Patients discharged from emergency care after acute myocardial infarction was ruled out: early follow-up in relation to gender

The aim of this research was to describe men and women who were discharged from the emergency department after having an initial suspicion of acute myocardial infarction ruled out in terms of patient characteristics, symptom reevaluation, electrocardiogram and exercise stress test. Consecutive patients below the age of 65 years who came to the emergency department of Sahlgrenska Hospital with acute chest pain or other symptoms raising suspicion of acute myocardial infarction for whom the suspicion was ruled out either directly in the emergency department or less than 1 day after hospital admission were included in the study. Four hundred and eighty-four patients participated, of whom 295 (61%) were men. Men had a higher prevalence of ischaemic heart disease. The cause of pain was judged similarly at reevaluation compared with in the emergency department in 53% of the cases. Only in 4.6% of the cases were the symptoms judged to be caused by myocardial ischaemia on both occasions. At the initial visit 36.0% of the patients were judged to have uncertain cause of the symptoms. This proportion was lowered to 26.4% at reevaluation. The exercise electrocardiogram at reevaluation revealed clinical and electrocardiographic signs indicating definite myocardial ischaemia in 2.6% of the cases. Early follow-up of patients discharged from the emergency department after acute myocardial infarction was ruled out revealed that a low proportion showed signs of myocardial ischaemia. In about half of the cases the judgement differed from that being made in the emergency department.

MRI-guided SPECT measurements of medial temporal lobe blood flow in Alzheimer's disease

In this study, we assessed the accuracy and reliability of MRI-guided SPECT measurements of medial temporal lobe blood flow in Alzheimer's disease (AD).

METHODS

Interactively aligned three-dimensional MP-RAGE MRI and 99mTc-HMPAO SPECT images were used for MRI-guided measurement of medial temporal lobe CBF in eight control subjects and eight patients with probable AD. Intraoperator reliability was assessed by repeated alignment and measurement by one experienced operator. Accuracy was assessed by examining two subjects with fiducial markers.

RESULTS

The alignment error was less than 1 SPECT pixel size (3.5 mm) and the coefficient of variation in repeated measures of medial temporal-to-cerebellar CBF ratios was 3.2%. The difference in mean medial temporal-to-cerebellar CBF ratios between eight control subjects and eight AD patients was 12%. Also by using three-dimensional seed-grow defined healthy brain reference regions, there were significant differences between control subjects and AD patients in medial temporal blood flow. Furthermore, the volumes of the MRI-defined medial temporal ROIs were smaller in the AD patients. The best separation between AD patients and control subjects was achieved by combining MRI measurements of atrophy and SPECT measurements of CBF.

CONCLUSION

These data show that the accuracy and reliability of MRI-guided SPECT measurements of medial temporal CBF clearly allow the detection of changes in AD. Also, a direct comparison of structural and functional changes is possible by this methodology, which might improve the early diagnosis of AD.

Improvement of ED prediction of cardiac mortality among patients with symptoms suggestive of acute myocardial infarction

A study was undertaken to evaluate the 1-year risk of cardiac death for patients with chest pain/suspected acute myocardial infarction in the emergency department (ED) and express the prognosis in a statistical model. Clinical variables and electrocardiogram were correlated to cardiac death during 1 year. Cox regression model was used to estimate the risk of death as a continuous function of a risk score and the time interval. From these, the prognosis for each patient can be calculated. There were 6,794 visits by 5,303 patients followed for 1 year, during which 604 patients died. The absolute risk of cardiac death can be calculated from the independent predictors for cardiac death: age; sex; histories of diabetes mellitus, hypertension, and congestive heart failure; and symptoms, electrocardiographic pattern, and degree of suspicion of acute myocardial infarction on admission. This model allows estimation of the prognosis for every patient with chest pain/suspected acute myocardial infarction from data easily available in the ED.

Frontal midline theta related to learning in a simulated driving task

The occurrence of frontal midline theta activity (4-7 Hz) was studied in a simulated driving task during consecutive phases of goal-directed behaviour. Electrical activity of the forebrain (Fz) was analysed in a simulated traffic situation in which the subject had to find the correct way to drive a car through a set of roads in a computer game. The occurrence of theta activity was analysed during seven consecutive sections of the game. The results showed that the occurrence of theta activity increased during learning--successful behaviour produced more theta than unsuccessful behaviour. In some sections of the game the percentage of theta was larger than in others. It is suggested that the theta activity reflects relaxed concentration after mastering the game.

Termination of paroxysmal supraventricular tachycardia with a nasogastric tube--a case report

The case is described of a 29-year-old man with a history of recurrent attacks of paroxysmal supraventricular tachycardia. The patient presented to the emergency ward with complaints of palpitations which had not been relieved by vagal stimulation maneuvers and propranolol. When intravenous metoprolol failed to convert the rhythm, a nasogastric tube was passed which immediately converted the tachycardia to normal sinus rhythm. The literature is reviewed and problems and complications of various techniques are discussed.