A dramatic course of myocardial infarction in 28 years old patient after amphetamine use

Zawał serca (MI) u młodych dorosłych występuje rzadko i najczęściej jest wywołany innymi przyczynami niż miażdżyca tętnic wieńcowych. Autorzy przedstawili opis przypadku 28-letniego palacza tytoniu, u którego po zażyciu amfetaminy i alkoholu doszło do MI powikłanego zatrzymaniem krążenia w mechanizmie migotania komór. W czasie długotrwałej resuscytacji powrót spontanicznego krążenia uzyskano dopiero po podaniu alteplazy. Po przeprowadzeniu przezskórnej interwencji wieńcowej pacjenta wprowadzono w stan hipotermii terapeutycznej, by ochronić mózg.Acute myocardial infarction in young adults occurs rarely and most often is induced by different causes than atheromatous coronary artery disease. We present a case report of amphetamine and alcohol induced myocardial infarction in 28 years old tobacco abuser, which was complicated by cardiac arrest caused by ventricular fibrillation. Return of spontaneous circulation (ROSC) during prolonged cardiopulmonary resuscitation was obtained only with administration of alteplase. After percutaneous coronary intervention (PCI) we induced therapeutic hypothermia to the patient in order to brain protection

Factors affecting short- and long-term survival of patients with acute coronary syndrome treated invasively using intravascular ultrasound and fractional flow reserve: Analysis of data from the Polish Registry of Acute Coronary Syndromes 2017–2020

Background: Intravascular ultrasound (IVUS) and fractional flow reserve (FFR) are invasive procedures increasingly used in acute coronary syndrome (ACS). Aims: The aim of this study was to evaluate the prevalence of IVUS and FFR use in patients with ACS in Poland and to assess the safety of these procedures, as well as their impact on short- and long-term survival. Methods and results: The retrospective study included 103849 patients enrolled in the PL-ACS registry in 2017-2020. IVUS was performed in 1,727 patients, FFR in 1,537 patients, both procedures in 37 patients. The frequency of performing FFR in ACS over the years increased from 1.3% to 1.8% (p <0.0001) and IVUS from 1.7% to 2.3% (p <0.0001). In the FFR and/or IVUS group, a similar incidence of stroke, reinfarction, target vessel revascularization and major bleeding was observed, while in-hospital mortality was lower (0% for IVUS + FFR vs. 0.9% for FFR vs. 2.3% for IVUS vs. 3.7 for no procedure; p <0.0001). FFR and IVUS did not affect the 30-day and one-year prognosis. Conclusion: In the consequent years, the number of FFR and IVUS procedures performed in patients with ACS in Poland increased. There was lower in-hospital mortality in the FFR and/or IVUS group in ACS, no differences in the incidence of stroke, reinfarction, target vessel revascularization and major bleeding were observed. Performing FFR and IVUS in ACS does not significantly affect 30-day or one-year mortality

Risk of perioperative death and sudden cardiac arrest: A study of 113 456 cases from the National Registry of Invasive Cardiology Procedures (ORPKI) for estimation of the perioperative prognosis

Background: Despite optimizing treatment of ST-segment elevation myocardial infarction (STEMI), a number of patients die during the invasive procedure or experience sudden cardiac arrest (SCA) that complicates further hospitalization.Aims: This study aimed to identify the most important risk factors leading to SCA and death in the cath lab among STEMI patients.Methods: We used data from the National Registry of Invasive Cardiology Procedures (ORPKI) collected between 2014 and 2019. The study population consisted of 113 465 patients. Descriptive statistics, univariate and multiple logistic regression analysis of factors affecting perioperative mortality (PM) and SCA in the cath lab were performed.Results: Death and SCA occurred in 1549 (1.4%) and 945 (0.8%) patients, respectively. Diabetes (odds ratio [OR], 1.76; P <0.0001), previous brain stroke (OR, 2.26; P <0.0001), prior myocardial infarction (OR, 1.81; P <0.0001), psoriasis (OR, 1.79; P = 0.04), and chronic renal failure (OR, 2.79; P <0.0001) were the strongest predictors of PM. The occurrence of SCA was dependent mainly on diabetes (OR, 1.37; P = 0.0001), previous brain stroke (OR, 2.23; P <0.0001), prior myocardial infarction (OR, 1.73; P <0.0001), psoriasis (OR, 2.03; P = 0.04), and chronic renal failure (OR, 2.79; P <0.0001). Of the pre-hospital factors, the Killip-Kimball class showed the strongest relationship with the two endpoints (OR 3.53; P <0.0001 and OR 2.65; P <0.0001, respectively).Conclusions: Diabetes, previous brain stroke, myocardial infarction, psoriasis, chronic renal failure, and the Killip-Kimball class were the strongest predictors of PM and SCA in the cath lab among STEMI patients

