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A patient with pulseless ST elevation myocardial infarction caused by a very late stent thrombosis 无脉ST段抬高型心肌梗死1例,由晚期支架血栓形成所致
Pub Date : 2022-09-24 DOI: 10.29328/journal.jccm.1001138
Satoda Masahiko, Yusa Hiroaki
Background: Persistent contrast staining is highly associated with stent thrombosis. Case summary: A 75-year-old woman presented with new-onset effort angina. A coronary angiogram revealed a 90% blockage of the distal left main trunk (LMT) and a 99% blockage of the ostial left anterior descending coronary artery (LAD). A 3.0 × 18-mm CYPHER™ the stent had previously been implanted into the dominant proximal circumflex artery (LCx) in 2009 because of unstable angina. The patient developed pulseless ST elevation myocardial infarction after the withdrawal of antiplatelet therapy before a scheduled CABG. The patient recovered with VA-ECMO and PCI using aspiration thrombectomy and urgent CABG. Discussion: This case highlighted that a preoperative patient may develop thrombosis at a previous stent site with peri-stent contrast staining and withdrawal of an antiplatelet regimen in certain settings poses an imminent risk for preoperative deterioration. A bridging strategy using intravenous PY12 inhibitor before CABG should be considered in this setting. The revascularization strategy should be selected based on coronary anatomy, hemodynamic status and baseline risk for CABG. A hybrid revascularization approach should be considered in this patient population.
背景:持续性对比染色与支架内血栓形成高度相关。病例总结:一名75岁女性,新发心绞痛。冠状动脉造影显示左主干远端90%阻塞,左冠状动脉左前降支(LAD)口99%阻塞。3.0 × 18 mm CYPHER™支架曾于2009年因不稳定型心绞痛植入优势旋近动脉(LCx)。患者在CABG术前停止抗血小板治疗后发生无脉ST段抬高型心肌梗死。患者通过VA-ECMO和PCI吸入性取栓和紧急冠脉搭桥恢复。讨论:该病例强调术前患者可能在支架周围造影剂染色的先前支架部位发生血栓形成,并且在某些情况下停用抗血小板方案会导致术前恶化的迫在眉睫的风险。在这种情况下,应考虑在冠脉搭桥前静脉注射PY12抑制剂的桥接策略。应根据冠状动脉解剖、血流动力学状况和CABG基线风险来选择血运重建策略。在这类患者中应考虑混合型血运重建术。
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引用次数: 0
Telemedicine in very elderly patients affected by end-stage Heart Failure: Wishful thinking or real opportunity? 远程医疗在高龄终末期心力衰竭患者中的应用:一厢情愿还是真正的机会?
Pub Date : 2022-09-15 DOI: 10.17352/2455-2976.000182
Mancinelli L, Mazzanti M, Antonicelli R
Telemedicine is a network of computerization and telecommunication technologies that provides health care services to remote patients. There is increasing evidence that telemedicine interventions are associated with a reduction in hospital admission rates and mortality in patients with heart failure [1,2].
远程医疗是一种计算机化和电信技术的网络,为远程患者提供卫生保健服务。越来越多的证据表明,远程医疗干预与降低心力衰竭患者的住院率和死亡率有关[1,2]。
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引用次数: 0
Cardiac arrest due to intentional yew tree (Taxus baccata) ingestion 心脏骤停,由于故意摄取红豆杉(红豆杉)
Pub Date : 2022-09-13 DOI: 10.17352/2455-2976.000181
Ochijewicz Dorota, Fojt Anna, Zieniewicz Jakub, Kowalik Robert
A 22-year-old woman with a history of bulimia, depression, and one suicidal attempt was admitted to the Emergency Department (ED) after out of hospital cardiac arrest. Her co-workers were proceeding with basic life support with an automated external defibrillator. After the arrival of the emergency service, advanced life support proceeded and ventricular fibrillation was the first rhythm recorded.
一名22岁的女性,有暴食症、抑郁症和一次自杀企图的病史,在院外心脏骤停后被送入急诊科。她的同事正在使用自动体外除颤器进行基本的生命支持。在紧急服务到达后,进行了高级生命支持,心室颤动是第一个记录的心律。
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引用次数: 0
Does global longitudinal strain improve stratification risk in heart failure with preserved ejection fraction? 整体纵向应变是否能提高保留射血分数的心力衰竭患者分层风险?
