Electrocardiograhic findings resulting in inappropriate cardiac catheterization laboratory activation for ST-segment elevation myocardial infarction.

BACKGROUND: Prompt reperfusion has been shown to improve outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) with a goal of culprit vessel patency in <90 minutes. This requires a coordinated approach between the emergency medical services (EMS), emergency department (ED) and interventional cardiology. The urgency of this process can contribute to inappropriate cardiac catheterization laboratory (CCL) activations. OBJECTIVES: One of the major determinants of inappropriate activations has been misinterpretation of the electrocardiogram (ECG) in the patient with acute chest pain. METHODS: We report the ECG findings for all CCL activations over an 18-month period after the inception of a STEMI program at our institution. RESULTS: There were a total of 139 activations with 77 having a STEMI diagnosis confirmed and 62 activations where there was no STEMI. The inappropriate activations resulted from a combination of atypical symptoms and misinterpretation of the ECG (45% due to anterior ST-segment elevation) on patient presentation. The electrocardiographic abnormalities were particularly problematic in African-Americans with left ventricular hypertrophy. CONCLUSIONS: In this single-center, prospective observational study, nearly half of the inappropriate STEMI activations were due to the misinterpretation of anterior ST-segment elevation and this finding was commonly seen in African-Americans with left ventricular hypertrophy.

Almost everyone over 50 should be put on a statin to reduce the risk of cardiovascular disease: A protagonist view.

The burden of cardiovascular disease (CVD) in the United States (U.S.) and worldwide is immense. The total cost for CVD care in the U.S. for 2010 was over 400 billion dollars.' The levels of total cholesterol and low density lipoprotein cholesterol (LDL-C) are critical determinants for the development of CVD.2 It has been clearly established that 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statin drugs), are potent LDL-C lowering agents that are the cornerstone of CVD treatment. We will review here the developing evidence to support statin therapy for primary prevention of cardiovascular disease for almost everyone over the age of 50.

Retroperitoneal hemorrhage as a complication of percutaneous intervention: report of 2 cases and review of the literature.

Retroperitoneal hemorrhage (RPH) is an infrequent but serious complication of transfemoral percutaneous procedures. We present 2 cases and review the literature regarding the incidence, risk factors, clinical features and complications of RPH. We propose a management strategy for this problem emphasizing an anatomical based interventional approach if the patient does not stabilize with volume resuscitation.

Atrial fibrillation in athletes.

A 60-year old male physician on staff at North Kansas City Hospital was admitted with paroxysmal atrial fibrillation. The physician is an avid long-distance runner. Ultimately, three other male physicians on staff, all long-distance runners, were identified as having lone atrial fibrillation. This prompted a literature search which initially indicated a higher than normal incidence of atrial fibrillation in endurance and elite athletes. However, recent data has questioned the validity of this observation. The management of the athlete with atrial fibrillation poses special concerns and can be problematic. The incidence, causes, implications, and management of atrial fibrillation in athletes is the subject of this review.

Stroke: a cardiologist's perspective.

This review is an attempt to give the primary care physician an overview of the risk factors for stroke in 2004. In addition, the available treatments both medical and interventional were reviewed.

Chest pain evaluation: a common clinical problem.

The clinical approach described here initially utilizing a careful focused history and physical examination, 12 lead ECG, as well as serum biomarkers, allows for an informed initial impression of the chest pain patient. Based upon the findings the practitioner can then initiate appropriate therapy or further testing based on this solid database. The therapy can vary from simple medical therapy involving aspirin and beta blockers to an invasive evaluation potentially involving percutaneous coronary interventions. If further non-invasive evaluation is chosen, then the choices for testing are as outlined here. The guidelines listed will help in selecting the appropriate test for the individual patient. We believe the approach used in this paper will help insure high quality cost-effective care of the chest pain patient.