In the body, water moves through semi-permeable membranes of cells and from one compartment of the body to another by a process called osmosis.
Human beings are mostly water, ranging from about 75 percent of body mass in infants to about 50–60 percent in adult men and women, to as low as 45 percent in old age. Body fluids can be discussed in terms of their specific fluid compartment, a location that is largely separate from another compartment by some form of a physical barrier. The compositions of the two components of the ECF—plasma and IF—are more similar to each other than either is to the ICF ([link]). Hydrostatic pressure, the force exerted by a fluid against a wall, causes movement of fluid between compartments. Watch this video to see an explanation of the dynamics of fluid in the body’s compartments.
Hydrostatic pressure is especially important in governing the movement of water in the nephrons of the kidneys to ensure proper filtering of the blood to form urine.
The movement of some solutes between compartments is active, which consumes energy and is an active transport process, whereas the movement of other solutes is passive, which does not require energy.
Passive transport of a molecule or ion depends on its ability to pass through the membrane, as well as the existence of a concentration gradient that allows the molecules to diffuse from an area of higher concentration to an area of lower concentration. In pulmonary edema resulting from heart failure, excessive leakage of water occurs because fluids get “backed up” in the pulmonary capillaries of the lungs, when the left ventricle of the heart is unable to pump sufficient blood into the systemic circulation. Mild, transient edema of the feet and legs may be caused by sitting or standing in the same position for long periods of time, as in the work of a toll collector or a supermarket cashier.
Medications that can result in edema include vasodilators, calcium channel blockers used to treat hypertension, non-steroidal anti-inflammatory drugs, estrogen therapies, and some diabetes medications. Solute contributes to the movement of water between cells and the surrounding medium by ________. It has a sensitivity of 35% and specificity of 59% (Gibbons RJ  Nitroglycerin: Should We Still Ask? Spontaneous coronary artery dissection remains an unusual cause of acute coronary syndrome. Retrospective study of confirmed MIs:  47% did not present with chest pain, Women and older patients more likely to present without chest pain. A prospective study of 796 ED patients with suspected cardiac chest pain assessed the value of individual historical and examination findings for diagnosing acute myocardial infarction (AMI) and the occurrence of adverse events (death, AMI or urgent revascularization) within 6 months.
A 2-Hour Diagnostic Protocol for Possible Cardiac Chest Pain in the Emergency DepartmentA Randomized Clinical Trial ONLINE FIRST M JAMA Intern Med. Conclusion: Among patients presenting with chest pain to the ED and a history of stress testing within the past 2 years, a normal stress test result was associated with a markedly reduced risk of having a major cardiac endpoint.
Performance of a sensitive troponin assay in the early diagnosis of acute myocardial infarction in the emergency department.Emerg Med Australas. LOW MOLECULAR WEIGHT HEPARINS VERSUS UNFRACTIONATED HEPARIN FOR ACUTE CORONARY SYNDROMES Background This review aimed to identify randomized controlled clinical trials to determine the relative safety and efficacy of subcutaneous low-molecular-weight heparins (LMWH) versus intravenous unfractionated heparin (UFH) for people with acute coronary syndromes (ACS; unstable angina or non-ST segment elevation myocardial infarction). Comment(s) Beta blockade for cocaine induced myocardial infarction has been advocated in some quarters. A majority of those that rule in for MI will have coronary artery blockage (not vasospastic) while a huge majority of those that rule out will have no structural disease. A 9-12 hour observation period with 2 sets negative is probably sufficient if follow-up can be arranged. Can lead to thrombus formation: Although a mural thrombus adheres to the endocardium overlying the infarcted myocardium, superficial portions of it can become detached and produce systemic arterial emboli. After the vascular sheath is removed from the femoral artery, a femoral pseudoaneurysm can form. Picked a group who were admitted, but deemed low risk (<7% by validated risk stratification mechanism), no signs heart failure, hypotension, or arrhythmia. Conclusion:  It might be ok to send home low risk patients after 12 hours, but only if follow up for stress testing or cath can be guaranteed in a timely (24-48 hour) manner.
