The Physical Examination Does Matter: A Case of Spontaneous Aortocaval Fistula.

A spontaneous aortocaval fistula is a rare complication of abdominal aortic aneurysms. In 50 percent of the patients, it presents with the classic signs of a pulsatile abdominal mass, continuous bruit, and low back pain. A high degree of clinical suspicion and a well-performed physical examination are important for its timely diagnosis.

Anomalous left internal mammary artery arising from an aberrant artery of the aorta in a patient with "pseudo bovine" aortic arch anatomy.

Many different aortic arch variants have been documented before. Pseudo bovine arch is the most common variant of the aortic arch. Pseudo bovine arch with other factors such as stenosis and calcification impose great difficulties even for experienced cardiologists. Knowledge of anatomical variants is useful information for interventional cardiologist, radiologist, and thoracic surgeons. Left vertebral artery left internal mammary artery (LIMA) alterations have been published a few times before, but here we present a first case to our knowledge with LIMA arising from an aberrant arterial branch of the aorta in a patient with a pseudo bovine aortic arch anatomy. .

Myocardial Bridge Complicated by Acute Myocardial Infarction.

Typically, myocardial bridging (MB) is considered a relatively benign condition; however, serious complications such as angina pectoris, myocardial infarction (MI), and sudden cardiac death may occur. The diagnosis and appropriate treatment of this pathology are important. We report a case of acute anterior wall ST-elevation MI occurring as a complication of MB involving the mid segment of the left anterior descending artery in a young, otherwise healthy woman who underwent a primary stenting procedure. Pathophysiologic mechanisms underlying the process leading from MB to acute MI vary, and so should the therapy for those patients. Coronary angiography, intravascular ultrasound, and, potentially, optical coherence tomography should be used to assist in establishing an accurate diagnosis in these complex patients and should guide the therapeutic decision in acute settings.

Cardiac sarcoid: a clinician's review on how to approach the patient with cardiac sarcoid.

Cardiac sarcoid is an infiltrative, granulomatous disease of the myocardium. It is more prevalent entity than once believed, especially subclinical disease. It affects heart mechanics causing ventricular failure, and disrupts the cardiac electrical system leading to third degree heart block, malignant ventricular arrhythmias, and sudden cardiac death. This makes early diagnosis and treatment of this devastating disease essential. Based on reviewed literature this paper proposes step-wise diagnostic and therapeutic algorithms for patients with suspected cardiac sarcoidoisis who do or do not have prior history of systemic sarcoidosis.

Transbrachial intra-aortic balloon pumping for high-risk percutaneous coronary intervention.

The beneficial effect of placement of intra-aortic balloon (IAB) pump before revascularization in patients with high-risk coronary anatomy and impaired left ventricular systolic function is documented. However, the conventional insertion of IAB pump via the common femoral artery may be contraindicated or may be even impossible in patients with severe vascular disease. Recently, the percutaneous insertion of IAB via the brachial artery has been shown to be effective and safe in small series of patients with vascular disease undergoing coronary artery bypass surgery. The authors report their experience with a patient with aortobifemoral bypass grafts who underwent successful stenting of a trifurcating distal left main stenosis after placement of a 7.5-Fr IAB pump via the left brachial artery.

Percutaneous intervention of Cabrol graft-left main anastomosis during acute myocardial infarction.

The Cabrol technique is used to reimplant coronary arteries after aortic root replacement using a Dacron graft interposed between the aortic root graft and the native coronary artery. Although stenosis of the graft-coronary anastomosis has been described, there have been few reports of percutaneous intervention to these stenoses. An understanding of the Cabrol technique and its associated anatomical considerations is essential for invasive cardiologists, as they may encounter patients who have undergone this procedure. We report a case of emergent percutaneous intervention to a Cabrol graft-left main anastomosis in a patient who presented with acute myocardial infarction complicated by cardiogenic shock.

Circulating Chlamydia pneumoniae DNA and advanced coronary artery disease.

BACKGROUND: Chlamydia pneumoniae (C. pneumoniae) has been linked to atherosclerosis. Detection of this pathogen in peripheral blood cells may be valuable in the diagnosis of disease state. This study aimed to evaluate the prevalence of circulating C. pneumoniae DNA and its relationship with severity and extent of coronary artery disease (CAD). METHODS: Blood samples from 269 patients undergoing coronary angiography were collected. The presence of circulating C. pneumoniae DNA was determined by real-time PCR assay. Data regarding coronary risk factors and severity and extent of CAD were collected. Severity and extent of CAD was defined by the number of major epicardial coronary arteries with >50% stenosis and by the Duke jeopardy score. RESULTS: Sixteen of 269 specimens (5.9%) from the study cohort were positive for C. pneumoniae DNA. Thirteen specimens among 149 samples from patients with multi-vessel disease (8.7%) were positive for C. pneumoniae DNA compared with 3 of 120 (2.5%) among patients without multi-vessel CAD. The prevalence of circulating C. pneumoniae DNA was significantly associated with multi-vessel disease. The odds ratio was 5.1 (P=0.02) after adjustment for conventional risk factors. CONCLUSIONS: Presence of circulating C. pneumoniae DNA is associated with advanced CAD, suggesting C. pneumoniae infection as a contributing factor to progression of coronary atherosclerosis.