Dynamic variations of P-wave duration in a patient with acute decompensated congestive heart failure

Interatrial block is an abnormally delayed atrial activation, characterized at ECG by prolonged P-wave duration (more than 110 ms), irrespective of morphology. We report the case of a patient with acute decompensated severe congestive heart failure, that at hospital admission showed a prolonged P-wave, which reverted after diuretic therapy. The dynamic change of the atrial P-wave correlates with clinical evolution and serum level modification of B-type natriuretic peptide. (Cardiol J 2012; 19, 1: 95–97

One-Year Mortality in Elderly Adults with Non-ST-Elevation Acute Coronary Syndrome: Effect of Diabetic Status and Admission Hyperglycemia

OBJECTIVES: To determine whether type 2 diabetes mellitus and hyperglycemia on admission should be considered independent predictors of mortality in elderly adults with acute coronary syndrome (ACS). DESIGN: Prospective cohort study. SETTING: Twenty-three hospitals in Italy. PARTICIPANTS: Individuals aged 75 and older with non-ST-elevation ACS (NSTEACS) (mean age 82, 47% female) (N = 645). MEASUREMENTS: Diabetic status and blood glucose levels were assessed on admission. Hyperglycemia was defined as glucose greater than 140 mg/dL. Multivariable Cox proportional hazard regression was used to assess the potential confounding effect of major covariates on the association between diabetic status, admission glucose, and 1-year mortality. RESULTS: A history of diabetes mellitus was found in 231 participants (35.8%), whereas 257 (39.8%) had hyperglycemia. Hyperglycemia was found in 171 participants with diabetes mellitus (70%) and 86 (21%) without diabetes mellitus. Participants with diabetes mellitus were significantly (P < .05) more likely to have had prior myocardial infarction and stroke and had lower ejection fraction and blood hemoglobin. Hyperglycemia was associated with lower (P < .05) ejection fraction and estimated glomerular filtration rate (eGFR). Diabetic status and hyperglycemia were associated with greater 1-year mortality according to univariate analysis (54 participants with diabetes mellitus died (23.4%), versus 66 (15.9%) without diabetes mellitus (hazard ratio (HR) = 1.5 95% confidence interval (CI) = 1.0-2.1), and 60 participants with hyperglycemia died (23.3%), versus 60 (15.5%) without hyperglycemia (HR=1.6; 95% CI = 1.1-2.2), but this association was not statistically significant after adjustment for ejection fraction, age, blood hemoglobin, and eGFR. CONCLUSION: In elderly adults with NSTEACS, diabetes mellitus and hyperglycemia on admission are associated with higher mortality, mostly because of preexisting cardiovascular and renal damage. J Am Geriatr Soc 2014

[Atherothrombosis in patients with type 2 diabetes mellitus: an overview of pathophysiology]

Type 2 diabetes mellitus is a well known condition characterized by a functional and metabolic milieu that promotes the development of the atherosclerotic process and its macrovascular complications (e.g., acute myocardial infarction, stroke, peripheral arterial disease). In diabetic patients, several negative alterations lead to the progression of the atherosclerotic disease. These alterations involve the coagulation cascade, the endothelial function, platelet and monocyte adhesiveness, macrophage function, and fibrinolysis: all these processes are adversely affected by hyperglycemia and insulin resistance. In diabetic patients, the fluid and the cellular phases are modified to generate a prothrombotic phenotype. In this review we will discuss about the main pathophysiological mechanisms involved in diabetic atherotrombosis in order to look beyond the usual "hydraulic-rheologic" picture of macrovascular diabetic disease, and to better understand the importance of the adverse interactions that occur between the endothelial wall and the circulating cells

[Air pollution exposure as an emerging risk factor for cardiovascular disease: a literature review]

Several epidemiological studies have demonstrated a consistent statistical association between cardiovascular disease and air pollution exposure. In this review we describe the nature of the most common ambient-air pollutants (either gaseous or particulate of different size); then, we examine the pathophysiological pathways linking the air pollutants with their cardiovascular effects (arterial vasoconstriction, systemic inflammatory response, enhanced thrombosis, a propensity for arrhythmia). A comprehensive review of the literature on air pollution and the rate of hospital admission, morbidity, and mortality due to cardiovascular reasons are also provided. In the last section, we review the most recent studies that have outlined the correlation between the onset of acute myocardial infarction and the level of outdoor air pollution. In conclusion, scientific evidence is growing in support of the hypothesis that ambient air pollution acts as a risk factor for cardiovascular disease, and may trigger the onset of acute myocardial infarction

Dynamic variations of P-wave duration in a patient with acute decompensated congestive heart failure

Interatrial block is an abnormally delayed atrial activation, characterized at ECG by prolonged P-wave duration (more than 110 ms), irrespective of morphology. We report the case of a patient with acute decompensated severe congestive heart failure, that at hospital admission showed a prolonged P-wave, which reverted after diuretic therapy. The dynamic change of the atrial P-wave correlates with clinical evolution and serum level modification of B-type natriuretic peptide

Meta-Analysis of Placebo-Controlled Trials of Levosimendan in Acute Myocardial Infarction

The treatment of acute myocardial infarction is early revascularization. Heart failure and cardiogenic shock may complicate acute myocardial infarction despite applying the best available strategy. Levosimendan is a relatively new drug to treat heart failure with a peculiar mechanism of action: calcium sensitization of myocardial fibres. Levosimendan has a direct inotropic effect but also pleiotropic effects; through the K+ATP channel’s opening, it also has a vasodilator effect which may participate concretely in the global effects of the drug. The focus of the literature is on the anti-heart failure and anti-cardiogenic shock properties of Levosimendan, but it may have effects also preventing the development of myocardial insufficiency in acute myocardial infarction. The aim of the meta-analysis is to evaluate the effect of Levosimendan on acute myocardial infarction in placebo-controlled trials. Based on the eight studies selected, we found a beneficial effect of Levosimendan on acute and long-term mortality of patients affected by acute myocardial infarction. With caution in interpreting the results of this meta-analysis, our data support the idea that Levosimendan may already have a role in the treatment of acute ischemic heart disease. Further studies specifically designed to investigate the early role in the treatment of ischemic heart failure are needed