Rozległy ostry zawał serca spowodowany jednoczesną zakrzepicą w dwóch stentach

We report a case of a patient presenting with an anterior and inferior ST-elevation myocardial infarction due to double- -arterial coronary stent thrombosis in the left anterior descending artery and right coronary artery, despite the administration of prasugrel and acetylsalicylic acid. Stent thrombosis is an uncommon, but serious complication, usually manifested by sudden death (20–40%) or acute ST-elevation myocardial infarction (50–70%). It is a multifactor phenomenon, which involves other factors of the patient. Understanding of its histopathology and risk factors becomes necessary to try to prevent it, and we should keep in mind, that the deployment of a drug-eluting stent could be unsafe if it is not supported by a suitable evidence-based clinical guideline.W pracy opisano przypadek pacjenta z zawałem ścian przedniej i dolnej serca z uniesieniem odcinka ST spowodowanymzakrzepicą w dwóch stentach wieńcowych umieszczonych w gałęzi międzykomorowej przedniej i prawej tętnicy wieńcowej, która wystąpiła mimo stosowania prasugrelu i kwasu acetylosalicylowego. Zakrzepica w stencie jest rzadkim,lecz poważnym powikłaniem, zwykle prowadzącym do nagłego zgonu (20–40%) lub ostrego zawału serca z uniesieniemodcinka ST (50–70%). Powikłanie to ma podłoże wieloczynnikowe. Poznanie cech histopatologicznych i czynników ryzykazakrzepicy w stencie jest konieczne, aby można było zapobiec wystąpieniu tego powikłania. Ponadto należy pamiętać,że wszczepienie stentu uwalniającego lek może być niebezpieczne, jeśli nie jest zgodne z wytycznymi opartymi na dowodach naukowych

Novedades en reanimación cardiopulmonar y cuidados postresucitación. Qué nos dicen las Guías de la European Resuscitation Council (ERC) del 2021.

Management of cardiorespiratory arrest needs clear and standardised algorithms based on the latest scientific evidence. Cardiorespiratory arrest is frequent in our environment, with an annual incidence of out-of-hospital-cardiac arrest (OHCA) and in-hospital-cardiac arrest  (IHCA)  in Europe of 67 - 170 / 100,000 inhabitants and 1.5 - 2.8 / 1,000 hospital admissions, respectively. The guideline emphasises the importance of recording, of knowing what is happening and what we are doing in the field of cardiac arrest. It encourages people to act in every cardiorespiratory arrest and focuses on the lack or delay in recognising it. It emphasises the importance of cardiopulmonary resuscitation with quality chest compressions. The objective of the article is to expose the main algorithms and the most important updates of the ERC Guidelines.El manejo de la parada cardiorrespiratoria (PCR) necesita de algoritmos claros y estandarizados basados en las últimas evidencias cientificas. La PCR es frecuente en nuestro medio, con una incidencia anual en Europa de PCR extrahospitalaria e intrahospitalaria entre 67 – 170 / 100.000 habitantes y 1.5 – 2.8 / 1000 ingresos hospitalarios, respectivamente. Se enfatiza la importancia del registrar, del saber que está ocurriendo y que estamos haciendo en el campo de la PCR. Se anima a la población a actuar ante toda PCR y se incide en la falta o el retraso en su reconocimiento. Se enfatiza en la importancia de realizar reanimación cardiopulmonar con compresiones torácicas de calidad. El objetivo del artículo es exponer los principales algoritmos y las actualizaciones más destacadas de la guía de la ERC.&nbsp

Optimal surgical timing after post-infarction ventricular septal rupture

Background: Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is a dan-gerous condition. Surgical VSR closure is the definitive therapy, but there is controversy regarding the surgical timing and the bridging therapy between diagnosis and intervention. The objective of this study is to analyze the ideal time of surgical repair and to establish the contribution of mechanical circulatory support (MCS) devices on the prognosis. Methods: We designed an observational, retrospective, multicenter study, selecting all consecutive patients with post-AMI VSR between January 1, 2008 and December 31, 2018, with non-exclusion criteria. The main objective of this study was to analyze the optimal timing for surgical repair of post-AMI VSR. Second- ary endpoints were to determine which factors could influence mortality in the patients of the surgical group. Results: A total of 141 patients were included. We identified lower mortality rates with an odds ratio of 0.3 (0.1 & ndash;0.9) in patients operated on from day 4 compared with the surgical mortality in the first 24 hours after VSR diagnosis. The use of MCS was more frequent in patients treated with surgery, par- ticularly for intra-aortic balloon pump (IABP; 79.6% vs. 37.8%, p < 0.001), but also for veno-arterial extracorporeal membrane oxygenation (VA-ECMO; 18.2% vs. 6.4%, p = 0.134). Total mortality was 91.5% for conservative management and 52.3% with surgical repair (p < 0.001). Conclusions: In our study, we observed that the lowest mortality rates in patients with surgical repair of post-AMI VSR were observed in patients operated on from day 4 after diagnosis of VSR, compared to earlier interventions. (Cardiol J 2022; 29, 5: 773 & ndash;781

Optimal surgical timing after post-infarction ventricular septal rupture

Background: Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is a dangerous condition. Surgical VSR closure is the definitive therapy, but there is controversy regarding the surgical timing and the bridging therapy between diagnosis and intervention. The objective of this study is to analyze the ideal time of surgical repair and to establish the contribution of mechanical circulatory support (MCS) devices on the prognosis. Methods: We designed an observational, retrospective, multicenter study, selecting all consecutive patients with post-AMI VSR between January 1, 2008 and December 31, 2018, with non-exclusion criteria. The main objective of this study was to analyze the optimal timing for surgical repair of post-AMI VSR. Secondary endpoints were to determine which factors could influence mortality in the patients of the surgical group. Results: A total of 141 patients were included. We identified lower mortality rates with an odds ratio of 0.3 (0.1–0.9) in patients operated on from day 4 compared with the surgical mortality in the first 24 hours after VSR diagnosis. The use of MCS was more frequent in patients treated with surgery, particularly for intra-aortic balloon pump (IABP; 79.6% vs. 37.8%, p &lt; 0.001), but also for veno-arterial extracorporeal membrane oxygenation (VA-ECMO; 18.2% vs. 6.4%, p = 0.134). Total mortality was 91.5% for conservative management and 52.3% with surgical repair (p &lt; 0.001). Conclusions: In our study, we observed that the lowest mortality rates in patients with surgical repair of post-AMI VSR were observed in patients operated on from day 4 after diagnosis of VSR, compared to earlier interventions

Novedades en reanimación cardiopulmonar y cuidados postresucitación. Qué nos dicen las Guías de la European Resuscitation Council (ERC) del 2021.

Management of cardiorespiratory arrest needs clear and standardised algorithms based on the latest scientific evidence. Cardiorespiratory arrest is frequent in our environment, with an annual incidence of out-of-hospital-cardiac arrest (OHCA) and in-hospital-cardiac arrest (IHCA) in Europe of 67 - 170 / 100,000 inhabitants and 1.5 - 2.8 / 1,000 hospital admissions, respectively. The guideline emphasises the importance of recording, of knowing what is happening and what we are doing in the field of cardiac arrest. It encourages people to act in every cardiorespiratory arrest and focuses on the lack or delay in recognising it. It emphasises the importance of cardiopulmonary resuscitation with quality chest compressions. The objective of the article is to expose the main algorithms and the most important updates of the ERC Guidelines.El manejo de la parada cardiorrespiratoria (PCR) necesita de algoritmos claros y estandarizados basados en las últimas evidencias cientificas. La PCR es frecuente en nuestro medio, con una incidencia anual en Europa de PCR extrahospitalaria e intrahospitalaria entre 67 – 170 / 100.000 habitantes y 1.5 – 2.8 / 1000 ingresos hospitalarios, respectivamente. Se enfatiza la importancia del registrar, del saber que está ocurriendo y que estamos haciendo en el campo de la PCR. Se anima a la población a actuar ante toda PCR y se incide en la falta o el retraso en su reconocimiento. Se enfatiza en la importancia de realizar reanimación cardiopulmonar con compresiones torácicas de calidad. El objetivo del artículo es exponer los principales algoritmos y las actualizaciones más destacadas de la guía de la ERC

Electrocardiographic characteristics and associated outcomes in patients with Takotsubo syndrome. Insights from the RETAKO registry

Electrocardiographic disturbances in Takotsubo syndrome have been previously partially described but their consequences remain mostly unknown. Our aim was to describe the prevalence and prognostic significance of different electrocardiographic features in patients with Takotsubo syndrome. Our data come from the Spanish multicenter REgistry of TAKOtsubo syndrome (RETAKO). All patients with an available 12-lead surface electrocardiogram at admission and 48 hours post-admission were included. A total of 246 patients were studied, mean age was 71.3±11.5 and 215 (87.4%) were women. ST-segment elevation was seen in 143 patients (59.1%) and was present in ≥2 wall leads in 97 (39.8%). Exclusive elevation in inferior leads was infrequent (5 - 2.0%). After 48 hours, 198 patients (88.0%) developed negative T waves in a median of 8 leads with a mean amplitude of 0.7±0.5 mV and 137 (60.9%) had pathological Q waves. The mean corrected QT interval was 520±72 ms. Corrected QT interval was independently associated with the primary endpoint of all-cause death and nonfatal cardiovascular events (p=0.002) and all-cause death (p=0.008). A higher heart rate at admission was an independent predictor of the primary endpoint (p=0.001) and of acute pulmonary edema (p=0.04). ST-segment elevation with reciprocal depression was an independent predictor of all-cause death (p=0.04). Absence of ST-segment deviation was a protective factor (p=0.005) for the primary endpoint. Tachyarrhythmias were independently associated with cardiogenic shock (p<0.001). Takotsubo syndrome patients present with distinct electrocardiographic features. Prolonged corrected QT interval, tachyarrhythmias, heart rate at admission, and more extensive repolarization alterations are associated with poor outcomes.Sin financiación5.200 JCR (2020) Q2, 42/142 Cardiac & Cardiovascular Systems0.634 SJR (2020) Q2, 156/349 Cardiology and Cardiovascular MedicineNo data IDR 2020UE

Repolarization parameters and ventricular arrhythmias in Takotsubo syndrome: A substudy from the RETAKO national registry

Sin financiación1.9 Q* JCR 20220.71 Q2 SJR 2022No data IDR 2022UE