Electrocardiographic changes in Emphysema

Chronic obstructive lung disease (COPD), predominantly emphysema, causes several thoracic anatomical and hemodynamic changes which may cause changes in various electrocardiographic parameters. A 12-lead electrocardiogram (ECG), which is often a part of routine evaluation in most clinical settings, may serve as a useful screening modality for diagnosis of COPD or emphysema. Our current article aims to provide a comprehensive review of the electrocardiographic changes encountered in COPD/emphysema utilizing published PubMed and Medline literature database. Several important ECG changes are present in COPD/emphysema and may serve as a good diagnostic tool. Verticalization of P-vector, changes in QRS duration, pattern recognition of precordial R-wave progression and axial shifts can be considered some of the most valuable markers among other changes. In conclusion, 12-lead surface electrocardiogram can serve as a valuable tool for the diagnosis of COPD and/or emphysema. An appropriate knowledge of these ECG changes can not only help in the diagnosis but can also immensely help in an appropriate clinical management of these patients.

Dobutamine stress echocardiogram-related in-stent thrombosis with acute myocardial infarction

Dobutamine stress echocardiogram (DSE) is considered a safe and reliable method for screening for underlying myocardial ischaemia. We report a case of a 60-year-old man who developed inferior ST-segment elevation myocardial infarction within 30 minutes of a normal DSE. The patient was found to have a 99% in-stent restenosis in the mid-right coronary artery with significant thrombosis for which successful percutaneous coronary intervention (PCI) was performed. Acute coronary syndrome after a normal DSE has been rarely reported in the literature. The reported cases were found to have obstructive or non-obstructive coronary plaques with overlying thrombus, which suggests plaque destabilisation and rupture as the possible underlying mechanism behind coronary occlusion.

Promotional effect of different phorbol esters on morphological transformation of hamster embryo cells

Hamster embryo cells were sequentially exposed to benzo[a]pyrene (BaP) (3 days) and different phorbol esters (4 days). Compounds which have been shown to act as tumor promoters in mouse skin carcinogenesis, showed a promotion-like effect on the formation of morphologically transformed colonies, while non-promoting analogs did not enhance the transformation frequency. In experiments where the exposure sequence was reversed, i.e. 12-O-tetradecanoyl phorbol-13-acetate (TPA) in the first exposure period and BaP in the second period, no significant enhancement of the transformation frequency was observed. The exposure to a low concentration of BaP in the second exposure period following a higher concentration in the first period, resulted in a strong enhancement of the transformation frequency suggesting that BaP also acts as a promoter.