Cardiac stab wound resulting in a left anterior descending artery to left ventricular fistula with delayed pericardial tamponade

1994 ◽  
Vol 31 (4) ◽  
pp. 283-285 ◽  
Author(s):  
Alfred Rossum ◽  
Larry Osborn ◽  
Jorge Wernly ◽  
Craig Timm ◽  
Jonathan Abrams
Keyword(s):  
Stab Wound ◽  
Pericardial Tamponade ◽  
Left Ventricular ◽  
Left Anterior Descending Artery

Stab wound to the chest with acute pericardial tamponade

1996 ◽  
Vol 14 (6) ◽  
pp. 743-745 ◽  
Author(s):  
Erik D. Barton ◽  
Aviva Jacoby
Keyword(s):  
Stab Wound ◽  
Pericardial Tamponade

Elderly woman presenting with multivessel coronary artery disease and Takotsubo syndrome

2021 ◽  
Vol 14 (7) ◽  
pp. e242367
Author(s):  
Hari Vivekanantham ◽  
Martin Scoglio ◽  
Philipp Suter ◽  
Stephane Cook ◽  
Yann Roux ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Takotsubo Syndrome ◽  
Left Main ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Left Anterior Descending Artery ◽  
Artery Disease

Takotsubo syndrome is an acute and often reversible condition, with initial presentation mimicking acute coronary syndrome. Typically, patients present with left ventricular regional wall motion abnormalities, without a corresponding coronary artery obstruction on angiography. Coexistence of a coronary artery disease is possible and may render the distinction between the two entities particularly challenging. We report the case of a 94-year-old woman with chest pain after an emotional upset and acute myocardial injury. Transthoracic echocardiogram (TTE) revealed a severely reduced left ventricular ejection fraction (LVEF) with apical ballooning. Coronary angiogram showed significant stenosis of the distal left main coronary artery and of the mid-left anterior descending artery, as well as a 30%–50% stenosis of the mid-distal right coronary artery. Revascularisation was deferred and antiplatelet as well as heart failure therapy begun. A repeat TTE 6 days later revealed a quasi-normalised LVEF. Ultimately, percutaneous coronary revascularisation of the left main and left anterior descending artery was performed, with favourable outcome at 6-month follow-up.

Comparison of Myocardial Infarction with Sequential Ligation of the Left Anterior Descending Artery and Its Diagonal Branch in Dogs and Sheep

2003 ◽  
Vol 26 (4) ◽  
pp. 351-357 ◽  
Author(s):  
W.G. Kim ◽  
Y.C. Shin ◽  
S.W. Hwang ◽  
C. Lee ◽  
C.Y. Na
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Pulmonary Artery ◽  
Left Ventricular ◽  
Coronary Artery Ligation ◽  
Suitable Model ◽  
Artery Ligation ◽  
Diagonal Branch ◽  
Left Anterior Descending Artery ◽  
Arterial Blood

We report a comparison of the effects of myocardial infarction in dogs and sheep using sequential ligation of the left anterior descending artery (LAD) and its diagonal branch (DA), with hemodynamic, ultrasonographic and pathological evaluations. Five animals were used in each group. After surgical preparation, the LAD was ligated at a point approximately 40% of the distance from the apex to the base of the heart, and after one hour, the DA was ligated at the same level. Hemodynamic and ultrasonographic measurements were performed preligation, 30 minutes after LAD ligation, and 1 hour after DA ligation. As a control, two animals in each group were used for the simultaneous ligation of the LAD and the DA. Two months after the coronary ligation, the animals were evaluated as previously, and killed for postmortem examination of their hearts. All seven animals in the dog group survived the experimental procedures, while in the sheep group only animals with sequential ligation of the LAD and DA survived. Statistically significant decreases in systemic arterial blood pressure and cardiac output, and an increase in the pulmonary artery capillary wedge pressure (PACWP) were observed one hour after sequential ligation of the LAD and its DA in the sheep, while only systemic arterial pressures decreased in the dog. Ultrasonographic analyses demonstrated variable degrees of anteroseptal dyskinesia and akinesia in all sheep, but in no dogs. Data two months after coronary artery ligation showed significant increases in central venous pressure, pulmonary artery pressure, and PACWP in the sheep, but not in the dog. Left ventricular end-diastolic dimension and left ventricular end-systolic dimension in ultrasonographic studies were also increased only in the sheep. Pathologically, the well-demarcated thin-walled transmural anteroseptal infarcts with chamber enlargement were clearly seen in all specimens of sheep, and only-mild-to-moderate chamber enlargements with endocardial fibrosis were observed in the dog hearts. In conclusion, this study confirms that the dog is not a suitable model for myocardial infarction with failure by coronary artery ligation despite negligent operative mortality, when compared directly with an ovine model.

scholarly journals Not Your Common Athletic Heart Problem: Using Coronary CTA to Visualize Spontaneous Coronary Artery Dissection

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Padma Shenoy ◽  
Taher Tayeb ◽  
Pedro Covas ◽  
Nardos Temesgen ◽  
Cynthia Tracy
Keyword(s):  
Coronary Artery ◽  
Young Patients ◽  
Reference Value ◽  
Left Ventricular ◽  
Artery Dissection ◽  
Heart Catheterization ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Catheterization ◽  
Left Anterior Descending Artery

