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1.
BMJ Case Rep ; 14(3)2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-33762295

RESUMO

A 34-year-old man presented with central chest pain heralded by bilateral arm numbness, tingling and pain soon after donation of 1000 mL of COVID-19 convalescent plasma (CP). ECG showed ST-elevation in lateral leads and coronary angiogram showed large thrombus in diagonal branch of the left anterior descending artery. The patient underwent successful thrombus aspiration and percutaneous coronary intervention of diagonal branch. In this report, we describe a case of coronary thrombosis leading to ST-elevation myocardial infarction in a naïve plasma donor after donation of COVID-19 CP.


Assuntos
Doadores de Sangue , Trombose Coronária/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Adulto , Angiografia Coronária/métodos , Trombose Coronária/diagnóstico , Trombose Coronária/terapia , Eletrocardiografia/métodos , Humanos , Imunização Passiva/efeitos adversos , Masculino , Intervenção Coronária Percutânea/métodos , Plasma , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Trombectomia/métodos , Resultado do Tratamento
2.
Int Heart J ; 62(2): 437-440, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-33731532

RESUMO

A 61-year-old woman suffered chest pain and was admitted to a nearby hospital emergency department. She was diagnosed with acute myocardial infarction probably due to thromboembolism in the left anterior descending coronary artery and aspiration thrombectomy was performed. Afterwards, she developed refractory heart failure with severe global left ventricular dysfunction and was transferred to our hospital. An 18F-FDG-PET/CT scan revealed abnormal 18F-FDG uptake in non-infarcted regions of the left ventricle. Non-caseating granulomas were detected by biopsy from a skin eruption. She was diagnosed with cardiac sarcoidosis. In cases of refractory heart failure which cannot be explained only by myocardial infarction, evaluation of other undiagnosed cardiomyopathies is important for optimal management.


Assuntos
Cardiomiopatias/complicações , Trombose Coronária/complicações , Insuficiência Cardíaca/etiologia , Infarto do Miocárdio/etiologia , Sarcoidose/complicações , Cardiomiopatias/diagnóstico , Trombose Coronária/diagnóstico , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Sarcoidose/diagnóstico
3.
Diabetes Res Clin Pract ; 173: 108670, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33453294

RESUMO

OBJECTIVES: We examined the association of the coronary thrombus microbiota and relative metabolites with major adverse cardiovascular events (MACE) in hyperglycemic patients with ST segment elevation myocardial infarction (STEMI). BACKGROUND: Hyperglycemia during STEMI may affect both development and progression of coronary thrombus via gut and thrombus microbiota modifications. METHODS: We undertook an observational cohort study of 146 first STEMI patients treated with primary percutaneous coronary intervention (PPCI) and thrombus-aspiration (TA). Patients were clustered, based on admission blood glucose levels, in hyperglycemic (≥140 mg/dl) and normoglycemic (<140 mg/dl). We analyzed gut and thrombus microbiota in all patients. Moreover, we assessed TMAO, CD40L and von Willebrand Factor (vWF) in coronary thrombi. Cox regressions were used for the association between Prevotellaspp. and TMAO terziles and MACE. MACE endpoint at 1 year included death, re-infarction, unstable angina. RESULTS: In fecal and thrombus samples, we observed a significantly different prevalence of both Prevotellaspp. and Alistipesspp. between patients with hyperglycemia (n = 56) and those with normal glucose levels (n = 90). The abundance of Prevotella increased in hyperglycemic vs normoglycemic patients whereas the contrary was observed for Alistipes. Interestingly, in coronary thrombus, the content of Prevotella was associated with admission blood glucose levels (p < 0.01), thrombus dimensions (p < 0.01), TMAO, CDL40 (p < 0.01) and vWF (p < 0.01) coronary thrombus contents. Multivariate Cox-analysis disclosed a reduced survival in patients with high levels of Prevotella and TMAO in coronary thrombus as compared to patients with low levels of Prevotella and TMAO, after 1-year follow up. CONCLUSIONS: Hyperglycemia during STEMI may increase coronary thrombus burden via gut and thrombus microbiota dysbiosis characterized by an increase of Prevotella and TMAO content in thrombi. CLINICAL TRIAL REGISTRATION: NCT03439592. September 30, 2016. Ethic Committee Vanvitelli University: 268/2016.


