Coronary Artery By-Pass Grafting in Patient With Paroxysmal Nocturnal Hemoglobinuria (Case Report)

Paroxysmal nocturnal haemoglobinuria (PNH) is a clonal haematopoietic stem cell disease that presents with haemolytic anaemia, thrombosis and bone marrow failure. We report a case of a 51-year-old male with a history of PNH in treatment with Eculizumab admitted to our Hospital for acute chest pain and dyspnoea. The diagnosis was a triple vessel disease and patient was scheduled for coronary artery bypass grafting surgery. To balance the risk between thrombosis and bleeding in this particular clinical setting, we decided to use thromboelastography (TEG) as point of care solution and we used the R parameter as the target of our anticoagulant therapy. The R parameter between 11 and 14 sec can be used as a target value to balance the risk; in addition, there was no evidence of acute hemolysis during the surgery and supplemental dose of Eculizumab was administered in order to minimize any potential exacerbation of intravascular hemolysis.

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Coronary Artery Bypass Grafting in a Patient with Organophosphate Poisoning

The Heart Surgery Forum ◽

10.1532/hsf.1370 ◽

2015 ◽

Vol 18 (4) ◽

pp. 167 ◽

Cited By ~ 1

Author(s):

Rajeeva R. Pieris ◽

Ravindra Fernando

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Previous History ◽

Organophosphate Poisoning ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Excellent Health ◽

History Of

A 43-year-old male, with no previous history of mental illness, was diagnosed with coronary heart disease, after which he became acutely depressed and attempted suicide by ingesting an organophosphate pesticide. He was admitted to an intensive care unit and treated with pralidoxime, atropine, and oxygen. His coronary occlusion pattern required early coronary artery bypass grafting (CABG) surgery. His family, apprehensive of a repeat suicidal attempt, requested surgery be performed as soon as possible. He recovered well from the OP poisoning and was mentally fit to express informed consent 2 weeks after admission. Seventeen days after poisoning, he underwent coronary artery bypass grafting and recovered uneventfully. Six years later, he remains in excellent health. We report this case because to the best of our knowledge there is no literature regarding CABG performed soon after organophosphate poisoning.

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Clinical judgement in chest pain: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02666-z ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Mishita Goel ◽

Shubhkarman Dhillon ◽

Sarwan Kumar ◽

Vesna Tegeltija

Keyword(s):

Chest Pain ◽

Coronary Artery ◽

Tobacco Use ◽

Stress Test ◽

Artery Bypass ◽

Pretest Probability ◽

Clinical Judgement ◽

Test Results ◽

Cardiac Stress ◽

History Of

Abstract Background Cardiac stress testing is a validated diagnostic tool to assess symptomatic patients with intermediate pretest probability of coronary artery disease (CAD). However, in some cases, the cardiac stress test may provide inconclusive results and the decision for further workup typically depends on the clinical judgement of the physician. These decisions can greatly affect patient outcomes. Case presentation We present an interesting case of a 54-year-old Caucasian male with history of tobacco use and gastroesophageal reflux disease (GERD) who presented with atypical chest pain. He had an asymptomatic electrocardiogram (EKG) stress test with intermediate probability of ischemia. Further workup with coronary computed tomography angiography (CCTA) and cardiac catheterization revealed multivessel CAD requiring a bypass surgery. In this case, the patient only had a history of tobacco use but no other significant comorbidities. He was clinically stable during his hospital stay and his testing was anticipated to be negative. However to complete workup, cardiology recommended anatomical testing with CCTA given the indeterminate EKG stress test results but the results of significant stenosis were surprising with the patient eventually requiring coronary artery bypass grafting (CABG). Conclusion As a result of the availability of multiple noninvasive diagnostic tests with almost similar sensitivities for CAD, physicians often face this dilemma of choosing the right test for optimal evaluation of chest pain in patients with intermediate pretest probability of CAD. Optimal test selection requires an individualized patient approach. Our experience with this case emphasizes the role of history taking, clinical judgement, and the risk/benefit ratio in deciding further workup when faced with inconclusive stress test results. Physicians should have a lower threshold for further workup of patients with inconclusive or even negative stress test results because of the diagnostic limitations of the test. Instead, utilizing a different, anatomical test may be more valuable. Specifically, the case established the usefulness of CCTA in cases such as this where other CAD diagnostic testing is indeterminate.

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Impact of a History of Hypertension on Symptoms and Quality of Life Prior to and at Five Years after Coronary Artery Bypass Grafting

Blood Pressure ◽

10.1080/08037051.2000.08037051 ◽

2000 ◽

Vol 9 (1) ◽

pp. 52-63 ◽

Cited By ~ 3

Author(s):

Johan Herlitz ◽

Kenneth Caidahl ◽

Ingela Wiklund ◽

Helén Sjöland ◽

Björn Karlson ◽

...

Keyword(s):

Quality Of Life ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

History Of

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TCT-96: Impact of Preexisting Cerebral Ischemia Detected by Magnetic Resonance Imaging and Angiography on Clinical Outcomes After Coronary Artery Bypass Graft in Patients Without History of Stroke

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2011.10.108 ◽

2011 ◽

Vol 58 (20) ◽

pp. B28-B29

Keyword(s):

Magnetic Resonance Imaging ◽

Coronary Artery ◽

Cerebral Ischemia ◽

Magnetic Resonance ◽

Coronary Artery Bypass Graft ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Resonance Imaging ◽

History Of

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Abstract 16260: Thirty Days Major Adverse Cardiac Events Following Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Non-ste-acute Coronary Syndrome: A Meta-analysis With Meta-regression

Circulation ◽

10.1161/circ.142.suppl_3.16260 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Kiro Barssoum ◽

Ashish Kumar ◽

Devesh Rai ◽

Adnan Kharsa ◽

Medhat Chowdhury ◽

...

Keyword(s):

Coronary Artery ◽

Meta Analysis ◽

Artery Bypass ◽

Coronary Intervention ◽

Cardiac Events ◽

Coronary Syndrome ◽

Adverse Cardiac Events ◽

History Of ◽

Meta Regression ◽

Meta Regression Analysis

Background: The optimum revascularization modality in multi-vessel and left main disease patients presenting with non-ST elevation acute coronary syndrome (non-STE-ACS) is not well studied. The current recommendations are based on studies that primarily included patients with stable angina. Patients with non-STE-ACS were under-represented in clinical trials. We performed a meta-analysis of studies comparing coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in non-STE-ACS, and reporting 30 days major adverse cardiac events (MACE). Methods: We searched Medline, EmCare, CINAHL, Cochrane database, and Google Scholar for relevant articles. We excluded studies that included patients with stable coronary artery disease and ST elevation myocardial infarction. Our primary outcome was 30 days MACE defined as all-cause death, stroke, repeat revascularization and re-infarction. We used the Paule-Mandel method with the Hartung-Knapp-Sidik-Jonkman adjustment to estimate risk ratio (RR) with a 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I 2 statistics. To account for heterogeneity, a meta-regression analysis was performed. Results: Five observational studies met our inclusion criteria summing to a total number of 7161 patients. At 30 days, there was no difference between CABG vs. PCI in terms of MACE, RR: 0.96, 95% CI 0.38 to 2.39, I 2 = 81% (Panel A). A meta-regression analysis reported that a history of PCI was associated with a lower risk of MACE with CABG compared to PCI (Panel B). Conclusion: At 30 days, there was no difference in MACE between the CABG and PCI groups. However, a history of PCI was associated with a lower risk of MACE in patients who underwent CABG.

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