Transient Myocardial Ischemia in a Case Post Intra-Muscular Adrenaline

Background: Anaphylaxis is a medical emergency and requires immediate medical attention. Kounis syndrome is myocardial infarction or injury occurring in the setting of anaphylaxis and can also be due to the effects of epinephrine. Adrenaline is a common drug in the management of anaphylaxis but the electrocardiographic consequences of its administration post an attack are seldomly seen. Vasospasm is generally the cause for myocardial injury in an acute setting following the administration of epinephrine. Case Presentation: A 21-year- old female developed sudden onset breathlessness and giddiness post vaccination with the oxford –AstraZeneca COVID -19 vaccine. She was administered 0.5 ml adrenaline (1:1000) intramuscularly on the lateral aspect of the left thigh, following which she complained of chest tightness and palpitations. This was accompanied by hypotension and global ST segment depression on her Electrocardiogram. The second electrocardiogram, done after 30 minutes showed a relative resolution in ST segment depressions with sinus rhythm in the one done at 16:00 hours. Creatine Kinase- MB and Troponin I were within normal limits and the patient experienced symptomatic improvement with normalization of blood pressure post fluid challenge. Conclusion: This case report highlights the case of a young female with no comorbidities who developed transient myocardial ischemia after administration of intramuscular adrenalin in therapeutic dose in view of an anaphylactic reaction. The probable action is alpha mediated coronary vasospasm. The potential adverse effects in an acute setting are hence outlined in this case report without discouraging its use given the potential benefits outweigh the risks.

Prediction of the fact and degree of coronary artery disease using the processing of clinical and instrumental data by artificial intelligence

Aim of the study was to analyze the possibility of using neural network analysis to predict the severity of coronary bed lesion. The study was also designated to determine the performance and accuracy of the trained neural network model receiving input as the structured data and EGG images with the parameters and leads positioning differ from the training sample, and also to compare the efficiency of detecting transient myocardial ischemia with traditional diagnostic methods, such as 24-hour Holter monitoring, treadmill test. Neural network analysis of the available clinical, laboratory and instrumentation data allow to configure the network parameters for further prediction of coronary artery disease. The results obtained in the form of an AUC score allow to consider this method to be effective in the coronary artery disease diagnosis using recorded ECG tape with parameters and lead positioning differ from initial training sample. The efficiency of transient myocardial ischemia detection on the training sample of the trained neural network is higher in comparison with traditional diagnostic methods, such as 24-hour Holter monitoring, treadmill test.

Diagnostics of myocardial damage in premature newborns with transient heart disease in the early neonatal period

Purpose. To assess frequency and severity of myocardial damage in premature infants with transient myocardial ischemia in the early neonatal period.Materials and methods. The study includes 73 newborns of a gestational age of 31–36 weeks with respiratory failure and oxygen dependence in the first 2 hours of life. Newborns are divided into groups: Group 1: classic electrocardiographic criteria of transient myocardial ischemia and an increase in the level of troponin I in the blood; Group 2: electrocardiographic criteria for transient myocardial ischemia and a normal level of troponin I; Group 3: no ECG changes and normal troponin I level. We assessed blood gases, conducted electrocardiography, determined troponin I in the blood on the 1st and 7th day of life, assesses duration of oxygen therapy in all the children.Results. Group I: troponin I concentration on the 7th day of life – 0.415 [0.222; 0.639] ng/ml, Group II – 0.073 [0.051; 0.104] ng/ml and Group III – 0.017 [0.006; 0.051] ng/ml. Transient myocardial ischemia was detected in 41% of examined patients, and destructive myocardial changes – in 21.9%. An analysis of the gas composition of blood in the first 2 hours demonstrated that there was a significant predominance of the level of bases in the children of Group I. The duration of artificial ventilation in children of Group I was 56 [3; 96] hours, exceeding the indicators of children of Group II (9 [8; 11]) by 5 times, and Group III (20.5 [13; 72]) – by 2.5 times. Also newborns in Group I experienced a maximum need for oxygen therapy through a mask.Conclusion. 21.9% of premature infants experience destructive myocardial changes against the background of transient myocardial ischemia; newborns with transient myocardial ischemia and destructive changes have a significantly more pronounced metabolic acidosis in the first hours of life and a longer need for oxygen therapy.

Stable angina pectoris: choice of therapeutic tactics.

In everyday practice, the basic principles of diagnosis and treatment of stable ischemic heart disease, set out in the clinical recommendations, are often not observed. For successful treatment of angina, first of all, it is necessary to verify the diagnosis. The diagnosis of stable angina pectoris can be considered sufficiently justified, provided the characteristic chest pain and documentary evidence of transient myocardial ischemia by stress tests. The patient should be evaluated as a whole, taking into account all existing diseases, since concomitant diseases can directly or indirectly exacerbate the course of coronary heart disease, and sometimes be the main cause of angina. In such cases, treatment of concomitant diseases has a pronounced positive effect on the course of angina pectoris. It is advisable to assess the magnitude of the coronary reserve, the severity and prevalence of transient myocardial ischemia, its impact on hemodynamics and, based on the analysis of these indicators, to identify patients with high or low risk of myocardial infarction. Revascularization brings a clear prognostic benefit only in subgroups at high risk.