Exactitud diagnóstica de la integral tiempo-velocidad del tracto de salida para choque cardiogénico: cohorte prospectiva / Diagnostic accuracy of the integral time-velocity of the outflow tract for cardiogenic shock: prospective cohort / Precisão diagnóstica da integral tempo-velocidade da via de saída para choque cardiogênico: coorte prospectiva

Resumen: Introducción: el choque cardiogénico (CC) es un estado de hipoperfusión sistémica causado por disfunción cardíaca severa. La medición de la integral tiempo-velocidad del tracto de salida del ventrículo izquierdo (ITV-TSVI, por sus siglas en inglés) < 15 cm permite evaluar la presencia del choque. Objetivo: evaluar a la ITV-TSVI < 15 cm como predictor de choque cardiogénico en el paciente con infarto agudo de miocardio anterior con elevación del segmento ST (IAM-ST). Material y métodos: estudio observacional prospectivo realizado de mayo a octubre de 2019. Se incluyeron pacientes con IAM-ST anterior y revascularización mediante intervencionismo coronario percutáneo. Se midió mediante ecocardiografía transtorácica la ITV-TSVI, se registraron y compararon las variables demográficas y clínicas de los pacientes con ITV-TSVI < 15 cm versus aquéllos con ITV-TSVI ≥ 15 cm y se calculó la exactitud diagnóstica de la ITV-TSVI < 15 cm para predecir choque cardiogénico. Resultados: se analizaron los datos de 50 pacientes con media de edad: 63.5 ± 9.9 años, 70% fueron hombres, 54% tuvieron choque cardiogénico y la ITV-TSVI < 15 cm se presentó en 95.8% de los pacientes con choque cardiogénico. La exactitud diagnóstica del ITV-TSVI < 15 cm en choque cardiogénico en pacientes con IAM-ST anterior mostró sensibilidad de 85% y especificidad de 96%, con área bajo la curva: 0.90 (IC 95%: 0.81-0.99). Conclusión: el ITV-TSVI < 15 cm en pacientes con IAM-ST anterior tiene una exactitud diagnóstica muy buena para la predicción del choque cardiogénico.

Abstract: Introduction: cardiogenic shock (CC) is a state of systemic hypoperfusion caused by severe cardiac dysfunction. The measurement of the integral time-velocity of the left ventricular outflow tract (ITV-LVOT) < 15 cm allows to evaluate the presence of shock. Objective: to evaluate the ITV-TSVI < 15 cm as a predictor of cardiogenic shock in the patient with ST-segment elevation anterior acute myocardial infarction (ST-AMI). Material and methods: prospective observational study conducted from May to October 2019. Patients with previous ST-AMI and revascularization by percutaneous coronary intervention were included. TVI-LVOT was measured by transthoracic echocardiography, the demographic and clinical variables of patients with TVI-LVOT < 15 cm vs. those with TVI-LVOT ≥ 15 cm were recorded and compared, and the diagnostic accuracy of TVI-LVOT < 15 cm to predict cardiogenic shock was calculated. Results: data from 50 patients were analyzed with a mean age of 63.5 ± 9.9 years, 70% were men, 54% had cardiogenic shock, and TVI-LVOT < 15 cm occurred in 95.8% of those patients with shock. cardiogenic. The diagnostic accuracy of the TVI-LVOT < 15 cm for cardiogenic shock in patients with anterior ST-AMI showed sensitivity of 85% and specificity of 96%, with area under the curve: 0.90 (95% CI: 0.81-0.99). Conclusion: The TVI-LVOT < 15 cm in patients with anterior ST-AMI has a very good diagnostic accuracy for the prediction of cardiogenic shock.

