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1.
BMJ Case Rep ; 14(8)2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433529

RESUMO

COVID-19 is a prothrombotic condition that is also associated with raised troponin levels and myocardial damage. We present a case of a 54-year-old man who was admitted with respiratory failure due to COVID-19 and developed a ST-elevation myocardial infarction (STEMI) during his admission. His coronary angiogram did not show any significant coronary artery disease other than a heavily thrombosed right coronary artery. In view of heavy thrombus burden, the right coronary artery was treated with thrombus retrieval using a distal embolic protection device in addition to manual thrombectomy and direct (intracoronary) thrombolysis without the need for implantation of a coronary stent. After successful revascularisation, triple antithrombotic therapy was instituted with an oral anticoagulant in addition to dual antiplatelets. This case illustrates the association of COVID-19 with coronary artery thrombosis, which may require disparate management of a STEMI than that resulting from atherosclerotic coronary artery disease.


Assuntos
COVID-19 , Trombose Coronária , Infarto do Miocárdio , Infarto do Miocárdio com Supradesnível do Segmento ST , Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Vasos Coronários , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia
2.
Am J Cardiol ; 156: 129-131, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34364657

RESUMO

COVID-19 vaccination was launched in the United States in mid-December 2020. There are limited data on the risk of thrombotic events related to COVID-19 vaccines. In conclusion, we report 2 cases of acute myocardial infarction with onset <24 hours after the first dose of a COVID-19 vaccine in patients presenting with shoulder pain.


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Infarto do Miocárdio/etiologia , SARS-CoV-2/imunologia , Vacinação/efeitos adversos , Adulto , Idoso , COVID-19/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Fatores de Tempo
3.
Sci Rep ; 11(1): 15667, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34341436

RESUMO

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and is primarily characterised by a respiratory disease. However, SARS-CoV-2 can directly infect vascular endothelium and subsequently cause vascular inflammation, atherosclerotic plaque instability and thereby result in both endothelial dysfunction and myocardial inflammation/infarction. Interestingly, up to 50% of patients suffer from persistent exercise dyspnoea and a post-viral fatigue syndrome (PVFS) after having overcome an acute COVID-19 infection. In the present study, we assessed the presence of coronary microvascular disease (CMD) by cardiovascular magnetic resonance (CMR) in post-COVID-19 patients still suffering from exercise dyspnoea and PVFS. N = 22 patients who recently recovered from COVID-19, N = 16 patients with classic hypertrophic cardiomyopathy (HCM) and N = 17 healthy control patients without relevant cardiac disease underwent dedicated vasodilator-stress CMR studies on a 1.5-T MR scanner. The CMR protocol comprised cine and late-gadolinium-enhancement (LGE) imaging as well as velocity-encoded (VENC) phase-contrast imaging of the coronary sinus flow (CSF) at rest and during pharmacological stress (maximal vasodilation induced by 400 µg IV regadenoson). Using CSF measurements at rest and during stress, global myocardial perfusion reserve (MPR) was calculated. There was no difference in left ventricular ejection-fraction (LV-EF) between COVID-19 patients and controls (60% [57-63%] vs. 63% [60-66%], p = NS). There were only N = 4 COVID-19 patients (18%) showing a non-ischemic pattern of LGE. VENC-based flow measurements showed that CSF at rest was higher in COVID-19 patients compared to controls (1.78 ml/min [1.19-2.23 ml/min] vs. 1.14 ml/min [0.91-1.32 ml/min], p = 0.048). In contrast, CSF during stress was lower in COVID-19 patients compared to controls (3.33 ml/min [2.76-4.20 ml/min] vs. 5.32 ml/min [3.66-5.52 ml/min], p = 0.05). A significantly reduced MPR was calculated in COVID-19 patients compared to healthy controls (2.73 [2.10-4.15-11] vs. 4.82 [3.70-6.68], p = 0.005). No significant differences regarding MPR were detected between COVID-19 patients and HCM patients. In post-COVID-19 patients with persistent exertional dyspnoea and PVFS, a significantly reduced MPR suggestive of CMD-similar to HCM patients-was observed in the present study. A reduction in MPR can be caused by preceding SARS-CoV-2-associated direct as well as secondary triggered mechanisms leading to diffuse CMD, and may explain ongoing symptoms of exercise dyspnoea and PVFS in some patients after COVID-19 infection.


