BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular ...BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.展开更多
Following surface rupture observations in populated areas affected by the KahramanmaraşEarthquake(Mw 7.7)on February 6th,2023,along the Pazarcık segment of the East Anatolian Fault Zone(EAFZ),this study presents novel...Following surface rupture observations in populated areas affected by the KahramanmaraşEarthquake(Mw 7.7)on February 6th,2023,along the Pazarcık segment of the East Anatolian Fault Zone(EAFZ),this study presents novel insights into physical criteria for delineating surface fault-rupture hazard zones(SRHZs)along ruptured strike-slip faults.To achieve this objective,three trench studies across the surface rupture were conducted on the Pazarcık segment of the EAFZ to collect field data,and earthquake recurrence intervals were interpreted using Bayesian statistics from previously conducted paleoseismological trenchings.The results of the proposed model indicate that the Pazarcık segment produced five significant surface-rupturing earthquakes in the last∼11 kyr:E1:11.13±1.74 kyr,E2:7.62±1.20 kyr,E3:5.34±1.05 kyr,E4:1.82±0.93 kyr,and E5:0.35±0.11 kyr.In addition,the recurrence intervals of destructive earthquakes on the subject in question range from 0.6 kyr to 4.8 kyr.Considering that the last significant earthquake occurred in 1513,the longest time since the most recent surface fault rupturing earthquake on this particular segment was 511 years.These results indicate that,in terms of the theoretical recurrence interval of earthquakes that can create surface ruptures on the Pazarcık segment,the period in which the February 6,2023,earthquake occurred was within the end of the expected return period.As a result,the potential for a devastating earthquake in the near future is not foreseen on the same fault.Finally,the SRHZ proposed for the Pazarcık section of Gölbaşıvillage was calculated as a 61-meter-wide offset on the fault lineament to reduce the negativities that may occur in the ruptured area in the future.It is recommended to take into account this width in the settlement of this area and nearby areas.展开更多
BACKGROUND Myocardial infarction,particularly ST-segment elevation myocardial infarction(STEMI),is a key global mortality cause.Our study investigated predictors of mortality in 96 STEMI patients undergoing primary pe...BACKGROUND Myocardial infarction,particularly ST-segment elevation myocardial infarction(STEMI),is a key global mortality cause.Our study investigated predictors of mortality in 96 STEMI patients undergoing primary percutaneous coronary intervention at Erbil Cardiac Center.Multiple factors were identified influencing in-hospital mortality.Significantly,time from symptom onset to hospital arrival emerged as a decisive factor.Consequently,our study hypothesis is:"Reducing time from symptom onset to hospital arrival significantly improves STEMI prognosis."AIM To determine the key factors influencing mortality rates in STEMI patients.METHODS We studied 96 consecutive STEMI patients undergoing primary percutaneous coronary intervention(PPCI)at the Erbil Cardiac Center.Their clinical histories were compiled,and coronary evaluations were performed via angiography on admission.Data included comorbid conditions,onset of cardiogenic shock,complications during PPCI,and more.Post-discharge,one-month follow-up assessments were completed.Statistical significance was set at P<0.05.RESULTS Our results unearthed several significant findings.The in-hospital and 30-d mortality rates among the 96 STEMI patients were 11.2%and 2.3%respectively.On the investigation of independent predictors of in-hospital mortality,we identified atypical presentation,onset of cardiogenic shock,presence of chronic kidney disease,Thrombolysis In Myocardial Infarction grades 0/1/2,triple vessel disease,ventricular tachycardia/ventricular fibrillation,coronary dissection,and the no-reflow phenomenon.Specifically,the recorded average time from symptom onset to hospital arrival amongst patients who did not survive was significantly longer(6.92±3.86 h)compared to those who survived(3.61±1.67 h),P<0.001.These findings underscore the critical role of timely intervention in improving the survival outcomes of STEMI patients.CONCLUSION Our results affirm that early hospital arrival after symptom onset significantly improves survival rates in STEMI patients,highlighting the critical need for prompt intervention.展开更多
文摘BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.
