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Kounis syndrome： allergic acute coronary syndrome

Chinese Medical Journal 2013年第13期126卷 2591-2592页

作者： XU Min wu xue-si JIANG Teng-yong HE Ji-qiang Department of Cardiology Beijing Anzhen Hospital Beijing Institute of Heart Lung and Blood Vessel Diseases Capital Medical University Beijing 100029 China

Kounis syndrome is defined as a group of acute coronary syndromes that manifests as unstable vasospasticor nonvasospastc angina, and even as acute myocarda! infarction triggered by the release of inflammatory mediators following an allergic insult.1 Kounis syndrome is a rare and complex syndrome. Instant treatment decisions need to be made once it happens. Here, we defined a case of severe Kounis syndrome, culminating in acute coronary syndrome, as a result of an acute allergic reaction, which was likely related to iodinated contrast media or dextran-40 use. A 71-year-old male patient, with a history of hypertension, no history of coronary heart disease and diabetes, was admitted to our hospital because of intermittent claudication for one year. On admission, his temperature was 36.4℃, pulse was 80 beats/min, respiratory rate was 18 beats/rain and blood pressure was 105/80 mmHg （1 mmHg=0.133 kPa）. Physical examination did not show any sign of heart disease, but the lower extremity arterial pulsation was weak. His artery angiography of abdominal aorta and lower limbs showed that the left iliac artery was completely obstructed. A total of 400 U iodinated contrast media was used during the operation. The patient was back to ward safely. Ten minutes after taking the dextran-40 as a postoperative treatment, he began to present sudden hyperspasmia, transient unconsciousness, skin flushes, excessive sweating and sinus tachycardia （approximately 140 beats/min）. At the same time, his skin temperature decreased and his blood pressure collapsed quickly. He accepted oxygen therapy, fluid replacement, dexamethasone and dopamine immediately. After that the ECG revealed ST elevation of 0.3-0.7 mV in leads II, III, avF, V3.6, and frequent premature ventricular （Figure 1A）. Following the therapy of promethazine, glycerin trinitrate and lidocaine, the shock symptoms was gradually relieved： consciousness was recovered, ST segment gradually went back to normal in half an hour （Figure 1

关键词： Kounis syndrome, coronary vasospasm anaphylaxis

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正确掌握β受体阻滞剂在慢性心力衰竭的应用时机

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中华心血管病杂志 2006年第9期34卷 769-771页

作者：吴学思首都医科大学附属北京安贞医院心内科 100029

随着对慢性收缩性心力衰竭（慢性心衰）发病机制认识的深入，β受体阻滞剂——这种曾禁用于心衰患者的药物，在慢性心衰中的治疗地位逐渐被认可，并以无可辩驳的事实证明了其卓越的疗效。

关键词： β受体阻滞剂慢性心力衰竭慢性收缩性心力衰竭慢性心衰发病机制心衰患者

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中国慢性心力衰竭指南2007版要点

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中华内科杂志 2008年第4期47卷 267-268页

作者：吴学思首都医科大学附属北京安贞医院心内科 100029

Braunwald教授早在本世纪初就指出，在21世纪，面临心血管医生的两个战场是“心力衰竭（心衰）”和“心房颤动（房颤）”。我国曾于2001年制定了“慢性收缩性心力衰竭（CHF）治疗建议”，随着“建议”的推广，6年来我国CHF的诊治水平已... 详细信息

Braunwald教授早在本世纪初就指出，在21世纪，面临心血管医生的两个战场是“心力衰竭（心衰）”和“心房颤动（房颤）”。我国曾于2001年制定了“慢性收缩性心力衰竭（CHF）治疗建议”，随着“建议”的推广，6年来我国CHF的诊治水平已有了长足的进步和发展。

关键词：慢性心力衰竭慢性收缩性心力衰竭指南中国心房颤动诊治水平心血管 CHF

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Myocardial autophagy variation during acute myocardial infarction in rats： the effects of carvedilol

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Chinese Medical Journal 2009年第19期122卷 2372-2379页

作者： ZHANG Jing-lan LU Jia-kai CHEN Dong CAI Qing LI Tong-xun wu Li-song wu xue-si Department of Surgical Intensive Care Unit Beijing Anzhen Hospital Capital Medical University Beijing 100029 China Department of Anesthesiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China Department of Pathology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China Medical Experiment & Testing Center Capital Medical University Beijing 100069 China Department of Cardiac Medicine Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

