Top PDF Acute coronary syndrome encompasses

Acute coronary syndrome encompasses

Acute coronary syndrome encompasses

The physical examination in patients with acute coronary syndrome frequently is nor- mal. Ominous physical findings include a new The term “acute coronary syndromeencompasses a range of thrombotic coronary artery diseases, including unstable angina and both ST-segment elevation and non–ST-segment elevation myocardial infarction. Diagnosis requires an electrocardiogram and a careful review for signs and symptoms of cardiac ischemia. In acute coronary syndrome, common electrocardiographic abnormalities include T-wave tenting or inversion, ST-segment elevation or depression (including J-point elevation in multiple leads), and pathologic Q waves. Risk stratification allows appropriate referral of patients to a chest pain center or emergency department, where cardiac enzyme levels can be assessed. Most high- risk patients should be hospitalized. Intermediate-risk patients should undergo a structured evaluation, often in a chest pain unit. Many low-risk patients can be discharged with appropriate follow-up. Troponin T or I generally is the most sensitive determinant of acute coronary syndrome, although the MB isoenzyme of creatine kinase also is used. Early markers of acute ischemia include myoglobin and creatine kinase–MB subforms (or isoforms), when available. In the future, advanced diagnostic modalities, such as myocardial perfusion imaging, may have a role in reducing unnecessary hospitalizations. (Am Fam Physician 2005;72:119-26. Copyright© 2005 American Academy of Family Physicians.)
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The Activity of Antioxidative Enzymes of Neutrophils in Patients with Unfavorable Outcome of Acute Coronary Syndrome

The Activity of Antioxidative Enzymes of Neutrophils in Patients with Unfavorable Outcome of Acute Coronary Syndrome

Background: There is a necessity for an establishment of specific markers of oxidative stress for screening in populations of high risk and an estimation of efficiency antioxidative therapies. Ob- jective: Studying the activity of antioxidative enzymes at neutrophils in patients with acute coro- nary syndrome depending on outcome during the year. Methods: Intracellular metabolism of neu- trophils was studied in 108 patients, of whom, in 58 persons has been diagnosed acute coronary syndrome, and 50 individuals were without coronary heart disease. Results: In patients with acute coronary syndrome, in comparison with patients without coronary heart disease, growth of pro- duction of superoxide anion on background reduction of glutathione reductase activity in neutro- phils was revealed. The greatest reduction in parameters of glutathione reductase and catalase at simultaneous growth of activity of NAD(P)H oxidase and myeloperoxidase at neutrophils was ob- served in patients with fatal outcome during the year. Conclusion: The decrease of efficiency anti- oxidative protection of neutrophils associates with risk of fatal outcome in patients with acute coronary syndrome.
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The Role of Insulin-Like Growth Factor-1 and Pregnancy-Associated Plasma Protein-A in Diagnosis of Acute Coronary Syndrome and Its Related Morbidities

The Role of Insulin-Like Growth Factor-1 and Pregnancy-Associated Plasma Protein-A in Diagnosis of Acute Coronary Syndrome and Its Related Morbidities

As presented in our study, it appears that measuring the level of IGF-1 could have a major role in predicting adverse events in patients with ACS especially renal failure. According to our results, the occurrence or uncovering of renal failure as a one of main ACS morbidities can be predicted by high serum levels of IGF-1. Similarly, in Teppala et al. study, higher serum IGF-1 levels were positively associated with CKD after adjusting for age, sex, race/ethnicity, education levels, smoking, alcohol intake, body mass index, diabetes, hypertension and serum cholesterol (27). Thus, it appears that increasing the level of IGF-1 can be helpful to assess tendency to renal failure especially in patients with coronary artery disease. In our study, there were no significant relationship between PAPP-A level and any of cardiac risk factors. Also, relationship of this biomarker with renal failure was not significant.
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Place of pitavastatin in the statin armamentarium: promising evidence for a role in diabetes mellitus

