Left main aneurysm and what's next?

The purpose of the case report is to present a case of a 65-year-old male, referred for coronary angiography because of a typical chest pain. The coronary angiography showed an aneurysm of the left main coronary artery. Despite the absence of obvious ischemic symptoms and because of the potential complications of the aneurysm with a width of 15 mm, the patient underwent surgery.

[Hypoxemia in pulmonary embolism--the occurrence, patomechanism and significance]. / Hipoksemia w zatorowosci plucnej--wystepowanie, patomechanizm, znaczenie.

Blood gas analysis is often performed in the initial diagnosis of acute pulmonary embolism (APE), and it is recognized that hypoxemia (H) strengthen its suspicion. However, the diagnostic power of hypoxemia is very week. Hypoxemia, usually deep, occurs in almost all patients with massive APE whereas moderate hypoxemia occurs in about 75% of unselected normotensive APE population without co-morbitides. H occurs also in most patients with chronic thromboembolic pulmonary hypertension (CTEPH). The patomechanism of H in pulmonary embolism is not completely known and is associated mainly with obstruction of pulmonary vasculature, pulmonary hypertension, and with co-morbitides. However, the secondary failure of ventilation followed by alveolar hypoxia can not be excluded in many cases of chronic pulmonary embolism. Hypoxemia seems to have moderate value in prognosis in APE and in CTEPH. H in massive APE requires oxygen therapy, and it can be speculated, whether long term oxygenation should be added to the anticoagulation in nonoperated, hypoxemic patients with CTEPH.

[Nocturnal and diurnal oxygen saturation in patients with chronic pulmonary embolism]. / Dzienne i nocne wysycenie krwi tetniczej tlenem u chorych na przewlekla, zatorowosc plucna.

UNLABELLED: Little is known on oxygen saturation in patients with chronic pulmonary embolism. AIM OF THE STUDY WAS: Tto assess the occurrence and importance of oxygen desaturations (D) in these patients. MATERIAL AND METHODS: The study involved 58 normotensive patients with chronic pulmonary embolism (18 males, 40 females, mean age 60 years, range 22-87 years) and was carried out 6 weeks to 2 years after an acute pulmonary embolic event. During 24-hour pulse oximetry mean oxygen saturation (SpO2), and number and duration of desaturations (D), defined as at least a 6% drop of pSO2, below 88%, lasting a minimum of 8 s, were recorded. Simultaneously echocardiographic study and blood gases analysis was performed. RESULTS: Desaturations were found in 39 (67.2%) patients, whereas 79% patients had pSO2 <95% in gasometry. 27 patients had both diurnal (06(00)-22(00)) and nocturnal (22(00)-06(00)) D, 9 patients only nocturnal D, and 3 patients only diurnal D. The number (14.7 vs 36.1) and duration (733.9 vs 1528 s) of D episodes were approximately 2 times greater at night than day. There were 18 (75%) desaturators among patients with pulmonary hypertension (defined as an echocardiographic tricuspid gradient >30 mmHg), and 21 (61.8%) desaturators among patients with chronic pulmonary embolism and without pulmonary hypertension. The patients with pulmonary hypertension had a lower mean SpO2 (p=0.005) and a lower number and duration of nocturnal (p=0.008, 0.03) and diurnal (p=0.008, 0.035) D. CONCLUSION: A large number of D episodes were found in the patients with chronic pulmonary embolism, mostly at night and in the patients with pulmonary hypertension. It is unclear whether D merely reflects pulmonary vasculature embolization or whether they are capable of impacting development of chronic thromboembolic pulmonary hypertension on the basis of vicious circle. In the latter case the need for a long term oxygen therapy, or at least nighttime oxygenation, should be taken into account to slow down progression of the disease.

[Results of one year pulse oxymetry in patients with chronic thromboembolic pulmonary hypertension]. / Roczna obserwacja przezskórnego wysycenia krwi tetniczej tlenem u chorych na przewlekle zakrzepowo-zatorowe nadcisnienie plucne.

UNLABELLED: It is little known on oxygen saturation in patients with chronic thromboembolic pulmonary hypertension (CTEPH). AIM OF THE STUDY: To assess the occurrence, evolution and clinical significance of oxygen desaturations (D) during 1-year observation in CTEPH patients. MATERIAL AND METHOD: The study involved 24 consecutive patients with CTEPH (6 males, 18 females, mean age 63, range 22-75 years). During 24-hour pulse oxymetry mean oxygen saturation (SpO2), number and duration of desaturations, defined as at least a 6% drop of SO2, below 88%, lasting a minimum of 8 s, were recorded at baseline and after 6 and 12 months of follow-up. Simultaneously echocardiographic study and blood gases analysis was performed. RESULTS: At baseline 18 of 24 (75%) CTEPH patients had desaturations. During follow-up none of nondesaturators had desaturations episodes and all baseline desaturators had desaturations episodes after 6 and 12 months. In desaturators there was trend to aggravate the number and duration of diurnal but not nocturnal desaturations episodes after 6 and 12 months. It was accompanied by trend (p = 0.05) to increase of pulmonary pressure as assessed by echocardiographic study, whereas the opposite trend to decrease of pulmonary pressure was seen in nondesaturators. CONCLUSIONS: Results of the study show that desaturations occur in most patients with CTEPH and desaturators may have worse clinical course than nondesaturators. It may suggest the need for long oxygen therapy in desaturating CTEPH patients to slow down progression of the disease.

[Coronary angiography is not always helpful in differential diagnosis between perimyocarditis and myocardial infarction - four case reports]. / Czy zmiany ST-T elektrokardiogramu sa wynikiem zapalenia osierdzia i miesnia sercowego - czy zawalu serca. Koronarografia nie zawsze rozstrzyga watpliwosc. Opis 4 przypadków.

Four males aged 17-42 years with ST-T segment changes suggesting perimyocarditis or non-Q acute myocardial infarction are presented. Coronary angiography was performed to establish the final diagnosis. Three patients had normal coronary arteries; two of them had typical clinical signs of perimyocarditis whereas the third patient had less typical changes. The fourth patient was a smoker, had a family history of coronary heart disease and left ventricular dysfunction due to a non-Q wave apical infarction. In this patient coronary angiography revealed small atheromatous plaques in the distal part of left anterior descending artery as well as left main and right coronary artery spasm. Angiospastic aetiology of infarction and probable endothelial dysfunction due to myocarditis were diagnosed. The authors conclude that coronary angiography is not always helpful if clinical, electrocardiographic and biochemical signs of perimyocarditis are observed.