首页 > 最新文献

Acute cardiac care最新文献

英文 中文
Red thrombus-like appearance of protruding calcification into the lumen of the coronary artery by optical coherence tomography 光学相干断层扫描显示冠状动脉腔内红色血栓样的突出钙化
Pub Date : 2016-01-02 DOI: 10.1080/17482941.2016.1234052
M. Terashima, H. Kaneda, T. Matsubara, Takahiko Suzuki
Calcification is usually identified by a well-delineated, low back-scattering heterogeneous region without signal attenuation on optical coherence tomography (OCT), whereas red-thrombus is characterized as a high-backscattering protrusion with attenuation. Although the visualization of intense dorsal shadowing must be interpreted as red-thrombus according to classical OCT diagnostic criteria, thick calcification ( 1.5 mm) may also generate intense posterior shadowing, due to inability of near-infrared light penetration. In this case, OCT images suggested redthrombus while MSCT/IVUS findings demonstrated calcification (Figure 1). Nodular calcification should be taken into account to prevent stent under-expansion or coronary perforation, even in cases with redthrombus on OCT.
钙化通常通过光学相干断层扫描(OCT)上清晰的低后向散射非均匀区来识别,而红色血栓的特征是高后向散射的衰减突出。尽管根据经典的OCT诊断标准,强烈的背侧阴影显示必须解释为红色血栓,但由于近红外光无法穿透,厚钙化(1.5 mm)也可能产生强烈的后侧阴影。在本例中,OCT图像提示红血栓,而MSCT/IVUS结果显示钙化(图1)。即使在OCT上有红血栓的病例中,也应考虑结节性钙化,以防止支架扩张不足或冠状动脉穿孔。
{"title":"Red thrombus-like appearance of protruding calcification into the lumen of the coronary artery by optical coherence tomography","authors":"M. Terashima, H. Kaneda, T. Matsubara, Takahiko Suzuki","doi":"10.1080/17482941.2016.1234052","DOIUrl":"https://doi.org/10.1080/17482941.2016.1234052","url":null,"abstract":"Calcification is usually identified by a well-delineated, low back-scattering heterogeneous region without signal attenuation on optical coherence tomography (OCT), whereas red-thrombus is characterized as a high-backscattering protrusion with attenuation. Although the visualization of intense dorsal shadowing must be interpreted as red-thrombus according to classical OCT diagnostic criteria, thick calcification ( 1.5 mm) may also generate intense posterior shadowing, due to inability of near-infrared light penetration. In this case, OCT images suggested redthrombus while MSCT/IVUS findings demonstrated calcification (Figure 1). Nodular calcification should be taken into account to prevent stent under-expansion or coronary perforation, even in cases with redthrombus on OCT.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"6 1","pages":"22 - 22"},"PeriodicalIF":0.0,"publicationDate":"2016-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17482941.2016.1234052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60086017","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}
引用次数: 2
Extrinsic compression of left main coronary artery due to dilated pulmonary trunk resulting in ischaemic symptoms 肺动脉干扩张导致左冠状动脉主干外源性受压,导致缺血症状
Pub Date : 2016-01-02 DOI: 10.1080/17482941.2016.1234053
R. Bhoil, S. Sood, Sabina Bhoil, Anshul Chamail, R. Sood
Left coronary artery compression syndrome is an uncommon entity and characterized by compression of the LMCA in-between the aorta and an enlarged main pulmonary arterial trunk. It is usually associated with a congenital cardiac defect. Cardiac 64-slice MDCT provides a non-invasive and an accurate method for assessing the degree of dynamic LMCA compression throughout the cardiac cycle, its angulation relative to the left sinus of Valsalva and depiction of pulmonary pathology, making it a valuable tool in the workup of patients suspected of left coronary artery compression.