Resumo: Introdução: o choque cardiogênico (CC) é um estado de hipoperfusão sistêmica causado por disfunções cardíacas severas. A medição da integral velocidade-tempo da vía de saída do ventrículo esquerdo (ITV-TSVI, por suas siglas em inglês) < 15 cm permite avaliar a presença do choque. Objetivo: avaliar a integral tempo-velocidade da via de saída do ventrículo esquerdo (ITV-TSVI) < 15 cm como preditor de choque cardiogênico em pacientes com infarto agudo do miocárdio anterior com supradesnivelamento do segmento ST (IAM-ST). Material e métodos: estudo observacional prospectivo realizado de maio a outubro de 2019. Incluíram-se pacientes com IAM-ST anterior e revascularização por intervenção coronária percutânea. Mediu-se por ecocardiografia transtorácica a ITV-TSVI, foram registradas e comparadas as variáveis demográficas e clínicas de pacientes com ITV-TSVI < 15 cm versus aqueles com ITV-TSVI ≥ 15 cm, e calculo-se a precisão diagnóstica de ITV-TSVI < 15 cm para prever o choque cardiogênico. Resultados: analizaram-se dados de 50 pacientes com idade média de 63.5 (± 9.9) anos, 70% eram homens, 54% apresentavam choque cardiogênico e ITV-TSVI < 15 cm apresentou-se em 95.8% dos pacientes com choque cardiogênico. A precisão diagnóstica do ITV-TSVI < 15 cm para choque cardiogênico em pacientes com IAM-ST anterior apresentou sensibilidade de 85% e especificidade de 96%, com área sob a curva: 0.90 (IC 95%: 0.81-0.99). Conclusão: ITV-TSVI < 15 cm em pacientes com IAM-ST anterior tem uma precisão diagnóstica muito boa para prever o choque cardiogênico.

Physical exercise on the recovery of obesity myocardial infarction / O exercício físico na recuperação de infarto do miocárdio por obesidade / El ejercicio físico en la recuperación del infarto de miocardio por obesidad

ABSTRACT Introduction: Myocardial infarction caused by human obesity can cause a decline in mobility and a decline in the quality of a healthy life. Sports training is beneficial to maintain early physical functions after myocardial infarction. Objective: This article deals with the effect of applying walking aerobic exercise in the rehabilitation treatment of patients with myocardial infarction. Methods: We enrolled 91 patients with myocardial infarction in the early exercise group and 90 patients in the control group. The control group received the routine nursing intervention, and the early exercise group received early physical exercise rehabilitation therapy. Results: The actual quality of life of the early exercise group was higher than that of the control group. The incidence of cardiovascular adverse events was lower than that of the control group. Conclusion: Physical exercise therapy used in acute myocardial infarction can reduce adverse cardiovascular events and improve the quality of life of patients. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: O infarto do miocárdio causado por obesidade pode levar a um declínio de mobilidade e na qualidade de uma vida saudável. O treinamento esportivo é benéfico para a manutenção precoce da função física após o infarto do miocárdio. Objetivo: Este estudo trata do efeito de exercícios aeróbicos de caminhada no tratamento de reabilitação de pacientes que sofreram infarto do miocárdio. Métodos: Recrutamos 91 pacientes que sofreram infarto do miocárdio no grupo de exercícios precoce e 90 pacientes no grupo de controle. O grupo de controle recebeu a intervenção de enfermagem de rotina, enquanto o grupo de exercícios precoce recebeu terapia de reabilitação com exercícios precoces. Resultados: A qualidade de vida efetiva do grupo de exercício precoce foi mais alta do que aquela do grupo de controle. Conclusão: A terapia de exercícios físicos usada no infarto agudo do miocárdio pode reduzir incidências cardiovasculares adversas e melhorar a qualidade de vida dos pacientes. Nível de evidência II; estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: El infarto de miocardio causado por obesidad puede ocasionar una caída de movilidad y de la calidad de una vida saludable. El entrenamiento deportivo es benéfico para la manutención temprana de la función física tras el infarto de miocardio. Objetivo: Este estudio trata del efecto de ejercicios aeróbicos de caminata en el tratamiento de rehabilitación de pacientes que sufrieron infarto de miocardio. Métodos: Reclutamos 91 pacientes que sufrieron infarto de miocardio en el grupo de ejercicios temprano y 90 pacientes en el grupo de control. El grupo de control recibió la intervención de enfermería de rutina, mientras el grupo de ejercicios tempranos recibió terapia de rehabilitación con ejercicios tempranos. Resultados: La calidad de vida efectiva del grupo de ejercicio temprano fue más alta que aquella del grupo de control. Conclusión: La terapia de ejercicios físicos usada en el infarto agudo de miocardio puede reducir incidencias cardiovasculares adversas y mejorar la calidad de vida de los pacientes. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

