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1.
S D Med ; 74(5): 227-229, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34437781

RESUMO

Atrial septal defects (ASDs) and patent foramen ovale (PFO) are common congenital cardiac malformations that portend a higher risk of ischemic stroke. Percutaneous closure of ASDs using septal occluder devices has proven to be a safe and effective alternative to surgery. We present a case of symptomatic cribriform secundum ASD and PFO who underwent successful percutaneous closure using two Amplatzer occluder devices using a novel "sandwich technique."


Assuntos
Forame Oval Patente , Dispositivo para Oclusão Septal , Acidente Vascular Cerebral , Cateterismo Cardíaco , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/cirurgia , Humanos , Resultado do Tratamento
2.
S D Med ; 74(6): 248-249, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34449162

RESUMO

Coronary vasospasm is an underdiagnosed cause of myocardial infarction in the absence of obstructive coronary artery disease. Systemic inflammation is one of several triggers associated with coronary vasospasm. We report the case of a 47-year woman incidentally found to be COVID-positive (RT-PCR) during evaluation of constitutional symptoms and breast cellulitis. Later in the hospitalization, she developed sudden-onset typical angina at rest; 12 lead EKG showed inferolateral ST-elevations. Urgent coronary angiogram showed nitrate-responsive subtotal focal occlusions in the right coronary and circumflex arteries. In the absence of sepsis, it is difficult to attribute coronary vasospasm solely to cellulitis. Focal coronary artery spasm mimicking ST-elevation myocardial infarction successfully managed solely with intracoronary nitroglycerine in an incidentally COVID-positive patient adds to the diverse manifestations of COVID infection. The exact mechanism of focal, as opposed to diffuse coronary vasospasm is unclear.


Assuntos
COVID-19 , Vasoespasmo Coronário , Infarto do Miocárdio , Infarto do Miocárdio com Supradesnível do Segmento ST , Angiografia Coronária , Vasoespasmo Coronário/complicações , Vasoespasmo Coronário/diagnóstico , Feminino , Humanos , Infarto do Miocárdio/diagnóstico , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
3.
S D Med ; 74(7): 334-343, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34449999

RESUMO

The last decade has seen the introduction of a number of important technological innovations in the management of advanced cardiovascular disease. These include transcatheter aortic valve replacement systems, a transcatheter mitral valve repair device, a left atrial appendage occluder device, coronary bioresorbable vascular scaffolds, leadless fully implantable pacemaker systems, wireless implantable pulmonary artery pressure monitors, transcatheter left ventricular assist pumping devices, drug-coated balloons, and robotic percutaneous coronary intervention devices. With the exception of drug coated balloon platforms, all have been utilized in our institution for patients from South Dakota and neighboring states. The objective of this study is to briefly describe these innovative devices, summarize the evidence for their benefit, and offer helpful pearls for the primary care providers who are key members of the care team for these patients.


Assuntos
Marca-Passo Artificial , Intervenção Coronária Percutânea , Substituição da Valva Aórtica Transcateter , Valva Aórtica , Humanos , Tecnologia , Resultado do Tratamento
4.
Indian Heart J ; 73(3): 281-288, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34154743

RESUMO

OBJECTIVE: To study the use of CYP2C19 genotyping to guide P2Y12 inhibitor selection to maximize efficacy, and attenuate risk in appropriate patients who underwent PCI for CAD. METHODS: We performed a retrospective analysis of 868 patients with CAD who received CYP2C19 genotyping after PCI and changed P2Y12 inhibitor based on the results. Patients were divided into two groups based on clopidogrel metabolizer status. Group I: Intermediate (IM) and poor metabolizers (PM). Group II: Ultra-rapid (UM), rapid (RM) and normal metabolizers (NM). Each group was then categorized to one of two treatment arms guided by CYP2C19 genotype. Category 1: IM/PM started on clopidogrel, switched to ticagrelor or prasugrel; 2:IM/PM started on ticagrelor/prasugrel, continued these medications; 3: UM/RM/NM started on ticagrelor/prasugrel, switched to clopidogrel; 4: UM/RM/NM started on clopidogrel, continued clopidogrel. Death due to cardiac causes, bleeding events, non-fatal MI, target vessel revascularization (TVR), and MACE in all four categories were considered at 1, 6 and 12 months. RESULTS: We did not observe significant difference between phenotypes for MACE at 1 (p = 0.274), 6 (p = 0.387), and 12 months (p = 0.083). Death due to cardiac causes, MI, and bleeding events were not significant at 1, 6, and 12 months. There was no significant difference in TVR at 6 (p = 0.491), and 12 months (p = 0.423) except at 1 month (p = 0.012). CONCLUSION: CYP2C19 genotype-based intervention can be implemented effectively and reliably to guide selection of P2Y12 inhibitor to optimize patient quality and safety when appropriate in post PCI patients.

