Pub Date : 2018-12-31DOI: 10.23937/iacvd-2017/1710005
Espejo-Paeres Carolina, O. Carmen, M. Pedro, I. Fabian, Higueras-Nafria Javier, V. David, Vilacosta Isidre
Background: An anomalous origin of a coronary artery is a rare congenital condition in which a coronary artery arises from the opposite coronary sinus. Most coronary artery anomalies are an incidental finding without clinical signifi -cance, although some cases may be potentially life threat-ening, depending on the origin, course and termination of the anomalous vessel. Anatomical features of risk are an aortic intramural course or inter-arterial course. Methods: We present 4 cases of an anomalous origin of the coronary arteries with radiological confirmation by cardiac computed tomography angiography (CCTA) and clinical history of chest pain. Two patients were incidentally diagnosed by invasive coronary angiography, while two of them under-went a CCTA exam directly. Ischemia detection tests such as treadmill test or myocardial perfusion imaging with single photon emission computed tomography (SPECT) were performed in all of them to rule out ischemia. Results: In all 4 cases, none relationship between clinical symptoms and anatomical features was established. Once ischemia was ruled-out by ischemia detection tests, we chose clinical follow-up instead of surgery given the ab-sence of anatomical or risk clinical features. Conclusion: Only a minority of patients have symptoms due to these coronary anomalies. An expectant attitude with periodical surveillance seems to be the best option in patients with low-risk variants of coronary artery anomalies without clinical documentation of myocardial ischemia.
{"title":"Clinical Features and Management of Patients with an Anomalous Origin of the Coronary Arteries","authors":"Espejo-Paeres Carolina, O. Carmen, M. Pedro, I. Fabian, Higueras-Nafria Javier, V. David, Vilacosta Isidre","doi":"10.23937/iacvd-2017/1710005","DOIUrl":"https://doi.org/10.23937/iacvd-2017/1710005","url":null,"abstract":"Background: An anomalous origin of a coronary artery is a rare congenital condition in which a coronary artery arises from the opposite coronary sinus. Most coronary artery anomalies are an incidental finding without clinical signifi -cance, although some cases may be potentially life threat-ening, depending on the origin, course and termination of the anomalous vessel. Anatomical features of risk are an aortic intramural course or inter-arterial course. Methods: We present 4 cases of an anomalous origin of the coronary arteries with radiological confirmation by cardiac computed tomography angiography (CCTA) and clinical history of chest pain. Two patients were incidentally diagnosed by invasive coronary angiography, while two of them under-went a CCTA exam directly. Ischemia detection tests such as treadmill test or myocardial perfusion imaging with single photon emission computed tomography (SPECT) were performed in all of them to rule out ischemia. Results: In all 4 cases, none relationship between clinical symptoms and anatomical features was established. Once ischemia was ruled-out by ischemia detection tests, we chose clinical follow-up instead of surgery given the ab-sence of anatomical or risk clinical features. Conclusion: Only a minority of patients have symptoms due to these coronary anomalies. An expectant attitude with periodical surveillance seems to be the best option in patients with low-risk variants of coronary artery anomalies without clinical documentation of myocardial ischemia.","PeriodicalId":170730,"journal":{"name":"International Archives of Cardiovascular Diseases","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124032834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.23937/iacvd-2017/1710010
A. Paolo
In this report, we describe a patient who presented with transient acute abdomen before the onset of an acute myocardial ischemic event. Chest pain, dyspnea, and hypotension requiring vasopressors developed 2 days after the patient presented with paralytic ileus. Transient left-bundle-branch block and mildly elevated troponin and brain-natriuretic peptide levels occurred. Echocardiography and left ventricular angiography revealed extensive periapical akinesia and a left ventricular ejection fraction of 35% that soon returned to normal. This case illustrates the possibility that a com-mon mechanism may help explain both transient functional events. We believe this presentation scenario could occur more frequently than usually assumed and should prompt further investigation in this regard.
