Vedic Guard is a polyherbal formulation used in the treatment of various ailments, however, is not scientifically assessed for its effect on doxorubicin-induced cardiotoxicity.To find out the preventive role of Vedic Guard against doxorubicin-induced myocardial toxicity in rats.Cardiotoxicity was produced by doxorubicin (15 mg/kg for 2 weeks). Vedic Guard (270 mg/kg, orally) was administered as pre-treatment for 2 weeks and then for 2 weeks alternated with doxorubicin (DXR). The general observations, mortality, histopathology, biomarker like lactate dehydrogenase (LDH), creatine phosphokinase (CPK), aspartate aminotransferase (AST), alanine transaminase (ALT), electrocardiographic (ECG) parameters, antioxidants such as glutathione (GSH), superoxide dismutase (SOD), and catalase (CAT) were monitored after 3 weeks of last dose.The repeated administration of DXR causes cardiomyopathy associated with an antioxidant deficit. Pre-treatment with Vedic Guard decreases serum enzyme viz LDH, CPK, AST, and ALT levels to that of normal values. Vedic Guard significantly protected the myocardium from the toxic effect of DXR, by increasing the levels of antioxidants such as GSH, SOD, and CAT and decreased the elevated level of malondialdehyde. The study shows significant alteration of ECG pattern in DXR administered rats. The characteristic findings were elevation of ST segment, reduction in P waves, QRS complex, and R-R interval. Vedic Guard showed a protective effect against DXR-induced altered ECG pattern. It also reduced the severity of cellular damage of the myocardium confirmed by histopathology.The results of the present study indicated cardioprotective effect of Vedic Guard might be attributed to its antioxidant activity.

Fragmented QRS encompasses different RSR' patterns showing various morphologies of the QRS complexes with or without the Q wave on a resting 12-lead electrocardiogram. It has been shown possibly to cause adverse cardiac outcomes in patients with some heart diseases, including coronary artery disease. In view of the need for risk stratification of patients presenting with acute coronary syndrome in the most efficacious and cost-effective way, we conducted this study to clarify the value of developing fragmented QRS in a cohort of patients presenting with their first acute coronary syndrome in predicting 6-month mortality and morbidity.One hundred consecutive patients admitted to the coronary care unit at Shahid Madani Heart Center in Tabriz from December 2008 to March 2009 with their first acute coronary syndrome were enrolled in this prospective study. Demographic and electrocardiographic data on admission, inhospital mortality, and need for revascularization were recorded. Electrocardiography performed 2 months after the index event was examined for development of fragmented QRS. Mortality and morbidity was evaluated at 6-month follow-up in all patients.The patients were of mean age 57.7 ± 12.8 years, and 84% were men. The primary diagnosis was unstable angina in 17 (17%) patients, non-ST elevation myocardial infarction (MI) in 11 (11%), anterior or inferior ST elevation MI in 66 (66%), and postero-inferior MI in six (6%). Fragmented QRS was present in 30 (30%) patients during the first admission, which increased to 44% at the 2-month follow-up and to 53% at the 6-month follow-up. The presence of various coronary risk factors and drug therapy given, including fibrinolytic agents, had no effect on development of fragmented QRS. Mortality was significantly higher (P = 0.032) and left ventricular ejection fraction was significantly lower (P = 0.001) in the fragmented QRS group at the 6-month follow-up.This study strongly suggests that fragmented QRS on initial presentation with acute coronary syndrome is not predictive of subsequent events but, if present 6 months later, could be predictive of an adverse outcome.

In this article, we present a case with isolated right ventricular myocardial infarction (MI) who underwent coronary angiography on suspicion of acute anteroseptal MI detected on ECG; however, occlusion of the proximal right coronary artery (RCA) was detected. A female patient aged 65 years was brought to the emergency room due to loss of consciousness 1 hour before. From the patient's history, it was understood that she had undergone stent placement to her proximal RCA 5 days before. On ECG, a decreasing elevation in ST segment elevation from V1 to V4 was seen, and pathologic Q waves were present at DIII and AVF. A complete AV block was detected on ECG. In the coronary angiography, thrombosis of the stent in the proximal RCA was seen. Stenosis detected in the mid-left anterior descending artery was 50% and at the distal part was 60%. The circumflex coronary artery was found normal. Percutaneous transluminal coronary angioplasty was performed to the 95% thrombotic lesion in the stent of the proximal RCA, and full patency was established. In our case, a decreasing elevation in the ST segment elevation from V1 to V4 was seen. Right ventricular MI usually occurs by an acute stenosis of the non-dominant proximal RCA branch that does not receive collateral flow. In our case, RCA was codominant and an acute stenosis of the stent in the proximal RCA was present. The occlusion of the non-dominant RCA can appear as isolated right ventricular MI without causing a left ventricular infarct, since it does not feed the left ventricle.

