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An old male patient visited the hospital due to shortness of breath and palpitation for 6 h, with fever 3 days before and pump failure at admission. Having no risk factor of coronary diseases such as hypertension, diabetes mellitus and obesity, with ST-T changes and abnormal Q wave on ECC, the signs were compatible with those of acute anterior wall myocardial infarction, while the characteristics of cardiac biomarkers ( significant increase in Troponin I and creatine kinase's isoform, and normal creatine kinase) were not in accordance with those of acute myocardial infarction. Emergency angiography was performed, which indicated normal coronary artery, normal pulmonary artery and global systolic dysfunction of left ventricle. The diagnosis of acute severe myocarditis was established, and intra-aortic balloon pump (IABP) was employed to provide hemodynamic support. Severe myocarditis mimicking acute myocardial infarction may be fatal, and can be easily misdiagnosed. Careful analysis of clinical manifestations, early diagnostic angiography and possible IABP placement are important for the successful treatment.
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Recently,the relationship between psoriasis and coronary heart disease(CHD)have been casting close attention.It has been demonstrated that the prevalence of CHD in patients with psoriasis is more than one time higher than that of healthy people. Meanwhile,the prevalences of hypertension,diabetes mellitus, hyperlipoidemia and smoking in patients with psoriasis are higher than those of normal people,and some drugs for treatment of psoriasis may induce CHD.Therefore,the relationship between psoriasis and CHD is still unclear.In this paper,two cases of psoriasis complicated with CHD are reported,and the relationship between psoriasis and CHD is explored.
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Objective To evaluate the effect of Tirofiban on CRP levels in patients with acute myocardial infarction (AMI) after primary emergency percutaneous coronary intervention (PCI). Methods Eighty-four AMI patients admitted on emergency were randomly divided into two groups: (1) early-treated group (n=45), immediately receiving Tirofiban intravenously on admission and (2) late-treated group (n=39), receiving Tirofiban intravenously after coronary angiography was performed. TIMI grading before and after PCI in beth groups were compared, CRP levels before and three days after PCI were estimated. The major adverse cardiovascular events (MACEs) occurred during hospitalization and following-up period of three months were recorded. Results Before PCI, TIMI grade 3 forward flow rate in early-treated group was significantly higher than that in late-treated group, while no significant difference existed between two groups after PCI. Three days after PCI, CRP level in early-treated group was markedly lower than that in late-treated group. During hospitalization, the occurrence of MACEs in early-treated group was lower than that in late-treated group, while no marked difference was found between two groups during the following-up period of three months. Conclusion In treating AMI patients with primary PCI, Tirofiban should be used as early as possible, which is safe and effective for PCI and can also significantly improve forward blood flow in target vessels, decrease the ClIP level and reduce the occurrence of MACEs during hospitalization.
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Objective To compare the effects of higher dosage of atorvastatin alone and combination of lower dosage of atorvastatin with ezetimibe on levels of lipid and metalloproteinases in patients with coronary artery disease. Methods Forty-two patients with coronary artery stenosis (50% to 70% stenosis) without stent replacement were selected, and were randomly divided into atorvastatin group (treated with 20 mg or 40 mg atorvastatin alone, n = 19) and combined-therapy group(treated with 5 mg, 10 mg atorvastatin and 10 mg ezetimibe, n =23). The levels of serum lipid, hepatic and renal functions, creatine kinase, metalloproteinase (MMP)-2, MMP-9 and tissue inhibitor of MMP-1 (TIMP-1) were detected 12 weeks after treatment. Results Twelve weeks after treatment, the level of LDL-C in atorvastain group was (1.94 ± 0.49) mmol/L (37.82% decrease from baseline), and that in combined-therapy group was (1.92 ±0.54) mmol/L(38. 26% decrease from baseline), and there was no significant difference between these two groups (P >0.05). Twelve weeks after treatment, the levels of MMP-2 and MMP-9 were significantly decreased and that of TIMP-1 was significantly increased compared with baseline levels in atorvastatin, while no such changes were detected in combined-therapy group. Conclusion In patients with coronary artery stenosis, combined therapy with lower dosage of atorvastatin and ezetimibe may lead to the same lipid-lowing effects compared with therapy with higher dosage of atorvastatin, but it may not result in a significant reduction in serum levels of MMP-2, MMP-9 and increase of TIMP-1.
