Systemic or local thrombolysis in high-risk pulmonary embolism

Background and Aim: High-risk pulmonary embolism (PE) represents an important health problem in emergency cardiology, being associated with a high rate of mortality. The aim of this study is to assess the efficacy and safety of pulmonary intra-arterial thrombolysis with streptokinase compared to systemic thrombolysis. Methods and Results: In our study, 28 patients with acute high risk PE were treated by intra-arterial thrombolysis with clinical success rate of 96.4%, while in the group with systemic thrombolysis (24 patients) the rate of clinical success was significantly lower (70.8%). Also, pressure gradient between right ventricle (RV) and right atrial (RA) (PRV-RA) decreased significantly in patients treated by pulmonary intra-arterial thrombolysis instead of systemic thrombolysis. Mortality during the hospitalization was 0% in the group with local thrombolysis and 29.2% in the other group, with a significant statistical difference. Major bleeding complications appeared in 14.3% of the patients with local thrombolysis and in 20.8% of the ones treated by systemic thrombolysis, without statistical significance. Moreover, the proportion of minor bleeding was comparable in the two groups of patients. There was no intracranial bleeding. Disseminated intravascular coagulation occurred in 1 patient with systemic thrombolysis. Conclusions: The rate of clinical success and the regression of RV overload were significantly higher in patients treated by pulmonary intra-arterial thrombolysis. The results regarding the efficiency of the pulmonary intra-arterial thrombolysis in high-risk PE are encouraging, the mortality in these patients being significantly lower than the one for systemic administration of the thrombolytic agent.

Simultaneous tromboembolic events in a patient with heterozygous MTHFR mutation

Background: Hyperhomocysteinemia is a well recognised risk factor for arterial and venous thrombosis. The most common form results from methylenetetrahydrofolate reductase (MTHFR) gene mutations leading to decreased enzymatic activity.Case report: We present the case of a 34 year-old woman with a sudden onset of left hemiparesis and aphasia accompanied by retrosternal pain. She is diagnosed with acute posteroinferolateral myocardial infarction and stroke. Homocysteine level was determined and it was moderately elevated. The coronary angiogram revealed partially recanalised embolic occlusion of posterior left ventricular branch and posterior interventricular artery. A conservative treatment management is adopted. She remained haemodynamically stable, with complete resolution of neurological symptoms and evolution to subacute myocardial infarction.Conclusions: The particularity of our case is represented by symultaneous thromboembolic events causing myocardial infarction and ischemic stroke in a patient with a history of recurrent pregnancy loss, which was previously diagnosed with MTHFR gene mutation. Moderate hyperhomocysteinemia, also found in our patient, is recognised as an ethiopathogenic factor of thrombophilia. The right diagnosis and therapeutic approach could be the key to improved prognosis in this category of patients. MTHFR gene mutation causing hyperhomocysteinemia should be suspected in patients with thromboembolic events, especially when occuring repeatedly or at young age

The Significance of New Left Bundle Branch Block Complicating Acute Myocardial Infarction

The aim of our study was to evaluate the impact of new LBBB on left ventricular systolic function and arrhythmic risk in patients with acute myocardial infarction and unicoronarian lesion. We prospectively studied the patients with acute myocardial infarction with and without LBBB and unicoronarian lesion after a mean of 16.51 � 2.41 months from the onset of acute coronary event. We observed a higher risk of ventricular premature beats and left ventricular systolic disfunction in patients with left bundle branch block. Also, the presence of left bundle branch block (F = 3.64; p [ 0.005; partly h2= 0.33) and the duration of the QRS complex (F = 4.17; p [ 0.005; partly h2= 0.36) was statistically significantly correlated with the value of left ventricular ejection fraction. Almost a double number of patients with left bundle branch block had an ejection fraction below 30%, despite an early revascularization. Patients with acute myocardial infarction and left bundle branch block represent a relatively small group but with an increased risk of malignant ventricular arrhythmias and left ventricular systolic dysfunction, and they should therefore benefit from a promptly and appropriately treatment in order to improve long term outcome. </jats:p

