Infarto agudo al miocardio con arterias coronarias sin lesiones obstructivas (MINOCA): características clínicas de pacientes / Myocardial infarction without obstructive coronary artery disease: clinical characteristics in patients hospitalized in a coronary care unit

Introducción: El término MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) ha cobrado relevancia como diagnóstico de trabajo en el contexto de pacientes con sospecha de isquemia miocárdica y estudio coronario sin lesiones obstructivas. Objetivos: Describir las distintas etiologías y variables clínicas de pacientes con MINOCA hospitalizados en la unidad coronaria de nuestro centro (Hospital de la P Universalidad de Chile) Métodos: Estudio observacional retrospectivo en el que se realizó un análisis descriptivo de las variables estudiadas. Además, se analizó el uso de los métodos de imágenes complementarios y otras variables pronósticas. El seguimiento se realizó dentro del primer año posterior al evento. Resultados: El diagnóstico etiológico más frecuente de los pacientes con MINOCA fue el de miocardiopatía por estrés (MCE). Se incluyeron 55 pacientes, 55% de ellos mujeres. La edad promedio fue 57 años y la frecuencia de factores de riesgo cardiovascular clásicos (FRCV) fue baja. En los pacientes con MCE se observó menores niveles de troponina ultrasensible; mayores niveles de NT-proBNP y mayor mortalidad en comparación a otras etiologías. Conclusiones: El perfil de pacientes con MINOCA hospitalizados en nuestro centro correspondió predominantemente a mujeres postmenopáusicas con baja frecuencia de FRCV. La mortalidad de los pacientes con MINOCA se concentró en el grupo con MCE.

Background: MINOCA (acronym for "Myocardial Infarction with Non-Obstructive Coronary Arteries") is relevant as a working guide in the diagnosis of patients with suspicion of ischemia and absence of obstructive coronary artery disease. Aim: to describe the different causes and clinical variables in patients with MINOCA admitted to a coronary care unit of a University hospital in Santiago, Chile. Methods: this is an observational retrospective analysis of relevant clinical variables in 55 patients finally diagnosed as having MINOCA. Use of image based studies and characteristics related to prognosis were also analyzed. Follow up extended for one year after the event. Results: 55 patients were included, 55% of them women. Mean age was 57 years; presence of traditional risk factors for myocardial infarction was low. The most common eventual etiologic diagnosis was Stress Cardiomyopathy (SCM) in which lower levels of ultrasensitive troponin and higher levels of NT-proBNP were observed. Mortality in SCM was higher than that observed in other etiologies. Conclusion: MINOCA was more frequent in post menopausal women. Mortality was greater in patients with SMC.

Asociación entre troponina y perfil lipídico Niveles en pacientes con insuficiencia cardíaca crónica / Association between Troponin and Lipid Profile Levels in Patients with Chronic Heart Failure

Background: Older women have a high chance of suffering from coronary heart diseases and heart failure. Possessing high-sensitive tests will permit early detection of cardiac troponin and lipid proteins (HDL, LDL, VLDL, & Triglyceride) I in levels that are below the diagnostic endpoint for the acute coronary syndrome. Aim of the study: The intent in this study is to analyze the association among the 3 ranks taking into consideration any future cardiac happening within the community setting and involving elderly women who are aged seventy years and above. Patients and Methods: 212 women were grouped for this study, and this lot was lacking any CHD within the set baseline or the troponin and lipid proteins (HDL, LDL, VLDL, & Triglyceride) established above the analytical limits for the disease to be studied (acute coronary syndrome). These elderly women had a 15-year continuation of hospitalization and mortality measures. Results: The analysis showed 22 percent of the study group to be suffering from CHD, there was 15 percent of myocardial infarction or death brought about by CHD, and 10 percent of the heart failure. The 99 percent of assessed serum illustrations, troponin, and lipid proteins (HDL, LDL, VLDL, & Triglyceride) levels were above recognition. Taking into consideration of the Framingham risk features, the correction done for each SD normal linear changed troponin and lipid proteins (HDL, LDL, VLDL, & Triglyceride) upsurge was connected to an upsurge uncertainty for the coronary heart disease. Conclusions: conclusively, the troponin and lipid profile (HDL, LDL, VLDL, & Triglyceride) I am autonomously linked with the foreseeable cardiac happenings in older women across Iraq without seeming clinical indicators. Adding cardiac troponin and lipid proteins (HDL, LDL, VLDL, & Triglyceride) 1 to the conventional risk factor can greatly enhance the risk prediction in this background.

