RESUMO
INTRODUCTION: The determination of natriuretic peptide levels in patients hospitalized for suspected acute heart failure is important for the confirmation of the diagnosis and for the prognosis. Changes in natriuretic peptide levels in response to therapy have a strong prognostic value. AIM: To decide whether repeated natriuretic peptide measurements for acute heart failure show changes that could influence the diagnosis and/or the prognosis. METHOD: Prospective data collection was carried out of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels on admission and within 12 hours in patients hospitalized for acute heart failure. Only the data of those patients were analyzed whose symptoms started within 24 hours prior to admission and were due to acute heart failure. RESULTS: The 23 patients whose data we analyzed had an average age of 77.9 ± 8.3 years. Most of them had left ventricular systolic dysfunction with an average ejection fraction of 34.1 ± 3.9%. The time between the start of symptoms and the first measurement was 6.7 ± 2.2 hours, while the time until the repeated determination was 6.5 ± 2.2 hours after the first measurement. The median value of the NT-proBNP levels in the 6 hours control showed an increase from 5064 pg/mL to 8847 pg/mL (p<0.0005), which amounts to a 75 percent increase - mean hs-troponin T showed an increase from 46 ± 25 ng/L to 78 ± 51 ng/L (p<0.002). CONCLUSIONS: A significant increase in NT-proBNP levels is to be expected in early repeated measurement after hospital admission. This fact could have diagnostic and prognostic consequences if validated in a larger patient population. Orv Hetil. 2018; 159(25): 1009-1012.
Assuntos
Insuficiência Cardíaca/sangue , Pacientes Internados , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
Patients with acute abdominal or acute thoracic events occasionally develop a curious electrocardiographic ST-segment elevation, where the upward shift of the baseline starts before the onset of the QRS complex. The shape of the complexes resembles a German military spiked helmet. It has been previously postulated that the "spiked helmet" sign is the result of an acute rise in intraabdominal or intrathoracic pressure causing pulsatile epidermal stretch that is in concert with the cardiac cycle. Here, we present 2 cases, where recognition of the spiked helmet sign led to immediate discovery of the underlying pathology. Removal of a large epigastric content resulted in the prompt resolution of the spiked helmet sign in the inferior leads, whereas suctioning of a large pneumothorax lead to the gradual disappearance of the spiked helmet sign in the chest leads. These cases provide the first definitive proof of a mechanical, noncardiac etiology of the spiked helmet sign.
Assuntos
Suco Gástrico/metabolismo , Pneumotórax/diagnóstico , Doença Aguda , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Diagnóstico Diferencial , Drenagem , Feminino , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnósticoRESUMO
The authors report the spiked helmet ST-segment elevation in two patients in order to draw attention to this high-risk electrocardiographic sign. This form of ST-segment elevation needs an urgent evaluation and management of the critically ill patient.
Assuntos
Arritmias Cardíacas/fisiopatologia , Estado Terminal , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Idoso , Arritmias Cardíacas/etiologia , Feminino , HumanosRESUMO
ST-segment elevation is the hallmark of acute transmural myocardial ischemia caused by acute occlusion of a coronary artery. ST-segment elevation is the major criterion for the patients with chest pain to immediate reperfusion therapy. Despite its clinical importance, the mechanism of ST-elevation remains unclear. Two patients are reported with proximal left anterior descending coronary occlusion but without ST-segment elevation. The distinct ECG patterns were tall, with symmetrical T-waves and upsloping and digoxin-like ST-segment depression. Patients with these ECG patterns need immediate coronary intervention.
Assuntos
Infarto Miocárdico de Parede Anterior/diagnóstico , Infarto Miocárdico de Parede Anterior/fisiopatologia , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Adulto , Idoso , Infarto Miocárdico de Parede Anterior/terapia , Humanos , MasculinoAssuntos
Sistema de Condução Cardíaco/fisiopatologia , Taquicardia Ventricular/fisiopatologia , Potenciais de Ação , Adulto , Antiarrítmicos/uso terapêutico , Cardiomiopatias/complicações , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Sistema de Condução Cardíaco/efeitos dos fármacos , Humanos , Sarcoidose/complicações , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/tratamento farmacológico , Taquicardia Ventricular/etiologia , Fatores de TempoRESUMO
A 42-year-old man is presented with acute coronary syndrome and De Winter ECG sign. The De Winter sign is a rare ECG manifestation of proximal LAD occlusion. The ECG sign was misinterpreted and the patient was transmitted to our percutan coronaria intervention centrum with 3 hours delay. The hyperacute T-waves and the precordial ST-depressions disappeared, but the biomarkers showed a marked elevation. Coronary angiography revealed LAD proximal thrombotic dissection treated with a drug-eluting stent. The authors suggest that in patients with this ECG pattern the immediate coronary intervention is the best treatment. Orv Hetil. 2019; 160(43): 1711-1713.
Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Angiografia Coronária/métodos , Stents Farmacológicos/efeitos adversos , Eletrocardiografia/métodos , Adulto , Coração/diagnóstico por imagem , Humanos , MasculinoRESUMO
INTRODUCTION: The phenomenon of stress induced left ventricular dysfunction has been long recognised. A special reversible form of it, characterized by left ventricular apical dilatation, is the so-called "tako-tsubo" or ampoule cardiomyopathy, based on its first description by Sato et al. in 1990. The tako-tsubo cardiomyopathy and stress cardiomyopathy are considered almost equivalent in the referring publications. METHODS: Retrospective analysis of patient data between 2002 and 2007: these patients suffered from transient left ventricular dysfunction and coronary artery disease and myocarditis were disclosed. RESULTS: 6 female patients between 55 and 80 years. In 5 of 6 cases the different forms of stress could be found before the patients were admitted to our department. CONCLUSIONS: The presented cases shed light to the fact that the apical dilatation of the left ventricle is only one of the possible presentations of stress induced cardiomyopathy. The main feature of this entity is not the tako-tsubo-like left ventricular dilatation, which is not always present, but the almost universal QT prolongation and negative T waves. These ECG features come a few days after the appearance of the reversible left ventricular dysfunction.
Assuntos
Sistema de Condução Cardíaco/fisiopatologia , Estresse Fisiológico/complicações , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Miocardite/complicações , Miocardite/fisiopatologia , Estudos Retrospectivos , Cardiomiopatia de Takotsubo/etiologia , Cardiomiopatia de Takotsubo/fisiopatologia , Disfunção Ventricular Esquerda/diagnósticoRESUMO
We report a new entity of the Takotsubo syndrome. While the classic form of Takotsubo syndrome presents as transient apical ballooning, in reverse Takotsubo syndrome we see just the opposite, i.e. transient dilatation of the basal segments and a hyperkinetic apex. The reverse Takotsubo phenomenon was seen in a 36-year-old female patient who had an injection of lidocaine with adrenaline for plastic surgery of the ear. Coronary artery disease was excluded as the cause of this patient's prolonged chest pain and troponin positivity. Echocardiography revealed akinesis of the basal segments and a hyperkinetic apex. The wall motion abnormalities resolved in three days.
Assuntos
Anestesia Local/efeitos adversos , Anestésicos Locais/efeitos adversos , Coração/efeitos dos fármacos , Coração/fisiopatologia , Cardiomiopatia de Takotsubo/fisiopatologia , Adulto , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Ecocardiografia , Eletrocardiografia , Epinefrina/efeitos adversos , Feminino , Humanos , Injeções , Lidocaína/efeitos adversos , Imageamento por Ressonância Magnética , Procedimentos de Cirurgia Plástica , Cardiomiopatia de Takotsubo/diagnóstico , Vasoconstritores/efeitos adversosRESUMO
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.
Assuntos
Agonistas Adrenérgicos beta/efeitos adversos , Albuterol/efeitos adversos , Asma/tratamento farmacológico , Broncodilatadores/efeitos adversos , Infarto do Miocárdio/induzido quimicamente , Agonistas Adrenérgicos beta/administração & dosagem , Idoso , Albuterol/administração & dosagem , Broncodilatadores/administração & dosagem , Eletrocardiografia , Feminino , Humanos , Infarto do Miocárdio/fisiopatologiaRESUMO
A rare form of pause dependent form of torsade de pointes ventricular tachycardia and T-wave alternans is reported. The life-threatening ventricular arrhythmia was associated with left sided intracerebral hemorrhage and elevated CKMB mass and Troponin T (0.14 ng/ml). The possible pathomechanism of torsade de pointes tachycardia is discussed.