Acute myocardial infarction in a young adult male associated with the use of smokeless tobacco [Sweka]

Dipping smokeless tobacco [ST] is used worldwide. We report a case of acute myocardial infarction in a young patient, who consumed smokeless tobacco [Sweka] for over one year. ST may be as harmful as smoking and carries adverse cardiac complications. A prompt call for restriction and prohibition is advised and its alternative use to quit smoking must be abandoned

Assessment of initiation time of thrombolytic therapy in patients with ST-segment elevation myocardial infarction in Hamad General Hospital

The elevation of reperfusion therapy for acute ST-segment elevation myocardial infarction are time-related and there are decreasing benefits with increasing delays to therapy. To determine whether the time interval between a patient's arrival at the emergency department of Hamad General Hospital, Qatar and initiation of thrombolytic therapy in the coronary care unit [door-to-needle time] is within the 30 minutes recommended by American College of Cardiology/American Heart Association guidelines, the medical records were reviewed of 213 patients with ST-segment elevation myocardial infarction who were admitted through the Emergency Department to receive thrombolysis in the Coronary Care Unit in the twelve months May 2006-April 2007. Medians were calculated for door-to-needle and pain-to-needle times and intermediate points. The median pain-to-needle and pain-to-door times were 211 and 143 minutes respectively, both increasing significantly with the age of the patient and were shorter in men than in women. The median door-to-needle time was 60 minutes with 11.7% of the sample having a door-to-needle time within the recommended 30 minutes. It is concluded that the need for transferring such patients from the emergency department to the coronary care unit of the hospital before the administration of thrombolysis incurs inevitable delays that can be minimized by administering thrombolysis in the emergency department

Catheter-induced left main coronary artery spiral dissection: Stenting or bypass? [case report and literature review]

Catheter-induced Left Main Coronary Artery [LMCA] dissection is a very uncommon but life-threatening complication of coronary intervention and requires urgent management. We report one such patient whose risk factors appear to be Coronary Artery Disease [CAD], smoking and a prior Myocardial Infarction [MI]

Digitalis toxicity and fab fragment

This article presents a brief overview of digitalis toxicity, class of medication that is notoriously know for its toxicity, but which still has significant use in clinical practice. We hereby briefly outline on the use of digoxin specific Fab fragment in the treatment of digitalis toxicity

Ximelagatran, the oral anticoagulant of the future an evidence based review

This article presents the available data on Ximelagatran, a novel oral direct thrombin inhibitor and explores its therapeutic potential. Recent large clinical trials have evaluated the efficacy and safety of this anticoagulant compared to the standard anticoagulation therapy with warfarin and heparins in several thrombotic disorders. These trials provide strong evidence for the efficacy and safety of ximelagatran in the following clinical indications; the prevention of venous thromboembolism after knee or hip replacement, the treatment of deep venous thrombosis, and prevention of stroke in patients with atrial fibrillation. Further evaluation of this promising oral anticoagulant is warranted in other thrombotic cardiovascular disorders requiring chronic oral anticoagulation therapy such as in patients with prosthetic heart valves, intracardiac thrombi dilated cardiomyopathy, after myocardial infarction am post percutaneous coronary interventions