The Management of Acute Coronary Syndromes in Patients Presenting
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Acute Coronary Syndrome in Young Sub-Saharan Africans: A
Sarr et al. BMC Cardiovascular Disorders 2013, 13:118 http://www.biomedcentral.com/1471-2261/13/118 RESEARCH ARTICLE Open Access Acute coronary syndrome in young Sub-Saharan Africans: A prospective study of 21 cases Moustapha Sarr1, Djibril Mari Ba1, Mouhamadou Bamba Ndiaye1*, Malick Bodian1, Modou Jobe1, Adama Kane1, Maboury Diao1, Alassane Mbaye2, Mouhamadoul Mounir Dia1, Soulemane Pessinaba1, Abdoul Kane2 and Serigne Abdou Ba1 Abstract Background: Coronary heart disease remains the leading cause of death in developed countries. In Africa, the disease continues to rise with varying rates of progression in different countries. At present, there is little available work on its juvenile forms. The objective of this work was to study the epidemiological, clinical and evolutionary aspects of acute coronary syndrome in young Sub-Saharan Africans. Methods: This was a prospective multicenter study done at the different departments of cardiology in Dakar. We included all patients of age 40 years and below, and who were admitted for acute coronary syndrome between January 1st, 2005 and July 31st, 2007. We collected and analyzed the epidemiological, clinical, paraclinical and evolutionary data of the patients. Results: Hospital prevalence of acute coronary syndrome in young people was 0.45% (21/4627) which represented 6.8% of all cases of acute coronary syndrome admitted during the same period. There was a strong male predominance with a sex-ratio (M:F) of 6. The mean age of patients was 34 ± 1.9 years (range of 24 and 40 years). The main risk factor was smoking, found in 52.4% of cases and the most common presenting symptom was chest pain found in 95.2% of patients. -
J Wave and Cardiac Death in Inferior Wall Myocardial Infarction
ORIGINAL ARTICLES Arrhythmia 2015;16(2):67-77 J Wave and Cardiac Death in Inferior Wall Myocardial Infarction Myung-Jin Cha, MD; Seil Oh, MD, ABSTRACT PhD, FHRS Background and Objectives: The clinical significance of J wave Department of Internal Medicine, Seoul National University presentation in acute myocardial infarction (AMI) patients remains Hospital, Seoul, Korea unclear. We hypothesized that J wave appearance in the inferior leads and/or reversed-J (rJ) wave in leads V1-V3 is associated with poor prognosis in inferior-wall AMI patients. Subject and Methods: We enrolled 302 consecutive patients with inferior-wall AMI who were treated with percutaneous coronary in- tervention (PCI). Patients were categorized into 2 groups based on electrocardiograms before and after PCI: the J group (J waves in in- ferior leads and/or rJ waves in leads V1-V3) and the non-J group (no J wave in any of the 12 leads). We compared patients with high am- plitude (>2 mV) J or rJ waves (big-J group) with the non-J group. The cardiac and all-cause mortality at 6 months and post-PCI ventricular arrhythmic events ≤48 hours after PCI were analyzed. Results: A total of 29 patients (including 19 cardiac death) had died. Although all-cause mortality was significantly higher in the post-PCI J group than in the non-J group (p=0.001, HR=5.38), there was no difference between the groups in cardiac mortality. When compar- ing the post-PCI big-J group with the non-J group, a significant dif- ference was found in all-cause mortality (n=29, p=0.032, HR=5.4) and cardiac mortality (n=19, p=0.011, HR=32.7). -
Unstable Angina with Tachycardia: Clinical and Therapeutic Implications
Unstable angina with tachycardia: Clinical and therapeutic implications We prospectively evaluated 19 patients with prolonged chest pain not evolving to myocardiai infarction and accompanied with reversible ST-T changes and tachycardia (heart rate >lOO beats/min) in order to correlate heart rate reduction with ischemic electrocardiographic (ECG) changes. Fourteen patients (74%) received previous long-term combined treatment with nifedipine and nitrates. Continuous ECG monitoring was carried out until heart rate reduction and at least one of the following occurred: (1) relief of pain or (2) resolution of ischemic ECG changes. The study protocol consisted of carotid massage in three patients (IS%), intravenous propranolol in seven patients (37%), slow intravenous amiodarone infusion in two patients (lo%), and intravenous verapamil in four patients (21%) with atrial fibrillation. In three patients (16%) we observed a spontaneous heart rate reduction on admission. Patients responded with heart rate reduction from a mean of 126 + 10.4 beats/min to 64 k 7.5 beats/min (p < 0.005) and an ST segment shift of 4.3 k 2.13 mm to 0.89 k 0.74 mm (p < 0.005) within a mean interval of 13.2 + 12.7 minutes. Fifteen (79%) had complete response and the other four (21%) had partial relief of pain. A significant direct correlation was observed for heart rate reduction and ST segment deviation (depression or elevation) (f = 0.7527 and 0.8739, respectively). These patients represent a unique subgroup of unstable angina, in which the mechanism responsible for ischemia is excessive increase in heart rate. Conventional vasodilator therapy may be deleterious, and heart rate reduction Is mandatory. -
