RESUMEN
BACKGROUND: Obstructive sleep apnea (OSA) may lead to myocardial preconditioning by increasing coronary collateral vessel recruitment in patients with acute coronary occlusion. AIM: To determine the relationship between the severity of obstructive sleep apnea and coronary collaterality during acute myocardial infarction. METHODS: This study prospectively included 71 patients with an inaugural myocardial infarction who had undergone a coronary angiography within 24h of onset. All patients underwent an overnight polygraph before discharge and were classified according to the apnea-hypopnea index (AHI). Coronary collaterals were scored by visual analyses and according to the Rentrop grading system. RESULTS: Mean age was 59±11years and 83% of patients were men. All patients had complete or subtotal occlusion of the infarct-related artery. After the sleep study, patients were divided into two groups: 25 were suffering from OSA (AHI>15/h). Patients with OSA showed better collateral vessel development (Rentrop score≥1) compared to non-OSA patients (68 vs. 41%, P=0.032). AHI was significantly higher in patients with developed coronary collaterals (Rentrop≥1) compared to those without collaterality (17.74±13.2 vs. 12.24±10.9, P=0.025). CONCLUSION: Coronary collateral development may be increased in OSA patients who are presenting with a first myocardial infarction.
Asunto(s)
Circulación Colateral/fisiología , Circulación Coronaria/fisiología , Precondicionamiento Isquémico Miocárdico , Infarto del Miocardio/fisiopatología , Apnea Obstructiva del Sueño/fisiopatología , Adulto , Anciano , Angiografía Coronaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea , Polisomnografía , Pronóstico , Estudios Prospectivos , Apnea Obstructiva del Sueño/diagnóstico , Terapia TrombolíticaRESUMEN
Atrial fibrillation can expose to thrombo-embolic complications. Many biomarkers have been tested to refine the stratification of thrombo-embolic risk. The study aim was to assess the interest of the d-dimer testing in this pathology. We conducted a prospective observational study including 50 cases and 19 controls, enrolled at the cardiology department of the Mongi Slim Hospital, from July to November 2012. The d-dimer assay was performed on mini-VIDAS(®) and analyzed according to clinical, echocardiographic and biological data. The mean age of patients was 61.8±10.6years. The mean CHA2DS2-VASc score was 2.58±1.31. The average of D-dimer levels was 590±506ng/ml in patients and 225.26±112.95ng/ml in controls (P=0.02). No significant difference has been found between the d-dimer level and age, sex, type and etiology of atrial fibrillation, the CHA2DS2-VASc score, the left atrial surface. Among patients on acenocoumarol, d-dimer levels was significantly higher in patients with an INR<2 compared to those with an INR≥2 (P=0.004). We identified a positive d-dimer threshold (300ng/ml) in patients distinguishing them significantly with controls (P<0.001). In conclusion, the measurement of d-dimers could help clinicians to identify patients with atrial fibrillation having an increased coagulability and, therefore, an increased thrombo-embolic risk. It could be complementary to the determination of INR in monitoring anticoagulation therapy: d-dimers level refines the thrombo-embolic risk and INR measurement assesses the level of anticoagulation and the bleeding risk.
Asunto(s)
Fibrilación Atrial/sangre , Biomarcadores/sangre , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Anciano , Fibrilación Atrial/tratamiento farmacológico , Femenino , Fibrinolíticos/efectos adversos , Fibrinolíticos/uso terapéutico , Hemorragia/inducido químicamente , Humanos , Relación Normalizada Internacional , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Riesgo , Tromboembolia/sangre , TúnezRESUMEN
BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is underdiagnosed in cardiologist daily practice, especially in patients with acute coronary syndrome. Its diagnosis is based on a polysomnography study. The Epworth Sleepiness Scale (ESS) stands as a simple and rapid means to select patients for the sleep investigation. AIM: The aim of this study was to determine the diagnostic accuracy of the ESS for screening OSAS in patients with ST elevation myocardial infarction. METHODS: We conducted a prospective study of 120 consecutive patients admitted for acute myocardial infarction, from April 2011 to March 2012. Daytime sleepiness was evaluated using the ESS, when patients were in the intensive care unit. All patients have undergone an overnight sleep study using a portable diagnostic device, in the 15 days following the acute coronary syndrome. The diagnostic of OSA was considered as apnea-hypopnea index (AHI) of ≥5 events/hour, severe OSA was defined as AHI of ≥30. RESULTS: The study included 120 patients comprising 102 men and 18 women. The mean age was 58 ± 12 years. Smoking was the major cardiovascular risk factor with 72% of all patients; prevalence of diabetes was 40% and hypertension was found in 44% of the population. The prevalence of OSA was 79%. Severe OSA was diagnosed in 16% of all patients and mean AHI was 15.76 ± 14.93. Mean ESS was 2.2 ± 1.84 in the global population while it was 5.2 ± 1.2 in patients with severe OSAS. Multivariate analysis showed that ESS score ≥ 4 was an independent predictive factor for severe OSA (OR=28; 95% IC: 8-101; P<0.001). CONCLUSION: The prevalence of OSA in patients with acute myocardial infarction was very high. ESS score ≥ 4 was an independent predictive factor for severe OSA. Despite its subjective feature, the ESS seems to be an interesting score for screening patients to undergo polysomnography.