Place of pitavastatin in the statin armamentarium: promising evidence for a role in diabetes mellitus

The Extended-JAPAN-ACS (Extended Japan Assessment of Pitavastatin and Atorvastatin in Acute Coronary Syndrome, NCT 01223586, UMIN 000003166) trial was carried out to verify the relationship between coronary plaque regression and cardiovascular events in long-term follow-up in ACS patients enrolled in JAPAN-ACS. There are few reports which eluci- date the relationship between coronary artery plaque regres- sion and cardiovascular event reduction, 114 and therefore the

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Misdiagnosed Acute Coronary Syndrome: Characteristics of Patients with Acute Coronary Syndrome Discharged Home from the Emergency Department

Misdiagnosed Acute Coronary Syndrome: Characteristics of Patients with Acute Coronary Syndrome Discharged Home from the Emergency Department

For the proper diagnosis of ACS, the history should be thorough, and include the characteristics of the pain, its duration, and physical findings that reflect the cardiac status. It is crucial that the ECG be performed within 5 minutes of the patients’ appearance at the ED. Lee and Goldman [8], in a study of 2000 patients with acute chest pain, found that 80% of those with an ST elevation of more than 1 mm, and 20% of those with ST depression or T-wave inversion, had acute MI. The prolonged ischemia in non-ST elevation MI causes irreversible myocardial necrosis with the release of cardiac enzymes. Thus, another diagnostic tool that aids the physician are laboratory tests of cardiac markers that indicate the destruction of myocytes. These include creatinine kinase- myocardial band (CK-MB) enzyme, which is known to increase 4 hours after onset of myocardial symptoms, in addition to troponin T and I, which are more specific and may stay elevated longer, sometimes up to 14 days [8-16]. Several authors have also suggested various supplemental computer protocols and predictive tools for use in the triage of patients with complaints of chest pain or other symptoms suggestive of ACS [17-22].
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A Case with Repeated Recurrent Acute Coronary Syndrome due to Pseudoephedrine Use: Kounis Syndrome

A Case with Repeated Recurrent Acute Coronary Syndrome due to Pseudoephedrine Use: Kounis Syndrome

Recurrent Kounis syndrome due to same agent is a quite rare condition. There are two cases in the literature. In the first case, it was observed that the patient, in whom clopidogrel treatment was commenced due to the diagnosis of acute coronary syndrome, developed chest pain and ST- T changes after clopidogrel. Similar findings were observed after the second clopidogrel given a day later [15]. In the second case, who was planned to undergo noncardiac sur- gical procedure under general anesthesia, the surgery was cancelled due to hypotension and ECG alterations developed after remifentanil. Similar clinical picture was observed when the patient again received remifentanil 1 month later for general anesthesia for the same surgery [16]. In the present case, pseudoephedrine use for two times at 8-month interval due to upper respiratory tract infection is in question. Chest pain and ECG changes were observed after pseudoephedrine use. Coronary arteries were normal on coronary angiography. Whilst there was a significant stenosis in coronary arteries in the aforementioned first case, coronary arteries were found to be normal in the second case.
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Polycythemia and the Coronary Complications of Acute Coronary Syndrome Patients in Yemen

Polycythemia and the Coronary Complications of Acute Coronary Syndrome Patients in Yemen

Coronary Artery Disease (CAD) is one of the main causes of premature death in indu- strialized countries [1], even though its incidence and mortality have been falling for more than a decade in most of these countries [2]. Conversely, it appears to be increas- ing in many developing countries [3]. It has been shown that coronary stenosis may “grow” rapidly, leading to total vessel occlusion, particularly in patients who develop serious coronary events [4]. In fact acute coronary syndromes are most commonly pre- cipitated when mild or moderate coronary stenosis becomes severely obstructive [5], and this transformation is usually associated with plaque fissuring, intramural hemorr- hage, and occlusive thrombosis [6]. In 1980, angiographic studies by De Wood and coworkers revealed that occlusive thrombus was responsible for most cases of acute myocardial infarction [7]. Thrombus formation was subsequently implicated in the pa- thogenesis of unstable angina. At that time, the prevailing concept was that myocardial infarction resulted from occlusion at a site of high-grade stenosis. The establishment of coronary thrombosis as the most common cause of myocardial infarction led to the development and use of thrombolytic agents [8]. The subsequent mortality has been correlated with the severity of the initial arteriographic lesion [9].
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Relative value of serum pregnancy-associated plasma protein A (PAPP-A) and GRACE score for a 1-year prognostication: A complement to calculation in patients with suspected acute coronary syndrome