A 2-Hour Diagnostic Protocol for Possible Cardiac Chest Pain in the Emergency DepartmentA Randomized Clinical Trial (JAMA Intern Med.
Deep symmetrical T-wave inversion across the precordial leads may indicate a critical stenosis of the left anterior descending coronary artery (Wellen’s phenomena).
Myocardial infarction (MI) was suspected if the electrocardiogram (ECG) showed ST-segment elevation of 1 mm or more or pathologic Q waves in two or more leads, and these findings were not known to be old. Are serial ECGs useful during the ED evaluation of patients with suspected acute coronary syndromes?
Patient Management Recommendations Level A recommendations Do not utilize cardiac serum marker tests to exclude non-AMI acute coronary syndromes (ie, unstable angina). Relationship of reported sensitivities of various serum markers in relationship to time of symptom onset. CONCLUSIONS: Patients who are symptomatic during acquisition of a normal or nonspecific ECG have rates of adverse cardiovascular events similar to those of patients without symptoms. Relationship between a Clear-cut Alternative Noncardiac Diagnosis and 30-day Outcome in Emergency Department Patients with Chest Pain Judd E. Objectives: To compare the 30-day event rate in ED chest pain patients whowere diagnosed with a clear-cut alternative noncardiac diagnosiswith the 30-day event rate in the cohort of patients in whoma definitive diagnosis could not be made in the ED.
Conclusions: In the ED chest pain patient, the presence of a clear-cut alternativenoncardiac diagnosis reduces the likelihood of a composite outcomeof death and cardiovascular events within 30 days. It is well known that the main pathogenesis of acute coronary syndromes consists of atherosclerotic plaque disruption and thrombus formation [10]. A unique complication of a right ventricular myocardial infarction is the development of a right-to-left shunt through a patent foramen ovale.  RV infarction causes reduced right ventricular myocardial compliance with increased RV end diastolic and right atrial pressures. Quite often there are no Deep Vein Thrombosis symptoms at the onset of the condition, although where they do appear, they may develop rapidly. Occasionally some of the surface veins become more visible through the skin, and there may also be some pain on flexing the foot upwards. There can be many causes of a painful or swollen leg, which means that it can be difficult for a doctor to successfully perform a first time DVT diagnosis.
DVTs are usually detected by ultrasound, which is capable of detecting even the smallest blood clots. If the results of an Ultrasound and D-dimer test cannot confirm a diagnosis of DVT, a venogram might be used. DVTs themselves are not dangerous, but they are associated with complications which can become life threatening, or prove fatal.
More rarely, a part of the clot may also lodge in other organs including the brain, where it can lead to a stroke.
Two thirds of people diagnosed with a DVT require initial treatment at a hospital, or possibly an anticoagulation clinic.
Painkillers and heat applied to the area may also be advised for relief of symptoms of a DVT, and compression stockings are often worn to cover the length of the whole leg to give support to the veins and reduce swelling. As well as wearing compression stockings, you may be advised to raise your leg while you are resting, as this helps to reduce the pressure in the veins of the leg, and also helps tp prevent blood and fluid from gathering in the leg.
Major surgical operations are known to be a risk for a DVT – particularly operations to the hip, lower abdomen, and leg. After a DVT has been diagnosed, persistent symptoms may occur in the affected part of the leg. The wave of excitation travels across the bundle of his in the septum. The wave of excitation then reaches the ventricles which cause contraction at the same time.
Osmosis is basically the diffusion of water from regions of higher concentration to regions of lower concentration, along an osmotic gradient across a semi-permeable membrane. The percent of body water changes with development, because the proportions of the body given over to each organ and to muscles, fat, bone, and other tissues change from infancy to adulthood ([link]).
The intracellular fluid (ICF) compartment is the system that includes all fluid enclosed in cells by their plasma membranes. The ICF makes up about 60 percent of the total water in the human body, and in an average-size adult male, the ICF accounts for about 25 liters (seven gallons) of fluid ([link]).
These include the cerebrospinal fluid that bathes the brain and spinal cord, lymph, the synovial fluid in joints, the pleural fluid in the pleural cavities, the pericardial fluid in the cardiac sac, the peritoneal fluid in the peritoneal cavity, and the aqueous humor of the eye.