Assuntos
COVID-19 , Cardiomiopatia Hipertrófica , Circulação Coronária , Vasos Coronários , Angiografia por Ressonância Magnética , Microcirculação , Infarto do Miocárdio , Imagem de Perfusão do Miocárdio , SARS-CoV-2 , Adulto , Idoso , COVID-19/complicações , COVID-19/diagnóstico por imagem , COVID-19/fisiopatologia , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/etiologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/fisiopatologia , Projetos Piloto
4.
PLoS One ; 16(7): e0255263, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34324524

RESUMO

BACKGROUND: Patients presenting with the coronavirus-2019 disease (COVID-19) may have a high risk of cardiovascular adverse events, including death from cardiovascular causes. The long-term cardiovascular outcomes of these patients are entirely unknown. We aim to perform a registry of patients who have undergone a diagnostic nasopharyngeal swab for SARS-CoV-2 and to determine their long-term cardiovascular outcomes. STUDY AND DESIGN: This is a multicenter, observational, retrospective registry to be conducted at 17 centers in Spain and Italy (ClinicalTrials.gov number: NCT04359927). Consecutive patients older than 18 years, who underwent a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV2 in the participating institutions, will be included since March 2020, to August 2020. Patients will be classified into two groups, according to the results of the RT-PCR: COVID-19 positive or negative. The primary outcome will be cardiovascular mortality at 1 year. The secondary outcomes will be acute myocardial infarction, stroke, heart failure hospitalization, pulmonary embolism, and serious cardiac arrhythmias, at 1 year. Outcomes will be compared between the two groups. Events will be adjudicated by an independent clinical event committee. CONCLUSION: The results of this registry will contribute to a better understanding of the long-term cardiovascular implications of the COVID19.


Assuntos
Arritmias Cardíacas/etiologia , COVID-19/complicações , Sistema Cardiovascular/virologia , Insuficiência Cardíaca/etiologia , Infarto do Miocárdio/etiologia , Acidente Vascular Cerebral/etiologia , Arritmias Cardíacas/virologia , Feminino , Insuficiência Cardíaca/virologia , Humanos , Itália , Masculino , Infarto do Miocárdio/virologia , Embolia Pulmonar/etiologia , Embolia Pulmonar/virologia , Sistema de Registros , Estudos Retrospectivos , Espanha , Acidente Vascular Cerebral/virologia , Fatores de Tempo , Resultado do Tratamento
5.
BMJ Case Rep ; 14(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34257123

RESUMO

A 27-year-old man presented to the emergency department of a tertiary care centre with complaints of acute onset breathing difficulty and retrosternal chest discomfort of 6 hours' duration. On primary survey, he was dyspnoeic with a room air saturation of 85% and a blood pressure of 80/50 mm Hg. A bedside ultrasound revealed an ejection fraction of around 40%, with hypokinesia of interventricular septum, left ventricular apex and anterior wall with bilateral multiple B lines in all lung zones. A 12 lead ECG showed ST segment elevation in leads V2-V6. He sustained a cardiac arrest. Return of spontaneous circulation was achieved following high-quality cardiopulmonary resuscitation. After successful resuscitation, the patient underwent primary percutaneous coronary intervention and recovered fully from the event. On further evaluation, an acute binge of marijuana smoking prior to the onset of symptoms was identified as the cause of the acute coronary syndrome.


Assuntos
Cannabis , Reanimação Cardiopulmonar , Infarto do Miocárdio , Intervenção Coronária Percutânea , Adulto , Cannabis/efeitos adversos , Angiografia Coronária , Eletrocardiografia , Humanos , Masculino , Infarto do Miocárdio/etiologia
6.
J Stroke Cerebrovasc Dis ; 30(9): 105955, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34242858

