Elevation In Electrocardiogram Research Articles

Comparative efficacy of sweated and non-sweated Salvia miltiorrhiza Bge. extracts on acute myocardial ischemia via regulating the PPARα/RXRα/NF-κB signaling pathway

Salvia miltiorrhiza Bge. (S. miltiorrhiza) is a well-known traditional Chinese medicine for the treatment of cardiovascular diseases. The processing of S. miltiorrhiza requires the raw herbs to sweat first and then dry. The aim of this study was to investigate the anti-acute myocardial ischemia (AMI) of S. miltiorrhiza extracts (including tanshinones and phenolic acids) before and after sweating, and to further explore whether the “sweating” primary processing affected the efficacy of S. miltiorrhiza. The AMI animal model was established by subcutaneous injection of isoprenaline hydrochloride (ISO). After treatment, the cardiac function of rats was evaluated by electrocardiogram (ECG), biochemical, and histochemical analysis. Moreover, the regulation of S. miltiorrhiza extracts on the peroxisome proliferator-activated receptor α (PPARα)/retinoid X receptor α (RXRα)/nuclear transcription factor-kappa B (NF-κB) signaling pathway of rats was assessed by the Western blotting. The results showed that sweated and non-sweated S. miltiorrhiza extracts including tanshinones and phenolic acids significantly reduced ST-segment elevation in ECG and the myocardial infarction area in varying degrees. Meanwhile, sweated and non-sweated S. miltiorrhiza reversed the activities of aspartate transaminase (AST), lactic dehydrogenase (LDH), creatine kinase-MB (CK-MB), and superoxide dismutase (SOD), as well as the levels of interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-α (TNF-α) in AMI rats. Concurrently, the results of Western blotting revealed that S. miltiorrhiza extracts regulated the PPARα/RXRα/NF-κB signaling pathway to exert an anti-inflammatory effect. Most importantly, sweated S. miltiorrhiza tanshinones extracts are more effective than the non-sweated S. miltiorrhiza, and the anti-inflammatory efficacy of tanshinones extract was also better than that of phenolic acid extract. Although phenolic acid extracts before and after sweating were effective in anti-AMI, there was no significant difference between them. In conclusion, both tanshinones and phenolic acids extracts of sweated and non-sweated S. miltiorrhiza promote anti-oxidative stress and anti-inflammatory against AMI via regulating the PPARα/RXRα/NF-κB signaling pathway. Further, the comparations between sweated and non-sweated S. miltiorrhiza extracts indicate that sweated S. miltiorrhiza tanshinones extracts have better therapeutic effects on AMI.

Subepicardial burn injuries in bullfrog heart induce electrocardiogram changes mimicking inferior wall myocardial infarction.

Using bullfrog hearts, we previously reproduced a ST segment elevation in electrocardiogram (ECG), mimicking human ischemic heart disease. In the present study, by inducing subepicardial burn injuries on the inferior part of the frog heart ventricle, we could reproduce typical ECG changes observed in human inferior wall myocardial infarction, such as the marked elevation of the ST segments in inferior limb leads (II, III, aVF) and their reciprocal depression in the opposite limb leads (I, aVL). Due to the decrease in Na+/K+-ATPase protein expression, the resting membrane potential of injured cardiomyocytes shifted toward depolarization. Such induced electrical difference between the injured and intact cardiomyocytes was thought to be responsible for the creation of “currents of injury” and the subsequent ST segment changes.

The association of early diarrhea after successful resuscitation following out-of-hospital cardiac arrest with neurological outcome: A retrospective observational study.

Gastrointestinal ischemia with reperfusion tissue injury contributes to post-cardiac arrest syndrome. We hypothesized that diarrhea is a symptom of intestinal ischemia/reperfusion injury and investigated whether the occurrence of early diarrhea (≤12 hours) after successful cardiopulmonary resuscitation is associated with an unfavorable neurological outcome.We analyzed data from the Vienna Clinical Cardiac Arrest Registry. Inclusion criteria comprised ≥18 years of age, a witnessed, non-traumatic out-of-hospital cardiac arrest, return of spontaneous circulation (ROSC), initial shockable rhythm, and ST-segment elevation in electrocardiogram after ROSC with consecutive coronary angiography. Patients with diarrhea caused by other factors (e.g., infections, antibiotic treatment, or chronic diseases) were excluded. The primary endpoint was neurological function between patients with or without “early diarrhea” (≤12 hours after ROSC) according to cerebral performance categories.We included 156 patients between 2005 and 2012. The rate of unfavorable neurologic outcome was higher in patients with early diarrhea (67% vs 37%). In univariate analysis, the crude odds ratio for unfavorable neurologic outcome was 3.42 (95% confidence interval, 1.11–10.56, P = .03) for early diarrhea. After multivariate adjustment for traditional prognostication markers the odds ratio of early diarrhea was 5.90 (95% confidence interval, 1.28–27.06, P = .02).In conclusion, early diarrhea within 12 hours after successful cardiopulmonary resuscitation was associated with an unfavorable neurological outcome.

