scholarly journals A Rare Cause of Supraventricular Ectopic Beats and Angina in a Young Patient

2018 ◽  
Vol 4 (2) ◽  
pp. 106-109
Author(s):  
Monica Jurcău ◽  
Mariana Floria ◽  
Bogdan Mazilu ◽  
Anca Ouatu ◽  
Daniela Maria Tanase
Keyword(s):  
Coronary Artery ◽  
Stress Test ◽  
Young Patients ◽  
Physical Exertion ◽  
Diagnostic Techniques ◽  
History Of ◽  
Ectopic Beats ◽  
Artery Disease ◽  
One Year ◽  
The Right

Abstract Introduction: We present the case of a young man with multiple atherosclerotic risk factors and a rare cause of angina and supraventricular ectopic beats. Case presentation: A 35-year-old man with one-year history of stable angina pectoris and supraventricular ectopic beats, without any medication, presented to the emergency room complaining of anterior chest pain that occurs at moderate physical exertion. The rest electrocardiogram, transthoracic echocardiography, and chest X-ray were normal; the exertion stress test was also normal, except for supraventricular ectopic beats (trigeminal rhythm). Due to the intermediate pre-test probability of coronary artery disease, he was evaluated using coronary computed tomography angiography. An anomalous origin of the right coronary artery from the left coronary sinus, with an inter-arterial course and without any atheroma plaques, was observed. During hospitalization the evolution was stable, without complications. The patient was further referred to a cardiac surgery clinic to evaluate the possibility of surgical treatment of this anomaly. Conclusions: Coronary artery anomalies are very rare; however, they present multiple implications in current practice. The most severe complication of this condition is represented by sudden death in young patients due to malignant ventricular arrhythmias. Imaging diagnostic techniques allow for a rapid, noninvasive diagnosis of this rare cause of angina.

Giant right coronary artery aneurysm

2020 ◽  
Vol 28 ◽  
pp. 1-3
Author(s):  
Alexandre Bonfim ◽  
Ronald Souza ◽  
Sérgio Beraldo ◽  
Frederico Nunes ◽  
Daniel Beraldo
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Coronary Artery Aneurysm ◽  
Clinical Course ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Coronary Artery Aneurysms ◽  
History Of ◽  
Artery Disease ◽  
The Right

Right coronary artery aneurysms are rare and may result from severe coronary disease, with few cases described in the literature. Mortality is high, and therapy is still controversial. We report the case of a 72-year-old woman with arterial hypertension, and a family history of coronary artery disease, who evolved for 2 months with episodes of palpitations and dyspnea on moderate exertion. During the evaluation, a giant aneurysm was found in the proximal third of the right coronary artery. The patient underwent surgical treatment with grafting of the radial artery to the right coronary artery and ligation of the aneurysmal sac, with good clinical course.

scholarly journals Demographic and clinic-angiographic profile of coronary artery disease in young adults: a retrospective observational study

2018 ◽  
Vol 6 (7) ◽  
pp. 2264 ◽  
Author(s):  
Lalatendu Swain ◽  
Prabhat Nalini Routray
Keyword(s):  
Young Adults ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Observational Study ◽  
Young Patients ◽  
Retrospective Observational Study ◽  
Age Group ◽  
Artery Disease ◽  
One Year

Background: Cardiovascular diseases (CVD) and its complications are on an increased trend in the younger age group. In this study we aimed to identify the different risk factor profile and coronary angiographic characteristics of young adults presenting with coronary artery disease.Methods: We conducted this retrospective observational study at SCB MC and H and Ashwini Hospital, Cuttack, Odisha, India over a period of one year from June 2016 to June 2017 on 170 patients who undergone coronary angiogram. Inclusion criteria being patients admitted for STEMI, NSTEMI, or UA, age <40 years and those who underwent coronary angiography. All patients who underwent coronary angiography for surgical fitness e.g., patients of rheumatic heart disease and congenital heart disease were excluded from the study.Results: Among the 150 cases included in the study, 85.3%were males and 14.7% were females. Maximum number of cases i.e. 71.3% were in the age group 36-40 yr, while 23.3% were between 31-35 and 5.4% were between 25-30 age group. Among 150 cases with critical CAD, SVD was most prevalent seen in 68.7% cases, followed by DVD in 22.6% and TVD in 8.7% cases.Conclusions: Incidence of critical CAD in young adults is quite high. Young patients with CAD are mainly males, and SVD is more common. Comparative analysis of young patients with STEMI and NTEMI/ UA revealed that SVD was predominantly involved in STEMI group, whereas TVD was predominant in NSTEMI/UA group.

