ST-segment Depression Research Articles

VASOSPATIC ANGINA IN GRAVES DISEASE

Category A Thyroid hormones play a key role in the growth and metabolism of almost all tissues. Any abnormal increase or decrease of these hormones can cause impairment in functioning of almost all organ systems. Hyperthyroidism has been associated with a number of cardiac manifestations including tachycardia, cardiac arrhythmia especially AF, cardiomyopathy, angina or even myocardial infarction. Here we present a case of a 38 year old female with no known comorbidities who presented to medicine casualty with complaints of recurrent episodes of typical angina lasting 15–20 min or more. Her vitals showed mildly elevated blood pressure of 150/90 mmHg and tachycardia. An ECG taken immediately showed ST segment depression in the anterolateral leads. Cardiac biomarkers were negative. A provisional diagnosis of acute coronary syndrome was made and treatment started. Echo was found to be normal. Patient continued to have recurrent episodes of angina. Coronary angiography was normal. On detailed evaluation patient gave a history of palpitation, loss of weight, diarrhoea and increased sweating in the last 3 months. Detailed physical examination revealed a painless neck swelling. Laboratory tests showed Hb – 12 g/dl, serum K – 4.1 mmol/dl, Ca – 9.2 mg/dl, LFT and RFT normal, fT3 – 22.9, fT4 – 64.2, TSH <0.01 suggestive of hyperthyroidism. On further evaluation she was found to be positive for TSH receptor antibody and was diagnosed with Grave’s disease. She was started on anti-thyroid drugs and propranolol. Nitrates were stopped after 6 months and patient remains asymptomatic on treatment. Conclusion: Hyperthyroidism may present in numerous ways and may even be life threatening. This case highlights the importance of checking the thyroid status of patients, especially in the younger age group, with no obvious cause or risk factors presenting with angina. They may not always have classical symptoms of hyperthyroidism. A delay in diagnosis can result in undue complications and unnecessary interventions. Most of these patients were found to lead a normal life with proper medications once diagnosed.

The Effects of Nitric Oxide Synthase Inhibition on Epinephrine-Induced Arrhythmia and Myocardial Damage

We have recently reported that methylene blue (MethyB) was able to inhibit epinephrine-induced arrhythmias and cardiac muscle injury. In this study, we investigated the effect of nitric oxide synthase inhibition by NG-nitro-L-arginine methyl ester (L-NAME) on cardiac arrhythmias, and myocardial damage induced by epinephrine in rats. Whether nitric oxide inhibition would affect the antiarrhythmic and cardiac protective actions of MethyB was also examined. L-NAME (40 mg/kg), L-arginine (200 mg/kg) + L-NAME, or MethyB (100 mg/kg) + L-NAME were given intraperitoneally (i.p.). Cardiac arrhythmia was then induced with intravenous (i.v.) injection of 10 μg/kg epinephrine. Results showed that epinephrine injection caused marked bradycardia (221.0 ± 1.37 vs. 409.4 ± 3.18 beats/min), shortened QTc interval (0.096 ± 0.0093 vs. 0.177 ± 0.0008 s), increased QRS duration (0.040 ± 0.0035 vs. 0.0185 ± 0.0002 s), decreased R wave amplitude (0.176 ± 0.0051 vs. 0.21 ± 0.0009 mv), ST segment height (-0.026 ± 0.007 vs. -0.002 ± 0.0005 mv), and induced ventricular extrasystoles. L-NAME given to untreated control rats resulted in a decrease in heart rate (288.2 ± 0.88 vs. 409.4 ± 3.18 beats/min), and increased R wave amplitude (0.436 ± 0.004 vs. 0.21 ± 0.0009 mv) compared to controls. L-NAME did not cause extrasystoles in untreated control rats but significantly increased the number of extrasystoles and duration of arrhythmia in the epinephrine-treated group. The administration of L-arginine (200 mg/kg, i.p.) to epinephrine plus L-NAME-treated rats resulted in increased heart rate and markedly decreased the number of extrasystoles and duration of arrhythmia. Methylene blue given at 100 mg/kg to rats treated with epinephrine and L-NAME caused a marked increase in heart rate. It also normalized QRS duration, prevented ST segment depression, markedly suppressed ventricular extrasystoles, and decreased the duration of arrhythmia compared with either epinephrine or L-NAME plus epinephrine-treated groups. Epinephrine injection caused disorganization, and necrosis of cardiac cells, interstitial hemorrhage, and cellular infiltrations. These changes were markedly improved by treatment with either L-NAME or L-NAME/MethyB. These results suggest that (i) inhibiting nitric oxide synthase by L-NAME increases epinephrine-induced arrhythmia which is inhibited by L-arginine or MethyB; (ii) either L-NAME alone or in combination with MethyB prevented cardiac muscle injury induced by epinephrine; (iii) L-NAME did not prevent the cardiac protective and antiarrhythmic actions of MethyB.