Background:

Electrocardiographic early repolarization (ER) occurring in <5% of general/atherosclerotic populations, is a marker of sudden cardiac death (SCD). The prevalence of ER in chronic kidney disease (CKD) patients, in whom SCD is common, is unknown. We aimed to determine the prevalence, contributing factors, and relationship of ER to all-cause mortality and progression to dialysis in CKD patients.

Methods:

A retrospective study of 197 patients with stage 3-5 CKD. Full demographic data were collected including cardiovascular risk factors and history. All patients underwent a 12-lead ECG, analysed for the presence of ER and other ECG findings. ER was defined as elevation of the QRS-ST junction (J point) by at least 0.1 mV from baseline with slurring/notching of the QRS complex. The primary and secondary endpoints were all cause mortality and progression to dialysis respectively at 1 year. To control for the effects of CKD, we evaluated the ECGs of 39 healthy renal transplant donors (RTD).

Results:

CKD patients had a mean age of 61.5 (±16.1). Prevalence of ER in pre-dialysis patients with CKD stage 4 and 5 was higher than in RTD (26.4 vs. 7.7%, p = 0.02). ER frequency increased with CKD stage (stage 3: 7.7%, stage 4: 29.7%, and pre-dialysis stage 5: 24.6%), but decreased in dialysis patients (13%). On multivariate analysis only the QRS duration was a significant independent predictor of ER (OR 0.97, 95% CI, 0.94-0.99, p = 0.01). At 1-year follow-up, there were 24 (12%) deaths in the patients with CKD of whom 5 (21%) had ER. ER was not a predictor of all cause mortality (p = 1.00) and had no effects on the rate of progression to dialysis (p = 0.67).

Conclusions:

ER is more common in pre-dialysis CKD patients, compared to healthy RTD but is not associated with increased 1-year mortality or entry onto dialysis programs. Further longitudinal studies are indicated to determine whether this increased prevalence of ER is associated with the rate of SCD seen in this population.

Since the invention of electrocardiogram (ECG or EKG), its significance in the diagnosis of acute ischemic disease, chronic ischemic disease, and its contribution to cardiology has been no less than remarkable. The pathophysiology of acute coronary syndromes in most cases correlates with the clinical outcomes, biochemical findings (cardiac biomarkers), and electrocardiographic patterns. Electric activity in the myocardium is registered in the ECG describing positive deflections when the depolarization potential orientates positive charges to the recording electrode (approaches to it) and negative deflections when the depolarization potential orientates negative charges to the recording electrode and gets away from it. The abnormal Q-wave is the cornerstone of the myocardial infarction diagnosis after several days of the ischemic event. Findings in the ECG suggestive of ischemia and necrosis are ST elevation/depression and deep Q-waves, respectively, and the presence of a deep abnormal Q-wave in the ECG is evidence of necrotic areas and an inert myocardium, which is not capable to depolarize. Non-Q-wave myocardial infarction has been defined as acute myocardial infarction without a new-onset deep Q-wave on the ECG after day(s) of evolution, and because of the anatomopathological concept of infarction is usually related to necrosis, it results paradoxical to consider this widely known clinical and biochemical entity as a myocardial infarction when there is no evidence of necrosis in the ECG.

Objective:

Evaluate treatment times and clinical outcome in a consecutive series of ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) in Los Angeles County.

Background:

Primary PCI for STEMI is beneficial if performed in a timely manner. Conflicting data exist regarding potential treatment delays for primary PCI performed during off hours.

Methods:

The Emergency Medical Services STEMI Receiving Center Database was queried from 2007 to 2009 to identify patients with a pre-hospital ECG showing STEMI who underwent PCI. On-hour PCI (On-hour Group, n = 1324) was defined as PCI occurring from 8 am to 5 pm and off-hour PCI (Off-hour Group, n = 922) was defined as occurring from 5 pm to 8 am. Treatment times, length of stay, vascular complications, achievement of TIMI 3 flow and in-hospital mortality were evaluated.

