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acute coronary syndrome with normal coronary artery

Yasmin Hakim, Anna Forbes, Momina Khan, Benjamin C Whitelaw
Chest pain with elevated serum troponin is a common clinical presentation and is normally managed as suspected myocardial infarction or acute coronary syndrome (ACS). We report a 49 year old man who presented with central chest pain sweating and breathlessness. He had a significantly elevated serum troponin I level and a subsequent angiogram showed near normal coronary arteries. He was subsequently investigated for fever and found to have a 3cm right sided adrenal mass consistent with a pheochromocytoma. After confirmation and appropriate blockade laparoscopic adrenalectomy was performed...
2016: Acute Medicine
Injune Park, Youn Jung Kim, Shin Ahn, Chang Hwan Sohn, Dong Woo Seo, Won Young Kim
Electrocardiogram changes in subarachnoid hemorrhage (SAH) have been described as ST-T changes that mimic acute coronary syndrome and even acute ST-segment elevation myocardial infarction. Elevation of cardiac enzymes and abnormality of regional myocardial wall motion have been reported frequently for SAH. We report a case of an out-of-hospital cardiac arrest survivor with high suspicion of ST-segment elevation myocardial infarction based on the electrocardiogram and bedside echocardiography, who had normal coronary arteries on emergent coronary angiography...
December 2015: Clin Exp Emerg Med
Shankar Iyer, Subhash Shivtarkar, Ameya Udyavar
Takotsubo cardiomyopathy, also called transient left ventricular apical ballooning syndrome or Gebrochenes-Herz-Syndrome, is a rare entity which may masquerade as acute coronary syndrome (ACS) with sudden onset of chest pain and/or dyspnea, transient left ventricle apical akinesia, electrocardiographic changes typical of ACS and mild increase in cardiac enzymes in the background of normal coronary arteries. Here, we present a case of a 45 year old female who presented with acute onset dyspnea and chest pain with severe ischemic changes on the ECG and raised troponin levels...
April 2016: Journal of the Association of Physicians of India
Radu Campean, Matthias Hasun, Claudia Stöllberger, Johannes Bucher, Josef Finsterer, Christoph Schnack, Franz Weidinger
BACKGROUND: Reversible left ventricular dysfunction, also termed Takotsubo cardiomyopathy, is rarely reported in Addison's disease after initiation of hormone replacement therapy. The pathogenesis of this cardiomyopathy is unknown. CASE PRESENTATION: A 41-year-old white woman with a history of autoimmune Hashimoto thyroiditis diagnosed 3 years earlier and acute adrenal insufficiency diagnosed 3 weeks earlier presented with new onset of heart failure New York Heart Association class IV, which had started shortly after initiation of hormone replacement therapy with hydrocortisone 20 mg/day and fludrocortisone 0...
October 12, 2016: Journal of Medical Case Reports
Giuseppe Damiano Sanna, Giuseppe Talanas, Giuseppina Fiore, Antonella Canu, Pierfranco Terrosu
Pheochromocytoma is a rare neuroendocrine tumor with a highly variable clinical presentation. The serious and potentially lethal cardiovascular complications of these tumors are related to the effects of secreted catecholamines. We describe a case of a 50-year-old woman urgently admitted to our hospital because of symptoms and clinical and instrumental findings consistent with an acute coronary syndrome complicated by acute heart failure. Urgent coronary angiography showed normal coronary arteries. During her hospital stay, the recurrence of episodes characterized by a sudden increase in blood pressure, cold sweating, and nausea allowed us to hypothesize a pheochromocytoma...
October 2016: Journal of the Saudi Heart Association
Milos Brankovic, K Martijn Akkerhuis, Nermina Buljubasic, Jin M Cheng, Rohit M Oemrawsingh, Hector M Garcia-Garcia, Evelyn Regar, Patrick W Serruys, Robert-Jan van Geuns, Eric Boersma, Isabella Kardys
BACKGROUND AND AIMS: We investigated whether plasma cystatin C (CysC) and neutrophil gelatinase-associated lipocalin (NGAL) are associated with intravascular ultrasound (IVUS)-derived characteristics of coronary atherosclerosis and 1-year adverse coronary events in patients with normal and mildly-to-moderately impaired kidney function. METHODS: Between 2008 and 2011, virtual histology (VH)-IVUS of a non-culprit coronary artery was performed in 581 patients undergoing coronary angiography...
