A patient in their 50s with a history of hypertension reported having 30 minutes of persistent chest pain. All vital signs were normal except for an elevated blood pressure of 188/104 mm Hg. Laboratory results (hemogram; serum electrolytes; kidney and hepatic; and levels of troponin I and D-dimer) were all within normal limits. An electrocardiogram (ECG) on admission is shown in theFigure, A. The patient was diagnosed with acute myocardial infarction (AMI) and prescribed 300 mg of aspirin and 600 mg of clopidogrel. The emergency coronary angiography findings were normal. A repeated ECG (Figure, B) after coronary angiography showed sinus rhythm without obvious ST-T deviation. Although the ECG findings had shown a significant improvement, the patient's chest pain still persisted. Over the next 8 hours, serial ECGs remained unchanged, and the troponin I level remained unremarkable. However, D-dimer levels significantly increased to 10.2 μg/mL (reference value, <0.25 μg/mL; to convert to nmol/L, multiply by 5.476).
The purpose of this study was to analyze the influencing factors of frailty in elderly patients with type II diabetes. 332 elderly patients with type II diabetes admitted to our hospital from May 2018 to December 2019 were selected as the study subjects. The degree of frailty was evaluated by the Fried fragility phenotype scale, and the general information and the clinical data of patients were collected by inquiry and questionnaire survey. After that, all the data were analyzed by SPSS 20.0. Univariate analysis showed that there were significant differences in age, medication types, dietary habits, exercise tolerance, exercise capacity, body balance, coordination ability, urinary incontinence, anxiety, etc., in elderly patients with type II diabetes who suffered from different degrees of frailty ( P < 0.01). In addition, there were significant differences in the presence of coronary heart disease, heart failure, atrial fibrillation, pulmonary diseases, osteoarticular diseases, anemia, and other blood diseases of elderly patients with type II diabetes who suffered from different degrees of frailty ( P < 0.01). Multiple Logistic regression analyses indicated that weakened exercise tolerance, reduced exercise capacity, atrial fibrillation, anemia, and other blood diseases were the influencing factors of the frailty in elderly patients with type II diabetes. The degree of frailty in elderly patients with diabetes is affected by many factors, such as exercise tolerance, exercise capacity, atrial fibrillation, anemia, and other blood diseases; thus, reasonable intervention should be implemented for elderly patients with type II diabetes according to the influencing factors so as to effectively relieve frailty.
A 61-year-old man with no history of heart or lung disease was admitted for benign prostatic hyperplasia surgery. On presentation, his physical examination findings were normal. His hemogram results and serum electrolyte levels were within normal limits. A 12-lead electrocardiogram (ECG) was obtained (Figure , A) at the time of admission. After a day of postoperative bed rest, he experienced sudden dyspnea and syncope while going to the toilet. His blood pressure was 75/38 mm Hg, and his peripheral oxygen saturation was 87% while breathing room air. There was obvious jugular venous distention. A repeated ECG is shown in the Figure , B.Questions: What are the clinically significant findings on the ECG in the Figure , B? What is the most likely diagnosis? InterpretationThe baseline 12-lead ECG shows sinus rhythm without obvious ST-T deviation. The repeated ECG shows atrial fibrillation (160 beats/ min) with rapid ventricular response, right axis deviation, S1Q3T3 pattern, ST-segment depression in leads V 4 to V 6 , ST-segment elevation in leads III, V 1 , and V 2 , and additional T-wave inversions in leads V 1 and V 2 that mimic a type 1 Brugada ECG pattern (named Brugada phenocopy [BrP]). All these ECG changes suggest a degree of right ventricular (RV) strain. Clinical CourseThe history of postoperative bed rest, signs of RV strain on the ECG, and dyspnea associated with syncope raised high suspicion of Figure. Electrocardiogram (ECG) Findings Admission ECG A Postsurgical ECG B A, Admission ECG showing sinus rhythm without obvious ST-T deviation. B, Postsurgical ECG showing ST-segment elevation on right precordial leads V 1 and V 2 that mimics a type 1 Brugada ECG pattern.
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