左冠状动脉压迫综合征是一种罕见的疾病,其特征是主动脉和肺动脉主干之间的左中动脉压迫。它通常与先天性心脏缺陷有关。心脏64层MDCT提供了一种无创和准确的方法来评估整个心脏周期内LMCA的动态压迫程度,其相对于左Valsalva窦的角度和肺部病理描述,使其成为怀疑左冠状动脉压迫患者的有价值的工具。
{"title":"Extrinsic compression of left main coronary artery due to dilated pulmonary trunk resulting in ischaemic symptoms","authors":"R. Bhoil, S. Sood, Sabina Bhoil, Anshul Chamail, R. Sood","doi":"10.1080/17482941.2016.1234053","DOIUrl":"https://doi.org/10.1080/17482941.2016.1234053","url":null,"abstract":"Left coronary artery compression syndrome is an uncommon entity and characterized by compression of the LMCA in-between the aorta and an enlarged main pulmonary arterial trunk. It is usually associated with a congenital cardiac defect. Cardiac 64-slice MDCT provides a non-invasive and an accurate method for assessing the degree of dynamic LMCA compression throughout the cardiac cycle, its angulation relative to the left sinus of Valsalva and depiction of pulmonary pathology, making it a valuable tool in the workup of patients suspected of left coronary artery compression.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"18 1","pages":"23 - 24"},"PeriodicalIF":0.0,"publicationDate":"2016-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17482941.2016.1234053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60086063","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}
引用次数: 4
Left ventricular non-compaction cardiomyopathy: Incidental diagnosis after ST-elevation myocardial infarction 左室非压实性心肌病:st段抬高心肌梗死后的偶然诊断
Pub Date : 2016-01-02 DOI: 10.1080/17482941.2016.1234055
J. Liang, E. Fenstad, Christopher D. Janish, L. Sinak
Left ventricular non-compaction cardiomyopathy is a rare congenital cardiomyopathy, which usually presents early in life but may also manifest into adulthood. We present the case of an elderly woman with left ventricular non-compaction cardiomyopathy, which was discovered incidentally following an ST-elevation myocardial infarction.
左室非压实性心肌病是一种罕见的先天性心肌病,通常表现在生命早期,但也可能表现在成年期。我们提出的情况下,一个老年妇女与左心室非压实性心肌病,这是偶然发现的st段抬高心肌梗死。
{"title":"Left ventricular non-compaction cardiomyopathy: Incidental diagnosis after ST-elevation myocardial infarction","authors":"J. Liang, E. Fenstad, Christopher D. Janish, L. Sinak","doi":"10.1080/17482941.2016.1234055","DOIUrl":"https://doi.org/10.1080/17482941.2016.1234055","url":null,"abstract":"Left ventricular non-compaction cardiomyopathy is a rare congenital cardiomyopathy, which usually presents early in life but may also manifest into adulthood. We present the case of an elderly woman with left ventricular non-compaction cardiomyopathy, which was discovered incidentally following an ST-elevation myocardial infarction.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"18 1","pages":"25 - 27"},"PeriodicalIF":0.0,"publicationDate":"2016-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17482941.2016.1234055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60086118","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}
引用次数: 1
Coronary artery spasm: Is ST-elevation key for diagnosis? 冠状动脉痉挛:st段抬高是诊断的关键吗?
Pub Date : 2016-01-02 DOI: 10.1080/17482941.2016.1234057
P. Villablanca, David F Briceño, Anand D. Jagannath, Martin N. Cohen, R. Pyo
Coronary vasospasm is uncommon during pregnancy and the postpartum period. We present a very rare case of an acute coronary vasospasm in a 36-year-old woman who was two weeks postpartum. The coronary arteriograms showed a coronary vasospasm in the distal left anterior descending and circumflex coronary arteries. Electrocardiogram (ECG) presentation was atypical, with T-wave inversions in leads I, aVL, and V2 to V6. To our knowledge, this is the first case with a well-documented coronary artery vasospasm in a postpartum woman without the classic ST elevation on ECG. Management should follow the usual principles of care for acute coronary vasospasm.
