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Acute myocardial infarction, hypotension

Masatsune Ogura, Hisashi Makino, Chizuko Kamiya, Jun Yoshimatsu, Handrean Soran, Ruth Eatough, Giuseppina Perrone, Mariko Harada-Shiba, Claudia Stefanutti
BACKGROUND AND AIMS: For patients with homozygous familial hypercholesterolemia (HoFH), atherogenic lipoprotein changes and increased stress on cardiovascular system during pregnancy may pose substantial risk for both the mother and her fetus. Although lipoprotein apheresis (LA) is reported as the most effective therapy to control LDL-C levels during pregnancy in HoFH patients, only case reports have been published, and there is no guidance for management. METHODS: We report twelve pregnancies and ten deliveries in seven patients with HoFH, and compare the clinical outcomes between patients who received LA during pregnancy and those who did not...
October 8, 2016: Atherosclerosis
Paul Whelton
BACKGROUND: Choice of the optimal target for blood pressure (BP) reduction during treatment of patients with hypertension, including those with underlying co-morbid conditions, is an important challenge in clinical practice. The Systolic Blood Pressure Intervention Trial (SPRINT) was designed to provide guidance in selection of a Systolic BP target during treatment of hypertension. METHODS: Adults ≥50 years old with hypertension and at least one additional risk factor for cardiovascular disease (CVD), but excluding persons with diabetes mellitus, prior stroke, or advanced chronic kidney disease (CKD) were randomly assigned to intensive therapy (intensive), targeting a systolic BP (SBP) <120 mmHg, or standard therapy (standard), targeting a SBP <140 mmHg...
September 2016: Journal of Hypertension
Faiçal Jarraya
Hypertension remains the most important risk factor for cardiovascular disease. If antihypertensive drugs choice is well guided today, blood pressure (BP) target still a subject of controversies. Residual risk is matter of debate and the lower- the better dogma is come back again regarding to data reported from recent trials. The J curve, reason for European Society of Hypertension Guidelines reappraisal in 2009, is criticized by recent data. The one goal (<140/90 mmHg) fit 90 mmg 90 mmHg) fit all should be adapted as a personalized goal guided by evidence generated by randomized controlled trials...
October 9, 2016: Advances in Experimental Medicine and Biology
Anishkumar Nair, Chakanalil Govindan Sajeev, Kader Muneer
CLINICAL INTRODUCTION: A 50-year-old hypertensive smoker presented with a typical angina of 2 days duration. An urgent ECG revealed extensive anterior wall myocardial infarction. In view of the delayed presentation, the patient was conservatively managed with heparin. In-hospital echocardiogram showed akinesia of entire left anterior descending artery (LAD) territory with severe left ventricular (LV) dysfunction. He was discharged with a plan for early coronary intervention. However, he presented a fortnight later with acute pulmonary oedema...
September 29, 2016: Heart: Official Journal of the British Cardiac Society
Paul Whelton
BACKGROUND: Choice of the optimal target for blood pressure (BP) reduction during treatment of patients with hypertension, including those with underlying co-morbid conditions, is an important challenge in clinical practice. The Systolic Blood Pressure Intervention Trial (SPRINT) was designed to provide guidance in selection of a Systolic BP target during treatment of hypertension. METHODS: Adults ≥50 years old with hypertension and at least one additional risk factor for cardiovascular disease (CVD), but excluding persons with diabetes mellitus, prior stroke, or advanced chronic kidney disease (CKD) were randomly assigned to intensive therapy (intensive), targeting a systolic BP (SBP) <120 mmHg, or standard therapy (standard), targeting a SBP <140 mmHg...
September 2016: Journal of Hypertension
Dileep Unnikrishnan, Aasems Jacob, Mark Anthony Diaz, Jeffrey Lederman
An 83-year-old female patient with rheumatoid arthritis and hypertension presented to the emergency department with fever and chills of 1 day duration. On examination, temperature was 100.9 F, heart rate 111/min and she had orthostatic hypotension. Laboratory tests showed elevated blood urea nitrogen and white cell count. The patient underwent treatment for symptomatic urinary tract infection and while her fever and leucocytosis resolved, tachycardia persisted. An EKG done showed T inversions in leads II, III, arteriovenous fistula, V2 and V3...
2016: BMJ Case Reports
Na Zhao, Jin Xu, Balwinder Singh, Xuerong Yu, Taixiang Wu, Yuguang Huang
BACKGROUND: Cardiac complications are not uncommon in patients undergoing non-cardiac surgery, especially in patients with coronary artery disease (CAD) or at high risk of CAD. Perioperative cardiac complications can lead to mortality and morbidity, as well as higher costs for patient care. Nitrates, which are among the most commonly used cardiovascular drugs, perform the function of decreasing cardiac preload while improving cardiac blood perfusion. Sometimes, nitrates are administered to patients undergoing non-cardiac surgery to reduce the incidence of cardiac complications, especially for patients with CAD...