Cardiovascular Disease and Rehab
EXERCISE AND CARDIOVASCULAR ! CARDIOVASCULAR DISEASE Exercise plays a significant role in the prevention and rehabilitation of cardiovascular diseases. High blood pressure, high cholesterol, diabetes and obesity can all be positively affected by an appropriate and regular exercise program which in turn benefits cardiovascular health. Cardiovascular disease can come in many forms including: Acute coronary syndromes (coronary artery disease), myocardial ischemia, myocardial infarction (MI), Peripheral artery disease and more. Exercise can improve cardiovascular endurance and can improve overall quality of life. If you have had a cardiac event and are ready to start an appropriate exercise plan, Cardiac Rehabilitation may be the best option for you. Please call 317-745-3580 (Danville Hospital campus), 317-718-2454 (YMCA Avon campus) or 317-456-9058 (Brownsburg Hospital campus) for more information. SAFETY PRECAUTIONS • Ask your healthcare team which activities are most appropriate for you. • If prescribed nitroglycerine, always carry it with you especially during exercise and take all other medications as prescribed. • Start slow and gradually progress. If active before event, fitness levels may be significantly lower – listen to your body. A longer cool down may reduce complications. • Stop exercising immediately if you experience chest pain, fatigue, or labored breathing. • Avoid exercising in extreme weather conditions. • Drink plenty of water before, during, and after exercise. • Wear a medical identification bracelet, necklace, or ID tag in case of emergency. • Wear proper fitting shoes and socks, and check feet after exercise. STANDARD GUIDELINES F – 3-5 days a week. Include low weight resistance training 2 days/week I – 40-80% of exercise capacity using the heart rate reserve (HRR) (220-age=HRmax; HRmax-HRrest = HRR) T – 20-60mins/session, may start with sessions of 5-15 mins if necessary T – Large rhythmic muscle group activities that are low impact (walking, swimming, biking) Get wellness tips to keep YOU healthy at HENDRICKS.ORG/SOCIAL.. -
The J Wave of the ECG. Concepts Compiled by Dr
The J wave of the ECG. Concepts Compiled by Dr. Andrés R. Pérez Riera The J wave is a positive deflection in the ECG normal (present in 2%–14% of healthy individuals and is more prevalent in young males, particularly if athletic and African descent. Additionally, ERP is a common finding in young teen athletes (the prevalence in the athletic population rises to 20-90%.).1 In this population ERP in both inferior and lateral leads is more common (18.2%) than isolated inferior (9.1%) or lateral (8.2%) ERP. Young age might be a contributing factor in causing a more diffuse repolarization abnormality. 2 or pathological that occurs approximately (There is an overlap of ≈10 msec. 3) after the junction between the end of the QRS complex and the beginning of the ST segment, also known as the J point (junction point), QRS end, J-junction, ST0 [zero millisecond] or ST beginning to occur after the notch/slur or J wave 4. It is described as J deflection as slurring/lambda 5 or notching of the terminal portion of QRS complex. Currently, J waves, is defined as an elevation of the QRS-ST junction ≥1 mm either as QRS slurring or notching in at least 2 contiguous leads. Additionally, when it becomes more accentuated, it may appear as a small, R wave (R′) or ST segment elevation. The term J deflection or J-wave has been used to designate the formation of the wave produced when there is a large, prominent deviation of the J point from the baseline with two shapes: notching/spike-and- slurring/lambda 5 or dome 6 variety. -
Myocardial Infarction (Heart Attack)
Sacramento Heart & Vascular Medical Associates February 19, 2012 500 University Ave. Sacramento, CA 95825 Page 1 916-830-2000 Fax: 916-830-2001 Patient Information For: Only A Test Myocardial Infarction (Heart Attack) What is a myocardial infarction (MI)? Myocardial infarction (MI) is a heart attack. It happens when blood flow to a part of the heart is suddenly blocked. How does it occur? Myocardial infarction may occur at any time and often occurs without warning. As we grow older, our coronary arteries may become narrowed by the buildup of cholesterol plaque. When the arteries narrow, less blood can go through them, and less oxygen gets to the heart muscle. The process of narrowing is called atherosclerosis. The narrower the artery becomes, the more likely it is that a blood clot may form and block the artery completely, causing a heart attack. Sometimes sudden blockages can occur even in places where the artery was not narrow before. A heart attack may also occur when the heart muscle needs more oxygen than the blood vessels can provide. This might happen, for example, during hard exercise such as shoveling snow, or with a sudden increase in blood pressure. Less commonly, a heart attack can occur due to coronary spasm. Coronary spasm is a sudden and temporary narrowing of a small part of an artery that supplies blood to the heart. It may be caused by smoking or drugs such as cocaine. Risk factors for heart disease include: - cigarette smoking - a family history of heart attack - diabetes - overweight - high blood pressure - high blood cholesterol - low HDL cholesterol (that is, too little "good" cholesterol) - stress - a lifestyle that does not include much physical activity. -