Obstructive – Nonobstructive hypertrophic cardiomyopathy: differences and predictors

Introduction Hypertrophic cardiomyopathy(HCM) is a genetic cardiomyopathy with a prevalence of 1/500 and causes adverse outcomes, usually due to left ventricular outflow tract obstruction. Aim In this study, we aimed to determine the possible differences and predictors of obstructive hypertrophic cardiomyopathy HCM (Obs-HCM) and nonobstructive HCM (Nonobs-HCM) by electrocardiographic (ECG) and echocardiographic (ECHO) evaluations with clinical, demographic, and biochemical characteristics. Methods This study is a subgroup analysis of a multicentre, national, and observational 'LVH-TR study’ that included 886 left ventricular hypertrophy(LVH) patients in 22 centres between February 2020 and August 2021. After excluding six patients with atrial fibrillation, pace rhythm, bundle branch blocks, and second, and third-degree atrioventricular(AV) block, 60 HCM patients were included, 23 of whom were obstructive, and 37 were nonobstructive. Results Body surface area(BSA) (2.01 ± 0.17, 1.89 ± 0.19; p = .01), ST-segment depression (%82.6, %54.1; p = .02), QT and QTc durations (436.3 ± 58.3, 398.0 ± 65.5; p = .02/470.6 ± 58.7, 432.8 ± 74.7; p = .04), left ventricular mass index(LVMI) (176.4 ± 47.0, 152.7 ± 10.2; p = .004), and systolic anterior motion(SAM) rates (%82.6, %18.9; p < 0.001) were significantly higher in the obstructive HCM compared to nonobstructive HCM. Furthermore, the significance of ST-segment depression, QT duration, LVMI, and SAM continued in the univariate analyses to assess obstruction prediction (all p values < .05). Conclusion In multivariate and correlation analyses, ST segment depression (rho = 0.29), QT prolongation (rho = 0.34), and SAM (rho = 0.62) are found as predictors for obstruction (all p values < .05). Our study will guide future studies since it has detailed ECG and ECHO comparisons of Obs-HCM and Nonobs-HCM patients over 18 are made.

Acute Coronary Syndrome Induced by Carbon Monoxide Intoxication: A Case Report

Carbon monoxide (CO) intoxication is the most frequent etiology of toxicological morbidity and mortality in the world. If the neurological manifestations are in the foreground, then cardiovascular signs of myocardial damage by necrosis are possible, which can result in angina, an acute coronary syndrome followed by myocardial stupor, collapse or even cardiac arrest.&#x0D; We report a case of CO intoxication inducing an acute coronary syndrome without ST elevation in an elderly diabetic patient with no coronary artery disease history.&#x0D; Diagnosis: This patient presented a CO intoxication after an accidental exposure; the electrocardiogram showed a depressed ST segment of the inferior and apico-lateral leads; cardiac enzyme troponins gradually increased. Echocardiography showed a preserved systolic function with a disorder of the heart wall motions. Coronary angiography revealed significant lesions of the proximal left anterior descending artery (LAD) and the first marginal evoking a diagnosis of acute coronary syndrome induced by CO intoxication.&#x0D; Interventions: His management consisted of the administration of hyperbaric oxygen therapy, a platelet aggregation inhibitor (aspirin plus clopidogrel), an anticoagulant (low molecular weight heparin) and myocardial support (Bisoprolol). Coronary angiography and the placement of two active stents were performed after 24hrs onset diagnosis.&#x0D; Results: The patient had a good clinical outcome under hyperbaric oxygen therapy, complete revascularization of the angiographic lesions which showed improvement in cardiac function and a slight improvement of heart wall motion on echocardiography performed on the 5th day. After 6 days, the patient had recovered well and was discharged from the hospital without chest discomfort, dizziness or headache.&#x0D; Lecture: This case suggests that the symptoms of carbon monoxide intoxication are complex and diverse. This can manifest as a primary hypoxic symptom or cause an exacerbation of underlying diseases due to hypoxia. Therefore, patients with carbon monoxide intoxication should actively seek a comprehensive cardiac examination to ensure early diagnosis. Whenever necessary, coronary angiography and stent implantation should be performed to improve the patient's chances of survival.

