The primary causes of uncontrolled diabetes are poor life-style, infection, ischemic heart disease and inappropriate usage of oral anti-diabetic agents and insulin. Supplementary causes are stroke, acute pancreatitis and endocrine diseases. Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal dominant syndrome characterized by primary hyperparathyroidism, pituitary neoplasia, and foregut lineage neuroendocrine tumors, and is associated with increased glucose levels. We present a case of a 69-year-old woman who had polyuria, polydipsia, weight loss and hyperglycemia over 6 months. She had hypertrophy of the face, hand, and foot, and active bleeding and large folds were observed in the stomach and duodenum upon esophagogastroduodenoscopy. She also had high levels of IGF-1 and gastrin and got the failure of growth hormone suppression after an oral glucose load (75 g). These findings suggested a diagnosis of acromegaly and gastrinoma, which was clinically diagnosed along with MEN 1. The patient improved glycemic control and symptoms after being treated with somatostatin analogues and insulin therapy over a 5-month follow-up period. Here, we report a case of MEN 1 in type 2 diabetes mellitus with a poorly controlled blood glucose level. Clinicians should consider endocrine disease in patients with poor glycemic control in diabetes.
Acromegaly ; Aged ; Blood Glucose ; Diabetes Mellitus* ; Diabetes Mellitus, Type 2 ; Diagnosis ; Duodenum ; Endocrine System Diseases ; Endoscopy, Digestive System ; Female ; Follow-Up Studies ; Foot ; Gastrinoma ; Gastrins ; Glucose ; Growth Hormone ; Hand ; Hemorrhage ; Humans ; Hyperglycemia ; Hyperparathyroidism, Primary ; Hypertrophy ; Insulin ; Insulin-Like Growth Factor I ; Multiple Endocrine Neoplasia Type 1* ; Multiple Endocrine Neoplasia* ; Myocardial Ischemia ; Neuroendocrine Tumors ; Pancreatitis ; Polydipsia ; Polyuria ; Somatostatin ; Stomach ; Stroke ; Weight Loss

Cardiovascular disease is one of the most frequent causes of death in both males and females throughout the world. However, women exhibit a greater symptom burden, more functional disability, and a higher prevalence of nonobstructive coronary artery disease (CAD) compared to men when evaluated for signs and symptoms of myocardial ischemia. This paradoxical sex difference appears to be linked to a sex-specific pathophysiology of myocardial ischemia including coronary microvascular dysfunction, a component of the 'Yentl Syndrome'. Accordingly, the term ischemic heart disease (IHD) is more appropriate for a discussion specific to women rather than CAD or coronary heart disease. Following the National Heart, Lung, and Blood Institute Heart Truth/American Heart Association, Women's Ischemia Syndrome Evaluation and guideline campaigns, the cardiovascular mortality in women has been decreased, although significant gender gaps in clinical outcomes still exist. Women less likely undergo testing, yet guidelines indicate that symptomatic women at intermediate to high IHD risk should have further test (e.g. exercise treadmill test or stress imaging) for myocardial ischemia and prognosis. Further, women have suboptimal use of evidence-based guideline therapies compared with men with and without obstructive CAD. Anti-anginal and anti-atherosclerotic strategies are effective for symptom and ischemia management in women with evidence of ischemia and nonobstructive CAD, although more female-specific study is needed. IHD guidelines are not "cardiac catheterization" based but related to evidence of "myocardial ischemia and angina". A simplified approach to IHD management with ABCs (aspirin, angiotensin-converting enzyme inhibitors/angiotensin-renin blockers, beta blockers, cholesterol management and statin) should be used and can help to increases adherence to guidelines.
Cardiovascular Diseases ; Cause of Death ; Cholesterol ; Coronary Artery Disease ; Coronary Disease ; Diagnosis* ; Exercise Test ; Female ; Heart ; Humans ; Ischemia ; Male ; Microvascular Angina ; Mortality ; Myocardial Ischemia* ; National Heart, Lung, and Blood Institute (U.S.) ; Prevalence ; Prognosis ; Sex Characteristics

