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1.
Medicine (Baltimore) ; 98(48): e18096, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770229

RESUMO

INTRODUCTION: Hiccup is usually a benign and self-limited phenomenon. Therefore, if hiccups do not resolve by themselves and even last for a long time, it may be the marker of serious medical conditions. PATIENT CONCERNS: We encountered a case presenting with recurrent abdominal discomfort. Diffuse ST-segment elevation in V2-V6 and elevated Troponin I was identified. He had complained about constipation and incomplete intestinal obstruction was ever suspected. Four days later, he exhibited persistent hiccups. DIAGNOSIS: He was diagnosed with acute anterior wall myocardial infarction. And elective coronary angiography showed that proximal left anterior descending (LAD) was occluded by fresh thrombus with TIMI 1 flow. INTERVENTIONS: The lesion in proximal LAD was dilated with low pressure. Interestingly, the hiccups reduced. And after stent implantation the hiccup disappeared in 24 hours. OUTCOMES: The patient was discharged in good general condition, with maintenance therapy and a follow-up protocol. CONCLUSION: Hiccup is only rarely described in the context of acute proximal LAD thrombosis. However, if this special symptom occurs intractably during disease progression, thrombus is revealed to be the probable cause, prompt opening of the criminal vessel should be performed besides strengthening of anticoagulant and antiplatelet.


Assuntos
Infarto Miocárdico de Parede Anterior/diagnóstico , Doenças da Aorta/diagnóstico , Trombose Coronária/diagnóstico , Soluço/diagnóstico , Doença Aguda , Infarto Miocárdico de Parede Anterior/complicações , Aorta Torácica/patologia , Doenças da Aorta/complicações , Trombose Coronária/complicações , Diagnóstico Diferencial , Soluço/etiologia , Humanos , Masculino , Pessoa de Meia-Idade
3.
Leg Med (Tokyo) ; 40: 1-4, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31254732

RESUMO

Cardiac rupture with intact pericardium is a dangerous lesion due to high and rapid mortality. Its most common etiologies are blunt chest trauma and myocardial infarction. In forensic practice, this type of rupture can involve a complex relationship between trauma and cardiac disease, so clarifying the main cause of rupture is critical. Herein, we present four cases of cardiac rupture with intact pericardium, which were due to trauma, pathology or both. We propose several diagnostic pointers to analyze this uncommon lesion. Furthermore, the possibility of cardiac rupture induced by cardiopulmonary resuscitation should also be discriminated in such cases.


Assuntos
Trombose Coronária/complicações , Ruptura Cardíaca/diagnóstico , Ruptura Cardíaca/etiologia , Pericárdio , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Adulto , Idoso , Autopsia , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
Echocardiography ; 36(6): 1103-1109, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31116460

RESUMO

OBJECTIVE: The correlation between the echocardiographic Doppler flow parameters of microvascular obstruction (MVO) and coronary wedge pressure (CWP) measured as a marker of severe compressive microvascular dysfunction and a predictor of adverse left ventricular remodeling was evaluated in a group of high-risk acute anterior myocardial infarction survivors. METHODS: Twenty-four patients with mechanically reperfused anterior STEMI were divided into two groups based on the 38 mm Hg CWP cutoff for adverse left ventricular remodeling. Diastolic deceleration time (DDT), coronary flow reserve (CFR), systolic retrograde flow, peak systolic and peak diastolic velocities in the infarct-related artery were determined 3-5 days after revascularization. An echocardiographic 20% increase in left ventricular volumes defined adverse remodeling. RESULTS: No significant differences were recorded between groups with regard to the echocardiographic parameters of MVO. No significant correlation was identified between CWP on one side and DDT (P = 0.30) and CFR (P = 0.39) on the other, irrespective of total ischemic time and extracted thrombus length. No difference in 5 years of follow-up left ventricular remodeling was detected in patients with DDT<900 msec as compared to those with DDT≥900 msec. The medium increase in left ventricular end-systolic volume in patients with low CWP was 24.78%, while it reached 127.27% (P = 0.03) in patients with CWP>38 mm Hg. CONCLUSIONS: Coronary wedge pressure did not correlate with the surrogate parameters for MVO, but it was a predictor of left ventricular remodeling. None of the echocardiographic MVO parameters was associated with adverse remodeling at 5 years of follow-up.