Asunto(s)
Trastornos de Somnolencia Excesiva/diagnóstico , Infarto del Miocardio/epidemiología , Encuestas y Cuestionarios , Diabetes Mellitus/epidemiología , Trastornos de Somnolencia Excesiva/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Obesidad Abdominal/epidemiología , Polisomnografía , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Apnea Obstructiva del Sueño/epidemiología , Fumar/epidemiología , Túnez/epidemiologíaRESUMEN
BACKGROUND: Obstructive sleep apnea has been implicated in the pathogenesis and aggravation of coronary atherosclerosis. However, it remains underdiagnosed in cardiology practice. AIM: The aim of this study was to determine the prevalence of obstructive sleep apnea and the predictors of severe sleep apnea in patients admitted for ST elevation myocardial infarction. METHODS: This was a prospective study which has included 120 patients hospitalized for ST elevation myocardial infarction, from April 2011 to March 2012. All patients have undergone an overnight sleep study using a portable polygraphy device, in the 15 days following the acute coronary syndrome. The diagnostic of obstructive sleep apnea was considered as apnea-hypopnea index of ≥ 5 events per hour, severe sleep apnea was defined as apnea -hypopnea index of ≥ 30. Subjective daytime sleepiness was assessed by the Epworth sleepiness scale. All patients have had an oxygen saturation monitoring in the coronary care unit using a pulse oxymeter, before undergoing the sleep study. RESULTS: The study population was made up of 102 men and 18 women. The mean age was 58 ± 12 years. Smoking was the major cardiovascular risk factor found in 72% of all patients, diabetes and hypertension were represented in 40% and 44% of the population, respectively. Eighty-seven percent of patients were admitted in the first 24 hours of symptom onset. A primary percutaneous coronary intervention was performed in 60% of cases while fibrinolysis was done in 10% of patients. The prevalence of obstructive sleep apnea was 79%. Mean apnea-hypopnea index was 15.76 ± 14.93 and severe form was diagnosed in 16% of all patients. Multivariate analysis showed that Epworth sleepiness score of ≥ 4 and nocturnal desaturation below 82% were independent predictive factors for severe obstructive sleep apnea. CONCLUSION: Prevalence of obstructive sleep apnea was very high in patients admitted for acute myocardial infarction. Epworth sleepiness score of ≥ 4 and nocturnal desaturation below 82% were independent predictive factors for severe form of sleep apnea.
Asunto(s)
Infarto del Miocardio/diagnóstico , Infarto del Miocardio/epidemiología , Admisión del Paciente/estadística & datos numéricos , Apnea Obstructiva del Sueño/diagnóstico , Apnea Obstructiva del Sueño/epidemiología , Anciano , Infarto de la Pared Anterior del Miocardio/diagnóstico , Infarto de la Pared Anterior del Miocardio/epidemiología , Índice de Masa Corporal , Femenino , Estudios de Seguimiento , Humanos , Infarto de la Pared Inferior del Miocardio/diagnóstico , Infarto de la Pared Inferior del Miocardio/epidemiología , Masculino , Persona de Mediana Edad , Polisomnografía , Valor Predictivo de las Pruebas , Prevalencia , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Túnez/epidemiologíaRESUMEN
Controversy persists over the safety of conducted electrical weapons, which are increasingly used by law enforcement agencies around the world. We report a case of 33-year-old man who had an acute inferior myocardial infarction after he was shot in the chest with an electrical weapon.
