Rationale: Left bundle branch block and hypertensive emergency are very common conditions in clinical cardiovascular and emergency practice. Hypertensive emergency encompasses a spectrum of clinical presentations in which uncontrolled blood pressure leads to progressive end-organ dysfunction. Suspected acute myocardial infarction in the setting of a left bundle branch block presents a unique diagnostic and therapeutic challenge to the clinician. The diagnosis is especially difficult due to electrocardiographic changes caused by altered ventricular depolarization. However, reports on the use of Sgarbossa’s criteria in the management of hypertensive emergency is rare. Patient concerns: A middle-aged married heavy-smoker Egyptian male worker presented to the emergency department with a hypertensive emergency patient with acute chest pain and left bundle branch block. Sgarbossa’s criteria were initially very weak and, over time, became highly suggestive of acute ST-segment elevation myocardial infarction. Interestingly, chest pain increased as Sgarbossa’s diagnostic criteria were met. Thrombolytic therapy was strongly indicated because of a higher development of Sgarbossa criteria scoring. Intervention; Electrocardiography, oxygenation, streptokinase IVI, and echocardiography Diagnosis: Developing acute ST-segment elevation myocardial infarction in the presence of left bundle branch block post- hypertensive emergency. Outcomes: The dramatic response to developing acute myocardial infarction in left bundle branch block with hypertensive emergency to streptokinase. Lessons: The higher Sgarbossa criteria scoring in the case was the only indication for thrombolytic. Therefore, how did Sgarbossa criteria develop during case management to indicate the need for thrombolytic therapy?
Calcium dramatically reverse the hypocalcaemia induced qt prolongation in mul...YasserMohammedHassan1
This is the first case that reports these adverse drug reactions with multiple oral drug toxicities. QT prolongation may be drug-induced. Hypocalcemia also is a trigger for QT prolongation. The identification of drug-induced complications is a pivotal step in the diagnosis decision-making of any medical problems. The effects of multiple drug toxicities may be balanced results.
Charge syndrome hallmarked with wpws and pda; 20 years post repairing-yasser ...YasserMohammedHassan1
CHARGE syndrome or Hall-Hittner syndrome is a pleiotropic disorder, in which the name is derived from the abbreviation epitomizing its six clinical criteria: ocular coloboma, cardiac defects, choanal atresia, growth or developmental retardation, genital hypoplasia, and ear anomalies or deafness. Wolff-Parkinson-White syndrome is the most frequent pattern of ventricular pre-excitation. Patent ductus arteriosus is one of the most frequent congenital heart diseases due to failure of closure of the ductus arteriosus within 72 hours of birth. CHARGE syndrome, Wolff-Parkinson-White syndrome, and patent ductus arteriosus are so difficult to be present in a single entity.
Calcium dramatically reverse the hypocalcaemia induced qt prolongation in mul...YasserMohammedHassan1
This is the first case that reports these adverse drug reactions with multiple oral drug toxicities. QT prolongation may be drug-induced. Hypocalcemia also is a trigger for QT prolongation. The identification of drug-induced complications is a pivotal step in the diagnosis decision-making of any medical problems. The effects of multiple drug toxicities may be balanced results.
Charge syndrome hallmarked with wpws and pda; 20 years post repairing-yasser ...YasserMohammedHassan1
CHARGE syndrome or Hall-Hittner syndrome is a pleiotropic disorder, in which the name is derived from the abbreviation epitomizing its six clinical criteria: ocular coloboma, cardiac defects, choanal atresia, growth or developmental retardation, genital hypoplasia, and ear anomalies or deafness. Wolff-Parkinson-White syndrome is the most frequent pattern of ventricular pre-excitation. Patent ductus arteriosus is one of the most frequent congenital heart diseases due to failure of closure of the ductus arteriosus within 72 hours of birth. CHARGE syndrome, Wolff-Parkinson-White syndrome, and patent ductus arteriosus are so difficult to be present in a single entity.
Acute coronary syndrome result from a sudden blockage in a coronary artery. this blockage causes unstable angina or heart attack (MI), depending on the location and amount of blockage.
people who experience an ACS usually have chest pressure or ache, shortness of breath and fatigue.
People who think they are experiencing ACS should call for emergency help.
Doctors use ECG and blood test (troponin level) to determine whether a person is experiencing an ACS.
Treatment varies depending on the type of syndrome but usually include attempts to increase blood flow to affected area.
Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02Afroza Prioty
A small overview on cardiogenic shock which sometimes becomes a burning issue for the medical personnels and to combat the situation, the measures should be taken immediately and urgently.
A presentatation on Acute coronary syndrome made while in Emergency Department. If you are making a presentation on ACS, you may want to add more on TIMI score as it is important. Some problems with display of pictures/diagrams due to ?conversion problems. Based on AHA Guidelines 2010 and from Harrison's 18th Ed.. Made using OpenOffice.
Acute coronary syndrome for critical care examDr fakhir Raza
This presentation is made to help students prepare for EDIC exam. this is board review for any exam for critical care examining acute MI, myocardial infarction, acute coronary syndrome.
Acute coronary syndrome management by RxVichuZ! ;)RxVichuZ
This is my 99th powerpoint...
Deals with ACS(Acute coronary syndrome), its clinical features, and management strategies, based on standard guidelines and literatures.
Sgarbossa Criteria in Left Bundle Branch Block in a Hypertensive Emergency, a...YasserMohammedHassan1
Left bundle branch block and hypertensive emergency are very often to occur in the clinical practice. But, developing of Sgarbossa criteria in left bundle branch block throughout the course of hypertensive emergency was an extremely rare. My current case is a hypertensive emergency patient with acute chest pain and left bundle branch block. Sgarbossa criteria were initially very weak but, became highly suggestive for acute ST-segment elevation myocardial infarction with time. With strong collective data for the case, the chance for thrombolytic therapy was strictly indicated. So why was the case developed an acute ST-segment elevation myocardial infarction to received thrombolytic therapy?.
