Zawał serca u 47-letniego mężczyzny spowodowany jednoczesnym zamknięciem dwóch tętnic wieńcowych

Simultaneous thrombosis of more than one coronary artery is an uncommon angiographic finding in acute ST-segment elevation myocardial infarction (STEMI), and is most commonly associated with cardiogenic shock or even sudden cardiac death. We describe a 47-year-old male, a heavy smoker, who was admitted to our department because of STEMI, in cardiogenic shock. Emergent coronary angiogram has shown total occlusion of both the proximal left anterior descending artery (LAD) and the proximal right coronary artery (RCA). The increased risk of occlusion of two vessels occurs in smokers, in patients with idiopathic thrombocytopenic purpura, coronary artery vasospasm, cocaine abuse, hyperhomocysteinemia and antithrombin III deficiency.Jednoczesna okluzja więcej niż jednej tętnicy wieńcowej jest bardzo rzadką przyczyną zawału serca z uniesieniem odcinka ST i najczęściej przebiega z objawami wstrząsu kardiogennego, a nawet nagłego zgonu sercowego. Przedstawiono przypadek 47-letniego mężczyzny, wieloletniego palacza tytoniu, przyjętego do oddziału z powodu zawału serca z uniesieniem odcinka ST ściany przedniej, powikłanego wstrząsem kardiogennym, u którego w wykonanej w trybie pilnym koronarografii stwierdzono jednoczesne zamknięcie proksymalnego odcinka gałęzi przedniej zstępującej oraz ostialną amputację prawej tętnicy wieńcowej. Zwiększone ryzyko okluzji dwóch naczyń występuje u osób palących tytoń, z nadpłytkowością samoistną, z tendencją do skurczu naczyń wieńcowych, po zażyciu kokainy, hiperhomocysteinemią oraz niedoborem antytrombiny III

Nawracające częstoskurcze komorowe w przebiegu zawału NSTEMI utrzymujące się pomimo rewaskularyzacji i zastosowanej farmakoterapii

We present a patient with recurrent hemodynamically unstable ventricular tachycardias in the period of myocardial infarction without elevation of the ST segment complicated by cardiac failure. Ventricular arrhythmias persisted despite the cardiac failure therapy, the use of amiodarone and revascularization. In the case description, we discuss further proceedings, the possibility of implementing non-standard, available pharmacotherapy, and discuss the use of invasive methods, i.e. endovascular ablation and implantation of a cardioverter-defibrillator.Przedstawiamy pacjenta z nawracającymi niestabilnymi hemodynamicznie częstoskurczami komorowymi w okresie zawału mięśnia sercowego bez uniesienia odcinka ST powikłanego niewydolnością krążenia. Komorowe zaburzenia rytmu utrzymywały się pomimo wdrożonej farmakoterapii przeciwniewydolnościowej, zastosowania amiodaronu i przeprowadzonej rewaskularyzacji. W związku z tym zastosowano niestandardową farmakoterapię oraz metody zabiegowe takie jak ablacja endowaskularna i implantacja kardiowertera-defibrylatora

Comparison of reorganized versus unaltered cardiology departments during the COVID-19 era: a subanalysis of the COV-HF-SIRIO 6 study

Background: Since the beginning of the coronavirus disease-2019 (COVID-19) pandemic, numerous cardiology departments were reorganized to provide care for COVID-19 patients. We aimed to compare the impact of the COVID-19 pandemic on hospital admissions and in-hospital mortality in reorganized vs. unaltered cardiology departments. Methods: The present subanalysis is a multicenter retrospective COV-HF-SIRIO 6 study that includes all patients (n = 101,433) hospitalized in 24 cardiology departments in Poland between January 1, 2019 and December 31, 2020, with a focus on patients with acute heart failure (AHF). Results: Reduction of all-cause hospitalizations was 50.6% vs. 21.3% for reorganized vs. unaltered cardiology departments in 2020 vs. 2019, respectively (p < 0.0001). Considering AHF alone respective reductions by 46.5% and 15.2% were registered (p < 0.0001). A higher percentage of patients was brought in by ambulance to reorganized vs. unaltered cardiology departments (51.7% vs. 34.6%; p < 0.0001) alongside with a lower rate of self-referrals (45.7% vs. 58.4%; p < 0.0001). The rate of all-cause in-hospital mortality in AHF patients was higher in reorganized than unaltered cardiology departments (10.9% vs. 6.4%; p < 0.0001). After the exclusion of patients with concomitant COVID-19, the mortality rates did not differ significantly (6.9% vs. 6.4%; p = 0.55). Conclusions: In cardiology departments reorganized to provide care for COVID-19 patients vs. unaltered ones, observed: i) a greater reduction in hospital admissions in 2020 vs. 2019; ii) higher rates of patients brought by ambulance and lower rates of self-referrals; and iii) higher all-cause in-hospital mortality for AHF due to COVID-19 related deaths

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Case reportLate stent thrombosis thirteen months after drug-eluting stent implantation

We present a case of a very late stent thrombosis which occurred 13 months after drug-eluting stent (DES) implantation. The DES was off-label used in a high-risk patient and was followed by 12-month clopidogrel administration. One month after the drug discontinuation the stent thrombosis occurred, resulting in acute myocardial infarction. The patient was successfully treated with balloon coronary angioplasty and was advised to use clopidogrel indefinitely

Elektrokardiograficzne objawy zawału serca ściany przedniej spowodowane zamknięciem gałęzi prawo-komorowej

Elektrocardiographic signs of anterior myocardial infarction caused by the occlusion of the right ventricular branch: A case of a 72-year-old male with electrocardiographic symptoms of anterior myocardial infarction resulting from the right ventricular branch occlusion is presented. The mechanisms of eliscrepancy between angiographic and electrocardiographic findings are discussed and diagnostic as well as therapeutic procedures are described