Total occlusion of the left main coronary artery in a young cocaine user.

A young woman, currently user of cocaine, was admitted because of acute myocardial infarction with cardiogenic shock. The coronary arteriography revealed total occlusion of the left main coronary artery. Despite the use of an intraaortic counterpulsation balloon and successful percutaneous transluminal coronary angioplasty, she developed electromechanical dissociation, unresponsive to resuscitation manoeuvres.

[Multiple coronary artery fistula to left ventricle as a cause of myocardial ischemia]. / Fístula arterial coronaria múltiple a ventrículo izquierdo como causa de isquemia miocárdica.

We describe a patient with effort angina in whom the coronary arteriography revealed a rare type of coronary arterial fistula. All three major coronary arteries communicated with the left ventricle through a plexus of thin vessels. Both exercise stress test and thallium-dipiridamol demonstrated reversible myocardial ischemia. We think this case supports the clinical significance of the coronary steal phenomenon induced by the coronary arterial fistulae.

[Significance of angina in patients with aortic valvulopathy]. / Significación de la angina en los pacientes con valvulopatía aórtica.

We have analyzed coronary arteriographies of 170 patients, 120 with isolated aortic stenosis and 50 with isolated aortic failure. Patients with stenosis showed higher frequency of angina (73% versus 54%, p = 0.0223). No significant differences were observed with respect to the incidence of the coronary artery disease (26.7% versus 31.8%, p = 0.18). The presence of angina was significantly more specific in aortic failure (specificity 52.4% versus 31.8% in aortic stenosis, p = 0.039). Among the patients with less than 56 years of age, the probability of developing coronary artery disease in absence of angina was 6.3% (1 out of 16), the confidence interval ranging from 1.5% to 30.2%. Our results do not support any modification of the conventional criteria for conducting coronary arteriographies in patients with aortic valvulopathy.