Acute coronary syndrome result from a sudden blockage in a coronary artery. this blockage causes unstable angina or heart attack (MI), depending on the location and amount of blockage.
people who experience an ACS usually have chest pressure or ache, shortness of breath and fatigue.
People who think they are experiencing ACS should call for emergency help.
Doctors use ECG and blood test (troponin level) to determine whether a person is experiencing an ACS.
Treatment varies depending on the type of syndrome but usually include attempts to increase blood flow to affected area.
Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02Afroza Prioty
A small overview on cardiogenic shock which sometimes becomes a burning issue for the medical personnels and to combat the situation, the measures should be taken immediately and urgently.
A presentatation on Acute coronary syndrome made while in Emergency Department. If you are making a presentation on ACS, you may want to add more on TIMI score as it is important. Some problems with display of pictures/diagrams due to ?conversion problems. Based on AHA Guidelines 2010 and from Harrison's 18th Ed.. Made using OpenOffice.
Acute coronary syndrome for critical care examDr fakhir Raza
This presentation is made to help students prepare for EDIC exam. this is board review for any exam for critical care examining acute MI, myocardial infarction, acute coronary syndrome.
Acute coronary syndrome management by RxVichuZ! ;)RxVichuZ
This is my 99th powerpoint...
Deals with ACS(Acute coronary syndrome), its clinical features, and management strategies, based on standard guidelines and literatures.
Sgarbossa Criteria in Left Bundle Branch Block in a Hypertensive Emergency, a...YasserMohammedHassan1
Left bundle branch block and hypertensive emergency are very often to occur in the clinical practice. But, developing of Sgarbossa criteria in left bundle branch block throughout the course of hypertensive emergency was an extremely rare. My current case is a hypertensive emergency patient with acute chest pain and left bundle branch block. Sgarbossa criteria were initially very weak but, became highly suggestive for acute ST-segment elevation myocardial infarction with time. With strong collective data for the case, the chance for thrombolytic therapy was strictly indicated. So why was the case developed an acute ST-segment elevation myocardial infarction to received thrombolytic therapy?.
Rationale: Coronary artery spasm is common ischemic heart disease. It is a serious clinical cardiovascular issue. Nitrates such as nitroglycerine have a pivotal role in the management of coronary artery disease.
Patient concerns: A 45-year-old married, officer, heavy smoker, Egyptian male patient presented with acute excruciating severe chest pain and combined electrocardiographic ST-segment coronary artery spasms.
Diagnosis: Combined ST-segment coronary artery spasms of ST-segment elevations and ST-depressions were the most probable diagnosis.
Interventions: Electrocardiogram, echocardiography, and nitroglycerine intravenous infusion.
Outcomes: Dramatic response of both clinical and electrocardiographic combined ST-segment coronary artery spasms to nitroglycerine.
Lessons: A combined ST-segment coronary artery spasms including ST-segment elevation and ST-depression may be present in the same ECG. The dramatic efficacy of later using nitroglycerine in the management of combined ST-segment coronary artery spasms.
ا.د/شريف مختار
Acute coronary syndrome management
المحاضرة التي قدمت يوم الاربعاء 9 ابريل 2014 في دار الحكمة بالقاهرة
من فعاليات مشروع اعداد طبيب حكيم ناجح بالتعاون مع معتمد باتحاد الاطباء العرب
و ضمن موديول الطوارئ و التخدير و العناية المركزة
- يعتبر تقييم نتائج غازات الدم الشرياني (ABG) مصدر إزعاج للعديد من الطلاب والأطباء المبتدئين حيث يتم تعلمها بشكل سيئ أو يتم تدريسها بشكل سيء.
- تحليل غازات الدم هو أداة تساعد على التشخيص، وليست تشخيصية، وهي شائعة الاستخدام لتقييم الضغوط الجزئية للغاز في الدم ومحتوى القاعدة الحمضية.
- يتيح فهم تحليل غازات الدم واستخدامه لمقدمي الخدمات تفسير اضطرابات الجهاز التنفسي والدورة الدموية والتمثيل الغذائي.
- يمكن إجراء "تحليل غازات الدم" على الدم المأخوذ من أي مكان في الدورة الدموية (الشريان أو الوريد أو الشعيرات الدموية).
- ارتباط تفسير نتائج غازات الدم الشرياني (ABG) مرتبط ارتباطا وثيقا بالحالة الاكلينيكية للمريض ولا يمكن فصلهما بحال.
- اختبار غازات الدم الشرياني (ABG) بشكل صريح للدم المأخوذ من الشريان. يقيم تحليل ABG ضغط المريض الجزئي للأكسجين (PaO2) وثاني أكسيد الكربون (PaCO2). يوفر PaO2 معلومات عن حالة الأوكسجين ، ويقدم PaCO2 معلومات عن حالة التهوية (فشل تنفسي مزمن أو حاد) يتأثر PaCO2 بفرط التنفس (التنفس السريع أو العميق) ، ونقص التهوية (التنفس البطيء أو الضحل)، وحالة القاعدة الحمضية. على الرغم من أنه يمكن تقييم الأكسجين والتهوية بطريقة غير جراحية عن طريق قياس التأكسج النبضي ومراقبة ثاني أكسيد الكربون في نهاية المد ، على التوالي ، فإن تحليل ABG هو المعيار.