Cardiovascular disease is one of the most frequent causes of death in both males and females throughout the world. However, women exhibit a greater symptom burden, more functional disability, and a higher prevalence of nonobstructive coronary artery disease (CAD) compared to men when evaluated for signs and symptoms of myocardial ischemia. This paradoxical sex difference appears to be linked to a sex-specific pathophysiology of myocardial ischemia including coronary microvascular dysfunction, a component of the 'Yentl Syndrome'. Accordingly, the term ischemic heart disease (IHD) is more appropriate for a discussion specific to women rather than CAD or coronary heart disease. Following the National Heart, Lung, and Blood Institute Heart Truth/American Heart Association, Women's Ischemia Syndrome Evaluation and guideline campaigns, the cardiovascular mortality in women has been decreased, although significant gender gaps in clinical outcomes still exist. Women less likely undergo testing, yet guidelines indicate that symptomatic women at intermediate to high IHD risk should have further test (e.g. exercise treadmill test or stress imaging) for myocardial ischemia and prognosis. Further, women have suboptimal use of evidence-based guideline therapies compared with men with and without obstructive CAD. Anti-anginal and anti-atherosclerotic strategies are effective for symptom and ischemia management in women with evidence of ischemia and nonobstructive CAD, although more female-specific study is needed. IHD guidelines are not "cardiac catheterization" based but related to evidence of "myocardial ischemia and angina". A simplified approach to IHD management with ABCs (aspirin, angiotensin-converting enzyme inhibitors/angiotensin-renin blockers, beta blockers, cholesterol management and statin) should be used and can help to increases adherence to guidelines.
Cardiovascular Diseases ; Cause of Death ; Cholesterol ; Coronary Artery Disease ; Coronary Disease ; Diagnosis* ; Exercise Test ; Female ; Heart ; Humans ; Ischemia ; Male ; Microvascular Angina ; Mortality ; Myocardial Ischemia* ; National Heart, Lung, and Blood Institute (U.S.) ; Prevalence ; Prognosis ; Sex Characteristics

BACKGROUND/AIMS: This study was designed to evaluate the dose-effect relationship of statins in patients with ischemic congestive heart failure (CHF), since the role of statins in CHF remains unclear. METHODS: The South koreAn Pitavastatin Heart FaIluRE (SAPHIRE) study was designed to randomize patients with ischemic CHF into daily treatments of 10 mg pravastatin or 4 mg pitavastatin. RESULTS: The low density lipoprotein cholesterol level decreased by 30% in the pitavastatin group compared with 12% in the pravastatin (p < 0.05) group. Left ventricular systolic dimensions decreased significantly by 9% in the pitavastatin group and by 5% in the pravastatin group. Left ventricular ejection fraction (EF) improved significantly from 37% to 42% in the pitavastatin group and from 35% to 39% in the pravastatin group. Although the extent of the EF change was greater in the pitavastatin group (16% vs. 11%) than that in the pravastatin group, no significant difference was observed between the groups (p = 0.386). Exercise capacity, evaluated by the 6-min walking test, improved significantly in the pravastatin group (p < 0.001), but no change was observed in the pitavastatin group (p = 0.371). CONCLUSIONS: Very low dose/low potency pravastatin and high dose/high potency pitavastatin had a beneficial effect on cardiac reverse remodeling and improved systolic function in patients with ischemic CHF. However, only pravastatin significantly improved exercise capacity. These findings suggest that lowering cholesterol too much may not be beneficial for patients with CHF.
Aged ; Biological Markers/blood ; Cholesterol, LDL/*blood ; Down-Regulation ; Dyslipidemias/blood/diagnosis/*drug therapy/epidemiology ; Exercise Tolerance/drug effects ; Female ; Heart Failure/diagnosis/*drug therapy/epidemiology/physiopathology ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*administration & dosage/adverse effects ; Male ; Middle Aged ; Myocardial Ischemia/diagnosis/*drug therapy/epidemiology/physiopathology ; Pravastatin/*administration & dosage/adverse effects ; Prospective Studies ; Quinolines/*administration & dosage/adverse effects ; Recovery of Function ; Republic of Korea ; Stroke Volume/drug effects ; Time Factors ; Treatment Outcome ; Ventricular Function, Left/drug effects ; Ventricular Remodeling/drug effects

Transient left bundle branch block (LBBB) is uncommon during anesthesia. It is mainly related to the changes in blood pressure or heart rate. Its occurrence can be confused with acute myocardial ischemia or ventricular tachycardia, therefore differential diagnosis is important. We report a case of transient LBBB which developed with hypoxia during monitored anesthesia care. LBBB is reversed to sinus rhythm after recovery from hypoxia.
Anesthesia* ; Anoxia* ; Blood Pressure ; Bundle-Branch Block* ; Conscious Sedation ; Diagnosis, Differential ; Heart Rate ; Myocardial Ischemia ; Tachycardia, Ventricular

