Association of hypokalemia with severe arrhythmias in patients with acute myocardial infarction

Clinical and animal studies suggest that the ischemic heart can be particularly vulnerable to hypokalemia leading to the cardiac arrhythmia. To evaluate the association of severe arrhythmia with hypokalemia in patients with acute myocardial infarction [AMI]. Retrospective study. Coronary Care Unit, Salmaniya Medical Complex. Two hundred and seventy-four patients with AMI had serum potassium levels measured on admission along with other cardiovascular risk factors. Serum potassium concentrations were significantly decreased with the severity of arrhythmias [no arrhythmias; 4.2 +/- 0.80 mmol/l, supra-ventricular; 3.8 +/- 0.9 mmol/l, and ventricular arrhythmias; 3.3 +/- 0.5 mmol/l, p=0.0001]. The risks of supra-ventricular and ventricular arrhythmias were significantly increased by 2.4 and 8.3 fold, respectively in patients with serum potassium levels at the lowest quartile [<3.5 mmol/l] compared with the highest quartile of serum potassium when adjusted for other risk factors. The results of this study suggest that hypokalemia is independently associated with the severity of arrhythmias in patients with AMI

predictive value of admission serum glucose and glycosylated haemoglobin [HbA1C] in patients presenting with acute myocardial infarction [AMI]: short term outcome

Recent data indicated a high prevalence of abnormal glucose metabolism in patients with no history of diabetes mellitus [DM] at the time of acute myocardial infarction [AMI]. The aim of this retrospective study was to assess the predictive value for clinical outcome for admission hyperglycemia in patients presenting with acute ST-elevation myocardial infarction [STEMI]. Other risk factors such as history of DM, hypertension, Body Mass Index [BMI], smoking, serum level of glycosylated haemoglobin [HbA1c] and low density lipoprotein [LDL] were evaluated. The data of two hundred and eighty five [285] patients with STEMI was extracted and evaluated retrospectively. Patients were classified according to admission serum glucose [AG] into three groups: Group 1 with AG level of <=7 mmol/L and group 2 with AG level between >7 and <15 mmol/Land group 3 of AG >/= 15 mmol/L. In the study group the mean age was 59.7 +/- 14 years, range [24-88] and 180 [63%] were male. 173 [60%] patients with STEMI had hyperglycemic with glucose of more than 7 mmol/L with or without history of DM, eighty four [29%] patients had hyperglycemia and history of DM,89 [31%] patients had hyperglycemia [stress] without DM. Thirty two percent had history of hypertension and 26% had history of smoking. The frequency of more than two Major Acute Cardiac Events [MACE] such as pulmonary odema, significant arrhythmias, or cardiogenic shock were at frequency of 70% in group 3.19% in group 2, and 11% in group 1. Thirty patients died during the study [10.5%]: twelve patients [4.2%] were in group 3, eleven patients [3.9%] in group 2 and seven [2.4%] in group 1. The odds ratio of stress hyperglycemia in group 3 compared with group 1 after adjustment for age and sex as predictor of mortality was 3.3 [Cl 0.99-10.98, P=0.032, like wise, the odds ratio in group 2 compared with group 1 after adjustment was 2.4 [Cl: 0.75- 8.07, P=0.065].The history of DM, high serum level of LDL and the level of HBA1 c and Anterior AMI were significant predictors of adverse outcome while other risk factors such as BMI, history of hypertension and smoking were of no significance. These data indicate that hyperglycemia of more than 15 mmol/L on admission without history of DM is powerful predictor of adverse clinical outcome in the setting of acute myocardial infarction. Other useful predictors are history of DM, and high serum level of glycosylated hemoglobin, LDL and the site of anterior MI on ECG. The BMI, history of hypertension and smoking are not useful predictors of adverse mortality

Cardiac echinococcosis: echocardiographic diagnosis with a fatel clinical outcome

Hydatid disease HD is an endemic disease found in various regions of the world. The organs mostly affected are the liver and lung. Cardiac involvement in HD is rare. The symptoms are mainly due to the mass effect of the calcific hydatid cyst obstructing the blood or the lymphatic vessels. Other manifestations are secondary infection or cyst rupture in the involved organ. Here, we report a middle aged female patient with no history of medical illness who presented to the emergency room with an unrecordable blood pressure. Echocardiogram showed multiple calcific cysts of echinococcosis granulosa in the left ventricle cavity. In the clinical setting, where there is detection of HD elsewhere in the body, an echocardiogram is mandatory as cardiac involvement is serious and may be fatal

clinical utility of intrapleural streptokinase in a patient with bilateral pleural empyema

Bilateral thoracic empyema is a rare clinical entity particularly when presented as an initial clinical manifestation. Antibiotic therapy with intercostal thoracostomy drainage tube of the infected pleural space in complicated parapneumonic empyema may not be adequate in many conditions due to multiloculation and adhesion. We describe in this case a previously healthy middle aged male, presented with a bilateral thoracic empyema that was treated initially with antibiotics and intercostal drainage tube without optimal drainage results. The administration of twice daily intrapleural streptokinase prolonged for the duration of more than 10 days proved to be safe and effective as an alternative line of management in such a clinical condition