- فمن المثير ألا ينزعج الطبيب أو الممرضة اذا وجد صعوبة في تفسير بعض النتائج لغازات الدم.
Three and One Method (Yasser’s Method) to Overcome Streptokinase-Induced Hypo...YasserMohammedHassan1
Aim of the study: The study aimed to clarify how to overcome streptokinase-induced hypotension during acute myocardial infarction intravenous infusion? Background: Streptokinase is the cheapest approved thrombolytic agent. Streptokinase is commonly associated with hypotension. The delay in giving a thrombolytic agent for acute myocardial infarction may be hazardous. Method of study and patients: My study was an observational-retrospective twenty-case report series. The study was conducted in Fraskour Central Hospital and Kafr El-Bateekh Central Hospital. The author reported twenty cases of confirmed acute myocardial infarction with indications for thrombolytic over about 34 months, starting on October 5, 2018, ended on July 25, 2021. Testing for the probability of hypotension during infusion of streptokinase was done for all cases. Three and One Method (Yasser’s Method) was only applied in the cases of hypotension during streptokinase intravenous infusion. Results: The mean age in the current study is; 60.6 with male sex predominance (85%). Acute inferior myocardial infarction is the most common (55%) infarction. Pre-testing for the probability of hypotension during infusion of streptokinase was only applied in (50%) with equal positive probability and negative probability test was (50%). Yasser’s Methods was applied in (75%) in response in (100%). Conclusions: Three and One Method (Yasser’s Method) is an innovative clinical and therapeutic method in cardiovascular science. The method is used in cases of acute myocardial infarction. It is indicated in the cases of hypotension during the intravenous infusion of streptokinase. Three and One Method (Yasser’s Method) is effective, safe, and time saving for cases of acute myocardial infarction.
Three and One Method (Yasser’s Method) to Overcome Streptokinase-Induced Hypo...YasserMohammedHassan1
Aim of the study: The study aimed to clarify how to overcome streptokinase-induced hypotension during acute myocardial infarction intravenous infusion? Background: Streptokinase is the cheapest approved thrombolytic agent. Streptokinase is commonly associated with hypotension. The delay in giving a thrombolytic agent for acute myocardial infarction may be hazardous. Method of study and patients: My study was an observational-retrospective twenty-case report series. The study was conducted in Fraskour Central Hospital and Kafr El-Bateekh Central Hospital. The author reported twenty cases of confirmed acute myocardial infarction with indications for thrombolytic over about 34 months, starting on October 5, 2018, ended on July 25, 2021. Testing for the probability of hypotension during infusion of streptokinase was done for all cases. Three and One Method (Yasser’s Method) was only applied in the cases of hypotension during streptokinase intravenous infusion. Results: The mean age in the current study is; 60.6 with male sex predominance (85%). Acute inferior myocardial infarction is the most common (55%) infarction. Pre-testing for the probability of hypotension during infusion of streptokinase was only applied in (50%) with equal positive probability and negative probability test was (50%). Yasser’s Methods was applied in (75%) in response in (100%). Conclusions: Three and One Method (Yasser’s Method) is an innovative clinical and therapeutic method in cardiovascular science. The method is used in cases of acute myocardial infarction. It is indicated in the cases of hypotension during the intravenous infusion of streptokinase. Three and One Method (Yasser’s Method) is effective, safe, and time saving for cases of acute myocardial infarction.
Mimic HL MI in chest tetany with mirror ECG change, Movable phenomenon (Yasse...YasserMohammedHassan1
The reversal of mirror electrocardiographic change, reversal of ST-segment depression coronary artery spasm, and normalization of Movable phenomenon (Yasser’s phenomenon) after oxygenation. It signifies the role of oxygen in both coronary artery spasm and tetany. Mirror local electrocardiographic change is a novel described expression that may reflect the myocardial polarity in this chest tetany.
COVID-19 Pneumonia with Atrial Fibrillation, Coronary Spasm, and Wavy Triple ...YasserMohammedHassan1
Rationale: A novel COVID-19 with severe acute respiratory syndrome had arisen in Wuhan, China in December 2019 Arrhythmias are commonly recognized sequel in COVID-19 patients. Interestingly, the presentation of COVID-19 infection with a newly coronary artery spasm has a risk impact on both morbidity and mortality of COVID-19 patients. Wavy triple an electrocardiographic sign (Yasser Sign) is a new innovated diagnostic sign in hypocalcemia. Patient concerns: An elderly farmer male COVID-19 patient presented to physician outpatient clinic with bilateral pneumonia, atrial fibrillation, evidence of coronary artery spasm, and Wavy triple an electrocardiographic sign (Yasser Sign). Diagnosis: COVID-19 pneumonia with coronary artery spasm and the Wavy triple an electrocardiographic sign (Yasser Sign). Interventions: Chest CT scan, electrocardiography, oxygenation, and echocardiography. Outcomes: Gradual dramatic clinical, electrocardiographic, and radiological improvement had happened. Lessons: The reversal of electrocardiographic ST-segment depressions in a COVID-19 patient after adding oral nitroglycerine is an indicator for the presence of coronary artery spasm. It signifies the role of the anti-infective drugs, anticoagulants, antiplatelet, and steroids in COVID-19 patients with bilateral pneumonia, AF, coronary artery spasm are effective therapies. The disappearance of AF after initial therapy may a guide for a good prognosis in this case study. The evanescence of Wavy triple ECG sign as a hallmark for the existence of the Movable-weaning phenomenon of hypocalcemia is recommended for further wide-study.