Puente miocárdico como causa de infarto a repetición

RESUMEN Se presenta el caso de un paciente, sin comorbilidades, que se interna por cuadro de infarto agudo de miocardio a repetición. En todas las ocasiones presentó dolor precordial típico y elevación de troponinas. En su primera cinecoronariografía no se encontraron lesiones angiográficas. Meses después vuelve a internarse por cuadro similar, se repite cinecoronariografía que informa nuevamente vasos coronarios sin lesiones angiográficas pero como hallazgo describe una imagen compatible con un puente muscular a nivel del tercio medio de la arteria descendente anterior, con efecto compresivo durante las sístoles y como responsable de las isquemias del miocardio. Finalmente se concluye como un infarto agudo de miocardio tipo 2 y se instaura tratamiento médico específico, respondiendo favorablemente.

ABSTRACT We present the case of a patient, without comorbidities, who is hospitalized due to recurrent acute myocardial infarction. On all occasions he presented typical precordial pain and elevated troponins. In his first cinecoronariography no angiographic lesions were found. Months later, he returned to hospital for a similar case, cinecoronariography is repeated that again reports coronary vessels without angiographic lesions but as a finding describes an image compatible with a muscular bridge at the level of the middle third of the anterior descending artery, with compressive effect during systoles and responsible for the myocardial ischemia. Finally, it is concluded as an acute type 2 myocardial infarction and specific medical treatment is established, responding favorably.

Anterior Wall Myocardial Infarction With Conduction Defect And It's Outcome During Hospital Stay

Background: Qrbb myocardial infarction has high mortality and morbidity. So we want to study in hospital outcome of qrbbb myocardial infarction Methods: It is a prospective study. We studied qrbbb mi patients admitted in our hospital from December 2016 to June 2017 Results: About 90% of patients had heart failure. And 80% of patients required ventilatory support in the form of non–invasive positive pressure ventilation (NIPPV) or invasive ventilation. About 37% of patients had ventricular arrhythmias. Thrombolysis with streptokinase was done in 64% of patients and with tenecteplase for 20% of the patients. Percutaneous transluminal coronary angioplasty (PTCA) was done in 47% patients. Two patients had pharmacoinvasive PTCA. 16% of patients were conservatively treated due to late presentation. 24% patients died during hospital stay while 76% got discharged. 14% of patients had reversal of rbbb wave. 14% had stent thrombosis. 100% of patients had left anterior descending artery (LAD) disease. While 10% had left main coronary artery disease and 14% had triple vessel disease (TVD), 10% were sent for coronary artery bypass grafting (CABG). Conclusions: qRBBB AWMI carries high mortality of 24% with 90% of patients going in to heart failure. Ejection fraction is a good predictor of death and diabetes is a covariate of predictor of death.

Usefulness of Myocardial Longitudinal Strain in Prediction of Heart Failure in Patients with Successfully Reperfused Anterior Wall ST-segment Elevation Myocardial Infarction

BACKGROUND AND OBJECTIVES: Acute myocardial infarction-related heart failure (HF) is associated with poor outcome. This study was designed to investigate the usefulness of global longitudinal strain (GLS), global circumferential strain (GCS) and mean longitudinal strain of left anterior descending artery territory (LSant) measured by 2-dimensional speckle tracking echocardiography (2D STE) in prediction of acute anterior wall ST-segment elevation myocardial infarction (ant-STEMI)-related HF. METHODS: A total of 171 patients with ant-STEMI who underwent successful primary coronary intervention and had available 2D STE data were enrolled. Patients were divided into 3 groups: in-hospital HF, post-discharge HF, and no-HF groups. RESULTS: In-hospital and post-discharge HF developed in 39 (22.8%) and 13 (7.6%) of patients, respectively and 113 patients (69.6%) remained without HF. Multivariate analysis showed that GLS was the only factor significantly associated with the development of in-hospital HF. For post-discharge HF, LSant was the only independent predictor. Other echocardiographic or laboratory parameters did not show independent association with the development of ant-STEMI-related HF. CONCLUSIONS: GLS is a powerful echocardiographic parameter related to development of in-hospital HF and LSant was significantly associated with post-discharge HF in patients with successfully reperfused ant-STEMI.

