Abstract In acute coronary syndromes, timely revascularization of the obstructed artery is crucial. In young patients, acute myocardial infarction can have a very severe evolution and is frequently associated with cardiogenic shock. We present the case of a 36-year-old male patient, smoker with no other apparent risk factors for coronary artery disease, who suffered a cardiac arrest while playing tennis. Emergency coronary angiography revealed acute occlusion of the left anterior descendent artery, which was promptly revascularized. The patient had a good clinical evolution and was discharged after six days. The case underlines the importance of a well-functioning emergency system and STEMI network, able to provide life-saving therapy in a timely manner.
{"title":"Acute Thrombosis of the Left Main on the Tennis Court in a Young Patient – a Case Report","authors":"T. Mihăilă, A. Roșca, B. Ion","doi":"10.2478/jce-2022-0008","DOIUrl":"https://doi.org/10.2478/jce-2022-0008","url":null,"abstract":"Abstract In acute coronary syndromes, timely revascularization of the obstructed artery is crucial. In young patients, acute myocardial infarction can have a very severe evolution and is frequently associated with cardiogenic shock. We present the case of a 36-year-old male patient, smoker with no other apparent risk factors for coronary artery disease, who suffered a cardiac arrest while playing tennis. Emergency coronary angiography revealed acute occlusion of the left anterior descendent artery, which was promptly revascularized. The patient had a good clinical evolution and was discharged after six days. The case underlines the importance of a well-functioning emergency system and STEMI network, able to provide life-saving therapy in a timely manner.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"83 1","pages":"31 - 34"},"PeriodicalIF":0.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79370185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction: Atherosclerosis represents the main cause of arterial stenosis, mostly affecting the arteries of the lower extremities. Atherosclerotic arterial disease presents multiple localizations, including the carotid, subclavian, coronary, and kidney arteries. The severity of the stenosis does not always correlate with the symptomatology. Case report: We present the case of a patient with multisite atherosclerotic disease. A 70-year-old smoker male patient, with a history of myocardial infarction and renal artery stenosis, presented in the emergency department complaining of vertigo, chest pain, and intermittent claudication. The diagnostic and treatment algorithm represented a challenge. Imaging assessment showed atherosclerotic lesions in a new vascular territory, which involved the left subclavian artery with a stenosis of 70%. Conclusions: Subclavian artery stenosis can be a hidden form of atherosclerotic disease, often undiagnosed, which needs urgent interventional treatment and can be easily unmasked using simple tools such as measuring the blood pressure on both arms. Patients with athero-sclerotic lesions must undergo comprehensive screening for multisite atherosclerotic disease.
{"title":"Diagnostic and Treatment Algorithm in a Plurivascular Patient – Case Report","authors":"A. Magdás, Z. Szász, Andrea Mária Kalapács","doi":"10.2478/jce-2022-0006","DOIUrl":"https://doi.org/10.2478/jce-2022-0006","url":null,"abstract":"Abstract Introduction: Atherosclerosis represents the main cause of arterial stenosis, mostly affecting the arteries of the lower extremities. Atherosclerotic arterial disease presents multiple localizations, including the carotid, subclavian, coronary, and kidney arteries. The severity of the stenosis does not always correlate with the symptomatology. Case report: We present the case of a patient with multisite atherosclerotic disease. A 70-year-old smoker male patient, with a history of myocardial infarction and renal artery stenosis, presented in the emergency department complaining of vertigo, chest pain, and intermittent claudication. The diagnostic and treatment algorithm represented a challenge. Imaging assessment showed atherosclerotic lesions in a new vascular territory, which involved the left subclavian artery with a stenosis of 70%. Conclusions: Subclavian artery stenosis can be a hidden form of atherosclerotic disease, often undiagnosed, which needs urgent interventional treatment and can be easily unmasked using simple tools such as measuring the blood pressure on both arms. Patients with athero-sclerotic lesions must undergo comprehensive screening for multisite atherosclerotic disease.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"77 1","pages":"35 - 38"},"PeriodicalIF":0.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75401803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Santomauro, C. Riganti, M. Santomauro, A. Viggiano, G. Castellano, G. Iovino, A. Rapacciuolo, Francesco Fiore, F. Cacciatore, G. Esposito
Abstract Introduction: The subcutaneous implantable cardioverter defibrillator (S-ICD) represents a major advancement in ICD technology. Inappropriate shocks (IAS) occur in more than 3.1% of the population with S-ICD each year and are usually followed by admission to the emergency department (ED). In this setting, the disabling of IAS is mandatory during a pseudo-electrical storm (ES). This report describes the strategies that can be followed in order to temporarily inhibit IAS in critical care settings with the use of magnets. Case presentation: An S-ICD was implanted more than 6 weeks prior to presentation in a 68-year-old man with hypertrophic cardiomyopathy. In the ED, the patient experienced 3 IAS in the last hour. A Medtronic magnet was applied to stop IAS, as the specific programmer was not available. The maneuver interrupted the IAS. In order to verify the universal magnetic response of the S-ICD, six different magnets and one smartphone with MagSafe technology were tested. All magnet models suspended arrhythmia detection and IAS, while the smartphone did not cause magnet interferences. Conclusions: This report demonstrates the safety and efficacy of all clinical magnet models in inhibiting IAS. In case of pseudo-ES, any type of magnet allows ED providers to easily and rapidly disable the functionality of the devices when appropriate.