Oxygen Reversal of Coronary Artery Spasm with Modification of International S...YasserMohammedHassan1
Abstract Aim of the study: the study aims to clear the initial effect of non-baric oxygen inhalation on the coronary artery spasm. Background: Coronary artery spasm (CAS) is a cardiovascular disorder that plays an important role in the pathogenesis of stable angina, unstable angina, myocardial infarction, and sudden cardiac death. Nitrate, calcium channel blockers, and statins are known established medications in the reversal of coronary artery spasms. Oxygen safety versus adverse effects of nitrate, calcium channel blockers, and statins are comparable. Method of study and patients: My case study was an observational-retrospective seventeen case report series. The study was conducted in Fraskour Central Hospital, Kafr El-Bateekh Central Hospital, and physician outpatient. The author reported the seventeen cases of acute angina with rest chest pain over about 38-months, starting on December 15, 2018, ended on February 7, 2022. Results: The mean age is; 43.2 with the female sex predominance (64.71%). Housewife (29.41%) and students (23.53%) are the most affected occupations. The main complaint is chest pain (64.71%). The most common associated risk factors are female sex (64.71%) and stress (23.53%). Drug-induced (23.53%), hyperventilation syndrome-induced (23.53%), and CO toxicity-induced coronary artery spasm (17.65%) are common diagnoses. The dose of inhaled O2 dose that achieved the reversal of CAS varied from 5 to 12 liter. A maximal dose (12 minutes) was given for CO toxicity. The duration of inhaled O2 dose that achieved the reversal CAS varied from 15 to 80 minutes. Maximal duration (80 minutes) was given in CO toxicity. The complete response had happened in 94.12%. Conclusions: Dramatic clinical reliving and reversal response of electrocardiographic ST-segment depression after oxygen inhalation is an indication for its initial use in coronary artery spasm. Yasser's Modification or Oxygen test for the past "international standards for the diagnostic criteria of coronary vasomotor disorders" improves patient safety and decreases the hazards of nitrate and other medications.
CHARGE syndrome hallmarked with Wolff-Parkinson-White syndrome and patent duc...YasserMohammedHassan1
Abstract
Rationale: CHARGE syndrome or Hall-Hittner syndrome is a pleiotropic disorder, in which the name is derived from the abbreviation epitomizing its six clinical criteria: ocular coloboma, cardiac defects, choanal atresia, growth or developmental retardation, genital hypoplasia, and ear anomalies or deafness. Wolff-Parkinson-White syndrome is the most frequent pattern of ventricular pre-excitation. Patent ductus arteriosus is one of the most frequent congenital heart diseases due to failure of closure of the ductus arteriosus within 72 hours of birth. CHARGE syndrome, Wolff-Parkinson-White syndrome, and patent ductus arteriosus are so difficult to be present in a single entity. Patient concerns: A young female girl patient presented to the physician outpatient clinic with acute confusion status with a past repaired patent ductus arteriosus. Diagnosis: CHARGE syndrome hallmarked with Wolff-Parkinson-White syndrome and patent ductus arteriosus; 20 years post-repairing. Interventions: Plain chest x-ray, electrocardiography, oxygenation, and echocardiography. Outcomes: A dramatic clinical improvement post-oxygenation had happened. Lessons: CHARGE syndrome with Wolff-Parkinson-White syndrome and repaired patent ductus arteriosus is an extreme combination. The existence of infantile electrocardiographic Tee-Pee sign of hypocalcemia and adult low ionized calcium with CHARGE syndrome is highly suggestive of associated DiGeorge phenotype syndrome. An absence of tachycardia post- repairing of patent ductus arteriosus from 11 mo until the 20th-year-old is a good prognostic sign. The presence of an infantile T-wave alternance will strengthen both the risk of serious arrhythmia and the efficacy of patent ductus arteriosus repairing.
Sgarbossa Criteria in Left Bundle Branch Block in a Hypertensive Emergency, a...YasserMohammedHassan1
ABSTRACT
Rationale: Left bundle branch block and hypertensive emergency are very common conditions in clinical cardiovascular and emergency practice. Hypertensive emergency encompasses a spectrum of clinical presentations in which uncontrolled blood pressure leads to progressive end-organ dysfunction. Suspected acute myocardial infarction in the setting of a left bundle branch block presents a unique diagnostic and therapeutic challenge to the clinician. The diagnosis is especially difficult due to electrocardiographic changes caused by altered ventricular depolarization. However, reports on the use of Sgarbossa’s criteria in the management of hypertensive emergencies are rare. Patient concerns: A middle-aged married heavy-smoker Egyptian male worker presented to the emergency department with a hypertensive emergency patient with acute chest pain and left bundle branch block. Sgarbossa’s criteria were initially very weak and, over time, became highly suggestive of acute ST-segment elevation myocardial infarction. Interestingly, chest pain increased as Sgarbossa’s diagnostic criteria were met. Thrombolytic therapy was strongly indicated because of a higher development of Sgarbossa criteria scoring. Intervention; Electrocardiography, oxygenation, streptokinase IVI, and echocardiography Diagnosis: Developing acute ST-segment elevation myocardial infarction in the presence of
left bundle branch block post hypertensive emergency. Outcomes: The dramatic response to developing acute myocardial infarction in the left bundle branch block with hypertensive emergency to streptokinase. Lessons: The higher Sgarbossa criteria scoring in the case was the only indication for thrombolytic. Therefore, how did Sgarbossa's criteria develop during case management to indicate the need for thrombolytic therapy?