Giant U Wave: Tanda Bahaya yang Harus Dikenali dalam Praktik Klinik Primer

Introduction: Detection of hypokalaemia by ECG accompanied by detailed history and physical examination will greatly facilitate diagnosis, initiate potassium correction therapy, and prevent further complications due to various cardiac arrhythmias and neurological dysfunctions. Case: A 40-year-old man with weakness in both leg muscles since last night, starting from the legs up to the thighs. Initial ECG showed sinus rhythm with a heart rate at 80 bpm, first-degree heart block (PR interval 240 ms); Q wave in III lead; “apparent” prolonged QTc interval at 551 ms; ST segment depression in I, II, and V3-V6 leads; ST segment elevation in aVR lead; T-wave inseparable from large U wave formed giant U wave that remarkedly seen in V2-V4 leads. Laboratory tests revealed very low serum potassium at 1.94 mmol/L Conclusion: In severe hypokalaemia, T and U waves will merge and form a giant U wave. Emergency and primary physicians should be familiar with the ECG changes of hypokalaemia, especially the giant U wave.

Wellens’ syndrome in clinical practice

Despite the declining cardiovascular mortality, the incidence of myocardial infarction (MI) is still high, and therefore the issues of its timely diagnosis remain extremely relevant. In addition to the main diagnostic criteria and typical electrocardiographic (ECG) signs, there are many secondary patterns that suggest MI. Wellens’ syndrome (WS) is one of these ECG patterns, which indicates that the patient is at high risk of left ventricular anterior wall MI, caused by occlusion of the anterior interventricular artery (AIA) or its critical stenosis. Despite the relatively low incidence of WS, it is necessary to increase physicians’ awareness in order to prevent MI and reduce its possible negative consequences.This article presents clinical cases of WS, which show the importance of its diagnosis in the management of patients with anginal pain. The first patient is 43-year-old with a diagnosis of class III exertional angina, a history of anginal pain, and the presence of inverted T waves in V2-V3 leads. AIA stenting was performed on the 7th day of hospitalization. The second patient is 67-year-old with a similar diagnosis and history, biphasic T waves in I, aVL, V1-V3 and V5-V6 leads, deeply inverted T waves in V4. Stenting of the AIA and right coronary artery (RCA) was performed on days 5-6 after the most severe episode of anginal pain and after the anginal pain became recurrent. In both cases, WS was not diagnosed. The third patient, 57-year-old, with T wave inversion in II, III, aVF, leads ST segment elevation of less than 1 mm in lead III, minimal ST segment depression in aVL and V2-V3 leads, followed in less than 2 hours by ST segment elevation in II, III, aVF leads. In this patient, WS was diagnosed in a timely manner, urgent coronary angiography was performed, 99% RCA stenosis was detected, and RCA stenting was performed. The outcome is left ventricular inferior wall non-Q wave MI. The last cited case of WS indicates that this syndrome develops not only with AIA damage, but also with damage to other coronary arteries.

Амплитудные показатели ЭКГ у мужчин разного возраста при субмаксимальной физической нагрузке (на примере жителей Европейского Севера России)

The purpose of this study was to investigate the effect of submaximal physical activity (PWC170 test) on electrocardiogram (ECG) amplitude parameters in men of different ages. Materials and methods. The research involved apparently healthy men aged 20–29 (n = 27) and 40–49 (n = 27) years living in the European North of Russia. They performed a bicycle ergometer PWC170 test with incrementally increasing 3-minute loads (50, 100 and 150 W) and ECG recording in the Nehb leads. Results. A and D leads showed the most informative dynamics of ECG parameters in the subjects during the exercise test. It was mainly expressed in an increase in P wave amplitude, a decrease in T wave amplitude, a deepening of the S wave, and ST segment depression. The group of 40–49-year-old men, compared to 20–29-year-olds, was characterized by less pronounced T wave (lead D) amplitude changes at the beginning of the test, a less deep S wave (lead I), no shift in the ST segment (lead D) as well as a smaller number of parameters that showed statistically significant changes in the exercise test. ST segment (lead A) depression during the final load was twice as common in the older group of men (13 % in 20–29-year-olds and 25 % in 40–49-year-olds). Heart rate (HR) at all stages of the test, except for the last one, was lower in 40–49-year-olds; however, its more significant increase by the end of the test eliminated the statistical differences in HR at the final stage and in physical work capacity (PWC170) between the groups. The revealed differences in ECG and HR parameters may be associated with morphological changes occurring in the cardiovascular system with age, in particular, with the decrease in left ventricular function. Submaximal physical activity in men of the older age group involves a greater expenditure of myocardial reserves.

