RESUMEN
A 67-year-old man was admitted to our hospital following cardiopulmonary arrest (CPA) during work. After resuscitation, coronary angiography revealed left main coronary artery stenosis and three-vessel disease. We considered that coronary artery revascularization was required, but the neurological prognosis was unknown. Thus, an IMPELLA CP® device was inserted and systemic management, including hypothermic therapy, was initiated. Circulatory conditions were stable during hypothermia therapy. Rewarming was initiated 24 h later, and we confirmed no abnormal neurological findings. Emergency off-pump coronary artery bypass was then performed. During the procedure, hemodynamic status was maintained using the IMPELLA CP® device. After surgery, the patient was discharged without neurological complications. We report the management of a patient with severe three-vessel disease after resuscitation for CPA using an IMPELLA CP® device and hypothermic therapy.
RESUMEN
Abstract: Introduction: IHD has become an important long-term end point for RA patients independent of traditional CVRF. Therefore, cardiovascular injury and mortality might be due to the presence of a chronic systematic inflammatory response. Nonetheless, there is a gap in its diagnosis since symptoms remain silent until major events occur. Objective: We aimed to evaluate by gated single-photon emission computed tomography (g-SPECT). Myocardial perfusion in asymptomatic Mexican patients with RA and at least one traditional CVRF, and without history of angina. Patients and methods: A prospective study with a total number of 91 patients was conducted. We evaluated CVRF and RA characteristics. We non-invasively assessed them with g-SPECT to reveal ischemia, territories and severity. We calculated relative risks and 95% CI of ischemia given the associated variables. Results: 22 (24.2%) patients presented ischemia, half of them in the LAD territory. Regarding CVRF and disease's characteristics; only smokers and patients under a steroid treatment were at more risk to present ischemia (0.49 [0.24 to 0.98] and 2.04 [1.01 to 4.14], respectively) with a p = 0.046. Conclusion: We have contributed with additional evidence to strategically diagnose IHD in patients with RA even if they have no symptoms and independently of the existence of cardiovascular risk factors to prevent and reduce cardiovascular mortality.
Resumen: Introducción: La IC se ha convertido en un importante punto de partida a largo plazo para los pacientes con AR independientemente de los FRCV tradicionales. Por lo tanto, las lesiones cardiovasculares y la mortalidad podrían deberse a la presencia de una respuesta inflamatoria sistemática crónica. Sin embargo, hay una brecha en su diagnóstico ya que los síntomas permanecen en silencio hasta que ocurren eventos importantes. Objetivo: Evaluar mediante tomografía computarizada de emisión de un solo fotón (g-SPECT). Perfusión miocárdica en pacientes mexicanos asintomáticos con AR y al menos un FRCV tradicional, sin antecedentes de angina. Pacientes y métodos: Se realizó un estudio prospectivo con un número total de 91 pacientes. Se evaluaron las características FRCV y AR. Los evaluamos de forma no invasiva con g-SPECT para revelar isquemia, territorios y severidad. Se calcularon los riesgos relativos la isquemia de 95% dadas las variables asociadas. Resultados: Veintidós (24.2%) pacientes presentaron isquemia, la mitad de ellos en territorio LAD. Respecto a los FRCV y características de la enfermedad; sólo los fumadores y los pacientes sometidos a un tratamiento con esteroides presentaron mayor riesgo de presentar isquemia (0.49 [0.24 a 0.98] y 2.04 [1.01 a 4.14], respectivamente) con p = 0.046. Conclusión: Hemos aportado pruebas adicionales para diagnosticar la isquemia estratégicamente en los pacientes con AR, incluso si no tienen síntomas y con independencia de la existencia de factores de riesgo cardiovascular para prevenir y reducir la mortalidad cardiovascular.
RESUMEN
Objective To discuss the feasibility of establishing the model of combining myocardial ischemic coronary disease with syndrome of kidney deficiency and blood stasis by surgical method.Methods Non-disease of kidney deficiency and blood stasis syndrome model was built by taking the methods of fright, being placed in a cold environment and injection of hydrocortisone. The model of combining the myocardial ischemic coronary disease with the syndrome of kidney deficiency and blood stasis was established through ligating the left anterior descending branch of artery and injecting hydrocortisone. The rats were divided into kidney deficiency and blood stasis group, combination of disease and syndrome group, and normal group, 5 rats in each group. The temperature, weight, heart rate, breathing rate and whole blood viscosity, casson viscosity of the rats in the two groups before and after modeling were observed. According to TCM clinical diagnosis criteria of kidney deficiency and blood stasis syndrome, TCM syndrome characteristics of the two groups were compared.ResultsCompared with normal groups and before modeling, rat temperature dropped and breathing rate increased in kidney deficiency and blood stasis group, combination of disease and syndrome group (P<0.05). Compared with normal group, rat weight decreased or grew slowly, and whole blood viscosity and casson viscosity increased (P<0.05, P<0.01). There were statistical significant differences in whole blood viscosity and electrocardiogram between the two groups (P<0.05).Conclusion There is no obvious difference between TCM syndrome characteristics of the two groups. They all meet the TCM clinical diagnosis criteria of kidney deficiency and blood stasis syndrome.