The aim of this study was to describe differences in treatment and in-hospital mortality of early, late, and very late stent thrombosis (ST). Early, late, and very late ST may differ in clinical presentation, management, and in-hospital outcomes. We analyzed definite (angiographically documented) ST cases identified from February 2009 to ...

We report the initiation of pacemaker-mediated tachycardia by a St Jude implantable cardioverter-defibrillator with a programmed Ventricular Intrinsic Preference algorithm used for minimizing or inhibiting right ventricular pacing. This feature prolongs the atrioventricular (AV) delay periodically to determine if ventricular sensed events follow atrial events. Retrograde ventriculoatrial conduction and pacemaker-mediated ...

BACKGROUND: Differentiating atypical atrio-ventricular re-entrant tachycardia (AVNRT) from septal orthodromic re-entrant tachycardia (ORT(Septal)) is challenging in non-sustained tachycardia. When sustained, the post-pacing interval minus tachycardia cycle length following entrainment (PPI(Entrainment)-TCL) and stimulation to atrial interval minus ventriculoatrial interval (Stim-A(Entrainment)-VA) is utilized. OBJECTIVE: We hypothesized that the first tachycardia cycle after ...

The outcome of the surgical repair in congenital heart disease correlates with the degree of myocardial damage. In this study, we determined whether mitochondrial DNA depletion is a sensitive marker of right ventricular (RV) damage and whether impaired mitochondrial DNA (mtDNA) replication contributes to the transition from compensated hypertrophy to ...

Comprehensive testing and evaluation of cardiovascular device function and performance is required prior to clinical implementation. Initial proof of concept investigations are conducted within in-vitro mock circulation loops, before proof of principle is demonstrated via in-vivo animal testing. To facilitate the rapid transition of cardiovascular devices through this development period, ...

We present the case of a 69-year-old woman with psychotic depression who suffered a non-ST segment elevation myocardial infarction at her first electroconvulsive therapy (ECT). Her course of ECT was resumed 19 days later, and she was able to complete it without further problems. Her depression remitted fully. We report ...

The goal of this study is to determine the predictive value of ST-segment resolution (STR) early after percutaneous coronary intervention (PCI), late STR, and no STR for left ventricular ejection fraction (LVEF) and infarct size (IS) by cardiovascular magnetic resonance (CMR) at follow-up in patients with ST-segment elevation myocardial infarction. ...

To investigate the specificity of the electrocardiographic diagnosis of ST-segment elevation myocardial infarction in the critical care unit setting. Retrospective observational cohort analysis. An 880-bed tertiary care teaching hospital with 120 intensive care unit beds. The population included medical, surgical, trauma, and neurosurgical intensive care unit patients. Electrocardiograms were systematically ...

Native coronary atherosclerosis (CAS) is a diffuse and progressive disease process that is occasionally associated with either clinical atherothrombosis and/or major adverse cardiac events (MACE) including: ST elevation myocardial infarction (STEMI), acute coronary syndromes without ST elevation (ACSWSTE), heart failure, cardiac arrest and sudden cardiac death. Both, the timing and ...

The utility of β-blockers during an evolving ST-segment elevation myocardial infarction (STEMI) has substantial theoretic physiological backing. This coupled with early successes using β-blockers in STEMI promulgated multiple guidelines expanding the use of this class of medication to all patients with acute coronary syndromes. However, recent studies have questioned the ...

We perform a systematic review to discern if ST resolution achieved via percutaneous coronary intervention (PCI) has a different meaning to that achieved via fibrinolysis. Resolution of ST-segment elevation in acute myocardial infarction has been widely used as a surrogate for treatment success. A recent randomized study suggested that after ...

Summary.  Background: Early coronary stent thrombosis occurs most frequent after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Objectives: To identify the specific predictors of, respectively, acute and subacute stent thrombosis in patients after primary PCI for STEMI. Patients/Methods: Consecutive STEMI patients with angiographically confirmed early stent ...

