RESUMEN
BACKGROUND: This is a prospective, observational review of medical records to investigate the associated comorbidities and angiographic anatomy in patients with chronic right bundle branch block (RBBB). METHODS: The analyses of 32,345 consecutive electrocardiograms (EKGs) between October 2010 and January 2012 revealed 583 patients with RBBB. The common comorbidities associated with RBBB were hypertension (82%), diabetes (42%), coronary artery disease (CAD) (44%), valvular heart disease (aortic--16% and mitral--17%) and pulmonary disease (33%). Demographic data including age, sex, EKG and associated comorbidities were analyzed from the medical records. Coronary angiograms within 6 months of EKG in patients with RBBB were available for 184 patients and were accordingly analyzed for significant obstructive CAD. RESULTS: In all, 33 patients had single-vessel disease, 52 patients had 2-vessel disease, and 87 patients had multivessel disease whereas 12 patients had no significant disease. Left anterior descending artery was the most frequent vessel involved (72%) followed by left circumflex (58%) and right coronary artery (53%). CONCLUSIONS: In conclusion, in chronic RBBB, wherever the angiograms were available, CAD predominantly involved left anterior descending artery. Most common associated comorbidities in chronic RBBB were systemic hypertension and CAD.
Asunto(s)
Bloqueo de Rama/epidemiología , Enfermedad de la Arteria Coronaria/epidemiología , Anciano , Anciano de 80 o más Años , Bloqueo de Rama/etiología , Comorbilidad , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/etiología , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , West Virginia/epidemiologíaRESUMEN
We report the case of a 45-year-old postpartum female at low risk for coronary artery disease (CAD) who presented with chest pain, a normal electrocardiogram (ECG) and elevation of serial troponin-T levels. Coronary angiography revealed dissection of the first obtuse marginal branch of the left circumflex coronary artery. The patient was treated medically and discharged home safely. Spontaneous coronary artery dissection (SCAD) is a rare condition. In the absence of CAD, it is seen most frequently in young females during the peripartum period. Insult from the hemodynamic stresses during pregnancy and labor combined with the underlying pregnancy related arterial wall changes is the proposed mechanism of dissection in this setting. The normal ECG in the presence of an acute myocardial infarction (AMI) in this case also demonstrates the occasional electrically silent ECG that can occur during acute compromise of the left circumflex coronary artery.
Asunto(s)
Dolor en el Pecho/etiología , Anomalías de los Vasos Coronarios/complicaciones , Periodo Posparto , Enfermedades Vasculares/congénito , Antagonistas Adrenérgicos beta/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina/uso terapéutico , Dolor en el Pecho/tratamiento farmacológico , Angiografía Coronaria/métodos , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/tratamiento farmacológico , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Nitratos/uso terapéutico , Resultado del Tratamiento , Enfermedades Vasculares/complicaciones , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/tratamiento farmacológicoRESUMEN
Atrial fibrillation (AF) is a cardiac arrhythmia associated with a wide range of other co-morbid medical conditions. The state of West Virginia has a higher prevalence of coronary artery disease (CAD) and CAD risk factors compared to the national average. We hypothesized that West Virginians with atrial fibrillation would also have a higher prevalence of CAD risk factors and higher CHADS2 stroke risk scores. This is particularly important since Louisiana is the only high CAD risk southern state included in the original verification of the CHADS2 risk scoring system (i.e. California, Connecticut, Louisiana, Maine, Missouri, New Hampshire, and Vermont). Accordingly, we performed a retrospective analysis of the association between AF and CAD, CAD risk factors and CHADS2 scores in a cohort of men and women in the West Virginia University Hospital population. We report a greater positive association between AF and hypertension, diabetes mellitus and obesity than the national average. AF was seen more commonly among men. But, CHADS2 scores were higher among women as a result of a higher prevalence of diabetes mellitus. This study indicates that AF is associated with a greater prevalence of CAD risk factors and higher CHADS2 scores among West Virginians in comparison with the rest of the nation.