Abstract 12088: Coronary Angiography and Revascularization After Out-of-Hospital Cardiac Arrest in Coronary Artery Disease Patients Without ST-segment Elevation

Introduction: The emergent coronary angiography and revascularization after out-of-hospital cardiac arrest (OHCA) in coronary artery disease (CAD) patients without ST-segment elevation remains controversial. Methods: There were 2391OHCA patients transferred to 2 hospitals. We included 405 cardiovascular arrest patients, who got return of spontaneous circulation (ROSC) from January 2015 to December 2018. Among them, 110 patients were diagnosed CAD with no ST-segment elevation in electro-cardiogram (51%: multi-vessel disease, 33%: chronic total occlusion). To predict mortality in hospital and neurological outcome at 1-year, we investigated basic patients’ characteristics, pre-hospital information, post-hospital care including coronary angiography (CAG) and revascularization. Results: In the Cox proportional hazards model, emergent coronary angiography (hazards ratio; HR: 0.90, 95%confidence interval (CI) 0.45-1.79, P=0.758) and emergent coronary revascularization (HR: 1.51, 95%CI 0.87-2.61, P=0.142) were not associated to predict the mortality. At 1-year, VF survivor (P=0.004), younger age (P=0.010), without ECMO support (P<0.001), pre-hospital ROSC (P<0.001), and low lactate level on admission (P<0.001) were associated with low mortality. The higher number of coronary vessel disease (P=0.020) such as multi-vessel disease (P=0.019), the coronary lesion of LAD (P=0.043), and larger infarct size (max CK level; P=0.014, max CK-MB level; P<0.001) were associated with high 1-year mortality. Zero-vessel disease (VSA, P=0.007) had lower mortality. Conclusions: Emergent coronary assessment and revascularization were not associated with the prognosis.

Accuracy of Resolution of ST-Segment Elevation in Electrocardiogram to Determine the Patency of Infarct-Related Artery.

Introduction: There is very limited data comparing the accuracy of ECG to angiography in predicting reperfusion status. In this study, we will determine the accuracy of ECG change i.e. resolution of ST-segment elevation in predicting infarct-related artery (IRA) patency after thrombolysis in patients with ST-segment elevated myocardial infarction (STEMI), in comparison to angiography.Methods: Three hundred and forty-one (n = 341) patients with acute STEMI received streptokinase, a thrombolytic agent within 12 hours of symptoms, and were enrolled in the study via consecutive convenient non-probability sampling. ECG was recorded as soon as the patient arrived in the emergency unit of cardiology. Subsequent ECG was recorded three hours after the administration of streptokinase to look for resolution of ST-segment elevation. ST-segment resolution was classified as greater/equal to 50% resolved or less than 50% resolved. Coronary angiography was performed within 24 hours of hospitalization and flow in the IRA was assessed.Results: The most common site of myocardial infarction (MI) was the anterior wall (50.1%) and the commonest artery involved was the left anterior descending artery (44.2%). On ECG, ST-resolution of more than 50% was found in 242 (70.9%) participants. Thrombolysis in MI (TIMI) grade III flow in angiography was found in 211 (61.8%) participants. The sensitivity and specificity of ST-resolution to detect TIMI grade III flow was 94.79% and 67.69%, respectively, while accuracy was 84.46%.Conclusion: ST-resolution on ECG after streptokinase can predict IRA patency on coronary angiography with moderate to good accuracy. ECG can assist in predicting the impact of streptokinase early in the course of management and give an option of monitoring patient prognosis with a non-invasive test in patients not comfortable with angiography.

