Severe Hypokalemia ECG Changes Mimicking Those of Acute Coronary Syndrome (ACS) in Patient with Underlying Ischaemic Heart Disease: A Case Review

Background: Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potassium level below 2.5 mmol/L [1]. Patient with hypokalemia can present with wide range of presentation including musculoskeletal complaints from numbness to acute paralysis. Severe hypokalemia has tendency to progress to intestinal paralysis and respiratory failure. In some cases of hypokalemia, cardiovascular system can also be affected causing cardiac arrhythmias and heart failure [2]. Aim: This case report is to highlight that severe hypokalaemia can present with ECG changes mimicking acute coronary syndrome (ACS) which was fully resolved with correction of potassium level. Methods: We report a case of 84 years old Chinese man with underlying triple vessel disease presented with generalised body weakness for 2 days. ECG on arrival noted changes suggestive of ACS with ST segment depression in lead V4-V6 with first degree heart block, however patient had no ischemic symptoms and the potassium level was severe low at 1.6 mmol/L (3.5 - 5.1 mmol/L). He was correctly not treated for ACS. Outcomes: Repeated ECG post fast intravenous potassium correction noted complete resolution of the ST segment depression and first degree heart block. Patient discharged well from hospital four days later with potassium level of 3.8 mmol/L. Conclusions: Severe hypokalemia with asymptomatic ECG of ACS changes can safely be treated as a single entity clinical emergency with good resolution and no complication after normalizing potassium level.

Effect of Low-Intensity Pulsed Ultrasound on Ischaemic Heart Disease Patients (Novel Technique)

Ischaemic Heart Disease (IHD) or Coronary heart disease means that the heart is not getting enough blood and oxygen supply through the coronary arteries. The most common cause of this disease is the process of atherosclerosis in the coronary arteries. Although significant progress has been made in the management of ischaemic heart disease (IHD) The number of severe IHD patients is increasing. The treatment options for IHD have not changed much over the last three decades, which is divided between medications, coronary Angioplasty and Coronary artery bypass surgery. Thus it was crucial to develop new, non-invasive therapeutic strategies in case of Failure of medical or interventional therapy or in case patient is not fit for surgery or angioplasty. In this study, we are pleased to reveal a novel technique that was carried out on a human model. We aimed to develop low-intensity pulsed ultrasound (LIPUS) therapy for the treatment of patients with Ischaemic Heart Disease. We have set up the inclusion and exclusion criteria, the treatment protocol of LIPUS on IHD patients. In this limited group of IHD patients, We found promising clinical results and improvement on myocardial functions.

Current role and future perspectives of cardiac rehabilitation in coronary heart disease

Ischaemic heart disease(IHD)is a major cause of morbidity and mortality worldwide.While there have been major advances in this field,these patients are still a higher risk subgroup.As such,strategies to mitigate risk and tailor secondary prevention measures are of the utmost relevance.Cardiac rehabilitation(CR),encompassing several domains including exercise training,cardiovascular risk factor optimization,nutritional and psychological assessments,as well as other ancillary interventions has shown to be one of the pillars in the contemporary management of patients with IHD.Indeed,CR is associated with several benefits in this population,ranging from functional capacity to improvements in outcomes.Whilst this,there are still several issues concerning the optimal application of CR which are still not fully ascertained,such as lack of referral and completion,as well as questions related to programme design(particularly among patients with multiple comorbidities).In this review,we aim at presenting a pragmatic overview on the current role of CR in the management of individuals with IHD,while also discussing some of the caveats in the current data,as well as future concepts which could help improve the uptake and personalization of this pivotal time-tested intervention.

Is the Mortality Trend of Ischemic Heart Disease by the GBD2013 Study in China Real?

To determine the reason for the different mortality trends of ischemic heart disease （IHD） for China between Global Burden of Disease （GBD） 2010 and GBD2013, and to improve garbage code （GC） redistribution. All data were obtained from the disease surveillance points system, and two proportions for assigning chronic pulmonary heart disease （PHD） as GC to IHD were from GBD2010 and GBD2013,

Are women more susceptible to ischemic heart disease compared to men? A literature overview

Ischemic heart disease(IHD) is known as the leading cause of death in both genders. Moreover, significant sex differences were found in cardiac structure, function, pathophysiology, presentation, treatment, and outcome of IHD. The presence of unique risk factors such as exposure to menarche and pregnancy, more anemia, hypertension, and autoimmune disorders in women have recently received attention. Ischemic symptoms are more indefinite and vague in women compared to men as well as a delay in diagnosis, treatment, and worse outcomes compared to men. Women usually receive less evidence-based treatment and intervention, with less concern on preventive health care. Clinical trials primarily recruit male patients and women are underrepresented. Without any correct diagnosis, treatment, and prevention, these problems are accumulated and continue up to older age. Accordingly, with the belief of longer life in women and the increased prevalence of IHD with aging, it will become an important public health problem and concern in the future. This narrative review aimed to provide an overview of some of the differences between the two genders in terms of IHD with paying more attention to practical points.