Oxygen Reversal of Coronary Artery Spasm with Modification of International S...YasserMohammedHassan1
Abstract
Aim of the study: the study aims to clear the initial effect of non-baric oxygen inhalation on the coronary artery spasm. Background: Coronary artery spasm (CAS) is a cardiovascular disorder that plays an important role in the pathogenesis of stable angina, unstable angina, myocardial infarction, and sudden cardiac death. Nitrate, calcium channel blockers, and statins are known established medications in the reversal of coronary artery spasms. Oxygen safety versus adverse effects of nitrate, calcium channel blockers, and statins are comparable. Method of study and patients: My case study was an observational-retrospective seventeen case report series. The study was conducted in Fraskour Central Hospital, Kafr El-Bateekh Central Hospital, and physician outpatient. The author reported seventeen cases of acute angina with rest chest pain over about 38 months; starting on December 15, 2018, ended on February 7, 2022. Results: The mean age is 43.2 with the female sex predominance (64.71%). Housewives (29.41%) and students (23.53%) are the most affected occupations. The main complaint is chest pain (64.71%). The most common associated risk factors are female sex (64.71%) and stress (23.53%). Drug-induced (23.53%); hyperventilation syndrome-induced (23.53%); and CO toxicity-induced coronary artery spasm (17.65%) are common diagnoses. The dose of inhaled O2 dose that achieved the reversal of CAS varied from 5 to 12 liter. A maximal dose (12 minutes) was given for CO toxicity. The duration of inhaled O2 dose that achieved the reversal CAS varied from 15 to 80 minutes. Maximal duration (80 minutes) was given in CO toxicity. The complete response had happened in 94.12%. Conclusion: Dramatic clinical reliving and reversal response of electrocardiographic ST-segment depression after oxygen inhalation is an indication of its initial use in coronary artery spasms. Yasser’s Modification or Oxygen test for the past “international standards for the diagnostic criteria of coronary vasomotor disorders” improves patient safety and decreases the hazards of nitrate and other medications.
Mimic high lateral myocardial infarction in chest tetany with mirror electroc...YasserMohammedHassan1
The reversal of mirror electrocardiographic change, reversal of ST-segment depression coronary artery spasm, and normalization of Movable phenomenon (Yasser’s phenomenon) after oxygenation. It signifies the role of oxygen in both coronary artery spasm and tetany. Mirror local electrocardiographic change is a novel described expression that may reflect the myocardial polarity in this chest tetany.
Zavras-Kounis syndrome simultaneously with reactional myoclonus post-streptok...YasserMohammedHassan1
Rationale: Drug-associated adverse effects are one of the most important entities in clinical medicine. Involuntary movements may have a dynamic serious impact on myocardial muscle. Myoclonus is well as abnormal involuntary movements with a distinct description. Myoclonus is a physical trauma and stress for coronary arteries. Physical and mechanical stress may be causing coronary artery spasm. Drug-inducing allergic angina, allergic coronary artery spasm, and allergic myocardial infarction are renowned as Zavras-Kounis syndrome. Streptokinase is a still-known effective thrombolytic in myocardial infarction. There is a correlation between COVID-19 infection and myocardial infarction. Patient concerns: A 70-year-old married, farmer, smoker, Egyptian male patient was admitted to the critical care unit with acute inferior myocardial infarction and suspected COVID-19 pneumonia. An interlacing generalized myoclonus and allergic coronary artery spasm occurred. Diagnosis: Reactional myoclonus with allergic coronary artery spasm post-streptokinase in COVID-19 inducing myocardial infarction. Interventions: Electrocardiography, oxygenation, streptokinase intravenous infusion, and echocardiography. Outcomes: Reactional generalized myoclonus with coronary artery spasm had happened during-streptokinase infusion but the dramatic response was the result. Lessons: Dramatic clinical and electrocardiographic response after using the traditional anti-allergic signifying its role and suggest the diagnosis of Zavras-Kounis syndrome. The presence of continuing generalized myoclonus movements with the disappearance of coronary artery spasm after stoppage may be directed to the myoclonus cause. Streptokinase causing generalized myoclonus movements previously unknown, so it is a new recording adverse effect finding. The presence of involuntary movements, COVID-19 pneumonia, myocardial infarction, elderly, and cigarette smoking are prognostic factors for the severity of the disease.
Café Au Lait Spot is A Marker for Pheochromocytoma in Hypertensive Crisis Wit...YasserMohammedHassan1
Café au lait Spot is a marker for pheochromocytoma in hypertensive crisis but with a wide-differential diagnosis. Labetalol may be chosen in hypertensive crisis due to pheochromocytoma.
Acute myocardial infarction associated with right bundle branch block and cha...YasserMohammedHassan1
Acute myocardial infarction may be associated right bundle branch block.
Accompanied trifascicular heart block had pre-streptokinase left anterior fascicular block
with left axis deviation and post-streptokinase left posterior fascicular block with right axis
deviation.
Wavy Triple Sign of Hypocalcemia or Yasser’s Sign-in Diabetic Ketoacidosis-Dr...YasserMohammedHassan1
The wavy triple an electrocardiographic sign (Yasser’s sign) and hypocalcemia are commonly seen in diabetic ketoacidosis. Dramatic spontaneous improvement of both wavy triple an electrocardiographic sign (Yasser’s sign) and hypocalcemia simultaneously after the management of diabetic ketoacidosis in most cases.
الأدوية الخطرة بالعناية والطوارئ-Dr. Yasser Mohammed Hassanain Elsayed.pptxYasserMohammedHassan1
• هنالك العديد من الأدوية الخطرة التي طالما نستخدمها بالمستشفيات، خاصة بأقسام الطوارىء أو الرعاية الحرجة.
• البعض منها يكون في أقسام الطوارئ، والبعض الأخر يكون في أقسام الرعاية الحرجة، وأحيانا تكون في الأقسام الداخلية للمستشفيات.
