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Introducción: la fibrilación auricular es la taquiarritmia sostenida más frecuente del ser humano. Su manejo requiere un abordaje holístico para que los resultados sean óptimos, por lo que se considera la epidemia cardiovascular del siglo XXI. Objetivo: establecer las variables ecocardiográficas asociadas al fracaso de la cardioversión en pacientes con diagnóstico clínico de fibrilación auricular y síndrome coronario agudo. Materiales y métodos: se realizó un estudio retrospectivo, analítico, no experimental de casos y controles en pacientes con fibrilación auricular y síndrome coronario agudo, durante el período comprendido entre los años 2017 y 2021. Resultados: la cardioversión eléctrica se observó en 55 pacientes (68,8 %) (OR = 0,24; IC 95 %: 0,08-0,7; p = 0,008). La terapia trombolítica se aplicó en 47 pacientes (58,8 %) (OR = 5,03; IC 95 %: 1,67-15,12; p = 0,0026). En cuanto a parámetros ecocardiográficos, la variable volumen de la aurícula izquierda ≥ 34 ml/sc predominó en 50 pacientes (62,5 %) (OR = 3,5; IC 95 %: 1,22-10,04; p = 0,016); la presión de la aurícula izquierda > 15 mmHg en 23 pacientes (OR = 3,61; IC 95 %: 1,23-10,54; p = 0,015), y el diámetro del ventrículo izquierdo > 57 mm en 20 pacientes (OR = 4,33; IC 95 %: 1,35-13,87; p = 0,009). Conclusiones: el volumen de la aurícula izquierda elevada, la presión de aurícula izquierda, el diámetro del ventrículo izquierdo, la terapia eléctrica y trombolítica, se asocian al fracaso de la cardioversión en pacientes con fibrilación auricular e infarto agudo de miocardio.
Introduction: atrial fibrillation is the most frequent sustained tachyarrhythmia in humans. Its management requires a holistic approach for the results to be optimal; it is considered the cardiovascular epidemics of the 21st century. Objective: to establish echo-cardiographic variables associated with cardioversion failure in patients with clinical diagnosis of atrial fibrillation and acute coronary syndrome. Materials and methods: a retrospective, analytical, non-experimental study of cases and controls was carried out in patients with atrial fibrillation and acute coronary syndrome, during the period between 2017 and 2021. Results: electrical cardioversion was observed in 55 patients (68.8%) (OR = 0.24; CI 95%: 0.08-0.7; p = 0.008). Thrombolytic therapy was applied in 47 patients (58.8%) (OR = 5.03; CI 95%: 1.67-15.12; p = 0.0026). Regarding echocardiographic parameters, the variable left atrial volume ≥ 34 ml/sc predominated in 50 patients (62.5%) (OR = 3.5; CI 95%: 1.22-10.04; p = 0.016); left atrial pressure > 15 mmHg predominated in 23 patients (OR = 3.61; CI 95%: 1.23-10.54; p = 0.015), and left ventricular diameter > 57 mm in 20 patients (OR = 4.33; CI 95%: 1.35-13.87; p = 0.009). Conclusions: elevated left atrial volume, left atrial pressure, and left ventricular diameter, electric and thrombolytic therapy, are all associated to cardioversion failure in patients with atrial fibrillation and acute myocardial infarction.
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RESUMEN Introducción: La transmisión de la foto del electrocardiograma vía teléfono móvil, reduciría los tiempos de reperfusión en el infarto agudo de miocardio con elevación del segmento ST. Objetivo: Evaluar la eficacia de la tecnología celular como estrategia para acortar los tiempos de reperfusión. Material y métodos: Estudio cuasi experimental, multicéntrico, que incluyó pacientes del Gran San Miguel de Tucumán, desde agosto de 2017 a abril de 2018. La estrategia consistió en la transmisión de fotos del electrocardiograma vía WhatsApp, para la activación temprana del protocolo de infarto. Se midió tiempos de demora e impacto en la calidad de atención. Resultados: Se analizaron 105 pacientes. Se observó reducción significativa del tiempo diagnóstico, 30 (10-90) vs. 10 (5-15) minutos en el grupo salud móvil < p = 0,0001; y en el tiempo puerta balón, 166 (135-210) vs. 132 (80-150) minutos p = 0,019. Conclusiones: La estrategia salud móvil mejoró los tiempos al diagnóstico y puerta balón, aunque, siguen siendo subóptimos.
ABSTRACT Background: Mobile phone transmission of electrocardiogram photos would reduce time to reperfusion in ST-segment elevation acute myocardial infarction. Objective: The aim of this study was to evaluate the efficacy of mobile phone technology as a strategy to shorten times to reperfusion. Methods: A quasi-experimental, multicenter study, including patients from the Greater San Miguel de Tucumán, was carried out from August 2017 to April 2018. The strategy consisted in the transmission of electrocardiogram photos by WhatsApp, for the early activation of the infarction protocol. Delay times and impact on the quality of care were assessed. Results: A total of 105 patients were analyzed. A significant reduction of the time to diagnosis was observed in the mobile health group [30 min (10-90) vs. 10 min (5-15); <p=0.0001] and in the door-to-balloon time [166 min (135-210) vs. 132 min (80-150); p=0.019]. Conclusions: The mobile health strategy improved the diagnosis and the door-to-balloon times, though they are still suboptimal.
