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1.
Curr Vasc Pharmacol ; 16(4): 368-375, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28677510

RESUMO

BACKGROUND: Dyslipidaemia is a risk factor for macrovascular complications in patients with type 2 diabetes mellitus (T2DM). Our aim was to assess the use of lipid lowering drugs (LLDs) in patients with T2DM and co-existing dyslipidaemia. METHOD: A multicentre, non-interventional survey conducted in 6 Middle Eastern countries (Bahrain, Oman, Qatar, United Arab Emirates, Kingdom of Saudi Arabia and Kuwait). Patients with T2DM (n = 3338) taking LLD treatment for ≥3 months with no dose change for ≥6 weeks were enrolled. RESULTS: The mean age (SD) of T2DM patients was 56.6 ±10.6 years; the majority (99%) were on statin monotherapy. Only 48% of these patients achieved their low density lipoprotein cholesterol (LDL-C) goal and 67.7% of the patients had a high cardiovascular disease (CVD) risk according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines. Of those who achieved LDL-C goals (n=1589), approximately one-third were at very high CVD risk and the patients who had received statin monotherapy showed the highest proportion in LDL-C goal attainment, followed by those treated with fibrate monotherapy. In a multivariate logistic regression model, taking drugs daily (odds ratio, OR: 1.64, 95% CI 1.25, 2.15) and older age (OR: 1.09, 95% CI 1.01, 1.18) were significantly associated with better odds of attaining LDL-C target. In contrast, patients with higher levels of ApoA1 (OR: 0.73, 95% CI [0.67,0.79]), Metabolic Syndrome (OR: 0.64, 95% CI [0.53, 0.76]), higher CV risk (OR: 0.33, 95% CI 0.27, 0.41), those who forgot to take their medication (OR: 0.74, 95% CI 0.62,0.88) and those who stopped taking medication when cholesterol became normal (OR: 0.67, 95% CI 0.55,0.82) were significantly associated with lower odds of attaining LDL-C target. CONCLUSION: The results of this study highlight the suboptimal management of dyslipidaemia in T2DM patients at high and very high risk of CVD.

2.
Heart Views ; 18(2): 41-46, 2017 Apr-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28706594

RESUMO

OBJECTIVES: The objective of this study is to describe contemporary management and 1-year outcomes of patients hospitalized with ST-segment elevation myocardial infarction (STEMI) in Arabian Gulf countries. METHODS: Data of patients admitted to 29 hospitals in four Gulf countries [Bahrain, Kuwait, Oman, United Arab Emirates (UAE)] with the diagnosis of STEMI were analyzed from Gulf locals with acute coronary syndrome (ACS) events (Gulf COAST) registry. This was a longitudinal, observational registry of consecutive citizens, admitted with ACS from January 2012 to January 2013. Patient management and outcomes were analyzed and compared between the four countries. RESULTS: A total of 1039 STEMI patients were enrolled in Gulf COAST Registry. The mean age was 58 years, and there was a high prevalence of diabetes (47%). With respect to reperfusion, 10% were reperfused with primary percutaneous coronary intervention, 66% with fibrinolytic therapy and 24% were not reperfused. Only one-third of patients who received fibrinolytic therapy had a door-to-needle time of 30 min or less. The in-hospital mortality rate was 7.4%. However, we noted a significant regional variability in mortality rate (3.8%-11.9%). In adjusted analysis, patients from Oman were 4 times more likely to die in hospital as compared to patients from Kuwait. CONCLUSIONS: In the Gulf countries, fibrinolytic therapy is the main reperfusion strategy used in STEMI patients. Most patients do not receive this therapy according to timelines outlined in recent practice guidelines. There is a significant discrepancy in outcomes between the countries. Quality improvement initiatives are needed to achieve better adherence to management guidelines and close the gap in outcomes.

