Giant thrombus on apical wall of left ventricle due to HIT syndrome after anterior MI.

Heparin-induced thrombocytopenia (HIT) is the most important and the most frequent drug-induced, immune-mediated type of thrombocytopenia. It is associated with significant mortality and morbidity if unrecognized. We describe a patient with a giant thrombus on the apical wall of the left ventricle that occurred due to HIT syndrome after anterior myocardial infarction.

Percutaneous coronary intervention vs. optimal medical therapy--the other side of the coin: medication adherence.

WHAT IS KNOWN AND OBJECTIVE: Although many studies have examined medication adherence in patients with coronary artery disease (CAD), no prospective trial has compared medication adherence between patients treated with percutaneous coronary intervention (PCI) or with optimal medical therapy (OMT) in real life. This study sought to compare the adherence to evidence-based secondary preventive medications in patients with documented CAD treated with PCI and OMT, or OMT alone. METHODS: We evaluated adherence to statins, beta-blockers, and angiotensin converting enzyme inhibitors (ACEI) during a 6-month follow-up in 232 patients with documented CAD, comparing patients treated with PCI and those receiving medical therapy alone. Medication adherence was measured with reference to national reimbursement database records. RESULTS AND DISCUSSION: Of the 232 patients who survived the 6-month follow-up, the percentages of adherent patients according to prescription records (prespecified primary endpoint) were 53·6% (n = 82) in the PCI group and 33·8% (n = 27) in the OMT group (P = 0·004). Analysis of the individual medication classes revealed similar results for beta-blockers (86·0% in PCI group vs. 72·5% in OMT group, P = 0·006) and statins (64·5% in PCI group vs. 44·0% in OMT group, P = 0·003). Adherence to ACEI was also higher in the PCI group, but the difference was not statistically significant (77·6% vs. 69·3%, P = 0·17). By logistic regression analysis, belonging to the PCI group was an independent predictor of medication adherence [B = 2·20 (1·06-4·50), P = 0·03)]. WHAT IS NEW AND CONCLUSION: In the present study we demonstrated that adherence to evidence-based medication therapies in patients treated with PCI is significantly higher than in patients treated with OMT alone. Medication adherence should be followed carefully in CAD patients treated with OMT.

Pulmonary arteriovenous fistula coexisting with secundum atrial septal defect. An unusual cause of stroke in a young woman.

Pulmonary arteriovenous malformations (PAVM) consist of an abnormal connection between the pulmonary artery and vein bypassing the pulmonary capillary bed. Pulmonary arteriovenous fistulae are characterized by a right-to-left shunt of variable magnitude, and they may be accompanied by other congenital anomalies. We describe a case of pulmonary arteriovenous fistula with a secundum type atrial septal defect (ASD) in a 38-year-old woman, who underwent successful transcatheter closure of both the ASD and PAVM.

N-acetylcysteine versus N-acetylcysteine + theophylline for the prevention of contrast nephropathy.

BACKGROUND: The use of N-acetylcysteine or theophylline in specific subgroups of patients has been suggested to reduce the incidence of contrast-induced nephropathy (CIN) in patients undergoing angiographic procedures. Our purpose was to compare the use of N-acetylcysteine versus N-acetylcysteine + theophylline for the prevention of CIN. MATERIALS AND METHODS: We randomized 217 patients with estimated glomerular filtration rate (eGFR) (calculated by Modification of Diet in Renal Disease formula) between 30 and 60 mL min(-1) 1.73 m(-2) who were undergoing coronary angiography to three prophylactic treatment groups: Group 1: Intravenous hydration with isotonic saline (1 mL kg(-1) h(-1) for 12 h before and after contrast, n = 72). Group 2: Intravenous hydration with isotonic saline (1 mL kg(-1) h(-1) for 12 h before and after contrast)+ N-acetylcysteine (600 mg p.o. twice daily the preceding day and the day of angiography, n = 73). Group 3: Intravenous hydration with isotonic saline (1 mL kg(-1) h(-1) for 12 h before and after contrast)+ N-acetylcysteine + theophylline (600 mg N-acetylcysteine p.o. and 200 mg theophylline p.o. twice daily for the preceding day and the day of angiography, n = 72). The incidence of CIN (0.5 mg dL(-1) increase in serum creatinine from the baseline value 48 h after intravascular injection of contrast) was compared in three groups. RESULTS: Of the 217 patients, 12 patients (5.5%) experienced CIN. Five patients (6.9%) in group 1, seven patients (9.6%) in group 2 and zero (0%) patients in group 3 experienced CIN (P < 0.033). CONCLUSION: Among patients with eGFR between 30 and 60 mL min(-1) 1.73 m(-2) undergoing coronary angiography, oral administration of N-acetylcysteine + theophylline in addition to saline hydration has a beneficial effect in the prevention of CIN.

Right coronary artery arising from the pulmonary trunk.

The prevalence of coronary artery anomalies is reported to be around 0.3-1 %. An anomalous origin of the right coronary artery (RCA) is a rare condition but may lead to myocardial ischemia and sudden death. Diagnosis is mainly made by conventional coronary arteriography. Nowadays, multislice computed tomography is a new noninvasive imaging technique with excellent spatial resolution which can detect the origin and course of an anomalous coronary vessel. Here we report on a 67-year-old woman with an anomalous origin of the RCA arising from the pulmonary trunk. The anomaly was diagnosed by cardiac catheterization and confirmed by multislice computed tomography.

Right heart haemodynamic values and respiratory function test parameters in chronic smokers.

During coronary angiography in 24 chronic smokers with coronary heart disease, cardiac function measurements were taken and correlated with respiratory function tests. Fourteen patients had evidence of chronic obstructive pulmonary disease. Cardiac output had a direct correlation with vital capacity, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and velocity at 25% of FVC (V(max)25). Pulmonary artery resistance was inversely correlated with FEV1/FVC, while pulmonary artery oxygen saturation weakly correlated with FEV1 and V(max)25. The pulmonary artery pressure had a weak correlation with the pulmonary artery resistance and an intermediate correlation with the right atrium and the right ventricular pressures. Early diagnosis and therapy of chronic obstructive pulmonary disease in smokers may be possible without using invasive methods.

Congenital absence of the left circumflex coronary artery and an unusually dominant course of the right coronary artery.

Congenital absence of the left circumflex artery (LCX) is a very rare congenital anomaly of the coronary circulation, and only a few cases have been reported in the literature. We report on a 55-year-old female with atypical chest pain. Routine coronary angiography showed a normal left anterior descending coronary artery (LAD), no LCX and a dominant right coronary artery (RCA), which continued beyond the crux, running the full course of the LCX and terminating in the left atrial branch. Neither aortography nor pulmonary angiography showed a separate ostium for the LCX. There were no atherosclerotic lesions in the coronary arteries, or ischaemia on stress myocardial perfusion imaging. Multidetector row computed tomography (MDCT) was performed to confirm the diagnosis.

[Chronic coronary pseudoaneurysm after stent implantation]. / Ein chronisches Koronarpseudoaneurysma nach Stentimplantation.

Recently, as a part of new stent implantation strategy in order to decrease stent thrombosis, final dilatations with high pressure and/or higher sized balloons were applied after the initial deployment of the stent. In this paper, we presented a case of chronic coronary pseudoaneurysm which occurred after an initially successful stent implantation in the left anterior descending artery, probably due to high pressure final dilatation.