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1.
BMJ Case Rep ; 14(4)2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33883112

RESUMO

Paradoxical coronary artery embolism is often an underdiagnosed cause of acute myocardial infarction (MI). It should always be considered in patient with acute MI and a low risk profile for atherosclerotic coronary artery disease. We describe a patient with simultaneous acute saddle pulmonary embolism (PE) and acute ST segment elevation MI due to paradoxical coronary artery embolism. Transoesophageal echocardiography demonstrated a patent foramen ovale with right to left shunt and large saddle PE in the main pulmonary artery and coronary angiography demonstrated acute thrombotic occlusion of the right coronary artery.


Assuntos
Embolia Paradoxal , Forame Oval Patente , Embolia Pulmonar , Infarto do Miocárdio com Supradesnível do Segmento ST , Trombose , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem
2.
Vasc Health Risk Manag ; 17: 123-133, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33833517

RESUMO

Background: The current ERC guidelines are the source of many positive changes, reduction of mortality, length of hospitalization and improvement of prognosis of STEMI patients. However, there is a small group of patients whose slight modification in guidelines would further reduce in-hospital mortality and hospitalization costs. These are patients with concomitant STEMI infarction and gastrointestinal bleeding. Methods: Two separate methods of treatment were compared in patients with concomitant gastrointestinal bleeding and ST-segment elevation myocardial infarction. The first - traditional approach, in the line with the ESC guidelines, the second innovative, with priority for endoscopy. Results: Despite the innovative approach, the patient with endoscopy before PCI was discharged without complication. A patient who has undergone coronary intervention and who has been started on typical antiplatelet therapy prior to gastroenterological diagnosis has died due to massive bleeding. Conclusion: For ethical reasons and in connection with the cardiological guidelines of the management of ACS, a study of patients with ASC a high risk of intestinal bleeding, in which endoscopy will have priority, and only later PCI, will probably never be performed. Although, as the described case shows, despite exceeding the 90 minutes time to implement PCI (<120 minutes) in logistic terms such behavior is completely feasible.


Assuntos
Endoscopia Gastrointestinal , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tomada de Decisão Clínica , Evolução Fatal , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento
4.
J Cardiothorac Surg ; 16(1): 106, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888133

RESUMO

BACKGROUND: Left ventricular free wall rupture (LVFWR) is a rare complication after myocardial infarction and usually occurs 1 to 4 days after the infarct. Over the past decade, the overall incidence of LVFWR has decreased given the advancements in reperfusion therapies. However, during the COVID-19 pandemic, there has been a significant delay in hospital presentation of patients suffering myocardial infarctions, leading to a higher incidence of mechanical complications from myocardial infarctions such as LVFWR. CASE PRESENTATION: We present a case in which a patient suffered a LVFWR as a mechanical complication from myocardial infarction due to delay in seeking care over fear of contracting COVID-19 from the medical setting. The patient had been having chest pain for a few days but refused to seek medical care due to fear of contracting COVID-19 from within the medical setting. He eventually suffered a cardiac arrest at home from a massive inferior myocardial infarction and found to be in cardiac tamponade from a left ventricular perforation. He was emergently taken to the operating room to attempt to repair the rupture but he ultimately expired on the operating table. CONCLUSIONS: The occurrence of LVFWR has been on a more significant rise over the course of the COVID-19 pandemic as patients delay seeking care over fear of contracting COVID-19 from within the medical setting. Clinicians should consider mechanical complications of MI when patients present as an out-of-hospital cardiac arrest, particularly during the COVID-19 pandemic, as delay in seeking care is often the exacerbating factor.


