scholarly journals PATHOPHYSIOLOGICAL AND CLINICAL ASPECTS OF MYOCARDIAL BRIDGES

2019 ◽  
pp. 62-70
Author(s):  
T.V. Bogdan ◽  
O.V. Savchenko ◽  
V.V. Bogdan ◽  
D.M. Pryadum ◽  
A.Y. Yakovenko
Keyword(s):  
Coronary Arteries ◽  
Clinical Manifestations ◽  
Vasospastic Angina ◽  
Clinical Aspects ◽  
Myocardial Bridges ◽  
Coronary Syndrome ◽  
Heart Perfusion ◽  
Pathophysiological Role ◽  
Male Patients

Coronary arteries are normally located on the epicardial surface of the heart (surrounded by adipose and loose connective tissue), can "plunge" into the thickness of the myocardium at different depths, and then again "appear" on the surface of the heart. The muscle that covers the intramural segment of the epicardial coronary artery is called the myocardial "bridge" (MB), and the artery extending into the thickness of the myocardium is called the tunnel. MB is the most common congenital pathology of the coronary arteries. MB occurs in about 1/3 of the entire population, but it does not always manifest itself in violation of heart perfusion and related symptoms: angina pectoris, vasospastic angina (Prinzmetalla), acute coronary syndrome, loss of consciousness, ventricular tachycardia, sudden death. This pathology is found in both women and men, but the target group remains in men 25–35 years of age, who experience clinical manifestations mainly during physical activity. According to autopsies, MB is found in 87 %, up to 5 % of them are hemodynamically significant. Among those who died suddenly, 25 % had MB. This topic is relevant because previously diagnosed with MB can prevent the development of the above pathological conditions and save the life of the patient. The article presents data on morphology, pathogenesis, clinical manifestations, diagnosis and treatment of myocardial bridges (MB). The role of this coronary vessel pathology in the emergence of vasospastic angina (Prinzmetal) and sudden cardiac death in young, mainly male patients has been revealed. The pathophysiological role of CO2 levels in the blood and its relationship to the clinical manifestations of the muscular bridges were also analyzed.

THE ROLE OF MAGNESIUM DEFICIENCY IN THE PATHOGENESIS OF THE FORMATION OF ARTERIAL HYPERTENSION IN WORKERS OF LOCOMOTIVE CREWS. CORRECTION METHODS

2021 ◽  
Author(s):  
V.G. Yarkova ◽  
◽  
V.A. Zhmurov ◽  
E.B. Klester ◽  
Keyword(s):  
Lipid Metabolism ◽  
Arterial Hypertension ◽  
Cardiovascular System ◽  
Magnesium Deficiency ◽  
Clinical Manifestations ◽  
Occupational Disability ◽  
Functional Studies ◽  
Complex Preparation ◽  
Male Patients

Abstract: Purpose of the study: To assess the effects of magnesium deficiency on the indices of lipid metabolism in patients with an arterial hypertension locomotive crews. Purpose of the work: To assess the effect of magnesium deficiency on the pathogenesis of the formation of arterial hypertension in workers of locomotive crews. Correction methods. Materials and methods: This work presents an analysis of the results of clinical observation, special biochemical and functional studies of 136 male patients with arterial hypertension, workers of locomotive crews. Results: In workers of locomotive crews patients with hypertension, increased individual cardiovascular risk according to the SCORE scale, remodeling of the cardiovascular system, as well as the risk of developing occupational disability are interrelated with signs of magnesium deficiency. Conclusion: The inclusion of a complex preparation of magnesium and vitamin B6 in the therapy of arterial hypertension in workers of locomotive crews has a significant effect on the clinical manifestations of chronic stress, magnesium deficiency, improves the dynamics of lipid metabolism, the structural and functional state of the cardiovascular system, and professionally important qualities.

scholarly journals Modern Concepts of Fibromuscular Dysplasia of the Coronary Arteries

2019 ◽  
Vol 15 (3) ◽  
pp. 431-438
Author(s):  
E. L. Trisvetova
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Arteries ◽  
Fibromuscular Dysplasia ◽  
Clinical Manifestations ◽  
Intramural Hematoma ◽  
Vascular Wall ◽  
Vascular Lesion ◽  
Diagnostic Methods ◽  
International Consensus ◽  
Coronary Syndrome

