A Case of Intraventricular Coronary Artery Perforation Following Percutaneous Coronary Intervention in the Setting of Myocardial Bridge of Left Anterior Descending Artery.

Coronary artery perforation during percutaneous coronary intervention is a rare but potentially fatal complication. Intraventricular rupture is more commonly seen in setting of myocardial bridging where the epicardial coronary artery takes an intramuscular course. We describe a case of acute thrombotic in-stent restenosis of the intramyocardial (myocardial bridge) distal left anterior descending artery complicated by intraventricular perforation in the setting of an anterior ST elevation myocardial infarction managed by covered stenting.

Complex Coronary Intervention - When Time Is of Essence: Ping Pong Technique.

Coronary artery disease (CAD) continues to be a significant cause of morbidity and mortality in the U.S. The prognosis and treatment of which is dependent on various factors including type, size, localization and extent of the coronary plaque and severity of the stenosis. Management of critical ostial left main CAD poses peculiar challenges. The present case report demonstrates a unique percutaneous coronary intervention technique helpful in the management of such complex left main coronary lesions.

Proprotein Convertase Subtilism/Kexin 9 (PCSK9) Inhibitors: Adding to the Armamentarium of the Primary Care Physician.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality worldwide, and its prevalence is expected to further increase in the next decade. It imparts a substantial burden on the healthcare system. Dyslipidemia, defined as low-density lipoprotein (LDL), total cholesterol, triglycerides, or lipoprotein levels more than 90th percentile, or an HDL level less than the 10th percentile, is significant risk factor for ASCVD and offers a therapeutic target to reduce the morbidity and mortality associated with ASCVD. While statins remain first-line therapy for the primary and secondary prevention of ASCVD, many patients may not be able to tolerate statins. Furthermore, in many patients, statin therapy alone may not be sufficient in decreasing LDL cholesterol levels. Within the past decade, several new classes of cholesterol lowering agents have been developed and studied as potential adjunctive therapy for patients who are unable to meet target LDL levels with traditional therapy alone. While many of these therapies (fibrates, bile acid sequestrants, and niacin) have demonstrated limited utility in dyslipidemia therapy, the newer proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors have proven to be some of the most potent lipid-lowering therapies available. Recent studies have demonstrated promise for these agents in the role of future management of dyslipidemia. In this review article, we aim to provide a review of recent literature of the PCSK9 inhibitors. These targets may provide additional benefit and alternative options in the treatment of dyslipidemia in the future.

Gender differences in management of patients undergoing catheter ablation of atrioventricular nodal reentry tachycardia.

BACKGROUND: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common type of supraventricular tachycardia (SVT). Similar to other cardiac tests and interventions, gender bias may influence clinical decision making in providing appropriate care for AVNRT patients. We assessed for gender differences in the diagnosis and management of AVNRT patients who underwent catheter ablation. METHODS: Patients who underwent catheter ablation for AVNRT were included. We explored the gender difference on various clinical parameters such as the time from SVT symptoms, SVT diagnosis, and first electrophysiology consult to time of catheter ablation. RESULTS: Among 140 patients screened, 116 patients met the inclusion criteria, including 67.2% women. Median time from symptoms onset to SVT diagnosis was 18.5 months (interquartile range [IQR] 4.0-58.5) in women versus 4.0 months (0.75-34.7) in men, P = .005. Once SVT was diagnosed, women took a median of 12.5 months (IQR 3.0-57.0) to proceed with ablation versus 3.0 months (1.0-7.0) for men, P ≤ .001. It took a longer time from the first electrophysiology consultation to ablation: 54.5 days (20.75-144.75) for women versus 20.5 days (6.0-46.25) for men, P = .008. Overall, it took 60.0 months (IQR 12.8-132.0) for women to have an ablation from initial symptoms onset versus 15 months (IQR 4.6-48.0) for men, P = .001. Prior to ablation, women had 3.78 ± 3.79 (mean ± SD) emergency department visits for SVT versus men 1.52 ± 1.72 and women tried 1.28 ± 0.82 medications versus men 0.76 ± 0.68, P < .001 and .001, respectively. CONCLUSIONS: This study demonstrates significant and multifactorial gender-related disparities in AVNRT diagnosis and treatment. Larger studies are needed to confirm these results.

Approach to high intracoronary thrombus burden in the era of COVID-19.

Since the start of the COVID-19 pandemic, several cases have reported extensive multivessel coronary thrombosis as a cardiovascular manifestation of SARS-CoV-2 infection. This case describes a patient who developed non-ST elevation myocardial infarction during hospitalization for acute hypoxic respiratory failure due to COVID-19. We review the immediate and delayed revascularisation strategies of culprit and non-culprit lesions in the setting of high intracoronary thrombus burden induced by SARS-CoV-2. Successful percutaneous intervention and stenting of a culprit lesion and resolution of an intracoronary thrombus using a delayed strategy of lesion passivation with adjuvant pharmacotherapy are demonstrated on index and follow-up angiography.

Giant coronary artery dilatation in an asymptomatic patient.

A case of giant dilatation of coronary arteries is presented, with review of the literature on the subject, and discussions about management of the patients with such disease.

Dilatações gigantes das artérias coronárias em paciente assintomático / Giant coronary artery dilatation in an asymptomatic patient

Um caso de dilatação gigante de artérias coronárias é apresentado, com revisão da literatura sobre o assunto, e discussão sobre como abordar esses pacientes

A case of giant dilatation of coronary arteries is presented, with review of the literature on the subject, and discussions about management of the patients with such disease