Assuntos
/epidemiologia , Ruptura Cardíaca/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Idoso , Comorbidade , Angiografia por Tomografia Computadorizada , Ecocardiografia Transesofagiana , Eletrocardiografia , Ruptura Cardíaca/diagnóstico , Ventrículos do Coração , Humanos , Masculino , Pandemias , Radiografia Torácica , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia
5.
Am J Physiol Heart Circ Physiol ; 320(6): H2240-H2254, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33844596

RESUMO

The outbreak of severe acute respiratory syndrome coronavirus 2 that first emerged in Wuhan in December 2019 has resulted in the devastating pandemic of coronavirus disease 2019, creating an emerging need for knowledge sharing. Meanwhile, myocardial infarction is and will probably remain the foremost cause of death in the Western world throughout the coming decades. Severe deregulation of the immune system can unnecessarily expand the inflammatory response and participate in target and multiple organ failure, in infection but also in critical illness. Indeed, the course and fate of inflammatory cells observed in severe ST-elevation myocardial infarction (neutrophilia, monocytosis, and lymphopenia) almost perfectly mirror those recently reported in severe coronavirus disease 2019. A pleiotropic proinflammatory imbalance hampers adaptive immunity in favor of uncontrolled innate immunity and is associated with poorer structural and clinical outcomes. The goal of the present review is to gain greater insight into the cellular and molecular mechanisms underlying this canonical activation and downregulation of the two arms of the immune response in both entities, to better understand their pathophysiology and to open the door to innovative therapeutic options. Knowledge sharing can pave the way for therapies with the potential to significantly reduce mortality in both infectious and noninfectious scenarios.


Assuntos
/imunologia , Sistema Imunitário/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/imunologia , /complicações , Humanos , Inflamação/etiologia , Inflamação/terapia , Infarto do Miocárdio/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações
6.
Kardiologiia ; 61(2): 99-105, 2021 Mar 06.
Artigo em Russo | MEDLINE | ID: mdl-33715614

RESUMO

Despite successful and timely revascularization of the infarct-related artery, myocardial tissue remains underperfused in some patients. This condition is known as the no-reflow phenomenon, which is associated with a worse prognosis. The first part of the systematic review on no-reflow focuses on description of the no-reflow pathogenesis and predictors. This phenomenon has a complicated, multifactorial pathogenesis, including distal embolization, ischemic injury, reperfusion injury, and a component of individual predisposition. Meanwhile, this phenomenon undergoes spontaneous regression in some patients. Several studies have demonstrated the role of definite biomarkers and clinical indexes as risk predictors for no-reflow. The significance of each pathogenetic component of no-reflow is suggested to be different in different patients, which may warrant an individualized approach in the treatment.


Assuntos
Trombose Coronária , Fenômeno de não Refluxo , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Angiografia Coronária , Humanos , Miocárdio , Fenômeno de não Refluxo/diagnóstico , Fenômeno de não Refluxo/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
7.
Isr Med Assoc J ; 23(3): 169-173, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33734630

RESUMO

BACKGROUND: Elevated C-reactive protein (CRP) was shown to be associated with an increased risk for new-onset atrial fibrillation (AF) in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI); however, the optimal time frame to measure CRP for risk stratification is not known. OBJECTIVES: To evaluate the relation between the change in CRP over time (CRP velocity [CRPv]) and new-onset AF among STEMI patients treated with primary PCI. METHODS: We included 801 STEMI patients who underwent PCI between 2007 and 2017 and had their CRP measured with a wide range assay (wr-CRP) at least twice during the 24 hours after admission. CRPv was defined as the change in wr-CRP concentration (mg/l) divided by the change in time (in hours) between the two measurements. Patient medical records were reviewed for occurrence of new-onset AF. RESULTS: New onset AF occurred in 45 patients (6%). Patients with new onset AF had significantly higher median CRPv (1.27 vs. 0.43 mg/l/h, P = 0.002). New-onset AF during hospitalization occurred in 3.4%, 4.5 %, and 9.1% of patients in the first, second and third CRPv tertiles, respectively (P for trend = 0.006). In a multivariable logistic regression, adjusting for clinical variables the odds ratios for new onset AF was 1.93 (95% confidence interval 1.0-3.59, P = 0.04) for patients in the third CRPv tertile. CONCLUSIONS: CRPv might be an independent and rapidly measurable biomarker for new-onset AF following primary PCI in STEMI patients.


