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 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 Myocarditis Mimicking an Acute Coronary Syndrome: A Case Related toSalmonella enteritis

2009 ◽  
Vol 2009 ◽  
pp. 1-2 ◽  
Author(s):  
B. Rossetti ◽  
G. Nguisseu ◽  
A. Buracci ◽  
L. Migliorini ◽  
G. Zanelli
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Salmonella Enteritidis ◽  
Clinical Laboratory ◽  
Final Diagnosis ◽  
Gastrointestinal Infections ◽  
Coronary Syndrome ◽  
Salmonella Enteritis

Infective myocarditis is most commonly due to a viral infection; occasionally it has been related to bacteria. Gastrointestinal infections associated with myocarditis have only rarely been described in young people, and the pathogenesis is unclear. We report a case of myocarditis mimicking an acute coronary syndrome (ACS) in a patient hospitalized for fever and diarrhoea.Salmonella enteritidiswas isolated from stool, and no other pathogens were found. The coronary angiography was normal, and there were not other coronary artery risk factors, other than hypertension. The patient was treated with ciprofloxacin, acetylsalicylate acid, and ramipril with rapid clinical improvement and normalization of cardiac abnormalities. Final diagnosis ofSalmonella enteritisand related myocarditis was made based on clinical, laboratory, ECG and echocardiographical findings.

scholarly journals Factors Associated with Sub-intimal Coronary Artery Dissection in MINOCA Patients with Delayed Washout at Coronary Angiography – Protocol for an Observational, OCT-based Study

2019 ◽  
Vol 4 (2) ◽  
pp. 59-63
Author(s):  
Zsolt Parajkó ◽  
András Mester ◽  
Dan Păsăroiu ◽  
Theodora Benedek ◽  
Imre Benedek
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Imaging Techniques ◽  
Underlying Mechanism ◽  
Artery Dissection ◽  
Coronary Artery Dissection ◽  
Coronary Syndrome ◽  
Acute Mi ◽  
Underlying Mechanisms

Abstract Background: Myocardial infarction (MI) with no obstructive coronary arteries (MINOCA) is a special form of the acute coronary syndrome. The heterogeneous pathophysiology of MINOCA is not well elucidated and includes cardiac and non-cardiac causes. Slow flow phenomenon on coronary angiography can be associated with several possible causes of MINOCA confirmed by optical coherence tomography (OCT). Therefore, the aim of this study is to assess the underlying mechanism of the delayed washout phenomenon on coronary angiography and the potential role of subintimal coronary artery dissection (SD) in the setting of an acute MI. Methods and design: This clinical prospective, descriptive research will enroll patients diagnosed with acute MI (STEMI or NSTEMI) identified by coronary angiography, followed by OCT imaging of the coronary arteries at the Emergency Clinical County Hospital of Târgu Mureş, Romania. The enrolled patients will be separated into two groups based on OCT examination, patients with SD and patients with no SD. Conclusion: The underlying mechanisms of MINOCA with delayed washout phenomenon on coronary angiography is still poorly understood. Modern invasive imaging techniques are capable to assess the microstructure of the coronary artery wall and are able to offer the much needed information to elucidate the pathophysiological changes which ultimately cause the acute event. The current study offers a new, complex – clinical, invasive and noninvasive imaging, as well as biomarker-based – approach, which may lead to a better understanding and treatment of this pathology.

scholarly journals Assessment of the effectiveness of treatment in patients after acute coronary syndrome

2020 ◽  
Vol 25 (2) ◽  
pp. 9-18
Author(s):  
D. A. Shvets ◽  
S. V. Povetkin ◽  
A. Yu. Karasev ◽  
V. I. Vishnevsky
Keyword(s):  
Acute Coronary Syndrome ◽  
Drug Therapy ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Secondary Prevention ◽  
Generic Drugs ◽  
Myocardial Revascularization ◽  
Cardiovascular Complications ◽  
Drug Prevention ◽  
Coronary Syndrome

