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normal coronary angiograms

Ayman Samman Tahhan, Pratik Sandesara, Salim S Hayek, Muhammad Hammadah, Ayman Alkhoder, Heval M Kelli, Matthew Topel, Wesley T O'Neal, Nima Ghasemzadeh, Yi-An Ko, Mohamad Mazen Gafeer, Naser Abdelhadi, Fahad Choudhary, Keyur Patel, Agim Beshiri, Gillian Murtagh, Jonathan Kim, Peter Wilson, Leslee Shaw, Viola Vaccarino, Stephen E Epstein, Laurence Sperling, Arshed A Quyyumi
BACKGROUND: The associations between high-sensitivity troponin I (hsTnI) levels and coronary artery disease (CAD) severity and progression remain unclear. We investigated whether there is an association between hsTnI and angiographic severity and progression of CAD and whether the predictive value of hsTnI level for incident cardiovascular outcomes is independent of CAD severity. METHODS AND RESULTS: In 3087 patients (aged 63±12 years, 64% men) undergoing cardiac catheterization without evidence of acute myocardial infarction, the severity of CAD was calculated by the number of major coronary arteries with ≥50% stenosis and the Gensini score...
February 21, 2018: Journal of the American Heart Association
Viveca Ritsinger, Christel Hero, Ann-Marie Svensson, Nawzad Saleh, Bo Lagerqvist, Katarina Eeg-Olofsson, Anna Norhammar
OBJECTIVE: To describe sex aspects on extent of coronary artery disease (CAD) and prognosis in a contemporary population with type 1 diabetes. RESEARCH DESIGN AND METHODS: All patients undergoing coronary angiography, 2001-2013, included in the Swedish Coronary Angiography and Angioplasty Registry and the Swedish National Diabetes Register as type 1 diabetes were followed for mortality until 31 December 2013. The coronary angiogram was classified into normal and one-, two-, three-, and left main vessel disease...
February 20, 2018: Diabetes Care
Murat Sucu, Berzal Ucaman, Gökhan Altunbas
BACKGROUND: The coronary slow flow phenomenon (CSFP) is well-documented, and the early repolarization pattern (ERP) has recently been shown to be a risk factor for the development of malignant ventricular arrhythmias. METHODS: Those with true CSFP were included as cases and those with normal angiograms were included as controls. We assessed J-point elevation on surface electrocardiograms (ECGs) and defined ERP as notching or slurring of the terminal portion of the QRS takeoff...
February 20, 2018: Scandinavian Cardiovascular Journal: SCJ
Laura Petruescu, Fabien Picard, Alain Cariou, Olivier Varenne
A 63-year-old man presented with an out-of-hospital cardiac arrest. The coronary angiogram with intravascular imaging was performed and showed a mid-left anterior descending artery atherosclerotic cap rupture with thrombus burden treated with drug-eluting stent (DES) implantation. During the hospitalisation in the intensive care unit, the patient experienced recurrent ventricular fibrillations and asystole with transient ST-segment elevation in the inferior leads with normal coronary angiography. A methylergonovine provocative test was therefore performed and showed an occlusive right coronary artery (RCA) spasm...
February 8, 2018: BMJ Case Reports
Sandeep Hedgire, Vinit Baliyan, Evan J Zucker, Daniel O Bittner, Pedro Staziaki, Richard A P Takx, Jan-Erik Scholtz, Nandini Meyersohn, Udo Hoffmann, Brian Ghoshhajra
Purpose To evaluate the frequency and implications of perivascular fat stranding on coronary computed tomography (CT) angiograms obtained for suspected acute coronary syndrome (ACS). Materials and Methods This retrospective registry study was approved by the institutional review board. The authors reviewed the medical records and images of 1403 consecutive patients (796 men, 607 women; mean age, 52.8 years) who underwent coronary CT angiography at the emergency department from February 2012 to March 2016. Fat attenuation, length and number of circumferential quadrants of the affected segment, and attenuation values in the unaffected epicardial and subcutaneous fat were measured...