基金This contribution was partially supported by the Turkish government through the 1002-C project in Natural Disasters Focused Fieldwork Emergency Support Program managed by the TUBITAK.I am grateful to F.Koçbulut and S.Koşaroğlu for helping me with the trenching studies.I also gratefully acknowledge H.Sözbilir,M.Nas,and E.Akgün for comments and suggestions.Furthermore,I extend my gratitude to the anonymous referees for their constructive criticisms and insightful feedback during the evaluation phase of this manuscript.
文摘Following surface rupture observations in populated areas affected by the KahramanmaraşEarthquake(Mw 7.7)on February 6th,2023,along the Pazarcık segment of the East Anatolian Fault Zone(EAFZ),this study presents novel insights into physical criteria for delineating surface fault-rupture hazard zones(SRHZs)along ruptured strike-slip faults.To achieve this objective,three trench studies across the surface rupture were conducted on the Pazarcık segment of the EAFZ to collect field data,and earthquake recurrence intervals were interpreted using Bayesian statistics from previously conducted paleoseismological trenchings.The results of the proposed model indicate that the Pazarcık segment produced five significant surface-rupturing earthquakes in the last∼11 kyr:E1:11.13±1.74 kyr,E2:7.62±1.20 kyr,E3:5.34±1.05 kyr,E4:1.82±0.93 kyr,and E5:0.35±0.11 kyr.In addition,the recurrence intervals of destructive earthquakes on the subject in question range from 0.6 kyr to 4.8 kyr.Considering that the last significant earthquake occurred in 1513,the longest time since the most recent surface fault rupturing earthquake on this particular segment was 511 years.These results indicate that,in terms of the theoretical recurrence interval of earthquakes that can create surface ruptures on the Pazarcık segment,the period in which the February 6,2023,earthquake occurred was within the end of the expected return period.As a result,the potential for a devastating earthquake in the near future is not foreseen on the same fault.Finally,the SRHZ proposed for the Pazarcık section of Gölbaşıvillage was calculated as a 61-meter-wide offset on the fault lineament to reduce the negativities that may occur in the ruptured area in the future.It is recommended to take into account this width in the settlement of this area and nearby areas.
文摘BACKGROUND Myocardial infarction,particularly ST-segment elevation myocardial infarction(STEMI),is a key global mortality cause.Our study investigated predictors of mortality in 96 STEMI patients undergoing primary percutaneous coronary intervention at Erbil Cardiac Center.Multiple factors were identified influencing in-hospital mortality.Significantly,time from symptom onset to hospital arrival emerged as a decisive factor.Consequently,our study hypothesis is:"Reducing time from symptom onset to hospital arrival significantly improves STEMI prognosis."AIM To determine the key factors influencing mortality rates in STEMI patients.METHODS We studied 96 consecutive STEMI patients undergoing primary percutaneous coronary intervention(PPCI)at the Erbil Cardiac Center.Their clinical histories were compiled,and coronary evaluations were performed via angiography on admission.Data included comorbid conditions,onset of cardiogenic shock,complications during PPCI,and more.Post-discharge,one-month follow-up assessments were completed.Statistical significance was set at P<0.05.RESULTS Our results unearthed several significant findings.The in-hospital and 30-d mortality rates among the 96 STEMI patients were 11.2%and 2.3%respectively.On the investigation of independent predictors of in-hospital mortality,we identified atypical presentation,onset of cardiogenic shock,presence of chronic kidney disease,Thrombolysis In Myocardial Infarction grades 0/1/2,triple vessel disease,ventricular tachycardia/ventricular fibrillation,coronary dissection,and the no-reflow phenomenon.Specifically,the recorded average time from symptom onset to hospital arrival amongst patients who did not survive was significantly longer(6.92±3.86 h)compared to those who survived(3.61±1.67 h),P<0.001.These findings underscore the critical role of timely intervention in improving the survival outcomes of STEMI patients.CONCLUSION Our results affirm that early hospital arrival after symptom onset significantly improves survival rates in STEMI patients,highlighting the critical need for prompt intervention.