Acute myocardial infarction (MI) remains a leading cause of death despite advances in pharmacologic and percutaneous therapies. Animal models of ischemia/reperfusion have demonstrated that single-dose erythropoietin may reduce infarct size, decrease apoptosis, and increase neovascularization, possibly through mobilization of endothelial progenitor cells. REVEAL is a randomized, double-blind, placebo-controlled, multicenter trial ...

Recently, we demonstrated that ajmaline caused ST segment elevation in the heart of an SCN5A mutation carrier by excitation failure in structurally discontinuous myocardium. In patients with Brugada syndrome, ST segment elevation is modulated by cardiac sodium (I(Na)), transient outward (I(to)), and L-type calcium currents (I(CaL)). To establish experimentally whether ...

Early abciximab administration in patients requiring transportation to undergo primary percutaneous coronary intervention (PPCI) has been reported to improve clinical outcome. We aimed to verify whether early administration leads to reduced infarct size (IS), assessed by delayed-enhancement magnetic resonance imaging (DE-MRI). We randomized 110 patients with acute myocardial infarction with ...

Introduction Isolated posterior ST-elevation myocardial infarction (STEMI) accounts for up to 7% of STEMIs. The diagnosis is suggested by indirect anterior-lead ECG changes. Confirmation requires presence of ST-elevation in posterior-leads (V7-V9). We investigated the ability of hospital doctors and paramedics to diagnose posterior STEMI (PMI). Methods Doctors in the emergency ...

Reciprocal changes may accompany ST segment elevation in the ischemic territory during acute myocardial infarction (AMI). We examined the hypothesis that isolated inferior ST segment depression on admission is an early sign of anterior wall infarction. 49 patients admitted to the coronary care unit between January 1996 and June 2008 ...

In emergency situations, intraosseous cannulation represents an alternative route of vascular access when peripheral vein insertion is difficult. We present the first documented case of intraosseous systemic fibrinolysis in a patient with ST-segment elevation myocardial infarction. In this case, repetitive episodes of ventricular fibrillation occurred soon after first contact with ...

Persistent ST elevation after reperfused ST elevation myocardial infarction (STEMI) is believed to be related to poor microvascular perfusion. Cardiac magnetic resonance imaging (CMR) can evaluate microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH) both of which represent severe microvascular damage, have independent prognostic value and are dynamic and evolving over ...

Many studies have looked at differences between men and women with acute coronary syndrome. These studies demonstrate that women have worse outcomes, receive fewer invasive interventions, and experience delay in the initiation of established medical therapies. Using innovative technology, we set out to unveil and resolve any gender disparities in ...

It is rare to observe ST-segment elevation in only the anterior leads and not the inferior leads during right coronary artery occlusion. We describe a case with acute myocardial infarction (MI) by right coronary artery occlusion who developed ST-segment elevation only in the precordial leads V1 to V3.

To review primary percutaneous coronary interventions performed for patients with ST elevation myocardial infarction with a focus on door-to-treatment time, especially after introduction of a new management programme in November 2003. Retrospective study. Regional hospital, Hong Kong. All patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention ...

Stent thrombosis (ST) has a very high case fatality and morbidity rates. The risk of very late ST is significantly increased with drug-eluting stents (DES) compared to bare-metal stents for at least up to 4 years. Discontinuation of clopidogrel therapy is the single most important consistently identified risk factor. Immediate ...

To establish the accuracy, intra- and inter-observer variabilities of four different segmentation methods for measuring cardiac functional parameters in healthy and infarcted rat hearts. Six Wistar rats were imaged before and after myocardial infarction using an electrocardiogram and respiratory-gated spoiled gradient echo sequence. Blinded and randomized datasets were analyzed by ...

We report a case of a middle-aged woman presenting with ST elevation myocardial infarction in early puerperium after Caesarean intervention secondary to left main coronary artery thrombosis, likely to be associated with thrombophilic state and concomitant use of oxytocin.

