Shoulder problems and related conditions in patients with implantable cardioverter defibrillators

Aim: Shoulder pain and disability is a complication that can be seen frequently after implantable cardioverter defibrillator (ICD) implantation. The aims of this study were to determine the causes of shoulder problems and related factors in patients with ICD implantation and to investigate the effects of shoulder problems on quality of life and psychological status. Material and Methods: A total of ninety-four consecutive patients (average age 59.38±10.75 years) who admitted to ICD follow up clinic were included in the study. Patients who had shoulder problems were referred to our physical therapy and rehabilitation outpatient clinic for further evaluation. The Shoulder Pain and Disability Index (SPADI), Short Form-36 (SF-36) and The Hospital Anxiety and Depression Scale (HADS) were used as the clinical assessment scales. Results: Thirty-nine (41.5%) patients had shoulder complaints. The patients were divided into two groups according to presence of shoulder problem. The statistical analysis revealed no significant differences between the groups in terms of the socio-demographic and clinical characteristics. None of these characteristics was demonstrated as a risk factor for the development of shoulder problem (p>0.05). There were significantly lower SF-36 subgroup scores and higher HADS depression and anxiety scores in patients with shoulder complaints. The SPADI scores also showed significant correlations with shoulder pain VAS score, several subgroups of SF-36 and HADS scores (p<0.05). Conclusion: Our study revealed that patients with shoulder complications had decreased quality of life and deteriorated psychological status. In patients with ICD, awareness should be increased in terms of shoulder problems and appropriate management strategies should be determined

Echogenicity And Echocardiographic Guidance

PubMe

Trombüs aspirasyonu yapılan akut anteriyor miyokard infaktüsünde reperfüzyon başarısının TIMI Frame sayımıyla değerlendirilmesi

Aim: Achieving reperfusion is the key target in the treatment of myocardial infarction with acute ST elevation. In our study,we aimed to compare the improvement in coronary blood flow using corrected TIMI frame score (cTFC) in patients, whopresented with acute anterior ST elevated myocardial infarction (AASTEMI), underwent primary percutaneous coronaryintervention (PPCI) with manual thrombus aspiration (MTA) and those, who underwent PPCI alone.Material and Methods: We included 30 patients with acute AASTEMI, who underwent PPCI with MTA and 60 patients,who underwent PPCI alone, between June 2009 and August 2013. Coronary angiography images were reviewed afterthe procedure to evaluate distal embolization, TIMI scores and the corrected TIMI frame scores in both groups. Allcause mortality and stent thrombosis were recorded at hospital admission. All-cause mortality, stent thrombosis, andhospitalization due to cardiac failure, occurring within a month of discharge, were investigated.Results: The mean age was 56.50 ± 16.45 among patients undergoing thrombus aspiration; there were 22 males and8 females. Among those who did not undergo MTA, the mean age was 56.57 ± 13.21; and there were 44 males and 16females. The rate of previous myocardial infarction (MI) (23.3 % vs 6.6 %; p = 0.019) and history of percutaneous coronaryintervention (PCI) (20.0 % vs 6.7 %, p = 0.040) was higher in patients, who underwent MTA. The mean TIMI frame scorewas 28.33 ± 7.24 and 26.68 ± 8.22, respectively in the patients, who underwent and did not undergo MTA; however, nostatistically significant difference was detected (p = 0.389). Overall time to ischemia was longer in the groups of patients,who underwent MTA (8.23 ± 9.68 vs 3.68 ± 8.22 hours, p = 0.003). Three patients, who underwent MTA (10 %, p = 0.007) diedbefore discharge and 1 patients (13.1 %, p = 0.003) died within a month. No cases of death were detected in the group ofpatients, who did not undergo MTA, in the hospital and within a month. There were no statistically significant differencesbetween these two groups with respect to hospitalization due to cardiac failure and occurrence of stent thrombosis.Conclusion: The use of MTA in AASTEMI did not have a favorable impact on reperfusion compared to not using MTA.Amaç: Akut ST yükselmeli miyokard enfarktüsü tedavisinde reperfüzyonun sağlanması temel hedeftir. Bizim çalışmamızda amacımız; akut anteriyor miyokard infarktüsü ile başvuran, manuel trombüs aspirasyonu ile primer perkütan koroner girişim yapılan ve yalnızca primer perkütan koroner girişim yapılan hastalarda, koroner kan akımındaki iyileşmeyi, düzeltilmiş TİMİ frame sayımı ( dTFS ) kullanarak kıyaslamaktır. Gereç ve Yöntemler: Çalışmaya retrospektif olarak akut anteriyor miyokard in-farktüsü olup manuel trombüs aspirasyonu ile birlikte primer perkütan koroner giri-şim uygulanmış 30, yalnızca primer perkütan koroner girişim uygulanmış 60 hasta alındı. Gruplar yaş ve cinsiyet açısından eşleştirdi. Koroner anjiografi filmleri tekrar izlenerek her iki grubta distal embolizasyon, TİMİ skoru ve dTFS değerlendirildi. Hastane yatışı esnasında tüm nedenli ölümler, stent trombozu kaydedildi. Taburcu-luk sonrası bir ay içinde meydana gelen tüm nedenli ölümler, stent trombozu ve kalp yetersizliği nedenli yatışları incelendi. Bulgular: Trombüs aspirasyonu yapılanların, ortalama yaşı 56.50±16.45. Tombüs aspirasyonu yapılmayanların ortalama yaşı 56.57±13.21 idi. Manuel trombüs aspi-rasyonu yapılan grupta dTFS ortalama 28.33±7.24, yapılmayan grupta ortalama 26,68±8.22, olarak tespit edildi. Ancak istastistiksel olarak fark tespit edilmedi (p=0.389). İşlem sonrası her iki grupta da EKG‘de benzer oranlarda ST segment rezolüsyonu tespit edildi. Manuel trombüs aspirasyonu yapılan 3 hasta (%10, p= 0.007) taburculuk öncesi, 1 hasta (%13.1, p=0.003) bir ay içinde ölmüştür. Trombüs aspirasyonu yapılmayan grupta hastane içinde ve bir ay içinde ölüm izlenmemiştir. Gruplar arasında bir ay içinde kalp yetersizliği nedenli hastane yatışı ve stent trom-bozu görülme oranları açısından istastistiksel fark tespit edilmedi. Sonuç: Çalışma grubumuzda akut anteriyor miyokard infarktüsünde manuel trom-büs aspirasyonun kullanılması, kullanılmamasına göre reperfüzyon üzerine olumlu etki göstermemiştir