Backgrounds ST-elevation myocardial infarction （STEMI） guidelines recommend reperfusion by primary percutaneous coronary in- tervention （PCI） ≤ 90 min from time of first medical contact （FMC）. This strategy is ...Backgrounds ST-elevation myocardial infarction （STEMI） guidelines recommend reperfusion by primary percutaneous coronary in- tervention （PCI） ≤ 90 min from time of first medical contact （FMC）. This strategy is challenging in rural areas lacking a nearby PCI-capable hospital. Recommended reperfusion times can be achieved for STEMI patients presenting in rural areas without a nearby PCI-capable hospital by ground transportation to a central PCI-capable hospital by use of protocol-driven emergency medical service （EMS） STEMI field triage protocol. Methods Sixty STEMI patients directly transported by EMS from three rural counties （Nassau, Camden and Charlton Counties） within a 50-mile radius of University of Florida Health-Jacksonville （UFHJ） from 01/01/2009 to 12/31/2013 were identified from its PCI registry. The STEMI field triage protocol incorporated three elements： （1） a cooperative agreement between each of the rural emergency medical service （EMS） agency and UFHJ; （2） performance of a pre-hospital ECG to facilitate STEMI identification and laboratory activation; and （3） direct transfer by ground transportation to the UFHJ cardiac catheterization laboratory. FMC-to-device （FMC2D）, door-to-device （D2D）, and transit times, the day of week, time of day, and EMS shift times were recorded, and odds ratio （OR） of achieving FMC2D times was calculated. Results FMC2D times were shorter for in-state STEMIs （81 ± 17 vs. 87± 19 min）, but D2D times were similar （37 ± 18 vs. 39 ± 21 min）. FMC2D 〈 90 min were achieved in 82.7% in-state STEMIs compared to 52.2% for out-of-state STEMIs （OR = 4.4, 95% CI： 1.24-15.57; P = 0.018）. FMC2D times were homogenous after adjusting for weekday vs. weekend, EMS shift times. Nine patients did not meet FMC2D ≤ 90 min. Six were within 10 min of target; all patient achieved FMC2D 〈 120 min. Conclusions Guideline-compliant FMC2D ≤90 min is achievable for rural STEMI patients within a 50 mile radius of a PCI-capable hospital by use of protocol-driven EMS ground transportation. As all patients achieved a FMC2D time 〈 120 min, bypass of non-PCI capable hospitals may be reasonable in this situation.展开更多
Diabetic ketoacidosis remains one of the most serious complications of diabetes mellitus. Among its precipitating factors is myocardial ischemia, responsible for 1% of the cases of diabetic ketoacidosis.Ell Diabetic k...Diabetic ketoacidosis remains one of the most serious complications of diabetes mellitus. Among its precipitating factors is myocardial ischemia, responsible for 1% of the cases of diabetic ketoacidosis.Ell Diabetic ketoacidosis both with and without hyperkalemia has been reported to mimic a myocardial infarction pattem on ECG with ST segment elevation, described as pseudoinfarction pattern. Thus, it is important to raise awareness among physicians, as subjecting patients to invasive medical management can be avoided. We present a case of a 47-year-old female with diabetic ketoacidosis and hyperkalemia with initial ECG findings of ST segment elevation, but an urgent left heart catheterization revealed non-obstructive coronary disease.展开更多
Myocarditis is an inflammatory disease of the myocardium. The clinical presentation of myocarditis may range from subclinical to sudden death. The incidence of fatal myocarditis, which often presents with sudden or ra...Myocarditis is an inflammatory disease of the myocardium. The clinical presentation of myocarditis may range from subclinical to sudden death. The incidence of fatal myocarditis, which often presents with sudden or rapid death, has been estimated at 0.15/100.000 in the general population and is highest in infants and young adults （but may affect any age group）. However, diffuse myocarditis in autopsies of sudden death is 〈 2% in adult.展开更多
Papillary fibroelastoma cardiac tumor. The most is the most common valvular common non-valvular site these minors present is the left ventricle, where they usually manifest as ischemic strokes or myocardial infarction...Papillary fibroelastoma cardiac tumor. The most is the most common valvular common non-valvular site these minors present is the left ventricle, where they usually manifest as ischemic strokes or myocardial infarction. Although these tumors also have a risk of embolization into the peripheral system, reports of such events are exceedingly rare.展开更多
Natriuretic peptides are synthesized in ventricular myocytes and released into the circulation in response to increased myocardial wall stress, Causes of myocardial wall stress include pulmonary hypertension, ventricu...Natriuretic peptides are synthesized in ventricular myocytes and released into the circulation in response to increased myocardial wall stress, Causes of myocardial wall stress include pulmonary hypertension, ventricular dilatation, as well as heart failure with reduced or preserved left ventricular function.展开更多
The primary cardiac tumors are extremely rare tumors that arise from the normal cardiac tissues. There are benign variants （mostly myxoma） and malignant tumors. Fibroelastoma （FE） is the most common primary tumor,...The primary cardiac tumors are extremely rare tumors that arise from the normal cardiac tissues. There are benign variants （mostly myxoma） and malignant tumors. Fibroelastoma （FE） is the most common primary tumor, of which myxoma is the most common subtype followed by papillary fibroelastomas （PFE）.展开更多
