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A multidisciplinary problem
Published in Olaf Dammann, Etiological Explanations, 2020
Etiological explanation is telling the story of illness occurrence at either the personal or the population level. At the personal level, the story is about the sequence of events, a detailed list of causal and pathomechanistic facts or events that occurred in a specific order and that culminated in the onset of illness. One example of such a sequence is the “chain of events” listed on death certificates; for example, death is the “onset of illness” to be explained, atherosclerotic coronary artery disease is the “underlying cause of death” that led to the “immediate cause of death” (rupture of myocardium) via inducing a thrombosis in the coronary artery with subsequent acute myocardial infarction. Taken as an etiological explanation, the sequence from thrombosis to myocardial rupture can be thought of as the pathomechanism that connects the underlying cause (atherosclerosis) with the death of the individual.
Therapy of acute myocardial infarction
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Joshua M. Stolker, Michael W. Rich
Impending myocardial rupture is occasionally heralded by persistent vague chest discomfort or unexplained hypotension, but sudden hemodynamic deterioration, new or worsening HF, or asystolic cardiac arrest may be the first indication of the rupture (213). The presence of a new systolic murmur, particularly in association with hemodynamic deterioration, strongly suggests the possibility of papillary muscle dysfunction or ventricular septal perforation, and prompt Doppler echocardiography should be performed (16). Pulmonary artery catheterization can provide definitive confirmation of a septal perforation by demonstrating an oxygen saturation step-up of greater than 10% at the level of the shunt (usually the right ventricle), or an elevated V wave in the pulmonary capillary wedge pressure waveform suggesting acute mitral regurgitation.
Cardiogenic Shock
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
The three categories of myocardial rupture following MI have unique presentations and usually require surgery for survival. The time course of these complications post-MI has a bimodal distribution with an occurrence that typically happens within 3-5 days but can occur up to 2 weeks postinfarction (Table 34.2).
Heart of lymphoma: a case report
Published in Acta Cardiologica, 2023
Annemie Jacobs, Thomas Gevaert, Wim Volders, Dieter De Cleen, Katrien Van Kolen, Frank Cools, Steven Hellemans
The current standard of treatment of a mediastinal DLBCL is rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). When there is septal involvement by DLBCL, complete heart block can be seen [8]. Given the risk of myocardial rupture during the chemotherapy treatment, close monitoring is necessary. Furthermore, DLBCL tumours localised to the heart can also be treated with radiotherapy [5]. Utility of surgery or extracorporeal membrane oxygenation (ECMO) in this patient population can address immediate hemodynamic instability but is high risk and not standard or care. Surgical resection is only possible at early stages of disease. Furthermore, surgery can also be palliative to help correct hemodynamics and improve blood flow to the lungs in the case of right ventricle outflow obstruction [1]. In this case, treatment options were discussed with the patient and his family members, and comfort care was preferred.
In vivo and in vitro protective effects of shengmai injection against doxorubicin-induced cardiotoxicity
Published in Pharmaceutical Biology, 2022
Peng Zhou, Ge Gao, Chun-chun Zhao, Jing-ya Li, Jian-fei Peng, Shu-shu Wang, Rui Song, Hui Shi, Liang Wang
DOX is an effective antitumor anthracycline that is widely used to treat ovarian cancer, breast cancer, prostate cancer, hepatocellular carcinoma, and acute lymphoblastic leukaemia. Due to dose-dependent and irreversible cardiac damage, atrial and ventricular arrhythmia, and heart failure, its clinical application is limited (Modesto et al. 2021). Chest pain, palpitations, abnormal electrocardiogram, decreased left ventricular ejection fraction, and alterations in the myocardial enzyme spectrum are all clinical symptoms of DOX-induced cardiotoxicity (Sadek et al. 2020; Che et al. 2021). Therefore, the acute cardiotoxicity rat model induced by DOX can be used in this study. Currently, a large dose of one-time injection of DOX can induce acute cardiotoxicity in rat models, and DOX (15 mg/kg) was injected in a single dose. The results showed that the rats myocardial rupture, disordered arrangement, myocyte sarcoplasmic dissolved, fibroblasts increased accompanied by inflammatory cells infiltration, myocardial enzyme changes, conform to the pathological physiology characteristic of myocardial injury caused by DOX, which showed that the rat model and the choice of the observation time is feasible, can be used in the evaluation of myocardial injury caused by drug prevention and treatment of DOX. Meanwhile, DOX-induced pathological changes in model rats' cardiac tissue, including necrosis, apoptosis, and interstitial fibrosis, and serum CK and LDH levels were dramatically elevated, meeting clinical diagnostic criteria, showing that the model was successfully prepared.
Myocardial Infarction Due to Coronary Artery Injury following High Force Blunt Trauma to the Upper Chest: A Case Illustrating the Prehospital, Hospital and Autopsy Findings
Published in Prehospital Emergency Care, 2020
Sophie A. Stanley, Matthew Woods, Guy N. Rutty
Given the rarity of the condition, the presentation, management and underlying pathological mechanism remain poorly understood. It is therefore challenging in the prehospital environment to separate this diagnosis from other cardiovascular differentials that may result from BCT, for example myocardial rupture, cardiac tamponade, myocardial contusion and aortic dissection (4). The prehospital clinician may face further difficulties in relation to the diagnosis and management of MI due to the co-existence of additional non-cardiac thoracic injuries. In the prehospital phase the clinician faces competing resuscitation goals in the context of this mixed presentation and is disadvantaged by the lack of available imaging. However, recognition of or indeed suspicion of myocardial injury may prompt the prehospital practitioner to transport to and alert the most appropriate hospital.