Patienter med icke ST-höjningsinfarkt [NSTEMI] och ST-höjningsinfarkt [STEMI] inkommer till sjukhuset för sent för att behandlingen ska kunna leda till bevarande av hjärtmuskelns funktion. Det råder bristfällig information till allmänheten men främst till personer med risk för att utveckla hjärtinfarkt, om vad de kan göra för att förkorta tiden från symtom till vårdkontakt. Primärpreventiv information är viktig och rekommendationen är att informera och bedöma personer primärpreventivt för att förbättra kunskapen. Dessa förkunskaper ger patienterna möjligheten att uppmärksamma symtom och snabbt ta informerade beslut i att söka vård, vilket minskar skadan på hjärtat efter en NSTEMI/STEMI.   Syftet var att undersöka förkunskaper om symtom vid hjärtinfarkt hos patienter som genomgått NSTEMI/STEMI.   En kvantitativ ansats valdes för att svara på studiens syfte, designen är en icke-experimentell deskriptiv, retrospektiv tvärsnittsstudie. En enkätundersökning genomfördes på ett sjukhus i Mellansverige, totalt n= 32 deltagare. Enkäten innehåller till en början demografiska frågor för att sedan inrikta sig på ämnesspecifika frågor med hjälp av likertskalan, flervalsfrågor och öppna fritextfrågor.   Resultatet visade att deltagarnas självskattade förkunskaper om symtom på hjärtinfarkt var bristfälliga, särskilt om atypiska symtom. Deltagarnas symtom vid NSTEMI/STEMI stämde inte överens med deras förväntade symtom, vilket utgjorde en osäkerhet om det verkligen var härledda till hjärtat. Detta ledde till att det tog lång tid från symtom till första vårdkontakt och deltagarna sökte vård på grund av ihållande symtom eller på anhörigas begäran. Fåtalet deltagare hade fått information om symtom eller blivit erbjuden en hälsoundersökning innan insjuknandet och den information de hade fått var från anhöriga eller sjukvården. Majoriteten av deltagarna upplevde inga kvarvarande komplikationer två till tre dagar efter den genomgångna NSTEMI/STEMIN.   Slutsatsen är bristande förkunskap om symtom vid NSTEMI/STEMI, speciellt atypiska symtom och vilka åtgärder som ska vidtas vid symtom. Majoriteten ansåg att symtomen inte stämde överens med den förväntade symtombilden och menade att de inte hade fått information kring hjärt-och kärlsjukdomar innan insjuknandet. Omvårdnadsprofessionen behöver arbeta för att tydliggöra informationen, därefter nå ut till samhället och primärpreventivt inom sjukvården. / Patients with non ST elevation myocardial infarction [NSTEMI] and ST elevation myocardial infarction [STEMI] enter the hospital too late for the treatment to lead to preservation of heart muscle function. There is inadequate information to the public, but mainly to people at risk of developing myocardial infarction, about what they can do to shorten delay, from symptoms to care contact. Primary preventive information is important and the recommendation is to inform and assess people primarily preventively in order to improve knowledge. These prerequisites give patients the opportunity to pay attention to symptoms and quickly make informed decisions in seeking care, which reduces the damage to the heart after an NSTEMI/STEMI.   The aim was to investigate prior knowledge of symptoms of myocardial infarction in patients undergoing NSTEMI/STEMI.   A quantitative approach was chosen to answer the study's purpose, the design is a non-experimental descriptive, retrospective cross-sectional study. A survey was conducted at a hospital in central Sweden, a total of n = 32 participants. The questionnaire initially contains demographic questions to then focus on subject-specific issues with the help of the likert scale, multiple choice questions and open free text questions.   The results showed that the participants' self-rated knowledge of heart attack symptoms was deficient, especially in atypical symptoms. The participants' symptoms at NSTEMI/STEMI didn’t match their expected symptoms, which constituted an uncertainty as to whether it really was derived from the heart. Therefore it took a long time from symptoms to first care contact and the participants sought care because of persistent symptoms or at the relatives' request. Few participants had received information about symptoms or had been offered a health survey before the onset of illness and the information they had received from relatives or health care. The majority of participants experienced no remaining complications two to three days after their NSTEMI/STEMIN.   The conclusion is that there is lack of knowledge of symptoms of NSTEMI/STEMI, especially atypical symptoms and what measures should be taken in the event of symptoms. The majority considered that the symptoms did not match the expected symptom picture and believed that they had not received information about cardiovascular disease before the onset of the disease. The nursing profession needs to work to clarify the information, then reach out to society and primarily preventive in the health care sector.

