Scorpion-Induced Acute Coronary Syndrome: A Stinging Complication.

The Tityus trinitatis, a black scorpion species endemic to the fauna of Trinidad, has been implicated in envenomation with devastating clinical sequelae such as acute pancreatitis and major adverse cardiovascular events. We present the first in-Caribbean case of a 59-year-old Caribbean South Asian male with human immunodeficiency virus who presented with a non-ST-segment-elevation acute coronary syndrome after being stung, which was managed with comprehensive, guideline-directed medical therapy. The clinician should be cognizant of scorpion-induced acute coronary syndrome (ACS) as a potential sequela of envenomation and its clinical management.

Endovascular therapeutic hypothermia adjunctive to percutaneous coronary intervention in acute myocardial infarction: realistic simulation as a game changer.

BACKGROUND: Endovascular therapeutic hypothermia (ETH) reduces the damage by ischemia/reperfusion cell syndrome in cardiac arrest and has been studied as an adjuvant therapy to percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI). New available advanced technology allows cooling much faster, but there is paucity of resources for training to avoid delays in door-to-balloon time (DTB) due to ETH and subsequently coronary reperfusion, which would derail the procedure. The aim of the study was to describe the process for the development of a simulation, training & educational protocol for the multidisciplinary team to perform optimized ETH as an adjunctive therapy for STEMI. METHODS AND RESULTS: We developed an optimized simulation protocol using modern mannequins in different realistic scenarios for the treatment of patients undergoing ETH adjunctive to PCI for STEMIs starting from the emergency room, through the CathLab, and to the intensive care unit (ICU) using the Proteus® Endovascular System (Zoll Circulation Inc™, San Jose, CA, USA). The primary endpoint was door-to-balloon (DTB) time. We successfully trained 361 multidisciplinary professionals in realistic simulation using modern mannequins and sham situations in divisions of the hospital where real patients would be treated. The focus of simulation and training was logistical optimization and educational debriefing with strategies to reduce waste of time in patient's transportation from different departments, and avoiding excessive rewarming during transfer. Afterwards, the EHT protocol was successfully validated in a trial randomizing 50 patients for 18 minutes cooling before coronary recanalization at the target temperature of 32 ± 1.0 ∘C or PCI-only. A total of 35 patients underwent ETH (85.7% [30/35] in 90 ± 15 minutes), without delays in the mean door-to-balloon time for primary PCI when compared to 15 control group patients (92.1 minutes versus 87 minutes, respectively; p = 0.509). CONCLUSIONS: Realistic simulation, intensive training and educational debriefing for the multidisciplinary team propitiated feasible endovascular therapeutic hypothermia as an adjuvant therapy to primary PCI in STEMI. CLINICALTRIALS: gov: NCT02664194.

Diagnóstico y tratamiento de la angina inestable aguda e infarto miocárdico sin elevación del segmento ST / Diagnosis and treatment of acute unstable angina and myocardial infarction without ST segment rise

La angina inestable aguda y el infarto miocárdico sin elevación del segmento ST son dos grandes afecciones del síndrome coronario agudo. Su frecuencia se incrementa con los novedosos y rápidos procedimientos terapéuticos que mejoran la supervivencia del paciente coronario. La presente investigación expone las clasificaciones más actuales, la fisiopatología, las causas y sus mecanismos patogénicos, los hallazgos según la coronariografía y las categorías de riesgo según los elementos clínicos, enzimáticos y electrocardiográficos cuyos marcadores contribuyen al diagnóstico y al pronóstico de ambas dolencias. Se valoran los diagnósticos diferenciales, la conducta médica y el arsenal terapéutico disponible en los distintos estadios de la angina inestable aguda, del infarto, de la angina refractaria y de Prinzmetal. Finalmente se presenta un algoritmo que resume el tratamiento en el síndrome coronario agudo sin elevación del segmento ST

The acute unstable angina and the myocardial infarction without ST segment rise are two major affections of acute coronary syndrome. Its frequency is increases with the novel and fast therapeutical procedures improving the coronary patient survival. Present research shows the more current classifications, the pathophysiology, the causes and its pathogenic mechanisms, the findings according the coronarygraphy and the risk categories according to the clinical, enzymatic and electrocardiographic elements whose markers contributing to diagnosis and prognosis of both diseases. The differential diagnoses, the medical behavior and the therapeutical armamentarium available in the different stages of the acute unstable angina, of infarction, of refractory angina and or the Prinzmetal. Finally, an algorithm summarizing the treatment of the acute coronary syndrome without ST segment rise is presented