Coronary Artery Disease/complications* ; Death, Sudden, Cardiac/etiology* ; Humans ; Myocardial Ischemia/diagnosis*

ST segment elevation is one of the most important electrocardiographic features that need to be recognised. Although ST segment elevation myocardial infarction is one of the main causes of this abnormality, there are other non-ischaemic causes that are also important. We discuss reversible apical ballooning syndrome or Takotsubo cardiomyopathy, pericarditis and a case of ST segment elevation due to 'early repolarisation pattern'.
Cardiology ; methods ; Coronary Angiography ; methods ; Dyslipidemias ; complications ; Electrocardiography ; methods ; Female ; Humans ; Leukemia, Myeloid, Acute ; complications ; Male ; Middle Aged ; Myelodysplastic Syndromes ; complications ; Myocardial Infarction ; complications ; diagnosis ; Myocardial Ischemia ; pathology ; Prostatic Neoplasms ; complications ; Respiratory Tract Infections ; complications

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

Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare type of cardiomyopathy, associated with apical aneurysm formation in some cases. We report a patient presenting with ventricular fibrillation, an ECG with an above normal ST segment, and elevated levels of cardiac enzymes but normal coronary arteries. Left ventriculography revealed a left ventricular obstruction without apical aneurysm. There was a significant pressure gradient between the apical and basal sites of the left ventricle. Cine magnetic resonance imaging (MRI), performed on the 10th hospital day, showed asymmetric septal hypertrophy, mid-ventricular obstruction, and an apical aneurysm with a thrombus. The first evaluation by contrast-enhanced imaging showed a subendocardial perfusion defect and delayed enhancement. It was speculated that the intraventricular pressure gradient, due to mid- ventricular obstruction, triggered myocardial infarction, which subsequently resulted in apical aneurysm formation.
Cardiomyopathy, Hypertrophic/complications/*diagnosis ; Coronary Angiography ; Echocardiography, Doppler ; Heart Aneurysm/*diagnosis/etiology ; Humans ; Hypertrophy, Left Ventricular/complications/*diagnosis ; Magnetic Resonance Imaging, Cine ; Male ; Middle Aged ; Myocardial Ischemia/complications/diagnosis

BACKGROUND: Most of the known risk factors associated with ischemic heart disease are based on studies from Western countries; there is only limited information on Korean populations. This study was designed to analyze age related differences in epidemiologic and clinical characteristics in patients who were admitted for coronary angiography for the evaluation of ischemic heart disease. METHODS: As part of the multicenter KCAR (Korean Coronary Artery disease Registry) Study, the clinical data of 6,549 patients, who were evaluated at the cardiac catheterization laboratory by coronary angiography, at seven university hospitals in Korea from March 1999 to December 2005, were registered into the KCAR database and analyzed. All patients were divided into three groups according to age: age < or =40, age 41-70 and age > or =71. All demographic and coronary angiographic features were analyzed for the different groups. RESULTS: The demographic data showed that compared to the older patients young patients < or =40 had a higher prevalence of males and smokers, but a lower prevalence of hypertension, diabetes and prior history of stroke and myocardial infarction. For the lipid profiles, the younger patients had much higher levels of total cholesterol, triglycerides and LDL-cholesterol than the older groups; however, there was no difference in the HDL-cholesterol levels among the three age groups. The most common component of the metabolic syndrome was obesity (79%) in the younger patients and hypertension (92%) in the older patients. The most common reason for presentation was ST-segment elevated myocardial infarction in the younger patients and unstable angina in the older patients. CONCLUSIONS: Ischemic heart disease in younger adults < or =40 had different demographic characteristics and clinical presentation than older patients.
Adult ; Age Factors ; Aged ; *Coronary Angiography ; Diabetes Complications/epidemiology ; Female ; Hospitals, University ; Humans ; Hypertension/epidemiology ; Korea/epidemiology ; Male ; Metabolic Syndrome X/epidemiology ; Middle Aged ; Myocardial Ischemia/*diagnosis/*epidemiology/radiography ; Prevalence ; Prospective Studies ; Registries ; Risk Factors ; Smoking