A novel electrocardiogram characteristic in patients with myocardial injury due to COVID-19

Background: Coronavirus disease of 2019 (COVID-19) is a respiratory disease which can lead to cardiovascular complications including myocarditis, myocardial infarction, and heart failure. Electrocardiogram (ECG) may change in patients with COVID-19 with or without heart involvement. In this study, the ECG changes were evaluated in myocardial injuries due to COVID-19. Methods: This study was done on 22 COVID-19 patients with ST segment elevation in ECG and high troponin level. COVID-19 was confirmed using reverse-transcription polymerase chain reaction test. The ECG variables were evaluated by an expert cardiologist. Statistical analyses were carried out on ECG variables where the significance level of 0.05 was assigned. Results: Of 22 patients, 17 cases (77.3%) were male and 6 cases (27.3%) had a history of coronary artery disease. The most common myocardial involvement was extensive anterior type (31.8%), followed by anterior type (22.7%). Sinus rhythm was observed in 95.5% of patients and 54.5% had low voltage ECG in limb leads. No significant correlation was found between low voltage ECG and demonstrable etiologies of low voltage. Conclusion: The prevalence of low voltage ECG was significantly high in limb leads of patients with myocardial injury due to COVID-19 which was considerably greater than that of myocarditis or myocardial infarction patients.

Ionic mechanisms of ST segment elevation in electrocardiogram during acute myocardial infarction

ST elevation on an electrocardiogram is a hallmark of acute transmural ischemia. However, the underlying mechanism remains unclear. We hypothesized that high ischemic sensitivities of epicardial adenosine triphosphate-sensitive potassium (IKATP) and sodium (INa) currents play key roles in the genesis of ST elevation. Using a multi-scale heart simulation under moderately ischemic conditions, transmural heterogeneities of IKATP and INa created a transmural gradient, opposite to that observed in subendocardial injury, leading to ST elevation. These heterogeneities also contributed to the genesis of hyper-acute T waves under mildly ischemic conditions. By contrast, under severely ischemic conditions, although action potentials were suppressed transmurally, the potential gradient at the boundary between the ischemic and normal regions caused ST elevation without a contribution from transmural heterogeneity. Thus, transmural heterogeneities of ion channel properties may contribute to the genesis of ST–T changes during mild or moderate transmural ischemia, while ST elevation may be induced without the contribution of heterogeneity under severe ischemic conditions.

The Significance of Dynamics of ST Segment Changes When Assessing the Effectiveness of Mechanical Reperfusion of the Myocardium in Hyperglycaemic Patients with Acute Myocardial Infarction with Persistent ST-Segment Elevation

Background: The coexistence of coronary heart disease and consequently, acute myocardial infarction with persistent ST-segment elevation (STEMI) and glucose metabolism disorders is well known. Still, glucose metabolism disorders in the STEMI population are not fully understood. We know that diabetes mellitus (DM) is a factor disabling the function of microcirculation, which in turn may affect the outcome of coronary intervention. The aim of this study was to evaluate the dynamics of ST-segment changes in ECG (electrocardiogram) in STEMI (ST-segment elevation myocardial infarction) patients with co-existing hyperglycaemia compared to those with normoglycaemia treated with a percutaneous coronary intervention (PCI), as well as to determine this parameter in the assessment of reperfusion effectiveness. Methods: The study included 92 patients with the diagnosis of STEMI enrolled in the PCI treatment and was divided into groups based on the glucose levels on admission (reactive hyperglycaemia): a group with higher glucose levels on admission (Glc ≥ 7.8 mmol/L, n = 46), a group with lower glucose levels on admission (Glc < 7.8 mmol/L, n = 46) and into groups based on the concentration of HbA1c: a group with a lower HbA1c level (<6.5% (48 mmol/mol), n=71) and a group with a higher level (≥6.5%, n=21). Results: On admission, there were no significant differences in terms of clinical characteristics between the groups of patients with normoglycemia and reactive hyperglycaemia. After PCI, the patients with normoglycemia had significantly higher (p = 0.021) dynamics of changes in the resolution of ST-segment elevation in ECG expressed in an indicator of sum STR (resolution of ST-elevation). A degree of resolution of ST elevation in ECG was significantly (p = 0.021) dependent on the level of blood glucose – higher the blood glucose level, weaker the resolution. The patients with glucose levels ≥7.8 mmol/L had significantly higher levels of CK and CK-MB during the first 48 hours of hospitalization. There was a statistically significant difference in the mean length of hospitalization between individuals from the group with lower and higher blood glucose levels on admission (p = 0.028). A 4-month follow-up revealed no significant difference in the incidence of major adverse cardiovascular events (MACE) in the study groups (p = 0.063). A 4-year follow-up of patients with higher levels of blood glucose on admission showed a higher incidence of MACE (p = 0.01). The patients with HbA1c ≥ 6.5% were older (p = 0.004), had a greater BMI > 30kg/m2 (p=0.019) and the lower ejection fraction of the left ventricle (p = 0.003) compared to those with the HbA1c levels <6.5%. The incidence of MACE in 4-month and 4-year follow-up was comparable in the study population.

