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1.
Pan Afr Med J ; 33: 74, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31448036

RESUMO

Myocardial infarction (MI) is a major cause of cardiovascular mortality. Inferior MI accounts for 30-50% of infarctions but it is associated with a favorable prognosis compared to anterior infarct. This study aimed to study the epidemiological, clinical, electrical, echocardiographic, angiographic features of inferior MI, as well as its complications and its therapeutic approaches. Over a period of 3 years, we admitted 720 patients with STEMI, of whom 103 with inferior STEMI, reflecting a rate of 14.3%. There was a clear male predominance, with an average age of 58 years (men) and 62 years (women). Smoking was the main risk factor for cardiovascular disease (57.28% of patients were smokers). Right ventricular infarction was found in 11.65% of cases. Half of these patients had hemodynamic instability. Third-degree atrioventricular block was diagnosed in 12.6% of patients. Therapeutic approach was based on thrombolysis (7 patients) and coronary angiogram (42 patients). Inferior MI was caused by right coronary lesion in 53% of cases and circumflex artery occlusion in 47% of cases. Right coronary is responsible for right ventricular infarction in 100% of cases. Coronary angioplasty was performed in 18 patients after coronary angiogram. Eleven patients underwent transluminal coronary angioplasty in the right coronary while 2 patients underwent transluminal coronary angioplasty in the circumflex artery. Early mortality at 30 days was 1.94%. In the right ventricular infarction group mortality rate was about 17%.


Assuntos
Angioplastia Coronária com Balão/métodos , Angiografia Coronária/métodos , Infarto Miocárdico de Parede Inferior/epidemiologia , Idoso , Bloqueio Atrioventricular/epidemiologia , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Infarto Miocárdico de Parede Inferior/fisiopatologia , Infarto Miocárdico de Parede Inferior/terapia , Masculino , Pessoa de Meia-Idade , Marrocos/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia
2.
Ann Cardiol Angeiol (Paris) ; 63(2): 65-70, 2014 Apr.
Artigo em Francês | MEDLINE | ID: mdl-24485826

RESUMO

BACKGROUND: Obstructive sleep apnea has been implicated in the pathogenesis and aggravation of coronary atherosclerosis. However, it remains underdiagnosed in cardiology practice. AIM: The aim of this study was to determine the prevalence of obstructive sleep apnea and the predictors of severe sleep apnea in patients admitted for ST elevation myocardial infarction. METHODS: This was a prospective study which has included 120 patients hospitalized for ST elevation myocardial infarction, from April 2011 to March 2012. All patients have undergone an overnight sleep study using a portable polygraphy device, in the 15 days following the acute coronary syndrome. The diagnostic of obstructive sleep apnea was considered as apnea-hypopnea index of ≥ 5 events per hour, severe sleep apnea was defined as apnea -hypopnea index of ≥ 30. Subjective daytime sleepiness was assessed by the Epworth sleepiness scale. All patients have had an oxygen saturation monitoring in the coronary care unit using a pulse oxymeter, before undergoing the sleep study. RESULTS: The study population was made up of 102 men and 18 women. The mean age was 58 ± 12 years. Smoking was the major cardiovascular risk factor found in 72% of all patients, diabetes and hypertension were represented in 40% and 44% of the population, respectively. Eighty-seven percent of patients were admitted in the first 24 hours of symptom onset. A primary percutaneous coronary intervention was performed in 60% of cases while fibrinolysis was done in 10% of patients. The prevalence of obstructive sleep apnea was 79%. Mean apnea-hypopnea index was 15.76 ± 14.93 and severe form was diagnosed in 16% of all patients. Multivariate analysis showed that Epworth sleepiness score of ≥ 4 and nocturnal desaturation below 82% were independent predictive factors for severe obstructive sleep apnea. CONCLUSION: Prevalence of obstructive sleep apnea was very high in patients admitted for acute myocardial infarction. Epworth sleepiness score of ≥ 4 and nocturnal desaturation below 82% were independent predictive factors for severe form of sleep apnea.