BACKGROUND: Mesenteric infarction is a significant cause of death in elderly patients, and is being reported with increasing frequency. The diagnosis seldom is made prior to the onset of gangrene, despite an increased awareness of the lethality of mesenteric ischemia. The outcome for patients with mesenteric ischemia depends on the age of the patient, the extent and the severity of the ischemia and the effectiveness of the collateral blood supply. METHODS: We retrospectively reviewed the cases of 23 patient with mesenteric infarction who had been treated at the Department of Surgery, Hallym University, Chunchon Sacred Heart Hospital, between September 1988 and August 1977. RESULTS: The mean age was 52.3 years and the ratio of males to females was 1:1.6. The most frequent underlying diseases were hypertension, congestive heart failure, atrial fibrillation, and myocardial infarction. The radiologic study of a simple plain abdomen revealed a paralytic ileus in 87% of the cases; a partial vascular occlusion was shown under angiogram. The mean time lapse from onset of symptom to operation was 38.3 hours. Eight (34.8%) patients died when renal failure, ARDS or peritonitis developed. CONCLUSIONS: The cause of the persistently high mortality in patients with mesenteric in farction and to define a more effective form of management based on our results and recent clinical or laboratory findings. This study was concluded that early detection of the mesenteric infarction was reduced postoperative complications.
Abdomen ; Aged ; Atrial Fibrillation ; Cause of Death ; Diagnosis ; Female ; Gangrene ; Gangwon-do ; Heart ; Heart Failure ; Humans ; Hypertension ; Infarction* ; Intestinal Pseudo-Obstruction ; Ischemia ; Male ; Mortality ; Myocardial Infarction ; Peritonitis ; Postoperative Complications ; Renal Insufficiency ; Retrospective Studies

OBJECTIVETo study the pathologic features of dilated heart in cardiac transplant recipients, with clinicoradiologic correlation.

METHODSSixty recipient hearts from cardiac transplantation performed in Fuwai Hospital were analyzed by gross examination, histologic observation and electron microscopy. Clinicoradiologic correlation was available in 40 cases.

RESULTSAmongst the 40 cases of dilated heart, 52.5% (21/40) were due to dilated cardiomyopathy, 22.5% (9/40) due to arrhythmogenic right ventricular cardiomyopathy, 15.0% (6/40) due to ischemic cardiomyopathy, and the remaining 10.0% (4/40) due to miscellaneous causes, including local noncompaction of ventricular myocardium, giant cell myocarditis, alcoholic cardiomyopathy and hypertensive cardiomyopathy. The discrepancy rate between clinical and pathologic diagnosis was 37.5% (15/40). The erroneous categories included arrhythmogenic right ventricular cardiomyopathy (7 cases), ischemic cardiomyopathy (5 cases), and giant cell myocarditis (1 case), which were all mistaken clinically as dilated cardiomyopathy. While ischemic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, noncompaction of ventricular myocardium and giant cell myocarditis have distinctive pathologic features, the diagnosis of alcoholic and hypertensive cardiomyopathies required clinicopathologic correlation. Dilated cardiomyopathy due to viral myocarditis was not identified in the cases studied.

CONCLUSIONPathologic examination is essential in analysis of transplant recipient heart and helps to rectify clinical diagnostic discrepancy.

Adolescent ; Adult ; Arrhythmogenic Right Ventricular Dysplasia ; diagnosis ; pathology ; Cardiomyopathy, Alcoholic ; diagnosis ; pathology ; Cardiomyopathy, Dilated ; diagnosis ; pathology ; Diagnostic Errors ; Dilatation, Pathologic ; diagnosis ; pathology ; Female ; Giant Cells ; pathology ; Heart Transplantation ; pathology ; Humans ; Hypertension ; complications ; Male ; Middle Aged ; Myocardial Ischemia ; diagnosis ; pathology ; Myocardium ; pathology