Assuntos
Fibrilação Atrial/sangue , Fibrilação Atrial/etiologia , Proteína C-Reativa/metabolismo , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Idoso , Fibrilação Atrial/diagnóstico , Biomarcadores/sangue , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Fatores de Tempo
8.
Am J Case Rep ; 22: e929573, 2021 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-33690260

RESUMO

BACKGROUND Myxedema coma is an endocrine emergency with a high mortality rate, defined as a severe hypothyroidism leading to hypotension, bradycardia, decreased mental status, hyponatremia, hypoglycemia, and cardiogenic shock. Although hypothyroidism and cardiac disease has been interlinked, ST elevation myocardial infarction in the setting of myxedema coma have not been reported previously. CASE REPORT We report the case of a 70-year-old man who presented to the Emergency Department with chest pain and confusion. He also reported fatigue for the past week, which was progressively worsening. His past medical history was significant for renal cell carcinoma with metastatic bone disease being treated with chemotherapy (axitinib and pembrolizumab). In the Emergency Department, an ECG revealed inferior ST elevations. Shortly after presentation, the patient's blood pressure was decreasing, he became bradycardic (sinus), and his mental status was getting worse, so he was intubated for airway protection and was taken emergently for a cardiac catheterization, which failed to reveal an acute coronary occlusion. TSH was 60.6 mIU/L (0.465-4.680) mIU/ML, and free T4 0.3 ng/dL (0.8-2.2) ng/dL. The cardiac index was calculated to be 0.8 L/min/m² (normal range 2.6-4.2 L/min/m²), which confirmed cardiogenic shock due to myxedema coma. He was treated with levothyroxine (T4), liothyronine (T3), hydrocortisone, and multiple vasopressors but failed to respond and died 13 h after admission to the hospital. CONCLUSIONS Because of its rarity and high mortality, early diagnosis of myxedema coma and initiation of treatment by cardiologists requires a high level of suspicion, especially when patients with a history of hypothyroidism present with a cardiac complaint (ie, acute coronary syndrome, or bradycardia) that does not completely fit the clinical picture. It is of utmost importance for physicians to keep a wide differential diagnosis of other causes of ST elevation and/or persistent cardiogenic shock.


Assuntos
Mixedema , Infarto do Miocárdio com Supradesnível do Segmento ST , Idoso , Coma/etiologia , Humanos , Masculino , Mixedema/complicações , Mixedema/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Choque Cardiogênico/etiologia , Tiroxina/uso terapêutico
10.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547120

RESUMO

There is increasing literature to suggest numerous subgroups of Brugada syndrome (BrS), including those with ST elevation in the lateral or inferior leads. We present a case of a patient presenting with recurrent collapse and inferior ST elevation degenerating to ventricular fibrillation and ultimately leading to a diagnosis of BrS.


Assuntos
Síndrome de Brugada/diagnóstico , Síndrome de Brugada/terapia , Desfibriladores Implantáveis , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/terapia , Idoso , Angiografia Coronária , Diagnóstico Diferencial , Progressão da Doença , Eletrocardiografia , Febre , Humanos , Imagem por Ressonância Magnética , Masculino , Recidiva
11.
Int Heart J ; 62(1): 23-32, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33518662

RESUMO

The aim of this study was to explore potential predictive biomarkers and therapeutic targets of post-infarct heart failure (HF) using bioinformatics analyses.CEL raw data of GSE59867 and GSE62646 were downloaded from the GEO database. Differentially expressed genes (DEGs) between patients with ST-segment elevation myocardial infarction (STEMI) and those with stable coronary artery disease (CAD) at admission and DEGs between admission and 6 months after myocardial infarction (MI) in patients with STEMI were analyzed. A gene ontology (GO) analysis and a gene set enrichment analysis (GSEA) were performed, and a protein-protein interaction network was constructed. Critical genes were further analyzed.In total, 147 DEGs were screened between STEMI and CAD at admission, and 62 DEGs were identified in patients with STEMI between admission and 6 months after MI. The results of GO and GSEA indicate that neutrophils, neutrophil-related immunity responses, and monocytes/macrophages play important roles in MI pathogenesis. SLED1 expression was higher in patients with HF than in those without HF at admission and 1 month after MI. GSEA indicates that mTORC1 activation, E2F targets, G2M checkpoint, and MYC targets v1 inhibition may play key roles in the development of post-infarct HF. Furthermore, SLED1 may be involved in the development of post-infarct HF by activating mTORC1 and inhibiting E2F targets, G2M checkpoint, and MYC targets v1.SLED1 may be a novel biomarker of post-infarct HF and may serve as a potential therapeutic target in this disease.


