scholarly journals Ritka etiológiájú fiatalkori szívinfarktus

2015 ◽  
Vol 156 (25) ◽  
pp. 1020-1025
Author(s):  
Gábor Zoltán Nagy ◽  
Gábor Gerges ◽  
Kálmán Csapó ◽  
Erika Csengő ◽  
Károly Minik
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Aortic Dissection ◽  
Young Patients ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Left Main ◽  
Diagnostic Challenge ◽  
Total Occlusion ◽  
Coronary Syndrome

Chest pain is not uncommon among young patients below the age of 35 years, however, it is rarely caused by acute coronary syndrome. The rarity of coronary artery occlusion in this population can easily lead to diagnostic mistakes. The authors present the case history of a 19-year-old young female, who was admitted to the emergency department of a local hospital due to the sudden onset of chest pain and malaise. ST-segment elevation was seen on the electrocardiogram raising the possibility of aortic dissection, therefore, emergency thoracic computed tomographic scan was performed. This proved to be negative and the patient was transferred to the coronary care unit. Urgent coronarography was carried out, which revealed the total occlusion of the left main coronary artery. The occluded artery was successfully opened with percutaneous coronary intervention, but despite revascularisation the patient died on the second postoperative day due to asystole. Autopsy revealed thrombotic embolization of the left main artery with consequent extensive haemorrhagic necrosis, involving almost the whole left ventricle. The source of embolization was not found. The authors note that left coronary artery occlusion in young patients can be a diagnostic challenge, because symptoms can be mistaken with aortic dissection or pulmonary embolism. Orv. Hetil., 2015, 156(25), 1020–1025.

scholarly journals Cardiac magnetic resonance assessment of diastolic dysfunction in acute coronary syndrome

2017 ◽  
Vol 45 (6) ◽  
pp. 1680-1692 ◽  
Author(s):  
Shah M. Azarisman ◽  
Karen S Teo ◽  
Matthew I Worthley ◽  
Stephen G Worthley
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Chest Pain ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Diastolic Dysfunction ◽  
Imaging Techniques ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Acute Setting ◽  
Coronary Syndrome

Chest pain is an important presenting symptom. However, few cases of chest pain are diagnosed as acute coronary syndrome (ACS) in the acute setting. This results in frequent inappropriate discharge and major delay in treatment for patients with underlying ACS. The conventional methods of assessing ACS, which include electrocardiography and serological markers of infarct, can take time to manifest. Recent studies have investigated more sensitive and specific imaging modalities that can be used. Diastolic dysfunction occurs early following coronary artery occlusion and its detection is useful in confirming the diagnosis, risk stratification, and prognosis post-ACS. Cardiac magnetic resonance provides a single imaging modality for comprehensive evaluation of chest pain in the acute setting. In particular, cardiac magnetic resonance has many imaging techniques that assess diastolic dysfunction post-coronary artery occlusion. Techniques such as measurement of left atrial size, mitral inflow, and mitral annular and pulmonary vein flow velocities with phase-contrast imaging enable general assessment of ventricular diastolic function. More novel imaging techniques, such as T2-weighted imaging for oedema, T1 mapping, and myocardial tagging, allow early determination of regional diastolic dysfunction and oedema. These findings may correspond to specific infarcted arteries that may be used to tailor eventual percutaneous coronary artery intervention.

Early time course of myocardial electrical impedance during acute coronary artery occlusion in pigs, dogs, and humans

2005 ◽  
Vol 99 (4) ◽  
pp. 1576-1581 ◽  
Author(s):  
Carlos L. del Rio ◽  
Patrick I. McConnell ◽  
Bradley D. Clymer ◽  
Roger Dzwonczyk ◽  
Robert E. Michler ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Time Course ◽  
Electrical Impedance ◽  
Early Time ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Acute Ischemia ◽  
Collateral Flow ◽  
Total Occlusion ◽  
Interspecies Differences

Changes in myocardial electrical impedance (MEI) and physiological end points have been correlated during acute ischemia. However, the importance of MEI's early time course is not clear. This study evaluates such significance, by comparing the temporal behavior of MEI during acute total occlusion of the left anterior descending coronary artery in anesthetized humans, dogs, and pigs. Here, interspecies differences in three MEI parameters (baseline, time to plateau onset, and plateau value normalized by baseline) were evaluated using Kruskal-Wallis ANOVA and post hoc tests ( P < 0.05). Noteworthy differences in the MEI time to plateau onset were observed: In dogs, MEI ischemic plateau was reached after 46.3 min (SD 12.9) min of occlusion, a significantly longer period compared with that of pigs and humans [4.7 (SD 1.2) and 4.1 min (SD 1.9), respectively]. However, no differences could be observed between both animal species regarding the normalized MEI ischemic plateau value (15.3% (SD 4.7) in pigs, vs. 19.6% (SD 2.6) in dogs). For all studied MEI parameters, only swine values resembled those of humans. The severity of myocardial supply ischemia, resulting from coronary artery occlusion, is known to be dependent on collateral flow. Thus, because dogs possess a well-developed collateral system (unlike humans or pigs), they have shown superior resistance to occlusion of a coronary artery. Here, the early MEI time course after left anterior descending coronary artery occlusion, represented by the time required to reach ischemic plateau, was proven to reflect such interspecies differences.

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