Assuntos
Circulação Coronária/fisiologia , Trombose Coronária/diagnóstico por imagem , Ecocardiografia Doppler/métodos , Microcirculação/fisiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Remodelação Ventricular/fisiologia , Trombose Coronária/complicações , Trombose Coronária/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pressão Propulsora Pulmonar , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações
5.
Am J Case Rep ; 20: 743-747, 2019 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-31129678

RESUMO

BACKGROUND Myasthenia gravis can precipitate severe stress particularly during a myasthenic crisis episode. Takotsubo cardiomyopathy has been demonstrated in several conditions associated with emotional or physical stress. As a result, Takotsubo cardiomyopathy is not uncommon in patients with MG. The severe complications of Takotsubo cardiomyopathy include heart failure and left ventricular thrombus associated with thromboembolic risk. The concomitant myasthenic crisis and Takotsubo cardiomyopathy with apical left ventricular thrombus has never been reported. CASE REPORT A 67-year- old Thai female diagnosed with myasthenia gravis was admitted to the intensive care unit due to the myasthenic crisis. The 12-lead electrocardiogram showed marked QT interval prolongation and diffuse large T-wave inversion. Echocardiogram demonstrated basal hyperkinesia and apical akinesia with apical ballooning. Hyperechoic mass was noted in akinetic left ventricular apex. Takotsubo cardiomyopathy with apical left ventricular thrombus was diagnosed. Both conditions were successfully treated in this patient without any complications. CONCLUSIONS The electrocardiogram surveillance in patients with myasthenic crisis is essential to detect the occurrence of Takotsubo cardiomyopathy and its complications. Early diagnosis and treatments may decrease mortality and morbidity related with this condition.


Assuntos
Trombose Coronária/complicações , Trombose Coronária/diagnóstico , Miastenia Gravis/complicações , Miastenia Gravis/diagnóstico , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico , Idoso , Trombose Coronária/terapia , Feminino , Humanos , Miastenia Gravis/terapia , Cardiomiopatia de Takotsubo/terapia
6.
Echocardiography ; 36(5): 975-979, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30957272

RESUMO

Takotsubo Cardiomyopathy (TC) is an uncommon, transient, reversible cardiomyopathy, with a classic pattern of wall-motion abnormalities, usually seen in women after an emotional stressor. Despite its increased recognition, there remain gaps in the exact mechanisms, predisposing factors, and predictors of recovery; this is particularly true for males where the condition occurs far less frequently than in females. TC typically resolves within weeks, and the prognosis is favorable compared to acute coronary syndromes. Nonetheless, about 1% of cases may be complicated by left ventricular (LV) thrombus and embolism. Herein we describe an atypical case of a man with no obvious trigger, who developed TC with left ventricular thrombus and multiple embolic complications, but subsequently showed complete and full resolution. Multimodality imaging including echocardiography, cardiac CT and cardiac MRI was instrumental in this diagnostic dilemma, as well as useful in guiding treatment options and informing prognosis.


Assuntos
Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
7.
Echocardiography ; 36(6): 1110-1117, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31012159

RESUMO

BACKGROUND: Coronary microvascular dysfunction (CMD) may cause angina in the absence of obstructive coronary artery disease (CAD) and increases the risk of future adverse cardiovascular events. Transthoracic Doppler echocardiography (TTDE) with pharmacological stress can assess coronary flow velocity reserve (CFVR), a measure of coronary microvascular function. However, simpler methods would be preferable for diagnosing CMD. Therefore, we examined the relationship between CFVR and cardiac time intervals measured by TTDE in a cohort of women with angina and no obstructive CAD. METHODS: In a prospective cohort study, we included 389 women with angina, left ventricular ejection fraction > 45%, and no obstructive CAD. CMD was defined as CFVR < 2.0. The study population was divided into three groups according to cutoff values of CFVR < 2, 2 ≤ CFVR ≤ 2.5, and CFVR > 2.5. Isovolumic contraction time (IVCT), ejection time (ET), and isovolumic relaxation time (IVRT) were measured by tissue Doppler M-mode, and the myocardial performance index (MPI = (IVCT + IVRT)/ET) was calculated. RESULTS: Coronary microvascular dysfunction was associated with increasing age, hypertension, higher resting heart rate, and lower diastolic blood pressure. Moreover, CMD was associated with higher E/e' ratio (P = 0.002) and longer IVCT (P < 0.001), higher MPI (P < 0.001) and shorter ET (P = 0.002), but not with IVRT or conventional measures of left ventricular geometry, mass, and function. In multivariable analysis, longer IVCT (P < 0.001) and higher MPI (P = 0.002) remained associated with CMD. CONCLUSION: In women with angina and no obstructive CAD, CMD is associated with longer IVCT and higher MPI indicating a link between CMD and subtle alternations of systolic and combined measures of cardiac time intervals.


