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9 results

  • Unexpected ischemia during transcatheter patent arterial duct closure

  • Part of
  • Ondrej Materna, Vojtech Suchanek, Oleg Reich
  • Journal:
    Cardiology in the Young / Volume 29 / Issue 11 / November 2019
    Published online by Cambridge University Press:
    23 September 2019, pp. 1410-1411

  • A child undergoing routine transcatheter patent arterial duct closure developed severe transient ischemic changes in the electrocardiogram (Pardee waves) while the aortic retention skirt of the Amplatzer™ Duct Occluder was pulled against the duct orifice. The occluder was then released, and the delivery system was pulled back to inferior caval vein which led to electrocardiogram normalisation. Aortic root angiography showed a single coronary artery originating from the right sinus of Valsalva with the left coronary stem wedged behind the posterior aspect of the right ventricular outflow tract. We believe that the left coronary artery was compressed while applying tension on the occluder delivery system.

  • 23 - Recentdevelopments in Doppler imaging

  • from Section 2 - Practical issues in transesophageal echocardiography
  • Edited by Robert Feneck, John Kneeshaw, Marco Ranucci
  • Book:
    Core Topics in Transesophageal Echocardiography
    Published online:
    10 May 2010
    Print publication:
    15 April 2010, pp 368-396

  • Summary

    This chapter focuses on isochemic heart disease (IHD) and an intervention-related analysis, combining all the utilities of transesophageal echocardiography (TEE) in a systematic approach towards the patient undergoing coronary artery bypass grafting (CABG) surgery. Patent foramen ovale (PFO) is the most frequently reported new diagnosis. It is a common observation in about 25% of postmortem studies, and TEE is able to detect it with about the same frequency in the clinical setting. TEE is a highly accurate method for identifying atrial thrombus. In most patients scheduled to undergo elective CABG surgery, the presence of mitral valve (MV) disease is well documented. The hallmark of myocardial ischemia is regional heterogeneity in the extent and time course of systolic wall motion. Intraoperative TEE is required for mitral valve repair during left ventricular (LV) restoration surgery, but caution should be exercised in grading the severity of mitral valve regurgitation.

  • 34 - CT Angiography of the Chest

  • from PART III - COMPUTED TOMOGRAPHY
  • Edited by J. Christian Fox, University of California, Irvine
  • Book:
    Clinical Emergency Radiology
    Published online:
    07 December 2009
    Print publication:
    29 September 2008, pp 482-488

  • Summary

    The three most common life-threatening conditions facing patients with chest pain in the ED are myocardial ischemia, pulmonary embolism, and aortic dissection. Coronary heart disease is the leading cause of death in the United States, responsible for about 817,000 deaths each year. Multidetector Computed Tomography (MDCT) coronary angiography has emerged as a highly sensitive tool to diagnose both obstructive and non-obstructive coronary artery disease. The sensitivity and specificity of CT for the detection of pulmonary embolism exceeds 90%, and a negative spiral CT is associated with a good prognosis when anticoagulation is withheld. The mortality of untreated aortic dissection involving the ascending aorta (Stanford type A dissection) can approach 1% to 2% per hour after symptom onset. During CT pulmonary angiography, the major limitation to imaging is proper timing of the contrast bolus and scan acquisition to maximize visualization of the central and peripheral pulmonary arteries.

  • Potential value for new diagnostic markers in the early recognition of acute coronary syndromes

  • Giuseppe Lippi, Martina Montagnana, Gian Luca Salvagno, Gian Cesare Guidi
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 8 / Issue 1 / January 2006
    Published online by Cambridge University Press:
    21 May 2015, pp. 27-31
    Print publication:
    January 2006
    • Article
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  • The diagnostic approach to acute coronary syndromes (ACS) remains one of the most difficult and controversial challenges facing emergency physicians. In recent years, cardiac troponins have emerged as the biochemical “gold standard” for diagnosis of patients with acute chest pain, enhancing our ability to recognize ACS. Early diagnosis and treatment of myocardial ischemia improve patient outcomes, but conventional markers are often nondiagnostic at the time of arrival at the emergency department. Promising new biomarkers, which appear earlier after the onset of ischemia, are being studied and integrated into clinical practice. Some are markers of myocyte necrosis, but others, including ischemia-modified albumin and natriuretic peptides, detect myocardial ischemia and myocardial dysfunction. The aim of the present article is to review the diagnostic approach to ACS, focusing on recent literature describing novel biochemical markers. If ongoing and future studies confirm their role in probability-based models risk assessment, a new era in the diagnostic approach to ACS may be dawning.

  • The Dynamic Nature of ST-Segment and T-Wave Changes During Acute MI

  • Richard A. Harvey, Frederick P. Fuller
  • Journal:
    Prehospital and Disaster Medicine / Volume 12 / Issue 4 / December 1997
    Published online by Cambridge University Press:
    28 June 2012, pp. 80-84
    Print publication:
    December 1997

  • Obtaining aprehospital 12-lead electrocardiogram (ECG) diagnostic of acute myocardial injury has been demonstrated to hasten the administration of thrombolytic agents in the emergency department. This case demonstrates that aprehospital electrocardiogram diagnostic of acute anterior wall infarction can become non-diagnostic following routine administration of oxygen, nitroglycerin, and morphine by paramedics. Although this phenomenon has been observed in the in-hospital setting, it has not been reported in patients with a prehospital ECG.

  • Paramedic Interpretation of Prehospital Lead-II ST-Segments

  • Robert Hill, Michael Heller, Alexander Rosenau, Scott Melanson, David Pronchik, John Patterson, H. Gulick
  • Journal:
    Prehospital and Disaster Medicine / Volume 12 / Issue 2 / June 1997
    Published online by Cambridge University Press:
    28 June 2012, pp. 70-73
    Print publication:
    June 1997
  • Objective:

    To determine the reliability of ST-segment interpretation by paramedics from lead-II rhythm strips obtained in the prehospital setting.

    Design:

    Prospective, blinded study of 127 patients transported by an urban/rural emergency medical services system with complaints consistent with ischemic heart disease.

    Methods:

    Emergency department physicians asked emergency medical technician-paramedics (EMT-P) via radio to evaluate ST-segments for elevation or depression and grade it as “mild,” “moderate,” or “severe.” Then, this rhythm strip was interpreted blindly by emergency physicians who also interpreted the lead-II obtained from a 12-lead electrocardiogram (ECG) obtained in the emergency department (ED). The field interpretation was compared with the subsequent readings and the final in-patient diagnosis using positive predictive value (PPV), negative predictive value (NPV), and the Kappa statistic. Markedly discrepant interpretations were analyzed separately.

    Results:

    Using physician interpretation as the reference standard, paramedic interpretation of the lead-II ST-segments obtained in the prehospital setting was correct (within ±1 gradation) in 113 out of 127 total cases (89%). Of 105 patients for whom final hospital diagnosis was available, the ST-segment on the rhythm strip obtained in the prehospital setting, had a positive predictive value of 74% and a negative predictive value of 85% for myocardial ischemia or myocardial infarction (MI) (p <0.001, Kappa = 0.59). Discordant interpretations between the paramedics and emergency physicians often were related to a basic misunderstanding of rhythm strip morphology.

    Conclusion:

    Field interpretation of ST-segments by paramedics is fairly accurate as judged both by emergency physicians and correlation with final patient outcome, but its clinical utility is unproved. A small but clinically significant number of outliers, consisting of markedly discrepant false positives, reflects paramedic uncertainty in identifying the deviations of the ST-segment.