{"title":"Safety and Efficacy of Magnet Use to Temporarily Inhibit Inappropriate Subcutaneous Implantable Cardioverter Defibrillator Therapy in Emergency Situations: A Case Report","authors":"M. Santomauro, C. Riganti, M. Santomauro, A. Viggiano, G. Castellano, G. Iovino, A. Rapacciuolo, Francesco Fiore, F. Cacciatore, G. Esposito","doi":"10.2478/jce-2022-0001","DOIUrl":"https://doi.org/10.2478/jce-2022-0001","url":null,"abstract":"Abstract Introduction: The subcutaneous implantable cardioverter defibrillator (S-ICD) represents a major advancement in ICD technology. Inappropriate shocks (IAS) occur in more than 3.1% of the population with S-ICD each year and are usually followed by admission to the emergency department (ED). In this setting, the disabling of IAS is mandatory during a pseudo-electrical storm (ES). This report describes the strategies that can be followed in order to temporarily inhibit IAS in critical care settings with the use of magnets. Case presentation: An S-ICD was implanted more than 6 weeks prior to presentation in a 68-year-old man with hypertrophic cardiomyopathy. In the ED, the patient experienced 3 IAS in the last hour. A Medtronic magnet was applied to stop IAS, as the specific programmer was not available. The maneuver interrupted the IAS. In order to verify the universal magnetic response of the S-ICD, six different magnets and one smartphone with MagSafe technology were tested. All magnet models suspended arrhythmia detection and IAS, while the smartphone did not cause magnet interferences. Conclusions: This report demonstrates the safety and efficacy of all clinical magnet models in inhibiting IAS. In case of pseudo-ES, any type of magnet allows ED providers to easily and rapidly disable the functionality of the devices when appropriate.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"44 1","pages":"14 - 19"},"PeriodicalIF":0.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78946260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction: The upper extremity is a frequent site of injury. Upper limb arterial thromboembolism, a rare complication of such injuries, may be missed if typical signs, such as pain, pulselessness, and sensory loss, cannot be ascertained or are overlooked by physicians, especially in the case of polytrauma or comatose patients. Case presentation: In this report, we present the case of a left brachial artery thromboembolism in a polytrauma patient for which brachial artery embolectomy was performed. Before surgery, the diagnosis was established with doppler ultrasonography of the upper limb vessels, performed upon suspicion of thrombus formation. Brachial artery arteriotomy and thrombo-embolectomy were performed using a size 6 Fr Fogarty catheter, after which 500 IU heparin was flushed to ensure adequate back and forward flow. Limb function and blood flow were restored immediately after the procedure. Conclusion: A high index of suspicion, timely assessment, and a prompt intervention can significantly reduce the rate of limb ischemia and/or amputations in polytrauma patients, especially in resource-limited settings.