ST Segment Depression In Male Athletes

ST Segment Depression In Male Athletes

Predictive factors for type A aortic dissection mortality based on electrocardiogram parameters and clinical presentations.

Aortic dissection is a rare but potentially lethal disorder and may be associated with electrocardiogram (ECG) changes. In this study, we aim to investigate ECG-related parameters alongside clinical presentations of type A aortic dissection to come up with the predictive factors for the severity of the disease and its mortality rate. In this retrospective study, 201 patients with type A aortic dissection were studied between March 2015 and March 2020. Two expert cardiologists blinded to the diagnosis studied former and new patients' ECGs and recorded changes. Two-hundred and one patients, including 143 (71.1%) men and 58 (28.9%) women, presented with acute dissection of the aorta, were studied. Forty-four (21.8%) and 84 (41.7%) patients had ST-segment elevation and depression in ECG, respectively. Bivariate analysis revealed that higher heart rate (p=0.006), longer QTc (p=0.044), and ST-segment elevation in aVR lead (p=0.044) were associated with mortality in the patients. Multivariate regression showed higher heart rate (OR=1.022, CI=1.003-1.041, p=0.012) and ST-segment elevation in aVR (OR=4.854, CI=2.255-10.477, p<0.001) were independently associated with increased odds of mortality in aortic dissection patients. ROC curve analysis showed heart rate equal to or >60 per minute (AUC=0.625, sensitivity=86%, specificity=10%, p=0.019) and ST-segment elevation in aVR >0.5mm (AUC=0.854, sensitivity=75%, specificity=92%, p<0.001) were associated with a higher mortality rate. Heart rate equal or >60 and ST-segment elevation >0.5mm in aVR lead can be used as predictive factors for mortality of patients with type A aortic dissection.

The Novel Familial ST-Depression Syndrome - Current Knowledge and Perspectives.

Familial ST-depression syndrome represents a novel inherited disease characterized by nonischemic ST-segment depressions in multiple leads. The ECG phenotype appears to debut around puberty, while the typical onset of arrhythmias occurs around 50years of age. Clinical manifestations include supraventricular arrhythmias, fast polymorphic ventricular tachycardia, sudden cardiac death, and left ventricular systolic dysfunction. The optimal treatment is unknown but asymptomatic individuals without red flags may not need treatment. In contrast, ICD implantation should be considered in patients with probable arrhythmic syncope and in those fulfilling general criteria for ICD treatment. Future research should focus on establishing the disease prevalence, optimizing risk stratification and treatment, and elucidating the underlying genetic etiology.

Diagnostic and Therapeutic Challenges of NON-ST-Elevation Myocardial Infarction in Sub-Saharian Africa

Introduction: Non-ST-elevation myocardial infarction (NonSTEMI) is most often associated with a non-occlusive coronary lesion. However, mortality remains high. The aim of this study was to evaluate the diagnostic and evolutionary aspects of patients presenting with NonSTEMI. Patients and methods: This was a descriptive cross-sectional study conducted from January 01, 2021 to June 31, 2021 in the cardiology department of Aristide Le Dantec Hospital It included all patients hospitalized for NonSTEMI in the study period. The data studied were clinical, paraclinical, therapeutic and evolutionary. Results: A total of 52 patients were included. Mean age was 60.69 years, with extremes of 32 and 86 years. The most common risk factors were hypertension (58.85%), diabetes (34.62%) and smoking (30.7%). Chest pain was the main symptom (73.1%). On physical examination, signs of heart failure were noted in 19.2% of cases. Troponinemia was positive in 94.2% of patients. Repolarization disorders occurred most frequently in the lateral territory (55.4%). ST-segment depression was most common (75%). Doppler echocardiography revealed segmental kinetic disorders in 22 patients (42.3%). Coronary angiography was performed in 36 patients. Significant lesions were found in 63.8% of cases, most often tri-truncular (56.5%). Fourteen patients underwent angioplasty. In-hospital mortality was 3.8%. Conclusion: NonSTEMI is a frequent clinical form of acute coronary syndrome, occurring most often in high-risk patients. It is the expression of coronary lesions that are often severe.

