Disección coronaria espontánea: a propósito de un caso / Spontaneous coronary artery dissection: concerning a case

RESUMEN Fundamento: la disección coronaria espontánea, aunque infrecuente, es causa de infarto agudo de miocardio. Objetivo: presentar el caso de una paciente con disección coronaria espontánea como causa de infarto agudo de miocardio. Presentación del caso: paciente de 55 años, raza blanca, sexo femenino, con antecedentes de hipertensión arterial esencial sistodiastólica estadio I controlada, sobrepeso, que asociado a esfuerzo físico comienza con dolor precordial típico de enfermedad coronaria. Tras realización de estudios con biomarcadores de daño miocárdico, electrocardiográficos e imagenológicos se diagnostica un síndrome coronario agudo sin elevación del ST, tipo infarto agudo de miocardio no Q, Killip Kimball I; se realiza estudio coronariográfico con diagnóstico de disección coronaria espontánea, se opta por tratamiento conservador con adecuada evolución de la paciente. Conclusiones: la disección coronaria espontánea, aunque infrecuente es causa de infarto agudo de miocardio. Su presentación clínica puede ser similar a la de un síndrome coronario agudo de causa ateroesclerótica. La coronariografía es una prueba valiosa para el diagnóstico. Según sea el caso se puede elegir un tratamiento médico conservador, endovascular con colocación de stent o quirúrgico.

ABSTRACT Background: the spontaneous coronary artery dissection causes an acute myocardial infarction. Objective: to present the case of a patient suffering from spontaneous coronary artery dissection, this causes an acute myocardial infarction. Case report: a 55 years old, white, female patient with antecedents of essential systodiastolic systemic arterial hypertension stage I, overweight. Related to a physical effort, the patient begins complaining of an oppressive pre-cordial pain with typical characteristics of coronary illness. After the performance of cardiac biomarkers, electrocardiographic and imaging studies was diagnosed a non ST segment elevation acute coronary syndrome type Q, Killip Kimball I acute myocardial infarction; after that a corona-graphic study was carried out with a diagnostic of spontaneous coronary dissection, and it was decided a conservative treatment, with a good recovery. Conclusion: the spontaneous coronary artery dissection, although infrequently, is cause of acute myocardial infarction. Its clinical presentation can be similar to an acute coronary syndrome caused by an atherosclerotic coronary artery disease. The coronary angiography is a valuable test for the diagnosis. As it is the case we can choose between a conservative, endovascular with stent placement treatment or surgical treatment.

Combined measurement of H-FABP and MPO in the prognosis of non-ST elevation acute cornary syndromes / 国际检验医学杂志

Objective To evaluate the prognosis value of heart‐type fatty‐acid binding protein(H‐FABP)and myeloperoxidase (MPO) in non‐ST elevation acute coronary syndromes(NSTE ACS) .Methods 181 NSTE ACS patients were divided into 4 groups according to the level of H‐FABP and MPO ,and the baselines of 4 groups such as gender ,age ,hypertension ,smoking ,body mass in‐dex ,diabetes mellitus ,hyperlipidemia were compared .The incidences of adverse cardiac events in 4 groups were compared after a 2 years′follow‐up .Results By multivariate COX regression adjustment for other risk factors ,the relative risk(RR) of H‐FABP for adverse cardiac events was 2 .023(95% CI:1 .029 -3 .987 ,P=0 .002) ,and MPO was (95% CI:2 .196 -5 .325 ,P< 0 .05) .The 2 years′follow‐up showed the incidence of adverse cardiac events in NSTE ACS patients with higher H‐FABP and MPO levels was higher than the NSTE ACS patients with one or two indicators of normal levels .Conclusion The combined application of H‐FABP and MPO could has clinical significance for the prognosis of patients with NSTE ACS .

Prevalência de manifestações atípicas em portadores de Síndrome Coronariana Aguda / The prevalence of atypical presentations in patients with Acute Coronary Syndrome

INTRODUÇÃO: A característica anginosa da dor torácica tem sido identificada como o dado com maior poder preditivo para Síndrome Coronariana Aguda (SCA), entretanto as características da dor torácica nem sempre se assemelham com aquelas classicamente descritas. OBJETIVO: Avaliar a prevalência de manifestações atípicas em pacientes internados com Síndrome Coronariana Aguda, correlacionar tais apresentações com os dados clínicos e de exames complementares e compará-las com as manifestações típicas. METODOS: Estudo de corte transversal.A classificação de dor torácica de Diamond foi utilizada para caracterização da dor (variável dependente). As frequências das variáveis independentes (fatores de risco para Doença Arterial Coronária - DAC, alterações eletrocardiográficas, laboratoriais, ecocardiográficas e angiográficas) foram calculadas e comparadas entre os grupos: 1) Dor típica, 2) Dor atípica e 3) Dor não anginosa, estabelecendo-se o valor de p<0,05 como estatisticamente significante. RESULTADOS: Foram avaliados 127 pacientes dos quais 16 (12,6%) apresentavam dor típica, 54(42,5%) dor atípica e 57 (44,9%) dor não anginosa. Os grupos não apresentaram diferença estatisticamente significante em relação aos fatores de risco para DAC; aos níveis dos marcadores de necrose miocárdica; às alterações ecocardiográficas e angiográficas. Pacientes do grupo 3 apresentaram frequência significativamente maior de arritmias ventriculares que aqueles dosgrupos 1 e 2 (21,1 x 6,7 x 5,7%, respectivamente; p=0,041). CONCLUSÃO: As frequências de dor torácica de características atípicas e não anginosas foram elevadas e significativamente maiores que a de dor torácica de características típicas. Não foi observado associação estatisticamente significante entre as características da dor torácica e perfil clínico e dos exames complementares...

