Murry et al in 1986 discovered the intrinsic mechanism of profound protection called ischemic preconditioning. The complex cellular signaling cascades underlying this phenomenon remain controversial and are only parti...Murry et al in 1986 discovered the intrinsic mechanism of profound protection called ischemic preconditioning. The complex cellular signaling cascades underlying this phenomenon remain controversial and are only partially understood. However, evidence suggests that adenosine, released during the initial ischemic insult, activates a variety of G protein-coupled agonists, such as opioids, bradykinin, and catecholamines, resulting in the activation of protein kinases, especially protein kinase C(PKC). This leads to the translocation of PKC from the cytoplasm to the sarcolemma, where it stimulates the opening of the ATP-sensitive K+ channel, which confers resistance to ischemia. It is known that a range of different hypoglycemic agents that activate the same signaling cascades at various cellular levels can interfere with protection from ischemic preconditioning. This review examines the effects of several hypoglycemic agents on myocardial ischemic preconditioning in animal studies and clinical trials.展开更多
Patients with coronary artery disease vary widely in terms of prognosis, which is mainly dependent on ventricular function. In relation to the major outcomes of death and myocardial infarction, it is not clear in the ...Patients with coronary artery disease vary widely in terms of prognosis, which is mainly dependent on ventricular function. In relation to the major outcomes of death and myocardial infarction, it is not clear in the literature if an invasive strategy of myocardial revascularization is superior to a conservative strategy of optimized medical therapy. Moreover, with the exception of patients with left main coronary disease, this similarity in prognosis also occurs in different subgroups of patients.展开更多
Thrombolytic therapy is indicated to the treatment of patients with ST-elevation myocardial infarction or pulmonary embolism. Its indication should especially consider the risk of bleeding, but other complications mig...Thrombolytic therapy is indicated to the treatment of patients with ST-elevation myocardial infarction or pulmonary embolism. Its indication should especially consider the risk of bleeding, but other complications might pose harm to patients. Although rarely reported, fibrinolysis can trigger thromboembolic phenomena from emboligenic sources such as aortic aneurysms. Clinicians should be aware of this life-threatening complication. In this case report, we present one patient admitted due to a ST-segment elevation acute myocardial infarction successfully treated with fibrinolytic treatment, but who evolved with a massive microembolism from an abdominal aortic aneurysm. Despite intensive medical care, the patient evolved with multiorganic failure due to distal microembolism to the guts and lower limbs, severe rhabdomyolysis and ultimately to death. In this challenging case, clinical, anatomical and histopathologic features are presented and discussed.展开更多
文摘Murry et al in 1986 discovered the intrinsic mechanism of profound protection called ischemic preconditioning. The complex cellular signaling cascades underlying this phenomenon remain controversial and are only partially understood. However, evidence suggests that adenosine, released during the initial ischemic insult, activates a variety of G protein-coupled agonists, such as opioids, bradykinin, and catecholamines, resulting in the activation of protein kinases, especially protein kinase C(PKC). This leads to the translocation of PKC from the cytoplasm to the sarcolemma, where it stimulates the opening of the ATP-sensitive K+ channel, which confers resistance to ischemia. It is known that a range of different hypoglycemic agents that activate the same signaling cascades at various cellular levels can interfere with protection from ischemic preconditioning. This review examines the effects of several hypoglycemic agents on myocardial ischemic preconditioning in animal studies and clinical trials.
文摘Patients with coronary artery disease vary widely in terms of prognosis, which is mainly dependent on ventricular function. In relation to the major outcomes of death and myocardial infarction, it is not clear in the literature if an invasive strategy of myocardial revascularization is superior to a conservative strategy of optimized medical therapy. Moreover, with the exception of patients with left main coronary disease, this similarity in prognosis also occurs in different subgroups of patients.
文摘Thrombolytic therapy is indicated to the treatment of patients with ST-elevation myocardial infarction or pulmonary embolism. Its indication should especially consider the risk of bleeding, but other complications might pose harm to patients. Although rarely reported, fibrinolysis can trigger thromboembolic phenomena from emboligenic sources such as aortic aneurysms. Clinicians should be aware of this life-threatening complication. In this case report, we present one patient admitted due to a ST-segment elevation acute myocardial infarction successfully treated with fibrinolytic treatment, but who evolved with a massive microembolism from an abdominal aortic aneurysm. Despite intensive medical care, the patient evolved with multiorganic failure due to distal microembolism to the guts and lower limbs, severe rhabdomyolysis and ultimately to death. In this challenging case, clinical, anatomical and histopathologic features are presented and discussed.
