Effects of intracoronary ergonovine on the contralateral coronary artery in patients with atypical chest pain

Introduction: The prevalence of Coronary Artery Disease (CAD) is increasing among Indian women and is the leading cause of death. Clinical presentation of CAD in women can widely vary from atypical chest pain, silent ischemia to massive myocardial infarction and death. Women have poor prognosis than men after myocardial infarction and are less likely to undergo revascularisation compared to men. Aim: To study the risk factors, clinical characteristics, severity of CAD and to evaluate the outcomes in women undergoing coronary angiogram. Materials and Methods: This retrospective study included 912 women who had undergone coronary angiogram in our hospital from January 2018 to December 2018. The patients were divided into three groups- Group A consisted of 230 (25%) women with age <50 years. Group B consisted of 591 (65%) women with age between 50 to 69 years. Group C consisted of 91 (10%) women with age >70 years. Continuous variables were analysed by paired t-test and categorical variables were analysed by chi-square test. Results: Most women were post menopausal (73.6%). Common risk factors were diabetes mellitus (63%) hypertension (56%), and hypothyroidism (16.8%). Out of the total study population, 51% (n=466) presented with a diagnosis of chronic stable angina, 34.7% (n=317) presented with acute coronary syndrome, and 7% (n=66) had atypical chest pain. Out of 500 patients with significant CAD, requiring revascularisation only 316 (63.2%) had undergone interventions out of which 193 (61%) had undergone percutaneous coronary intervention and 123 (39%) had undergone Coronary Artery Bypass Grafting (CABG) as the modality of revascularisation. conclusion: Clinical presentation of CAD in women varies widely from atypical chest pain to acute infarction. Diabetes and hypertension are the most common risk factors for CAD in our study. Chronic stable angina was the most common spectrum of presentation. Single vessel disease is the most common finding on coronary angiogram.

Download Full-text

Abnormal Origin of the Left Coronary Artery From the Pulmonary Artery Discovered at Age 67: What to Do?

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135118772834 ◽

2018 ◽

Vol 11 (4) ◽

pp. NP207-NP209 ◽

Cited By ~ 1

Author(s):

Fadoua Lachhab ◽

Rachida Amri ◽

Loubna Mahfoudi ◽

Said Moughil

Keyword(s):

Chest Pain ◽

Coronary Artery ◽

Mortality Rate ◽

Pulmonary Artery ◽

Left Coronary Artery ◽

Anomalous Left Coronary Artery ◽

Atypical Chest Pain ◽

Common Cause ◽

Medical Regimen ◽

Anomalous Left Coronary

Anomalous left coronary artery from the pulmonary artery (ALCAPA) was described by Abbott in 1908. In most cases, it is an isolated lesion, being the most common cause of myocardial ischemia in children. The associated mortality rate without intervention reaches 90% during childhood. We report the case of a 67-year-old woman, who underwent coronary angiography for investigation of atypical chest pain and was found to have ALCAPA. The patient refused surgery and has remained asymptomatic on a medical regimen.

Download Full-text

Coronary artery disease--ignored in women or inherently more lethal in women?

American Journal of Critical Care ◽

10.4037/ajcc1998.7.1.77 ◽

1998 ◽

Vol 7 (1) ◽

pp. 77-79 ◽

Cited By ~ 3

Author(s):

KB Keller ◽

L Lemberg

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Coronary Artery Disease ◽

Heart Disease ◽

Cardiovascular Risk ◽

Chest Pain ◽

Coronary Artery ◽

Noninvasive Testing ◽

Atypical Chest Pain ◽

Artery Disease

The leading cause of death in women is cardiovascular disease. The major cardiovascular risk factors have a greater impact on women. The prognosis for women with CAD is worse than for men. Women frequently present with symptoms of heart disease at a much later age and have a greater frequency of atypical chest pain. Noninvasive testing is less reliable in women. Do these facts indicate that CAD is inherently a more lethal disease in women? Or is CAD, as some would suggest, traditionally ignored in women? Stay tuned!

