A Case of Cardiogenic Cerebral Infarction after Repair of the Post-Myocardial Infarction Ventricular Septal Perforation / 日本心臓血管外科学会雑誌

Post-myocardial infarction ventricular septal perforation (VSP) is one of the lethal complications of transmural myocardial infarction. Although the treatment of VSP mostly requires surgical procedures using heterologous pericardium, thromboembolism rarely occurs in patients who undergo VSP repair. Herein we report the case of a patient who died of sudden massive cerebral infarction two weeks after the surgery. The autopsy findings revealed concaved mural LV thrombus in the dissected heart. It is suspected that the patient died of extensive cerebral infarction due to thromboembolic occlusion of the carotid or central cerebral artery. In the postoperative period after VSP repair, several risk factors for thrombus formation may occur, such as postoperative hypercoagulability due to systemic inflammation by the high operative invasiveness, the presence of foreign material in the impaired left ventricle, or pericardial patch suturing methods. Our clinical experience indicates that meticulous postoperative management may be needed, keeping LV thrombus formation in mind after VSP repair.

Defecto septal postinfarto agudo de miocardio causado por hematoma disecante: A propósito de un caso

La ruptura del septum interventricular es reconocida como una complicación seria del infarto agudo de miocardio (IAM). Se han demostrado 2 tipos de ruptura cardíaca en el contexto de un IAM: simple y compleja, también llamada disección hemorrágica o hematoma disecante intramiocárdico. Se describe el caso de un paciente con IAM complicado con un gran defecto septal que comunica ambos ventrículos.

Rupture of the ventricular septum is a recognized serious complication of acute myocardial infarction (AMI). Two tipes of myocardial rupture have been previously described: simple and complex (hemorrhagic dissection or dissecting intramyocardial hematoma). This presentation reports the case of a patient with AMI complicated with a large ventricular septal defect in the inferior septum interventricular with communication between the right and left ventricles.

A ruptura do septo interventricular é reconhecida como uma complicação grave do infarto agudo do miocárdio (IAM). Dois tipos de ruptura cardíaca foram demonstrados no contexto de um IAM: Simples e complexo, também chamado de dissecção hemorrágica ou hematoma dissecante intramiocárdico. Descrevemos o caso de um paciente com IAM complicado por um grande defeito septal que comunica os dois ventrículos.

Early thrombolysis is associated with decreased operative mortality in postinfarction ventricular septal rupture

Background Post myocardial infarction ventricular septal rupture (PMI-VSR) is a dreaded mechanical complication of acute coronary syndromes. Given that surgical mortality approaches 50%, it is pragmatic that the risk factors for mortality and outcomes after surgical correction of PMI- VSR are carefully scrutinized. Methods We performed a single-center, retrospective cohort study of 35 patients presenting for surgical closure of post myocardial infarction ventricular septal rupture over six years. We reviewed patient characteristics, clinical, echocardiographic, angiographic and perioperative risk factors which may affect mortality after surgical repair of PMIVSR and 30 day and one year mortality rates of these patients. Univariate and multivariate logistic and cox proportional hazard regression analysis was used to identify predictors of operative and overall mortality. Long term survival was presented with Kaplan-Meier Survival Curve. Results Sixteen patients (46%) were in cardiogenic shock. Concomitant coronary artery bypass grafting (CABG) was done in 22 patients (63%) but did not influence survival. Preoperative thrombolysis was done in 12 patients (34%) out of which 10 (53%) survived Operative mortality was 46% and one-year mortality was 49%. Multivariate analysis identified preoperative thrombolysis: Hazards ratio, 0.12; 95% CI, 0.02-0.61; p value of 0.01, as significant independent predictor of survival in PMIVSR cohort. Conclusions Preoperative thrombolysis is associated with decreased odds of operative and overall mortality after surgical repair in PMIVSR patients.

Primary transcatheter closure of post-myocardial infarction ventricular septal rupture using amplatzer atrial septal occlusion device: A study from tertiary care in South India

