Symptoms Predictive of Acute Myocardial Infarction in the Troponin Era: Analysis From the TRAPID-AMI Study.

The TRAPID-AMI (High Sensitivity Cardiac Troponin T assay for rapid Rule-out of Acute Myocardial Infarction) study evaluated a rapid "rule-out" acute myocardial infarction (AMI). We evaluated what symptoms were associated with AMI as part of a substudy of TRAPID-AMI. There were 1282 patients evaluated from 12 centers in Europe, the United States of America, and Australia from 2011 to 2013. Multiple symptom variables were prospectively obtained and evaluated for association with the final diagnosis of AMI. Multivariate logistic regression analysis was done, and odds ratios (OR) were calculated. There were 213/1282 (17%) AMIs. Four independent predictors for the diagnosis of AMI were identified: radiation to right arm or shoulder [OR = 3.0; confidence interval (CI): 1.8-5.0], chest pressure (OR = 2.5; CI: 1.3-4.6), worsened by physical activity (OR = 1.7; CI: 1.2-2.5), and radiation to left arm or shoulder (OR = 1.7; CI: 1.1-2.4). In the entire group, 131 (10%) had radiation to right arm or shoulder, 897 (70%) had chest pressure, 385 (30%) worsened with physical activity, and 448 (35%) had radiation to left arm or shoulder. Duration of symptoms was not predictive of AMI. There were no symptoms predictive of non-AMI. Relationship between AMI size and symptoms was also studied. For 213 AMI patients, cardiac troponins I values were divided into 4 quartiles. Symptoms including pulling chest pain, supramammillary right location, and right arm/shoulder radiation were significantly more likely to occur in patients with larger AMIs. In a large multicenter trial, only 4 symptoms were associated with the diagnosis of AMI, and no symptoms that were associated with a non-AMI diagnosis.

Recurrent ventricular tachycardia from severe aortic stenosis improves after percutaneous aortic balloon valvuloplasty and transcatheter aortic valve replacement.

We report a case of recurrent ventricular tachycardia from severe aortic stenosis that improved after percutaneous aortic balloon valvuloplasty and transcatheter aortic valve replacement. The electrocardiographic features of the arrhythmia were compatible with ventricular tachycardia originating from the left ventricle. Myocardial ischemia and electrolyte abnormalities were ruled out. Clinicians should be aware that recurrent left ventricular tachycardia associated with severe aortic stenosis is a potentially reversible condition by transcatheter intervention. .

The relationship between chest pain duration and the incidence of acute myocardial infarction among patients with acute chest pain.

OBJECTIVE: Eight to ten million individuals are evaluated for chest pain (CP) in Emergency Departments (ED) in the United States each year. CP characteristics are an important factor used to help determine a diagnosis. We studied the relationship between the duration of CP and the diagnosis of acute myocardial infarction (AMI) in patients evaluated in the ED. METHODS: The study population consisted of a sub-group analysis of a previously published study. The survey population consisted of 1024 consecutive encounters of patients who were evaluated for possible ACS in the ED of Henry Ford Hospital between January and May of 1999, CP duration could be obtained in 426 who were included in this analysis. RESULTS: Of the 426 patients included in the study, 38 (8.9%) had a final diagnosis of AMI, with a median CP duration of 120 minutes (interquartile range, 30-240 minutes), compared with 40 minutes (interquartile range, 6-180 minutes) in patients without AMI (p =0.003). In patients with CP duration less than 5 minutes, there were no AMIs and no deaths at 30 days. There were 10 patients dead at 30 days, with a median CP duration of 180 minutes (interquartile range, 120-1440 minutes) compared to 40 minutes (interquartile range, 10-180 minutes) in patients alive at 30 days (p = 0.011). A longer CP duration and ST depression of 1 mm of less were independently associated with a final diagnosis of AMI. CONCLUSION: Patients with AMI have longer duration of CP than those without AMI; patients with CP of short duration, less than 5 minutes, are unlikely to have AMI and have a good prognosis at 30 days.

Prognostic importance of electrocardiographic abnormalities in patients with acute noncardiac conditions.

The electrocardiogram's (ECG) ability to aid in the diagnosis and risk stratification of patients with acute coronary syndromes is well established. We sought to investigate the prognostic significance of ECG abnormalities in patients with noncardiac conditions in the emergency department. Patients presenting to the emergency department who were evaluated for possible acute coronary syndrome were consecutively enrolled and an initial ECG was obtained (n = 1024). Only patients with noncardiac diagnoses were reviewed in this analysis (n=493) and 30-month follow-up was obtained. Sinus tachycardia, atrial fibrillation/flutter, ST depression, and left bundle branch block were associated with increased 30-month mortality. After controlling for history of coronary artery disease, age, sex, diabetes mellitus, hypertension, and renal insufficiency, sinus tachycardia and ST-segment depression ≥1 mm were independent predictors of 30-month mortality with a hazard ratio of 2.33 (95% confidence interval, 1.36-4.00; P = 0.002) and 2.49 (95% confidence interval, 1.10-5.67; P = 0.029), respectively. In conclusion, ST-segment depression and sinus tachycardia in patients presenting to the hospital with noncardiac conditions are independently associated with increased 30-month mortality.