RESUMO

BACKGROUND: Inflammatory mechanisms play an important role in both atherosclerosis and stroke. There are several inflammatory peripheral blood count markers associated with carotid artery stenosis degree, symptomatic carotid artery lesions and carotid artery stent restenosis that reported in previous studies. However, the prognostic role of the blood cell counts and their ratios in predicting in-hospital and long-term outcomes in patients undergoing carotid artery stenting (CAS) has not been comprehensively investigated. Systemic immune-inflammation index (SII) proved its' efficiency in patients with solid tumors and its' role was rarely examined in cardiovascular disorders and stroke. The current study evaluated the effect of this novel risk index on in-hospital and long-term outcomes in a large patient population who underwent CAS. METHOD: A total of 732 patients with carotid artery stenosis who underwent CAS were enrolled to the study. SII was calculated using the following formula: neutrophil-to-lymphocyte ratio × total platelet count in the peripheral blood (per mm3) and the patients were stratified accordingly: T1, T2 and T3. In-hospital and 5-year outcomes were compared between the tertiles of SII. RESULTS: During the hospitalization, major stroke, ipsilateral stoke, myocardial infarction, death and major adverse cardiovascular events (MACE) rates were significantly higher in high SII level (T3) compared to SII levels (T1 and 2). In long-term outcomes, ipsilateral stroke, major stroke, transient ischemic attack, death, and MACE were significantly higher in the patients with higher SII level (T3). The 5-year Kaplan-Meier overall survival for T1, T2, and T3 were 97.5%, 96.7% and 86.0% respectively. In-hospital and 5-year regression analyses demonstrated that high SII was independently associated with MACE and mortality. CONCLUSION: SII was independently associated with in-hospital and long-term clinical outcomes in patients undergoing CAS. Immune and inflammation status, as assessed easily and quickly using SII, has a good discriminative value in these patients.


Assuntos
Plaquetas , Estenose das Carótidas/terapia , Procedimentos Endovasculares/instrumentação , Linfócitos , Neutrófilos , Stents , Idoso , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/imunologia , Estenose das Carótidas/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Ataque Isquêmico Transitório/etiologia , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Contagem de Plaquetas , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento
7.
Arch Iran Med ; 24(4): 339-340, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-34196196

RESUMO

Since the emergence of novel coronavirus and the disease named as COVID-19 in late December of 2019 in Wuhan, Hubei province, China, many aspects of this disease have been reported in the literature (mainly pulmonary manifestations). In patients with COVID-19, rheumatic and cardiovascular manifestations and interactions were reported separately, but they were all very rare. This is the report of a 14-year-old teenager with GPA (previously known as Wegner's granulomatosis) who was in remission with immunosuppressive therapy. Post COVID-19 infection, she developed exacerbation of her disease. Besides the rheumatologic manifestations, she developed epigastric pain found to be acute myocardial infarction (MI) that needed primary percutaneous coronary intervention (PCI).


Assuntos
COVID-19/complicações , COVID-19/diagnóstico , Granulomatose com Poliangiite/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Adolescente , COVID-19/terapia , Feminino , Humanos , Infarto do Miocárdio/terapia
8.
Medicine (Baltimore) ; 100(27): e26604, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232213

RESUMO

RATIONALE: Congenital agenesis of the right coronary artery (CARCA) initially presenting as acute myocardial infarction (AMI) due to total occlusion is a rare clinical condition that can lead to severe complications, including death. We report a case of successful percutaneous coronary intervention (PCI) in a patient with this condition. PATIENT CONCERNS: A 57-year-old man was admitted to our center with chest pain that had occurred several hours prior. Since he was initially diagnosed with AMI with ST-segment elevation, we promptly commenced coronary angiography (CAG). DIAGNOSIS: CAG revealed the absence of a right coronary artery (RCA). In the left coronary cusp area, the left circumflex coronary artery (LCX) was occluded totally. INTERVENTIONS: We performed PCI for total occlusion of the proximal part of the LCX. Follow-up CAG showed a superdominant branch of the LCX, sprouting into the RCA territory. OUTCOMES: The patient was discharged uneventfully after successful PCI. LESSONS: CARCA with AMI, which is an extremely unusual case, can be fatal; however, PCI seems to be an effective treatment option.


Assuntos
Oclusão Coronária/complicações , Anomalias dos Vasos Coronários/complicações , Vasos Coronários/cirurgia , Infarto do Miocárdio/etiologia , Intervenção Coronária Percutânea/métodos , Angiografia Coronária , Oclusão Coronária/diagnóstico , Oclusão Coronária/cirurgia , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/cirurgia
9.
BMJ Case Rep ; 14(7)2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34285017

RESUMO

Rheumatic heart disease is an important cause of mortality and morbidity in developing countries, and is the leading cause of triple valve replacement. Myocardial infarction (MI) in such cases can be due to the coronary embolism from the prosthetic valves or due to atherosclerotic vascular disease. Intravascular imaging helps in delineating the cause. We present a case of a 34-year-old premenopausal woman with no conventional cardiovascular risk factors and had triple valve replacement 4 years ago and anterior wall MI with cardiogenic shock and left ventricular failure. She was managed with mechanical ventilation, thrombolysis, diuretics, double antiplatelets and anticoagulation with low molecular weight heparin. Intravascular ultrasound showed a lipid-rich plaque with associated plaque rupture and thrombosis. Intravascular imaging helps in delineating the cause of MI and further management. Atherosclerotic MI in a patient with no conventional risk factors is rare and needs to be considered.