Assuntos
Proteína Básica Maior de Eosinófilos/metabolismo , Insuficiência Cardíaca/metabolismo , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Biomarcadores/metabolismo , Proteína Básica Maior de Eosinófilos/genética , Perfilação da Expressão Gênica , Insuficiência Cardíaca/genética , Humanos , Mapas de Interação de Proteínas , Infarto do Miocárdio com Supradesnível do Segmento ST/genética , Infarto do Miocárdio com Supradesnível do Segmento ST/metabolismo
12.
IEEE J Biomed Health Inform ; 25(4): 903-908, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33596179

RESUMO

Because of the rapid and serious nature of acute cardiovascular disease (CVD) especially ST segment elevation myocardial infarction (STEMI), a leading cause of death worldwide, prompt diagnosis and treatment is of crucial importance to reduce both mortality and morbidity. During a pandemic such as coronavirus disease-2019 (COVID-19), it is critical to balance cardiovascular emergencies with infectious risk. In this work, we recommend using wearable device based mobile health (mHealth) as an early screening and real-time monitoring tool to address this balance and facilitate remote monitoring to tackle this unprecedented challenge. This recommendation may help to improve the efficiency and effectiveness of acute CVD patient management while reducing infection risk.


Assuntos
/prevenção & controle , Doenças Cardiovasculares/diagnóstico , Monitorização Ambulatorial/instrumentação , Monitorização Ambulatorial/métodos , Pandemias , Telemedicina , Dispositivos Eletrônicos Vestíveis , Doença Aguda , /epidemiologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/terapia , Humanos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
13.
Cardiovasc Ther ; 2021: 1716546, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33488770

RESUMO

Ventricular free wall rupture (FWR) is a catastrophic complication after acute myocardial infarction (AMI). However, patients with FWR die of cardiac tamponade secondary to intrapericardial hemorrhage that can be treated if properly diagnosed. Unfortunately, FWR was still not diagnosed and classified quickly and accurately. The aim of this study was to present a new clinical classification for FWR. Seventy-eight patients with FWR after STEMI were enrolled in the study. We classified FWR, according to clinical situations after onset, into the cardiac arrest type, unstable type, and stable type. The cardiac arrest type was the most common type, accounting for about 83.3%. 90.8% of patients of this type were complicated with electromechanical dissociation at the time of FWR onset, and 100% of patients of this type died in the hospital. The unstable type was characterized by sudden clinical condition changes with moderate/massive pericardial effusion. In this study, 9.0% of patients were diagnosed as the unstable type. The average time from onset to death was 4.5 hours. This period was the "golden time" to rescue such patients. The stable types usually have stable hemodynamics, but may worsen, requiring rigorous detection of pericardial effusion and vital signs. In this study, 7.7% of patients were diagnosed as the stable type, and 83.5% of them survived in the hospital. The new clinical classification provides a basis for clinical diagnosis and treatment of FWR. The clinical application of the new classification is expected to improve the prognosis of FWR patients.