scholarly journals Double Coronary Artery Anomaly in an Elderly Asymptomatic Patient with Positive Electrocardiogram Stress Test

2013 ◽  
Vol 3 ◽  
pp. 68
Author(s):  
Giuseppe Cannavale ◽  
Fabiana Trulli ◽  
Marco Colotto
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Stress Test ◽  
Young Patients ◽  
Coronary Artery Anomaly ◽  
Myocardial Bridging ◽  
Professional Soccer ◽  
Computed Tomography Images ◽  
Cardiac Symptoms ◽  
The Right

Malignant coronary artery anomalies and myocardial bridging are more common findings in young patients with cardiac symptoms, but these two associated yet different types of anomalies in an elderly patient has been rarely described. The following case describes the diagnostic use of 128-slice coronary-computed tomography images of an 82-year-old male, former professional soccer player, who reached the age of 82 years without any symptoms of coronary heart disease. In this patient, an association of a malignant coronary artery anomaly of origin and course (left descending coronary artery originating from the right sinus of valsalva running between the aorta and the right ventricular outflow tract), together with a long myocardial bridging over the obtuse marginal branch was diagnosed by multi-slice computed tomography thanks to an initial positive electrocardiogram screening stress test.

scholarly journals Clinical profile & long-term natural history of symptomatic coronary artery disease in young patients (<30 yr)

2020 ◽  
Vol 152 (3) ◽  
pp. 263
Author(s):  
Harikrishnan Sivadasanpillai ◽  
Arun Gopalakrishnan ◽  
Sanjay Ganapathi ◽  
KrishnaKumar Mohanan Nair ◽  
Sivasankaran Sivasubramonian ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Natural History ◽  
Young Patients ◽  
Clinical Profile ◽  
History Of ◽  
Symptomatic Coronary Artery Disease ◽  
Artery Disease

Natural History of Patients with Ischemia and No Obstructive Coronary Artery Disease: The CIAO-ISCHEMIA Study

Circulation ◽  
2021 ◽  
Author(s):  
Harmony R. Reynolds ◽  
Michael H. Picard ◽  
John A. Spertus ◽  
Jesus Peteiro ◽  
Jose Luis Lopez-Sendon ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Natural History ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Obstructive Coronary Artery Disease ◽  
History Of ◽  
Wall Motion Abnormalities ◽  
Artery Disease ◽  
One Year

Background: Ischemia with no obstructive coronary artery disease (INOCA) is common and has an adverse prognosis. We set out to describe the natural history of symptoms and ischemia in INOCA. Methods: CIAO-ISCHEMIA (Changes in Ischemia and Angina over One year in ISCHEMIA trial screen failures with INOCA) was an international cohort study conducted from 2014-2019 involving angina assessments (Seattle Angina Questionnaire [SAQ]) and stress echocardiograms 1-year apart. This was an ancillary study that included patients with history of angina who were not randomized in the ISCHEMIA trial. Stress-induced wall motion abnormalities were determined by an echocardiographic core laboratory blinded to symptoms, coronary artery disease (CAD) status and test timing. Medical therapy was at the discretion of treating physicians. The primary outcome was the correlation between changes in SAQ Angina Frequency score and change in echocardiographic ischemia. We also analyzed predictors of 1-year changes in both angina and ischemia, and compared CIAO participants with ISCHEMIA participants with obstructive CAD who had stress echocardiography before enrollment, as CIAO participants did. Results: INOCA participants in CIAO were more often female (66% of 208 vs. 26% of 865 ISCHEMIA participants with obstructive CAD, p<0.001), but the magnitude of ischemia was similar (median 4 ischemic segments [IQR 3-5] both groups). Ischemia and angina were not significantly correlated at enrollment in CIAO (p=0.46) or ISCHEMIA stress echocardiography participants (p=0.35). At 1 year, the stress echocardiogram was normal in half of CIAO participants and 23% had moderate or severe ischemia (≥3 ischemic segments). Angina improved in 43% and worsened in 14%. Change in ischemia over one year was not significantly correlated with change in angina (rho=0.029). Conclusions: Improvement in ischemia and improvement in angina were common in INOCA, but not correlated. Our INOCA cohort had a similar degree of inducible wall motion abnormalities to concurrently enrolled ISCHEMIA participants with obstructive CAD. Our results highlight the complex nature of INOCA pathophysiology and the multifactorial nature of angina. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT02347215

scholarly journals Trans-septal course of anomalous left main coronary artery originating from single right coronary ostium presenting with atrial fibrillation in a severely obese patient: a case report