{"title":"Takotsubo Cardiomyopathy Pathophysiology May Also Affect the Gut","authors":"A. Paolo","doi":"10.23937/iacvd-2017/1710010","DOIUrl":"https://doi.org/10.23937/iacvd-2017/1710010","url":null,"abstract":"In this report, we describe a patient who presented with transient acute abdomen before the onset of an acute myocardial ischemic event. Chest pain, dyspnea, and hypotension requiring vasopressors developed 2 days after the patient presented with paralytic ileus. Transient left-bundle-branch block and mildly elevated troponin and brain-natriuretic peptide levels occurred. Echocardiography and left ventricular angiography revealed extensive periapical akinesia and a left ventricular ejection fraction of 35% that soon returned to normal. This case illustrates the possibility that a com-mon mechanism may help explain both transient functional events. We believe this presentation scenario could occur more frequently than usually assumed and should prompt further investigation in this regard.","PeriodicalId":170730,"journal":{"name":"International Archives of Cardiovascular Diseases","volume":"80 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130756765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.23937/iacvd-2017/1710007
S. Matthew, Paterick Timothy E
Coronary artery ectasia is defined as a localized, or diffuse dilation of a coronary artery lumen. Coronary artery ecta sia is well recognized, but a rare finding encountered dur ing diagnostic coronary angiography. Coronary artery ec tasia represents a form of atherosclerotic coronary artery disease, seen in 1.4-4.9% of patients undergoing coronary angiography. It may be an isolated finding, or in combination with stenotic lesions. The classification of coronary artery ectasia is divided into four groups: Type 1: Diffuse ectasia of two or three vessels, Type 2: Diffuse ectasia in one vessel and localized disease in another vessel, Type 3: Diffuse ectasia in one vessel only, and Type 4: Localized or segmental involvement. This case illuminates the difficult decision making regarding stenting of coronary arteries with ectasia and atherosclero sis. The additional challenge is whether the benefit of anti coagulation with warfarin outweighs the bleeding risk. The treatment approach is often ambiguous, and can be a vex ing clinical question, as identified in our case presentation.
{"title":"Coronary Artery Ectasia: An Interventional Cardiologist's Dilemma","authors":"S. Matthew, Paterick Timothy E","doi":"10.23937/iacvd-2017/1710007","DOIUrl":"https://doi.org/10.23937/iacvd-2017/1710007","url":null,"abstract":"Coronary artery ectasia is defined as a localized, or diffuse dilation of a coronary artery lumen. Coronary artery ecta sia is well recognized, but a rare finding encountered dur ing diagnostic coronary angiography. Coronary artery ec tasia represents a form of atherosclerotic coronary artery disease, seen in 1.4-4.9% of patients undergoing coronary angiography. It may be an isolated finding, or in combination with stenotic lesions. The classification of coronary artery ectasia is divided into four groups: Type 1: Diffuse ectasia of two or three vessels, Type 2: Diffuse ectasia in one vessel and localized disease in another vessel, Type 3: Diffuse ectasia in one vessel only, and Type 4: Localized or segmental involvement. This case illuminates the difficult decision making regarding stenting of coronary arteries with ectasia and atherosclero sis. The additional challenge is whether the benefit of anti coagulation with warfarin outweighs the bleeding risk. The treatment approach is often ambiguous, and can be a vex ing clinical question, as identified in our case presentation.","PeriodicalId":170730,"journal":{"name":"International Archives of Cardiovascular Diseases","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131140707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.23937/IACVD-2017/1710012
Sloop Gregory D, Popa Gheorghe, Weidman Joseph J, Cyr John A St
The authors hypothesize that thrombosis causes both the complications of atherosclerosis as well as the underlying lesion, the atherosclerotic plaque. Atherosclerotic plaques develop from the organization of mural thrombi. In this process, circulating progenitor cells trapped within the thrombus differentiate into myofibroblasts which synthesize collagen, and endothelial cells which form granulation tissue. Eventually, all or most of the thrombus is replaced by collagen. Thus, conditions and drugs which affect thrombosis also affect the development of atherosclerotic plaques, i.e., atherogenesis. The authors review the process of organization and evidence showing that altered hemodynamics, increased blood viscosity, thrombophilias, coagulopathies, myeloproliferative disorders and drugs which modify the risk of thrombosis also affect atherogenesis. Accelerated atherogenesis is an underappreciated complication of many of these conditions. This paradigm explains how diverse risk factors, many of which have no association with inflammation or dyslipidemia, cause the same lesion. These data have implications for atherothrombosis theory and clinical practice.