Prevalence of Cardiovascular Risk Factors Among Patients with Acute Myocardial Infarction and New Left Bundle Branch Block in North East Romania

The prevalence of coronary artery disease, a major contributor to cardiovascular disease, is related to the increasing prevalence of modifiable risk factors.The aim of our study was to determine the risk factors for acute myocardial infarction among patients from North East Romania.We evaluated patients with acute myocardial infarction with or without left bundle-branch block, hospitalized in Georgescu Institute of Cardiovascular Disease Iasi for three years. The results of our study show that patients with acute myocardial infarction and new left bundle branch block have a more recent history of hypertension, dyslipidemia and smoker status compared to patients without left bundle branch block. Nearly two thirds of patients included in the study (65.47%) had an elevated cholesterol level, with a high prevalence of dyslipidemia in patients with myocardial infarction and new left bundle branch block. More than two-thirds of patients with new left bundle branch block had a history of arterial hypertension (69.04% vs. 50.0%, p = 0.354), especially grade 2 hypertension, with a slight predominance in those with new left bundle branch block, but without statistically significant differences between the two groups (45.23% vs. 30.95%, p = 0.358). Early identification of modifiable risk factors is vital to set the strategy for prevention and special attention must be paid to smoking. An adequate control of cardiovascular risk factors would result in a significant reduction of coronary events in patients from the North East part of Romania. </jats:p

Long Term Assessment of the Biological Profile in Patients with Acute Myocardial Infarction and Left Bundle Branch Block

In order to study the impact of an acute coronary syndrome on the lifestyle changes of the patients, we prospectively studied the long term biological parameters of patients with myocardial infarction. After a median follow-up of 17 months, we noticed a significant improvement in the lipid profile of patients, both due to lifestyle changes and therapeutic compliance. Certainly, the occurrence of an acute coronary event has altered patients� attitudes about cardiovascular risk, motivating changing lifestyle and choosing the right therapy. </jats:p

Is There a Sex Difference of Cardiovascular Risk Factors in Patients with Acute Myocardial Infarction?

Conventional cardiovascular risk factors, such as hypertension, diabetes, smoking, and dyslipidemia, increase the risk of developing acute myocardial infarction. Primary prevention studies have shown that early detection and aggressive treatment of risk factors prevent cardiovascular events. In women, coronary artery disease appears up to 10 years later in life than in men. We analyzed the presence of conventional risk factors in patients with acute myocardial infarction and compared findings according to sex. We observed that more than 90% of patients included in the study had at least one of these risk factors, hypertension and diabetes predominated in women and smoking was more frequent in men. Because many of these risk factors are modifiable and amenable to treatment, an early detection and aggressive treatment can prevent cardiovascular events. </jats:p

VULNERABILITY INDEX ASSESSMENT OF THE EROSIVE ATHEROSCLEROTIC PLAQUE ON ENDARTERECTOMY SPECIMENS

Background Atherosclerosis is an arterial inflammatory process which causes associated tissue ischemia of different degrees. It is not yet calculated an index of plaque vulnerability as a histological marker of acute cardiac event risk at these patients. Aim of the study This retrospective study aimed to answer the question of whether the index of plaque vulnerability can appreciate the risk of atherothrombosis of the erosive plaques using histological measurements. Material and methods 30 patients were included in the study. American Heart Association (AHA) classification was used for appreciating the histological degree of ATS lesions on endarterectomy pieces. In all patients, intima-media thickness (IMT), erosion depth, and parietal thrombosis area were assessed. Results The proposed vulnerability index showed that about 50% of patients have a medium risk of plaque vulnerability and of associated acute coronary syndrome (ACS). Conclusions The index of plaque vulnerability may be used as a reference in ATS assessment by using intravascular ultrasound (IVUS) methods