3.
Diabetol Metab Syndr ; 8: 49, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27468314

RESUMO

BACKGROUND: The aim of this study was to determine the impact of metabolic syndrome (MetS) on lipid target achievements in the Arabian Gulf. METHODS: The centralized pan-middle east survey on the undertreatment of hypercholesterolemia (CEPHEUS) included 4171 high and very high atherosclerotic cardiovascular disease (ASCVD) risk patients from six Arabian Gulf countries. Analyses were performed using univariate statistics. RESULTS: The overall mean age was 57 ± 11 years, 41 % were females and 71 % had MetS. MetS patients were less likely to attain their HDL-C (34 vs. 79 %; P < 0.001), LDL-C (27 vs. 37 %; P < 0.001), non HDL-C (35 vs. 55 %; P < 0.001) and Apo B (35 vs. 54 %; P < 0.001) compared to those without MetS. Within the MetS cohort, those with very high ASCVD risk were less likely to attain their lipid targets compared to those with high ASCVD risk [HDL-C (32 vs. 41 %; P < 0.001), LDL-C (24 vs. 43 %; P < 0.001), non HDL-C (32 vs. 51 %; P < 0.001) and Apo B (33 vs. 40 %; P = 0.001)]. In those with MetS and very high ASCVD risk status, females were less likely to attain their HDL-C (27 vs. 36 %; P < 0.001), LDL-C (19 vs. 27 %; P < 0.001) and Apo B (30 vs. 35 %; P = 0.009) compared to males. CONCLUSIONS: MetS was associated with low lipid therapeutic targets. Women and those with very high ASCVD risk were also less likely to attain their lipid targets in the Arabian Gulf.

4.
J Clin Lipidol ; 10(2): 368-77, 2016 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27055968

RESUMO

BACKGROUND: Atherogenic dyslipidemia is highly prevalent in the Arabian Gulf. Non-high-density lipoprotein cholesterol (non-HDL-C) reduction has been proposed as an additional goal to low-density lipoprotein cholesterol (LDL-C) lowering to prevent atherosclerotic cardiovascular disease (ASCVD). Data on non-HDL-C goal attainment in patients with high triglycerides (TGs) on lipid-lowering drugs (LLDs) in the region is scarce. OBJECTIVE: Evaluate non-HDL-C target attainment according to the National Lipid Association in patients on LLDs stratified by TG (<150 [1.69], 150-200 [1.69-2.26], >200 [2.26] mg/dL [mmol/L]) levels in the Arabian Gulf. METHODS: Overall, 4383 patients on LLD treatment from 6 Middle Eastern countries participating in the Centralized Pan-Middle East Survey on the Undertreatment of Hypercholesterolemia study were evaluated. Patients were classified according to TG levels and ASCVD risk. RESULTS: The overall non-HDL-C goal attainment was 41% of the subjects. Non-HDL-C goal was less likely attained in patients with high TGs (12% vs 27% vs 55%; P < .001). Very high ASCVD risk patients with high TGs attained less their non-HDL-C targets compared with those with lower TG levels (8% vs 23% vs 51%; P < .001). Similarly, high ASCVD risk patients with high TGs also failed more in attaining non-HDL-C targets compared with those with lower TGs (26% vs 42% vs 69%; P < .001). In addition, those with high TG also succeeded less in attaining LDL-C and apolipoprotein B goals (P < .001). CONCLUSIONS: A large proportion of very high and high ASCVD patients on LLDs in the Arabian Gulf are not at recommended non-HDL-C targets and hence remain at a substantial residual risk.


Assuntos
Colesterol/sangue , Metas , Hipolipemiantes/farmacologia , Triglicerídeos/sangue , Feminino , Humanos , Oceano Índico , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
5.
Curr Vasc Pharmacol ; 14(4): 374-81, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26496982

RESUMO

We evaluated the control of cardiovascular disease (CVD) risk factors among patients with atherosclerotic cardiovascular disease (ASCVD) in the Centralized Pan-Middle East Survey on the undertreatment of hypercholesterolaemia (CEPHEUS) in the Arabian Gulf. Of the 4398 enrolled patients, overall mean age was 57 ± 11 years, 60% were males, 13% were smokers, 76% had diabetes, 71% had metabolic syndrome and 78% had very high ASCVD risk status. The proportion of subjects with body mass index <25 kgm2, HbA1c <7% (in diabetics), low-density lipoprotein cholesterol (LDL-C) <2.6 mmol/L (100 mg/dL) and <1.8 mmol/L (70 mg/dL) for high and very high ASCVD risk cohorts, respectively and controlled blood pressure (<140/90 mmHg) was 14, 26, 31% and 60%, respectively. Only 1.4% of the participants had all of their CVD risk factors controlled with significant differences among the countries (P < .001). CVD risk goal attainment rates were significantly lower in those with very high ASCVD risk compared with those with high ASCVD risk status (P < .001). Females were also, generally, less likely to attain goals when compared with males (P < .001).


