scholarly journals ST Segment Elevation Myocardial Infarction Due to Severe Ostial Left Main Stem Stenosis in a Patient with Syphilitic Aortitis

2016 ◽  
Vol 54 (1) ◽  
pp. 74-79 ◽  
Author(s):  
L.M. Predescu ◽  
L. Zarma ◽  
P. Platon ◽  
M. Postu ◽  
A. Bucsa ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Aortic Regurgitation ◽  
Systolic Dysfunction ◽  
Ascending Aorta ◽  
Left Main ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Syphilitic Aortitis

Cardiovascular manifestations of tertiary syphilis infections are uncommon, but represent an important cause of mortality and morbidity. Syphilitic aortitis is characterized by aortic regurgitation, dilatation of ascending aorta and ostial coronary artery lesions. We report a case of 36 years old man admitted to our hospital for acute anterior ST segment elevation myocardial infarction complicated with cardiogenic shock (hypotension 75/50 mmHg). Transthoracic echocardiography revealed a dilated left ventricle with severe systolic dysfunction (ejection fraction = 25%), severe mitral regurgitation, moderate aortic regurgitation and mildly dilated ascending aorta. Coronary angiography showed a severe ostial lesion of left main coronary artery which was treated by urgent stent implantation and an intra-aortic contrapulsation balloon was implanted. Blood tests for syphilitic infection were positive. The patient was discharged with treatment including benzathine penicillin. In our case, we present an acute manifestation of a syphilitic ostial left main stenosis treated by primary percutaneous coronary intervention in acute myocardial infarction. Long term follow-up of the patient is crucial as a result of potential rapid in-stent restenosis caused by continuous infection of the ascending aorta. This case is particular because it shows that syphilitic aortitis can be diagnosed in acute settings, like ST segment elevation myocardial infarction.

scholarly journals Outcomes of ST-Segment Elevation Myocardial Infarction Involving the Left Main Coronary Artery

2020 ◽  
Vol 4 (3) ◽  
pp. 345-346 ◽  
Author(s):  
Saraschandra Vallabhajosyula ◽  
Abhiram Prasad ◽  
Malcolm R. Bell ◽  
Mandeep Singh ◽  
Rajiv Gulati ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

scholarly journals Clinical and Angiographic Prole of Patients with Left Bundle Branch Block

2018 ◽  
Vol 6 (1-2) ◽  
pp. 14-19
Author(s):  
Sahela Nasrin ◽  
F Aaysha Cader ◽  
M Maksumul Haq
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Systolic Dysfunction ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Vessel Disease ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Artery Disease

Background & objective: Left bundle branch block (LBBB), resulting in an alteration of the normal sequence of activation in the left ventricle, commonly occurs in patients with underlying heart disease particularly coronary artery disease (CAD), but it may also be associated with progressive conducting system disease in an otherwise structurally normal heart. The aim of this study was to evaluate the clinical and angiographic profile of patients presenting with LBBB. Materials & Methods: This study was a cross-sectional observational study. A total of 542 patients of LBBB (as evident by ECG) who underwent coronary angiography from 1st September 2005 to 31st August 2016 were identified from the records of Cath Lab database of Ibrahim Cardiac Hospital & Research Institute and were selected for the study. LBBB was defined as a QRS complex duration ≥120 ms with a broad notched or slurred R wave in leads I, aVL, V5 and V6. Results: Majority (95.8%) of the patients was over 40 years of age with mean age being 59.7 ± 10.7 years (range: 25-95 years). Nearly 60% of the patients were male, 62.2% diabetic and 69.7% hypertensive. Over one-third (37.1%) of patients had moderate left ventricular (LV) systolic dysfunction (ejection fraction 30-44%) and 7% had severe LV systolic dysfunction. Over half (51.9%) had normal body mass index. Unstable angina (45.8%) was the most common indication for angiography. Other indications included non-ST segment elevation myocardial infarction (17.2%), ST segment elevation myocardial infarction (11.3%), stable coronary artery disease (SCAD) (9.8%), prior myocardial infarction (13.3%) and atypical chest pain (2.6%). Nearly 60% of the patients had obstructive coronary artery disease and the rest (40.6%) had normal epicardial coronaries on angiography. Among those with obstructive CAD, 4.1% had left main disease, 20.5% had triple vessel disease (TVD), 14.4% double vessel disease (DVD) and 9.5% single vessel disease (SVD). Conclusion: There is an optimum prevalence of CAD among LBBB patients, with TVD being predominant. LBBB cases with normal coronaries are no less. The latter cases suggest an alternative cause for LBBB. Thus, the usual diagnosis of CAD in patients with presumably new onset LBBB may be over-estimated in clinical practice. Ibrahim Card Med J 2016; 6 (1&2): 14-19