Objective The study investigated effectiveness of transcatheter closure of post-myocardial infarction (MI) ventricular septal rupture (VSR) using atrial septal device (ASD) occluder in a cohort of patients admitted at our institute. Method This was a retrospective, observational and single center study, which included patients who were treated with transcatheter closure for post-MI VSR at our tertiary care center between May 2000 and August 2014 depending upon inclusion and exclusion criteria. Primary outcome was all-cause mortality at 30-days follow-up. The MELD-XI (Model for End Stage Liver Disease) score was used as a predictor for poor outcome in these patients. Results A total of 21 patients (mean age 66.4 ± 5.9 years) were included in the study. Study cohort predominantly included male patients (n = 15; 71.4%) and patients with single vessel disease (n = 15; 71.4%). Revascularization of the culprit lesion, before VSR closure, was attempted in 6 patients. Except one patient (treated with Cera® occluder), all patients were treated with Amplatzer® ASD occluders. Average diameter of VSR was 20.8 ± 6.9 mm. Diameter of the device used in the study ranged from 10 mm to 30 mm. Residual defect was detected in 13 patients (62%). All-cause mortality at 30-day follow-up was observed in 9 (42.9%) patients. Time to VSR closure, diameter of VSR, and serum creatinine levels were significantly related to the 30-day mortality. MELD-XI score was found to be strongly associated with increased risk of mortality. Conclusion Primary transcatheter VSR closure using ASD occluders is a feasible approach which can provide reasonable survival outcomes along with equitable mortality rates.

Clinical analysis of cardiac failure in post-myocardial infarction patients

Background: Cardiac failure is one of the common complications of Acute Myocardial Infarction. As CAD is the leading cause of death and post MI Cardiac failure also causing increase in rate of Mortality. It directs us to assess the complications of MI and to evaluate the precautionary & preventive steps of cardiac failure.Methods: The present study comprises of 50 cardiac failure patients with history of MI in the past and who presented with myocardial infarction with cardiac failure were included in this study. We excluded the patients who presented with Cardiac failure without Prior history of MI. This hospital based cross sectional study was conducted at Rajiv Gandhi Institute of Medical Sciences (RIMS), Ongole, Prakasam District, Andhra Pradesh. The study was carried out for a period of 1 year with informed consent.Results: In present study majority number of patients (33) show hypokinesia and 10 are found to have dyskinesia and only 4 are akinesia. In this study More than 50% patients are with history of anterior wall involvement. 36(72%) patients have elevated JVP, 34(68%) have cardiomegaly, 38 patients presented with PND. 29(58%) patients are DM and 35(70%) are HTN and only 6(12%) patients are neither DM, nor HTN.Conclusions: Cardiac failure is a common complication after MI. Most common presentations are breathlessness, chest pain, PND, JVP etc. Anterior wall MI on ECG either isolated or associated with other walls is the leading cause of post MI cardiac failure.

Autoeficacia en pacientes post-infarto agudo de miocardio en una IPS especializada en Girardot / Self-efficacy in post-acute myocardial infarction patients in a specialized IPS in Girardot