Relative value of serum pregnancy-associated plasma protein A (PAPP-A) and GRACE score for a 1-year prognostication: A complement to calculation in patients with suspected acute coronary syndrome

MI – myocardial infarction; MACE – major adverse cardiovascular event; GRACE – Global Registry of Acute Coronary Events; GRACE in hospital – patients with intermediate and high risk of death during hospitalization according to GRACE scale; PAPP-A – pregnancy-associated plasma protein A; ≥PAPP-A cut-off – number of patients that exceeded cut-off PAPP-A concentration; PPV – positive predictive value; NPV – negative predictive value; GRACE 6 months – patients with intermediate and high risk of death in 6 months from hospitalization according to GRACE scale; NS – not significant.
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Gene expression profiling reveals potential prognostic biomarkers associated with the progression of heart failure

Gene expression profiling reveals potential prognostic biomarkers associated with the progression of heart failure

A patient who has had an acute MI may or may not progress to develop LV dysfunction and HF [32]. The prognosis of patients after acute coronary syndrome (ACS) largely depends on the extent of myocardial dam- age during the acute phase. In the cohorts of nine pa- tients from the study group and seven from the validation group we observed that the future LV dys- function had a specific biosignature in blood cells already in the acute phase of MI. The identified tran- scripts that differentiated on the first day of myocardial infarction the HF patients from the non-HF ones and the control group can serve as a novel tool contributing to early prognosis and diagnosis of post-AMI patients. This approach, validated in an independent cohort, may also be useful in searching for the molecular predispos- ition to the development of HF after AMI.
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Associations between endothelial progenitor cells, clinical characteristics and coronary restenosis in patients undergoing percutaneous coronary artery intervention

Associations between endothelial progenitor cells, clinical characteristics and coronary restenosis in patients undergoing percutaneous coronary artery intervention

Patients were followed for 1  year, with clinical assess- ments every 3 months. The primary outcome was defined as the recurrence of typical or atypical angina and evi- dence of restenosis detected by coronary angiography or by evidence of inducible myocardial ischaemia in the region of the stented coronary artery, demonstrated by stress/rest myocardial perfusion scintigraphy per- formed according to standard protocols [13]. Secondary outcomes were typical or atypical angina without con- firmation of ischaemia by myocardial scintigraphy, the occurrence of acute coronary syndrome (defined by typi- cal symptoms and cardiac biomarkers elevated above the upper limit of normal or new pathological Q waves in at least 2 contiguous electrocardiogram leads) or all-cause death.
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The polypill approach – An innovative strategy to improve cardiovascular health in Europe

The polypill approach – An innovative strategy to improve cardiovascular health in Europe

ACE: Angiotensin-converting-enzyme; ACS: Acute coronary syndrome; AHA: American Heart Association; AMI: Acute myocardial infarction; APAC: Asia-Pacific region; CHD: Coronary heart disease; CNIC: National Centre for Cardiovascular Research (from the Spanish, Centro Nacional de Investigaciones Cardiovasculares); CV: Cardiovascular; CVD: Cardiovascular disease; DAPT: Dual antiplatelet therapy; EC: European Commission; EHN: European Heart Network; ESC: European Society of Cardiology; EU: European Union; FDC: Fixed-dose combination; IMF: International Monetary Fund; LDL: Low-density lipoprotein; MENA: Middle East and North African region; MEP: Member of the European Parliament; MI: Myocardial infarction; NCD: Non-communicable disease; SBP: Systolic blood pressure; UEMS: Union of European Medical Specialists (from the French, Union Européenne des Médecins Spécialistes); WHO: World Health Organization
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Assessing cardiovascular risk in chronic kidney disease patients prior to kidney transplantation: clinical usefulness of a standardised cardiovascular assessment protocol