内质网应激(ERS)在缺血性心脏病(IHD)中的作用机制

内质网应激(endoplasmic reticulum stress,ERS)与缺血性心脏病(ischemic heart disease,IHD)的发生和治疗有着密切的关系。进入21世纪之后,ERS作为IHD的重要机制受到各国学者的广泛关注。本文着重阐述以下三方面的研究进展:ERS激活的信号通路、内质网应激反应(ERS response,ERSR)范围内ERS对细胞保护作用的信号通路及超出ERSR范围后ERS对细胞损伤作用的信号通路,并在此基础上经过分析提出4条治疗IHD的思路。

Testosterone and cardiovascular disease in men

Despite regional variations in the prevalence of coronary artery disease （CAD）, men are consistently more at risk of developing and dying from CAD than women, and the gender-specific effects of sex hormones are implicated in this inequality. This ＇Perspectives＇ article reviews the current evidence regarding the cardiovascular effects of testosterone in men including an examination of the age-related decline in testosterone, the relationship between testosterone levels and coronary disease, coronary risk factors and mortality. We also review the vaso-active effects of testosterone, and discuss how these have been used in men with heart failure and angina. We discuss the ＇cause＇ versus ＇effect＇ controversy, regarding low testosterone levels in men with coronary heart disease, as well as concerns over the use of testosterone replacement therapy in middle aged and elderly men. The article concludes with a discussion regarding the future direction for work in this interesting area, including the relative merits of screening for, and treating hypogonadism with testosterone replacement therapy in men with heart disease.

Empirical anticoagulation for patients in sinus rhythm at high risk of ischaemic stroke:A review of current literature

Ischaemic stroke is one of the commonest causes of morbidity and mortality worldwide and around a fifth of events can be attributed to a cardioembolic source. This is typically due to atrial fibrillation(AF), the most common sustained cardiac arrhythmia. However, AF can, at times, be difficult to detect due to a relative lack of symptoms and the fact that it can be paroxysmal in nature. Studies have shown that diagnosis of AF improves as the length of cardiac monitoring increases. However, prolonged cardiac monitoring is not a costeffective way of diagnosing AF. Therefore, an alternative approach may be to empirically anticoagulate individuals who are at high risk of stroke. This article summarises current evidence surrounding stroke risk prediction, the use of anticoagulation in the secondary prevention of stroke and its use in the primary prevention of stroke in high risk groups with the aim of determining whether empirical anticoagulation is a safe and effective strategy.

缺血性心脏病促血管生成治疗方法的研究进展

缺血性心脏病(IHD),也称为冠心病,是由冠状动脉狭窄或阻塞引起的一组疾病。治疗IHD诱导血管生成和血管重建至关重要。近年来研究表明,外泌体可以通过促进血管生成,从而减轻心肌缺血再灌注损伤,抑制纤维化和促进心脏再生等作用,对IHD具有保护作用。促血管生成的研究可能为IHD的治疗提供新的选择。该文对IHD促血管生成治疗方法的研究进展作一综述。

慢性阻塞性肺疾病并发肺外系统疾病调查

目的近年来,国外大量研究发现,慢性阻塞性肺疾病（COPD）常合并其他系统性疾病,如冠心病、高血压病和糖尿病。国内尚缺乏这方面的资料分析。本研究目的是调查北京2所医院的COPD患者合并冠心病、高血压病或糖尿病的患病率。方法分析了2007年1月-2009年5月间因慢性阻塞性肺疾病（COPD）急性发作住院的患者468例。冠心病诊断条件是根据既往有心肌梗死病史或冠状动脉造影提示冠状动脉狭窄。结果全部468例COPD患者,男性319例,女性149例,年龄70.6±9.2岁,FEV147.7%±18.9%预计值。单纯COPD有214例（45.7%）,COPD合并肺外疾病有254例（54.3%）,其中冠心病73例（15.6%）,高血压病200例（42.7%）,糖尿病80例（17.1%）。高血压是COPD并发冠心病的危险因素[odds ratio（OR）：3.163,95%可信区间（95%CI）：1.431-6.991];年龄（OR：1.042,95%CI：1.012-1.073）和体质指数（OR：1.122,95%CI：1.049-1.200）是COPD并发高血压的危险因素;C反应蛋白（OR：1.020,95%CI：1.005-1.034）和体质指数（OR：1.163,95%CI：1.062-1.274）是COPD并发糖尿病的危险因素。结论 COPD并发其他疾病在国内也很常见,年龄、体质指数和CRP是其高危因素。