• ربما تتصدر مشكلات كبيرة عن استخدام هذه الأدوية، هذا فضلا عن الصغيرة منها، مثل:
- توقف القلب وربما الموت المفاجيء.
- الزيادة الخطرة بضربات القلب
- حدوث ذبحة صدرية
- أو حدوث جلطة دموية في القلب
- حدوث ألم شديد بالصدر
- حدوث فشل تنفسي أو إثارته.
- حدوث فشل كبدي أو إثارته.
- حدوث ضعف حاد بعضلة القلب أو إثارته.
- الى غير ذلك من صور وأشكال عديدة، من المضاعفات.
ألم الصدر التشخيص- وكيفية التعامل معه-Dr. Yasser Mohammed Hassanain Elsayed.pptxYasserMohammedHassan1
• يعتمد تشخيص وعلاج ألم الصدر على السبب.
فقد تتنوع أسباب ألم الصدر من مشكلات صغيرة، مثل:
- حرقة المعدة
- الضغط النفسي
- حالات الطوارئ الطبية الخطيرة مثل النوبة القلبية
- أو تكوُّن جلطة دموية في الرئتين (الإنصمام الرئوي).
• يأخذ ألم الصدر صورا وأشكالا عديدة، وتتراوح حدته بين الشعور بطعنات حادة وحتى الألم الخفيف. وفي بعض الأحيان، يكون ألم الصدر ساحقًا أو حارقًا. وفي حالات أخرى، ينتقل الألم صعودًا إلى الرقبة وإلى داخل الفك، ثم ينتشر للخلف أو للأسفل لتشعر به في أحد الذراعين أو في الذراعين معًا.
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
Sgarbossa criteria in left bundle branch block in a hypertensive emergency yasser mohammed hassanain elsayed
1.
2.
3.
4.
5.
6. . The researcher will be lucky if the case report will be
including complex data.
. Sometimes, the case report takes multiple directions
in understanding.
. The physician should be a strong observer of the new
clinical findings.
7.
8. Rationale: Left bundle branch block and hypertensive emergency are very common conditions in clinical cardiovascular and
emergency practice. Hypertensive emergency encompasses a spectrum of clinical presentations in which uncontrolled blood
pressure leads to progressive end-organ dysfunction. Suspected acute myocardial infarction in the setting of a left bundle branch
block presents a unique diagnostic and therapeutic challenge to the clinician. The diagnosis is especially difficult due to
electrocardiographic changes caused by altered ventricular depolarization. However, reports on the use of Sgarbossa’s criteria in
the management of hypertensive emergency is rare.
Patient concerns: A middle-aged married heavy-smoker Egyptian male worker presented to the emergency department with a
hypertensive emergency patient with acute chest pain and left bundle branch block. Sgarbossa’s criteria were initially very weak
and, over time, became highly suggestive of acute ST-segment elevation myocardial infarction. Interestingly, chest pain increased
as Sgarbossa’s diagnostic criteria were met. Thrombolytic therapy was strongly indicated because of a higher development of
Sgarbossa criteria scoring.
Intervention; Electrocardiography, oxygenation, streptokinase IVI, and echocardiography.
Diagnosis: Developing acute ST-segment elevation myocardial infarction in the presence of left bundle branch block post-
hypertensive emergency.
Outcomes: The dramatic response to developing acute myocardial infarction in left bundle branch block with hypertensive
emergency to streptokinase.
Lessons: The higher Sgarbossa criteria scoring in the case was the only indication for thrombolytic. Therefore, how did Sgarbossa
criteria develop during case management to indicate the need for thrombolytic therapy?
9.
10. . Left bundle branch block.
. Sgarbossa criteria and its modification.
. Hypertensive emergency.
. ST-segment elevation myocardial infarction.
. The decision of thrombolytic in left bundle
branch block.
14. 1. Left bundle branch block and ST-segment elevation
myocardial infarction
• Diagnosis of ST-segment elevation myocardial infarction (STEMI) in the
setting of a left bundle branch block (LBBB) is difficult.
• Timely and accurate identification of acute coronary occlusion in the setting
of ischemic symptoms is critical to initiating urgent angiography and
appropriate reperfusion therapy.
• ST elevation on the ECG is the primary indication for emergency reperfusion
therapy.
• However, identification of STEMI in the setting of left bundle branch block
remains challenging.
• LBBB is a major ECG confounder for STEMI diagnosis using ECG.
15. 2. Sgarbossa criteria and its modification
• Sgarbossa et al. introduced ECG criteria for detecting STEMI in the presence of LBBB.
• The criteria are based on concordant ST-segment elevation, discordant ST elevation and
anterior ST depression in leads V1-V3, with points assigned for each criterion.
• In several studies, the discordant ST-segment elevation criterion has been shown to be less
useful than the other two criteria to maintain a high specificity.
• The best threshold for the Sgarbossa score is greater than or equal to 3.
• A score of three or greater generated from the Sgarbossa criteria has been commonly used
by researchers. Sgarbossa et al proposed requiring at least 3 points from the following
criteria for the diagnosis of acute myocardial infarction in the presence of left bundle
branch block: (1) concordant ST-segment elevation of 1 mm (0.1 mV) in at least 1 lead (5
points), (2) concordant ST-segment depression of at least 1 mm in leads
16. V1 to V3 (3 points), or (3) excessively discordant ST-segment elevation, defined
as greater than or equal to 5 mm of ST-segment elevation when the QRS result
is negative (2 points) (Table 1).
Table 1: Sgarbossa criteria scoring and its modification.
