Symptoms Of Myocardial Ischemia Research Articles

Prevalence of diabetes and impact on cardiovascular events and mortality in patients with chronic coronary syndromes, across multiple geographical regions and ethnicities.

In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009-2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure.Among 32694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ISRCTN43070564.

The effect of anesthesia on the risk of postoperative myocardial injury in elderly patients with hip fracture: randomized controlled trial

Hip fractures are a common pathology among patients older 50 years and cause disability, reduced duration and quality of life, even with adequate management and surgery. In the perioperative period, the most common complications leading to the death of patients are cardiovascular disease. about a hip fracture.
 The aim of our study was to determine the safest method of anesthesia in the context of acute myocardial injury during hip fracture surgery. The objectives of the study were to determine the frequency of postoperative myocardial damage in patients with hip fractures; compare the frequency of MINS with different types of anesthesia: general anesthesia (GA), spinal anesthesia (SA) and compartment psoas block with sciatic nerve block.
 Materials and methods. Randomized controlled trial was conducted from January 2018 to August 2019 in the medical center “Into-Sana” (Odessa, Ukraine). Patients with planned osteosynthesis of the proximal femur were randomized into 3 groups depending on the method of anesthesia: general anesthesia and postoperative systemic analgesia, spinal anesthesia and postoperative systemic analgesia, prolonged compartment psoas block with sciatic nerve block.
 Results. The study involved 90 patients. Acute postoperative myocardial injury was diagnosed in 17.6 % of cases. Postoperative elevation of troponins was significantly more often diagnosed in groups of patients with spinal anesthesia and general anesthesia compared to the group in which the psoas block compartment was used in combination with the sciatic nerve block. None of the patients had symptoms of myocardial ischemia and were not diagnosed with myocardial infarction. Hypotension was significantly more common in group 2 spinal anesthesia (OR 9 95 % CI 1.9-47, p=0.004) There was a direct moderate association between the intraoperative hypotension and the development of postoperative myocardial injury (r = 0.5).
 Conclusions. Prolonged compartment psoas block with sciatic nerve block intraoperatively is the safest method of anesthesia in the context of the development of postoperative myocardial injury. Intraoperative hypotension is associated with postoperative myocardial injury

Cardiovascular Risk Assessment in the Older Athlete

Limited data are available to guide cardiovascular screening in adult or masters athletes (≥35 years old). This review provides recommendations and the rationale for the cardiovascular risk assessment of older athletes. Review of available clinical guidelines, original investigations, and additional searches across PubMed for articles relevant to cardiovascular screening, risk assessment, and prevention in adult athletes (1990-2020). Clinical review. Level 3. Atherosclerotic coronary artery disease (CAD) is the leading cause of exercise-induced acute coronary syndromes, myocardial infarction, and sudden cardiac death in older athletes. Approximately 50% of adult patients who experience acute coronary syndromes and sudden cardiac arrest do not have prodromal symptoms of myocardial ischemia. The risk of atherosclerotic cardiovascular disease (ASCVD) can be estimated by using existing risk calculators. ASCVD 10-year risk is stratified into 3 categories: low-risk (≤10%), intermediate-risk (between 10% and 20%), and high-risk (≥20%). Coronary artery calcium (CAC) scoring with noncontrast computed tomography provides a noninvasive measure of subclinical CAD. Evidence supports a significant association between elevated CAC and the risk of future cardiovascular events, independent of traditional risk factors or symptoms. Statin therapy is recommended for primary prevention if 10-year ASCVD risk is ≥10% (intermediate- or high-risk patients) or if the Agatston score is >100 or >75th percentile for age and sex. Routine stress testing in asymptomatic, low-risk patients is not recommended. We propose a comprehensive risk assessment for older athletes that combines conventional and novel risk factors for ASCVD, a 12-lead resting electrocardiogram, and a CAC score. Available risk calculators provide a 10-year estimate of ASCVD risk allowing for risk stratification and targeted management strategies. CAC scoring can refine risk estimates to improve the selection of patients for initiation or avoidance of pharmacological therapy.

