Asunto(s)
Analgesia por Acupuntura/efectos adversos , Estenosis Coronaria , Migración de Cuerpo Extraño , Oro , Neumonía , Edema Pulmonar , Tomografía Computarizada por Rayos X , Anciano , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/etiología , Estenosis Coronaria/virología , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/cirugía , Humanos , Neumonía/diagnóstico por imagen , Neumonía/etiología , Neumonía/cirugía , Edema Pulmonar/diagnóstico por imagen , Edema Pulmonar/etiología , Edema Pulmonar/cirugíaRESUMEN
INTRODUCTION: The mainstay treatment for reducing the symptoms of angina and long-term risk of heart attacks in patients with heart disease is stent implantation in the diseased coronary artery. While this procedure has revolutionised treatment, the incidence of secondary events remains a concern. These repeat events are thought to be due, in part, to continued enhanced platelet reactivity, endothelial dysfunction and ultimately restenosis of the stented artery. In this study, we will investigate whether a once a day inorganic nitrate administration might favourably modulate platelet reactivity and endothelial function leading to a decrease in restenosis. METHODS AND DESIGN: NITRATE-OCT is a double-blind, randomised, single-centre, placebo-controlled phase II trial that will enrol 246 patients with stable angina due to have elective percutaneous coronary intervention procedure with stent implantation. Patients will be randomised to receive 6â months of a once a day dose of either nitrate-rich beetroot juice or nitrate-deplete beetroot juice (placebo) starting up to 1â week before their procedure. The primary outcome is reduction of in-stent late loss assessed by quantitative coronary angiography and optical coherence tomography at 6â months. The study is powered to detect a 0.22±0.55â mm reduction in late loss in the treatment group compared with the placebo group. Secondary end points include change from baseline assessment of endothelial function measured using flow-mediated dilation at 6â months, target vessel revascularisation (TVR), restenosis rate (diameter>50%) and in-segment late loss at 6â months, markers of inflammation and platelet reactivity and major adverse cardiac events (ie, myocardial infarction, death, cerebrovascular accident, TVR) at 12 and 24â months. ETHICS AND DISSEMINATION: The study was approved by the Local Ethics Committee (15/LO/0555). Trial results will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals. TRIAL REGISTRATION NUMBERS: NCT02529189 and ISRCTN17373946, Pre-results.
Asunto(s)
Angina Estable/cirugía , Plaquetas/efectos de los fármacos , Estenosis Coronaria/prevención & control , Vasos Coronarios/efectos de los fármacos , Nitratos/uso terapéutico , Activación Plaquetaria/efectos de los fármacos , Stents , Adolescente , Adulto , Angina Estable/terapia , Beta vulgaris/química , Implantación de Prótesis Vascular , Estenosis Coronaria/etiología , Estenosis Coronaria/cirugía , Vasos Coronarios/cirugía , Método Doble Ciego , Endotelio Vascular/efectos de los fármacos , Humanos , Inflamación/etiología , Infarto del Miocardio/etiología , Infarto del Miocardio/prevención & control , Isquemia Miocárdica/tratamiento farmacológico , Isquemia Miocárdica/cirugía , Nitratos/farmacología , Cuidados Preoperatorios , Stents/efectos adversosAsunto(s)
