Subject(s)
Aneurysm, Infected/drug therapy , Intracranial Aneurysm/drug therapy , Aneurysm, Infected/etiology , Angiography, Digital Subtraction , Anti-Bacterial Agents/therapeutic use , Echocardiography , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/drug therapy , Female , Humans , Infarction, Middle Cerebral Artery/complications , Intracranial Aneurysm/etiology , Mitral Valve/microbiology , Mitral Valve/surgery , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/microbiology , Mitral Valve Insufficiency/surgery , Young AdultSubject(s)
Aorta , Carcinoma/diagnosis , Heart Diseases/diagnosis , Lung Neoplasms/diagnosis , Thrombosis/diagnosis , Aorta/pathology , Blood Coagulation Disorders/diagnosis , Blood Coagulation Disorders/etiology , Carcinoma/complications , Diagnosis, Differential , Female , Heart Diseases/etiology , Humans , Lung Neoplasms/complications , Middle Aged , Stroke/diagnosis , Stroke/etiology , Thrombosis/etiology , Tomography, X-Ray ComputedSubject(s)
Cardiomyopathies/complications , Cardiomyopathy, Dilated/complications , Cerebral Infarction/etiology , Stroke/etiology , Adult , Anticoagulants/therapeutic use , Cardiomyopathies/diagnostic imaging , Echocardiography, Transesophageal , Electrocardiography , Facial Paralysis/etiology , Humans , Male , Mutism/etiologyABSTRACT
OBJECTIVES: Acute coronary syndromes (ACSs) and coronary artery disease are emerging complications in HIV-infected patients on highly active antiretroviral treatment. The aim of this study was to determine the mid-term prognosis of ACS in HIV-infected patients. METHODS: We evaluated the clinical characteristics and follow-up profile [38+/-15 months; mean+/-standard deviation (SD)] of ACS in 20 HIV-infected patients (mean +/-SD: age 44+/-8 years; range 35-65 years). All had coronary angiograms performed mean time 3+/-48 h after the onset of symptoms. RESULTS: Eighteen patients were on antiretroviral therapy, of whom 13 patients were on regimens including protease inhibitors (mean duration+/-SD: 19+/-13 months). Fifteen patients had a first episode of ST segment elevation ACS and five had non-ST segment elevation ACS. Tobacco consumption (80%) and hypercholesterolaemia (50%) were the most frequent cardiovascular risk factors. During initial hospitalization, four patients were treated with thrombolysis, two had primary coronary angioplasty and seven had secondary coronary angioplasty. At follow up, 10 patients (50%) had had 18 cardiovascular events: one cardiovascular death, seven episodes of recurrent myocardial ischaemia in four patients, three pulmonary oedemas in two patients, and seven revascularization procedures in five patients. CONCLUSIONS: This preliminary report highlights the risk of ACS and related complications in HIV-infected patients and raises questions regarding the implications of antiretroviral treatment.
Subject(s)
Anti-Retroviral Agents/therapeutic use , HIV Infections/drug therapy , Myocardial Infarction/complications , Adult , Aged , Angioplasty, Balloon, Coronary/methods , Cardiovascular Diseases/mortality , Female , HIV Infections/complications , Humans , Hypercholesterolemia/complications , Male , Middle Aged , Myocardial Infarction/therapy , Prognosis , Protease Inhibitors/therapeutic use , Recurrence , Risk Factors , Smoking/adverse effects , Syndrome , Thrombolytic Therapy/methodsABSTRACT
The authors report 4 cases of acute coronary syndromes with increased troponine levels during junctional tachycardia in patients with angiographically normal coronary arteries. ST segment changes during junctional tachycardia have no predictive value for the detection of coronary artery disease. Increased troponine, a marker of myocardial cellular necrosis, is not a sign of coronary lesions. A disequilibrium between the increased metabolic and energetic requirements of the myocardium and decreased perfusion due to the tachycardia could explain this observation. The recommended management of these patients is not to perform coronary angiography initially in the absence of cerebrovascular risk factors, but rather to document myocardial ischaemia by a non-invasive method such as echocardiography or scintigraphy.
