RESUMO
BACKGROUNDS: Study concerning the clinical features, electrocardiogram (ECG) findings and outcomes in patients presenting with acute total occlusion of left main coronary artery (LM) without collateral circulation is limited. METHODS: 25 patients with acute total LM occlusion without collateral circulation by emergency coronary angiography, from muti-center registry, were retrospectively studied. The clinical and angiographic characteristics, ECG and in-hospital mortality were reviewed. RESULTS: Nineteen patients (76%) presented with cardiogenic shock. Twelve (60%, 12/20) patients had coronary slow flow or no reflow phenomenon after primary percutaneous coronary intervention (PCI). The in-hospital mortality rate was 88% (n = 22). All the patients presented with ST-segment elevation myocardial ischemia (STEMI) pattern, mostly involving leads I, aVL, V2, V3, V4, V5 and ST-segment depression in leads II, III and aVF. CONCLUSIONS: Acute total LM occlusion without collateral circulation portends high in-hospital mortality. Anterior ST elevation in the precordial leads from V2 to V4 through V6, and ST elevation in leads I and aVL, accompanying with ST depression in the inferior leads is associated with acute total LM occlusion without collateral circulation.
Assuntos
Oclusão Coronária , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Estudos Retrospectivos , Vasos Coronários , Circulação Colateral , Eletrocardiografia , Oclusão Coronária/diagnóstico , Oclusão Coronária/cirurgia , Oclusão Coronária/complicações , Angiografia Coronária , Arritmias CardíacasAssuntos
Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica , Arritmias Cardíacas/patologia , Dor no Peito/patologia , Extremidades/fisiopatologia , Cardiopatias/diagnóstico , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico , Idoso , Arritmias Cardíacas/etiologia , Bortezomib/administração & dosagem , Cardiomiopatias , Dor no Peito/etiologia , Ciclofosfamida/administração & dosagem , Dexametasona/administração & dosagem , Eletrocardiografia , Cardiopatias/tratamento farmacológico , Cardiopatias/fisiopatologia , Humanos , Cadeias Leves de Imunoglobulina , Amiloidose de Cadeia Leve de Imunoglobulina/tratamento farmacológico , Amiloidose de Cadeia Leve de Imunoglobulina/fisiopatologia , MasculinoRESUMO
Negative T waves in electrocardiography have been widely studied. We presents a case of Wellens' syndrome which is a pattern of global inverted T waves with QT prolongation on ECG due to transient proximal LAD occlusion and pointed out other differential diagnosis.
Assuntos
Síndrome de Brugada/diagnóstico , Estenose Coronária/diagnóstico , Eletrocardiografia , Síndrome de Brugada/etiologia , Doença do Sistema de Condução Cardíaco , Dor no Peito/etiologia , Angiografia Coronária , Estenose Coronária/sangue , Estenose Coronária/complicações , Estenose Coronária/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Troponina I/sangueRESUMO
CLINICAL INTRODUCTION: An 88-year-old man, admitted to the emergency room (ER) after three episodes of syncope within 1â day, reported a precursory of syndrome of light-headedness with rapid palpitations that led to an abrupt loss of consciousness. After undergoing percutaneous and surgical revascularisation, he started complaining of chest and back discomfort for the past 20â years and searching for help from Chinese medicine, Fuzi. He had history of chronic renal failure and heart failure, but denied neither taking digitalis nor having family history related to sudden death.On arrival, heart rate was 150â bpm and blood pressure (BP) by cuff was 91/81â mmâ Hg (non-invasive BP could not be accurately obtained during tachycardia) plus oedema on both lower extremities. There were diffuse crackles and indistinct heart sounds on auscultation.The admission ECG was performed in the ER (figure 1). His serum creatinine was 139.7â mmol/L, serum K(+) was 4.7â mmol/L, N-terminal of the prohormone brain natriuretic peptide was highly elevated (12â 000â pg/mL) and troponin I was negative. QUESTION: What is the most likely diagnosis suggested based on the patient's ECG and history? Aconite poisoningDigitalis toxicityCatecholaminergic polymorphic ventricular tachycardia (CPVT)Andersen-Tawil syndrome (ATS).
Assuntos
Aconitum/intoxicação , Diterpenos/intoxicação , Medicamentos de Ervas Chinesas/intoxicação , Sistema de Condução Cardíaco/efeitos dos fármacos , Síncope/induzido quimicamente , Taquicardia/induzido quimicamente , Potenciais de Ação/efeitos dos fármacos , Idoso de 80 Anos ou mais , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Síncope/diagnóstico , Síncope/fisiopatologia , Taquicardia/diagnóstico , Taquicardia/fisiopatologiaRESUMO
Reelin is an extracellular glycoprotein that is highly conserved in mammals. In addition to its expression in the nervous system, Reelin is present in erythroid cells but its function there is unknown. We report in this study that Reelin is up-regulated during erythroid differentiation of human erythroleukemic K562 cells and is expressed in the erythroid progenitors of murine bone marrow. Reelin deficiency promotes erythroid differentiation of K562 cells and augments erythroid production in murine bone marrow. In accordance with these findings, Reelin deficiency attenuates AKT phosphorylation of the Ter119(+)CD71(+) erythroid progenitors and alters the cell number and frequency of the progenitors at different erythroid differentiation stages. A regulatory role of Reelin in erythroid differentiation is thus defined.
