scholarly journals A typical presentation of right coronary artery occlusion

2005 ◽  
Vol 58 (9-10) ◽  
pp. 498-502
Author(s):  
Vladimir Ivanovic ◽  
Nikola Jelkic ◽  
Svetozar Srdic ◽  
Miroslav Bikicki ◽  
Tibor Canji ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Chest Pain ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Right Coronary Artery ◽  
Collateral Circulation ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Atypical Chest Pain ◽  
St Segment Elevation

Introduction Inferior wall myocardial infarctions are usually benign and uncomplicated and rarely result in ventricular disturbances of the heart rhythm. An unusual presentation of an inferior acute myocardial infarction (AMI) with atypical symptoms, and ventricular tachycardia is described. Case report A 44-year-old patient was admitted to the coronary care unit (CCU) due to atypical chest pain during exercise and ECG abnormalities in leads L2. L3 and aVF. On admission, ECG could mimic myocarditis, pericardia/ effusion, left anterior bundle branch block or early repolarization. Two-dimensional echo-cardiography revealed a hypertrophic myocardium without abnormal regional wall motion, good left ventricular function and ejection fraction of 65%. The presumptive prediction of a culprit artery based on the ECG recorded on admission was conclusive for inferior AMI. Fibrinolytic therapy was started 3 hours after the onset of chest pain. Resolution of ST segment elevation and relief of chest pain occurred within one hour of the infusion. On the fifth day after admission, the patient had a nonsustained ventricular tachycardia (VT) which was resolved with amioda-one. Angiography showed acute occlusion of the mid portion, right coronary artery (RCA) and collateral circulation in the distal portion. Discussion and conclusion Malignant ventricular arrhythmias can result from isolated inferior wall AMI, but literature reports on this phenomenon are rather rare. Collateral circulation can prevent myocardial ischemia and preserve myocardial function, but does not provide protection against exercise-induced myocardial ischemia.

scholarly journals Successful Revascularization to Right Coronary Artery by Percutaneous Coronary Intervention after Endovascular Therapy for Leriche Syndrome

2014 ◽  
Vol 7 ◽  
pp. CCRep.S13551 ◽  
Author(s):  
Takeshi Niizeki ◽  
Kazuyoshi Kaneko ◽  
Shigeo Sugawara ◽  
Toshiki Sasaki ◽  
Yuichi Tsunoda ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Endovascular Therapy ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Leriche Syndrome ◽  
Percutaneous Coronary ◽  
The Right

A 69-year-old man with effort angina was admitted to our institution. Echocardiography showed poor left ventricular systolic function with akinesis of the anterior wall and severe hypokinesis of the inferior wall. We performed coronary angiography, which revealed two diseased vessels including chronic total occlusion in the left anterior descending artery and severe stenosis in the right coronary artery (RCA). In addition, aortography revealed aortoiliac occlusive disease known as Leriche syndrome. As the patient's symptom was stable, we first planned to perform endovascular therapy (EVT) for Leriche syndrome to make a route for intra-aortic balloon pumping. We prepared a bi-directional approach from bi-femoral arteries and a left brachial artery. The guidewire was passed through the occlusive area using the retrograde approach. The self-expanding stents were deployed by a kissing technique. At one week after EVT, a 6Fr sheath was inserted from the right radial artery and an intra-aortic balloon pump was successfully inserted through the right femoral artery for percutaneous coronary intervention (PCI) to the RCA. Two drug-eluting stents were successfully deployed to RCA after using an atherectomy device (rotablator). We reported the case as a successfully performed PCI to the RCA after EVT for Leriche syndrome.

scholarly journals Perforation of saphenous vein graft with mediastinal haemorrhage leading to near closure of distal graft segment

2019 ◽  
Vol 7 ◽  
pp. 2050313X1983874
Author(s):  
Rafał Wyderka ◽  
Jakub Adamowicz ◽  
Przemysław Nowicki ◽  
Adam Ciapka ◽  
Bartłomiej Kędzierski ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Inferior Wall ◽  
Coronary Syndrome ◽  
Drug Eluting

Perforations of saphenous venous grafts during coronary angioplasty are rare and potentially lethal. The objective of this clinical case report is to highlight this unusual complication and necessary treatment. A 76-year-old woman, 3 months after coronary artery bypass grafting (left internal mammary artery to left anterior descendant artery, saphenous vein graft to obtuse marginal, saphenous vein graft to right coronary artery), demonstrated typical signs of acute coronary syndrome. Coronary angiogram revealed, inter alia, two critical lesions in saphenous vein graft to right coronary artery. Percutaneous coronary intervention was performed with placement of two drug-eluting stents, complicated by a vessel rupture and heavy extravasation of contrast. A polyurethane-covered stent was then deployed and successfully sealed the vascular wall. In a computed tomography of the chest, a mediastinal haematoma near the heart base and right heart margin was found. Subsequently, this intrathoracic bleeding caused external impression on saphenous vein graft to right coronary artery, leading to near occlusion of the vessel with recurrence of chest pain and ST-segment elevation in inferior wall electrocardiogram leads. Immediate coronary angiography and drug-eluting stent implantation was performed. During, further, in-hospital follow-up, patient was free of chest pain; computed tomography scan performed after 10 days revealed regression of haematoma. Clinicians must remain alert to the potential of life-threatening complications associated with saphenous venous graft angioplasty, as their recognition is critical to institution of prompt, appropriate therapy.