Reduction of the Isolated Anterior Wall of the Maxillary Sinus Fracture with Double Urinary Balloon Catheters and Fibrin Glue

BACKGROUND: Conservative treatment is performed for isolated anterior wall of the maxillary sinus fractures, in many cases when the fracture is clinically not severe and asymptomatic. Despite the absence of symptoms, complications such as sinusitis, rhinitis, and chronic purulent secretion may develop; therefore, successful reduction is required. We attempted to reduce the risk of complications using an alternative technique: reduction of the fracture with two urinary balloon catheters inserted through the maxillary ostium and fixation using fibrin glue, which minimizes the damage to the bony fragments and sinus mucosa. METHODS: In this study, 38 patients who were diagnosed with an isolated anterior wall of the maxillary sinus fracture at our hospital between January 2014 and January 2017 were enrolled. The fracture site was exposed via the Caldwell-Luc approach followed by reduction through the insertion of two urinary balloon catheters using a nasal endoscope and fixation with fibrin glue. The sex, cause of fracture, physical examination, and presence of complications were examined and patient's medical records and facial bone computed tomography scans were analyzed. RESULTS: Radiological evaluation showed that there was no evidence of collapsed reduction fragments. Although some patients had remaining symptoms of hypoesthesia (15%; 3 patients), there were no complications such as infection, rhinitis, sinusitis, and chronic purulent secretion at the surgical site. CONCLUSION: In this study, we present an alternative surgical technique using two urinary balloon catheters and fibrin glue for the successful reconstruction of an isolated anterior wall of the maxillary sinus fracture. This technique enables precise restoration with a reduced risk of complications.

Intraoperative localization of acetabular phase parameters and their clinical significance / 局解手术学杂志

Objective To study the significance of the related parameters of the abduction angle ,anteversion angle and summit arc angle in the intraoperative localization of anterior column and anterior wall acetabular fractures .Methods The safety angle of abduction angle ,an-teversion angle,summit arc angle and anterior wall acetabular of 318 adult pelvic specimen(109 males and 109 females) were measured.The data was statistical analyzed.Results For the male pelvic specimen,the measured values of abduction angle of acetabulum was (43.5 ± 2.9)°, anteversion angle was (13.7 ±5.2)°,summit arc angle inside was(25.5 ±7.3)°,summit arc angle front was(37.8 ±7.2)°,sum-mit arc angle back(49.9 ±12.7)°.For female pelvic specimen,the measured values of abduction angles of acetabulum was (44.1 ±3.2)° and anteversion angle was (14.3 ±4.9)°,summit arc angle inside was(27.1 ±6.5)°,summit arc angle front was(36.3 ±9.2)°,summit arc angle back was(52.3 ±13.6)°.According to '2-7' sector method, the thickness of different point of anterior wall was measured .There were statistically significant differences in abduction angles ,anteversion angle and summit arc angle (P<0.05).And there was no statistically sig-nificant difference in the thickness of anterior column and anterior wall between the above three one angles (P>0.05),there was no signifi-cant difference in the acetabular abduction angle ,anteversion angle and summit arc angle between males and females .Conclusion The intra-operative localization of acetabulum abducted angle ,anteversion angle and summit arc angle in the acetabulum anterior column and anterior wall fractures can achieve satisfactory therapeutic effect .

