scholarly journals Post cardiac injury syndrome successfully treated with medications: a report of two cases

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mu-Shiang Huang ◽  
Yan-Hua Su ◽  
Ju-Yi Chen
Keyword(s):  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Cardiac Injury ◽  
Coronary Intervention ◽  
Moderate Amount ◽  
Percutaneous Coronary ◽  
Pacing Lead ◽  
History Of ◽  
Low Incidence ◽  
The Right

Abstract Background Post cardiac injury syndrome (PCIS) is induced by myocardial infarction or cardiac surgery, as well as minor insults to the heart such as percutaneous coronary intervention (PCI), or insertion of a pacing lead. PCIS is characterized by pericarditis after injury to the heart. The relatively low incidence makes differential diagnosis of PCIS after PCI or implantation of a pacemaker a challenge. This report describes two typical cases of PCIS. Case presentation The first patient presented with signs of progressive cardiac tamponade that occurred two weeks after implantation of a permanent pacemaker. Echocardiography confirmed the presence of a moderate amount of newly-formed pericardial effusion. The second patient underwent PCI for the right coronary artery. However, despite an uneventful procedure, the patient experienced dyspnea, tightness of chest and cold sweats, and bradycardia two hours after the procedure. Echocardiography findings, which showed a moderate amount of newly-formed pericardial effusion, suggested acute cardiac tamponade, and compromised hemodynamics. Both patients recovered with medication. Conclusion These cases illustrated that PCIS can occur after minor myocardial injury, and that the possibility of PCIS should be considered if there is a history of possible cardiac insult.

scholarly journals Prevalence, Predictors, and Clinical Presentation of Acute Pericardial Effusion Following Percutaneous Coronary Intervention

2022 ◽  
Vol 8 ◽  
Author(s):  
Bei Zhao ◽  
Jie Zhang ◽  
Yun Li ◽  
Xueyao Feng ◽  
Shuai Mao ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Pericardial Effusion ◽  
Clinical Presentation ◽  
Troponin T ◽  
Cardiac Injury ◽  
Coronary Intervention ◽  
Cardiac Damage ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Procedural Time

Background: Iatrogenic pericardial effusion (PE) has been demonstrated to lead to cardiac injury as a sign of systemic inflammatory response.Objectives: This study sought to determine the anatomical characteristics and clinical presentation associated with PE after percutaneous coronary intervention (PCI) by using echocardiography.Methods: The clinical outcomes of all patients with coronary artery disease who underwent PCI from July 2014 to December 2018 were evaluated. The quantitative and qualitative analyses of PE were performed. The associations between the presence of PE and procedural factors were also evaluated.Results: A total of 882 patients were enrolled. PE was found in 144 patients (16.3%) and was mostly located in the anterior pericardium at low amounts. The serum levels of high-sensitive C-reaction protein before PCI and troponin T in the group with PE after PCI were significantly higher than those in the group without PE (p < 0.0001). The presence of PE was associated with the procedural time (OR = 1.02, p = 0.035) and the degree of interventional complexity (multiple vessels OR = 1.89, p = 0.014; chronic total occlusion OR = 2.04, p = 0.005; and PCI with rotational atherectomy OR = 1.15, p = 0.011) independent of the number of culprit vessels and stents. During 1-year follow-up, a significantly higher number of cardiac deaths (3) and myocardial infarctions (8) occurred in patients with PE than in patients without PE (P < 0.05).Conclusion: Post-PCI acute PE was frequent, generally mild, mainly asymptomatic, and independently associated with procedural time and complexity. This effusion, which is considered as a cardiac damage marker, could be a predominant clinical sign for long-term prognosis.

Dose All of the Coronary Fistulas been Created by the Reopening Wire After Successful Revascularization of Chronic Total Occlusion?

2020 ◽  
Author(s):  
Rong Fan ◽  
Haipeng Tan ◽  
Yanan Song ◽  
Wang Yao ◽  
Yawei Yang ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Complete Revascularization ◽  
Total Occlusion ◽  
Left Anterior Descending Artery ◽  
Percutaneous Coronary ◽  
History Of ◽  
The Right