Yamaguchi Sendromu: Akut Koroner Sendrom Ayırıcı Tanısında Zor Bir Tanı

Apical hypertrophic cardiomyopathy (ApHCM) (Yamaguchi Syndrome) with hypertrophy of the ventricular apex constitutes 8% of the hypertrophic cardiomyopathies (HCMs). ApHCM can cause ventricular malignant dysrhythmias, atrial fibrillation, and ischemic chest pain. Definitive diagnosis is made by electrocardiography (ECG) and transthoracic echocardiography. A 73-year-old male patient was admitted to the emergency department with chest pain. The patient's vital signs were within the normal range. In the ECG, there were giant negative T wave in leads V4-5-6, 0.5 mm ST segment depression, and left ventricular hypertrophy in the inferior derivations. The left ventricular apex thickness was measured as 14 mm (reference range: 6-11). Although the HEART score was 4, the preliminary diagnosis of the patient was determined as ApHCM. Beta-blocker and antiplatelet therapy were started. The mortality and morbidity rates of ApHCM are higher among HCMs. Clinicians should be aware of such ECG and echocardiography findings to prevent possible morbidity and mortality.

Acute coronary syndrome with simultaneous two-vessel occlusion De Winter ST-segment depression or reciprocal change?

We discuss a case of acute coronary syndrome (ACS) with simultaneous two-vessel occlusions in a man in his 20s. The serial electrocardiograms (ECG) showed very early dynamic changes of ST-T configuration resulting from ischemic zone depth or area between anterior wall versus inferior wall. The upsloping ST depression along with tall tentorial T waves in the precordial leads, as shown in the index ECG, raises the possibilities of a de Winter pattern. The retrospective assessment of the index ECG identified prominent T waves and a mild degree of ST-segment elevations in the inferior leads, given the electrocardiographic findings previously recorded at his workplace medical examination obtained at a later date. If the subtle ST-segment elevations in leads II, III, and aVF and the tall T waves were not overlooked in the index ECG, the probability of reciprocal ST-segment depressions in the precordial leads should also be taken into account. We recognize our ECG findings as intriguing ST-T deviation patterns that can change depending on the time sequence and anatomical dominancy of two infarct-related arteries. We finally suggest physicians should bear in mind the possibility of simultaneous multiple vessel occlusions when they encounter ACS patients with hemodynamic instability as in this present case

Early prediction of ventricular fibrillation using electrocardiographic characteristics in prehospital suspected ST-segment elevation myocardial infarction: a case-control study.

Our objective was to determine characteristics of electrocardiograms (ECG) that predict ventricular fibrillation (VF) among prehospital patients with suspected ST-segment elevation myocardial infarction (STEMI) in Québec. We performed a matched case-control study of prehospital adult suspected with STEMI. Patients in case group (STEMI/VF+) were matched with controls (STEMI/VF-) for age and sex and then compared for ECG characteristics, including ST-segment elevations (STE) and depressions (STD), duration of interval complexes, general characteristics, and several calculated variables. Logistic regression was used to measure the association between ECG characteristics and VF development. Overall, 310 prehospital patients with suspected STEMI were included in the analysis (case group, n = 155; control group, n = 155). We confirmed that the presence of TW-pattern complex (OR 7.0, 95% CI 1.55-31.58), premature ventricular contraction (PVC) (OR 5.5, 95% CI 2.04-14.82), and STE in V2-V6 (OR 3.8, 95% CI 1.21-11.74) were electrocardiographic predictors of VF. We also observed that STD in V3-V5 (OR 6.5, 95% CI 1.42-29.39), atrial fibrillation (AF) ≥ 100 beats per minute (bpm) (OR 6.3, 95% CI 1.80-21.90), the combination of STE in V4 and V5, and STD in II, III and aVF (OR 4.8, 95% CI 1.01-22.35), and the presence of STD in ≥ 6 leads (OR 4.2, 95% CI 1.33-13.13) were also associated with VF development. Finally, simultaneous association of 2 (OR 2.3, 95% CI 1.13-4.06) and 3 (OR 11.6, 95% CI 3.22-41.66) predictors showed significant association with VF. In addition to some already known predictors, we have identified several ECG findings associated with the development of VF in patients with suspected STEMI. Early identification of patients with STEMI at increased risk of VF should help EMS providers anticipate adverse events and encourage use of defibrillation pads.