Late-presenting ST-elevation myocardial infarction (STEMI) patients possess larger, more organized coronary thrombus leading to greater ventricular remodeling and arrhythmia despite angioplasty and pharmacological therapies. We hypothesized that myocardial injury would be reduced in late STEMI by proximal embolic protection (PEP). 31 patients with first STEMI 12-24 hr after pain onset ...

A large-scale magnetocardiogram (MCG) database was produced, and standard MCG waveforms of healthy patients were calculated by using this database. It was clarified that the standard MCG waveforms are formed with the same shape and current distribution in healthy patients. A new subtraction method for detecting abnormal ST-T waveforms in ...

Malignant ventricular arrhythmias resulting from isolated right ventricular myocardial infarction (RVMI) without left ventricular myocardial ischaemia or infarction occur rarely. We present a case of a 61 year-old male with acute onset of chest pain and ventricular fibrillation cardiac arrest requiring prompt defibrillation. Subsequent 15-lead EKG, showed ST-segment elevation in ...

Anemia has been associated with adverse outcomes in patients with acute coronary syndromes (ACS). However, the underlying pathophysiologic mechanisms have not been well elucidated. We sought to determine the independent relation between the hemoglobin level and recurrent ischemia in patients with non-ST-segment elevation ACS using continuous electrocardiographic monitoring. In the ...

We report the first clinical studies of intracardiac ST-segment monitoring in ambulatory humans to alert them to significant ST-segment shifts associated with thrombotic occlusion. Despite improvements in door-to-balloon times, delays in symptom-to-door times of 2 to 3 h remain. Early alerting of the presence of acute myocardial infarction could prompt ...

BACKGROUND: Among individuals experiencing an ST segment-elevation myocardial infarction, current guidelines recommend that the interval from first medical contact to percutaneous coronary intervention be ≤90 minutes. The objective of this study was to determine whether prehospital time intervals were associated with ST-elevation myocardial infarction system performance, defined as first medical ...

Few studies specify the methods used to measure ST-segment elevation (STE). We therefore assessed differences in electrocardiography results depending on STE measurement methods for patients with inferior acute myocardial infarction (MI) and right ventricular infarction. This study was a retrospective analysis. The STE group consisted of 88 patients consecutively admitted ...

BACKGROUND: Tako-tsubo cardiomyopathy (TTC) was first described in 1990 in Japan. A TTC registry was initiated by the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK) in order to evaluate the clinical spectrum and the management of patients with this syndrome in Germany. METHODS: Patients from 37 hospitals were included in the registry ...

Telemedicine allows exchange of information and has therefore become an important tool for optimizing patient treatment in the field of cardiology. Transmission of electrocardiograms (ECGs) from the prehospital setting to the receiving hospital is the most widespread technology in the prehospital setting. Providing a diagnostic ECG from patients with acute ...

Acute coronary syndromes (ACSs)--unstable angina, non-ST-segment (ST, part of an electrocardiogram between the QRS complex and the T wave) or ST-segment elevation myocardial infarction (MI)--remain extremely common and clinically challenging. In addition to electrocardiography and biomarkers, formal risk stratification using risk scores has become an important part of the initial ...

In 1996 Sgarbossa reviewed 17 ventricular-paced electrocardiograms (ECGs) in acute myocardial infarction (AMI) for signs of ischemia. Several characteristics of the paced ECG were predictive of AMI. We sought to evaluate the criteria in ventricular-paced ECGs in an emergency department (ED) cohort. Ventricular-paced ECGs in patients with elevated cardiac markers ...

Stress-induced cardiomyopathy (SCMP) is diagnosed in 1-2% of patients presenting with symptoms suggestive of acute coronary syndrome. Because of sharing many common clinical features with SCMP, acute ST-segment elevation myocardial infarction (STEMI) can be misdiagnosed as SCMP. However, it can be associated with fatal outcome of the patient. Also, diagnosis ...