When blood volume decreases due to sweating, from what source is water taken in by the blood?
Thus, cations, or positively charged ions, and anions, or negatively charged ions, are balanced in fluids. The hydrostatic pressure of blood is the pressure exerted by blood against the walls of the blood vessels by the pumping action of the heart. As hydrostatic pressure in the kidneys increases, the amount of water leaving the capillaries also increases, and more urine filtrate is formed. Recall that an osmotic gradient is produced by the difference in concentration of all solutes on either side of a semi-permeable membrane. Sweating depletes your tissues of water and increases the solute concentration in those tissues. Active transport allows cells to move a specific substance against its concentration gradient through a membrane protein, requiring energy in the form of ATP.
Some molecules, like gases, lipids, and water itself (which also utilizes water channels in the membrane called aquaporins), slip fairly easily through the cell membrane; others, including polar molecules like glucose, amino acids, and ions do not. People with pulmonary edema likely will experience difficulty breathing, and they may experience chest pain.
Because the left side of the heart is unable to pump out its normal volume of blood, the blood in the pulmonary circulation gets “backed up,” starting with the left atrium, then into the pulmonary veins, and then into pulmonary capillaries. A decrease in the normal levels of plasma proteins results in a decrease of colloid osmotic pressure (which counterbalances the hydrostatic pressure) in the capillaries.
This is because deep veins in the lower limbs rely on skeletal muscle contractions to push on the veins and thus “pump” blood back to the heart. Underlying medical conditions that can contribute to edema include congestive heart failure, kidney damage and kidney disease, disorders that affect the veins of the legs, and cirrhosis and other liver disorders.
Activities that can reduce the effects of the condition include appropriate exercises to keep the blood and lymph flowing through the affected areas. Body fluids are aqueous solutions with differing concentrations of materials, called solutes. How can this be if individual ions of sodium and chloride exactly balance each other out, and plasma is electrically neutral?


The osmotic pressure results from differences in solute concentrations across cell membranes. A loading dose of 0.5 mg per kg may be given by slow intravenous administration (2 to 5 min) for a more rapid onset of action.
Narrative review: alternative causes for elevated cardiac troponin levels when acute coronary syndromes are excluded.
2 Any type of BBB (right, left, and atypical ? new or old) thought to be obscuring ST-segment analysis in patients with clinical presentation strongly suggestive of AMI. ST elevation (greater than 0.1 mV, two or more contiguous leads),  time to therapy 12 hours or less, age less than 75 years. At first sight it would seem to make sense as many of these patients will be hypertensive and suffering the effects of an adrenergic drive. Although estimates vary based on patient selection, about 10% of mural thrombi result in systemic embolization (2).
Palpation of localized swelling or tenderness in the area, or loss of sensory or motor function, is highly suggestive of hematoma.
A pseudoaneurysm is a communication between the femoral artery and the overlying fibromuscular tissue, resulting in a blood-filled cavity. Derivation of the Four Initial Risk Groups on the Basis of Data Available at the Time of Presentation in the Emergency Department. Ischemia was suspected if the ECG showed ST-segment depression of 1 mm or more or T-wave inversion in two or more leads, and these findings were not known to be old. Level B recommendations Perform repeat ECG or automated serial ECGs during the ED evaluation of patients in whom the initial ECG is nondiagnostic for injury and who have symptoms consistent with ongoing or recurrent ischemia.
Exclusion Criteria Contraindications for a glycoprotein inhibitor (bleeding disorder, renal insufficiency, etc).