Assuntos
Angina Pectoris/etiologia , Doença da Artéria Coronariana , Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Ecocardiografia Doppler/métodos , Microcirculação/fisiologia , Angina Pectoris/fisiopatologia , Velocidade do Fluxo Sanguíneo , Estudos de Coortes , Circulação Coronária , Trombose Coronária/fisiopatologia , Ecocardiografia sob Estresse , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
9.
J Invasive Cardiol ; 31(2): E45, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30700634

RESUMO

To our knowledge, this is the first report of primary percutaneous coronary intervention in a patient with a superdominant left circumflex artery, in which the entire right coronary artery myocardium territory is provided by the left circumflex. Coronary angiographic images of our 80-year-old male patient illustrate this anomaly. Single coronary arteries are among the most rare anatomic coronary anomalies, and the absence of right coronary artery ostium has been described as the rarest of these anomalies. Coronary events in such cases can be catastrophic due to the large amount of myocardium at risk.


Assuntos
Oclusão Coronária/diagnóstico , Trombose Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Seio Aórtico/diagnóstico por imagem , Idoso de 80 Anos ou mais , Angiografia Coronária , Oclusão Coronária/complicações , Oclusão Coronária/cirurgia , Trombose Coronária/complicações , Trombose Coronária/cirurgia , Humanos , Masculino , Intervenção Coronária Percutânea/métodos
10.
Clin Res Cardiol ; 108(8): 950-962, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30710262

RESUMO

OBJECTIVE: The tightly packed arrays of polyhedral erythrocytes, polyhedrocytes, formed during thrombus contraction, have been detected in some intracoronary thrombi (ICT) obtained from patients with ST-segment elevation myocardial infarction (STEMI). We sought to investigate determinants of polyhedrocyte content in ICT and its association with reperfusion in STEMI. METHODS: We assessed the composition of ICT obtained during thrombectomy within 12 h since the symptom onset in 110 STEMI patients, following 300 mg of aspirin (n = 110) and 600 mg of clopidogrel (n = 75). The predominance of fibrin, erythrocytes, polyhedrocytes or platelets was evaluated using scanning electron microscopy. RESULTS: Polyhedrocytes were found in 34 (30.9%) ICT, in which they covered 20-50% (median 38.8%) fields of view. Patients with polyhedrocytes in ICT had lower median minimal reference infarct-related artery (IRA) diameter by 20% (p < 0.0001) and area by 31% (p < 0.0001) versus those without polyhedrocytes. Time of ischemia showed association with the polyhedrocyte content (r = 0.26, p = 0.007). By multivariate analysis, minimal IRA diameter (ß = - 0.50, p < 0.0001) and ischemia time (ß = 0.20, p = 0.035) independently affected polyhedrocyte content in ICT (R2 = 0.45, p < 0.0001). Patients with ischemia time of > 3 h and polyhedrocytes present in ICT had more frequently TIMI-2/3 flow after thrombus aspiration (96% vs. 67%, p = 0.02) and final TIMI-2/3 myocardial perfusion grade (92% vs. 57%, p = 0.044) versus those without polyhedrocytes. CONCLUSIONS: Our findings indicate that the presence of polyhedrocytes in ICT, observed in one-third of STEMI patients, is associated with smaller minimal IRA diameter, prolonged ischemia and their formation in late presenters is associated with more effective thrombus aspiration and better myocardial reperfusion.


