scholarly journals Complications of X-ray Endovascular Interventions in Patients with Coronary Heart Disease with Reduced Left Ventricular Systolic Function

2021 ◽  
pp. 10-14
Author(s):  
Yevhenii V. Aksenov ◽  
Ruslan B. Demchenko
Keyword(s):  
Systolic Function ◽  
Mean Value ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
X Ray ◽  
Coronary Syndrome ◽  
Coronary Stent Implantation ◽  
Study Results

The work is dedicated to the research of direct results and immediate possible complications of interventions in X-ray surgery with coronary stent implantation. Our patients with chronic coronary syndrome and reduced left ventricular ejection fraction (LVEF) of less than 40% were studied. The study included 112 patients who were divided into two groups. The first group included 51 patients with LVEF <40% (mean value 32.8 ± 1.14%), the second group involved 61 patients with LVEF >40% (mean value 59.4 ± 1.02%). The mean age of the subjects ranged from 59 to 74 years (mean value 63.85 ± 1.73 years). There were no gender-related differences among the selected patients. There was no statistical difference in comorbidities in both groups. Both groups of patients were examined and managed according to the protocol of diagnosis and treatment adopted at the National Amosov Institute of Cardiovascular Surgery for patients suffering from chronic coronary syndrome. The study results show that patients with coronary artery disease and reduced LVEF 2 times more often developed complications in early postoperative period after PCI with revascularization through stent placement than in group of patients with preserved contractile myocardial function. Duration of PCI procedure and contrast agent use was 26.3±1.4% and 29.8±4.2% higher, respectively; the frequency of life-threatening arrhythmias was 54% higher. Intraoperational signs of acute heart failure developed 4.8 times less often in the control group than in the experimental group. In general, all the patients after stenting achieved good anti-ischemic effect.

scholarly journals Study of Cardiac Troponin I level in Acute Coronary Syndrome and its correlation with Left Ventricular Systolic Function

2019 ◽  
Vol 12 (1) ◽  
pp. 24-29
Author(s):  
Mohammad Jakir Hossain ◽  
Khondoker Asaduzzaman ◽  
Solaiman Hossain ◽  
Muhammad Badrul Alam ◽  
Nur Hossain
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Systolic Function ◽  
Left Ventricular ◽  
Cardiac Troponin I ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome

Background: In the diagnosis of acute coronary syndrome, cardiac troponin I is highly reliable and widely available biomarker. Serum level of cardiac troponin I is related to amount of myocardial damage and also closely relates to infarct size. Our aim of the study is to find out the relationship between cardiac troponin I and left ventricular systolic function after acute coronary syndrome. Methods: Total of 132 acute coronary syndrome patients were included in this study after admission in coronary care unit of Sir Salimullah Medical College, Mitford Hospital. Troponin I level was measured at admission and left ventricular ejection fraction (LVEF) was measured by echocardiography between 12-48 hours of onset of chest pain. Results: There was negative correlation between Troponin I at 12 to 48 hours of chest pain with LVEF in these study patients. With a cutoff value of troponin I e”6.8 ng/ml in STEMI patients there is a significant negative relation between 12 to 48 hrs troponin I and LVEF (p<0.001). Sensitivity of troponin I e” 6.8 ng/ml between 12 to 48 hours of chest pain in predicting LVEF <50% in STEMI was 93.75% and specificity was 77.78%. In NSTEMI sensitivity of troponin I e” 4.5 ng/ml between 12 to 48 hours of chest pain in predicting LVEF <50% was 65% and specificity was 54.05%. Conclusion: Serum troponin I level had a strong negative correlation with left ventricular ejection fraction after acute coronary syndrome and hence can be used to predict the LVEF in this setting. Cardiovasc. j. 2019; 12(1): 24-29

Abstract 387: Practice Patterns and Use of High Sensitivity Troponin Assays in the Outpatient Setting

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Enrico G Ferro ◽  
Ankeet S Bhatt ◽  
Karen Fiumara ◽  
Jason H Wasfy ◽  
Thomas Sequist ◽  
...  
Keyword(s):  
Primary Care Physicians ◽  
High Sensitivity ◽  
Outpatient Setting ◽  
Left Ventricular ◽  
Cardiac Ischemia ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
High Sensitivity Troponin