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Armando Ugo Cavallo ◽  
Emanuele Muscogiuri ◽  
Marco Forcina ◽  
Antonio Colombo ◽  
Flavio Fiore ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Left Coronary Artery ◽  
Invasive Coronary Angiography ◽  
Interventricular Septum ◽  
Case Presentation ◽  
Severely Obese ◽  
History Of ◽  
Artery Disease ◽  
The Right

Abstract Background To present a case of anomalous origin of the left coronary artery evaluated with invasive coronary angiography (ICA) and ECG-gated coronary computed tomography (CCT). Case presentation A patient (55 years old, male) with a past medical history of respiratory failure and atrial fibrillation underwent ICA to rule out coronary artery disease. Subsequently, the patient underwent ECG-gated CCT to evaluate a suspected anomalous aortic origin of the left coronary artery, since the interventional cardiologist was not able to properly identify the left coronary artery and its distal branches. CCT showed left coronary artery originating from the right coronary Valsalva sinus, coursing within the interventricular septum and emerging at the middle segment of the interventricular sulcus, where the left anterior descending and circumflex arteries originated. Conclusion The case we presented highlights the value of ECG-gated CCT in the evaluation of coronary anomaly anatomy and thus risk stratification derived by proper coronary anatomy assessment. Although ICA was not helpful in the diagnosis, it also has a pivotal role regarding the therapeutic management of this condition.

scholarly journals Risk factor analysis and angiographic findings in young myocardial infarction patients in tertiary care centre of rural population in South India

2019 ◽  
Vol 6 (1) ◽  
pp. 160
Author(s):  
J.M. Ravichandran Edwin ◽  
E. Thirulogachandar ◽  
Heber Anandan
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Lifestyle Modification ◽  
Tertiary Care ◽  
Young Patients ◽  
Tertiary Care Centre ◽  
Vessel Disease ◽  
History Of ◽  
Artery Disease ◽  
Angiographic Findings

Background: Coronary Artery Disease (CAD) is the leading cause of death and accounts for around 12million deaths annually worldwide. The pattern of coronary artery involvement and clinical outcome varies with age suggesting different underlying pathophysiology. Better understanding this specific problem will lead to further improvement in management. The aim was to study the risk factors and angiographic findings in young patients with acute myocardial infarction.Methods: Thirty-nine patients were included in this study. Patients included in the study underwent elective angiographic performed by the percutaneous femoral approach using standard angiographic techniques. Echo and lipid profile were done to all patients. Data were analysed using MS-Excel.Results: In this study, 39 patients were included, 37 male and 2 female patients, the average age of the patients was 35.12 years. 59% of patients had hypertriglyceridemia, 23.1% of patients hypercholesteremia. 45.9% of male patients were having a history of smoking and alcoholism. 84.6% of patients had obstructive CAD, single vessel disease was observed in 59%, double vessel disease in 7.7%, triple vessel in 2.6% patients.Conclusions: Acute myocardial infarction in young predominantly affects males. Dyslipidemia, smoking and alcoholism were found to be common associated factors in young MI. This emphasizes the need for lifestyle modification for primary prevention. Coronary angiography revealed normal coronaries in 12% suggesting different underlying process other than atherosclerosis. With timely intervention and appropriate management, prognosis is good in young MI patients.

scholarly journals Commentary on "Systemic candidiasis and cytomegalovirus infection in the setting of artificial cardiac device deployment"

2015 ◽  
Author(s):  
Moises A. Huaman
Keyword(s):  
Coronary Artery ◽  
Total Artificial Heart ◽  
Elderly Male ◽  
Cardiac Device ◽  
Ventricular Assist ◽  
Refractory Heart Failure ◽  
Cardiac Devices ◽  
History Of ◽  
Artery Disease ◽  
The Right

Thangam and associates [1] report the case of an unfortunate elderly male with history of coronary artery disease who developed an acute myocardial infarction due to occlusion of the right coronary artery. This was complicated by the development of a ventricular septal defect and refractory heart failure requiring implantation of cardiac devices including intra-aortic balloon pump, ventricular assist device (VAD) and ultimately total artificial heart (TAH). Despite all efforts, the patient expired ~3 months after the AMI event.

