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Introduction and Purpose: The COVID-19 pandemic has posed significant challenges to healthcare systems worldwide, particularly impacting the management of critical non-COVID conditions such as myocardial infarction (MI). This review aims to explore the alterations in the management of MI during the pandemic and assess how these changes have influenced patient outcomes. State of Knowledge: Numerous studies have reported delays in MI treatment during the pandemic due to healthcare resource reallocation towards COVID-19 care and patient hesitance in seeking timely medical help. Innovations such as telemedicine have been integrated into patient care to overcome barriers. However, these changes have varied impacts on clinical outcomes, including increased mortality and complication rates among MI patients during the pandemic. This review consolidates findings from recent studies focusing on altered treatment protocols, patient care strategies, and overall health system response during this period. Summary: The management of myocardial infarction during the COVID-19 pandemic has witnessed substantial shifts, leading to both challenges and innovations in cardiac care. While some adjustments have provided temporary solutions, the overall impact on MI outcomes has highlighted the need for more resilient healthcare strategies that ensure the continuity of care for acute cardiac events during global health emergencies.

Dressler syndrome is a form of pericarditis arising from acute injury to the myocardium or pericardium. It manifests within the tenth week post-infarction. It is noteworthy that the myocardial injury preceding the syndrome may result from cardiotomy. Thus, while the general focus is post-infarction, sources also refer to post-cardiotomy syndrome. Its pathophysiology remains uncertain, potentially involving an interaction between the complement system and affected tissue. To date, no pathognomonic signs or consensus criteria exist, posing a substantial challenge for clinicians. Diagnosis necessitates a history of myocardial or pericardial injury, in conjunction with inflammatory markers and electrocardiographic abnormalities; imaging aids in ruling out differentials and complications. Treatment is tailored based on hemodynamic stability and comorbidities. Acquaintance with this syndrome is crucial, as though it often follows a self-limiting course, a high recurrence rate impairs patients’ quality of life.

Kounis syndrome is defined by the appearance of acute coronary events associated to anaphylactic symptoms. The pathophysiological mechanism is still uncertain, however, coronary vasospastic activity secondary to a hy-persensitivity type I response is postulated as a triggering factor. In the con-text of an accident due to a massive bee’s attack, poisoning syndrome also occurs, where the poison components directly damage the myocardium. Kounis syndrome has been reported in SARS-CoV-2 infection, opening the possibility of other mechanisms, among which the cytokine storm stands out. This narrative review aims to consider the mechanisms of damage in Kounis syndrome secondary to poisoning by a massive bee attack and its relationship with the development of short-term complications.

ABSTRACT Introduction and objectives: Ischemic postconditioning (iPost, coronary intermittent re-occlusion maneuvers immediately after PCI-mediated reperfusion) has been proposed to limit infarct size (IS). However, a few experimental and clinical contradictory results have been reported. We hypothesized that iPost cardioprotection is affected by the duration of ischemia. Our objective was to assess IS in the presence/absence of iPost in a pig model of myocardial infarction of variable ischemia duration. Methods: Large white pigs (n = 38) underwent angioplasty balloon-induced coronary ischemia followed by reperfusion. Two set of experiments were carried out: intermediate (30 min) and prolonged (40 min) ischemia. In both, pigs were allocated on a 1:1 ratio to receive iPost (4 cycles of “1 min balloon inflation followed by 1 min deflation” upon reperfusion) or control. Animals underwent contrast-enhanced multiparametric cardiac magnetic resonance scan on day 7. Primary outcome measure was cardiac magnetic resonance-based IS (% of left ventricular mass). The interaction between treatment allocation and ischemia duration was assessed using a 2-way ANOVA test. Results: iPost was not associated with smaller IS in any of the ischemia duration protocols (intermediate ischemia: 0.3% [0.0–3.9] vs 0.9% [0.0–2.6] in iPost and control, respectively; P = .378; long ischemia: 31.1% [27.3–32.8] vs 27.3% [25.1–27.5]; P = .248). When both ischemia-duration protocols were combined, iPost was not associated with smaller IS (3.9% [0.0–30.9] vs 4.6% [0.2–25.1]; P = .672). T1 relaxation times were longer in animals undergoing iPost compared to controls (1306.2 ms [1190.7–1492.7] vs 1240.7 ms [1167.1–1304.5]; P = .024). Conclusions: In a pig model of reperfused myocardial infarction of variable ischemia duration, iPost failed to reduce IS. T1 relaxation times were longer in animals undergoing iPost indicative of the potential harm involved in this procedure.

ABSTRACT Introduction and objectives: Systemic coronary artery embolism is one of the mechanisms of acute myocardial infarction of nonatherosclerotic origin. However, the epidemiological, clinical, and angiographic profile of this entity has not been properly established yet. Our objective was to describe the clinical characteristics, angiographic features, and prognosis of acute coronary syndromes (ACS) due to systemic embolism (ACS-E), compare them to those due to coronary atherosclerosis (ACS-A), and identify predictive clinical factors of ACS-E. Methods: All consecutive patients with ACS—admitted to a tertiary hospital from 2003 through 2018—were classified as ACS-E (n = 40) or ACS-A (n = 4989), and prospectively recruited on a multipurpose database. Results: Patients with ACS-E were younger (27.5% vs 9.6% were < 45 years old, P < .001), more often women (42.5% vs 22.5%, P = .003), and had higher rates of atrial fibrillation (AF) (40.0% vs 5.3%, P < .001), previous stroke (15.0% vs 3.6%, P < .001), active neoplasms (17.5% vs 6.9%, P =.009), and previous valvular surgery (12.5% vs 0.5%, P < .001). Also, a higher proportion of them were on warfarin (27.5% vs 2.9%, P < .001). The most frequent culprit vessel was the left anterior descending coronary artery in both groups. A percutaneous coronary intervention was attempted in all patients with ACS-A, and in 75.0% of those with ACS-E (P < .001) being successful in 99.1% and 80.0%, respectively. The in-hospital all-cause mortality rate was 15.0% regarding ACS-E, and 4.0% in the control group (P < .001). A multivariate analysis was performed to study the independent predictors of ACS-E, identify AF, previous valvular surgery, and active neoplasms, younger age, and female sex. Conclusions: ACS-E and ACS-A have different clinical and angiographic characteristics. Atrial fibrillation, previous valvular surgery, active neoplasms, younger age, and female sex were all independent predictors of ACS-E.

Chest pain is a frequent complaint in the emergency department, and the lack of timely diagnosis of the acute coronary syndrome is associated with high mortality and malpractice lawsuits. There are multiple algorithms to rule out this condition; however, they are designed for institutions with the availability of cardiac biomarkers; In Colombia, few primary care settings have these. This article reviews the tools that have been described in the literature to rule out this diagnosis in the low-complexity emergency department. There are three scales: Vancouver Chest Pain Rule, INTERCHEST, and Marburg Heart Score; the latter has the most evidence with some limitations as it was developed in the context of intermittent and non-acute pain. We propose a diagnostic algorithm including physical findings, electrocardiogram, and prediction scales.

