CHA2DS2-VASc评分对急性心肌梗死患者行冠状动脉介入治疗无复流现象预测

目的 本研究旨在验证CHA2DS2 VASc评分对直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者无复流现象的临床预测价值。方法 将我院收治接受原发性PCI治疗的300例STEMI患者分为两组：将27例无复流患者作为第一组，将其余273例患者作为对照组。计算每例患者CHA2DS2 VASc风险评分。结果 CHA2DS2 VASc评分与无复流相关性的多变量分析差异有统计学意义（P<0.05）。CHA2DS2 VASc评分中各个成分对无复流预测能力差异有统计学意义（P<0.05）。结论 在接受PCI治疗的STEMI患者中，较高的CA2DS2 VASc评分与无复流现象风险和住院病死率相关。     

Spontaneous Coronary Artery Dissection with Cardiac Tamponade

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Clinical presentation ranges from chest pain alone to ST-segment-elevation myocardial infarction, ventricular fibrillation, and sudden death. The treatment of patients with spontaneous coronary artery dissection is challenging because the disease pathophysiology is unclear, optimal treatment is unknown, and short- and long-term prognostic data are minimal.We report the case of a 70-year-old woman who presented with an acute ST-segment-elevation myocardial infarction secondary to a spontaneous dissection of the left anterior descending coronary artery. She was treated conservatively. Cardiac tamponade developed 16 hours after presentation. Repeat coronary angiography revealed extension of the dissection. Medical therapy was continued after the hemopericardium was aspirated. The patient remained asymptomatic 3 years after hospital discharge. To our knowledge, this is the first reported case of spontaneous coronary artery dissection in association with cardiac tamponade that was treated conservatively and had a successful outcome.     

急诊心肌梗死冠状动脉介入治疗术后患者T3水平与心肌再灌注的关系

目的探讨急性心肌梗死（AMI）患者急诊经皮冠状动脉介入治疗（PCI）术后血清三碘甲状腺原氨酸（T3）与心肌再灌注的关系。方法采用化学发光法检测205例AMI患者PCI术后血清T3水平，根据T3水平将患者分为A、B、C、D4组，记录并比较4组患者术后冠状动脉TIMI血流分级、心肌呈色分级（MBG）。结果A组（重度低T3组）TIMI3级比例低于B、C、D组，差异有统计学意义（P＜0.01）；MBG3级比例低于B、C、D组，差异有统计学意义（P＜0.01）。女性患者T3水平（1.00±0.05）nmol/L、TIMI3级比例（32/46，69.6%）、MBG3级比例（24/46，52.2%）均低于男性患者，后者分别为（1.19±0.02）nmol/L、（143/159，89.9%）、（110/159，69.2%），差异均有统计学意义（P＜0.05或0.01）。结论女性AMI患者心肌再灌注水平较男性患者低。AMI患者T3水平与PCI术后冠状动脉再灌注相关，监测T3可以间接反映病情的严重程度。     

Mechanical,inflammatory, and embolic complications of myocardial infarction: An emergency medicine review

IntroductionDespite the declining incidence of coronary heart disease (CHD) in the United States, acute myocardial infarction (AMI) remains an important clinical entity, with many patients requiring emergency department (ED) management for mechanical, inflammatory, and embolic complications.ObjectiveThis narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of post myocardial infarction mechanical, inflammatory, and embolic complications.DiscussionWhile 30-day mortality rate after AMI has decreased in the past two decades, it remains significantly elevated at 7.8%, owing to a wide variety of subacute complications evolving over weeks. Mechanical complications such as ventricular free wall rupture, ventricular septal rupture, mitral valve regurgitation, and formation of left ventricular aneurysms carry significant morbidity. Additional complications include ischemic stroke, heart failure, renal failure, and cardiac dysrhythmias. This review provides several guiding principles for management of these complications. Understanding these complications and an approach to the management of various complications is essential to optimizing patient care.ConclusionsMechanical, inflammatory, and embolic complications of AMI can result in significant morbidity and mortality. Physicians must rapidly diagnose these conditions while evaluating for other diseases. In addition to understanding the natural progression of disease and performing a focused physical examination, an electrocardiogram and bedside echocardiogram provide quick, noninvasive determinations of the underlying pathophysiology. Management varies by presentation and etiology, but close consultation with cardiology and cardiac surgery is recommended.     