Pharmacoinvasive Strategy Versus Lysis and Risk Stratification Strategy in Treatment of Stemi Patients

Stemi is a clinical syndrome defined by characteristic symptoms of myocardial ischemia in association with persistent electrocardiographic (ECG) ST elevation and subsequent release of biomarkers of myocardial necrosis.Was to detect efficacy and predictors of outcomes of pharmacoinvasive treatment strategy in STEMI patients over reperfusion with thrombolysis only in areas with non-PCI capable centers as in most of hospitals in middle east. A time limited prospective interventional study started in November 2016 till November 2018. Patients divided into two groups, first group 300 patients treated with Lysis full dose TNK followed by risk stratification, the other 300 will go through pharmacoinvasive strategy as stream study by doing routine coronary angiography 3 to 24 hours after successful lysis, if lysis failed in both groups’ patient will go directly to rescue PCI. Successful lysis is defined as > 50% regression of ST segment elevation with pain relief. Lysis associated with more myocardial damage, more Troponin release and less preservation of myocardial contractility function measured by Echo by EF. Pharmacoinvasive strategy significantly reduce risk of reinfarction, need for CABG, PCI, arrhythmia, preservation of EF and at least is as effective as 1ry PCI.

Degrees of Cross-Sectional-Area Luminal Narrowing of the Four Major Epicardial Coronary Arteries in Patients With Otherwise Functionally and Anatomically Normal Hearts

Described herein are necropsy findings in the 4 major (left main, left anterior descending, left circumflex, and right) epicardial coronary arteries in 86 patients aged 10-70 years who never had symptoms of myocardial ischemia, and at autopsy had otherwise anatomically normal hearts. All 86 died of a non-cardiovascular condition. In each of these patients all 4 major epicardial coronary arteries were excised intact from the heart, divided into 5-mm segments, and each segment prepared for histologic examination. The degrees of cross-sectional area (CSA) narrowingwere determined from histologic examination of each 5-mm segment. The degree of narrowing in each 5 mm segment was divided into 4 categories: 0% to 25%, 26% to 50%, 51% to 75%, and 76% to 100%. Twelve patients (14%) had ≥1 artery narrowed >75% in CSA, a single artery in 9 patients, and 2 arteries in each of 3 patients. In contrast to the relative infrequency of narrowing >75%, narrowing 51-75% was common, and was present in 36 (42%) of the 86 patients. Of the 258 major coronary arteries (excludes the left main) studied in the 86 patients, 15 (6%) were narrowed >75%, and 70 (24%) were narrowed 51% to 75% in CSA. Even mild narrowing (26% to 50%) of the left main coronary artery (66 patients) was generally accompanied by 51% to 75% or greater narrowing of at least one of the other major coronary arteries. In conclusion, even hearts which have functioned normally and are otherwise anatomically normal, usually have some degree of atherosclerotic plaque in the major epicardial coronary arteries.

Percutaneous Coronary Intervention in Anomalous Single Coronary Artery From the Anterior Right Sinus of Valsalva

An anomalous single coronary artery (SCA) is extremely rare with registry studies suggesting a prevalence of 0.014%-0.066%. SCA may be associated with symptomatic transient myocardial ischaemia, arrhythmias, and sudden cardiac death regardless of the presence of coronary atherosclerosis.

Cardiovascular imaging of women and men visiting the outpatient clinic with chest pain or discomfort: design and rationale of the ARGUS Study

IntroductionChest pain or discomfort affects 20%–40% of the general population over the course of their life and may be a symptom of myocardial ischaemia. For the diagnosis of obstructive macrovascular...

Intracoronary acetylcholine spasm testing: differences in epicardial coronary artery response between smooth and atherosclerotic coronary arteries