{"title":"Brachial Artery Embolectomy in a Polytrauma Patient: A Case Report","authors":"K. Wiredu, O. Isaac","doi":"10.2478/jce-2022-0003","DOIUrl":"https://doi.org/10.2478/jce-2022-0003","url":null,"abstract":"Abstract Introduction: The upper extremity is a frequent site of injury. Upper limb arterial thromboembolism, a rare complication of such injuries, may be missed if typical signs, such as pain, pulselessness, and sensory loss, cannot be ascertained or are overlooked by physicians, especially in the case of polytrauma or comatose patients. Case presentation: In this report, we present the case of a left brachial artery thromboembolism in a polytrauma patient for which brachial artery embolectomy was performed. Before surgery, the diagnosis was established with doppler ultrasonography of the upper limb vessels, performed upon suspicion of thrombus formation. Brachial artery arteriotomy and thrombo-embolectomy were performed using a size 6 Fr Fogarty catheter, after which 500 IU heparin was flushed to ensure adequate back and forward flow. Limb function and blood flow were restored immediately after the procedure. Conclusion: A high index of suspicion, timely assessment, and a prompt intervention can significantly reduce the rate of limb ischemia and/or amputations in polytrauma patients, especially in resource-limited settings.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"263 1","pages":"20 - 23"},"PeriodicalIF":0.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77875637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aim: To demonstrate that in patients with acute coronary syndrome (ACS), using Cordis 6F Infiniti diagnostic catheters for angioplasty may represent a safe alternative associated with lower contrast volume and radiation dosage, improving cardiovascular and renal outcomes. Material and Methods: In 1,800 patients with ACS (2,331 lesions/2,603 stents), angioplasty was performed with Cordis 6F Infiniti Thrulumen diagnostic catheters. Primary angioplasty was performed in 545 cases, and only balloon angioplasty in 67 patients. All procedures were performed through the femoral route, and switch-over to the radial route was made in 5 cases due to associated aortic/iliac obstructive lesions. Iodixanol was used in 76% of cases, and tirofiban in 99% of cases with adjusted dosages based on creatinine values. The mean contrast volume used per patient was 28 mL (± 6 mL) including the angiogram prior to the angioplasty. Results: The median fluoroscopy time was 4.4 min (IQR 3–6.8), the mean fluoroscopy time was 5.59 min (± 0.28), the median dose-area product or kerma-area product was 1,507 µGym2 (IQR 918–2,611), median total or cumulative dose including backscatter was 2,702 µGym2 (IQR 1,805–4,217), and the median cumulative skin dose was 468 mGy (IQR 296–722). Groin hematoma was seen in 7 cases, proximal mild edge dissection in the deployed stent in 3 cases, and acute in-hospital stent thrombosis in 7 cases. In total, 33 deaths were registered and 19 of these patients had cardiogenic shock, of which 11 subjects were late presenters. Three patients died after discharge due to possible acute stent thrombosis. Conclusions: Angioplasty and stenting can be performed safely in patients with acute coronary syndromes using Cordis 6F diagnostic catheters. The procedure was associated with a very low volume of contrast and radiation dose, leading to improved clinical outcomes..
{"title":"Coronary Angioplasty and Stenting in Acute Coronary Syndromes Using Very Low Contrast Volume and Radiation Dosage Improves Renal and Cardiovascular Outcomes","authors":"M. Arokiaraj","doi":"10.2478/jce-2022-0004","DOIUrl":"https://doi.org/10.2478/jce-2022-0004","url":null,"abstract":"Abstract Aim: To demonstrate that in patients with acute coronary syndrome (ACS), using Cordis 6F Infiniti diagnostic catheters for angioplasty may represent a safe alternative associated with lower contrast volume and radiation dosage, improving cardiovascular and renal outcomes. Material and Methods: In 1,800 patients with ACS (2,331 lesions/2,603 stents), angioplasty was performed with Cordis 6F Infiniti