Comparative analysis of myocardial protection with htk solution and hypothermic hyperkalemic blood solution in the correction of acyanogenic congenital cardiopathies - a randomized study

Abstract Objective: The goal of the present study was to compare the myocardial protection obtained with histidine-tryptophan-ketoglutarate (HTK) cardioplegic solution (Custodiol®) and with intermittent hypothermic blood solution. Methods: Two homogenous groups of 25 children with acyanotic congenital heart disease who underwent total correction with mean aortic clamping time of 60 minutes were evaluated in this randomized study. Troponin and creatine kinase-MB curves, vasoactive-inotropic score, and left ventricular function were obtained by echocardiogram in each group. The values were correlated and presented through graphs and tables after adequate statistical treatment. Results: It was observed that values of all the studied variables varied over time, but there was no difference between the groups. Conclusion: We conclude that in patients with acyanotic congenital cardiopathies submitted to total surgical correction, mean aortic clamping time around one hour, and cardiopulmonary bypass with moderate hypothermia, the HTK crystalloid cardioplegic solution offers the same myocardial protection as the cold-blood hyperkalemic cardioplegic solution analyzed, according to the variables considered in our study model.

Síndrome de tako-tsubo, caracterización clínica y evolución a un año plazo / Tako-tsubo syndrome: analysis of 37 cases

Background: Tako-tsubo Syndrome (TTS) is characterized by transient regional systolic dysfunction of the left ventricle (LV), mimicking myocardial infarction. It accounts for 0.9-1.2% of all acute coronary syndromes (ACS). Aim: To describe the incidence and characteristics of TTS within our population. Material and Methods: All patients diagnosed with ACS and TTS were selected from a clinical registry of all the coronary angiographies done in our hospital. Clinical features during initial presentation, hospital evolution and one year follow-up were analyzed. Results: The first case diagnosed in our hospital occurred in 2001. Since then, 4,433 coronary angiographies were done to patients with ACS until 2014 and 37 corresponded to TTS (0.83% incidence). The mean age of patients was 64 years, 73% were female, and 62% had hypertension. All patients had an identifiable trigger factor, abnormal EKG and elevated troponin. The coronary angiography did not show lesions in 97%. However, all had the characteristic extensive segmental-motility alteration with a mean ejection fraction of 44%. All patients were treated initially as an ACS. Seven patients had complications, namely acute cardiac failure in six and stroke in one. No patient died. At one year of follow-up, 100% showed normal segmental motility and ejection fraction, no patient had a new episode of TTS and all were alive. Conclusions: TTS is rare and the incidence found in this study is slightly lower than that reported elsewhere. TTS mimics ACS and it should be suspected by its clinical, electrocardiographic and enzymatic particularities. Coronary angiography helps to rule out other diagnosis. All patients normalize motility and ventricular function, which is the definitive differential feature respect to ACS.

Clozapine-induced hypersensitivity myocarditis presenting as sudden cardiac death

Hypersensitivity myocarditis is a rare but serious adverse effect of clozapine, a commonly used psychiatric drug. We report the case of sudden cardiac death from clozapine-induced hypersensitivity myocarditis diagnosed at autopsy. A 54-year-old Caucasian male on clozapine therapy for bipolar disorder presented with a sudden onset of shortness of breath. Laboratory studies were significant for elevated N-terminal prohormone of brain natriuretic peptide. During his hospital stay, the patient died of sudden cardiac arrest from ventricular tachycardia. The autopsy revealed hypersensitivity myocarditis, which usually occurs in the first 4 weeks after the initiation of clozapine. A 4-week monitoring protocol, including laboratory assessment of troponin and C-reactive protein, may assist in the early diagnosis of this potentially fatal condition.

Utilidade do Imageamento Multimodal na Detecção de Infarto do Miocárdio em Paciente com Insuficiência Renal Avançada: Relato de Caso / Usefulness of Multimodality Imaging for Detection of Myocardial Infarction in Patients with Advanced Kidney Failure: Case Report

A terceira definição universal de Infarto agudo do miocárdio(IAM) baseia-se na elevação das troponinas em associaçãoa sintomas isquêmicos, alterações eletrocardiográficas eachados de exames de imagem.1 Em pacientes com dortorácica, o diagnóstico do IAM é realizado por meio dadosagem dos marcadores séricos de necrose miocárdica,em especial as troponinas, mediante as alterações doeletrocardiograma (ECG) de doze derivações ou pelaidentificação de alterações da dinâmica contrátil do ventrículoesquerdo ao ecocardiograma transtorácico.1Em algumas situações o diagnóstico pode ser dificultadopor fatores confundidores, como: (a) na presença de alteraçõesprévias no ECG basal, principalmente o bloqueio de ramoesquerdo (BRE); (b) elevações dos marcadores de necrosemiocárdica (MNM) decorrentes de situações que não o IAMe; (c) alterações antigas da contratilidade detectadas peloecocardiograma transtorácico.2...

