scholarly journals 698 Acute coronary syndrome in neoatherosclerosis with major stent malapposition and OCT-guided PCI

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Angela Buonpane ◽  
Rocco Vergallo ◽  
Emiliano Bianchini ◽  
Marco Lombardi ◽  
Alessandro Maino ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Randomized Clinical Trials ◽  
Neointimal Hyperplasia ◽  
Left Ventricular ◽  
Optical Biopsy ◽  
Inferior Wall ◽  
Coronary Syndrome ◽  
Oct Imaging

Abstract Aims Due to its bidimensional nature, angiography is not always sufficient to accurately define coronary lesions, in particular when they are ambiguous or indeterminate. Intracoronary imaging, such as intravascular ultrasound or optical coherence tomography (OCT), is often useful in these cases to better characterize the ambiguous angiographic images, to identify the culprit lesion during acute coronary syndrome (ACS) and to guide percutaneous coronary intervention (PCI). Methods and results We report a case of a 61-year-old male with multiple cardiovascular risk factors and a previous ST-segment elevation myocardial infarction treated by PCI of the right coronary artery (RCA) about 7 years before, wo was admitted to our emergency department after acute onset chest pain. At the time of admission, his ECG was normal and cardiac troponin was below the upper reference limit of normality with positive molecular SARS-CoV-2 diagnostic test. Echocardiogram disclosed a mild left ventricular dysfunction with inferior wall hypokinesia. Coronary angiography showed a moderate in-stent restenosis at mid RCA and a hazy, undetermined image at the proximal edge of the previously implanted stent. Left coronary artery angiography showed only diffuse atherosclerotic disease without significant stenoses and a myocardial bridge at the mid tract of left anterior descending artery. OCT pullback of RCA to better characterize the undetermined lesions shown by angiography. OCT revealed significant neointima hyperplasia and a focal area of neoatherosclerosis with unstable features (fissure/microthrombi) at mid RCA. Severe stent strut malapposition embedded neointimal hyperplasia was observed at the proximal stent edge, resulting in ‘dual’ lumen appearance. The two lesions were treated with a single 3.5/48 mm everolimus-eluting stent (stent-in-stent), which was post-dilated with a 3.5/20 mm non-compliant balloon (18 atm) in the mid-to-distal segments, and 4.5/15 mm (16 atm) and 5.0/8 mm (14 atm) semi-compliant balloons in the proximal stent segment. Post-PCI OCT imaging confirmed good stent expansion and apposition. Our case demonstrates the utility of OCT in clarifying the aetiology of ambiguous angiographic lesions and as a guide for PCI. Indeed, the ‘hazy’ appearance on the angiograms corresponded to the major stent malapposition covered by neointima disclosed by OCT as a ‘dual-lumen’. Of note, OCT allowed to confirm the correct guidewire position in the ‘true’ lumen preventing a crush of the previously implanted stent. OCT was also useful as a diagnostic modality for the identification and characterization of the mechanism underlying the ACS (neoatherosclerosis instability). Conclusions Due to its unprecedented spatial resolution, OCT enables an ‘optical biopsy’ of the coronary artery wall and intrastent tissue. Therefore, OCT imaging should be considered when lesions are ambiguous or indetermined by coronary angiography to guide the diagnosis and treatments of ACS patients. OCT imaging is also useful to guide stenting and to optimize PCI result, and its impact on clinical outcome is under investigation in large randomized clinical trials.

scholarly journals Postpartum Coronary Artery Embolism

2021 ◽  
Author(s):  
Fatima M Ezzeddine ◽  
Meghan Hill ◽  
Mohamad Alkhouli ◽  
Joseph Murphy
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Post Partum ◽  
Acute Chest Pain ◽  
Left Ventricular ◽  
Diagonal Branch ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Artery Embolism

Abstract Background Acute coronary syndrome (ACS) is rare in post-partum women. Prompt diagnosis of ACS and its etiology in postpartum women is crucial to guide the management of these complicated cases. Case summary In this case, a 37-year-old woman presented with acute chest pain. Transthoracic echocardiography revealed a large left ventricular apical thrombus. The patient underwent coronary angiography in the setting of ST segment elevation on the electrocardiogram (ECG) and troponin elevation. Coronary angiography showed a large thrombus in the proximal left anterior descending artery (LAD) with embolization to the distal (LAD) artery and distal second diagonal branch. Thrombophilia workup was unremarkable. The patient was managed with anticoagulation. Conclusion This case demonstrates an example of acute coronary syndrome in the postpartum period due to coronary artery thrombosis.