Aim. To assess the effectiveness of secondary drug prevention and surgical myocardial revascularization in patients with coronary artery disease (CAD) during long-term follow-up after acute coronary syndrome (ACS).Material and methods. The study involved 400 patients with ACS discharged from the hospital in 2012-2016. The diagnosis was verified according to the European Society of Cardiology (ESC) guidelines. There were no exclusion criteria. We analyzed the data of medical records (complaints, medical history, physical examination, laboratory and instrumental data). Repeated data collection was carried out by distance survey and during a face-to-face examination during 2018. According to the clinical course of CAD, all patients were divided into 2 groups. Group 1 consisted of 151 patients with complicated course of CAD, group 2 — 249 patients with stable CAD. We analyzed drug therapy recommended at hospital discharge and taken at the time of the repeated examination. The drug names and daily dosage used for the secondary prevention of CAD were recorded. Assessment of survival without cardiovascular complications was carried out according to the Kaplan-Mayer analysis.Results. Seven-year mortality was 22,5%. The total number of cardiovascular events was 37,7%. The main reason for the frequent complications was the insufficient secondary prevention of CAD after ACS. We found that the drugs and their dosage did not have a significant effect on survival. Statin use is associated with a paradoxical increase in the number of complications. The increased frequency of use and dosage of statins are a consequence of unfavorable course of CAD and do not have the proper preventive effect. For some groups of drugs, we observed irregular intake over the observation period. The low effectiveness of therapy is not only due to insufficient doses, but also in the frequent use of generic drugs. The significant effect of coronary angiography on the probability of cardiovascular complications compared with stenting is due to high proportion of coronary angiography use without revascularization.Conclusion. The combination of following factors of drug therapy can explain the low effectiveness of secondary CAD prevention: low dose (26,1±2,8 mg for atorvastatin), irregular intake and common use of generic drugs (97,6% for statins), present in different ratios. The contribution of surgical treatment to reducing cardiovascular complications is lower, the more significant residual coronary artery stenosis.

scholarly journals HUBUNGAN KADAR LEUKOSIT DENGAN SEVERITAS LESI PEMBULUH DARAH KORONER PADA PASIEN SINDROM KORONER AKUT DI RSUP. PROF. DR. R. D. KANDOU PERIODE JULI-SEPTEMBER 2015

e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Lucky A. Tulung ◽  
A. Lucia Panda ◽  
Starry H. Rampengan
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Pearson Correlation ◽  
Gensini Score ◽  
Cross Sectional ◽  
Coronary Syndrome ◽  
Pearson Correlation Test ◽  
Artery Disease ◽  
The Relationship

Abstract: Acute Coronary Syndrome (ACS) is a set of manifestations or symptoms of coronary artery disease and thrombosis which can threaten the patien’s life due to interfering the blood supply of heart muscle. The infarct size is determined by assessing the coronary arteries lesion, stenosis. This study was aimed to determine the relationship between levels of leukocytes and the severity of coronary arteries lesions in patients with ACS. This was a descriptive analytical study with a cross-sectional retrospective design. The modified Gensini score was used to assess the severity of coronary artery lesion. The first leukocyte count examined when the patients was admitted to the hospital was obtained from the medical records period July to September 2015. Data were analyzed by using SPSS 20.0. The Pearson correlation test showed no significant relationship between the levels of leukocytes and the severity of coronary arteries lesions in patients with ACS (p >0.05). Conclusion: There was no significant correlation between the levels of leukocytes and the severity of coronary arteries lesions in patients with ACS.Keywords: leukocyte, severity of lesion, acute coronary syndrome, modified Gensini score Abstrak: Sindrom koroner akut (SKA) merupakan sekumpulan manifestasi atau gejala akibat penyakit arteri koroner dan trombosis yang dapat mengancam kehidupan pasien karena mengganggu pasokan darah ke otot jantung. Penilaian luas infark dilakukan dengan menilai lesi pembuluh darah koroner yang mengalami stenosis. Penelitian ini bertujuan untuk mengetahui hubungan antara kadar leukosit dengan severitas lesi pembuluh darah koroner pada pasien SKA. Jenis penelitian ialah deskriptif analitik retrospektif dengan desain potong lintang. Penilaian severitas pembuluh darah yang mengalami lesi menggunakan skor modifikasi Gensini. Hitung leukosit yang digunakan ialah saat pasien pertama kali masuk Rumah Sakit yang diperoleh dari rekam medis periode Juli-September 2015. Data dianalisis menggunakan SPSS 20.0. Hasil uji korelasi Pearson memperlihatkan tidak terdapat hubungan bermakna antara kadar leukosit dan severitas lesi pembuluh darah koroner pada pasien SKA (p >0,05). Simpulan: Tidak terdapat hubungan bermakna antara kadar leukosit dan severitas lesi pembuluh darah koroner pada pasien Sindrom Koroner Akut. Kata kunci: leukosit, severitas lesi, sindrom koroner akut, skor modifikasi Gensini

