ABSTRACT
The purpose of this study is to assess the relationship between left atrial (LA) size and outcome after acute myocardial infarction (AMI) in patients undergoing primary percutaneous coronary intervention (PCI) and to evaluate dynamic changes in LA size during long-term follow-up. Echocardiographic analyses were performed on 253 AMI patients (174 male and 79 female, 65.4 +/- 13.7 yr) undergoing PCI. These subjects were studied at baseline and at 12 months. Clinical follow-up were done at 30.8 +/- 7.5 months. We assessed LA volume index (LAVI) at AMI-onset and at 12-month. Change of LAVI was an independent predictor of new onset of atrial fibrillation or hospitalization for heart failure (P = 0.002). Subjects who survived the 12-month period displayed an increased LAVI mean of 1.86 +/- 4.01 mL/m2 (from 26.1 +/- 8.6 to 28.0 +/- 10.1 mL/m2, P < 0.001). The subject group that displayed an increased LAVI correlated with a low left ventricular ejection fraction, large left ventricle systolic and diastolic dimensions and an enlarged LA size. In conclusion, change of LAVI is useful parameter to predict subsequent adverse cardiac event in AMI patients. Post-AMI echocardiographic evaluation of LAVI provides important prognostic information that is significantly greater than that obtained from clinical and laboratory parameters alone.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Echocardiography , Follow-Up Studies , Heart Atria/pathology , Myocardial Infarction/pathology , Prognosis , Time FactorsABSTRACT
Endotracheal intubation is a quick, simple and safe procedure for airway management and is used in various medical procedures. Many endotracheal tubes have a cuff system, which prevents aspiration and allows positive pressure ventilation. However excessive inflation of the cuff can cause mucosal ischemia with tracheal dilation which may result in tracheal rupture, or even death. Fortunately, mucosal ischemia of the trachea can be treated successfully with well-timed control of cuff pressure. It is essential for medical practitioners to be aware of these complications and to be able to manage them effectively if they arise. We present a case of diverticular-like dilation of the lower trachea detected by fiberoptic bronchoscopy that eventually improved in the hemoptysis patient after endotracheal intubation.
Subject(s)
Humans , Airway Management , Bronchoscopy , Hemoptysis , Inflation, Economic , Intubation, Intratracheal , Ischemia , Positive-Pressure Respiration , Rupture , TracheaABSTRACT
Takotsubo cardiomyopathy is characterized clinically by transient left ventricular dysfunction in patients with normal coronary angiography findings. We report a case of Takotsubo cardiomyopathy with significant stenosis on coronary angiography. A 71-year-old woman was admitted to our hospital in a drowsy mental state. She was suspected to have diabetic ketoacidosis, but cardiac enzyme levels and electrocardiogram results were typical of myocardial infarction. Coronary angiography revealed occlusion of the distal right coronary artery. Echocardiography and left ventriculography revealed reduced left ventricular function with apical ballooning. However, coronary artery stenosis did not explain the severe reduction in left ventricular function. After 11 days, her left ventricular function and electrocardiogram results had returned to normal. Therefore, coronary artery disease does not rule out the presence of Takotsubo cardiomyopathy.