About 2 percent of developed countries population use vitamin K antagonists (VKA), such as warfarin. These anticoagulation drugs are commonly prescribed for the purpose of thromboembolism prevention, in cases of atrial fibrillation, mechanical heart valves, deep vein thrombosis, pulmonary embolism and etc. The frequency of VKA prescription is massively increasing in the whole world. The main reason for it is the ageing of the population. As the usage of anticoagulants is increasing, doctors more often get to encounter patients with gastrointestinal bleeding taking anticoagulating drugs. The treatment of these patients is difficult because there are several important factors that have to be considered while choosing the tactic of treatment, such as the intensity of bleeding, coagulation, thrombotic risk and endoscopic findings. Even if practical guidelines partially indicate the main principles of actions for similar cases, the treatment of bleeding patients taking anticoagulants remains seriously challenging. This article contains clinical case report and the discussion of the treatment that has been chosen in this case, based on practical guidelines provided by American Society for Gastrointestinal Endoscopy (ASGE), European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Cardiology (ESC). This topic is also addressed in guidelines from the American College of Gastroenterology, the American College of Chest Physicians, the American College of Cardiology, which give similar recommendations.
Background: A recent scientific statement from the American Heart Association included ST-segment elevation in the absence of chest pain in the definition of early repolarization (ER). ST-elevation at J-point termination (Jt)-point was not taken into account in previous heritability studies. The relevance of ST-elevation at Jt point (especially in inferior leads) is not evident enough. Our aim was to assess the heritability of ER with ST-elevation in inferior leads among offspring of such patients and patients' follow-up results. Materials and Methods: A prospective study of 16 consecutive patients with inferior ST-elevation at Jt ≥0.1 mV, who have arrived to outpatient department most often due to chest pain not associated with coronary stenosis according to multislice computed tomography angiography, started in 2013. Repeated cardiologist evaluation included their 12 children in 2017. Comparisons were made with 16 age- and gender-matched control patients' rest 12-lead electrocardiograms (ECGs) from the outpatient department of year 2018. Impact of ST-elevation's localization and sex on heritability were assessed by odds ratio (OR) with 95% confidence interval (CI). Results: There were no significant changes of patients' (all men) health and ECGs during follow-up. Eight (66.7%) of their children were ECG-positive versus 1 (6.2%) control patient,P = 0.001. All siblings (from the same father) of 5 (62.5%) ECG-positive children were ECG-positive. Two of the 5 (male and female) underwent detailed evaluation, including cardiac magnetic resonance, without abnormalities. In cases of only inferior father's ST-elevation, OR, 3.00; 95%CI, 0.24-37.7, and for male children, OR, 7.00; 95%CI, 0.400-23, for presenting with this pattern. Conclusions: Constant inferior ST-elevation, even in cases of chest pain, maybe ER, heritable without structural abnormalities. Heritability may be greater for male offspring and in cases of only inferior father's ST-elevation. Longer studies are necessary to confirm that it is benign. We suggest the term “a constant ST-segment elevation (at Jt)” instead of “ST-segment elevation in the absence of chest pain,” with adding that it is possible latent, depending on the heart rate.
Įvadas. COVID-19 yra greitai plintanti kvėpavimo sistemos infekcinė liga, kurią sukelia virusas, vadinamas ūminiu kvėpavimo sindromu koronavirusu-2 (SARS-CoV-2). Ši infekcija naudoja angiotenziną konvertuojamųjų fermentų 2 (AKF 2) receptorius ir paprastai plinta per kvėpavimo takus. SARS-CoV-2 pažeidžia ir kitus organus, kurie ekspresuoja AKF 2 receptorius. Patekę į organizmą virusai veikia imuninį atsaką. Padidėjęs imuninis atsakas dažnai sukelia citokinų antplūdžius, kurie gali sąlygoti mirtį nuo COVID-19. Sergantiesiems šia liga pastebėti pokyčiai ir elektrokardiogramose. Dažniausi iš jų yra: sinusinė tachikardija, PV, PP, skilvelių aritmijos, rečiau: bradikardijos, ašies nuokrypis, ST segmento ir T bangos pokyčiai. Tikslas. Apžvelgti LSMU Kauno ligoninėje hospitalizuotų pacientų, sirgusių COVID-19 infekcija, demografinius, klinikinius duomenis bei EKG pokyčius hospitalizavimo metu. Metodai. tyrimui naudotos 30 pacientų, hospitalizuotų LSMU Kauno ligoninėje dėl COVID-19, atliktos EKG. Rezultatai analizuoti naudojant „IBM SPSS statistics 20“ duomenų analizės paketą, pritaikytą „Windows“ operacinei sistemai ir analizuoti EKG pokyčiai sergantiesiems COVID-19. Rezultatai. 33,33 proc. pacientų – prailgėjęs QRS, 30,00 proc. pacientų stebėta levograma, 10,00 proc. – dekstrograma, 23,33 proc. pacientų EKG stebima ST segmento elevacija, 16,66 proc. – T inversija, 10,00 proc. – ST segmento depresija, 10,00 proc. PV, 13,33 proc. pacientų kairės Hiso pluošto kojytės blokada, o mažiausiai pacientų sudarė turintys dešinės Hiso pluošto kojytės blokadą – 3,33 proc. Išvados. Atliktų tyrimų analizių ir LSMU Kauno ligoninės tyrimo išvados: 1. Sergantiesiems COVID-19 liga, hospitalizavimo metu atliktose elektrokardiogramose dažniausiai stebimi šie pokyčiai: prailgėjęs QRS, ašies nuokrypis į kairę, ST segmento elevacija, T dantelio inversija, ST segmento depresija, kairės Hiso pluošto kojytės blokada, PV, dekstrograma ir mažiausiai pacientų sudarė turintys dešinės Hiso pluošto kojytės blokadą. 2. Norint įvertinti ilgalaikius širdies ir kraujagyslių sistemos pokyčius po persirgto COVID-19 reikalingi tolesni pacientų tyrimai.
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