Assessing cardiovascular risk in chronic kidney disease patients prior to kidney transplantation: clinical usefulness of a standardised cardiovascular assessment protocol

This study was a retrospective cohort study. Data was obtained using medical chart review. All prospective renal transplant recipients were assessed according to the same work-up protocol (Fig. 1). The clinical evalu- ation protocol used during the period of study was based on published recommendations from European Renal Best Practice, UK Renal Association and British Trans- plant Society, European Association of Urology and American Society of Transplantation [21–24]. All pa- tients referred for evaluation for suitability for cadaveric or live-donor kidney transplantation between 1st Febru- ary 2012 and 31st Dec 2014 were included. Each patient underwent cardiac risk stratification and was assigned to a ‘high-risk’ group, i.e. those older than 60 years of age or 60 and below with at least one of the following cardiac risk factors: diabetes, ischaemic heart disease, peripheral vascular disease, congestive cardiac failure; a ‘low-risk’ group i.e. those patients aged between 40 to 60 years old with none of the mentioned cardiac risk factors; and a ‘minimal risk’ group i.e. those younger than 40 with none of these risk factors. The ‘low-risk’ group adopted in the data analysis comprised patients belonging to the minimal-risk and low-risk cohorts of the protocol. Other CV risk factors such as smoking his- tory, family history of CV disease or dialysis duration were not included in the protocol. After the risk stratifi- cation, cardiac investigations were requested according to our recipient evaluation protocol (Fig. 1); high-risk patients requiring DSE; minimal-risk patients below age 40 years undergoing transthoracic echocardiogram (TTE); and low-risk patients between ages 40-60 years requiring an exercise treadmill test (ETT). The low-risk patients with positive or inconclusive exercise treadmill test or abnormal TTE were assessed with DSE. The pa- tients with positive DSE, symptomatic angina or acute coronary syndrome (ACS) underwent coronary angiog- raphy. If the coronary lesions were felt to be amenable to coronary stenting by the treating cardiologist, these were deployed at the time of coronary angiography. For more complex lesions, revascularisation strategy (i.e. coronary stenting, CABG or pharmaceutical therapy) was determined at a multidisciplinary meeting between cardiology and cardiothoracic specialties. The case- records of each patient were reviewed from the date of referral to the end of the study.
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A Study of the Cardiovascular Risk Factor Profile in Patients with Acute Coronary Syndrome with Particular Reference to Metabolic Syndrome

A Study of the Cardiovascular Risk Factor Profile in Patients with Acute Coronary Syndrome with Particular Reference to Metabolic Syndrome

Metabolic syndrome (MS) comprises of a miscellany of metabolic and hemodynamic disorders that elevate the development of atherosclerosis and upsurge cardiovascular morbidity and mortality [3]. The ultimate impor- tance of this condition is that it helps to identify individuals at high risk of cardiovascular disease [4]. Thus, presence of MS along with ACS synergistically indicates the increased cardiovascular risk. The major characte- ristics of MS include insulin resistance, abdominal obesity, hypertension, and lipid abnormalities [i.e., elevated levels of triglycerides (TG) and low levels of high density lipoprotein (HDL)] [5]. The prevalence of MS is in- tensifying worldwide mostly due to obesity and sedentary lifestyles [6].
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Determinates of depressive disorder among adult patients with cardiovascular disease at outpatient cardiac clinic Jimma University Teaching Hospital, South West Ethiopia: cross-sectional study

Determinates of depressive disorder among adult patients with cardiovascular disease at outpatient cardiac clinic Jimma University Teaching Hospital, South West Ethiopia: cross-sectional study

