RESUMO
OBJECTIVES: This study sought to assess the benefits of a coronary chronic total occlusion CTO recanalization after adjusting for the case-mix and the propensity to undergo the CTO intervention in a population of patients with stable coronary artery disease. BACKGROUND: The benefits of percutaneous recanalization of CTO are disputed. METHODS: In 1,602 patients with a least one CTO and treated by percutaneous coronary intervention (PCI), we derived a propensity score to undergo a CTO recanalization by comparing the characteristics of patients who did (n = 346) and did not (n = 1,256) undergo a CTO PCI attempt. Among the patients who underwent a CTO PCI attempt, we identified the angiographic predictors of failure. The primary analysis was ultimately performed by looking at the association between the outcome of the CTO recanalization and the survival free of death and cardiovascular rehospitalizations. Sensitivity analyses were performed by adjusting for the propensity to undergo a CTO recanalization, for the anatomical predictors of failure, and for the extent of coronary artery revascularization achieved. RESULTS: A successful CTO recanalization was not significantly associated with survival free of death and cardiovascular rehospitalization (HR = 0.90, 95% CI 0.64-1.25). Even more conservative hazards ratio point estimates were obtained with the sensitivity analyses. CONCLUSIONS: Successful percutaneous CTO recanalization is not associated with survival free of death and cardiovascular hospitalizations in a contemporary population of patients with symptomatic coronary artery disease.
Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Doenças Cardiovasculares/etiologia , Oclusão Coronária/terapia , Idoso , Angioplastia Coronária com Balão/mortalidade , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/terapia , Distribuição de Qui-Quadrado , Doença Crônica , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , North Carolina , Readmissão do Paciente , Valor Preditivo dos Testes , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
Abnormal Left Coronary Artery from Pulmonary Artery (ALCAPA) is a rare congenital coronary anomaly in which the left main coronary artery arises from the pulmonary trunk, resulting in a left to right shunt. ALCAPA is associated with septal defects and patent ductus arteriosus. The case discussed had a secundum atrial septal defect. Sudden cardiac death is a feared complication. We discuss the hemodynamics of this shunt combination and outline its management, emphasizing shunt hemodynamics during pregnancy. This case highlights that pregnant patients with ALCAPA are at high risk and require optimal peri- and postpartum care. After surgical establishment of dual coronary circulation, patients have carried subsequent pregnancies to term.
L'ALCAPA est une anomalie coronarienne congénitale rare caractérisée par la naissance de l'artère coronaire gauche du tronc pulmonaire, qui entraîne un shunt gauche-droit. L'ALCAPA est associée à des malformations septales et une persistance du canal artériel. Le cas sur lequel nous nous sommes penchés avait une communication interauriculaire (CIA) de type ostium secundum. La mort subite d'origine cardiaque est la complication redoutée. Nous nous penchons sur l'hémodynamique de la combinaison de ce shunt et décrivons sa prise en charge, notamment celle de l'hémodynamique du shunt au cours de la grossesse. Ce cas illustre que les patientes enceintes qui ont une ALCAPA sont exposées à un risque élevé et qu'elles ont besoin de soins optimaux avant et après l'accouchement. Après l'établissement chirurgical de la circulation coronarienne double, les patientes ont mené à terme les grossesses subséquentes.
RESUMO
Acute biventricular dysfunction complicating acute ischaemic stroke poses diagnostic and therapeutic challenges with respect to anticoagulation and short-term and long-term prognosis. We present the uncommon case of an elderly patient presenting with this clinical scenario, who made a full recovery on conservative therapy. Management strategies are discussed and the emerging topic of neuro-cardiac syndromes, namely neurogenic stress cardiomyopathy as distinct from Takotsubo syndrome, is explored.
Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Cardiomiopatia de Takotsubo , Idoso , Humanos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnósticoRESUMO
We present a case of a 56-year-old patient with obstructive sleep apnoea (OSA) presenting with acute decompensated heart failure and signs of cardiogenic shock. Echocardiography and CT imaging led to the diagnosis of acute type A aortic dissection (AD) complicated by aortopulmonary fistula (APF). The patient underwent successful surgical repair with complicated postoperative course including pulseless electrical activity arrest. This case highlights the underappreciated role of untreated OSA as a risk factor for AD. Furthermore, it presents an opportunity to review APFs as a rare complication of AD. We discuss the available evidence linking OSA and AD, review currently reported cases of APF, briefly outline the haemodynamics of this acute left-to-right shunt and discuss management of this rare but deadly complication.