Assuntos
Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/terapia , Hipercolesterolemia/tratamento farmacológico , Hipertensão/terapia , Hipolipemiantes/uso terapêutico , Síndrome Metabólica/terapia , Obesidade/terapia , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/epidemiologia , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Obesidade/diagnóstico , Obesidade/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fumar/efeitos adversos , Fumar/epidemiologia
6.
Glob Heart ; 10(4): 265-72, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26271552

RESUMO

BACKGROUND: Comprehensive cardiovascular disease risk factor (CVDRF) screening programs are limited in the developing world. Simplifying screening can increase its utility. OBJECTIVES: The present study aims to estimate the burden of CVDRF in volunteers and the yield of newly discovered CVDRF comparing different sites and nationalities using this screening method. METHODS: Voluntary point-of-care CVDRF screening was conducted in 4 shopping malls, 9 health care facilities, and 3 labor camps in 5 cities in the United Arab Emirates. Follow-up for newly diagnosed diabetes mellitus, hypertension, and dyslipidemia was made 1 month after screening to inquire about physician consultation, confirmation of diagnosis, and lifestyle changes. RESULTS: A total of 4,128 subjects were screened (43% at malls, 36% at health care facilities, and 22% at labor camps). Subjects were relatively young (38 ± 11 years), predominantly male (75%), and of diverse nationalities (United Arab Emirates: 7%, other Arabs: 10%, South Asians: 74%, other Asians: 5%, and other nationalities: 5%). CVDRF were frequent (diabetes mellitus: 32%, hypertension: 31%, dyslipidemia: 69%, current smokers: 21%, obesity: 20%, and central obesity: 24%). Most subjects (85%) had ≥1 CVDRF, and many (17%) had ≥3 CVDRF. A new diagnosis of diabetes mellitus, hypertension, or dyslipidemia was uncovered in 61.5%, with the highest yield (74.0%) in labor camps. At follow-up of those with new CVDRF, positive lifestyle changes were reported in 60%, but only 33% had consulted a doctor; of these, diagnosis was confirmed in 63% for diabetes mellitus, 93% for hypertension, and 87% for dyslipidemia. CONCLUSIONS: In this relatively young and ethnically diverse cohort, CVDRF burden and yield of screening was high. Screening in these settings is pertinent and can be simplified.


Assuntos
Doenças Cardiovasculares/diagnóstico , Adulto , Assistência Ambulatorial , Diabetes Mellitus/diagnóstico , Dislipidemias/diagnóstico , Diagnóstico Precoce , Feminino , Humanos , Hipertensão/diagnóstico , Achados Incidentais , Masculino , Projetos Piloto , Sistemas Automatizados de Assistência Junto ao Leito , Fatores de Risco , Distribuição por Sexo , Emirados Árabes Unidos
7.
BMJ Case Rep ; 20152015 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-25953581

RESUMO

A healthy 32-year-old Asian man presented in emergency with a history of severe chest pain. ECG showed normal sinus rhythm with ST elevations in the anterior chest leads. He was diagnosed with anterior wall ST segment elevation myocardial infarction and was thrombolysed with tenecteplase. The cardiac enzymes and troponin level were significantly high and echocardiography demonstrated akinetic anterior segment of left ventricle. Coronary angiography exhibited anomalous left anterior descending artery originating from right sinus of Valsalva without atherosclerotic lesion.


