additional intramural anterior wall infarctions were studied. 20 patients without heart disease or after successful transluminal coronary angioplasty and 18 patients with intramural anterior wall infarction after successful transluminal dilatation of the LAD (remaining stenosis maximal 30%) served as controls. The normal range of global and regional left ventricular ejection fraction response to exercise was defined based on the data of 25 further patients without relevant coronary heart disease. Thus, a decrease in global ejection fraction and regional wall motion abnormalities were judged pathological. All patients were comparable with respect to age, ejection fraction at rest and work load. Myocardial ischemia could be detected by the exercise ECG in 81% of all patients without infarction and in 71% of patients with infarction. The corresponding values for global left ventricular ejection fraction were 76% and 81%, respectively, and for regional ejection fraction 95% in both groups. No false-positive exercise ECGs were observed in the healthy controls and 2(11%) in the corresponding group with intramural infaction. The global ejection fraction was pathological in 1(5%) healthy subject without infarction and in 3(17%) corresponding patients with infarction. Sectorial analysis revealed 5 and 22%, respectively. Our findings suggest that the exercise ECG has a limited sensitivity to detect myocardial ischemia in patients with isolated LAD-stenoses and intramural myocardial infarction. Radionuclide ventriculography yields pathological values more often; however, false-positive results also occur more frequently. (orig.) [de

  8. Evaluation of (99)  (m)TcN-MPO as a new myocardial perfusion imaging agent in normal dogs and in an acute myocardial infarction canine model: comparison with (99)  (m)Tc-sestamibi.

    Science.gov (United States)

    Bu, Lihong; Li, Renfei; Jin, Zhongnan; Wen, Xiaofei; Liu, Shuang; Yang, Baofeng; Shen, Baozhong; Chen, Xiaoyuan

    2011-02-01

    (99)  (m)TcN-MPO ([(99)  (m)TcN(mpo)(PNP5)](+): mpo = 2-mercaptopyridine oxide and PNP5 = N-ethoxyethyl-N,N-bis[2-(bis(3-methoxypropyl)phosphino)ethyl]amine) is a cationic (99)  (m)Tc-nitrido complex, which has favorable biodistribution and myocardial uptake with rapid liver clearance in Sprague Dawley rats. The objective of this study was to compare the biodistribution and pharmacokinetics of (99)  (m)TcN-MPO and (99)  (m)Tc-Sestamibi in normal dogs, and to evaluate the potential of (99)  (m)TcN-MPO as a myocardial perfusion agent in canines with acute myocardial infarction. Five normal mongrel dogs were injected intravenously with (99)  (m)TcN-MPO. Venous blood samples were collected via a femoral vein catheter at 0.5, 1, 2, 3, 4, 5, 10, 20, 30, 40, 60, and 90 min post-injection (p.i.). Anterior-posterior planar images were acquired by γ-camera at 10, 20, 30, 60, 90, and 120 min p.i. Regions of interest (ROIs) were drawn around the heart, liver, and lungs. The heart/liver and heart/lung ratios were calculated by dividing the mean counts in heart ROI by the mean counts in the liver and lung ROI, respectively. For comparison, (99)  (m)Tc-sestamibi was also evaluated in the same five dogs. The interval period between the two examinations was 1 week to eliminate possible interference between these two radiotracers. In addition, single positron emission computed tomography (SPECT) images in the canine infarct model were collected 24 h after myocardial infarction at 30 and 60 min after the administration of (99)  (m)TcN-MPO (n = 4) or (99)  (m)Tc-Sestamibi (n = 4). It was found that (99)  (m)TcN-MPO and (99)  (m)Tc-Sestamibi displayed very similar blood clearance characteristics during the first 90 min p.i. Both (99)  (m)TcN-MPO and (99)  (m)Tc-Sestamibi had a rapid blood clearance with less than 50% of initial radioactivity remaining at 1 min and less than 5% at 30 min p.i. (99)  (m)TcN-MPO and (99)  (m)Tc-Sestamibi both showed good

  9. Radioimmunoassay of serum myoglobin: evaluation and modification of a commercial kit and assessment of its usefulness for detecting acute myocardial infarction

    International Nuclear Information System (INIS)

    Kubasik, N.P.; Guiney, W.; Warren, K.; D'Souza, J.P.; Sine, H.E.; Brody, B.B.

