Assuntos
Adenosina/análogos & derivados , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Cloridrato de Prasugrel/uso terapêutico , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Adenosina/uso terapêutico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Estudos Retrospectivos , Ticagrelor , Resultado do TratamentoAssuntos
Algoritmos , Doença da Artéria Coronariana/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Imagem Multimodal/métodos , Fístula Vascular/diagnóstico , Angiografia Coronária/métodos , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/terapia , Anomalias dos Vasos Coronários/terapia , Gerenciamento Clínico , Ecocardiografia/métodos , Humanos , Tomografia Computadorizada Multidetectores/métodos , Imagem de Perfusão do Miocárdio/métodos , Prognóstico , Fístula Vascular/etiologia , Fístula Vascular/terapiaAssuntos
Angioplastia Coronária com Balão/efeitos adversos , Doença das Coronárias/cirurgia , Reestenose Coronária , Stents Farmacológicos/efeitos adversos , Implantes Absorvíveis , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Doença das Coronárias/diagnóstico , Doença das Coronárias/fisiopatologia , Reestenose Coronária/diagnóstico , Reestenose Coronária/fisiopatologia , Reestenose Coronária/cirurgia , Gerenciamento Clínico , Análise de Falha de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação/métodos , Alicerces Teciduais , Tomografia de Coerência Óptica/métodos , Ultrassonografia de Intervenção/métodosAssuntos
Adenosina , Angiografia Coronária/métodos , Vasos Coronários , Reserva Fracionada de Fluxo Miocárdico , Fibrilação Ventricular , Adenosina/administração & dosagem , Adenosina/efeitos adversos , Angina Instável/diagnóstico , Angina Instável/etiologia , Fármacos Cardiovasculares/administração & dosagem , Fármacos Cardiovasculares/efeitos adversos , Estenose Coronária/complicações , Estenose Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Fibrilação Ventricular/induzido quimicamente , Fibrilação Ventricular/terapiaAssuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Imagem Multimodal/métodos , Doenças Vasculares/congênito , Diagnóstico Precoce , Humanos , Guias de Prática Clínica como Assunto , Tomografia de Coerência Óptica/métodos , Ultrassonografia de Intervenção/métodos , Doenças Vasculares/diagnóstico por imagemRESUMO
Coronary artery fistulas represent the most common hemodynamically significant congenital defect of the coronary arteries and the clinical presentation is mainly dependent on the severity of the left-to-right shunt. We describe a case of a 55-year-old man with history of chest pain and without history of previous significant chest wall trauma or any invasive cardiac procedures. A coronary multislice computed tomography showed two large coronary fistulas arising from the left anterior descending coronary artery and ending in an angiomatous plexus draining into the common pulmonary trunk. Coronary angiography confirmed the CT finding and showed a third fistulous communication arising from the sinus node artery. Although coronary fistulas are infrequent, they are becoming increasingly important because their management and treatment could prevent serious complications. The latest guidelines of the American College of Cardiology/American Heart Association indicate as Class I recommendation the percutaneous or surgical closure for large fistulas regardless of symptoms. In this manuscript, we provide a detailed review of the literature on this topic, focusing on the clinical management of these patients.
Assuntos
Angina Pectoris/cirurgia , Doença da Artéria Coronariana/cirurgia , Fístula/cirurgia , Artéria Pulmonar/cirurgia , Angina Pectoris/diagnóstico , Angina Pectoris/patologia , Angiografia Coronária/métodos , Doença da Artéria Coronariana/complicações , Fístula/etiologia , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
INTRODUCTION: Eosinophilic granulomatosis with polyangiitis is a rare and potentially fatal disease if not readily diagnosed. Cerebral involvement is extremely rare and clinical presentation as hemorrhagic stroke is even rarer. CASE PRESENTATION: A 58-year-old Caucasian man was admitted to our medical unit because of a computed tomography-diagnosed hemorrhagic stroke with right-sided hemiparesis and fever. A chest computed tomography scan also revealed multiple bilateral pulmonary infiltrates; coronary artery, and carotid and left vertebral artery calcifications were also observed. Empiric antimicrobial therapy with cephalosporins was promptly undertaken; low-molecular-weight heparin was introduced as prophylaxis for venous thromboembolism. Over the following days, magnetic resonance imaging scans showed a regression of the hemorrhagic framework, also revealing hypoxic areas consistent with acute ischemic lesions. With a computed tomography scan showing a worsening of his pulmonary framework, antimicrobial therapy was modified and corticosteroids were introduced. A new blood cell count revealed further increased leukocytosis (17.49 × 10(3) µL), characterized by a surprising rise of eosinophilic cells (32.8%). Angiography of the coronary arteries found diffuse dilatations with severe signs of endothelial damage. Such an unexpected framework induced a strong suspicion that the stroke was the expression of a systemic vasculitis, which had triggered his cerebral, coronary, and pulmonary frameworks. The search for antineutrophil cytoplasmic antibody was positive for perinuclear antineutrophil cytoplasmic antibody, and eosinophilic granulomatosis with polyangiitis was diagnosed. Explaining to the patient the rarity of his disease, and what the most typical presentations of eosinophilic granulomatosis with polyangiitis were, he revealed that before admission he had had scalp injuries, in the nuchal region, and had taken corticosteroids as self-medication, with subsequent disappearance of the lesions. Therefore, high-dose corticosteroid treatment was started, and at discharge he was in good clinical condition with a slight right-sided hyposthenia. CONCLUSIONS: A diagnosis of eosinophilic granulomatosis with polyangiitis is often difficult, but we are convinced that intake of corticosteroids on a self-prescribed basis may have obscured the clinical presentation. Therefore, this case also suggests how the growing phenomenon of self-medication can be harmful, and that a careful investigation of clinical history is still an act of paramount importance.