scholarly journals Anomalous origin of left main coronary artery from right coronary artery in a patient presenting with inferior wall myocardial infarction: a case report and literature review

2019 ◽  
Vol 3 (4) ◽  
pp. 1-6
Author(s):  
Dipesh Ludhwani ◽  
Vincent Woo
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Left Main Coronary Artery ◽  
Anomalous Origin ◽  
Single Coronary Artery ◽  
Inferior Wall ◽  
Left Main ◽  
St Segment Elevation ◽  
St Segment ◽  
The Right

Abstract Background Anomalous origin of the coronary arteries is seen in less than 1% of the general population. Single coronary artery (SCA) is a congenital anatomic abnormality identified by a single coronary ostium giving rise to one coronary artery. We present an extremely rare variant of the left main coronary artery (LMCA) branching off from the right coronary artery (RCA) and following a prepulmonic course. Case summary A 72-year-old woman presented due to ongoing chest pain with associated ST-segment elevation involving the inferior leads. Emergent cardiac catheterization revealed a 99% ulcerated lesion in distal RCA, which was intervened on with angioplasty and stent placement. The RCA was noted giving rise to LMCA, which followed a prepulmonic course (anterior to pulmonary artery) before trifurcating into a small caliber left anterior descending, ramus intermedius, and hypoplastic left circumflex arteries. The non-malignant course of the aberrant LMCA was confirmed on the coronary computed tomography angiogram. The patient was discharged home on guideline-directed medical therapy. Discussion The patient illustrated congenital SCA with type RIIA pattern of the aberrant vessel based on the Lipton anatomic classification for SCA. The prepulmonic course of SCA is usually benign and can be managed conservatively.

scholarly journals Case Report: Phloroglucinol-Induced Kounis Syndrome

2021 ◽  
Vol 8 ◽  
Author(s):  
Hao-Yu Wu ◽  
Tian-Jiao Gao ◽  
Yi-Wei Cao ◽  
Peng-Hua You
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Troponin I ◽  
Plaque Rupture ◽  
Type Ii ◽  
Kounis Syndrome ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Background: Kounis syndrome is an allergy-related acute coronary syndrome that is induced by various pharmacological and environmental factors. Given that many clinicians are not aware of this condition, many cases may be underdiagnosed. We report a case of type II Kounis syndrome induced by phloroglucinol.Case Summary: A 52-year-old man with pre-existing coronary artery stenosis presented with a 30-min history of chest pain and erythematous rash after intramuscular administration of phloroglucinol. An electrocardiogram demonstrated ST-segment elevation in leads II, III and aVF. Emergency coronary angiography revealed severe stenosis in the distal right coronary artery. Intravascular ultrasound showed plaque rupture and thrombosis, and the minimum lumen area was 3.0 mm2. A 3.5 × 38 mm stent was implanted in the distal right coronary artery. Troponin I levels were elevated. A diagnosis of type II Kounis syndrome induced by phloroglucinol was made, and the condition manifested as acute ST-segment elevation myocardial infarction.Conclusions: Clinicians should be aware of Kounis syndrome as a possible diagnosis in a patient who presents with chest pain and allergic manifestations given that an increasing number of triggers are being reported.

scholarly journals A Case of Malignant Right Coronary Artery: Frequent Angina in Young Person

2021 ◽  
Vol 57 (4) ◽  
pp. 341
Author(s):  
Sidhi Laksono Purwowiyoto ◽  
Steven Philips Surya
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Young Adult ◽  
Right Coronary Artery ◽  
Main Pulmonary Artery ◽  
Young Person ◽  
Coronary Artery Anomalies ◽  
Atypical Chest Pain ◽  
Congenital Condition ◽  
Rare Situation

Highlight:A young adult has activity-triggered atypical chest pain and diagnosed malignant RCA.Congenital anomalies  needed to be aware by cardiologists to help clinical practice.Planning a treatment about management of the CAAs condition should be undertaken by the inter-specialist team. Abstract:We presented a case a young adult with activity-triggered atypical chest pain and diagnosed with anomalous origin of right coronary artery (RCA) from the left coronary sinus with an interarterial course between the aorta and the main pulmonary artery that was detected by CT coronary angiography. This anomaly has been called malignant RCA. Coronary artery anomaly is a congenital condition. Most of the cases remain asymptomatic. This condition is also one of the most causes of sudden cardiac death, because the coronary artery examination is not regularly done. Nevertheless, during high intensity activity, it could be symptomatic and might be lethal. Diagnosing coronary artery anomalies might be tricky and cardiologists must be aware of this. The CAAs condition is a rare situation. The CAAs condition is associated with sudden death, especially intense physical activity. There was no rigid guideline for the management of the CAAs condition, so that planning a treatment in the inter-specialist team should be done.