Cardiovascular diseases (CVD) are still the leading cause of death. Environmental factors such as smoking, low physical activity and poor diet have the greatest impact on the incidence of the disease. For patients after a cardiovascular incident, cardiac rehabilitation is the key to recovery. One possible path of rehabilitation is sexual activity (SA). Sexual activities are similar to mild/moderate physical activity during a short period. Most patients are recommended to involve in sexual activity after prior comprehensive evaluation of physical condition. Before involving in sexual activity the general condition of the patient needs to be checked. A useful method for this is a stress testing. The patients with stable cardiac symptoms and good functional capacity are at a low risk of recurrent cardiovascular events, and others require treatment or improvement of heart function. The most efficient way to provide SA is a sexual counseling. Evidence suggests that relatively few cardiac patients receive sexual counseling, which can result in negative outcomes ranging from psychological, physical, and quality of life. Sexual problems and concerns are prevalent, including patient and partner fear of causing another heart attack. It is because people still believe that sexual activity is too risky and they cease all of it. Sexual counseling is needed across health care settings to ensure that patients receive information to safely resume SA.

ABSTRACT Introduction and objectives: There is scarce information available on the long-term outcomes of primary angioplasty (PA) in patients over 80 years of age. Our objective was to analyze the characteristics and results of PA in these patients and recognize the prognostic factors and long-term survival. Methods: Observational and retrospective single-center study of consecutive patients over 80 years of age treated with PA between January 2013 and September 2019. A long-term clinical follow-up was performed (mean follow-up of 29 ± 25 months). Results: The study included 133 patients (mean age 85.3 ± 3.8 years and 57 women [43%]). Seventeen percent of the patients were in Killip class III-IV at admission. The mean Charlson Comorbidity index was 2.3 ± 1.6. During the hospitalization, almost half of the patients developed heart failure and mortality rate was 18%. The overall mortality rate at the follow-up was 23%, yet 97.2% of the deaths were due to non-cardiac causes. The independent predictors of overall mortality at the follow-up were chronic kidney disease (HR, 5.7; 95%CI, 1.29-25.5; P = .022), and a Charlson Comorbidity index > 2 (HR, 2.57; 95%CI, 1.07-6.18; P = .035). Conclusions: Patients over 80 years of age treated with PA have high in-hospital and long-term mortality...

IntroductionA Latin adage says that "good health is better than the greatest wealth." [3] It has been known for a long time that the heart is the most important organ that works continuously throughout life to properly nourish all tissues, and thus determines the proper functioning and health of the entire human body. Meanwhile, despite the development of science, the advancement of diagnosis and treatment techniques, cardiovascular diseases, often leading to a heart attack, are the leading cause of death in most developed countries. [4]. Estimates of the National Centre For Heart Statistic say that 143 million people worldwide suffer from ischemic heart disease. [6]. A past of myocardial infarction, despite the high mortality, also affects the quality of life of patients. According to the definition of the World Health Organization (WHO), quality of life is an individual way in which an individual perceives his or her position in life in relation to the culture and value system in which he or she functions, as well as in the context of expectations, tasks and standards set by environmental determinants. [5]. The medical approach to the quality of life consists in identifying the patient's problems related to his physical, mental and social activity resulting from the disease and the treatment used, as well as describing his views on health and subjective well-being.

Despite the improvement of revascularization procedures, patients with acute coronary syndrome often develop recurrent ischemic events, suggesting a high residual cardiovascular risk in these patients, which requires a strict clinical monitoring as well as an optimal control of modifiable risk factors. To this aim, an optimal management of index event and appropriate preventive measures are equally important. Hospital care by cardiologists should be followed by outpatient management by general practitioners, as established by specific diagnostic and therapeutic pathways, which should warrant an optimal support to the patient. A strict collaboration between hospital and primary care is crucial to monitor and adapt drug therapy after the acute event and improve adherence of the patients to prescribed treatments and implementation of life-style modifications, with benefits also in term of cost-effectiveness. In this context, individualized rehabilitation programs should also be offered to patients with acute coronary syndromes, in order to improve survival and quality of life.

Resumen: Objetivo: Analizar y sintetizar la evidencia sobre el efecto del consumo habitual de café en la aparición de enfermedad cardiovascular. Métodos: Se realizó una evaluación crítica de la literatura basada en metaanálisis y revisiones sistemáticas publicadas en Medline, EMBASE, Cochrane Database of Systematic Reviews y LILACS (enero 1966 a junio 2018). La búsqueda, selección y extracción de información fue llevada a cabo por una pareja de investigadores. La calidad de los manuscritos fue evaluada con AMSTAR. Resultados: Se analizaron cuatro revisiones sistemáticas que consideraron como desenlaces enfermedad coronaria, riesgo cardiovascular e infarto del miocardio; para el primer y segundo desenlace se encontró una reducción del riesgo con consumo de 3-4 tazas/día (RR = 0,90; IC95% 0,84-0,9; p de heterogeneidad = 0,02 y RR = 0,85; IC95% 0,80-0,90; p de heterogeneidad = 0,09); para 1-2 tazas/día (RR = 0,89; IC95% 0,85-0,94; p de heterogeneidad = 0,83 y RR = 0,89; IC95% 0,84-0,94; p de heterogeneidad = 0,09) respectivamente. Para infarto agudo de miocardio se reportó un aumento del riesgo en hombres con consumo de 3-4 tazas/día (OR = 1,75; IC95% 1,44-2,14; p de heterogeneidad = 0,005) y de ≥ 4 tazas/día (OR = 2,01; IC95% 1,7-2,36; p de heterogeneidad

Resumen: Es frecuente la relación entre la adrenalina administrada por vía intramuscular y el desarrollo de cardiopatía isquémica. La adrenalina potencia las hemostasias primaria y secundaria —puede producir trombosis intracoronaria— y causa vasoconstricción transitoria arteriolar. Se presenta un caso clínico de una paciente que acudió a urgencias por dolor torácico pocas horas después de una intervención dentaria. En el estudio posterior se descubrió un infarto de miocardio por trombosis intracoronaria de la descendente anterior distal. Abstract: There is a relationship between adrenaline administered intramuscularly and the development of ischaemic heart disease. Adrenaline promotes primary and secondary haemostasis, which can produce a coronary thrombosis and cause a transient arteriolar vasoconstriction. A case is presented of a patient who was seen in the Emergency Department with chest pain a few hours after dental treatment. In the subsequent work-up, it was discovered that she had a myocardial infarction due to a coronary thrombosis of the left anterior distal artery.