Therapeutic effect of spironolactone combined benazepril on patients with acute anterior myocardial in-farction / 心血管康复医学杂志

Objective:To explore therapeutic effect of spironolactone combined benazepril on patients with acute ante-rior myocardial infarction(AAMI)and its influence on left ventricular remodeling.Methods:A total of 100 AAMI patients treated in our hospital were regard as study object.According to therapeutic method,they were divided into benazepril group(n=50)and combined treatment group(n=50,received spironolactone combined benazepril),both groups were treated for six months.Therapeutic effect,left ventricular remodeling condition and incidence of adverse reactions were compared between two groups.Results:Compared with before treatment,after six-month treatment,there were significant rise in all indexes of heart rate variability(HRV)and left ventricular ejection fraction(LVEF),and significant reductions in left ventricular end-systolic dimension(LVESd)and left ventricular end-diastolic dimension(LVEDd)in two groups,P<0.05 or <0.01;compared with benazepril group after treatment,there were significant rise in all HRV indexes and LVEF[(52.45 ± 8.65)% vs.(57.85 ± 9.70)%],and significant reductions in LVESd[(36.25 ± 2.13)mm vs.(30.10 ± 2.06)mm]and LVEDd[(58.60 ± 6.41)mm vs.(51.29 ± 6.20)mm]in combined treatment group,P<0.01 all;there was no significant difference in total adverse reaction rate between two groups,P=1.000. Conclusion:Spironolactone combined benazepril can significantly improve HRV and heart function,inhibit left ventricular remodeling in patients with acute anterior myocardial infarction.

Evaluation effect of three-dimensional speckle tracking imaging on left ventricular systolic function in patients with acute anterior myocardial infarction / 心血管康复医学杂志

Objective: To explore evaluation effect of three-dimensional speckle tracking imaging (3D-STI) on left ventricular systolic function in patients with acute anterior myocardial infarction (AAMI).Methods: A total of 40 AAMI patients and 40 healthy subjects were enrolled as AAMI group and healthy control group respectively.Left ventricular longitudinal strain (LS), radial strain (RS), circumferential strain (CS), area of strain (AS), general longitudinal strain (GLS), general radial strain (GRS), general circumferential strain (GCS) and general area of strain (GAS) were measured, compared and analyzed between two groups for 3D-STI technique.Results: Compared with healthy control group, there were significant reductions in left ventricular LS of 12/17 segment, RS and AS of 10/17 segment, and CS of 9/17 segment in AAMI group, P<0.05 or <0.01;for general strain values, compared with healthy control group, there were significant reductions in GLS[(19.59±3.52) vs.(9.25±2.16)], GRS[(36.73±4.83) vs.(25.26±5.19)], GCS[(22.63±4.38) vs.(15.15±3.98)], GAS[(32.87±4.41) vs.(21.73±3.84)]in AAMI group, P<0.01 all.Conclusion: The three-dimensional speckle tracking imaging can accurately detect segmental myocardial strains of left ventricular systolic function in patients with acute anterior myocardial infarction.It can be used as a quantitative measure for clinical evaluation of these patients′ condition.

Miocardiopatía de takotsubo y la arteria coronaria única: una combinación excepcional / Takotsubo cardiomyopathy and single coronary artery: a unique combination

La miocardiopatía de takotsubo es una entidad que clínicamente simula un síndrome coronario agudo, siendo indispensable para su diagnóstico la exclusión de la enfermedad coronaria significativa. Se presenta el caso de una mujer postmenopáusica, quien durante un episodio de migraña desarrolla un cuadro clínico similar a un infarto del miocardio anterior, donde la ecocardiografía durante el evento agudo, orientó hacia el diagnóstico correcto de miocardiopatía de Takotsubo, encontrándose incidentalmente una arteria coronaria única sin enfermedad obstructiva.

Takotsubo cardiomyopathy is a condition that clinically simulates an acute coronary syndrome, thus it remains indispensable for its diagnosis to exclude a significant coronary disease. We present the case of a postmenopausal woman who developed a clinical picture similar to an anterior myocardial infarction during a migraine episode, where the echocardiogram during the acute event oriented towards the correct diagnosis of a Takotsubo cardiomyopathy, incidentally finding a single coronary artery with no obstructive disease.