{"title":"Why Atherothrombosis is in Principle a Hematologic Disease: The Effect of Disorders and Drugs which Affect Thrombosis on the Development of Atherosclerotic Plaques","authors":"Sloop Gregory D, Popa Gheorghe, Weidman Joseph J, Cyr John A St","doi":"10.23937/IACVD-2017/1710012","DOIUrl":"https://doi.org/10.23937/IACVD-2017/1710012","url":null,"abstract":"The authors hypothesize that thrombosis causes both the complications of atherosclerosis as well as the underlying lesion, the atherosclerotic plaque. Atherosclerotic plaques develop from the organization of mural thrombi. In this process, circulating progenitor cells trapped within the thrombus differentiate into myofibroblasts which synthesize collagen, and endothelial cells which form granulation tissue. Eventually, all or most of the thrombus is replaced by collagen. Thus, conditions and drugs which affect thrombosis also affect the development of atherosclerotic plaques, i.e., atherogenesis. The authors review the process of organization and evidence showing that altered hemodynamics, increased blood viscosity, thrombophilias, coagulopathies, myeloproliferative disorders and drugs which modify the risk of thrombosis also affect atherogenesis. Accelerated atherogenesis is an underappreciated complication of many of these conditions. This paradigm explains how diverse risk factors, many of which have no association with inflammation or dyslipidemia, cause the same lesion. These data have implications for atherothrombosis theory and clinical practice.","PeriodicalId":170730,"journal":{"name":"International Archives of Cardiovascular Diseases","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134197863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.23937/IACVD-2017/1710009
Kerkütlüoğlu Murat, Katircibaşi Mahmut Tuna
Congenital anomalies of the heart may generate difficul ties for cardiac invasive procedures. Dextrocardia is a rare congenital heart disease in which the apex of the heart is located on the right side of the chest. Patients with trans position of great arteries (TGA) abnormalities are at risk for complete cardiac block and usually require a permanent cardiac pacemaker in long-term follow-up. The persistent left superior vena cava (PLSCV) is a rare venous anomaly, often associated with abnormalities of the cardiac transduc tion system. It is usually seen by chance during permanent pacemaker implantation. Even if electrodes are not impos sible to be placed through this abnormal venous structure, it can be challenging. In this study, we present a permanent pacemaker implantation to a 31-year-old female patient with a combination of dextrocardia, PLSVC, and TGA due to complete heart block. Congenital anomalies of the heart can make transvenous procedures such as right heart catheterization or pacemak er implantation difficult. During embryological development, PLSVC occurs as a result of obliteration of the proximal part of the right anterior and right cardinal veins [ 1 ]. The left an terior cardinal vein creates a vena cava superior that opens to the right atrium through the left coronary sinus or direct ly to the left atrium. The persistent left superior vena cava (PLSCV) is rare but the most common systemic venous anomaly, which is 0.5% in general population and 3-10% in congenital heart defects [ 2 ]. Another anomaly is congenital dextrocardia, which is
{"title":"Implantation of Pacemaker in a Patient with Dextrocardia, Persistent Left Superior Vena Cava, TGA and Heart Block","authors":"Kerkütlüoğlu Murat, Katircibaşi Mahmut Tuna","doi":"10.23937/IACVD-2017/1710009","DOIUrl":"https://doi.org/10.23937/IACVD-2017/1710009","url":null,"abstract":"Congenital anomalies of the heart may generate difficul ties for cardiac invasive procedures. Dextrocardia is a rare congenital heart disease in which the apex of the heart is located on the right side of the chest. Patients with trans position of great arteries (TGA) abnormalities are at risk for complete cardiac block and usually require a permanent cardiac pacemaker in long-term follow-up. The persistent left superior vena cava (PLSCV) is a rare venous anomaly, often associated with abnormalities of the cardiac transduc tion system. It is usually seen by chance during permanent pacemaker implantation. Even if electrodes are not impos sible to be placed through this abnormal venous structure, it can be challenging. In this study, we present a permanent pacemaker implantation to a 31-year-old female patient with a combination of dextrocardia, PLSVC, and TGA due to complete heart block. Congenital anomalies of the heart can make transvenous procedures such as right heart catheterization or pacemak er implantation difficult. During embryological development, PLSVC occurs as a result of obliteration of the proximal part of the right anterior and right cardinal veins [ 1 ]. The left an terior cardinal vein creates a vena cava superior that opens to the right atrium through the left coronary sinus or direct ly to the left atrium. The persistent left superior vena cava (PLSCV) is rare but the most common systemic venous anomaly, which is 0.5% in general population and 3-10% in congenital heart defects [ 2 ]. Another anomaly is congenital dextrocardia, which is","PeriodicalId":170730,"journal":{"name":"International Archives of Cardiovascular Diseases","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114212697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.23937/2643-3966/1710054
Melo Oscar Rene Vazquez, Cahuich Ramon Eduardo Garcia, Rodriguez Jose Julián Sosa, Báez María Valeria Jiménez
{"title":"Cardiovascular Disease as a Chronic Sequel to COVID-19: A Case Report","authors":"Melo Oscar Rene Vazquez, Cahuich Ramon Eduardo Garcia, Rodriguez Jose Julián Sosa, Báez María Valeria Jiménez","doi":"10.23937/2643-3966/1710054","DOIUrl":"https://doi.org/10.23937/2643-3966/1710054","url":null,"abstract":"","PeriodicalId":170730,"journal":{"name":"International Archives of Cardiovascular Diseases","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131456865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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