Pub Date : 2022-09-08 DOI: 10.29328/journal.jccm.1001137
Haddad Assia, Guerchani Mohamed Karim, Bessi Nadia Ould, Djermane Dalila, Mokhtar Omar Ait, Himeur Hakim, Benkhedda Salim
Background: Heart Failure with Preserved Ejection Fraction (HFPEF) accounts for more than half of the cases of heart failure. Long regarded as an abnormality of left ventricular diastolic function, recent studies using longitudinal strain (two-dimensional speckle tracking mode) have suggested that left ventricular longitudinal systolic function is altered in HFPEF. Despite these interesting pathophysiological perspectives, the data in the literature on the prognostic value of the alteration of longitudinal strain are controversial. Given these conflicting results, it is difficult to confirm the magnitude and prevalence of impaired LV longitudinal systolic function in patients with HFPEF and its prognostic relevance. Purposes: This work aims to study the prognostic value of Global the left ventricle’s Global Longitudinal Strain (GLS) Algerian cohort of patients with HFPEF. Patients and methods: We conducted a monocentric prospective observational study from April 2018 to April 2020, with a minimum follow-up of 1 year for each recruited patient. We included patients over the age of 18 referred to the echocardiography laboratory for chronic or acute HFpEF, defined according to the criteria of ESC 2016. 153 consecutive patients underwent clinical examination, biological tests, and echocardiography with measurement of GLS at rest, in addition to routine management by the attending physicians. Results: 153 patients were collected. The average age of our patients is 73 +/- 11 years ranging from 42 to 91 years old. The female population is predominant with a rate of 67%. Comorbidities are predominant mainly by arterial hypertension (86%) and diabetes (64%), with a history of atrial fibrillation (46%). 63% of patients have impaired GLS (< 16%). Contrary to our hypothesis, GLS was not shown to be a powerful predictor of cardiovascular events in HFPEF patients either in dichotomous analysis (OR = 0.79; p = 0.64) or in continuous analysis (OR = 0.97; p = 0.69).We were able to identify that congestive venous signs, anemia, and pulmonary hypertension, are the main independent prognostic factors in our Algerian population study. Conclusion: We were unable to demonstrate the prognostic role of mpaired GLS in our population of patients with HFPEF.
背景:心力衰竭伴保留射血分数(HFPEF)占心力衰竭病例的一半以上。长期以来,HFPEF一直被认为是左室舒张功能异常,最近使用纵向应变(二维斑点跟踪模式)的研究表明,HFPEF的左室纵向收缩功能发生了改变。尽管有这些有趣的病理生理学观点,但文献中关于纵向应变改变的预后价值的数据存在争议。鉴于这些相互矛盾的结果,很难确认HFPEF患者左室纵向收缩功能受损的程度和患病率及其预后相关性。目的:本研究旨在研究HFPEF患者的全局左心室纵向应变(GLS)阿尔及利亚队列的预后价值。患者和方法:我们于2018年4月至2020年4月进行了一项单中心前瞻性观察性研究,每位入选患者至少随访1年。我们纳入了根据ESC 2016标准定义的18岁以上的慢性或急性HFpEF超声心动图实验室患者。153名连续患者接受了临床检查、生物学检查和超声心动图检查,并在静息时测量GLS,此外还接受了主治医生的常规管理。结果:共收集患者153例。患者平均年龄73±11岁,42 ~ 91岁。女性人口占主导地位,发病率为67%。合并症主要是动脉高血压(86%)和糖尿病(64%),并有心房颤动史(46%)。63%的患者GLS受损(< 16%)。与我们的假设相反,无论是在二分类分析中,GLS都没有被证明是HFPEF患者心血管事件的有力预测因子(OR = 0.79;p = 0.64)或连续分析(or = 0.97;P = 0.69)。我们能够确定充血性静脉征象、贫血和肺动脉高压是阿尔及利亚人口研究中主要的独立预后因素。结论:我们无法证明GLS受损在HFPEF患者群体中的预后作用。
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引用次数: 0
Ethical problems in pediatric cardiology 儿科心脏病学中的伦理问题
Pub Date : 2022-09-08 DOI: 10.17352/2455-2976.000180
T. Jurko, A. Jurko, M. Mestanik, M. Minárik, M. Zibolen
The authors discuss new ethical problems associated with the use of modern diagnostic and therapeutic modalities in pediatric cardiology. They underline the role of pediatric cardiologists in the process of approaching specific ethical problems. In the assessment of specific medical problems, authors pay greater attention to ethical principles of beneficence and nonmaleficence, which continue to be problematic areas in pediatric cardiology.