September 17, 2016: Atherosclerosis
Jacek Bil, Robert J Gil
Bioresorbable vascular scaffolds (BVS) have emerged as an interesting alternative since the presence of the prosthesis in the coronary artery is transient. This technology enables to restore the normal vasomotor tone and allows positive remodeling, simultaneously reducing the trigger for persistent inflammation and facilitating further interventions by percutaneous or surgical means. Absorb BVS(®) is the first generation everolimus-eluting poly-L-lactide (PLLA) bioresorbable scaffold. In recent meta-analyses Absorb BVS(®) was definitely proved to be safe and effective device in the treatment of symptomatic coronary artery disease...
August 2016: Journal of Thoracic Disease
Ana Goico, Mercy Chandrasekaran, Cesar J Herrera
Stress cardiomyopathy (SC) is characterized by transient left ventricular (LV) wall motion abnormalities typically involving the apex with preserved basal contractility, chest discomfort, ST-T ischemic changes and elevated cardiac markers with normal or non-flow limiting coronary artery lesions. It represents an important differential diagnosis of Acute Coronary Syndromes caused by atherosclerotic vessel occlusion; most commonly, Tako-tsubo occurs in postmenopausal women after physical or emotional stress. While the exact mechanism of SC remains controversial, various hypotheses have been suggested concerning the vascular, central nervous and endocrine system participation where catecholamines, particularly epinephrine, seem to play a major role...
November 15, 2016: International Journal of Cardiology
Julio Cesar Tolentino, Juliana J Schmidt, Guilherme J Schmidt, Claudio Tinoco Mesquita, Sergio L Schmidt
Mental stress-induced myocardial ischemia (MSIMI) has been described in patients with acute coronary syndrome (ACS). We reported the case of a patient admitted with ACS and MSIMI related to generalized anxiety disorder (GAD). Myocardial perfusion imaging (MPI) after exercise stress and computed tomography coronary angiography showed normal results. In contrast, MPI with mental stress documented MSIMI. He began to improve 7 days after starting escitalopram and remained without angina at 1-year follow-up. These data suggest the applicability of mental stress radionuclide imaging for the detection of MSIMI in patients with ACS and GAD, even in normal coronary arteries...
November 2016: Clinical Nuclear Medicine
Na Zhao, Lan Mi, Yaping Zhang, Na Li, Jiaojiao Xu, Dongyu Xia, Junkui Wang, Yue Wu, Xiaojun Liu
OBJECTIVE: Neutrophils enhancing atherosclerotic plaque instability have been observed in patients with acute coronary syndrome (ACS). Generally, activation of neutrophils in lesions depends on the interaction of Fcγ receptors (FcγRs) with immunoglobulin G antibodies in immune complexes. However, altered FcγR expression on neutrophils of patients with ACS is unknown. We aimed to evaluate changes in FcγR expression on neutrophils of patients with ACS. METHODS: We enrolled 106 patients who were divided into four groups: acute myocardial infarction (AMI), unstable angina (UA), stable angina, and normal coronary arteries...
September 3, 2016: Coronary Artery Disease
Hafeez Ul Hassan Virk, Faisal Inayat
CONTEXT: Takotsubo cardiomyopathy (TCM) mimics acute coronary syndrome and is accompanied by reversible left ventricular apical ballooning in the absence of angiographically significant coronary artery stenosis. It is a transient condition that typically precedes physical or emotional triggers. CASE REPORT: We describe the case of a 65-year-old woman who presented to our institution with symptomatic Clostridium difficile infection. 24 hours after admission, the patient complained of severe, retrosternal chest pain...