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Objective To investigate the effects of tirofiban application time on middle-term clinical prognosis in patients with acute ST segment elevation myocardial infarction (STEMI)treated by primary percutsneous coronary intervention (PCI). Methods The study of tirofiban was carried out in 50 patients with STEM[in cardiology department from January to December 2006. Twenty-nine patients were randomized to receive tirofiban after PCI for 24 - 36 hours(short time group, STG) and 21 patients for 48 - 72 hours (long time group,LTG). Clinical characteristics, angiography data, main adverse cardiovascular events (MACE) and coronary restenosis rate in 6-month follow-up of the two groups were. compared. Results Follow-up data showed that there was less intractable angina pectoris (14.3% vs 24.1%, P< 0.05) in LTG. But there was no significant difference in coronary restenosis rate between two groups. Conclusion Long time application of tirofiban following PCI in patients with STEMI could improve middle-term clinical prognosis by alleviating the incidence of intractable angina pectoris.
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0.05).Follow-up data showed that there were less angina pectoris attack and higher levels of LVEF in LPG comparing with SPG;showing as 1.26?0.72/day vs 1.75?0.88/day(P=0.040)and 57.2?8.6% vs 52.0?8.5%(P=0.037)respectively.Conclusions Long period application of tirofiban following PCI in patients with STEMI is safe and effective,providing alleviation both on angina pectasis and left ventricular ejectory fraction.(J Intervent Radiol,2007,16:796-798)
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Objective To investigate the effects of Tongxinluo on C reactive protein(CRP)and clinical prognosis in patients after coronary stenting. Methods From January 2003 to December 2004, 132 patients in our department diagnosed as coronary artery disease(including acute myocardial infarction, unstable angina pectoris and stable angina pectoris)were divided into two groups: Tongxinluo group and control group. The control group received routine treatment, while Tongxinluo group based on routine treatment was administrated with Tongxinluo capsule in combination for 6 months. Results CRP level was much lower in Tongxinluo group together with apparent decrease of the major adverse cardiac event(MACE)rate in 6 months' follow-up than those of the control group, but showing no difference in coronary arterial restenosis between the two groups at 6 months after coronary stenting. Conclusion Tongxinluo has favorable effects to decrease the CRP level and improve clinical efficiency together with prognosis for patients after coronary stenting.
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<p><b>OBJECTIVE</b>To examine the relationship between coronary arterial remodeling and clinical presentation.</p><p><b>METHODS</b>A total of 34 patients with acute (10 with recent myocardial infarction and 24 with unstable angina) and 26 with stable (8 with old myocardial infarction and 18 with stable angina) coronary syndrome underwent intravascular ultrasound (IVUS) before intervention. Target lesions were classified as soft or hard plaques. Quantitative measurements of cross-sectional area (CSA) of external elastic membrane (EEM), lumen and plaque were performed at the lesion site and at the proximal and distal reference sites. Remodeling index (RI) was expressed by the ratio of EEM CSA at the lesion site to the mean EEM CSA of both proximal and distal reference sites. Positive remodeling was defined as RI > 1.05 and negative remodeling as RI < 0.95.</p><p><b>RESULTS</b>Soft plaque was observed more frequently in acute than in stable coronary syndrome (59% vs 31%), whereas hard plaque was more common in stable coronary syndrome (69% vs 41%) (P = 0.03). The EEM CSA (15.11 +/- 2.89 mm(2) vs 13.25 +/- 3.10 mm(2), P = 0.019) and plaque CSA (10.83 +/- 2.62 mm(2) vs 9.30 +/- 2.84 mm(2), P = 0.035) were significantly greater at target lesions in patients with acute rather than stable coronary syndrome, while lumen CSA and percent area stenosis were similar in both groups. RI was significantly higher (1.08 +/- 0.16 vs 0.95 +/- 0.14, P = 0.002) and positive remodeling was more frequent in acute coronary syndrome (53% vs 23%, P = 0.019), whereas negative remodeling was more common in stable coronary syndrome (58% vs 24%, P = 0.007).</p><p><b>CONCLUSIONS</b>The study indicates that clinical characteristics of patients with coronary artery disease depend largely upon underlying types of coronary arterial remodeling.</p>
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Aged , Female , Humans , Male , Middle Aged , Coronary Disease , Diagnostic Imaging , Pathology , Coronary Vessels , UltrasonographyABSTRACT