O BNP tem sido apontado como ótimo marcador de disfunção ventricular esquerda na sala de emergência. O poder de complementar informação prognóstica aos pacientes com SCA ainda não está bem estabelecido. Analisar a contribuição do BNP no prognóstico a longo prazo de pacientes com SCASSST. A partir dos resultados obtidos, verificar a associação dos níveis séricos do BNP com o TIMI RISK escore e com a área de miocárdio sob risco isquêmico. Foram avaliados 46 pacientes consecutivos portadores de SCASSST, discriminados por troponina I positiva (valor >0,5ng/ml), admitidos no período de maio/2003 a janeiro/2004, e acompanhados por um período de seguimento de 48 meses. O estudo foi completado por 40 pacientes. A análise do BNP de admissão e após 96 horas foi realizada pelo teste não paramétrico de Wilcoxon com intervalo de confiança de 95%. Um valor de p<0,05 foi considerado significante. Utilizou-se a curva ROC para analisar a acurácia do BNP de 96 horas como preditor de morte, além de definir o ponto de corte. O teste do qui-quadrado de Pearson foi utilizado para comparar as frequências das características clínicas, eletrocardiográficas e bioquímicas. Para avaliar um possível fator de confusão entre o BNP de 96 horas, idade e desfecho, usou-se a análise de regressão logística. Houve uma elevação do BNP entre a admissão e 96 horas (mediana de 148 vs. 267 p=0,04). Ocorreram 13 óbitos no período de seguimento. Utilizando o valor de corte do BNP de 96 horas de 300pg/ml como preditor de morte, observou-se sensibilidade de 92,3%, especificidade de 77,8%, valor preditivo positivo de 66,7% e valor preditivo negativo de 95,5%. A área sob a curva ROC foi de 0,93. Diferenças significativas não foram observadas nas características clínicas, eletrocardiográficas e angiográficas entre sobreviventes e não sobreviventes. Observou-se nítida associação entre o BNP de 96 horas com a pontuação do TIMI RISK escore. Verificou-se também a relação entre o incremento do BNP, admissão e 96 horas, e a anatomia coronariana no grupo com extensa área do miocárdio sob risco isquêmico (p=0,021). A elevação do BNP após 96 horas da admissão está associada a uma população com maior área de miocárdio sob risco isquêmico. Os resultados Indicam que o maior incremento entre o BNP de admissão e após 96 horas está associado à maior gravidade e extensão de miocárdio sob risco isquêmico. Tal fato poderia explicar a relação entre BNP elevado com a pontuação do TIMI RISK escore. Análise do BNP obtido após 96 horas de evento isquêmico é uma importante ferramenta na estratificação de risco de morte a longo prazo na SCASSST. / BNP has been considered an excellent marker of left ventricular dysfunction in the emergency room. However, its ability to provide prognostic information on patients with acute coronary syndrome has not been well established. To assess the contribution of BNP to predict the long-term prognosis of patients with non-ST segment elevation myocardial infarction (NSTEMI). In addition, to assess the association of BNP serum levels with TIMI risk score and with jeopardized myocardial area. The study comprised 46 consecutive patients with NSTEMI, discriminated by positive troponin I (>0.5ng/mL), admitted from May 2003 to January 2004, and followed up for 48 months. Forty patients completed the study. The BNP levels at admission and 96 hours after that were analyzed by using the non parametric Wilcoxon test with 95% confidence interval. A p value <0.05 was considered significant. The ROC curve was used to assess the accuracy of the 96-hour BNP as a predictor of death, in addition to defining the cutoff point. The Pearson chi-square test was used to compare the frequencies of clinical, electrocardiographic, and biochemical characteristics. Logistic regression analysis was used to assess a possible confounding factor between 96-hour BNP, age, and outcome. An elevation in BNP was observed between admission and 96 hours after that (median of 148 vs. 267, respectively; p=0.04). Thirteen patients died during follow-up. By using the 96-hour BNP cutoff point of 300pg/mL as a predictor of death, the following were observed: sensitivity of 92.3%, specificity of 77.8%, positive predictive value of 66.7%, and negative predictive value of 95.5%. The area under the ROC curve was 0.93. Significant differences were not observed in clinical, electrocardiographic, and angiographic characteristics between survivors and non-survivors. A clear association of 96-hour BNP with TIMI risk score was observed. A relation between BNP increase, both at admission and after 96 hours, and coronary anatomy was observed in the group with an extensive jeopardized myocardial area (p=0.021). The increase in BNP 96 hours after admission is associated with a larger jeopardized myocardial area. The results indicate that the greater increase in BNP 96 hours after admission is associated with greater severity and extension of the jeopardized myocardium. That fact could explain the relation between increased BNP and TIMI risk score. Assessing BNP 96 hours after an ischemic event is an important tool to stratify the long-term risk of death in NSTEMI.