Thrulumen diagnostic catheters. Primary angioplasty was performed in 545 cases, and only balloon angioplasty in 67 patients. All procedures were performed through the femoral route, and switch-over to the radial route was made in 5 cases due to associated aortic/iliac obstructive lesions. Iodixanol was used in 76% of cases, and tirofiban in 99% of cases with adjusted dosages based on creatinine values. The mean contrast volume used per patient was 28 mL (± 6 mL) including the angiogram prior to the angioplasty. Results: The median fluoroscopy time was 4.4 min (IQR 3–6.8), the mean fluoroscopy time was 5.59 min (± 0.28), the median dose-area product or kerma-area product was 1,507 µGym2 (IQR 918–2,611), median total or cumulative dose including backscatter was 2,702 µGym2 (IQR 1,805–4,217), and the median cumulative skin dose was 468 mGy (IQR 296–722). Groin hematoma was seen in 7 cases, proximal mild edge dissection in the deployed stent in 3 cases, and acute in-hospital stent thrombosis in 7 cases. In total, 33 deaths were registered and 19 of these patients had cardiogenic shock, of which 11 subjects were late presenters. Three patients died after discharge due to possible acute stent thrombosis. Conclusions: Angioplasty and stenting can be performed safely in patients with acute coronary syndromes using Cordis 6F diagnostic catheters. The procedure was associated with a very low volume of contrast and radiation dose, leading to improved clinical outcomes..","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"41 1","pages":"1 - 13"},"PeriodicalIF":0.4,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80682031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT Background: Hematological parameters, such as white blood cell count (WBC), mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and WBC to MPV ratio (WMR), could provide data in prognosis, risk stratification, and optimal management in patients with acute coronary syndromes. Aim: We aimed to investigate the prognostic value of hematological parameters and their relationship with the TIMI risk score in non-ST elevation myocardial infarction (NSTEMI) patients. Material and Methods: A total of 259 adult patients with NSTEMI were included in this retrospective and observational cohort study. During a 1-year follow-up period, the efficacy of the main hematological parameters in predicting major adverse cardiovascular events (MACE) and their correlation with the TIMI risk score was analyzed. Results: Among the 259 patients, 188 (72.6%) were male, and the mean age was 60.4 ± 11.9 years. MACE was observed in 60 patients (23.2%). Elevated baseline levels of WBC, neutrophils, NLR, PLR, and WMR were associated with MACE development throughout the 1-year follow-up. Moreover, WBC, WMR, and NLR were correlated with the TIMI risk score. When the predictive power of these parameters for MACE was evaluated by ROC analysis, the AUC values for WBC, WMR, and NLR were 0.670 (95% CI 0.590–0.750), 0.666 (95% CI 0.582–0.746), and 0.689 (95% CI 0.610–0.767), respectively. Conclusion: WBC, NLR, and WMR predicted MACE in NSTEMI patients and were consistent with the TIMI risk score. On this basis, they could provide supportive data for early risk stratification and optimized therapeutic approach, particularly in high-risk patients.
背景:血液学参数，如白细胞计数(WBC)、平均血小板体积(MPV)、中性粒细胞与淋巴细胞比(NLR)、血小板与淋巴细胞比(PLR)和白细胞与淋巴细胞比(WMR)，可以为急性冠状动脉综合征患者的预后、危险分层和最佳管理提供数据。目的:探讨非st段抬高型心肌梗死(NSTEMI)患者血液学参数的预后价值及其与TIMI风险评分的关系。材料和方法:这项回顾性和观察性队列研究共纳入了259例成人非stemi患者。随访1年，分析主要血液学参数对主要心血管不良事件(MACE)的预测效果及其与TIMI风险评分的相关性。结果:259例患者中，男性188例(72.6%)，平均年龄60.4±11.9岁。60例(23.2%)出现MACE。在1年的随访中，WBC、中性粒细胞、NLR、PLR和WMR的基线水平升高与MACE的发展有关。此外，WBC、WMR和NLR与TIMI风险评分相关。当这些参数对MACE的预测能力进行ROC分析时，WBC、WMR和NLR的AUC值分别为0.670 (95% CI 0.590-0.750)、0.666 (95% CI 0.582-0.746)和0.689 (95% CI 0.610-0.767)。结论:WBC、NLR和WMR预测NSTEMI患者的MACE，与TIMI风险评分一致。在此基础上，它们可以为早期风险分层和优化治疗方案提供支持数据，特别是在高危患者中。