An Atypical Presentation of Acute Coronary Syndrome

2012 ◽  
Vol 8 (1) ◽  
pp. 67
Author(s):  
Syed Khurram Mushtaq Gardezi ◽  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Systolic Function ◽  
Artery Bypass ◽  
Left Ventricular Systolic Function ◽  
Regional Wall Motion ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
Coronary Syndrome

A 61-year-old man was admitted to hospital with severe occipital headache and weakness and numbness of the left arm. His electrocardiograms showed changes hinting at acute coronary syndrome (ACS). However, in view of his clinical presentation, he underwent tests for likely subarachnoid haemorrhage, but this was ruled out. The next day, he was referred to cardiology. A transthoracic echocardiogram showed reduced left ventricular systolic function along with regional wall motion abnormalities involving inferoposterior walls. The patient was treated as per the protocol for ACS. A dobutamine stress echocardiogram confirmed inferior myocardial infarction with evidence of myocardial viability in the affected left ventricular segments. Subsequent investigations confirmed three-vessel coronary artery disease and reduced left ventricular systolic function. The patient underwent successful coronary artery bypass grafting.

scholarly journals A pebble clogging a river: a case report of thrombosed coronary aneurysmal ectasia

2020 ◽  
Author(s):  
Akshar Jaglan ◽  
Tarek Ajam ◽  
Steven C Port ◽  
Tanvir Bajwa ◽  
A Jamil Tajik
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Treatment Options ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Artery Ectasia ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Patient Reported

Abstract Background Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in the older generation. We present a unique case of the management of a young woman diagnosed with multivessel CAE with aneurysmal changes in the setting of acute coronary syndrome and subsequently during pregnancy. Case summary A 23-year-old woman presented with acute onset chest pain. Electrocardiogram revealed no ischaemic changes; however, troponin I peaked at 16 ng/mL (reference range 0–0.04 ng/mL). Echocardiogram showed apical dyskinesis with preserved left ventricular ejection fraction. Coronary angiography showed multivessel CAE along with significant thrombus burden in an ectatic lesion of the left anterior descending artery. Since the patient was haemodynamically stable, conservative management with dual antiplatelet therapy and anticoagulation was started. On follow-up, coronary computed tomographic angiogram illustrated resolution of the coronary thrombi and echocardiogram showed improvement to the apical dyskinesis. It was presumed that Kawasaki disease was the most likely aetiology of her disease. Subsequently the patient reported that, contrary to medical advice, she was pregnant, adding another layer of complexity to her case. Discussion Coronary artery ectasia can be discovered as an incidental finding or can present with an acute coronary syndrome. Management is challenging in the absence of randomized trials and large-scale data. Treatment options include medications, percutaneous intervention, and surgical revascularization. Close surveillance is required in these patients to assess progression of disease. Here we discuss treatment options during acute coronary syndrome and pregnancy.

scholarly journals Myocarditis Mimicking an Acute Coronary Syndrome: A Case Related toSalmonella enteritis

2009 ◽  
Vol 2009 ◽  
pp. 1-2 ◽  
Author(s):  
B. Rossetti ◽  
G. Nguisseu ◽  
A. Buracci ◽  
L. Migliorini ◽  
G. Zanelli
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Salmonella Enteritidis ◽  
Clinical Laboratory ◽  
Final Diagnosis ◽  
Gastrointestinal Infections ◽  
Coronary Syndrome ◽  
Salmonella Enteritis

Infective myocarditis is most commonly due to a viral infection; occasionally it has been related to bacteria. Gastrointestinal infections associated with myocarditis have only rarely been described in young people, and the pathogenesis is unclear. We report a case of myocarditis mimicking an acute coronary syndrome (ACS) in a patient hospitalized for fever and diarrhoea.Salmonella enteritidiswas isolated from stool, and no other pathogens were found. The coronary angiography was normal, and there were not other coronary artery risk factors, other than hypertension. The patient was treated with ciprofloxacin, acetylsalicylate acid, and ramipril with rapid clinical improvement and normalization of cardiac abnormalities. Final diagnosis ofSalmonella enteritisand related myocarditis was made based on clinical, laboratory, ECG and echocardiographical findings.