Background The loss of cardiac myocytes is one of the mechanisms involved in acute myocardial infarction （AMI）-related heart failure. Autophagy is a common biological process in eukaryote cells. The relationship between cardiac myocyte loss and autophagy after AMI is still unclear. Carvedilol, a non-selective α1-and β-receptor blocker, also suppresses cardiac myocyte necrosis and apoptosis induced by ischemia. However, the association between the therapeutic effects of carvedilol and autophagy is still not well understood. The aim of the present study was to establish a rat model of AMI and observe changes in autophagy in different zones of the myocardium and the effects of carvedilol on autophagy in AMI rats. Methods The animals were randomly assigned to a sham group, an AMI group, a chloroquine intervention group and a carvedilol group. The AMI rat model was established by ligating the left anterior descending coronary artery. The hearts were harvested at 40 minutes, 2 hours, 24 hours and 2 weeks after ligation in the AMI group, at 40 minutes in the chloroquine intervention group and at 2 weeks in other groups. Presence of autophagic vacuoles （AV） in the myocytes was observed by electron microscopy. The expression of autophagy-, anti-apoptotic- and apoptotic-related proteins, MAPLC-3, Beclin-1, Bcl-xl and Bax, were detected by immunohistochemical staining and Western blotting. Results AVs were not observed in necrotic regions of the myocardium 40 minutes after ligation of the coronary artery. A large number of AVs were found in the region bordering the infarction. Compared with the infarction region and the normal region, the formation of AV was significantly increased in the region bordering the infarction （P 〈0.05）. The expression of autophagy- and anti-apoptotic-related proteins was significantly increased in the region bordering the infarction. Meanwhile, the expression of apoptotic-related proteins was significantly increased in the infarction region. In the

关键词： acute myocardial infarction myocardial autophagy carvedilol rats

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Neuregulin-1 attenuates mitochondrial dysfunction in a rat model of heart failure

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Chinese Medical Journal 2012年第5期125卷 807-814页

作者： GUO Yong-fang ZHANG Xiao-xia LIU Yong DUAN Hong-yan JIE Bing-zhang wu xue-si Department of Cardiology Beijing Anzhen Hospital CapitalMedical University Beijing 100029 China Laboratory of Apoptosis and Cancer Biology National KeyLaboratory of Biomembrane and Membrane BiotechnologyInstitute of Zoology Chinese Academy of Sciences Beijing100101 China

Background Mitochondrial dysfunction plays a pivotal role in the progression of left ventricular （LV） remodeling and heart failure （HF）. Recombinant human neuregulin-1 （rhNRG-1） improves cardiac function in models of experimental HF and in clinical trials; however, its impact on mitochondrial function during chronic HF remains largely unknown. The purpose of this study was to investigate whether rhNRG-1 could attenuate the functional and structural changes that occur in cardiac mitochondria in a rat model of HF induced by myocardial infarction.

关键词： neuregulin-1 heart failure mitochondria cardioprotection

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Hypereosinophilia with a giant thrombus in the right ventricle： Loffler endocarditis in an ll-year-old girl

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Chinese Medical Journal 2009年第23期122卷 2914-2916页

作者： GUO Yong-fang HAN Zhi-hong JIANG Teng-yong FANG Wei DONG Ran wu xue-si Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China Department of Pathology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China Department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

Hypereosinophilic syndrome （HES） is a rare disorder that can be seen in various organ systems, but its major tissue target is the heart.＇ The most characteristic cardiovascular abnormality in HES is endomyocardial fibrosis, initially described in 1936 by Loffler, who called it ＂fibroplastic parietal endocarditis with blood eosinophilia.＂ The overall prognosis of patients with Loffler endocarditis is very poor. Current treatments include anticoagulation and anti-eosinophils therapy, and surgery only has been used in selected cases.

关键词： hypereosinophilic syndrome Loffler endocarditis adolescent

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预防为首,阻断心力衰竭发生

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中华内科杂志 2005年第7期44卷 482-483页

作者：吴学思首都医科大学附属北京安贞医院心内科 100029

20世纪后50年里，全球对心血管疾病的各种治疗手段有了长足的进步和突破性的发展，包括调脂治疗、急性冠状动脉综合征的诊治、介入治疗的广泛应用等，仅急性心肌梗死住院病死率就从30％下降至5％左右，人口平均寿命也普遍增加30～40岁... 详细信息

20世纪后50年里，全球对心血管疾病的各种治疗手段有了长足的进步和突破性的发展，包括调脂治疗、急性冠状动脉综合征的诊治、介入治疗的广泛应用等，仅急性心肌梗死住院病死率就从30％下降至5％左右，人口平均寿命也普遍增加30～40岁，但这些又都带来各种中老年心血管疾病，以及心力衰竭（心衰）患病率的增加。

关键词：预防医学心血管疾病中医 VHP 心脏移植心力衰竭

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2009美国《成人心力衰竭诊疗指南更新》解读

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中华内科杂志 2009年第10期48卷 807-808页

