Repeated coronary artery spasm in a young woman with the eosinophilia-myalgia syndrome.

We report a case of repeated coronary artery spasm with myocardial injury in a 37-year-old woman with the eosinophilia-myalgia syndrome. This patient did not have a medical history of cardiac-related illness or risk factors for coronary artery disease. The presence of eosinophil granule major basic protein in otherwise normal-appearing myocardial tissue, along with normal plasma levels of tryptophan metabolites, suggests that the mechanism of vasospasm in this patient might involve toxic eosinophil proteins or focal myocardial lesions, but not the production of excess tryptophan metabolites.

Power injection of contrast media during percutaneous transluminal coronary artery angioplasty.

Visualization of the coronary arteries during all phases of percutaneous transluminal coronary angioplasty using hand-held contrast media injection devices is suboptimal. Power injection of contrast media for diagnostic coronary cineangiography has been performed in over 18,000 cases without power injector complication. Here we report our experience with 294 patients using power injection for visualization during all phases of PTCA. It provides optimal visualization of the coronary arteries and has not been associated with complications. It is a safe and efficient system with reduction in both the time and radiation exposure required to perform PTCA and allows determination of the adequacy of the result without unnecessary recrossing of the area of dilatation.

Angina and vasospasm at rest in a patient with an anomalous left coronary system.

An anomalous left main coronary artery with passage between the right ventricular infundibulum and aortic root has been incriminated as the causation of sudden death in a small number of individuals, many of whom are quite young. Mechanical features such as angulation and compression are most often incriminated. A 59-year-old man with such a coronary anomaly who had chest pain at rest, ST segment elevation, and ventricular tachycardia, but who had no evidence of effort-related myocardial ischemia, is reported. Improvement in the degree of coronary tone in the anomalous left main coronary with intracoronary nitroglycerin administration was demonstrated. This represents the first report of an individual with an anomalous left main coronary system with ventricular tachycardia/ventricular fibrillation and documented vasospasm in the anomalous artery.

Coronary angioplasty for acute mitral regurgitation due to myocardial infarction. A nonsurgical treatment preserving mitral valve integrity.

Three patients presented to the cardiac catheterization laboratory with myocardial infarction, severe mitral regurgitation, and pulmonary edema. Two patients were in cardiogenic shock at the time of cardiac catheterization. Percutaneous transluminal coronary angioplasty was done on the occluded artery in all three patients with resolution of the pulmonary edema as well as auscultative evidence of mitral regurgitation. The mean pulmonary wedge pressure dropped from 34 to 10 mm Hg in these patients. Mean follow-up of 11.7 months showed no evidence of clinical heart failure, angina pectoris, or auscultative evidence of mitral regurgitation.

Left main coronary artery embolism: a case report.

A 27-year-old man had recurrent myocardial infarction found to be due to coronary embolism to the left main coronary artery with downstream embolization. The presumed etiology of thromboembolism was idiopathic cardiomyopathy. A unique method of treatment with Fogarty catheter retrieval was used.

Bacterial endocarditis caused by Oerskovia turbata.

Oerskovia turbata is a yellow, motile actinomycete, which before now has only been found in soil and has not been known to cause disease in man or animals. It was isolated from 29 cultures of blood taken during 6 months from an urban pensioner after homograft replacement of his aortic valve. The combination of ampicillin, sulfamethoxazole, and trimethoprim was lethal for O. turbata in vitro; however, antimicrobial therapy alone failed to eradicate the patient's infection. Cure was achieved after the infected homograft was replaced with a prosthetic aortic valve. Although the source of O. turbata in this patient is unknown, sterilization of homograft valves with antimicrobial solutions is difficult. Moreover, environmental contamination during cardiopulmonary bypass is common. Oerskovia turbata is another opportunistic pathogen of man.