Resumen: Objetivo: : Informar Sobre Un Caso De Infarto Simultáneo Cardio-Cerebral Y Sus Características, Comparado Con Lo Descrito En La Actualidad.Caso Clínico: Paciente Femenina De 64 Años, Con Infarto Simultáneo Cardio-Cerebral (Isquemia En Territorio De Arteria Cerebral Media Derecha Y Elevación Del Segmento St En Cara Antero Inferior), Tratada Con Fibrinólisis Resultados: Evoluciona Con Sensorio Fluctuante, Requiriendo Intubación Orotraqueal Y Manejo En Unidad De Terapia Intensiva Por Sangrado Cerebral Conclusiones: el infarto simultáneo cardio-cerebral es infrecuente y representa un desafío para el equipo de salud a fin de evitar que el manejo temprano de una condición retrase la otra Summary: Objective: To Report On A Case Of Simultaneous Cardio-Cerebral Infarction And Its Characteristics, Compared With What Is Currently Described. Clinical case: a 64-year-old female patient with simultaneous cardio-cerebral infarction (ischemia in the territory of the right middle cerebral artery and elevation of the st segment in the lower anterior aspect), treated with fibrinolysis. Results: it evolves with fluctuating sensory, requiring orotracheal intubation and management in intensive therapy unit due to cerebral bleeding. Conclusions: The Simultaneous Cardio-Cerebral Infarction Is Infrequent And Represents A Challenge For The Health Team In Order To Avoid That The Early Management Of One Condition Delays The Other

Abstract In Mexico, the number of confirmed and estimated cases of COVID-19 has been going up gradually from the second week of March 2020. This directly and indirectly altered the normal care of patients with ischemic heart disease. This is a consensus document achieved by different societies (the Mexican Society of Interventional Cardiology [SOCIME], the Mexican Society of Cardiology [SMC], the Mexican National Association of Cardiologists [ANCAM], the National Association of Cardiologists at the Service of State Workers [ANCISSSTE]), and the Coordinating Commission of National Institutes of Health and High Specialty Hospitals [CCINSHAE]). Its main objective is to guide the decision-making process on coronary revascularization procedures for the management of patients with acute coronary syndrome in catheterization laboratories during the current health emergency generated by the SARS-CoV-2 pandemic.

Almost half of deaths in Poland (approximately 49%) are caused by cardiovascular system diseases. It means that in 2018 it contributed to the death of over two hundred thousand people in our country. Myocardial infarction, stroke and heart failure are the most common of cardiovascular diseases (CVD). The main risk factor for progression of cardiovascular diseases is type 2 diabetes mellitus (T2D). It is estimated that almost 3 million people suffer from T2D in Poland. Metformin is a promising medicine that reduces cardiovascular risk in patients with T2D. It is currently used as the first line drug in patients suffering from T2D. The aim of the presented article is to review current research on the effectiveness of the metformin as a medicine that reduces cardiovascular risk in patients with T2D. Metformin is the oldest and most commonly used medicine that reduces the concentration of glucose in the peripheral blood in patients with T2D. Due to its very good safety profile, low cost and high effectiveness, metformin is used in the first-line treatment for T2D. Recent studies indicate its protective effect by vasodilation, reducing the size of myocardial infarction, inhibiting apoptosis of cardiomyocytes or reducing oxidative stress. Currently, metformin can be seen to have a great potential in the treatment of cardiovascular complications occurring in the course of T2D. Despite the fact that this medicine has been on the market for many years, the studies on its cardioprotective effects have been carried out for a relatively short period of time. It is possible that the detailed understanding of all mechanisms of action of metformin will lead to future advances in the treatment of not only T2D, but also cardiovascular and cancer diseases.

Resumen: Objetivo: Evaluar la factibilidad y los efectos sobre la capacidad funcional de un programa de entrenamiento físico supervisado, aplicado en pacientes con disfunción sistólica severa del ventrículo izquierdo después de infarto agudo de miocardio. Métodos: Se estudiaron 37 pacientes, de ambos sexos y sin límites de edad, con diagnóstico de disfunción sistólica severa del ventrículo izquierdo, después de haber sufrido un infarto agudo de miocardio, que consecutivamente se incorporaron al programa ambulatorio del Centro de Rehabilitación del Instituto de Cardiología.Se hicieron pruebas de esfuerzo máximas limitadas por síntomas con determinación de consumo de oxígeno, ecocardiogramas en reposo y ventriculografías isotópicas en reposo y esfuerzo a los 2, 8 y 18 meses de evolución, y un tiempo medio de seguimiento clínico de 4,1 años. A todos se les prescribió un régimen de entrenamiento físico moderado o intenso, durante un año como mínimo. Se consideró disfunción sistólica severa cuando la fracción de eyección del ventrículo izquierdo fue menor de 35%. Resultados: Todos los parámetros ergométricos que expresaron capacidad funcional incrementaron significativamente en la evaluación del octavo mes (p

The adequacy of recovery processes in myocardial infarction (MI) significantly depends on the state of reactivity of the organism, which, in turn, is determined by the adequacy of neuro-endocrine regulation, in particular, hypothalamic-pituitary-adrenocortical (HPA) and hypothalamic-pituitary-thyroid (HPT) system system.Purpose of the study. To investigate the condition of HPA and HPT in acute experimental MI against the background of different reactivity of the organism.Material and methods. The study was performed on 20 outbred adult dogs weighing 8-12 kg, in which MI was simulated by ligation of the anterior interventricular artery. Animals were divided into three groups (n =5 in each group). The condition of hyperreactivity was caused by the introduction of pyrogenal (group 2), the state of hyporeactivity - the introduction of azothioprine (group 3), in group 1 drugs were not used (state of normoreactivity). In the control group used 5 falsely operated dogs with thoracopericardiotomy. In animals before surgery, on 1, 4, 7, 11 and 15 days in the blood was determined by the content of adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH) , cortisol (Cr), aldosterone (Ald), thyroxine and triiodothyronine. Statistical processing was performed using license packages Statistica 5.5 (Stat Soft Rus), Statistica Neural Networks (Statsoft Inc.).Results. Normoreactive course of myocardial infarction was characterized by primary activation of HPA, which was most pronounced for Cortisol, followed by restoration of ACTH and Aldosterone levels and duration of activation of the central link up to 4 days, peripheral - up to 7-11 days; reciprocal in relation to HPA inhibition of the functional activity of the HPT, most pronounced on the 4th day and lasting up to 15 days. Such changes caused the healing of myocardial infarction through the formation of a full-fledged post-infarction scar. The hyperreactive course of myocardial infarction was characterized by hypersecretion of ACTH with hypercorticism and hyperaldosteronism and less pronounced suppression of HPT with the restoration of its functional activity on the 7th day. The hyporeactive course of myocardial infarction was characterized by a minimally pronounced and delayed up to 4 days activation of HPA with Aldosterone hyposecretion on the 15th day; deep hypothyroidism of both central and peripheral genesis. Impaired reactivity was accompanied by an increase in the area of necrosis and a decrease in the thickness of the heart wall with the formation of postinfarction aneurysm.Conclusions. Desynchronization of necrotic and reparative processes with a change in reactivity leads to a disruption in the relationship between necrosis and repair with the formation of postinfarction aneurysm, which is accompanied by different activities of the HPA and HPT.

ABSTRACT The current COVID-19 outbreak is forcing healthcare workers to continuously reconsider the proper indications for cardiac catheterization. Human and material resources optimization, infection prevention for patients and healthcare workers, and transfer times force a rethink of the previously established protocols. This article is a consensus statement of the Interventional Cardiology Association and the Ischemic Heart Disease Association of the Spanish Society of Cardiology, and aims to provide information to healthcare workers on the indications of diagnostic or therapeutic cardiac catheterization during the current COVID-19 pandemic.

