Three Vessel Coronary Cameral Fistulae Associated with New Onset Atrial Fibrillation and Angina Pectoris

Coronary cameral fistulas are abnormal communications between a coronary artery and a heart chamber or a great vessel which are reported in less than 0.1% of patients undergoing diagnostic coronary angiography. All three major coronary arteries are even less frequently involved in fistula formation as it is the case in our patient. A 68-year-old woman was admitted to cardiology clinic with complaints of exertional dyspnea and angina for two years and a new onset palpitation. Standard 12-lead electrocardiogram revealed atrial fibrillation (AF) with a ventricular rate of 114 beat/minute and accompanying T wave abnormalities and minimal ST-depression on lateral derivations. Transthoracic echocardiographic examination was normal except for diastolic dysfunction, minimally mitral regurgitation, and mild to moderate enlargement of the left atrium. Sinus rhythm was achieved by medical cardioversion with amiodarone infusion. Coronary angiography revealed diffuse and multiple coronary-left ventricle fistulas originating from the distal segments of both left and right coronary arterial systems without any stenosis in epicardial coronary arteries. The patient’s symptoms resolved almost completely with medical therapy. High volume shunts via coronary artery to left ventricular microfistulas may lead to increased volume overload and subsequent increase in end-diastolic pressure of the left ventricle and may cause left atrial enlargement.

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Left ventricular dysfunction causing ischemia in patients with patent coronary arteries

Perfusion ◽

10.1177/0267659117727826 ◽

2017 ◽

Vol 33 (2) ◽

pp. 115-122

Author(s):

Thach Nguyen ◽

Hoang Do ◽

Tri Pham ◽

Loc T Vu ◽

Marco Zuin ◽

...

Keyword(s):

Chest Pain ◽

Coronary Artery ◽

Diastolic Pressure ◽

Left Ventricular ◽

T Wave ◽

St Depression ◽

Wave Inversion ◽

Group A ◽

Group B ◽

New Onset

Background: New onset of heart failure (HF) is an indication for the assessment of coronary artery disease. The aim of this study was to clarify the mechanistic causes of new onset HF associated with ischemic electrocardiograph (EKG) changes and chest pain in patients with patent or minimally diseased coronary arteries. Methods: Twenty consecutive patients (Group A) were retrospectively reviewed if they had an history of new onset of HF, chest pain, electrocardiographic changes indicating ischemia (ST depression or T wave inversion in at least two consecutive leads and a negative coronary angiogram [CA]) and did not require percutaneous coronary intervention or coronary artery bypass grafting. A 1:1 matched cohort (Group B) was adopted to validate the results. Results: All patients had a negative CA. The majority of subjects in Group A had a higher left ventricular end diastolic pressure (LVEDP) when compared to the control group (p<0.05). Similarly, the aortic diastolic (AOD) pressure was lower in Group A than in Group B (p<0.05). In patients with elevated LVEDP and low AOD, with a coronary perfusion pressure (CPP) <20 mmHg, deep T wave inversion in two consecutive leads were more frequently observed. When the CPP was between 20-30 mmHg, a mild ST depression were more frequently recorded (p<0.05). Conversely, when the CPP was >30 mmHg, only mild non-specific ST-T changes or normal EKG were observed. Conclusions: In patients with HF and EKG changes suggestive of ischemia in at least two consecutive leads, a lower AOD could aggravate ischemia in patients with elevated left ventricular end diastolic pressure.