O BNP tem sido apontado como ótimo marcador de disfunção ventricular esquerda na sala de emergência. O poder de complementar informação prognóstica aos pacientes com SCA ainda não está bem estabelecido. Analisar a contribuição do BNP no prognóstico a longo prazo de pacientes com SCASSST. A partir dos resultados obtidos, verificar a associação dos níveis séricos do BNP com o TIMI RISK escore e com a área de miocárdio sob risco isquêmico. Foram avaliados 46 pacientes consecutivos portadores de SCASSST, discriminados por troponina I positiva (valor >0,5ng/ml), admitidos no período de maio/2003 a janeiro/2004, e acompanhados por um período de seguimento de 48 meses. O estudo foi completado por 40 pacientes. A análise do BNP de admissão e após 96 horas foi realizada pelo teste não paramétrico de Wilcoxon com intervalo de confiança de 95%. Um valor de p<0,05 foi considerado significante. Utilizou-se a curva ROC para analisar a acurácia do BNP de 96 horas como preditor de morte, além de definir o ponto de corte. O teste do qui-quadrado de Pearson foi utilizado para comparar as frequências das características clínicas, eletrocardiográficas e bioquímicas. Para avaliar um possível fator de confusão entre o BNP de 96 horas, idade e desfecho, usou-se a análise de regressão logística. Houve uma elevação do BNP entre a admissão e 96 horas (mediana de 148 vs. 267 p=0,04). Ocorreram 13 óbitos no período de seguimento. Utilizando o valor de corte do BNP de 96 horas de 300pg/ml como preditor de morte, observou-se sensibilidade de 92,3%, especificidade de 77,8%, valor preditivo positivo de 66,7% e valor preditivo negativo de 95,5%. A área sob a curva ROC foi de 0,93. Diferenças significativas não foram observadas nas características clínicas, eletrocardiográficas e angiográficas entre sobreviventes e não sobreviventes. Observou-se nítida associação entre o BNP de 96 horas com a pontuação do TIMI RISK escore. Verificou-se também a relação entre o incremento do BNP, admissão e 96 horas, e a anatomia coronariana no grupo com extensa área do miocárdio sob risco isquêmico (p=0,021). A elevação do BNP após 96 horas da admissão está associada a uma população com maior área de miocárdio sob risco isquêmico. Os resultados Indicam que o maior incremento entre o BNP de admissão e após 96 horas está associado à maior gravidade e extensão de miocárdio sob risco isquêmico. Tal fato poderia explicar a relação entre BNP elevado com a pontuação do TIMI RISK escore. Análise do BNP obtido após 96 horas de evento isquêmico é uma importante ferramenta na estratificação de risco de morte a longo prazo na SCASSST. / BNP has been considered an excellent marker of left ventricular dysfunction in the emergency room. However, its ability to provide prognostic information on patients with acute coronary syndrome has not been well established. To assess the contribution of BNP to predict the long-term prognosis of patients with non-ST segment elevation myocardial infarction (NSTEMI). In addition, to assess the association of BNP serum levels with TIMI risk score and with jeopardized myocardial area. The study comprised 46 consecutive patients with NSTEMI, discriminated by positive troponin I (>0.5ng/mL), admitted from May 2003 to January 2004, and followed up for 48 months. Forty patients completed the study. The BNP levels at admission and 96 hours after that were analyzed by using the non parametric Wilcoxon test with 95% confidence interval. A p value <0.05 was considered significant. The ROC curve was used to assess the accuracy of the 96-hour BNP as a predictor of death, in addition to defining the cutoff point. The Pearson chi-square test was used to compare the frequencies of clinical, electrocardiographic, and biochemical characteristics. Logistic regression analysis was used to assess a possible confounding factor between 96-hour BNP, age, and outcome. An elevation in BNP was observed between admission and 96 hours after that (median of 148 vs. 267, respectively; p=0.04). Thirteen patients died during follow-up. By using the 96-hour BNP cutoff point of 300pg/mL as a predictor of death, the following were observed: sensitivity of 92.3%, specificity of 77.8%, positive predictive value of 66.7%, and negative predictive value of 95.5%. The area under the ROC curve was 0.93. Significant differences were not observed in clinical, electrocardiographic, and angiographic characteristics between survivors and non-survivors. A clear association of 96-hour BNP with TIMI risk score was observed. A relation between BNP increase, both at admission and after 96 hours, and coronary anatomy was observed in the group with an extensive jeopardized myocardial area (p=0.021). The increase in BNP 96 hours after admission is associated with a larger jeopardized myocardial area. The results indicate that the greater increase in BNP 96 hours after admission is associated with greater severity and extension of the jeopardized myocardium. That fact could explain the relation between increased BNP and TIMI risk score. Assessing BNP 96 hours after an ischemic event is an important tool to stratify the long-term risk of death in NSTEMI.

