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A study on clinical profile and in-hospital outcome of elderly patients receiving thrombolytic therapy for ST elevation myocardial infarction 老年ST段抬高型心肌梗死患者接受溶栓治疗的临床特点及院内转归研究
Pub Date : 2022-01-01 DOI: 10.4103/jicc.jicc_3_21
D. Thakkar, Rangaraj Ramalingam, A. Palakshachar, S. Patil, K. Subramanyam, N. Moorthy, Meet M Thacker, B. Arun, C. Manjunath
Objective: Ischemic heart disease is the leading cause of mortality in population above the age of 70 years. ST-elevation myocardial infarction (STEMI) constitutes important treatable cause of death in elderly population. However, many large, randomized trials have excluded this age group. The present study was planned to find out the benefits and complications related to thrombolytic therapy in elderly patients. Materials and Methods: The study was done between January 1, 2019, and December 31, 2019, in the Department of Cardiology, Sri Jayadeva Institute Of Cardiovascular Sciences and Research, Bengaluru, India, which included the study group comprising 106 elderly patients (age >70 years) with acute STEMI and underwent thrombolytic therapy. All patients were followed up till the index hospitalization and evaluated for in-hospital outcome. Results: Out of the 106 patients in the study group, 64 (60.38%) were male and 42 (39.62%) were female. Out of which, 88 (83%) patients were between 70 and 80 years whereas 18 (17%) patients were >80 years. Mortality was happened in 32 patients (30.2%). Coronary angiogram post thrombolysis was performed as pharmacoinvasive or rescue percutaneous coronary intervention (PCI) in 25 patients (23.6%), and cardiac arrhythmias were noted in 22 (20.6%) patients, acute kidney injury in 7 (6.6%) patients, ventricular septal rupture in 5.7%, ischemic stroke in 4.7%, free-wall rupture in 2.8%, and intracranial hemorrhage in 0.9% of patients. Conclusions: Primary PCI may offer clinical advantage over fibrinolytic therapy as manifested by the trends toward improvements in the combined endpoint of death, reinfarction, and stroke in the oldest patients. Despite the higher prevalence of comorbidities and high-risk features in elderly patients of acute STEMI, timely thrombolysis is also beneficial particularly who present early after symptom onset, absence of comorbid condition, and lower NYHA class on admission (NYHA I/II). In developing countries like India where primary PCI may not be feasible, timely thrombolysis should be given to the elderly patients also.
目的:缺血性心脏病是70岁以上人群死亡的主要原因。st段抬高型心肌梗死(STEMI)是老年人重要的可治死亡原因。然而,许多大型随机试验都将这一年龄组排除在外。本研究旨在了解老年患者溶栓治疗的益处和并发症。材料和方法:该研究于2019年1月1日至2019年12月31日在印度班加罗尔Sri Jayadeva心血管科学与研究所心脏病学系完成,其中包括106名急性STEMI老年患者(年龄在100至70岁之间),并接受了溶栓治疗。所有患者均随访至指数住院,并进行院内预后评估。结果:研究组106例患者中,男性64例(60.38%),女性42例(39.62%)。其中88例(83%)患者年龄在70 ~ 80岁之间,18例(17%)患者年龄在80 ~ 80岁之间。死亡32例(30.2%)。溶栓后冠脉造影25例(23.6%)患者作为药物侵入性或抢救性经皮冠状动脉介入治疗(PCI),出现心律失常22例(20.6%),急性肾损伤7例(6.6%),室间隔破裂5.7%,缺血性卒中4.7%,游离壁破裂2.8%,颅内出血0.9%。结论:首次PCI治疗可能比纤溶治疗具有临床优势,这体现在老年患者死亡、再梗死和卒中的综合终点改善的趋势上。尽管老年急性STEMI患者的合并症患病率和高危特征较高,但及时溶栓也是有益的,特别是在症状出现后早期、无合并症、入院时NYHA分级较低(NYHA I/II)的患者。在印度等发展中国家,初级PCI可能不可行,老年患者也应及时进行溶栓治疗。
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引用次数: 0
Giant carotid aneurysm in takayasu arteritis 巨颈动脉瘤在高须动脉炎
Pub Date : 2022-01-01 DOI: 10.4103/jicc.jicc_10_21
D. Acharya, Dr. Rabindra Das, Jogendra Singh, Subhash R. Pramanik
Takayasu arteritis is an arteritis of unknown etiology, resulting in stenosis or dilatation of the aorta and its major branches. .We report a rare case of a giant right common carotid artery aneurysm on the one side in a 29-year-old young male with refractory hypertension with severely stenotic, diffusely diseased, corkscrew appearance of the contralateral carotid artery, which has not been described in the literature so far. Our case is a unique demonstration of nature's paradox in vascular behavior in Takayasu arteritis in the right and left carotid arteries in an index patient; one having a giant aneurysm and the other one being severely stenotic, diffusely diseased with corkscrew appearance.
