Acute inferior myocardial infarction combined with papillary muscle rupture: A case report / 中南大学学报(医学版)

The incidence of acute myocardial infarction (AMI) is increasing. Acute papillary muscle rupture is one of the serious and rare mechanical complications of AMI, which occurs mostly in inferior and posterior myocardial infarction. A patient with acute inferior myocardial infarction developed pulmonary edema and refractory shock, followed by cardiac arrest. After cardiopulmonary resuscitation (CPR), revascularization of criminal vessels was carried out by emergency percutaneous transluminal coronary angioplasty (PTCA) under the support of intra-aortic balloon pump (IABP) and extra corporeal membrane oxygenation (ECMO). Although the patient was given a chance for surgery, his family gave up treatment due to unsuccessful brain resuscitation. It reminds that mechanical complications such as acute papillary muscle rupture, valvular dysfunction and rupture of the heart should be highly suspected when cardiogenic pulmonary edema and cardiogenic shock are difficult to correct in acute inferior myocardial infarction. Echocardiogram and surgery should be put forward when revascularization of criminal vessels is available.

Acute myocardial infarction at a district hospital in KwaZulu-natal ­ management and outcomes

Acute myocardial infarction (AMI) following ischaemic heart disease (IHD) is associated with increased morbidity and mortality. The condition remains a management challenge in resource-constrained environments. This study analysed the management and outcomes of patients presenting with AMI at a district hospital in KwaZulu-Natal. Methods: A descriptive study that assessed hospital records of all patients diagnosed with AMI over a 2-year period (01 August 2016 to 31 July 2018). Data extracted recorded patient demographics, risk factors, timing of care, therapeutic interventions, follow up with cardiology and mortality of patients. Results: Of the 140 patients who were admitted with AMI, 96 hospital records were analysed. The mean (standard deviation [s.d.]) age of patients was 55.8 (±12.7) years. Smoking (73.5%) and hypertension (63.3%) were the most prevalent risk factors for patients with ST elevation myocardial infarction (STEMI) in contrast to dyslipidaemia (70.2%) and hypertension (68.1%) in patients with non-ST elevation myocardial infarction (NSTEMI). Almost 49.5% of patients arrived at hospital more than 6 h after symptom onset. Three (12.5%) patients received thrombolytic therapy within the recommended 30-min time frame. The mean triage-to-needle time was 183 min ­ range (3; 550). Median time to cardiology appointment was 93 days. The in-hospital mortality of 12 deaths considering 140 admissions was 8.6%. Conclusion: In a resource-constrained environment with multiple systemic challenges, in-hospital mortality is comparable to that in private sector conditions in South Africa. This entrenches the role of the family physician. There is need for more coordinated systems of care for AMI between district hospitals and tertiary referral centres.

Detection of inferior myocardial infarction based on morphological characteristics / 生物医学工程学杂志

Early accurate detection of inferior myocardial infarction is an important way to reduce the mortality from inferior myocardial infarction. Regrading the existing problems in the detection of inferior myocardial infarction, complex model structures and redundant features, this paper proposed a novel inferior myocardial infarction detection algorithm. Firstly, based on the clinic pathological information, the peak and area features of QRS and ST-T wavebands as well as the slope feature of ST waveband were extracted from electrocardiogram (ECG) signals leads Ⅱ, Ⅲ and aVF. In addition, according to individual features and the dispersion between them, we applied genetic algorithm to make judgement and then input the feature with larger degree into support vector machine (SVM) to realize the accurate detection of inferior myocardial infarction. The proposed method in this paper was verified by Physikalisch-Technische Bundesanstalt (PTB) diagnostic electrocardio signal database and the accuracy rate was up to 98.33%. Conforming to the clinical diagnosis and the characteristics of specific changes in inferior myocardial infarction ECG signal, the proposed method can effectively make precise detection of inferior myocardial infarction by morphological features, and therefore is suitable to be applied in portable devices development for clinical promotion.