作者讨论新的伦理问题与使用现代诊断和治疗方式在儿科心脏病学。他们强调儿科心脏病专家在处理特定伦理问题过程中的作用。在具体的医疗问题的评估中,作者更加注重慈善和无害的伦理原则,这仍然是儿科心脏病学中有问题的领域。
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引用次数: 0
An empirical study on factors responsible for Rheumatic Heart Disease (RHD) and its severity levels amongst the Bhutanese populace 不丹人群风湿性心脏病发病因素及其严重程度的实证研究
Pub Date : 2022-08-30 DOI: 10.29328/journal.jccm.1001136
Lhendup Karma, Penjore Yeshey
Background and objectives: This paper is aimed at excavating the factors responsible for RHD events and vis-à-vis establishing severity levels of RHD patients referred to Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu’s capital city of Bhutan. Methods: By taking notorious advantage of the data gathered over the past five years (2016-2020) from RHD patients across 20 districts of Bhutan, about 232 RHD patients are involved in this study recorded in JDWNRH by the Cardiology Department. Besides descriptive methods, multivariate linear regression models augmented by the multinomial logistic regression models had been applied to establish the causual links. Results: The findings revealed that RHD prevailed amongst the young populace of Bhutan, especially females. Variables like age, frequency of visits, number of diagnostics, levels of education and region had been found as predictors of RHD prevalence. Other socio-demographic factors like occupation and status of employment did not affect the RHD prevalence. The multinomial logistic regression results indicated that higher levels of education as an important factor for not making the patient fall into the category of ‘severe.’ Age has been constantly found to be a highly significant variable contributing to RHD events and a quadratic relationship is revealed between age and the severity of RHD. Conclusion and implications for translation: This study pigeonholed the significant factors responsible for RHD events and entailed severity levels by gender and age. The findings of this study also provide additional important insights into developing public health policies and programs.
背景和目的:本文旨在挖掘导致RHD事件的因素,并在-à-vis建立在不丹首都廷布的吉格梅多吉旺楚克国家转诊医院(JDWNRH)转诊的RHD患者的严重程度。方法:利用过去5年(2016-2020年)从不丹20个地区的RHD患者收集的数据,心脏病科在JDWNRH中记录了约232名RHD患者。除描述性方法外,还采用多项逻辑回归模型增强的多元线性回归模型来建立因果联系。结果:研究结果显示,RHD在不丹的年轻人群中普遍存在,尤其是女性。年龄、就诊频率、诊断次数、教育水平和地区等变量被发现是RHD患病率的预测因素。其他社会人口因素如职业和就业状况对RHD患病率没有影响。多项logistic回归结果表明,较高的教育程度是患者不属于“严重”类别的重要因素。“年龄一直被发现是影响RHD事件的一个非常重要的变量,年龄和RHD的严重程度之间呈二次关系。”结论和翻译意义:本研究划分了RHD事件的重要因素,并按性别和年龄划分了严重程度。这项研究的发现也为制定公共卫生政策和项目提供了额外的重要见解。
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引用次数: 0
A rare form of complex cardiac anomaly 一种罕见的复杂心脏异常
Pub Date : 2022-08-30 DOI: 10.17352/2455-2976.000179
Kritika Kritika, Sharma Rajaram, Tiwari Tapendra, Goyal Saurabh
Congenital corrected Transposition Of Great Arteries (TGA) is one of the rarest complex cardiac anomalies, comprising 1% of Congenital Heart Disease (CHD) and 20% of cases of fetal TGA [1,2]. It is characterized by an atrioventricular discordance with a concurrent ventricular-arterial discordance. Its features include the aorta, which arises from the left-sided morphologic right ventricle, anterior and left of the pulmonary artery.
先天性纠正性大动脉转位(TGA)是最罕见的复杂心脏异常之一,占先天性心脏病(CHD)的1%,占胎儿TGA的20%[1,2]。它的特征是房室不一致并伴有室动脉不一致。它的特征包括主动脉,起源于左侧形态的右心室,肺动脉的前部和左侧。
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引用次数: 0
Clinical utility of intracardiac echocardiography in transvenous lead extraction 心内超声心动图在经静脉铅提取中的临床应用
Pub Date : 2022-08-04 DOI: 10.29328/journal.jccm.1001135
Kautzner Josef, Skala Tomas, F. Marian, Wünschová Hanka, Taborsky Milos
Despite some good experience with the rotational ultrasound-tipped catheters [7,8], this technology has limited maneuverability and depth of imaging. On the contrary, phased-array systems are very versatile and provide the whole spectrum of 2D images, including color-coded or pulsed wave Doppler. Besides, they allow adjustment of ultrasound frequency to optimize imaging quality. For all these advantages, phased-array ICE has become the dominant imaging modality in the EP laboratory.
