Lingual angioedema with macroglossia during the treatment of acute ischemic stroke with alteplase

Alteplase (recombinant tissue plasminogen activator) has been used in the treatment of acute ischemic stroke for 10 years. The application of this drug is considered safe and effective. However, alteplase is also associated with side effects. The author is reporting on an unusual side effect of angioedema that is triggered by alteplase. Angioedema occurs through alteplase according to this study at a frequency of 5.88% (95% confidence interval: 0.98% to 28.76%). In this case immunoglobulin G was slightly increased. The relative risk to get an angioedema compared between the two genders is elevated in men 3.3 (95% confidence interval: 0.15% to 71.90%; P = 0.4423), who were 3.3 times more likely to suffer than women. The use of angiotensin-converting-enzyme (ACE) inhibitors is considered a possible risk factor for the occurrence of angioedema with concomitant administration of tissue plasminogen activator. The angioedema may occur with use of alteplase at any time, so treatment with this drug must always be carried out in intensive care and doctors must be ready for intubation if necessary

Erythrocyte sedimentation rate as a marker for coronary heart disease

Josef YayanDepartment of Internal Medicine, Vinzentius Hospital, Landau, GermanyBackground: Patients with angina pectoris or myocardial infarction frequently present without evidence of cardiac-specific heart enzymes by laboratory analysis or specific pathologic electrocardiogram findings. The current study analyzed the efficacy of the erythrocyte sedimentation rate as an additional potential indicator for coronary heart disease, the aim being to enable quicker identification of patients with angina pectoris or myocardial infarction so that they can be more rapidly treated.Methods: Patients with angina pectoris or myocardial infarction who had undergone a heart catheter examination were included in the study. The diagnosis of acute coronary heart disease was made by the physician who performed coronary angiography. Patients without coronary heart disease were used as a control group. The erythrocyte sedimentation rate was measured in all patients. Patients with angina pectoris or myocardial infarction and an inflammatory or tumor disease were excluded.Results: The erythrocyte sedimentation rate was prolonged in 79 (58.09%) of 136 patients; 69 (50.74%) patients (95% confidence interval ±8.4%, 42.34%–59.14%) had coronary heart disease and a prolonged erythrocyte sedimentation rate. The erythrocyte sedimentation rate was prolonged in ten (7.35%) patients (95% confidence interval ±4.39%, 2.96%–11.74%) without coronary heart disease by coronary angiography. The specificity of the erythrocyte sedimentation rate for coronary heart disease was 70.59% and the sensitivity was 67.65%.Conclusion: Erythrocyte sedimentation rate may be a useful additional diagnostic criterion for coronary heart disease.Keywords: erythrocyte sedimentation rate, coronary heart disease, myocardial infarction, coronary angiograph

Weak prediction power of the Framingham Risk Score for coronary artery disease in nonagenarians.

Coronary artery disease (CAD) is caused by an acute myocardial infarction and is still feared as a life-threatening heart disease worldwide. In order to identify patients at high risk for CAD, previous studies have proposed various risk assessment scores for the prevention of CAD. The most commonly used risk assessment score for CAD worldwide is the Framingham Risk Score (FRS). The FRS is used for middle-aged people; hence, its appropriateness has not been demonstrated to predict the likelihood of CAD occurrence in very elderly people. This article examines the possible predictive value of FRS for CAD in very elderly people over 90 years of age.Data on all patients over 90 years of age who received a cardiac catheter were collected from hospital charts from the Department of Internal Medicine, Saarland University Medical Center, and HELIOS Hospital Wuppertal, Witten/Herdecke University Medical Center, Germany, within a study period from 2004 to 2013. The FRSs and cardiovascular risk profiles of patients over 90 years of age with and without CAD after cardiac catheterization were compared.One hundred and seventy-five (91.15%, mean age 91.51±1.80 years, 74 females [42.29%]; 95% confidence interval [CI], 0.87-0.95) of a total 192 of the very elderly patients were found to have CAD. Based on the results of our study, the FRS seems to provide weak predictive ability for CAD in very elderly people (P = 0.3792).We found weak prediction power of FRS for CAD in nonagenarians

Comparison of acute illnesses in patients with and without CAD.

<p><b>Abbreviations:</b> CAD: coronary artery disease; CI: confidence interval. <b>Notes:</b> Significant <i>P</i> values are shown in bold.</p><p>Comparison of acute illnesses in patients with and without CAD.</p

Comparison of cardiovascular risk factors with stable angina pectoris and acute coronary syndrome in very elderly people over 90 years of age with CAD.

<p><b>Abbreviations:</b> NSTEMI: non-ST segment elevation myocardial infarction; STEMI: ST segment elevation myocardial infarction. <b>Notes:</b> Significant <i>P</i> values are shown in bold.</p><p>Comparison of cardiovascular risk factors with stable angina pectoris and acute coronary syndrome in very elderly people over 90 years of age with CAD.</p

Comparison of demographic data, duration of hospital stay, cholesterol, high sensitivity lipoproteins, systolic blood pressure, Framingham Risk Score, and Risk Score between elderly people over 90 years of age with and without CAD.

<p><b>Abbreviations:</b> CAD: coronary artery disease; BMI: body mass index; HDL: high sensitivity lipoproteins. <b>Notes:</b> Significant <i>P</i> values are shown in bold.</p><p>Comparison of demographic data, duration of hospital stay, cholesterol, high sensitivity lipoproteins, systolic blood pressure, Framingham Risk Score, and Risk Score between elderly people over 90 years of age with and without CAD.</p