1
|
Tsega W, Awoke W, Sendekie AK, Dagnew EM, Bayih H. Electrocardiogram and echocardiography findings and the outcomes of patients with myocardial infarction: Retrospective study in tertiary care hospitals in Northwest Ethiopia. PLoS One 2023; 18:e0288698. [PMID: 37540698 PMCID: PMC10403055 DOI: 10.1371/journal.pone.0288698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/03/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Myocardial infarction (MI) is diagnosed when there is a rise in cardiac biomarkers along with supportive evidence in the form of typical symptoms, suggestive electrocardiographic (ECG) changes, or imaging evidence of a new loss of viable myocardium or a new regional wall motion abnormality. The data regarding the use of ECG and echocardiography (Echo) findings and their impact on mortality are still lacking in Ethiopia. This study assessed the utilization of ECG and Echo findings and outcomes of patients with MI in tertiary care hospitals in Northwest Ethiopia. METHODS A retrospective chart review was conducted on patients with MI who were admitted to the adult intensive care units (ICUs) of two selected hospitals between January 2018 and July 30, 2021. Data was entered and analyzed using the SPSS 25 software. Logistic regression analysis was used to assess the association between in-hospital mortality and other variables. A P-value < 0.05 was considered significant. RESULTS Among the 203 participants, 67.5% were male, and the mean age of the participants was 59 (13.8). Around two-thirds (66.5%) of patients had STEMI and a regional all-motion abnormality. More than half (54.1%) of the cases were in the anteroapical region. For MI, there was a 23.2% inconsistency between ECG and Echo findings. The rate of in-hospital mortality for patients with MI was 23%. Pulmonary hypertension [AOR = 7.8, 95% CI: 1.72-34.93], inferobasal regional wall motion abnormality [AOR = 7.9, 95% CI: 1.340-46.093], Killip's classes III and IV [AOR = 2.7, 95% CI: 1.103-6.314], infection [AOR = 3.2, 95% CI: 1.108-10.65], and ischemic stroke [AOR = 1.9, 95% CI: 1.091-5.222] were significantly associated with in-hospital mortality compared with their counterparts. CONCLUSIONS The mortality of patients with MI in this study was higher than in other reports. Killip's class, pulmonary hypertension, infection, ischemic stroke, and inferobasal regional wall motion abnormalities were significantly associated with the in-hospital mortality of the patients with MI. There was a higher degree of inconsistency between ECG and Echo findings. The treatment of patients with MI should be tailored to their specific risk factors and causes.
Collapse
Affiliation(s)
- Wondale Tsega
- Department of Internal Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Worku Awoke
- Department of Epidemiology, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ashenafi Kibret Sendekie
- Department of Clinical pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ephrem Mebratu Dagnew
- Depatment of Pharmacy, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Habtamu Bayih
- Department of Internal Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
2
|
Naji A, Chappidi M, Ahmed A, Monga A, Sanders J. Perioperative Point-of-Care Ultrasound Use by Anesthesiologists. Cureus 2021; 13:e15217. [PMID: 34178536 PMCID: PMC8221658 DOI: 10.7759/cureus.15217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Point-of-Care ultrasound (POCUS) is the bedside utilization of ultrasound, in real-time, to aid in the diagnosis and treatment of patients. Image acquisition from POCUS utilization by anesthesiologists involves the assessment of multiple organs in different perioperative situations. POCUS can be utilized to enhance clinical decision-making in a variety of perioperative situations due to its ability to assess endotracheal tube placement, cardiac function, pulmonary function, aspiration risk, hemodynamics, vascular access, and nerve visualization for regional procedures. The mounting clinical evidence for the value of POCUS in perioperative settings, its growing affordability, and its low associated risks are responsible for the nationwide movement across many anesthesiology residency programs to increase the focus on perioperative ultrasound training. The purpose of this review is to present to current anesthesiologists and anesthesiology trainees, a broad discussion regarding the diverse utility and importance of POCUS in perioperative settings.