Clinicians should not rely on the absence of ECG abnormalities during symptoms to help exclude ACS. Data included demographics, medical and cardiac history, laboratory and electrocardiogram results, and whether or not the treating physician ascribed the conditionto a clear-cut alternative noncardiac diagnosis. However,it does not reduce the event rate to an acceptable level toallow ED discharge of these patients. However, no atherosclerotic plaque in the major coronary arteries was detected on coronary angiography. In patients with an interatrial septal defect, a right-to-left shunt may develop when the right atrial pressure exceeds the left atrial pressure. The problem may only become apparent when a crisis develops into a medical emergency, and the blood clot reaches the lungs, where it becomes what is known as a pulmonary embolism. If you have some of the DVT risk factors listed above, and your doctor suspects that you may have a DVT, they will usually recommend that you have some urgent tests performed, which will normally be carried out in a hospital, or possibly a specialist anti-coagulation clinic. If a doctor suspects a DVT he or she will usually request an urgent ultrasound test, and a follow-up blood test. This is a more detailed test that involves a contrast dye being injected into the vein in your leg. The most common serious complication is a pulmonary embolism, which occurs in approximately 30% of cases of DVT. The aim of the DVT treatment is to dissolve the blood clot and prevent further clots from forming. DVT prophylaxis is always preferable than having to deal with consequences of developing the condition. You may be given an anticoagulant such as a heparin injection just before having an operation to help prevent a DVT.
In order to minimise the risk of further complications you may be advised to wear a compression stocking for many months or even years. Blood from the lungs enter the left atrium through the pulmonary vein.  The heart beat is initiated and maintained by special muscle cells known collectively as the pace maker or sinoatrial node. The tricuspid and bicuspid valves are both closed during contraction of the ventricles causing blood having reached the ventricles, to be forced into the aorta from the left ventricle, and into the pulmonary artery from the right ventricle.
In the human body, solutes vary in different parts of the body, but may include proteins—including those that transport lipids, carbohydrates, and, very importantly, electrolytes.
As a result, water will move into and out of cells and tissues, depending on the relative concentrations of the water and solutes found there.
Your brain and kidneys have the highest proportions of water, which composes 80–85 percent of their masses. This fluid volume tends to be very stable, because the amount of water in living cells is closely regulated. Plasma travels through the body in blood vessels and transports a range of materials, including blood cells, proteins (including clotting factors and antibodies), electrolytes, nutrients, gases, and wastes.
Because these fluids are outside of cells, these fluids are also considered components of the ECF compartment. The IF has high concentrations of sodium, chloride, and bicarbonate, but a relatively lower concentration of protein. As seen in the previous graph, sodium (Na+) ions and chloride (Cl-) ions are concentrated in the ECF of the body, whereas potassium (K+) ions are concentrated inside cells.
In capillaries, hydrostatic pressure (also known as capillary blood pressure) is higher than the opposing “colloid osmotic pressure” in blood—a “constant” pressure primarily produced by circulating albumin—at the arteriolar end of the capillary ([link]).
If hydrostatic pressure in the kidneys drops too low, as can happen in dehydration, the functions of the kidneys will be impaired, and less nitrogenous wastes will be removed from the bloodstream. The magnitude of the osmotic gradient is proportional to the difference in the concentration of solutes on one side of the cell membrane to that on the other side. As this happens, water diffuses from your blood into sweat glands and surrounding skin tissues that have become dehydrated because of the osmotic gradient. For example, the sodium-potassium pump employs active transport to pump sodium out of cells and potassium into cells, with both substances moving against their concentration gradients.
Some of these molecules enter and leave cells using facilitated transport, whereby the molecules move down a concentration gradient through specific protein channels in the membrane.
Pulmonary edema can be life threatening, because it compromises gas exchange in the lungs, and anyone having symptoms should immediately seek medical care. The resulting increased hydrostatic pressure within pulmonary capillaries, as blood is still coming in from the pulmonary arteries, causes fluid to be pushed out of them and into lung tissues. This process causes loss of water from the blood to the surrounding tissues, resulting in edema. Otherwise, the venous blood pools in the lower limbs and can leak into surrounding tissues. Other therapies include elevation of the affected part to assist drainage, massage and compression of the areas to move the fluid out of the tissues, and decreased salt intake to decrease sodium and water retention. An appropriate balance of water and solute concentrations must be maintained to ensure cellular functions. Hydrostatic pressure results from the pressure of blood as it enters a capillary system, forcing some fluid out of the vessel into the surrounding tissues. All possible R-values are easily constructed graphically from any PB on the PO2 - PCO2 diagram. Some studies have reported false-positive elevation of markers for acute myocardial infarction (AMI) in ESRD patients.