Introduction: High sensitivity troponin T (hs-TnT) are more sensitive than prior assays to evaluate patients for acute coronary syndrome. To date, hs-TnT utilization in the outpatient setting is not well described. Methods: We identified outpatient hs-TnT tests ordered at a large medical center in the first 9 months of implementation (April-December 2018). Charts were reviewed by physicians to identify patient characteristics, specialty of ordering provider, reason for ordering hs-TnT, and clinical action taken. Using unadjusted two-sample t-tests, we compared the proportion of patients referred to the ED between patients with hs-TnT levels ≥99 th % sex-specific cutoffs (≥15 ng/dL men, ≥10 ng/dL women) versus those with either undetectable hs-TnT or detectable <99 th % (control group). Results: About 100 hs-TnT outpatient tests were ordered. Patients had mean age of 66 years, 53% were male; 30% had coronary artery disease, and 12% had left ventricular ejection fraction ≤40%. Most orders were placed by cardiologists (n=58) followed by primary care physicians (n=30). The top chief complaints were dyspnea (n=38) and chest pain (n=33). Of all hs-TnT samples, 27% were undetectable, while mean detectable hs-TnT level was 38.8 ng/L, of which 57% were ≥99 th %. About 25% of patients had chronic cardiovascular conditions (like heart failure) but were asymptomatic at the time of the test. Among symptomatic patients (n=75), 31% were sent home, 28% to stress test, and 16% to the ED. Patients with hs-TnT ≥99 th % were 4.6 times more likely (95% CI 1.1-19.5, p=0.04) to be referred to the ED, compared to control. Conclusions: This is the first study describing outpatient utilization of the novel hs-TnT assay in the U.S. Despite the lack of consensus on diagnosing cardiac ischemia in outpatient clinics, providers are ordering hs-TnT in this setting - and hs-TnT values seem to influence their decision to triage patients to the ED. Our results highlight the need to standardize the implementation of hs-TnT for outpatient evaluation of cardiac ischemia. Providers are also collecting hs-TnT among asymptomatic patients with heart disease unrelated to ischemia. This suggests that novel uses of hs-TnT may emerge to monitor and prognosticate chronic cardiovascular conditions. Figure. Patient Triage based on Elevation in Outpatient hs-TnT Level

scholarly journals Selenium supplementation in patients with peripartum cardiomyopathy: a proof-of-concept trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kamilu M. Karaye ◽  
Hadiza Sa’idu ◽  
Suleiman A. Balarabe ◽  
Naser A. Ishaq ◽  
Bushra Sanni ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Systolic Function ◽  
Randomised Trial ◽  
Selenium Deficiency ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Selenium Supplementation ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction

Abstract Background We studied the efficacy and safety of selenium supplementation in patients who had peripartum cardiomyopathy (PPCM) and selenium deficiency. Methods We randomly assigned 100 PPCM patients with left ventricular ejection fraction (LVEF) < 45% and selenium deficiency (< 70 μg/L) to receive either oral Selenium (L-selenomethionine) 200 μg/day for 3 months or nothing, in addition to recommended therapy, in an open-label randomised trial. The primary outcome was a composite of persistence of heart failure (HF) symptoms, unrecovered LV systolic function (LVEF < 55%) or death from any cause. Results Over a median of 19 months, the primary outcome occurred in 36 of 46 patients (78.3%) in the selenium group and in 43 of 54 patients (79.6%) in the control group (hazard ratio [HR] 0.69; 95% confidence interval [CI] 0.43–1.09; p = 0.113). Persistence of HF symptoms occurred in 18 patients (39.1%) in the selenium group and in 37 patients (68.5%) in the control group (HR 0.53; 95% CI 0.30–0.93; p = 0.006). LVEF < 55% occurred in 33 patients (71.7%) in the selenium group and in 38 patients (70.4%) in the control group (HR 0.91; 95% CI 0.57–1.45; p = 0.944). Death from any cause occurred in 3 patients (6.5%) in the selenium group and in 9 patients (16.7%) in the control group (HR 0.37; 95% CI 0.10–1.37; p = 0.137). Conclusions In this study, selenium supplementation did not reduce the risk of the primary outcome, but it significantly reduced HF symptoms, and there was a trend towards a reduction of all-cause mortality. Clinical trial registration ClinicalTrials.gov Identifier: NCT03081949.