Assuntos
Infarto Cerebral/diagnóstico , Síndrome de Churg-Strauss/diagnóstico , Pulmão/diagnóstico por imagem , Automedicação , Hemorragia Subaracnóidea/diagnóstico , Corticosteroides/uso terapêutico , Infarto Cerebral/etiologia , Síndrome de Churg-Strauss/complicações , Síndrome de Churg-Strauss/tratamento farmacológico , Angiografia Coronária , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Hemorragia Subaracnóidea/etiologiaAssuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/diagnóstico , Tomada de Decisões , Stents Farmacológicos , Trombose/diagnóstico , Ponte de Artéria Coronária/estatística & dados numéricos , Doença da Artéria Coronariana/terapia , Stents Farmacológicos/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Trombose/terapiaRESUMO
AIM: To compare the incidence, and risk factors, in-hospital and at the 18-month prognosis of contrast-induced nephropathy (CIN) according to the definition utilized: as an increase in serum creatinine (Scr) ≥ 0.5 mg/dL (CIN 1) or as an increase in Scr ≥ 25% above baseline values (CIN 2). METHODS AND RESULTS: We prospectively evaluated CIN according to two different definitions in 150 patients who underwent percutaneous coronary intervention (PCI) in simple lesions employing a low-medium dose of contrast media. Incidence of CIN was higher using the CIN 2 definition than CIN 1 (9.3% vs. 4%; p=0.0133). Patients with CIN 1 had a higher incidence of chronic kidney disease (CKD) (66.7% vs. 13.9%; p=0.006), higher mean serum creatinine levels (1.35±0.42 vs. 0.98±0.35; p=0.001) and lower mean eGFR levels (58.3±19.6 vs. 84±25.9; p=0.002). Patients with CIN 2 had a higher incidence of anemia (57.1% vs. 30.9%; p=0.049) and a higher mean contrast media volume was used (142.6±62.2 mL vs. 110.6±57.2 mL; p=0.05). In the multivariate analysis the only significant variable associated with CIN (CIN 2) was a higher volume of contrast media (OR=1.01; p=0.04). There were no differences in the major in-hospital events, but patients with CIN (both definitions) had a longer in-hospital stay. A persistent rise in serum creatinine at discharge occurred in only one patient. There were no differences between patients with and without CIN in events at the follow-up, with the exception of an increased risk of new hospitalization in patients with CIN 2. CONCLUSION: After PCI employing low-medium dose of contrast media the incidence of CIN varied according to the definition used. Neither of the two definitions offers additional information compared with the other. Chronic kidney disease and baseline parameters of renal function are the risk factors associated with CIN 1; anemia and higher volume of contrast media are associated with CIN 2.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Meios de Contraste/efeitos adversos , Nefropatias/etiologia , Idoso , Anemia/complicações , Meios de Contraste/administração & dosagem , Creatinina/sangue , Feminino , Humanos , Incidência , Itália/epidemiologia , Nefropatias/sangue , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Insuficiência Renal Crônica/complicações , Fatores de RiscoRESUMO
BACKGROUND: Coronary angiography is actually the gold standard to visualize coronary artery bypass graft patency and to detect bypass stenoses. However, it is an invasive examination that makes use of X-ray emission and it may lead to deleterious effects even at low dosage. Therefore, it is still needed a non-invasive examination with good diagnostic accuracy for the follow-up of patients with coronary artery bypass grafts. The aim of this study was to evaluate the diagnostic accuracy of a 40-row multidetector computed tomography scanner for the assessment of bypass surgery versus coronary angiography. METHODS: Twenty-six consecutive patients (20 male, 6 female, mean age 65 years) and a total number of 68 coronary bypass grafts (25 arterial and 43 venous grafts, 111 anastomoses) were examined by 40-row multidetector computed tomography. RESULTS: It was possible to analyze coronary artery bypass graft patency for every patient. At coronary angiography 23 patients showed bypass stenoses or occlusion: 19 of them were correctly diagnosed by computed tomography (sensitivity 84%, specificity 100%). In particular, computed tomography showed a sensitivity of 90% and a specificity of 100% for coronary artery bypass grafts, whereas it showed a sensitivity of 88% and a specificity of 94% for anastomoses. CONCLUSIONS: On the basis of the results of our study, computed tomography is a valuable tool for assessing coronary artery bypass graft patency in patients with clinical suspect of coronary occlusion.