冠状血管痉挛在妊娠期和产后并不常见。我们提出一个非常罕见的病例急性冠状动脉痉挛在一个36岁的妇女谁是产后两周。冠状动脉造影显示左前降支和旋支远端冠状动脉血管痉挛。心电图表现不典型,导联I、aVL和V2至V6的t波反转。据我们所知,这是第一例有充分记录的产后女性冠状动脉血管痉挛,而心电图上没有典型的ST段抬高。治疗应遵循急性冠状血管痉挛的一般护理原则。
{"title":"Coronary artery spasm: Is ST-elevation key for diagnosis?","authors":"P. Villablanca, David F Briceño, Anand D. Jagannath, Martin N. Cohen, R. Pyo","doi":"10.1080/17482941.2016.1234057","DOIUrl":"https://doi.org/10.1080/17482941.2016.1234057","url":null,"abstract":"Coronary vasospasm is uncommon during pregnancy and the postpartum period. We present a very rare case of an acute coronary vasospasm in a 36-year-old woman who was two weeks postpartum. The coronary arteriograms showed a coronary vasospasm in the distal left anterior descending and circumflex coronary arteries. Electrocardiogram (ECG) presentation was atypical, with T-wave inversions in leads I, aVL, and V2 to V6. To our knowledge, this is the first case with a well-documented coronary artery vasospasm in a postpartum woman without the classic ST elevation on ECG. Management should follow the usual principles of care for acute coronary vasospasm.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"18 1","pages":"11 - 12"},"PeriodicalIF":0.0,"publicationDate":"2016-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17482941.2016.1234057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60085675","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}
引用次数: 1
Emergency physician accuracy in interpreting electrocardiograms with potential ST-segment elevation myocardial infarction: Is it enough? 急诊医师对潜在st段抬高型心肌梗死心电图的准确解读是否足够?
Pub Date : 2016-01-02 DOI: 10.1080/17482941.2016.1234058
G. Veronese, F. Germini, S. Ingrassia, Ombretta Cutuli, V. Donati, L. Bonacchini, M. Marcucci, A. Fabbri
Background: Electrocardiogram (ECG) interpretation is widely performed by emergency physicians. We aimed to determine the accuracy of interpretation of potential ST-segment elevation myocardial infarction (STEMI) ECGs by emergency physicians. Methods: Thirty-six ECGs resulted in putative STEMI diagnoses were selected. Participants were asked to focus on whether or not the ECG in question met the diagnostic criteria for an acutely blocked coronary artery causing a STEMI. Based on the coronary angiogram, a binary outcome of accurate versus inaccurate ECG interpretation was defined. We computed the overall sensitivity, specificity, accuracy and 95% confidence intervals (95%CIs) for ECG interpretation. Data on participant training level, working experience and place were collected. Results: 135 participants interpreted 4603 ECGs. Overall sensitivity to identify ‘true’ STEMI ECGs was 64.5% (95%CI: 62.8–66.3); specificity in determining ‘false’ ECGs was 78% (95%CI: 76–80.1). Overall accuracy was modest (69.1, 95%CI: 67.8–70.4). Higher accuracy in ECG interpretation was observed for attending physicians, participants working in tertiary care hospitals and those more experienced. Conclusion: The accuracy of interpretation of potential STEMI ECGs was modest among emergency physicians. The study supports the notion that ECG interpretation for establishing a STEMI diagnosis lacks the necessary sensitivity and specificity to be considered a reliable ‘stand-alone’ diagnostic test.