Collapse
Affiliation(s)
- Abdullah Naji
- Anesthesiology and Perioperative Medicine, Oregon Health Science University Hospital, Portland, USA
| | - Monica Chappidi
- Anesthesiology, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, USA
| | | | - Aaron Monga
- Anesthesiology, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, USA
| | | |
Collapse
|
3
|
|
4
|
Ismail S, Wong C, Rajan P, Vidovich M. ST-elevation acute myocardial infarction in pregnancy: 2016 update. Clin Cardiol 2017; 40:399-406. [PMID: 28191905 PMCID: PMC6490392 DOI: 10.1002/clc.22655] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/09/2016] [Indexed: 12/26/2022] Open
Abstract
Acute myocardial infarction (AMI) during pregnancy or the early postpartum period is rare, but can be devastating for both the mother and the fetus. There have been major advances in the diagnosis and treatment of acute coronary syndromes in the general population, but there is little consensus on the approach to diagnosis and treatment of pregnant women. This article reviews the literature relating to the pathophysiology of AMI in pregnant patients and the challenges in diagnosis and treatment of ST-elevation myocardial infarction (STEMI) in this unique population. From a cardiologist, maternal-fetal medicine specialist, and anesthesiologist's perspective, we provide recommendations for the diagnosis and management of STEMI occurring during pregnancy.
Collapse
Affiliation(s)
- Sahar Ismail
- Division of CardiologyEmory UniversityAtlantaGeorgia
| | - Cynthia Wong
- Department of AnesthesiaUniversity of Iowa Carver College of MedicineIowa CityIowa
| | - Priya Rajan
- Department of Obstetrics and Gynecology, Maternal–Fetal MedicineNorthwestern University Feinberg School of MedicineChicagoIllinois
| | | |
Collapse
|
5
|
Benyounes N, Lang S, Gout O, Ancédy Y, Etienney A, Cohen A. Could quantitative longitudinal peak systolic strain help in the detection of left ventricular wall motion abnormalities in our daily echocardiographic practice? Arch Cardiovasc Dis 2016; 109:533-541. [DOI: 10.1016/j.acvd.2016.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 10/21/2022]
|
6
|
2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Am Coll Radiol 2016; 13:e1-e29. [PMID: 26810814 DOI: 10.1016/j.jacr.2015.07.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 01/02/2023]
|
7
|
Rybicki FJ, Udelson JE, Peacock WF, Goldhaber SZ, Isselbacher EM, Kazerooni E, Kontos MC, Litt H, Woodard PK. 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Am Coll Cardiol 2016; 67:853-79. [PMID: 26809772 DOI: 10.1016/j.jacc.2015.09.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
8
|
Lee NJ, Litt H. Cardiac CT angiography for evaluation of acute chest pain. Int J Cardiovasc Imaging 2015; 32:101-12. [PMID: 26342713 DOI: 10.1007/s10554-015-0763-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/31/2015] [Indexed: 01/23/2023]
Abstract
Chest pain is the second most common emergency department (ED) presentation in the United States. Cardiac computed tomography angiography (CCTA) now plays an important role in the evaluation of patients with suspected acute coronary syndrome in the ED setting. In this article, we review the available techniques focused on the use of CCTA to evaluate patients fosr coronary atherosclerosis for timely triage of acute chest pain.
Collapse
Affiliation(s)
- Nam Ju Lee
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Harold Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
9
|
Davis MB, Shafton A, Desai A, Childers D, Bach DS. Reliable exclusion of acute coronary syndrome among hospitalized patients with elevated troponin. Clin Cardiol 2015; 37:395-401. [PMID: 25180409 DOI: 10.1002/clc.22263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Elevated cardiac troponin I (cTnI) occurs in acute coronary syndrome (ACS) as well as various scenarios not associated with ACS. HYPOTHESIS Simple clinical criteria can reliably exclude ACS among hospitalized patients with elevated cTnI. METHODS Records for patients hospitalized from January to April 2011 with elevated cTnI (>0.29 ng/dL) and an available echocardiogram were retrospectively reviewed. Patients with ST-segment elevation myocardial infarction were excluded. Based on available clinical data, patients were classified as having ACS or elevation of cTnI unrelated to ACS (non-ACS). Median follow-up was 365 days. RESULTS Of 265 records meeting inclusion criteria, 82 (31%) had ACS and 183 (69%) had non-ACS. In multivariable analysis, odds ratios for non-ACS were 7.6 (95% confidence interval [CI]: 3.8-15.3) for peak cTnI <2 ng/dL, 6.3 (95% CI: 3.1-13.0) for absent wall-motion abnormality, and 4.4 (95% CI: 2.2-8.6) for no prior coronary artery disease history. The area under the receiver operating curve for amodel using these 3 variables was 0.86, with a 98% negative predictive value for excluding ACS. Patients who met these 3 criteria had no ACS-related deaths over 1-year follow-up. CONCLUSIONS Hospitalized patients with peak Tn level<2 ng/dL, no prior history of coronary artery disease, and no new echocardiographic wall-motion abnormality appear to have a very low likelihood of ACS. Prospective validation of these results is needed to determine whether additional diagnostic testing could be safely avoided in hospitalized patients meeting these simple clinical criteria.