Resumen: Objetivo: describir factores de riesgo y características clínicas, electrocardiográficas y angiográficas de pacientes jóvenes que sufren síndromes coronarios agudos y son llevados a arteriografía coronaria a causa de este diagnóstico. Métodos: estudio retrospectivo, de corte transversal. Se revisaron historias clínicas de pacientes entre 18 y 50 años, con síndrome coronario agudo en una institución de Cardiología Intervencionista en Bucaramanga. Resultados y conclusiones: se identificaron 128 casos, con una mediana de edad de 45 años, y predominancia del género masculino (80,4%). La mediana de tiempo a la consulta fue de 7 horas. El factor de riesgo más frecuente fue el exceso de peso (71,3% de los casos). La mayoría de los casos correspondió a infarto con elevación del segmento ST (44% de los casos). En el 60,9% de los casos se identificó enfermedad coronaria, con 55,1% de enfermedad coronaria multivaso. La intervención de reperfusión más frecuente fue la intervención coronaria percutánea mediante angioplastia coronaria con implantación de stent coronario convencional (60,25% de los casos). La mortalidad intrahospitalaria fue del 2,34%. El exceso de peso como principal factor de riesgo observado plantea la importancia de intervenciones poblacionales dirigidas a controlar su prevalencia. La elevada frecuencia de infartos con elevación del segmento ST y de enfermedad coronaria multivaso llama la atención sobre el riesgo de estos pacientes y la importancia de su atención temprana y diligente. Abstract: Objective: To describe the risk factors and clinical, electrocardiographic, and angiographic characteristics of young adults that suffer from acute coronary syndromes and have been subjected to a coronary angiography due to this diagnosis. Methods: A retrospective, cross-sectional study was performed by reviewing the clinical records of patients between 18 and 50 years-old with an acute coronary syndrome in a Interventional Cardiology institution in Bucaramanga, Colombia. Results and conclusions: A total of 128 cases were identified, with a median age of 45 years, and the large majority (80.4%) male. The median time in the clinic was 7 hours. The most frequent risk factor was overweight (71.3% of cases). The majority of cases corresponded to an infarction with elevated ST segment (44% of cases). Coronary disease was identified in 60.9% of cases, and 55.1% with multiple vessel coronary disease. The most frequent reperfusion treatment was percutaneous coronary intervention by means of coronary angioplasty with the implantation of a conventional coronary stent (60.25% of cases). The in-hospital mortality was 2.34%. The excess weight as the main risk factor observed, shows the importance of population interventions directed at controlling its prevalence. The increased frequency of infarctions with elevated ST segment and multiple vessel coronary disease highlights the risk of these patients, and the importance of their early and rapid care.

The methods used to diagnose cardiovascular diseases are constantly being improved, leading to an expanded perception of the diagnostic value of biomarkers and their new diagnostic possibilities. One striking example are the main biomarkers used to diagnose acute myocardial infarction: cardiac troponins. The first methods for determining cardiac troponins (proposed 30 years ago) were characterized by extremely low sensitivity. Therefore, they could only detect large acute myocardial infarctions. These methods were also characterized by low specificity, expressed as a high probability of cross-reactivity with skeletal troponin isoforms, which generated false-positive results in the presence of skeletal myopathies and skeletal muscle lesions. With the introduction of high-sensitivity cardiac troponins into clinical practice, the possibility of early diagnosis and exclusion of acute myocardial infarction by assessing troponin concentrations in the first few hours (from admission to the first hour, second hour, or third hour) has become more specific. Our knowledge about cardiac troponins has changed over the years and promising new medical uses have emerged. This paper reviews current data on the diagnostic value of cardiac troponins, the main methods used for their determination, and their analytical characteristics from historical and modern insights.

Introduction and Objectives: The present study sought to establish the diagnostic yield of cardiovascular magnetic resonance (CMR) in a large cohort of patients admitted with myocardial infarction (MI) with nonobstructive coronary artery disease (MINOCA) based on the timing of referral to CMR., Methods: Consecutive patients referred to CMR from January 2009 to February 2022 with a working diagnosis of MINOCA were retrospectively evaluated. Cine, T 2 -weighted, early, and late gadolinium-enhanced images were acquired and analyzed. The frequency of the underlying diagnosis and the association between timing of CMR and relative frequency of each diagnosis were assessed., Results: We included 207 patients (median age 50 years, 60% men). Final diagnosis after CMR was achieved in 91% of the patients (myocarditis in 45%, MI in 20%, tako-tsubo cardiomyopathy in 19%, and other cardiomyopathies in 7%). The performance of CMR within 7 days of admission with MINOCA (median, 5 days; 117 patients) allowed a higher diagnostic yield compared with CMR performed later (median, 10 days; 88 patients) (96% vs 86%, P=.02). Although myocarditis was the most frequent diagnosis in both groups according to time to CMR, its frequency was higher among patients with a CMR performed within the first 7 days (53% vs 35%, P=.02). The frequency of other underlying diagnoses was not influenced by CMR timing., Conclusions: CMR led to an underlying diagnosis of MINOCA in 91% of patients and its diagnostic yield increased to 96% when CMR was performed within 7 days of admission. The most frequent diagnosis was myocarditis.., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Multivessel percutaneous coronary intervention (MV-PCI) is recommended in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD) without cardiogenic shock. The present network meta-analysis investigated the optimal timing of MV-PCI in this context., Methods: We pooled the aggregated data from randomized trials investigating stable STEMI patients with multivessel CAD treated with a strategy of either MV-PCI or culprit vessel-only PCI. The primary outcome was all-cause death. The main secondary outcomes were cardiovascular death, myocardial infarction, and unplanned ischemia-driven revascularization., Results: Among 11 trials, a total of 10 507 patients were randomly assigned to MV-PCI (same sitting, n=1683; staged during the index hospitalization, n=3460; staged during a subsequent hospitalization within 45 days, n=3275) or to culprit vessel-only PCI (n=2089). The median follow-up was 18.6 months. In comparison with culprit vessel-only PCI, MV-PCI staged during the index hospitalization significantly reduced all-cause death (risk ratio, 0.73; 95%CI, 0.56-0.92; P=.008) and ranked as possibly the best treatment option for this outcome compared with all other strategies. In comparison with culprit vessel-only PCI, a MV-PCI reduced cardiovascular mortality without differences dependent on the timing of revascularization. MV-PCI within the index hospitalization, either in a single procedure or staged, significantly reduced myocardial infarction and unplanned ischemia-driven revascularization, with no significant difference between each other., Conclusions: In patients with STEMI and multivessel CAD without cardiogenic shock, multivessel PCI within the index hospitalization, either in a single procedure or staged, represents the safest and most efficacious approach. The different timings of multivessel PCI did not result in any significant differences in all-cause death. This study is registered at PROSPERO (CRD42023457794)., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Myocardial infarction (MI) incidence and case fatality trends are highly informative but relatively untested at the population level. The objective of this work was to estimate MI incidence and case fatality in the Girona population aged 35-74 years, and to determine their 30-year trends (1990-2019)., Methods: The REGICOR (Girona Heart Registry) monitored MI incidence and case fatality rates from 1990 to 2008. For the period 2008 to 2019, we linked discharges from Girona hospitals (n=4 974 977) and mortality registry (n=70 405) during this period. Our linkage algorithm selected key MI diagnostic codes and removed duplicates. Estimates from the linkage algorithm and the REGICOR registry were compared using chi-square tests for overlapping years (2008-2009). We estimated the annual percent change (APC) of standardized MI incidence and 28-day case fatality, and analyzed their trends using joinpoint regression., Results: MI incidence and case fatality estimates were similar in the linkage algorithm and the REGICOR registry. We observed significant decreasing trends in the incidence of MI. The trend was APC, -0.96% (95% confidence interval (95%CI), -1.4 to -0.53) in women from 1990 to 2019 and -4.2% (95%CI, -5.5 to -3.0) in men from 1994 to 2019. The largest decrease in case fatality was -3.8% (95%CI, -5.1 to -2.5) from 1995 to 2003 in women and -2.4% (95%CI, -2.9 to -1.9) from 1995 to 2004 in men, mainly due to prehospital case fatality declines: -1.8% (95%CI, -2.6 to -1.1) in men and -3.2% (95%CI, -4.6 to -1.8) in women., Conclusions: In Girona, MI incidence and case fatality decreased between 1990 and 2019. The incidence showed a slow but continuous decrease while case fatality only stabilized in the last decade, particularly in women., (Copyright © 2023. Published by Elsevier España, S.L.U.)

