ABSTRACT
Background: The early mortality rate from AMI is 30% with about half of them occurring within 1hour of disability. Although the mortality rate after admission for AMI has declined by 30% over the past decades, approximately 1 of every 25 patients who survive the initial hospitalization die in the first year after AMI. The gold standard for diagnosis of MI has been an elevated serum level of creatinine kinase – myocardial band (CK- MB), the cardiac-specific isoenzyme of CK. However, elevated CK-MB may not detect all myocardial necrosis. In patients who die suddenly after severe or silent episodes of ischemia, autopsies frequently reveal micronecrosis that was not reflected in routine CK-MB measurements. The present study was undertaken to know that serum Cardiac Troponin-I is more sensitive marker than serum CPK-MB in early diagnosis of acute myocardial infarction (AMI).Methods: The study was carried out in tertiary care hospital in Gulbarga. The study was undertaken with an aim to study that serum cardiac troponin-I (cTnl) is more sensitive than serum CK-MB in early diagnosis of acute myocardial infarction (AMI). The study was conducted on patients admitted with history of chest pain suggestive of AMI as diagnosed by WHO criteria to medicine ward of Basaveshwar Teaching and General Hospital, Gulbarga. The period of study was from June 2012 to June 2014. The sample size included 100 patients with history of chest pain suggestive of AMI, selected by simple random method.Results: Our results revealed that cardiac troponin I was more sensitive (62%) than CK-MB in overall cases admitted in between 6-24 hrs from the onset of chest pain. Maximum number (41%) of AMI patients were affected on the anterior wall followed by Inferior wall of AMI. 11 percent were affected with Antero lateral wall wereas 5 to 6 percent were affected with anteroseptal and global acute and right ventricular AMI was seen among 2 percent of patients. Anterior wall AMI was the significantly affected site with AMI (ʎ2:12.5, P:0.0004). The maximum number of acute myocardial infarctions were ST elevation myocardial infarctions. 28% of cases where CKMB is normal, the cTnI detects the AMI cases indicating its sensitivity.Conclusions: Cardiac troponin-I (cTnI) was more sensitive serum marker than CKMB in the early diagnosis of acute myocardial infarction (AMI). Anterior wall was the most significantly affected site of AMI. In the future, further improvements in analytical performance may open additional diagnostic windows
ABSTRACT
Although frequently in humans, hypoxic and ischemic heart diseases are poorly documented in dogs, with only few reports of acute myocardial infarction (AMI) in this species. Some electrocardiographic findings might suggest myocardium hypoxia/ischemia, like ST segment elevation or depression, but there are no studies showing whether deviations in ST segment are associated to myocardial injury and serum increase of creatine phosphokinase (CPK-MB). In order to investigate possible myocardial cells injury in poor perfusion conditions, 38 dogs were studied, 20 with normal electrocardiogram and 18 with ST segment elevation or depression, recorded in lead II, at a paper speed of 50 mm/sec and N sensibility (1mV=1cm). Serum measurement of creatine phosphokinase isoenzyme MB (CPK-MB) in normal dogs (group 1) determined control values (in ng/mL), which were compared to those obtained from dogs with deviation (group 2), which allowed confirmation or not of myocardial injury. CPK-MB mean values obtained from dogs in groups 1 and 2 were 0.540ng/ml (SD±0.890)ng/mL and 0.440ng/mL (SD±1.106), respectively. At a significance level of 5%, the relation of CPK-MB with age, mass and total creatine phosphokinase (CPK-T) was not significant in groups 1 and 2. CPK-MB showed no difference, at 5% level, between groups 1 and 2. In conclusion, it is possible to use the human chemiluminescent immunometric assay kit in canine species and that hypoxia/ischemia revealed by ST segment deviation does not mean significant myocardium injury.(AU)
Embora frequente em humanos, as doenças hipóxicas e isquêmicas do coração são pouco relatadas em cães, com poucos relatos de infarto agudo do miocárdio (IAM) nesta espécie. Alguns achados no eletrocardiograma podem sugerir hipóxia/isquemia miocárdica, como a elevação ou depressão do segmento ST, mas não há estudos que mostram se os desvios do segmento ST estão associados a lesões miocárdicas e aumento sérico da creatinafosfoquinase (CPK-MB). A fim de investigar possíveis lesões nas células miocárdicas em condições de má perfusão, 38 cães foram estudados, 20 com eletrocardiograma normal e 18 com elevação ou depressão do segmento ST, registrados em papel, na derivação II, velocidade de 50 mm/s e sensibilidade N (1mV = 1cm). A mensuração da creatinafosfoquinase isoenzima MB (CPK-MB) em cães normais (grupo 1) determinou os valores controle (em ng/ml), que foram comparados com os obtidos a partir de cães com desvio (grupo 2), permitindo a confirmação ou não da lesão miocárdica. Os valores médios de CPK-MB obtidos de cães nos grupos 1 e 2 foram 0,540ng/ml (DP±0,890) e 0,440ng / ml (DP ± 1.106), respectivamente. A um nível de significância de 5%, a relação de CPK-MB com a idade, massa e creatinofosfoquinase total (CPK-T) não foi significativa nos grupos 1 e 2. Não houve diferenças na CPK-MB, ao nível de 5%, entre os grupos 1 e 2. Conclui-se que é possível utilizar o kit de ensaio imunométrico por quimioluminescência humano na espécie canina e que a hipoxia/isquemia revelada pelos desvios do segmento ST, não significa lesão miocárdica.(AU)