Fibromuscular dysplasia of the coronary arteries is a rare non-atherosclerotic and non-inflammatory vascular lesion that is asymptomatic until serious complications develop: stenosis, dissection, rupture, sudden cardiac death. Since there are no long-term numerous clinical observations of patients with fibromuscular dysplasia of the coronary arteries, recommendations have not been developed for diagnosing and treating the disease, which often manifests with acute coronary syndrome. In 2014, the European Consensus was published, and in 2019, the first international consensus document on the diagnosis and treatment of fibromuscular dysplasia with lesions of vessels from different regions (renal, cerebrovascular, coronary, and others). The documents state that the development of fibromuscular dysplasia of the coronary arteries considers the participation of the PHACTR1 gene mutation and the transcriptional activity of the EDN1 gene, smoking, prolonged exertion of the vascular wall, and possibly female sex hormones. In the case of acute coronary syndrome, the most informative diagnostic method is computed tomography with angiography, which reveals a smooth narrowing of the lumen in the middle or distal section in the epicardial artery, often due to intramural hematoma, and also finds dissection, spasm, and tortuous vessel. Additional diagnostic methods ‒ intravascular ultrasound and optical coherence tomography allow differentiation of fibromuscular dysplasia with atherosclerosis of the coronary artery, vasculitis, and other diseases. The choice of treatment tactics for fibromuscular dysplasia of the coronary arteries depends on the severity of the clinical manifestations ‒ conservative medical treatment and interventional methods are used.

scholarly journals Diagnostic Utility and Pathogenic Role of Circulating MicroRNAs in Vasospastic Angina

2020 ◽  
Vol 9 (5) ◽  
pp. 1313
Author(s):  
Chan Soon Park ◽  
Inho Kim ◽  
Gyu Chul Oh ◽  
Jung-Kyu Han ◽  
Han-Mo Yang ◽  
...  
Keyword(s):  
Diagnostic Value ◽  
Vasospastic Angina ◽  
Circulating Microrna ◽  
Diagnostic Utility ◽  
Human Coronary Artery ◽  
Circulating Micrornas ◽  
Pathophysiological Role ◽  
Oxide Synthase ◽  
Endothelial Nitric Oxide

We investigated the diagnostic value and pathophysiological role of circulating microRNA (miR) in vasospastic angina (VA). We enrolled patients who underwent coronary angiography for chest pain to explore the miR’s diagnostic utility. In addition, we investigated the role of miRs in regulating endothelial nitric oxide synthase (eNOS) expression in human coronary artery endothelial cells (hCAECs). Among the 121 patients, 46 were diagnosed with VA (VA group), 26 with insignificant coronary lesions (ICL group), and 49 with atherothrombotic angina (AA group). The VA group showed a significantly higher expression of miR-17-5p, miR-92a-3p, and miR-126-3p than the ICL group. In contrast, miR-221-3p and miR-222-3p were upregulated in the AA group compared to the VA group, and all levels of miR-17-5p, miR-92a-3p, miR-126-3p, miR-145-5p, miR-221-3p, and miR-222-3p differed between the AA group and the ICL group. In the hCAECs, transfection with mimics (pre-miR) of miR-17-5p, miR-92a-3p, and miR-126-3p was associated with eNOS suppression. Additionally, transfection with inhibitors (anti-miR) of miR-92a-3p significantly rescued the eNOS suppression induced by lipopolysaccharide. In conclusion, the circulating miRs not only proved to have diagnostic utility, but also contributed to pathogenesis by eNOS regulation.

scholarly journals MYOCARDIALBRIDGINGOFA CORONARYARTERY

2017 ◽  
pp. 108-113
Author(s):  
A. M. Kravchenko ◽  
E. G. Malayeva ◽  
A. N. Tsyrulnikova ◽  
I. A. Hudyakov ◽  
A. A. Dmitrienko ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Middle Segment ◽  
Myocardial Bridges ◽  
Coronary Syndrome ◽  
Coronary Artery Segment ◽  
Artery Segment ◽  
Myocardial Muscle

Myocardial (muscle) bridges are a common congenital anomaly of coronary arteries which is characterized by running of a coronary artery segment under the myocardial layer. According to literary data, the most frequent localization of myocardial bridges is observed in the middle segment of the anterior interventricular branch. In the majority of cases, the presence of a muscular bridge is not accompanied by clinical manifestations, and patients have a favorable long-term prognosis.Under certain circumstances, the course of the intramural course of the coronary artery may be accompanied by development of acute coronary syndrome, a sudden cardiac death. The main method of the diagnosis is coronary angiography. The article presents brief data on the prevalence, clinical picture, diagnosis, treatment of patients with myocardial bridges. Also, it describes a clinical case of a patient havinga myocardial bridge in the middle segment of the anterior interventricular branch with characteristic clinical symptoms confirmed by tool research methods.

scholarly journals DIAGNOSIS OF ACUTE CORONARY SYNDROME IN PATIENTS WITH CONGENITAL ANOMALY OF CORONARY ARTERIES

2021 ◽  
Vol 21 (2) ◽  
pp. 225-228
Author(s):  
O.A. Shaposhnyk ◽  
T.I. Shevchenko ◽  
S.I. Sorokina ◽  
I. P. Kudrya ◽  
N.G. Tretiak
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Relevant Literature ◽  
Clinical Manifestations ◽  
Diagnostic Methods ◽  
Coronary Artery Anomalies ◽  
Coronary Syndrome ◽  
Cardiac Symptoms