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Collateral Circulation in Human Heart

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2005.3295 ◽

2008 ◽

Vol 5 (2) ◽

pp. 87-91

Author(s):

Aida Hasanović ◽

Fuad Šišić ◽

Faruk Dilberović ◽

Fehim Ovčina

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Left Ventricular Function ◽

Ventricular Function ◽

Coronary Arteries ◽

Collateral Circulation ◽

Left Ventricular ◽

Cardiology Department ◽

Different Types ◽

The Right

The aim of the investigations was to demonstrate different types of collaterals of coronary arteries using the method of coronary angiography and injection-corrosion method. The investigations were carried out on 30 human cadaveric hearts from the Department of Anatomy, and 30 angiograms of patients from the Cardiology Department of Clinics Centre in Sarajevo. Clinical investigations were retrospective and prospective on patients that were treated in hospital, and on patients that just arrived in hospital (based on findings of coronary angiohra-phy). The results show the existence of different types of collaterals: intercoronary and intra-coronary. We established collaterals in a case with occlusion of the right coronary artery and left coronary artery in which better development of collaterals was established. Our patients were classified in two groups:1) Patients with good collaterals and good left ventricular function;2) Patients with good collaterals and impaired left ventricular function. On the anatomical material we found different types of collaterals as well.Our results show that coronanary angiography is useful diagnostic method for the demonstration of coronary collaterals.The collaterals of human coronary arteries have always attracted the attention of anatomists, pathologists, surgeons, as well as experts in many clinical disciplines. The occurrence of coronary diseases has increased recently so much that it stimulates researchers to become acquainted with collaterals of coronary arteries. Its real significance is expressive in cases with occlusion or stenosis of coronary arteries -angina, myocardial infarction, congenital cardiovascular malformations etc. (1,2,3,4,5). Therefore, the aim of the investigations was to demonstrate different types of collaterals of the coronary arteries in normal condition and the conditions of coronary disease using the method of coronary angiography and injection corrosion method. On the other side, these investigations are important because of contrast opinions that are given in literature concerning coronary arteries collaterals. According to some authors collaterals exist and they are functional (6,7,8,9,10). The others think that collaterals exist, but that they are insufficient for collateral circulation and only develop in pathological conditions (11). Ishemia changes of the heart, variations of coronary arteries and the collaterals have been studied by many authors: Hadžiselimović, Werner, Pohl, Seiler, Kamenica, Šišić, Rockostroh, Rapps, Holmvang, Billinger, Meier and others.

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Prevalence of Myocardial Infarction with Non-Obstructive Coronary Arteries in Western Nepal

Nepalese Heart Journal ◽

10.3126/njh.v17i2.32677 ◽

2020 ◽

Vol 17 (2) ◽

pp. 39-42

Author(s):

Ram Chandra Kafle ◽

Girija Shankar Jha ◽

Dibya Sharma ◽

Vijay Madhav Alurkar

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Coronary Angiography ◽

Coronary Arteries ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Systemic Hypertension ◽

Ventricular Ejection Fraction ◽

St Segment Elevation ◽

Prior Use

Background and Aims: It is well known that ST segment elevation myocardial infarction results from complete occlusion of a coronary artery supplying that area. However, in up to 15% of patients with clinical diagnosis of myocardial infarction, early angiography reveal either non-obstructive or normal coronary artery. This subgroup of disease, myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA), represent a diagnostic and therapeutic challenge to clinicians. We aimed to determine prevalence and clinical profile of patients with MINOCA in current study. Methods: This is a retrospective, observational study conducted in cardiology department of Manipal Teaching Hospital, Pokhara, Nepal from 6th April 2014 to 5th April 2019. Patients with age ≥18 years and clinically diagnosed acute myocardial infarction who underwent coronary angiography without prior use of thrombolytic agents were selected. Data were analyzed using the software SPSS for windows version 18. Results: A total of 177 patients’ underwent early coronary angiography without prior use of thrombolytic agent. The prevalence of MINOCA was 13.5% (n=24) in our study population. MINOCA patients were younger (p<0.001) compared to non-MINOCA. Smoking, systemic hypertension, access through femoral route and depressed left ventricular ejection fraction were significantly lower in MINOCA patients (p<0.05, for all). Conclusion: The prevalence of MINOCA was high (13.5%) in our study. Prospective studies are needed to conclude its high prevalence and to look for other associated factors and etiology.