Assuntos
Hiperglicemia/complicações , Microbiota/fisiologia , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Trombose/microbiologia , Idoso , Estudos de Coortes , Trombose Coronária/complicações , Trombose Coronária/mortalidade , Trombose Coronária/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(27): e20994, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629716

RESUMO

INTRODUCTION: Acute myocardial infarction with simultaneous coronary thrombosis has been rarely reported. This combination induces various arrhythmias and is a high-risk factor for cardiogenic shock. PATIENT CONCERNS: A 65-year-old man presented with sweating and a 3-h abrupt persistent back pain that radiated to the anterior. DIAGNOSIS: Multisite myocardial infarction, coronary thrombosis with and complex malignant arrhythmia INTERVENTIONS:: Prompt intervention includes cardiac pacing, percutaneous coronary intervention (PCI), thrombus aspiration and intra-aortic balloon pump (IABP). OUTCOMES: The patient was successfully rescued after PCI and thrombus aspiration. CONCLUSIONS: Recognition of dynamic electrocardiographic changes enhances our understanding of the pathogenesis of myocardial infarction.


Assuntos
Arritmias Cardíacas/complicações , Trombose Coronária/complicações , Infarto do Miocárdio/complicações , Idoso , Arritmias Cardíacas/cirurgia , Trombose Coronária/cirurgia , Eletrocardiografia , Humanos , Masculino , Intervenção Coronária Percutânea/métodos , Choque Cardiogênico/etiologia
10.
Leg Med (Tokyo) ; 42: 101662, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31896072

RESUMO

In clinical and forensic practice, the cause of death is often attributed to acute myocardial infarction, among which the coronary atherosclerosis being the Captain of the Men of Death. However, other reasons such as coronary septic embolization with neutrophilic granulocyte myocarditis although rare, can also cause sudden unexpected death. This paper reports a case with this rare cause-a 21-year-old woman diagnosed with "acute gastroenteritis" who died 4 days later. A forensic autopsy revealed an inflammatory polypous embolic located at 1.0 cm from the left anterior descending branch (LAD) with serve neutrophilic granulocyte myocarditis, which resulted in embolic at the opening of the left main coronary artery, acute myocardial infarction and eventually leading to her death. Histopathological examination showed large amounts of neutrophilic granulocyte infiltration in the arterial layer forming the septic embolic and eventually resulting in coronary occlusion. To find the real cause of septic embolic, myocarditis, bacterial, fungal, protozoan and virus detection was performed through RT-PCR, with negative findings. Septic embolic leading coronary occlusion in left main coronary artery and LAD is rarely reported in forensic practice, we hope this report can pave the way on understanding this rare disease to make correct diagnosis in medical practice.


Assuntos
Trombose Coronária/complicações , Morte Súbita/etiologia , Medicina Legal , Infarto do Miocárdio/etiologia , Miocardite/complicações , Feminino , Humanos , Adulto Jovem
11.
BMJ Case Rep ; 13(1)2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31900297

RESUMO

Hypereosinophilic syndrome (HES) is a rare disorder characterised by eosinophilic infiltration of tissues. Myocardial infiltration occurs in 50%-60% of HES and leads to a condition called Loeffler's endocarditis. This can lead to endomyocardial injury with resultant superimposed thrombus formation and embolic stroke. We describe the case of a 57-year-old female patient presenting with neurological symptoms who was found to have multiple embolic strokes on a background of long-standing eosinophilia. Following a series of investigations, including transthoracic and transoesophageal echocardiographies and cardiovascular MRI, she was confirmed to have Loeffler's endocarditis with left ventricular thrombus. She was treated successfully with steroids and anticoagulation. We describe the pathophysiology of HES and Loeffler's endocarditis and stress the crucial role of multimodality cardiac imaging in establishing its diagnosis and treatment monitoring.


Assuntos
Trombose Coronária/diagnóstico por imagem , Eosinofilia/complicações , Síndrome Hipereosinofílica/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Trombose Coronária/complicações , Trombose Coronária/tratamento farmacológico , Diagnóstico Diferencial , Ecocardiografia , Feminino , Humanos , Síndrome Hipereosinofílica/complicações , Síndrome Hipereosinofílica/tratamento farmacológico , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Esteroides/uso terapêutico , Acidente Vascular Cerebral/etiologia
12.
J Thromb Thrombolysis ; 49(1): 138-140, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31654193

RESUMO

A case is described in which the short-acting glycoprotein IIb/IIIa receptor antagonist tirofiban was used in combination with heparin, aspirin and prasugrel to successfully treat extensive intracoronary thrombus in a delayed presentation STEMI, illustrating the utility of this approach.