However, it must be remembered that cocaine affects both alpha and beta receptors and that by giving a beta blocker the effects of alpha blockade on the heart may become unopposed. Indications for surgical intervention include persistent hypotension, decreasing hematocrit despite transfusion, or femoral neuropathy (due to nerve compression). Risk factors included systolic blood pressure below 110 mm Hg, rales heard above the bases bilaterally on physical examination, and known unstable ischemic heart disease, defined as a worsening of previously stable angina, the new onset of postinfarction angina or angina after a coronary-revascularization procedure, or pain that was the same as that associated with a prior myocardial infarction.
Patients stratified as moderate risk who also had a high probability of significant coronary artery disease (using the Diamond and Forrester criteria25) were recommended for cardiology consultation. Peaks A, B, and C respectively demonstrate release of myoglobin, troponin, and CK-MB in acute myocardial infarction as defined by WHO diagnostic criteria.
The main outcomewas death, acute myocardial infarction (AMI), or revascularizationwithin 30 days, as determined by phone follow-up or medicalrecord review.
There was temporary systolic coronary arterial luminal narrowing at the mid-portion of LAD at LAO view.
Such a situation should be suspected in a patient who exhibits significant hypoxemia that is not responsive to the administration of oxygen.
Our blood needs to be able to clot in order to provide the necessary protection for the body against severe loss of blood from an injury to a vein or an artery. This presents an increased risk of a solid clot forming, which can cause a partial or complete blockage in the vein. There is a special blood test known as the D-dimer test, which is capable of detecting fragments of a blood clot that have broken up, and present within the blood stream.
An X-ray is then used to see whether the dye is flowing through your vein, or if it is blocked by a blood clot.
This is where a part of the blood clot in the leg vein breaks off and travels through the blood stream to the lung, where it becomes lodged, causing chest pain and severe breathing difficulties. The primary DVT therapy is with anticoagulant medicines such as Heparin or Warfarin which thin the blood, allowing it to flow more freely. This is usually necessary only in the case of a severe form of DVT called phlegmasia cerulea dolens, which does not respond to the non-surgical treatments described above.
An inflatable sleeve connected to a pump to compress the legs during a long operation may also be used.
Often in medicine, a mineral dissociated from a salt that carries an electrical charge (an ion) is called and electrolyte. An appropriate balance of solutes inside and outside of cells must be maintained to ensure normal function.
Extracellular fluid has two primary constituents: the fluid component of the blood (called plasma) and the interstitial fluid (IF) that surrounds all cells not in the blood ([link]). If the amount of water inside a cell falls to a value that is too low, the cytosol becomes too concentrated with solutes to carry on normal cellular activities; if too much water enters a cell, the cell may burst and be destroyed.
Although sodium and potassium can “leak” through “pores” into and out of cells, respectively, the high levels of potassium and low levels of sodium in the ICF are maintained by sodium-potassium pumps in the cell membranes. This pressure forces plasma and nutrients out of the capillaries and into surrounding tissues.


Water will move by osmosis from the side where its concentration is high (and the concentration of solute is low) to the side of the membrane where its concentration is low (and the concentration of solute is high). Additionally, as water leaves the blood, it is replaced by the water in other tissues throughout your body that are not dehydrated.
Edema is almost always caused by an underlying medical condition, by the use of certain therapeutic drugs, by pregnancy, by localized injury, or by an allergic reaction.
Cardiac troponin I (cTnI) has been reported to be specific for cardiac muscle, and is excreted by the kidneys. The sensitivity of the test will be influenced by the amount of METs, the duration of exercise greater than 6?12 min, as well a heart rate at 85% of predicted [1, 2, 3, 4 and 6]. These trials seems to confirm this concern with a decrease in myocardial blood flow and coronary vasoconstriction. Studies suggest that 30 to 60 minutes after baseline may be a reasonable time interval for repeat ECG. Also, it is often considered as a simple variant of the normal anatomy of coronary arteries. Our patient had a smoking history, and nicotine could have damaged the endothelial structure at the bridged segment.