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Objective To investigate the effect of psychological intervention, Plavix, Aspirin Enteric-coated Tablets combined in the treatment of non ST segment elevation acute myocardial infarction. Methods 102 patients with non ST elevation acute myocardial infarction were selected in Taizhou Central Hospital from January 2015 to January 2017 and divided into study group (n=51) and control group (n=51) by single and double number (hospital admission order) method. The control group were treated with clopidogrel, Aspirin Enteric-coated Tablets, the study group on the basis of routine treatment, were given plavix, Aspirin Enteric-coated Tablets, comprehensive psychological intervention program. Results The total effective rate of the study group was 90.20%, and the total effective rate of the control group was only 70.59%, the difference was statistically significant (P<0.05). Conclusion The application of psychological intervention combined with plavix, Aspirin Enteric-coated Tablets treatment of non ST elevation acute myocardial infarction can significantly improve the clinical efficacy, to ensure the quality of life, life is of positive significance to safety.
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Objective To investigate the effect of psychological intervention, Plavix, Aspirin Enteric-coated Tablets combined in the treatment of non ST segment elevation acute myocardial infarction. Methods 102 patients with non ST elevation acute myocardial infarction were selected in Taizhou Central Hospital from January 2015 to January 2017 and divided into study group (n=51) and control group (n=51) by single and double number (hospital admission order) method. The control group were treated with clopidogrel, Aspirin Enteric-coated Tablets, the study group on the basis of routine treatment, were given plavix, Aspirin Enteric-coated Tablets, comprehensive psychological intervention program. Results The total effective rate of the study group was 90.20%, and the total effective rate of the control group was only 70.59%, the difference was statistically significant (P<0.05). Conclusion The application of psychological intervention combined with plavix, Aspirin Enteric-coated Tablets treatment of non ST elevation acute myocardial infarction can significantly improve the clinical efficacy, to ensure the quality of life, life is of positive significance to safety.
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Objective To investigate the therapeutic effects and adverse drug reactions of different doses of rosuvastatin in patients with acute ST segment elevation myocardial infarction (STEMI). Methods A total of 115 patients with STEMI were collected from Department of Cardiology, the Second Hospital of Tianjin Medical University. According to different oral doses of rosuvastatin, patients were divided into two groups including 5 mg/d rosuvastatin treatment group (low-dose group, n=44) and 10 mg/d Rosuvastatin treatment group (moderate-dose group, n=71). Patients of two groups were treated with Rosuvastatin at least 1 month after discharge. Data of total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were analyzed and compared before and after treatment between two groups. The major cardiovascular adverse events (MACE) and adverse reactions were recorded in two groups of patients. Results There were no significant differences in blood lipid and liver function levels before and after one month treatment between the two groups. After one month treatment, levels of TC, LDL-C, ALT and AST were significantly decreased in both groups of patients compared with those before treatment (P<0.05). There were no significant differences in levels of TG, and HDL-C before and after treatment between two groups. The incidence of MACE (heart failure and angina pectoris) was significantly lower in moderate-dose group than that in low-dose group (P<0.05). There was no significant difference in the proportion of malignant arrhythmia between the moderate-dose group and the low-dose group (P<0.05). No target vessel repair and death were found in the two groups. No obvious adverse drug reactions were found during the follow-up period. Conclusion The hypolipidemic effects are epuivalent between 5 mg/d rosuvastatin and 10 mg/d on the basis of conventional treatment for STEMI patients, but the moderate dose can reduce the incidence of MACE and improve prognosis.