Assuntos
Ruptura Cardíaca Pós-Infarto/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Terminologia como Assunto , Idoso , Tamponamento Cardíaco/etiologia , Feminino , Parada Cardíaca/etiologia , Ruptura Cardíaca Pós-Infarto/classificação , Ruptura Cardíaca Pós-Infarto/etiologia , Ruptura Cardíaca Pós-Infarto/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/etiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade
14.
Am J Cardiol ; 144: 8-12, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33385357

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has greatly impacted the US healthcare system. Cardiac involvement in COVID-19 is common and manifested by troponin and natriuretic peptide elevation and tends to have a worse prognosis. We analyzed patients who presented to the MedStar Health system (11 hospitals in Washington, DC, and Maryland) with either an ST-elevation myocardial infarction or non-ST-elevation myocardial infarction early in the pandemic (March 1, 2020 to June 30, 2020) using the International Classification of Diseases, Tenth Revision. Patients' clinical course and outcomes, including in-hospital mortality, were compared on the basis of the results of COVID-19 status (positive or negative). The cohort included 1533 patients admitted with an acute myocardial infarction (AMI), of whom 86 had confirmed severe acute respiratory syndrome coronavirus 2 infection, during the study period. COVID-19-positive patients were older and non-White and had more co-morbidities. Furthermore, inflammatory markers and N-terminal-proB-type-natriuretic peptide were higher in COVID-19-positive AMI patients. Only 20.0% (17) of COVID-19-positive patients underwent coronary angiography. In-hospital mortality was significantly higher in AMI patients with concomitant COVID-19-positive status (27.9%) than in patients without COVID-19 during the same period (3.7%; p < 0.001). Patients with AMI and COVID-19 tended to be older, with more co-morbidities, when compared to those with an AMI and without COVID-19. In conclusion, myocardial infarction with concomitant COVID-19 was associated with increased in-hospital mortality. Efforts should be focused on the early recognition, evaluation, and treatment of these patients.


Assuntos
/complicações , Infarto do Miocárdio/complicações , Idoso , Idoso de 80 Anos ou mais , /mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações
15.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509857

RESUMO

Takotsubo cardiomyopathy (TCM) associated with left ventricular outflow tract (LVOT) obstruction in the event of an ST-elevation myocardial infarction (STEMI) is a rare cause of hypotension during percutaneous coronary intervention (PCI). Herein, we describe a 57-year-old woman who presented with STEMI and underwent PCI. She developed hypotension which worsened during inotropic therapy. Echocardiography revealed evidence of LVOT obstruction in the setting of TCM. Therefore, inotropic support was promptly discontinued. Beta blockers and phenylephrine were rapidly administrated, resulting in improved blood pressure and stabilisation of the patient.


Assuntos
Hipotensão/etiologia , Complicações Intraoperatórias/etiologia , Intervenção Coronária Percutânea , Complicações Pós-Operatórias/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Cardiomiopatia de Takotsubo/complicações , Obstrução do Fluxo Ventricular Externo/complicações , Antagonistas Adrenérgicos beta/uso terapêutico , Cardiotônicos/efeitos adversos , Angiografia Coronária , Stents Farmacológicos , Ecocardiografia , Feminino , Ventrículos do Coração , Humanos , Hipotensão/tratamento farmacológico , Complicações Intraoperatórias/tratamento farmacológico , Pessoa de Meia-Idade , Fenilefrina/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Trombectomia , Trombose , Vasoconstritores/uso terapêutico , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem
16.
Am J Physiol Endocrinol Metab ; 320(3): E539-E550, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33459180