Takayasu动脉炎是一种病因不明的动脉炎,导致主动脉及其主要分支狭窄或扩张。我们报告一例罕见的右侧颈总动脉瘤单侧巨大病例,患者为29岁年轻男性,顽固性高血压,对侧颈动脉严重狭窄,弥漫性病变,呈螺旋状,迄今文献未见报道。我们的病例是一个独特的证明,在血管行为的自然悖论在右颈动脉和左颈动脉高松动脉炎的指数患者;一个有巨大的动脉瘤,另一个严重狭窄,弥漫性病变,呈螺旋状。
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引用次数: 0
Assessment of risk factors, clinical presentation and angiographic profile of coronary slow flow phenomenon 冠状动脉慢血流现象的危险因素、临床表现和血管造影特征评估
Pub Date : 2022-01-01 DOI: 10.4103/jicc.jicc_6_21
Sara Abd-Elghaffar, R. E. El Sheikh, A. Gaafar, Yasser Elbarbary
Background: Primary coronary slow flow phenomenon (PCSFP) is a clinical entity that causes attacks of mild to severe chest pain. It is characterized by delayed coronary vessel opacification in the absence of epicardial stenosis. This work aimed for the assessment of predictors, clinical presentation, and angiographic profile of PCSFP. Subjects and Methods: This cross-sectional case–control study was done between February 2019 and January 2020, including 150 patients who presented by ST-segment myocardial infarction, non-ST segment myocardial infarction, unstable angina, chronic coronary syndrome, or atypical chest pain. The patients were divided into two groups: group 1: consisted of 100 patients who had PCSFP and Group 2: consisted of 50 patients who had normal coronary flow (NCF). Results: PCSFP was significantly more prevalent in young male patients. Among the traditional risk factors, there was significantly more prevalence of hypertension (63.0% vs. 28.0%, P = 0.001), obesity (body mass index ≥30 kg/m2 (47.0% vs. 4.0%, P = 0.001), and history of smoking (66.0% vs. 40.0%, P < 0.002) in PCSFP patients as compared to NCF patients. Triglyceride (TG), cholesterol, low-density lipoprotein, high-sensitivity C-reactive protein (hs-CRP), and hemoglobin all were higher in patients with PCSFP. Low high-density lipoprotein levels were associated with PCSFP. In multivariable analysis, PCSFP was significantly independently associated with male sex, high TG, cholesterol, and hs-CRP. TG (odds ratio [OR]: 14.427, 95% confidence interval [CI]: 3.514–59.226) and cholesterol (OR: 11.739, 95% CI, 2.439–56.513) are the strongest independent predictors for PCSFP. Conclusion: PCSFP is more common in young smoker males, is associated with hypertension, obesity, high hs-CRP, TG, and cholesterol levels. High cholesterol and TG and male sex are the strongest risk factors for PCSFP. Furthermore, inflammation plays an important factor in the pathogenesis of PCSFP due to the association of high hs-CRP level in those patients.
背景:原发性冠状动脉慢血流现象(PCSFP)是一种引起轻至重度胸痛发作的临床现象。它的特征是在没有心外膜狭窄的情况下,冠状血管延迟浑浊。这项工作旨在评估PCSFP的预测因素、临床表现和血管造影特征。研究对象和方法:本横断面病例对照研究于2019年2月至2020年1月进行,包括150例st段心肌梗死、非st段心肌梗死、不稳定型心绞痛、慢性冠状动脉综合征或非典型胸痛患者。将患者分为两组:第一组为100例PCSFP患者,第二组为50例冠状动脉血流正常(NCF)患者。结果:PCSFP在年轻男性患者中更为普遍。在传统危险因素中,PCSFP患者的高血压患病率(63.0%比28.0%,P = 0.001)、肥胖(体重指数≥30 kg/m2)(47.0%比4.0%,P = 0.001)和吸烟史(66.0%比40.0%,P < 0.002)明显高于NCF患者。甘油三酯(TG)、胆固醇、低密度脂蛋白、高敏c反应蛋白(hs-CRP)和血红蛋白在PCSFP患者中均升高。低高密度脂蛋白水平与PCSFP相关。在多变量分析中,PCSFP与男性、高TG、胆固醇和hs-CRP显著独立相关。TG(比值比[OR]: 14.427, 95%可信区间[CI]: 3.514-59.226)和胆固醇(OR: 11.739, 95% CI: 2.439-56.513)是PCSFP最强的独立预测因子。结论:PCSFP在年轻吸烟男性中更为常见,与高血压、肥胖、高hs-CRP、TG和胆固醇水平相关。高胆固醇、高甘油三酯和男性是PCSFP最强的危险因素。此外,炎症在PCSFP的发病机制中起着重要的作用,因为这些患者的hs-CRP水平较高。
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引用次数: 1
Multiple systemic cardio-embolism in native aortic valve endocarditis 原发性主动脉瓣心内膜炎的多发全身性心脏栓塞
Pub Date : 2022-01-01 DOI: 10.4103/jicc.jicc_5_21
C. Paraschiv, L. Trasca, A. Popescu, S. Balanescu
We present a challenging case of native aortic valve endocarditis with Enterococcus faecalis in a patient with a history of multiple urinary tract infections and urethral strictures treated by local dilations. The case was complicated by Clostridium difficile colitis and multiple septic embolization. Despite intensive antibacterial therapy, guided by the antibiogram, the vegetations grew in size and the infection became uncontrolled causing recurrent embolism.