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Objective To observe the influence of different level of hyperhomocysteinemia on mRNA and protein expressions of KV1 .3 ,CaN,NFAT,IL-6 and TNF-αin lymphocytes of patients with acute ST-segment elevation myocardial infarction (STEMI).Methods We selected 90 STEMI patients and divided them into three groups according to the level of plasma homocysteine:the first experimental group (STEMI group,Hcy30 μmol/L,n=30 ).Another 30 healthy examined people were selected as control group (n=3 0 ).Peripheral lymphocytes were isolated by Ficoll density gradient centrifugation.The Hcy in the plasma was measured with the IMX assays.Real-time quantitative PCR (RT-PCR)was used to detect mRNA expressions of KV1.3,CnAα,NFAT1,IL-6 and TNF-αand Western blot technique was used to detect the expressions of KV1.3,CnAαand NFAT1.Results The mRNA and protein expression levels of KV1.3,CnAαand NFAT1 in each experimental group were significantly higher than those in control group (P<0 .0 5 or P<0 .0 1 ).Multiple comparison in each experimental group showed that compared with that in the first experimental group,the expression level of the second experimental group increased (P<0.05 or P<0.01)and compared with first and second experimental groups,the expression level of the third experimental group increased (P<0.05 or P<0.01).The mRNA expression levels of IL-6 and TNF-αin each experimental group were significantly higher than those in control group (P<0.05 or P<0.01 ).Multiple comparison in each experimental group showed that compared with that in the first experimental group,the expression level of the second experimental group increased (P<0 .0 5 or P<0 .0 1 )and compared with first and second experimental groups,the expression level of the third experimental group increased (P<0.01).Plasma total Hcy levels were positively correlated with mRNA and protein expressions of KV1.3 in all observed groups (r=0.503 P=0.000,r=0.726 P=0.000).Conclusion The higher level of Hcy in plasma,the higher mRNA and protein expression levels of KV1.3,CnAα,NFAT1 and the higher mRNA expression levels of IL-6,TNF-αin the lymphocyte of STEMI patients,which may be one mechanism for Hcy exacerbating the inflammatory reaction of STEMI.
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Resumen: Objetivo: Revisar la evidencia existente sobre el papel de la trombólisis prehospitalaria en los pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) como parte de una estrategia de vanguardia para reducir el tiempo de reperfusión miocárdica y, con ello, mejorar la supervivencia y la función. Métodos: Se utilizó la técnica de exploración-reducción-evaluación-análisis y síntesis de estudios relacionados, con una visión general de las recomendaciones actuales, de los datos de ensayos clínicos controlados y de los registros nacionales e internacionales sobre las diferentes estrategias de reperfusión para el IAMCEST. En total, se examinaron 186 referencias sobre trombólisis prehospitalaria, 130 referencias en tiempos puerta-tratamiento, 139 referencias en la gestión de IAMCEST y los registros nacionales e internacionales, así como 135 referencias en intervención coronaria percutánea primaria y de rescate en IAMCEST. Finalmente se retuvieron las 48 referencias que se consideraron más relevantes e informativas. Conclusión: El factor "tiempo" es esencial en el éxito de la reperfusión temprana en el IAMCEST sobre todo si se toma en cuenta la trombólisis prehospitalaria. La intervención coronaria percutánea primaria está sujeta a su factibilidad antes de 120 min del inicio de los síntomas. En nuestro medio, al igual que en el ámbito internacional, la trombólisis continúa siendo una estrategia con gran alcance en las expectativas de vida y función de los pacientes. Los sistemas de telecomunicación deben incorporarse en tiempo real a las necesidades prioritarias de enfermedades catastróficas como el IAMCEST, donde la vida es dependiente del tiempo.
Abstract: Objective: To review the existing evidence on the role of prehospital thrombolysis in patients with ST-segment elevation acute myocardial infarction (STEMI) as part of a strategy of cutting edge to reduce the time of coronary reperfusion and as a consequence improves both the survival and function. Methods: We used the technique of exploration-reduction-evaluation-analysis and synthesis of related studies, with an overview of current recommendations, data from controlled clinical trials and from the national and international registries about the different strategies for STEMI reperfusion. In total, we examined 186 references on prehospital thrombolysis, 130 references in times door-treatment, 139 references in STEMI management and national and international registries as well as 135 references on rescue and primary percutaneous coronary intervention for STEMI. Finally the 48 references that were more relevant and informative were retained. Conclusion: The "time" factor is crucial in the success of early reperfusion in STEMI especially if thrombolysis is applied correctly during the prehospital time. The primary percutaneous coronary intervention is contingent upon its feasibility before 120 min from the onset of symptoms. In our midst to internationally, thrombolysis continues to be a strategy with great impact on their expectations of life and function of patients. Telecommunication systems should be incorporate in real time to the priority needs of catastrophic diseases such as STEMI where life is depending on time.
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Humans , Myocardial Infarction/drug therapy , Thrombolytic Therapy , Early Medical Intervention , Emergency Medical Services , Mexico , Myocardial Reperfusion , Myocardial Infarction/physiopathology , Myocardial Infarction/surgery , RegistriesABSTRACT
Objective To study the thrombolysis effect and safety of tirofiban combined with half dose reteplase in patients with ST segment elevation acute myocardial infarction .Methods 60 patients with ST segment elevation acute myocardial infarction in our hospital from January 2011 to March 2013 were selected as research object ,and they were divided into reteplase group (control group ,n=32) and tirofiban combined with reteplase group (observation group ,n=28) ,then the recanalization rate of infarct-relat-ed artery at different time and incidence of complications were compared .Results The recanalization rate of infarct-related artery of observation group at different time were all higher than those of control group (P0 .05) .Conclusion The thrombolysis effect of tirofiban combined with half dose reteplase in patients with ST segment elevation acute myocardial infarction is better ,and it does not increase the incidence of complications .