Assuntos
Infarto Miocárdico de Parede Anterior , Doença da Artéria Coronariana , Infarto do Miocárdio , Trombose , Adulto , Feminino , Humanos , Infarto do Miocárdio/etiologia , Choque Cardiogênico
10.
Am Heart J ; 239: 100-109, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34077743

RESUMO

BACKGROUND: Stable chest pain is a common indication for cardiac catheterization. We assessed the prognostic value of the Prospective Multicenter Imaging Study for Evaluation (PROMISE) Minimal-Risk Tool in identifying patients who are at very low risk of obstructive coronary artery disease (CAD) or downstream cardiovascular adverse outcomes. METHODS: We applied the PROMISE Minimal-Risk Tool to consecutive patients without known CAD who underwent elective cardiac catheterization for stable angina from January 1, 2000 to December 31, 2014 in the Duke Databank for Cardiovascular Disease (DDCD). Patients with scores >0.46 (top decile of lowest-risk from the PROMISE cohort) were classified as low-risk. Logistic regression modeling compared likelihood of freedom from obstructive coronary artery disease on index angiography, 2-year survival, and 2-year survival free of myocardial infarction (MI) and MI/revascularization between low- and non low-risk patients. Alternative cut points to define low- risk patients were also explored. RESULTS: Among 6251 patients undergoing cardiac catheterization for stable chest pain, 1082 (17.3%) were low-risk per the PROMISE minimal-risk tool. Among low risk patients, obstructive coronary artery disease was observed in 14.9% and left main disease (≥ 50% Stenosis) was rare (0.9%). Compared with other patients, low risk patients had a higher likelihood of freedom from obstructive coronary disease on index catheterization (85.1% vs. 44.2%, OR 4.84, 95% CI 4.06-5.77). Low risk patients had significantly higher survival (98.2% vs. 94.4%, OR 3.18, 95% CI 1.99-5.08), MI-free survival (97.2% vs. 91.9%, OR 3.03, 95% CI 2.07-4.45), and MI/revascularization-free survival (86.2 vs. 59.9%, OR 4.19, 95% CI 3.48-5.05) at 2 years than non-low risk patients. Operating characteristics for predicting the outcomes of interest varied modestly depending on the low-risk cut-point used but the positive predictive value for 2 year freedom from death was >98% regardless. CONCLUSION: The PROMISE minimal-risk tool identifies 17% of stable chest pain patients referred to cardiac catheterization as low risk. These patients have a low prevalence of obstructive CAD and better survival than non-low risk patients. While this suggests that these patients are unlikely to benefit from catheterization, further research is needed to confirm a favorable downstream prognosis with medical management alone.


Assuntos
Angina Estável , Estenose Coronária , Vasos Coronários/diagnóstico por imagem , Fatores de Risco de Doenças Cardíacas , Sobremedicalização , Infarto do Miocárdio , Medição de Risco/métodos , Angina Estável/complicações , Angina Estável/diagnóstico , Angina Estável/etiologia , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico , Estenose Coronária/epidemiologia , Estenose Coronária/fisiopatologia , Estenose Coronária/cirurgia , Feminino , Humanos , Masculino , Sobremedicalização/prevenção & controle , Sobremedicalização/estatística & dados numéricos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Revascularização Miocárdica/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Prognóstico , Estados Unidos/epidemiologia
11.
Life Sci ; 279: 119676, 2021 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-34087285