Assuntos
Anomalias dos Vasos Coronários/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Adulto , Diagnóstico Diferencial , Eletrocardiografia , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Infarto do Miocárdio/tratamento farmacológico , Inibidores da Agregação de Plaquetas/uso terapêutico , Terapia Trombolítica , Resultado do Tratamento
8.
Angiology ; 66(6): 578-83, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25092679

RESUMO

We evaluated the association between risk variables in diabetic patients with normal and diseased coronary arteries in a retrospective cohort study conducted at Rashid Hospital, Dubai. A total of 4446 patients underwent coronary angiography due to various indications; 43% had type 2 diabetes mellitus (T2DM). Among the diabetic patients, 94% had diseased coronary arteries and the remaining 6% had absolutely normal arteries. The normal coronary group had significantly lower low-density lipoprotein cholesterol (LDL-C) and a higher high-density lipoprotein cholesterol (HDL-C) levels than the diseased group. Patients with normal coronaries were more likely to be females, have T2DM for a shorter duration, and were nonsmokers and non-South Asians. They also had lower levels of LDL, hemoglobin A1c, and fasting glucose and higher levels of HDL-C. Apart from these variables, genetic or environmental factors could protect these patients from atherosclerosis.


Assuntos
Doença da Artéria Coronariana/prevenção & controle , Vasos Coronários , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/prevenção & controle , Biomarcadores/sangue , Glicemia/análise , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Angiografia Coronária , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Vasos Coronários/diagnóstico por imagem , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/diagnóstico por imagem , Angiopatias Diabéticas/epidemiologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Fatores de Proteção , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Emirados Árabes Unidos/epidemiologia
9.
Open Cardiovasc Med J ; 8: 88-93, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25328551

RESUMO

OBJECTIVES: To describe the risk profile, management and one-year outcomes of patients hospitalized with acute coronary syndrome (ACS) in the Gulf region of the Middle East. SUBJECTS AND METHODS: The Gulf locals with acute coronary syndrome events (Gulf COAST) registry is a prospective, multinational, longitudinal, observational, cohort-based registry of consecutive citizens, from the Gulf region of the Middle East, admitted from January 2012 to January 2013 to 29 hospitals with a diagnosis of ACS. Data entered online included patient demographics, cardiovascular risk profiles, past medical history, physical findings on admission, in-hospital diagnostic tests and therapeutic management, as well as one year outcomes. RESULTS: 3188 patients were recruited. The mean age was 60.4 ± 12.6years (range: 22-112), 2104 (66%) were males and 1084 (34%) females. The discharge diagnosis was ST-segment elevation myocardial infarction (STEMI) in 741 (23.2%), new-onset left bundle branch block myocardial infarction (LBBBMI) in 30 (0.9%), non-ST-segment elevation myocardial infarction (NSTEMI) in 1486 (46.6%) and unstable angina in 931 (29.2%). At hospital presentation, 2105 (66%), 1779 (55.8%), 1703 (53.4%) and 740 (23.2%) had history of hypertension, dyslipidemia, diabetes mellitus and active smoking, respectively. CONCLUSION: Patients with ACS in our region are young with very high risk profile. The Gulf COAST registry is an example of successful regional collaboration and will provide information on contemporary management of ACS in the region.

10.
BMJ Case Rep ; 20142014 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-24827670

RESUMO

A 27-year-old woman with a history of bileaflet mitral valve prolapse and moderate mitral regurgitation presented to our emergency with untractable polymorphic wide complex tachycardia and unstable haemodynamics. After cardiopulmonary resuscitation, return of spontaneous circulation was achieved 30 min later. Her post-resuscitation ECG showed a prolonged QT interval which progressively normalised over the same day. Her laboratory investigations revealed hypocalcaemia while other electrolytes were within normal limits. A diagnosis of ventricular arrhythmia secondary to structural heart disease further precipitated by hypocalcaemia was made. Further hospital stay did not reveal a recurrence of prolonged QT interval or other arrhythmias except for an episode of non-sustained ventricular tachycardia. However, the patient suffered diffuse hypoxic brain encephalopathy secondary to prolonged cardiopulmonary resuscitation.