Angioplastia Coronaria con Balón , Ablación por Catéter/efectos adversos , Estenosis Coronaria , Vasos Coronarios/patología , Complicaciones Posoperatorias , Taquicardia Supraventricular/cirugía , Adulto , Angioplastia Coronaria con Balón/instrumentación , Angioplastia Coronaria con Balón/métodos , Ablación por Catéter/métodos , Angiografía Coronaria/métodos , Estenosis Coronaria/diagnóstico , Estenosis Coronaria/etiología , Estenosis Coronaria/terapia , Técnicas Electrofisiológicas Cardíacas , Femenino , Fibrosis , Humanos , Enfermedad Iatrogénica , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Stents , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatología , Resultado del Tratamiento , Remodelación VascularRESUMEN
Atherosclerotic cardiovascular disease is an epidemic in today's world. It is one of the most common causes of hospitalization and death. Therefore, remedies to control or heal the disease are continuously sought. In addition to scientifically researched therapies, patients frequently utilize alternative medicine. However, effective and toxic doses, metabolisms, and drug interactions of the herbs and herbal nutrition supplements are largely unknown. Herein, we present two cases with acute coronary syndrome. The first case was admitted with a diagnosis of acute inferior myocardial infaction (MI) and a stent was implanted to the occluded right coronary artery (RCA). There was a 50% stenosis in his left anterior descending artery (LAD). He was admitted with a diagnosis of non-ST elevation MI (NSTEMI) 6 months later. In the coronary angiogram, there was stent restenosis in RCA, the lesion in LAD had become thrombotic and progressed to a stenosis of 90%. He was referred to surgical revascularization. The second case was admitted for acute inferior MI and a stent was implanted to the occluded circumflex artery. Two months later, he was hospitalized for NSTEMI. Progression of coronary plaques to stenosis and stent restenosis was detected and he was referred to surgical revascularization. Both patients used the product sold as Clavis Panax, which contains panax ginseng, tribulus terrestris, and oat, after their first coronary intervention. Intake of a mixture of plant extracts may have serious consequences in humans as drug interactions and side effects are unknown.
Asunto(s)
Síndrome Coronario Agudo/etiología , Avena/efectos adversos , Panax/efectos adversos , Extractos Vegetales/efectos adversos , Tribulus/efectos adversos , Síndrome Coronario Agudo/cirugía , Angiografía Coronaria , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/etiología , Estenosis Coronaria/terapia , Humanos , Infarto de la Pared Inferior del Miocardio/etiología , Infarto de la Pared Inferior del Miocardio/cirugía , Masculino , Persona de Mediana Edad , StentsRESUMEN
Supplementary oxygen is commonly administered in current medical practice. Recently it has been suggested that hyperoxia causes acute oxidative stress and produces prompt and substantial changes in coronary resistance in patients with ischemic heart disease. In this report, we examined whether the effects of hyperoxia on coronary blood velocity (CBV) would be associated with a reduction in myocardial function. We were also interested in determining if the postulated changes in left ventricular (LV) function seen with tissue Doppler imaging (TDI) could be reversed with intravenous vitamin C, a potent, acute anti-oxidant. LV function was determined in eight healthy subjects with transthoracic echocardiography and TDI before and after hyperoxia and with and without infusing vitamin C. Hyperoxia compared with room air promptly reduced CBV by 28 ± 3% (from 23.50 ± 2.31 cm/s down to 17.00 ± 1.79 cm/s) and increased relative coronary resistance by 34 ± 5% (from 5.63 ± 0.88 up to 7.32 ± 0.94). Meanwhile, LV myocardial systolic velocity decreased by 11 ± 6% (TDI). These effects on flow and function were eliminated by the infusion of vitamin C, suggesting that these changes are mediated by vitamin C-quenchable substances acting on the coronary microcirculation.