We have always assumed that when a patient experiences an acute myocardial infraction (AMI), it occurs because of a ruptured plaque followed by coronary thrombosis. However, blood can sometimes form clots whilst inside a blood vessel, which is the definition of a Deep Vein Thrombosis (DVT). Inactivity and bed rest is discouraged and patients are encouraged to move around as much as possible. Phlegmasia cerulea dolens, if not adequately treated, can cause gangrene, which is when the tissues do not receive sufficient oxygen, and subsequently die. It is also common practice to get you up and walking as soon as possible after an operation. The pacemaker sends a wave of excitation through the muscles of the right atrium and to the muscles of the left atrium. For instance, sodium ions (Na+) and chloride ions (Cl-) are often referred to as electrolytes. Cells are separated from the IF by a selectively permeable cell membrane that helps regulate the passage of materials between the IF and the interior of the cell. These pumps use the energy supplied by ATP to pump sodium out of the cell and potassium into the cell ([link]). Fluid and the cellular wastes in the tissues enter the capillaries at the venule end, where the hydrostatic pressure is less than the osmotic pressure in the vessel.
In the body, water moves by osmosis from plasma to the IF (and the reverse) and from the IF to the ICF (and the reverse). For example, glucose is transferred into cells by glucose transporters that use facilitated transport ([link]). In the limbs, the symptoms of edema include swelling of the subcutaneous tissues, an increase in the normal size of the limb, and stretched, tight skin.
If the cytosol becomes too dilute due to water intake by cells, cell membranes can be damaged, and the cell can burst. Exercise capacity itself shows a linear relation to adverse cardiac outcomes; the greater the METs achieved, the lower the relative risk of events [5]. In a patient with myocardial ischaemia this could result in an even lower coronary blood flow thereby worsening the ischaemia. Most larger pseudoaneurysms can be treated with ultrasound-guided compression, ultrasound-guided thrombin injection, or surgical repair. Possible explanation of AMI in our patient could be endothelial injury, severe coronary spasm and finally thrombotic occlusion [11]. Perhaps, the patient can have an AMI due to vasospasm within clean coronaries or coronaries that have minimal stenoses?maybe. Regular blood tests are performed monitor the effectiveness of the treatment and to reduce the risk of a haemorrhage. Gangrene is a very serious condition that may result in the amputation of the affected limb. The excitation results in the contraction of both atria (plural for atrium) at the same time resulting in blood rushing across the tricuspid and bicuspid valves into the right and left ventricles. Filtration pressure squeezes fluid from the plasma in the blood to the IF surrounding the tissue cells. In the body, water moves constantly into and out of fluid compartments as conditions change in different parts of the body. When a dehydrated person drinks water and rehydrates, the water is redistributed by the same gradient, but in the opposite direction, replenishing water in all of the tissues. One quick way to check for subcutaneous edema localized in a limb is to press a finger into the suspected area. Hydrostatic pressure is the force exerted by a fluid against a wall and causes movement of fluid between compartments.
METHODS: The authors, from Henry Ford Hospital in Detroit, measured pre- and post- dialysis cTnI in 113 ESRD patients aged 26-92 with no symptoms of acute coronary syndrome who presented for maintenance dialysis.
No evidence was found for difference in occurrence of recurrent angina, or major or minor bleeds.
4 ST depressions greater than or equal to 0.2 mV (2 mm) with upright T-waves in 2 or more contiguous anterior precordial leads (V1 to V4) in patients with clinical presentation suggestive of AMI involving the posterior left ventricular wall.
The sensitivity of a standard ETT is thought to be approximately 66%, ranging from 40% to 90%, depending on the severity of disease when compared to the gold standard of coronary angiography, whereas specificity is approximately 84% [6]. However, we must remember that this is a small study in an experimental setting with patients receiving very small amounts of cocaine (much less than the typical recreational user). An emerging alternative therapy is percutaneous polytetrafluoroethylene-covered stent-graft deployment at the site of the pseudoaneurysm. Stable or unstable angina pectoris, acute myocardial infarction, complete atrioventricular block or sudden death associated with myocardial bridges have been described [8,9].