scholarly journals Cardiorehabilitation of Patients with Acute Coronary Syndrome Who Were Performed Coronary Arteries Revascularization

2017 ◽  
Vol 24 (4) ◽  
Author(s):  
Mykola Shved ◽  
Lesja Tsuglevych ◽  
Iryna Kyrychok ◽  
Tetiana Boiko ◽  
Larysa Levutska
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Cardiac Rehabilitation ◽  
Rehabilitation Program ◽  
Left Ventricular ◽  
Cardiac Rehabilitation Program ◽  
Coronary Artery Revascularization ◽  
Coronary Syndrome

In patients with acute coronary syndrome who were performed coronary arteries’ revascularization, in the postoperative period disorders of hemodynamics and heart rate variability often develop. The aim of our work was to optimize the cardiac rehabilitation of such patients by individualization of physical activity depending on the state of systolic and diastolic left ventricular dysfunction and heart rate variability.                 40 patients with acute coronary syndrome and coronary artery revascularization were included into the experimental group. The control group consisted of 20 patients of the same age, clinical and laboratory manifestations of ACS who were treated according to the protocol of Ministry of Health of Ukraine. In both groups of patients clinical efficacy of cardiac rehabilitation process was evaluated according to the dynamics of clinical symptoms, systolic and diastolic left ventricular function and heart rate variability.                 In patients with acute coronary syndrome and coronary artery revascularization in the initial state the clinical and laboratory signs of myocardial ischemia disappear, but subclinical and clinical manifestations of heart failure remain.                 During the first month of training, the original accelerated cardiac rehabilitation program leads to the decrease of systolic and diastolic signs of cardiac dysfunction and improves heart rate variability, which significantly improves the quality of life of these patients.                 For monitoring the efficacy and safety of the performance of cardiac rehabilitation program in patients with acute coronary syndrome and coronary artery revascularization, in addition to conventional methods (determination of heart rate, blood pressure, 6-minute test), it is useful to diagnose subclinical stage of heart failure by examination of systolic, diastolic function and vegetative regulation.

scholarly journals Role of HbA1c with mortality and severity among the patients of Acute coronary syndrome: a prospective study

2019 ◽  
Vol 6 (3) ◽  
pp. 796
Author(s):  
Satish Chandel ◽  
Shishirendu Parihar ◽  
Bharat Gramani ◽  
T. N. Dubey
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Glucose Intolerance ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Study Cohort ◽  
Medical College ◽  
Coronary Syndrome ◽  
Gandhi Medical College ◽  
A Prospective Study

Background: Blockage of coronary artery lead to a reduction of blood flow towards heart resulting in Coronary Artery Disease (CAD). CAD leads to myocardial complications. CAD is one of the important causes of death all over the world including India. Diabetes mellitus is a risk factor for CAD. Reports have also shown to increase in cardiovascular morbidity among patients with glucose intolerance. In present study we tried to find the relationship of HbA1c levels with mortality, morbidity, and severity in Acute Coronary Syndrome (ACS).Methods: Two hundred patients with ACS were studied from 2018 to 2019 at Gandhi Medical College and Hamidia Hospital, Bhopal. Following a thorough medical history routine medical examination including laboratory investigations was performed in all the patients. Electrocardiography (ECG), creatine phosphokinase-muscle/brain (CPK-MB), echocardiography and coronary angiography (CAG) was also done as part of this study.Results: Mean age of the study cohort was 59.17±8.75 years. Out of 200 subjects, 110 (55%) were non-diabetic, 52 (26%) were diabetic, 38 (19%) had weakened glucose tolerance and 82 (41%) had hypertension. Left ventricular dysfunction (LVD) and heart failure (HF) were the common complications and were more prevalent among diabetic patients than the nondiabetics (p=0.009). HbA1c level (7.01±2.23) was high among subjects with complications than the subjects without complications (6.01±1.36).Conclusions: The patients with DM have higher morbidity and mortality than the non-diabetic patients of ACS and therefore such patients should be screened for diabetes and glucose intolerance for better management of CAD.

scholarly journals Assessment of the effectiveness of treatment in patients after acute coronary syndrome

