25 research outputs found
Localization of the occluded vessel in acute myocardial infarction
No full textThis is a review of features in ECG to diagnose the culprit artery responsible for the infarction. Localization of the occluded vessel in acute myocardial infarction is important for many reasons: to know which artery is to dilate and stent; to assess the severity of the lesion; to compare with the echocardiographic area with hypokinesia or akinesia and to differentiate the recent from the old occluded vessel. The ST-segment changes in 12-lead ECG form the basis of diagnosis, management, and prognosis
Upgrading Patients with Pacemakers to Resynchronization Pacing: Predictors of Success
No full textThe investigations of predictors of success or failure of cardiac resynchronization therapy (CRT) were studied previously. But assessment of success in patients already on dual or single pacemakers and upgraded to CRT were not extensively studied before. How to select patients in whom this may be the most optimal strategy is unclear. We sought to determine factors associated with success or failure in this group of patients who were already paced for heart block. 81 pts were subjected to upgrade to CRT implantation after being on pacemaker. The study was conducted in Germany. Data was presented as Median (Min. – Max.) for abnormally distributed data or Mean ± SD. for normally distributed data. Parameters that revealed no statistical significance in response: Age, sex, EF, diabetes, renal disease, GFR, MR, QRS duration (all above 150 msec), AF and CRT optimization. The following parameters revealed significant influence on response to CRT: Less responders with: Higher CRP, presence of TR, presence of PHN, presence of previous MI, being ischemic vs nonischemic cardiomyopathy (less responders with ischemic CM). EF improved in responders from 30+8.6 to 39.86+9.77. The findings through light on specific parameters that predict response to upgrade to CRT after usual pacemaker. It confirms the benefit of upgrading to CRT from DDD or VVI in patients with EF less than 35%
Shear resistance of beams based on the effective shear depth
No full textDespite extensive experimental and theoretical studies the shear resistance of beams with longitudinal reinforcement is described by empirical expressions. A reliable empirical formula is derived by Rafla [10]. This formula is based on 442 experimental results. In this report no experiments are described. It is endeavoured to make a new contribution to the theoretical study of shear strength. The model presented in this report is based on the idea that apart from the effective depth of the compressive zone there is an effective shear depth. The model developed is compared with empirical expressions defined by Rafla and other investigators. The results are promising. With the model the time-dependent behaviour of the shear resistance, the strength criterion and the durability are discussed. For beams with web reinforcement it is explained which mechanism causes the almost constant contribution of the 'compressive zone' to the shear resistance in spite of the increasing deformations. According to the model derived, a formula is presented for lightweight concrete by substitution of the proper material properties into the general expressions for the shear resistance. This formula is in good agreement with the experinents reported by other investigators. Due to the complex internal equilibrium in the case of (partially) prestressed concrete the influence of a normal force on the shear strength is not discussed in detail. The general principle is presented and an example is given. The observed experimental behaviour can be explained with the model derived.Design & ConstructionCivil Engineering and Geoscience
Smoking is a more dangerous risk factor than metabolic syndrome in Egyptian patients with acute myocardial infarction
No full textThe effect of metabolic syndrome (MS) and other risk factors of myocardial infarction (MI) are not consistent in all studies. Aim: To assess the incidence of each risk factor in our community as a predictor of acute myocardial infarction. Methods: Fifty patients (Pts) admitted to the main university hospital with acute myocardial Infarction were studied. All risk factors were recorded as well as echocardiographic measurements. Metabolic syndrome components were defined as detailed in the ATP III report: (1) waist circumference >102cm in men and >88cm in women, (2) fasting triglycerides ⩾150mg/dl, (3) HDL cholesterol <40mg/dl in men and <50mg/dl in women, (4) blood pressure ⩾130/85mmHg, and (5) fasting – glucose ⩾110mg/dl. Participants with at least three of these components were determined to have the MS.ResultsMS was present in 27pts (54%). The incidence of different risk factors in the 50 pts: Family history of any point as before age 60 as coronary disease, sudden death, diabetes, Ht was present in 36pts (72%), smoking (current or stopped less than 6 months 38pts (76%)).Comparison of those with MS vs. those without: Male to female ratio: Not significant (NS), Diabetes present/absent: 21/6 vs. 9/14, p=0.005; HT : 18/9 vs. 6/17, p=0.004; Smoking 18/9 vs. 20/3, p=0.09; family history of any major risk factor including sudden death or premature coronary disease: 21/6 vs. 16/7, p=NS; BMI>30 : 14/13 vs. 5/18, p=0.02; waist >102, 88 in m and f respectively: 18/9 vs. 7/14, p=0.01.Comparison with Egyptian prevalence: data in our study vs. prevalence in Egypt above age 15yr respectively: Diabetes: 30 (60%) vs. 10%, p=0.000; HT 24 (48%) vs. 26%, p=0.007; smoking 76% vs. 40 in males, p=0.000; Ms 27 (54%) vs. 24%, p=0.0003.ConclusionsSmoking was the highest risk factor among pts with acute MI (76%0 followed by positive family history (72%) then diabetes (60%), metabolic s. (54%), HT (48%). We highlight the danger of smoking beside other factors as predictors of MI in Egyptian population
ECG interpretation and commentary
No full textThis is demonstration of selected ECGs for learning or for exams; guided by lessons from great teachers as Prof. Hein Wellens MD. Here we provide advanced examples with comment and analysis
THE DANGER OF DUAL ANTIPLATELET THERAPY IN A PATIENT WITH ACUTE EFFUSIVE CONSTRICTIVE PERICARDITIS WHO WAS SUBJECTED TO STENTING.