This is a case of acute myocardial infarction caused by coronary thrombosis in the setting of myocardial bridging. The surplus fluid in the interstitial space that is not returned directly back to the capillaries is drained from tissues by the lymphatic system, and then re-enters the vascular system at the subclavian veins. Edema is likely if the depression persists for several seconds after the finger is removed (which is called “pitting”). Level C recommendations Assess for fibrinolytic therapy in patients with symptoms suggestive of AMI and presenting within 12 hours of symptom onset if ECG reveals: 1 New or presumably new right bundle branch block (RBBB). An arteriovenous (AV) fistula can result from sheath-mediated communication between the femoral artery and femoral vein. A possible association between myocardial bridging and acute myocardial infarction following excess blood donation could not be excluded.
Active transport processes require ATP to move some solutes against their concentration gradients between compartments. On balance, in light of the feasible pathophysiological argument against the use of beta blockers, and the findings of these limited studies it appears sensible not to advocate the use of beta blockers in acute myocardial pain secondary to cocaine use.
An AV fistula may be suggested by the presence of a systolic and diastolic bruit and confirmed by Doppler ultrasonography.
This is a report of a case of acute ischemic complication related to myocardial bridging of the LAD, which was resolved by appropriate blood transfusion, and acetylsalicilic acid, beta-blocker, nytroglicerin. So if you the physician are caring for a patient with chest pain that recently had a bnegativeQ catheterization (ie, clean catheterization or a catheterization with insignificant stenoses), then you assume that there is almost no chance that that patient can be having real ACS event. Passive transport of a molecule or ion depends on its ability to pass easily through the membrane, as well as the existence of a high to low concentration gradient. CLINICAL BOTTOM LINE Beta Blockers should not be used in the treatment of cocaine induced myocardial ischaemia. AV fistulae can be treated with conservative therapy (careful observation) in most patients or with ultrasound-guided compression, surgical repair, or percutaneous implantation of covered stents if necessary. CONCLUSIONS: These findings suggest that cardiac troponin I is a reliable marker of myocardial injury in patients with ESRD on chronic dialysis. Planar Tc99m sestamibi imaging increases the sensitivity to 84%, whereas specificity is 83% [6].
Although this study is not groundbreaking, it does reaffirm what many other studies have indicated: it is very possible, and in fact not infrequent, to have an AMI even in the setting of minimal or no coronary stenosis.
Single photon emission computed tomography (SPECT) with Tc99m sestamibi can increase both the sensitivity and specificity to 90% and 93%, respectively [6].
Factors associated with increased risk for stroke include older age, presence of diabetes, saphenous vein graft interventions, and placement of an intra-aortic balloon pump (placed either prophylactically or for intraprocedural complications).
The authors analyzed 38,301 patients from a registry (the CRUSADE registry) of patients with non?ST-segment elevation MI who underwent cardiac catheterization to determine the extent of coronary artery disease. The researchers found that 8.6% of these AMI patients had binsignificantQ coronary stenoses (b50% occlusions). The overall sensitivity of a standard Tc-99 MIBI SPECT is approximately 60?70% in patients with multivessel disease [7 and 9].
These devices can percutaneously place one or more sutures in the femoral artery or deliver a procoagulant, such as collagen or collagen and thrombin, through a sheath to stimulate local hemostasis. Note that these 3 patient factors are the kind of characteristics that are very likely to make us discount the coronary artery disease risk. Additional modalities added to the standard SPECT study, such as echocardiogram or adding pharmacologic agents like dipyridamole, can increase the sensitivity to 82% and 76%, respectively [7 and 9]. Physicians should be aware that hemostasis success rates are less than 100% and that these devices are associated with a risk for vascular complications.
These complications include pseudoaneurysm, bleeding and hematoma, infection, arterial stenosis or occlusion, and venous thrombosis. Several reports in the surgical literature suggest that vascular closure devices are associated with a higher incidence of large pseudoaneurysms and pseudoaneurysms not amenable to ultrasound compression therapy, greater loss of blood and need for transfusions, higher incidence of arterial stenosis or occlusion, more extensive surgical repair, and higher incidence of groin infections compared with manual compression. Thus, the possibility of vascular complications should be considered at least as seriously in patients treated with vascular closure devices as in those treated with manual compression.



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