Criteria Description Score points
Sgarbossa A Concordant ST elevation > 1mm (0.1 mV) in at
least 1 lead, in leads with positive QRS
5
Sgarbossa B Concordant ST depression ≥ 1mm in V1 - V3 3
Sgarbossa C Discordant ST elevation ≥ 5mm , in leads with
negative QRS
2
Modified Sgarbossa C
(Smith critreia)
Discordant ST elevation and ST/S ratio ≤ 0.25 Modified Sgarbossa criteria: superior to
original Sgarbossa criteria
For Dx ACO in LBBB
Dx ; diagnosing , ACO; acute coronary occlusion, LBBB; left bundle branch block
17. 3. Hypertensive emergency
• Hypertensive crises (76% urgencies and 24% emergencies) represented 3%
of all the patient visits, but 27% of all medical emergencies.
• Hypertensive crisis is defined as levels of systolic blood pressure >180 mmHg
and/or levels of diastolic blood pressure >120 mmHg.
• Depending on whether there is damage to vital organs or not, we can
distinguish between hypertensive emergency and hypertensive urgency.
Hypertensive emergencies are life-threatening conditions because their
outcome is complicated by acute damage to vital organs, and can be presented
with neurological, renal, cardiovascular, microangiopathic and obstetric
complications. Hypertensive emergencies include hypertensive encephalopathy,
hypertensive acute left ventricular relaxation associated with acute
18. myocardial infarction or unstable angina, aortic dissection,
subarhnoic hemorrhage, ischemic stroke, and severe pre-eclampsia
or eclampsia6.
• Hypertensive emergencies occur in up to 2% of patients with
systemic hypertension.
• The most common symptoms are headache, dyspnea, nausea,
vomiting, epistaxis, and pronounced anxiety.
• Immediate reduction in blood pressure is required only in patients
with acute endorgan damage.
• Nitroglycerin as a potent venodilator reduces BP, decreasing
preload and cardiac output Therefore, it is not an acceptable first
choice for hypertensive emergencies except in patients with acute
coronary ischemia.
19. 5. The decision of thrombolytic in LBBB
• The decision of receiving thrombolytic in LBBB
is depending on the Sgarbossa criteria scoring
• The presence of acute ischemic chest pain share
in this decision
• A new or old LBBB is cornerstone.
21. 1. Complaint and History
• A 53 year-old married heavy-smoker Egyptian male worker patient presented to the ED
with acute chest pain, palpitations, rapid breathing, and dizziness
• Patient had recent history of psycho-familial troubles.
• Chest pain had anginal characteristics.
• There was past history of hypertension on chest pain furosemide tablet (40 mg once
daily), and captopril tablet (25 mg twice daily).
• The patient denied a history of cardiac or other relevant diseases.
22. 2. Physical examination
• Generally; the patient appeared irritable, sweaty, anxious,
and tachypneic.
• Vital signs; blood pressure of 240/140 mmHg, the pulse rate
of 100/bpm; and regular, the respiratory rate of 36/min, the
temperature of 36.2°C, and the pulse oximeter of oxygen
(O2) saturation of 92%.
• Otherwise of tachypnia, dyspnea, and tachycardia, there no
local cardio-respiratory signs were noted during the clinical
examination.
23. Figure 1A: ECG tracing of presentation in the ED showing sinus tachycardia (VR;180 bpm) with LBBB.
Red arrows; indicate Sgarbossa criteria with discordant ST elevation > 5mm (V2-4). Both blue and black
arrows; indicate no other ST-segment abnormalities.
24. Figure 2B-D serial ECG: 2B. ECG tracing: the initial ECG tracing in ICU was done within 12 minutes of ED ECG tracing
showing no more difference than 1A. 2C. ECG tracing showing concordant ST elevation > 5mm in high lateral leads (I,
aVL) (=blue arrows) with ST-segment depression in inferior leads (II, III, aVF) (=black arrows). 2D. ECG tracing was taken
within five hours of first ECG tracing and within two hours of streptokinase showing the same 1A. ECG tracing.
25. B. Troponin test
• The troponin test was positive.
C. RBS
• Measured random blood sugar was 223 mg/dl.
D. Echocardiography
• Later echocardiography showed antro-lateral hypokinesia with EF 63%.
E. No more workup
• No more workup was done.
26. The most probable diagnosis
• Developing acute ST-segment
elevation myocardial infarction in the
presence of left bundle branch block
post-hypertensive emergency.
27.
28. • Patient was admitted to ICU as a hypertensive emergency with angina and
LBBB.
• He was initially managed with O2 inhalation using nasal cannula in rate of 5
L/min, sublingual isosorbide dinitrate tablet (4 mg), and sublingual captopril
tablet (25 mg) were given.
• The initial ECG tracing was taken in the ED; that showed sinus tachycardia
(VR;180 bpm) with LBBB (Figure 1A).
• The only taken score of initial Sgarbossa criteria was (2) with discordant ST
elevation > 5mm.
• Nitroglycerin IVI (5 µg/min with intermittent titration) was maintained.
29. • Serial ECG tracings were taken. No significant change within 12 minutes of
first ECG tracing (Figure 2B). ST-segment elevation myocardial infarction
appeared in high lateral leads (I, aVL) with ST-segment depression in inferior
leads (II, III, aVF) (Figure 2C). Sgarbossa criteria reached to score (7).
• Blood pressure was controlled within three hours of admission (140/85
mmHg). Aspirin 4 oral tablet (75 mg), clopidogril 4 oral tablet (75 mg),
streptokinase IVI (1.5 million units over 60 minutes) were added.
• ECG tracing was taken within five hours of first ECG tracing and within
two hours of streptokinase infusion. Sgarbossa criteria return to the initial
score that was (2) (Figure 2D).