我们提出了一个具有挑战性的病例,原发性主动脉瓣心内膜炎伴粪肠球菌,患者有多次尿路感染和局部扩张治疗的尿道狭窄史。患者并发艰难梭菌性结肠炎,多次脓毒症栓塞。尽管在抗生素的指导下进行了密集的抗菌治疗,但植物的体积越来越大,感染变得无法控制,导致复发性栓塞。
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引用次数: 0
Strontium in atrioventricular conduction disorder: Is it a new target? 锶在房室传导障碍中的作用:是一个新的靶点吗?
Pub Date : 2022-01-01 DOI: 10.4103/jicc.jicc_82_20
Subhabrata Mukherjee, D. Kumar, D. Bera, Arindam Pande, S. Patra, R. Roy, Rabin Chakraborty
Introduction: Atrioventricular (AV) block is a common problem worldwide requiring permanent pacemaker implantation, which results in a huge economic burden on society. In our country, the major burden is noted in eastern India. The etiopathological correlation of degenerative conduction tissue disorder does o't explain the differential volume of disease. We speculate environmental link, particularly the influence of elevated trace metals in the pathogenesis of this condition. Purpose: The purpose of the study was to investigate and correlate the concentration of trace metals in blood of patients who have received a permanent pacemaker. Materials and Methods: The blood samples of 81 patients who had permanent pacemaker implantation in the past 3 years were collected and levels of various trace metals were evaluated. It was done using inductively coupled plasma mass spectrometry. The values were expressed in μg/l. Results: There were elevated trace metals in 21 patients and 4 among them had an overlap of more than one abnormal values. Strontium (Sr) surprisingly was elevated in a maximum of 11 patients. The most interesting observation was a trend of Sr being elevated in male sex with AV nodal disease. Conclusion: From this study we hypothesize, Sr affects ion channels in conduction tissue due to its close chemical similarity to calcium. In long run, it could have been inducing fibrosis causing AV blocks. Our observation suggests that trace metal screening may be considered in areas with a high prevalence of AV blocks requiring permanent pacemakers.
房室传导阻滞是世界范围内普遍存在的问题,需要植入永久性心脏起搏器,这给社会带来了巨大的经济负担。在我国,主要的负担出现在印度东部。退行性传导组织障碍的病因病理学相关性并不能解释疾病的差异体积。我们推测环境的联系,特别是在这种情况的发病机制中微量金属升高的影响。目的:本研究的目的是调查并关联接受永久性起搏器的患者血液中微量金属的浓度。材料与方法:收集近3年来81例永久性起搏器植入术患者的血液标本,测定其血液中各种微量金属的含量。它是用电感耦合等离子体质谱法完成的。以μg/l表示。结果:21例患者微量金属含量升高,其中4例有1个以上异常值重叠。在最多11例患者中,锶(Sr)令人惊讶地升高。最有趣的观察结果是,患有房室淋巴结疾病的男性中,Sr有升高的趋势。结论:从本研究中我们推测,锶影响传导组织中的离子通道是由于其与钙的化学相似性。从长远来看,它可能会诱发纤维化,导致AV阻滞。我们的观察表明,在需要永久性起搏器的房室传导阻滞高发地区,可以考虑进行微量金属筛查。
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引用次数: 0
Nonvalvular atrial fibrillation and acute coronary syndrome: Present Indian perspective and assessment 非瓣膜性心房颤动和急性冠状动脉综合征:目前印度的观点和评估
Pub Date : 2021-10-01 DOI: 10.4103/jicc.jicc_74_20
R. Modi, A. Jaswal, S. Modi
Background: The number of patients undergoing percutaneous coronary intervention (PCI) who mandate additional oral anticoagulant therapy, due to presence of Atrial Fibrillation (AF), has been increasing. Dual antiplatelet therapy (DAPT) is associated with reduced ischemic events including stent thrombosis, myocardial infarction and stroke following PCI. However, the trade-off is an increased risk for bleeding while on DAPT. The addition of an anticoagulation further increases the likelihood of bleeding while on antiplatelet therapy. Thus, the overall risks and benefits for each patient undergoing PCI on anticoagulation (VKA/ NOAC) must be assessed and therapy individualized to ensure optimal therapy for each unique situation. Aims and Objectives: The aim of the study was to determine the diversity in the antiplatelet and anticoagulation treatment of patients with nonvalvular AF or flutter who develop acute coronary syndrome (ACS) or undergo PCI in India.Materials and Methods: All patients who had AF and underwent PCI were included in the study. Results: In the study 100 patients of AF with PCI were evaluated, among who 95 % were started on triple therapy (TT) and 5 % on DAPT. The patients were followed up at 1 month, 3 months, 6 months, and 1 year for adjustment of antiplatelet, anticoagulation medicines, and their dosage. Conclusion: The study reviewed the best practices for the pharmacologic management of patients requiring anticoagulation with NOAC who are treated with PCI and require antiplatelet therapy.
