Kardiol Pol
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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.
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We describe the management of a young patient who had experienced a cocaine overdose. The patient presented with altered mental status and seizures and subsequently developed a wide complex arrhythmia with a rare alternating bundle branch block pattern. Intravenous lipid emulsion was administered following initial resuscitation and endotracheal intubation, because conservative methods of treating the persistent cardiac arrhythmias failed.
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Thoracic aortic rupture is usually the result of a sudden deceleration caused by a traffic accident, fall or some other misfortune. Before the endovascular era, there was only one treatment option: open repair, burdened by high morbidity and significant mortality. Now, we have the ability to treat it with a stent graft. The advantages of this method include avoiding a thoracotomy or aorta cross-clamping and their associated complications. ⋯ Our experience with traumatic thoracic aortic ruptures suggests that endovascular treatment should be the method of choice, especially in unstable multi-trauma patients. However, long-term studies are required to assess the durability of this technique after many years.