{"title":"Predictive Value of Hematological Parameters in Non-ST Segment Elevation Myocardial Infarction and Their Relationship with the TIMI Risk Score","authors":"Ulaş Karaoğlu, M. Bulut, T. Omar","doi":"10.2478/jce-2021-0018","DOIUrl":"https://doi.org/10.2478/jce-2021-0018","url":null,"abstract":"ABSTRACT Background: Hematological parameters, such as white blood cell count (WBC), mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and WBC to MPV ratio (WMR), could provide data in prognosis, risk stratification, and optimal management in patients with acute coronary syndromes. Aim: We aimed to investigate the prognostic value of hematological parameters and their relationship with the TIMI risk score in non-ST elevation myocardial infarction (NSTEMI) patients. Material and Methods: A total of 259 adult patients with NSTEMI were included in this retrospective and observational cohort study. During a 1-year follow-up period, the efficacy of the main hematological parameters in predicting major adverse cardiovascular events (MACE) and their correlation with the TIMI risk score was analyzed. Results: Among the 259 patients, 188 (72.6%) were male, and the mean age was 60.4 ± 11.9 years. MACE was observed in 60 patients (23.2%). Elevated baseline levels of WBC, neutrophils, NLR, PLR, and WMR were associated with MACE development throughout the 1-year follow-up. Moreover, WBC, WMR, and NLR were correlated with the TIMI risk score. When the predictive power of these parameters for MACE was evaluated by ROC analysis, the AUC values for WBC, WMR, and NLR were 0.670 (95% CI 0.590–0.750), 0.666 (95% CI 0.582–0.746), and 0.689 (95% CI 0.610–0.767), respectively. Conclusion: WBC, NLR, and WMR predicted MACE in NSTEMI patients and were consistent with the TIMI risk score. On this basis, they could provide supportive data for early risk stratification and optimized therapeutic approach, particularly in high-risk patients.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"36 1","pages":"116 - 122"},"PeriodicalIF":0.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85483622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ferdi Kahraman, S. Kanat, T. Peker, Sema Can, M. Demir
ABSTRACT Introduction: Idiopathic ventricular arrhythmias, which occur in the absence of structural heart disease, are commonly originating from the outflow tract, and 80% of the them arise from the right ventricle. Epicardial adipose tissue (EAT), which originates from the splanchnopleuric mesoderm, has been shown to be an important source of inflammatory mediators and plays an important role in cardiac autonomic function by epicardial ganglionated plexuses. EAT may potentially contribute to the pathophysiology of idiopathic right ventricular outflow tract (RVOT) tachycardia by different mechanisms. In this study, we aimed to investigate the relationship between EAT thickness and RVOT tachycardia. Methods: This study included 55 patients (32 male, 23 female) with RVOT tachycardia and 60 control subjects (38 male, 22 female). Patients who had more than three consecutive ventricular beats over 100 bpm with specific morphological features on the electrocardiogram (ECG) were diagnosed with RVOT tachycardia. EAT thickness was measured by transthoracic echocardiography. Results: EAT thickness was significantly higher in the RVOT tachycardia group (p <0.05). Ejection fraction (EF), and the thickness of the posterior wall of the left ventricle and of the interventricular septum were significantly lower, and left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and left atrial diameter were significantly higher in patients who had RVOT tachycardia compared to normal subjects (p <0.05). Conclusion: Patients who were diagnosed with RVOT tachycardia had increased EAT thickness compared to normal subjects. The underlying mechanism of the condition could be mechanical, metabolic, infiltrative, or autonomic effects of the EAT.