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Fibromuscular dysplasia of the coronary arteries: a rare cause of death in infants and young children

Cardiology in the Young ◽

10.1017/s104795111500061x ◽

2015 ◽

Vol 26 (1) ◽

pp. 202-205 ◽

Cited By ~ 1

Author(s):

Carolin Mogler ◽

Wolfgang Springer ◽

Matthias Gorenflo

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Left Ventricle ◽

Coronary Arteries ◽

Left Coronary Artery ◽

Fibromuscular Dysplasia ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Severe Left Ventricular Dysfunction ◽

Infants And Young Children

AbstractFibromuscular dysplasia is a common vascular disease, which mainly affects the renal arteries. In this study, we report the case of a 1-day-old infant who presented with severe left ventricular dysfunction immediately after birth, and subsequently died 3 days postnatally. At autopsy, an extensive myocardial infarction of the left ventricle and the septum was found, caused by an isolated fibromuscular dysplasia of left coronary artery.

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P1399 Global longitudinal systolic deformation of the left ventricle during stress echocardiography with physical exercise may identify patients with severe coronary artery disease

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.832 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Stepanova ◽

M N Alekhin

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Left Ventricle ◽

Stress Echocardiography ◽

Left Ventricular ◽

Gensini Score ◽

Treadmill Test ◽

Artery Disease ◽

Diagnostic Capabilities

Abstract Background Assessment of longitudinal systolic deformation of the left ventricular myocardium during speckle tracking stress echocardiography can potentially be significant in the diagnosis of transient myocardial ischemia. In this regard, determination of the global longitudinal systolic deformation (GLSD) of the left ventricle during stress echocardiography is challenging and its diagnostic capabilities can be assessed by comparing them with the data obtained with invasive methods for diagnosing coronary artery disease (CAD). Aim of the study The aim of this study was to determine the diagnostic capabilities of the left ventricular GLSD obtained during stress echocardiography with exercise on the treadmill in defining the presence and significance of CAD. Methods The study included 80 patients (mean age 68.3 ± 7.8 years; 29 females). All patients underwent stress echocardiography with exercise on the treadmill. At rest and after treadmill-test, all patients were measured for the values of the left ventricular GLSD using the AFI (Automated functional imaging) algorithm. The delta of the left ventricular GLSD values was counted. The delta of the left ventricular GLSD values was counted as the difference of the left ventricular GLSD values at rest and after the exercise. All patients underwent coronary angiography, assessment of the severity of CAD was counted according to the Gensini score. According to the results of coronary angiography, the patients were divided into 3 groups: 21 patients without CAD, 45 patients with moderate CAD (<34 points on the Gensini score) and 14 patients with severe CAD (> 34 points on the Gensini score). Results In the group of patients with severe CAD, the value of the left ventricular GLSD delta at rest and after treadmill-test significantly differed from the groups of patients with moderate CAD and without CAD (-0.56 compared with 2.17; p = 0,009). In the group of patients without CAD, the value of the left ventricular GLSD delta at rest and after treadmill-test did not significantly differ from the group of patients with CAD (0.23 compared to -0.95; p = 0.199). Conclusions The delta of the left ventricular GLSD obtained during stress echocardiography with exercise on the treadmill showed a reliable significance in determining severe CAD, but did not demonstrate a reliable significance in identifying the absence of CAD.

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Incidence of coronary artery disease before valvular replacement in isolated severe aortic stenosis patients in Western Rajasthan

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20214415 ◽

2021 ◽

Vol 9 (11) ◽

pp. 3347

Author(s):

Ramesh Patel ◽

Sandeep Aggarwal

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Coronary Arteries ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Artery Disease