6117Persistent LBBB and AV block with high-burden RV pacing following transcatheter aortic valve replacement are associated with new onset cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Ananwattanasuk ◽  
M Ghannam ◽  
S Lathkar-Pradhan ◽  
R Latchamsetty ◽  
S Jame ◽  
...  
Keyword(s):  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
High Burden ◽  
Transcatheter Aortic Valve ◽  
Rv Pacing ◽  
New Onset

Abstract Background Left bundle branch block (LBBB) and AV nodal block (AVB) requiring permanent pacemaker implantation occur frequently following transcatheter aortic valve replacement (TAVR) and may be associated with adverse clinical events. Objectives The study aims to assess the incidence of new onset cardiomyopathy among patients with normal left ventricular systolic function patients who developed LBBB or persistent AVB with high-burden right ventricular (RV) pacing (>80%) following TAVR procedure. Methods Consecutive patients who underwent TAVR procedure from January 2012 to June 2017 at the University of Michigan Health System were included in the retrospective analysis. Those who had a preexisting cardiac implantable electronic device (CIED), prior LBBB, left ventricular ejection fraction (LVEF) <50%, and follow up period less than 1 year were excluded from this analysis. New onset cardiomyopathy was defined by a left ventricular ejection fraction (LVEF) <45% within 1 year after TAVR. Results A total of 362 patients were included in the study (mean age 76.9±11.5 years, 56.1% male). Of these, 30 patients (8.3%) developed persistent AVB and required >80% RV pacing (pacing group), 61 patients (16.9%) developed persistent LBBB (LBBB group), and 271 patients (74.9%) did not have LBBB or AVB or required <80% RV pacing (control group). Baseline LVEF was 63.9+6.4% in pacing group (p=0.76) and 64.4+7.4% in LBBB group (p=0.89) compared to 64.3+6.5% in control group. Within 1 year after TAVR, 10/30 patients (33.3%) in pacing group (p<0.01) and 20/61 patients (32.8%) in LBBB (p<0.01) developed new onset cardiomyopathy compared to 9/271 patients (3.3%) in control group. LVEF at 1 year was 53.8+11.9% in pacing group (p<0.01) and 53.7+12.1% in LBBB group (p<0.01) compared to 64.8+7.7% in control group. Conclusion Among patients with normal baseline left ventricular systolic function, AV block required high-burden RV pacing and persistent LBBB following TAVR were associated with significantly higher incidence of new onset cardiomyopathy.

scholarly journals Pamidronate Attenuates Oxidative Stress and Energetic Metabolism Changes but Worsens Functional Outcomes in Acute Doxorubicin-Induced Cardiotoxicity in Rats

2016 ◽  
Vol 40 (3-4) ◽  
pp. 431-442 ◽  
Author(s):  
Paula Bernardo de Carvalho ◽  
Andréa de Freitas Gonçalves ◽  
Patrícia Helena Correa Alegre ◽  
Paula Schmidt Azevedo ◽  
Meliza Goi Roscani ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Systolic Function ◽  
Isolated Heart ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Energetic Metabolism ◽  
Ventricular Ejection Fraction ◽  
Heart Study ◽  
Male Wistar Rats