RESUMO

AIMS: The effects of three types of bariatric interventions on myocardial infarct size were tested in the rat model of type 2 diabetes mellitus (T2DM). We also evaluated the effects of bariatric surgery on no-reflow phenomenon and vascular dysfunction caused by T2DM. MAIN METHODS: Rats with T2DM were assigned into groups: without surgery, sham-operated, ileal transposition, Roux-en-Y gastric bypass, and sleeve gastrectomy. Oral glucose tolerance, glucagon-like peptide-1, and insulin levels were measured. Six weeks after surgery, the animals were subjected to myocardial ischemia-reperfusion followed by histochemical determination of infarct size (IS), no-reflow zone, and blood stasis area size. Vascular dysfunction was characterized using wire myography. KEY FINDINGS: All bariatric surgery types caused significant reductions in animal body weight and resulted in T2DM compensation. All bariatric interventions partially normalized glucagon-like peptide-1 responses attenuated by T2DM. IS was significantly smaller in animals with T2DM. Bariatric surgery provided no additional IS limitation compared with T2DM alone. Bariatric surgeries reversed T2DM-induced enhanced contractile responses of the mesenteric artery to 5-hydroxytryptamine. Sleeve gastrectomy normalized decreased nitric oxide synthase contribution to the endothelium-dependent vasodilatation in T2DM. SIGNIFICANCE: T2DM resulted in a reduction of infarct size and no-reflow zone size. Bariatric surgery provided no additional infarct-limiting effect, but it normalized T2DM-induced augmented vascular contractility and reversed decreased contribution of nitric oxide to endothelium-dependent vasodilatation typical of T2DM. All taken together, we suggest that this type of surgery may have a beneficial effect on T2DM-induced cardiovascular diseases.


Assuntos
Cirurgia Bariátrica/métodos , Diabetes Mellitus Experimental/cirurgia , Diabetes Mellitus Tipo 2/cirurgia , Angiopatias Diabéticas/prevenção & controle , Derivação Gástrica/métodos , Infarto do Miocárdio/prevenção & controle , Animais , Glicemia/análise , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/etiologia , Angiopatias Diabéticas/patologia , Peptídeo 1 Semelhante ao Glucagon/análise , Masculino , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/patologia , Ratos , Ratos Wistar
12.
Medicine (Baltimore) ; 100(25): e26278, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160392

RESUMO

BACKGROUND: Numerous studies have shown that high-dose statin pretreatment may reduce the risk of periprocedural myocardial infarction (PMI) and short-term major adverse cardiac events (MACE) in western people undergoing percutaneous coronary intervention (PCI). However, the effects in East Asian patients are still controversial. The objective was to evaluate the effects of short-term high-dose statin (all types) pretreatment compared with the control (low-dose or no statin) on the reduction of the rate of MACE and PMI in East Asian patients. METHODS: PubMed/Medline, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched for randomized controlled trials (RCTs) in East Asian patients up to December 2019, in which short-term high-dose statin pretreatment was compared with control for patients undergoing PCI. The primary outcome measure was the incidence of MACE at 30 days. The secondary outcome measure was the incidence of PMI. The meta-analysis was performed with the fixed-effect model or random-effects model according to the heterogeneity. The meta-analysis was performed using RevMan 5.3 software (Cochrane Collaboration). RESULTS: Fifteen RCTs that enrolled 4313 East Asian patients were identified. High-dose statin pretreatment was associated with a 54% relative reduction in 30-day MACE (OR, 0.46; 95% CI, 0.31-0.67; P < .001) and a 50% relative reduction in PMI (OR, 0.50; 95% CI, 0.34-0.76; P = .001). CONCLUSIONS: High-dose statin pretreatment can significantly reduce 30-day MACE and PMI for East Asian patients undergoing PCI.


Assuntos
Doença da Artéria Coronariana/cirurgia , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Infarto do Miocárdio/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Relação Dose-Resposta a Droga , Extremo Oriente/epidemiologia , Humanos , Incidência , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/prevenção & controle , Razão de Chances , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
13.
Pan Afr Med J ; 38: 302, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34178220

RESUMO

Acute myocardial infarction (AMI) is a major cause of death in a patient with systemic lupus erythematosus (SLE). Due to their chronic inflammatory state, patient with SLE has an increased risk of developing coronary artery disease. We report a case of a middle-aged woman with an acute myocardial infarction (AMI) caused by a right coronary artery (RCA) stenosis complicated with severe coronary artery spasm. Our patient has a history of long-standing SLE. Clinical expression of coronary artery disease (CAD) in SLE is the result of different pathophysiologic mechanism. From this case, we raise the importance of the clinician to be aware of the diverse pathophysiologic pathways involving a coronary artery in a patient with SLE.


