scholarly journals Cardiogenic shock in the context of newly diagnosed anomalous origin of the right coronary artery originating from the pulmonary artery: a case report

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Coralea Kappel ◽  
Justin Chow ◽  
Zeeshan Ahmed ◽  
Jon-David Schwalm ◽  
Faizan Amin
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Cardiogenic Shock ◽  
Right Coronary Artery ◽  
Congenital Heart ◽  
Cardiac Computed Tomography ◽  
Obstructive Coronary Artery Disease ◽  
Heart Catheterization ◽  
Cardiac Computed Tomography Angiography ◽  
Multiple Imaging

Abstract Background Anomalous right coronary artery (RCA) from the pulmonary artery (ARCAPA) is a rare congenital heart abnormality with varying clinical presentations, for which multiple imaging modalities are often required for diagnosis. Case summary We present a case of a 76-year-old female presenting with 2 weeks of palpitations and shortness of breath who was found to be in rapid atrial fibrillation (AF) with congestive heart failure. Despite initial medical management, the patient developed cardiogenic shock with anuric renal failure. Emergent right and left heart catheterization did not demonstrate any significant obstructive coronary artery disease but showed severe right ventricular (RV) failure and raised the possibility of an ARCAPA. This diagnosis was further corroborated by findings on a subsequent transoesophageal echocardiogram. In view of profound decline and limited anticipated improvement, the patient ultimately decided to pursue comfort measures in a hospice setting. Discussion We postulate that the underlying aetiology of our patient’s shock state was multifactorial, notably progressive RCA-territory ischaemia and RV failure, sepsis, and new-onset uncontrolled AF. In adults, unrecognized congenital heart disease can uncommonly cause cardiogenic shock. In our case, echocardiography and invasive angiography were integrated for the diagnosis of ARCAPA given the clinical circumstances that limited the use of cardiac computed tomography angiography.

scholarly journals Cardiac Computed Tomography Angiography for Imaging Coronary Arteriovenous Malformation: a Case Report

2014 ◽  
Vol 60 (1) ◽  
pp. 22-24
Author(s):  
Suciu Zsuzsanna ◽  
Jakó Beáta ◽  
Benedek Theodora ◽  
Benedek I
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Coronary Artery ◽  
Pulmonary Artery ◽  
Arteriovenous Malformation ◽  
Computed Tomography Angiography ◽  
Cardiac Computed Tomography ◽  
Main Pulmonary Artery ◽  
Cardiac Computed Tomography Angiography ◽  
Ionic Contrast

Abstract Background: Coronary arteriovenous malformation is a rare congenital disease consisting mainly in a direct communication between a coronary artery and any one of the four cardiac chambers, coronary sinus, pulmonary arteries or veins. This disease can lead to various cardiovascular events, their severity depending on the degree of the malformation. Case report: We present the case of a 56-year-old male patient, who was admitted to our institution with dyspnea, palpitation and chest pain, having a history of hypertension and hyperlipidemia, and an abnormal electrocardiogram. Physical examination did not reveal any alterations and the cardiac enzymes were in normal ranges. Cardiac computed tomography was performed before any other invasive studies, with a 64-row scanner (Somatom Sensation multislice 64 equipment, Siemens) after intravenous administration of non-ionic contrast material. CT scan revealed a large (2-2.5 mm) coronary fistula originating from the LAD to the main pulmonary artery, and multiple significant atherosclerotic coronary lesions. Coronary angiography confirmed the arteriovenous malformation between LAD and pulmonary artery, associated with three vascular coronary artery disease. Conclusions: Cardiac computed tomography angiography can help for a non-invasive diagnosis of the coronary artery malformations, in the same time revealing anatomic details which can be particulary useful for choosing the appropriate management strategy (surgical planning, interventional treatment or optimum medical treatment)

scholarly journals Images of Anomalous Origin of The Right Coronary Artery From the Pulmonary Artery

2019 ◽  
Vol 22 (4) ◽  
pp. E308-E309
Author(s):  
He Fan ◽  
Weng Jiakan ◽  
He Qicai ◽  
Qian Ximing ◽  
Chen Huaidong
Keyword(s):  
Coronary Artery ◽  
General Population ◽  
Pulmonary Artery ◽  
Coronary Arteries ◽  
Congenital Heart Defects ◽  
Right Coronary Artery ◽  
Congenital Heart ◽  
Heart Defects ◽  
Anomalous Origin ◽  
The Right

Anomalies of the coronary arteries -- especially their abnormal origin from the pulmonary artery (ARCAPA) trunk -- are among the least common. They’re also the most dangerous of congenital heart defects with an incidence of 0.002% in the general population [Williams 2006]. The diagnosis exceedingly is difficult because anatomical abnormalities of the coronary arteries are subtle. We present a case of an anomalous origin of the right coronary artery.

scholarly journals Increased Epicardial Fat Tissue is Predictor for Patients with Ischemia and No Obstructive Coronary Artery Disease

2020 ◽  
Vol 17 (4) ◽  
Author(s):  
Lin Qi ◽  
Kailei Shi ◽  
Xinkai Qu ◽  
Dingbiao Mao ◽  
Ming Li
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiac Computed Tomography ◽  
Obstructive Coronary Artery Disease ◽  
Multiple Logistic Regression Analysis ◽  
Control Group ◽  
Fractional Flow ◽  
Cardiac Computed Tomography Angiography ◽  
Flow Reserve ◽  
Artery Disease

