scholarly journals Dual coronary embolization associated with atrial fibrillation: a case report

STEMedicine ◽  
2021 ◽  
Vol 2 (8) ◽  
pp. e99
Author(s):  
Yonggang Yuan ◽  
Zesheng Xu
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Blood Flow ◽  
Coronary Angiography ◽  
Coronary Intervention ◽  
Circumflex Artery ◽  
Effective Measure ◽  
St Segment Elevation ◽  
Left Circumflex Artery ◽  
Coronary Embolization

Background: Thrombotic occlusion of the coronary artery, which succeeds the atherosclerotic plaquerupture or erosion, gives rise to a major portion of acute myocardial infarction (AMI) incidences.Nevertheless, coronary embolism is gaining increasing recognition as another important factor contributingto AMI. Case presentation: A 72-year-old woman with atrial fibrillation (AF) and diabetes mellitus histories,presented with chest pain radiating to the left arm and shoulder that began 6 hours prior to admission.Electrocardiogram revealed AF plus ST-segment elevation in the anterior leads.Intervention: Patient was first treated with anti-platelet agents (aspirin plus ticagrelor) and atorvastatin.Emergency coronary angiography depicted multi-site coronary embolization of the left circumflex artery(LCX) and the left anterior descending artery (LAD). Blood flow was not restored after intracoronaryinjection of 600 ug tirofiban. 40 mg recombinant human prourokinase was then administered via aspirationthrombectomy catheter. Outcome: Two weeks later, coronary angiography showed no residual obstructive lesion in the LCX andLAD with TIMI (thrombolysis in myocardial infarction) 3 flow. Conclusion: Primary percutaneous coronary intervention is the most effective measure. In the case offailed blood flow restoration, thrombolytic treatment in both intravenous and intracoronary route should beconsidered.

scholarly journals ST-Segment Elevation During Treadmill Exercise Test in a Patient without Prior Myocardial Infarction. A Case Report and Literature Review

2019 ◽  
Vol 13 (1) ◽  
pp. 37-40
Author(s):  
Vasiliki Katsi ◽  
Konstantinos Konstantinou ◽  
Antonios Karanasos ◽  
Ilias Tolis ◽  
Sophia Vaina ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Exercise Test ◽  
Coronary Intervention ◽  
Circumflex Artery ◽  
Current Case ◽  
St Segment Elevation ◽  
Left Circumflex Artery ◽  
Prior Myocardial Infarction ◽  
St Elevation ◽  
Exercise Induced

Exercise-induced ST-elevation is extremely uncommon especially in patients without prior myocardial infarction. It is more common among post-infarction patients with Q waves on the resting ECG. In the current case we report a 50-year-old man with a history of chest pain on exertion started four months ago. During the exercise test, ST-elevation was observed in leads II, III, AVF. Coronary angiography revealed significant stenoses in the right coronary artery and left circumflex artery, which were treated with percutaneous coronary intervention. This case highlights the rare finding of exercise-induced ST-elevation and reviews possible mechanisms.

scholarly journals A case of left circumflex artery stenosis involving ST segment depression in multiple leads with ST elevation in lead augmented vector right

2019 ◽  
Vol 6 (7) ◽  
pp. 2598
Author(s):  
C. P. Karunadas ◽  
Cibu Mathew
Keyword(s):  
Beta Blockers ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Circumflex Artery ◽  
St Segment Elevation ◽  
Left Circumflex Artery ◽  
St Depression ◽  
St Segment ◽  
Lead Avr ◽  
St Elevation

Electrocardiography (ECG) patterns of ST-segment elevation in lead aVR with or without diffuse ST segment depression may predict either left main coronary artery or triple vessel stenosis. Here, we have presented the case of a 56-year-old female involving such an ECG pattern with ST-segment depression in more than eight leads and ST Segment elevation in lead aVR, however, showing stenosis of the mid-segment of the left circumflex artery (LCX). She was scheduled to undergo percutaneous coronary intervention with implantation of a drug-eluting stent with respect to mid LCX stenosis. The patient was asymptomatic post procedure and was discharged on beta blockers. To conclude, the ECG pattern of ST depression in multiple leads with ST-elevation in aVR lead can occur in LCX obstruction as well. 

