Skip to main content

Posts

Showing posts with the label Myocardial infarction

What is the role of troponins in the diagnosis of myocardial infarction ?

What is the role of troponins in the diagnosis of myocardial infarction ? 

Raised concentrations of the myocardial regulatory protein troponin I are highly specific for myocardial injury. Estimation of troponin I concentration may be par-ticularly useful in patients with acute or chronic skeletal muscle disease or those with renal failure in whom the CK-MB (MB isoenzyme of creatine kinase) level may be raised in the absence of myocardial infarction. The measurement of troponin 1 is a sensitive and specific method (more specific than CK-MB) in the setting of perioperative myocardial infarction. Troponin T is also useful because it has a large diagnostic window, as it is increased from 12 hours to 10 days after myocardial infarction.

Why is the Asian population in Britain susceptible to premature myocardial infarction ?

Why is the Asian population in Britain susceptible to premature myocardial infarction ? 

Premature ischaemic heart disease in migrants from the Indian subcontinent is associated with insulin resistance. The site of this defective insulin action has been localized to the skeletal muscle by means of positron emission tomography (Baliga RR et al. Positron emission tomography localizes insulin resistance to skeletal muscle in premature coronary heart disease. Circulation1995; 92: 1-16).

Is intravenous nitrate therapy routinely administered in acute myocardial infarction ?

Is intravenous nitrate therapy routinely administered in acute myocardial infarction ? 

Routine administration of nitrates is not recommended since the ISIS-4 and GISSI-3 trials (in which >70 000 patients were randomized to nitrates or placebo) showed no improvement in outcome. However, nitroglycerine is the agent of choice for recurrent ischaemic pain and is useful in lowering blood pressure or relieving pulmonary congestion.

What is the role of angiotensin converting enzyme inhibitors (ACE) inhibitors following myocardial infarction ?

What is the role of angiotensin converting enzyme inhibitors (ACE) inhibitors following myocardial infarction ?

Several large trials (SAVE, AIRE, SMILE, TRACE, GISSi-lll and IS1S-IV) have shown both short- and long-term improvement in survival with ACE inhibitor therapy. The benefits are greatest in patients with low ejection fractions, large iufa, ction~ tn ulinical evidence of heart failure.

• The AIRE (Acute Infarction Ramipril Efficacy) and the AIREX (AIRE Extension) trials assessed the long-term (mean follow-up 59 months) efficacy of ramipril compared with placebo in 603 patients with heart failure after myo-cardial infarction. Treatment with ramipril resulted in a large and sustained reduction in mortality (relative risk reduction 36%).

• The SAVE (Survival and Ventricular Enlargement) Trial compared the effect of captopril or placebo in 2231 patients up to 16 days post myocardial infarction with an asymptomatic ejection fraction ?

What are the complications of myocardial infarction ?

What are the complications of myocardial infarction ?

• Extension of infarct and post-infarct ischaemia.

• Rhythm disorders: tachycardia, bradycardia, ventricular ectopics, ventricular fibrillation, atrial fibrillation and tachycardia.

• Heart failure: acute puhnonary oedema.

• Circulatory failure: cardiogenic shock.

• Infarction of papillary muscle: mitral regurgitation and acute puhmmary oedema.

• Rupture of interventricular septum.

• Left ventricular aneurysm.

• Mural thrombus.

• Thromboembolism: cerebral or peripheral.

• Venous thrombosis.

• Pericarditis.

• Dressler's syndrome, characterized by persistent pyrexia, pericarditis, pleurisy. It was first described in 1956 when Dressier recognized that chest pain following myocardial infarction is not caused by coronary artery insufficiency.

Postimet e fundit






Related Posts Plugin for WordPress, Blogger...

Labels

Show more