scholarly journals Exercise-Induced Abnormalities of Regional Myocardial Deformation in Anomalous Aortic Origin of the Right Coronary Artery

2020 ◽  
Vol 11 (6) ◽  
pp. 712-719
Author(s):  
Edem Binka ◽  
Ni Zhao ◽  
Scott Wood ◽  
Stefan L. Zimmerman ◽  
W. Reid Thompson
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Exercise Stress ◽  
Inferior Wall ◽  
Regional Wall ◽  
The Right

Aims: Congenital coronary artery anomalies are uncommon and may result in sudden death. Management of asymptomatic patients with anomalous aortic origin of the right coronary artery (AAORCA) remains controversial with a lack of evidence to guide decision-making. We hypothesized that patients with AAORCA may have exercise-inducible ischemia detectable as abnormalities in regional myocardial deformation on exercise stress echocardiography (ESE). Methods: We reviewed clinical data, computed tomography angiography, and treadmill ESE from 33 AAORCA patients (21 unoperated, 12 operated) and 11 controls. Regional wall motion on ESE was visually assessed. Doppler tissue imaging was done pre and post exercise to evaluate regional myocardial wall deformation. The post- to pre-exercise time to peak systolic strain corrected for heart rate ratio (TPScR) for the left ventricular inferior and anterior walls of AAORCA patients was compared to controls. Results: No regional wall motion abnormalities were noted. The TPScR of the inferior wall was higher in unoperated (0.96 ± 0.41) but not operated (0.84 ± 0.28) AAORCA patients compared to controls (0.76 ± 0.18, P = .03 vs .23, respectively). There was no significant difference in TPScR of the anterior wall between unoperated patients and controls ( P = .08). Conclusion: In some AAORCA patients undergoing ESE, TPScR of the left ventricular inferior wall is elevated, suggestive of ischemia induced by exercise in myocardium supplied by the right coronary artery. Further work is needed to understand the potential role of this finding in risk assessment.

scholarly journals Inferior acute myocardial infarction caused by left anterior descending coronary artery, worse prognosis? experience in our center

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
IR Martinez Primoy ◽  
J Carmona Carmona ◽  
T Seoane Garcia ◽  
R Martinez Nunez ◽  
DF Arroyo Monino ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Inferior Wall ◽  
Circumflex Artery ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. I Key diagnostic test in acute myocardial infarction with ST segment elevation(STEMI)is 12-lead electrocardiogram, which guides initial treatment and informs about area at necrosis risk, necrosis extension, and culprit coronary artery. ST elevation in leads II, III, aVF is related to obstruction of right coronary artery(RCA)or circumflex artery. Inferior STEMI with occlusion of left anterior descending artery(LAD)has been described. Our goal is to analyse incidence and characteristics of inferior STEMI due to LAD occlusion. M Observational retrospective study, of patients admitted to our Coronary Care Unit due to inferior STEMI, between08/2011-12/2020. We analysed all patients whose culprit artery was LAD and a random sample of138patients among those with RCA as culprit. Chi-square, Student-t or Mann-Whitney tests were used. R there were a total of2498acute coronay syndromes, 1541were STEMI. 47.7%of them(n:735)were from inferior wall. From inferior STEMI, 12were caused by LAD occlusion(1.6%, 95%confidence interval0.8-2.8%), representing0.8%of all STEMI. There were21.3%women(n:32)and a mean age of61.6 ± 12.5years, without differences by culprit artery. STEMI related with RCA presented a 28.3% of  either right ventricular dysfunction or atrioventricular block, versus none of those related to LAD(p0.037). There was difference in dominance: STEMI caused by LAD presented right dominance in72.7%of cases, while caused by RCA in94.4%(p0.034). All inferior LAD STEMIs had normal left ventricular ejection fraction(LVEF) at admission. There was no statistically significant difference in LVEF at discharge(RCA54.3 ± 7.6vsLAD50.5 ± 13.6), but there was in maximum troponin, which was higher in those STEMI related to RCA(2208 ± 1756mg/dl vs 4095 ± 3833mg/dl, p0.040). Complementary comparisons in Table. Conclusion we found that1.6%of inferior STEMI are caused by LAD occlusion instead of RCA or circumflex coronary artery. These STEMI do not cause more severe affectation of left ventricle and run without typical complications of inferior STEMI. RCALADSite of occlusion-nProximal65(47.1%)5(41.7%)Medium41(29.7%)5(41.7%)Distal32(23.2%)2(16.7%)Worst Killip-Kimbal-nI112(81.2%)10(83.3%)II11(8.0%)1(8.3%)III2(1.4%)1(8.3%)IV13(9.4%)0

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