Download Full-text

Large sub-mitral aneurysm compressing the left circumflex coronary artery presenting with atypical chest pain – Rare presentation

Journal of Cardiology Cases ◽

10.1016/j.jccase.2020.02.008 ◽

2020 ◽

Vol 21 (5) ◽

pp. 193-196

Author(s):

Senthilraj Thangasami ◽

Sibasis Shasikant Sahoo ◽

Ananthanarayanan Chandrasekaran ◽

Pratik Raval ◽

Parth Shaniswara

Keyword(s):

Chest Pain ◽

Coronary Artery ◽

Circumflex Coronary Artery ◽

Rare Presentation ◽

Atypical Chest Pain ◽

Left Circumflex Coronary Artery

Download Full-text

Solitary coronary artery: An unusual cause of atypical chest pain

Nepalese Heart Journal ◽

10.3126/njh.v16i1.23903 ◽

2019 ◽

Vol 16 (1) ◽

pp. 55-56

Author(s):

Laxman Dubey ◽

Ridhi Adhikari ◽

Suresh Deep

Keyword(s):

Computed Tomography ◽

Congenital Anomaly ◽

Chest Pain ◽

Coronary Artery ◽

Coronary Angiography ◽

Coronary Sinus ◽

Sinus Of Valsalva ◽

Atypical Chest Pain ◽

Rare Congenital Anomaly ◽

The Right

Coronary arteries arising from single coronary sinus is a rare congenital anomaly. We report a 30-year-old male who presented with atypical chest pain and computed tomography coronary angiography revealed a solitary coronary artery originating from a single ostium in the right sinus of Valsalva.

Download Full-text

Epicardial fat attenuation, not volume, predicts obstructive coronary artery disease and high risk plaque features in patients with atypical chest pain

British Journal of Radiology ◽

10.1259/bjr.20200540 ◽

2020 ◽

Vol 93 (1114) ◽

pp. 20200540 ◽

Cited By ~ 1

Author(s):

Niraj Nirmal Pandey ◽

Sanjiv Sharma ◽

Priya Jagia ◽

Sanjeev Kumar

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Multivariate Analysis ◽

Cardiovascular Risk ◽

Chest Pain ◽

Coronary Artery ◽

Obstructive Coronary Artery Disease ◽

Epicardial Fat ◽

Atypical Chest Pain ◽

Artery Disease

Objective: This study sought to investigate the association between volume and attenuation of epicardial fat and presence of obstructive coronary artery disease (CAD) and high-risk plaque features (HRPF) on CT angiography (CTA) in patients with atypical chest pain and whether the association, if any, is independent of conventional cardiovascular risk factors and coronary artery calcium score (CACS). Methods: Patients referred for coronary CTA with atypical chest pain and clinical suspicion of CAD were included in the study. Quantification of CACS, epicardial fat volume (EFV) and epicardial fat attenuation (EFat) was performed on non-contrast images. CTA was evaluated for presence of obstructive CAD and presence of HRPF. Results: 255 patients (median age [interquartile range; IQR]: 51[41-60] years, 51.8% males) were included. On CTA, CAD, obstructive CAD (≥50% stenosis) and CTA-derived HRPFs was present in 133 (52.2%), 37 (14.5%) and 82 (32.2%) patients respectively. A significantly lower EFat was seen in patients with obstructive CAD than in those without (−86HU [IQR:−88 to −82 HU] vs −84 [IQR:−87 HU to −82 HU]; p = 0.0486) and in patients with HRPF compared to those without (−86 HU [IQR:−88 to −83 HU] vs −83 HU [−86 HU to −81.750 HU]; p < 0.0001). EFat showed significant association with obstructive CAD (unadjusted Odd’s ratio (OR) [95% CI]: 0.90 [0.81–0.99];p = 0.0248) and HRPF (unadjusted OR [95% CI]: 0.83 [0.76–0.90];p < 0.0001) in univariate analysis, which remained significant in multivariate analysis. However, EFV did not show any significant association with neither obstructive CAD nor HRPF in multivariate analysis. Adding EFat to conventional coronary risk factors and CACS in the pre-test probability models increased the area-under curve (AUC) for prediction of both obstructive CAD (AUC[95% CI]: 0.76 [0.70–0.81] vs 0.71 [0.65–0.77)) and HRPF (AUC [95% CI]: 0.92 [0.88–0.95] vs 0.89 [0.85–0.93]), although not reaching statistical significance. Conclusion: EFat, but not EFV, is an independent predictor of obstructive CAD and HRPF. Addition of EFat to traditional cardiovascular risk factors and CACS improves estimation for pretest probability of obstructive CAD and HRPF. Advances in knowledge: EFat is an important attribute of epicardial fat as it reflects the “quality” of fat, taking into account the effects of brown-white fat transformation and fibrosis, as opposed to mere evaluation of “quantity” of fat by EFV. Our study shows that EFat is a better predictor of obstructive CAD and HRPF than EFV and can thus explain the inconsistent association of increased EFV alone with CAD.

Download Full-text