Introduction. Half of deaths in Poland are caused by cardiovascular diseases. Such a high percentage causes them to rank first among the causes of death. According to the Polish Cardiac Society, acute coronary syndromes are the reason for hospitalization of 140,000 people annually, including myocardial infarction of 90,000 people each year [4]. In addition to sudden cardiac deaths, cardiovascular disease is also a major cause of hospitalization, as well as permanent or temporary disability, both physical and mental. This condition has consequences in the form of, among others, inability to work, which leads to the gradual development of social disability [7]. The multitude and variety of problems faced by patients determines the need to recognize and eliminate them.The aim of the study is to present the required scope of patient care after myocardial infarction, based on individual case study.A case report. A 82-year-old patient admitted to hospital after losing consciousness while working in the garden. The ECG showed myocardial ischaemia without visible ST segment elevation. Coronary angiography in the hemodynamic laboratory revealed stenosis of the left coronary artery, which was cleared by the introduction of a vascular stent. An individual care plan has been developed for the patient in accordance with the problems encountered.Conclusions. Patients after myocardial infarction have numerous nursing problems, which require professional actions performed by a nurse, which results in minimizing the problems and their consequences. Thanks to these activities, the patient and his immediate surroundings are prepared to continue providing care in the home environment.

Introduction Despite the advancement of medicine in the field of diagnostics and treatment of myocardial infarction, the annual mortality rate exceeds 40%, which is why it is still being strived to develop better and more specific markers of myocardial damage, which would allow for faster diagnosis and thus would improve the prognosis in this group of patients. Objective The objective of the study was to assess the relationship between the platelet with distribution (PDW) and plateletcrit (PCT) and the occurrence of myocardial infarction. Results People who suffered from a heart attack had higher PLT and PCT values than those who did not. Conclusions Author study research has not confirmed the relationship between PDW and PCT and the occurrence of myocardial infarction. Keywords: myocardial infarction

A 86-year old female patient with hypertension was admitted to emergency due to chest pain, dyspnea, hypotension and bradycardia with confusional symptoms. The electrocardiogram and the laboratory are compatible with acute non-Q myocardial infarction, with a left ventricular ejection fraction of 20% in the ultrasound, with pericardial effusion and hyperechoic mass compatible with a clot. The diagnosis was a low cardiac output due to an evolutive non-Q myocardial infarction with myocardial rupture. The patient required endotracheal intubation and mechanical ventilation, evolved with cardiac arrest and was resuscitated without success. The diagnosis and timely management of cardiac rupture is discussed as a mechanical complication of acute myocardial infarction. DOI:10.25176/RFMH.v19.n2.2076

Background: There is no national registry on dyslipidemia and low-density lipoprotein cholesterol (LDL-c) goals by risk groups for atherosclerotic cardiovascular disease (ACVD) focused on beneficiaries of the Mexican Institute for Social Security (IMSS)., Objective: To determine the frequency of dyslipidemia, LDL-c goals and patients in treatment from high and very high-risk groups of ACVD., Material and Methods: Multicenter, cross-sectional, descriptive study. This article derives from the Mexican Registry of Dyslipidemias in patients at high-risk and very high-risk of atherosclerotic cardiovascular disease (REMEXDIS-IMSS Project). Patients with high-risk and very high-risk criteria for ACVD were included., Results: From July 2022 to March 2023, 6000 patients were included (3289 patients in the high-risk group and 2771 in the very high-risk group). The frequency of dyslipidemia was observed in 49% of the cohort. The very high-risk group presented a higher percentage of dyslipidemia in 66.8%, acute myocardial infarction in 81.0% and angina pectoris in 21.9%. The use of statins was higher in this group (93.3%) and the LDL-c goal was achieved in 72.9% (p < 0.0001)., Conclusions: The frequency of dyslipidemia is found in almost half of the population. The very high-risk group had a higher frequency of dyslipidemia, better use of statins for indication of secondary prevention, and a greater number of patients with LDL-c goals compared to the high-risk group., (Licencia CC 4.0 (BY-NC-ND) © 2024 Revista Médica del Instituto Mexicano del Seguro Social.)

Background: Mexico is the country with the highest mortality from acute myocardial infarction (AMI), which is why guidelines have been established for early reperfusion in which fibrinolysis is the second most accessible method. However, there is a percentage of patients who do not achieve acceptable myocardial perfusion and this is associated with adverse cardiovascular outcomes. Different adenosine schemes have been used as an adjuvant to restore adequate myocardial perfusion., Objective: To compare the final angiographic flow in patients undergoing pharmacoinvasive percutaneous coronary intervention (PCI) with the use of intracoronary adenosine versus patients without its use., Material and Methods: Single-center, prospective, longitudinal, single-blind study carried out in patients with AMI, thrombolyzed, with reperfusion data, sent to a tertiary care center from March 2022 to June 2023, randomized to receive intracoronary adenosine previous to intervention. Drug-eluting stents were placed in all patients. Initial and final angiographic flow was compared., Results: 33 patients were included, randomized 1:1 to control and intervention groups. 75.8% of the participants were male. The most frequent artery responsible for the infarction was the anterior descending (63.6%). An average of 350 mcg of intracoronary adenosine was used in the intervention group, and the most frequent complication in both groups was the presence of no-reflow phenomenon., Conclusions: Due to the small sample size, it is not possible to conclude the usefulness of adenosine for improving final angiographic flow in pharmacoinvasive PCI. More adverse effects were reported in the intervention group, without a significant statistical difference., (Licencia CC 4.0 (BY-NC-ND) © 2024 Revista Médica del Instituto Mexicano del Seguro Social.)

In this letter to the editor are highlighted the results of the article "Clinical characteristics of patients with acute myocardial infarction treated with thrombolysis". To this, it was carried out a comparative analysis between genders using the data reported by the authors and the finding was that mortality in women is higher. It was used Pearson's chi-square, and the results were statistically significant: p = 0.038, corrected chi-square p = 0.07. Given that the proportion of women is typically lower in reported series in the literature, these data are relevant despite the small sample size., (Licencia CC 4.0 (BY-NC-ND) © 2024 Revista Médica del Instituto Mexicano del Seguro Social.)

