How much do the Patients with Acute Myocardial Infarction Know about Chest Pain, Thrombolytic Therapy, and Other Factors Affecting the Treatment Time in the Emergency Room?

Abstract Background: Treatment time in the emergency room for acute myocardial infarction is very important and can be life-saving if one understands the importance of a patient's chest pain. Objetice: The aim of this study is to evaluate how much patients entering the emergency room due to acute myocardial infection (AMI) know about chest pain and thrombolytic therapy. Materials and Methods: One hundred fifty patients (126 males,14 females) from three different institutes with complaints of chest pain were randomly chosen to participate in this study. The mean age of the patients was 55.4 ± 11.2 years (71+33). Patients were asked to fill out a questionnaire consisting of 70 questions within the first seven days. All differences in categorical variables were computed using the χ2-test and Fisher Exact test. A two-tailed hypothesis was used in all statistical evaluations, and p<0.05 was considered significant. Results: It was observed that 17% of the patients came to the hospital within the first 30 minutes; 18.3% of them came to the hospital between 30 minutes and 1 hour; 27.5% of them came to the hospital between 1 hour and 3 hours; and 21.4% of them came to the hospital more than 6 hours after symptoms began. It was also observed that 68% of the patients were not aware of the AMI, and 96% of them had no prior knowledge of antithrombolytic therapy. Conclusion: Because the majority of the patients did not have enough information about AMI, a training program should be implemented to ensure that people to come to the hospital earlier. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

Do Restoring and Maintaining Sinus Rhythm Have a Beneficial Effect on Secondary Prevention of Stroke in Patients With Atrial Fibrillation? A Pilot Study.

We aimed to determine whether attempts to restore and maintain sinus rhythm will reduce recurrent stroke in patients with atrial fibrillation (AF). Patients (n = 245) between March 1998 and May 2002 with AF who had an ischemic stroke including transient ischemic attack 1 to 12 months before transesophageal echocardiographic examination and had been followed for 3 years were retrospectively reviewed. Cardioversion was attempted in 130 patients; 117 (90%) patients were successfully cardioverted (rhythm control group). The 13 patients who could not be cardioverted and 115 patients who did not undergo cardioversion were assigned to the rate control group. Age, gender, ischemic heart disease, hypertension, diabetes mellitus, congestive heart failure, mitral valve disease, and left atrial diameter were similar in both groups. The rhythm control group included 56 patients (48.7%) who were still in sinus rhythm after 3 years. During follow-up, there were 2 embolic events (3.4%) and 2 deaths (3.4%) in the rhythm control group, whereas 18 embolic events (14.6%) and 18 deaths (14.6%) occurred in the rate control group (P = .049 and P = .049, respectively). Restoration and maintenance of sinus rhythm seems to have a beneficial effect on secondary prevention of stroke in patients with AF.

The fate of small side branches following drug eluting stent implantation.

OBJECTIVES: Although drug eluting stents (DES) have documented convenience in bifurcation lesions, possible unfavorable effects on small side branch ostium (SBO) remain a question. We aimed to explore the effects of DES on small jailed SBs (1.5-2.25 mm) which originated from the lesion on the main vessel and were not treated with either stenting or balloon dilatation. METHODS: Angiographic data of 107 consecutive patients (129 SB) with Medina 1,1,1 or 1,1,0 lesions were evaluated at the time of procedure and at the follow-up. RESULTS: Of all DES used, 70 (54.7%) was sirolimus-eluting, 39 (30.5%) was paclitaxel-eluting and 20 (14.8%) was zotarolimus-eluting. The diameter of SBs was 1.84 ± 0.41 mm with a stenosis of 20.7 ± 26.6% at SBO at baseline. The lesion at the SBO had progressed after the procedure when the pre vs postprocedure values and follow-up vs pre-procedure values are compared (20.7 ± 26.6% vs 29.4 ± 27.4%; p < 0.0001 and 25.4 ± 25.1 vs 20.7 ± 26.6%; p = 0.004 respectively). A significant reduction in stenosis was revealed over the follow-up (29.4 ± 27.4 vs 25.4 ± 25.1 respectively; p = 0.013). The severity of the disease at the SBO at baseline was the only parameter that affected the severity of SB stenosis in acute, longterm and follow-up. Additional parameters with influence on SB patency at different times were female gender, stent deployment with low pressure, cTFC of the main lesion, age, cTFC of the lesion, late loss index and the preprocedure TIMI flow grade of the SB. CONCLUSIONS: Although there was a significant deterioration of SBO immediately after stenting, follow-up data showed that the lesion at SBO improved but remained worse than baseline.

Evaluation of global function of the heart in scleroderma patients.

OBJECTIVE: Scleroderma is a connective tissue disease characterized by diffuse vascular lesions and fibrosis of the skin and major organs including lungs, kidneys, and heart. When cardiac involvement is clinically evident, it is recognized as a poor prognostic factor. The early detection of cardiac involvement in scleroderma would be desirable both for implementation of preventive measures in the early stages of the disease and for optimal treatment. METHODS: Left (LV) and right (RV) ventricular function were examined in 31 scleroderma patients and 21 healthy controls. Conventional and tissue Doppler echocardiography was used to evaluate systolic and diastolic function. Systolic indices including systolic (S) velocity, isovolumetric acceleration (IVA), ejection time (ET), and isovolumetric contraction time (IVCT) were measured. Early diastolic (E) velocity, late diastolic (A) velocity, E/A and E'/A' ratios, isovolumetric relaxation time (IVRT), and deceleration time (DT) were the diastolic measurements obtained. Myocardial performance index (Tei index) calculated by 2 different methods was used to assess global ventricular function. RESULTS: In our study; mitral S velocity, biventricular ET, E', E/A, E'/A', RV IVA, LV IVA, and tricuspid S velocity were significantly lower in scleroderma patients. Mitral DT, IVCT, and biventricular IVRT, were significantly higher in scleroderma patients (P < 0.0001). In addition, RV and LV Tei indices were significantly increased in scleroderma patients compared with the control group (P < 0.0001 and P < 0.001, respectively). CONCLUSIONS: In scleroderma patients, global function was depressed prior to the onset of clinical symptoms. Biventricular diastolic and systolic function abnormalities were also observed.