Background: The use of percutaneous left ventricular assist devices in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) is evolving. The aim of the study was to assess the long-term outcome of patients with AMICS depending on early initiation of Impella CP® support prior to a percutaneous coronary intervention (PCI). Methods: We retrospectively reviewed all patients who underwent PCI and Impella CP® support between 2014 and 2016 for AMICS at our institution. We compared survival to discharge between those with support initiation before (pre-PCI) and after (post-PCI) PCI. Results: A total of 73 consecutive patients (69±12 years old, 27.4% female) were supported with Impella CP® and underwent PCI for AMICS (34 pre-PCI vs. 39 post-PCI). All patients were admitted with cardiogenic shock, and 58.9% sustained cardiac arrest. Survival at discharge was 35.6%. Compared with the post-PCI group, patients in the pre-PCI group had more lesions treated (p=0.03), a higher device weaning rate (p=0.005) and higher survival to discharge as well as to 30 and 90 days after device implantation, respectively (50.0% vs. 23.1%, 48.5% vs. 23.1%, 46.9 vs. 20.5%, p < 0.05). Kaplan–Meier analysis showed a higher survival at one year (31.3% vs. 17.6%, log-rank p-value=0.03) in the pre-PCI group. Impella support initiation before PCI was an independent predictor of survival up to 180 days after device implantation. Conclusions: In this small, single-centre, non-randomized study Impella CP® initiation prior to PCI was associated with higher survival rates at discharge and up to one year in AMICS patients presenting with high risk for in-hospital mortality.

Acute coronary syndrome (ACS) refers to a group of clinical conditions caused by myocardial ischemia including unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segmcnt elevation myocardial infarction (STEMI). Appropriate and accurate diagnosis has life-saving implications and requires a quick but thorough evaluation of the patient's history, physical examination, electrocardiogram, radiographic studies, and cardiac biomarkers. The management of patients with suspected or confirmed ACS continues to evolve as new evidence from clinical trials is considered and as new technology becomes available to both primary care physicians and cardiologists. Low- and intermediate-risk patients have frequently been managed in a chest pain center or in the emergency department. While stress testing with or without radionuclide imaging is the most common evaluation method, a CT angiogram is sometimes substituted High-risk patients are often managed with an early invasive strategy involving left heart catheterization with a goal of prompt revascularization of at-risk, viable myocardium. With the increased availability of cardiac catheterization facilities, patients with STEMI are more commonly being managed with primary percutaneous coronary intervention, although thrombolysis is still used where such facilities are not immediately available. This article provides primary care physicians with a concise review of the pathophysiology, clinical evaluation, and management of ACS based on the best available evidence in 2008.

The anomalous origin of coronary arteries has been extensively documented in the literature. Most of the anomalies are incidentally found either during coronary angiography or imaging studies and are usually benign; however, malignant outcomes have been reported in the literature. Here, we present the case of a 76-year-old male with non-ST segment elevation myocardial infarction who was found to have an asymptomatic anomalous origin left anterior descending artery from the right sinus of Valsalva.