Objective To estimate the value of the Angio seal (Vascular Cloure Device, St Jude Medical) in femoral artery closure after CAG (coronary angiography) or PCI (percutaneous coronary intervention). Methods From Oct 2002 to Oct 2003 316 patients received CAG or PCI at our hospital They were divided into group A (150 patients) and group B (166 patients) The Angio seal was useded in group A to close the puncturing spot of femoral artery, and the side of the body punctured was trigged for 4 hours Common hemostasis was adopted in group B Results As compared with group B, time to hemostasis and time to ambulation were notably decreased and groin hematoma and time to bleeding disposed at the puncture site were markedly reduced in group A Conclusion Safe and effective, the Angio seal may be widely adopted in clinical practice
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<p><b>OBJECTIVES</b>To compare primary stenting in the infarct-related coronary artery with intravenous rt-PA therapy plus rescue intracoronary stenting.</p><p><b>METHODS</b>Ninety-eight patients with a first acute myocardial infarction (AMI) were randomly treated with primary intracoronary stenting (primary stenting group) or with intravenous rt-PA therapy plus rescue intracoronary stenting (thrombolysis plus stenting group). Thrombolysis in myocardial infarction (TIMI) flow grade was assessed by angiography in emergency, and cardiac function (left ventricular ejection fraction, LVEF) was calculated by echocardiography before discharge between the two groups.</p><p><b>RESULTS</b>There were 47 patients (97.91%) in primary stenting group and 50 patients (100%) in thrombolysis plus stenting group had achieved TIMI grade 2 - 3 flow after the procedure. But the former had more cases (93.8%) of TIMI 3 flow than that of latter (60.0%, P = 0.0001). There was no difference between the two groups in cardiac events during hospitalization. But the patients in primary stenting group had better cardiac function (LVEF 0.62 +/- 0.14 vs. 0.50 +/- 0.12, respectively, P = 0.0001) between the two groups.</p><p><b>CONCLUSIONS</b>Primary intracoronary stenting may improve myocardial reperfusion in emergency and inhibit the decline of cardiac function after AMI in comparison with intravenous rt-PA thrombolysis plus rescue intracoronary stenting.</p>
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Aged , Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Combined Modality Therapy , Creatine Kinase , Blood , Fibrinolytic Agents , Therapeutic Uses , Infusions, Intravenous , Isoenzymes , Blood , Myocardial Infarction , Blood , Therapeutics , Recombinant Proteins , Therapeutic Uses , Stents , Tissue Plasminogen Activator , Therapeutic Uses , Treatment OutcomeABSTRACT
Objective To follow up the patients with pacemaker, observe the condition of pacemaker lead, to explore the cause of lead dislocation, to find out and prevent its occurrence.Methods Summarizing the clinical data of 6 patients with pacemaker,7 pacemaker leads with 8 time dislocation,pacemaker 2 DDDR、2 DDD、2 VVI。 Results Four patients were punctured from right subclavian vein、one from left subclavian vein and one from right brachiocephalic vein; four leads were dislocation in atrium and one mildly dislocation; four leads dislocation in ventricle and two mildly dislocation; There were 3 old women with 4 leads and 5 times of dislocation. Conclusions
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0 1 ng/ml) and minor value (0 01～0 1 ng/ml) in cardiac troponin T within 6 hours after PCA may be correlated with an increased risk for early adverse clinical outcomes after successful operation
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Objective To evaluate the clinical efficacy of cutting balloon angioplasty (CBA) for treating lesions in small coronary arteries. Methods The diameter for reference of coronary artery is less than 2.7mm which is considered as “small vessel”. CBA procedures were performed on 25 lesions in 22 patients. Results The procedure was successfully obtained in 21 lesions(84%). Seven severe stenotic lesions (diameter of stenosis≥90%) underwent dilatation with small conventional balloon(1.5 mm diameter). Bail out stenting was performed in 2 lesions because of severe dissections. Failure of cutting balloon to pass through the stenosis in one lesion. During follow up, 5 patients had recurrence of coronary angina and 3 of them underwent coronary angiography for check up, In stent restenosis (ISR) occurred in one patient, which was successfully redilated using CBA. One patient had total occlusion of the diagonal branch with ISR of LAD. One patient developed new lesion in other coronary artery.Conclusions CBA is safe and effective, and provides a new therapeutic strategy for lesions in the small coronary arteries.