Type 2 myocardial infarction resulted from the left thoracic stomach

Abstract The universal definition of myocardial infarction (MI) provides five subtypes of acute myocardial infarction (AMI). We present an interesting case of a type 2 myocardial infarction caused by the dilation of the left thoracic stomach.

Mechanical Extraction of a Massive Intracoronary Thrombus from the Super-Dominant Right Coronary Artery in Thrombogenic Lung Cancer Patient

The congenital absence of the left circumflex artery and a compensatory super-dominant right coronary artery (RCA) is a very rare benign coronary anomaly in the clinic. The presence of a massive thrombus in the super-dominant RCA can lead to fatal results in cases of acute myocardial infarction, unless the thrombus is mechanically removed. Aspiration of the thrombus using a 6 Fr right Judkins guide catheter is useful to extract a massive thrombus and is both safe and effective. We report a case of complete revascularization of the super-dominant RCA after thrombus aspiration using a 6 Fr Judkins right catheter in a patient with acute inferior and inferolateral wall myocardial infarction.

Type 2 myocardial infarction after ingestion of mad honey in a patient with normal coronary arteries

No abstract available.

Segurança da intervenção fisioterápica precoce após o infarto agudo do miocárdio / Safety of early physical therapy intervention after acute myocardial infarction

INTRODUÇÃO: A fisioterapia na fase I da reabilitação cardiovascular (FTCV) pode ser iniciada de 12 a 24 horas após o infarto agudo do miocárdio (IAM), no entanto, é comum o repouso prolongado no leito em razão do receio de instabilização do paciente. OBJETIVOS: Avaliar as respostas autonômicas e hemodinâmicas de pacientes pós-IAM submetidos ao primeiro dia de protocolo de FTCV fase I, bem como sua segurança. MATERIAIS E MÉTODOS: Foram estudados 51 pacientes com primeiro IAM não complicado, 55 ± 11 anos, 76% homens. Foram submetidos ao primeiro dia do protocolo de FTCV fase I, em média 24 horas pós-IAM. A frequência cardíaca (FC) instantânea e os intervalos R-R do ECG foram captados pelo monitor de FC (Polar®S810i) e a pressão arterial (PA) aferida pelo método auscultatório. A variabilidade da FC foi analisada nos domínios do tempo (RMSSD e RMSM dos iR-R em ms) e da frequência. A densidade espectral de potência foi expressa em unidades absolutas (ms²/Hz) e normalizada (un) para as bandas de baixa (BF) e alta frequência (AF) e pela razão BF/AF. RESULTADOS: O índice RMSSD, a AF e a AFun apresentaram redução na execução dos exercícios em relação ao repouso pré e pós-exercício (p < 0,05), a BFun e a razão BF/AF aumentaram (p < 0,05). A FC e a PA sistólica apresentaram aumento durante a execução dos exercícios em relação ao repouso (p < 0,05). Não foi observado qualquer sinal e/ou sintoma de intolerância ao esforço. CONCLUSÕES: O exercício realizado foi eficaz, pois promoveu alterações hemodinâmicas e na modulação autonômica nesses pacientes, sem ocasionar qualquer intercorrência clínica.

INTRODUCTION: Physical therapy during phase I of cardiac rehabilitation (CPT) can be started 12 to 24 hours after acute myocardial infarction (AMI), however, it is common to extend the bed rest due to fear of patient’s instability. OBJECTIVES: To assess the hemodynamic and autonomic responses to post-AMI patients when subjected to first day of phase I protocol of CPT, as well as their safety. MATERIALS AND METHODS: We studied 51 patients with first uncomplicated AMI, 55 ± 11 years, 76% men. The patients were subjected to first day protocol phase I CPT, on average, 24 hours after AMI. The Instantaneous heart rate (HR) and RR interval were acquired by HR monitor (Polar™S810i) and blood pressure (BP) checked by auscultation. HR variability was analyzed in the time (RMSSD and RMSM-Ri in ms) and frequency domains. Power spectral density was expressed in absolute (ms²/Hz) and normalized (nu) units for the bands of low (LF) and high frequencies (HF) and as LF/HF ratio. RESULTS: The RMSSD, HF and HFnu have reduced performance of the exercises in relation to rest and post-exercise (p < 0.05), LFnu and LF/HF ratio increased (p < 0.05). HR and systolic BP showed an increase during the execution of the exercises in relation to rest (p < 0.05). There were no any signs and/or symptoms of exercise intolerance. CONCLUSION: The exercise was effective, because it caused changes hemodynamic and autonomic modulation in these patients, without causing any medical complications.

