Jorge Salamanca

Factors Associated With Delays in Seeking Medical Attention in Patients With ST-segment Elevation Acute Coronary Syndrome

INTRODUCTION AND OBJECTIVES Prompt coronary reperfusion is crucial in patients with ST-segment elevation acute coronary syndrome. The aim of this study was to determine factors associated with a delay in seeking medical attention after the onset of symptoms in patients with this condition. METHODS Prospective cohort study in consecutive patients with ST segment elevation infarction. Multiple logistic regression analysis was used to identify factors independently associated with a longer delay in requesting medical help. RESULTS In total, 444 consecutive patients were included (mean age, 63 years; 76% men, 20% with diabetes). Median total ischemia time was 225 (160-317) minutes; median delay in seeking medical attention was 110 (51-190) minutes. Older patients (age > 75 years; odds ratio = 11.6), women (odds ratio = 3.4), individuals with diabetes (odds ratio = 2.3), and those requesting medical care from home (odds ratio = 2.2) showed the longest delays in seeking medical attention. Lengthy delay was associated with higher in-hospital mortality (9.8% vs 2.7%; P<.005) and 1-year mortality (7.3% vs 2.9%; P<.05) than when attention was promptly solicited. CONCLUSIONS Elderly patients, women, and diabetic individuals with ST-segment elevation myocardial infarction show longer delays in seeking medical attention for their condition. Delays in seeking medical attention are associated with greater in-hospital and 1-year mortality.

Wide QRS Complex Tachycardia: What the Algorithms Fear

A 70-year-old man was admitted to the emergency department for several hours of palpitations, dizziness, and dyspnea. The patient had a history of hypertension, diabetes mellitus, dyslipidemia, chronic obstructive pulmonary disease, and paroxysmal atrial fibrillation. His medications included eprosartan, amlodipine, atorvastatin, sitagliptin, indacaterol, and acenocoumarol. On arrival, his heart rate was 170 bpm and blood pressure was 110/50 mm Hg. The following 12-lead ECG was obtained (Figure 1). Figure 1. ECG obtained at admission in the emergency department. Based on the ECG, what is the most likely diagnosis? Please turn the page to read the diagnosis. The ECG in Figure 1 shows a wide QRS complex tachycardia at 170 bpm. Wide QRS complex tachycardia can be originated by 3 main mechanisms1: 1. Ventricular tachycardia (VT). 2. Supraventricular tachycardia (SVT) …

Methyl-Ergonovine Stress Echocardiography in the Study of Kounis Syndrome due to Anisakis Simplex: A Case Report

C l i n M e d International Library Citation: Restrepo JA, Salamanca J, Diego G, Rivero F, Alfonso F, et al. (2015) MethylErgonovine Stress Echocardiography in the Study of Kounis Syndrome due to Anisakis Simplex: A Case Report. Int J Clin Cardiol 2:056 Received: September 09, 2015: Accepted: October 07, 2015: Published: October 10, 2015 Copyright: