The Role of High Sensitivity Troponin: More Acute Coronary Syndromes or More False Positive Results?

Cardiac troponins (cTn) are the most sensitive and specific biomarkers of myocardial damage. Troponin has both diagnostic and prognostic significance for acute coronary syndrome (ACS). The joint European Society of Cardiology/American College of Cardiology Foundation/American Heart Association/World Heart Federation task force recommendations for a universal definition of acute myocardial infarction (AMI) in 2007 are based on detection of cTn and associated clinical evidence. Although the clinical introduction of new generation high sensitivity cTnT and cTnI assays is certainly valuable in the appropriate setting, its widespread use in a variety of clinical situations may lead to the detection of cTn elevation in absence of thrombotic ACS. Until now there is no clarity between “sensitive” and “high sensitive” cTn assays something that raises concerns regarding the interpretation of the latest clinical studies. The increased analytical sensitivity against compromised specifity may increase ‘‘false positive’’ results in patients with cardiovascular disease or apparently healthy subjects with previously undetected cTn levels. A cTn rise in the absence of ACS should prompt for an assessment for a different, non-ischemic mechanism of troponin elevation and direct management at the primary cause. The role of the clinician is to apply clinical doubts where abnormal cTn levels are not due to myocardial injury. The current strategy of management of such patients is based on established algorithms and clinical knowledge

Advances in Post Resuscitation Care:Mild Therapeutic Hypothermia

Out of hospital cardiac arrest remains a major cause of mortality and morbidity despite progress in resuscitative practices. The number of survivors with severe neurologicalimpairment at hospital discharge is similarly dismal. Recently, much attention has been directed toward the use of mild therapeutic hypothermia in postresuscitation care of comatose survivors of cardiac arrest. Two randomized, controlled clinical trials published in the New England Journal of Medicine showed that after resuscitation mild hypothermia lowers mortality, improves neurological outcome after successfully treated cardiac arrest, and is recommended by the 2005 update guidelines of International Liaison Committee on Resuscitation and European Resuscitation Council (ERC). In the present article pathophysiological mechanisms of hypothermia, cooling methods and potential side effects are briefly discussed. Questions regarding implementation of therapeutic hypothermia recommendations in every day clinical practice and future investigation are also addressed

Acute post cardiac injury syndrome occurring immediately after a demanding percutaneous coronary intervention.

Postcardiac injury syndrome (PCIS) occurs as a complication of myocardial infarction (Dressler's syndrome), of cardiac surgery (post-pericardiotomy syndrome), or post-traumatic (either iatrogenic or non-iatrogenic) and involves a pericardial or myocardial injury. There is scarce data regarding occurrence and pathogenesis of PCIS after invasive procedures. Herein, we describe a unique case of acute PCIS with typical clinical, laboratory, echocardiographic findings that occurred one hour after a demanding multi-stenting percutaneous coronary intervention. Possible pathogenetic mechanisms and treatment options are being discussed

Torsade de Pointes related to the co-administration of amiodarone and digoxin

A case of acquired long QT syndrome and subsequent torsade de pointes related to the co-administration of amiodarone and digoxin is described in the present case report. The underlying electrophysiologic mechanism of this proarrhythmic event is discussed

Severe accordion effect: Myocardial ischemia due to wire complication during percutaneous coronary intervention: A case report

A mechanical alteration during manoeuvring of stiff guidewires in tortuous coronary arteries frequently induces vessel wall shortening and coronary psedostenosis, referred as accordion phenomenon. Subtraction of the guidewires normally leads to the entire resolution of the lesions. A case of this transient angiographic finding, during percutaneous coronary intervention in a tortuous right coronary artery, which resulted in a flow limiting effect and myocardial ischemia, is described in the present report. Differential diagnosis from potential procedure complications and interventional methodology issues are discussed, while similar reports are reviewed