6.
Catheter Cardiovasc Interv ; 97(1): 74-77, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31876350

RESUMO

OBJECTIVE: The aim is to evaluate the feasibility of using mechanical circulatory support, specifically the Impella device, in spontaneous coronary artery dissection (SCAD) patients with cardiogenic shock. BACKGROUND: The therapeutic options for managing SCAD complicated by cardiogenic shock are limited. Risky revascularization procedures are often necessary. METHODS: This was a multicenter case series in the United States. Approximately 20 cases of Impella implantation in patients with SCAD are known. The implanting physician for each of these cases was contacted and de-identified records were requested. The records were analyzed for Impella indications, outcomes, and complications. RESULTS: Records from four cases were received. All patients survived to hospital discharge and no major complications were observed. In two cases, cardiogenic shock developed in the absence of ongoing ischemia, suggesting a Takotsubo-like cardiomyopathy. In these cases, the Impella provided hemodynamic support until the patient's cardiac function recovered. CONCLUSION: Although a small case series, given the scarcity of SCAD cases complicated by cardiogenic shock and the limited therapies available to treat these patients, these data are of clinical value in highlighting the feasibility of Impella use in SCAD. The Impella can be valuable for procedural support and in cardiogenic shock, especially in cases without evidence of ongoing ischemia.

7.
Tex Heart Inst J ; 47(2): 144-148, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32603464

RESUMO

Robotic-assisted percutaneous coronary intervention can reduce the exposure of interventional cardiologists to radiation and minimize the risk of occupational orthopedic injuries from wearing heavy protective aprons. The PRECISE (Percutaneous Robotically-Enhanced Coronary Intervention) study showed the efficacy and safety of robotic-assisted procedures for relatively low-risk lesions in single coronary arteries. Several reports have described robotic-assisted treatment of complex high-risk lesions, mostly through the transfemoral approach. We report 4 cases of patients in whom we used the transradial approach to treat complex lesions in the left anterior descending coronary artery with bifurcation balloon angioplasty reconstruction (2 cases), in the ostium of the first diagonal branch, and in the right coronary artery.

8.
Tex Heart Inst J ; 47(2): 155-159, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32603468

RESUMO

Stent underexpansion, a potential complication of percutaneous coronary intervention in severely calcified and stenotic coronary arteries, may result in in-stent thrombosis and restenosis. Different balloon-based and atheroablative techniques have been proposed to reduce the risk of these complications. We describe a simple triple-guidewire technique that we used to treat stent underexpansion in 2 elderly men.

9.
S D Med ; 73(5): 202-207, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32579799

RESUMO

Optical coherence tomography (OCT) has been revolutionary in the field of medical imaging since its inception in 1991, especially in the field of ophthalmology, but its use in coronary artery disease (CAD) and percutaneous coronary intervention (PCI) is still to be explored to its full potential. OCT has proven benefits in guiding PCI when it comes to assessing baseline lesion characteristics, plaque burden and its composition. OCT images provide high axial resolution (10 micrometer) in assessing intra and transluminal coronary structures, which is useful in identifying vulnerable thin fibrous cap atheroma (TCFA) and to differentiate plaque rupture from plaque erosion causing acute coronary syndrome. Optimal stent placement and periprocedural complications (for example stent malposition, coronary dissections, thrombosis) can be assessed by OCT post intervention. It has also seen increasing use in studies trying to elucidate evolution of atherosclerosis, effects of therapeutic interventions on coronary artery plaques and to follow long-term stent outcomes. In this review, we focus on an overview of OCT imaging, techniques employed in its use, its clinical and research applications, indications and limitations.


Assuntos
Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Tomografia de Coerência Óptica , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários , Humanos , Stents
10.
S D Med ; 73(4): 164-167, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32445303

RESUMO

Right heart thrombus (RHT) occurs secondary to deep venous thrombus in transit to pulmonary veins, intra cardiac devices and prosthetic valves. When RHT is present in a patient with pulmonary embolism (PE) it is generally shown to be associated with worse outcomes. Even though multiple trials have studied treatment of PE, the optimal treatment of PE associated with RHT is still largely based on clinical judgment. We present a 73-year- old female patient with submassive PE and right ventricular thrombus in transit, who was successfully treated with ultrasound guided catheter based thrombolysis.