Results:

Off-hours PCI occurred in 41% of patients. Medical contact to door time was similar in the Off-hour Group compared to the On-hour Group, 20.7 ± 14.6 versus 20.3 ± 12.3 min, respectively, P = 0.47. In patients with available data (n = 1366), the door-to-catheterization laboratory (CL) activation time was significantly shorter in the On-hour Group as compared to the Off-hour Group, -4.9 ± 11.9 versus -0.2 ± 27.5 min, respectively, P < 0.0001. Door-to-balloon time was significantly longer in the Off-hour Group compared to the On-hour Group, 74 ± 35 versus 60 ± 26 min respectively, P < 0.0001. Length of stay, vascular complications, final TIMI 3 flow and in-hospital mortality were similar between both groups.

Conclusions:

In STEMI patients receiving primary PCI in Los Angeles County, off-hour PCI was common. Short-term clinical outcomes were similar despite longer door-to-balloon time in patients receiving off-hour PCI. The longer door-to-balloon time in the off-hour PCI patients were partly explained by longer door-to-CL activation time.

Abstract

Introduction.

Despite attention directed at treatment times of ST-segment elevation myocardial infarctions (STEMIs), little is known about the types of STEMIs presenting to the emergency department (ED).

Objective.

The purpose of this study was to determine the relative frequencies and characteristics of emergency medical services (EMS) STEMIs compared with those in patients who present to the ED by walk-in. This information may be applied in EMS training, system planning, and public education. Methods. This was a query of a prospectively gathered database of all STEMIs in patients presenting to Summa Akron City Hospital ED in 2009 and 2010. We collected demographic information, chief complaint, mode and time of arrival, and STEMI pattern (anterior, lateral, inferior, or posterior). We excluded transfers and in-hospital STEMIs. We calculated means, percentages, significance, and 95% confidence intervals (CIs) ± 10%.

Results.

We analyzed data from 308 patients. Most patients (241/308, 78%, CI 73%-83%) arrived by EMS, were male (203/308, 66%, CI 60%-71%), and were white (286/308, 93%, CI 89%-96%). Patients arriving by EMS were older (average 63 years, range 35-95) than walk-in patients (average 57 years, range 24-92). Two percent (5/241, 2%, CI 1%-5%) of EMS STEMI patients were under 40 years of age, compared with 10% (7/67, 10%, CI 4%-20%) of walk-in patients (p = 0.0017). The most common chief complaint was chest pain (278/308, 90%, CI 86%-93%). Inferior STEMIs were most common (167/308, 54%, CI 49%-60%), followed by anterior (127/308, 41%, CI 48%-60%), lateral (8/308, 3%, CI 1%-5%), and posterior (6/308, 2%, CI 1%-4%). A day-of-the-week analysis showed that no specific day was most common for STEMI presentation. Forty percent (122/308, 40%, CI 34%-45%) of patients presented during open catheterization laboratory hours (Monday through Friday, 0730-1700 hours). There was no significant statistical difference between EMS and walk-in patients with regard to STEMI pattern or patient demographics.

Conclusions.

In this study, 95% (294/308) of all STEMIs were inferior or anterior infarctions, and these types of presentations should be stressed in EMS education. Most STEMI patients at this institution arrived by ambulance and during off-hours. Younger patients were more likely to walk in. We need further study, but we may have identified a target population for future interventions. Key words: emergency medical services; allied health personnel; electrocardiography; myocardial infarction; heart catheterization; STEMI.

Hypoxaemia during labour can alter the shape of the fetal electrocardiogram (ECG) waveform, notably the relation of the PR to RR intervals, and elevation or depression of the ST segment. Technical systems have therefore been developed to monitor the fetal ECG during labour as an adjunct to continuous electronic fetal heart rate monitoring with the aim of improving fetal outcome and minimising unnecessary obstetric interference.To compare the effects of analysis of fetal ECG waveforms during labour with alternative methods of fetal monitoring.The Cochrane Pregnancy and Childbirth Group's Trials Register (latest search 12 February 2013).Randomised trials comparing fetal ECG waveform analysis with alternative methods of fetal monitoring during labour.Trial quality assessment and data extraction were performed by one review author, without blinding.Six trials (16,295 women) were included: five trials of ST waveform analysis (15,338 women) and one trial of PR interval analysis (957 women). In comparison to continuous electronic fetal heart rate monitoring alone, the use of adjunctive ST waveform analysis made no significant difference to primary outcomes: births by caesarean section (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.91 to 1.08), the number of babies with severe metabolic acidosis at birth (cord arterial pH less than 7.05 and base deficit greater than 12 mmol/L) (RR 0.78, 95% CI 0.44 to 1.37, data from 14,574 babies), or babies with neonatal encephalopathy (RR 0.54, 95% CI 0.24 to 1.25). There were, however, on average fewer fetal scalp samples taken during labour (RR 0.61, 95% CI 0.41 to 0.91) although the findings were heterogeneous; there were fewer operative vaginal deliveries (RR 0.89, 95% CI 0.81 to 0.98) and admissions to special care unit (RR 0.89, 95% CI 0.81 to 0.99); there was no statistically significant difference in the number of babies with low Apgar scores at five minutes or babies requiring neonatal intubation. There was little evidence that monitoring by PR interval analysis conveyed any benefit.These findings provide some modest support for the use of fetal ST waveform analysis when a decision has been made to undertake continuous electronic fetal heart rate monitoring during labour. However, the advantages need to be considered along with the disadvantages of needing to use an internal scalp electrode, after membrane rupture, for ECG waveform recordings.