Objective: to describe a patient with myocardial ischemia with multiple causes., Clinical Case: This clinical case describes a 58-year-old man with a history of hypertension, dyslipidemia, COPD and previous myocardial infarction (AMI). He went to the emergency room with chest pain and dyspnea. Findings included bibasal crackles, electrocardiogram with old anterior fibrosis, elevated NT-ProBNP, and echocardiogram with septoapical akinesia. During hospitalization, he experienced tachyarrhythmia and hemodynamic deterioration, undergoing electrical cardioversion (CVE). Non-ST segment elevation acute coronary syndrome (NSTEACS) complicated with ventricular arrhythmia and acute pulmonary edema was diagnosed. Coronary angiography revealed coronary ectasias without obstructive lesions, but with mild stenosis in three vessels. The patient was successfully treated with non-invasive ventilation, diuretics, vasodilators and anticoagulation. The discharge was granted with the plan to further studies to optimize and guide treatment and finally the diagnosis of Myocardial Infarction with Non-Obstructive Arteries (MINOCA) and the presence of coronary ectasias was addressed., Conclusion: it is important to highlight the non-ischemic causes in MINOCA and the association between coronary ectasia and cardiovascular events, which is why we emphasize the need for more studies to better understand the relationship between these phenomena., (Universidad Nacional de Córdoba)

Introduction and Objectives: Clinical and experimental studies have shown that, in patients with reperfused ST-segment elevation myocardial infarction (STEMI), abnormalities in the endothelial monolayer are initiated during ischemia but rapidly intensify upon restoration of blood perfusion to the ischemic area. We aimed to evaluate the effect of serum isolated after revascularization from STEMI patients on the degree of endothelial permeability in vitro, by promoting endothelial cell apoptosis and necrosis in vitro. We also investigated the association between the percentage of serum-induced endothelial cell apoptosis or necrosis in vitro and the extent of cardiovascular magnetic resonance (CMR)-derived parameters of reperfusion injury (edema, hemorrhage, and microvascular obstruction)., Methods: Human coronary artery endothelial cells were incubated with serum isolated 24hours after revascularization from 43 STEMI patients who underwent CMR and 14 control participants. We assessed the effect of STEMI serum on activation of apoptosis and necrosis, as well as on the permeability and structure of the endothelial monolayer., Results: Serum from STEMI patients increased apoptosis (P <.01) and necrosis (P <.05) in human coronary artery endothelial cells and caused increased permeability of the endothelial monolayer in vitro (P <.01), due to enlarged intercellular spaces (P <.05 vs control in all cases). Higher serum-induced necrosis was associated with greater endothelial permeability in vitro (P <.05) and with more extensive CMR-derived indices of reperfusion injury and infarct size., Conclusions: Postreperfusion serum activates necrosis and apoptosis in endothelial cells and increases the degree of endothelial permeability in vitro. The more potent the necrosis-triggering effect of serum, the more deleterious the consequences in terms of the resulting cardiac structure., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

ABSTRACT Objectives: to describe the Adult's perception of healthcare after Myocardium Infarction. Methods: qualitative descriptive analysis carried out with 12 adults who had myocardial infarction and conducted from February to May 2018. The research design was based on the “Consolidated Criteria for Reporting Qualitative Research”. Data collection was performed through semi-structured questionnaire, interview script and field diary. The interviews were encoded, and their content was analyzed using software support. Results: three classes were obtained: “Fear, (un) certainty and (un) awareness”; “Lifestyle and beliefs of illness” and “Health care search”. Unhealthy lifestyle habits, lack of health prevention / promotion, difficulties in accessing services and lack of knowledge about the disease generated fear and uncertainty about the future. Final Considerations: the perception of acute myocardial infarction is related to the trajectory of illness, lifestyle and the belief that the infarction only affects others.

Background: echocardiography is the standard investigation to assess patients with heart failure due to acute coronary syndromes. The scientific literature makes dereference to the prognostic value of left atrial remodeling in this context.Objective: to assess the utility of left atrial measures and the association with adverse events in patients with acute heart failure due to acute coronary syndrome treated at the “Dr. Ernesto Guevara de la Serna” General Teaching Hospital of Las Tunas, Cuba, from January 2017 to March 2018.Methods: an observational, analytical case-control study was carried out, 1:5, with patients diagnosed with acute heart failure and acute coronary syndrome, treated at the aforementioned institution and during the period herein declared. By deliberate sampling, 66 patients, divided into 11 cases and 55 controls, were selected. Epidemiological and echocardiographic variables were assessed. Descriptive statistics and bivariate analysis were used.Results: senile patients represented 78,8 %, the male sex predominated. High blood pressure was present in 82,7 %. Mortality was above the results of international studies. The most frequent adverse events were malignant ventricular arrhythmias. High atrial volumes presented good associations with the onset of adverse events. The area of the left atrial enlargement presented poor statistical significance.Conclusions: in the sample of patients with acute heart failure due to acute coronary syndrome, the study sowed that the increased left atrial volume may be an echocardiographic predictor of risk of adverse events.

Fundamento: el choque cardiogénico es la forma más grave de insuficiencia cardíaca aguda y la principal causa de muerte en pacientes con infarto agudo del miocardio. En Cuba ha existido un descenso de la mortalidad por insuficiencia cardiaca aguda, pero se reportan tasas aún por encima de lo reportado para América Latina.Objetivo: actualizar algunos aspectos relacionados con la perspectiva histórica, definición, clasificación, epidemiología y fisiopatología del choque cardiogénico.Métodos: se realizó una revisión utilizando recursos disponibles en internet, en sitios como: IntraMed, PubMed, Cochrane Library, Sciencdirect, Clinicalkey, Archivos Mexicanos de Cardiología, Revista Cubana de Cardiología y Cirugía cardiovascular, Revista Cubana de Medicina Intensiva y Emergencias y la revista Circulation, entre otros, utilizando estrategias de búsqueda con términos afines definidos en los descriptores en ciencias de la salud.Resultados: el choque cardiogénico está caracterizado por una reducción global en la entrega de oxígeno a los tejidos, debido a una reducción en el gasto cardiaco, pero la fisiopatología evoluciona con la progresión del choque hacia un fenotipo hemodinámico análogo al choque séptico. La restauración temprana y efectiva de la entrega de oxígeno, limitando la toxicidad asociada a inotropos y catecolaminas, para evitar este fenotipo, merecen investigaciones más profundas. El tratamiento farmacológico dirigido a la manipulación de la microcirculación en la utilización del oxígeno celular también puede resultar fructífero en el tratamiento del choque cardiogénico avanzado.Conclusiones: la literatura evidencia que el choque cardiogénico sigue siendo la complicación más temida y mortal de un infarto agudo de miocardio. Se estudian nuevas opciones terapéuticas.

Myocardial infarction with non-obstructive coronary arteries is a new definition and clinical manifestation that includes multiple cardiac conditions. The importance in its recognition and search of the etiology lies in the long-term prognosis given the higher incidence of major cardiovascular events. Therefore, the differentiation of other clinical causes of elevation of cardiac biomarkers and a detailed diagnostic approach based on clinical history and complementary studies are fundamental to define treatment, follow-up and impact on the evolution of patients.