El Infarto Agudo de Miocardio es la principal causa de muerte en personas mayores de 55 años. Así, la morbilidad y mortalidad de esta entidad plantean un reto importante debido al impacto que producen en el estado de salud y la calidad de vida1 . Los pacientes que presentan un infarto agudo de miocardio experimentan altos niveles de estrés emocional y ansiedad. Estas percepciones se asocian a sucesos negativos como la incapacidad de cambiar comportamientos y estilo de vida o aún más, por la sensación de poder morir ante un nuevo episodio. Estas percepciones se presentan con mayor frecuencia en la fase aguda del periodo post-infarto. Se perciben a sí mismos como incapaces y limitados para desempeñar sus labores diarias, percibiendo una reducción en su calidad de vida y una baja adherencia a los tratamientos. Objetivo: Determinar el nivel de Autoeficacia general en pacientes Post-Infarto Agudo de Miocardio según la edad, género, rehabilitado o no rehabilitado atendidos en la consulta de Cardiología en una IPS especializada de la ciudad de Girardot. Método: Se llevó a cabo un estudio de abordaje cuantitativo de diseño descriptivo mediante el uso de la Escala General de Autoeficacia versión II. Esta investigación estuvo conformada por 149 personas (69 hombres y 80 mujeres) entre los 35 y 65 años que presentaron infarto agudo de miocardio y las cuales cumplieron los criterios de inclusión, a saber, haber presentado infarto agudo de miocardio (IAM) y la asistencia o no asistencia a un programa de Rehabilitación cardiaca. Para el análisis estadístico de los resultados, se utilizaron medidas estadísticas descriptivas, pruebas no paramétricas y pruebas de correlación. Resultados: La edad de los participantes de este estudio osciló entre los 35 y 65 años con una media de 52 años. La distribución general, está organizada por rangos de edad para efectos de síntesis, evidencia una población heterogénea donde el mayor porcentaje se sitúa entre los 46 y 55 años, con 38.9%. La edad no modifica el nivel de Autoeficacia. El análisis de la autoeficacia por grupo de edad evidencia que la autoeficacia tiene una incidencia mínima en el grupo de edad. Los niveles de autoeficacia no demuestran diferencias entre los grupos: depende, en realidad, de otros factores. Según el género, la autoeficacia en las mujeres se percibió ligeramente menor que en los hombres mientras que, utilizando la prueba U de Mann-Whitney, no se percibe una diferencia importante entre los niveles de autoeficacia en hombres y mujeres, al reportar la prueba un valor P de 0,783. Además, los pacientes que no asistieron a la rehabilitación cardiaca tienen una mayor significancia frente a la autoeficacia que los rehabilitados. Una parte de la muestra de esta investigación (67 pacientes) logró acceder a cualquier forma de rehabilitación cardiaca. En comparación, una parte mayor (82 pacientes) no asistió a dicha rehabilitación. Vale la pena aclarar que en la ciudad de Girardot no existe programa de rehabilitación cardiaca, pero sí existen algunos componentes de la primera fase que se implementa en la Ips Especializada como son la asesoría y entrenamiento en actividad física y algunos programas educativos frente a infarto de miocardio. Se evidencia una sutil variabilidad en las fases de la rehabilitación cardiaca con un nivel ligeramente inferior no significativo frente a la autoeficacia. No existe relación entre la edad, el género y la rehabilitación frente al nivel de autoeficacia y éstas dependen de otras variables diferentes a las del estudio. Conclusión: Se evidenció que la edad no influye en la autoeficacia. El paciente post-infarto de menor edad presenta el mismo nivel que un paciente adulto. Con respecto a la autoeficacia frente al género (hombres y mujeres), se evidencia una sutil variación, presentándose un nivel ligeramente menor en éstas debido, probablemente, a la falta de apoyo en el tratamiento y cuidado de la enfermedad dado por la pareja y la familia. La autoeficacia en los pacientes no rehabilitados es ligeramente mayor que en pacientes rehabilitados, posiblemente, porque los pacientes post-infarto participantes en las sesiones educativas y seguimiento por parte de la Ips de Girardot aprendieron a partir de las fuentes de información como la experiencia vicaría (del ejemplo del otro), la persuasión verbal brindada por el personal médico y de enfermería y a través de la experiencia personal. Así, obtuvieron el juicio o la decisión para alcanzar el nivel de autoeficacia y lograr comportamientos saludables.

The acute myocardial infarction is the leading cause of death in people over 55 years, the morbidity and mortality of this condition poses a major challenge because of the impact they have on the health and quality of life. Patients presenting with acute myocardial infarction experience high levels of emotional stress and anxiety, these perceptions are associated with negative consequences such as the ability to change behavior and lifestyle or even more, for the feeling to die before a new episode. These perceptions occur most frequently in the acute phase of post-infarction period. They perceive themselves as limited and unable to perform their daily tasks, reduced quality of life and low adherence to treatment. Objective: Determine the level of general self-efficacy in patients Post-Acute Myocardial Infarction by age, gender, rehabilitated rehabilitated or not treated at the Cardiology in a specialized city of Girardot IPS. Method: a study of quantitative approach of descriptive design was conducted using the scale General Self-Efficacy version II. This research of is conformed 149 people (69 men and 80 women) who had acute myocardial infarction and who met the inclusion criteria. In the range between 35 to 65 years, having presented acute myocardial infarction and attending cardiology consultation, assistance or support to a cardiac rehabilitation program. For the statistical analysis of the results, descriptive statistical measures, nonparametric tests and correlation tests were used. Results: The age of the study participants ranged from 35-65 years with a mean of 52 years. The general distribution is organized by age, for purposes of synthesis, shows a heterogeneous population, which presents the highest percentage aged between 46 and 55, with 38.9%. Age does not change the level of self-efficacy. The analysis of the self-efficacy by age group shows that has a low significance in the age group. the self-efficacy levels show no differences between groups, it depends on other factors. According to the by gender selfefficacy the women slightly less significant than men are perceived, using the U test Mann-Whiteny an important difference between the levels of selfefficacy in men and women, the test report a P value of 0.783 is not perceived. in addition, patients did not attended cardiac rehabilitation has a slightly greater significance in the rehabilitated self-efficacy. A sample of this research, 67 patients gained access to any form of cardiac rehabilitation. Compared to 82 patients post myocardial infarction who did not attend cardiac rehabilitation. It is worth noting that there is no cardiac rehabilitation program in the city of Girardot, but if there are some components of the first phase is implemented in the Specialized Ips; advice and training and educational programs in physical activity against myocardial infarction. A subtle variability is evident in the phases of cardiac rehabilitation with a slightly non-significant selfefficacy against lower level. No correlation with age, gender and rehabilitation against self-efficacy and this depends different from the other study variables. Conclusion: It showed that age does not influence selfefficacy. The post-infarction, younger patient presents the same level as an adult patient. Regarding the self efficacy against gender (men and women), a subtle variation in women than men and a slightly lower level thereof, opposite the selfefficacy, probably due to lack of support evidenced disease care given by the couple and the family. The selfefficacy in non-rehabilitated patients is slightly higher than in rehabilitated patients, possibly this is because patients post-myocardial who participated in educational sessions and follow-up by the Ips of Girardot, learned from sources information and experience vicarage (the example of the other), verbal persuasion provided by the nurses and doctor, enactive achievement. Getting the judgment or the decision to reach the level of self-efficacy and achieve healthy behaviors.