Postoperative Cardiac Ischemic Complications in Lung Cancer Patients

Background. Perioperative myocardial ischemia often complicates extracardiac surgery. The problems of its prediction, diagnostics, treatment and prevention are not solved. Frequency, structure and clinical features of cardiac ischemic complications of surgical treatment of lung cancer are not well understood.The aim of the study was to investigate the frequency of postoperative myocardial infarction and myocardial ischemia in the surgical treatment of patients with non-small cell lung cancer.Methods. The frequency (%) of myocardial infarction (MI) with and without ST segment elevation of electrocardiogram, acute myocardial ischemia in a complete sample of cancer patients (n = 2051) who underwent treatment for non-small cell lung cancer for the last 10 years was calculated. By comparing the relative indicators and calculating the Odds Ratio (OR), we studied the relationship between the cardiac ischemic events with age, type of surgery, prevalence and localization of the tumour. The clinical manifestations and pathomorphology of postoperative myocardial infarction were analysed.Results. Cardiac ischemic complications of thoracotomy for lung cancer occurred in 2.73 % (95% CI 1.98–3.48) cases. Myocardial infarction with ST segment elevation was recorded in 1.07 % (95% CI 0.58–1.57) patients, MI without ST segment elevation – in 0.54 % (95% CI 0.17–0.9), myocardial ischemia – in 1.12 % (95% CI 0.62–1.63). An increase in the frequency of ischemic events after pneumonectomy was observed compared with lobectomy (OR 6.5, 95% CI 3.5–12.2) and after right-sided pneumonectomy compared with left-sided one (OR 3.2, 95% CI 1.6–6.3), and also the age over 70. Hospital mortality from MI was 39.3 %. According to autopsies of patients who died of МI, coronary atherothrombosis was detected in 2 of 22 cases.Conclusion. In the surgical treatment of non-small cell lung cancer, cardiac ischemic events develop in 2.73 % of patients. The greatest risk is associated with right-sided pneumonectomy.

Congenital disorder of glycosylation type 1T with a novel truncated homozygous mutation in PGM1 gene and literature review

The congenital disorders of glycosylation are a group of clinically and biochemically heterogeneous diseases characterized by multisystem involvement due to glycosylation defect of protein and lipid. Here we report a 49-year-old man with exercise-induced fatigue and pain of muscle, tachypnea, cleft palate and bifid uvula. Exercise induced elevation of serum creatine kinase (CK), ammonia and lactic acid was recorded. The abnormal levels of myoglobin, CK-MB and LDH as well as S-T elevation in electrocardiogram were observed in repeated hospitalization recordings. Electromyography showed myopathic damage. Repetitive nerve stimulation test of low rates showed decrement in the left deltoid muscle. He was identified with a novel homozygous frameshift variant in Phosphoglucomutase type 1 gene (c.405delT p.N135Kfs*9) by whole exome sequencing. Muscle biopsy exhibited minimal variation in fiber size without abnormal glycogen accumulation. Compared with controls’, the patient's sample showed no signal at ∼61 kDa using N- or C-terminus antibody of Phosphoglucomutase type 1 in western blotting. A signal at ∼20 kDa was detected in patient using N-terminus antibody. Immunofluorescence revealed trace expression of C-terminus and a much lower expression of N-terminus on the sarcolemma than normal. Our findings indicate that c.405delT encodes a truncated protein with abnormal distribution and expression in skeletal muscle. In conclusion, genes associated with congenital disorders of glycosylation should be analyzed in patients with maxillofacial dysplasia, exertional weakness, cardiac involvement and exercise-induced-ammoniemia, without glycogen storage in skeletal muscle.

