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1.
Artigo em Inglês | MEDLINE | ID: mdl-38966496

RESUMO

Coronary artery anomalies (CAA) define a wide array of congenital abnormalities that stem from the origin, course, and distribution of coronary arteries. CAAs can lead to severe complications such as arrhythmias, myocardial ischemia, and even sudden cardiac death. We describe the case of a 58-year-old female who presented to the emergency department with chest discomfort and shortness of breath and received a workup for acute coronary syndrome. She underwent a cardiac catheterization, which incidentally found an anomalous left anterior descending artery with a right sinus of Valsalva origin, an absent left circumflex coronary artery, and a dominant right coronary artery of unusually large caliber and distribution. There were no identified atherosclerotic plaques. This anomalous configuration of the coronary arteries is exceptionally rare. She required medical management with daily oral acetylsalicylic acid 81 mg, atorvastatin 80 mg, twice daily metoprolol tartrate 50 mg, and hydrocodone/acetaminophen 7.5mg/325 mg oral tablet to be taken every 4 h, as needed for severe pain. Despite optimal medical management, she continued to have chronic angina. A surgical evaluation by a cardiovascular surgeon deemed her anomaly to be inoperable.

2.
Am J Cardiol ; 101(4): 467-70, 2008 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-18312759

RESUMO

The prevalence of >70% narrowing of 1, 2, or 3 major coronary arteries and of 3 major coronary arteries was investigated in 2,465 patients (1,437 men, 1,028 women; mean age 69 +/- 13 years) with severe, moderate, mild, or no mitral annular calcium (MAC) diagnosed by 2-dimensional echocardiography who underwent coronary angiography for suspected coronary artery disease. Greater than 70% narrowing of 1, 2, or 3 major coronary arteries was present in 259 of 315 patients (82%) with severe MAC (group 1), in 835 of 1,052 patients (79%) with moderate or mild MAC (group 2), and in 756 of 1,098 patients (69%) with no MAC (group 3) (p <0.001 comparing group 1 with group 3 and group 2 with group 3). Greater than 70% narrowing of 3 major coronary arteries was present in 149 of 315 patients (47%) in group 1, in 366 of 1,052 patients (35%) in group 2, and in 325 of 1,098 patients (30%) in group 3 (p <0.001 comparing group 1 with group 3 and group 1 with group 2; p <0.01 comparing group 2 with group 3). In conclusion, MAC is associated with obstructive >or=1-vessel coronary artery disease and with obstructive 3-vessel coronary artery disease.


Assuntos
Calcinose/diagnóstico por imagem , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Idoso , Feminino , Humanos , Masculino , Prevalência , Índice de Gravidade de Doença , Ultrassonografia
3.
J Gerontol A Biol Sci Med Sci ; 60(5): 605-6, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15972612

RESUMO

BACKGROUND: Little is known about patients admitted with chest pain to inpatient telemetry units directly from an emergency department. METHODS: We analyzed data from 105 consecutive patients who presented with chest pain to an emergency department and who were hospitalized in an inpatient telemetry unit but who were at low risk for a coronary event. RESULTS: Telemetry yielded no information which was used to manage any patient. None of the 105 patients (0%) developed a myocardial infarction or died during hospitalization. At 4.8-year follow-up, 8 of 105 patients (8%) died. Significant risk factors for long-term mortality were age (p < .001), prior coronary artery disease (p < .05), and diabetes (p < .02). CONCLUSIONS: Inpatient telemetry was of no value in predicting short-term coronary events or mortality or long-term mortality in low-risk patients hospitalized with chest pain.