Abstract Background Coronary artery spasm is an established cause for angina pectoris. Epicardial coronary spasm may occur in patients with obstructed as well as unobstructed coronary arteries. Previous studies have suggested that epicardial plaque/atherosclerosis is a prerequisite for the development of epicardial spasm. The aim of the present study was to compare the results of intracoronary acetylcholine (ACh) testing in patients with signs and symptoms of myocardial ischemia with completely smooth versus atherosclerotic yet unobstructed epicardial arteries. Methods Between 2008 and 2016 a total number of 617 patients with signs and symptoms of myocardial ischemia yet unobstructed epicardial arteries (<50% epicardial stenosis) was included in the present study (mean age 61±11, 61% female). All patients underwent invasive diagnostic coronary angiography followed by intracoronary ACh testing according to a standardized protocol. The ACh-test was considered “positive” in the presence of (a) angina, ischemic ECG shifts during the test and ≥75% focal or diffuse coronary diameter reduction (“epicardial coronary artery spasm”) or (b) ischemic ST-shifts and angina in the absence of epicardial spasm (“microvascular spasm”). All angiograms were assessed regarding any visible epicardial plaque/atherosclerosis in a blinded fashion and patients were categorized into those with completely smooth versus those with atherosclerotic coronary arteries. The analysis included 179 patients (29%) with epicardial spasm and 172 patients with microvascular spasm (28%). The remaining 266 patients (43%) had an uneventful or an inconclusive ACh-test result. Results There were 389 patients (63%) with completely smooth epicardial arteries. The remaining 228 patients (37%) had non-obstructive epicardial plaques <50%. Patients with smooth arteries developed epicardial spasm in 24%, microvascular spasm in 32% and a negative/inconclusive test result in 44% of cases. Patients with atherosclerotic arteries developed epicardial spasm in 38%, microvascular spasm in 21% and an inconclusive/negative test result in 41% of cases. On univariate analysis the presence of epicardial atherosclerosis was associated with epicardial spasm (p=0.006) whereas this was not the case for microvascular spasm (p=0.094). Multivariate analysis revealed the presence of epicardial atherosclerosis (OR 1.921, CI 1.285–2.871, p=0.001) as well as female sex (OR 1.526, CI 1.024–2.274, p=0.038) as independent predictors for epicardial spasm. Conclusion In patients with signs and symptoms of myocardial ischemia yet unobstructed coronary arteries the presence of epicardial atherosclerosis is an independent predictor for the occurrence of epicardial spasm but not microvascular spasm on acetylcholine testing. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Robert-Bosch-Stiftung, Berthold-Leibinger-Stiftung

Quality of Life After Coronary Artery Bypass Surgery: A Systematic Review and Meta-Analysis.

Coronary heart disease is a public health problem and is one of the leading causes of loss of quality of life, disability, and death worldwide. The main procedure these patients undergo is cardiac catheterisation, which helps improve their quality of life, symptoms of myocardial ischemia, and ventricular function, thus helping increase the survival rate of sufferers. It can also, however, lead to physical consequences, including kidney failure, acute myocardial infarction, and stroke. The objective of this study was to analyse how coronary artery bypass grafting (CABG) influences quality of life. A systematic review and meta-analysis were conducted using the CINAHL, PubMed, Scopus, and Cuiden databases in June 2020. A total of 7537 subjects were included, 16 in the systematic review and 3 in the meta-analysis. The studies analysing quality of life using the SF questionnaire showed improvements in the quality of physical and mental appearance, and those using the NHP questionnaire showed score improvements and, in some cases, differences in quality of life between women and men. This operation seems to be a good choice for improving the quality of life of people with coronary pathologies, once the possible existing risks have been assessed.

Hospitalization for Acute Myocardial Infarction: A Population-Based Registry.

ResumoFundamento:O infarto agudo do miocárdio com supradesnivelamento do segmento ST (STEMI) é uma das principais apresentações clínicas da cardiopatia isquêmica. Dados de base populacional são relevantes para entendimento contemporâneo da epidemiologia da doença.Objetivo:Descrever incidência, manejo terapêutico, desfechos clínicos hospitalares e eventos cardiovasculares do primeiro ano de seguimento dos indivíduos hospitalizados por STEMI.Métodos:Estudo de coorte prospectiva de base populacional com registro consecutivo das hospitalizações por STEMI em uma cidade do Sul do Brasil entre 2011 e 2014. Foram incluídos indivíduos com STEMI que apresentaram sintomas de isquemia miocárdica aguda nas últimas 72 horas. Os valores de p < 0,05 foram considerados significativos.Resultados:A incidência anual de hospitalizações por STEMI foi de 108 casos por 100.000 habitantes. A incidência ajustada foi maior entre os mais velhos (risco relativo 64,9; IC95% 26,9 – 156,9; p para tendência linear < 0,001) e entre os homens (risco relativo 2,8; IC95% 2,3 – 3,3; p < 0,001). Ocorreram 530 hospitalizações durante o período avaliado e a taxa de reperfusão foi de 80,9%. A mortalidade hospitalar e a taxa de eventos cardiovasculares em 1 ano foram, respectivamente, 8,9% e 6,1%. Os mais velhos apresentaram maior mortalidade hospitalar (risco relativo 3,72; IC95% 1,57 – 8,82; p para tendência linear = 0,002) e mais eventos cardiovasculares em 1 ano (hazard ratio 2,35; IC95% 1,12 – 4,95; p = 0,03).Conclusão:Este registro demonstra abordagem terapêutica e mortalidade hospitalar semelhante às observadas em países desenvolvidos. Entretanto, a taxa de hospitalizações foi maior comparada com esses países.

