Assuntos
Tamponamento Cardíaco , Derrame Pericárdico , Humanos , Pericardiocentese , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Derrame Pericárdico/cirurgia , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Estudos RetrospectivosRESUMO
A man in his 40s who was previously well had an out-of-hospital cardiac arrest. Postresuscitation ECG showed ST-elevation myocardial infarction (MI). Emergency coronary angiogram revealed MI with non-obstructive coronary arteries (MINOCA) with evidence of spasm in the right coronary artery. Both his echocardiogram and cardiac MRI revealed a normal heart. Further workup showed markedly elevated free T4 (99.5 pmol/L) and free T3 (26.7 pmol/L) with low thyroid stimulating hormone (<0.02 pmol/L) in keeping with thyroid storm. He also had an elevated adjusted calcium level (2.84 mmol/L), which could have contributed to his coronary artery spasm. His peak troponin T was elevated at 798 ng/L (<14) suggesting myocardial damage. He was treated with propylthiouracil, steroids, beta-blocker, calcium channel blocker and intravenous fluids. The patient achieved a full recovery and was discharged home. This is an unusual case of thyroid dysfunction resulting in coronary artery spasm, cardiac arrest and MINOCA.
Assuntos
Vasoespasmo Coronário , Parada Cardíaca , Masculino , Humanos , Vasoespasmo Coronário/complicações , Vasoespasmo Coronário/diagnóstico por imagem , MINOCA , Vasos Coronários/diagnóstico por imagem , Angiografia Coronária , Parada Cardíaca/complicaçõesRESUMO
Imagine that it is possible to know, the actual coronary blood flow. Would this not remove any doubt, if a chest pain is the heart's fault?
RESUMO
Radial artery access has transformed cardiac catheterisation, allowing it to be performed in a daycase setting, saving both hospital beds, and nursing care costs. However, there are two common and seemingly diametrically opposite complications. These are radial artery occlusion and forearm haematoma; the former could be reduced by heparin, but at the expense of precipitating the latter. These complications increase proportionally to the size of radial artery sheath used. Interestingly, by cannulating the radial artery more distally beyond its bifurcation in the hand, the distal radial approach appears to be the 'one stone, two birds' or the synchronous Chinese idiom, 'yishí'èrniao's' solution, reducing both complications at the same time. Extending this further and downsizing to a 4Fr catheter system, heparin use could be spared altogether, without complications, and haemostasis achieved with short manual pressure at the puncture site. Hence, further cost savings by foregoing commercial compression bands, and abolishing access site care for nurses. We illustrate the above strategy in a patient with challenging radial anatomy, made simple and easy.