Assuntos
Abciximab , Aspirina/administração & dosagem , Trombose Coronária/tratamento farmacológico , Heparina/administração & dosagem , Cloridrato de Prasugrel/administração & dosagem , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Tirofibana/administração & dosagem , Idoso , Trombose Coronária/complicações , Humanos , Masculino , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações
13.
Platelets ; 31(2): 167-173, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30973035

RESUMO

Stent thrombosis remains an infrequent but significant complication following percutaneous coronary intervention. Preclinical models to rapidly screen and validate therapeutic compounds for efficacy are lacking. Herein, we describe a reproducible, high throughput and cost-effective method to evaluate candidate therapeutics and devices for either treatment or propensity to develop stent thrombosis in an in vitro bench-top model. Increasing degree of stent malapposition (0.00 mm, 0.10 mm, 0.25 mm and 0.50 mm) was associated with increasing thrombosis and luminal area occlusion (4.1 ± 0.5%, 6.3 ± 0.5%, 19.7 ± 4.5%, and 92.6 ± 7.4%, p < 0.0001, respectively). Differences in stent design in the form of bare-metal, drug-eluting, and bioresorbable vascular scaffolds demonstrated differences in stent thrombus burden (14.7 ± 3.8% vs. 20.5 ± 3.1% vs. 86.8 ± 5.3%, p < 0.01, respectively). Finally, thrombus burden was significantly reduced when healthy blood samples were incubated with Heparin, ASA/Ticagrelor (DAPT), and Heparin+DAPT compared to control (DMSO) at 4.1 ± 0.6%, 6.9 ± 1.7%, 4.5 ± 1.2%, and 12.1 ± 1.8%, respectively (p < 0.01). The reported model produces high throughput reproducible thrombosis results across a spectrum of antithrombotic agents, stent design, and degrees of apposition. Importantly, performance recapitulates clinical observations of antiplatelet/antithrombotic regimens as well as device and deployment characteristics. Accordingly, this model may serve as a screening tool for candidate therapies in preclinical evaluation.


Assuntos
Trombose Coronária/etiologia , Stents/efeitos adversos , Fenômenos Fisiológicos Sanguíneos/efeitos dos fármacos , Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/enzimologia , Stents Farmacológicos/efeitos adversos , Enzimas/sangue , Humanos , Técnicas In Vitro , Modelos Biológicos , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação de Plaquetas/uso terapêutico , Trombose/sangue , Trombose/complicações , Trombose/enzimologia , Tomografia de Coerência Óptica
14.
BMJ Case Rep ; 12(11)2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31748353

RESUMO

Steven-Johnson syndrome (SJS) is a rare but serious mucocutaneous reaction to medications. We present a rare case of SJS developing after antibiotic administration for a lower respiratory tract infection and whose inpatient course was complicated with an acute ST-segment elevation myocardial infarction (MI). The laboratory findings revealed thrombocytosis which was possibly reactive and explained the underlying pathophysiology of the thrombus formation seen in the coronary artery. Stenting and aspiration of thrombus was performed. This case illustrates a possibly rare association between SJS and MI.


Assuntos
Antibacterianos/efeitos adversos , Infecções Respiratórias/tratamento farmacológico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Síndrome de Stevens-Johnson/complicações , Adulto , Angiografia Coronária/métodos , Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Vasos Coronários/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Stents , Trombectomia/métodos , Trombocitose/complicações , Resultado do Tratamento
15.
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
16.
Prehosp Disaster Med ; 34(6): 677-680, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31597072

RESUMO

Carbon monoxide (CO) poisoning is the most common cause of death and injury among all poisonings. Myocardial injury is detected in one-third of CO poisonings. In this Case Report, a previously healthy 41-year-old man was referred for CO poisoning. The initial electrocardiogram (ECG) showed 1mm ST segment elevation in leads DII, DIII, and aVF. As the patient did not describe chest pain and had no cardiac symptoms, ECG was repeated 10 minutes later and it was seen that ST segment elevation disappeared. As the patient had a transient ST segment elevation and elevated high-sensitive Tn-T (HsTn-T), the patient was transferred to the coronary angiography laboratory. The patient's left coronary system was normal, but a thrombus image narrowing the lumen by approximately 60% was observed in the right coronary artery. Intravenous tirofiban was administered for 48 hours. Control coronary angiography showed continuing thrombus formation and a bare metal stent was successfully implanted. This is the first reported case with transient ST segment elevation associated with acute coronary thrombus caused by CO poisoning. It may be recommended that patients with CO poisoning should be followed-up with a 12-lead ECG monitor or 24-hour ECG Holter monitoring, even if they show no cardiac symptoms and echocardiography shows no wall motion abnormality. Early coronary angiography upon detection of such dynamic ECG changes in these recordings as ST segment elevation can reduce the risk of myocardial infarction (MI) and mortality in these patients.