Asunto(s)
Lesiones por Armas Conductoras de Energía/complicaciones , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/etiología , Armas , Adulto , Agresión , Diagnóstico Diferencial , Humanos , MasculinoRESUMEN
Coronary anomalies are a rare entity. The gold standard remains the coronary angiogram. However, the identification of the origin and the course of aberrant coronary arteries using angiography may be difficult. We report two cases regarding two patients who underwent coronary angiography in order to evaluate coronary heart disease. In the first case, angiography has shown a left anterior descending artery (LAD) originating from the right anterior sinus. A multidetector CT scan (MDCT) showed an inter-aortopulmonary course of the LAD. In the second case, selective catheterization of the right coronary artery could not be done. A MDCT scan was performed. An abnormal origin of the right coronary artery was detected. It originates from the left sinus with a separate ostium of the left main coronary artery. This artery had an inter-aortopulmonary course. The 64 MDCT scan can be useful as a complementary tool for the diagnosis of coronary artery anomalies. Detection of the inter-aortopulmonary course is essential, since this situation will require surgical treatment to avoid sudden cardiac death.
Asunto(s)
Angiografía Coronaria/métodos , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Tomografía Computarizada Multidetector , Seno Aórtico/diagnóstico por imagen , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/cirugía , Complicaciones de la Diabetes/diagnóstico por imagen , Humanos , Hipercolesterolemia/complicaciones , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Readmisión del Paciente , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , Seno Aórtico/anomalías , Seno Aórtico/cirugía , Fumar/efectos adversos , StentsRESUMEN
Peripartum cardiomyopathy is a rare and under recognized form of dilated cardiomyopathy, defined as a heart failure in the last month of pregnancy or in the first five months post-partum with absence of determinable cause for cardiac failure and absence of demonstrable heart disease. The incidence of peripartum cardiomyopathy ranges from 1 in 1300 to 1 in 15,000 pregnancy. Advanced maternal age, multiparity, twin births, preeclampsia and black race are known risk factors. The etiology of peripartum cardiomyopathy remains unknown but viral, autoimmune or idiopathic myocarditis are highly suggested. The clinical presentation on patients with peripartum cardiomyopathy is similar to that of patients with systolic heart failure. The treatment is based on drugs for sympyomatic control. Studies in graeter populations are need to determine the role of immunosupressive treatment. About half patients of peripartum cardiomyopathy recover. The left ventricular ejection fraction and the left ventricular end-diastolic diameter are statistically significant prognostic factors. The risk of developing peripartum cardiomyopathy in subsequent pregnancies remains high. The place of dobutamine stress test in counseling the patients who desire pregnancy must be more studied.
Asunto(s)
Cardiomiopatía Dilatada , Complicaciones Cardiovasculares del Embarazo , Trastornos Puerperales , Cardiomiopatía Dilatada/tratamiento farmacológico , Femenino , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/tratamiento farmacológico , Pronóstico , Trastornos Puerperales/tratamiento farmacológicoRESUMEN
The Brugada syndrome is a clinical-electrocardiographic diagnosis characterised by syncopal or sudden death episodes in patients with a structurally normal heart with a characteristic electrocardiographic pattern consisting of ST segment elevation in the precordial leads V1 to V3 and a morphology of the QRS complex resembling a right bundle branch block. In many patients with the Brugada syndrome, the electrocardiographic manifestations transiently normalize; leading to underdiagnosis of the syndrome. The administration of sodium channel blockers such as ajmaline, flecainide or procainamide accentuate the ST segment elevation and can be used to unmask concealed and intermittent forms of the disease. The incidence of sudden death in this syndrome is very high and can only be prevented by implanting a cardioverter-defibrillator. Because of high incidence of familial occurrence, the extension of the testing to family members is important.
