Acute Coronary Failure Research Articles

Chapter 24 - The hypothalamus and its role in hypertension

For the majority of hypertensive patients, the etiology of their disease is unknown. The hypothalamus is a central structure of the brain which provides an adaptive, integrative, autonomic, and neuroendocrine response to any fluctuations in physiological conditions of the external or internal environment. Hypothalamic insufficiency leads to severe metabolic and functional disorders, including persistent increase in blood pressure. Here, we discuss alterations in the neurochemical organization of the paraventricular and suprachiasmatic nucleus in the hypothalamus of patients who suffered from essential hypertension and died suddenly due to acute coronary failure. The changes observed are hypothesized to contribute to the pathogenesis of disease.

Possibilities of PRECISE-DAPT Score for Risk Prediction of Ischemic and Hemorrhagic Events in ST-Elevated Myocardial Infarction (According to the Data of the Registry Study in Kemerovo)

Aim.We aimed to study in real clinical practice the clinical and anamnestic characteristics, the peculiarities of double antiplatelet therapy (DAPT) prescription as well the incidence of ischemic and hemorrhagic events in patients with ST-elevated myocardial infarction (MI) during a year of follow-up, taking into account the baseline PRECISE-DAPT scores.Material and methods.The study included 680 patients with MI from the database of Kemerovo observational registry for acute coronary syndrome (ACS). All the patients retrospectively underwent an individual calculation using the PRECISE-DAPT score. Then, depending on the number of the points, all the patients were divided into the low (less than 25 points) and high (25 or more points) risks groups. Differences in clinical and anamnestic parameters, the peculiarities of DAPT prescription, as well as the incidence of ischemic and hemorrhagic outcomes during a year of follow-up after MI were estimated in the groups.Results.The Russian patients with ST-elevated MI and the high PRECISE-DAPT hemorrhagic risk score had a history of renal pathology (р=0.010), multivessel coronary artery disease and polyvascular disease (р=0.002), prior angina pectoris (р=0.001), as well as the course of the index event with the manifestations of acute coronary failure (р=0.001) more often than the patients from the low-risk group. The patients of the high-risk group less often underwent coronary angiography with stenting (р=0.001), as well as coronary artery bypass grafting (р=0.010) at hospitalization and had a higher in-hospital mortality rate (р=0.002). The patients at high hemorrhagic risk according to the PRECISE-DAPT score were less often prescribed with DAPT within a year after MI (р=0.001) and aspirin monotherapy was preferred more often (р=0.001). At the same time, the patients at high hemorrhagic risk on the PRECISE-DAPT score had more often major bleedings, recurrent MI and deaths (р=0.001) within a year after MI.Conclusion.In the present study, the possibilities of risk assessment with the PRECISE-DAPT score were retrospectively tested on the sample of patients with MI from the ACS registry in Kemerovo city. Good identification of patients with the high risks of hemorrhagic events and ischemic outcomes within 12 months of the follow-up after index MI has been shown, which allows to recommend the PRECISE-DAPT score for a clinical practice in order to rationalize the approaches to DAPT prescription and to optimize the existing approaches to the comprehensive risk assessment of patients with ACS along with existing scales.

ROLE OF THE SERUM NGAL FOR ASSESSMENT OF HOSPITAL PROGNOSIS IN MEN WITH ST ELEVATION MYOCARDIAL INFARCTION

Aim. To evaluate clinical significance of serum NGAL in ST elevation myocardial infarction (STEMI) patients in relation with the occurrence of in-hospital period complications. Material and methods. Totally 260 men included with STEMI, hospitalized in 24 hours after the onset of clinical symptoms of the disease. The measurement of serum NGAL concentration (ng/ml, sNGAL) at 1st and 2nd day of hospitalization was done with the hard-phase immune-enzyme analysis by Hycult® biotech assay (USA), registration was done on the plain reader “UNIPLAN” (SPF “PIKON”, Russia). At the stage of in-hospital treatment we registrated endpoints — signs of coronary failure (early post infarction angina, recurrent MI), grade of acute coronary failure (Killip I-IV class), grade of chronic heart failure (by NYHA), hospital mortality. Results. Patients were selected into 2 groups depending on the endpoints occurrence at hospital stage. Adverse hospital outcome (at least one endpoint) was found in 83 (32%) patients. The level of renal damage sNGAL, measured on the 1st day did not reveal any difference between groups with adverse or benign course of MI in hospital, and on 12th day the sNGAL concentration was significantly higher in group with adverse course — 2,1 ng/ml (1,44; 2,8) vs 1,55 ng/ml (1,11; 2,3), p=0,033. Monofactor analysis showed significance for adverse outcome, the factors as 2nd type diabetes, age >60 y., the fact of glomerular filtration rate decline during hospitalization, increase of sNGAL by 12th day. By the result of multifactor analysis — increase of the age by 1 year increases the chance of adverse outcome by 14%, increase of sNGAL by 12th day of MI increases adverse outcome chance by 3,2 times. the level of sNGAL ≥1,046 ng/ml associated with complicated course of in-hospital MI period. Conclusion. The level of sNGAL, measured on 1st day of MI did not have prognostic value for the inhospital complications, however concentration of sNGAL on 12th day was associated with already occured adverse outcomes, being a marker of MI severity.

Assistência circulatória em choque cardiogênico pós-infarto agudo do miocárdio

Mortality is high in patients with acute coronary failure and cardiogenic shock. The most commonly used device for hemodynamic support is the intra-aortic balloon, which, however, may be insufficient in patients with refractory cardiogenic shock. This is a case report of a patient complaining of two days of intense and oppressive chest pain, radiating to the left arm. The ECG showed ST elevation. The patient was submitted to angioplasty and stent implant in the anterior descending artery and developed cardiogenic shock refractory to vasoactive drugs and intra-aortic balloon. Hemodynamic measures were carried out and we chose to use an Impella 2.5 device, by percutaneous route, for circulatory support.

Chronobiology of Cardiac Ventricular Fibrillation Development in Experimental Acute Coronary Failure

Numerous experiments on simulation of acute coronary failure in initially intact rabbits showed that under the same experimental conditions irreversible ventricular fibrillation developed in some animals and did not develop in other. We hypothesize that the probability of fibrillation development was determined by the time of the day, during which acute coronary failure developed. The study was carried out on 2 groups of rabbits in winter in Moscow. In group 1, the failure was induced by ligation of the left descending coronary artery at the interface between its middle and lower thirds at 11.00-18.00 with 30-min intervals. In group 2, the microcirculatory status of the left-ventricular myocardium was studied by light microscopy and morphometry at 12.00 and 18.00. Induction of coronary failure during the period from 15.30 to 18.00 led to irreversible ventricular fibrillation and death in 100% cases. Modeling of the condition from 11.00 to 15.00 caused no ventricular fibrillation in 89% cases, and the animals survived. The area of left-ventricular myocardial capillaries at 12.00 virtually 2-fold surpassed that at 18.00. Presumably, the electrolyte balance and metabolic characteristics of the myocardium switch over to the nocturnal mode of functioning at 15.30 due to changes in blood filling of the myocardium. The appearance of an ischemic focus in the myocardium during this period inevitably leads to the development of irreversible ventricular fibrillation.

On some pathogenetic and adaptation mechanisms of acute coronary disease

Acute coronary failure was modeled in rabbits by ligation of the descending left coronary artery at the interface of its middle and lower thirds. The function and morphology of left-ventricular and right-ventricular myocardium were studied on days 1, 3, and 5 of the pathological process. It was found that left-ventricular contractility decreased, while right-ventricular contractility increased. Deep morphological changes were observed in both ventricles: pronounced extracellular edema, increased content of collagen, decreased percentage of myofibrils. Hence, acute coronary failure involves both compartments of the heart, but the adaptive mechanisms more actively develop in the right ventricle.

Generalisierte Argyrose

For many years a 52-year-old patient suffering from duodenal ulcer had taken a silver-containing preparation, the total quantity of silver ingested in this manner amounting to about 35 g. 18 years after the first manifestation of duodenal ulcer a dermatologist diagnosed argyria and confirmed this by biopsy. After acute coronary failure with marked nicotine abuse autopsy revealed granulated deposits of silver in the corium, particularly on elastic fibres, at the sweat glands, sebaceous glands and hair follicles. There were no deposits in the epidermis. Dense silver deposits were also seen in the walls of most of the blood vessels, in the basal membranes of the renal glomeruli, of the choroid plexus and of the seminiferous tubules, as well as in the portal fields. Definite intracellular deposits occurred in macrophages only. The metal was found only rarely in epithelial basal membranes. Generalised argyria does not entail any pathological implications and is considered to be intractable.

Associação rara entre lúpus eritematoso sistêmico, obesidade mórbida e Síndrome de Takotsubo

The authors report a 68-year-old white female with long-term systemic lupus erythematosus as well as morbid obesity, characterized by very elevated body mass index, who presented a classical picture of acute coronary failure ascribed to Takotsubo syndrome.

Coronary insufficiency and necroses of the myocardium induced in cats by injection of potassium chloride into the lateral ventricles of the brain

An experimental model has been produced of acute coronary failure in response to potassium chloride injection into the lateral ventricle of the cat brain. It was found that under these conditions potassium chloride activates the sympathetic nervous system, causes a spasm of the coronary vessels, an increase in the oxygen requirements of the blood, and ischemic changes in the electrocardiogram. The above disturbances end in focal necrotic and dystrophic lesions of the myocardium.