Electrocardiographic approach to classification of acute pericarditis in emergency department: Typical and atypical pericarditis

BACKGROUND: In typical pericarditis, concave ST–segment elevation can be characteristically seen in electrocardiogram (ECG). However, PR-segment depression may be the earliest ECG change in patients with acute pericarditis and in following time, from atypical pattern to typical pattern transition may be occur. Without ST-segment elevation in ECG may undergo misdiagnosed or overestimated condition, including acute coronary syndrome. Therefore, we classified acute pericarditis by highlighting ECG features to prevent any possible failure to notice acute pericarditis in emergency department (ED). METHODS: This study included 216 patients selected from the 2140 patients acute chest pain admitted into ED between 2015 and 2018. The two groups were retrospectively created by virtue of the presence or absence of typical ECG findings. Typical ECG refers to diffuse or regional concave ST-segment elevations with reciprocal ST-segment depression in aVR, and V1 in ECG, and atypical ECG refers to PR-segment depression in leads V5 to V6 in ECG. 100 patients (group I) had typical ECG, whereas 116 patients (group II) had atypical ECG changes. RESULTS: The mean age of the patients with typical pericarditis was higher than those with atypical pericarditis (P<0.05). Typical pericarditis group had higher CRP level (P<0.05). Atypical pericarditis group had more recurrence rate than typical pericarditis (P<0.05). In ECG following time, 10 patients with the atypical pericarditis pattern were transformed typical pericarditis pattern. CONCLUSION: We classified acute pericarditis as typical and atypical by highlighting ECG features to prevent any possible failure to notice acute pericarditis. Thanks to PR-segment recognition, acute pericarditis diagnosis may confirm and prevent the inappropriate coronary intervention. It is recommended that the ECG features should be examined thoroughly, especially with a focus on ST-segment elevation besides PR-segment depression.

Complete Healing of Spontaneous Coronary Artery Dissection Demonstrated by Optical Coherence Tomography in a Young Postpartum Female Presenting With Acute Coronary Syndrome

A 27-year-old primigravida presented with chest pain, ST-segment elevation in electrocardiogram leads I, aVL, and V1 to V6, positive troponin I, and apical hypokinesia with a left ventricular ejection fraction of 45%, 20 days following a cesarean section. The patient was a smoker, with no other

De winter sign: A masquerading electrocardiogram in ST-elevation myocardial infarction

Electrocardiogram (ECG) is usually the first and most important test in patients with acute coronary syndrome which helps to diagnose as well as classify patients into ST elevation or non-ST elevation myocardial infarction (STEMI). This classification is important as both the groups differ in their pathophysiology as well as management. Patients with STEMI require urgent reperfusion therapy either with percutaneous coronary intervention or fibrinolysis, if the earlier is not available. They may, however, sometimes present without obvious ST elevation in ECG resulting in delayed diagnosis and reperfusion therapy. Identification of such STEMI equivalents, therefore, becomes very important for physicians as well as interventional cardiologists. We report a 62-year-old male who presented without an obvious ST elevation in ECG and subsequently found to be having acute obstruction of mid-left anterior descending artery.

Role of electrocardiogram in identification of culprit vessel occlusion in acute ST elevation myocardial infarction in relation to coronary angiography

Objective: The objective of the study is to study the usefulness of electrocardiography in localizing the culprit vessel in acute ST-elevation myocardial infarction (STEMI) and to assess the diagnostic accuracy of the electrocardiogram (ECG) findings by comparing them with coronary angiographic findings. Materials and Methods: This study is prospective observational study, conducted on fifty patients in tertiary care center attached to medical college. Patients with ST-segment elevation in ECG was evaluated to identify culprit vessel and later correlated with their coronary angiography. Results: Among fifty patients in the study, 34 had anterior wall, and 16 had inferior wall myocardial infarction. ST↑ >1 mm in V4R, ST↓V3/ST↑LIII lead II was the most sensitive and ratio of ST↓V3/ST↑LIII >1.2 was the most specific criterion. In anterior wall STEMI, 52.9% patients had occlusion proximal to first septal (S1), 17.6% had occlusion proximal to first diagonal (D1), 8.8% had occlusion distal to S1, and 20.5% had occlusion distal to D1. Q wave in aVL had maximum sensitivity for identifying occlusion proximal to D1 and Q wave in leads V4-V6 for occlusion distal to S1. Conclusion: The admission ECG in patients with STEMI is valuable not only for determining early reperfusion treatment, but also provides important information to guide clinical decision-making.