Assuntos
Dissecção Aórtica , Fístula Artério-Arterial , Apneia Obstrutiva do Sono , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Fístula Artério-Arterial/complicações , Fístula Artério-Arterial/diagnóstico por imagem , Fístula Artério-Arterial/cirurgia , Humanos , Pessoa de Meia-Idade , Artéria Pulmonar/anormalidades , Apneia Obstrutiva do Sono/complicações , Síncope/etiologiaRESUMO
We present the case of a 34-year-old woman with a rare constellation of congenital cardiovascular defects. She presented with new-onset dyspnoea on exertion and intermittent palpitations. Extensive cardiac workup revealed anomalous drainage of the inferior vena cava and a large secundum atrial septal defect. She underwent surgical repair. Intraoperatively, an additional congenital venous anomaly was discovered, a partial anomalous pulmonary venous connection. Specifically, the right inferior pulmonary vein connected to the inferior vena cava, and together, they drained into the left atrium. On conducting a thorough literature review, we believe this is the first reported case in an adult female.
Assuntos
Comunicação Interatrial , Veias Pulmonares , Malformações Vasculares , Adulto , Feminino , Átrios do Coração , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Humanos , Veia Cava InferiorRESUMO
We report an interesting case of a 38-year-old woman presenting with reverse Takotsubo syndrome (TTS) secondary to an Addisonian crisis, her second such episode. A few years prior, she had presented with typical TTS in the setting of Addisonian crisis; diagnostic work-up revealing Auto-Immune Polyglandular Syndrome Type II (APS II). We believe this to be the first case report of typical and variant phenotypes of TTS in a patient with APS II. The pathogenic link between these two conditions is explored. In patients presenting with Addisonian crises and refractory shock, the possibility of concurrent TTS should be considered. TTS muddies the diagnostic waters and poses therapeutic challenges as outlined.
Assuntos
Doença de Addison/tratamento farmacológico , Hidrocortisona/uso terapêutico , Adesão à Medicação , Poliendocrinopatias Autoimunes/tratamento farmacológico , Cardiomiopatia de Takotsubo/fisiopatologia , Doença de Addison/complicações , Adulto , Progressão da Doença , Ecocardiografia , Feminino , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Poliendocrinopatias Autoimunes/complicações , Recidiva , Infecções Respiratórias/complicações , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/etiologia , Tiroxina/uso terapêuticoRESUMO
We present the case of a 61-year-old woman with chest pain syndrome. Cardiac catheterisation did not reveal atherosclerotic coronary disease. However, a haemodynamically significant fistula connecting the left coronary artery to the left atrial appendage was found to be the culprit through a left-to-left shunting mechanism. In this report, we review the pathophysiology of coronary artery fistulas and the mechanism by which these fistulas may lead to 'coronary steal syndrome'. Indications for interventional and surgical management are outlined. Ultimately, we suggest the consideration of coronary artery fistulas in the differential diagnosis of patients presenting with chest pain.
Assuntos
Doença da Artéria Coronariana , Fístula , Dor no Peito/etiologia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Coração , Humanos , Pessoa de Meia-IdadeRESUMO
The simultaneous occurrence of Takotsubo syndrome, congenital coronary artery anomaly and severe coronary artery disease is a rare clinical triad. This case report highlights the intricacies of management of this 'triple jeopardy' scenario.
Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Cardiopatias Congênitas , Cardiomiopatia de Takotsubo , Síndrome Coronariana Aguda/diagnóstico , Humanos , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnósticoRESUMO
We present the case of a 50-year-old man presenting with new heart failure symptoms. He had no evidence of any ischaemic cardiomyopathy, however, further cardiac imaging showed a left ventricular non-compaction cardiomyopathy. He was noted to have muscular weakness and an exhaustive search for associated comorbidities yielded a diagnosis of Becker muscular dystrophy. In this report, we review the pathophysiology, comorbidities and diagnostic workup in patients presenting with left ventricular non-compaction in the context of dystrophinopathy. Ultimately, we suggest the consideration of rare cardiomyopathies in all patients presenting with neuromuscular syndromes and vice versa.