Out-of-hospital cardiac arrest: data from the National Registry of Invasive Cardiology Procedures (ORPKI) in a long-term survival analysis of patients with acute coronary syndromes in a Polish region

Background: Out‑of‑hospital cardiac arrest (OHCA) is one of the leading causes of death in high‑income countries. Aims: This study aimed to analyze long ‑term survival in patients with OHCA in the ŚwiętokrzyskieProvince, who were included in the National Registry of Invasive Cardiology Procedures (ORPKI), estimate survival probability, and evaluate associated risk factors. Methods: Based on the ORPKI registry, we identified subjects with OHCA prior to hospitalization. Data were collected from January 1, 2014 to December 31, 2016. Results: Out‑of ‑hospital cardiac arrest occurred in 90 of 9855 patients diagnosed with myocardial infarction. We identified 2 significant risk factors: renal failure (HR, 6.53; 95% CI, 1.17–36.40; P = 0.03) and time (hours) from symptom onset to first medical contact (HR, 1.04; 95% CI, 1.01–1.08; P = 0.02). The probability of survival in patients below 66 years of age was almost 2‑fold higher (HR, 1.99; 95% CI, 1.1–3.59; P = 0.02) than in those over the age of 66 years. In those without diabetes mellitus, it was more than 2‑fold higher (HR, 2.36; 95% CI, 1.12–4.98; P = 0.03) than in diabetic patients, and in individuals with single‑vessel coronary artery disease, it was almost 3‑fold higher (HR, 2.76; 95% CI, 1.51–5.06; P = 0.001) than in those with multivessel coronary artery disease. Conclusions: Well‑documented predictors of all ‑cause mortality include: age, history of diabetesmellitus and renal failure, multivessel coronary artery disease on angiography, and time from pain onset to first medical contact. The total amount of contrast agent administered during invasive procedures and patient radiation exposure during procedures are less commonly reported risk factors for unfavorable outcomes

Medium-term prognosis of survival and hospitalization of patients after permanent pacemaker implantation based on BNP, high-sensitivity troponin T, and left atrium volume index

Introduction : Determination of predictors of survival and hospitalization can optimise a medical care of patient with permanent pacemaker. Aim of the research : Use of the B-type natriuretic peptide (BNP), high-sensitivity troponin T (TnT hs), and left atrial volume index (LAVI) to control survival and hospitalizations due to cardiovascular causes in patients after pacemaker implantation. Material and methods : The study covered a sample of 123 patients qualified for pacemaker implantation. During 23-month observation, cyclic BNP, TnT hs and LAVI examinations were performed. Mortality and hospitalization rate in groups with normal and elevated values were assesed using Kaplan-Meier curves. Results : A statistical relationship was observed between survival and increased initial BNP plasma level (log-rank test = 2.11, p < 0.05). Significantly higher frequency of hospitalizations was observed with a higher initial BNP plasma level (log-rank test = 2.01, p < 0.05). No statistically significant relationships were found between the TnT hs concentration and the duration of survival and hospitalizations. A strong tendency was confirmed (p < 0.10) towards a higher probability of the survival of patients with low values of LAVI, compared to patients with high values of LAVI. Conclusions : Results of the study conducted in regional centre (over 1000 implantations per year) confirmed that BNP peptide is an important indicator of survival and hospitalization due to cardiovascular causes after permanent pacemaker implantation. From among the 3 parameters examined: BNP, TnT hs LAVI, only BNP peptide and LAVI may be justified in the evaluation of patients after pacemaker implantation. Determination of BNP for evaluation medium-term prognosis of survival and hospitalization may be considered during routine pacemaker control visit

Trudności techniczne w uzyskaniu prawidłowej czasowej stymulacji przezżylnej u pacjenta z zespołem ciasnoty górnego otworu klatki piersiowej