February 5, 2018: Radiology
Stephanie Wu, Anna Sarcon, Khuyen Do, Jerold Shinbane, Rahul Doshi, Helga Van Herle
We present a case of a 48-year-old female who developed myocarditis and near fatal arrhythmias during high dose Il-2 therapy for metastatic renal cancer. On day 5 of therapy, the patient developed sudden onset chest pain, elevated cardiac enzymes and ST segment changes on EKG. Coronary angiogram was normal, however echocardiogram showed reduced ejection fraction and hemodynamic measurements showed elevated bilateral elevated filling pressures. The patient then developed episodes of recurrent ventricular arrhythmia, precipitated by bradycardia and PVC, requiring defibrillation and temporary pacemaker placement...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Annick Haouzi, Ahmed Ahmed
A 51-year-old man presented with chest pain, high troponin level, inflammatory syndrome and ST-segment elevation in the anterior leads. While the transthoracic echocardiogram (TTE) showed anteroseptal hypokinesis and apical akinesis, the coronary angiogram was normal. Cardiac MR demonstrated a typical aspect of myocarditis (multiple areas of mid-myocardial late gadolinium enhancement, sparing the subendocardial layer, along with oedema). The initial diagnosis was clinically suspected myocarditis with pseudoinfarct presentation...
January 17, 2018: BMJ Case Reports
Aharon Frimerman, Simcha Meisel, Avraham Shotan, David S Blondheim
BACKGROUND: Since the introduction of the electrocardiogram (ECG) in 1902, the fundamentals of ECG data acquisition, display, and interpretation in the clinical arena have not changed much. OBJECTIVES: To present a new method to enhance and improve acquisition, analysis, and display of the standard ECG. METHODS: We performed ECG enhancement by superimposition and summation of multiple standard ECG cycles of each lead, by temporal alignment to peak R wave and voltage alignment to an improved baseline, at the T-P segment...
January 2018: Israel Medical Association Journal: IMAJ
Punag Divanji, Kendrick Shunk
A 67-year-old man with coronary artery disease and previous coronary underwent successful Guideliner reverse CART percutaneous coronary intervention of a chronic total occlusion of the right coronary artery. He later developed evidence of myocardial ischemia, and imaging, including angiogram, echocardiogram, and cardiac computed tomography revealing active dye extravasation from the previously normal RV marginal branches, in addition to a large subepicardial hematoma. Despite these dramatic findings, the patient remained hemodynamically stable and pain-free, with resolving ECG changes...
December 30, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Ashraf Abugroun, Daniel Vilchez, Osama Hallak, Anahita Shahrrava
Coronary artery ectasia (CAE) is an uncommon anomaly, usually found in 1.2-2% of patients undergoing coronary angiography, defined as a segment of the coronary artery that has a diameter of more than 1.5 times the normal adjacent segments. Atherosclerosis is considered as the cause of half of the CAE cases. We herein present a 65-year-old Asian male with past medical history of Kawasaki disease (KD) who developed recurrent episodes of inferior wall ST-elevation myocardial infarction (STEMI) despite treatment with dual antiplatelet therapy (DAPT)...
December 2017: Cardiology Research
Ronan Conlon, Richard Tanner, Santhosh David, Gabor Szeplaki, Joseph Galvin, John Keaney, Edward Keelan, Usama Boles
Background: Coronary artery ectasia (CAE) is defined as a diffuse dilatation of the diameter of the ectatic segment of the coronary artery, 1.5 times greater than that of the adjacent segment. The Tp-Te interval, P-wave and QTc dispersions are relatively new electrocardiographic markers associated with an increased risk of developing arrhythmias. Despite CAE increasing in prevalence in recent years, there is a sparsity of data available about its arrhythmogenic effect. The aim of the study was to evaluate QTc, P-wave dispersion and Tp-Te and Tp-Te/QT ratio in patients with CAE...
December 2017: Cardiology Research
Caitlin E O'Brien, John D Coulson, Priya Sekar, Jon R Resar, Kristen Nelson McMillan
An adolescent male with a recent history of streptococcal pharyngitis presented with severe substernal chest pain, troponin leak, and ST-segment elevation, which are suggestive of acute inferolateral myocardial infarction. The coronary angiogram was normal. The patient was subsequently diagnosed with non-rheumatic streptococcal myocarditis. He was treated with amoxicillin and had excellent recovery. Non-rheumatic streptococcal myocarditis is an important mimic of acute myocardial infarction in young adults.
January 8, 2018: Cardiology in the Young
Sundeep Chaudhry, Ross Arena, Deepak L Bhatt, Subodh Verma, Naresh Kumar
PURPOSE OF REVIEW: There is growing clinical interest for the use of cardiopulmonary exercise testing (CPET) to evaluate patients with or suspected coronary artery disease (CAD). With mounting evidence, this concise review with relevant teaching cases helps to illustrate how to integrate CPET data into real world patient care. RECENT FINDINGS: CPET provides a novel and purely physiological basis to identify cardiac dysfunction in symptomatic patients with both obstructive-CAD and nonobstructive-CAD (NO-CAD)...