Collapse
Affiliation(s)
- Melinda B Davis
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | | | | | | | | |
Collapse
|
10
|
Abstract
OBJECTIVE Echocardiography, radionuclide myocardial perfusion imaging (MPI), and coronary CT angiography (CTA) are the three main imaging techniques used in the emergency department for the diagnosis of acute coronary syndrome (ACS). The purpose of this article is to quantitatively examine existing evidence about the diagnostic performance of these imaging tests in this setting. CONCLUSION Our systematic search of the medical literature showed no significant difference between the modalities for the detection of ACS in the emergency department. There was a slight, positive trend favoring coronary CTA. Given the absence of large differences in diagnostic performance, practical aspects such as local practice, expertise, medical facilities, and individual patient characteristics may be more important.
Collapse
|
11
|
Michalski B, Kasprzak JD, Szymczyk E, Lipiec P. Diagnostic utility and clinical usefulness of the pocket echocardiographic device. Echocardiography 2011; 29:1-6. [PMID: 22044766 DOI: 10.1111/j.1540-8175.2011.01553.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The pocket echocardiograph (PE) with color Doppler imaging belongs to a new class of diagnostic tools, the feasibility and accuracy of which is not well established. The aim of this study was to assess the feasibility and diagnostic value of transthoracic echocardiography (TTE) performed with the use of PE by a cardiology resident (2nd year of training) and by an experienced cardiologist. METHODS The study population comprised 220 consecutive patients (142 men, mean age 63 ± 8 years), 110 of whom were admitted to our intensive cardiac care unit (ICU) and 110 patients referred for TTE from the outpatient clinic. All patients had PE TTE performed by a resident (60 ICU patients, 60 outpatients) or a cardiologist (50 ICU patients, 50 outpatients). Within 24 h of PE TTE, all subjects had a standard TTE (sTTE) performed by an experienced echocardiographer. RESULTS 96% of patients had echocardiographic measurements completed by both PE TTE and sTTE. The dimensions measured with PE TTE by the resident and the cardiologist showed good to excellent correlation with sTTE (r = 0.64-0.96, P < 0.001). The agreement in detection of various pathologies between PE TTE performed by the resident and sTTE examinations was moderate to very good, whereas it was good to excellent if PE TTE was performed by the experienced cardiologist. CONCLUSION The diagnostic accuracy of the PE in basic assessment of cardiac morphology and function as compared to standard echocardiography is moderate to very good for a cardiology resident and good to excellent for an experienced cardiologist. (Echocardiography 2012;29:1-6).
Collapse
|
12
|
Abstract
Perinatal asphyxia commonly results in multi-organ damage, and cardiovascular dysfunction is a frequent association. Myocardial damage, right ventricular dysfunction, abnormal circulatory transition, and impaired autoregulation may all contribute to postnatal neurological damage. Adequate monitoring and appropriate targeted treatment therefore are essential after an asphyxial insult. Standard methods of cardiovascular monitoring in the neonate have limitations. Point of care ultrasound scanning or functional echocardiography offers extra information to assist the clinician in identifying when there is significant cardiovascular impairment, classifying the underlying abnormal physiology and potentially targeting appropriate therapy, thereby optimizing the post-insult cerebral blood flow and oxygen delivery.