Thoracic outlet syndrome (TOS) is a group of clinical symptoms caused by pressure on the vascular-nerve structures, passing through the upper thoracic opening. The etiology of this syndrome has many causes, congenital, traumatic and functionally acquired. We presented a patient with bradycardia, who had a problem during implanting an endocavitary electrode from the access through the right subclavian vein. There was a possibility of functionally acquired, age-related cervical spine abnormalities and incorrect position of the neck. In similar cases, when TOS is suspected, accessing the vessels in the upper thoracic opening might be problematic and other vascular access should be consideredZespół ciasnoty górnego otworu klatki piersiowej (TOS) to grupa objawów klinicznych spowodowanych uciskiem struktur naczyniowo-nerwowych przechodzących przez górny otwór klatki piersiowej. Zespół ten może mieć różną etiologię, w tym przyczyny wrodzone, urazowe i czynnościowe. Przedstawiamy pacjenta z bradykardią, u którego wystąpiły problemy podczas implantacji elektrody endokawitarnej z dostępu przez prawą żyłę podobojczykową. Wysunięto podejrzenie czynnościowych, związanych z wiekiem nieprawidłowości kręgosłupa szyjnego i związanego z tym nieprawidłowego ustawienia szyi. W podobnych przypadkach, kiedy podejrzewa się TOS, uzyskanie dostępu naczyniowego przez górny otwór klatki piersiowej może być problematyczne i należy rozważyć inną drogę dostępu naczyniowego

Correlation analysis of the relationship between B-type natriuretic peptide and selected echocardiographic parameters in patients with permanent pacemakers

Introduction: The present study was undertaken to evaluate the practical value of BNP measurements and echocardiographic left ventricular volume index in patients with permanent pacemakers because there are no such reports in the literature. Aim of the research: The aim of the study was to reveal multiple correlations between BNP levels and selected echocardiographic parameters of the left atrium in patients with permanent pacemakers. In the literature there are reports on the significance of BNP values and left atrial size in patients with permanent pacemakers. The results of the present study appear to be of value in the outpatient assessment of these patients. Material and methods: We analysed a group of 117 patients with permanent pacemakers (AAI/R 21 patients, DDD/R 59 patients, VVI/R 37 patients) and 48 healthy volunteers serving as the control group. BNP measurements were performed on venous blood samples using Triage meters. The Simpson method and the ellipse method were used to assess the left atrium on echocardiography. Results: There was a significant correlation between BNP and maximum left atrial volume, minimum left atrial volume, and left atrial volume index in patients with AAI/R, DDD/R, and VVI/R pacemakers at 3 and 6 months after the implantation. Conclusions : In patients after implantation of permanent pacemakers there are correlations between BNP values and echocardiographic left atrial parameters, especially in patients with DDD/R pacemakers. Left atrial function improves in patients with DDD/R pacemakers. Pacemaker check-up should be extended to include BNP measurements and echocardiographic assessment of the left atrium

High-risk pulmonary embolism in the course of COVID-19 infection: safety and efficacy of systemic thrombolysis

Coronavirus disease 2019 (COVID-19) is an established risk factor for venous thrombosis. Treatment of pulmonary embolism (PE) of this etiology is standard, but the course of systemic thrombolysis is relatively poorly studied. The authors present the case of an 86-year-old woman with high-risk PE related to COVID-19 infection, who was treated with thrombolytic therapy with a very good clinical effect confirmed in additional studies.COVID-19 is an established risk factor for venous thrombosis. Treatment of pulmonary embolism of this etiology is standard, but the course of systemic thrombolysis is relatively poorly studied. The authors present the case of an 86-year-old woman with high-risk pulmonary embolism related to COVID-19 infection, who was treated with thrombolytic therapy with a very good clinical effect confirmed in additional studies

The Effect of Periprocedural Clinical Factors Related to the Course of STEMI in Men and Women Based on the National Registry of Invasive Cardiology Procedures (ORPKI) between 2014 and 2019

Background: There are several sex-related differences in the course, management, and outcomes of ST-elevation myocardial infarction (STEMI). This study aimed to identify the risk factors that may affect the odds of procedure-related death in patients with STEMI. Methods: The observational cohort study group consisted of 118,601 participants recruited from the National Registry of Invasive Cardiology Procedures (ORPKI). Results: Procedure-related death occurred in 802 (1.0%) men and in 663 (1.7%) women. The odds of procedure-related death among women were significantly higher than among men (OR, 1.76; 95% CI, 1.59–1.95; p < 0.001). The probability of procedure-related mortality was highest in both men and women with cardiac arrest in the cath lab, critical stenosis of the left main coronary artery, and direct transfer to the cath lab. The factors that reduced the probability of procedure-related mortality in both men and women were thrombolysis in myocardial infarction (TIMI) flow grade and the use of P2Y12 inhibitors in the peri-infarct period. Psoriasis was associated with increased odds of procedure-related death among men, whereas cigarette smoking reduced the odds among women. Conclusions: Procedure-related deaths occurred more frequently in women than men with STEMI. Additional scrutiny needs to be undertaken to identify factors influencing survival regarding gender differences