scholarly journals Nonalcoholic Fatty Liver Disease and Coronary Artery Disease: Big Brothers in Patients with Acute Coronary Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Mauricio Montemezzo ◽  
Ahmed AlTurki ◽  
Fabio Stahlschmidt ◽  
Marcia Olandoski ◽  
Jean Rodrigo Tafarel ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Liver Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Nonalcoholic Fatty Liver ◽  
Coronary Syndrome ◽  
Diagnostic Coronary Angiography ◽  
Grade Iii

Background. The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing. This study aimed to evaluate the prevalence of NAFLD, as diagnosed by ultrasound, in patients with acute coronary syndrome (ACS) and to assess whether NAFLD is associated with the severity of coronary obstruction as diagnosed by coronary angiography. Methods. We performed a prospective single-center study in patients hospitalized due to acute coronary syndrome who underwent diagnostic coronary angiography. Consecutive patients who presented to the emergency room were diagnosed with acute coronary syndrome and were included. All patients underwent ultrasonography of the upper abdomen to determine the presence or absence of NAFLD; NAFLD severity was graded from 0 to 3 based on a previously validated scale. All patients underwent diagnostic coronary angiography in the same hospital, with the same team of interventional cardiologists, who were blinded to the patients’ clinical and ultrasonographic data. CAD was then angiographically graded from none to severe based on well-established angiographic criteria. Results. This study included 139 patients, of whom 83 (59.7%) were male, with a mean age of 59.7 years. Of the included patients, 107 (77%) patients had CAD, 63 (45%) with serious injury. Regarding the presence of NAFLD, 76 (55.2%) had NAFLD including 18 (23.6%) with grade III disease. In severe CAD, 47 (60.5%) are associated with NAFLD, and 15 (83.3%) of the patients had severe CAD and NAFLD grade III. Conclusions. NAFLD is common in patients with ACS. The intensity of NAFLD detected by ultrasonography is strongly associated with the severity of coronary artery obstruction on angiography.

Introduction

ESC CardioMed ◽  
2018 ◽  
pp. 1209-1209 ◽  
Author(s):  
Stefan James ◽  
Marco Roffi
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Stable Coronary Artery Disease ◽  
Clinical Manifestations ◽  
Myocardial Cell ◽  
Coronary Syndrome ◽  
Arterial Plaque ◽  
Artery Disease ◽  
Late Stages

Coronary artery disease may develop slowly and create symptoms only in late stages due to marked narrowing of one or more coronary arteries. However, the disease progression can also be rapid and be triggered by disruption of a coronary arterial plaque, complicated by thrombosis, embolization, and varying degrees of obstruction to myocardial perfusion. The term acute coronary syndrome is used to denote the acute phases of ischaemic coronary artery disease with or without myocardial cell necrosis. This term is preferred to earlier symptom-related terminology because it encompasses the common underlying pathophysiology. The clinical features depend upon the extent and severity of myocardial ischaemia. Acute coronary syndrome describes the spectrum of clinical manifestations from worsening of stable coronary artery disease to large myocardial infarction with shock or sudden cardiac death.

scholarly journals Role of cardiovascular magnetic resonance in the prognosis of patients with myocardial infarction with non-obstructive coronary arteries

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Nuria Vicente-Ibarra ◽  
Eloisa Feliu ◽  
Vicente Bertomeu-Martínez ◽  
Pedro Cano-Vivar ◽  
Pilar Carrillo-Sáez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Cardiovascular Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Coronary Arteries ◽  
Coronary Artery Lesions ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Adverse Cardiac Events