Assuntos
Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Idoso , Infarto Miocárdico de Parede Anterior/diagnóstico , Infarto Miocárdico de Parede Anterior/epidemiologia , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Infarto Miocárdico de Parede Inferior/diagnóstico , Infarto Miocárdico de Parede Inferior/epidemiologia , Masculino , Pessoa de Meia-Idade , Polissonografia , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Tunísia/epidemiologia
3.
Am J Cardiol ; 112(11): 1714-9, 2013 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-24063834

RESUMO

Although the incidence of and mortality after ST-segment elevation myocardial infarction (STEMI) is decreasing, time trends in anatomical location of STEMI and associated short-term prognosis have not been examined in a population-based community study. We determined 22-year trends in age- and race-adjusted gender-specific incidences and 28-day case fatality of hospitalized STEMI by anatomic infarct location among a stratified random sample of 35- to 74-year-old residents of 4 communities in the Atherosclerosis Risk in Communities study. STEMI infarct location was assessed by 12-lead electrocardiograms from the hospital record and was coded as anterior, inferior, lateral, and multilocation STEMIs using the Minnesota code. From 1987 to 2008, a total of 4,845 patients had an incident STEMI; 37.2% were inferior STEMI, 32.8% were anterior, 16.8% occurred in multiple infarct locations, and 13.2% were lateral STEMI. For inferior, anterior, and lateral STEMIs in both men and women, significant decreases were observed in the age-adjusted annual incidence and the associated 28-day case fatality. In contrast, for STEMI in multiple infarct locations, neither the annual incidence nor the 28-day case fatality changed over time. The age- and race-adjusted annual incidence and associated 28-day case fatality of STEMI in anterior, inferior, and lateral infarct locations decreased during 22 years of surveillance; however, no decrease was observed for STEMI in multiple infarct locations. In conclusion, our findings suggest that there is room for improvement in the care of patients with multilocation STEMI.


Assuntos
Infarto Miocárdico de Parede Anterior/epidemiologia , Infarto Miocárdico de Parede Inferior/epidemiologia , Adulto , Idoso , Infarto Miocárdico de Parede Anterior/mortalidade , Infarto Miocárdico de Parede Anterior/terapia , Comorbidade , Ponte de Artéria Coronária/tendências , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Incidência , Infarto Miocárdico de Parede Inferior/mortalidade , Infarto Miocárdico de Parede Inferior/terapia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/tendências , Prognóstico , Estudos Retrospectivos , Terapia Trombolítica/tendências , Estados Unidos
6.
Coron Artery Dis ; 22(3): 165-70, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21394028

RESUMO

OBJECTIVES: Inferior ST-elevation myocardial infarction (I-STEMI) caused by proximal occlusion of the left circumflex artery (LCx) or right coronary artery (RCA) is associated with poor outcomes. We tested two new electrocardiographic (ECG) algorithms to identify proximal RCA (P-RCA), proximal LCx (P-LCx), or distal RCA or LCx in I-STEMI. METHODS: In 135 patients with I-STEMI, 115 (85.2%) had RCA occlusion [49 (36.3%) with P-RCA occlusion] and 15 (11.1%) had LCx occlusion [4 (2.9%) with P-LCx occlusion]. In the ECG algorithms, P-RCA occlusion was indicated by STE in lead III higher than lead II and no ST depression in V1. P-LCx occlusion was indicated by STE in lead II higher than in lead III and no ST depression in aVL. One algorithm included an additional step: whether the ST-T pattern in aVL represents reciprocal changes to lead III (differences in the magnitude of ST deviation or T-wave direction were considered to indicate P-LCx occlusion). RESULTS: The positive and negative predictive values of these algorithms were low (45.6 and 76.8% for P-RCA occlusion and 6.7 and 97.5% for P-LCx occlusion). CONCLUSION: The ECG algorithms cannot reliably identify the culprit artery in I-STEMI. Right precordial leads may be needed to determine the site of lesion.


Assuntos
Oclusão Coronária/diagnóstico , Vasos Coronários/patologia , Eletrocardiografia , Infarto Miocárdico de Parede Inferior/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Estudos de Coortes , Feminino , Humanos , Infarto Miocárdico de Parede Inferior/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos
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