Supradesnivel del segmento ST en derivación aVR en el síndrome coronario agudo con elevación persistente del segmento ST. revisión de la literatura a propósito de un caso / ST segment elevation in aVR derivation in acute coronary syndrome with persistent elevation of ST segment. literature review following a case

Durante los últimos años, se ha observado la asociación del supradesnivel de ST en la derivación aVR con el compromiso de la arteria descendente anterior (DA), tronco coronario izquierdo (TCI) y coronaria derecha (CD), en el contexto de un infarto de miocardio agudo con segmento ST elevado (IMA-STE). Por medio del electrocardiograma se puede predecir con una probabilidad del 80% el compromiso de TCI frente a DA, cuando la relación aVR sobre V1 es mayor a la unidad. Asimismo, la presencia de un supradesnivel en aVR se asocia a mayor mortalidad a los 30 dias en IMA-STE de cara anterior e inferior. Por lo expuesto previamente, se recalca la importancia del análisis de la elevación del ST en aVR en un IMA-STE de cara anterior puesto que predice compromiso de gran territorio vascular y empeora el pronóstico del paciente.

During last years an association between elevation of the ST segment in the aVR derivation with the affection of the anterior descending coronary artery (ADCA), left coronary artery trunk (LCT) and right coronary artery (RCA) in the context of acute myocardial infarction with elevated ST segment (AMI-ESS) has been observed. The electrocardiogram may predict with 80% accuracy the affection of the LCT versus ADCA when the relation of aVR over V1 in higher than 1. Moreover, an elevation of the ST segment in aVR is associated with higher 30- day mortality in patients with AMI-ESS of the anterior and inferior side. Therefore, we emphasize the importance of analyzing the elevation of the ST segment in aVR in patients with AMI-ESS of the anterior side as it predicts extensive vascular affection and worsens prognosis.

Study of adjacent anatomy between the middle and distal section of bony nasolacrimal Duct and the anterior wall of maxillary sinus / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo observe the anatomic relationship between the middle and distal section of bony nasolacrimal duct and anterior wall of maxillary sinus. METHODS206 cases of sinus CT without maxillary disorders were enrolled. The middle and distal section of bony nasolacrimal duct and anterior wall of maxillary sinus is divided into fusion type and separation types, and the angle between the anterior and medial wall of the maxillary sinus is divided into frontal and lateral types in relation to the middle and distal section of bony lacrimal duct.RESULTSThe fusion type accounted for 40.05%, and the separate type was 59.95%. There was no statistical difference between male and female.The proportion of inconsistency on both sides was 16.02%. The frontal type of the angle between the anterior and medial wall of the maxillary sinus accounted for 64.08%, meanwhile the proportion of the lateral type was 35.92%. The lateral type was 84.24% out of the cases of fusion type, whereas the frontal type was15.76%. In the separate type, the frontal type accounted for 97.17%, and the lateral type was 2.92%. CONCLUSIONThe anatomic relationship between the middle and distal section of bony nasolacrimal duct and anterior wall of maxillary sinus shows different type, which is helpful to choose operative strategy.

Effect analysis of anterior wall cartilage resection plus V suture for large pseudocyst of auricle / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo evaluate the efficacy of anterior wall cartilage resection plus V suture and anterior wall cartilage resection combined with compression and fixation in treating large pseudocyst of auricle through comparison analysis.METHODSA retrospective case-control study, comparing the efficacy of anterior wall cartilage resection and suture to wear a V type (45 cases) and anterior wall cartilage resection and compression bandage fixation (43 cases) for the treatment of large pseudocyst of auricle.RESULTS6 months after surgery for observation, the cure rate of treatment group was 88.89%, the rate of control group was 72.09%, the differences between the two groups was statistically significant (P<0.05).CONCLUSIONAnterior wall cartilage resection plus V suture for large pseudocyst of auricle is simple to operate, with fast recover and reliable effect.

