Kardiol Pol
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We present a case of a 58-year-old man presenting with chest pain irradiating to the back and left arm, history of smoking and untreated hypertension. The anamnesis, symptoms and ECG findings consisting of ST elevation in leads aVR and V1-V2 suggested ST segment elevated myocardial infarction. ⋯ Considering haemodynamic instability, augmentation of chest pain and passing time which was obviously worsening the prognosis patient was submitted to aortography which finally proofed acute aortic dissection. Patient was subsequently transferred to cardiac surgery unit and successfully treated.
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Ischaemic stroke is a common complication of atrial fibrillation (AF). Cardiology societies recommend assessing the risk of ischaemic stroke and using adequate prevention in patients with AF. Currently, oral anticoagulants and antiplatelet drugs are the most commonly used methods of stroke prevention. Left atrial appendage (LAA) is thought to be the main source of thrombi in patients with AF. LAA closure procedures that have been recently introduced into the clinical practice are an alternative method of stroke prevention in patients with contraindications to oral anticoagulants or with a high risk of bleeding. Two systems of percutaneous LAA closure are currently available, the Watchman plug and the Amplatzer Cardiac Plug, but experience with these procedures is still very limited. ⋯ Successful LAA occlusion is feasible in a vast majority of patients undergoing this procedure. The rate of serious periprocedural complications is relatively low. LAA occlusion is justified in a group of patients with a high risk of ischaemic stroke and a high risk of bleeding or contraindications to oral anticoagulants.
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Management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) depends on risk evaluation. The recommended approach involves the use of risk stratification tools such as TIMI and GRACE risk scores. However, these clinical scores do not include variables derived from coronary angiography which is currently performed in most patients. ⋯ The extent score added to the TIMI risk score improves the prognostic value of the latter in patients with NSTEMI. Angiographic variables should be more widely used in risk stratification models in patients with acute coronary syndromes.
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Acute hyperglycaemia in patients with acute coronary syndromes (ACS) is associated with increased cardiovascular (CV) risk among both diabetic and non-diabetic patients although the mechanisms underlying this association are not clearly understood. Acute hyperglycaemia in patients with ACS may be associated with increased systemic inflammation. Leukocytes are the major cellular mediators of inflammation and their elevated count is associated with higher CV event rate in ACS patients. Thus, it is possible that there is a relationship between acute hyperglycaemia and high leukocyte count and concomitant presence of these two conditions may contribute to increased CV risk among patients with ST segment elevation myocardial infarction (STEMI). ⋯ Acute hyperglycaemia is associated with worse in-hospital outcomes in patients with STEMI. More severe inflammation (defined as leukocyte count on admission) is noted in STEMI patients with adverse events. A significant positive correlation can be seen between glucose level and leukocyte count on admission, and concomitant presence of both acute hyperglycaemia and more severe inflammation in patients with STEMI was found to be an independent predictor of poor in-hospital outcomes.
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Incompleted ST segment resolution (STR) after primary percutaneous coronary intervention (PCI) is associated with worse clinical outcomes. ⋯ Plasma NT-proBNP level on admission is a strong and independent predictor of no-reflow phenomenon following primary PCI and mid-term cardiovascular mortality in patients with STEMI.