BACKGROUND: We analyzed the result of the "Off-Pump" Coronary Artery Bypass grafting (OPCAB) performed to minimize inflammatory responses to cardiopulmonary bypass and myocardial ischemia during the aortic cross-clamp period. MATERIAL AND METHOD: The preoperative diagnosis operative procedure mortality complication and postoperative course of the 50 patients who underwent OPCAB between January 1998 and September 1998 were analyzed. There were 34 males and 16 females with mean age of 60+/-9 years. Preoperative clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and postinfarction angina in 3(6%) patients. Preoperative angiographic diagnoses were three-vessel disease in 25(50%) two-vessel disease in 5(10%) one-vessel disease in 7(14%) and left main disease in 13(26%) patients. There were elective operation in 37 cases and urgent operation in 13 cases. RESULT: The mean number of grafts was 3.2+/-1.2 per patient. Grafts used were unilateral internal thoracic artery in 43 greater saphenous vein in 37 radial artery in 7 bilateral internal thoracic arteries in 4 and right gastroepiploic artery in 2 cases Forty sequential anastomoses were performed in 18 cases. Vessels accessed were left anterior descending artery in 48 diagonal branch in 41 obtuse marginal branch in 30 right coronary artery in 24 posterior descending artery in 9 ramus intermedius in 5 and posterolateral branch in 5 anastomoses. Predischarge coronary angiography performed in 44 patients demonstrated the patency rate of 89.5%(128/143) Operative mortality was 2%(1/150) Postoperative complications were arrhythmia in 5 graft occlusion that needed reoperation in 4. perioperative myocardial infarction in 2 femoral artery thromboembolism developed after the application of IABP in 1 postoperative transient delirium in 1 peripheral compression neuropathy in 1 case. Sixteen patients(32%) were extubated at the operating room and the other patients were extubated at the mean 13+/-20 hours after the operation. Mean duration of stay in intensive care unit was 49+/-46 hours. Thirteen patients(26%) required blood transfusions perioperatively and the amount of perioperative blood transfusion was mean 0.70+/-1.36 pack/patient. CONCLUSIONS: OPCAB is suggested to be the ideal technique with less postoperative complication less hospitalization time and less cost.
Angina, Stable ; Angina, Unstable ; Arrhythmias, Cardiac ; Arteries ; Blood Transfusion ; Cardiopulmonary Bypass ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Coronary Vessels ; Delirium ; Diagnosis ; Female ; Femoral Artery ; Gastroepiploic Artery ; Hospitalization ; Humans ; Intensive Care Units ; Male ; Mammary Arteries ; Mortality ; Myocardial Infarction ; Myocardial Ischemia ; Operating Rooms ; Postoperative Complications ; Radial Artery ; Reoperation ; Saphenous Vein ; Surgical Procedures, Minimally Invasive ; Surgical Procedures, Operative ; Thromboembolism ; Transplants*

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

We report on a case of ischemic dysfunction of the sinus node as a complication after percutaneous transluminal coronary angioplasty of the distal left circumflex artery. After local thrombolytic therapy in the sinus node artery, sinus node arterial flow was re-established and sinus node function normalized over the period of a week. Our experience suggests that immediate reperfusion of a totally occluded nodal artery can be re-established. Ischemic dysfunction of the sinus node, as a complication of angioplasty, is generally transient and requires a prolonged period for recovery. Therefore the decision to implant a permanent pacemaker should be delayed for at least one week after the ischemic insult.
Urinary Plasminogen Activator/administration & dosage/*therapeutic use ; Thrombolytic Therapy/*methods ; Sinoatrial Node/*physiopathology ; Myocardial Ischemia/*complications/radiography/therapy ; Middle Aged ; Male ; Infusions, Intravenous ; Humans ; Follow-Up Studies ; Fibrinolytic Agents/administration & dosage/*therapeutic use ; Electrocardiography ; Coronary Angiography ; Arrhythmia/diagnosis/*drug therapy/etiology ; Angioplasty, Transluminal, Percutaneous Coronary/adverse effects