When ST-segment elevation myocardial infarction is complicated by hemodynamic instability, clinical evaluation alone cannot be relied upon for accurate assessment. Invasive hemodynamic monitoring with a pulmonary artery catheter and intra-arterial catheter should, therefore, be performed to gauge impaired hemodynamics in such patients and make necessary changes in therapy. There are ...

The Brugada syndrome (BS) accounts for approximately 20% of cases of sudden cardiac death in patients with structurally normal hearts. The electrophysiologic basis for ST-segment elevation in the precordial electrocardiogram (ECG) leads that characterize the Brugada phenotype and its strong linkage to ventricular tachycardia (VT)/ventricular fibrillation is still a subject ...

A 33-year-old man presented to the emergency department with lightheadedness and diffuse maculopapular pruritic rash 30 min after taking naproxen for headache. While in the emergency department he developed hypotension and chest pain. An electrocardiograph showed ST-segment elevation in the inferior leads. His symptoms and the electrocardiographic changes resolved after ...

Erythropoietin improves myocardial function in experimental models of myocardial infarction. The aim of the present study was to determine the value of erythropoietin in patients with acute ST-elevation myocardial infarction. This randomized, double-blind study included 138 patients admitted with acute ST-elevation myocardial infarction and treated with primary percutaneous coronary intervention. ...

Post hoc analyses from several randomized, controlled trials have established the prognostic importance of different measures of ST-segment recovery in highly selected patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction (STEMI). In this single-center registry, we investigated whether various measures of ST-segment recovery can be applied to ...

Shortening symptom-to-reperfusion time improves prognosis in patients with ST-segment elevation myocardial infarction. Accordingly, current guidelines target a door-to-balloon time <90 minutes, irrespective of symptom-to-door time; nevertheless, the relation between door-to-balloon and symptom-to-door time and its potential impact on myocardial salvage remains largely unknown. We investigated the influence of door-to-balloon guideline ...

We present the case of a 60-year-old male who presented to our emergency department approximately 2 hours after a suspected intravascular pit viper envenomation to the area of the left ankle. By his arrival to our facility he was profoundly confused and hypotensive with bloody diarrhea, coagulopathy and multi-organ dysfunction ...

It is becoming increasingly common to offer primary percutaneous coronary intervention as first line treatment for ST elevation myocardial infarction (STEMI). In a subset of patients presenting with suspected STEMI, coronary arteries appear normal at coronary angiography. In this article, the current literature of this group of patients is reviewed. ...

Longitudinal myocardial tissue velocity imaging (TVI) and strain rate imaging (SRI) quantify regional myocardial function. We aimed to measure TVI and SRI indices for inferobasal aneurysmal segments by echocardiography at rest. Sixteen patients with inferobasal left ventricular (LV) aneurysm, LV ejection fraction (EF) ≤50%, and 14 normal coronaries with normal ...

With the advent of thrombolytics, guidelines for ST-elevated myocardial infarction (STEMI) recognition were presented in terms of an ST segment exceeding a particular level (1 or 2 mm) in 2 contiguous leads. However, more than half of prehospital electrocardiograms that exceed these ST criteria are from patients not having an ...

We describe the case of a 63-year-old man whose electrocardiogram showed transition of the ST segment from a J wave to a coved-type elevation in precordial leads before ventricular fibrillation induced by right coronary artery vasospasm. Simultaneously, the ST segment in inferior leads was gradually depressed with a J wave. ...

A variety of conditions other than acute myocardial infarction may cause ST-elevation. Our objective was to evaluate the impact of cardiac magnetic resonance (CMR) on differential diagnosis from a prospective series of patients with suspected ST-elevation myocardial infarction (STEMI) and completely normal coronary arteries. Among 1,145 patients with suspected STEMI, ...

BACKGROUND: Lead V(1) directly faces the right ventricle and may exhibit ST elevation during an acute inferior myocardial infarction when the right ventricle is also involved. Leads V(1) and V(3) indirectly face the posterolateral left ventricle, and ST depression ("mirror-image" ST elevation) in V(1) through V(3) may reflect concomitant posterolateral ...