Which treatment strategy is preferred in the octogenarians with acute coronary syndrome?

Objective: To compare the efficacy of invasive and conservative strategy in the management of octogenarians with acute coronary syndrome. Methods: The retrospective study was conducted after approval from the ethics review committee of University of Health Sciences, Derince Training and Research Hospital, Turkey and comprised data from April 2020 to April 2021 related to octogenarian patients of either gender admitted to University of Health Sciences, Darica Farabi Training and Research Hospital, Turkey with acute coronary syndrome diagnosis. The data was divided into invasive group A and conservative group B. Data was analysed using SPSS 25. Results: Of the 168 patients with median age 84(interquartile range: 81-86 years), there were 25(14.9%) in group A; 14(56%) males and 11(44%) females. There were 143(85.1%) patients in group B; 70(49%) males and 73(51%) females. Overall mortality was 111(66.1%); 11(44%) in group A, and 100(69.9%) in group B (p=0.012). Elevated alanine aminotransferase and invasive strategy were independent factors associated with mortality (p<0.05). Conclusion: The invasive strategy in the management of octogenarian patients presenting with acute coronary syndrome was found to be more efficient compared to the conservative strategy. Key Words: Octogenarians, Acute coronary syndrome, Mortality

An example of apparently normal electrocardiogram originating from incorrect electrocardiographic acquisition in a patient with ST-segment elevation myocardial infarction

Electrocardiography (ECG) is proved to be an invaluable tool for diagnosis of ischemic heart disease for a long while. Importance of ECG in acute management decision makes it a crucial method that must be known in depth by every physician, and the clinicians should also be aware of the dangerous pitfalls of ECG. We present a patient with ST-segment elevation myocardial infarction in whom incorrect interpretation of an inaccurately taken ECG might have led to disastrous consequences. (C) 2010 Elsevier Inc. All rights reserved

Brugada type 1 electrocardiogram unmasked by a febrile state following syncope

Brugada syndrome is a genetic disease characterized by persistent or transient ST elevation in the right precordial electrocardiogram (ECG) leads with or without right bundle branch block. It represents an increased risk for sudden cardiac death despite a structurally normal heart. Brugada-type ECG can be unmasked and induced by several circumstances. We report on a 24-year-old male patient who experienced a syncopal episode and manifested Brugada type 1 ECG during a febrile state. His ECG changed to normal after treatment of fever. A single-chamber ICD was implanted to the patient because of syncope, fever-induced type I Brugada ECG pattern, and ventricular fibrillation during ajmaline challenge

Atrioventricular complete block occurring 12 years after successful ablation of slow-slow atrioventricular nodal reentrant tachycardia

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most frequent form of paroxysmal supraventricular tachycardia. Selective radiofrequency (RF) catheter ablation of the slow pathway is an ideal method for treatment of patients with AVNRT. Complete atrioventricular block is a rare but serious complication of RF ablation, and primarily occurs during or immediately after the procedure. We report on a 45-year-old woman who underwent successful ablation for symptomatic AVNRT at the age of 33. She presented with paroxysmal complete AV block, which developed twelve years after RF ablation of the slow pathway and a permanent DDD pacemaker was implanted. As seen in the case we report, complete AV block complicating RF ablation can occur years after the procedure