De Winters pattern: Spotted and successfully thrombolysed with streptokinase

When it comes to management of acute coronary syndrome (ACS), no other investigation can replace the role electrocardiogram (ECG) that still holds the pivotal role in emergency rooms. Rightfully thence, the classification of ACS patients into ST elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) is based on these zig-zag lines on a squared paper strip. This classification is important as both the groups differ in their pathophysiology as well as management. While, thrombolysis or percutaneous coronary intervention is done in STEMI sufferers; thrombolysis is contraindicated in the ones with NTEMI. There are, however, some patterns which do not show obvious ST elevation in ECG but are in fact associated with critical narrowing of major heart vessels. de Winter is one such “NSTEMI-STEMI equivalent.” Although now widely agreed on as a STEMI equivalent, its management with streptokinase (STK) is controversial. We are reporting a case of 38-year-old male with chest pain, whose ECG revealed the classical de Winter pattern and was successfully thrombolysed with STK. Complete set of classical ECG tracings and its management with STK (perhaps first such report across the globe) are the two major highlights of this report.

An unusual cause of chest pain – Nocardiosis presenting as acute pericarditis in an immune-competent patient

Acute pericarditis caused by nocardia is a microbiological riddle and cardiological rarity. A 63-year-old farmer, with no significant past medical history presented with fever for 10 days and chest pain and shortness of breath for one day. Widespread ST elevation in electrocardiogram was typical of acute pericarditis. Chest X-ray and subsequent CT thorax revealed bilateral basal consolidation with hilar lymphadenopathy. CT guided biopsy from lung revealed long slender weakly acid fast bacilli, later diagnosed as nocardia by culture isolation. We report a case of Nocardiosis presenting as acute pericarditis in an immune-competent patient is not only rare but also enlightening to clinicians, cardiologists and microbiologists especially in tropical countries. The patient was treated successfully with trimethoprim–sulphamethoxazole.

Prevalence, Clinical Characteristics, and Predictors of Patients with Thromboembolic Events in Takotsubo Cardiomyopathy

BACKGROUNDSeveral acute complications related to takotsubo cardiomyopathy (TTC) have been documented recently. However, the incidence and clinical significance of acute thromboembolic events in TTC is not well established.METHODSA detailed investigation of the clinical characteristics and in-hospital complications of 114 consecutive patients diagnosed with TTC between January 2003 and September 2015 was carried out. This study was initiated to reveal the predictors, clinical significance, and short-term and long-term outcomes of patients with TTC associated with acute thromboembolic events on index presentation.RESULTSThe incidence of acute thromboembolic events related to TTC was around 12.2%, and these included ventricular thrombi, cerebrovascular events, retinal and brachial artery pathologies, renal, splenic, and aortic involvement. The most frequent complication on initial presentation was cardiogenic shock (20%) accompanied with pulmonary congestion (20%). Interestingly, patients experiencing thromboembolic events had higher C-reactive protein (CRP) levels as compared to the non-thromboembolic group (P = 0.02). Certain thromboembolic events were characterized by the presence of ST-segment elevation in electrocardiogram (P = 0.02). Chest pain was the primary symptom in these patients (P = 0.09). Furthermore, there was significant right ventricular involvement (as assessed by transthoracic echocardiography) in patients presenting with an acute thromboembolic event (P = 0.08). A Kaplan–Meier analysis indicated a significantly higher mortality rate over a mean follow-up of three years in the thromboembolic group than the non-thromboembolic group (log-rank, P = 0.02).CONCLUSIONSOur results confirmed the relative common occurrence of thromboembolic events in the setting of TTC. Inflammation might play an important role in the development of thromboembolic events, and a right ventricular involvement and ST-segment elevation could be positive predictors for this occurrence. In order to circumvent the risk of a negative outcome, it is recommended that an anticoagulation therapy be initiated in all high-risk patients.

