Predicting apical hypertrophic cardiomyopathy using T-wave inversion:Three case reports

BACKGROUND Apical hypertrophic cardiomyopathy(AHCM)is a subtype of hypertrophic cardiomyopathy.Due to its location,the thickening of the left ventricular apex can be missed on echocardiography.Giant negative T waves(GNTs)in left-sided chest leads are the hallmark electrocardiogram(ECG)change of AHCM.CASE SUMMARY The first patient was a 68-year-old woman complaining of recurrent chest tightness persisting for more than 3 years.The second was a 59-year-old man complaining of spasmodic chest tightness persisting for more than 2 years.The third was a 55-year-old woman complaining of recurrent chest pain persisting for 4 mo.In all three cases,GNTs were observed several years prior to apical cardiac hypertrophy after other causes of T-wave inversion were ruled out.CONCLUSION Electrophysiological abnormalities of AHCM appear earlier than structural abnormalities,confirming the early predictive value of ECG for AHCM.

Entire process of electrocardiogram recording of Wellens syndrome:A case report

BACKGROUND Wellens syndrome is an electrocardiogram(ECG)pattern seen in high-risk patients with unstable angina pectoris.It is characterized by inverted or biphasic T-waves that change into positive or pseudo-normalized waves at precordial leads when the patient experiences an angina attack;however,the mechanism for this condition remains unclear.CASE SUMMARY A 47-year-old male patient experienced repeated,unprovoked episodes of chest pain for>20 d,with worsening during the previous day.On the day of admission,he experienced episodes of paroxysmal chest pain lasting more than 30 min,in addition to radiating pain to the left arm and exertional dyspnea.The patient presented to the emergency department with no chest pain or other discomfort at that time.ECG at presentation showed sinus tachycardia and Twave changes,which were identified as Wellens syndrome when combined with previous ECG findings.ECGs and myocardial enzymology examinations were normal when angina was present,but the ECG showed inverted or biphasic Twaves when angina was absent.After percutaneous coronary intervention,the ECGs demonstrated inverted or biphasic T-waves in the anterior precordial leads on days 0,1,and 2,but normal T-waves on day 3.The ECGs showed no subsequent ischemic ST-T-wave changes.CONCLUSION The Wellens syndrome pseudo-normalized T-waves likely reflect development of unstable angina pectoris into the hyperacute phase of ST-segment elevation myocardial infarction.

Effect of clearing heat and detoxification method on macrophages polarization in patients with acute myocardial infarction and heat toxin syndrome after intervention

Objective:To evaluate the effect of heat-clearing and detoxifying method on the macrophages polarization in patients with acute myocardial infarction with heat toxin syndrome after intervention.Methods:Sixty patients with acute myocardial infarction and undergoing percutaneous coronary intervention with heat toxin syndrome were randomly divided into a control group and a test group with 30 cases each.The control group was given conventional treatment,and the test group was given Huanglian Jiedu Decoction,the representative of the method of clearing heat and detoxification,orally on the basis of the control group.The intervention time of both groups was 2 weeks.Comparing The Seattle Angina Pectoris Scale(SAQ)before and after treatment,creatine kinase(CK),creatine kinase MB isoenzyme(CKMB),high-sensitivity troponin I(hs-TnI),and Lipoprotein-associated phospholipaseA2(LPPLA_2)),the phenotype ratio of M1 and M2 macrophages,and observe the adverse reactions.Results:After treatment,the SAQ scores of the two groups of patients were improved,and the levels of CK,CK-MB,hs-TnI,and LP-PLA_2 decreased significantly.The scores of AS,AF,TS,and DP in the SAQ of the test group were all higher than those of the control group,and the hs-TnI and LP-PLA_2 were better than those of the control Group(P<0.05 or P<0.01).After treatment,the proportion of M1 type macrophages in the two groups of patients'macrophages decreased significantly(P<0.05 or P<0.01),the ratio of M2 type macrophages increased(P<0.05),and the M1/M2 ratio decreased.The ratio of M1/M2 in the test group of the control group was significantly lower than that of the control group(P<0.01).There were no obvious adverse reactions in both groups.Conclusions:The method of clearing heat and detoxifying has a definite effect on patients with acute myocardial infarction of heat toxin syndrome after interventional operation.It can reduce myocardial damage,improve myocardial function,and reduce inflammation.And it is safe for clinical treatment without any increasing risk of bleeding or other risk of cardiovascular events.