54 research outputs found
ST-Elevation Myocardial Infarction in Situs Inversus Dextrocardia : A Case Report
ST-elevation myocardial infarction (STEMI) in situs inversus dextrocardia is a rare combination and poses many challenges in terms of diagnosis and management. These include the early detection of dextrocardia as well as the interpretation of the ECG. In addition, percutaneous coronary intervention could be challenging in the setting of dextrocardia because of diffi culty in cannulating the coronary arteries, selection of catheters, catheter manipulation, image acquisition and interpretation
Increased serum levels of interleukin-6 and von Willenbrand Factor in early phase of acute coronary syndrome in a young and multiethnic Malaysian population
Objective Interleukin-6 (IL6; proinflammatory marker),
von Willebrand Factor (vWF; endothelial dysfunction
marker) and P-selectin ( platelet activation marker), may
play important roles in defining the pathogenesis of
vulnerable plaques in acute coronary syndrome (ACS).
This study aims to investigate the expression and
relationship of these markers in early phases of ACS in a
young and multiethnic Malaysian population.
Design Peripheral whole blood mRNA, and serum levels
of IL6, vWF and P-selectin were measured in 22 patients
with ACS, and in 28 controls with angiographically
significant coronary artery disease without previous ACS
events. Venous blood from ACS patients was obtained
within 1 h of hospital admission.
Results No significant differences of IL6, vWF and
P-selectin mRNA levels between ACS and controls were
seen. ACS patients had significantly higher serum levels
of IL6 and vWF ( p<0.001), compared with controls.
P-selectin correlated with IL6 (r=0.697, p=0.003) and
vWF (r=0.497, p=0.05) at mRNA levels, indicating a
possible association between these three indices of ACS
pathogenesis.
Conclusions Increased serum levels of IL6 and vWF
suggest that inflammation and endothelial dysfunction
may play a prominent role in the pathogenesis of the
disease during the early phase of ACS
Massive haemorrhagic pericardial effusion as the cardiac manifestation of Salmonella enteritidis infection in a severely immunocompromised patient
A 41-years-old gentleman was admitted for reduced effort
tolerance with non-specific symptoms of weight loss and
generalised body weakness. Chest X-ray (CXR) showed
cardiomegaly. Echocardiography showed a large pericardial
effusion with septation. Emergency pericardiocentesis was
performed and pericardial fluid culture grew Salmonella
enteritidis (S. enteritidis). He tested positive for the retroviral
disease, with a CD4 count of 10 cells/µL. Intravenous (IV)
ceftriaxone was administered. A pericardial drain was
inserted due to the rapid re-accumulation of pericardial fluid
after the initial pericardiocentesis. He also had drainage of
his left pleural effusion. He had a guidewire exchange of
pericardial drain around 2 weeks after admission, with
flushing performed whenever the flow was poor. A repeat
echocardiogram showed early signs of constrictive
pericarditis with residual pericardial effusion in which intrapericardial fibrinolysis was considered. He was started on
antiretroviral therapy (ART) and his condition remained
stable. The pericardial drain was kept throughout his
admission. Unfortunately, he developed severe sepsis and
succumbed to it about a month post-admission
Comprehensive right heart systolic function assessment using cardiac magnetic resonance imaging after inferior ST elevation myocardial infarction
Acute Inferior ST Elevation Myocardial Infarction
(Ac-Inf-STEMI) and associated posterior and right ventricular (RV) infarction has been extensively studied
with electrophysiology and echocardiography. A recent
CMR study showed that poor RV function was associated with poor long term survival post myocardial
infarction. However, limited CMR data exists especially
on short term clinical outcomes in Ac-Inf-STEMI
Drug-coated balloon treatment in coronary artery disease: Recommendations from an Asia-Pacific Consensus Group
Coronary artery disease (CAD) is currently the leading cause of death globally, and the prevalence of thisdisease is growing more rapidly in the Asia-Pacific region than in Western countries. Although the useof metal coronary stents has rapidly increased thanks to the advancement of safety and efficacy of newergeneration drug eluting stent (DES), patients are still negatively affected by some the inherent limitationsof this type of treatment, such as stent thrombosis or restenosis, including neoatherosclerosis, andthe obligatory use of dual antiplatelet therapy (DAPT) with unknown optimal duration.Drug-coated balloon (DCB) treatment is based on a leave-nothing-behind concept and therefore it is notlimited by stent thrombosis and long-term DAPT; it directly delivers an anti-proliferative drug whichis coated on a balloon after improving coronary blood flow. At present, DCB treatment is recommendedas the first-line treatment option in metal stent-related restenosis linked to DES and bare metal stent.For de novo coronary lesions, the application of DCB treatment is extended further, for conditions suchas small vessel disease, bifurcation lesions, and chronic total occlusion lesions, and others. Recently,several reports have suggested that fractional flow reserve guided DCB application was safe for largercoronary artery lesions and showed good long-term outcomes. Therefore, the aim of these recommendationsof the consensus group was to provide adequate guidelines for patients with CAD based on objectiveevidence, and to extend the application of DCB to a wider variety of coronary diseases and guide theirmost effective and correct use in actual clinical practice