Background: Cardiotoxicity is the major side effect of doxorubicin. As mechanisms that are involved in cardiotoxicity are ambiguous, new methods for attenuating cardiotoxicity are needed. Recent studies have shown that bisphosphonates can decrease oxidative stress. Therefore, the objective of this study was to evaluate the effect of pamidronate on preventing acute doxorubicin-induced cardiotoxicity. Methods: Sixty-four male Wistar rats were allocated into four groups: the control group (C), the pamidronate group (P), the doxorubicin group (D) and the doxorubicin/pamidronate group (DP). The rats in the P and DP groups received pamidronate injections (3 mg/kg, IP). After 24 hours, the rats in the D and DP groups received doxorubicin injections (20 mg/kg, IP). Forty-eight hours after doxorubicin injection, the rats were killed. Echocardiography, isolated heart study and biochemical analysis were performed. Results: Doxorubicin-induced acute cardiotoxicity showed increased matrix metalloproteinases (MMP)-2 activation, oxidative damage and induced alterations in myocardial energetic metabolism. Pamidronate did not inhibit MMP-2 activation but attenuated oxidative stress and improved myocardial energetic metabolism. Regarding cardiac function, the DP group exhibited a decrease in the left ventricular ejection fraction in the echocardiography and a decrease in +dP/dt in the isolated heart study compared with other groups. The same DP group presented serum hypocalcaemia. Conclusions: Despite its ability to reduce oxidative stress and improve energy metabolism in the heart, pamidronate worsened systolic function in rats treated with doxorubicin, and therefore we cannot recommend its use in conjunction with anthracycline chemotherapy.

Prognostic role of results of dynamic capnography in integral assessment of parameters of respiratory system in 6-minute walk test in patients with chronic heart failure

2020 ◽  
Vol 28 (3) ◽  
pp. 290-299
Author(s):  
Kira A. Ageeva ◽  
Evgenii V. Filippov
Keyword(s):  
Respiratory System ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Walk Test ◽  
Ventricular Ejection Fraction ◽  
6Mwt Distance ◽  
6 Minute Walk Test ◽  
Minute Walk

Aim. To study the prognostic value of the results of dynamic capnography in the complex assessment of parameters of the respiratory system in 6-minute walk test in patients with chronic heart failure (CHF). Materials and Methods. 73 Patients were examined: the group of study included 48 patients with IIA or IIB stage CHF (mean age 57.94.6 years, 23 men), the control group included 25 practically healthy volunteers (mean age 47.63.5 years, 9 men). The patients were conducted complex determination of parameters of the respiratory system: clinical scaling before and after 6-minute walk test (6MWT), instrumental examinations including spirometry, capnography and pulse oximetry before, during and after physical activity. The analysis of survival was conducted on the basis of the dynamic follow-up of patients within 5 years (60 months). Results. In the analysis of parameters of dyspnea at rest, all the parameters were higher in the group of patients with CHF (р0.05). The distance walked by the patients with CHF in 6 minutes was 488.2390.84 m, which was significantly less than in the control group (815.6053.89 m, р=0.009). Dyspnea as the cause of stoppage/slowing down of walking in 6MWT, was also more often recorded in patients with CHF (93.83.0% and 48.05.1%, р=0.049). Besides, in 6MWT the patients noted: weakness in legs (50.15.0% in the group of CHF and 40.05.0% in the control group, р=0.014), palpitation (29.04.6% and 20.04.1%, respectively, р=0.004). Worsening of dyspnea parameters in 6MWT was more evident in patients with CHF than in the control group (р0.01). In the CHF group, hypocapnic type of ventilation was revealed in 6MWT, analysis of РЕТСО2 trend graphs revealed a wave-like increase in the parameters, the so called periodic breathing (PB). CO2 trend was recorded in CHF group in 58.31.0% of cases (the difference with the control group with р=0.046), the trend of heart rate in 18.80.3% of cases (р=0.027). Cox proportional hazards regression analysis of mortality in patients with CHF showed a prognostic significance of a complex model comprising the following parameters of a patient: body mass index (р=0.005), left ventricular end-diastolic dimension (р=0.034), left ventricular end-systolic dimension (р=0.002), left ventricular ejection fraction (р=0.041), 6MWT distance (р=0.004), desaturation (р=0.009), and the presence of signs of PB during 6MWT (р=0.005). Model coefficients were statistically significant at р0.0001. Conclusions. Dynamic capnography and pulse oximetry allow to identify signs of PB in patients with CHF during 6MWT which may deepen a complex assessment of parameters of the cardio-respiratory system in patients with CHF in order to determine tolerance to physical exercise as well as the effectiveness of the conducted treatment. Complex assessment of survival of patients with CHF showed prognostic significance of the following parameters of a patient: body mass index, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, left ventricular ejection fraction, 6MWT distance, desaturation, PB during 6MWT.