The effects of percutaneous coronary intervention on mortality in elderly patients with non-ST-segment elevation myocardial infarction undergoing coronary angiography

2020 ◽  
Vol 65 (3) ◽  
pp. 81-88
Author(s):  
Pınar D Gündoğmuş ◽  
Emrah B Ölçü ◽  
Ahmet Öz ◽  
İbrahim H Tanboğa ◽  
Ahmet L Orhan
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Elderly Patients ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
One Year

Introduction Although it is recommended that elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) should undergo an assessment for invasive revascularization, these patients undergo fewer coronary interventions despite the current guidelines. The aim of the study is to evaluate the effectiveness of percutaneous coronary intervention on all-cause mortalities monthly and annually in the population. Methods Three hundred and twenty-four patients with NSTEMI aged 65 years or older who underwent coronary angiography and treated with conservative strategy or percutaneous coronary intervention were included in the study. All demographic and clinical characteristics of the patients were recorded and one-month and one-year follow-up results were analysed. Results Two hundred eight cases (64.19%) were treated with percutaneous coronary intervention and 116 cases (35.81%) of the participant were treated with conservative methods. The mean age of the participants was 75.41 ± 6.65 years. The treatment strategy was an independent predictor for the mortality of one-year (HR: 1.965). Furthermore, Killip class ≥2 (HR:2.392), Left Ventricular Ejection Fraction (HR:2.637) and renal failure (HR: 3.471) were independent predictors for one-year mortality. Conclusion The present study has revealed that percutaneous coronary intervention was effective on one-year mortality in NSTEMI patients over the age of 65. It is considered that percutaneous coronary intervention would decrease mortality in these patients but it should be addressed in larger population studies.

scholarly journals The effect of predilation on the incidence of the no/slow-reflow phenomenon in patients with acute coronary syndrome with ST segment elevation

2020 ◽  
Vol 101 (2) ◽  
pp. 284-288
Author(s):  
G V Sazanov ◽  
O S Belokon'
Keyword(s):  
Myocardial Infarction ◽  
Blood Flow ◽  
Percutaneous Coronary Intervention ◽  
Balloon Catheter ◽  
Coronary Intervention ◽  
Occurrence Rate ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
The Moment

Aim. To assess the effect of balloon predilation on the incidence of no/slow-reflow complication during percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). Methods. We analyzed the experience of the department of endovascular diagnostic and treatment methods of the Stavropol Regional Clinical Hospital for endovascular surgical treatment of patients with STEMI, including after thrombolytic therapy (TLT). The study included 721 patients admitted to the hospital within the first 12 hours from the moment of the first contact with a medical staff. For the study, patients were divided into 2 comparable groups according to the gradation scale TIMI (Thrombolysis in myocardial infarction), comparable the patients' gender, age and other characteristics. Each of the groups also was divided into 2 subgroups according to performing predilation. The study also analyzed the correlation between patients' mortality and existence of the no/slow-reflow phenomenon. Results. The lowest incidence of the no/slow-reflow phenomenon was in groups in which predilation before stent implantation was not performed. In the group where the blood flow was higher than TIMI 0, the occurrence rate of the no/slow-reflow phenomenon was 7.2 times higher in group with predilation. In the group where the artery was occluded, the risk of the phenomenon during predilation was 3.6 times higher than in group with the tracking method. The risk of mortality in patients with no/slow-reflow phenomenon was 3.9 times higher. Conclusion. In carrying out the percutaneous coronary intervention, the most preferable is the refusal to perform predilation if there is an appropriate technical feasibility; it is recommended for patients with a blood flow level TIMI 0 to draw a balloon catheter for an occlusion site, which may allow antegrade blood flow to be achieved.

scholarly journals Glycoprotein IIb/IIIa Receptor Inhibitors in Patients with ST-Segment Elevation Myocardial Infarction and Primary Percutaneous Coronary Intervention

