Objectives: To investigate the characteristics of the acute coronary syndromes underlying acute pulmonary oedema and their 30 day prognosis. Patients: 185 consecutive patients with acute coronary syndromes and acute p...Objectives: To investigate the characteristics of the acute coronary syndromes underlying acute pulmonary oedema and their 30 day prognosis. Patients: 185 consecutive patients with acute coronary syndromes and acute pulmonary oedema admitted to a tertiary care centre. Main outcome and measures: Clinical, ECG, echocardiographic, enzymatic, and angiographic features were prospectively investigated. Results: Non-ST segment elevation myocardial infarction(NSTEMI) was the most frequent cause of acute pulmonary oedema(61%) followed by unstable angina(UA; 21%) and ST segment elevation myocardial infarction(STEMI; 18%). In each group, mean age was ≥70 years, but NSTEMI patients were the oldest and ≥65%of patients had chronic hypertension. Moreover, patients with NSTEMI and UA were older and had a higher incidence of diabetes, previous myocardial infarction, and moderate to severe mitral regurgitation but a similarly reduced ejection fraction(NSTEMI, 41%; UA, 39%; and STEMI, 39%) and increased incidence of diastolic dysfunction and rate of multivessel disease(94%, 87%, and 86%, respectively). However, patients with STEMI had a higher creatine kinase MB peak concentration(158 v 76 μg/l in the NSTEMI group, p< 0.001) and 30 day mortality(26%v 9%in the NSTEMI group and 8%in the UA group, p< 0.024). Multivariate analysis identified ejection fraction< 40%and a peak creatine kinase MB concentration >100 μg/l as the main prognostic markers(p< 0.03). Conclusions: Acute pulmonary oedema is mostly a complication of elderly hypertensive patients with NSTEMI or UA(82%) and with multivessel disease often associated with mitral regurgitation. On the other hand, the larger infarct size and higher mortality in patients with STEMI with a similarly reduced ejection fraction suggest a more extensive acute systolic loss.展开更多
Patients with variant angina pectoris showed greater serotonin plasma levels than did control subjects and patients with healed myocardial infarction. The levels also tended to be greater in those with >1 episode/m...Patients with variant angina pectoris showed greater serotonin plasma levels than did control subjects and patients with healed myocardial infarction. The levels also tended to be greater in those with >1 episode/month than in those with fewer episodes. Moreover, patients with variant angina pectoris also had greater levels of nitrite and nitrate plasma levels than did control subjects or patients with healed myocardial infarction, partly, perhaps, as a compensatory mechanism.展开更多
文摘Objectives: To investigate the characteristics of the acute coronary syndromes underlying acute pulmonary oedema and their 30 day prognosis. Patients: 185 consecutive patients with acute coronary syndromes and acute pulmonary oedema admitted to a tertiary care centre. Main outcome and measures: Clinical, ECG, echocardiographic, enzymatic, and angiographic features were prospectively investigated. Results: Non-ST segment elevation myocardial infarction(NSTEMI) was the most frequent cause of acute pulmonary oedema(61%) followed by unstable angina(UA; 21%) and ST segment elevation myocardial infarction(STEMI; 18%). In each group, mean age was ≥70 years, but NSTEMI patients were the oldest and ≥65%of patients had chronic hypertension. Moreover, patients with NSTEMI and UA were older and had a higher incidence of diabetes, previous myocardial infarction, and moderate to severe mitral regurgitation but a similarly reduced ejection fraction(NSTEMI, 41%; UA, 39%; and STEMI, 39%) and increased incidence of diastolic dysfunction and rate of multivessel disease(94%, 87%, and 86%, respectively). However, patients with STEMI had a higher creatine kinase MB peak concentration(158 v 76 μg/l in the NSTEMI group, p< 0.001) and 30 day mortality(26%v 9%in the NSTEMI group and 8%in the UA group, p< 0.024). Multivariate analysis identified ejection fraction< 40%and a peak creatine kinase MB concentration >100 μg/l as the main prognostic markers(p< 0.03). Conclusions: Acute pulmonary oedema is mostly a complication of elderly hypertensive patients with NSTEMI or UA(82%) and with multivessel disease often associated with mitral regurgitation. On the other hand, the larger infarct size and higher mortality in patients with STEMI with a similarly reduced ejection fraction suggest a more extensive acute systolic loss.
文摘Patients with variant angina pectoris showed greater serotonin plasma levels than did control subjects and patients with healed myocardial infarction. The levels also tended to be greater in those with >1 episode/month than in those with fewer episodes. Moreover, patients with variant angina pectoris also had greater levels of nitrite and nitrate plasma levels than did control subjects or patients with healed myocardial infarction, partly, perhaps, as a compensatory mechanism.