Assuntos
Trombose Coronária/metabolismo , Eritrócitos/ultraestrutura , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Trombectomia/métodos , Angiografia Coronária , Trombose Coronária/complicações , Trombose Coronária/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Microscopia Eletrônica de Varredura , Pessoa de Meia-Idade , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia
11.
Echocardiography ; 36(4): 794-796, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30735269

RESUMO

Chronic myeloid leukaemia (CML) is a neoplastic disorder of myeloid cell lines and is a less aggressive disease compared to acute myeloid leukemia (AML). Although cardiovascular complications are not uncommon, intracardiac thrombosis in CML is rarely reported. Herein, we report a case of CML presenting with an intracardiac thrombus attached to the posterior mitral leaflet, and subsequently resulting in peripheral embolization.


Assuntos
Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Ecocardiografia/métodos , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Humanos , Masculino , Pessoa de Meia-Idade
12.
Angiology ; 70(7): 642-648, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30621429

RESUMO

The incidence of contrast-induced nephropathy (CIN) increases in the range from patients with unstable angina to ST-segment elevation myocardial infarction (STEMI). Platelet activation has been associated with pathophysiology of nephropathy and thrombus burden in the infarct-related arteries. We investigated the impact of thrombus burden on CIN in patients with STEMI. We enrolled 883 patients with STEMI who received primary percutaneous coronary intervention. Patients were divided into groups according to thrombus burden and CIN development. Thrombus burden was scored based on thrombolysis in myocardial infarction thrombus grades (TGs). Thrombus grade 4 was defined as large thrombus burden (LTB), while thrombus burden

Assuntos
Lesão Renal Aguda/induzido quimicamente , Angiografia Coronária/efeitos adversos , Trombose Coronária/complicações , Intervenção Coronária Percutânea/efeitos adversos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Lesão Renal Aguda/diagnóstico , Adulto , Idoso , Trombose Coronária/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Índice de Gravidade de Doença , Resultado do Tratamento
13.
Ann Pharmacother ; 53(2): 171-177, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30132336

RESUMO

BACKGROUND: Cangrelor is an intravenous P2Y12 receptor antagonist approved for use during percutaneous coronary intervention (PCI) to reduce ischemic events associated with new stent placement and has been used off-label at reduced doses guided by platelet function testing as a "bridge" from discontinuation of oral P2Y12 receptor antagonists to surgical procedures when the long-term effects of oral agents are undesirable. OBJECTIVE: To describe the dosing, laboratory monitoring, and clinical outcomes of a series of patients who received cangrelor as a "bridging" antiplatelet agent. METHODS: This study is a retrospective analysis of all patients within the study center with coronary stents who received cangrelor as a bridge to surgical procedure and had VerifyNow monitoring during treatment. RESULTS: A total of 11 patients were identified for inclusion. The median cangrelor dose was 0.5 µg/kg/min (interquartile range = 0.5-0.5) and was maintained in 7 of 11 patients. Doses ranged from 0.25 to 2 µg/kg/min during therapy, and 81.6% of VerifyNow results assessed were within goal range (⩽208 P2Y12 reaction units). Bleeding complications during therapy occurred in 3 patients, all of whom were receiving concomitant heparin infusions, and no stent thrombosis was reported. Conclusion and Relevance: Low-dose cangrelor may represent an effective option for bridging antiplatelet therapy in patients with coronary stents. This study demonstrated that the majority of patients received adequate platelet inhibition without any incidence of stent thrombosis on 0.5 µg/kg/min using the VerifyNow assay to monitor platelet inhibition, which represents a lower dose than previously reported in the literature.


Assuntos
Monofosfato de Adenosina/análogos & derivados , Trombose Coronária/cirurgia , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/administração & dosagem , Stents , Monofosfato de Adenosina/administração & dosagem , Monofosfato de Adenosina/efeitos adversos , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Trombose Coronária/complicações , Relação Dose-Resposta a Droga , Esquema de Medicação , Substituição de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação de Plaquetas/efeitos adversos , Testes de Função Plaquetária , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Antagonistas do Receptor Purinérgico P2Y/administração & dosagem , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Estudos Retrospectivos , Stents/efeitos adversos , Resultado do Tratamento
14.
Eur Heart J Acute Cardiovasc Care ; 8(1): 45-53, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28868906

