International journal of cardiology
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Comparative Study
The impact of the 2007 ESC-ACC-AHA-WHF Universal definition on the incidence and classification of acute myocardial infarction: a retrospective cohort study.
To investigate the impact on the apparent incidence and classification of acute myocardial infarction (AMI) after employing the ESC-ACC-AHA-WHF 2007 Universal definition of myocardial infarction (the 2007 definition). ⋯ Employing the 2007 revision of the Universal definition of AMI did not substantially alter the apparent incidence of acute AMI substantially in our population. The level of misclassification of acute coronary syndromes after introduction of the 2007 definition may depend on the clinical acceptance of AMI subgrouping.
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Letter Case Reports
Coronary emergency and diabetes as manifestations of pheochromocytoma.
We report on a woman with refractory hypertension and diabetes suffering from hypertensive crises, one with chest pain suggesting acute coronary syndrome, and another with an abdominal pain, after which a para-aortic abdominal mass was diagnosed, by ultrasound, as pheochromocytoma, later confirmed by an adrenal scintigraphic study with (131)I-labeled metaiodobenzylguanidine. The patient was successfully treated with complete reversal of hypertension and diabetes. Our case illustrates the importance of maintaining a high index of suspicion in patients simultaneously presenting with an acute myocardial event and hypertensive crises.
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Obese patients are at increased risk of acute coronary syndromes (ACS). We evaluated the prevalence of obesity in a large ACS population, as well as the relationship between body mass index (BMI) and the use of cardiac medications and procedures, clinical outcomes, and treatment effects between enoxaparin and unfractionated heparin (UFH). ⋯ Nearly one third of patients in SYNERGY were obese. Despite multiple comorbidities, obese patients had better unadjusted short- and long-term outcomes. After adjustment, higher BMI was not an independent predictor of in-hospital bleeding events or 30-day death/MI, but increased BMI was an independent predictor of 1-year mortality in patients with lower BMI but not in heavier patients. No interaction between the randomized treatment and obesity for efficacy and safety outcomes was observed across the range of BMI in this dataset. Standard dosing of enoxaparin should be used in patients without extreme obesity due to limited outcome data in these patients.
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Letter Case Reports
Left ventricular hypertrabeculation/noncompaction in a patient with peripartum cardiomyopathy.
Left ventricular hypertrabeculation/noncompaction (LVHT) is characterized by prominent apical or mid-ventricular lateral and inferior trabeculations that are separated by deep recesses perfused from the left ventricular cavity. Affected myocardium is often thickened with a distinct two-layer appearance of both spongy or noncompacted elements and "normal" or compacted myocardium. This uncommon condition is considered by the World Health Organization to be an unclassified cardiomyopathy. ⋯ Intraoperative transesophageal echocardiography performed during emergent placement of a left ventricular assist device revealed the typical changes of LVHT in the apex. To our knowledge, this is the first case in which findings consistent with LVHT have been found in a patient with dilated cardiomyopathy in the peripartum period. The patient we present would thus meet existing diagnostic criteria for both LVHT and peripartum cardiomyopathy.