Asunto(s)
Bloqueo de Rama/patología , Muerte Súbita Cardíaca/etiología , Bloqueo de Rama/diagnóstico , Bloqueo de Rama/tratamiento farmacológico , Diagnóstico Diferencial , Cardioversión Eléctrica , Electrocardiografía , Humanos , Pronóstico , Factores de Riesgo , Bloqueadores de los Canales de Sodio/uso terapéutico , SíndromeRESUMEN
There is many progresses in term of comprehension of physiopathologic mechanisms and also therapeutic indications. The increase of treatment modalities need a clear strategy and an adapted choice from pharmacologic, to surgical, external electric shock, prophylactic cardiac stimulation, implantable auricular defibrillation, and ablative methods.
Asunto(s)
Fibrilación Atrial/terapia , Cardiotónicos/uso terapéutico , Desfibriladores Implantables , Cardioversión Eléctrica , HumanosRESUMEN
Cardiac failure with normal systolic function represents 30 to 50% of all the cardiac failures. Ther is no clinical radiographical electrocardio graphical symptom to characterize this Kind of Cardiac failure. It's diagnosis and its valuation could be done with doppler chocardiography. The etiology is dominated by the ischemic cardopathy, the hpertophic myocardis fathies and senile heart. It's treatment isn't codified Yet.
Asunto(s)
Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Sístole , Factores de Edad , Ecocardiografía Doppler , Electrocardiografía , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/etiología , Hemodinámica , Humanos , Hipertrofia Ventricular Izquierda/complicaciones , Isquemia Miocárdica/complicaciones , Prevalencia , PronósticoRESUMEN
We report three observations of Diltiazem intoxication at therapeutic doses with occurence of sino auricular block. The situation evolute favorably for two patients while the third die. The electro systolic stimulate seems to be justified in case of Diltiazem intoxication.
Asunto(s)
Fármacos Cardiovasculares/efectos adversos , Diltiazem/efectos adversos , Bloqueo Sinoatrial/inducido químicamente , Anciano , Fármacos Cardiovasculares/uso terapéutico , Diltiazem/uso terapéutico , Cardioversión Eléctrica , Resultado Fatal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Bloqueo Sinoatrial/terapiaRESUMEN
We report the case of a 32 years old patient, with a known diagnostic of hypertrophic cardiomyopathy; who has presented at the first trimester of pregnancy a ventricular fibrillation treated by electric shock with a favorable outcome. The risks for the mother and the foetus are discussed; The recommendations for the conduct of the delivery are reviewed.
Asunto(s)
Cardiomiopatía Hipertrófica/terapia , Complicaciones del Embarazo , Fibrilación Ventricular/etiología , Adulto , Cardiomiopatía Hipertrófica/patología , Cardioversión Eléctrica , Femenino , Humanos , Embarazo , Resultado del Embarazo , Pronóstico , Fibrilación Ventricular/terapiaAsunto(s)
Insuficiencia de la Válvula Aórtica/cirugía , Adolescente , Adulto , Válvula Aórtica , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/fisiopatología , Niño , Enfermedad Crónica , Femenino , Implantación de Prótesis de Válvulas Cardíacas , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Complicaciones PosoperatoriasRESUMEN
We have report one hundred cases of chronic pulmonary heart observed between 1982 and 1991. Mean age was 63 years, 61% were men. COPD was the most frequent etiology of CP (84%) before restrictive (14%) and thromboembolic diseases (2%). Diuretics were used in all patients, nifedipine in 32% and digitalis in 16%. Eleven patients died during their first admission, and six died later. Only 31 patients are still regularly.
Asunto(s)
Hipertensión Pulmonar/mortalidad , Hipertensión Pulmonar/terapia , Adulto , Anciano , Anciano de 80 o más Años , Cardiomiopatía Restrictiva/complicaciones , Glicósidos Digitálicos/uso terapéutico , Diuréticos/uso terapéutico , Femenino , Mortalidad Hospitalaria , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/etiología , Masculino , Persona de Mediana Edad , Nifedipino/uso terapéutico , Terapia por Inhalación de Oxígeno , Admisión del Paciente , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Tromboembolia/complicacionesRESUMEN
The authors report a case of aortic insufficiency with aneurysm of the ascending aorta of syphilitic origin. The diagnosis was made only histologically in the presence of a syphilitic granuloma. This opportunity is taken to review the various aspects of cardiovascular syphilis.