The description of stenocardial ailments was presented for the first time in 1772. Until the 1950s, the patients suffering from myocardial infraction were treated with the wait-and-see attitude – they were confined to bed for 6 weeks, were not allowed to eat or to take up everyday activities on their own. It was as late as in the 1960 it was discovered that being immobilised for too long may be harmful and lead to the increase of the clotting/embolism complications. The first issue of Harrison’s Principles of Internal Medicine was released in 1950 which advised the oxygen therapy, as well as pharmacotherapy (nitro-glycerine, anticoagulants) used in the severe phase of myocardial infraction. One on the breaking moments on the path of the development of care considering the patient with myocardial infraction was the introduction of CCU (Desmond Julian, 1961).

The coexistence of acute ischemic stroke and acute myocardial infarction is rare. The reperfusion therapy used in the therapeutic window is the golden standard in the treatment of both diseases. We present a case of successful aspiration thrombectomy circumflex anterior artery and effective mechanical thrombectomy of the right internal carotid artery in a 49 - year-old female patient with myocardial infarction and ischemic stroke. When admitted in a neurological examination she received 16 points. on the NIHSS scale. The patient was discharged from the clinic as an independent, with slight hemiparesis (NIHSS 4 points). The result of recanalization was 3 points in the TICI scale. After intravascular treatment, the patient was advised to use anticoagulant therapy due to arterial thrombosis in two vascular areas and a high probability of thrombophilia until complete diagnostics. During the hospitalization, cardiovascular diseases were diagnosed. Transesophageal echocardiography showed a left-right flow through Botallio foramen width of 3 mm, with no visible reversal of leakage after contrast administration. After 3 months, tests were performed that did not confirm thrombophilia. The question of closing the surviving Botallio foramen, re-performing Holter and further genetic testing remains to be considered.

The aim of this study was evaluation of the impact of complex cardiac rehabilitation on the improvement of exercise tolerance of patients after myocardial infarction. Material and methods: Sixty patients after myocardial infarction underwent cardiac rehabilitation (physical activities, cardio-respiratory exercise, education). Their heart rate, blood pressure, energy expenditure and duration of exercise tolerance test were evaluated. Results: Resting heart rate was slightly reduced and exercise heart rate increased as a result of cardiac rehabilitation. Blood pressure did not change significantly after rehabilitation. Energy expenditure was changed from 5.74 MET before rehabilitation to 7.56 MET after it. Duration of exercise tolerance test was changed from 5.07 min. To 7.34 min. Conclusion: Myocardial infarction causes significant reduction of exercise tolerance of the patient. After cardiac rehabilitation resting heart rate does not change and exercise heart rate increases as well as energy expenditure and duration of exercise tolerance test. As a result of cardiac rehabilitation exercise tolerance of patients after myocardial infarction increase.

ABSTRACT OBJECTIVE To evaluate the performance of the Mobile Emergency Medical Services (SAMU) in the ABC Region, using myocardial infarction as tracer condition. METHODS The analysis of interrupted time series was the approach chosen to test immediate and gradual effects of the intervention on the study population. The research comprised adjusted monthly time series of the hospital mortality rate by myocardial infarction in the period between 2000 and 2011. Data were extracted from the Mortality Information System (SIM), using segmented regression analysis to evaluate the level and trend of the intervention before and after its implementation. To strengthen the internal validity of the study, a control region was included. RESULTS The analysis of interrupted time series showed a reduction of 0.04 deaths per 100,000 inhabitants in the mortality rate compared to the underlying trend since the implementation of the Emergency Medical Services (p = 0.0040; 95%CI: −0.0816 – −0.0162) and a reduction in the level of 2.89 deaths per 100,000 inhabitants (p = 0.0001; 95%CI: −4.3293 – −1.4623), both with statistical significance. Regarding the control region, Baixada Santista, the difference in the result trend between intervention outcome and post-intervention control of −0.0639 deaths per 100,000 inhabitants was statistically significant (p = 0.0031; 95%CI: −0.1060 – −0.0219). We cannot exclude confounders, but we limited their presence in the study by including control region series. CONCLUSIONS Although the analysis of interrupted time series has limitations, this modeling can be useful for analyzing the performance of policies and programs. Even though the intervention studied is not a condition that in itself implies effectiveness, the latter would not be present without the former, which, integrated with other conditions, generates a positive result. SAMU is a strategy that must be expanded when formulating and consolidating policies focusing on emergency care.

Introduction: Transient ischemic attack (TIA) is a reversible episode of neurologic deficit, that symptomatically can be similar to stroke, but lasts shorter than 24 hours and does not cause any radiological changes in brain images. TIA is a major risk factor for subsequent ischemic stroke. Fahr’s syndrom is a rare, genetically conditioned incidence of calcified deposits in basal ganglia and cerebral cortex. Case report: A 68-year-old female patient was admitted to the Department of Neurology due to an incident of left limbs weakness and left mouth angle drop. The symptoms lasted 5 minutes. The initial brain CT revealed no acute ischemic foci, although the radiologist found characteristic features of Fahr’s syndrome. Carotid ultrasound showed stenosis of right internal carotid artery. The patient experienced an ischemic stroke in 6th day from initial symptoms. 4 days later a myocardial infarction occurred as well. Discussion: TIA is a major prognostic factor for an ischemic stroke with the greatest risk of incidence in the first week after initial symptoms. Proper imaging diagnostics and prophylactic treatment with aspirin and statins should be administered. Patients after TIA incident should stay under watchful neurological supervision during the first 3 months after the attack.

Introduction: Health education in a holistic approach consists in motivating and stimulating the sick and healthy people to learn to strengthen their own health, responsibility for their own health and shaping a healthy lifestyle. Contemporary education is focused on self-observation and self-care, these are the basic forms of health care. In everyday life, people undertake activities that strengthen the pursuit of health through: lifestyle, avoiding life-threatening situations, comfort in the biopsychosocial area, the use of therapeutic methods and rehabilitation. Sudden cardiac arrest is a condition which directly threatens life, and there is a cessation of cardiac mechanical activity. This Life-threatening condition occurs when one ceases to function properly with the systems responsible for maintaining vital functions. Aim .: Presenting the role of nurses in the care of patients after cardiac arrest in the course of myocardial infarction and the need for education to prevent recurring health risks. Material and method: The method applied was that case study. Conclusions: The main problem of the patient after cardiac arrest were as follows- the possibility of re-cardiac arrest, shortness of breath, discomfort due to immobilization, depressed mood. During the nursing actions should eliminate the factors influencing the development of complications that can lead to death. The role of nurses is patient education aimed at improving the quality of life and reduce the risk of recurrence of cardiac arrest. Nursing care of the patient after cardiac arrest requires nurses to constantly extend knowledge, excellence and knowledge of the latest guidelines. Sudden cardiac arrest is a major challenge for modern medicine and should increase the scope of research on this issue

Introduction: A sudden cardiac arrest is a condition, which directly threatens life, and there is a cessation of cardiac mechanical activity. This Life-threatening condition occurs when one ceases to function properly with the systems responsible for maintaining vital functions. Purpose .: Presenting the role of nurses in the care of patients after cardiac arrest in the course of myocardial infarction. Material and method: The method applied was that case study. Conclusions: The main problem of the patient after cardiac arrest were as follows- the possibility of re-cardiac arrest, shortness of breath, discomfort due to immobilization, depressed mood. During the nursing actions should eliminate the factors influencing the development of complications that can lead to death. The role of nurses is patient education aimed at improving the quality of life and reduce the risk of recurrence of cardiac arrest. Nursing care of the patient after cardiac arrest requires nurses to constantly extend knowledge, excellence and knowledge of the latest guidelines. Sudden cardiac arrest is a major challenge for modern medicine and should increase the scope of research on this issue.