ACCESSMENT OF RIGHT VENTRICULAR SYSTOLIC FUNCTION USING TAPSE

2011 ◽  
pp. 62-70
Author(s):  
Lien Nhut Nguyen ◽  
Anh Vu Nguyen
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Systolic Function ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background: The prognostic importance of right ventricular (RV) dysfunction has been suggested in patients with systolic heart failure (due to primary or secondary dilated cardiomyopathy - DCM). Tricuspid annular plane systolic excursion (TAPSE) is a simple, feasible, reality, non-invasive measurement by transthoracic echocardiography for evaluating RV systolic function. Objectives: To evaluate TAPSE in patients with primary or secondary DCM who have left ventricular ejection fraction ≤ 40% and to find the relation between TAPSE and LVEF, LVDd, RVDd, RVDd/LVDd, RA size, severity of TR and PAPs. Materials and Methods: 61 patients (36 males, 59%) mean age 58.6 ± 14.4 years old with clinical signs and symtomps of chronic heart failure which caused by primary or secondary DCM and LVEF ≤ 40% and 30 healthy subject (15 males, 50%) mean age 57.1 ± 16.8 were included in this study. All patients and controls were underwent echocardiographic examination by M-mode, two dimentional, convensional Dopler and TAPSE. Results: TAPSE is significant low in patients compare with the controls (13.93±2.78 mm vs 23.57± 1.60mm, p<0.001). TAPSE is linearly positive correlate with echocardiographic left ventricular ejection fraction (r= 0,43; p<0,001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation was found with LVDd and PAPs. Conclusions: 1. Decreased RV systolic function as estimated by TAPSE in patients with systolic heart failure primary and secondary DCM) compare with controls. 2. TAPSE is linearly positive correlate with LVEF (r= 0.43; p<0.001) and linearly negative correlate with RVDd (r= -0.39; p<0.01), RVDd/LVDd (r=-0.33; p<0.01), RA size (r=-0.35; p<0.01), TR (r=-0.26; p<0.05); however, no correlation is found with LVDd and PAPs. 3. TAPSE should be used routinely as a simple, feasible, reality method of estimating RV function in the patients systolic heart failure DCM (primary and secondary).

STUDY THE CHANGES IN MORPHOLOGY AND LEFT VENTRICULAR FUNCTION IN OVERWEIGHT-OBESE CHILDREN 5-15 YEARS OLD WHO VISITED CHILDREN'S HOSPITAL IN CAN THO

2011 ◽  
pp. 36-42
Author(s):  
Hung Viet Bui ◽  
Thi Cu Nguyen
Keyword(s):  
Left Ventricular Function ◽  
Ventricular Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Obese Children ◽  
Ventricular Ejection Fraction ◽  
Children's Hospital ◽  
Number Of Patients ◽  
Children’S Hospital

Objective: In Vietnam, obesity is increasing particularly in many large cities. Adult cardiovascular diseases are often derived from cardiovascular disorders during the children period. The implementation of early measures to prevent atherosclerosis, such as weight control, better lipid control will reduce the cardiovascular complications, such as hypertension (HTA), coronary heart diseases and some other diseases. Materials and Methods: Overweight - obese children from 5 to 15 years old who visited the Children's Hospital in Can Tho from May 2009 to May 2010. Total number of patients were chosen as 50 children. Method: Descriptive cross-sectional. Children in the study underwent Doppler ultrasound exam to evaluate cardiac morphology and cardiac function. Results: There were increases in left ventricular systolic diameter, left ventricular diastolic diameter, LV mass in overweight-obese children in the study compared with controls at all ages (p <0.05 ). Left ventricular ejection fraction in overweight-obese children in the study was lower than the control group at all ages (p> 0.05). The average rate of left ventricular shortening of overweight-obese children in the study was 34.8 ± 4.5(%). There was no difference in the rate of shortening of the left ventricle in overweight-obese children in the study compared with controls (p>0.05). There was no relationship between variation in morphology and left ventricular function with the degree of overweight-obesity in this study. Conclusion: The study showed that disturbances in morphology and left ventricular function in overweight-obese children but did not find a strong association with the disorder degree of overweight-obesity.