Background: Epicardial adipose tissue (EAT) may play a vital role in the progression of ischemia and no obstructive coronary artery disease (INOCA). CT can achieve a precise quantification of EAT for its higher spatial resolution compared to other methods. Objectives: This study aimed at exploring EAT in patients with INOCA, and its associations with other clinical factors. Methods: From January 2017 to October 2018, a total of 254 consecutive patients suspected with coronary atherosclerotic disease (CAD) underwent cardiac computed tomography angiography (CCTA). There were 195 patients who were excluded for obstructive CAD by CCTA analysis and CT derived fractional flow reserve (CT-FFR) (≤ 0.80). Seventy-two patients with either angina and/or signs of ischemia but without obstructive CAD were recruited as INOCA group. Forty-eight controls without angina and risk factors for INOCA were enrolled as the control group. EAT volume and thickness, and other factors were analyzed in INOCA and control groups. Results: Despite similar body mass index (BMI), EAT thickness and volume were significantly elevated in INOCA patients compared with the control group (P < 0.001). Receiver operating characteristic curve analysis for identifying INOCA exhibited a higher area under the curve of EAT volume (0.773, 95%CI 0.616-0.930) than EAT thickness (0.692, 95%CI 0.597-0.786). The cut-off values for EAT thickness and volume were 3.2 mm and 179.6 cm3, respectively. Presence of hypertension, triglyceride levels, and EAT thickness and volume were significantly associated with INOCA and lowly affected by other factors in multiple logistic regression analysis. Conclusions: INOCA patients have more EAT compared with controls. EAT is a marker of INOCA and may be a predictor of pharmacological therapy and a prognostic indicator. Further research should focus on the myocardial microcirculation changes by EAT volume reduction.

scholarly journals Appropriate utilization of cardiac computed tomography for the assessment of stable coronary artery disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael Hammer ◽  
Muhtashim Mian ◽  
Levi Elhadad ◽  
Mary Li ◽  
Idan Roifman
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiac Imaging ◽  
Cardiac Computed Tomography ◽  
The United States ◽  
Appropriate Use ◽  
Potential Cost ◽  
Cardiac Computed Tomography Angiography ◽  
Artery Disease

Abstract Background Appropriate use criteria (AUC) have been developed in response to growth in cardiac imaging utilization and concern regarding associated costs. Cardiac computed tomography angiography (CCTA) has emerged as an important modality in the evaluation of coronary artery disease, however its appropriate utilization in actual practice is uncertain. Our objective was to determine the appropriate utilization of CCTA in a large quaternary care institution and to compare appropriate utilization pre and post publication of the 2013 AUC guidelines. We hypothesized that the proportion of appropriate CCTA utilization will be similar to those of other comparable cardiac imaging modalities and that there would be a significant increase in appropriate use post AUC publication. Methods We employed a retrospective cohort study design of 2577 consecutive patients undergoing CCTA between January 1, 2012 and December 30, 2016. An appropriateness category was assigned for each CCTA. Appropriateness classifications were compared pre- and post- AUC publication via the chi-square test. Results Overall, 83.5% of CCTAs were deemed to be appropriate based on the AUC. Before the AUC publication, 75.0% of CCTAs were classified as appropriate whereas after the AUC publication, 88.0% were classified as appropriate (p < 0.001). The increase in appropriate utilization, when extrapolated to the Medicare population of the United States, was associated with potential cost savings of approximately $57 million per year. Conclusions We report a high rate of appropriate use of CCTA and a significant increase in the proportion of CCTAs classified as appropriate after the AUC publication.

Heart failure in an elderly man: where is that coronary?

2021 ◽  
pp. 1-4
Author(s):  
Charlie J. Sang ◽  
Stephen A. Clarkson ◽  
Elizabeth A. Jackson ◽  
Firas Al Solaiman ◽  
Marc G. Cribbs
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Pulmonary Artery ◽  
Medical Therapy ◽  
Coronary Arteries ◽  
Right Coronary Artery ◽  
Adult Population ◽  
Anomalous Coronary ◽  
Anomalous Coronary Arteries

Abstract Anomalous coronary arteries from the pulmonary artery are uncommon causes of heart failure in the adult population. This case demonstrates the unusual presentation in a patient with anomalous right coronary artery from the pulmonary artery and discusses the complex pathophysiology of this lesion and the role of guideline-directed medical therapy in the management of these patients.

scholarly journals Anomalous Origin of the Left Anterior Descending Coronary Artery in an Adult

2021 ◽  
Vol 10 (01) ◽  
pp. e9-e10
Author(s):  
Keisuke Shibagaki ◽  
Chikara Shiiku ◽  
Hiroyuki Kamiya ◽  
Yoichi Kikuchi
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Pulmonary Artery ◽  
Congenital Heart ◽  
Left Coronary Artery ◽  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Anomalous Origin ◽  
Bypass Grafting

AbstractAn anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart disease. Among the variants, an anomalous origin of the left anterior descending coronary artery from the pulmonary artery (ALADPA) is extremely rare. Here, we report a case of ALADPA in an adult that was treated with coronary artery bypass grafting using the left internal thoracic artery.

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