Abstract Background: Coronary fistulas may be congenital or acquired generally as consequence of coronary interventions, mainly chronic total occlusion (CTO) reopening. When the reopening wire passes through the occlusion it may microperforate the advential vascular layers, favoring the fistulous communication between coronary vessel and cardiac chambers. But some of acquired coronary fistulas (ACFs) had been already present at the CTO vessels and would been seen after revascularization. This study was designed to investigate the characteristics of ACFs, which albeit mostly benign can cause concern and unnecessary treatment post successful CTO percutaneous coronary intervention (PCI).Methods: Data, including clinical and procedural characteristics, medical history, and findings in electrocardiography, echocardiography and coronary angiography, from 2169 consecutive patients undergoing CTO PCI between January 2018 and December 2019 were analyzed retrospectively. Results: 1844 (85.0%) underwent successful CTO PCI with complete revascularization. Among them, there were 49 cases (mean age, 62.80 ± 11.24 years; 40 men) of ACFs: 24 (49%) involved the right coronary artery, 19 (38.8%) the left anterior descending artery, and 6 (12.2%) the circumflex branch; and 38 (77.6%) were coupled with multiple fistulas (>3), and 29 (59.2%) affected multiple branches of the CTO vessel (>3). The majority of patients with ACFs had a history of MI or Q-wave (n=34, 69.4%), and angina was the most common complaint (n=41, 83.7%). None of them had pericardial effusion, tamponade and Hemodynamic abnormalities before or after PCI.Conclusion: ACFs after successful CTO PCI mostly developed in patients with MI history, originated from the right coronary artery or left anterior descending artery, and involved multiple fistulas and CTO vessel branches.

scholarly journals Guide Extension Catheter-Facilitated Reverse Controlled Antegrade and Retrograde Tracking for Retrograde Recanalization of Chronic Total Occlusion

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Rohit Mody ◽  
Debabrata Dash ◽  
Bhavya Mody ◽  
Aditya Saholi
Keyword(s):  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Case Presentation ◽  
Percutaneous Coronary ◽  
Retrograde Filling ◽  
History Of ◽  
Drug Eluting ◽  
The Right ◽  
Anomalous Coronary

Background. In recent years, the retrograde approach has become a common practice in the treatment of chronic total occlusion (CTO) of coronary ostium which is arising abnormally and has an ambiguous proximal cap. In this case report, we report a case of retrograde percutaneous coronary intervention (PCI) done successfully on an abnormally originating artery which was guideliner assisted. Case Presentation. A 65-year-old gentleman with a history of hypertension, diabetes, and PCI presented to us with angina. Physical examination, electrocardiography (ECG), and echocardiography were done. Coronary angiography (CAG) revealed a normal left anterior descending artery (LAD), an anomalous circumflex (CX) artery arising from the right cusp. The abnormal CX had an implanted stent from which the abnormal right coronary artery (RCA) was arising and had a CTO. It also revealed the retrograde filling of distal RCA through grade 2 Werner collateral channels (CCs) from the LAD, a long CTO segment with a distal cap at the bifurcation. PCI of an RCA-CTO was scheduled utilizing a primary retrograde strategy, since antegrade ostium was abnormal in origin, and the patient was previously stented across the origin. The retrograde wire was externalized, and the procedure was completed with 3 overlapping drug-eluting stents (DESs). We used a guideliner which also assisted in the capture of retrograde corsair during the retrograde procedure of CTO [assisted reverse controlled antegrade and retrograde tracking (CART)]. These measures helped us to complete the CTO intervention successfully. Conclusion. The antegrade crossing is the most common approach to CTOs. However, it is sometimes difficult to penetrate the proximal hard ambiguous cap with guidewires, especially in the case of CTOs of anomalous coronary arteries because of a lack of support. Herein, we describe an iteration of reverse CART technique using a guide extensor catheter to facilitate externalizing the retrograde wire from false to true lumen.

scholarly journals Superficial temporal artery access for percutaneous coronary artery stenting during the COVID-19 pandemic: a case report

2020 ◽  
Author(s):  
Ádám Csavajda ◽  
Olivier F Bertrand ◽  
Béla Merkely ◽  
Zoltán Ruzsa
Keyword(s):  
Coronary Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Coronary Intervention ◽  
Femoral Access ◽  
St Segment Elevation ◽  
Invasive Cardiology ◽  
Percutaneous Coronary ◽  
Diagnostic Angiography ◽  
The Right

Abstract Background The COVID-19 pandemic creates new challenges for healthcare, including invasive cardiology. Case summary We discuss the case of a 65-year-old man who presented with non-ST segment elevation myocardial infarction combined with bilateral pneumonia. The patient had known severe iliac artery lesions with prior interventions and bilateral subclavian artery occlusions. After unsuccessful femoral artery access, the diagnostic angiography and the right coronary artery percutaneous coronary intervention were successfully performed from ultrasound-guided lower superficial temporal artery access. Discussion We showed that superficial temporal access can be used as an alternate access site for diagnostic coronary angiography and intervention when standard wrist and femoral access sites are not readily accessible.

