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Objectives: To evaluate the clinical utility of and demand for the creatine kinase (CK)-MB assay. Methods: We examined the number of CK-MB tests from 2007 through 2013 while we progressively deemphasized their use. We first removed CK-MB from the acute coronary syndrome (ACS) panel and then from the main menu and observed the demand for the test. We also reviewed patient medical records to assess the appropriateness of its use. Results: After removing CK-MB from the ACS panel, the test volume dropped from around 12,000 per year to about 150 per year. In reviewing the records of 171 patients who had CK-MB determination done over a 28-month period, we discovered that CK-MB contributed to the diagnosis in only one patient, although it was not essential. Since removing CK-MB from the laboratory menu, two CK-MB tests were ordered in 4 months, and neither added value. Conclusions: CK-MB determinations do not add value to information available from the troponin assay and can be safely removed from the laboratory menu. [ABSTRACT FROM AUTHOR]

Repolarization alternans has been considered a strong marker of electrical instability. The objective of this study was to investigate the hypothesis that ischemia-induced contrasting effects on the kinetics of membrane voltage and intracellular calcium transient (CaiT) can explain the vulnerability of the ischemic heart to repolarization alternans. Ischemia-induced changes in action potential (AP) and CaiT resulting in alternans were investigated in perfused Langendorff guinea pig hearts subjected to 10–15 min of global no-flow ischemia followed by 10–15 min of reperfusion. The heart was stained with 100 μl of rhod-2 AM and 25 μl of RH-237, and AP and CaiT were simultaneously recorded with an optical mapping system of two 16 × 16 photodiode arrays. Ischemia was associated with shortening of AP duration (D) but delayed upstroke, broadening of peak, and slowed decay of CaiT resulting in a significant increase of CaiT-D. The changes in APD were spatially heterogeneous in contrast to a more spatially homogeneous lengthening of CaiT-D. CaiT alternans could be consistently induced with the introduction of a shorter cycle when the upstroke of the AP occurred before complete relaxation of the previous CaiT and generated a reduced CaiT. However, alternans of CaiT was not necessarily associated with alternans of APD, and this was correlated with the degree of spatially heterogeneous shortening of APD. Sites with less shortening of APD developed alternans of both CaiT and APD, whereas sites with greater shortening of APD could develop a similar degree of CaiT alternans but slight or no APD alternans. This resulted in significant spatial dispersion of APD. The study shows that the contrasting effects of ischemia on the duration of AP and CaiT anad, in particular, on their spatial distribution explain the vulnerability of ischemic heart to alternans and the increased dispersion of repolarization during alternans. [ABSTRACT FROM AUTHOR]

The article focuses on a medical identity theft case. It discusses a patient who used someone else's health insurance to cure his prosthetic aorticvalve. It also presents information on the medical history of the patient including rheumatic heart disease, valve replacement due to regurgitation from the valve, and echocardiography results of the patient.

Background: Cardiac imaging is the cornerstone of the pretranscatheter aortic valve replacement (TAVR) assessment. Multi‐detector computed tomography (MDCT) is considered the conventional imaging modality. However, there is still no definitive gold standard. Targeted cohort of inoperable high‐risk patients with underlying comorbidities, particularly renal impairment, makes apparent the need for MDCT alternative. We aimed to demonstrate the correlation extent between MDCT and three‐dimensional transesophageal echocardiography (3DTEE) aortic annular area measures and to answer the question: Is 3DTEE a good alternative to MDCT? Methods: A systematic literature search and meta‐analysis were conducted to evaluate the degree of correlation and agreement between 3DTEE and MDCT aortic annular sizing. A thorough assessment of EMBASE, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) was performed. All studies comparing 3DTEE and MDCT in relation to aortic annular sizing were included. Results: Thirteen studies were included (N = 1228 patients). A strong linear correlation was found between 3DTEE and MDCT measurements of aortic annulus area (r = 0.84, P < 0.001), mean perimeter (r = 0. 0.85, P < 0.001), and mean diameter (r = 0.80, P < 0.001). Bland–Altman plots revealed smaller mean 3DTEE values in comparison to MDCT for aortic annular area, the mean difference being −2.22 mm2 with 95% limits of agreement −12.79 to 8.36. Conclusion: Aortic annulus measurements obtained by 3DTEE demonstrated a high level of correlation with those evaluated by MDCT. This makes 3DTEE a feasible choice for aortic annulus assessment, with advantage of real time assessment, lack of contrast, and no radiation exposure. [ABSTRACT FROM AUTHOR]

Water immersion-induced skin wrinkling (WISW) is dependent on intact peripheral sympathetic function. WISW was hypothesized to reflect autonomic function in subjects without peripheral neuropathy. We prospectively studied 70 healthy subjects (aged 31 ± 8 years, 63% females) without cardiovascular risk factors or neurological disease. All subjects underwent short-term heart rate variability (HRV) studies. Time and frequency domain variables were derived including the HRV index. WISW was graded using a previously validated scale of 1-4 of which 18.6% of subjects exhibited grade 1 (minimal) WISW and 35.7% had grade 2 WISW. On multivariate analysis using the HRV index, WISW was independently related to height and the HRV index. We conclude that WISW is related to central autonomic function. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction: Post cardiopulmonary resuscitation (CPR) ST elevation is usually a sign of an urgent need for cardiac catheterization (CC), especially in the setting of shockable rhythm cardiac arrest. Post CPR ST elevation can be attributed to pericarditis, early repolarization or acute myocardial infarction. CC is mandated in this situation to rule out acute coronary syndrome. Hypothesis: We report a case of post CPR inferior ST elevation that is likely to be related to escalation of vasopressors which lead to generalized coronary vasospasm. There are few cases that report epinephrine-induced ST-elevation myocardial infarction during anaphylactic shock or septoplasty. To our knowledge, this is the first case report of a typical inferior ST elevation in post CPR that was due to vasospasm secondary to vasopressor escalation. Case: A 47 years old male with a history of malignant hypertension and end stage renal disease who presented to the hospital with cardiac arrest (pulseless electrical activity (PEA) and VT/VF). Initial electrocardiogram (EKG) post return of spontaneous circulation did not show acute ischemic changes but on a later repeat, it showed ST elevations in the inferior leads with ST depression in AVR consistent with possible inferior myocardial infarction. The patient was taken emergently to coronary angiogram which demonstrated severe diffuse vasospasm in all three coronary arteries that were completely reversed with intracoronary vasodilator injection. No definite obstructive coronary artery disease was found. The decision was to de-escalate vasopressors doses and follow up EKG demonstrated resolved EKG ischemic changes. Conclusions: Post CPR ST elevation EKG changes can be attributed to vasopressor induced coronary vasospasm without underlying obstructive coronary artery disease. Vasopressor's dose should be adjusted in this setting to avoid inducing myocardial infarction secondary to severe and prolonged coronary vasospasm. [ABSTRACT FROM AUTHOR]