BACKGROUND:

We wanted to evaluate predictors of direct admittance to a coronary care unit (CCU) and predictors of death in patients with suspected acute coronary syndromes (ACS).

METHODS:

During 2004-2007, all consecutive prehospitally triaged patients with suspected ACS were prospectively included. Prehospital and emergency data were collected at point of care. Data from medical records, ECG-, echocardiography- and laboratory databases was collected retrospectively.

RESULTS:

In all, 2757 patients were included. Out of these 858 were directly admitted to the CCU or cath/lab. Predictors for direct admittance to the CCU were ST-segment elevation on the initial ECG; odds ratio (OR) 46.11, left bundle branch block; OR 3.30, ongoing symptoms; OR 2.90, current smoking; OR 2.18 and ST-segment depression; OR 2.05. Independent predictors for 1-year mortality were cardiogenic shock; OR 14.40, increasing age OR (per year) 1.08, diabetes; OR 2.09 and chronic heart failure; OR 1.67. ST-segment elevation was associated with a lower 1-year mortality rate; OR 0.52.

CONCLUSIONS:

Among patients with a suspected ACS, prehospital ECG-signs indicating an acute coronary occlusion were not only a predictor for direct admission to acute coronary care but also a predictor for increased survival. To improve future outcome in acute ischemic heart diseases we must find and treat not only the STEMI's but also the high-risk NSTEMIs that otherwise would have a poor prognosis.

Patients present with chest pain. Electrocardiography (ECG) is used and troponin-T levels slowly increases. Diagnosis of myocardial infarction requires prolonged monitoring, over six to nine hours, for serial blood sampling. It is the cause of delayed treatment and lead to a crowded emergency room. Troponin is a marker of myocardial necrosis, the gold standard in detection of acute myocardial infarction (AMI). Copeptin, the C-terminal part ofthe vasopressin prohormone, as a marker of acute endogenous stress, adds diagnosis information to cardiac troponin in early evaluation ofpatients with suspected myocardial infarction.To determine the correlation between plasma copeptin level and troponin-T It is also to determine if the copeptin level can be used as early diagnosis in patients who present with chest pain and are suspected to be acute myocardial infarction (AMI).Patients with chest pain that presented to the emergency department ofRajavithi Hospital between October 2010 and October 2011 and were suspected to have myocardial infarction were consecutively enrolled in thepresent study. The level ofplasma copeptin and troponin-T were measured at presentation and six hours after presentation. Results: One hundred fifty patients presented to the emergency department with chest pain. Their average age was 66.71+/-7.78 years. The mean plasma copeptin level was 13.91+/-5.01 pmol/l in acute myocardial infarction. Plasma copeptin level increased compared with troponin-T Plasma copeptin level increased and correlated with troponin-T to diagnose myocardial infarction (r = 0.317) at presentation. It further increased and correlated (r = 0.562) at six hours after presentation. Plasma copeptin levels for diagnosis of ST elevate myocardial infarction (STEMI) at presentation have an area under curve (AUC) = 0.91, p<0.001, sensitivity 90.9%, and specificity 87.8%. The non-ST elevated myocardial infarction (NSTEMI) have an area under curve (AUC) = 0.71, p<0.001, sensitivity 88.8%, specificity 69.8%, and cut-off point of 10.25 pmol/l.Plasma copeptin can be used for early diagnosis of myocardial infarction. The additional use of copeptin to Troponin-T allows for a rapid triage of chest pain patients to an early diagnosis of non-ST elevation myocardial infarction.