Cardiovascular events associated with nicorandil administration prior to primary percutaneous coronary intervention in patients with acute ST-segment elevated myocardial infarction: a systematic review and meta-analysis

Introduction: Nicorandil may exert cardioprotective effects in ischemic heart disease. However, its efficacy in combination with early reperfusion is uncertain. The authors performed a meta-analysis of the short- and long-term clinical outcomes of nicorandil administration at the time of primary percutaneous coronary intervention (PCI) in patients with ST-elevated myocardial infarction (STEMI).

Methods: PubMed, MEDLINE, Embase, and the Cochrane Library databases were systematically searched for eligible randomized controlled studies. The primary endpoint was major adverse cardiovascular events (MACE), both in-hospital and post-discharge. The secondary endpoint was the incidence of no-reflow phenomenon.

Results: Ten studies were included (n = 1105). Mean patient age was 63.0 ± 10.0 years; 76.6% of patients were male. Compared with controls who received primary PCI, combined nicorandil/primary PCI significantly reduced in-hospital MACE (pooled odds ratio [OR] 0.16; 95% confidence interval [CI] 0.09–0.27), follow-up MACE (pooled OR 0.53; 95% CI 0.37–0.75), and total MACE (pooled OR 0.27; 95% CI 0.15–0.49). The combined treatment also reduced the incidence of no-reflow phenomenon (pooled OR 0.34; 95% CI 0.23–0.50).

Conclusion: Nicorandil administration at the time of primary PCI is associated with reduced MACE (both short- and long-term) and no-reflow phenomenon in patients with STEMI.     

Cerebellar artery infarction with sudden hearing loss and vertigo as initial symptoms: A case report

BACKGROUNDSudden hearing loss (SHL) is associated with serious systematic conditions such as neoplasms, vascular events, autoimmune diseases, infections, and iatrogenic injury. Some authors report that SHL can be an early warning sign of impending vertebrobasilar ischemic stroke. It is important to distinguish stroke from benign disease. CASE SUMMARYA 48-year-old male patient presented with SHL and vertigo as first symptoms. Diffusion-weighted imaging revealed high signal intensity in the left posterior inferior cerebellar artery territory of the cerebellar hemisphere and high signal intensity in the right pons and bridge cerebellar arm, confirming that the patient had cerebral infarction. Treatment with antiplatelet drugs, steroid anti-inflammatory drugs, and neurotrophic nerve therapy promoted blood circulation and removed blood stasis, and the symptoms of the patient were significantly improved. CONCLUSIONSHL and vertigo could be the initial symptoms of vertebrobasilar ischemic stroke.     

心理护理联合针灸对急性脑梗死后吞咽困难患者的影响研究

目的研究心理护理联合针灸对急性脑梗死后吞咽困难患者的影响。方法患者资料自临床住院患者中获取,入院治疗时间均是2018年2月—2019年2月,患者共计100例,盲选法均分患者,对照组、观察组各50例,对照组行常规康复联合针灸治疗,观察组则在对照组基础上增加心理护理,对比指标选择:有效率、负性情绪、吞咽困难评分。结果观察组治疗之后有效率为94.00%,高于对照组80.00%;观察组HAMD、SAS评分在治疗前对比差异无统计学意义(P>0.05),而在治疗后评分均低于对照组(P<0.05);观察组吞咽功能评分治疗前差异无统计学意义(P>0.05),治疗后评分显著高于对照组(P<0.05)。结论对于急性脑梗死后吞咽困难患者开展心理护理联合针灸治疗,整体有效率提升,负性情绪改善,有效控制吞咽困难疾病症状,治疗效果理想。     

Coronary Artery Embolism: Two Case Reports and a Review of the Literature

Coronary embolism (CE) is an uncommon and unique cause of acute myocardial infarction. In this report, we review 216 cases of CE including 2 new cases from our institution. The mean patient age was 52.5 years and 62% of the patients were males. Chest pain was the most common presenting symptom followed by dyspnea, and the most commonly affected vessel was the left anterior descending artery. Leading etiologies of the embolus were atrial fibrillation, septic emboli, and iatrogenic causes. Treatment approaches varied with thrombus aspiration being used in 30% of cases. In-hospital mortality rate was 36% and 13% of the cases were complicated by cerebrovascular accident. CE is a unique pathology that leads to acute myocardial infarction. It portends a high mortality rate and requires a high level of suspicion as symptoms may be misleading. Further research is needed in order to improve recognition and management and to lower associated mortality.