背景:心电图(ECG)的解读被急诊医师广泛使用。我们的目的是确定急诊医生解释潜在st段抬高型心肌梗死(STEMI)心电图的准确性。方法:选择36例疑似STEMI诊断的心电图。参与者被要求关注所讨论的心电图是否符合急性冠状动脉阻塞导致STEMI的诊断标准。根据冠状动脉造影,定义了准确和不准确的心电图解释的二元结果。我们计算了心电图解释的总体敏感性、特异性、准确性和95%置信区间(95% ci)。收集参与者的培训水平、工作经验和工作地点等数据。结果:135名参与者解释了4603张心电图。鉴别“真实”STEMI心电图的总体敏感性为64.5% (95%CI: 62.8-66.3);判定“假”心电图的特异性为78% (95%CI: 76-80.1)。总体准确度一般(69.1,95%CI: 67.8-70.4)。观察到主治医生、三级护理医院工作的参与者和更有经验的参与者的心电图解释准确性更高。结论:急诊医师对潜在STEMI心电图的解释准确性一般。该研究支持了这样一种观点,即用于建立STEMI诊断的ECG解释缺乏必要的敏感性和特异性,不能被认为是可靠的“独立”诊断测试。
{"title":"Emergency physician accuracy in interpreting electrocardiograms with potential ST-segment elevation myocardial infarction: Is it enough?","authors":"G. Veronese, F. Germini, S. Ingrassia, Ombretta Cutuli, V. Donati, L. Bonacchini, M. Marcucci, A. Fabbri","doi":"10.1080/17482941.2016.1234058","DOIUrl":"https://doi.org/10.1080/17482941.2016.1234058","url":null,"abstract":"Background: Electrocardiogram (ECG) interpretation is widely performed by emergency physicians. We aimed to determine the accuracy of interpretation of potential ST-segment elevation myocardial infarction (STEMI) ECGs by emergency physicians. Methods: Thirty-six ECGs resulted in putative STEMI diagnoses were selected. Participants were asked to focus on whether or not the ECG in question met the diagnostic criteria for an acutely blocked coronary artery causing a STEMI. Based on the coronary angiogram, a binary outcome of accurate versus inaccurate ECG interpretation was defined. We computed the overall sensitivity, specificity, accuracy and 95% confidence intervals (95%CIs) for ECG interpretation. Data on participant training level, working experience and place were collected. Results: 135 participants interpreted 4603 ECGs. Overall sensitivity to identify ‘true’ STEMI ECGs was 64.5% (95%CI: 62.8–66.3); specificity in determining ‘false’ ECGs was 78% (95%CI: 76–80.1). Overall accuracy was modest (69.1, 95%CI: 67.8–70.4). Higher accuracy in ECG interpretation was observed for attending physicians, participants working in tertiary care hospitals and those more experienced. Conclusion: The accuracy of interpretation of potential STEMI ECGs was modest among emergency physicians. The study supports the notion that ECG interpretation for establishing a STEMI diagnosis lacks the necessary sensitivity and specificity to be considered a reliable ‘stand-alone’ diagnostic test.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"18 1","pages":"10 - 7"},"PeriodicalIF":0.0,"publicationDate":"2016-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17482941.2016.1234058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60085686","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}
引用次数: 22
Spinal cord infarction post cardiac arrest in STEMI: A potential complication of intra-aortic balloon pump use STEMI患者心脏骤停后脊髓梗死:主动脉内球囊泵使用的潜在并发症
Pub Date : 2016-01-02 DOI: 10.1080/17482941.2016.1232411
M. Harris, G. Karamasis, Shayna Chotai, K. Tang, G. Clesham, P. Kelly
Intra-aortic balloon pump (IABP) is commonly used as a cardiac assist device in various clinical situations: cardiogenic shock, mechanical complications of acute myocardial infarction, high risk percutaneous coronary interventions, coronary artery bypass graft surgery and refractory unstable angina and ventricular arrhythmias as bridge to therapy. Although current data support its safety, there is limited or no support for its efficacy. We present the case of spinal cord infarction after IABP use in a patient who presented with ST elevation myocardial infarction and cardiac arrest and we discuss the potential mechanism of such a devastating complication.
