ABSTRACT
We present the case of a patient with known situs inversus referred for cardiac catheterization, which revealed a chronic total occlusion of the right coronary artery. Situs inversus, a rare congenital abnormality, is a term used to describe the inverted position of the chest and abdominal organs. Cardiac catheterization is rare in patients with this particular abnormality. It is important to customize techniques to engage coronary arteries and optimize guide support if percutaneous coronary intervention is required in these particular cases.
Subject(s)
Dextrocardia , Situs Inversus , Vascular Diseases , Humans , Coronary Angiography , Dextrocardia/complications , Situs Inversus/complications , AngioplastyABSTRACT
BACKGROUND: Sudden Cardiac Death (SCD) is an unexpected death caused by heart dysfunction. Autoantibodies against cardiac proteins may be potentially involved in the occurrence and progression of cardiac disease and SCD. The first report on the role of autoantibodies in idiopathic dilated cardiomyopathy appeared in the 1980s. In recent years new studies on the effects of the presence of specific autoantibodies and their relationship to ventricular arrhythmias and SCD were published. The purpose of the current mini-review is to analyze the results of the research studies focused on the relationship between anti-cardiomyocyte autoantibodies and SCD with respect to autoimmune disorders. CONCLUSION: According to our analysis, more research is needed to understand the role of these autoantibodies against cardiac proteins in the SCD pathogenesis, and potentially employ this knowledge for improving prognosis of SCD.
Subject(s)
Autoantibodies/metabolism , Autoimmune Diseases/genetics , Death, Sudden, Cardiac/etiology , Autoantibodies/blood , Autoimmune Diseases/pathology , Death, Sudden, Cardiac/pathology , Humans , Risk FactorsSubject(s)
Lemierre Syndrome/etiology , Lupus Erythematosus, Systemic/complications , Adult , Anticoagulants/therapeutic use , Enzyme Inhibitors/therapeutic use , Female , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Lemierre Syndrome/diagnosis , Lemierre Syndrome/drug therapy , Lupus Erythematosus, Systemic/drug therapy , Mycophenolic Acid/therapeutic use , Tomography, X-Ray ComputedABSTRACT
OBJECTIVES: ST-segment elevation myocardial infarction (STEMI) can be associated with many conduction disturbances including complete atrioventricular block (CAVB). CAVB complicating STEMI resulted in an increased mortality before the modern era of primary percutaneous coronary intervention (PCI). The aim of this study was to ascertain the rate and risk factors for CAVB in STEMI patients undergoing rapid reperfusion with PCI. METHODS: We analyzed 223 patients presenting with STEMI. Patient characteristics, procedural characteristics, and in-hospital data were compared between patients with and without CAVB. RESULTS: Out of 223 patients, 174 underwent PCI; the majority (87%) was African-American. CAVB was present in 8 patients (4.6%), and 6 of them had RCA occlusion. Independent predictors of CAVB included diabetes mellitus, female gender, lower systolic and diastolic blood pressure, and inferior-lateral/lateral STEMI. Ten patients (5.7%) required temporary pacing at presentation; only 1 patient required permanent pacing before discharge. No patient with anterior STEMI developed CAVB. CONCLUSIONS: The incidence and in-hospital mortality rate of CAVB in patients with STEMI who underwent primary PCI was reduced when compared to data from the thrombolytic era. This may be due to faster flow recovery in the infarct-related artery achieved with PCI.
Subject(s)
Atrioventricular Block/complications , Hospital Mortality , Percutaneous Coronary Intervention/adverse effects , ST Elevation Myocardial Infarction/therapy , Adult , Aged , Atrioventricular Block/diagnosis , Atrioventricular Block/mortality , Electrocardiography , Female , Humans , Incidence , Kaplan-Meier Estimate , Logistic Models , Male , Middle Aged , Multivariate Analysis , New York , Percutaneous Coronary Intervention/mortality , Retrospective Studies , Risk Factors , ST Elevation Myocardial Infarction/mortality , Treatment OutcomeABSTRACT
INTRODUCTION: Cardiogenic shock (CS) is a life-threatening condition associated with significant morbidity and mortality. The Impella (Abiomed Inc.) is an axial flow pump on a pigtail catheter that is placed across the aortic valve to unload the left ventricle by delivering non-pulsatile blood flow to the ascending aorta. It is used for high-risk percutaneous coronary intervention and CS. AREAS COVERED: Percutaneous mechanical support devices are placed in a minimally invasive manner and provide life-saving assistance. We review Impella and other percutaneous devices such as intra-aortic balloon pump, TandemHeart, and extracorporeal membrane oxygenation (ECMO) and the evidence supporting their use in the setting of CS. EXPERT COMMENTARY: Impella has been proven to be safe and may be superior to other mechanical support devices in CS.