Kardiol Pol
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Myocardial infarction (MI) is one of the most serious challenges of contemporary cardiology. Among biochemical markers, heart-type specific fatty acid binding protein (h-FABP) has a high potential as a marker for the early diagnosis of acute MI. The h-FABP is released early to the bloodstream and may be useful for both rapid confirmation and exclusion of infarction. As opposed to patients with ST segment elevation MI (STEMI), patients with unstable angina (UA)/non-ST segment elevation MI (NSTEMI) present a heterogeneous group in which the confirmation of MI often meets diagnostic difficulties. A rapid, qualitative immunoenzymatic 'point of care' type test, revealing h-FABP in blood, has recently been made available (CardioDetect med). ⋯ Qualitative h-FABP test (CardioDetect med) showed excellent sensitivity, higher than measurements of CK-MB mass, CK-MB, and cTnT on hospital admission, and high specificity in the patient group with NSTE ACS. The h-FABP seems to be an excellent biochemical cardiac marker for diagnosing NSTEMI, especially in its early phase, allowing exclusion of myocardial necrosis.
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We describe a case of a 19-year-old pregnant woman with paroxysmal atrio-ventricular reentrant tachycardia (AVNRT). Transoesophageal atrial pacing (TAP) successfully terminated the arrhythmia, however, AVNRT restarted after 20 min and was initiated by ventricular ectopy. Intravenous metoprolol effectively suppressed ventricular ectopy and AVNRT did not recur. A modification of the ESC algorithm, with the inclusion of pacing techniques to terminate AVNRT, is proposed.
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Cardiac resynchronisation therapy (CRT) has been shown to be effective in the treatment of patients with end-stage heart failure (HF). However, long-term results of CRT have not yet been validated. ⋯ Clinical improvements with CRT are progressive and sustained over 2 years of follow-up.
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Case Reports
[Variant Brugada syndrome--mild ST segment elevation in inferior leads and aborted sudden cardiac death].
We describe a case of an otherwise healthy 48-year-old man who survived aborted sudden cardiac death (SCD). His ECG showed ST segment elevation in inferior leads, therefore an acute coronary syndrome was suspected. ⋯ On the basis of electrophysiological study, positive ajmaline test, persistent ST segment elevation in inferior leads and other clinical features (PQ interval of 240 ms, family history of SCD) a diagnosis of variant Brugada syndrome was made. Persistent ST segment elevations in inferior leads can be a marker of variant Brugada syndrome.