Cardiac tamponade following post myocardial ventricular wall rupture: A case report.

Cardiac tamponade is a clinical syndrome caused by an increase in intrapericardial pressure due to the accumulation of blood, pus, other fluid, or gas in the pericardial space. Cardiac tamponade typically leads to a crisis by decreasing venous return, which impairs diastolic ventricular filling. Ventricular wall rupture is an uncommon complication after a myocardial infarction that is associated with a high mortality rate from pericardial tamponade, especially in the elderly. Cardiac ruptures following acute myocardial infarction include rupture of the left ventricle free-wall, ventricular septal defects, and papillary muscle rupture. Cardiac tamponade is a life-threatening clinical syndrome that requires timely diagnosis. A high index of suspicion of this clinical entity as cause of death during autopsy in suspected cardiac cases is imperative. In recent years, several different therapeutic approaches have been described including percutaneous seals and surgical mechanical closure of ventricular free wall rupture. We present a case of a 41 year-old man who suffered myocardial infarction, had findings of ventricular wall rupture complicated by pericardial tamponade. A brief overview of the clinical presentation, diagnosis, and management of this challenging and potentially fatal complication is presented.

Information Needs of Post Myocardial Infarction (MI) Patients: Nurse’s Perception in Universiti Kebangsaan Malaysia Medical Centre (UKMMC)

Patient education has been considered as an integral component of care for patient after myocardial infarction. Post myocardial infarction patients require information and knowledge related to their conditions to reduce anxiety and aid recovery. The objective of this study was to identify nurses’ perception on information needs of post MI patients of UKMMC. A cross sectional study using Cardiac Patient Learning Needs Inventory (CPLNI) adopted from Timmins and Kalizer (2002) was used. It comprises seven cate-gories: related to anatomy and physiology, psychological factor, life style factor, medi-cation information, dietary information, physical activity, and symptom management. This study was conducted in coronary care unit (CCU), coronary rehabilitation ward (CRW), medical ward 1 and medical ward 2 from January 2007 to March 2007. 56 res-pondents (96%) who fulfilled the inclusion criteria were recruited in this study. Results showed that CCU and CRW respondents ranked symptom management as their first ranking followed by medication, life style factor, anatomy and physiology, dietary in-formation, physical activity and psychological factor. However, respondents in Medical Ward 1 and 2 reported and ranked medication information as their top priorities fol-lowed by symptom management, psychological factors, dietary information, physical activity, anatomy and physiology and life style factor. There were significant differ-ences between ward nurses’ responses with their perception related to anatomy and physiology, psychology factor, life style factor, physical activity, and symptom man-agement with p value<0.05. This study concluded that the information needs are not always perceived in unison by nursing personnel as the CCU and CRW nurses ranked symptoms management as the cardinal factor whilst Medical Ward 1 and 2 nurses give paramount importance to medication. In order to improve this situation for post MI pa-tient, information need has to be tailored, individualized and prioritized based upon their needs.

Cardiovascular responses between post myocardial infarction patients with different levels of ST segment depression during exercise / 中国康复医学杂志

Objective: To investigate selected cardiovascular responses of post myocardial infarction patients(PMIP)during exercise within the context of different levels of ST segment depression. Method: Forty-six male recent PMIP performed a graded exercise test on a motorized treadmill during which time blood pressure and heart rate were measured and a 12 lead electrocardiogram (ECG) was monitored continuously. They were then subdivided into those ST segment depression ＜1.0 mm at exercise stage Ⅱ (group 1) and those who had ST segment depression ＞1.0 mm at this stage (group 2). Result: The results showed that the patients with a larger degree of ST segment depression at the given work load exhibited higher a value of rate-pressure product (RPP).Conclusion: RPP may be of particular value in estimating the clinical response to exercise when ECG monitoring is not available.