Identificação e distribuição de lesões cardíacas em bovinos intoxicados por Amorimia exotropica / Identification and distribution of cardiac lesions in cattle poisoned by Amorimia exotropica

Amorimia exotropica é um arbusto escandente que pertence à família Malpighiacea, cujo princípio tóxico é o monofluoracetato de sódio e possui ação cardiotóxica em bovinos. Ela é a única representante, na região Sul do país, do grupo de plantas que causam morte súbita associada ao exercício. Este trabalho identificou e mapeou as lesões cardíacas observadas em bovinos intoxicados naturalmente por A. exotropica. Selecionaram-se nove corações bovinos, provenientes de um surto de intoxicação natural pela planta em uma propriedade de gado de corte do Rio Grande do Sul e procedeu-se o mapeamento de oito regiões topográficas distintas (ápice, ventrículos direito e esquerdo, septo interventricular, músculos papilares direito e esquerdo e átrios direito e esquerdo). À avaliação macroscópica quatro bovinos apresentaram lesão focal e bem delimitada no músculo papilar esquerdo. Estas áreas na histologia correspondiam à necrose de coagulação em diferentes estágios de evolução, similares a infartos. Todos os bovinos apresentavam necrose de cardiomiócitos, caracterizadas por retração e hipereosinofilia citoplasmática e fragmentação celular em todas as áreas amostradas. A severidade da injúria celular foi avaliada pela imuno-histoquímica anti-troponina C, a qual demonstrou acentuada perda e/ou diminuição de marcação citoplasmática em células necróticas. O músculo papilar esquerdo foi a região mais acometida nos casos de intoxicação por Amorimia exotropica...

Amorimia exotropica is a shrub of the Malpighiacea family that contains sodium monofluoroacetate as the toxic principle, which has a cardiotoxic action in cattle. In Southern Brazil it is the only species of the group of plants that causes "sudden death during exercise". This study has identified and mapped cardiac lesions observed in cattle naturally poisoned by A. exotropica. An outbreak of poisoning by the plant occurred in a beef cattle herd in Rio Grande do Sul, where nine bovine hearts were selected for examination and mapping of eight distinct topographical regions (apex, right and left ventricles, interventricular septum, right and left papillary muscles , right and left atrium). At gross examination, four cattle showed focal and well-defined lesions in the left papillary muscle. This corresponds to areas of coagulation necrosis in different stages of evolution on histology, similar to infarcts. All hearts showed cardiomyocytes necrosis, characterized by shrinkage and hypereosinophilic cytoplasm and cellular fragmentation in all sampled areas. The severity of cellular injury was evaluated by immunohistochemistry anti-troponin C, which showed marked decrease of cytoplasm staining in necrotic cells. The left papillary muscle was the most affected region in cases of poisoning by A. exotropica...

Troponinas: biomarcadores de lesão miocárdica / Troponins: myocardial injury biomarker

A troponina é um complexo composto por três polipeptídeos de filamentos finos do sarcômero nos músculos estriados e está enbolvida na regulação da contração, Ao contrário da troponina C (TnCc), a troponina T (TnTc) e a troponina I (TnIc) apresentam isoformas no músculo esquelético diferentes da isoformas do músculo cardíaco e, por isso, são marcadores específicos para o diagnóstico de lesão miocárdica. Mas é preciso lembrar que a elevação do nível sérico da troponina indica a presença de lesão miocárdica, não o mecanismo envolvido em sua liberação. A lesão do miocárdio pode ocorrer por uma variedade de anormalidades patológicas além das síndromes coronárias agudas, ressaltando-se que para diversas entidades clínicas não-coronárias e até mesmo não-cardíacas a elevação dos níveis de troponina tem sido objeto de estudo para análise de seu real significado, tanto diagnóstico como prognóstico. Embora a troponina seja um marcador específico para o diagnóstico de lesão miocárdica, existe grande variação na sensibilidade e na especificidade dos diferentes testes disponíveis no mercado. Atualmente discute-se qual seria o valor normal desses marcadores: indivíduos com níveis indetectáveis de troponina...