Jeopardised Inferior Myocardium (JIM) score: an arithmetic electrocardiographic score to predict the infarct-related artery in inferior myocardial infarction

<p><b>INTRODUCTION</b>A few electrocardiographic criteria have been described to identify the infarct-related artery in inferior myocardial infarction. The aim of this study was to devise an arithmetic score to further improve the diagnostic accuracy.</p><p><b>MATERIALS AND METHODS</b>From 2004 to 2006, 78 patients who underwent primary angioplasty for inferior myocardial infarction within 6 hours from symptom onset were recruited for electrocardiographic and angiographic analysis.</p><p><b>RESULTS</b>The mean age of patients was 65 ± 12 years with male predominance (74%). Less ST depression in lead I and aVL, and more prominent ST depression in lead V1-3 were observed in left circumflex artery (LCX) than right coronary artery (RCA) occlusions. In addition, more prominent ST depression in lead I and ST elevation in V1 were found in proximal RCA than distal RCA occlusions. Based on the findings, the Jeopardised Inferior Myocardium (JIM) score was constructed and defi ned as [II-V3/III+V1- I]. The sensitivity and specificity of JIM score ≤0.5 to predict proximal RCA occlusions; 0.5 <JIM score ≤1.5 to predict distal RCA occlusions; and JIM score >1.5 to predict LCX occlusions were 58% and 85%, 69% and 68%, and 79% and 94%, respectively. The accuracy of prediction is slightly better than the 2 previously reported criteria.</p><p><b>CONCLUSION</b>By taking into account more leads, the JIM score is capable of identifying the infarct-related artery with an improved diagnostic accuracy.</p>

Two Cases of Multivessel Coronary Artery Ectasias Resulting in Acute Inferior Myocardial Infarction

The incidence of multivessel coronary artery ectasias (CAEs) among patients undergoing coronary artery angiography is very rare. All three coronary vessels can be affected by CAE, but most patients have an isolated arterial ectasia, commonly the right coronary artery. In this report we present two cases with inferior myocardial infarction that was likely caused by thrombotic occlusion of CAEs.

A Rare Coronary Anomaly: Atypical Double Right Coronary Artery With an Acute Inferior Myocardial Infarction

Coronary artery anomalies are uncommon and often asymptomatic. A double right coronary artery (RCA) is an extremely rare coronary artery anomaly, and only a few cases of double RCA have been reported. We report on an atherosclerotic double RCA that appeared after primary percutaneous intervention in a patient with an acute inferior myocardial infarction. This is the second case in the literature in which coronary arteries can be accepted as a double RCA, which were hidden by a total atherosclerotic occlusion in the proximal part of the RCA.

Emergências hipertensivas como manifestação clínica inicial de síndrome coronariana aguda / Hypertensive emergencies as the initial clinical manifestation of acute coronary syndrome

Relata-se uma série de três pacientes idosos, apresentando hipertensão arterial e coronariopatia crônica,assintomáticos e clinicamente controlados até o início das alterações tensionais súbitas que marcaram o início da evolução do evento coronariano. Foram realizados ECG, enzimas cardíacas seriadas, raios-X de tórax eecocardiograma, optando-se por cineangiocoronariografia. Em todos os pacientes observou-se ausência de estresse emocional/físico exorbitante ou perda da adesão ao tratamento, ausência de precordialgia, presença de lesões obstrutivas críticas, com presença de trombos em vasos de grande relevância anatômica e funcional (artéria culpada), com retorno à estabilização pressórica anterior após correção da isquemia por angioplastia coronariana.