老年缺血性心脏病患者组织因子组织因子途径抑制物比值的变化及意义

目的观察老年缺血性心脏病（IHD）患者血浆组织因子（TF）、组织因子途径抑制物（TFPI）比值的变化及意义。方法选择IHD患者135例分为急性冠状动脉综合征（ACS）组97例[其中急性心肌梗死（AMI）组52例，不稳定型心绞痛（uA）组45例]；稳定型心绞痛（SA）组38例。正常对照组50例。采用ELISA法对所有纳入对象进行血浆TF、TFPI测定分析，比较各组间TF、TFPI比值表达的差异。结果AMI组和UA组TF、总TFPI（t-TFPI）[（263．14±114．98）ng／L和（102．07±27．43）μg/L]和[（258．73±110．12）ng／L和（96．86±23．08）μg/L]、全长TFPI（fl-TFP1）[（59．18±19．78）μg/L和（53．164-18．10）μg/L]及TF/截短TFPI（tr-TFPI）[（0．16±0．23）％和（0．59±0．24）％]、fl—TFPI／t-TFPI[（0．58±0．17）和O．55±O．15]的表达均较SA组[（201．41±101．36）ng／L、（87．02±17．85）μg/L、（36．44±10．21）μg/L、（0．42±0．15）％及0．42±0．10]和正常对照组[（192．89±91．36）ng／L、（86．98±21．34）μg/L、（31．62±11．23）μg/L、（0．35±0．14）％及0．36±0．11]明显增高（P〈0．05），tr-TFPI／t-TFPI、tr-TFPI／n-TFPI又明显低于SA组和正常对照组（P〈0．05）；tr-TFPI、TF／fl—TFPI在AMI组低于SA和正常对照组，而在UA组仅低于正常对照组（P〈0．05），与SA组比较差异无统计学意义（P〉0．05）。结论ACS患者发作期血液呈高凝状态，导致血栓形成风险增加；在血栓事件发生过程中血浆TF与tr—TFPI的平衡起着关键作用。

2012ESC《ST段抬高急性心肌梗死治疗指南》解读

本指南对写作过程中所有该领域可利用的证据进行总结和评估,为协助医师在日常实践中对每个不同情况的患者选择最佳诊断或治疗方案。和其他学会及组织一样,欧洲心脏学会(ESC)近年来发表并定期更新了大量指南。

雷诺嗪对缺血心肌的保护作用及其研究进展

雷诺嗪是一个新型的心血管治疗药物,其作用机制同其抑制心肌细胞动作电位中的晚期钠离子流有关。雷诺嗪能有效抑制晚钠内流,进而缓解心肌缺血,改善心脏舒缩功能和遏止相关心律失常的发生,临床研究表明雷诺嗪可提高运动耐量,减少心绞痛发作次数,减少硝酸甘油用量。雷诺嗪尚有抗心律失常和改善心脏收缩及舒张功能的作用。

终末期肾病患者发生缺血性心脏病的危险因素分析

目的探讨终末期肾病患者发生缺血性心脏病的危险因素。方法选取终末期肾病患者102例，根据缺血性心脏病确认标准分为缺血性心脏病组52例，无缺血性心脏病组50例。记录两组患者年龄、性别、原发病、透析龄，同时记录血生化指标血尿酸、血红蛋白、血浆白蛋白、总蛋白、胆固醇、甘油三酯、低密度脂蛋白、血钙、血磷、全段甲状旁腺素（iPTH）、25-（OH）D、尿素氮和肌酐水平。结果缺血性心脏病组血浆总蛋白、白蛋白（28．13±1．07比35．44±1．08）、血红蛋白（80．63±3．24比96．54±4．51）、血肌酐、25-（OH）D（9．31±0．64比15．22±1．09）水平均低于无缺血性心脏病组（P〈0．05或P〈0．01）；而年龄、血胆固醇、尿酸（484．27±26．34比365．22±20．76）水平则明显高于无缺血性心脏病组（P〈0．01）。二分类Logistic回归分析显示，血浆白蛋白、胆固醇、血红蛋白、血尿酸、25-（OH）D可能是终末期肾病患者发生缺血性心脏病的危险因素。结论缺血性心脏病是终末期肾病患者常见的并发症之一，血脂异常、营养不良、贫血、高血尿酸、低血25-（OH）D是终末期。肾病患者发生缺血性心脏病的重要危险因素。

