Cardiology
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Thrombin generation (TG) is an important pathogenic factor in acute coronary syndromes including acute myocardial infarction (AMI). Since the diagnostic utility of TG remains uncertain we sought to determine whether markers of TG may triage patients presenting to the Emergency Department with chest pain. Soluble plasma levels of prothrombin fragment 1+2 (F(1+2)), and thrombin/antithrombin III complexes (TAT) were determined by ELISA in 80 patients presenting with chest pain to the Emergency Department and compared with 20 controls. ⋯ Moreover, plasma F(1+2) levels were significantly lower than in healthy controls (0.84 +/- 0.10 ng/ml versus 1.22 +/- 0.11, p = 0.026). At the time of presentation to the Emergency Department, F(1+2) and TAT failed to suitably triage patients with chest pain. The surprisingly low levels of TG markers in AMI patients before applying intensive therapy and reperfusion strategies deserves further investigation.
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To evaluate whether the incidence of acute myocardial infarction (AMI) attack would have circadian, weekly and monthly variations in a subtropical area, 540 consecutive patients with AMI who were admitted to our coronary care units were analyzed. Six-hour intervals over 24 h, daily intervals in a week (7 days) and monthly intervals in a year (12 months) were studied, respectively. Results showed that there was a circadian variation in the onset of AMI with a morning (6 a.m. to noon) peak (34%, p < 0.01) but no secondary late evening (18-24 p.m.) peak. ⋯ This study demonstrated a circadian variation in the onset of AMI attack with a predominant morning peak. The fewer AMI cases on Sundays compared to the other weekdays suggested that freedom from 'stress' or 'work-load' on Sundays might have an important impact on this low incidence of AMI. Unlike the large ranges in cold or hot weather found in temperate regions, the warm climate of a subtropical region does not affect the frequency of AMI.
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The objective of this study was to determine whether two novel rapid bedside assays for whole-blood detection of cardiac troponin T and creatine kinase (CK)-MB mass/myoglobin could rule out or rule in acute myocardial infarction in patients with acute chest pain. Ninety-two patients with chest pain <12 h prior to admission were investigated. ⋯ The negative predictive value was 97% for the TropT test and 98% for the CARDIAC STATus test at this time point. Our data show that the rapid assays provide diagnostic as well as prognostic information shortly after admission.
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Aortic intramural hematoma (IMH) is a rarely diagnosed pathological condition that is not well characterized to date. We diagnosed IMH in 4 of 31 patients with suspected aortic dissection admitted to our coronary care unit from 1992 to 1995. In all 4 cases, IMH was located in the ascending aorta. ⋯ In another patient, the diagnosis was confirmed during successful surgery, while the remaining 2 patients recovered after medical therapy. The 3 surviving patients are still under follow-up control 12, 16 and 20 months after the initial acute event. We briefly discuss the epidemiological, clinical, diagnostic, therapeutic and prognostic aspects of IMH.
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Recent studies have suggested that positive troponin I tests are associated with an increased risk of cardiac death during short-term follow-up. However, it is unknown if troponin I tests alone or in addition to CK-MB measurements are superior to predict unfavorable outcome during long-term follow-up. ⋯ Our data suggest the superiority of combined CK-MB and troponin I measurements in clinical practice for the early risk stratification of patients presenting with acute chest pain. In nonmyocardial infarctions, both CK-MB and troponin I convey independent prognostic information with regard to fatal outcome. Troponin I tests in addition to CK-MB measurements contribute to a lower rate of misdiagnoses.