主动脉内球囊泵(IABP)常作为心脏辅助设备用于各种临床情况:心源性休克、急性心肌梗死机械性并发症、高风险经皮冠状动脉介入治疗、冠状动脉搭桥手术以及难治性不稳定心绞痛和室性心律失常作为治疗的桥梁。虽然目前的数据支持其安全性,但对其有效性的支持有限或没有。我们报告了一例IABP使用后出现ST段抬高型心肌梗死和心脏骤停的患者脊髓梗死的病例,并讨论了这种破坏性并发症的潜在机制。
{"title":"Spinal cord infarction post cardiac arrest in STEMI: A potential complication of intra-aortic balloon pump use","authors":"M. Harris, G. Karamasis, Shayna Chotai, K. Tang, G. Clesham, P. Kelly","doi":"10.1080/17482941.2016.1232411","DOIUrl":"https://doi.org/10.1080/17482941.2016.1232411","url":null,"abstract":"Intra-aortic balloon pump (IABP) is commonly used as a cardiac assist device in various clinical situations: cardiogenic shock, mechanical complications of acute myocardial infarction, high risk percutaneous coronary interventions, coronary artery bypass graft surgery and refractory unstable angina and ventricular arrhythmias as bridge to therapy. Although current data support its safety, there is limited or no support for its efficacy. We present the case of spinal cord infarction after IABP use in a patient who presented with ST elevation myocardial infarction and cardiac arrest and we discuss the potential mechanism of such a devastating complication.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"18 1","pages":"18 - 21"},"PeriodicalIF":0.0,"publicationDate":"2016-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17482941.2016.1232411","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60086010","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}
引用次数: 4
Syncope, seizure or both? 晕厥,癫痫还是两者都有?
Pub Date : 2016-01-02 DOI: 10.1080/17482941.2016.1234056
Paraskevi Koutrolou-Sotiropoulou, Abhijeet Singh, Mason Leeman-Markowski, E. Rashba
Ictal asystole (IA) is a rare phenomenon in patients with seizures with an incidence of 0.27–0.4% and has been proposed as a possible mechanism of sudden unexpected death in epilepsy patients (SUDEP). We present a case of a 53-year-old woman who initially presented with episodes of expressive aphasia and was treated with antiepileptic drugs (AEDs). While on therapy she experienced episodes of syncope. During her hospitalization for tapering of AEDs and 24-hour EEG monitoring, the patient developed a seizure followed by sinus bradycardia and an 18-second sinus pause, resulting in loss of consciousness and slowing of cerebral activity. Ten seconds after the return of cardiac activity, the EEG showed return of cerebral activity. A dual chamber pacemaker was implanted.
骤停(IA)在癫痫发作患者中是一种罕见的现象,发生率为0.27-0.4%,已被认为是癫痫患者猝死(SUDEP)的可能机制。我们报告了一例53岁的女性,她最初表现为表达性失语发作,并接受了抗癫痫药物(AEDs)的治疗。在接受治疗期间,她有晕厥的症状。在她因aed减量和24小时脑电图监测住院期间,患者出现癫痫发作,随后出现窦性心动过缓和18秒窦性暂停,导致意识丧失和大脑活动减慢。心脏活动恢复10秒后,脑电图显示大脑活动恢复。植入双室起搏器。
{"title":"Syncope, seizure or both?","authors":"Paraskevi Koutrolou-Sotiropoulou, Abhijeet Singh, Mason Leeman-Markowski, E. Rashba","doi":"10.1080/17482941.2016.1234056","DOIUrl":"https://doi.org/10.1080/17482941.2016.1234056","url":null,"abstract":"Ictal asystole (IA) is a rare phenomenon in patients with seizures with an incidence of 0.27–0.4% and has been proposed as a possible mechanism of sudden unexpected death in epilepsy patients (SUDEP). We present a case of a 53-year-old woman who initially presented with episodes of expressive aphasia and was treated with antiepileptic drugs (AEDs). While on therapy she experienced episodes of syncope. During her hospitalization for tapering of AEDs and 24-hour EEG monitoring, the patient developed a seizure followed by sinus bradycardia and an 18-second sinus pause, resulting in loss of consciousness and slowing of cerebral activity. Ten seconds after the return of cardiac activity, the EEG showed return of cerebral activity. A dual chamber pacemaker was implanted.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"78 1","pages":"31 - 34"},"PeriodicalIF":0.0,"publicationDate":"2016-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17482941.2016.1234056","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60086130","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}