Assuntos
Estenose Coronária/complicações , Vasoespasmo Coronário/complicações , Lúpus Eritematoso Sistêmico/complicações , Infarto do Miocárdio/etiologia , Adulto , Estenose Coronária/fisiopatologia , Vasoespasmo Coronário/fisiopatologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/fisiopatologia , Infarto do Miocárdio/fisiopatologia
14.
Eur Heart J ; 42(27): 2630-2642, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-34059914

RESUMO

A substantial number of chronic coronary syndrome (CCS) patients undergoing percutaneous coronary intervention (PCI) experience periprocedural myocardial injury or infarction. Accurate diagnosis of these PCI-related complications is required to guide further management given that their occurrence may be associated with increased risk of major adverse cardiac events (MACE). Due to lack of scientific data, the cut-off thresholds of post-PCI cardiac troponin (cTn) elevation used for defining periprocedural myocardial injury and infarction, have been selected based on expert consensus opinions, and their prognostic relevance remains unclear. In this Consensus Document from the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI), we recommend, whenever possible, the measurement of baseline (pre-PCI) cTn and post-PCI cTn values in all CCS patients undergoing PCI. We confirm the prognostic relevance of the post-PCI cTn elevation >5× 99th percentile URL threshold used to define type 4a myocardial infarction (MI). In the absence of periprocedural angiographic flow-limiting complications or electrocardiogram (ECG) and imaging evidence of new myocardial ischaemia, we propose the same post-PCI cTn cut-off threshold (>5× 99th percentile URL) be used to define prognostically relevant 'major' periprocedural myocardial injury. As both type 4a MI and major periprocedural myocardial injury are strong independent predictors of all-cause mortality at 1 year post-PCI, they may be used as quality metrics and surrogate endpoints for clinical trials. Further research is needed to evaluate treatment strategies for reducing the risk of major periprocedural myocardial injury, type 4a MI, and MACE in CCS patients undergoing PCI.


Assuntos
Doença da Artéria Coronariana , Traumatismos Cardíacos , Infarto do Miocárdio , Intervenção Coronária Percutânea , Biomarcadores , Consenso , Humanos , Infarto do Miocárdio/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Fatores de Risco , Resultado do Tratamento
16.
Isr Med Assoc J ; 23(6): 353-358, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34155848

RESUMO

BACKGROUND: Real-world information regarding the use of direct oral anticoagulants therapy and the outcome in patients with renal dysfunction is limited. OBJECTIVES: To evaluate the clinical characteristics and outcomes of patients with atrial fibrillation (AF) and severe renal dysfunction who are treated with apixaban. METHODS: A sub-analysis was conducted within a multicenter prospective cohort study. The study included consecutive eligible apixaban- or warfarin-treated patients with non-valvular AF and renal impairment (estimated glomerular filtration rate [eGFR] modification of diet in renal disease [MDRD] < 60 ml/min/BSA) were registered. All patients were prospectively followed for clinical events and over a mean period of 1 year. Our sub-analysis included the patients with 15 < eGFR MDRD < 30 ml/min/BSA. The primary outcomes at 1 year were recorded. They included mortality, stroke or systemic embolism, major bleeding, and myocardial infarction as well as their composite occurrence. RESULTS: The sub-analysis included 155 warfarin-treated patients and 97 apixaban-treated ones. All had 15 < eGFR MDRD < 30 ml/min/BSA. When comparing outcomes for propensity matched groups (n=76 per group) of patients treated by reduced dose apixaban or warfarin, the rates of the 1-year composite endpoint as well as mortality alone were higher among the warfarin group (30 [39.5%] vs. 14 [18.4%], P = 0.007 and 28 [36.8%] vs.12 [15.8%], P = 0.006), respectively. There was no significant difference in the rates of stroke, systemic embolism, or major bleeding. CONCLUSIONS: Apixaban might be a reasonable alternative to warfarin in patients with severe renal impairment.