Cardiovascular Risk Reduction After Renal Denervation According to Time in Therapeutic Systolic Blood Pressure Range
Background: Renal denervation (RDN) has been shown to lower blood pressure (BP), but its effects on cardiovascular events have only been preliminarily evaluated. Time in therapeutic range (TTR) of BP is associated with cardiovascular events. Objectives: This study sought to assess the impact of catheter-based RDN on TTR and its association with cardiovascular outcomes in the GSR (Global SYMPLICITY Registry). Methods: Patients with uncontrolled hypertension were enrolled and treated with radiofrequency RDN. Office and ambulatory systolic blood pressure (OSBP and ASBP) were measured at 3, 6, 12, 24, and 36 months postprocedure and used to derive TTR. TTR through 6 months was assessed as a predictor of cardiovascular events from 6 to 36 months using a Cox proportional hazard regression model. Results: As of March 1, 2022, 3,077 patients were enrolled: 42.2% were female; mean age was 60.5 ± 12.2 years; baseline OSBP was 165.6 ± 24.8 mm Hg; and baseline ASBP was 154.3 ± 18.7 mm Hg. Patients were prescribed 4.9 ± 1.7 antihypertensive medications at baseline and 4.8 ± 1.9 at 36 months. At 36 months, mean changes were −16.7 ± 28.4 and −9.0 ± 20.2 mm Hg for OSBP and ASBP, respectively. TTR through 6 months was 30.6%. A 10% increase in TTR after RDN through 6 months was associated with significant risk reductions from 6 to 36 months of 15% for major adverse cardiovascular events (P < 0.001), 11% cardiovascular death (P = 0.010), 15% myocardial infarction (P = 0.023), and 23% stroke (P < 0.001). Conclusions: There were sustained BP reductions and higher TTR through 36 months after RDN. A 10% increase in TTR through 6 months was associated with significant risk reductions in major cardiovascular events from 6 to 36 months. (Global SYMPLICITY Registry [GSR] DEFINE; NCT01534299
Early cardiovascular MRI post successful reperfusion of acute myocardial infarction : An exploratory study
Post-myocardial infarction (MI) patients has varied outcome despite successful reperfusion. Our study aimed to use cardiac magnetic resonance imaging (CMR) to explore parameters that may influence outcome in successfully reperfused post-MI patients. We used left ventricular (LV) remodelling and major adverse cardiovascular event (MACE) at 6 months as a pooroutcome indicator. Consecutive patients admitted to Sarawak Heart Centre from Dec 2012 to Nov 2014 with acute anterior or
inferior ST elevation MI were screened. A total of 101 patients with TIMI-3 flow were recruited. Patients underwent CMR imaging during the index admission, and another between 3 to 6 months later. LV remodelling occurred in 21.8% while microvascular obstruction (MVO) in 38.6% of patients. LV infarct size and MVO were significant in those who developed LV remodelling, while door-to-perfusion time and total-ischaemic time were not significantly different. MACE was significant in patients with larger infarcts but not significant in patients with MVO. LV infarct size was also significant in those who had reverse LV remodelling. These results suggest that early CMR measurement of infarct size and detection of MVO has the potential to predict LV improvement or deterioration at 6 months
COVID-19 Antibody Surveillance Among Healthcare Workers in A Non-COVID designated Cardiology Centre
BACKGROUND: Reports on healthcare worker antibody response to COVID-19 infection are scarce. We aim to determine theCOVID-19 antibody prevalence among healthcare workers in a cardiology centre and the relationship between case definitioncriteria with the COVID-19 antibody result. METHODS: Convenience sampling was applied. Healthcare workers in SarawakHeart Centre (SHC) cardiology, radiology, and emergency unit were recruited. A survey form on clinical symptoms and closecontact history was distributed. HEALGEN COVID-19 IgG/IgM rapid test was performed using serum/ whole blood specimen.Staff with positive COVID-19 antibody results were referred to the infectious disease specialist for assessment. RESULTS: Atotal of 310 staff were screened. 220(71%) were female, and the mean age was 36±7.7 years old. 46(14.8%) staff reported havingclinical symptoms at some stage from the end of January 2020 to the time of this surveillance. Number of staff who had a historyof overseas travel, close contact with confirmed COVID-19 patients, or had visited places with identified COVID-19 clusterswere 4(1.3%), 24(7.7%) and 24(7.7%) respectively. There were 14 staff (4.5%) with positive tests positive, 2 for IgM, and 12for IgG. All those with positive antibody were subsequently tested negative with RT-PCR test. The history of having clinicalsymptoms and exposure to COVID-19 cluster area were independently associated with a positive IgG result. CONCLUSION:The application of COVID-19 antibody serology rapid tests could determine true exposure of staff to the infection and allowus to reassess existing measures of infection control within the hospital
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