Assuntos
Dor no Peito/diagnóstico , Dor no Peito/mortalidade , Mortalidade Hospitalar/tendências , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Telemetria/normas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Dor no Peito/terapia , Feminino , Seguimentos , Avaliação Geriátrica , Hospitalização , Humanos , Pacientes Internados , Masculino , Infarto do Miocárdio/terapia , Probabilidade , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Telemetria/tendências
4.
Cardiol Rev ; 13(5): 219-22, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16106182

RESUMO

Coronary artery anomalies have an incidence of 0.6% to 1.3% in angiographic studies and 0.3% in an autopsy series. Anomalous origin of the left main coronary artery (LMCA) from the right sinus of Valsalva (RSOV) represents a small fraction (1.3%) of these anomalies, with an overall prevalence of 0.017% to 0.03% in angiographic studies. The high incidence of sudden cardiac death associated with this specific anomaly during or immediately after vigorous physical exercise makes identification and appropriate surgical intervention critical. We present a case report of a 14-year-old patient with an LMCA arising from the RSOV with an initial intramural course, presenting with acute myocardial infarction (AMI) as the first indication of the anomaly. Transthoracic echocardiogram suggested this anomaly, which was confirmed by cardiac catheterization and transesophageal echocardiogram.


Assuntos
Anomalias dos Vasos Coronários/complicações , Vasos Coronários/cirurgia , Ecocardiografia Transesofagiana , Infarto do Miocárdio/etiologia , Seio Aórtico/anormalidades , Adolescente , Aspirina/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/métodos , Fármacos Cardiovasculares/uso terapêutico , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Eletrocardiografia , Enalapril/uso terapêutico , Hemodinâmica , Humanos , Incidência , Masculino , Metoprolol/uso terapêutico , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Seio Aórtico/diagnóstico por imagem , Resultado do Tratamento
5.
Am J Cardiol ; 93(6): 763-4, 2004 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-15019888

RESUMO

Percutaneous transluminal coronary angioplasty (PTCA) was performed in all 1,050 patients hospitalized within 24 hours of symptoms of documented acute myocardial infarction (AMI) from 1998 to 2002. Hospital mortality was similar in women and men who underwent PTCA for AMI but was higher in patients aged 75 to 95 years (10%) than in patients aged 21 to 50 (2.1%, p <0.001), 51 to 64 (2.3%, p <0.001), and 65 to 74 years (4%, p <0.02). Hospital mortality was higher in patients who had PTCA for AMI during off-normal (5.8%) than normal hours (3.2%, p <0.05).


Assuntos
Angioplastia Coronária com Balão/mortalidade , Mortalidade Hospitalar , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Resultado do Tratamento , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , New York/epidemiologia , Radiografia , Fatores Sexuais , Carga de Trabalho
6.
Cardiovasc Revasc Med ; 12(5): 299-303, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21454139

RESUMO

BACKGROUND: Patients undergoing percutaneous coronary intervention (PCI) who are at high risk for cardiovascular collapse during the procedure may benefit from prophylactic circulatory support. The objective was to evaluate the safety and feasibility of prophylactic use of the Impella 2.5 during high-risk PCI. METHODS AND MATERIALS: We used the Impella 2.5 for partial circulatory support during 60 consecutive elective high-risk PCI cases over 20 months. All patients either were deemed inoperable by the cardiac surgeons or were offered bypass surgery but declined. RESULTS: The patients had multiple risk factors including hypertension (95%), diabetes (52%), chronic pulmonary disease (23%), prior myocardial infarction (62%) and prior bypass surgery (18%). Forty-five percent presented with acute coronary syndrome. The mean left ventricular ejection fraction was 23%±15%. Nearly all patients had multivessel disease (93%), and 60% had left main disease. The average SYNTAX score was 30±9. Despite lesion complexity and high-risk factors, we achieved an angiographic success rate of 96%. Left main lesions were treated in 55% of the patients, and 83% of patients had multiple lesions treated. There was one procedural death. At 30 days postintervention, mortality was 5%, and rates of myocardial infarction, stroke, target vessel revascularization and urgent bypass surgery were 0%. CONCLUSIONS: The single-center experience reported here demonstrates that use of the Impella 2.5 during high-risk PCI in the "real world" - outside the controlled environment of a clinical trial - is safe and feasible.


Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Estenose Coronária/terapia , Coração Auxiliar , Choque/prevenção & controle , Idoso , Angioplastia Coronária com Balão/mortalidade , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Estudos de Viabilidade , Feminino , Coração Auxiliar/efeitos adversos , Hemodinâmica , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Choque/etiologia , Choque/mortalidade , Choque/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
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