Protective properties of nanoparticles green-synthesized by plant on myocardial ischemia

The formulation and characterization of novel cardiovascular supplements and drugs without any side effects are in both developed and developing countries research priority. Myocardial ischemia-reperfusion causes to an inflammatory response that leads more damage to apoptosis. Chronic and acute immune responses elicited by myocardial ischemia is in the heart functional deterioration. In this study, we formulated a modern cardioprotective protective drug by gold nanoparticles containing Silybum marianum on isoproterenol-induced myocardial ischemia mice by investigating the PPAR-Υ/NF-κB pathway. Determining the antioxidant capacities of gold nanoparticles was done with the conventional free radical scavenging test, i.e., DPPH in the presence of butylated hydroxytoluene as the positive control. The gold nanoparticles were characterized by standard physicochemical techniques, including FT-IR, FE-SEM, UV-Vis, and TEM. The nanoparticles inhibited half of the DPPH molecules in the concentration of 72 μg/mL. In the in vivo design, to induce myocardial ischemia in C57BL/6 mice, isoproterenol (40 mg/kg) was administered. The mice were randomly divided into five groups: (1) control; (2) isoproterenol; (3-5) isoproterenol + gold nanoparticles at different doses (10, 20 and 40 μg/ml) and timings. After treatment, cardiac function was evaluated by histochemical and biochemical analysis. Gold nanoparticles treatment decreased the inflammatory milieu in the myocardial ischemia mice heart, thereby blocking the proinflammatory cytokines upregulation (IL-1β, TNF-α and IL-6). Also, gold nanoparticles treatment significantly ameliorate ventricular wall ischemia, reduces the mortality incidence, and inhibits the myocardial injury markers levels. In addition, gold nanoparticles administration significantly prevents the typical ST segment depression. Treatment with gold nanoparticles significantly suppresses the inflammation cytokines expression and decrease cell death. The gold nanoparticles beneficial effects is related to the normalization in PPAR-Υ and PPAR-Υ/NF-κB/ΙκB-α/ΙΚΚα/β phosphorylation gene expression. Gold nanoparticles exert cardioprotective properties against isoproterenol-induced myocardial ischemia in mice, which may associated to the PPAR-γ activation and NF-κB signaling inhibition.

Acute coronary syndrome due to multi-vessel coronary artery spasm in an Afghan refugee adolescent mimicking recurrent myocarditis.

Vasospastic angina is extremely uncommon for adolescents to experience chest discomfort, which is defined by transitory ST segment elevation or depression and angina symptoms that occur while at rest. It may result in potentially fatal conditions like myocardial infarction, ventricular fibrillation, or even sudden cardiac arrest. To aim of this article is to report a very rare case of a 17-year-old male Afghan refugee who was diagnosed with vasospastic angina after presenting with chest pain, and after receiving calcium channel blocker and nitrates for medical therapy, there were no angina attacks. Our case underlines the value of a thorough evaluation of adolescent's chest pain, the need to diagnose based on the symptoms, and the necessity of performing coronary angiography to rule out coronary causes when there is a high suspicion to a cardiac cause.

Nanostructured lipid carriers of ivabradine hydrochloride: Optimization, characterization and in-vivo estimation for management of stable angina