干细胞治疗缺血性心脏病的主要问题

干细胞治疗是缺血性心脏病治疗的一种新的治疗策略,是心血管疾病治疗研究的前沿。国内外大量研究显示出细胞移植能够修复受损心肌,减少梗死面积,改善心脏功能。但目前细胞治疗仍处于早期阶段,各种问题尚待解决,如种子细胞类型的选择、细胞分化、梗死区细胞存活、最佳移植途径、安全性等问题还需深入探讨。为此,现总结前期干细胞治疗基础及临床研究结果,就目前存在的问题进行阐述。

扩张型心肌病的临床分析

目的：探讨近年来扩张型心肌病（DCM）的临床表现特点及预后。方法：对2005年1月-2009年12月入院治疗的DCM患者140例的病吏、诊治过程、随访结果进行回顾性分析。结果：140例不同0功能级别的DCM患者中，123例（87．8％）出现各种心律失常，包括0房颤动32例（23．3％），多源室性期前收缩44例（31．1％），短阵室性心动过速56例（40．0％），左束支传导阻滞28例（20．o％）。结论：DCM患者确诊时心功能多已达Ⅲ-Ⅳ级，伴有各种心律失常及心腔扩大；2年和5年生存率较以往已有改善，心力衰竭和猝死仍是主要死亡原因；2．9％的患者为家族性DCM，起病年龄较轻，预后较差。

心肌细胞晚钠离子流与心血管疾病

近年来的研究证明,心肌细胞膜钠通道晚钠离子流(晚/Na)与心血管疾病,尤其与缺血性心脏病及其相关疾病状态的发生、发展密切相关。晚/Na抑制剂雷诺嗪能有效抑制晚/Na内流,进而缓解心肌缺血,改善心脏舒缩功能和遏止相关心律失常的发生。目前为止,除众多基础研究的证据外,尚有雷诺嗪治疗慢性缺血性心脏病临床试验的证据。现就晚/Na与缺血性心脏病及其相关疾病,如稳定型心绞痛、心功能不全和心律失常的关系及雷诺嗪心血管保护作用的研究进展做一综述。

MG53蛋白的研究进展

近年来发现mitsugumin 53(MG53)蛋白是广泛表达于心肌和骨骼肌tripartite motif的家族成员之一。它可以通过与微囊蛋白-3结合后形成复合物进而与磷酸肌醇3-激酶的P85亚基结合激活再灌注损伤补救酶通路,借此参与缺血前处理和缺血后处理的心肌保护作用,减轻心肌缺血再灌注损伤。最新研究发现,MG53蛋白还可通过与胰岛素受体1结合后导致泛素依赖的胰岛素受体表达下降,最终导致胰岛素抵抗和代谢综合征。现介绍了MG53蛋白既有对心肌细胞的修复作用,与此同时,又会诱发胰岛素抵抗,这有望为冠心病和代谢综合征的治疗提供新的靶点。

中药复方改善老年人慢性冠脉缺血的心电学研究

目的 探讨老年冠脉缺血者心电图QTcd与健康老年人相比有无显著差异及自主研制的复方黄芪袋泡饮能否改善这种差异。方法 对比分析冠脉缺血组 31例和健康老年组 33例QTcd测定值 ,并比较复方黄芪袋泡饮治疗冠脉缺血组前后的QTcd和血液流变学测值变化。结果 冠脉缺血组QTcd值显著大于健康老年对照组 (t=6 .91,P <0 .0 1) ,复方黄芪袋泡饮治疗冠脉缺血组后的QTcd值较治疗前显著缩短 (t=5 .31,P <0 .0 1) ,该药能明显降低血液粘度 (P <0 .0 1) ,使冠脉缺血症状改善率达 90 %。结论 老年冠脉缺血者心电图QTcd值较健康老年人显著延长 ,复方黄芪袋泡饮能够改善这种异常延长。

心血管磁共振成像对扩张型心肌病和缺血性心脏病诊断及鉴别诊断中的价值分析

目的分析心血管磁共振成像(CMRI)对鉴别诊断扩张型心肌病(DCM)及缺血性心脏病(IHD)的价值。方法选择梅州市人民医院2015年10月—2018年7月收治的95例伴有左心室扩大及左心收缩功能减低的患者作为研究对象,按照疾病类型将其分成两组,其中DCM组54例,IHD组41例。所有患者均行CMRI检查,大多数患者同时行冠状动脉造影或冠脉CTA检查,观察患者的诊断结果。结果不同年龄的两组患者左心扩大情况及左心室射血分数存在差异,有统计学意义(P<0.05)。两组患者心脏磁共振延迟强化部位及形式各有特点,可为鉴别诊断提供有利证据。结论针对DCM患者及IHD患者实施心血管磁共振成像鉴别诊断的价值较高,能为患者的临床治疗提供参考及依据。