SIGN 148 • Acute Coronary Syndrome
SIGN 148 • Acute coronary syndrome A national clinical guideline April 2016 Evidence KEY TO EVIDENCE STATEMENTS AND RECOMMENDATIONS LEVELS OF EVIDENCE 1++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias 1+ Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias 1 - Meta-analyses, systematic reviews, or RCTs with a high risk of bias High-quality systematic reviews of case-control or cohort studies ++ 2 High-quality case-control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal Well-conducted case-control or cohort studies with a low risk of confounding or bias and a moderate probability that the 2+ relationship is causal 2 - Case-control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal 3 Non-analytic studies, eg case reports, case series 4 Expert opinion RECOMMENDATIONS Some recommendations can be made with more certainty than others. The wording used in the recommendations in this guideline denotes the certainty with which the recommendation is made (the ‘strength’ of the recommendation). The ‘strength’ of a recommendation takes into account the quality (level) of the evidence. Although higher-quality evidence is more likely to be associated with strong recommendations than lower-quality evidence, a particular level of quality does not automatically lead to a particular strength of recommendation. Other factors that are taken into account when forming recommendations include: relevance to the NHS in Scotland; applicability of published evidence to the target population; consistency of the body of evidence, and the balance of benefits and harms of the options. -
Acute Coronary Syndrome 1
Acute Coronary Syndrome 1. Which one of the following is not considered a benefit of Chest Pain Center Accreditation? a. Improved patient outcomes b. Streamlined processes to allow for rapid treatment c. Reduce costs and readmission rates d. All of the above are benefits of Chest Pain Center Accreditation 2. EHAC stands for Early Heart Attack Care? a. True b. False 3. What is the primary cause of acute coronary syndrome (ACS)? a. Exercise b. High blood pressure c. Atherosclerosis d. Heart failure 4. Which one of the following is not considered a symptom of ACS? a. Jaw Discomfort b. Abdominal discomfort c. Shortness of breath without chest discomfort d. All of the above are considered symptoms of ACS 5. There are age and gender differences associated with signs and symptoms of ACS? a. True b. False 6. Altered mental status may be a sign of ACS in some individuals? a. True b. False 7. All of the following are considered modifiable risk factors for ACS except: a. Smoking b. Sedentary lifestyle c. Age d. High cholesterol 8. Heart attacks occur immediately and never have warning signs? a. True b. False 9. If someone is having a heart attack, which of the following is the best option for seeking treatment? a. Wait a few hours and see if the symptoms resolve, if they do not, then call your physician b. Drive yourself to the ED. You can get there faster since you know a short-cut c. Call 9-1-1 to activate EMS immediately d. Call a family member or neighbor to drive you to the ED 10. -
Risk Stratification in Acute Coronary Syndrome: Focus on Unstable Angina/Non-ST Segment Elevation Myocardial Infarction R Bugiardini
729 EDITORIAL Heart: first published as 10.1136/hrt.2004.034546 on 14 June 2004. Downloaded from Risk stratification in acute coronary syndrome: focus on unstable angina/non-ST segment elevation myocardial infarction R Bugiardini ............................................................................................................................... Heart 2004;90:729–731. doi: 10.1136/hrt.2004.034546 Although there have been advances in the management of fashion. Experts in a variety of fields make decisions using a more intuitive process of unstable angina/non-ST segment elevation myocardial recognising patterns and applying their own infarction syndromes, the rate of cardiovascular mortality rules. In varying proportions, pathophysiologic after discharge is still unacceptably high. With many reasoning, personal clinical experience, and recent published research each play a role in therapeutic options available, the clinician is challenged to the development of our own clinical rules. This identify the safest and most effective treatment for long term approach may produce incorrect use of tools of survival of each individual patient risk stratifications and inappropriate use of treatment strategies and procedures. However, ........................................................................... errors are more often due to ‘‘failure’’ of the system, not of the doctors. Most errors occur at the transfer of care, and particularly at the transfer from the outpatient to the inpatient ‘‘Simple, but not too simple’’—Albert Einstein sites. There are a number of programs now focusing on errors and strategies to reduce errors welve million individuals in the USA and (GAP, CRUSADE QI, JACHO).5–7 All of these 143 million worldwide have coronary artery programs focus on education of physicians, Tdisease. Two million US patients are better interaction between health care organisa- admitted annually to cardiac care units with tions and physicians, and appropriate use of care acute coronary syndromes (ACS). -