Persepsi Keluarga dan Peran Pengetahuan Dalam Mengurangi Kedatangan Pasien Yang Tertunda Dengan Sindrom Koroner Akut

Sindrom Koroner Akut (SKA) adalah suatu tanda dan gejala klinis adanya iskemia miokard yang merupakan suatu kegawatdaruratan kardiovaskuler, namun, keterlambatan pasien tiba di IGD masih sering terjadi. Keterlambatan tiba dihubungkan dengan faktor pengetahuan keluarga dan persepsi keluarga dalam mengenali tanda dan gejala SKA, dimana keluarga terdekat dengan pasien SKA menjadi salah datu komponen penting dari keterlambatan tiba pasien SKA dating ke IGD PJT RSUP Sanglah Denpasar. Tujuannya penelitian ini untuk mengetahui hubungan pengetahuan dan persepsi keluarga dengan keterlambatan tiba pasien SKA Di IGD Pelayanan Jantung Terpadu RSUP Sanglah Denpasar. Penelitian ini merupakan penelitian kuantitatif dengan desain cross sectional, dan teknik pengambilan data menggunakan purposive sampling dengan jumlah 292 keluarga pasien yang mengantar pasien SKA ke IGD PJT. Hasil yang diperoleh yaitu sebanyak 73,3% keluarga pasien tidak memiliki pengetahuan yang baik tentang gejala SKA dan terdapat 62,3% keluarga pasien memiliki persepsi bahwa gejala SKA yang dirasakan merupakan kelelahan akibat dari aktiftas sehari-hari. Dari analisa data diperoleh bahwa terdapat hubungan antara pengetahuan dan persepsi keluarga dengan keterlambatan SKA dimana terdapat hubungan yang sedang antara penetahuan keluarga dan persepsi keluarga dengan keterlambatan tiba pasien SKA di IGD. Keluarga yang tidak mengetahui tanda dan gejela SKA dan persepsi keluarga bahwa gejala yang dialami pasien karena kelelahan, sehingga petugas kesehatan perlu memberikan penyuluhan kepada keluarga mengenai tanda dan gejala SKA, pola hidup sehat, dan pentingnya untuk datang ke IGD ketika tanda SKA dirasakan.

Dysfonction microcirulatoire coronaire et 2D strain à la dobutamine chez un patient dyspnéique

Microcirculatory dysfunction despite the absence of angiographically obvious significant coronary artery disease may potentially generate symptomatic myocardial ischemia; comprehensive assessment both noninvasive and invasive could prove to be of critical interest. We report the case of a 54-year old patient referred for an exertion dyspnea that proved to be caused by both micro and microvascular dysfunction. We present key elements for diagnosis, functional evaluation and management and demonstrate the potential role of speckle tracking imaging in that setting.