Assuntos
Arritmias Cardíacas/etiologia , Eletrólitos/sangue , Sistema de Condução Cardíaco/anormalidades , Hipocalcemia/complicações , Prolapso da Valva Mitral/complicações , Valva Mitral/anormalidades , Taquicardia/etiologia , Fibrilação Ventricular/etiologia , Adulto , Síndrome de Brugada , Doença do Sistema de Condução Cardíaco , Reanimação Cardiopulmonar , Eletrocardiografia Ambulatorial , Feminino , Humanos , Insuficiência da Valva Mitral/complicações , Taquicardia/diagnóstico , Disfunção Ventricular/etiologia , Fibrilação Ventricular/diagnóstico
11.
J Emerg Med ; 46(6): 763-6, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24565879

RESUMO

BACKGROUND: Kawasaki disease usually affects infants and young children. It often goes unrecognized in adults due to varying symptoms and lack of definite diagnostic criteria. OBJECTIVES: To describe the potential for acute myocardial infarction as a complication of antecedent Kawasaki Disease (KD). CASE REPORT: We describe a case of a 19-year-old man who presented to the Emergency Department (ED) with an acute myocardial infarction that was subsequently determined to be the result of previously untreated KD. CONCLUSION: Kawasaki disease can cause coronary complications in a teenager. A high level of suspicion in the ED can help in proper management of these patients.


Assuntos
Aneurisma Coronário/etiologia , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Infarto do Miocárdio/etiologia , Aneurisma Coronário/diagnóstico , Humanos , Masculino , Adulto Jovem
12.
Angiology ; 65(10): 919-26, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24301426

RESUMO

The Centralized pan-Middle East Survey on the undertreatment of hypercholesterolemia (CEPHEUS) survey evaluated the attainment of low-density lipoprotein cholesterol (LDL-C) goals among patients on lipid-lowering drugs (LLDs) according to the updated National Cholesterol Education Program (NCEP)-Adult Treatment Panel (ATP-III) guideline. The survey was conducted in 6 Arabian Gulf countries. Patients aged ≥18 years on LLDs for at least ≥3 months (stable medication for ≥6 weeks) were recruited. Fasting blood samples were collected at a single visit. In this survey, 5276 (58.2% male) patients were included in the final analysis. The LDL-C goal was attained in 91.1% of low-risk, 52.7% of high-risk, and 32.0% in very-high-risk categories. Goal attainment was directly related to female gender, age<40 years, history of diabetes, and family history of cardiovascular disease. The results of this survey highlight the suboptimal management of hypercholesterolemia across Arabian Gulf countries.


Assuntos
Doença das Coronárias/tratamento farmacológico , Fidelidade a Diretrizes/estatística & dados numéricos , Hipercolesterolemia/tratamento farmacológico , Hipolipemiantes/administração & dosagem , Adulto , Idoso , Árabes , LDL-Colesterol/sangue , Doença das Coronárias/sangue , Doença das Coronárias/epidemiologia , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Inquéritos Epidemiológicos , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/epidemiologia , Lipídeos/sangue , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Oriente Médio , Garantia da Qualidade dos Cuidados de Saúde , Inquéritos e Questionários , Resultado do Tratamento
13.
BMJ Case Rep ; 20132013 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-23704457

RESUMO

Intracranial haemorrhage is a known complication after fibrinolytic therapy and occurs usually in the first 24 h. We report a 35-year-old woman who presented with severe central chest pain and she was diagnosed as anterior ST elevation myocardial infarction. She was given fibrinolytic therapy with Tenecteplase. She responded well to the treatment with a decrease in the intensity of chest pain and resolution of the ST segment elevation. She was taken for coronary angiogram the next day, which revealed an occlusion of the left anterior descending (LAD) artery, and stenting of LAD was carried out. Four days later, she developed severe headache, confusion, slurring of speech and right haemiparesis. CT brain revealed intracerebral haemorrhage and she was referred to an neurosurgeon who advised for conservative management. Her condition gradually improved with physiotherapy and was discharged home with no marked functional impairment.