The article highlights the issues of terminology, prevalence, diagnosis, clinical manifestations, and the therapy of patients with congenital anomalies of the coronary arteries. Special attention is paid to the current state of the problem of congenital coronary artery anomalies and their in coverage in the relevant literature. Anomalies of the coronary arteries can cause the development of acute coronary syndrome and then lead to disability of the employable population. The aim of thus study was to analyze and compare clinical manifestations in coronary artery anomalies and angiographic changes of coronary arteries in order to improve the diagnosis of acute forms of coronary heart disease, and namely, acute coronary syndrome. We underscored the clinical significance of invasive diagnosis of coronary artery abnormalities using coronary angiography. We represented detailed analysis of the clinical case of an atypical course of acute coronary syndrome, accompanied by cardiac symptoms supported with changes on the electrocardiogram. Coronary angiography revealed a myocardial muscle bridge, which compressed the trunk of the left coronary artery during the systole, thus significantly reducing coronary artery diameter and provoking an attack of chest pain. Modern diagnostic methods enable to assess not only the condition of the coronary arteries, but also the features of their topography, and, in particular, in the myocardium.

scholarly journals The role of peak troponin in patients with a working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA)

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
MGL Williams ◽  
K Liang ◽  
E De Garate ◽  
L Spagnoli ◽  
E Fiori ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Arteries ◽  
Troponin T ◽  
Diagnostic Yield ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
Tertiary Centre ◽  
St Elevation ◽  
The Mean

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Rosetrees Trust James Tudor Foundation Background 6-10% of patients who present with an acute coronary syndrome have a myocardial infarction with non-obstructive coronary arteries (MINOCA). Troponin T predicts infarct size and outcomes in patients with ST-elevation myocardial infarction. The value of peak troponin T in patients with a working diagnosis of MINOCA is not well understood. Purpose The aim of this study is to investigate the diagnostic and prognostic role of troponin in patients with MINOCA.  Methods Consecutive patients with a working diagnosis of MINOCA (n = 719) from a single tertiary centre who underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) were followed prospectively. The primary endpoint was all-cause mortality. Results Peak troponin T ≥211 ng/L and time to CMR of ≤17 days have a positive predictive value of 94% for being able to make a diagnosis on CMR. If the scan was performed in ≤17 days the diagnostic yield was still 75% even in the lowest troponin decile, but this was 59% if performed after 17 days. Each increase in troponin decile increases the mean diagnostic yield of the CMR by 3.7% (p < 0.001, 95% CI 3.4 – 3.9; R2 0.84; Figure 1). There is no overall difference in median troponin in patients who died and those who survived (229 ng/l v. 424 ng/l; p = 0.157), however mortality is significantly lower in the highest two troponin quartiles (11.9% versus 6.9%; p = 0.009, figure 2).  Conclusions Peak troponin T and time to CMR can be used by cardiologists to determine the likelihood of making a diagnosis using CMR. A higher troponin quartile is associated with lower mortality.

Review: SARS-CoV-2, Cardiovascular Disease, Pathophysiology and Role of ACE2 in Cardiac Injury

2021 ◽  
pp. 1-20
Keyword(s):  
Cardiovascular Disease ◽  
Angiotensin Converting Enzyme ◽  
Angiotensin Receptor Blockers ◽  
Cardiac Injury ◽  
Clinical Manifestations ◽  
Cardiac Complications ◽  
Converting Enzyme ◽  
Structural Protein ◽  
Coronary Syndrome

The coronavirus disease-2019 (COVID-19), an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has hit the world very hard by affecting millions of people across countries hence posing a major health threat on a global scale. This novel virus is thought to enter and cause infection in its host through the attachment of its structural protein known as the S-glycoprotein to angiotensin-converting enzyme 2 (ACE2). COVID-19 is presented with asymptomatic, mild, or severe pneumonia-like symptoms. During the infection, the cardiovascular system is affected by unknown pathophysiological processes. Among COVID-19 patients, cardiovascular disease (CVD) is resulting into cardiac injury, acute coronary syndrome (ACS), myocardial infarction (MI), arrhythmic infestation and myocarditis. The results of the meta-analysis suggest that CVD and its risk factors are closely related to fatal outcomes in COVID-19 for patients across all ages. Hence, from a cardiovascular standpoint, there are concerns as to whether patients with underlying cardiovascular conditions are at a higher risk of an aggravated COVID-19 infection. Also, as to whether COVID-19 infections induce cardiomyopathies that were not in existence prior to the infection. Nonetheless, much needs to be discovered about the cardiac involvement of this novel coronavirus (nCoV) infection and its relationship with cardiovascular diseases (CVDs). For acute CVD events, the use of antiplatelet agents, β-blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs) and statins are recommended per practice guidelines. Whether the medications which patients used for cardiovascular disease will interfere with the treatment or the outcome of COVID-19, is still unknown. With the invent of vaccines and as new clinical evidences emerging, the diagnosis and treatment may change. The purpose of this concise review is to discuss CVD and related potential disorders in patients with COVID-19 which involves SARS-CoV-2 infection, pathophysiology, role of ACE2 in cardiac injury, possible mechanism of cardiac complications and clinical manifestations.

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