Background: The aim of the study was to evaluate the incidence of Coronary artery disease (CAD) and predictors of CAD in patients with severe AS in western Rajasthan population.Methods: Data from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Udaipur were entered in a prospective registry beginning in 2015. Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70% and left main coronary arteries having an estimated narrowing of ≥50% on coronary angiography. We excluded patients with multiple valve disease, significant aortic regurgitation, or prior CAD or valve surgery.Results: Mean age of 55 enrolled patients was 52.64±15.5 years. Diabetes mellitus and hypertension were present in 3.64% and 5.45% of patients, respectively. Moderate and severe Left ventricular ejection fraction (LVEF) was found in 16.36% and 10.91% patients, respectively. Only 5.45% patient had severe CAD and thus underwent AVR and coronary artery bypass grafting, and rest 94.55% patients underwent AVR. Mean age of patients who underwent AVR was 51.75±15.36 years and who underwent AVR and CABG was 68±11.14 years with no significant association (p=0.078). Proportion of patients requiring AVR and CABG was significantly higher in moderate (22.22%) and severe LVEF (16.67%) as compared to normal or mild (p=0.034).Conclusions: Coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients above 68 years of age without risk factors for cardiovascular disease. However, larger studies on heterogeneous population are required to prove our findings.

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Is There Any Difference in Risk Factors between Male and Female Patients in New-Onset Atrial Fibrillation after Coronary Artery Bypass Grafting?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1629921 ◽

2018 ◽

Vol 66 (06) ◽

pp. 483-490 ◽

Cited By ~ 1

Author(s):

Nevzat Erdil ◽

Mehmet Colak ◽

Olcay Disli ◽

Bektas Battaloglu ◽

Cemil Colak ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Artery Bypass ◽

Left Ventricular ◽

Bypass Grafting ◽

Male And Female ◽

Female Patients ◽

New Onset

Background We aimed to investigate the risk factors of post-coronary artery bypass grafting (CABG) atrial fibrillation (AF) in male and female patients without any history of AF, to identify the sex-specific risk factors, and to examine the effect of sex-specific risk factors on the overall population. Methods This retrospective study was conducted using the hospital database with 4,758 patients who underwent CABG surgery. Among them, 2,836 patients with complete data participated in this study. The female patients were divided into two groups as patients who developed new-onset AF after CABG and those who did not. The relationship between the patients' variables and risk factors of post-CABG AF was examined. Results The overall incidence of post CABG AF was 12.9% (386/2,836). Sex-specific incidence of AF was similar: 3.2% (91/690) and 12.9% (277/2146) in female and male patients, respectively (p = 0.849). Multiple analysis revealed the independent risk factors for male and female patients, respectively: mean age (odds ratio [OR] = 1.057, OR = 1,076), age over 65 years (OR = 2.156, OR = 2.736), the European System For Cardiac Operative Risk Evaluation Scores (EuroSCORE) (OR = 1.13, OR = 1.218), COPD (OR = 1.589, OR = 1.789), BUN level (OR = 1.026, OR = 1.019), mean cardiopulmonary bypass (CPB) time (OR = 1.007, OR = 1.010), prolonged CPB time (OR = 1.604, OR = 2.309), mean cross-clamp time (OR = 1.009, OR = 1.017), need of inotropic support (OR = 2.249, OR = 2.731), and mean mechanical ventilation time (VT) (OR = 1.026, OR = 1.027).Low left ventricular ejection fraction (LVEF) (OR = 1.419), left ventricular (LV) aneurysm repair (OR = 1.533), carotid artery disease (OR = 1.750), prolonged VT (OR = 1.729), and use of intra-aortic balloon pump (IABP) (OR = 2.436) were found to be the risk factors only for male AF patients.Unstable angina (OR = 1.969), right coronary artery (RCA) disease (OR = 2), prolonged cross-clamp time (OR = 2.152), and the number of grafts per operation (OR = 1.298) were found to be the risk factors only for female AF patients. Conclusion This study suggests that predictors of AF in the overall population may be due to isolated patient groups. Multiple regression analysis and artificial intelligence modelling should be performed on large-scale, isolated groups to make strong AF prediction.