背景:由于房颤(AF)的存在,接受经皮冠状动脉介入治疗(PCI)而需要额外口服抗凝治疗的患者数量一直在增加。双重抗血小板治疗(DAPT)与PCI术后支架血栓形成、心肌梗死和中风等缺血性事件的减少有关。然而,代价是使用DAPT时出血的风险增加。抗凝剂的加入进一步增加了在抗血小板治疗时出血的可能性。因此,必须评估每位接受PCI抗凝治疗(VKA/ NOAC)的患者的总体风险和收益,并进行个体化治疗,以确保针对每种独特情况的最佳治疗。目的和目的:本研究的目的是确定在印度发生急性冠脉综合征(ACS)或接受PCI治疗的非瓣膜性房颤或扑动患者抗血小板和抗凝治疗的多样性。材料与方法:所有房颤患者均行PCI治疗。结果:本研究对100例房颤PCI患者进行了评估,其中95%开始三联治疗(TT), 5%开始DAPT。随访1个月、3个月、6个月、1年,调整抗血小板、抗凝药物及剂量。结论:本研究回顾了需要抗凝治疗的NOAC患者接受PCI治疗并需要抗血小板治疗的最佳药理学管理实践。
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引用次数: 0
Retrograde his activation and resetting of the sinus node in parahisian pathway 逆行他的激活和重置窦结在旁张通路
Pub Date : 2021-10-01 DOI: 10.4103/jicc.jicc_27_21
D. Acharya, Debasish Das, T. Das, Subhash R. Pramanik
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引用次数: 0
Woes of follow-up patients: A stumbling block, every cardiologist needs to intervene 随访患者的困境:这是一个绊脚石,每个心脏病专家都需要介入
Pub Date : 2021-10-01 DOI: 10.4103/jicc.jicc_16_21
B. Naik, S. Biradar
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引用次数: 0
Newer oral anticoagulants in venous thromboembolism 静脉血栓栓塞的新型口服抗凝剂
Pub Date : 2021-10-01 DOI: 10.4103/jicc.jicc_73_20
S. Modi, R. Modi
Venous thromboembolism (VTE) is an important medical condition for morbidity and mortality. Adequate anticoagulant treatment is necessary to reduce short- and long-term VTE related conditions. In the past low molecular weight heparin (LMWH) and Vitamin K antagonists (VKAs) have been the mainstay of anticoagulation therapy for VTE patients. The patients require frequent monitoring with INR to keep balance between effectiveness and safety in clinical practice. NOACs have been the main stay of treatment in conditions requiring effective anticoagulation. They may prove to do the same in VTE. This article analyses, the present literature on use of NOACs in VTE.
静脉血栓栓塞(VTE)是一个重要的疾病发病率和死亡率。充分的抗凝治疗是必要的,以减少短期和长期静脉血栓栓塞相关的条件。过去,低分子肝素(LMWH)和维生素K拮抗剂(VKAs)一直是静脉血栓栓塞(VTE)患者抗凝治疗的主要药物。在临床实践中,患者需要经常进行INR监测,以保持有效性和安全性之间的平衡。在需要有效抗凝治疗的情况下,noac一直是主要的治疗手段。它们在静脉血栓栓塞中也可能起到同样的作用。本文对NOACs在VTE中的应用进行了文献分析。
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引用次数: 0
Retraction: The sensitivity and specificity of electrocardiogram in localizing the culprit artery with angiographic correlation in indian patients with acute st-segment elevation myocardial infarction 缩回:印度急性st段抬高型心肌梗死患者心电图与血管造影相关性定位罪魁动脉的敏感性和特异性
Pub Date : 2021-10-01 DOI: 10.4103/1561-8811.329184
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引用次数: 0
期刊
Journal of Indian College of Cardiology
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