ABSTRACT
Background Coronary heart disease has multiple risk factors, including air pollution. Numerous pathophysiological mechanisms have been identified with increasing levels of air pollution, mainly with ozone (O3), nitrogen dioxide (NO2), sulphur dioxide (SO2), particulate matter (PM10), fine particulate matter (PM2.5) and carbon monoxide (CO). In Mexico, the pollution level is reported using an air quality index called IMECA. Methods All patients with STEMI admitted at Hospital Español were collected between 2012 and 2019 (Nâ¯=â¯348). We conducted a retrospective analysis using the air pollution exposure at the time of each event (lag0), the previous 24â¯h (lag1), 48â¯h (lag2), 72â¯h (lag3) and 5-day cumulative lag. The level of air pollution was analyzed independently using IMECA and particle concentrations. The data was divided in two groups: days with one of more STEMI's (MI group) and days free of events (Control group), using ANCOVA to evaluate the difference between means of both groups taking into account confounders. Results: For days with one or more cardiovascular event, a significant increase in SO2 was observed at lag1; similar increase was found in CO, PM2.5, SO2 at lag2. For the 5-day cumulative lag, SO2 and PM2.5 showed a significant increase. No differences were found using the IMECA levels in both groups. Conclusions: The elevated concentrations levels of CO, SO2 and PM2.5 showed significant association with STEMI at different time points before the event. Ozone, PM10 and NO2 showed no difference between groups. IMECA levels showed no association with STEMI in our study.
ABSTRACT
Atrial fibrillation (Afib) is clinically the most common arrhythmia. Its main complications are recurrent embolic events and a variable deterioration of functional class. Atrial fibrillation induces changes in cellular ionic channels that self-perpetuate the arrhythmia. The pharmacologic treatment of Afib is directed toward correction of those changes and return to sinus rhythm. It is also intended to maintain adequate heart rates and prevent embolic events through anticoagulation or platelet antiagregation. There are presently several class IC or class III antiarrhythmics available for attempting a return to sinus rhythm. The success rates are irregular, the best achieved with flecainide or propafenone among patients without structural heart disease. Amiodarone is the best choice when there is such a problem. The combination possibilities are huge, so that each case must be individualized. The new class III antiarrhythmics are very effective, but have a relatively high rate of side effects including torsade de pointes. Anticoagulation should be the preferred treatment among the majority of patients, but each case should be individually evaluated. New therapies such as focal or linear catheter ablation techniques, atrial or biatrial programmed stimulation, and atrial cardioverter-defibrillator need longer follow-up and experience to be objectively evaluated, although there are reasons to be optimistic in the future, even if patients need antiarrhythmic support at present. Surgery has high morbi-mortality rates, so it is not the preferred approach.
Subject(s)
Atrial Fibrillation , Algorithms , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Atrial Fibrillation/epidemiology , Atrial Fibrillation/physiopathology , Humans , Thromboembolism/etiology , Thromboembolism/prevention & controlABSTRACT
INTRODUCTION: The calcium score (CS) of the coronary arteries by computed tomography (CT) is an useful procedure for the diagnosis of obstructive coronary disease (OCD), with an average sensitivity of 82 +/- 6%, specificity of 88 +/- 2%, positive predictive value (PPV) of 57 +/- 7% and negative predictive value (NPV) of 96 +/- 2%. The objective of this trial was to compare helicoidal CT Scan with the traditional method and define sensitivity, specificity, Positive predictive value and negative predictive value against the coronary angiography. METHODS: From June of 1998 to March of 1999, one hundred and sixty six patients with coronary arteries CT were studied. The CT was done with an ELSCINT-CT Twin equipment and a software for the quantification of the coronary arteries CS in Hounsfield units. In forty one, coronary angiography was performed. A significant obstructive lesion was defined as > or = 70% of luminal stenosis in at least one artery, or > or = 50% in the left main and > or = 50% if some other artery was involved. This group was divided in accordance to the CS in two subgroups: A with a CS < or = 150 and B those with a CS > or = 151. RESULTS: In group A, 45% had significative lesions vs 95% in group B (p = 0.001). The sensitivity was 65%, specificity 95%, PPV 64% and the NPV 92%. Relative risk 2.08 (CI 95% 1.38-3.54) and Odds ratio 21.6 (CI 95% 2.43-191.37). CONCLUSIONS: Even though the small sample, CT is an useful procedure for the diagnosis of the OCD.