RESUMO

Association between receptor for advanced glycation end products (RAGE) and postmyocardial infarction (MI) ventricular arrhythmias (VAs) in diabetes was investigated. Correlation between premature ventricular contractions (PVCs) and serum advanced glycation end products (AGEs) content was analyzed in a cohort consisting of 101 patients with ST-segment elevated MI (STEMI). MI diabetic rats were treated with anti-receptor for AGE (RAGE) antibody. Electrocardiography was used to record VAs. Myocytes were isolated from adjacent area around infracted region. Immunofluorescent stains were used to evaluate the association between FKBP12.6 (FK506-bindingprotein 12.6) and ryanodine receptor 2 (RyR2). Calcium sparks were evaluated by confocal microscope. Protein expression and phosphorylation were assessed by Western blotting. Calcineurin (CaN) enzymatic activity and RyR2 channel activity were also determined. In the cohort study, significantly increased amount of PVC was found in STEMI patients with diabetes (P < 0.05). Serum AGE concentration was significantly positively correlated with PVC amount in patients with STEMI (r = 0.416, P < 0.001). Multivariate analysis showed that serum AGE concentration was independently and positively related to frequent PVCs (adjusted hazard ratio, 1.86; 95% CI, 1.09-3.18, P = 0.022). In the animal study, increased glucose-regulated protein 78 (GRP78) expression, protein kinase RNA-like ER kinase (PERK) phosphorylation, CaN enzymatic activity, FKBP12.6-RyR2 disassociation, RyR2 channel opening, and endoplasmic reticulum (ER) calcium releasing were found in diabetic MI animals, which were attenuated by anti-RAGE antibody treatment. This RAGE blocking also significantly lowered the VA amount in diabetic MI animals. Activation of RAGE-dependent ER stress-mediated PERK/CaN/RyR2 signaling participated in post-MI VAs in diabetes.NEW & NOTEWORTHY In this study, we proposed a possible mechanism interpreting the clinical scenario that after myocardial infarction (MI) patients were more vulnerable to ventricular arrhythmias (VAs) when complicated with diabetes. A cohort study revealed that advanced glycation end products (AGEs) accumulated in patients with diabetes and closely associated post-MI VAs. In vivo and in vitro studies indicated that receptor for AGEs (RAGE)-dependent endoplasmic reticulum (ER) stress protein kinase RNA-like ER kinase (PERK) pathway triggered VAs, via ER calcium releasing, through calcineurin/RyR2 mechanism.


Assuntos
Arritmias Cardíacas/patologia , Diabetes Mellitus , Estresse do Retículo Endoplasmático/fisiologia , Receptor para Produtos Finais de Glicação Avançada/metabolismo , Infarto do Miocárdio com Supradesnível do Segmento ST , Animais , Anticorpos/farmacologia , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/metabolismo , Arritmias Cardíacas/terapia , Estudos de Casos e Controles , Diabetes Mellitus/metabolismo , Diabetes Mellitus/patologia , Angiopatias Diabéticas/metabolismo , Angiopatias Diabéticas/patologia , Angiopatias Diabéticas/terapia , Progressão da Doença , Feminino , Produtos Finais de Glicação Avançada/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Ratos , Ratos Sprague-Dawley , Receptor para Produtos Finais de Glicação Avançada/agonistas , Receptor para Produtos Finais de Glicação Avançada/imunologia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/metabolismo , Infarto do Miocárdio com Supradesnível do Segmento ST/patologia
17.
Heart Lung ; 50(2): 292-295, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33387761

RESUMO

The COVID 19 pandemic resulted in a total reduction in the number of hospitalizations for acute coronary syndromes. A consequence of the delay in coronary revascularization has been the resurgence of structural complications of myocardial infarctions. Ventricular septal rupture (VSR) complicating late presenting acute myocardial infarction (AMI) is associated with high mortality despite advances in both surgical repair and perioperative management. Current data suggests a declining mortality with delay in VSR repair; however, these patients may develop cardiogenic shock while waiting for surgery. Available options are limited for patients with VSR who develop right ventricular failure and cardiogenic shock. The survival rate is very low in patients with cardiogenic shock undergoing surgical or percutaneous VSR repair. In this study we present two late presenting ST elevation MI patients who were complicated by rapidly declining hemodynamics and impending organ failure. Both patients were bridged with venoarterial extracorporeal membrane oxygenation (ECMO) to cardiac transplant.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST , Ruptura do Septo Ventricular , Humanos , Pandemias , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Choque Cardiogênico/etiologia , Resultado do Tratamento , Ruptura do Septo Ventricular/diagnóstico , Ruptura do Septo Ventricular/epidemiologia , Ruptura do Septo Ventricular/etiologia
18.
N Z Med J ; 133(1526): 45-54, 2020 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-33332339