scholarly journals Review of Irish patients meeting ST elevation criteria during the COVID-19 pandemic

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001716
Author(s):  
Luke Byrne ◽  
Roisin Gardiner ◽  
Patrick Devitt ◽  
Caleb Powell ◽  
Richard Armstrong ◽  
...  
Keyword(s):  
Public Health ◽  
Public Perception ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
St Elevation ◽  
The Impact ◽  
Transfer Times

IntroductionThe COVID-19 pandemic has seen the introduction of important public health measures to minimise the spread of the virus. We aim to identify the impact government restrictions and hospital-based infection control procedures on ST elevation myocardial infarction (STEMI) care during the COVID-19 pandemic.MethodsPatients meeting ST elevation criteria and undergoing primary percutaneous coronary intervention from 27 March 2020, the day initial national lockdown measures were announced in Ireland, were included in the study. Patients presenting after the lockdown period, from 18 May to 31 June 2020, were also examined. Time from symptom onset to first medical contact (FMC), transfer time and time of wire cross was noted. Additionally, patient characteristics, left ventricular ejection fraction, mortality and biochemical parameters were documented. Outcomes and characteristics were compared against a control group of patients meeting ST elevation criteria during the month of January.ResultsA total of 42 patients presented with STEMI during the lockdown period. A significant increase in total ischaemic time (TIT) was noted versus controls (8.81 hours (±16.4) vs 2.99 hours (±1.39), p=0.03), with increases driven largely by delays in seeking FMC (7.13 hours (±16.4) vs 1.98 hours (±1.46), p=0.049). TIT remained significantly elevated during the postlockdown period (6.1 hours (±5.3), p=0.05), however, an improvement in patient delays was seen versus the control group (3.99 hours (±4.5), p=0.06). There was no difference seen in transfer times and door to wire cross time during lockdown, however, a significant increase in transfer times was seen postlockdown versus controls (1.81 hours (±1.0) vs 1.1 hours (±0.87), p=0.004).ConclusionA significant increase in TIT was seen during the lockdown period driven mainly by patient factors highlighting the significance of public health messages on public perception. Additionally, a significant delay in transfer times to our centre was seen postlockdown.

scholarly journals A pebble clogging a river: a case report of thrombosed coronary aneurysmal ectasia

2020 ◽  
Author(s):  
Akshar Jaglan ◽  
Tarek Ajam ◽  
Steven C Port ◽  
Tanvir Bajwa ◽  
A Jamil Tajik
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Kawasaki Disease ◽  
Treatment Options ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Artery Ectasia ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Patient Reported

Abstract Background Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in the older generation. We present a unique case of the management of a young woman diagnosed with multivessel CAE with aneurysmal changes in the setting of acute coronary syndrome and subsequently during pregnancy. Case summary A 23-year-old woman presented with acute onset chest pain. Electrocardiogram revealed no ischaemic changes; however, troponin I peaked at 16 ng/mL (reference range 0–0.04 ng/mL). Echocardiogram showed apical dyskinesis with preserved left ventricular ejection fraction. Coronary angiography showed multivessel CAE along with significant thrombus burden in an ectatic lesion of the left anterior descending artery. Since the patient was haemodynamically stable, conservative management with dual antiplatelet therapy and anticoagulation was started. On follow-up, coronary computed tomographic angiogram illustrated resolution of the coronary thrombi and echocardiogram showed improvement to the apical dyskinesis. It was presumed that Kawasaki disease was the most likely aetiology of her disease. Subsequently the patient reported that, contrary to medical advice, she was pregnant, adding another layer of complexity to her case. Discussion Coronary artery ectasia can be discovered as an incidental finding or can present with an acute coronary syndrome. Management is challenging in the absence of randomized trials and large-scale data. Treatment options include medications, percutaneous intervention, and surgical revascularization. Close surveillance is required in these patients to assess progression of disease. Here we discuss treatment options during acute coronary syndrome and pregnancy.

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