作者：吴学思首都医科大学附属北京安贞医院心内科 100029

心力衰竭（心衰）是各种心血管疾病发展的最后阶段，随着对心血管疾病治疗方法的进展和人口寿命的延长，心衰的发生率逐年增加。在美国心衰已经成为65岁以上人群住院的首要原因，也是心血管疾病医疗费用的主要支出部分，因而成为重要的... 详细信息

心力衰竭（心衰）是各种心血管疾病发展的最后阶段，随着对心血管疾病治疗方法的进展和人口寿命的延长，心衰的发生率逐年增加。在美国心衰已经成为65岁以上人群住院的首要原因，也是心血管疾病医疗费用的主要支出部分，因而成为重要的公共卫生问题。2009年3月美国心脏病学会及美国心脏学会（ACC／AHA）联合国际心肺移植协会共同出版了2009心衰诊疗指南更新。对2005年版的诊疗建议进行了适当的调整，主要包括以下几个方面。

关键词：美国心脏学会诊疗指南心力衰竭心血管疾病美国心脏病学会解读成人疾病治疗方法

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心力衰竭治疗的基础与关键：全程限钠

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中华内科杂志 2010年第11期49卷 905-906页

作者：吴学思首都医科大学附属北京安贞医院心内科 100029

心力衰竭（心衰）是各种心血管疾病发展的最后阶段，随着对心血管疾病治疗方法的进展和人口寿命的延长，心衰的发生率逐年增加，已成为全球重要的公共卫生问题。近20余年来，心衰的药物治疗策略已从短期血液动力学或药理学措施转为长期... 详细信息

心力衰竭（心衰）是各种心血管疾病发展的最后阶段，随着对心血管疾病治疗方法的进展和人口寿命的延长，心衰的发生率逐年增加，已成为全球重要的公共卫生问题。近20余年来，心衰的药物治疗策略已从短期血液动力学或药理学措施转为长期修复性策略，即强调充分应用改善心脏重构和预后的肾素-血管紧张素-醛固酮系统（RAAS）阻断剂[血管紧张素转换酶抑制剂（ACEI）／血管紧张素Ⅱ受体拮抗剂（ARB）]和β受体阻滞剂。

关键词：疾病治疗方法心力衰竭肾素-血管紧张素-醛固酮系统血管紧张素Ⅱ受体拮抗剂血管紧张素转换酶抑制剂限钠公共卫生问题 β受体阻滞剂

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Factors influencing recovery of left ventricular structure in patients with chronic heart failure

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Chinese Medical Journal 2011年第18期124卷 2868-2873页

作者： DUAN Hong-yan wu xue-si HAN Zhi-hong GUO Yong-fang FANG Shan-juan ZHANG Xiao-xia WANG Chun-mei Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

Background Angiotensin converting enzyme （ACE） inhibitors and G-blockers （13B） have beneficial effects on left ventricular （LV） remodeling, alleviate symptoms and reduce morbidity and mortality in patients with chronic heart failure （CHF）. However the correlation between the d osages of ACE inhibitors, βB, and recovery of LV structure remains controversial. Clinical factors associated with recovery of normal ventricular structure in CHF patients receiving medical therapy are poorly defined. Here we aimed to identify variables associated with recovery of normal or near-normal structure in patients with CHF. Methods We recruited 231 consecutive CHF outpatients, left ventricular ejection fraction （LVEF）〈40% and left ventricular end diastolic diameter （LVEDD）〉55/50 mm （male/female）, who were receiving optimal pharmacotherapy between January 2001 and June 2009, and followed them until December 31,2009. They were divided into three groups according to LVEDD and whether they were still alive at final follow-up： group A, LVEDD 〈60/55 mm （male/female）; group B, LVEDD 〉60/55 mm （male/female）; and group C, those who died before final follow-up. Apart from group C, univariate analysis was performed followed by Logistic multivariate analysis to determine the predictors of recovery of LV structure. Results A total of 217 patients completed follow-up, and median follow-up time was 35 months （range 6-108）. Twenty-five patients died during that period; the all-cause mortality rate was 11.5%. Group A showed clinical characteristics as follows： the shortest duration of disease and shortest QRS width, the lowest N-terminal brain natriuretic peptide （NT-proBNP） at baseline, the highest dose of I3B usage, the highest systolic blood pressure （SBP）, diastolic blood pressure （DBP） and the lowest New York Heart Association （NYHA） classification, serum creatinine, uric acid, total bilirubin and NT-proBNP after treatment. Logistic multivariate analysis was performed according to recovery or

关键词： heart failure drug therapy prognosis prognostic factors

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