Safety of laparoscopically assisted vaginal hysterectomy for women with anterior wall adherence after cesarean section

OBJECTIVE: To evaluate the safety and surgical outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for women with anterior wall adherence after cesarean section. METHODS: We conducted a retrospective study of 328 women with prior cesarean section history who underwent LAVH from March 2003 to July 2013. The subjects were classified into two groups: group A, with anterior wall adherence (n=49); group B, without anterior wall adherence (n=279). We compared the demographic, clinical characteristics, and surgical outcomes of two groups. RESULTS: The median age and parity of the patients were 46 years (range, 34 to 70 years) and 2 (1 to 6). Patients with anterior wall adherence had longer operating times (175 vs. 130 minutes, P<0.05). There were no significant differences in age, parity, number of cesarean section, body mass index, specimen weight, postoperative change in hemoglobin concentration, or length of hospital stay between the two groups. There was one case from each group who sustained bladder laceration during the vaginal portion of the procedure, both repaired vaginally. There was no conversion to abdominal hysterectomy in either group. CONCLUSION: LAVH is effective and safe for women with anterior wall adherence after cesarean section.

A study of clinical profile of acute ST elevation myocardial infarction patients from GMERS Medical College and Hospital, Gandhinagar, Gujarat.

Acute myocardial infarction is the most common and potentially life-threatening cardiac emergency presenting to a hospital. Having significant mortality and morbidity, the emergency requires early recognition, efficient triage and prompt therapeutic, interventions for maximum benefit. The objective was to study the age & sex distribution, clinical features, risk factors, ECG findings, complications, outcome of pts admitted with acute ST elevation myocardial infarction pts admitted in GMERS medical college and hospital, Gandhinagar, Gujarat. Methods: This is a retrospective study of all new patients managed for acute ST elevation myocardial infarction in the I.C.C.U. of GMERS medical college and hospital, Gandhinagar, Gujarat from January1 2012 to December 31, 2013. Results: Acute ST elevation myocardial infarction was more common in males (71.7%). Male to female ratio was 3.6:1. Mean age was 55.72 years & most pts were in age group of 51-60. most common clinical feature was chest pain (96.9%). Most of the pts (22.8%) presented in the hospital after onset of chest pain in 0>6 hrs duration. Most pts were having anterior wall infarction (47.5%). Most common risk factor was smoking or any form of tobacco consumption (28.3%). Most common complication was congestive cardiac failure (42.9%). In hospital mortality was 13.2%. Conclusion: Acute ST elevation myocardial infarction was having male predominance with anterior wall myocardial infarction most common and most common risk factor was smoking and most common complication was congestive cardiac failure.

Prevención secundaria post infarto agudo de miocardio en hospitales públicos: implementación y resultados de las garantías GES / Universal health coverage and accomplishment of secondary prevention goals among patients with acute myocardial infarction

Background: In 2005, acute myocardial infarction (AMI) was included in a universal health plan (GES) to reduce inequity in care and optimize its diagnosis and treatment. Aim: To evaluate the effect of GES in risk factor control and therapeutic management among patients with AMI. Material and Methods: A survey was conducted in 2008-2009 in six public hospitals. Patients were identified from a hospital based registry of AMI and evaluated one year later with laboratory tests and an interview. Results: The registry enrolled 534 patients with ST and non ST segment elevation myocardial infarction. Of these, 416 patients aged 63 ± 12 years (25% women) were evaluated one year later. Eighty three percent were evaluated by a cardiologist and 37% by a general practitioner. Twenty two percent were evaluated by a nurse and 22% by a nutritionist. At the moment of the interview, 9% smoked, 78% were overweight or obese, 24% performed moderate or vigorous physical activity ≥ 150 min/week, 60% had systolic pressure > 130 mmHg and 63% a diastolic pressure > 80 mmHg. In 30%, LDL cholesterol was > 100 mg/dl and in 43%, triglycerides were > 150 mm/dl. Twenty two percent were diabetic and among them, 52% had a glycosilated hemoglobin > 7%. Forty five percent of non-diabetic patients had a fasting glucose > 100 mg/dl. Ninety three percent were in treatment with aspirin, 86% with statins, 66% with b-blockers, and 73% with angiotensin converting enzyme inhibitors or angiotensin receptor blockers and 20% with clopidogrel. Conclusions: Despite the high proportion of patients in treatment with evidence-based therapy, many do not achieve the targets for risk factor control with the new health care model.