The spectrum of coronary heart disease in a community of 30,000. A clinicopathologic study.

The high rate of necropsy in deaths among permanent residents of Rochester, Minnesota, provided a unique opportunity to study the prevalence of coronary heart disease and the frequency and mode of death resulting from this disease. In this community of approximately 30,000 population, necropsy was done in 73 per cent of all resident deaths during the years 1947 through 1952. Included in this group were 691 necropsies that represented 67 per cent of the 1,026 deaths of persons 20 years of age or older. Coronary heart disease caused death in 221 patients (23 per cent of all necropsies and 32 per cent of all necropsies on adults). These 221 coronary deaths in adults represented 41 per cent of the men and 22 per cent of the women. The coronary deaths were attributed to acute coronary failure (sudden death) in 94 patients (43 per cent), acute myocardial infarction in 87 patients (39 per cent), congestive heart failure in 32 patients (14 per cent) and thromboembolism in eight patients (4 per cent). The 87 patients dying during acute myocardial infarction died of congestive heart failure (30 per cent), myocardial rupture (24 per cent), acute coronary failure (23 per cent), and thromboembolism (14 per cent), with the remaining 9 per cent dying of a combination of acute myocardial infarction and additional serious systemic disease. The greatest number of deaths from coronary heart disease occurred during the seventh decade of life in men and the eighth decade in women. At least one coronary artery exhibited from 25 to 100 per cent obstruction from atherosclerosis in 513 hearts (74 per cent of the adult necropsies). These necropsies, representing two thirds of all deaths in adults in this community, disclosed that significant coronary-artery disease was present in three of four adults and was the cause of death in four of 10 men and two of 10 women.

Differential diagnosis of the pain of coronary heart disease.

Article1 February 1957DIFFERENTIAL DIAGNOSIS OF THE PAIN OF CORONARY HEART DISEASEA. CARLTON ERNSTENE, M.D., F.A.C.P.A. CARLTON ERNSTENE, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-46-2-247 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe three most common clinical manifestations of coronary heart disease are, in their order of frequency, angina pectoris, acute myocardial infarction and acute coronary failure. Each of these conditions is characterized by pain in the chest due to anoxia of one or more areas of the myocardium. The pain is similar in location in all three, and the syndromes are distinguished from one another chiefly by the length of time the distress persists and by whether the anoxia is of sufficient severity and duration to result in the death of myocardial tissue. Pain in the chest may also be caused...Bibliography1. LaDueNydickWroblewski JSIF: Serum glutamic oxalacetic transaminase as an index of acute heart muscle damage, Circulation 12: 735, 1955. Google Scholar2. ViarHarrison WNTR: Chest pain in association with pulmonary hypertension. Its similarity to the pain of coronary disease, Circulation 5: 1, 1952. CrossrefMedlineGoogle Scholar3. BlumgartSchlesingerDavis HLMJD: Studies on the relation of the clinical manifestations of angina pectoris, coronary thrombosis, and myocardial infarction to the pathologic findings with particular reference to the significance of the collateral circulation, Am. Heart J. 19: 1, 1940. CrossrefGoogle Scholar4. PrinzmetalMassumi MRA: The anterior chest wall syndrome—chest pain resembling pain of cardiac origin, J. A. M. A. 159: 177, 1955. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Cleveland, Ohio*Presented at the Thirty-seventh Annual Session of The American College of Physicians, Los Angeles, California, April 19, 1956.From the Cleveland Clinic and the Frank E. Bunts Educational Institute, Cleveland, Ohio.Requests for reprints should be addressed to A. Carlton Ernstene, M.D., The Cleveland Clinic, 2020 East Ninety-third Street, Cleveland 6, Ohio. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDie Coronarerkrankungen. Coronarinsuffizienz, Angina pectoris und Herzinfarkt 1 February 1957Volume 46, Issue 2Page: 247-254KeywordsAnginaAortaCoronary heart diseaseElectrocardiographyEmphysemaHerniaMyocardiumOsteoarthritisThoraxWalking Issue Published: 1 February 1957 PDF downloadLoading ...

Angina pectoris and myocardial infarction as complications of myxedema: With especial reference to the danger of treatment with thyroid preparations

1. 1. A review of the literature dealing with myxedema complicated by angina pectoris and myocardial infarction disclosed five cases in which autopsy showed that death was caused by acute coronary failure. These cases are summarized. 2. 2. One case of myxedema and angina pectoris in which myocardial infarction 3. developed during treatment with thyroid substance is reported. 4. 3. Before giving thyroid gland products, a careful estimate of the cardiovascular status is necessary.