引用次数: 0
Successful drug-coated balloon angioplasty and single anti-platelet therapy to treat an ischaemic stroke patient with haemorrhage and acute coronary syndrome 药物包被球囊血管成形术和单抗血小板治疗缺血性脑卒中合并出血和急性冠状动脉综合征的成功
Pub Date : 2016-01-02 DOI: 10.1080/17482941.2016.1234054
H. Ho, K. Mok
A 55-year-old male presented with two challenging problems, i.e. acute coronary syndrome (ACS) and a major bleeding episode. He first presented with ischaemic stroke and was treated with thrombolysis. However this was complicated by haemorrhagic transformation. He subsequently developed ACS with urgent coronary angiography demonstrating a critical stenosis in the proximal left anterior descending artery. Percutaneous coronary intervention (PCI) was deemed necessary but we were mindful of causing bleeding complications from the use of anti-thrombotic therapy. Despite the complexities, we used a novel approach in terms of PCI strategy and anti-platelet regimen (drug-coated balloon angioplasty and a single anti-platelet therapy) and achieved a successful outcome.
一个55岁的男性提出了两个具有挑战性的问题,即急性冠状动脉综合征(ACS)和大出血发作。他最初表现为缺血性中风,并接受了溶栓治疗。然而,这是复杂的出血转化。他随后发展为ACS,急诊冠状动脉造影显示左前降支近端严重狭窄。经皮冠状动脉介入治疗(PCI)被认为是必要的,但我们注意到使用抗血栓治疗会引起出血并发症。尽管情况复杂,我们在PCI策略和抗血小板方案(药物包被球囊血管成形术和单一抗血小板治疗)方面采用了一种新的方法,并取得了成功的结果。
{"title":"Successful drug-coated balloon angioplasty and single anti-platelet therapy to treat an ischaemic stroke patient with haemorrhage and acute coronary syndrome","authors":"H. Ho, K. Mok","doi":"10.1080/17482941.2016.1234054","DOIUrl":"https://doi.org/10.1080/17482941.2016.1234054","url":null,"abstract":"A 55-year-old male presented with two challenging problems, i.e. acute coronary syndrome (ACS) and a major bleeding episode. He first presented with ischaemic stroke and was treated with thrombolysis. However this was complicated by haemorrhagic transformation. He subsequently developed ACS with urgent coronary angiography demonstrating a critical stenosis in the proximal left anterior descending artery. Percutaneous coronary intervention (PCI) was deemed necessary but we were mindful of causing bleeding complications from the use of anti-thrombotic therapy. Despite the complexities, we used a novel approach in terms of PCI strategy and anti-platelet regimen (drug-coated balloon angioplasty and a single anti-platelet therapy) and achieved a successful outcome.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"18 1","pages":"28 - 30"},"PeriodicalIF":0.0,"publicationDate":"2016-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17482941.2016.1234054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"60086076","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}
引用次数: 1
Assessment of safety of performing percutaneous coronary intervention after a recent episode of gastrointestinal bleeding 评估近期消化道出血后经皮冠状动脉介入治疗的安全性
Pub Date : 2016-01-02 DOI: 10.3109/17482941.2016.1174269
Saima Karim, Sweetheart T. Ador-Dionisio, M. Karim, Mohammad Karim, Sadaf S Khan, A. Atreja, S. Ellis