Comparison of complications in patients of inferior wall myocardial infarction with and without right ventricular infarction

To compare in-hospital complications in terms of complete heart block and mortality in patients of inferior wall myocardial infarction with or without right ventricular infarction and to see the frequency of right ventricle infarction in patients of inferior wall myocardial infarction. Cross-sectional comparative study. The study was conducted at Chaudary Pervez Elahi Institute of Cardiology, Multan from 7th August 2009 to 6th February 2010. 73 patients with inferior ST-segment elevation myocardial infarction were distributed into two groups; one with IWMI only and second with IWMI with RV infarction. Patients with prior MI, pre-exiting heart failure, valvular heart disease, pericardial disease, acute pulmonary embolism, significant pulmonary diseases were excluded from the study. The data was analyzed by using software SPSS. The difference in frequencies of complications in two groups was compared using chi square test and a p value of <0.05 was considered significant. Mean age was 51.95 +/- 11.8 years in group 1 and 54.17 +/- 12.0 years in group 2. Patients in group 2 had more complications as compared to group 1. The incidence of Complete AV block was 7 [38%] in group 2 vs. 3 [5%] in group 1 [p=<0.001]. The incidence of right ventricular infarction in patients of inferior wall myocardial infarction was noted to be 26%. RVI results in increase in the frequency of complete heart block and mortality in patients of inferior wall myocardial infarction with right ventricular infarction and the incidence of right ventricular infarction in inferior wall MI was 26%

Anomalous Origin of the Left Circumflex Coronary Artery From the First Diagonal Branch Presented as Acute Myocardial Infarction

Coronary artery anomalies are diagnosed in 0.6 to 1.5% of patients who undergo coronary angiography (CAG). They may present with life threatening conditions but are generally asymptomatic. Recognition and adequate visualization of the anomaly is essential for correct management of the condition. However, in some cases the exact orifice and course of an anomalous coronary vessel cannot be selectively identified by CAG. In this report, a 54-year-old man was admitted to the hospital with acute inferior myocardial infarction and had an anomalous origin of the left circumflex coronary artery (LCX) from the first diagonal branch (D1). In CAG, the right CAG showed no significant stenosis and fortunately we found an anomalous origin of the LCX from the D1. The course of LCX was precisely established by 64-slice multi-detector computed tomography.

Clinical and angiographic findings of complete atrioventricular block in acute inferior myocardial infarction

<p><b>INTRODUCTION</b>The angiographic findings and prognosis of patients with complete atrioventricular block (AVB) complicating acute inferior myocardial infarction (MI) remain unclear.</p><p><b>MATERIALS AND METHODS</b>The clinical and angiographic findings of 70 consecutive patients with complete AVB were compared with those of 319 patients with inferior MI without AVB (control group) admitted within the same study period.</p><p><b>RESULTS</b>Patients with complete AVB were older (68 +/- 12 vs 63 +/- 13 years; P = 0.004) and clustered with clinical features indicative of larger infarct size, such as right ventricular infarction, cardiogenic shock, or low left ventricular ejection fraction (LVEF). The onset of the complete AVB was observed within 24 hours in 62 (88.6%), preceded by second-degree AVB in 26 (37.1%) and the escape QRS complex was wide in 8 (11.4%) patients. In patients with complete AVB, a dominant right coronary artery occlusion was found in >95% of cases and in-hospital mortality was increased (27.1% vs 10.7%; P = 0.000), especially in those with widen QRS escape rhythm (75.0%). Reperfusion therapy had a positive impact on the natural course of complete AVB.</p><p><b>CONCLUSIONS</b>Complete AVB in acute inferior MI was associated with advanced age and larger infarct size. Complete AVB was virtually always caused by dominant right coronary artery occlusion. The in-hospital mortality was significantly higher, but improved by reperfusion therapy. No permanent pacemaker is performed at a mean follow-up of 47 months.</p>

