Acute myocardial infarction (AMI) in pregnant women is a rare but potentially lethal occurrence that should be carefully managed, especially in consideration of cardiac conditions being a rising cause of maternal deaths. Risk factors for AMI occurrence, in addition to typical cardiac-related risk factors, include medical conditions such as (pre) eclampsia, blood transfusions, thrombophilia and postpartum infections. Being older, multigravida or in the third trimester of pregnancy is also associated with an increased risk. The pathophysiological causes underlying AMI in pregnancy are diverse but generally associated with the coagulative and physiological changes related to the pregnancy. The selection of diagnostic modality and treatment options require careful consideration for pregnancy-related changes as well as risk of harm to the patient and fetus. This paper serves to review available literature regarding an extensive range of management issues that directly impact on maternal and fetal outcomes.
Adult ; Female ; Humans ; Myocardial Infarction ; complications ; physiopathology ; therapy ; Pregnancy ; Pregnancy Complications, Cardiovascular ; physiopathology ; therapy ; Young Adult

Adult ; Bundle-Branch Block ; physiopathology ; Electrocardiography ; Humans ; Male ; Myocardial Infarction ; complications ; Syndrome ; Ventricular Fibrillation ; etiology ; physiopathology

Acute Disease ; Electrocardiography ; Humans ; Myocardial Infarction ; chemically induced ; physiopathology ; Poisoning ; complications ; physiopathology

OBJECTIVESTo investigated the prognosis of primary percutaneous coronary intervention (PCI) in acute myocardial infarction patients with or without diabetes mellitus (DM) in terms of myocardial blush grade (MBG) and ST-segment elevation resolution (STR).

METHODSMBG and STR were measured in AMI patients with (n = 95) and without (n = 192) diabetes mellitus after successful primary PCI.

RESULTSPost-procedural TIMI grade 3 flow (>95%) were similar between two groups. Compared to non-DM patients, DM patients were more likely to have absent myocardial perfusion (MBG 0/1, 56.0% vs. 41.1%, P = 0.019) and absent STR (43.2% vs. 30.7%, P = 0.038). MACE rate was also higher in DM patients than that in non-DM patients during follow-up (27.4% vs. 16.1%, P = 0.025). Multivariate analysis showed DM was an independently factor related to the risk of poor prognosis (RR 1.83, 95% CI 1.04 - 3.36], P = 0.01).

CONCLUSIONDespite similar TIMI-3 flow after primary PCI, DM patients are more likely to have abnormal myocardial perfusion as assessed by both incomplete STR and reduced MBG and poor prognosis compared to non-DM patients. Poor prognosis in DM patients with AMI post PCI might be related to more disturbed micro-vascular perfusion.

Aged ; Angioplasty, Balloon, Coronary ; Diabetes Complications ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; physiopathology ; therapy ; Myocardial Reperfusion ; Prognosis

OBJECTIVETo evaluate the effects of antiarrhythmic peptide (AAP10) on ventricular arrhythmias in rabbits with healed myocardial infarction (OMI).

METHODSThirty rabbits were randomly divided into three groups (n = 10 each): Sham group, left thoracotomy was performed without coronary ligation; OMI group and OMI + AAP10 group, the circumflex coronaries were ligated. Three months post operation, the electrophysiological and antiarrhythmic effects of AAP10 were assessed in the arterially perfused rabbit left ventricular wedge preparation. Sham and OMI group were perfused with Tyrode's solution and OMI + AAP10 group was perfused with Tyrode's solution + AAP10 (80 nmol/L). Transmembrane action potentials were recorded simultaneously from endocardium and epicardium together with a transmural ECG by use of 2 separate intracellular floating microelectrodes. The stimulus-response-interval (SRI) of the epicardium and the incidence of ventricular tachycardia (VT) were observed. Whole heart and left ventricular weights, the left ventricular thickness at infarct border zone were measured.

