RESUMO
BACKGROUND: ST elevation myocardial infarction (STEMI) in old and old-old patients presents several peculiarities in natural history, delay of hospitalization and response to treatment. Aim of this retrospective case control study was to determine presentation, complications and management of elderly patients with STEMI compared to a younger population. METHODS: 462 patients (205 M and 257 F) aged > or =75 years, hospitalized in CCU between 1999 and 2003 for STEMI, were evaluated. The control group consisted of 490 consecutive patients (268 M and 222 F) aged 50-70 years. Attention was focused on clinical presentation, complications, management and outcome in elderly compared with younger patients. RESULTS: The mean interval between the onset of symptoms and the arrive in CCU was of 9 hour in the elderly compared to 4,5 hour in the control. Chest pain was less frequent (50% vs 90%) in the elderly; the prevalence of dyspnoea and neurological symptoms was higher in patients >75 years (30% vs. 15% and 25% vs. 10%). In the elderly, previous angina and AMI, cerebral and peripheral vascular diseases, peripheral and renal failure were frequent. Early severe complications prevailed in the elderly. Thrombolysis was performed only in 39% of the elderly compared to 65% of the control. Significantly higher was cerebral haemorrhage after thrombolysis (4.9% vs. 1.8%). Comparable were the mayor extra cranial bleedings. Primary or facilitated PTCA was performed in few patients in the last year. Two weeks mortality was 20%, compared to 6.5% in the control group. CONCLUSION: The patients >75 years with STEMI were hospitalized later, had atypical presentation with less chest pain and more cardiac failure, were less likely to receive thrombolysis, had more complications and more cerebral bleedings. Elderly had more associated diseases and in-hospital mortality was higher.
Assuntos
Envelhecimento , Sistema de Condução Cardíaco/fisiopatologia , Infarto do Miocárdio/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão , Estudos de Casos e Controles , Eletrocardiografia , Estudos de Avaliação como Assunto , Feminino , Fibrinolíticos/efeitos adversos , Fibrinolíticos/uso terapêutico , Hospitalização/estatística & dados numéricos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/terapia , Estudos Retrospectivos , Fatores de Risco , Análise de SobrevidaRESUMO
Incidental detection of a mediastinal mass in a asymptomatic patient poses a not easy diagnostic problem. For solid masses or cysts, histology or cytology is often necessary. Although substernal extension of a cervical goiter is common, totally intrathoracic primary thyroidal mass is unusual. We describe a rare case of heterotopic accessory mediastinal thyroid in a patient completely asymptomatic both for signs of thyroid dysfunction and mechanical compression. Radiological and hormonal 6 and 12 months follow-up is reported.
Assuntos
Coristoma/diagnóstico , Doenças do Mediastino/diagnóstico , Glândula Tireoide , Adulto , Coristoma/diagnóstico por imagem , Humanos , Masculino , Doenças do Mediastino/diagnóstico por imagem , Radiografia , Cintilografia , Testes de Função TireóideaRESUMO
Recent observational studies have pointed out many problems regarding the pre-hospital and in-hospital management of patients with acute coronary syndrome (ACS). The present study analyses the epidemiology of ACS in Campania Region. It has enrolled the 92.3% of coronary care units (CCU) of the Campania. The results indicate that 77% of patients admitted in CCU have ACS and the time of admission in CCU is still too long. Moreover the vast majority of patients arrive at the hospital without emergency ambulance and 48% of patients admitted in CCU for ACS with elevated ST segment do not receive any reperfusion therapy; compared with the 35.1% of patients included in the BLITZ study. The challenge of the SSN in the next future is to improve the "decision making" in the management of patients with ACS. This goal could be reached by an optimal organization of the hospital and out-of-hospital emergency services creating an integrated network of cardiological assistance.
Assuntos
Angina Instável/epidemiologia , Infarto do Miocárdio/epidemiologia , Doença Aguda , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angina Instável/diagnóstico , Angina Instável/terapia , Unidades de Cuidados Coronarianos , Eletrocardiografia , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Admissão do Paciente , Fatores Sexuais , Inquéritos e Questionários , Síndrome , Fatores de TempoRESUMO
Glycoprotein IIb/IIIa inhibitors have been recently proposed as a bridge to rescue transluminal coronary angioplasty in ST elevation myocardial infarction patients in whom thrombolysis fails; but data in its feasibility, safety and efficacy are still limited. In 47 consecutive acute myocardial infarction patients in whom thrombolysis failed to achieve 90 minute reperfusion, tirofiban was given at full regimen. Our results have been compared with those obtained in a control group of 48 consecutive acute myocardial infarction patients admitted two years before, period in which tirofiban and rescue angioplasty were not available in our hospital. Our preliminary data suggest this approach is feasible and safe, with possible clinical benefit in this high-risk subgroup of patients.
Assuntos
Fibrinolíticos/administração & dosagem , Tirosina/análogos & derivados , Tirosina/administração & dosagem , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Terapia Trombolítica , Tirofibana , Falha de TratamentoRESUMO
The clinical outcome of 48 consective patients with myocardial infarction who received tirofiban for unsuccessful thrombolysis was compared with that of 48 patients matched for age, gender, and infarct location who did not receive rescue treatment. Those who received tirofiban had more successful reperfusions, and there were few bleeding complications.
Assuntos
Fibrinolíticos/uso terapêutico , Infarto do Miocárdio/tratamento farmacológico , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Tirosina/análogos & derivados , Tirosina/uso terapêutico , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retratamento/métodos , Tirofibana , Falha de TratamentoRESUMO
Authors describe a case of partial atrio ventricular septal defect--cushion defect--with only a mitral valve cleft and mild valvular insufficiency. There were present also, since the childhood, an atrio ventricular primary block, and a left axis deviation. Late appeared a RBBB. The correct diagnosis has been done at the age of 67 years. The patient refers mean rhythm disorders and effort dyspnea. She refused surgical correction successful also in the late age.
Assuntos
Comunicação Interatrial/diagnóstico , Comunicação Interventricular/diagnóstico , Fatores Etários , Idoso , Ecocardiografia , Eletrocardiografia , Feminino , HumanosRESUMO
Spontaneous coronary dissection is responsible for acute coronary syndromes particularly in females during and in the peri-partum period. It rarely occurs in patients without atherosclerotic coronary plaques. We report a particular clinical course of a 39-year-old patient with spontaneous dissection of two coronary arteries. His clinical course suggested only medical treatment, with aspirin, beta-blockers and ACE-inhibitors. At 3 months of follow-up the patient is free of symptoms.