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Association of Atrial Fibrillation with Coronary Lesion in Ischemic Heart Disease Patients

Kardiologiia ◽

10.18087/cardio.2019.9.2641 ◽

2019 ◽

Vol 59 (9) ◽

pp. 5-12 ◽

Cited By ~ 2

Author(s):

E. I. Yaroslavskaya ◽

V. A. Kuznetsov ◽

E. A. Gorbatenko ◽

L. V. Marinskikh

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Ischemic Heart Disease ◽

Right Coronary Artery ◽

Coronary Circulation ◽

Left Ventricular ◽

Ischemic Heart ◽

Coronary Artery Lesions

Aim: to find out whether atrial fibrillation (AF) in patients with ischemic heart disease (IHD) is related to some definite localization or extent of coronary artery lesions or type of coronary circulation. Materials and methods. We compared data of clinical, laboratory, and instrumental examination of 178 IHD patients from the Registry of coronary angiography of patients with AF (main group) and 331 patients (comparison group) selected according to propensity score matching with balancing by sex, age, body mass index, severity of chronic heart failure, frequency of myocardial infarctions, detection of arterial hypertension, and thyroid diseases. Results. The groups did not differ in terms of alcohol use, frequency of smoking, and detection of diabetes. Patients with AF compared with those without had higher mean heart rate (105±32 vs. 70±13 bpm, р<0.001), lower level of triglycerides (1.74±1.08 vs. 1.94±1.17 mmol / l, р=0.019). AF patients more rarely had class III–IV effort angina (52.9 % vs. 66.5 %, р=0.041). Rate of detection of left ventricular (LV) dilatation and index of LV asynergy in both groups were similar, but absolute dimensions and indexes of LV, left atrium, right ventricle, LV myocardial mass were higher in the AF group. Hemodynamically significant mitral regurgitation and lowering of LV contractility were more often detected in patients with AF (49.1 % vs. 18.4 %, р<0.001, and 56.2 % vs. 39.5 %, р<0.001, in main and comparison groups, respectively). Analysis of coronary angiography data showed that patients with compared with those without AF more often had right type of coronary circulation (87.5 % vs. 80.4 %, р=0.043) as well as lesions of the right coronary artery (92.1 % vs. 85.8 %, р=0.037), and less often lesions of left coronary artery trunk (16.3 % vs. 24.8 %, р=0.027). Conclusion. AF in patients with IHD is associated with right coronary artery lesions and right type of coronary circulation.

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Quantification of Coronary Artery Stenosis with 16-Slice MSCT in Patients before CABG Surgery: Comparison to Standard Invasive Coronary Angiography

The Heart Surgery Forum ◽

10.1532/hsf98.20041144 ◽

2005 ◽

Vol 8 (1) ◽

pp. 42 ◽

Cited By ~ 12

Author(s):

C. Probst ◽

A. Kovacs ◽

C. Schmitz ◽

W. Schiller ◽

H. Schild ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Coronary Arteries ◽

Artery Bypass ◽

Invasive Coronary Angiography ◽

Bypass Graft ◽

Heart Association ◽

Artery Stenosis ◽

Vessel Disease ◽

Selective Coronary Angiography

Objective: Invasive, selective coronary angiography is the gold standard for evaluation of coronary artery disease (CAD) and degree of stenosis. The purpose of this study was to compare 3-dimensional (3D) reconstructed 16-slice multislice computed tomographic (MSCT) angiography and selective coronary angiography in patients before elective coronary artery bypass graft (CABG) procedure. Methods: Sixteen-slice MSCT scans (Philips Mx8000 IDT) were performed in 50 patients (42 male/8 female; mean age, 64.44 8.66 years) scheduled for elective CABG procedure. Scans were retrospectively electrocardiogram-gated 3D reconstructed. The images of the coronary arteries were evaluated for stenosis by 2 independent radiologists. The results were compared with the coronary angiography findings using the American Heart Association segmental classification for coronary arteries. Results: Four patients (8%) were excluded for technical reasons. Thirty-eight patients (82.6%) had 3-vessel disease, 4 (8.7 %) had 2-vessel disease, and 4 (8.7%) had an isolated left anterior descending artery stenosis. In the proximal segments all stenoses >50% (56/56) were detected by MSCT; medial segment sensitivity was 97% (73/75), specificity 90.3%; distal segment sensitivity was 90.7% (59/65), specificity 77%. Conclusion: Accurate quantification of coronary stenosis greater than 50% in the proximal and medial segments is possible with high sensitivity and specificity using the new generation of 16-slice MSCTs. There is still a tendency to overestimate stenosis in the distal segments. MSCT seems to be an excellent diagnostic tool for screening patients with possible CAD.