RESUMO

In the past few decades, cardiac ultrasound has become a widely available, easy-to-use diagnostic tool in many scenarios in acute cardiac care. The introduction of microbubbles extended its diagnostic value. Not long thereafter, several investigators explored the therapeutic potential of contrast ultrasound on thrombus dissolution. Despite large improvements in therapeutic options, acute ST elevation myocardial infarction remains one of the main causes of mortality and morbidity in the western world. The therapeutic effect of contrast ultrasound on thrombus dissolution might prove to be a new, effective treatment strategy in this group of patients. With the recent publication of human studies scrutinising the therapeutic options of ultrasound and microbubbles in ST elevation myocardial infarction, we have entered a new stage in this area of research. This therapeutic effect is based on biochemical effects both at macrovascular and microvascular levels, of which the exact working mechanisms remain to be elucidated in full. This review will give an up-to-date summary of our current knowledge of the therapeutic effects of contrast ultrasound and its potential application in the field of ST elevation myocardial infarction, along with its future developments.


Assuntos
Meios de Contraste/farmacologia , Circulação Coronária/fisiologia , Trombose Coronária/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Ultrassonografia de Intervenção/métodos , Angiografia Coronária , Trombose Coronária/complicações , Trombose Coronária/diagnóstico , Ecocardiografia , Humanos , Microcirculação , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia
15.
Eur Heart J Acute Cardiovasc Care ; 8(1): 24-38, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30160519

RESUMO

BACKGROUND:: The role of thrombus aspiration plus primary percutaneous coronary intervention in ST-segment elevation myocardial infarction remains controversial. METHODS:: We performed a meta-analysis of 25 randomised controlled trials in which 21,740 ST-segment elevation myocardial infarction patients were randomly assigned to thrombus aspiration plus primary percutaneous coronary intervention or primary percutaneous coronary intervention. Study endpoints were: death, myocardial infarction, stent thrombosis and stroke. RESULTS:: On pooled analysis, the risk of death (4.3% vs. 4.8%, odds ratio (OR) 0.90, 95% confidence interval (CI) 0.79-1.03; P=0.123), myocardial infarction (2.4% vs. 2.5%, OR 0.95, 95% CI 0.80-1.13; P=0.57) and stent thrombosis (1.3% vs. 1.6%, OR 0.80, 95% CI 0.63-1.01; P=0.066) was similar between thrombus aspiration plus primary percutaneous coronary intervention and primary percutaneous coronary intervention. The risk of stroke was higher in the thrombus aspiration plus primary percutaneous coronary intervention than the primary percutaneous coronary intervention group (0.84% vs. 0.59%, OR 1.401, 95% CI 1.004-1.954; P=0.047). However, on sensitivity analysis after removing the TOTAL trial, thrombus aspiration plus primary percutaneous coronary intervention was not associated with an increased risk of stroke (OR 1.01, 95% CI 0.58-1.78). The weak association between thrombus aspiration and stroke was also confirmed by the fact that the lower bound of the 95% CI was slightly below unity after removing either the study by Kaltoft or the ITTI trial. There was no interaction between the main study results and follow-up, evidence of coronary thrombus, or study sample size. CONCLUSIONS:: In patients with ST-segment elevation myocardial infarction, thrombus aspiration plus primary percutaneous coronary intervention does not reduce the risk of death, myocardial infarction or stent thrombosis. Thrombus aspiration plus primary percutaneous coronary intervention is associated with an increased risk of stroke; however, this latter finding appears weak.


Assuntos
Trombose Coronária/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Trombectomia/métodos , Angiografia Coronária , Trombose Coronária/complicações , Trombose Coronária/diagnóstico , Eletrocardiografia , Humanos , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia
16.
Ann Thorac Surg ; 107(5): e307-e308, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30403982

RESUMO

An 8-year-old girl presenting with fulminant myocarditis and cardiogenic shock underwent peripheral extracorporeal membrane oxygenation. She was switched to central extracorporeal membrane oxygenation because of inadequate venous drainage, and an echocardiogram showed left ventricular (LV) thrombus. She underwent removal of the LV thrombus with LV venting. An echocardiogram showed LV thrombus again 2 days later. The LV thrombus was again removed, and a biventricular assist device support was initiated to avoid further thrombus formation. The patient was completely weaned from mechanical circulatory support after 7 days. She recovered fully without any neurologic deficit.