    1978-01-01

    We evaluated a modified procedure for a commercially available myoglobin radioimmunoassay kit (Nuclear Medical Systems). Within-run and run-to-run precision was acceptable. Normal ranges were established and parallelism studies performed. Clinical usefulness was assessed in 100 consecutive patients admitted to our coronary-care facility. The determinations were done daily, along with creatine kinase and its isoenzymes, and lactate dehydrogenase and its isoenzymes. Fifty of the 100 patients ultimately were shown to have had acute myocardial infarction. Myoglobinemia was present in most of the patients with acute myocardial infarction, but information on its presence was less useful clinically than was detection of creatine kinase isoenzyme MB

  10. Do episodes of anger trigger myocardial infarction?

    DEFF Research Database (Denmark)

    Möller, J; Hallqvist, J; Diderichsen, Finn

    1999-01-01

    Our objectives were to study anger as a trigger of acute myocardial infarction (MI) and to explore potential effect modification by usual behavioral patterns related to hostility.......Our objectives were to study anger as a trigger of acute myocardial infarction (MI) and to explore potential effect modification by usual behavioral patterns related to hostility....

  11. Diagnostic Accuracy of a New Cardiac Electrical Biomarker for Detection of Electrocardiogram Changes Suggestive of Acute Myocardial Ischemic Injury

    Science.gov (United States)

    Schreck, David M; Fishberg, Robert D

    2014-01-01

    Objective A new cardiac “electrical” biomarker (CEB) for detection of 12-lead electrocardiogram (ECG) changes indicative of acute myocardial ischemic injury has been identified. Objective was to test CEB diagnostic accuracy. Methods This is a blinded, observational retrospective case-control, noninferiority study. A total of 508 ECGs obtained from archived digital databases were interpreted by cardiologist and emergency physician (EP) blinded reference standards for presence of acute myocardial ischemic injury. CEB was constructed from three ECG cardiac monitoring leads using nonlinear modeling. Comparative active controls included ST voltage changes (J-point, ST area under curve) and a computerized ECG interpretive algorithm (ECGI). Training set of 141 ECGs identified CEB cutoffs by receiver-operating-characteristic (ROC) analysis. Test set of 367 ECGs was analyzed for validation. Poor-quality ECGs were excluded. Sensitivity, specificity, and negative and positive predictive values were calculated with 95% confidence intervals. Adjudication was performed by consensus. Results CEB demonstrated noninferiority to all active controls by hypothesis testing. CEB adjudication demonstrated 85.3–94.4% sensitivity, 92.5–93.0% specificity, 93.8–98.6% negative predictive value, and 74.6–83.5% positive predictive value. CEB was superior against all active controls in EP analysis, and against ST area under curve and ECGI by cardiologist. Conclusion CEB detects acute myocardial ischemic injury with high diagnostic accuracy. CEB is instantly constructed from three ECG leads on the cardiac monitor and displayed instantly allowing immediate cost-effective identification of patients with acute ischemic injury during cardiac rhythm monitoring. PMID:24118724

  12. The aminoterminal propeptide of type III procollagen provides new information on prognosis after acute myocardial infarction

    DEFF Research Database (Denmark)

    Høst, N B; Jensen, L T; Bendixen, P M

    1995-01-01

    The aim of the study was to examine sequential changes in serum levels of the aminoterminal propeptide of type III procollagen (S-PIIINP) after acute myocardial infarction (AMI), and to assess the value of S-PIIINP as a predictor of outcome. The study group comprised 74 patients with AMI, and 24 ...

  13. Multiparametric approach to diagnosis of non-Q-wave acute myocardial infarction

    International Nuclear Information System (INIS)

    Carpeggiani, C.; L'Abbate, A.; Marzullo, P.

    1989-01-01

    The present study investigated whether the lack of enzyme increase is reason enough to exclude necrosis in patients with ischemic heart disease who develop electrocardiographic sustained ST-T changes in the absence of Q waves. In 15 consecutive patients with angina who developed sustained ST-T changes during hospitalization, the presence of myocardial necrosis was investigated by a prospective multiparametric approach. Serum enzymes and myoglobin, pyrophosphate uptake, 2-dimensional echocardiography, perfusion scintigraphy, left ventriculography and coronary angiography were evaluated. According to creatine kinase and creatine kinase-MB peak at twice the upper normal value, the diagnosis of acute myocardial infarction applied only to 40% of patients. However, myoglobin was positive in 80% and a perfusion defect could be documented by an electrocardiographic gated microsphere technique in 100% of patients. The positivity of myoglobin increased to 100% and of creatine kinase and creatine kinase-MB to 87 and 60%, respectively, when a peak value twice the individual lowest value was considered for positivity. The 100% presence of perfusion defects associated with the high prevalence of