RESUMO
Coronary artery fistula (CAF) is the most common congenital anomaly of coronary arteries. Management strategies for CAF causing symptoms and large shunting are well described. With growing use of noninvasive imaging modalities, the diagnosis of asymptomatic CAF has increased. This poses challenge on the management of CAF with high-risk features as therapeutic strategy of incidentally found CAF remains open to debate. The actual risk of complications in such cases is mere speculations based on small studies and need to be revisited. We describe the case of an asymptomatic 78-year-old woman with a large saccular coronary aneurysm associated with coronary artery to pulmonary artery fistula that was treated successfully using coils. We discuss the updated literature on the management of CAF as well.
RESUMO
Coronary spasm may present as acute coronary syndrome (ACS), "which can be an ST segment elevation myocardial infarction (STEMI), non-STEMI, or unstable angina." However, the prevalence of coronary spasm in patients with ACS remains unknown due to scarcity of data. Concomitant coronary spasm may mask the true atherosclerosis burden in such cases, posing several management challenges. We illustrate the case of managing an ACS patient with concomitant spasm and atherosclerotic disease. We show that the routine use of vasodilator treatment in ACS cases may prevent inappropriate stenting by identifying concomitant coronary spasm, influencing the clinical outcomes associated with inappropriate stenting in the setting of coronary spasm.
Assuntos
Bebidas/efeitos adversos , Bradicardia/induzido quimicamente , Cocos/efeitos adversos , Hiperpotassemia/induzido quimicamente , Esforço Físico , Soluções para Reidratação/efeitos adversos , Síncope/induzido quimicamente , Adulto , Bradicardia/diagnóstico , Bradicardia/terapia , Estimulação Cardíaca Artificial , Eletrocardiografia , Temperatura Alta , Humanos , Hiperpotassemia/diagnóstico , Hiperpotassemia/terapia , Masculino , Síncope/diagnóstico , Síncope/terapia , Tênis , Resultado do TratamentoRESUMO
Biventricular pacing for the treatment of congestive heart failure is now one of the forefront therapies for symptomatic heart failure patients who are receiving maximal medical therapy. Recent advances in lead technology and delivery systems have improved the success rates of left ventricular (LV) lead implantation. A major difficulty in LV lead implantation, however, occurs in patients with coronary vein stenoses, insufficient coronary vein caliber, or significant variations in coronary venous anatomy, in terms of left ventricular lead implantation. We sought to examine whether cardiac vein angioplasty and/or stenting would allow for the proper placement of the LV lead in these patients.
Assuntos
Angioplastia Coronária com Balão/métodos , Estimulação Cardíaca Artificial/métodos , Desfibriladores Implantáveis , Insuficiência Cardíaca/terapia , Stents , Taquicardia Ventricular/terapia , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/métodos , Terapia Combinada , Ecocardiografia Transesofagiana , Eletrocardiografia , Seguimentos , Insuficiência Cardíaca/diagnóstico , Ventrículos do Coração , Humanos , Masculino , Medição de Risco , Índice de Gravidade de Doença , Taquicardia Ventricular/diagnóstico , Resultado do TratamentoRESUMO
Penetrating chest wounds leading to damage of thoracic structures are common. A rare sequelae of chest trauma is a contained rupture of the left ventricle of the heart leading to the development of a pseudoaneurysm. This complication needs prompt recognition and repair because of the high likelihood of rupture and death. We report the case of a 47-year-old man who underwent repair of a stab wound to the heart 25 years ago and subsequently developed a large left ventricular pseudoaneurysm and presented with angina.
Assuntos
Falso Aneurisma/etiologia , Aneurisma Cardíaco/etiologia , Traumatismos Cardíacos/complicações , Ventrículos do Coração/lesões , Traumatismo Múltiplo/complicações , Ferimentos Perfurantes/complicações , Falso Aneurisma/diagnóstico , Falso Aneurisma/cirurgia , Angina Pectoris/diagnóstico , Angina Pectoris/etiologia , Procedimentos Cirúrgicos Cardíacos , Angiografia Coronária , Ecocardiografia Transesofagiana , Seguimentos , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/cirurgia , Traumatismos Cardíacos/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/cirurgiaRESUMO
Tetralogy of Fallot is the most common cyanotic congenital heart defect during infancy. It is composed of a ventricular septal defect, an overriding aorta, obstruction of right ventricular outflow, and right ventricular hypertrophy. Most patients experience cyanosis at birth and die in childhood without surgical intervention. The rate of survival at 40 years without surgical correction is only 3%. We present the case of a man with tetralogy of Fallot who survived until the age of 52 years without surgical intervention.