What is the infarct artery????? And have you ever seen a troponin this high?
An elderly woman with h/o stroke and aphasia seemed different to her daughter, and was pointing all over her body as if in pain.They called 911.She had a history of PCI to the circumflex and also of severe mitral regurgitation, status post bioprosthetic valve replacement. Also a h/o LV aneurysm with thrombus, on anticoagulation, as well as a dual chamber pacemaker. On arrival, the BP was 60/30.Here is the initial ECG:There is atrial pacing and Right Bundle Branch Block (RBBB)There is STE in I and aVL, V5, V6, with reciprocal STD in II, III, aVFThere is appropriately discordant ST depression in V1-V3 (appropriate to RBBB) TheRBBB is newand the previous ECG had no ST elevation What is the infarct artery?The cath lab was activated.Here is the bedside echo (POCUS): Short AxisExtremely poor LV function and massive wall motion abnormalityLong AxisExtremely poor LV function and massive wall motion abnormalityAt 20 minutes, just before cath, another ECG was recorded:More (worsening) STEHer initial troponin I returned at 0.341 ng/mL (URL = 0.030 ng/mL) (not per L, not high sensitivity)Lactate was 3.7 mEq/LHer BP with pressors came up to 80, then 100.Angiogramshowed a 99% left main thrombotic occlusion with TIMI-1 flow (this is considered " occlusion " even though there is some flow. It was opened and stented with resulting TIMI-3 (normal) flow.The stent to LCX is patent. OM1 is occluded and OM2 has 60% stenosis. Her RCA is a mediu...
This study compares the effect of Helicobacter (H.) pylori and Lactobacillus (L.) acidophilus on the cytokine profile of PBMCs of 5 men with abdominal aortic aneurysm (AAA) and 5 men with normal/insignificant angiography, CT-Scan and ultrasonography results in the single-culture and in the co-culture with HUVECs. IL-2, IL-4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-17A, IL-17 F, IL-21, IL-22, IFN-γ and TNF-α were measured in culture supernatants using a commercial fluorescent-labeled-bead assay.In general, CagA+ H. pylori-extract induced higher production of IFN-γ, IL-13 and IL-21 by PBMCs. Treatment of ...
We report a case of a young male with no prior genitourinary history who presents to an emergency department with sudden onset gross hematuria, clot retention, and right-sided flank pain. On evaluation, he was found to have a renal artery aneurysm bleeding into his collecting system and underwent renal artery embolization and rapid resolution of his hematuria. Renal vascular pathology should be considered in the differential diagnosis and timely diagnosis of this condition is imperative as surgical interventions have proven to be life-saving. PMID: 32065873 [PubMed - in process]
CONCLUSIONS: BTX-A treatment using either a trigone-sparing or trigone-including injection template resulted in significant, but not location-dependent, improvement in IC/BPS symptom scores at 30 and 90 day points post-procedure with no significant difference in post-treatment complication profiles. PMID: 32065870 [PubMed - in process]
CONCLUSION: Large variability exists in the definitions, methods of reporting, and analysis of PD-associated peritonitis across trials and observational studies. Standardizing definitions for reporting of peritonitis and associated outcomes will better enable assessment of the comparative effect of interventions on peritonitis. This will facilitate continuous quality improvement measures through reliable benchmarking of this patient-important outcome across centers and countries. PMID: 32063197 [PubMed - as supplied by publisher]
CONCLUSIONS: Insertion-related complications leading to significant adverse events following laparoscopic placement of PD catheters are common. Many complications occur before the start of PD. Insertion-related complications are an important area of focus for future research and quality improvement efforts. PMID: 32063191 [PubMed - as supplied by publisher]
ConclusionsThe present study demonstrates that IPEE treatments can enhance cerebral ischemic tolerance by regulating the toll-like receptor 4 (TLR4) signaling pathway. The mechanisms of this response come in two primary forms: inhibiting MyD88 dependent pro-inflammatory pathways and activating TRIF dependent anti-inflammatory pathways.Graphical abstract
Excessive masculinity is linked to a significantly increased risk for death by suicide in men, a finding that underscores the central role of gender in suicide death, new research shows.Medscape Medical News
ConclusionThe final results of this study showed that there was no significant difference between the four study groups and arrhythmia status. Therefore, f-QRS was not introduced as an independent predictor of arrhythmia in patients with acute MI.
ConclusionsCardiac rehabilitation programs containing exercise may provide broader cardiovascular benefits compared to those without exercise.
Publication date: Available online 19 February 2020Source: Canadian Journal of CardiologyAuthor(s): Hsin-Fu Lee, Yi-Hsin Chan, Pei-Ru Li, Jia-Rou Liu, Tze-Fan Chao, Lung-Sheng Wu, Shang-Hung Chang, Yung-Hsin Yeh, Chi-Tai Kuo, Lai-Chu See, Gregory Y.H. LipAbstractBackgroundEvidences of clinical outcomes for oral anticoagulants and antiplatelet treatment (APT) in atrial fibrillation (AF) patients with critical limb ischemia (CLI) are very limited.MethodsIn this nationwide retrospective cohort study collected from Taiwan National Health Insurance Research Database, 1,223 AF patients with CLI taking DOACs, warfarin, or APT wer...