Management of arrythmia in the COVID 19 era

There is currently well-documented evidence that SARS CoV2 infection is frequently associated with secondary cardiac damage. Although lung damage is a priority, the evolution over time of COVID 19 infection frequently includes cardiovascular complications, the most common being: myocarditis, heart failure and acute coronary syndrome resulting from coronary artery thrombosis or plaque ruptures associated with SARS-CoV-2. Therefore, for the judicious use of resources, both human and material, and for the protection of medical staff, it is necessary to establish standard procedures to limit the contact of medical staff with the infected patient COVID 19.

Kawasaki Disease and General Anesthesia for Dental Treatment: A Case Report

Kawasaki disease (KD) is an acute vasculitis of childhood and is the leading cause of acquired heart disease in children in developed countries. Failure to quickly diagnose and treat patients with KD can result in severe cardiac sequelae, especially coronary artery aneurysms (CAAs). Patients with a prior diagnosis of KD who require general anesthesia (GA) may present unique challenges depending on the severity of any cardiovascular sequelae. This case report describes the perioperative management of a 5-year-old male patient previously diagnosed with incomplete KD approximately 1 year before presenting to Stony Brook University Hospital for full mouth dental rehabilitation under GA. Most uniquely, the patient was at high risk for coronary artery thrombosis due to a giant CAA of his right coronary artery and a small CAA of his left anterior descending artery. The discussion also includes the implications of dental treatment under GA for patients with a history of KD.

Computational modeling of blood component transport related to coronary artery thrombosis in Kawasaki disease

Coronary artery thrombosis is the major risk associated with Kawasaki disease (KD). Long-term management of KD patients with persistent aneurysms requires a thrombotic risk assessment and clinical decisions regarding the administration of anticoagulation therapy. Computational fluid dynamics has demonstrated that abnormal KD coronary artery hemodynamics can be associated with thrombosis. However, the underlying mechanisms of clot formation are not yet fully understood. Here we present a new model incorporating data from patient-specific simulated velocity fields to track platelet activation and accumulation. We use a system of Reaction-Advection-Diffusion equations solved with a stabilized finite element method to describe the evolution of non-activated platelets and activated platelet concentrations [AP], local concentrations of adenosine diphosphate (ADP) and poly-phosphate (PolyP). The activation of platelets is modeled as a function of shear-rate exposure and local concentration of agonists. We compared the distribution of activated platelets in a healthy coronary case and six cases with coronary artery aneurysms caused by KD, including three with confirmed thrombosis. Results show spatial correlation between regions of higher concentration of activated platelets and the reported location of the clot, suggesting predictive capabilities of this model towards identifying regions at high risk for thrombosis. Also, the concentration levels of ADP and PolyP in cases with confirmed thrombosis are higher than the reported critical values associated with platelet aggregation (ADP) and activation of the intrinsic coagulation pathway (PolyP). These findings suggest the potential initiation of a coagulation pathway even in the absence of an extrinsic factor. Finally, computational simulations show that in regions of flow stagnation, biochemical activation, as a result of local agonist concentration, is dominant. Identifying the leading factors to a pro-coagulant environment in each case—mechanical or biochemical—could help define improved strategies for thrombosis prevention tailored for each patient.

Emergency treatment of thrombus in right coronary artery and aortic root in a newborn with acute myocardial infarction

Perinatal myocardial infarction caused by aortic root and coronary artery thrombosis in neonatal period is extremely rare and has a gloomy prognosis that may cause devastating complications. A 3-h newborn baby who had acute myocardial infarction findings on postnatal electrocardiography had a thrombus in the aortic root with hyperechogenic right coronary artery region, and impaired right ventricular functions on echocardiography. The patient was urgently operated and thrombus was successfully removed from the aortic root and the right coronary artery. In conclusion, for large thrombi posing a risk for embolization in the aortic root, an urgent surgical thrombectomy procedure should be performed.

The Complementary Relationship Between Echocardiography and Multi-Slice Spiral CT Coronary Angiography in the Diagnosis of Coronary Artery Thrombosis in Children With Kawasaki Disease

Aim: To compare the diagnostic values by using transthoracic echocardiography (ECHO) and multi-slice spiral CT coronary angiography (CTCA) for identifying coronary artery thrombosis in children with Kawasaki disease (KD).Methods: Total 97 KD children with coronary artery dilation complications in our hospital from June 2012 to December 2020 were included in the study. CTCA and ECHO were performed after over 1 month of illness.Results: Coronary artery thrombosis was found in 14 out of 97 patients. Among them, 10 were identified as positive by CTCA, 9 were identified as positive by ECHO, and 5 were identified as positive by both CTCA and ECHO.Conclusion: Both CTCA and ECHO can be used to diagnose coronary artery thrombosis. ECHO has advantage in identifying low-density thrombus, and CTCA is better for the clot in distal coronary artery. They can complement each other.

Left main coronary artery thrombus after cannabis consumption: a case report

Background Left main coronary thrombus is a rare angiographic finding associated with serious outcomes such as sudden death and cardiogenic shock. Rupture of an underlying atherosclerotic plaque is the main risk factor. The role of cannabis consumption in the pathophysiology of acute cardiovascular disease is controversial. Case presentation We present a case of non-ST-elevation myocardial infarction characterized by a mobile left main coronary thrombus in a young male cannabis consumer successfully treated with manual aspiration, dual anti-platelet, and unfractionated heparin therapy. Conclusion Cannabis consumption could be a risk factor for coronary artery thrombosis. The pathophysiology mechanism of action is not well understood. Reaching an optimal management is a potential challenge for physicians.

Surgical Thrombectomy of dual coronary artery thrombosis

Concomitant thrombosis of two coronary arteries is an uncommon condition that is reported to cause sudden cardiac death. In this paper, we describe the case of a 42-year-old man who presented with simultaneous LAD and RCA occlusion causing anterior and inferior myocardial infarctions. PCI was attempted and failed, an Intra-Aortic Balloon Pump (IABP) was inserted and the patient was referred to surgery. Following surgical thrombectomy and coronary artery bypass grafting (CABG), the patient recovered with no complications.

On the 95th anniversary of the first description of right ventricular myocardial infarction

An analysis of the publication of the outstanding Russian therapist and cardiologist D.D. Pletnev (18711941) is given in the article. In 1925, he published an article On the issue of lifetime differential diagnosis of right and left coronary artery thrombosis in the journal Russian Clinics in Russian and German languages. Timely diagnosis of right myocardial infarction determines the prognosis and treatment tactics of this disease, and the case itself has a priority for the Russian science. The authors emphasize the outstanding talent of D.D. Pletnev as a physician and scientist, whose name is associated with the emergence of one of the most brilliant therapeutic schools (A.L. Myasnikov, E.I. Chazov, etc.).