Subacute thrombosis after primary percutaneous coronary intervention with bioresorbable vascular scaffold implantation

Everolimus-eluting bioresorbable vascular scaffold (BVS) is a promising new technology recently applied in the treatment of coronary artery lesions that might overcome the limitations of the currently used drug eluting stents. There were no scaffold thromboses reported in the first-in-human trials with BVS implantation. However, the current body of evidence on its safety and incidence of early thrombotic complications in the setting of acute coronary syndromes is still limited. We present the case of a 58-year-old male who was admitted to a coronary care unit due to typical (two-hour long) chest pain with electrocardiographic signs of anterior wall ST segment-elevation myocardial infarction. Coronary angiography revealed critical stenosis of the proximal left anterior descending artery (Fig. 1A). Subsequent primary angioplasty with manual aspiration thrombectomy, balloon predilatation, and implantation of BVS (ABSORB, 3.5/28 mm, 12 atm.) was performed, with good angiographic result (TIMI 3 flow) (Fig. 1B). Optical coherence tomography (OCT) confirmed good scaffold expansion and complete strut apposition (Fig. 1C–F). Further in-hospital course was uneventful and the patient was discharged after five days of hospitalisation. On the ninth day after BVS implantation he presented again with acute severe chest pain and anterior ST-segment elevation in electrocardiogram. The patient confirmed that he discontinued both antiplatelet drugs (aspirin and clopidogrel) after discharge. Repeat coronary angiography revealed a subacute scaffold thrombosis (Fig. 2A). Manual aspiration thrombectomy, abciximab infusion, and plain old balloon angioplasty was performed (Fig. 2B), with good final angiographic result (TIMI 3) (Fig. 2C). Echocardiography revealed an impaired left ventricular ejection fraction of 38%, compared to 50% directly after the primary index procedure. As there was appropriate scaffold expansion and strut apposition in OCT directly after the index procedure, the most likely cause of scaffold thrombosis was the cessation of antiplatelet therapy. Figure 2. A. Occlusion of the proximal left anterior descending artery in the place of bioresorbable vascular scaffold implantation (arrow); B. Plain old balloon angioplasty performed in the occluded left anterior descending artery; C. Good final angiographic result of the treatment of scaffold thrombosis (TIMI 3) Figure 1. A. Coronary angiography revealing critical stenosis of the proximal left anterior descending artery (arrow); B. Good angiographic result of primary angioplasty with bioresorbable vascular scaffold implantation (TIMI 3); C–F. Good scaffold expansion and complete strut apposition in optical coherence tomography A

Total Flavones of Choerospondias axillaris Attenuate Cardiac Dysfunction and Myocardial Interstitial Fibrosis by Modulating NF-κB Signaling Pathway

This study aimed to investigate the effect of total flavonoids of Choerospondias axillaris (TFC) on myocardial infarction (MI)-induced cardiac dysfunction, interstitial fibrosis and inflammatory reaction and further to clarify the potential signaling pathway involved. Rats were subjected to MI via coronary artery occlusion. The model establishment was confirmed by the occurrence of ST-segment elevation in electrocardiogram. Then, TFC was administrated at doses of 75, 150 and 300 mg/kg for 28 consecutive days (gavage). Body weight and heart weight were recorded. Hemodynamics, infarct size and myocardial fibrosis were examined. Blood samples were collected to determine tumor necrosis factor-α (TNF-α) and interleukin 6, 10 (IL-6, IL-10) levels. The expressions of matrix metalloproteinases-2, 9 (MMP-2, 9), phosphor-IKBα (p-IKBα) and transforming growth factor-β1 (TGF-β1) were assayed by Western blot. The results indicated that TFC significantly improved cardiac dysfunction, the heart coefficient and myocardial fibrosis in MI rat. TFC also decreased the levels of TNF-α and IL-6, but increased IL-10 content. Moreover, treatment with TFC protected the heart from chronic MI injury by decreasing the expressions of MMP-2, 9, TGF-β1 and p-IKBα. The results suggested that TFC attenuated cardiac dysfunction and myocardial interstitial fibrosis by modulating nuclear factor-kappa B (NF-κB) signaling pathway.

A diagnostic dilemma: early repolarization syndrome associated with ventricular fibrillation

An early repolarization (ER) pattern, characterized by J-point elevation, slurring of the terminal part of the QRS and ST-segment elevation, is a common finding on the 12-lead electrocardiogram. It has been suggested that J-point elevation, which was considered benign for many years, may play a critical role in the pathogenesis of idiopathic ventricular fibrillation (VF). Recent studies have shown that an ER pattern in inferior leads or inferolateral leads is associated with increased risk for life-threatening arrhythmias. We report the case of a 52-year-old man with no structural heart disease whose electrocardiogram showed type 2 ER pattern (with evidence of J-point and ST-segment elevation in electrocardiogram leads II, III, and aVF). The patient presented with VF.