A 63-year-old man was admitted to our observation unit with atypical angina found to be non-adherent with his an- ti-hypertensive medication regimen for one month. His medical history was notable for hypertension for ...A 63-year-old man was admitted to our observation unit with atypical angina found to be non-adherent with his an- ti-hypertensive medication regimen for one month. His medical history was notable for hypertension for ten years and current tobacco smoking. He was hypertensive with otherwise, stable vital signs. Cardiac auscultation revealed normal S1 and $2 without a murmur.展开更多
文摘Backgrounds ST-elevation myocardial infarction （STEMI） guidelines recommend reperfusion by primary percutaneous coronary in- tervention （PCI） ≤ 90 min from time of first medical contact （FMC）. This strategy is challenging in rural areas lacking a nearby PCI-capable hospital. Recommended reperfusion times can be achieved for STEMI patients presenting in rural areas without a nearby PCI-capable hospital by ground transportation to a central PCI-capable hospital by use of protocol-driven emergency medical service （EMS） STEMI field triage protocol. Methods Sixty STEMI patients directly transported by EMS from three rural counties （Nassau, Camden and Charlton Counties） within a 50-mile radius of University of Florida Health-Jacksonville （UFHJ） from 01/01/2009 to 12/31/2013 were identified from its PCI registry. The STEMI field triage protocol incorporated three elements： （1） a cooperative agreement between each of the rural emergency medical service （EMS） agency and UFHJ; （2） performance of a pre-hospital ECG to facilitate STEMI identification and laboratory activation; and （3） direct transfer by ground transportation to the UFHJ cardiac catheterization laboratory. FMC-to-device （FMC2D）, door-to-device （D2D）, and transit times, the day of week, time of day, and EMS shift times were recorded, and odds ratio （OR） of achieving FMC2D times was calculated. Results FMC2D times were shorter for in-state STEMIs （81 ± 17 vs. 87± 19 min）, but D2D times were similar （37 ± 18 vs. 39 ± 21 min）. FMC2D 〈 90 min were achieved in 82.7% in-state STEMIs compared to 52.2% for out-of-state STEMIs （OR = 4.4, 95% CI： 1.24-15.57; P = 0.018）. FMC2D times were homogenous after adjusting for weekday vs. weekend, EMS shift times. Nine patients did not meet FMC2D ≤ 90 min. Six were within 10 min of target; all patient achieved FMC2D 〈 120 min. Conclusions Guideline-compliant FMC2D ≤90 min is achievable for rural STEMI patients within a 50 mile radius of a PCI-capable hospital by use of protocol-driven EMS ground transportation. As all patients achieved a FMC2D time 〈 120 min, bypass of non-PCI capable hospitals may be reasonable in this situation.
文摘Diabetic ketoacidosis remains one of the most serious complications of diabetes mellitus. Among its precipitating factors is myocardial ischemia, responsible for 1% of the cases of diabetic ketoacidosis.Ell Diabetic ketoacidosis both with and without hyperkalemia has been reported to mimic a myocardial infarction pattem on ECG with ST segment elevation, described as pseudoinfarction pattern. Thus, it is important to raise awareness among physicians, as subjecting patients to invasive medical management can be avoided. We present a case of a 47-year-old female with diabetic ketoacidosis and hyperkalemia with initial ECG findings of ST segment elevation, but an urgent left heart catheterization revealed non-obstructive coronary disease.
文摘Myocarditis is an inflammatory disease of the myocardium. The clinical presentation of myocarditis may range from subclinical to sudden death. The incidence of fatal myocarditis, which often presents with sudden or rapid death, has been estimated at 0.15/100.000 in the general population and is highest in infants and young adults （but may affect any age group）. However, diffuse myocarditis in autopsies of sudden death is 〈 2% in adult.
文摘Papillary fibroelastoma cardiac tumor. The most is the most common valvular common non-valvular site these minors present is the left ventricle, where they usually manifest as ischemic strokes or myocardial infarction. Although these tumors also have a risk of embolization into the peripheral system, reports of such events are exceedingly rare.
文摘Natriuretic peptides are synthesized in ventricular myocytes and released into the circulation in response to increased myocardial wall stress, Causes of myocardial wall stress include pulmonary hypertension, ventricular dilatation, as well as heart failure with reduced or preserved left ventricular function.
文摘The primary cardiac tumors are extremely rare tumors that arise from the normal cardiac tissues. There are benign variants （mostly myxoma） and malignant tumors. Fibroelastoma （FE） is the most common primary tumor, of which myxoma is the most common subtype followed by papillary fibroelastomas （PFE）.
文摘A 63-year-old man was admitted to our observation unit with atypical angina found to be non-adherent with his an- ti-hypertensive medication regimen for one month. His medical history was notable for hypertension for ten years and current tobacco smoking. He was hypertensive with otherwise, stable vital signs. Cardiac auscultation revealed normal S1 and $2 without a murmur.