Assuntos
Trombose Coronária/terapia , Oxigenação por Membrana Extracorpórea , Coração Auxiliar , Miocardite/terapia , Choque Cardiogênico/terapia , Criança , Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Feminino , Humanos , Miocardite/complicações , Miocardite/diagnóstico por imagem , Choque Cardiogênico/etiologia
17.
Am J Case Rep ; 19: 1306-1310, 2018 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-30385736

RESUMO

BACKGROUND Non-atherosclerotic causes of ST-segment elevation myocardial infarction (STEMI) are uncommon, and there are few case reports of acute myocardial infarction secondary to coronary artery embolism. CASE REPORT A 66-year-old man presented with shortness of breath and leg swelling. Diagnoses of congestive heart failure and atrial fibrillation were made. He was electrically cardioverted to normal sinus rhythm. Coronary angiogram was performed to rule out ischemic etiology of new-onset systolic heart failure, and anticoagulation therapy was interrupted for cardiac catheterization. His coronary angiogram showed 60% angiographic but hemodynamically insignificant stenosis by fractional flow reserve in the left anterior descending artery. The following day, the patient developed chest pain and ST-segment elevation in the anterolateral leads of the ECG. An emergent coronary angiogram showed thrombotic occlusion of the left anterior descending artery distal to the mid-left anterior descending artery lesion that was found on the initial angiogram. Successful thrombus aspiration was performed, and the patient was discharged to home on oral anticoagulation therapy with rivaroxaban. Most likely, the cause of thrombotic occlusion of the left anterior descending artery was an atrial fibrillation-related thromboembolic phenomenon due to interruption of anticoagulation therapy soon after direct-current cardioversion. CONCLUSIONS Subtherapeutic anticoagulation therapy soon after direct-current cardioversion of atrial fibrillation can lead to potentially fatal coronary artery embolism and acute myocardial infarction.


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Trombose Coronária/diagnóstico por imagem , Cardioversão Elétrica/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Idoso , Anticoagulantes/uso terapêutico , Cateterismo Cardíaco/métodos , Angiografia Coronária/métodos , Trombose Coronária/complicações , Trombose Coronária/terapia , Ecocardiografia Transesofagiana/métodos , Eletrocardiografia/métodos , Humanos , Masculino , Obesidade Mórbida , Prognóstico , Medição de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Trombectomia/métodos , Resultado do Tratamento
20.
Circ J ; 82(9): 2299-2304, 2018 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-29973431

RESUMO

BACKGROUND: Detection of yellow plaques (YP) by coronary angioscopy (CAS) 1 year after 1st-generation drug-eluting stent (DES) implantation has been related to future coronary events. However, the association between CAS findings and clinical outcomes following 2nd-generation DES implantation has not been investigated. Methods and Results: This study included a total of 248 2nd-generation DES in 179 patients, who were examined by CAS 9±2 months after implantation. Angioscopic evaluation included dominant neointimal coverage (NIC) grade, heterogeneity of NIC, presences of YP and intrastent thrombus. The outcome measure was major adverse cardiac events (MACE) defined as a composite of cardiac death, acute myocardial infarction and any coronary revascularization. The association between the CAS findings and MACE was evaluated using the Kaplan-Meier method. A Cox proportional hazards model was used to assess the predictors of MACE. The mean follow-up duration was 1,367±843 days. Dominant NIC grade (P=0.98), heterogeneity of NIC (P=0.20) and YP (P=0.53) were not associated with the incidence of MACE. However, intrastent thrombus was significantly associated with MACE (P=0.033). Intrastent thrombus (adjusted hazard ratio: 2.22; 95% confidence interval [CI]: 1.12-4.39), acute coronary syndrome (2.83; 95% CI: 1.42-5.67) and B2/C lesion (2.13; CI: 1.12-4.05) were independent predictors of MACE. CONCLUSIONS: Subclinical intrastent thrombus observed by CAS at 9 months after 2nd-generation DES implantation was independently associated with poor clinical outcome.


Assuntos
Trombose Coronária/complicações , Stents Farmacológicos/efeitos adversos , Infarto do Miocárdio/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Síndrome Coronariana Aguda/complicações , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/cirurgia , Feminino , Seguimentos , Oclusão de Enxerto Vascular/complicações , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/patologia , Resultado do Tratamento
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