P2426Validating the diagnostic value of a machine learning algorithm for STEMI detection

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mehta ◽  
R Botelho ◽  
F Fernandez ◽  
C Villagran ◽  
A Frauenfelder ◽  
...  
Keyword(s):  
Medical Information ◽  
Learning Algorithm ◽  
Artery Bypass ◽  
Hospital Setting ◽  
Coronary Intervention ◽  
Diagnostic Value ◽  
Retrospective Case ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
The Right

Abstract Background We have previously reported the use of Artificial Intelligence (AI) guided EKG analysis for detection of ST-Elevation Myocardial Infarction (STEMI). To demonstrate the diagnostic value of our algorithm, we compared AI predictions with reports that were confirmed as STEMI. Purpose To demonstrate the absolute proficiency of AI for detecting STEMI in a standard12-lead EKG. Methods An observational, retrospective, case-control study. Sample: 5,087 EKG records, including 2,543 confirmed STEMI cases obtained via feedback from health centers following appropriate patient management (thrombolysis, primary Percutaneous Coronary Intervention (PCI), pharmacoinvasive therapy or coronary artery bypass surgery). Records excluded patient and medical information. The sample was derived from the International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes by wavelet system, segmentation of each EKG into individual heartbeats (53,667 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented, “STEMI” and “Not-STEMI” classes were considered for each heartbeat, individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample were used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVIDIA GTX 1070 GPU, 8GB RAM. Results The model yielded an accuracy of 97.2%, a sensitivity of 95.8%, and a specificity of 98.5%. Conclusion(s) Our AI-based algorithm can reliably diagnose STEMI and will preclude the role of a cardiologist for screening and diagnosis, especially in the pre-hospital setting.

Cardiac tamponade as an unusual initial presentation of squamous cell carcinoma of the esophagus

2021 ◽  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Pericardial Effusion ◽  
Cell Carcinoma ◽  
Cardiac Tamponade ◽  
Squamous Cell ◽  
Unknown Etiology ◽  
Thoracic Esophagus ◽  
Moderate Amount ◽  
Carcinoma Of The Esophagus

Pericardial effusions leading to cardiac tamponade have previously been described with esophageal cancer. However, up to eighty percent of these cases have been reported in association with chemotherapy and radiation. Patients with esophageal cancer seldom initially present with pericardial effusion resulting from esophageal pericardial fistula (EPF). Herein, we present the case of a 62-year-old man who presented with pericardial effusion with an unknown etiology at presentation. Subsequently, the patient developed cardiac tamponade and was referred to the tertiary hospital for further evaluation. Computed tomography of the chest revealed a circumferential irregular enhancing lesion at the mid-thoracic esophagus suspecting esophageal cancer with EPF and a moderate amount of pericardial effusion. The patient underwent esophagoscopy and squamous cell carcinoma was found from the esophageal biopsy. An esophageal stent was successfully placed to conceal the perforation. Eventually, the patient died 13 days after admission complicated by refractory septic shock. This case highlights an atypical presentation of esophageal cancer and an unusual cause of cardiac tamponade.

Cardiac cephalalgia: severe, non-exertional headache presenting as unstable angina

2018 ◽  
Vol 19 (2) ◽  
pp. 173-175
Author(s):  
Jonathan Lazari ◽  
Andrew Money-Kyrle ◽  
Benjamin R Wakerley
Keyword(s):  
Clinical Characteristics ◽  
Troponin I ◽  
Coronary Intervention ◽  
Severe Stenosis ◽  
Exertional Headache ◽  
Percutaneous Coronary ◽  
History Of ◽  
St Elevation ◽  
Cardiac Cephalalgia

Cardiac cephalalgia is a migraine-like headache that occurs during episodes of myocardial ischaemia. Clinical characteristics of the headache vary widely but are often severe in intensity, worsen with reduced myocardial perfusion and resolve with reperfusion. It can present along with typical symptoms of angina pectoris, although not always. We present a 64-year-old man with a 6-month history of severe, non-exertional headaches occurring with increasing frequency. A resting ECG showed ST elevation in the inferior leads. His serum troponin I was not elevated. Coronary angiography showed severe stenosis of his right coronary artery, which was successfully stented by percutaneous coronary intervention. He remains headache free at 2-year follow-up.

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