scholarly journals Cardiogenic shock in patients presenting with acute left main coronary artery occlusion

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Braga ◽  
J Calvao ◽  
J C Silva ◽  
A Campinas ◽  
A Alexandre ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background and purpose Acute myocardial infarction (AMI) due to left main coronary artery (LMCA) occlusion is a rare event, often catastrophic. Limited data are available about management and outcomes of patients with acute LMCA occlusion, including those presenting with cardiogenic shock (CS) at hospital admission. This study sought to describe patients with AMI due unprotected LMCA occlusion presenting with CS and to evaluate their in-hospital outcomes and 1-year mortality. Methods In this retrospective 2-center study, we identified 7630 patients with ST-segment elevation myocardial infarction (STEMI) or hight risk non-ST segment elevation myocardial infarction who underwent to emergent coronary angiography between January 2008 and December 2020. Among this cohort, we analysed 94 patients who presented with unprotected LMCA occlusion (Thrombolysis In Myocardial Infarction – TIMI ≤2) and divided them in 2 groups according to presence of signs of cardiogenic shock at admission: CS and no-CS. Results Of 94 patients with AMI due LMCA occlusion, 52 patients presented with CS (53.3%). Mean age was 62.8±11.5 years in CS and 62.0±15.9 years in no-CS patients, p=0.766. In both groups, most patients were male. STEMI presentation was more frequent in CS group (80.4% vs. 52.4%, p=0.004). Severe systolic dysfunction of left ventricle was more frequent in CS patients (81.1% vs. 33.3%, p<0.001). Compared to no-CS patients, CS group shown more often TIMI=0 (67.3% vs. 26.2%, p<0.001), collateral coronary circulation Rentrop 0–1 (95.3% vs. 75.0%, p=0.008), and slow-reflow/no-reflow phenomena (30.6% vs 3.8%, p=0.019) in emergent coronary angiography. The need of invasive mechanical ventilation (68.9% vs. 21.4%, p<0.001), and haemodialysis (20.5% vs. 2.4%, p=0.010) were more prevalent in CS patients. Likewise, mechanical circulatory support (MCS) was more frequently used in patients presented with CS (52.9% vs. 26.2%, p=0.009). In subgroup analysis, MCS implantation was not a survival predictor in CS patients (Odds ratio: 3.9 [95% confidence interval: 0.4 to 36.3], p=0.229). Ultimately, in-hospital mortality (78.8% vs. 16.7%, p<0.001) was higher in CS patients. On the other hand, in hospital survivors, there was no significant differences in 1-year mortality (11.1% vs. 23.5%, p=0.42) between both groups. Conclusions Nearly half of patients with AMI due LMCA occlusion presented with CS signs at first medical evaluation. This subgroup of patients had higher in-hospital mortality compared to those without CS, despite MCS implantation. Whether the use of a specific MCS device or whether early use of MCS can change the outcome remains to be elucidated. CS patients who survive to index-hospitalization, had similar long-term outcomes compared to no-CS patients. Further studies are imperative in this population to refine initial medical treatment in order to improve their prognosis. FUNDunding Acknowledgement Type of funding sources: None.

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