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RELATIVE CONTRIBUTIONS OF FIBROSIS AND CONNEXIN CHANGES TOTHE ATRIAL FIBRILLATION SUBSTRATE DURING THE DEVELOPMENT AND REVERSAL OF CONGESTIVEHEART FAILURE

Clinical & Investigative Medicine ◽

10.25011/cim.v31i4.4793 ◽

2008 ◽

Vol 31 (4) ◽

pp. 5

Author(s):

Brett Burstein ◽

Kunihiro Nishida ◽

Philippe Comtois ◽

Louis Villenuve ◽

Yung-Hsin Yeh ◽

...

Keyword(s):

Atrial Fibrillation ◽

Potential Model ◽

Diastolic Pressure ◽

Recovery Period ◽

Left Ventricular ◽

Muscle Bundle ◽

Protein Ratio ◽

Conduction Disturbances ◽

Conduction Abnormalities ◽

Mrna And Protein Expression

Background: Connexin alterations occur in various atrial fibrillation (AF) paradigms, but their functional significance remains unclear. No data are available regarding the effects of CHF on atrial connexin expression and phosphorylation. We therefore analyzed connexin changes and their contribution to the AF substrate during the development and reversal ofCHF. Methods and Results: Dogs were allocated to three groups: CHF induced by 2-week ventricular tachypacing (CHF, n=15); CHF dogs allowed to recover for 4 weeks after 2-week tachypacing (REC, n=15) and non-paced shams (CTL, n=11). Left ventricular end-diastolic pressure increased with CHF (14.5±1.0*** vs.3.7±0.7, ***P < 0.001 vs. CTL) and normalized upon CHF recovery (5.1±1.0^†††, ^††† P < 0.001 vs. CHF). Real-time PCR and Western-blot analyses revealed connexin43 (Cx43) and connexin40 (Cx40) mRNA and protein expression to be unchanged by CHF and REC. However, CHF caused Cx43 dephosphorylation(by ~73%***) and increased Cx40/Cx43 protein ratio (by ~35%***), with both alterations completely reversing in REC. Immunofluorescent confocal microscopy confirmed connexin protein trends, with a reduction in phosphorylated Cx43 (by ~68%*** in CHF) that returned to control in REC. CHF caused conduction abnormalities (phasedelay-range and heterogeneity index, both P < 0.01) and burst pacing-induced AF prolongation (CTL 22±7s, CHF 1100±171s***, REC 884±220s***) which persisted in the recovery period, along with residual fibrosis (CTL 3.6±0.7%, CHF 14.7±1.5%***, REC13.3±2.3%***). Fibrosis physically interrupted muscle bundle continuity and anionically-based action potential model of canine atrium showed that fibrosiswas able to account for the observed conduction abnormalities. Conclusions: CHF causes connexin-dephosphorylation and Cx40/Cx43ratio increases. With CHF reversal, atrial connexin alterations recover completely, but tissue fibrosis, conduction abnormalities and a substrate forAF remain with fibrosis accounting for conduction abnormalities. Thus, althougha trial connexin changes occur with CHF, they are not essential for conduction disturbances and AF promotion, which appear rather to be related primarily tofibrotic interruption of muscle-bundle continuity.

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