Treatment of Acute Coronary Syndrome
Acute Coronary Syndrome: Current Treatment TIMOTHY L. SWITAJ, MD, U.S. Army Medical Department Center and School, Fort Sam Houston, Texas SCOTT R. CHRISTENSEN, MD, Martin Army Community Hospital Family Medicine Residency Program, Fort Benning, Georgia DEAN M. BREWER, DO, Guthrie Ambulatory Health Care Clinic, Fort Drum, New York Acute coronary syndrome continues to be a significant cause of morbidity and mortality in the United States. Family physicians need to identify and mitigate risk factors early, as well as recognize and respond to acute coronary syn- drome events quickly in any clinical setting. Diagnosis can be made based on patient history, symptoms, electrocardi- ography findings, and cardiac biomarkers, which delineate between ST elevation myocardial infarction and non–ST elevation acute coronary syndrome. Rapid reperfusion with primary percutaneous coronary intervention is the goal with either clinical presentation. Coupled with appropriate medical management, percutaneous coronary interven- tion can improve short- and long-term outcomes following myocardial infarction. If percutaneous coronary interven- tion cannot be performed rapidly, patients with ST elevation myocardial infarction can be treated with fibrinolytic therapy. Fibrinolysis is not recommended in patients with non–ST elevation acute coronary syndrome; therefore, these patients should be treated with medical management if they are at low risk of coronary events or if percutaneous coronary intervention cannot be performed. Post–myocardial infarction care should -
Angina: Contemporary Diagnosis and Management Thomas Joseph Ford ,1,2,3 Colin Berry 1
Education in Heart CHRONIC ISCHAEMIC HEART DISEASE Heart: first published as 10.1136/heartjnl-2018-314661 on 12 February 2020. Downloaded from Angina: contemporary diagnosis and management Thomas Joseph Ford ,1,2,3 Colin Berry 1 1BHF Cardiovascular Research INTRODUCTION Learning objectives Centre, University of Glasgow Ischaemic heart disease (IHD) remains the leading College of Medical Veterinary global cause of death and lost life years in adults, and Life Sciences, Glasgow, UK ► Around one half of angina patients have no 2 notably in younger (<55 years) women.1 Angina Department of Cardiology, obstructive coronary disease; many of these Gosford Hospital, Gosford, New pectoris (derived from the Latin verb ‘angere’ to patients have microvascular and/or vasospastic South Wales, Australia strangle) is chest discomfort of cardiac origin. It is a 3 angina. Faculty of Health and Medicine, common clinical manifestation of IHD with an esti- The University of Newcastle, ► Tests of coronary artery function empower mated prevalence of 3%–4% in UK adults. There Newcastle, NSW, Australia clinicians to make a correct diagnosis (rule- in/ are over 250 000 invasive coronary angiograms rule- out), complementing coronary angiography. Correspondence to performed each year with over 20 000 new cases of ► Physician and patient education, lifestyle, Dr Thomas Joseph Ford, BHF angina. The healthcare resource utilisation is appre- medications and revascularisation are key Cardiovascular Research Centre, ciable with over 110 000 inpatient episodes each aspects of management. University of Glasgow College year leading to substantial associated morbidity.2 In of Medical Veterinary and Life Sciences, Glasgow G128QQ, UK; 1809, Allen Burns (Lecturer in Anatomy, Univer- tom. -
Coronary Artery Disease Management
HealthPartners Inspire® Special Needs Basic Care Clinical Care Planning and Resource Guide CORONARY ARTERY DISEASE MANAGEMENT The following Evidence Base Guideline was used in developing this clinical care guide: National Institute of Health (NIH); American Heart Association (AHA) Documented Health Condition: Coronary Artery Disease, Coronary Heart Disease, Heart Disease What is Coronary Artery Disease? Coronary artery disease (CAD) is a disease in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen‐rich blood to your heart muscle. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH‐er‐o‐skler‐O‐sis). The buildup of plaque occurs over many years. Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen‐rich blood to the heart. If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. Over time, ruptured plaque also hardens and narrows the coronary arteries. Common Causes of Coronary Artery Disease? If the flow of oxygen‐rich blood to your heart muscle is reduced or blocked, angina or a heart attack can occur. Angina is chest pain or discomfort. It may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. A heart attack occurs if the flow of oxygen‐rich blood to a section of heart muscle is cut off. If blood flow isn’t restored quickly, the section of heart muscle begins to die.