Background: Little literature exists on the risk of performing coronary intervention (PCI) on patients who have had recent gastrointestinal bleeding (GIB), although bleeding after PCI has been identified as a risk factor for long-term mortality. Methods: Patients within the Cleveland Clinic PCI database who had acute GIB within 30 days preceding PCI during the same hospitalization (n = 79) were retrospectively compared to those who had PCI without recent GIB (n = 10 979) for mortality and need for revascularization. Baseline characteristics, laboratory values, procedures, morbidities, and mortality were compared using chi-square test for categorical variables and using Wilcoxon rank sum test for continuous variables. Mortality data was obtained using Social Security Death Index and demonstrated using Kaplan–Meier method. Results: The GIB group had more prevalent history of peptic ulcer disease, GIB, gastrointestinal or liver disease (P < 0.0001), transient ischemic accident (P = 0.017), peripheral vascular disease (P = 0.0002), significant carotid artery occlusion (P = 0.023), and myocardial infarction (P < 0.0001). 47% of patients had upper GIB with 20% needing endoscopic intervention. This group had more anemia (P < 0.0001), heart failure (P = 0.0001), cardiogenic shock (10% versus 1.4%, P < 0.001), cardiac arrest (7.6% versus 1%, P < 0.001). GIB group had worse in-hospital mortality (P < 0.0001), long-term mortality (P < 0.001), and a 7.6% re-bleeding incidence. Conclusions: Overall, the patients who had GIB preceding PCI had higher in-hospital mortality and long-term mortality compared with those without GIB before PCI.
背景:尽管PCI术后出血已被确定为长期死亡的危险因素,但关于近期胃肠道出血患者行冠状动脉介入治疗(PCI)风险的文献很少。方法:回顾性比较克利夫兰诊所PCI数据库中同一住院期间PCI术前30天内发生急性GIB的患者(n = 79)与近期未发生GIB的PCI患者(n = 10979)的死亡率和血管重建术需求。对分类变量使用卡方检验,对连续变量使用Wilcoxon秩和检验,比较基线特征、实验室值、程序、发病率和死亡率。死亡率数据采用社会安全死亡指数(Social Security Death Index)获取,并采用Kaplan-Meier法进行论证。结果:GIB组消化性溃疡、GIB、胃肠道或肝脏疾病(P < 0.0001)、短暂性脑缺血意外(P = 0.017)、外周血管疾病(P = 0.0002)、颈动脉明显闭塞(P = 0.023)、心肌梗死(P < 0.0001)病史更为普遍。47%的患者有上GIB, 20%的患者需要内镜干预。该组贫血(P < 0.0001)、心力衰竭(P = 0.0001)、心源性休克(10%比1.4%,P < 0.001)、心脏骤停(7.6%比1%,P < 0.001)较多。GIB组住院死亡率(P < 0.0001)、长期死亡率(P < 0.001)较低,再出血发生率为7.6%。结论:总体而言,PCI前有GIB的患者与PCI前无GIB的患者相比,住院死亡率和长期死亡率更高。
{"title":"Assessment of safety of performing percutaneous coronary intervention after a recent episode of gastrointestinal bleeding","authors":"Saima Karim, Sweetheart T. Ador-Dionisio, M. Karim, Mohammad Karim, Sadaf S Khan, A. Atreja, S. Ellis","doi":"10.3109/17482941.2016.1174269","DOIUrl":"https://doi.org/10.3109/17482941.2016.1174269","url":null,"abstract":"Background: Little literature exists on the risk of performing coronary intervention (PCI) on patients who have had recent gastrointestinal bleeding (GIB), although bleeding after PCI has been identified as a risk factor for long-term mortality. Methods: Patients within the Cleveland Clinic PCI database who had acute GIB within 30 days preceding PCI during the same hospitalization (n = 79) were retrospectively compared to those who had PCI without recent GIB (n = 10 979) for mortality and need for revascularization. Baseline characteristics, laboratory values, procedures, morbidities, and mortality were compared using chi-square test for categorical variables and using Wilcoxon rank sum test for continuous variables. Mortality data was obtained using Social Security Death Index and demonstrated using Kaplan–Meier method. Results: The GIB group had more prevalent history of peptic ulcer disease, GIB, gastrointestinal or liver disease (P < 0.0001), transient ischemic accident (P = 0.017), peripheral vascular disease (P = 0.0002), significant carotid artery occlusion (P = 0.023), and myocardial infarction (P < 0.0001). 