ABSTRACT
A 52-year-old male with history of dilated cardiomyopathy was admitted with progressive dizziness and worsening dyspnea. His blood pressure was 100/60 with a regular pulse of 70 per minute. Jugular vein wave showed a prominent pulse like regular cannon waves. Cannon wave occurs in conditions with atrioventricular dissociation and right atrial contraction against a closed tricuspid valve. Large A waves are associated with reduced right ventricular compliance or elevated right ventricular end-diastolic pressure.
Subject(s)
Cardiomyopathy, Dilated/physiopathology , Electrocardiography , Heart Atria/physiopathology , Heart Block/physiopathology , Heart Rate/physiology , Heart Ventricles/physiopathology , Tricuspid Valve/physiopathology , Cardiac Catheterization , Cardiomyopathy, Dilated/complications , Cardiomyopathy, Dilated/diagnosis , Echocardiography , Heart Atria/diagnostic imaging , Heart Block/complications , Heart Block/diagnosis , Heart Ventricles/diagnostic imaging , Humans , Male , Middle Aged , Tricuspid Valve/diagnostic imagingABSTRACT
OBJECTIVE: High levels of mean platelet volume (MPV) may be associated with adverse outcomes in patients with myocardial infarction (MI). We examined the association between MPV and the risk of death and adverse cardiovascular outcomes in patients with MI. METHODS: We studied consecutive patients with MI admitted to a tertiary-care hospital during a period of 1â year. MPV was measured at admission and at third month. Patients were followed up for 1-year primary composite outcome of cardiovascular death, stroke, fatal or non-fatal MI and cardiac failure. Patients were classified according to tertile of baseline MPV. RESULTS: A total of 1206 patients with MI, including 934 men (77.4%) and 272 women (22.6%) were studied. The mean age of the study population was 56â years. At 1-year follow-up, 292 (28.57%) primary outcome occurred: cardiovascular mortality 78 (7.6%), fatal or non-fatal MI 153 (15.0%), stroke 30 (2.9%) and cardiac failure 128 (12.52%). Patients with the highest tertile MPV had higher primary outcome as compared with those with MPV in the lowest tertile (adjusted OR=2.31; 95% CI 1.60 to 3.35; p<0.001). Total mortality was also more in high-MPV group (adjusted OR 2.62; 95% CI 1.47 to 4.70; p<0.001). There were no significant changes in mean MPV values at admission from those at third month interval (9.15, (SD 0.99) vs 9.19 (SD 0.94); p=0.2). CONCLUSIONS: Elevated MPV was associated with worse outcome in patients with acute MI. Elevated MPV in these patients may be due to inherently large platelets. TRIAL REGISTRATION NUMBER: http://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=5485&EncHid=98036.61144&modid=1&compid=19; CTRI/2012/12/003222.
