scholarly journals Clinical outcomes of discordant exercise electrocardiographic and echocardiographic findings compared with concordant findings in patients with chest pain and no history of coronary artery disease

Medicine ◽  
2019 ◽  
Vol 98 (39) ◽  
pp. e17195
Author(s):  
Hui-Jeong Hwang ◽  
Il Suk Sohn ◽  
Chang-Bum Park ◽  
Eun-Sun Jin ◽  
Jin-Man Cho ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Clinical Outcomes ◽  
History Of ◽  
Artery Disease ◽  
Echocardiographic Findings

P2503Clinical outcomes of discordant exercise electrocardiographic and echocardiographic findings in patients with chest pain and no history of coronary artery disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E.-S Im ◽  
I.-S Sohn
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Clinical Outcomes ◽  
Treadmill Exercise ◽  
Coronary Revascularization ◽  
Exercise Echocardiography ◽  
Cardiac Events ◽  
History Of ◽  
Artery Disease

Abstract Purposes The aim of this study was to evaluate comparative clinical outcomes of discordant electrocardiographic (ECG) and echocardiographic (Echo) findings compared to concordant findings during treadmill exercise echocardiography in patients with chest pain and no history of coronary artery disease (CAD). Methods A total of 1725 consecutive patients who underwent treadmill echocardiography with chest pain and no history of CAD were screened. The patients were classified into four groups: ECG−/Echo− (negative ECG and Echo), ECG+/Echo− (positive ECG and negative Echo), ECG−/Echo+, and ECG+/Echo+. Concomitant CAD was determined using coronary angiography or coronary computed tomography. Major adverse cardiac events (MACEs) were defined as a composite of coronary revascularization, acute myocardial infarction, and death. Results MACEs were similar between ECG−/Echo− and ECG+/Echo− groups. Compared to ECG+/Echo− group, ECG−/Echo+ group had more MACEs [adjusted hazard ratio (HR) adjusted by clinical risk factors (95% confidence interval), 3.57 (1.75–7.29), p<0.001]. Compared with ECG+/Echo+ group, ECG−/Echo+ group had lower prevalence of concomitant CAD and fewer MACEs [HR, 0.49 (0.29–0.81), p=0.006]. Conclusions Positive exercise Echo alone during treadmill exercise echocardiography had worse clinical outcomes than positive ECG alone, and the latter had similar outcomes to both negative ECG and Echo. Positive exercise Echo alone also had better clinical outcomes than both positive ECG and Echo. Therefore, exercise Echo findings might be superior for predicting clinical outcomes compared to exercise ECG findings. Additional consideration of ECG findings on positive exercise Echo will also facilitate better prediction of clinical outcomes

scholarly journals Emergency Department Visits and Subsequent Hospital Admission Trends for Patients with Chest Pain and a History of Coronary Artery Disease

2020 ◽  
Vol 9 (1) ◽  
pp. 153-165 ◽  
Author(s):  
Christine Eichelberger ◽  
Aarti Patel ◽  
Zhijie Ding ◽  
Christopher D. Pericone ◽  
Jennifer H. Lin ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Emergency Department ◽  
Chest Pain ◽  
Coronary Artery ◽  
Hospital Admission ◽  
Emergency Department Visits ◽  
History Of ◽  
Artery Disease

Abstract 17234: Cisplatin Induced Coronary Artery Atherosclerosis Leading To St-elevation Myocardial Infarction: A Case Report

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Sheikh Bilal B Khalid ◽  
Javaria Mahmood
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Premature Coronary Artery Disease ◽  
Chemotherapeutic Regimen ◽  
History Of ◽  
St Elevation ◽  
Artery Disease

Introduction: Cisplatin-based chemotherapeutic regimen (CBCR) is known for increasing risk of venous thromboembolic (TE) disease. We report a unique case of STEMI associated with CBCR which we believe was caused by coronary artery thrombosis. Case description: A 31-yo man with a past history of germ cell tumor presented with chest pain radiating to back and left arm. It started this morning and intensity did not worsen with exertion. He denied any dyspnea, diaphoresis or palpitations. He was non-smoker and non-obese. He denied any family history of premature coronary artery disease. He had undergone unilateral orchiectomy a year ago, and was currently receiving chemotherapy with bleomycin, etoposide and cisplatin; the last dose of his 3 rd cycle was given the day before. EKG showed ST elevation in leads I, aVL, V4 and V5. Troponin I was high to 6.9 ng/ml (ULN 0.045 ng/ml). He received intravenous infusion of thrombolytic. An angiogram done the next day showed moderate mid-LAD disease with residual clot. A CT scan and an echocardiogram later showed left ventricular thrombus (LVT). He was kept on therapeutic enoxaparin along with aspirin. Follow up echocardiogram showed resolution of the thrombus. His chemotherapy was stopped, and he has been kept on active surveillance since then. Discussion: Most cases of CBCR-associated myocardial infarction that have been reported have been seen in the older population with other risk factors for coronary artery disease. Cases where angiographic data was available, coronary artery vasospasm appeared to be the culprit rather than a true plaque rupture. While the presence of LVT raises possibility of thromboembolism to coronaries causing MI, the angiographic findings support accelerated plaque formation to be the cause of infarction. In earlier reports, elevated pre-treatment level of von Willebrand factor has been postulated to have some role in the disease pathogenesis. Other possible mechanisms for pathogenesis include endothelial cell damage, platelet activation, and imbalance between thromboxane-prostacyclin levels. This case emphasizes the need to keep cardiac etiologies of chest pain in the differential when evaluating patients on CBCR as timely intervention is life saving and prevent morbidity.

PCI is a long-lasting solution for abolishing angina. Or maybe not?

2020 ◽  
pp. 27-31
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Cardiovascular Diseases ◽  
Coronary Angiography ◽  
Previous History ◽  
History Of ◽  
Artery Disease ◽  
Vessel Coronary Artery ◽  
Typical Chest Pain

We describe a case of a 62-year-old man with no previous history of cardiovascular diseases presenting with typical chest pain. The patient was referred for coronary angiography, which revealed the presence of single-vessel coronary artery disease. After intracoronary stent implantation, the patient experienced recurrent episodes of angina followed by further revascularizations that did not clear up his symptoms.

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