{"title":"Epicardial Adipose Tissue Thickness is Higher in Right Ventricular Outflow Tract Tachycardia","authors":"Ferdi Kahraman, S. Kanat, T. Peker, Sema Can, M. Demir","doi":"10.2478/jce-2021-0019","DOIUrl":"https://doi.org/10.2478/jce-2021-0019","url":null,"abstract":"ABSTRACT Introduction: Idiopathic ventricular arrhythmias, which occur in the absence of structural heart disease, are commonly originating from the outflow tract, and 80% of the them arise from the right ventricle. Epicardial adipose tissue (EAT), which originates from the splanchnopleuric mesoderm, has been shown to be an important source of inflammatory mediators and plays an important role in cardiac autonomic function by epicardial ganglionated plexuses. EAT may potentially contribute to the pathophysiology of idiopathic right ventricular outflow tract (RVOT) tachycardia by different mechanisms. In this study, we aimed to investigate the relationship between EAT thickness and RVOT tachycardia. Methods: This study included 55 patients (32 male, 23 female) with RVOT tachycardia and 60 control subjects (38 male, 22 female). Patients who had more than three consecutive ventricular beats over 100 bpm with specific morphological features on the electrocardiogram (ECG) were diagnosed with RVOT tachycardia. EAT thickness was measured by transthoracic echocardiography. Results: EAT thickness was significantly higher in the RVOT tachycardia group (p <0.05). Ejection fraction (EF), and the thickness of the posterior wall of the left ventricle and of the interventricular septum were significantly lower, and left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and left atrial diameter were significantly higher in patients who had RVOT tachycardia compared to normal subjects (p <0.05). Conclusion: Patients who were diagnosed with RVOT tachycardia had increased EAT thickness compared to normal subjects. The underlying mechanism of the condition could be mechanical, metabolic, infiltrative, or autonomic effects of the EAT.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"25 1","pages":"123 - 128"},"PeriodicalIF":0.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83290980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Mester, D. Cernica, D. Opincariu, N. Raț, R. Hodaș, I. Kovács, T. Benedek, I. Benedek
ABSTRACT Background: The integrated ST segment elevation score (ISSTE) score objectively quantifies the ECG changes before and after primary percutaneous coronary intervention (pPCI) for ST segment elevation myocardial infarction (STEMI). The inflammatory response is a major component in scar formation and remodeling process of the myocardial tissue following myocardial infarction (MI). Cardiac magnetic resonance imaging (CMR) precisely quantifies the cardiac function and assesses the pattern of the myocardial scar tissue. The aim of the study was to evaluate the relations between the ISSTE score and: (1) acute inflammatory biomarkers and (2) extent of the myocardial scar determined by CMR in STEMI treated with pPCI. Material and methods: One hundred thirty STEMI patients were included in the study, who underwent pPCI in the first 12 hours from symptom debut. ISSTE-1 was calculated at presentation and 2 hours following pPCI (ISSTE-2). Inflammatory biomarkers were determined at admission and day 5, followed by LGE-CMR at 4 weeks, with quantification of cardiac function and extent of infarct size (IS) and transmurality. Patients were divided in low and high ISSTE groups based on the median values. Results: No significant differences were noted in terms of CMR parameters or inflammatory biomarkers and between the groups with low or high ISSTE-1. Significantly higher levels of day-5 hs-CRP (p = 0.03) and day-1 IL-6 (p = 0.02), MMP-9 (p = 0.05) were recorded in high ISSTE-2 groups. LV IS mass (23.11 ± 5.31 vs. 57.94 ± 8.33, p = 0.001), percentage (13.55 ± 6.22 vs. 27.15 ± 7.12, p = 0.001) and transmurality (p = 0.001) was significantly higher in ISSTE-2 group. ISSTE-2 significantly correlated with LV IS mass (r = 0.391, p <0.0001), percentage (r = 0.541, p <0.0001) high transmurality (r = 0.449, p <0.0001) and LV EF (r = -0.397, p <0.0001). Conclusions: A high ISSTE-2 score is associated with increased inflammatory response exhibited by elevated serum IL-6 and MMP-9 levels determined on the day of admission, and with persistently increased serum hs-CRP levels on day 5 of the acute event. A higher ISSTE-2 score is associated with larger myocardial scar extent expressed by IS, higher transmurality and reduced LV EF at 1-month LGE CMR follow-up.