Prevalencia de neuropatía diabética dolorosa en los pacientes ambulatorios con diabetes mellitus tipo 2 en un hospital general / Prevalence of painful diabetic neuropathy in type-2 diabetic outpatients in a general hospital

OBJETIVO. Determinar la frecuencia de neuropatía diabética dolorosa (NDD) en pacientes con diabetes mellitus tipo 2 y sus características. MATERIAL Y MÉTODOS: Se realizó un estudio prospectivo, descriptivo y transversal en 258 pacientes diabéticos ambulatorios. Se les aplicó el cuestionario DN4 (dolor neuropático 4 preguntas). RESULTADOS. La frecuencia de NDD fue de 31 por ciento y la localización del dolor más frecuente fue en miembros inferiores, 94 por ciento. Los opioides y AINE fueron los fármacos más usados entre los pacientes con dolor neuropático, 10 por ciento y 9 por ciento respectivamente. Se encontró una asociación estadísticamente significativa (p menor que 0,05) entre la NDD con la edad y tiempo de duración de la diabetes. CONCLUSIONES: La neuropatía diabética dolorosa es una complicación muy frecuente y existe una asociación significativa con la edad y tiempo de enfermedad. La localización más frecuente fue en los miembros inferiores.

OBJECTlVE. To find the frequency and characteristics of painful diabetic neuropathy (PDN) in patients with diabetes mellitus type 2. MATERIALS AND METHODS. A prospective, transversal, descriptive study was carried out in 258 type 2 diabetic outpatients. The DN4 questionnaire (neuropathic painfour questions) was applied. RESULTS. The frequency of painful diabetic neuropathy was 31 per cent. The pain was mainly localized in the lower limbs, in 94 per cent. Opioids and NSAlDs were the most used drugs, 10 per cent and 9 per cent, respectively. A statistic significant association was found between PDN and the age and the time of diagnosis of diabetes mellitus type 2. CONCLUSIONS. PDN is a high frequent complication of diabetes and there is an association with the age and diabetes duration. The most frequent localization of the PDN was in the lower limbs.

Características clínicas de un adolescente con obesidad e inicio de debut de diabetes mellitus tipo 2 con cetoacidosis: reporte de un caso / Clinical characteristics of a teenager with obesity and an early debut with type 2 diabetes mellitus ketoacidosis: a case report

Se reporta el caso de un paciente adolescente de 14 años, obeso con síntomas de poliuria, polidipsia, baja de peso y antecedente de gran consumo de dulces y alimentos azucarados, antecedente familiar de diabetes y que debuta con cetoacidosis diabética y anticuerpos antidescarboxilasa del ácido glutámico (anti GAD) negativo y que al seguimiento a los tres meses está controlado con dieta e hipoglicemiantes orales. Esta entidad clásicamente se encuentra relacionada a diabetes mellitus tipo 1, sin embargo, estudios muestran la incidencia elevada en diabetes tipo 2 (DM 2), en su mayoría adolescentes obesos afroamericanos e hispanos.

It is report the case of a teenager patient 14 years old of age, obese with symptoms of polyuria and polydipsia, loss of weight and history of great food consumption of sweets, with a family history of diabetes whose debut is diabetic ketoacidosis and anti GAD negative and that the follow-up to three months is controlled with diet and oral agents. This entity is traditionally linked to a type 1 diabetes mellitus, however studies show the high incidence in type 2 diabetes (DM 2) mostly teenagers obese of African Americans and Hispanics race.

Síndrome metabólico en los pacientes con eventos cardiovasculares agudos en la unidad de cuidados coronarios / Metabolic syndrome in patients with acute cardiovascular events in the coronary care unit

Objetivo: Evaluar la frecuencia del síndrome metabólica (SM) en los pacientes con eventos cardiovasculares agudos en una unidad de cuidados coronarios. Material y Métodos: Se hizo un estudio descriptivo, retrospectivo y transversal. Se recogió los datos de 64 pacientes hospitalizados por algún evento cardiovascular agudo en la unidad de cuidados coronarios del Hospital Nacional Arzobispo Loayza de Lima. El diagnóstico de SM se realizó utilizando los criterios de la IDF. Resultados: La frecuencia de SM en este estudio fue de 75 por ciento (IC 95 por ciento: 63,3-84,4), 65,1 por ciento para varones y 95,24 por ciento para mujeres. La frecuencia de obesidad abdominal y de HDL bajo fue significativamente mayor en las mujeres que en los varones. Se encontró diferencia estadística de una mayor frecuencia de SM en las mujeres. Los criterios de la IDF identificaron un número estadísticamente mayor de casos de SM en comparación con el ATP III/NCEP (75,0 por ciento vs. 56,25 por ciento). Conclusión: El presente estudio halló una elevada frecuencia de síndrome metabólico en los pacientes admitidos en una en la unidad de cuidados coronarios, especialmente en las mujeres.

Objetive. To asses the frecuency of metabolic (MS) in patients with acute cardiovascular events in a coronary care unit. Material and Methods. A descriptive, retrospective and cross-sectional study was done. Data were collected on 64 patients hospitalized for any acute cardiovascular event in the coronary care unit of the Hospital Nacional Arzobispo Loayza of Lima. MS was diagnosed according to the IDF criteria. Results. MS frequency was 75 per cent (CI 95 per cent 63,3-84,4 per cent), 65,1 per cent for men and 95,24 per cent for women. Abdominal obesity and low HDL was significantly higher in women than men. MS was significantly more frequent among women than among men. The IDF criteria identified a significant higher number of MS cases patients compared with the ATP III/NCEP criteria (75,0 per cent vs. 56,25 per cent). Conclusion: High metabolic syndrome frequency was found in admitted patients to the coronary care unit and it was significantly higher in women.