2016: Cochrane Database of Systematic Reviews
Masayoshi Kiyokuni, Masaaki Konishi, Kentaro Sakamaki, Chika Kawashima, Masatoshi Narikawa, Hiroshi Doi, Kiwamu Iwata, Sakie Tomari, Naoki Nakayama, Naohiro Komura, Takayuki Mitsuhashi, Hideto Yano, Teruyasu Sugano, Tomoaki Ishigami, Tsutomu Endo, Toshiyuki Ishikawa, Takeharu Yamanaka, Kazuo Kimura
BACKGROUND: An early IV beta blocker during primary percutaneous coronary intervention (PCI) has been shown to reduce infarct size in ST-segment elevation acute myocardial infarction (STEMI), although the underlying mechanism is unknown. The aim of this study was to investigate the efficacy of early infusion of landiolol, the short-acting beta-1 adrenergic receptor blocker, on the reperfusion status in a STEMI. METHODS: We conducted a prospective, single-group trial of landiolol during the primary PCI for a STEMI...
October 15, 2016: International Journal of Cardiology
Jingjin Che, Guangping Li, Kangyin Chen, Tong Liu
Common clinical features of subacute rupture left ventricular free wall after acute ST segment elevation myocardial infarction are: (1) recurrent or persistent chest pain; (2) recurrent or persistent ST segment elevation; (3) hypotension. Integrating these signs into a syndrome can increase the clinician's awareness to the fatal complication.
June 2016: Clinical Case Reports
Russell D MacDonald, Felipe Allendes
OBJECTIVE: Transport of intra-aortic balloon pump (IABP)-dependent patients between hospitals is increasingly common. The transports are typically time-sensitive and require personnel familiar with IABP operation and management of a potentially unstable patient. This study examined transports performed by specially trained critical care paramedics in a large air medical and land critical care transport service. METHODS: This retrospective, descriptive review prospectively collected data for IABP-dependent patient transports in Ontario, Canada in a 10-year interval beginning September 2003...
July 2016: Air Medical Journal
Yan-Bei Sun, Bi-Cheng Liu, Yun Zou, Jia-Rong Pan, Yuan Tao, Min Yang
OBJECTIVES: To study the risk factors for acute kidney injury (AKI) in-patients with acute myocardial infarction (AMI). METHODS: A total of 1371 cases of adult in-patients with AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were retrospectively analyzed. Based on the occurrence of AKI diagnosed according to the 2012 KDIGO AKI criteria, they were divided into AKI group and non-AKI group and further into conservative treatment groups, coronary angiography (CAG) groups, and coronary artery bypass grafting (CABG) groups based on the timing of AKI occurrence, respectively...
June 14, 2016: Renal Failure
Takao Konishi, Naohiro Funayama, Tadashi Yamamoto, Hiroshi Nishihara, Daisuke Hotta, Kenjiro Kikuchi, Hideo Yokoyama, Katsumi Ohori
BACKGROUND: Left ventricular wall rupture remains a major lethal complication of acute myocardial infarction and hypertension is a well-known predisposing factor of cardiac rupture after myocardial infarction. CASE PRESENTATION: An 87-year-old man was admitted to our hospital, diagnosed as acute myocardial infarction (AMI). The echocardiogram showed 0.67-cm(2) aortic valve, consistent with severe aortic stenosis (AS). A coronary angiography showed a chronic occlusion of the proximal left circumflex artery and a 99 % stenosis and thrombus in the mid right coronary artery...
2016: BMC Cardiovascular Disorders
Cian P McCarthy, Kieran V Mullins, Sunjeet S Sidhu, Steven P Schulman, John W McEvoy
With potent analgesic properties, perceived hemodynamic benefits and limited alternatives, morphine is the analgesic mainstay for patients with nitrate resistant chest pain due to acute Myocardial Infarction (MI). However, observational data suggest that morphine administration during MI may have negative consequences. While vomiting, hypotension and respiratory depression are established side effects, recent reports have demonstrated attenuated and delayed oral anti-platelet agent absorption, as well as suboptimal reperfusion after MI, all of which may translate into adverse cardiovascular outcomes...
June 2016: American Heart Journal
Jeff D Williamson, Mark A Supiano, William B Applegate, Dan R Berlowitz, Ruth C Campbell, Glenn M Chertow, Larry J Fine, William E Haley, Amret T Hawfield, Joachim H Ix, Dalane W Kitzman, John B Kostis, Marie A Krousel-Wood, Lenore J Launer, Suzanne Oparil, Carlos J Rodriguez, Christianne L Roumie, Ronald I Shorr, Kaycee M Sink, Virginia G Wadley, Paul K Whelton, Jeffrey Whittle, Nancy F Woolard, Jackson T Wright, Nicholas M Pajewski
IMPORTANCE: The appropriate treatment target for systolic blood pressure (SBP) in older patients with hypertension remains uncertain. OBJECTIVE: To evaluate the effects of intensive (<120 mm Hg) compared with standard (<140 mm Hg) SBP targets in persons aged 75 years or older with hypertension but without diabetes. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, randomized clinical trial of patients aged 75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT)...
June 28, 2016: JAMA: the Journal of the American Medical Association
L M Predescu, L Zarma, P Platon, M Postu, A Bucsa, M Croitoru, B Prodan, O Chioncel, D Deleanu
Cardiovascular manifestations of tertiary syphilis infections are uncommon, but represent an important cause of mortality and morbidity. Syphilitic aortitis is characterized by aortic regurgitation, dilatation of ascending aorta and ostial coronary artery lesions. We report a case of 36 years old man admitted to our hospital for acute anterior ST segment elevation myocardial infarction complicated with cardiogenic shock (hypotension 75/50 mmHg). Transthoracic echocardiography revealed a dilated left ventricle with severe systolic dysfunction (ejection fraction = 25%), severe mitral regurgitation, moderate aortic regurgitation and mildly dilated ascending aorta...
January 2016: Romanian Journal of Internal Medicine, Revue Roumaine de Médecine Interne
Nestoras N Mathioudakis, Monica Giles, Hsin-Chieh Yeh, Carlton Haywood, Raquel C Greer, Sherita Hill Golden
OBJECTIVE: To determine whether there is a racial difference in the risk of acute kidney injury between hospitalized black and white adults with diabetes mellitus in the United States RESEARCH DESIGN AND METHODS: We analyzed cross-sectional data from the 2000-2010 National Hospital Discharge Survey (NHDS) to compare the odds of AKI among hospitalized black and white adults with diabetes. After excluding records in which race status was missing, race was other than white or black, discharge status was not provided, or end-stage renal disease was a diagnosis, we identified 276,138 eligible records for analysis...
August 2016: Journal of Diabetes and its Complications
Vincent Roolvink, Borja Ibáñez, Jan Paul Ottervanger, Gonzalo Pizarro, Niels van Royen, Alonso Mateos, Jan-Henk E Dambrink, Noemi Escalera, Erik Lipsic, Agustín Albarran, Antonio Fernández-Ortiz, Francisco Fernández-Avilés, Javier Goicolea, Javier Botas, Wouter Remkes, Victoria Hernandez-Jaras, Elvin Kedhi, José L Zamorano, Felipe Navarro, Fernando Alfonso, Alberto García-Lledó, Joaquin Alonso, Maarten van Leeuwen, Robin Nijveldt, Sonja Postma, Evelien Kolkman, Marcel Gosselink, Bart de Smet, Saman Rasoul, Jan J Piek, Valentin Fuster, Arnoud W J van 't Hof
BACKGROUND: The impact of intravenous (IV) beta-blockers before primary percutaneous coronary intervention (PPCI) on infarct size and clinical outcomes is not well established. OBJECTIVES: This study sought to conduct the first double-blind, placebo-controlled international multicenter study testing the effect of early IV beta-blockers before PPCI in a general ST-segment elevation myocardial infarction (STEMI) population. METHODS: STEMI patients presenting <12 h from symptom onset in Killip class I to II without atrioventricular block were randomized 1:1 to IV metoprolol (2 × 5-mg bolus) or matched placebo before PPCI...
June 14, 2016: Journal of the American College of Cardiology
Matthew M Carrick, Catherine Anne Morrison, Nicole M Tapia, Jan Leonard, James W Suliburk, Michael A Norman, Francis J Welsh, Bradford G Scott, Kathy R Liscum, Sally R Raty, Matthew J Wall, Kenneth L Mattox
BACKGROUND: Hemorrhagic shock is responsible for one third of trauma related deaths. We hypothesized that intraoperative hypotensive resuscitation would improve survival for patients undergoing operative control of hemorrhage following penetrating trauma. METHODS: Between July 1, 2007, and March 28, 2013, penetrating trauma patients aged 14 years to 45 years with a systolic blood pressure of 90 mm Hg or lower requiring laparotomy or thoracotomy for control of hemorrhage were randomized 1:1 based on a target minimum mean arterial pressure (MAP) of 50 mm Hg (experimental arm, LMAP) or 65 mm Hg (control arm, HMAP)...
June 2016: Journal of Trauma and Acute Care Surgery
Louis P Kohl, Jeffrey D Leimberger, Karen Chiswell, W Schuyler Jones, Holger Thiele, Richard W Smalling, Praveen Chandra, Marc Cohen, Divaka Perera, Derek P Chew, John K French, Jonathan Blaxil, A Sreenivas Kumar, E Magnus Ohman, Manesh R Patel
BACKGROUND: Despite advances in primary percutaneous coronary intervention (pPCI) and regional systems of care, the development of cardiogenic shock is associated with poor clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). We sought to better characterize the baseline characteristics and clinical outcomes of patients who underwent crossover to intraaortic balloon counterpulsation (IABC) in the CRISP AMI trial. METHODS: Patients with anterior STEMI were randomized to IABC before pPCI or pPCI alone...
April 2016: American Heart Journal
Jiří Widimský
BACKGROUND: The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain. METHODS: We randomly assigned 9 361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes...
January 2016: Vnitr̆ní Lékar̆ství
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