In this new edition of the Clinical and Epidemiological Round, the reader will be able to find four articles that we consider of special interest for current clinical practice. Abuzaid A., et al, performed a systematic review and meta-analysis comparing the outcomes of oxygen therapy vs. no-oxygen therapy in post-acute myocardial infarction settings. Freund Y., et al, present a non-inferiority cluster clinical trial in which they seek to prospectively validate the safety of a strategy based on clinical criteria to rule out pulmonary embolism. Also, using a retrospective cohort with propensity score matching study, Pasternak et al intend to investigate whether the use of oral fluoroquinolone is associated with an increased risk of aortic aneurysm or dissection. Finally, the SMART investigators group assess, through a pragmatic randomized clinical trial in critically ill patients, the impact of balanced crystalloids versus saline in the risk of developing major renal events.

In this edition of the clinical and epidemiological round, we analyzed four articles which we have considered relevant to the clinical practice. Spaite et al. studied for the first time in the medical literature the truly prognosis value of a hypotensive threshold in the reanimation of the patient with moderate to severe traumatic brain injury. Oluwalana et al. assessed the impact of oral administration of azithromycin during delivery on the risk of maternal and neonatal infections. On the other hand, Esplin et al. evaluated the accuracy of the transvaginal cervical length and serial fetal fibronectin, alone or in combination, to predict spontaneous preterm birth in nulliparous pregnant women. Finally, the FOURIER group’s study assessed the effect of the reduction on LDL cholesterol levels achieved through evolocumab administration, in patients with clinically-evident cardiovascular disease which have a statin optimized therapy, on the composite outcome of cardiovascular death, stroke, myocardial infarction and need of hospitalization due to unstable angina or coronary revascularization.

Objective: To evaluate the feasibility of performing a hemodynamic stratification in patients with ST segment elevation acute myocardial infarction using transthoracic echocardiography. Materials and methods: A descriptive, prospective and cross-sectional study that included 30 patients in sinus rhythm with ST segment elevation acute myocardial infarction, admitted to the coronary care unit of Hospital Edgardo Rebagliati Martins. Cardiac output, left ventricle filling pressure, systemic vascular resistance and pulmonary vascular resistance were estimated. Results: The mean age was 67 ± 10.6 years old, with male predominance (86.7%). The estimation of cardiac output and left ventricle filling pressure was possible in 100% of the individuals. The systemic vascular resistance and pulmonary vascular resistance could be estimated in 29 (96.6%) and 28 (93.3%) patients, respectively. The hemodynamic stratification was as follows: stage I (normal): 18 patients (60%), stage II (congestive): 6 patients (20%), stage III (hypovolemia, RV infarction): 5 patients (16.7%) and stage IV (shock): 1 patient (3.3%). Conclusions: It is concluded that a transthoracic chocardiographic hemodynamic stratification may be performed in the studied population.

We present a case of acute coronary syndrome with ST-segment elevation (ACS-STEMI) and spontaneous dissection of the right coronary artery, as evidenced by coronary angiography in a male patient, previously submitted to primary angioplasty with a stent implantation 3 years ago.

Objective: To identify in the nursing literature the health care systems used by individuals going through myocardial infarction.Method: Integrative review conducted in five national and international databases from 2007 to 2017. In the review, 398 studies were identified and 13 were analyzed according to the classification of the health care systems into formal and informal.Results: Health care was impacted by values, beliefs and social norms constructed throughout the lives of the individuals, and which guide the search for different health care systems during the acute episode of infarction, with emphasis to the informal system structured by the individuals’ families and community.Conclusion: The understanding of health care systems by nursing professionals facilitates the elaboration of educational health actions and the management of care to patients going through myocardial infarction.

ABSTRACT Objective: To elaborate a terminological subset for the International Classification for Nursing Practice (ICNP®) for patients with acute myocardial infarction using the Activities of Living Model. Method: A methodological study which followed the guidelines of the International Nursing Council and was based on theoretical framework of the Activities of Living Model for its elaboration. Content validation was performed by 22 nursing specialists. Results: Twenty-two (22) diagnoses and 22 nursing outcomes were elaborated. Of these, 17 nursing diagnosis statements and 17 nursing outcome statements presented Content Validity Index (CVI) ≥ 0.80. Of the 113 elaborated nursing interventions, 42 reached a CVI ≥ 0.80, and 51 interventions made up the terminological subset after the expert suggestions. Conclusion: The ICNP® was suitable for use with the Activities of Living Model, having compatible terms with those used in clinical nursing practice, and valid for construction of the terminological subset for patients with acute myocardial infarction and most likely to facilitate clinical nursing judgment.

The treatment of ST-segment elevation myocardial infarction has barriers depending on the geographic region. Primary coronary angioplasty is the treatment of choice, if it is performed on time and by experienced operators. However, when it is not available, the administration of fibrinolysis and referral for rescue angioplasty, in case of negative reperfusion, is the best strategy. In the same way, coronary angioplasty, as part of a pharmacoinvasive strategy, is the best alternative when there is positive reperfusion. The development of infarct treatment networks increases the number of patients reperfused within the recommended times and improves outcomes. In Latin America, national myocardial infarction treatment programs should focus on improving outcomes, and long-term success depends on working toward defined goals and enhancing functionality, therefore programs should develop capacity to measure their performance. The following document discusses all of these alternatives and suggests opportunities for improvement.

Background: The debate on percutaneous coronary intervention (PCI) of the unprotected left main coronary artery (LMCA) has been constant over time., Objective: To investigate the clinical and procedural characteristics and cardiovascular outcomes of PCI of unprotected LMCA., Material and Methods: Observational study which included patients with unprotected LMCA disease undergoing PCI; patients with cardiogenic shock prior to the procedure were excluded. We describe the clinical and angiographic characteristics, as well as the major adverse cardiac and cerebrovascular events (MACCE) according to the year of the procedure., Results: We included 73 patients, with a SYNTAX I score of 31.2 ± 9.1, mostly with ST-elevation acute coronary syndrome (35%). There was a higher frequency of triple vessel coronary disease (63%) and distal LMCA lesions (35%). The provisional stent technique was the most used for distal lesions (58%) and the 2-stent technique for bifurcation lesions (78%), supported by intravascular ultrasound (IVUS) in 38%. During follow-up, 19 presented MACCE (26%), out of which cardiac death occurred in 13%, non-cardiovascular death in 5%, non-fatal acute myocardial infarction in 1%, cerebrovascular event in 2%, and revascularization of the treated vessel in 4%., Conclusions: It was observed a similar frequency to the one appearing in other studies of cardiovascular events, mainly in patients with intermediate risk, which supports the increasing use of percutaneous intervention in this population., (Licencia CC 4.0 (BY-NC-ND) © 2024 Revista Médica del Instituto Mexicano del Seguro Social.)