RESUMO

AIMS: The incidence of left ventricular (LV) thrombus following ST segment elevation myocardial infarction (STEMI) has reduced with modern reperfusion therapies. There is scant local data on the incidence and outcomes of LV thrombus in the contemporary era of rapid reperfusion. METHODS: Patients with STEMI admitted to Auckland City Hospital between January 2014 and December 2015 were identified using the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry and their clinical notes were retrospectively reviewed. RESULTS: Among the 997 patients admitted with STEMI, 53 patients (5%) had LV thrombus. Most patients with LV thrombus had an anterior STEMI (87%). The median time from admission to echocardiography was 48 hours (range 6-552 hours); the median LV ejection fraction was 38% (range 15-53%). Oral anticoagulation was initiated in 44 (83%) patients. LV thrombus resolved in 81% by six months in 42 patients given warfarin. Total mortality at 12 months was 13%. Bleeding occurred in 11% and was the most common treatment-related morbidity. CONCLUSIONS: The incidence of LV thrombus following STEMI was low and it was associated with a low rate of stroke and systemic embolism but high mortality. Randomised studies are needed to evaluate the efficacy of NOAC's in this context.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Trombose/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Seguimentos , Ventrículos do Coração , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Trombose/diagnóstico , Trombose/epidemiologia
20.
Am J Cardiol ; 134: 1-7, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32933753

RESUMO

Mortality in patients with STEMI-associated cardiogenic shock (CS) is increasing. Whether a comprehensive ST-elevation myocardial infarction (STEMI) protocol (CSP) can improve their care delivery and mortality is unknown. We evaluated the impact of a CSP on incidence and outcomes in patients with STEMI-associated CS. We implemented a 4-step CSP including: (1) Emergency Department catheterization lab activation; (2) STEMI Safe Handoff Checklist; (3) immediate catheterization lab transfer; (4) and radial-first percutaneous coronary intervention (PCI). We studied 1,272 consecutive STEMI patients who underwent PCI and assessed for CS incidence per National Cardiovascular Data Registry definitions within 24-hours of PCI, care delivery, and mortality before (January 1, 2011, to July 14, 2014; n = 723) and after (July 15, 2014, to December 31, 2016; n = 549) CSP implementation. Following CSP implementation, CS incidence was reduced (13.0% vs 7.8%, p = 0.003). Of 137 CS patients, 43 (31.4%) were in the CSP group. CSP patients had greater IABP-Shock II risk scores (1.9 ± 1.8 vs 2.8 ± 2.2, p = 0.014) with otherwise similar hemodynamic and baseline characteristics, cardiac arrest incidence, and mechanical circulatory support use. Administration of guideline-directed medical therapy was similar (89.4% vs 97.7%, p = 0.172) with significant improvements in trans-radial PCI (9.6% vs 44.2%, p < 0.001) and door-to-balloon time (129.0 [89:160] vs 95.0 [81:116] minutes, p = 0.001) in the CSP group, translating to improvements in infarct size (CK-MB 220.9 ± 156.0 vs 151.5 ± 98.5 ng/ml, p = 0.005), ejection fraction (40.8 ± 14.5% vs 46.7 ± 14.6%, p = 0.037), and in-hospital mortality (30.9% vs 14.0%, p = 0.037). In conclusion, CSP implementation was associated with improvements in CS incidence, infarct size, ejection fraction, and in-hospital mortality in patients with STEMI-associated CS. This strategy offers a potential solution to bridging the historically elusive gap in their care.


Assuntos
Anticoagulantes/uso terapêutico , Protocolos Clínicos , Mortalidade Hospitalar , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação de Plaquetas/uso terapêutico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Choque Cardiogênico/terapia , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Aspirina/uso terapêutico , Lista de Checagem , Gerenciamento Clínico , Serviço Hospitalar de Emergência , Oxigenação por Membrana Extracorpórea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Artéria Radial , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Choque Cardiogênico/etiologia , Choque Cardiogênico/mortalidade , Volume Sistólico , Resultado do Tratamento
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