Koroner anjiyografide yavaş akım tespit edilen kararlı anjina pektorisli hastalarda CHA2DS2-VASc skorunun kullanımı

Purpose: Coronary slow flow (CSF) phenomenon is the slow movement of contrast to distal vascular structures during coronary angiography. Eventhough It has a high morbidity due to recurrent chest pain and different ischemic presentations, it is linked to coronary artery diseases (myocardial ischemia symptoms, life-threatening arrhythmias, recurrent acute coronary syndromes and sudden cardiac death). CHA2DS2-VASc score is a total of several risk factors for thromboembolism. Impaired renal function was shown to be a predictor of stroke and systemic embolism. We aimed to evaluate the CHA2DS2-VASc score to predict coronary slow flow.Materials and Methods: Of the 3772 patients who applied to Tokat State Hospital with the diagnosis of stable angina pectoris (SAP) were screened retrospectively. A total of 71 patients with angiographically proven CSF and to meet the age characteristics of the CSF group, 84 patients who were completely normal coronary arteries (NCA) in the control group (n = 84) were screened and total of 155 patients were included in the study.Results: Patients were classified into two groups: the CSF group (n=71) and the NCA group (n=84). When the characteristics of the CSF and control groups were compared, age, body mass index, systolic blood pressure, diastolic blood pressure, gender were similar. According to the results of the multivariate regression analysis, CHA2DS2-VASc score was an independent predictor (odds ratio: 1.872, 95 % CI: 0.849-1.981, p&amp;lt;0.001)Conclusion: CHA2DS2-VASc score can be very useful in this regard as an easily applicable instrument. CHA2DS2-VASc score is independent indicators of CSF and can be used to predict CSF risk.

Outcomes of Early Coronary Angiography or Revascularization After Cardiac Surgery

Early coronary ischemic events are uncommon after cardiac surgery, with little known about their management or associated outcomes. We evaluated clinical outcomes of patients undergoing coronary angiography ± percutaneous coronary intervention or redo coronary artery bypass grafting for suspected coronary ischemia within 3 weeks after index cardiac surgery. This is a retrospective observational study based on data from 53,287 patients who underwent cardiac surgery at our institution (1996-2017); 180 patients (0.34%) satisfied the inclusion criteria. The primary outcome was 1-year all-cause mortality. Statistical evaluation involved χ2, analysis of variance, Kaplan-Meier, and receiver operating characteristic curve analyses. Most coronary angiography ± percutaneous coronary intervention and redo coronary artery bypass grafting procedures occurred in the first 2 weeks after index cardiac surgery. Patients presenting with ST elevation myocardial infarction (STEMI)/non-STEMI had the lowest 1-year mortality (13.5%), followed by patients with ventricular tachycardia/fibrillation (28.1%), and patients with non-ventricular tachycardia/fibrillation arrest or hemodynamic instability alone the worst (38.6%) (χ2= 17.3, P= .001). Peak troponin T level after cardiac surgery was strongly predictive of 1-year mortality (area under the curve, 0.74; 95% confidence interval, 0.65-0.84; P < .001) but did not predict the presence of coronary compromise. For acute graft failure, 1-year mortality was better with percutaneous coronary intervention (18.2%) than redo coronary artery bypass grafting (23.5%) or no indicated/feasible intervention (29.2%). Although suspected myocardial ischemia requiring coronary angiography or intervention early after cardiac surgery was rare, mortality was high, particularly in presentations other than STEMI/non-STEMI. In patients with overt signs and symptoms of myocardial ischemia after index cardiac surgery, troponin T was not a reliable marker of underlying coronary or graft obstruction but was a robust predictor of 1-year mortality.

International prospective cohort study of microvascular angina - Rationale and design.

BackgroundPatients with signs and symptoms of myocardial ischemia and non-obstructive coronary artery disease (CAD) frequently have coronary functional abnormalities, including coronary microvascular dysfunction. Those with the latter are grouped under the term “microvascular angina” (MVA). Although diagnostic criteria exist for MVA, as recently proposed by our COVADIS (COronary VAsomotor Disorders International Study) group and the condition has been increasingly recognized in clinical practice, the clinical characteristics and long-term prognosis of MVA patients in the current era remain to be fully elucidated.AimsIn the present study, we aimed to prospectively assess the clinical characteristics and long-term prognosis of MVA subjects in the current era in an international, multicenter, observational, and prospective registry study.MethodsA total of 15 medical centers across 7 countries (USA, UK, Germany, Spain, Italy, Australia, and Japan) enrolled subjects fulfilling the COVADIS diagnostic criteria for MVA as follows; (1) signs and/or symptoms of myocardial ischemia, (2) absence of obstructive CAD, and (3) objective evidence of myocardial ischemia and/or coronary microvascular dysfunction. The primary endpoint was the composite of major cardiovascular events (MACE), including cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, hospitalization due to heart failure or unstable angina. Between July 2015 and December 2018, a total of 706 subjects with MVA (M/F 256/450, 61.1 ± 11.8 [SD] yrs.) were registered. Subjects will be followed for at least 1 year.SummaryThe present study will provide important information regarding the clinical characteristics, management, and long-term prognosis of MVA patients in the current era.