Anomalous Separate Origin of Left Anterior Descending Coronary Artery: Presented as Acute Anterior Myocardial Infarction

Coronary artery anomalies are rare presentations in primary percutaneous coronary interventions of acute myocardial infarction. Herein, we report the case of a 59-year-old man with acute anterior myocardial infarction who had anomalous separate origin of left anterior descending artery (LAD) and left circumflex artery (LCX) from the left coronary aortic sinus. Coronary angiography showed a normal right coronary artery and LCX, but no visualization of the LAD. After several unsuccessful attempts to cannulate the LAD, we found the LAD ostium located by the side of the LCX ostium. There was total occlusion at proxymal LAD. Coronary computed tomography angiography demonstrated the precise, separate origin of LAD and LCX from the left coronary aortic sinus.

Coronary Slow Flow Phenomenon Leads to ST Elevation Myocardial Infarction

The exact etiology of the coronary slow flow phenomenon (CSFP) is not certain. CSFP is not a normal variant as it is an absolutely pathological entity. Furthermore, CSFP not only leads to myocardial ischemia but it can also cause classical acute ST elevation myocardial infarction, which necessitates coronary angiography for a definite diagnosis.

Index of Microcirculatory Resistance as Predictor for Microvascular Functional Recovery in Patients with Anterior Myocardial Infarction

IMR is useful for assessing the microvascular dysfunction after primary percutaneous coronary intervention (PCI). It remains unknown whether index of microcirculatory resistance (IMR) reflects the functional outcome in patients with anterior myocardial infarction (AMI) with or without microvascular obstruction (MO).This study was performed to evaluate the clinical value of the IMR for assessing myocardial injury and predicting microvascular functional recovery in patients with AMI undergoing primary PCI. We enrolled 34 patients with first anterior AMI. After successful primary PCI, the mean distal coronary artery pressure (Pa), coronary wedge pressure (Pcw), mean aortic pressure (Pa), mean transit time (Tmn), and IMR (Pd * hyperemic Tmn) were measured. The presence and extent of MO were measured using cardiac magnetic resonance image (MRI). All patients underwent follow-up echocardiography after 6 months. We divided the patients into two groups according to the existence of MO (present; n = 16, absent; n = 18) on MRI. The extent of MO correlated with IMR (r = 0.754; P < 0.001), Pcw (r = 0.404; P = 0.031), and Pcw/Pd of infarct-related arteries (r = 0.502; P = 0.016). The IMR was significantly correlated with the DeltaRegional wall motion score index (r = -0.61, P < 0.01) and DeltaLeft ventricular ejection fraction (r = -0.52, P < 0.01), implying a higher IMR is associated with worse functional improvement. Therefore, Intracoronary wedge pressures and IMR, as parameters for specific and quantitative assessment of coronary microvascular dysfunction, are reliable on-site predictors of short-term myocardial viability and Left ventricle functional recovery in patients undergoing primary PCI for AMI.

Reporte de caso clínico: remodelado ventricular después del infarto agudo de miocardio / Clinical case report: ventricular remodeling after acute myocardial infarction

La dilatación cardíaca y la insuficiencia cardíaca pos-infarto agudo de miocardio son eventos frecuentes en la práctica clínica diaria de los consultorios de cardiología. Tiene una importancia creciente por el aumento continuo en la incidencia de necrosis miocárdica y por su relación con la morbi-mortalidad. Por lo tanto, toda terapéutica que usemos destinada a limitar su patogénesis o mejor aún a revertirla, incidirá en los descensos de la tasa de mortalidad en este grupo poblacional que se ha convertido últimamente en uno de los de más riesgo en nuestro país. Con el caso que se presenta se intenta encontrar las posibles explicaciones fisiopatológicas en relación con la evolución clínica ante los diferentes fármacos que se utilizaron en el tratamiento.

Post-acute myocardial infarction cardiac dilation and heart failure are common events in daily clinical practice in the cardiology doctors’ offices. It has a growing importance due to the continued increase in the incidence of myocardial necrosis and its relationship to morbidity and mortality. Therefore, any therapeutics aimed at limiting its pathogenesis or better yet reversing it, will produce a decline in the mortality rate in this population group which has recently become one of the riskiest in our country. In the case presented, we try to find the possible pathophysiological explanations regarding the clinical evolution when different drugs are used in treatment.