RESULTSWhole heart and left ventricular weights as well as the left ventricular thickness at the infarct border zone significantly increased post infarction. VT was induced in 8 out of 10 rabbits in OMI group and in 2 out of 10 rabbits in OMI + AAP10 group (P < 0.05). SRI was also significantly shortened in OMI + AAP10 group compared to OMI group [SRI-1: (20.59 +/- 0.79) ms vs. (28.71 +/- 0.55) ms; SRI-2: (30.42 +/- 0.74) ms vs. (38.67 +/- 0.49) ms, all P < 0.01]. However, the action potential morphology and duration were similar between OMI and OMI + AAP10 groups.

CONCLUSIONThe antiarrhythmic peptide (AAP10) can increase gap junctional intercellular conductance without affecting the action potential morphology and duration and decrease the incidence of inducible ventricular tachycardia.

Animals ; Arrhythmias, Cardiac ; etiology ; prevention & control ; Male ; Myocardial Infarction ; complications ; physiopathology ; Oligopeptides ; pharmacology ; Rabbits ; Random Allocation

BACKGROUNDVentricular septal rupture (VSR) remains an infrequent but devastating complication of acute myocardial infarction (AMI). The best time to undergo surgical repair is controversial and there is currently no risk stratification for patients with VSR to guide treatment. The purpose of this study was to review the clinical outcomes of 70 patients with VSR, to analyze the short-term prognosis factors of VSR following AMI, and to make a risk stratification for patients with VSR.

METHODSA total of 70 consecutive VSR patients following AMI treated in our hospital from January 2002 to October 2010 were enrolled in this study retrospectively. The difference of clinical characteristics were observed between patients with VSR who survived ≤30 days and survived >30 days. We analyzed the short-term prognosis factors of VSR and established the short-term prognosis index of VSR (SPIV) based on the Logistic regression analysis to stratify patients with VSR.

RESULTSAmong 12 354 patients with acute ST-segment elevation myocardial infarction, 70 (0.57%) patients (33 males and 37 females) were found to have VSR. The average age was (68.1±8.5) years. Fifty-four (77.1%) patients were diagnosed with an acute anterior infarction. Patients with VSR selected for surgical repair had better outcomes than patients treated conservatively; 1-year mortality 9.5% versus 87.8%, P < 0.005. Logistic regression analysis revealed that female (P = 0.013), anterior AMI (P = 0.023), non-ventricular aneurysm (P = 0.023), non-diabetes (P = 0.009), Killip class 3 or 4 (P = 0.022) and time from AMI to VSR less than 4 days (P = 0.027) were independent risk determinants for shortterm mortality. SPIV ≥9 indicates a high risk as the 30-day mortality is 77.4%; SPIV <8 indicates a low risk as the 30-day mortality is 28.6%; SPIV between 8 and 9 indicates a moderate risk.

CONCLUSIONSVSR remains a rare but devastating complication of AMI. The independent risk determinants for short-term mortality of VSR were female gender, anterior AMI, non-ventricular aneurysm, non-diabetes, Killip class 3 or 4, and the time from AMI to VSR less than 4 days. It is reasonable to take more active treatments for the patients at high risk to save more lives.

Aged ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; physiopathology ; Ventricular Septal Rupture ; diagnosis ; etiology

Adult ; Aneurysm, Dissecting ; diagnosis ; physiopathology ; Aneurysm, False ; Coronary Aneurysm ; diagnosis ; physiopathology ; Coronary Vessels ; pathology ; physiopathology ; Humans ; Male ; Myocardial Infarction ; diagnosis ; physiopathology ; Thoracic Injuries ; complications ; physiopathology ; Young Adult

We report the case of a 41-year-old Chinese woman with Behçet's disease (BD) complicated by acute myocardial infarction, requiring inotropic and ventilatory support. Angiography showed critical left anterior descending coronary artery stenosis, a blocked left subclavian artery and left carotid artery stenosis. The patient was successfully treated with a high dose of immunosuppressants, standard anti-ischaemic therapy and percutaneous coronary intervention. Although life-threatening, coronary arteritis is a treatable manifestation of BD. We suggest that the diagnosis of coronary arteritis be considered in patients with BD who present with chest pain. Involvement of other arteries should also be looked out for in these patients.
Adult ; Angiography ; Angioplasty, Balloon, Coronary ; Arterial Occlusive Diseases ; physiopathology ; Arteritis ; physiopathology ; Behcet Syndrome ; complications ; Coronary Angiography ; Coronary Vessels ; physiopathology ; Female ; Humans ; Infarction ; complications ; Inflammation ; physiopathology ; Magnetic Resonance Imaging ; Myocardial Infarction ; complications ; Prednisolone ; therapeutic use ; Subclavian Artery ; pathology ; physiopathology