Abstract Background It is estimated that 5% to 10% of patients with myocardial infarction (MI) present with no obstructive coronary artery lesions. Until now, most studies have focused on acute coronary syndrome, including different clinical entities with a similar presentation encompassed under the term MINOCA (MI with non-obstructive coronary arteries). The aim of this study is to assess the prognosis of patients diagnosed with true infarction, confirmed by cardiovascular magnetic resonance (CMR), in the absence of significant coronary lesions. Methods Prospective multicenter registry study, including 120 consecutive patients with a CMR-confirmed MI without obstructive coronary artery lesions. The primary clinical outcome was major adverse cardiovascular events (MACE: death, non-fatal infarction, stroke, or cardiac readmission), assessed over three years. Results Seventy-six patients (63.3%) were admitted with a diagnosis of acute coronary syndrome, and 44 (36.6%) for other causes (mainly heart failure); the definitive diagnosis was established by CMR. Most patients (64.2%) were men, and the mean age was 58.8 ± 13.5 years. Patients presented with small infarcts: 83 (69.1%) showed late gadolinium enhancement (LGE) in one or two myocardial segments, mainly transmural (in 77.5% of patients) and with a preserved left ventricular ejection fraction (median 54.8%, interquartile range 37–62). The most frequent infarct location was inferolateral (n = 38, 31.7%). During follow-up, 43 patients (35.8%) experienced a MACE, including 9 (7.5%) who died. In multivariable analysis, LGE in two versus one myocardial segment doubled the risk of adverse cardiac events (hazard ratio [HR] 2.32, 95% confidence interval [CI] 0.97–5.83, p = 0.058). Involvement of three or more myocardial segments almost tripled the risk (HR 2.71, 95% CI 1.04–7.04, p = 0.040 respectively). Conclusions Patients with true MI but without significant coronary artery lesions predominantly had small infarcts. Myocardial 3-segment LGE involvement is associated with a significantly higher risk of adverse cardiac events.

scholarly journals Features of coronary artery patterns and percutaneous coronary intervention in patients with acute coronary syndrome and stable angina in patients aged below 40 years

2020 ◽  
Vol 101 (1) ◽  
pp. 18-24 ◽  
Author(s):  
F Z Abdullaev ◽  
N M Babaev ◽  
L S Shikhieva
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Right Coronary Artery ◽  
Stable Angina ◽  
Coronary Intervention ◽  
Left Circumflex Artery ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Aim. To study the features of risk profile, coronary artery patterns, and percutaneous coronary intervention in patients aged below 40 years with acute coronary syndrome and stable angina. Methods. 208 patients with coronary artery disease aged below 40 years were examined: 51 (24.5%) patients aged 35 years and younger and 157 (75.5%) aged 3640 years. 98 (47.1%) patients were admitted with acute coronary syndrome; 110 (52.9%) patients with stable angina. In groups of acute coronary syndrome and stable angina, myocardial infarction in past medical history was revealed in 23.5% and 36.4%, respectively. 165 patients underwent percutaneous coronary intervention: 84 (50.9%) with acute coronary syndrome; 81 (40.1%) with stable angina. Results. Patients with stable angina differed by prevalence of myocardial infarction in past medical history, overweight, and family history of coronary artery disease. In group of acute coronary syndrome urban cohort prevailed as well as consumption of energy drinks among patients below 35 years; high prevalence of left ventricular dysfunction. Patients with acute coronary syndrome were characterized by involvement of one and three coronary arteries, and patients with stable angina by pathology of two and three coronary arteries. Involvement of three coronary arteries was equal in both groups. In both groups, anterior interventricular artery was target coronary artery. Patients with stable angina had the same rate of right coronary artery and left circumflex artery involvement. In patients with stable angina, right coronary artery involvement was rarer, and left main coronary artery involvement was two times more frequent than in patients with acute coronary syndrome. The group with acute coronary syndrome was characterized by predominance of discrete lesions and coronary occlusions over diffuse lesions; and the group of stable angina by diffuse lesions, and two-times less frequent coronary occlusions. Conclusion. Among patients with acute coronary syndrome aged below 36 years, revascularization of right coronary artery was predominant, and among patients aged 3640 years with acute coronary syndrome revascularization of left circumflex artery.

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