ACS: acute coronary syndrome; AMI: acute myocardial infarction; AF: atrial fib- eraltion; BDI: Beck depression inventory; BMI: body mass index; BSC: Bachelor of science; CAD: coronary arterial disease; CABG: coronary artery bypass graft; CHD: coronary heart disease; CHF: congestive heart disease; CVD: cardio- vascular disease; CPMJU: College of Public Health Medical Science of Jimma University; DIS: diagnostic interview schedule; DSM-IV: Diagnostic and Statisti- cal Manual of Mental Health Disorders, Fourth Edition; HADS: Hospital anxiety and depression scale; HHD: hypertension heart disease; HRQOL: heart-related quality of life; HTN: hypertension; ICD: implantable cardioverter-defibrillator; IHD: ischemic heart disease; JUST: Jimma University Specialized Hospital; JUTH: Jimma University Teaching Hospital; LVEF: left ventricular ejection fraction; MDD: major depressive disorder; MI: myocardial infarction; NYHA: New York Heart Association; NCDs: non-communicable diseases; PHQ-9: patient health questioner; QOL: quality of life; RHD: rheumatic heart disease; SHHD: Sudan household survey; SPSS: statistical package for social sciences; USA: United States of America; WHO: World health organization; YLL: years of life lost.
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Anemia and red blood cell transfusion in critically ill cardiac patients

Anemia and red blood cell transfusion in critically ill cardiac patients

On the other hand, six studies of adults undergoing cardiac surgery, CABG or with myocardial infarction re- ported increased mortality in transfused cardiac patients [39,40,42-44,47]. Rao et al . [43] published a descriptive epidemiological study on 24,112 patients with acute cor- onary syndrome who were enrolled in three large ran- domized controlled trials (RCTs). They compared the outcomes of those who received at least one RBC trans- fusion (n = 21,711) and those who did not (n = 2,401); RBC transfusion was associated with an increased HR for 30-day mortality (HR = 3.94; 95% CI: 3.26 to 4.75). Probability of 30-day mortality was higher in transfused patients with nadir hematocrit values above 25%. In the systematic review of Chatterjee et al . [51], the risk ratio of death in transfused patients versus controls was 2.91 (95% CI: 2.46 to 3.44) and the risk of secondary myocar- dial infarction was 2.04 (95% CI: 1.06 to 3.93), but there was a very significant heterogeneity in both instances ( I 2 : 92% and 98% respectively). Garfinkle et al . [53] also published a systematic review on 11 observational stud- ies that enrolled 290,847 patients with acute coronary syndrome: the unadjusted OR of mortality in transfused patients ranged from 1.9 to 11.2; a meta-analysis was not performed because there was too much heterogen- eity, but the data suggested a protective effect of RBC transfusion if nadir Hb drops below 80 g/L and neutral or harmful effects above 110 g/L. In summary, there is evidence in adults with cardiac disease that RBC trans- fusion is associated with mortality and ischemic events.
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Eosinophilic myocarditis mimicking acute coronary syndrome secondary to idiopathic hypereosinophilic syndrome: a case report

Eosinophilic myocarditis mimicking acute coronary syndrome secondary to idiopathic hypereosinophilic syndrome: a case report

Different etiologies have been described as a cause for EM, but the cause is frequently unknown. Well-estab- lished etiologies include hypersensitivity myocarditis due to medication (Table 1); acute necrotizing eosinophilic myocarditis (ANEM), usually with a fulminant course; hypersensitivity myocarditis associated with specific agents including smallpox, meningococcal C and hepati- tis B vaccines; hypereosinophilic syndrome; Loeffler ’ s endocarditis; tropical endomyocardial fibrosis; vasculitis such as Churg-Strauss; and malignancies including T- cell lymphoma and cancer of the lung and biliary tract [8,15].
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Predictive role of high sensitivity troponin T within four hours from presentation of acute coronary syndrome in elderly patients