Subject(s)
Calcinosis/diagnostic imaging , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Tomography, X-Ray Computed/methods , Aged , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Sensitivity and SpecificityABSTRACT
We report the alterations of the left ventricular diastolic function studied with pulsed Doppler echocardiography. We measured different parameters of the transvalvular mitral blood flow in four patients with Unstable Angina Pectoris and six patients with Acute Myocardial Infarction. The results of these patients were compared with the results of a control group of twelve normal subjects. All subjects of study had no previous history of cardiovascular disease. The studied parameters were the acceleration and deceleration half times (t1(2a)/t1(2d), respectively), the diastolic deceleration slope (PD), the maximum velocity of the atrial filling and rapid filling quotient (A/E), and the first third diastolic fraction (FD). We found significant difference in the mean value of the A/E and the FD between the normal subjects and 80% of the patients with Ischemic Heart Disease. We also found significant difference in the other studied parameters between the normal and Unstable Angina groups. We concluded that Acute Ischemic Heart Disease causes significant anomalies of the left ventricular diastolic function and that pulsed Doppler echocardiography is a good method to demonstrate it.
Subject(s)
Angina Pectoris/physiopathology , Angina, Unstable/physiopathology , Diastole/physiology , Echocardiography, Doppler , Myocardial Contraction/physiology , Myocardial Infarction/physiopathology , Adult , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
A case of post-partum cardiomyopathy in a patient with pansystolic mitral prolapse is presented. Two days after delivery the patient had an episode suggestive of pulmonary thromboembolism with heart failure. The diagnosis was not confirmed by a lung scan. Chest X rays showed cardiomegaly and pulmonary congestion. M-mode echocardiography showed pansystolic mitral prolapse, dilatation of the left ventricle and generalized hypomobility of the walls. Two weeks later the patient was asymptomatic, chest X rays were normal and the echocardiogram showed mitral prolapse with normal size cavities and movement of the walls. The difficulties to establish the diagnosis of this process employing conventional methods of diagnosis is discussed. The importance of echocardiography in the detection and follow-up of this condition is stressed.
Subject(s)
Echocardiography , Heart Failure/diagnosis , Mitral Valve Prolapse/diagnosis , Puerperal Disorders/diagnosis , Adult , Diagnosis, Differential , Female , Humans , Pregnancy , Pulmonary Embolism/diagnosisABSTRACT
Fourty patients with acute myocardial infarction were studied by M-mode echocardiography. A significant correlation was established between the electrocardiographic localization of the infarction and the decreased motion of the left ventricular walls. Even when a significant correlation was present between decreased ventricular function and heart failure in anterior myocardial infarction, this was not found in the inferior and posterior wall myocardial infarction. In practice these findings should be accepted cautiously. Our findings show the high frequency of pericardial effusion in acute myocardial infarction. In spite of its limitations, the echocardiogram may be useful in the clinical assessment of patients with acute myocardial infarction, specially when it is anterior, or when complications are suspected.
Subject(s)
Echocardiography , Myocardial Infarction/physiopathology , Adult , Aged , Female , Heart Block/etiology , Heart Failure/etiology , Heart Ventricles/physiopathology , Hemodynamics , Humans , Male , Middle Aged , Myocardial Infarction/complications , Pericardial Effusion/etiologyABSTRACT
Se estudiaron con ecocardiografia modo M 40 pacientes con infarto del miocardio en evolucion. Se encontro una correlacion significativa entre la localizacion electrocardiografica del infarto y la alteracion del movimiento de las paredes del ventriculo izquierdo en el ecocardiograma. Aunque existe una correlacion significativa en los infartos anteriores entre la presencia de insuficiencia cardiaca y la disminucion de la funcion ventricular a traves del calculo por el ecocardiograma, esto no es valedero en los posteroinferiores y en la practica clinica tal parametro debe tomarse con cautela. En nuestro estudio se demuestra que el derrame pericardico es frecuente en los infartos agudos del miocardio. A pesar de sus limitaciones, el ecocardiograma puede ser util para valorar a los pacientes con infarto del miocardio en evolucion, especialmente cuando este es anterior extenso o se sospechan complicaciones