INTRODUCTION: Anginal symptoms of chest pain have been identified as the greatest predictive power for Acute Coronary Syndrome (ACS), however chest pain symptoms do not always resemble those, which are classically described. OBJECTIVES: To assess the prevalence of atypical presentations in patients admitted to hospital with Acute Coronary Syndrome, to correlate these presentations with clinical data and additional tests and to compare them with typical presentations. METHODOS: This was a cross-sectional study. The Diamond classification of chest pain was used to characterise chest pain (dependent variable). The frequencies of the independent variable (risk factors for Coronary Artery Disease - (CAD), electrocardiographic, laboratory, echocardiographic and angiographic changes) were calculated and compared between each group: 1) Typical chestpain, 2) Atypical chest pain and 3) Non-anginal chest pain. A p-value <0.05 was established as statistical significance. RESULTS: A total of 127 patients were assessed, of whom 16(12.6%) presented typical chest pain, 54 (42.5%) atypical chest pain and 57 (44.9%) non-anginal chest pain. The groups didnot present any statistically significant differences regarding Coronary Artery Disease risk factors, markers for myocardialnecrosis, and echocardiographic and angiographic changes. Patients in group 3 presented a significantly higher frequency of ventricular arrhythmias than those in groups 1 and 2 (21.1 x6.7 x 5.7%, respectively; p=0.041). CONCLUSION: The frequencies of atypical and non-anginal chest pain were higherand significantly greater than those of typical chest painsymptoms. No statistically significant association was observed between the chest pain symptoms and the clinical profile and the additional tests...

Biomarcadores cardíacos na avaliação da síndrome coronariana aguda: [revisão] / Cardiac biomarkers for assessment of acute coronary syndrome: [review]

Objetivos: abordar o uso dos biomarcadores cardíacos associados à necrose, inflamação, desestabilização da placa, isquemia e disfunção cardíaca na avaliação da síndrome coronariana aguda a fim de propiciar a melhor compreensão sobre as vantagens e desvantagens do uso clínico desses biomarcadores laboratoriais.Fonte de dados: artigos científicos originais e de revisão indexados nas bases de dados PubMed e SciELO.Síntese dos dados: as doenças cardiovasculares, especialmente a síndrome coronariana aguda, representam a principal causa de mortalidade no Brasil e no mundo, sendo que seu contínuo crescimento representa uma das questões de saúde pública mais relevantes da atualidade. Nesse sentido, os biomarcadores cardíacos constituem elementos fundamentais para o diagnóstico da síndrome coronariana aguda, sendo que as troponinas cardíacas continuam sendo consideradas o padrão ouro para o diagnóstico. Com o desenvolvimento dos recentes métodos ultrassensíveis para mensuração das troponinas cardíacas, tem sido possível detectar a lesão cardíaca dentro de duas horas, melhorando substancialmente o diagnóstico precoce do infarto agudo do miocárdio. Outros biomarcadores vêm apresentando relevância, especialmente em relação ao prognóstico e estratificação de risco dos pacientes com cardiopatia isquêmica.Conclusões: vários marcadores têm apresentado eficácia na detecção da necrose, isquemia, inflamação, desestabilização da placa e disfunção cardíaca. No entanto, as troponinas cardíacas continuam sendo consideradas o padrão ouro para o diagnóstico do infarto agudo do miocárdio.

Aims: To address the use of cardiac biomarkers associated with necrosis, inflammation, plaque destabilization, and cardiac ischemia in the evaluation of acute coronary syndrome in order to provide a better understanding of the advantages and disadvantages of the clinical use of these biomarkers.Source of data: Scientific original and review articles from the PubMed and SciELO databases.Summary of findings: Cardiovascular diseases, especially acute coronary syndrome, are the leading cause of mortality in Brazil and worldwide, and its continued growth is one of public health issues most relevant today. In this sense, the cardiac biomarkers are key to the diagnosis of acute coronary syndrome, and the cardiac troponins are still considered the gold standard for its diagnosis. With the recent development of ultra-sensitive methods for measuring cardiac troponins, it has been possible to detect heart damage within two hours, substantially improving the early diagnosis of acute myocardial infarction. Other biomarkers have been showing relevance, especially in relation to prognosis and risk stratification of patients with ischemic heart disease.Conclusions: Several biomarkers have shown efficacy in the detection of necrosis, ischemia, inflammation, plaque destabilization and cardiac dysfunction. However, cardiac troponins are still considered the gold standard for diagnosis of acute myocardial infarction.