Absent or Mild Coronary Calcium Predicts Low-Risk Stress Test Results and Outcomes in Patients Considered for Flecainide Therapy

2021 ◽  
pp. 107424842110466
Author(s):  
Jeffrey L. Anderson ◽  
Stacey Knight ◽  
Raymond O. McCubrey ◽  
Heidi T. May ◽  
Steve Mason ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Stress Testing ◽  
Stress Test ◽  
Clinical Information ◽  
Major Adverse Cardiovascular Events ◽  
Quantitative Ct ◽  
Flow Reserve ◽  
History Of ◽  
Artery Disease

Background: Flecainide is a useful antiarrhythmic for atrial fibrillation (AF). However, because of ventricular proarrhythmia risk, a history of myocardial infarction (MI) or coronary artery disease (CAD) is a flecainide exclusion, and stress testing is used to exclude ischemia. We assessed whether absent/mild coronary artery calcium (CAC) can supplement or avoid the need for stress testing. Methods: We assessed ischemic burden using regadenoson Rb-82 PET/CT in 1372 AF patients ≥50 years old without symptoms or signs of clinical CAD. CAC was determined qualitatively by low dose attenuation computed tomography (CT) (n = 816) or by quantitative CT (n = 556). Ischemic burden and clinical outcomes were compared by CAC burden. Results: Patients with CAC absent or mild (n = 766, 57.2%) were younger, more frequently female, and had higher BMI but lower rates of diabetes, hypertension, and dyslipidemia. Average ischemic burden was lower in CAC-absent/mild patients, and CAC-absent/mild patients showed greater coronary flow reserve, had fewer referrals for coronary angiography, and less often had obstructive CAD. Revascularization at 90 days was lower, and the rate of longer-term major adverse cardiovascular events was favorable. Conclusions: An easily administered, inexpensive, low radiation CAC scan can identify a subset of flecainide candidates with a low ischemic burden on PET stress testing that rarely needs coronary angiography/intervention and has favorable outcomes. Absent or mild CAC-burden combined with other clinical information may avoid or complement routine stress testing. However, additional, ideally randomized and multicenter trials are indicated to confirm these findings before replacing stress testing with CAC screening in selecting patients for flecainide therapy in clinical practice.

scholarly journals Family history of coronary artery disease is associated with acute coronary syndrome in 28,188 chest pain patients

2019 ◽  
Vol 9 (7) ◽  
pp. 741-747 ◽  
Author(s):  
Agnes Wahrenberg ◽  
Patrik KE Magnusson ◽  
Andrea Discacciati ◽  
Lina Ljung ◽  
Tomas Jernberg ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Coronary Artery ◽  
Family History ◽  
Young Patients ◽  
Coronary Syndrome ◽  
History Of ◽  
Artery Disease ◽  
Pain Patients

Background: The value of family history of coronary artery disease (CAD) in diagnosing acute coronary syndrome (ACS) in chest pain patients is uncertain, especially in relation to high-sensitivity assays for cardiac troponin T (hs-cTnT), which have improved ACS diagnostics. Our objective was to investigate the association between verified family history of CAD and ACS in chest pain patients, overall and in different strata of initial hs-cTnT. Methods: Data on chest pain patients visiting four emergency departments in Sweden during 2013–2016 were cross-referenced with national registers of kinship, diseases and prescriptions. Family history of early CAD was defined as the occurrence of myocardial infarction or coronary revascularization before the age of 55 years in male and 65 years in female first-degree relatives. The outcome was combined including ACS and cardiovascular death within 30 days of presentation. Results: Of 28,188 patients, 4.7% of patients had ACS. In total, 8.2% and 32.4% had a family history of early and ever-occurring CAD, respectively. Family history of CAD was positively associated with the outcome, independently of age, gender, cardiovascular risk factors and electrocardiogram findings. The strongest association was observed for family history of early CAD (odds ratio 1.62, 95% confidence interval 1.35–1.94). Stronger associations were observed in young patients (e.g. <65 years) and in patients with non-elevated initial hs-cTnT levels ( p-value for interaction = 0.004 and 0.001, respectively). Conclusions: Family history of CAD is associated with ACS in chest pain patients, especially in patients of young age or with non-elevated initial hs-cTnT levels.

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