Assuntos
Cardiomiopatias , Insuficiência Cardíaca , Distrofia Muscular de Duchenne , Cardiomiopatias/diagnóstico , Cardiomiopatias/diagnóstico por imagem , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Distrofia Muscular de Duchenne/complicações , Distrofia Muscular de Duchenne/diagnóstico , SíncopeRESUMO
A 63-year-old man with hypertension was referred for catheter ablation of persistent atrial fibrillation. He was diagnosed with paroxysmal atrial fibrillation approximately 6 years prior. Over the previous 12 months, his atrial fibrillation had become persistent despite medication optimisation for rate control and elective cardioversion. Sinus rhythm was restored briefly. The decision was made to pursue catheter ablation and isolation of the pulmonary veins. On anaesthetic induction, the patient suffered from a hypertensive crisis. The procedure was aborted, and the patient was admitted to hospital for investigations of secondary hypertension. Ultimately, the patient was diagnosed with bilateral pheochromocytomas. This case outlines the diagnostic challenges and cardiac comorbidities associated with bilateral pheochromocytomas.
Assuntos
Neoplasias das Glândulas Suprarrenais , Fibrilação Atrial , Ablação por Cateter , Feocromocitoma , Veias Pulmonares , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/cirurgia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Feocromocitoma/complicações , Feocromocitoma/cirurgia , Veias Pulmonares/cirurgia , Resultado do TratamentoRESUMO
We present the case of a previously healthy 25-year-old woman who presented with an out-of-hospital ventricular fibrillation arrest. Postresuscitation ECG did not show any evidence of ST segment elevation. Echocardiogram showed regional wall abnormalities in keeping with takotsubo syndrome (TTS). Urgent coronary angiogram to rule out malignant congenital coronary artery anomaly revealed an isolated severe ostial left main coronary artery (LMCA) stenosis, a rare disease, approximately 0.2% in previous case series. The LMCA was aneurysmal. Genetic studies revealed a novel frameshift pathogenic variant in the transforming growth factor B two ligand gene (TGFB2) gene, suggestive of Loeys-Dietz syndrome (LDS) type 4, an aggressive vascular disease. Ostial LMCA stenosis has not been previously reported in LDS, and we outline the management of this unique disease combination. We also reflect on its presentation as TTS and infer that TTS and acute coronary syndromes are not mutually exclusive.
Assuntos
Estenose Coronária , Síndrome de Loeys-Dietz , Cardiomiopatia de Takotsubo , Adulto , Angiografia Coronária , Estenose Coronária/diagnóstico , Estenose Coronária/diagnóstico por imagem , Feminino , Humanos , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/etiologiaRESUMO
Trichinellosis is a parasitic infection that is associated with the consumption of raw meat. The specific genotype Trichinella nativa has been found in raw bear meat. The most common genotype that has been linked with myocarditis is T spiralis. We present a case of T nativa myocarditis secondary to consumption of raw bear meat. The clinical manifestations as well as therapy of this specific genotype is outlined.
Assuntos
Carne/parasitologia , Mebendazol/administração & dosagem , Miocardite , Prednisona/administração & dosagem , Músculo Quadríceps/patologia , Trichinella , Triquinelose , Adulto , Animais , Anti-Inflamatórios/administração & dosagem , Antinematódeos/administração & dosagem , Biópsia/métodos , Feminino , Testes de Função Cardíaca/métodos , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Miocardite/sangue , Miocardite/tratamento farmacológico , Miocardite/etiologia , Miocardite/fisiopatologia , Alimentos Crus/efeitos adversos , Alimentos Crus/parasitologia , Testes Sorológicos/métodos , Resultado do Tratamento , Trichinella/genética , Trichinella/isolamento & purificação , Triquinelose/diagnóstico , Triquinelose/tratamento farmacológico , Triquinelose/etiologia , Triquinelose/fisiopatologiaRESUMO
We present the case of a young male with an orthopedic injury after a mechanical fall, who developed atypical chest pain associated with ST elevation and elevated biomarkers suggestive of myocardial injury. He was found to have myocarditis on cardiac magnetic resonance imaging that we postulate was secondary to inhalation of marijuana. Cannabis-induced myocarditis and its potential complications are a health hazard that is bound to grow with the legalization of marijuana use in many countries.
Nous présentons ici le cas d'un jeune homme souffrant d'une lésion orthopédique subie après une chute mécanique, qui a développé une douleur thoracique atypique associée à une élévation du segment ST et à des biomarqueurs élevés évocateurs d'une lésion myocardique. L'imagerie par résonance magnétique cardiaque a révélé qu'il souffrait d'une myocardite que nous supposons être consécutive à l'inhalation de marijuana. La myocardite induite par le cannabis et ses complications potentielles constituent un risque pour la santé qui ne peut que croître avec la légalisation de l'usage de la marijuana dans de nombreux pays.