2020 ◽  
Vol 15 (6) ◽  
pp. 918-927 ◽  
Author(s):  
A. S. Tereshchenko ◽  
Е. V. Merkulov ◽  
A. M. Samko
Keyword(s):  
Myocardial Infarction ◽  
Blood Flow ◽  
Percutaneous Coronary Intervention ◽  
Randomized Trials ◽  
Coronary Intervention ◽  
Thrombus Aspiration ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Recently, there has been a positive trend to reduce mortality from myocardial infarction. One of the reasons for such dynamics is the development of angiographic service in our country and the increase in the number of primary percutaneous coronary interventions. One of the most serious complications of endovascular interventions affecting the prognosis is the development of the phenomenon of slow or unrecoverable blood flow (≪slow/no-reflow≫ phenomenon). The reason for the development of this phenomenon is associated, first of all, with distal embolization by thrombotic masses and fragments of atherosclerotic plaque. In order to prevent this complication, manual thromboextraction was developed – the aspiration of thrombotic masses from the infarct-related artery. The manual thrombus aspiration has not been proven effective in a number of large randomized trials. In addition to the lack of influence on the prognosis, the method of manual thrombus aspiration significantly more often led to the development of ischemic strokes and currently should not be routinely carried out. Another method of preventing the phenomenon of delayed or unrecoverable blood flow is the use of glycoprotein IIb/IIIa receptor inhibitors which is, in contrast to the instrumental method, effective and relatively safe. According to a number of large randomized trials, drug treatment of this complication influences life expectancy in patients with ST-elevation myocardial infarction. At a time when there is already a meta-analysis on the routine use of glycoprotein IIb/IIIa receptor inhibitors during primary percutaneous coronary intervention and their positive impact on survival, in our country, unfortunately, the importance of these drugs is underestimated and according to the register they are used only in 3% of patients with ST-segment elevation myocardial infarction. This review presents studies and comparisons of glycoprotein IIb/IIIa receptor inhibitors existing on the market.

Acute Myocardial Infarction Due to Left Circumflex Artery Occlusion and Significance of ST-Segment Elevation

2010 ◽  
Vol 106 (8) ◽  
pp. 1081-1085 ◽  
Author(s):  
Aaron M. From ◽  
Patricia J.M. Best ◽  
Ryan J. Lennon ◽  
Charanjit S. Rihal ◽  
Abhiram Prasad
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Artery Occlusion ◽  
Circumflex Artery ◽  
St Segment Elevation ◽  
Left Circumflex Artery ◽  
St Segment

scholarly journals Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction in a Patient Taking Dabigatran for Chronic Anticoagulation

2015 ◽  
Vol 42 (2) ◽  
pp. 158-161
Author(s):  
Imdad Ahmed ◽  
Stephen J. Voyce
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Primary Percutaneous Coronary Intervention ◽  
Oral Anticoagulation ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Interventional cardiologists have few data on which to base clinical decisions regarding optimal care for ST-segment-elevation myocardial infarction patients who are taking therapeutic chronic oral anticoagulation. We present what we believe to be the first reported case of emergency coronary angiography and primary percutaneous coronary intervention in an ST-segment-elevation myocardial infarction patient who was on a dabigatran regimen for atrial fibrillation. The patient tolerated the procedures well and had no observable bleeding sequelae. In addition to the patient's case, we discuss the current evidence regarding the periprocedural management of oral anticoagulation in patients who need coronary angiography and percutaneous coronary intervention.

scholarly journals Anomalous Origin of a Stenosed Left Circumflex Coronary Artery in a Patient Presenting with Unstable Angina: A Case Report

2016 ◽  
Vol 54 (4) ◽  
pp. 247-249
Author(s):  
Hossein Vakili ◽  
Isa Khaheshi ◽  
Mehdi Memaryan ◽  
Mohammadreza Naderian
Keyword(s):  
Case Report ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Unstable Angina ◽  
Coronary Intervention ◽  
Sinus Of Valsalva ◽  
Circumflex Coronary Artery ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Diagnostic Coronary Angiography

Abstract 73 year-old man presented to our emergency department with complaint of retrosternal chest pain since 2 day and admitted with diagnosis of unstable angina. He underwent diagnostic coronary angiography in which left circumflex artery (LCX) was not visualized during injection of the left coronary artery; indeed, it was originated, with common origin with RCA, from right coronary sinus of Valsalva. This case report is one of the uncommon cases with aberrant coronary arteries who presented with unstable angina. Moreover, coronary angiography with following coronary angioplasty was performed for him in a challenging course and angle for coronary intervention.

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