Assuntos
Fibrilação Atrial , Hemorragia , Infarto do Miocárdio , Insuficiência Renal , Acidente Vascular Cerebral , Varfarina , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/mortalidade , Estudos de Coortes , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Inibidores do Fator Xa/administração & dosagem , Inibidores do Fator Xa/efeitos adversos , Feminino , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Israel/epidemiologia , Testes de Função Renal/métodos , Testes de Função Renal/estatística & dados numéricos , Masculino , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Avaliação de Resultados em Cuidados de Saúde , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Piridonas/administração & dosagem , Piridonas/efeitos adversos , Insuficiência Renal/complicações , Insuficiência Renal/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Análise de Sobrevida , Varfarina/administração & dosagem , Varfarina/efeitos adversos
17.
Artigo em Inglês | MEDLINE | ID: mdl-34067428

RESUMO

This cross-sectional study aimed to investigate the difference in ranking of risk factors of onset age of acute myocardial infarction (AMI) between urban and rural areas in Eastern Taiwan. Data from 2013 initial onset of AMI patients living in the urban areas (n = 1060) and rural areas (n = 953) from January 2000 to December 2015, including onset age, and conventional risk factors including sex, smoking, diabetes, hypertension, dyslipidemia, and body mass index (BMI). The results of multiple linear regressions analysis showed smoking, obesity, and dyslipidemia were early-onset reversible risk factors of AMI in both areas. The ranking of impacts of them on the age from high to low was obesity (ß = -6.7), smoking (ß = -6.1), and dyslipidemia (ß = -4.8) in the urban areas, while it was smoking (ß = -8.5), obesity (ß= -7.8), and dyslipidemia (ß = -5.1) in the rural areas. Furthermore, the average onset ages for the patients who smoke, are obese, and have dyslipidemia simultaneously was significantly earlier than for patients with none of these comorbidities in both urban (13.6 years) and rural (14.9 years) areas. The findings of this study suggest that the different prevention strategies for AMI should be implemented in urban and rural areas.


Assuntos
Infarto do Miocárdio , Adolescente , Idade de Início , Estudos Transversais , Humanos , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Prevalência , Fatores de Risco , População Rural , Taiwan/epidemiologia , População Urbana
18.
Int J Mol Sci ; 22(10)2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-34068392

RESUMO

Myocardial infarction (MI) remains the leading cause of death in the western world. Despite advancements in interventional revascularization technologies, many patients are not candidates for them due to comorbidities or lack of local resources. Non-invasive approaches to accelerate revascularization within ischemic tissues through angiogenesis by providing Vascular Endothelial Growth Factor (VEGF) in protein or gene form has been effective in animal models but not in humans likely due to its short half-life and systemic toxicity. Here, we tested the hypothesis that PR1P, a small VEGF binding peptide that we developed, which stabilizes and upregulates endogenous VEGF, could be used to improve outcome from MI in rodents. To test this hypothesis, we induced MI in mice and rats via left coronary artery ligation and then treated animals with every other day intraperitoneal PR1P or scrambled peptide for 14 days. Hemodynamic monitoring and echocardiography in mice and echocardiography in rats at 14 days showed PR1P significantly improved multiple functional markers of heart function, including stroke volume and cardiac output. Furthermore, molecular biology and histological analyses of tissue samples showed that systemic PR1P targeted, stabilized and upregulated endogenous VEGF within ischemic myocardium. We conclude that PR1P is a potential non-invasive candidate therapeutic for MI.


Assuntos
Antígeno AC133/metabolismo , Modelos Animais de Doenças , Isquemia/complicações , Infarto do Miocárdio/prevenção & controle , Neovascularização Fisiológica/efeitos dos fármacos , Fragmentos de Peptídeos/farmacologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , Animais , Feminino , Isquemia/metabolismo , Isquemia/patologia , Camundongos , Camundongos Endogâmicos C57BL , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/metabolismo , Infarto do Miocárdio/patologia , Ratos , Ratos Sprague-Dawley , Transdução de Sinais , Fator A de Crescimento do Endotélio Vascular/genética , Função Ventricular Esquerda/efeitos dos fármacos
19.
BMJ Case Rep ; 14(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34117002

RESUMO

Hyperthyroidism represents a state of hypercoagulability and hypofibrinolysis, which predisposes an individual to the increased risk of thromboembolism. We present a case of a 25-year-old patient presenting with an acute myocardial infarction secondary to plaque rupture with thrombotic occlusion of proximal left anterior descending artery, in a patient known to have Graves' disease. She had a sudden ventricular fibrillation arrest and a precordial thump given and cardiopulmonary resuscitation started. She successfully underwent cardiac catheterisation. Subsequent thyroid function tests showed she was in active thyrotoxicosis.


Assuntos
Doença de Graves , Hipertireoidismo , Infarto do Miocárdio , Tireotoxicose , Adulto , Feminino , Doença de Graves/complicações , Humanos , Infarto do Miocárdio/etiologia , Testes de Função Tireóidea
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