Chest Pain Severity Rating Is a Poor Predictive Tool in the Diagnosis of ST-Segment Elevation Myocardial Infarction.

Current ST-segment elevation myocardial infarction (STEMI) guidelines require persistent electrocardiogram ST-segment elevation, cardiac enzyme changes, and symptoms of myocardial ischemia. Chest pain is the determinant symptom, often measured using an 11-point scale (0-10). Greater severity of chest pain is presumed to be associated with a stronger likelihood of a true positive STEMI diagnosis. This retrospective observational cohort study considered consecutive STEMI patients from May 02, 2009 to December 31, 2018. Analysis of standard STEMI metrics included positive electrocardiogram-to-device and first medical contact-to-device times, presence of comorbidities, false-positive diagnosis, 30-day and 1-year mortality, and 30-day readmission. Chest pain severity was assessed upon admission to the primary percutaneous coronary intervention hospital. We analyzed 1409 STEMI activations (69% male, 66.3 years old ± 13.7 years). Of these, 251 (17.8%) had no obstructive lesion, consistent with false-positive STEMI. Four hundred sixty-six (33.1%) reported chest pain rating of 0 on admission, 378 (26.8%) reported mild pain (1-3), 300 (21.3%) moderate (4-6), and 265 (18.8%) severe (7-10). Patients presenting without chest pain had a significantly higher rate of false-positive STEMI diagnosis. Increasing chest pain severity was associated with decreased time from first medical contact to device, and decreased in-hospital, 30-day and 1-year mortality. Severity of chest pain on admission did not correlate to the likelihood of a true-positive STEMI diagnosis, although it was associated with improved patient prognosis, in the form of improved outcomes, and shorter times to reperfusion.

Recurrent attack of acute myocardial infarction complicated with ventricular fibrillation due to coronary vasospasm within a myocardial bridge: a case report

BackgroundMyocardial bridge (MB) often an inoffensive condition that goes in one or more of the coronary arteries through the heart muscle instead of lying on its surface. MBs sometimes leads to myocardial ischemic symptoms such as chest pain, even an occurrence of myocardial infarction. However, reports of severe and recurrent cardiac adverse events related to the MBs are rare.Case presentationA 44-year-old male patient who suffered from a four-hour crushing chest pain ten years ago, was diagnosed as acute anterior ST-elevation myocardial infarction (STEMI). The initial findings of coronary angiography (CAG) showed MB was located in the middle part of the left anterior descending coronary artery (LAD). The patient was managed medically. Another re-attack of similar previous chest pain characteristics occured just after 3 days of discharge. Supra-arterial myotomy and CABG were the next adopted management. Postoperative progression was uneventful. However, 32 months after surgical treatment, the patient experienced an abrupt onset of chest pain accompanied by loss of consciousness. The ECG showed ventricular fibrillation (VF). After electrical cardioversion, an immediate CAG followed by CTA was performed which excluded thrombus or acute occlusion in the native coronary artery and an occlusion was observed at the end of the left internal mammary artery. An implantable cardioverter-defibrillator (ICD) was successfully performed for prevention of malignant arrhythmia. During ten years of follow-up, no complications have been identified.ConclusionsAlthough MB is mostly benign, it may lead to significant cardiovascular consequences. Supra-arterial myotomy is an appropriate treatment option for this patient who failed to optimal medical therapy. Furthermore, ICD implantation must be considered in order to prevent malignant ventricular arrhythmia caused by continuous spasm resulting in ischemia. Further investigations are required to confirm the clinical effectiveness of these procedures.