Subject(s)
Animals , Dogs , Creatine Kinase, MB Form/blood , Luminescent Measurements/veterinary , Myocardium/cytologyABSTRACT
Introducción: condicionar el corazón para mejorar sus capacidades cardioprotectoras endógenas con el uso de isquemias breves a distancia proporciona un novedoso abordaje potencial a la protección miocárdica durante la cirugía cardiaca. Objetivo: identificar el impacto económico del precondicionamiento isquémico a distancia en los pacientes revascularizados quirúrgicamente. Métodos: se realizó un estudio longitudinal prospectivo experimental en dos grupos de 100 personas, a los que se les realizó revascularización por injerto de la arteria coronaria. Se procedió a colocar un torniquete en el brazo no dominante en quienes se incluyeron en el grupo de estudio prueba, alternando tres insuflaciones con tres desinsuflaciones con una presión de 200 mmHg, manteniéndola por espacio de cinco minutos cada una, este proceder se realizó previo, durante y después del evento isquémico mayor que se corresponde con el pinzamiento de la arteria coronaria. Resultados: se logró una importante disminución del consumo de drogas inotrópicas, vasoactivas y de otros medicamentos ahorrándose una importante suma disminuyendo los costos hospitalarios. Comprobándose además, la disminución en la incidencia de arritmias ventriculares letales, bajo gasto cardiaco fatal y de muerte postoperatoria, en todos los casos muy por debajo de la predicción previamente realizada para estas complicaciones. Conclusiones: el precondicionamiento isquémico a distancia puede ser una importante herramienta a tener en cuenta en la protección antisquémica de la revascularización miocárdica que puede disminuir la morbimortalidad y los costos hospitalarios.
Background: to condition the heart to improve its endogenous cardioprotective capacity using brief remote ischemia provides a novel potential approach to myocardial protection during cardiac surgery. Objective: to identify the economic impact of remote ischemic preconditioning in surgically revascularized patients. Methods: an experimental prospective longitudinal study was conducted in two groups of 100 people who underwent revascularization by coronary artery graft. A tourniquet was placed on the non-dominant arm in those who were included in the test study group, alternating three insufflations with three desinsufflations with a pressure of 200 mmHg, each one being maintained for five minutes. This procedure was performed prior to, during and after the greater ischemic event that corresponds to the pinching of the coronary artery. Results: an important decrease of the consumption of inotropic, vasoactive and other drugs was achieved, saving an important sum, decreasing hospital costs, and also proving a reduction in the incidence of lethal ventricular arrhythmias, low cardiac output and postoperative death which were, in all cases, below the prediction previously made for these complications. Conclusions: remote ischemic preconditioning can be an important tool to be considered in the antischemic protection of myocardial revascularization that can diminish morbimortality and hospital costs.
ABSTRACT
We performed a electrophoresis to determine the serum level of isoenzyme of creatine phosphokinase in 30 patients with head injuries. The present study was undertaken to examine whether the measurement of serum level of brain type isoenzyme(CPK-BB) and heart type isoenzyme(CPKMB) were valuable in evaluating the clinical status of head injuries. All patients were diagnosed by Glasgow coma scale score, CT scan and then we performed a serial blood sampling during the first 7days. Brain type creatine phosphokinase(CPK-BB) was detected in the serum in 4 of 30 patientts(13.3%) and heart type creatine phosphokinase(CPK-MB) was detected in the serum in 8 of 30 patients(26.7%). These findings were seen within 48 hours after head injuries. The higher level were associated with severe brain damage; hemorrhagic contusion, subdural hemorrhage, subarachnoid hemorrhage and pneumocephalus.
Subject(s)
Humans , Brain , Contusions , Craniocerebral Trauma , Creatine Kinase , Creatine , Electrophoresis , Glasgow Coma Scale , Head , Heart , Hematoma, Subdural , Isoenzymes , Pneumocephalus , Subarachnoid Hemorrhage , Tomography, X-Ray ComputedABSTRACT
The authors studied the changes of myocardial enzymes (CPK, CPK-MB, LDH) in the wall of the right atrium during cardioplegic arrest in ninsecutive patients who had an open heart operation, observed the changes of these enzymes in seium as well The results indicate that when the crystalloid cardioplegic solution, systemic moderate hypothermia and decp local hypothermia are used to protect the myocardium, the right atrium can get satisfactory protection during cardioplegic arrest and there is no statistical differences of enzyme changes between samples taken from the right atrium before and after the arrest. The article still discussed the possibility of using the changes of atrial myocardial enzymes as an index to reflect the extent of myocardial protion. The authors consider that the change of myocardial enzyme can better reflect the metabolic activity of myocardium during cardioplegic arrest.