RESUMEN
The authors report the case of an 77-year-old woman with no evidence of previous cardiac disease who developed a non-Q-wave myocardial infarction after beta2-mimetic treatment for the exacerbation of her chronic bronchial asthma. After the five dose of salbutamol spray she developed chest pain. The electrogram showed ST segment elevation in leads I-aVL-V4-6. Urgent coronary angiography showed only non significant left anterior coronary artery stenosis (20%). A subsequent echocardiogram also revealed anterolateral hypokinesia and acute reversible left ventricular dysfunction (LVEF:30%). Both troponin T concentration and creatine kinase rose. Next day in the lateral leads negative T-waves developed with QT-prolongation and without pathologic Q-waves. Although myocardial infarction and acute reversible left ventricular dysfunction is a rare complication following beta2 mimetic treatment one should use high-dose beta2-agonists with caution.
Asunto(s)
Agonistas Adrenérgicos beta/efectos adversos , Albuterol/efectos adversos , Asma/tratamiento farmacológico , Broncodilatadores/efectos adversos , Infarto del Miocardio/inducido químicamente , Agonistas Adrenérgicos beta/administración & dosificación , Anciano , Albuterol/administración & dosificación , Broncodilatadores/administración & dosificación , Electrocardiografía , Femenino , Humanos , Infarto del Miocardio/fisiopatologíaRESUMEN
Tombstoning ST-segment elevation myocardial infarction (STEMI) has been associated with a poor prognosis ever since Wimalaratna's first description of this clinical entity, and the reasons for this are not fully understood. We studied 87 consecutive patients who had anterior STEMI (January 2004 to September 2004) to compare the form of STEMI, coronary anatomy, and initial N-terminus pro-brain natriuretic peptide (NT-pro-BNP) level. Patients who had tombstoning STEMI had higher levels of NT-pro-BNP despite significant differences in cardiac enzyme levels or extent of coronary disease. This finding suggests that, in addition to changing the shape of repolarization, decreased microcirculation plays a role in the development of increased wall tension. Increased wall tension in turn is the probable cause of higher NT-pro-BNP levels and increased mortality.
Asunto(s)
Electrocardiografía , Infarto del Miocardio/sangre , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Precursores de Proteínas/sangre , Biomarcadores/sangre , Estudios de Seguimiento , Humanos , Inmunoensayo , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
At the two hospitals, first percutaneous coronary intervention was performed on 1031 patients (700 male and 331 female, average age 59.8 +/- 15.1 years) between July 2000 and June 2002. The indications were: stable effort angina 679 (65.8%), unstable angina and non-ST elevation myocardial infarction 267 (26.0%), ST elevation myocardial infarction 85 (8.2%). Single vessel dilatation was performed on 906 (87.9%), double and triple vessel on 125 (12.1%) pts in 1170 vessels (1145 native, 24 saphenous vein and 1 mammary artery graft) and in 1372 stenoses. During the interventions, 1043 stents were implanted in 797 pts, average 1.3/pt. The intervention was clinically successful in 950 (92.1%) and unsuccessful in 81 (7.9%) pts. In most of cases, the lack of success was a result of ineffective recanalisation. 65 major adverse cardiac events occurred in 35 (3.4%) pts (acute redilatation 20 (1.9%), acute surgery 4 (0.4%), acute myocardial infarction 34 (3.3%) and fatal outcome 7 (0.7%). Fatal outcome occurred in the group of stable angina 1 (0.1%), in the group of unstable angina and non-ST elevation myocardial infarction 4 (1.5%), in the group of ST elevation myocardial infarction 2 (2.4%). Within one year, 228 (22.1%) repeated dilatations were performed because of chronic restenosis. The results suggest that the moderate risk interventions can be performed with satisfactory result and average risk even without in-hospital cardiac surgery. High-risk interventions are still to be performed in institutes without on-site surgery.
Asunto(s)
Angioplastia Coronaria con Balón , Enfermedad Coronaria/patología , Enfermedad Coronaria/terapia , Stents , Adulto , Anciano , Angina de Pecho/terapia , Angina Inestable/terapia , Angioplastia Coronaria con Balón/mortalidad , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/fisiopatología , Femenino , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/terapia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
A 56 year old woman was admitted to our hospital with crescendo chest pain in the last ten days. Her past history included hypertension treated by 100 mg metoprolol for more than ten years and right carotid endarterectomy. She complained headache and a treatment of 20 mg nicergoline (ergoline derivate) daily was started. Her chest pains started always one hour after the nicergoline intake. The chest pain was accompanied by breathing difficulties and sweating of 5 min duration at first but the next days it lasted longer and longer. Next morning following her admission, one hour after the nicergoline administration she had severe chest pain again. The ECG showed ST-segment elevation in inferior leads resolved after nitroglycerin administration. The angiogram revealed normal coronary artery. Nicergoline was stopped. The patient was treated with felodipine and remains free of symptoms. Nicergoline was good for head but worse for heart in this case.
Asunto(s)
Angina Pectoris Variable/inducido químicamente , Cefalea/tratamiento farmacológico , Nicergolina/efectos adversos , Vasodilatadores/efectos adversos , Angina Pectoris Variable/complicaciones , Disnea/etiología , Felodipino/administración & dosificación , Femenino , Humanos , Persona de Mediana Edad , Nicergolina/administración & dosificación , Nootrópicos/efectos adversos , Sudoración , Vasodilatadores/administración & dosificaciónRESUMEN
The authors report an early occurrence (within 48 hours) of the newly described form of pause-dependent torsade de pointes following acute myocardial infarction. QT prolongtion after myocardial infarction a common ECG finding. Postextrasystolic QT prolongation rare but one of the warning signs for torsade de pointes ventricular tachycardia following myocardial infarction. Careful monitoring is suggested in these cases.