47% of patients had upper GIB with 20% needing endoscopic intervention. This group had more anemia (P < 0.0001), heart failure (P = 0.0001), cardiogenic shock (10% versus 1.4%, P < 0.001), cardiac arrest (7.6% versus 1%, P < 0.001). GIB group had worse in-hospital mortality (P < 0.0001), long-term mortality (P < 0.001), and a 7.6% re-bleeding incidence. Conclusions: Overall, the patients who had GIB preceding PCI had higher in-hospital mortality and long-term mortality compared with those without GIB before PCI.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"18 1","pages":"1 - 6"},"PeriodicalIF":0.0,"publicationDate":"2016-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17482941.2016.1174269","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69458215","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}
引用次数: 2
Intrathecal baclofen withdrawal: A rare cause of reversible cardiomyopathy* 鞘内巴氯芬戒断:可逆性心肌病的罕见病因*
Pub Date : 2016-01-02 DOI: 10.3109/17482941.2016.1174273
Stephen O Awuor, Paul M. Kitei, Y. Nawaz, Amy M. Ahnert
Baclofen is commonly used to treat spasticity of central etiology. Unfortunately, a potentially lethal withdrawal syndrome can complicate its use. This is especially true when the drug is administered intrathecally. There are very few cases of baclofen withdrawal leading to reversible cardiomyopathy described in the literature. The authors present a patient with a history of chronic intrathecal baclofen use who, in the setting of acute baclofen withdrawal, develops laboratory, electrocardiogram, and echocardiogram abnormalities consistent with cardiomyopathy. Upon reinstitution of intrathecal baclofen, the cardiomyopathy and associated abnormalities quickly resolve. Although rare, it is crucial to be aware of this reversible cardiomyopathy to ensure its prompt diagnosis and treatment.
巴氯芬常用于治疗中枢病因性痉挛。不幸的是,一种潜在的致命戒断综合症会使其使用复杂化。在鞘内给药时尤其如此。文献中很少有巴氯芬停药导致可逆性心肌病的病例。作者报告了一位有慢性鞘内巴氯芬使用史的患者,在急性巴氯芬戒断的情况下,出现了与心肌病一致的实验室、心电图和超声心动图异常。重新使用鞘内巴氯芬后,心肌病和相关异常迅速消退。虽然罕见,但了解这种可逆性心肌病以确保其及时诊断和治疗至关重要。
{"title":"Intrathecal baclofen withdrawal: A rare cause of reversible cardiomyopathy*","authors":"Stephen O Awuor, Paul M. Kitei, Y. Nawaz, Amy M. Ahnert","doi":"10.3109/17482941.2016.1174273","DOIUrl":"https://doi.org/10.3109/17482941.2016.1174273","url":null,"abstract":"Baclofen is commonly used to treat spasticity of central etiology. Unfortunately, a potentially lethal withdrawal syndrome can complicate its use. This is especially true when the drug is administered intrathecally. There are very few cases of baclofen withdrawal leading to reversible cardiomyopathy described in the literature. The authors present a patient with a history of chronic intrathecal baclofen use who, in the setting of acute baclofen withdrawal, develops laboratory, electrocardiogram, and echocardiogram abnormalities consistent with cardiomyopathy. Upon reinstitution of intrathecal baclofen, the cardiomyopathy and associated abnormalities quickly resolve. Although rare, it is crucial to be aware of this reversible cardiomyopathy to ensure its prompt diagnosis and treatment.","PeriodicalId":87385,"journal":{"name":"Acute cardiac care","volume":"18 1","pages":"13 - 17"},"PeriodicalIF":0.0,"publicationDate":"2016-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3109/17482941.2016.1174273","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69458221","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}
引用次数: 2
期刊
Acute cardiac care
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1