RESUMO
Background. Emerging evidence suggests that nonalcoholic fatty liver disease (NAFLD) is associated with coronary artery diseases and arrhythmias. The FibroScan (Echosens, France), a widely available, noninvasive device, is able to detect liver fibrosis and steatosis within this patient population. However, the FibroScan is currently contraindicated in patients with cardiac pacemakers (PM) or implantable cardioverter-defibrillators (ICD). Objective. To determine the safety profile of FibroScan testing in patients with PM or ICD. Methods. Consecutive outpatients undergoing routine device interrogations at a tertiary level teaching hospital underwent simultaneous liver stiffness measurements. PM or ICD performance data, device types, patient demographics, medical history, and previous laboratory and conventional liver imaging results were collected. Results. Analysis of 107 subjects with 33 different types of implanted cardiac devices, from 5 different companies (Medtronic, Sorin, ELA Medical, Boston Scientific, and St. Jude), did not demonstrate any adverse events as defined by abnormal device sensing/pacing or ICD firing. This population included high risk subjects undergoing active pacing (n = 53) and with right pectoral PM placement (n = 1). None of the subjects had any clinical signs of decompensated congestive heart failure or cirrhosis during the exam. Conclusion. TE with FibroScan can be safely performed in patients with PM or ICD.
Assuntos
Desfibriladores Implantáveis , Técnicas de Imagem por Elasticidade/instrumentação , Segurança de Equipamentos , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Marca-Passo Artificial , Segurança do Paciente , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , MasculinoRESUMO
We describe a case of a previously healthy 58-year-old woman who presented with gradual onset shortness of breath on exertion, erythrocytosis, hypoxia and hypoxaemia. Initial investigations revealed a normal chest radiography and pulmonary function test, however, there was an isolated reduction in diffusion capacity. She was subsequently found to have a patent foramen ovale (PFO) with intermittent shunting. A contrast echocardiography study hinted towards an extracardiac shunt. No shunt was detected in spite of using advanced imaging techniques. A lung biopsy was ultimately performed and histopathology revealed diffuse microvascular pulmonary arteriovenous malformations. This is one of few cases reported of this rare vascular abnormality and highlights its strong genetic association with hereditary haemorrhagic telangiectasia. The diagnostic challenges and management of this unique condition are reviewed in detail.
Assuntos
Fístula Arteriovenosa/diagnóstico , Ecocardiografia/métodos , Forame Oval Patente/diagnóstico por imagem , Hipóxia/etiologia , Pulmão/patologia , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Telangiectasia Hemorrágica Hereditária/diagnóstico , Biópsia , Feminino , Humanos , Hipóxia/terapia , Transplante de Pulmão , Pessoa de Meia-Idade , Oxigenoterapia , Listas de EsperaRESUMO
We present a case of a 30-year-old woman with a history of HIV and hepatitis C who sought medical attention because of severe oedema of the lower limbs and abdomen. CT of the chest showed a thickened pericardium, and cardiac catheterisation demonstrated constrictive physiology. She underwent pericardiectomy, but the procedure was unsuccessful because the pericardium was densely adherent to the myocardium. After consultation with several pathologists, she was diagnosed with primary pericardial mesothelioma (PPM), an exceedingly rare cardiac tumour with a fatal prognosis. She died within 3 months of presentation. The details of the case as well as pertinent literature are reviewed.
Assuntos
Tamponamento Cardíaco/diagnóstico , Insuficiência Cardíaca/diagnóstico , Neoplasias Cardíacas/diagnóstico , Mesotelioma/diagnóstico , Pericárdio , Adulto , Diagnóstico Diferencial , Ecocardiografia , Feminino , Infecções por HIV/complicações , Insuficiência Cardíaca/etiologia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/cirurgia , Hepatite C/complicações , Humanos , Imageamento por Ressonância Magnética , Mesotelioma/complicações , Mesotelioma/cirurgia , Pericárdio/diagnóstico por imagem , Pericárdio/patologia , RadiografiaRESUMO
We report the case of a 43-year-old man with anaphylactic shock and concurrent ST-elevation myocardial infarction during a planned inguinal hernia surgery. This event occurred shortly after introduction of latex into the surgical field. Coronary angiography revealed a 70% occlusive lesion in the right coronary artery. Further discussion with the patient revealed a potential latex allergy. Skin prick testing showed marked sensitisation to latex. The patient was subsequently diagnosed with the type II variant of Kounis syndrome.