China
Africa
Explore chapters and articles related to this topic
Vascular Trauma
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
Patient's ECG shows ST depression, and this is quickly followed by a transient episode of loss of consciousness associated with a ventricular pause …. What now? The A&E consultant does a rapid finger thoracostomy in the left chest and the patient rapidly improves and wakes up again.
Thoracic Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Post-pericardiotomy syndrome (Dressler’s syndrome) is infrequent. Symptoms include low-grade fever and chest pain and the diagnosis is confirmed by ST elevation in most, if not all leads, without reciprocal ST depression. Treatment consists of aspirin or non-steroidal anti-inflammatory medications.
Risk stratification in acute coronary syndromes
Published in K Sarat Chandra, AJ Swamy, Acute Coronary Syndromes, 2020
Avanti Gurram Reddy, Gianluca Rigatelli, Ramesh Daggubati
Stress testing is crucial to predict recurrent ischaemic events and revascularisation protocol for uncomplicated MI as it adds value for pre-discharge risk stratification. ST depression, higher exertional intolerance, arrhythmias and failure of BP to rise during exercise are the usual abnormalities. A normal stress test usually would not require additional investigations, but an abnormal test has a more negative predictive value for post-MI mortality in the first year [6]. A stress test corresponds to reversible thallium perfusion defects and is cost effective.
Dobutamine stress echocardiography in patients with moderate coronary artery disease detected by coronary computed tomography angiography could reduce the rate of unnecessary coronary angiography
Published in Acta Cardiologica, 2022
Claudiu Ungureanu, Daniela Corina Mirica, Olivier Marcovitch, Auriane Ceulemans, Olivier Godefroid, Gregory Nicaise, Antoine de Meester, Phillipe Van de Borne
DSE was successfully performed in all 49 patients. Good quality images were obtained in most patients 41 (83.6%), contrast agent was used in 8 patients (16.4%) with suboptimal echocardiographic images defined as more than 3 segments with poor endocardial border definition. Of the patients 38 (77%) attained at least 85% of their maximal heart rate, 11 (33%) attained maximal heart rate of 100%. Atropine was used in 26 patients (53%) in order to attain at least 85% of age predicted maximal heart rate. In 22 (44.89%) patients DSE was interrupted due to contractility changes suggestive of myocardial ischaemia. ECG changes were observed as ST depression in 10 patients, arrhythmias such as isolated ectopic ventricular beats were recorded in 3 patients, chest pain was reported in 12 patients. No severe side effects or complications were reported. The chest pain was reversible by stopping the dobutamine infusion and after beta-blockers and nitrates administration.
Exercise-induced ST depression in an asymptomatic population without coronary artery disease
Published in Scandinavian Cardiovascular Journal, 2019
Anna Carlén, Mikael Gustafsson, Meriam Åström Aneq, Eva Nylander
The clinical significance of exercise-induced ST segment deviations in apparently healthy subjects has been under debate for several decades. An increase in long-term risk for myocardial infarction or future need for coronary artery bypass grafting has been seen with risk factor adjusted ST depression in healthy middle-aged men, acknowledging a possible prognostic value [4]. Nevertheless, due to the low prevalence of disease in asymptomatic populations, the positive predictive value of a positive test response in low-risk individuals is poor, which limits the diagnostic value [5]. Multiple studies have evaluated both the diagnostic and prognostic capacity of ST depression in relation to CAD [6,7]. The cause of ST depression in the absence of CAD as well as its relation to cardiovascular risk factors and test-derived variables such as heart rate (HR), blood pressure (BP) and exercise capacity, remains to be further investigated.
Myocardial ischemia in an adolescent secondary to nutritional thiamine deficiency
Published in Baylor University Medical Center Proceedings, 2018
Cassandra Lefevre, Lea H. Mallett, Lori Wick
Overnight, the patient's blood pressure improved but remained marginal with addition of a modest dopamine infusion. Her central venous pressure remained between 6 and 8 mm Hg, electrolytes were stable, and acidosis improved. Electrocardiogram findings disclosed ST depression in the lateral leads (Figure 1). Repeat labs (creatinine at 1.64 mg/dL, blood urea nitrogen of 52 mg/dL, hemoglobin dropped to 7.0 g/dL, platelets dropped to 75×109) showed deterioration of renal function as well as worsening anemia and persistent thrombocytopenia. Urine output was minimal. The patient was transfused with packed red blood cells. Follow-up labs revealed a thiamine level of 33 pg/mL, well below assay, and peak troponin at 19 ng/mL. She had not taken her oral medications for 3 months. She was diagnosed with acute decompensated heart failure secondary to dehydration and thiamine deficiency.