December 13, 2017: Current Opinion in Cardiology
Steven P Rowe, Pamela T Johnson, Elliot K Fishman
BACKGROUND: Cinematic rendering (CR) a new method of 3D computed tomography (CT) volumetric visualization that produces photorealistic images. As with traditional 3D visualization methods, CR may prove to be of value in providing important information when evaluating regions of complex anatomy such as the heart. METHODS: The gated, IV contrast-enhanced chest CT angiogram data from three recent patients were evaluated with CR. Image comparision demonstrates the difference between CR and traditional volume rendering (VR), owing to a more complex lighting model that enhances surface detail and produces realistic shadows to add depth to 3D visualizations...
January 2018: Journal of Cardiovascular Computed Tomography
Erkan Yildirim, Uygar Cagdas Yuksel, Murat Celik, Baris Bugan, Mutlu Gungor, Yalcin Gokoglan, Mustafa Koklu, Suat Gormel, Salim Yasar, Cem Barcin
Objective The vessels involved in the microcirculation are too small to be visualized by conventional angiography and no tools are currently available that can directly evaluate the coronary microcirculation. This study evaluated the coronary clearance frame count (CCFC) in patients with cardiac syndrome X (CSX). Methods The retrospective study enrolled patients with angina, who had a positive nuclear imaging test and normal coronary angiography; and a control group consisting of patients who underwent an angiogram to exclude coronary artery disease...
January 1, 2017: Journal of International Medical Research
Vicken Zeitjian, Carmel Moazez, Mehrdad Saririan, David L August, Ranjini Roy
Introduction: Anomalous origin of the right coronary artery (RCA) from the left coronary cusp of the aorta is a moderately rare but potentially life-threatening incident. Myocardial infarction (MI) and sudden cardiac death have been described with this anomaly, especially in those who engage in excessive exercise. However, this case study shows this incidence in association with hyperthyroidism. Case description: A previously healthy 51-year-old female with history of hypothyroidism presented with acute onset chest pain for 1 day...
2017: International Journal of General Medicine
Muhammad Umer Awan, Bassam Omar, Ghazanfar Qureshi, Ghulam Mustafa Awan
Retroperitoneal hemorrhage from iliac artery injury is a potentially serious complication of vascular interventional procedures leading to hemorrhagic shock and death if not diagnosed early and treated promptly. We report a 70-year-old male admitted to our facility with non-ST-elevation myocardial infarction, whose heart catheterization revealed left anterior descending artery (LAD) with 80% proximal, 95% mid and 100% distal disease. The left circumflex and right coronary arteries were 100% occluded proximally and received collaterals from the LAD...
October 2017: Cardiology Research
Ahmed Fathala, Salma Salem, Fahad Alanazi, Deema Abunayyan, Abdelmoneim M Eldali, Abdulaziz Alsugair
Background: The aim of this study was to determine if breast arterial calcification (BAC) on mammography predicts myocardial ischemia (MI) on stress myocardial perfusion single-photon emission computed tomography (MPS). BAC is a type of medial artery calcification that can be seen incidentally on mammography, but the relationship between coronary artery calcification and MI on MPS is yet unknown. Methods: A total of 435 consecutive women underwent mammography and stress MPS within 1 year of each other...
October 2017: Cardiology Research
Wei Hong, Rui-Qiang Guo, Jin-Ling Chen, E-Hui Han, Tian Wu
The pathological technique is time consuming, costly, and patients are not preferred routinely. Histopathological findings have very low affectability and greater occurrence of β-errors, specifically in the diagnosis of cardiomyopathies. Angiography provides a two-dimensional view only. Vascular ultrasound elastography is a comparatively simple diagnostic method with a high resolution of images. The objective of this study was to compare the accuracy of ultrasound, followed by elastography with coronary angiography and endomyocardial biopsy, in the diagnosis of cardiovascular diseases in a Chinese population...
October 27, 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
Armin Attar, Arman Mehrzadeh, Mohsen Foulad, Davar Aldavood, Mohammad Amin Fallahzadeh, Mohammad Assadian Rad, Shahdad Khosropanah
BACKGROUND: Exercise is a physiologic stress that helps the physicians to clarify the presence or absence of cardiovascular disease which may be obscure at rest. Although it is sensitive, its specificity is affected by several parameters, such as some metabolic conditions, some structural heart diseases, and some baseline electrocardiogram abnormalities. Currently, the relationship between coronary dominance and accuracy of EET is not examined. Therefore, this study was conducted to determine the potential impact of coronary dominance on the accuracy of EET...
September 2017: Indian Heart Journal
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