RESUMO
OBJECTIVES: 1. To study the incidence and clinical features of patients with Congenital Coronary Anomalies of Origin from Oppossite or Non-coronary Sinus; 2. To study the course of these Anomalous Coronary Artery Origins with CT Coronary Angiography. METHODS: A Cross Sectional Observation study was conducted at Department of Cardiology, in a tertiary Hospital for a period of 3 years. Patients undergoing Coronary Angiography (CAG) were screened and patients having Anomalous Coronary Origin from the Opposite or Non-Coronary Sinus of Valsalva were selected. CT Cronary Angiography was done in all such patients and the course of the anomalous artery was studied. RESULTS: During the 3 years period of study, total of 5241 CAGs were conducted of which 42 (0.8%) patients were found to have Anomalous Coronary Artery Origin as per the inclusion criteria. Out of the 42 cases, Anomalous origin of RCA from Left Corornary Cusp was the commonest with 23(0.43%) cases, followed by Anomalous Origin of LCX from Right Coronary or RCC with 17 (0.32%) cases. Other anomalies of origin were quite rare (n=2) which included Anomalous origin of Left Main from RCA (n=1) and Dual origin of LAD (n=1). CT Coronary Angiography showed that of the 23 patients with Anomalous Origin of RCA from Left side,27.4% had Inter-Arterial course and 56.1% had Retro-Aortic course. Of the 17 patients with Anomalous Origin of LCX from Right sinus, 88.23% had Retro-Aortic course. CONCLUSIONS: This study showed that anomalous origin of Coronary Artery from the opposite sinus is quite rare with RCA from Left Sinus and LCX from Right sinus comprised the vast majority of cases. Most of these anomalous Coronaries have on benign course as defined on CT Coronary Angiography. However, it is important to recognize to delineate the origin and course as it can have significant clinical, therapeutic and prognostic implications.
Assuntos
Anomalias dos Vasos Coronários , Seio Aórtico , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Estudos Transversais , Humanos , PrevalênciaRESUMO
We report a 30 year female with rheumatic mitral stenosis, presenting with progressive right heart failure without overt leftheart symptoms. Rapid progression to severe right heart failure with moderate pericardial effusion prompted the diagnosis of associated restrictive cardiomyopathy. A MRI scan of the heart revealed diffuse subendocardial scarring of LV and RV explaining patient's rapid downhill course.
Assuntos
Países em Desenvolvimento , Fibrose Endomiocárdica/diagnóstico , Ventrículos do Coração , Estenose da Valva Mitral/diagnóstico , Cardiopatia Reumática/diagnóstico , Disfunção Ventricular Direita/diagnóstico , Adulto , Cardiomiopatia Restritiva/diagnóstico , Diagnóstico Diferencial , Progressão da Doença , Ecocardiografia , Eletrocardiografia , Evolução Fatal , Feminino , Ventrículos do Coração/patologia , Humanos , Índia , Imagem Cinética por Ressonância Magnética , Valva Mitral/patologia , Derrame Pericárdico/diagnóstico , PrognósticoRESUMO
A young male presented with multiple xanthomas and xanthelesmas, progressive breathlessness and angina on exertion. Investigations confirmed diagnosis of familial hypercholesterolaemia, bicuspid aortic valve with severe aortic stenosis and significant obstructive coronary artery disease.
Assuntos
Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/complicações , Hiperlipoproteinemia Tipo II/complicações , Adolescente , Estenose da Valva Aórtica/etiologia , Doença da Válvula Aórtica Bicúspide , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/etiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Masculino , RadiografiaRESUMO
Idiopathic ventricular tachycardia is a defined set of tachycardias when structural or pathological cause has been ruled out for the same. This paper tries to define and classify these arrhythmias to organize a logical therapeutic approach to deal with them. 60-80% of the idiopathic tachycardias originate from the right ventricular outflow tract (RVOT) and in 10% from the left ventricular outflow tract (LVOT). Outflow tract tachycardias have either LBBB or RBBB morphology with early R wave transition in chest leads. Adenosine, beta blockers and calcium channel blockers is the common medical treatment. Radiofrequency ablation is however the treatment of choice. Verapamil sensitive left ventricular tachycardia (ILVT) and propranolol sensitive left ventricular tachycardia (IPVT) are the other two forms recognized. RF ablation seems ideal for long-term management of ILVT and implantable cardioverter defibrillator (ICD) for IPVT. Inherited channelopathies include catecholaminergic polymorphic ventricular tachycardia (CPVT), Brugada syndrome and long QT syndrome where there is an inherited disorder in the ion-exchange channels of the cell-membrane leading to tachycardia. Prognosis in these is variable; CPVT, in particular, has a malignant course when untreated. RF ablation and placement of an ICD are important in the overall management of specific arrhythmia.
Assuntos
Taquicardia Ventricular , Adenosina/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Ablação por Cateter , Desfibriladores Implantáveis , Eletrocardiografia , Humanos , Prognóstico , Taquicardia Ventricular/classificação , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/terapiaAssuntos
Taquicardia Ventricular , Antiarrítmicos/uso terapêutico , Ablação por Cateter , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Eletrocardiografia , Serviços Médicos de Emergência , Previsões , Humanos , Recidiva , Risco , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/terapiaRESUMO
An 18-year-old girl with pre-excitation presented with a history of recurrent syncope preceded by palpitation. The accessory pathway, which had a relatively long antegrade effective refractory period of 340 ms, was mapped and successfully ablated in the left lateral region. However, after ablation, she had reproducible sustained polymorphic ventricular tachycardia, which was found to be the cause of her syncope. Thus, alternate mechanisms of tachycardia need to be considered in patients with pre-excitation when the presentation is atypical.
Assuntos
Síndromes de Pré-Excitação/complicações , Síndromes de Pré-Excitação/fisiopatologia , Síncope/etiologia , Síncope/fisiopatologia , Adolescente , Ablação por Cateter , Eletrocardiografia , Feminino , Humanos , Síndromes de Pré-Excitação/cirurgia , Síncope/cirurgia , Taquicardia Ventricular/complicações , Taquicardia Ventricular/fisiopatologiaRESUMO
A total of 29 patients with mycologically and histopathologically proven mycetomas were examined for radiological manifestations from April 1984 to March 1996. Twenty cases were actinomycotic mycetomas, while nine were maduromycotic mycetomas. Plain x-rays of the regions of interest were taken in all the cases and CT scan was performed on five selected cases to compare the findings. Soft tissue changes were observed in all the examined cases, while bony changes were observed in 16 (55.7%). CT scan is useful for showing soft tissue changes, erosion and destruction of bone in cases with an early infection only, which cannot be demonstrated in plain radiographs.
RESUMO
Tetanus in lepromatous leprosy is rare and reported occasionally as case reports only. We present a case of lepromatous leprosy who succumbed to death due to rapidly progressing tetanus. The mechanism of protection from tetanus in leprosy is discussed.