Asunto(s)
Fibrilación Atrial/etiología , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/epidemiología , Hipertensión/complicaciones , Obesidad/complicaciones , Accidente Cerebrovascular/etiología , Adulto , Anciano , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/epidemiología , Índice de Masa Corporal , Enfermedad de la Arteria Coronaria/diagnóstico , Diabetes Mellitus/epidemiología , Femenino , Hospitales Universitarios , Humanos , Hipertensión/epidemiología , Incidencia , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Sobrepeso/complicaciones , Valor Predictivo de las Pruebas , Prevalencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Distribución por Sexo , Fumar/efectos adversos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Factores de Tiempo , West Virginia/epidemiologíaRESUMEN
NK T cells are a unique lymphocyte population that have developmental requirements distinct from conventional T cells. Mice lacking the tyrosine kinase Fyn have 5- to 10-fold fewer mature NK T cells. This study shows that Fyn-deficient mice have decreased numbers of NK1.1(-) NK T cell progenitors as well. 5-Bromo-2'-deoxyuridine-labeling studies indicate that the NK T cells remaining in fyn(-/-) mice exhibit a similar turnover rate as wild-type cells. The fyn(-/-) NK T cells respond to alpha-galactosylceramide, a ligand recognized by NK T cells, and produce cytokines, but have depressed proliferative capacity. Transgenic expression of the NK T cell-specific TCR alpha-chain Valpha14Jalpha18 leads to a complete restoration of NK T cell numbers in fyn(-/-) mice. Together, these results suggest that Fyn may have a role before alpha-chain rearrangement rather than for positive selection or the peripheral upkeep of cell number. NK T cells can activate other lymphoid lineages via cytokine secretion. These secondary responses are impaired in Fyn-deficient mice, but occur normally in fyn mutants expressing the Valpha14Jalpha18 transgene. Because this transgene restores NK T cell numbers, the lack of secondary lymphocyte activation in the fyn-mutant mice is due to the decreased numbers of NK T cells present in the mutant, rather than an intrinsic defect in the ability of the other fyn(-/-) lymphoid populations to respond.
Asunto(s)
Células Asesinas Naturales/citología , Células Asesinas Naturales/enzimología , Proteínas Tirosina Quinasas/genética , Proteínas Tirosina Quinasas/fisiología , Proteínas Proto-Oncogénicas/genética , Receptores de Antígenos de Linfocitos T alfa-beta/fisiología , Subgrupos de Linfocitos T/citología , Subgrupos de Linfocitos T/enzimología , Animales , Antígenos/metabolismo , Antígenos Ly , Antígenos de Superficie , Subgrupos de Linfocitos B/inmunología , Diferenciación Celular/genética , Diferenciación Celular/inmunología , Ceramidas/farmacología , Citocinas/metabolismo , Genes Codificadores de la Cadena alfa de los Receptores de Linfocito T , Células Asesinas Naturales/inmunología , Células Asesinas Naturales/metabolismo , Lectinas Tipo C , Activación de Linfocitos , Recuento de Linfocitos , Proteína Tirosina Quinasa p56(lck) Específica de Linfocito/deficiencia , Proteína Tirosina Quinasa p56(lck) Específica de Linfocito/genética , Linfopenia/genética , Linfopenia/inmunología , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Ratones Transgénicos , Subfamilia B de Receptores Similares a Lectina de Células NK , Proteínas Tirosina Quinasas/deficiencia , Proteínas/metabolismo , Proteínas Proto-Oncogénicas/deficiencia , Proteínas Proto-Oncogénicas/fisiología , Proteínas Proto-Oncogénicas c-fyn , Receptores de Antígenos de Linfocitos T alfa-beta/genética , Células Madre/patología , Subgrupos de Linfocitos T/inmunología , Subgrupos de Linfocitos T/metabolismo , Transgenes/inmunologíaRESUMEN
The GrpE heat shock protein from Escherichia coli has a homodimeric structure. The dimer interface encompasses two long alpha-helices at the NH(2)-terminal end from each monomer (forming a "tail"), which lead into a small four-helix bundle from which each monomer contributes two short sequential alpha-helices in an antiparallel topological arrangement. We have created a number of different deletion mutants of GrpE that have portions of the dimer interface to investigate requirements for dimerization and to study four-helix bundle formation. Using chemical crosslinking and analytical ultracentrifugation techniques to probe for multimeric states, we find that a mutant containing only the long alpha-helical tail portion (GrpE1-88) is unable to form a dimer, most likely due to a decrease in alpha-helical content as determined by circular dichroism spectroscopy, thus one reason for a dimeric structure for the GrpE protein is to support the tail region. Mutants containing both of the short alpha-helices (GrpE1-138 and GrpE88-197) are able to form a dimer and presumably the four-helix bundle at the dimer interface. These two mutants have equilibrium constants for the monomer-dimer equilibrium that are very similar to the full-length protein suggesting that the tail region does not contribute significantly to the stability of the dimer. Interestingly, one mutant that contains just one of the short alpha-helices (GrpE1-112) exists as a tetrameric species, which presumably is forming a four-helix bundle structure. A proposed model is discussed for this mutant and its relevance for factors influencing four-helix bundle formation.