Acute hypertensive pulmonary edema after Cesarean section in a patient with an antepartum myocardial infarction: A case report / 대한마취과학회지

We report a case of 29-year-old, morbidly obese, diabetic primigravida who had undergone previously primary percutaneous coronary intervention with stent placement for an inferior wall myocardial infarction at 10 weeks of gestation. She remained asymptomatic with medication during the remainder of her pregnancy, but preoperative echocardiography revealed left ventricular dilation and a restrictive diastolic dysfunction with a preserved ejection fraction (46%). She developed acute pulmonary edema associated with hypertension after an elective Cesarean delivery under continuous epidural anesthesia despite the meticulous restriction of fluid.

Impact of Right Ventricular Myocardial Involvement on Mortality and Morbidity during Percutaneous Coronary Intervention

PURPOSE: Right ventricular (RV) involvement during acute inferior myocardial infarction (MI) is associated with increased early mortality and morbidity. However, little is known concerning mortality and morbidity after right ventricular myocardial infarction (RVMI) during percutaneous coronary intervention (PCI). METHODS: This retrospective study was performed in a university training hospital. Patients with inferior MI (n=94) who presented to the emergency department between November 2005 and October 2007 were included. We examined the incidence of death, mechanical complications and electrical complications in patients with (n=29) and without (n=65) RV myocardial involvement. RV involvement was assessed by ST-Segment elevation > or =0.1 mV in lead V4R. PCI was performed in all patients. RESULTS: In-hospital mortality was 3.4% in RVMI compared with 3.1% in non-RVMI (p=1.00). There was no significant difference in the incidence of mechanical complications and electrical complications between patients with and without RVMI. CONCLUSION: Patients who have inferior MI with RV myocardial involvement are not at increased risk of death, mechanical complications and electrical complications.

Correlation of severity of ST segment elevation in acute inferior wall myocardial infarction with the proximity of right coronary artery disease

A number of researchers have used different electrocardiographical criteria to predict the culprit vessel in acute inferior wall myocardial infarction [MI] cases. Therefore, the determination of infarct related artery in AMI is extremely important with regard to prediction of potential complications, furthermore, predicting the probable site of occlusion within RCA is worthwhile because proximal occlusions are likely to cause greater myocardial damage and an early invasive strategy may be planned in such cases. Our study aimed at evaluating the ECG criteria to predict the proximity of lesion in the right coronary artery [RCA] in acute inferior wall MI cases. The Objectives were to predict the presence of a proximal lesion in right coronary artery by severity of ST segment elevation in inferior ECG leads. This cross-sectional study carried out at the department of cardiology and cardiac catheterization at Jinnah Hospital, Lahore from April 2008 to September 2008. A total of 60 patients who suffered from inferior wall MI were included in the study who underwent coronary angiography in the first week. The ECGs of these patients were then compared with the angiographic findings to correlate the proximity of culprit lesion in RCA with the degree of ST segment elevation in inferior limb leads. Out of 60 patients, 29 [48.4%] had the culprit lesion in proximal, 23 [38.5%] in mid and 8 [13.4%] in distal RCA. Patients with proximal RCA disease showed a mean ST segment elevation of 12.55 +/- 1.38 mm, with mid RCA disease 8.39 +/- 0.89 mm and with distal RCA disease 6.0 +/- 0.54 mm. This study demonstrated that the severity of ST segment elevation was correlated with proximity of RCA lesion

A Case of In-Stent Plaque Rupture Presenting as an Acute Myocardial Infarction

In-stent atheromatous plaque rupture is a very rare event. A 51-year-old man presented with an acute inferior myocardial infarction 9 years after bare-metal stent implantation in the mid-portion of right coronary artery. After thrombolytic therapy, coronary angiography and intravascular ultrasound (IVUS) revealed a ruptured plaque at the mid portion of the stented segment.