Acute coronary syndromes arrhythmias

Overdose is common amongst users (up to 22% of heavy users report losing consciousness). The desired euphoria and excitement turns to acute fear, with psychotic symptoms, convulsions, hypertension, haemorrhagic storke, tachycardia, arrhythmias, hyperthermia coronary vasospasm (sufficient to present as the acute coronary syndrome with chest pain and myocardial infarction) may occur, and acute left ventricular dysfunction. Treatment is chosen according to the clinical picture (and the known mode of action), from amongst, e.g. haloperidol (rather than chlorpromazine) for mental disturbance diazepam for convulsions a vasodilator, e.g. a calcium channel blocker, for hypertension glyceryl trinitrate for myocardial ischaemia (but not a p-... 

This review summarizes the available morphological evidence for coronary microembolization in patients who died from coronary artery disease, most notably from sudden death. Then the experimental pathophysiology of coronary microembolization in animal models of acute coronary syndromes is detailed. Finally, the review presents the available clinical evidence for coronary microembolization in patients, highlights its key features - arrhythmias, contractile dysfunction, microinfarcts and reduced coronary reserve -, compares these features to those of the experimental model and addresses its prevention by mechanical protection devices and glycoprotein Ilb/IIIa antagonism. 

Clearly, coronary microembolization is a frequent event in ischemic heart disease, spontaneously in patients with unstable angina / acute coronary syndromes as well as artificially during coronary interventions with typical consequences, such as malignant arrhythmias and contractile dysfunction (Figure 7). The resulting microcirculatory impairment causes patchy microinfarction, and is often associated with coronary hyperemia at baseline and, conversely, transiently reduced coronary reserve. These obser-... 

The electrocardiogram (ECG), which was discovered more than 100 years ago and has just celebrated its first century, appears to be more alive than ever. Until recently its utility was especially important for identifying different ECG morphological abnormalities, including arrhythmias, blocks at all levels, pre-excitation, acute coronary syndromes, as well as Q-wave acute myocardial infarction, for which ECG was the gold-standard diagnostic technique. 

P Receptor antagonists are used extensively in the treatment of hypertension (see Chapter 32), angina and acute coronary syndromes (see Chapter 31), and congestive heart failure (see Chapter 33). These drugs also are used frequently in the treatment of supraventricular and ventricular arrhythmias (see Chapter 34). 

Cardiovascular A 64-year-old woman treated for macular degeneration with intraocular injections of bevacizumab presented with chest pain, nausea and vomiting. After an initial diagnosis of acute coronary syndrome and anticoagulation treatment with intravenous heparin, she remained stable without chest pain or shortness of breath and with no evidence of arrhythmias. This may be the first report of an association between intraocular bevacizumab and reversible myocardial dysfunction with a pattern similar to stress-induced cardiomyopathy (also called Takotsubo cardiomyopathy or apical ballooning), although clear evidence for a causal relationship is lacking [97 ]. 

The table below lists the best leads for monitoring challenging cardiac arrhythmias and special situations such as acute coronary syndromes. 

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