Stable angina (angina pectoris) is a type of chest pain that happens when the heart muscle needs more oxygen than usual but it's not getting it at that moment because of heart disease. The drawback of the marketed formulation is required repeated administration of the drug due to low bioavailability. A recently licenced medication called ivabradine hydrochloride (IVB) is used to treat stable angina and signs of heart failure. Technical problems in the approved IBH tablets include a two-hour half-life, erratic systemic absorption, and a high rate of first-pass metabolism (>50%). We therefore created a distinctive and cutting-edge formulation of IVB using a nano formulation approach like nanostructured lipid carriers (NLCs). The response surface method with a three-level Box–Behnken design was used for the creation and improvement of IVB. The optimized formulation was proceeded for physicochemical characterizations like particle size, zeta potential, morphology (TEM and SEM), entrapment efficiency, in-vitro release, stability studies, compatibility study (DSC, FTIR and XRD), hemocompatibility study, ex-vivo permeability, and in-vivo angina study. As results, optimized formulation was found to be 114.45 ± 5.14 nm particle size with 83.45 ± 3.23% entrapment efficiency and biphasic release. The formulation showed spherical and compatible with excipients, no interaction was observed and hemocompatible. The IBH-NLCss showed more permeability (1.85 folds) as compared to the marketed dosage form. The in-vivo pharmacological activity was established in terms of decrease in severity and duration of ST-segment depression in vasopressin-induced angina model in experimental rats.

Abnormal ECG Findings of Known Type 2 Diabetics Attending the Endocrinology Clinic at the Federal Medical Centre, Yenagoa

Diabetes mellitus is a chronic disease with life-threatening micro- and macro-vascular complications with cardiovascular complications being the major cause of death among those with type 2 diabetes. The study was aimed at evaluating the abnormal electrocardiographic changes associated with type 2 diabetes mellitus among diabetic patients attending the endocrinology clinic in FMC Yenagoa during the study period. The study made use of 162 apparently healthy individuals and 300 diabetic patients. Interviewer-administered questionnaire, 12-lead ECG and fasting blood sugar were the study tools. The data obtained were analyzed using descriptive statistics, paired sample T-test and Pearson Product Moment correlation. The results revealed that the ECG abnormalities associated with type 2-DM were abnormal axis, widened QRS duration, elevated and depressed ST-segment and LVH. Again, age, gender, BMI, smoking and FSB were the risk factors found to be associated with cardiac abnormalities. A close and regular monitoring of the FBS, BP and ECG were therefore recommended for diabetic patients.

Coronary Stent Restenosis in a Patient with Sepsis Caused by Pseudomonas Aeruginosa. Case Report

Coronary artery disease is a major global health problem, leading to the accumulation of atheromatous plaque within the tunica intima of the coronary artery, limiting blood perfusion throughout the heart. To restore normal blood flow within the coronary artery, the coronary artery is expanded using a balloon-tipped catheter and a stent is placed. Drug-eluting coronary stents are the most effective option in percutaneous coronary intervention while reducing restenosis. However, the implantation of a stent can cause other complications such as infection and thrombosis. The case of a 51-year-old man is presented, who presents a picture of oppressive chest pain intensity 10/10, radiating to the neck and left scapula, an electrocardiogram with ST-segment depression in V3-V6 is performed, coronary angiography is performed with coronary artery disease of multiple vessels, stent restenosis of the circumflex and anterior descending artery, with chronic total occlusion of the right coronary artery, saccular aneurysm of the anterior descending artery. At 3 weeks he presented fever spikes and new very high-risk angina events due to dynamic electrocardiographic changes in the anterolateral face, for which blood cultures were taken, resulting positive for Pseudomonas aeruginosa. Complications such as stenosis phenomenon and stent thrombosis occur in approximately 2% of cases, while coronary stent infection occurs in less than 0.1% of cases.

Combination of acute myocardial infarction and Takotsubo syndrome

A 79-year-old woman was admitted to the emergency department of cardiology after transient loss of consciousness episode and a recorded ventricular tachycardia. The ST segment elevation in I, aVL, V1-V5 leads up to 6 mm and ST-segment depression up to 1 mm in III, aVF were registered at admission. The emergency coronary angiography showed of slowed coronary blood flow without stenosing atherosclerosis. The diagnosis of acute myocardial infarction was based on: 1. The typical progression of ECG: ST elevation resolved and the T wave become inverted; 2. The transient increasing CK up to 439 U/l, CK-MB up to 52 U/l and troponin I up to 5.8 ng/ml; 3. The inclusion of paramagnetic in the myocardium in the anterior wall and septum of LV by the type of ischemic damage. The diagnosis of Takotsubo syndrome based on rapid and complete recovery of contractility and geometry of the left ventricle (LV). At the 2nd day LV ejection fraction was 21%; the dyskinesis, akinesis of the anterior and antero-lateral walls of the left ventricle were registered. At the 7th day the hypokinesis zones was not detected. The article discusses the literature data on the frequency of combination of these diseases and possible pathogenetic mechanisms of this combination.