BACKGROUND/AIMS: Combination single-pill therapy can improve cost-effectiveness in a typical medical therapy. However, there is a little evidence about the efficacy and tolerability of combination single-pill antiplatelet therapy after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). METHODS: From June to November 2012, in total, 142 patients who met the following criteria were enrolled: at least 18 years old; successful PCI with DES at least 3 months earlier; and regular medication of aspirin and clopidogrel with no side effects. After VerifyNow P2Y12 and aspirin assays, the combination single pill of aspirin and clopidogrel was given and laboratory tests were repeated 6 weeks later. RESULTS: At baseline, the incidence of aspirin resistance, defined as aspirin reaction unit (ARU) > or = 550, was 9.2%, that of clopidogrel resistance, defined as P2Y12 reaction unit (PRU) > or = 230, was 46.5%, and that of percent inhibition of PRU < 20% was 32.4%. At follow-up, the incidence of resistance by ARU value was 7.0%, 50.0% by PRU value, and 35.9% by percentage inhibition of PRU, respectively. The mean values of ARU (431.5 +/- 63.6 vs. 439.8 +/- 55.2; p = 0.216) and PRU (227.5 +/- 71.4 vs. 223.3 +/- 76.0; p = 0.350) were not significantly different before versus after antiplatelet-combination single-pill therapy. Five adverse events (3.5%) were observed during the study period. CONCLUSIONS: Combination single-pill antiplatelet therapy, which may reduce daily pill burden for patients after PCI with DES, demonstrated similar efficacy to separate dual-pill antiplatelet therapy.
Aged ; Antiplatyhelmintic Agents/*administration & dosage/adverse effects ; Aspirin/*administration & dosage/adverse effects ; Drug Combinations ; Drug Resistance ; *Drug-Eluting Stents ; Female ; Humans ; Intention to Treat Analysis ; Male ; Middle Aged ; Myocardial Ischemia/blood/diagnosis/*therapy ; Percutaneous Coronary Intervention/adverse effects/*instrumentation ; Platelet Function Tests ; Prospective Studies ; Tablets ; Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives ; Time Factors ; Treatment Outcome

INTRODUCTIONThe relationship between electrocardiograph (ECG) changes and troponin levels after the emergency orthopaedic surgery are not well characterised. The aim of this study was to determine the correlation between ECG changes (ischaemia or arrhythmia), troponin elevations perioperatively and cardiac complications.

MATERIALS AND METHODSOne hundred and eighty-seven orthopaedic patients over 60 years of age were prospectively tested for troponin I and ECGs were performed on the fi rst 3 postoperative mornings or until discharge.

RESULTSThe incidences of pre- and postoperative troponin elevation were 15.5% and 37.4% respectively, the majority were asymptomatically detected. Most of the patients who sustained a troponin rise did not have any concomitant ECG changes (51/70 or 72.9%). Postoperative ECG changes were noted in 18.4% (34/185) and of those with ECG changes, slightly more than half (55.9%) had a troponin elevation. Most ECG changes occurred on postoperative day 1 and were non-ST elevation in type. ECG changes occurred more frequently with higher troponin levels. Postoperative troponin elevation (P = 0.018) and not preoperative troponin level (P = 0.060) was associated with ECG changes on univariate analysis. Two premorbid factors were predictors of postoperative ECG changes using multivariate logistical regression; age [odds ratio (OR), 1.05; 95% CI, 1.005 to 1.100, P = 0.029) and sex OR, 2.4; 95% CI, 1.069 to 5.446, P = 0.034). Twenty patients sustained postoperative cardiac complications; 9 (45%) were associated with ECG changes and 16 (80%) with postoperative troponin elevation. Pre- or postoperative troponin elevation better predicted cardiac complications compared with preoperative ECG changes.

CONCLUSIONElectrocardiograph changes do not necessarily accompany troponin elevations after the emergency orthopaedic surgery but are more likely to have higher troponin levels. The best predictor of postoperative cardiac complications is troponin elevation.

Aged ; Aged, 80 and over ; Arrhythmias, Cardiac ; blood ; diagnosis ; etiology ; mortality ; Biomarkers ; blood ; Electrocardiography ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Ischemia ; blood ; diagnosis ; etiology ; mortality ; Orthopedic Procedures ; Postoperative Complications ; blood ; diagnosis ; etiology ; mortality ; Postoperative Period ; Preoperative Period ; Prospective Studies ; ROC Curve ; Risk Factors ; Single-Blind Method ; Troponin I ; blood

OBJECTIVETo investigate the syndrome property of myocardial ischemic (MI) model rats, and to objectively evaluate the blood stasis pattern related information in them.

METHODSSD rats were established to MI model by left anterior descending coronary artery (LAD) ligation. Global physical signs observation, colorimetric analysis on images of auricle, plantar and tongue, as well as the hemorrheologic indices detection were conducted dynamically at various time points after modeling. LARS regression was subjected to calculate the correlation between the color and hemorrheologic indices.

