Aims
The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI).
Methods and results
Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0–100%), fibrinolysis (18.8%; 0–100%), and no reperfusion therapy (9.0%; 0–75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5–5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8–97.5%) for the performance of reperfusion therapy of all patients with STEMI <12 h and 54.4% (region range 37.1–70.1%) for timely reperfusion.
Conclusions
The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality.
The knowledge of certain electrocardiographic signs in patients with acute coronary syndrome and left bundle branch block increases the chances of early diagnosis and the possibility of better and timely treatment.
UVODU interpretaciji elektrokardiograma, aVR odvod ima višestruku kliničku primenu. Dobro je poznat značaj ovog odvoda u akutnoj plućnoj tromboemboliji gde pored dijagnostičke ima i prognostičku vrednost (1-4). Njegov značaj se pored kardioloških oboljenja opisuje i u dijagnozi trovanja tricikličnim antidepresivima (5, 6) i tenzionom pneumotoraksu (7). U kardiološkoj praksi analizi ovog odvoda ne poklanja se dovoljna pažnja. Promene u smislu recipročne depresije ST segmenta i elevacije PR segmenta u odnosu na ostale odvode opisane su u u akutnom perikarditisu (8, 9), dok je morfologija P talasa opisana kao značajna u razlikovanju atrijalnih tahikardija (10, 11). Pažljivija interpretacija aVR odvoda može da pomogne u dijagnostici akutne okluzije glavnog stabla leve koronarne arterije (LMCA) ili okluzije proksimalnog segmenta prednje silazne arterije (RIA), i na taj način utiče na vreme i vrstu terapije, ali i da ukaže na prognozu kod bolesnika sa akutnim infarktom miokarda (12, 13).Odvod aVR je pojačani unipolarni električni odvod sa desne ruke za koji se smatra da gleda u šupljinu srca s desnog ramena. Ovaj odvod ima vektor u frontalnoj ravni od -150º, koji direktno gleda u gornju desnu stranu srca i obezbeđuje specifične informacije, koje se odnose na izlazni trakt desne komore i bazalni deo interventrikularnog septuma ispod aortnog i pulmonalnog zalistka. Kroz šupljinu leve komore aVR odvod gleda u unutrašnju stranu apeksa i lateralnog zida i direktno se električno suprotstavlja standardnim odvodima DI, DII, aVL i prekordijalnim odvodima V4-V6. U praksi, većina kliničara smatra da aVR odvod daje recipročne informacije iz leve lateralne strane, koja je već pokrivena odvodima aVL, V4-V6. To je razlog za zanemarivanje aVR odvoda (14).Bazalni deo interventrikularnog septuma ishranjuje se najčešće iz septalnih grana proksimalnog dela RIA, a u slučaju njene okluzije, taj deo interventrikularnog septuma ishranjuje se iz heterokolateralne cirkulacije zadnje interventrikularne grane desne koronarne arterije. Transmuralni infarkt miokarda ove regije obično uzrokuje ST elevaciju u aVR odvodu (15, 16).
DIJAGNOSTIČKI I PROGNOSTIČKI ZNAČAJ -REZULTATI ISTRAŽIVANJA
AbstractWe have described a rare case of Takotsubo cardiomyopathy in pregnancy, which is presented with cardiac arrest (ventricular fibrillation) at onset. In this case, the transient left ventricular ballooning in absence of coronary artery disease, produced a severe impairment of cardiac function with typical echocardiographic and electrocardiographic findings. There were complications in the form of ventricular fibrillation, with recurrence due to possible Takotsubo cardiomyopathy and new malignant heart rhythm disorder that increases the mortality rate compared with the first attack of Takotsubo cardiomyopathy. Due to presented symptoms the patient has opted for the implantation of cardioverter defibrillator.
Apstrakt Uvod / Cilj. Procena stanja volemije pacijenata na hroničnom programu hemodijalize (HD) je teška uprkos postojećim razvijenim tehnikama. Cilj ove studije je bio da pokaže adekvatnost i efikastnost ultrazvuka pluća (UZP) i B linijskog skora (BLS) u proceni stanja volemije kod pacijenata na HD u poređenju sa drugim tehnikama: dijametrom donje šuplje vene (DŠVD) i B tipom natriuretskog peptida (BNP). Metode.UZP, ehokardiografija sa ultrasonografijom donje šuplje vene u inspirijumu (DŠVDi) i ekspirijumu (DŠVDe) i kolekcija krvi za određivanje BNP-a su izvršeni pre i posle HD kod 83 pacijenta. Rezultati. Registrovana je signifikantna redukcija BLS, DŠVDii DŠVDe, BNP i nekoliko ehokardiografskih (EHO) parametara (dimenzije leve pretkomore, komore u sistoli i dijastoli i zapremina leve pretkomore) (p < 0.001). Postojala je signifikantna korelacija između BLS i BNP pre i posle HD (p=0.01), između BLS i EHO parametara(p=0.01), i slabija, signifikantna korelacija između BLS i DŠVDi i DŠVDe pre HD (p=0.01). Zaključak. Sve tehnike su uspešno procenile hipervolemiju pre i posle HD. BNP je korelirao sa UZ pre i posle HD, a DŠVDi i DŠVDe korelirari su sa UZP većinom pre HD. UZP je jeftin, jednostavan, može se izvoditi pored postelje i pouzdano koristi za procenu stanja volemije na HD.
Clinical manifestations are different and in most patients asymptomatic. The diagnosis is established by anamnesis, physical examination, M-mode and 2-dimen-sional transthoracic and transesophageal echocardiography, left ventriculography and direct histopathologic investigation of mitral apparatus. Although MVP is a benign condition, there are certain complications such as infective endocarditis, severe mitral regurgitation, heart failure, cerebral and coronary embolism events, arrhythmias and sudden death. Complications mostly occur in patients with heart murmurs and mitral insufficiency in contrast to patients with cusps.
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