Predictive role of high sensitivity troponin T within four hours from presentation of acute coronary syndrome in elderly patients

The European Society of Cardiology (ESC) state that non-ST-elevation acute coronary syndromes can be ex- cluded with a rapid 3 h HsTn sampling protocol [17]. We found that this protocol, using the standard cut-off 14 ng/L, had a sensitivity for ACS at 3–4 h of less than 90 % with a NPV of 90 %. Our conclusion is that the ESC ’ s rapid HsTn sampling protocol cannot rule out ACS within 3–4 h after presentation. These results are in accordance with our previous finding in patients of all ages that HsTnT cannot rule out ACS up to 6–7 h after presentation [8], and with the results of the meta-analysis by Sethi et al. [18]. Table 2 Diagnostic performance for ACS (a), NSTEMI (b), all AMI (c) and MACE after 2 months (d) of HsTnT analysed 3 – 4 h
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Broken heart syndrome: Update

Broken heart syndrome: Update

Numerous studies support this hypothesis. Martin et al. (2010) reported reduced endothelial function and heightened vascular reactivity resulting from acute mental stress in patients with a history of BHS. Galuito et al. (2010) investigated 15 patients with BHS and found that adenosine infusion leads to a complete recovery from altered myocardial perfusion and myocardial dysfunction; their study strongly suggested that reversible coronary microvascular dysfunction could play a role in the pathophysiology of BHS. A Japanese study of 8 females with BHS reported that endothelial cell apoptosis of coronary microvessels was observed in biopsied myocardial specimens (Uchida et al., 2010). Moreover, a recent study published on March 2017 in JAMA Cardiology confirmed the occurrence of microvascular coronary dysfunction in 15 consecutive patients with BHS by invasive physiological assessment of the coronary arteries using a pressure wire and intravenous adenosine administration (Rivero et al, 2017). The inflammatory hypothesis
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Implications of bleeding in acute coronary syndrome and percutaneous coronary intervention

Implications of bleeding in acute coronary syndrome and percutaneous coronary intervention

demonstrated that the majority of ischemic event reduction associated with prasugrel occurs during the first 30 days of treatment while bleeding events continue to accrue during long-term maintenance therapy. Hence, it has been suggested that one strategy to minimize bleeding while maximizing ischemic protection might involve the early use of prasugrel in patients with ACS undergoing PCI, followed by long-term therapy with clopidogrel. Such strategy might also reduce the rates of bleeding-related discontinuation of therapy, which was significantly greater among prasugrel versus clopidogrel-treated patients. The routine recommendation of short-term prasugrel followed by long-term clopidogrel to maximize treatment efficacy and minimize bleeding risk awaits further studies. Nonetheless, it should be noted that prasugrel is contraindicated in patients with active pathologi- cal bleeding, history of stroke or transient ischemic attack, and those who will likely require coronary artery bypass grafting.
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The HEART score in predicting major adverse cardiac events in patients presenting to the emergency department with possible acute coronary syndrome: protocol for a systematic review and meta-analysis

The HEART score in predicting major adverse cardiac events in patients presenting to the emergency department with possible acute coronary syndrome: protocol for a systematic review and meta-analysis

Ischaemia involving the full thickness of the heart wall is identified by characteristic electrocardiogram (ECG) findings termed ST elevation. If coronary artery occlu- sion persists, cardiac tissue is irreparably damaged and markers of cardiac injury become detectable in the blood. When this occurs, the term ST elevation myocar- dial infarction (STEMI) is used. Myocardial ischaemia and subsequent cardiac injury can also occur in the ab- sence of ST elevation. This characterises non-ST eleva- tion myocardial infarction (NSTEMI). Coronary artery occlusion can also result in a reduction in blood flow not severe enough to produce cardiac injury. This pres- entation is known as unstable angina (UA) and occurs when symptoms of ACS are present, but markers of car- diac injury are undetectable [1].
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