A 19-year-old healthy male collegiate athlete presented with typical anginal symptoms after running a 5K race. He had complained of similar symptoms off and on for the past month. On presentation, troponin was 0.12 ng/ml (reference value < 0.01 ng/ml), which peaked at 17.7 ng/ml and CK-MB was 28.71 IU/L (reference value < 25 IU/L). ECG showed diffuse biphasic T-waves. Coronary computed tomography angiogram (cCTA) demonstrated a 1.5 cm dissection in the left anterior descending artery and a 1.9 × 1.8  cm attenuation defect in the left ventricular apex consistent with thrombus. Subsequent coronary catheterization confirmed dissection of the left anterior descending artery. Spontaneous coronary artery dissection (SCAD) is a rare phenomenon. Diagnosis can be made through noninvasive measures but is usually done through left heart catheterization. In young patients who present with an NSTEMI, clinical suspicion for SCAD among other conditions should be raised. Additionally, recognizing that complications such as intracardiac thrombi can occur in SCAD is critical in ensuring appropriate therapy.

scholarly journals Bioenergetic and Functional Consequences of Bone Marrow–Derived Multipotent Progenitor Cell Transplantation in Hearts With Postinfarction Left Ventricular Remodeling

Circulation ◽  
2007 ◽  
Vol 115 (14) ◽  
pp. 1866-1875 ◽  
Author(s):  
Lepeng Zeng ◽  
Qingsong Hu ◽  
Xiaohong Wang ◽  
Abdul Mansoor ◽  
Joseph Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Cell Transplantation ◽  
Cyclosporine A ◽  
Artery Occlusion ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Infarct Zone ◽  
Ventricular Ejection Fraction ◽  
Left Anterior Descending Artery

Background— The present study examined whether transplantation of adherent bone marrow–derived stem cells, termed pMultistem, induces neovascularization and cardiomyocyte regeneration that stabilizes bioenergetic and contractile function in the infarct zone and border zone (BZ) after coronary artery occlusion. Methods and Results— Permanent left anterior descending artery occlusion in swine caused left ventricular remodeling with a decrease of ejection fraction from 55±5.6% to 30±5.4% (magnetic resonance imaging). Four weeks after left anterior descending artery occlusion, BZ myocardium demonstrated profound bioenergetic abnormalities, with a marked decrease in subendocardial phosphocreatine/ATP ( 31 P magnetic resonance spectroscopy; 1.06±0.30 in infarcted hearts [n=9] versus 1.90±0.15 in normal hearts [n=8; P <0.01]). This abnormality was significantly improved by transplantation of allogeneic pMultistem cells (subendocardial phosphocreatine/ATP to 1.34±0.29; n=7; P <0.05). The BZ protein expression of creatine kinase–mt and creatine kinase–m isoforms was significantly reduced in infarcted hearts but recovered significantly in response to cell transplantation. MRI demonstrated that the infarct zone systolic thickening fraction improved significantly from systolic “bulging” in untreated animals with myocardial infarction to active thickening (19.7±9.8%, P <0.01), whereas the left ventricular ejection fraction improved to 42.0±6.5% ( P <0.05 versus myocardial infarction). Only 0.35±0.05% donor cells could be detected 4 weeks after left anterior descending artery ligation, independent of cell transplantation with or without immunosuppression with cyclosporine A (with cyclosporine A, n=6; no cyclosporine A, n=7). The fraction of grafted cells that acquired an endothelial or cardiomyocyte phenotype was 3% and ≈2%, respectively. Patchy spared myocytes in the infarct zone were found only in pMultistem transplanted hearts. Vascular density was significantly higher in both BZ and infarct zone of cell-treated hearts than in untreated myocardial infarction hearts ( P <0.05). Conclusions— Thus, allogeneic pMultistem improved BZ energetics, regional contractile performance, and global left ventricular ejection fraction. These improvements may have resulted from paracrine effects that include increased vascular density in the BZ and spared myocytes in the infarct zone.

scholarly journals Successful treatment of an acute type A aortic dissection presented with ST segment elevation on ECG and pericardial tamponade. Case report

2014 ◽  
Vol 155 (44) ◽  
pp. 1763-1767
Author(s):  
Miklós Pólos ◽  
Zoltán Szabolcs ◽  
Astrid Apor ◽  
István Édes ◽  
Erzsébet Paulovich ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Successful Treatment ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Pericardial Tamponade ◽  
Left Ventricular ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
St Segment Elevation ◽  
St Segment

Successful treatment of type A acute aortic dissection depends on the promptness of diagnostic evaluation and therapy. Fast diagnosis can be challenged by numerous complications such as myocardial ischemia, acute aortic insufficiency, and disturbances in organ perfusion and pericardial tamponade. The authors report the case history of a 72-year-old woman, who was admitted after resuscitation with ST segment elevation. Echocardiography revealed acute type A aortic dissection with signs of pericardial tamponade. An emergency operation consisting of the resection of the ascending aorta and the reconstruction of the aortic root was performed, which took six hours from admission until the end of the operation. Follow-up examinations demonstrated good left ventricular function and competent aortic valve. The authors propose that with the development of diagnostic and therapeutic options, faster and less invasive interventions will be introduced in near future for the treatment of acute aortic dissection, which may reduce the morbidity and mortality rates of this lethal illness. Orv. Hetil., 2014, 155(44), 1763–1767.

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