Collapse
|
13
|
Brauchli YB, Wais T, Gratwohl A, Heim D, Schipf A, Diebold J, Krähenbühl S. Fatal myocardial infarction during nilotinib treatment in a 60-year-old male patient. Acta Oncol 2010; 49:523-5. [PMID: 20307244 DOI: 10.3109/02841861003691952] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
14
|
Kansal M, Kessler C, Frazin L. Hand-held echocardiogram does not aid in triaging chest pain patients from the emergency department. Echocardiography 2009; 26:625-9. [PMID: 19594811 DOI: 10.1111/j.1540-8175.2008.00873.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Accurate triage of emergency department (ED) patients presenting with chest pain is a primary goal of the ED physician. In addition to standard clinical history and examination, a hand-held echocardiogram (HHE) may aid the emergency physician in making correct decisions. We tested the hypothesis that an HHE performed and interpreted by a cardiology fellow could help risk-stratify patients presenting to the ED with chest pain. METHODS ED physicians evaluated 36 patients presenting with cardiovascular symptoms. Patients were then dispositioned to either an intensive care bed, a monitored bed, an unmonitored bed, or home. Following disposition, an HHE was performed and interpreted by a cardiology fellow to evaluate for cardiac function and pathology. The outcomes evaluated (1) a change in the level of care and (2) additional testing ordered as a result of the HHE. RESULTS The HHE showed wall motion abnormalities in 31% (11 out of 36) of the studies, but the level of care did not change after HHE for any patients who presented with chest pain to the ED. No additional laboratory or imaging tests were ordered for any patients based on the results of the HHE. Eighty-six percent (31 out of 36) of the studies were of adequate quality for interpretation, and 32 out of 36 (89%) interpretations correlated with an attending overread. CONCLUSION Despite the high prevalence of abnormal wall motion in this population, hand-held echocardiography performed in this ED setting did not aid in the risk stratification process of chest pain patients.
Collapse
Affiliation(s)
- Mayank Kansal
- Department of Cardiology, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | | | | |
Collapse
|
15
|
Perk G, Kronzon I. Non-Doppler two dimensional strain imaging for evaluation of coronary artery disease. Echocardiography 2009; 26:299-306. [PMID: 19291015 DOI: 10.1111/j.1540-8175.2008.00863.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Over the recent years, strain echocardiography has emerged as a quantitative technique for the evaluation of global and segmental cardiac function. Strain is a measure of deformation, expressed as a percent change in a segment's length compared to its predeformation length. Strain rate (SR) is the local rate of deformation or strain per unit time. Recently non-Doppler two dimensional strain imaging has been developed. This technique is based on tracking ultrasonic speckles from the two dimensional echocardiographic images. These speckles are followed over a number of successive frames, and myocardial velocity is calculated by measuring frame-to-frame changes. This technique is independent of the Doppler angle of incidence and allows measurement of several vectors of strain within myocardial tissue. Non-Doppler strain is a powerful tool, enabling detection of subtle abnormalities in myocardial function. Current evidence shows that non-Doppler strain imaging may allow identification of the early changes that occur with ischemic insult to the myocardium. It may also provide a tool for identification of scarred, non-viable myocardium, with similar accuracy to that of cardiac MRI. Non-Doppler strain imaging is likely to become a standard tool in the evaluation of patients with ischemic heart disease.
Collapse
Affiliation(s)
- Gila Perk
- Noninvasive Cardiology, The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY 10016, USA.
| | | |
Collapse
|
16
|
|
17
|
Szymankiewicz M, Matuszczak-Wleklak M, Hodgman JE, Gadzinowski J. Usefulness of cardiac troponin T and echocardiography in the diagnosis of hypoxic myocardial injury of full-term neonates. Neonatology 2005; 88:19-23. [PMID: 15731551 DOI: 10.1159/000084067] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Accepted: 11/23/2004] [Indexed: 12/19/2022]
Abstract
BACKGROUND Perinatal asphyxia constitutes a significant problem influencing neonatal mortality and morbidity. OBJECTIVES The aim of the present work was to provide evidence of the usefulness of cardiac troponin T (cTnT) and echocardiographic investigations in the diagnosis of heart damage in full-term infants after intrauterine hypoxia. MATERIAL AND METHODS The subjects were 39 asphyxiated and 44 term infants without fetal anoxia. Quantitative determinations of cTnT were performed between 12 and 24 h of life. Two-dimensional Doppler and color Doppler studies were performed at the bedside. We evaluated fractional shortening (FS), cardiac output (CO), cardiac index (CI), tricuspid (TI) and mitral (MI) insufficiency. RESULTS Asphyxiated infants presented increased cTnT (mean 0.141+/-0.226 vs. 0.087+/-0.111 ng/ml; p<0.01) and TI (38.5 vs. 11.4% of population; p<0.05) compared to healthy infants. CO, CI and FS remained in the same range. CONCLUSIONS We found cTnT to be the most useful among accessible diagnostic tools used in post-hypoxic heart damage in neonates. The data from our relatively small population study suggest a cTnT value of >0.1 ng/ml as a reliable marker of myocardial injury in neonates. Further study should be performed to generate a receiver-operator characteristic curve to discover what the cut-off level should be.
Collapse
Affiliation(s)
- Marta Szymankiewicz
- Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland.
| | | | | | | |
Collapse
|