OBJECTIVETo summarize current understanding of the roles of anti-inflammatory and proinflammatory mechanisms in the development of atherosclerosis and acute coronary syndrome and to postulate the novel concept of inflammation stress as the most important factor triggering acute coronary syndrome. Moreover, markers of inflammation stress and ways to block involved pathways are elucidated.

DATA SOURCESA literature search (MEDLINE 1997 to 2002) was performed using the key words "inflammation and cardiovascular disease". Relevant book chapters were also reviewed.

STUDY SELECTIONWell-controlled, prospective landmark studies and review articles on inflammation and acute coronary syndrome were selected.

DATA EXTRACTIONData and conclusions from the selected articles providing solid evidence to elucidate the mechanisms of inflammation and acute coronary syndrome were extracted and interpreted in the light of our own clinical and basic research.

DATA SYNTHESISInflammation is closely linked to atherosclerosis and acute coronary syndrome. Chronic and long-lasting inflammation stress, present both systemically or in the vascular walls, can trigger acute coronary syndrome.

CONCLUSIONSInflammation stress plays an important role in the process of acute coronary syndrome. Drugs which can modulate the balance of pro- and anti-inflammatory processes and attenuate inflammation stress, such as angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers, statins, and cytokine antagonists may play active roles in the prevention and treatment of acute coronary syndrome when used in addition to conventional therapies (glycoprotein IIb/IIIa receptor antagonists, mechanical intervention strategies, etc).

Angina Pectoris ; etiology ; Arteriosclerosis ; etiology ; Biomarkers ; blood ; Blood Vessels ; physiopathology ; Humans ; Inflammation ; complications ; drug therapy ; physiopathology ; Myocardial Infarction ; etiology ; Stress, Physiological ; complications ; Syndrome

PURPOSE: Symptoms of postmyocardial infarction (post-MI) patients at risk for progression to heart failure are often ignored, and lack of symptom recognition or misinterpretation may diminish health-related quality of life (HRQoL). This study was conducted to evaluate the differences in HRQoL by symptom experience and determine factors that predict diminished HRQoL in post-MI patients. METHODS: Using a descriptive correlational study design, post-MI patients with left ventricular dysfunction (ejection fraction < 50%) completed face-to-face interviews for symptoms, HRQoL, covariates including self-care compliance, New York Heart Association class, and demographic and clinical questionnaires. RESULTS: A total of 105 post-MI patients participated (mean age 65 years, 79.0% male, mean ejection fraction 43.6%, New York Heart Association class III/IV 33.3%). Mean length of time after the cardiac event was 48 months. Patients reported four or more symptoms, with fatigue being the most common symptom (63.8%), followed by shortness of breath (56.2%), weakness (54.3%), and dizziness (51.4%). HRQoL was moderately poor, with a mean score of 44.38 +/- 27.66. There was no significant relationship between self-care compliance and HRQoL. Patients who were female, with low monthly income, and had lower functional capacity and more symptoms had worse HRQoL, after controlling for age and length of time after the event (adjusted R2 = 0.53, p < .001). CONCLUSIONS: A need for transitional care that assists post-MI patients take an active involvement in symptom monitoring arises so that they can get into the system earlier and benefit from treatment, and eventually achieve desirable HRQoL.
Adult ; Aged ; Aged, 80 and over ; Female ; *Health Status ; Humans ; Male ; Middle Aged ; Myocardial Infarction/complications/*physiopathology ; *Quality of Life ; Risk Factors ; Surveys and Questionnaires ; Ventricular Dysfunction, Left/complications/*physiopathology