Asunto(s)
Ácido Ascórbico/administración & dosificación , Estenosis Coronaria/prevención & control , Estenosis Coronaria/fisiopatología , Hiperoxia/tratamiento farmacológico , Hiperoxia/fisiopatología , Disfunción Ventricular Izquierda/tratamiento farmacológico , Disfunción Ventricular Izquierda/fisiopatología , Adulto , Antioxidantes/administración & dosificación , Estenosis Coronaria/etiología , Femenino , Humanos , Hiperoxia/complicaciones , Masculino , Resultado del Tratamiento , Vasoconstricción/efectos de los fármacos , Disfunción Ventricular Izquierda/etiologíaRESUMEN
BACKGROUND AND OBJECTIVES: Cardiovascular disease in chronic kidney disease (CKD) is explained in part by traditional cardiovascular risk factors; by uremia-specific factors; and by abnormalities of mineral metabolism, factors involved in its regulation, and in the vascular calcification process. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In an unselected population of 177 patients with calculated GFR (eGFR) between 90 and 30 ml/min per 1.73 m(2), the link between the mineral metabolism abnormalities (calcium, phosphorus, calcium-phosphorus product), regulatory factors (parathyroid hormone [PTH], intact PTH [iPTH], vitamin D, fibroblast growth factor 23 [FGF 23], and fetuin A), and the severity of coronary artery disease (CAD) assessed by coronary angiography were evaluated in three subgroups defined by tertiles of Gensini lesion severity score. RESULTS: The mean serum values for FGF 23 in the entire study population was 28.1 ± 17.3 RU/ml and for fetuin A was 473.1 ± 156.2 µg/ml. Patients with eGFR < 60 ml/min per 1.73 m(2) had significantly higher values of FGF 23 compared with patients with eGFR > 60 ml/min per 1.73 m(2). The Gensini score values significantly correlated with gender; arterial hypertension; and HDL cholesterol, eGFR, iPTH, FGF 23, and fetuin A levels. After the adjustments for traditional and uremia-related cardiovascular risk factors, the FGF 23 and fetuin A remained significant predictors of the Gensini score. CONCLUSIONS: This study suggests that in a relatively young population with mild-to-moderate alteration of kidney function and with less traditional cardiovascular risk factors, anomalies of the serum FGF 23 and fetuin A levels appear early in the course of disease and are independent major predictors for extent of CAD.
Asunto(s)
Proteínas Sanguíneas/análisis , Estenosis Coronaria/etiología , Factores de Crecimiento de Fibroblastos/sangre , Enfermedades Renales/sangre , Adulto , Biomarcadores/sangre , Calcio/sangre , Distribución de Chi-Cuadrado , Enfermedad Crónica , Angiografía Coronaria , Estenosis Coronaria/sangre , Estenosis Coronaria/diagnóstico por imagen , Estudios Transversales , Femenino , Factor-23 de Crecimiento de Fibroblastos , Tasa de Filtración Glomerular , Humanos , Enfermedades Renales/complicaciones , Enfermedades Renales/fisiopatología , Masculino , Persona de Mediana Edad , Hormona Paratiroidea/sangre , Fósforo/sangre , Valor Predictivo de las Pruebas , Pronóstico , Análisis de Regresión , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Turquía , Vitamina D/sangre , alfa-2-Glicoproteína-HSRESUMEN
This case report describes multivessel coronary artery spasm refractory to oral nifedipine, intravenous isosorbide dinitrate, diltiazem and nicorandil, and intracoronary nitroglycerin. Intracoronary administration of nicorandil only transiently relieved coronary artery spasm. Prednisolone was effective in preventing coronary artery spasm.
Asunto(s)
Angina de Pecho/etiología , Estenosis Coronaria/etiología , Vasoespasmo Coronario/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Prednisolona/uso terapéutico , Vasodilatadores/uso terapéutico , Administración Oral , Adulto , Angina de Pecho/tratamiento farmacológico , Angina de Pecho/patología , Angiografía Coronaria , Estenosis Coronaria/complicaciones , Estenosis Coronaria/tratamiento farmacológico , Estenosis Coronaria/patología , Vasoespasmo Coronario/complicaciones , Vasoespasmo Coronario/patología , Diltiazem/uso terapéutico , Electrocardiografía , Femenino , Glucocorticoides/administración & dosificación , Humanos , Infusiones Intravenosas , Dinitrato de Isosorbide/uso terapéutico , Nicorandil/uso terapéutico , Nifedipino/uso terapéutico , Nitroglicerina/uso terapéutico , Prednisolona/administración & dosificación , Insuficiencia del Tratamiento , Vasodilatadores/administración & dosificaciónRESUMEN
Occlusion of LCX During RF Catheter Ablation. We report a case of acute occlusion of the left circumflex coronary artery during catheter ablation in the coronary sinus to complete the linear lesion between the postero-lateral mitral annulus and the left inferior pulmonary vein for the treatment of atrial fibrillation.