No full textStudy of Bradyarrhythmias in Acute Myocardial Infarction
No full textAbstract Background Arrhythmias after acute myocardial infarction are common. Bradyarrhythmias need specific insight into when and how to treat them. Objective Is to delineate the incidence, course, and management of different types of bradyarrhythmia after acute myocardial infarction, study period was 5 years. Methods Four hundred and fifty-three patients with acute myocardial infarction (AMI) were admitted to intensive care in 5 years. ECGs were analyzed for the presence of bradyarrhythmias and details of management. Results Sixty-five patients with bradycardia were found. Sinus bradycardia in 40, sick sinus syndrome in 10, junctional rhythm in 10, second-degree block in 10, complete heart block in 24. We divided patients with sinus bradycardia into stable and unstable. Unstable sinus bradycardia is more prevalent in cases with hypotension or shock, slower heart rates, gross or transmural infarction, changeable morphology of the P wave, and inferior rather than anterior infarction. The indications and danger of atropine are defined. Complete heart block was found in 24 patients (0.053%). Thirteen were managed by drug therapy (isoprenaline, corticosteroids, and atropine); 11 were paced. Fourteen out of the 24 patients died (58%), the total mortality rate among the 453 patients was 22%. The prognostic factors of CHB were defined. Techniques of introducing lead in RV without fluoroscopy are described. Conclusions Sinus bradycardia in AMI is accompanied by a lower incidence of mortality. Atropine is not a safe drug to be given as routine. Complete heart block predictors of mortality are the association with heart failure, early onset, and persistence of the block
Upgrading patients with pacemakers to resynchronization pacing: Predictors of success
No full textBackground: The investigations of predictors of success or failure of cardiac resynchronization therapy were studied previously. Assessment of success in patients already on dual or single pacemakers and upgraded to cardiac resynchronization therapy (CRT) were not extensively studied before. How to selectpatients in whom this may be the most optimal strategy is unclear. We sought to determine factors associated with success or failure in this group of patients who were already paced for heart block.Methods: 81 pts were subjected to upgrade to CRT implantation after being on pacemaker. The study was conducted in Germany. Data was presented as Median (Min.–Max.) for abnormally distributed data or Mean ± SD. for normally distributed data. Parameters that revealed no statistical significance in response: Age, sex, EF, diabetes, renal disease, GFR, MR, QRS duration (all above 150 ms), history of ablation, AF recurrence, previous pacemaker, optimization. The following parameters revealed significant influence on response to CRT: Less responders with: Higher C reactive protein (CRP), presence of tricuspid incompetence (TR), presence of pulmonary hypertension (PHN), presence of previous MI, being ischemic vs nonischemic cardiomyopathy (CM) (less responders with ischemic CM).Conclusions: The findings through light on specific parameters that predict response to upgrade to CRT after usual pacemaker.Keywords: Heart failure, Resynchronization therapy, CPR, Ischemic vs non-ischemic cardiomyopath
Robotic ablation of paroxysmal atrial fibrillation saves time and irradiation dose
No full textMethodsWe studied 150 patients (pts) (86 males and 64 females) having a mean age of 51.3yrs (54>50, 96 below 50yrs), who suffered from symptomatic drug refractory paroxysmal AF. Cardiac MSCT image integration to the 3D electroanatomic LA map was used in 106 pts (70.6%, however all of them underwent intracardiac echo guided imaging during the ablation procedure. 40 pts underwent manual RF ablation using CARTO, 40 pts underwent ablation using NavX system, 70 pts underwent robotic ablation using Sensui system. Pulmonary vein isolation was done to all pts using either pulmonary vein (PV) antral isolation in 116 (77.3%) or circumferential pulmonary vein ablation in 34 pts (22.7%). Circumferential PV ablation was usually associated with posterior wall ablation. All pts were followed at 3, 6, 9, and 12months.Results34 Patients (22.6%) developed early recurrence of AF after an initial blanking period of 3 months. We had 16 patients(10.6%) with treatment failure at short term follow up, this number increased to 18 patients (12%) at midterm follow up and further small increase to 20 patients (13.3%) at long term follow up, recurrences were any episode of AF and/or AFL/AT>30s after the blanking period. The incidence of recurrence of AF in males was 13% (11/86), 14% in females (9/64), P NS.Comparison between manual and robotic groups as regards ablation points.Groups no. of patientsMeanPTotal no. of ablation pointsManual group8072.20.000∗Robotic group7049.9Total ablation timeManual group802094.80.000∗Robotic group701323.1Total fluoroscopy timeManual group8019.90.000∗Robotic group706.9Total fluoroscopy doseManual group8022570.000∗Robotic group70552.7Complications rateNone in 92.5%, air embolism zero, cardiac tamponade zero, trivial pericardial effusion 1, groin hematoma 5%, pulmonary vein stenosis >50% zero. No difference in complications between robotic and manual groups.ConclusionsRobotic ablation of paroxysmal atrial fibrillation saves time and irradiation dose
