Cardiology
Shibley Rahman, Avinash Sharma in MRCP Part 2 Best of Five Practice Questions, 2018
A 65-year-old man presents with severe central crushing chest pain. ECG demonstrates evidence of an inferior myocardial infarction. He receives TPA, heparin and aspirin. Four hours after presentation, he starts to feel dizzy and breathless, his pulse is 40 bpm regular, blood pressure is 80/50, heart sounds are soft, and chest is clear to auscultation. ECG demonstrates 2:1 block with T wave inversion inferiorly. Intravenous atropine is administered, to no effect. The next best management step is: i.v. dopaminei.v. isoprenalineinsertion of a permanent pacemakerinsertion of a temporary pacing wiremonitor conservatively
Epidemiology and its uses
Liam J. Donaldson, Paul D. Rutter in Donaldsons' Essential Public Health, 2017
Most measures reported in randomized controlled trials are the same as those reported for the study types already described. One additional measure that arises particularly in randomized controlled trials is the number needed to treat (NNT). This reports the number of people who must be given the intervention under study in order for one life to be saved. The calculation is made by comparing mortality in the intervention and control groups. For example, aspirin is an effective treatment for myocardial infarction. But not everybody who is treated with aspirin lives, and neither does everybody who is not given aspirin die. The studies have shown that for every 25 people treated with aspirin, 1 more person survives. This is the number needed to treat. When an intervention causes harm, rather than benefit, an equivalent calculation can be made of the number needed to harm (NNH).
The electrocardiogram in ischaemic heart disease
John Edward Boland, David W. M. Muller in Interventional Cardiology and Cardiac Catheterisation, 2019
This is complete conduction failure of propagation of impulse from atrium to ventricle and results in ventricular standstill, evident as a prolonged flat ECG signal. It may occur in inferior or anterior myocardial infarction. The mechanisms differ and have different prognostic implications. In inferior infarction it is the result of necrosis or ischaemia of the AV node (with or without vagal stimulation) and may progress from 1° AV block to 2° AV block (Mobitz Type I) to 3° AV block. Usually it is benign and haemodynamics are maintained, although a temporary pacemaker may at times be required. In anterior myocardial infarction the prognosis is much poorer due to the extensive nature of the infarct. Rather than having a gradual onset as in inferior infarction it may be of abrupt onset with major haemodynamic impairment. A temporary pacemaker is usually required to maintain haemodynamics and often a permanent pacemaker is required if the patient survives. Due to the large amount of left ventricular impairment associated with an anterior myocardial infarction and heart block, an implantable defibrillator may be indicated to prevent subsequent death.
Acute myocardial infarction following misoprostol treatment
Published in Journal of Obstetrics and Gynaecology, 2021
Gabriel Levin, Ahmad Badrieh, Alla Abu Khatab, Natali Schachter-Safrai, Rami Attari, Rani Haj Yahya
Approximately three days after administration, she complained of a sudden-onset retrosternal chest pain and nausea. On her admission to the emergency department, an electrocardiogram (ECG) showed a regular sinus rhythm at 82 beats/minute with a notable ST elevation in anterior wall leads (Figure 1(A)). The patient was diagnosed with acute inferior myocardial infarction. Fifteen minutes after her arrival, the patient had entered the catheterisation theatre after treatment with heparin, aspirin and prasugrel. Coronary angiography demonstrated total occlusion of the proximal left anterior descending (LAD) artery (Figure 1(B)). After balloon intraluminal inflation and aspiration of clots, a drug eluting stent was deployed (Figure 1(C)). Following the procedure, the patient’s chest pain had resolved and she was discharged home in a good condition after two days of hospitalisation. Evaluation of the events from misoprostol treatment until the onset of chest pain for risk stratification reveals no abnormal events that might cause myocardial or coronary insults.
Cardioprotective doses of thyroid hormones improve NO bioavailability in erythrocytes and increase HIF-1α expression in the heart of infarcted rats
Published in Archives of Physiology and Biochemistry, 2022
Alexandre Luz de Castro, Rafael Oliveira Fernandes, Vanessa D. Ortiz, Cristina Campos, Jéssica H. P. Bonetto, Tânia Regina G. Fernandes, Adriana Conzatti, Rafaela Siqueira, Angela Vicente Tavares, Adriane Belló-Klein, Alex Sander da Rosa Araujo
Acute myocardial infarction is an ischaemic pathology of the heart that involves an irreversible loss of cardiomyocytes, leading to a decrease in cardiac function (Schenkel et al. 2010). This condition is a leading cause of morbidity and mortality (Hong et al. 2019). Besides that, myocardial infarction is also associated with a decrease in nitric oxide (NO) bioavailability in the heart and in the red blood cells (Eligini et al. 2013, De Castro et al. 2015). The maintenance of NO levels in the cardiac tissue is important, mainly after the ischaemic injury, since this molecule can upregulate the expression of the hypoxia inducible factor-1α (HIF-1α) by activating the phosphatidylinositol 3-kinase (PI3K)-Akt pathway (Sandau et al. 2000, Kasuno et al. 2004). Activation and upregulation of HIF-1α has been recently found to be a protective mechanism against ischemia-reperfusion injury in the heart (Alchera et al. 2008, Zhong et al. 2008).
Takotsubo cardiomyopathy and its variants: a case series and literature review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Syed Mustajab Hasan, Jay D. Patel, Mohammed Faluk, Jigar Patel, Premranjan Singh
Patients typically present with symptoms classic of an acute myocardial infarction which include acute and unstable substernal, pressure like chest pain, shortness of breath, palpitations, or arrhythmia. In the more severe cases involving severe left ventricular outflow tract obstruction, patients may also be in cardiogenic shock. Additionally, EKG changes classic of acute ST-segment elevation myocardial infarction are also seen but follow-up catheterization does not reveal coronary artery disease in the location of myocardial dysfunction. Important complications to keep in mind are as follows. Firstly, right ventricular involvement occurs from 18% to 34% of patients and has been associated with other complications such as lower EF, worsening heart failure, pleural effusions, and even longer hospital course. Other factors that were related to heart failure, cardiogenic shock, and longer hospital course were the presence of left ventricular outflow tract obstruction, acute mitral regurgitation, new-onset atrial fibrillation, thrombus formation due to akinetic myocardium, pericardial effusion, or ventricular-free wall rupture [4,9–16].
Related Knowledge Centers
- Angina
- Heartburn
- Infarction
- Lightheadedness
- Shortness of Breath
- Ischemia
- Nausea
- Heart
- Cardiac Muscle
- Coronary Arteries
- Shortness of Breath