Nyeri Orofasial Sebagai Salah Satu Nyeri Alih Dari Iskemia Miokardium

Referred pain on the orofacial structures can be diagnostically challenging for the dentists. Dental pain, which is the most common pain in the orofacial structures, is commonly resolved with satisfactory result, However, some dental pain can have a non-odontogenic characteristics which originate from myocardial ischemia. Myocardial ischemia symptoms may be presented as angina pectoris specific pain, but also as trigeminal pain, with or without angina pectoris symptoms. When this occurred, an improper diagnostic can lead to unnecessary dental treatment and delayed of myocardial ischemia treatment which can lead to myocardium infarct.

Preliminary attempt of infrared thermography for the screening of male myocardial ischemia

PurposeThe threat of myocardial ischemia (MI) to human health is recognized worldwide. Most of the technologies currently used for disease screening have various disadvantages and it is difficult for them to play a role in clinical physical examination. Infrared thermography (IRT) has been a successful technology in a lot of clinical research. This study tried to establish a screening method for male MI with a high detection rate by IRT technology. MethodA method for measuring symmetry based on low temperature sensitivity was proposed to extract the symmetry features of the IRT of the three groups of research subjects (93 persons in total) and a statistical test was performed to this method. If there was statistical significance, a mathematical model for classification would be constructed. In order to explore the value of IRT for MI screening, a double-blind comparison was made between the most common clinical method, ECG stress test (EST) and the method proposed in this study. The sensitivity, specificity and screening detection rate of the two methods to MI were calculated. ResultAfter one-way analysis of variance (ANOVA), it could be drawn that the measurement features of the symmetry extracted in the sample had significant statistical differences among the three groups (P < 0.01). Based on the theory of fuzzy mathematics, a fuzzy classification model was constructed. According to the statistics, the sensitivity was 90%, the specificity was 90.91%, and the detection rate for the people who had symptoms of MI but undiagnosed was 83.33%. The specificity of EST detection was 93.94%, and the detection rate was 66.67%. In terms of disease screening ability and operability, IRT worked better. ConclusionMI can be screened by IRT non-invasively and non-radiatively. The measurement method and fuzzy classification model proposed can screen MI quickly. This study has played a certain role in the promotion of IRT in the field of MI screening. In subsequent research, more accurate inspection techniques will be integrated to further promote cardiac function measurement technology, contributing to human health.

Long-Term Follow-Up in Patients With Stable Angina and Unobstructed Coronary Arteries Undergoing Intracoronary Acetylcholine Testing

ObjectivesThe aim of this study was to investigate the prognosis of a large cohort of patients with stable angina and unobstructed coronaries undergoing acetylcholine spasm testing. BackgroundCoronary artery spasm can be found in up to 60% of patients with symptoms of myocardial ischemia despite unobstructed coronary arteries. MethodsConsecutive symptomatic patients with unobstructed coronary arteries undergoing acetylcholine testing to detect epicardial or microvascular coronary spasm were prospectively enrolled. After a median follow-up period of 7.2 years (6.5 to 7.9 years), data regarding mortality, nonfatal myocardial infarction, stroke, repeat coronary angiography, recurrent symptoms, and quality of life were obtained in 736 patients (57% women, mean age 62 ± 12 years). ResultsIn total, 55 deaths (7.5%), 8 nonfatal myocardial infarctions (1.4%), and 12 strokes (2.2%) occurred during the follow-up period. Recurrent symptoms were reported by 64% of patients, and repeat coronary angiography was performed in 12% of cases. Multivariate analysis revealed epicardial spasm as a predictor of nonfatal myocardial infarction (hazard ratio: 14.469; 95% confidence interval: 1.735 to 120.646) and repeat angiography (hazard ratio: 1.703; 95% confidence interval: 1.062 to 2.732), whereas patients with microvascular spasm more often had recurrent angina at follow-up (hazard ratio: 1.311; 95% confidence interval: 1.013 to 1.697). ConclusionsIn this long-term follow-up study, the overall prognosis of patients with coronary spasm was favorable. Patients with epicardial spasm were at increased risk for myocardial infarction and repeat angiography, while microvascular spasm was associated with recurrent angina. Acetylcholine testing may help identify patients at increased risk for adverse cardiac events among this overall low-risk population.