Assuntos
Intoxicação por Monóxido de Carbono/complicações , Trombose Coronária/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Adulto , Intoxicação por Monóxido de Carbono/sangue , Angiografia Coronária , Trombose Coronária/complicações , Trombose Coronária/diagnóstico por imagem , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Masculino , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem
17.
Ann Cardiol Angeiol (Paris) ; 68(6): 423-428, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31648796

RESUMO

Transcatheter aortic valve implantation (TAVI) has become the major approach to manage the severe aortic stenosis in inoperable patients that frequently present a coronary artery disease. To date, the available data related to the impact of these coronary lesions on survival is conflicting. When indicated, coronary revascularization could be beneficial for proximal lesions when performed before or during TAVI. The per-procedure coronary artery occlusion is rare, but with a bad prognosis. The coronary occlusion is more frequent with short distance of the coronary implantation and the small aortic sinuses, mostly occurring in the left main coronary. The scan analysis to identify high-risk cases is therefore important before the procedure in order to anticipate and prevent complications by specific techniques. Recently, late occlusion cases have been described and linked to thrombus or fibrosis mechanisms. The rate of success of percutaneous coronary intervention (PCI) after TAVI approach is weak, because of the difficulties of selective catheterization due to the stent of prosthesis. The different techniques of PCI have been outlined according to the type of the prosthesis.


Assuntos
Doença da Artéria Coronariana/cirurgia , Oclusão Coronária/etiologia , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/etiologia , Substituição da Valva Aórtica Transcateter , Angioplastia Coronária com Balão/métodos , Aorta/anatomia & histologia , Aorta/diagnóstico por imagem , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Oclusão Coronária/terapia , Trombose Coronária/complicações , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Fibrose , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Desenho de Prótese , Risco , Substituição da Valva Aórtica Transcateter/efeitos adversos
20.
Sci Adv ; 5(6): eaav5463, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31206016

RESUMO

Persons with HIV infection (PWH) have increased risk for cardiovascular disease (CVD), but the underlying mechanisms remain unclear. Coronary thrombosis is known to provoke myocardial infarctions, but whether PWH have elevated thrombotic propensity is unknown. We compared thrombogenicity of PWH on antiretroviral therapy versus matched controls using the Badimon chamber. Measures of inflammation, platelet reactivity, and innate immune activation were simultaneously performed. Enrolled PWH were then randomized to placebo, aspirin (81 mg), or clopidogrel (75 mg) for 24 weeks to assess treatment effects on study parameters. Thrombogenicity was significantly higher in PWH and correlated strongly with plasma levels of D-dimer, soluble TNF receptors 1 and 2, and circulating classical and nonclassical monocytes in PWH. Clopidogrel significantly reduced thrombogenicity and sCD14. Our data suggest that higher thrombogenicity, interacting with inflammatory and immune activation markers, contributes to the increased CVD risk observed in PWH. Clopidogrel exhibits an anti-inflammatory activity in addition to its antithrombotic effect in PWH.


Assuntos
Anti-Inflamatórios/uso terapêutico , Aspirina/uso terapêutico , Plaquetas/efeitos dos fármacos , Clopidogrel/uso terapêutico , Trombose Coronária/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Inibidores da Agregação de Plaquetas/uso terapêutico , Adulto , Terapia Antirretroviral de Alta Atividade/métodos , Biomarcadores/sangue , Plaquetas/imunologia , Plaquetas/virologia , Trombose Coronária/complicações , Trombose Coronária/imunologia , Trombose Coronária/virologia , Estudos Transversais , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/genética , Produtos de Degradação da Fibrina e do Fibrinogênio/imunologia , Expressão Gênica , Infecções por HIV/complicações , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Imunidade Inata , Inflamação , Receptores de Lipopolissacarídeos/genética , Receptores de Lipopolissacarídeos/imunologia , Masculino , Pessoa de Meia-Idade , Monócitos/efeitos dos fármacos , Monócitos/imunologia , Monócitos/virologia , Agregação Plaquetária/efeitos dos fármacos , Receptores Tipo I de Fatores de Necrose Tumoral/genética , Receptores Tipo I de Fatores de Necrose Tumoral/imunologia , Receptores Tipo II do Fator de Necrose Tumoral/genética , Receptores Tipo II do Fator de Necrose Tumoral/imunologia
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