RESULTSBoth colorimetric and hemorrheologic indices in MI rats were significantly different to those in sham-operated rats (control) on day 7-28 after operation, showing significant difference between them in terms of plantar R on day 7 (176.29 +/- 4.96 vs. 182.04 +/- 6.35, P < 0.05); R, G and B values of plantar on day 14, 21 and 28; G and R values of tongue on day 14 and G value of auricle on day 21 (130.38 +/- 7.52 vs. 138.02 +/- 9.32, P < 0.05), as well as B value of tongue on day 28 (93.70 +/- 4.79 vs. 85.80 +/- 6.60, P < 0.01). Results of hemorrheologic indices showed that hematocrit in MI rats was higher than that in control on day 14 and 28 (P < 0.05), it was even higher on day 21 (45.38 +/- 1.96 vs. 41.50 +/- 2.12, P < 0.01); and platelet aggregation rate (PAR) was significantly higher in MI on day 7 (49.35 +/- 6.74 vs. 37.83 +/- 9.94, P < 0.01) and day 14 (58.19 +/- 7.57 vs. 48.00 +/- 10.44, P < 0.05). Besides, various degree of changes could also be seen in whole blood apparent viscosity and reduced viscosity at different shear rate on day 7-28 in the model group. LARS regression showed there existed correlation of local colorimetric indices with levels of hematocrit and PAR.

CONCLUSIONMI model rat induced by LAD ligation can be diagnosed as the qi-deficiency and blood stasis syndrome, indications of the syndromes could be seen on 7-28 days after operation; the change of colorimetric indices of local images in MI rats might be related with their levels of hematocrit and PAR.

Animals ; Diagnosis, Differential ; Hematocrit ; Hemorheology ; Male ; Medicine, Chinese Traditional ; Myocardial Ischemia ; blood ; physiopathology ; Platelet Aggregation ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo assess the value of an improved ischemia modified albumin (IMA) assay in the diagnosis of early acute myocardial infarction (AMI).

METHODSForty-three patients with AMI were enrolled in this study with 41 patients with chest pain serving as the control. Blood samples were obtained from all the patients within 6 h after the onset. IMA was measured by the albumin cobalt binding test and results were presented by absorbance units (ABSU). Receiver operator characteristic curve (ROC curve) was used to evaluate the optimal cut-off value of the assay.

RESULTSThe mean absorbance in AMI group was obviously higher than that in the control group (1.195-/+0.320 vs 0.855-/+0.068, P<0.001). The area under the receiver of ROC curve was 0.947, and at the cut-off value of 0.906 ABSU, the sensitivity and specificity of the assay were 93.0% and 82.9%, respectively.

CONCLUSIONThe improved IMA assay shows good value in early diagnosis of AMI in patients with acute chest pain.

Acute Coronary Syndrome ; Adult ; Aged ; Aged, 80 and over ; Biomarkers ; blood ; Early Diagnosis ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; blood ; diagnosis ; Myocardial Ischemia ; diagnosis ; Sensitivity and Specificity ; Serum Albumin ; Serum Albumin, Human ; Troponin T ; blood

OBJECTIVETo investigate the changes of N-terminal pro-brain natriuretic peptide (NT-proBNP) in neonates with hypoxic-ischemic encephalopathy (HIE) complicated by myocardial ischemic injury.

METHODSThirty-five neonates with HIE (17 cases with concurrent myocardial injury and 18 cases without) were enrolled. Twenty healthy neonates were used as the control group. Plasma NT-proBNP levels were measured using enzyme immunoassay.

RESULTSThe mean plasma NT-proBNP levels in patients with myocardial injury (338.8 + or - 76.2 fmol/mL) were significantly higher than those in patients with non-myocardial injury (137.5 + or - 45.1 fmol/mL) and in the control group (113.7 + or - 53.6 fmol/mL) (p<0.01). The NT-proBNP levels in mild, moderate and severe HIE neonates were 141.3 + or - 41.6, 271.8 + or - 118.1 and 347.2 + or - 85.1 fmol/mL, respectively. Compared with the control group, the NT-proBNP levels in the moderate and the severe HIE groups significantly increased (p<0.01). There were significant differences in the NT-proBNP level among the mild, moderate and severe HIE groups (p<0.05). In patients with myocardial injury, the NT-proBNP levels significantly decreased in the convalescent phase compared with those in the acute phase (225.0 + or - 80.0 fmol/mL vs 338.8 + or - 76.2 fmol/mL (p<0.01).

CONCLUSIONSPlasma NT-proBNP levels increase in neonates with HIE complicated by myocardial ischemic injury in the acute phase. Detection of NT-proBNP levels may be useful in the diagnosis of myocardial ischemic injury and the severity evaluation of HIE.

Female ; Humans ; Hypoxia-Ischemia, Brain ; complications ; Immunoenzyme Techniques ; Infant, Newborn ; Male ; Myocardial Ischemia ; blood ; diagnosis ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood