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Coronary Artery Disease
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
The diagnosis of acute MI starts with initial and serial ECG. Then, serial measurements of cardiac biomarkers help to identify the subtype of MI that is present, or distinguish between these and unstable angina. Additionally, urgent cardiac catheterization is needed for some patients. An ECG is crucial for diagnosis, and must be done within 10 minutes of the patient’s arrival. An initial ECG usually reveals an ST-segment elevation. If possible, emergency coronary angiography and PCI are performed very soon after the onset of an acute MI.
Acute coronary syndromes
Published in Henry J. Woodford, Essential Geriatrics, 2022
Patients may require transfer to a centre that can provide PCI. Ideally, STEMI is diagnosed pre-hospital and the initial ambulance transfer is to a PCI centre. To achieve this, an ECG must be performed at first contact with a healthcare professional. Trans-radial access for PCI is preferred due to lower local bleeding risk. Coronary stenting, with drug-eluting stents, is recommended rather than angioplasty.12 A parenteral anticoagulant, such as unfractionated heparin, is used around the time of the procedure. Initial post-procedure management should be on a coronary care unit. If PCI fails, for example, due to unsuitable vascular anatomy, then emergency surgical coronary artery bypass grafting may be considered. Older age is associated with increased coronary artery calcification, which increases the risk of complications such as artery dissection and stent thrombosis. Older people also tend to have more extensive arterial disease. Renal impairment increases the risk of adverse effects with the contrast used during PCI.
Cardiac Diagnostic Testing in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
The electrocardiogram (ECG) is often one of the initial diagnostic modalities performed in pregnant women with suspected heart disease. The ECG is helpful in identifying conditions such as myocardial infarction, arrhythmia, and PE. During normal pregnancy there may be some subtle changes in the ECG, such as shortening of the PR and QT intervals, left axis deviation [5], and nonspecific ST-T wave changes in the left precordial leads [16].
The correlation between T-wave abnormalities and adverse cardiovascular events and echocardiographic changes in hypertensive patients
Published in Clinical and Experimental Hypertension, 2023
Shengnan Liu, Chao Zhang, Jing Wan
An increasing number of studies have observed the changes in cardiac structure and function as well as the occurrence of long-term adverse cardiovascular events in hypertensive patients. Therefore, effective diagnostic methods are essential for timely prevention and treatment of MACE in hypertensive patients. ECG has long been used as an important auxiliary clinical examination for various forms of heart disease in many areas of medical practice due to its simple clinical operation and high safety. The most common minor ECG abnormalities were abnormal T-wave inversion and minor isolated ST abnormalities(11). Patients with minor nonspecific ST-segment and T-wave abnormalities on ECG may benefit from annual ECG to refine risk estimates for future CVD and coronary heart disease (CHD) events (12–14).
Angina due to coronary artery spasm (variant angina): diagnosis and intervention strategies
Published in Expert Review of Cardiovascular Therapy, 2021
Thanh Ha Nguyen, Gao-Jing Ong, Olivia C Girolamo, Viviane De Menezes Caceres’, Armin Muminovic, Yuliy Y Chirkov, John D Horowitz
Clinical descriptions of symptoms, ECG changes, and outcomes in patients with angina pectoris considerably antedated the widespread utilization of coronary angiography, and therefore initial observations focused on clinical changes, with speculation about pathogenesis. In his now-classical observations about angina pectoris, William Heberden [2] referred to cases of angina occurring predominantly at rest, but did not describe such cases in detail. In 1959, Prinzmetal et al. [1] described three cases of what they termed as ‘a variant form of angina,’ characterized by episodes of angina occurring entirely at rest, with normal exercise tolerance: they also mentioned that they had personally observed a total of 20 cases. All of the patients were middle-aged men. All cases showed episodes of transient S-T segment elevation on ECG during pain, but in all cases, there were also episodes of pain without obvious ECG changes. One patient showed evidence of impaired responsiveness to sublingual nitroglycerin (NTG), consuming up to 50 tablets per day. One patient later died, and at postmortem examination there was evidence of extensive coronary atheroma. Thus, it was assumed that this ‘variant’ pattern of pain arose, like that of classical angina, from the obstructive effects of coronary atherogenesis.
Safety of FLT3 inhibitors in patients with acute myeloid leukemia
Published in Expert Review of Hematology, 2021
Claudio Cerchione, Andrés Peleteiro Raíndo, Adrián Mosquera Orgueira, Alicia Mosquera Torre, Laura Bao Pérez, Giovanni Marconi, Alessandro Isidori, Manuel Mateo Pérez Encinas, Giovanni Martinelli
Midostaurin has to be interrupted if a QTc interval > 500 ms is detected during therapy. In case that the QTc interval is between 470 and 500 ms, midostaurin has to be reduced to 50 mg qod. Midostaurin can be restarted to the original dose if the QTc interval is ≤470 ms at the starting point of the next cycle [11]. For this reason, an electrocardiogram (ECG) is necessary before starting treatment with midostaurin and periodic monitoring of electrolytes (potassium, magnesium, calcium) and ECGs should be performed during treatment. No dosage adjustment is necessary in patients with mild or moderate renal impairment. Among patients with severe renal impairment, clinical experience is limited and there is no data in patients with end-stage renal disease. In a similar way, no dose adjustment is necessary in patients with mild or moderate hepatic impairment (Child-Pugh A or B), but no experience exists in patients with severe hepatic impairment [11] (Table 2).