2020 ◽  
Vol 25 (2) ◽  
pp. 9-18
Author(s):  
D. A. Shvets ◽  
S. V. Povetkin ◽  
A. Yu. Karasev ◽  
V. I. Vishnevsky
Keyword(s):  
Acute Coronary Syndrome ◽  
Drug Therapy ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Secondary Prevention ◽  
Generic Drugs ◽  
Myocardial Revascularization ◽  
Cardiovascular Complications ◽  
Drug Prevention ◽  
Coronary Syndrome

Aim. To assess the effectiveness of secondary drug prevention and surgical myocardial revascularization in patients with coronary artery disease (CAD) during long-term follow-up after acute coronary syndrome (ACS).Material and methods. The study involved 400 patients with ACS discharged from the hospital in 2012-2016. The diagnosis was verified according to the European Society of Cardiology (ESC) guidelines. There were no exclusion criteria. We analyzed the data of medical records (complaints, medical history, physical examination, laboratory and instrumental data). Repeated data collection was carried out by distance survey and during a face-to-face examination during 2018. According to the clinical course of CAD, all patients were divided into 2 groups. Group 1 consisted of 151 patients with complicated course of CAD, group 2 — 249 patients with stable CAD. We analyzed drug therapy recommended at hospital discharge and taken at the time of the repeated examination. The drug names and daily dosage used for the secondary prevention of CAD were recorded. Assessment of survival without cardiovascular complications was carried out according to the Kaplan-Mayer analysis.Results. Seven-year mortality was 22,5%. The total number of cardiovascular events was 37,7%. The main reason for the frequent complications was the insufficient secondary prevention of CAD after ACS. We found that the drugs and their dosage did not have a significant effect on survival. Statin use is associated with a paradoxical increase in the number of complications. The increased frequency of use and dosage of statins are a consequence of unfavorable course of CAD and do not have the proper preventive effect. For some groups of drugs, we observed irregular intake over the observation period. The low effectiveness of therapy is not only due to insufficient doses, but also in the frequent use of generic drugs. The significant effect of coronary angiography on the probability of cardiovascular complications compared with stenting is due to high proportion of coronary angiography use without revascularization.Conclusion. The combination of following factors of drug therapy can explain the low effectiveness of secondary CAD prevention: low dose (26,1±2,8 mg for atorvastatin), irregular intake and common use of generic drugs (97,6% for statins), present in different ratios. The contribution of surgical treatment to reducing cardiovascular complications is lower, the more significant residual coronary artery stenosis.

scholarly journals Nonalcoholic Fatty Liver Disease and Coronary Artery Disease: Big Brothers in Patients with Acute Coronary Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Mauricio Montemezzo ◽  
Ahmed AlTurki ◽  
Fabio Stahlschmidt ◽  
Marcia Olandoski ◽  
Jean Rodrigo Tafarel ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Liver Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Nonalcoholic Fatty Liver ◽  
Coronary Syndrome ◽  
Diagnostic Coronary Angiography ◽  
Grade Iii

Background. The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing. This study aimed to evaluate the prevalence of NAFLD, as diagnosed by ultrasound, in patients with acute coronary syndrome (ACS) and to assess whether NAFLD is associated with the severity of coronary obstruction as diagnosed by coronary angiography. Methods. We performed a prospective single-center study in patients hospitalized due to acute coronary syndrome who underwent diagnostic coronary angiography. Consecutive patients who presented to the emergency room were diagnosed with acute coronary syndrome and were included. All patients underwent ultrasonography of the upper abdomen to determine the presence or absence of NAFLD; NAFLD severity was graded from 0 to 3 based on a previously validated scale. All patients underwent diagnostic coronary angiography in the same hospital, with the same team of interventional cardiologists, who were blinded to the patients’ clinical and ultrasonographic data. CAD was then angiographically graded from none to severe based on well-established angiographic criteria. Results. This study included 139 patients, of whom 83 (59.7%) were male, with a mean age of 59.7 years. Of the included patients, 107 (77%) patients had CAD, 63 (45%) with serious injury. Regarding the presence of NAFLD, 76 (55.2%) had NAFLD including 18 (23.6%) with grade III disease. In severe CAD, 47 (60.5%) are associated with NAFLD, and 15 (83.3%) of the patients had severe CAD and NAFLD grade III. Conclusions. NAFLD is common in patients with ACS. The intensity of NAFLD detected by ultrasonography is strongly associated with the severity of coronary artery obstruction on angiography.