Assuntos
Embolia Pulmonar , Trombose , Idoso , Feminino , Humanos , Embolia Pulmonar/diagnóstico por imagem , Trombose/diagnóstico por imagem , Ultrassonografia
11.
S D Med ; 73(2): 68-70, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32135054

RESUMO

Bartonella species was first reported as a cause of endocarditis in 1993, currently it is thought to account for 3-4 percent of all diagnosed cases. Initial symptoms of Bartonella endocarditis are non-specific like weight loss, fever and fatigue. There are very few reported cases of Bartonella endocarditis causing mycotic aneurysm. We present a case of a 60-year-old male who presented with subarachnoid hemorrhage secondary to mycotic aneurysm. Due to high suspicion of endocarditis leading to mycotic aneurysm he underwent transesophageal echocardiography which showed mitral valve vegetations. His blood cultures were negative, he was eventually diagnosed with Bartonella henselae by elevated IgG titers greater than 1:800. Due to repeated mycotic aneurysms on antibiotics, he underwent surgical mitral valve replacement along with the full course of antibiotics and has been asymptomatic since.


Assuntos
Aneurisma Infectado , Bartonella henselae , Endocardite Bacteriana , Hemorragia Subaracnóidea , Aneurisma Infectado/complicações , Aneurisma Infectado/diagnóstico , Bartonella henselae/isolamento & purificação , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média , Hemorragia Subaracnóidea/etiologia
12.
S D Med ; 73(2): 72-76, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32135055

RESUMO

IMPORTANCE AND OBJECTIVE: Dietary supplements and herbs (called naturoceuticals) are commonly used by Americans, but little is known about their use in cardiovascular disease patient populations. The objective was to evaluate naturoceutical use in a sample population of cardiovascular disease patients in the U.S. DESIGN, SETTING and PARTICIPANTS: A non-blinded, single medical center clinic open questionnaire was delivered to cardiovascular clinic patients with known cardiovascular diseases. MAIN OUTCOMES AND MEASURES, AND RESULTS: Estimation of naturoceutical usage prevalence and frequency in the sample population of cardiovascular disease patients. A total of 163 patients (n = 99 males, 64 females) participated (mean age: males, 66 years; females, 64 years). Overall, 76.7 percent of participants reported using naturoceuticals. Of them, about 63.2 percent took more than one type, and 90.3 percent reported daily usage. Of the naturoceuticals reportedly being taken, multivitamins containing vitamin K were the most commonly consumed (32.3 percent male, 29.7 percent female), followed by vitamin D (23.2 percent male, 31.3 percent female) and fish oil (24.2 percent male, 15.6 percent female). CONCLUSIONS AND RELEVANCE: The present study revealed that naturoceutical use was very popular in cardiovascular disease patients, largely due to the belief that they could reduce and/or prevent symptoms and disease in general. The benefits and hazards of those naturoceuticals being used concurrent with other prescription medications were discussed.


Assuntos
Doenças Cardiovasculares , Suplementos Nutricionais , Medicamentos sob Prescrição , Idoso , Doenças Cardiovasculares/dietoterapia , Suplementos Nutricionais/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Vitaminas/uso terapêutico
13.
Tex Heart Inst J ; 47(1): 41-43, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32148453

RESUMO

Percutaneous coronary intervention in the diseased saphenous vein graft differs significantly from that in the diseased native coronary artery. After being exposed to arterial pressures over time, vein grafts have substantially different plaque characteristics, with more inflammatory cells, more diffuse disease, and less calcification. Severe calcification of saphenous vein grafts, although uncommon, poses a high risk of stent underexpansion. Orbital atherectomy for treatment of de novo calcified coronary lesions has been associated with better outcomes at 5-year follow-up. However, there are no published data on the use of orbital atherectomy to treat severely calcified saphenous vein graft lesions. We present the case of a 77-year-old woman with non-ST-segment-elevation myocardial infarction who underwent successful orbital atherectomy to prepare a severely calcified saphenous vein graft lesion for stent implantation.


Assuntos
Angioplastia Coronária com Balão , Aterectomia Coronária , Ponte de Artéria Coronária/efeitos adversos , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Veia Safena/transplante , Calcificação Vascular/terapia , Idoso , Angioplastia Coronária com Balão/instrumentação , Aterectomia Coronária/instrumentação , Stents Farmacológicos , Feminino , Humanos , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio sem Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/etiologia , Calcificação Vascular/fisiopatologia
15.
Methodist Debakey Cardiovasc J ; 16(4): e1-e4, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33500768

RESUMO

Hyperdominant left anterior descending artery (LAD) is a rare anomaly in which the LAD gives rise to the posterior descending artery. Our case report describes an extreme case of hyperdominant LAD supplying the anterior, inferior, and partially the lateral walls of the left ventricle. It is crucial that physicians be aware of the possibility of extreme LAD dominance. A proximal occlusion of such a vessel might have catastrophic consequences with atypical presentation on electrocardiogram.