尽管在旋转超声尖端导管方面有一些良好的经验[7,8],但该技术的可操作性和成像深度有限。相反,相控阵系统是非常通用的,并提供全光谱的二维图像,包括彩色编码或脉冲波多普勒。此外,他们允许调整超声频率,以优化成像质量。由于所有这些优点,相控阵ICE已成为EP实验室的主要成像方式。
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引用次数: 1
Chaos, resistant and pseudoresistant hypertension “Thousands of butterflies in the BP control system” “血压控制系统中的万千蝴蝶”
Pub Date : 2022-07-29 DOI: 10.17352/2455-2976.000177
Yugar-Toledo Juan Carlos, Dinamarco Nelson, Rodrigues Bruno, Moreno Heitor
In Cardiology, we classify hypertensive patients as resistant to treatment, pseudo-resistant, or hyperreactivity subjects, including the WCH (white-coat or masked hypertension). Compliance is another cause of failure in antihypertensive therapy. Hypertension is a complex clinical syndrome and many variables that interfere in BP depend on “The Theory of Chaos” and are not considered. We do not know how many variations the Chaos on BP levels can be. Still, as we have around 30% of “uncontrolled” patients, the Chaos and effects on BP regulation as taking part in this high rates of “uncontrolled” subjects. Chaos is a complicated issue to study, but multi-professional efforts must keep the attention to this relevant “cause” of hypertension. Finally, Chaos theory is well known and accepted in Maths, Economy, Philosophy, Meteorology, Ecology, and other areas of knowledge, but not in the Health area. Crescent attention to Chaos may help better understand some mechanisms and clinical expression of Chaos in pseudo-resistant hypertension and correlated hypertensive syndromes.
在心脏病学中,我们将高血压患者分为耐药、伪耐药或高反应性受试者,包括WCH(白大褂或蒙面高血压)。依从性是抗高血压治疗失败的另一个原因。高血压是一种复杂的临床综合征,许多干扰血压的变量依赖于“混沌说”而未被考虑。我们不知道混沌在BP水平上会有多少变化。尽管如此,由于我们有大约30%的“不受控制”的病人,混乱和对血压调节的影响参与了高比例的“不受控制”的受试者。混沌是一个复杂的研究问题,但多专业的努力必须保持对高血压的相关“原因”的关注。最后,混沌理论在数学、经济、哲学、气象学、生态学和其他知识领域众所周知,但在卫生领域却不被接受。对混沌的关注可能有助于更好地理解混沌在假性抵抗性高血压及相关高血压综合征中的一些机制和临床表现。
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引用次数: 1
Prospective geo-modeling in cardiac surgery with extra-corporeal circulation-partial assessment at the Lille University Hospital 里尔大学医院体外循环部分评估心脏手术的前瞻性地理建模
Pub Date : 2022-07-28 DOI: 10.17352/2455-2976.000178
Quesnel-Barbet Anne, Soula Julien, Albert Frédéric, Hansske Arnaud, Maignant Gilles
Faced with the imminent opening of the new competing “Lens/Bois-Bernard” care unit in the Nord - Pas-de-Calais region (4 million inhabitants), a prospective modeling study was carried out in 1999 in response to a request from the Lille University Hospital (LUH), which sought to estimate the positive or negative impact on its recruitment catchment areas and consequently on its 1996 cardiac surgery activity (comprising 2 care units, i.e., 84 beds). In 1996, only 3 care units with the “Clinique du Bois” in Lille showed our regional undersupply of cardiac surgery compared to the national average of 5.96 [1,2].
面对即将在北加莱海峡地区(400万居民)开设新的竞争性" Lens/Bois-Bernard "护理单位,应里尔大学医院(LUH)的要求,于1999年进行了一项前瞻性模型研究,该研究试图估计对其招聘集水区的积极或消极影响,从而对其1996年心脏手术活动(包括2个护理单位,即84张病床)的影响。1996年,里尔只有3家拥有“波依斯诊所”的护理单位出现心脏手术供应不足,而全国平均水平为5.96家[1,2]。
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引用次数: 0
期刊
Journal of cardiology and cardiovascular medicine
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