{"title":"Magnitude of ST-segment Elevation Is Associated with Increased Acute Inflammatory Response and Myocardial Scar in Patients with Acute Myocardial Infarction Undergoing pPCI","authors":"A. Mester, D. Cernica, D. Opincariu, N. Raț, R. Hodaș, I. Kovács, T. Benedek, I. Benedek","doi":"10.2478/jce-2021-0020","DOIUrl":"https://doi.org/10.2478/jce-2021-0020","url":null,"abstract":"ABSTRACT Background: The integrated ST segment elevation score (ISSTE) score objectively quantifies the ECG changes before and after primary percutaneous coronary intervention (pPCI) for ST segment elevation myocardial infarction (STEMI). The inflammatory response is a major component in scar formation and remodeling process of the myocardial tissue following myocardial infarction (MI). Cardiac magnetic resonance imaging (CMR) precisely quantifies the cardiac function and assesses the pattern of the myocardial scar tissue. The aim of the study was to evaluate the relations between the ISSTE score and: (1) acute inflammatory biomarkers and (2) extent of the myocardial scar determined by CMR in STEMI treated with pPCI. Material and methods: One hundred thirty STEMI patients were included in the study, who underwent pPCI in the first 12 hours from symptom debut. ISSTE-1 was calculated at presentation and 2 hours following pPCI (ISSTE-2). Inflammatory biomarkers were determined at admission and day 5, followed by LGE-CMR at 4 weeks, with quantification of cardiac function and extent of infarct size (IS) and transmurality. Patients were divided in low and high ISSTE groups based on the median values. Results: No significant differences were noted in terms of CMR parameters or inflammatory biomarkers and between the groups with low or high ISSTE-1. Significantly higher levels of day-5 hs-CRP (p = 0.03) and day-1 IL-6 (p = 0.02), MMP-9 (p = 0.05) were recorded in high ISSTE-2 groups. LV IS mass (23.11 ± 5.31 vs. 57.94 ± 8.33, p = 0.001), percentage (13.55 ± 6.22 vs. 27.15 ± 7.12, p = 0.001) and transmurality (p = 0.001) was significantly higher in ISSTE-2 group. ISSTE-2 significantly correlated with LV IS mass (r = 0.391, p <0.0001), percentage (r = 0.541, p <0.0001) high transmurality (r = 0.449, p <0.0001) and LV EF (r = -0.397, p <0.0001). Conclusions: A high ISSTE-2 score is associated with increased inflammatory response exhibited by elevated serum IL-6 and MMP-9 levels determined on the day of admission, and with persistently increased serum hs-CRP levels on day 5 of the acute event. A higher ISSTE-2 score is associated with larger myocardial scar extent expressed by IS, higher transmurality and reduced LV EF at 1-month LGE CMR follow-up.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"51 1","pages":"100 - 106"},"PeriodicalIF":0.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81006043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Réka Kaller, A. Mureṣan, D. Popa, Emil-Marian Arbănași, E. Russu
ABSTRACT Introduction: Ruptured abdominal aortic aneurysm (AAA) has a high mortality, even when the patients reach the hospital in time and the intervention is expeditious. Case presentation: We present the case of a 66-year-old male patient, with a known history of AAA, presenting to the emergency room in a state of hypovolemic shock due to massive bleeding in the upper and lower gastrointestinal tract and acute abdominal pain, which presented an abrupt onset one hour before presentation. The computed tomography angiography identified an aortoduodenal fistula with a trajectory toward the D3 segment of the duodenum, as well as a common iliac artery occlusion and extensive atherosclerotic stigmas. The patient was rushed to the operation room where he was resuscitated with intravenous fluids, two units of packed red blood cells, and hemostatic agents. The bleeding was stopped by clamping the aorta above the aneurysm. The duodenum was sutured, and the aorta was reconstructed with an aortobifemoral graft. Unfortunately, even though intensive care procedures continued for a few hours after surgery, all therapeutic efforts failed and the patient had succumbed.
{"title":"Fatal Aortoduodenal Fistula Caused by a Ruptured Abdominal Aortic Aneurysm - a Case Report","authors":"Réka Kaller, A. Mureṣan, D. Popa, Emil-Marian Arbănași, E. Russu","doi":"10.2478/jce-2021-0015","DOIUrl":"https://doi.org/10.2478/jce-2021-0015","url":null,"abstract":"ABSTRACT Introduction: Ruptured abdominal aortic aneurysm (AAA) has a high mortality, even when the patients reach the hospital in time and the intervention is expeditious. Case presentation: We present the case of a 66-year-old male patient, with a known history of AAA, presenting to the emergency room in a state of hypovolemic shock due to massive bleeding in the upper and lower gastrointestinal tract and acute abdominal pain, which presented an abrupt onset one hour before presentation. The computed tomography angiography identified an aortoduodenal fistula with a trajectory toward the D3 segment of the duodenum, as well as a common iliac artery occlusion and extensive atherosclerotic stigmas. The patient was rushed to the operation room where he was resuscitated with intravenous fluids, two units of packed red blood cells, and hemostatic agents. The bleeding was stopped by clamping the aorta above the aneurysm. The duodenum was sutured, and the aorta was reconstructed with an aortobifemoral graft. Unfortunately, even though intensive care procedures continued for a few hours after surgery, all therapeutic efforts failed and the patient had succumbed.","PeriodicalId":15210,"journal":{"name":"Journal Of Cardiovascular Emergencies","volume":"39 1","pages":"129 - 132"},"PeriodicalIF":0.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84434625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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