Assuntos
Dor no Peito/diagnóstico , Fibrinolíticos/efeitos adversos , Hemorragias Intracranianas/induzido quimicamente , Infarto do Miocárdio/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Adulto , Dor no Peito/etiologia , Oclusão Coronária/cirurgia , Feminino , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/cirurgia , Tenecteplase
14.
BMJ Case Rep ; 20132013 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-23329715

RESUMO

We describe a case of a 50-year-old lady with newly diagnosed primary Sjogren syndrome who presented with severe pulmonary artery hypertension and pericardial effusion. She was managed by immunosuppressive agents and a combination of standard therapy for pulmonary hypertension. Our patient had a clinically significant involvement of cardio-pulmonary system that is atypical of this disease. Prompt recognition and management of this condition are extremely crucial as untreated cases carry a grave prognosis. However, the ideal treatment strategy is yet to be defined for this condition.


Assuntos
Dispneia/etiologia , Hipertensão Pulmonar/complicações , Derrame Pericárdico/complicações , Síndrome de Sjogren/complicações , Diagnóstico Diferencial , Dispneia/diagnóstico , Ecocardiografia , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico , Síndrome de Sjogren/diagnóstico , Tomografia Computadorizada por Raios X
15.
BMJ Case Rep ; 20122012 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-23188853

RESUMO

A 72-year-old man was referred to our hospital as a case of postcardiac arrest following a long distance air flight. Work-up in the emergency department revealed the presence of deep vein thrombosis (DVT), bilateral pulmonary embolism, inferior STEMI (ST elevation myocardial infarction) and ischaemic stroke. He received thrombolysis by recombinant tissue plasminogen activator (tPA) following which his haemodynamic status improved, but he developed haemorrhagic transformation of the stroke as a complication. The haemorrhagic lesion gradually resolved with conservative management, leaving behind a residual neurological deficit. His haemodynamic status was stable after the management. Although a diagnosis of right-to-left shunt lesion was highly suggestive in this condition, it could not be confirmed on the transthoracic echocardiogram. Our patient had a unique presentation of multiple thrombi in different organs that caused significant morbidity and haemodynamic instability. There are no well-established guidelines that discuss the acute management of such cases. This situation requires a careful assessment and management of the patient by a multidisciplinary team.


Assuntos
Aeronaves , Infarto Cerebral/diagnóstico , Parada Cardíaca/etiologia , Infarto do Miocárdio/diagnóstico , Embolia Pulmonar/diagnóstico , Viagem , Trombose Venosa/diagnóstico , Idoso , Angiografia , Infarto Cerebral/tratamento farmacológico , Eletrocardiografia , Fidelidade a Diretrizes , Humanos , Masculino , Infarto do Miocárdio/tratamento farmacológico , Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/uso terapêutico , Tomografia Computadorizada por Raios X , Trombose Venosa/tratamento farmacológico
17.
BMJ Case Rep ; 20122012 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-22922925

RESUMO

An Indian man in his late 30s presented with ischaemic stroke and eosinophilia of 711/mm(3). ECG showed first-degree heart block with ST depression and symmetrical T-wave inversions in the chest leads. Subsequently, the patient was further evaluated by echocardiography and cardiac MRI which identified the presence of endomyocardial fibrosis in the heart.


Assuntos
Isquemia Encefálica/etiologia , Fibrose Endomiocárdica/complicações , Fibrose Endomiocárdica/diagnóstico , Acidente Vascular Cerebral/etiologia , Adulto , Anticoagulantes/uso terapêutico , Ecocardiografia Transesofagiana , Eletrocardiografia , Humanos , Imagem por Ressonância Magnética , Masculino , Acidente Vascular Cerebral/tratamento farmacológico , Varfarina/uso terapêutico
18.
Am Heart J ; 159(4): 593-8, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20362717