Assuntos
Circulação Coronária , Anomalias dos Vasos Coronários/fisiopatologia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade
16.
S D Med ; 72(10): 467-471, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31816209

RESUMO

Iodinated contrast media used during cardiac catheterization predispose patients to develop contrast-induced nephropathy. Reducing contrast volumes without impairing the quality of angiographic imaging appears to be a viable solution. We present three cases of patients with chronic kidney disease in which we used an ultra-low contrast volume technique to help minimize contrast exposure risk. This technique uses an automated contrast injection system that can be used during diagnostic or coronary interventional cases and reduces the risk of iatrogenic kidney disease without compromising imaging quality.


Assuntos
Cateterismo Cardíaco , Meios de Contraste , Angiografia Coronária/métodos , Humanos
18.
Indian Heart J ; 71(4): 297-302, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31779856

RESUMO

BACKGROUND: We aimed to assess the decrease in contrast media volume (CMV) with ultra-low contrast delivery technique (ULCD) developed at our institution versus the usual automated contrast injector system (ACIS) contrast delivery in coronary procedures. METHODS: We analyzed the amount of contrast given in the consecutive 204 patients of the operators who use ULCD technique versus consecutive 200 patients of the other operators who use ACIS without ULCD technique for coronary angiograms and/or percutaneous coronary interventions (PCIs) from May 2017 to July 2018 at our center. We calculated the mean CMV between these groups. RESULTS: We observed a significant reduction in mean CMV with ULCD technique versus standard ACIS, respectively: angiogram 24.8 ± 15.8 mL (n = 194) vs 42.3 ± 25.1 mL (n = 200) (p < 0.0001); PCI 23.5 ± 19.7 mL (n = 52) vs 48.2 ± 30.8 mL (n = 16) (p < 0.0070); angiogram with ad hoc PCI 53.4 ± 32.1 mL (n = 23) vs 89.7 ± 35.6 mL (n = 16) (p < 0.0024); and overall angiogram and PCI 27.4 ± 20.5 mL (n = 204) vs 44.9 ± 28.0 mL (n = 181) (p < 0.0001). CONCLUSION: Our study showed a highly significant reduction in CMV using ULCD technique compared to standard ACIS contrast delivery in coronary invasive procedures. Even in the standard ACIS arm, CMV was significantly lower than values reported in literature, possibly due to operators' bias toward contrast preservation.


Assuntos
Meios de Contraste/administração & dosagem , Angiografia Coronária , Intervenção Coronária Percutânea , Ácidos Tri-Iodobenzoicos/administração & dosagem , Idoso , Algoritmos , Feminino , Humanos , Injeções , Masculino , Estudos Prospectivos , South Dakota
19.
S D Med ; 72(4): 174-177, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31436931

RESUMO

The effect of pre-existing collateral circulation on presentation of acute coronary syndrome (ACS) is not well known. We present a case of a 54-year-old male with a known history of chronic total occlusion of left circumflex artery and well-developed collaterals, who presented to the emergency department with non-STsegment elevation myocardial infarction. He underwent urgent coronary angiogram which showed an acute total thrombotic occlusion in proximal large right coronary artery with collaterals from left to right. After percutaneous coronary intervention, the collaterals reversed to a right to left direction. We postulate that the well-developed collateral circulation protected the patient from larger transmural ischemia and ST elevation myocardial infarction.


Assuntos
Síndrome Coronariana Aguda , Infarto do Miocárdio , Circulação Colateral , Angiografia Coronária , Circulação Coronária , Humanos , Masculino , Pessoa de Meia-Idade
20.
S D Med ; 72(5): 218-224, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31454475

RESUMO

Pulmonary hypertension (PH) is defined as mean pulmonary artery pressure (mPAP) 25 mmHg or greater at rest; this measurement is obtained during right heart catheterization. The exact prevalence of PH in the U.S. is unknown. Advances in hemodynamic studies of the right heart side and pulmonary circulations has helped improve our understanding of this condition. This better understanding aids the development of treatment agents aimed at improving quality of life, morbidity and mortality. Awareness of this condition and understanding the classification of PH and the available treatment modalities is crucial hence we aim to briefly review the classification, diagnosis and treatment of PH in this article.


Assuntos
Hipertensão Pulmonar , Qualidade de Vida , Cateterismo Cardíaco , Hemodinâmica , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/terapia , Prevalência
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