The troponin complex consists of 3 thin filament polypeptides of the striated muscle sarcomere and is involved in the regulation of contraction. Unlike Troponin C (TnCc), troponin T (TnTc) and troponin I (TnIc) skeletal muscle isoforms are different from the cardiac muscle isoform and therefore, are specific markers for the diagnosis of myocardial injury. However, one should keep in mind that increased troponin serum levels indicate the presence of myocardial injury and not the mechanism involved in its release. Myocardial injury may result from several pathological abnormalities in addition to acute coronary syndromes and increased troponin levels have been evaluated to analyze their significance both in terms of diagnosis and prognosis in several non-coronary and even non-cardiac clinical disorders. Although troponin is a specific marker for the diagnosis of myocardial injury, there is great variation in the sensitivity and specificity of the different assays commercially available. The normal range of these markers is currently undefined: individuals with undetectable troponin levels might be normal, whereas those with detectable levels, within the normal range, may have underlying undiagnosed comorbidities. The diagnostic and prognostic relevance of troponins in acute coronary syndrome has been clearly demonstrated and proven. The most recent and highly sensitive troponin assays will be able to detect concentrations below the current 99th percentile, with greater analytical ability and susceptibility. Unstable angina will be diagnosed less frequently. Despite all of the improvements and the potential use of highly sensitive troponin assays, they must be further analyzed, since the number of patients with positive results might be very frequent.

Estudo das alterações da variabilidade da frequência cardíaca e troponina no paciente séptico / Alterations study of the variability of rate heart and troponin in patients with sepsis

Estudos observacionais têm demonstrado alterações na variabilidade da frequência cardíaca em pacientes em sepse, embora não exista publicação correlacionando lesão cardíaca causada pela inflamação sistêmica e redução da variabilidade da frequência cardíaca. Objetivos: determinar, em pacientes em sepse, se a lesão cardíaca é causa das alterações da variabilidade da frequência cardíaca, troponina, lesão celular à microscopia eletrônica / Context: Observational studies have shown alterations in the variability of heart rate in patients with sepsis, although there is not a published study showing correlation to cardiac lesion caused by systemic inflammation and reduction on the heart rate variability and access its correlation with mortality...

Comparison in the measurements of myoglobin and troponins between cardiac reader and AxSYM system

The time factor is important in the diagnosis of myocardial infarction and therefore methods that help in diagnosis in a short time are preferable. This study was performed to compare the methods of detecting troponins and myoglobin in the blood, one, a bedside method and the other, a laboratory-based method. Forty-nine patients admitted to Rashid Hospital Coronary Care Unit, were studied. Thirty-five were confirmed to have acute myocardial infarction by the standard criteria of history, ST elevation in the ECG and rise of C.K.M.B. enzyme. The remaining l4 patients who were regarded as controls did not have acute myocardial infarction or acute coronary syndromes. Blood was taken from these patients up to 24 hours from the onset of chest pain and sent for analysis of myoglobin and troponin. From each patient, half of the blood specimens were analysed using CARDIAC reader [Boehringer Manheim [B.M.]] and the other half using AxSYM machine [Abbott]. In patients with acute myocardial infarction, both methods gave comparable and positive results. In the control group, both methods gave negative results. We conclude that both CARDIA C reader and AxSYM methods of assaying myoglobin and troponin are accurate and comparable in predicting patients with acute myocardial infarction

Indicadores pronósticos en la angina inestable: papel de la troponina T cuantitativa / Prognostic markers in unstable angina: role of the quantitative T-troponine determination

Con el objetivo de identificar marcadores pronósticos en la angina inestable fueron incluídos en este estudio 335 pacientes, a quienes se les realizaron determinaciones de CPK, CK-MB y troponina T entre 6 y 24 horas. A 30 días el 21,9 por ciento tuvo una angina refractaria y el 11,4 por ciento sufrió infarto o murió. Una troponina T mayor o igual 0,1 ng/ml fue considerada positiva, detectándose en el 23,7 por ciento. La angina recurrente y una troponina T > 0,1 ng/ml se asociaron, en el análisis multivariado, con la evolución a infarto o muerte; mientras que ambos predictores, el angor de reposo y el alto riesgo inicial, son marcadores independientes de la evolución a infarto, óbito o angina refractaria