RESUMO

BACKGROUND: QRS prolongation with or without bundle branch block (BBB) has been associated with adverse outcome in myocardial infarction; we examined the relationship between QRS duration and outcome in a broad spectrum of patients with acute coronary syndrome (ACS). METHOD AND RESULTS: Core laboratory evaluation of the presenting electrocardiogram in Canadian ACS Registry patients (n = 5,003) showed 4,289 (85.7%) had QRS <120 milliseconds, 202 (4.0%) patients had QRS > or =120 milliseconds without BBB, 262 (5.2%) had left BBB (LBBB), and 250 (5.0%) had right BBB. Compared to patients with QRS <120 milliseconds, patients with QRS > or =120 milliseconds without BBB had higher in-hospital (3.5% vs 1.9%, odds ratio [OR] 1.87, 95% CI 0.85-4.09, P = .12) and 1-year mortality (14.9% vs 7.7%, OR 2.10, 95% CI 1.38-3.18, P = .001). In-hospital and 1-year mortality was significantly higher in patients with BBB (eg, LBBB compared with QRS <120 milliseconds) (5.0% vs 1.9%, OR 2.71, 95% CI 1.49-4.94, P = .001, and 23.8% vs 7.7%, OR 3.74, 95% CI 2.72-5.13, P < .001). Analyzed as a continuous variable and after adjustment for validated prognosticators, QRS duration was an independent predictor of 1-year death (OR 1.11, 95% CI 1.06-1.16, P < .001) and death/myocardial infarction (OR 1.06, 95% CI 1.02-1.11, P = .003). However, when using clinically applicable QRS duration evaluation, only LBBB was an independent predictor of 1-year mortality (OR 1.93, 95% CI 1.28-2.90, P = .002). CONCLUSIONS: In patients presenting with a broad spectrum of suspected ACS, QRS prolongation-particularly in the setting of LBBB-is an independent predictor of in-hospital and 1-year mortality.


Assuntos
Síndrome Coronariana Aguda/mortalidade , Bloqueio de Ramo/mortalidade , Idoso , Eletrocardiografia , Feminino , Sistema de Condução Cardíaco , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
19.
Am Heart J ; 156(4): 797-803, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18926163

RESUMO

BACKGROUND: The prognostic value of admission ST-segment changes in patients with non-ST elevation acute coronary syndromes (NSTE ACS) is well established; however, the value of a next-day follow-up electrocardiogram (ECG) is unclear. METHOD: We evaluated ST-depression (ST(downward arrow)) and Q-wave status on the admission and 24 to 36-hour follow-up ECG in 2,743 patients in a prospective Canadian ACS registry. RESULTS: Of patients with ST(downward arrow) > or =1 mm on admission (n = 533 [19.4%]), 366 (68.7%) normalized their ST segment on follow-up ECG. Among patients without ST(downward arrow) on admission (n = 2,110), 97 (4.4%) developed new ST(downward arrow) at follow-up. Patients with normalized ST(downward arrow) at follow-up had higher 1-year myocardial infarction (MI) (10.1% vs 5.7%, odds ratio [OR] 1.77, 95% CI 1.12-2.81, P = .015) and death/MI rates (19.5% vs 10.2%, OR 1.69, 95% CI 1.18-2.41, P = .004), respectively, as compared to those who never had ST(downward arrow). Patients with persistent ST(downward arrow) had higher 1-year MI (10.8% vs 5.7%, OR 1.95, 95% CI 1.09-3.51, P = .025) and death/MI rates (25.6% vs 10.2%, OR 1.78, 95% CI 1.13-2.79, P = .013), respectively. In multivariable analysis, ST(downward arrow) on baseline ECG was an independent predictor of 1-year mortality; however, ST(downward arrow) on the follow-up ECG did not provide additional prognostic value. There were no differences in outcomes between the 4 different Q-wave status groups. CONCLUSIONS: Although dynamic and persistent ST(downward arrow) are associated with worse unadjusted outcome in patients with NSTE ACS, there was no incremental prognostic value of a follow-up ECG evaluating ST depression and/or Q-wave status beyond that already provided by the initial ECG together with established prognostic factors.


Assuntos
Síndrome Coronariana Aguda/mortalidade , Continuidade da Assistência ao Paciente , Eletrocardiografia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Idoso , Canadá , Fatores de Confusão (Epidemiologia) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prognóstico , Estudos Prospectivos , Sistema de Registros , Análise de Sobrevida
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