Role of Segmental and Global Left Ventricular Strain in Diagnosis of Acute Coronary Syndrome

Kardiologiia ◽  
2020 ◽  
Vol 60 (5) ◽  
pp. 20-24
Author(s):  
A. L. Chilingaryan ◽  
L. G. Tunyan ◽  
R. V. Shamoyan
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Sensitivity And Specificity ◽  
False Negative ◽  
Left Ventricular ◽  
Middle Part ◽  
Control Group ◽  
Acute Ischemia ◽  
Coronary Syndrome

Aim To determine the role of left ventricular segmental (SLS) and general longitudinal strain (GLS) in early diagnosis of acute coronary syndrome (ACS).Material and methods The study included 112 patients aged 58±7 years with suspected ACS without a history of ischemic heart disease (IHD) who were admitted to the hospital within 12 h of complaint onset. The control group consisted of 20 healthy, age- and sex-matched subjects. Speckle-tracking echocardiography was performed to assess SLS and GLS on admission and discharge. Ischemia was diagnosed when the SLS was decreased to 14% or lower with a simultaneous post-systolic shortening (PSS) of these segments >20% or when the initial lengthening of the segments was followed by PSS.Results Decreased SLS with PSS of one or more segments was observed in 51.8 % of patients; 16.1% of patients had initial systolic lengthening of one or more segments followed by PSS. In 30.3 % of patients, GLS was 15.5 % or less; 82.3% of these patients had SLS disorders. Later, ACS was diagnosed in 72.3 % of the patients. ACS was not confirmed in 4 (5.2%) of 76 (67.9 %) patients with abnormal SLS changes. All these patients had low SLS values and high PSS values and did not have the initial systolic segmental lengthening. Seven of 9 (8 %) patients with false-negative SLS values had distal narrowing of a coronary artery and two patients had narrowing in the middle part of the artery. All patients with ACS and decreased GSL had a hemodynamically significant narrowing of more than one coronary artery. Incidence of two and more stenosed arteries was higher in patients with PSS and low GSL. Sensitivity and specificity of SLS for diagnosis of acute ischemia were 88.9 and 84.6 %, respectively.Conclusion Assessment of LV strain has high sensitivity and specificity for diagnosis of ACS in patients with the first IHD episode. The presence of PSS associated with decreased GSL may indicate multivascular IHD.

scholarly journals Evaluation of Platelet Parameters in Patients With Coronary Artery Disease

2020 ◽  
Author(s):  
Mahdieh Mehrpouri1 ◽  
Afshin Ahmad Pour ◽  
Esmail Shahabi Satlsar
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Healthy Volunteers ◽  
Ecg Changes ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Artery Disease

Coronary artery disease (CAD) is one of the leading causes of death worldwide; therefore, identifying new risk factors to predict the severity of the disease is thought to be associated with mortality reduction. In an effort to investigate whether platelet parameters are related to the extent of CAD and can be considered as risk factors, we designed experiments to evaluate platelet parameters in these patients. In a cross‐sectional study, sixty-nine patients with CAD (including fifty-two patients with acute coronary syndrome and seventeen patients with stable angina) and sixty-four healthy volunteers were evaluated for platelet count, mean platelet volume (MPV), and platelet distribution width (PDW). Echocardiography, electrocardiogram (ECG), and coronary angiography were conducted as well. Results showed significantly higher values for MPV and PDW in patients with acute coronary syndrome as compared to patients with stable angina and healthy volunteers (P<0.001 and P=0.009, respectively). There was no significant difference in platelet count between patients and healthy volunteers (P=0.379). Our results also revealed a significant difference in the ejection fraction (EF) percentage between the three groups (P=0.008). Investigating the correlation between platelet parameters and EF percentage, ECG changes, and the results of coronary angiography did not show any significant association. The present study showed that the elevated levels of MPV and PDW in patients with CAD are not related to the extent of coronary artery disease, which was estimated by echocardiography, ECG changes, and coronary angiography. Thus, these parameters cannot be considered as risk factors for coronary artery disease.

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