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Editor-in-Chief: Dario Galante

Website: http://www.sciepub.com/journal/AJCDR

   

Article

“Requiring Intravenous Nitroglycerin” Should be considered a High Risk Feature in Patients with Non-ST Elevation Myocardial Infarction and Unstable Angina

1Department of Medicine, Harlem Hospital Center in affiliation with Columbia University Medical Center New York, NY 10037

2Division of Cardiology, Department of Medicine, Harlem Hospital Center in affiliation with Columbia University Medical Center New York, NY 10037


American Journal of Cardiovascular Disease Research. 2015, 3(1), 9-12
doi: 10.12691/ajcdr-3-1-3
Copyright © 2015 Science and Education Publishing

Cite this paper:
Olusegun Sheyin, Melissa Fajardo, Oladapo Igandan, Bredy Pierre-Louis. “Requiring Intravenous Nitroglycerin” Should be considered a High Risk Feature in Patients with Non-ST Elevation Myocardial Infarction and Unstable Angina. American Journal of Cardiovascular Disease Research. 2015; 3(1):9-12. doi: 10.12691/ajcdr-3-1-3.

Correspondence to: Olusegun  Sheyin, Department of Medicine, Harlem Hospital Center in affiliation with Columbia University Medical Center New York, NY 10037. Email: oas2120@columbia.edu

Abstract

Introduction: Early risk stratification of patients with unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI) is crucial to identify those at high risk for further cardiac events as they may benefit from an early invasive strategy of coronary angiography and revascularization. The TIMI score, a widely used predictive model to guide management strategy in UA and NSTEMI may not accurately stratify risk. Case description: A 63-year-old man, who is an active smoker with past medical history of hypertension and dyslipidemia, presented with severe sub-sternal, crushing chest pain, which began four hours prior to presentation. His EKG revealed sinus tachycardia, without ST segment deviations or Q waves. He received aspirin, three doses of sublingual nitroglycerin and metoprolol, but continued to have chest pain, thus he was commenced on intravenous nitroglycerin infusion. His chest pain went away after two hours on nitroglycerin infusion. His initial serum troponin I was 0.31 ng/mL and 3.60 ng/mL four hours after presentation. He was admitted for NSTEMI and started on clopidogrel, atorvastatin and intravenous heparin. Echocardiogram revealed inferio-septal wall a kinesis and severely reduced left ventricular systolic function. His troponin I continued to rise, peaking at 37.4 ng/mL. He was started on eptifibatide and was referred for coronary angiography and percutaneous coronary intervention, with finding of fifty percent proximal and distal left anterior descending artery (LAD) lesions. Discussion: With a TIMI score of 2, our patient was classified as low risk at presentation. The need for intravenous nitroglycerin infusion for continuing chest pain in the management of UA or NSTEMI may suggest a greater degree of myocardial ischemia and a higher risk for adverse cardiovascular outcomes. This case demonstrates that UA and NSTEMI patients requiring intravenous nitroglycerin initially planned for conservative therapeutic approach need continuous risk stratification which may dictate a change to the invasive management strategy.

Keywords

References

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Article

The Metabolic Syndrome in Offspring of Women with a Family History of Early Onset Type 2 Diabetes Mellitus Who Developed Gestational Diabetes Mellitus

1Department of Basic Medical Sciences, Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica


American Journal of Cardiovascular Disease Research. 2016, 4(1), 1-6
doi: 10.12691/ajcdr-4-1-1
Copyright © 2016 Science and Education Publishing

Cite this paper:
R Irving. The Metabolic Syndrome in Offspring of Women with a Family History of Early Onset Type 2 Diabetes Mellitus Who Developed Gestational Diabetes Mellitus. American Journal of Cardiovascular Disease Research. 2016; 4(1):1-6. doi: 10.12691/ajcdr-4-1-1.

Correspondence to: R  Irving, Department of Basic Medical Sciences, Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica. Email: rachael.irving@uwimona.edu.jm

Abstract

Objective: To evaluate for the metabolic syndrome (MS) in offspring of women with family history of early onset type 2 diabetes mellitus (T2DM) who developed gestational diabetes mellitus (GDM) using as controls offspring of women with no family history of diabetes and normal glucose tolerance (NGT). Methods: Anthropometric and biochemical measurements were evaluated for 30 offspring age 10-16 years of women with family history of early onset T2DM who developed GDM. Obstetrical records of these mothers were also noted. Thirty offspring of women (30) with NGT and no family history of diabetes served as controls. Measurements included: Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), fasting and postprandial glucose, insulin, waist circumference, weight and height. For analyses, MS was defined as ≥3 of 4 features: glucose intolerance, dyslipidemia, obesity and hypertension in the childhood/adolescence criteria as recommended by the National Cholesterol Education Program Adult Treatment Panel Third (NCEP-ATP III) modified standard. Cox regression analysis was used to determine the independent hazard (risk) of developing MS attributable to GDM with a family history of early onset T2DM. Results: Offspring of women with GDM and family history of early onset T2DM had significantly more (≥ 2, p<0.05) features of MS than offspring of women with NGT and no family history of diabetes. Thirty percent (30.0%), 29.5% and 39.0% of the offspring of these GDM women had glucose intolerance, obesity and dyslipidemia respectively. These offspring had a hazard of 3.33 (95% CI: 2.12-9.15) of having MS compared to offspring of women with NGT and no family history of diabetes. Conclusion: Offspring of women with GDM and family history of early onset T2DM are at increased risk for MS.

Keywords

References

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Article

Severe Cardiomyopathy from Limb Girdle Muscular Dystrophy: A Nidus for a Catastrophic Cascade

1Department of Medicine, Overlook Medical Center, Summit, NJ, USA

2Department of Cardiology, Morristown Medical Center, Morristown, NJ, USA


American Journal of Cardiovascular Disease Research. 2016, 4(1), 7-10
doi: 10.12691/ajcdr-4-1-2
Copyright © 2016 Science and Education Publishing

Cite this paper:
Glenmore Lasam, Jenny Lam. Severe Cardiomyopathy from Limb Girdle Muscular Dystrophy: A Nidus for a Catastrophic Cascade. American Journal of Cardiovascular Disease Research. 2016; 4(1):7-10. doi: 10.12691/ajcdr-4-1-2.

Correspondence to: Glenmore  Lasam, Department of Medicine, Overlook Medical Center, Summit, NJ, USA. Email: glenmore_md@yahoo.com

Abstract

We report a case of a 57-year-old female with Limb Girdle Muscular Dystrophy (LGMD) who initially presented to her outpatient physician a year ago with progressive shoulder and pelvic girdle muscle weakness associated with slight limitation of movement, gradual onset of easy fatigability, intermittent episodes of exertional dyspnea, and trace bipedal edema. On the day of admission, she had sudden onset of unresponsiveness due to massive cerebral infarct likely cardioembolic as evidenced by left ventricular thrombus, in the setting of severe cardiomyopathy associated from LGMD. The patient was treated with hemodynamic support and systemic anticoagulation but did not show any signs of neurologic improvement. Comfort care measures were initiated, eventually, the patient succumbed to death.

Keywords

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