30. • Patient became symptomatic free after streptokinase infusion and controlling
blood pressure.
• Patient was continued on; captopril tablet (25 mg twice daily), aspirin tablet
(75 mg, once daily), clopidogril tablet (75 mg, once daily), nitroglycerin
retard capsule (2.5 mg twice daily), and atorvastatin (40 mg once daily) until
discharged on the 5th day.
31.
32. • Overview: A middle-aged married heavy-smoker Egyptian male worker
presented to the emergency department with a hypertensive emergency
patient with acute chest pain and left bundle branch block.
• The primary objective for the current case study was the presence of
angina, sinus tachycardia, hypertensive emergency, and LBBB.
• The secondary objective for the case study was the priority in the
management of angina, sinus tachycardia, hypertensive emergency, and
LBBB. And how would you manage the case in the ICU?
• LBBB is a common problem in our clinical practice but an extremely rare to
see LBBB given STEMI with developement of Sgarbossa criteria.
33. • The only initial criteria for Sgarbossa was discordant ST elevation > 5mm
(score 2) which very low (Figure 1, and Figure 2A). This only initial taken
score of Sgarbossa criteria indicated that there was no seriousness.
• Appearance of concordant ST elevation > 1mm in leads with positive QRS
(I, aVL) but with reciprocal ST depression in inferior leads (II, III, aVF)
indicates ST-segment elevation myocardial infarction appeared in high lateral
leads rather the extensive anterior STEMI.
• Return of LBBB to basic initial Sgarbossa criteria (Figure 2D) after
streptokinase infusion and controlling blood pressure.
34.
35. • The current case was LBBB with subsequently
developed acute ST-segment elevation myocardial
infarction that was indicating for thrombolytic
therapy.
• Both hypertensive emergency and ECG LBBB
pattern were encompassing the serious consequences in
the case.
• Serial ECG tracings were showing a graded
developing of Sgarbossa criteria of LBBB that is
meeting with the diagnosis of acute myocardial
infarction.
36. • Upgrading of Sgarbossa criteria of LBBB had happened throughout the
course of the hypertensive emergency.
• Presence of LBBB, angina, positive troponin, and Sgarbossa score of 7 were
indications for the presence of acute ST-segment elevation myocardial
infarction.
• The only initial electrocardiographic Sgarbossa criteria were discordant ST
elevation > 5mm (score 2). This lonely ECG sign is an insufficient indication
for a more serious condition.
• concordant ST elevation > 1mm in leads (I, aVL) with reciprocal ST
depression in inferior leads (II, III, aVF) are specified for a high lateral ST-
segment elevation myocardial infarction rather than the extensive anterior
infarction.
• Resolving of developed Sgarbossa criteria in LBBB to the initial condition
after streptokinase infusion and controlling of blood pressure had occurred.
37. • The novelty in the case study was the marvelous progression of the LBBB to
the acute infarction that is an indication for thrombolytic therapy.
• Unfortunately, there were similar cases for comparison in the past literature.
40. • Resolving of upgrading of Sgarbossa criteria in LBBB to the initial status
after streptokinase infusion with controlling of blood pressure will strengthens
the role of streptokinase and tight blood pressure control.
• The current case is considered the first reported case study where up-grading
of Sgarbossa criteria for LBBB into acute ST-segment elevation myocardial
infarction during the course of hypertensive emergency had happened.
• Moreover, this case report highlights the importance of adequate and tight
controlling for patients of hypertensive emergency with LBBB.
42. 1 Stephen W. Smith, Kenneth W. Dodd, Timothy D. Henry, David M. Dvorak, Lesly A. Pearce. Diagnosis of ST-
Elevation Myocardial Infarction in the Presence of Left Bundle Branch Block With the ST-Elevation to S-Wave Ratio in
a Modified Sgarbossa Rule. Ann Emerg Med. 2012;60:766-776.
2 Richard E Gregg, Eric D Helfenbein, Sophia H Zhou. Combining Sgarbossa and Selvester ECG Criteria to Improve
STEMI Detection in the Presence of LBBB. Computing in Cardiology 2010;37:277−280. ISSN 0276−6574
3 Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial
infarction in the presence of left bundle branch block. N Engl J Med. 1996;334:481-487.
4 Meyers HP III, Limkakeng AT, Jr., Jaffa EJ, Patel A, Theiling BJ, Rezaie SR, Steward T, Zhuang C, Pera VK, Smith SW.
Validation of the Modified Sgarbossa Criteria for Acute Coronary Occlusion in the Setting of Left Bundle Branch
Block: Retrospective Case Control Study. Annals of Emergency Medicine. 2015 Oct.; (66) 4S:S17.
5 Joseph Varon and Paul E Marik. Clinical review: The management of hypertensive crises. Critical Care. 2003;7:374-
384. DOI 10.1186/cc2351
6 Sabina Salkic, Olivera Batic-Mujanovic, Farid Ljuca, Selmira Brkic. Clinical Presentation of Hypertensive Crises in
Emergency Medical Services. Mater Sociomed. 2014 Feb; 26(1): 12-16. DOI: 10.5455/msm.2014.26.12-16
7 Paul E. Marik and Racquel Rivera.Hypertensive emergencies: an update. Curr Opin Crit Care. 17:569–580.
DOI:10.1097/MCC.0b013e32834cd31d
8 Norman M. Kaplan, Ronald G. Victor, Joseph T. Flynn. Chapter 8;Hypertensive Emergencies. Kaplan’s Clinical
Hypertension. Eleventh edit. 2015;269-272. 2015 Wolters Kluwer. ISBN 978-1-4511-9013-7.