July 2016: North American Journal of Medical Sciences
David G Rizik, James B Hermiller, Charles A Simonton, Kevin J Klassen, Dean J Kereiakes
Although current everolimus-eluting coronary stents have shown improved event-free survival within the first year following implantation compared with bare-metal stents or earlier generation drug-eluting stents, they remain associated with an ongoing risk for adverse outcomes (thrombosis, myocardial infarction, and restenosis) beyond 1 year at rates similar to those observed following bare-metal stent deployment. This ongoing very late hazard has been attributed to the permanent presence of the metal frame and/or polymer in these stents...
August 24, 2016: Coronary Artery Disease
Massimo De Filippo, Raffaella Capasso
Acute chest pain is an important clinical challenge and a major reason for presentation to the emergency department. Although multiple imaging techniques are available to assess patients with suspected acute coronary syndrome (ACS), considerable interest has been focused on the use of non-invasive imaging options as coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR). According to several recent evidences, CCTA has been shown to represent a useful tool to rapidly and accurately diagnose coronary artery disease (CAD) in patients with low to intermediate cardiovascular risk...
July 2016: Annals of Translational Medicine
Hassan Alkhawam, Robert Sogomonian, Mohammed El-Hunjul, Mohamad Kabach, Umer Syed, Neil Vyas, Sumair Ahmad, Timothy J Vittorio
OBJECTIVE: In this study, we assessed the risk factor profile in premature coronary artery disease (CAD) and acute coronary syndrome for adults ≤40 years old. METHODS: A retrospective chart analysis of 397 patients ≤40 years old admitted from 2005 to 2014 for chest pain and who underwent coronary arteriography. RESULTS: Of 397 patients that had undergone coronary arteriography, 54% had CAD while 46% had normal coronary arteries. When compared with patients with normal coronary arteries, patients with CAD were more likely to smoke tobacco, have dyslipidemia, be diabetic, have BMI >30 kg/m(2), have a family history of premature CAD and be male in gender...
September 2016: Future Cardiology
Amir Ahmadi, Gregg W Stone, Jonathon Leipsic, Patrick W Serruys, Leslee Shaw, Harvey Hecht, Graham Wong, Bjarne Linde Nørgaard, Patrick T O'Gara, Y Chandrashekhar, Jagat Narula
IMPORTANCE: Obstructive coronary lesions with reduced luminal dimensions may result in abnormal regional myocardial blood flow as assessed by stress-induced myocardial perfusion imaging or a significant fall in distal perfusion pressure with hyperemia-induced vasodilatation (fractional flow reserve [FFR] ≤0.80). An abnormal FFR has been demonstrated to identify high-risk lesions benefitting from percutaneous coronary intervention while safely allowing revascularization to be deferred in low-risk lesions, resulting in a decrease in the number of revascularization procedures as well as substantially reduced death and myocardial infarction...
June 1, 2016: JAMA Cardiology
Leila Abid, Salma Charfeddine, Samir Kammoun, Mouna Turki, Fatma Ayedi
AIMS: Cystatin C is an endogenous marker of renal function. It is a well established better marker of glomerular filtration rate than serum creatinine. There is also evidence that cystatin C is associated with atherosclerotic disease. The present prospective study evaluated the prognostic value of cystatin C after myocardial infarction in patients without chronic kidney disease. METHODS AND RESULTS: A total of 127 patients who underwent coronary angiography after an acute coronary syndrome (ACS) were included...
July 2016: Journal of the Saudi Heart Association
Rokas Navickas, Diane Gal, Aleksandras Laucevičius, Agnė Taparauskaitė, Monika Zdanytė, Paul Holvoet
The aim of the present study is to identify microRNAs (miRs) with high potential to be used as biomarkers in plasma and/or serum to clinically diagnose, or provide accurate prognosis for survival in, patients with atherosclerosis, coronary artery disease, and acute coronary syndrome (ACS). A systematic search of published original research yielded a total of 72 studies. After review of the risk of bias of the published studies, according to Cochrane Collaboration and the QUADUAS Group standards, 19 studies were selected...
September 2016: Cardiovascular Research
Atike Tekeli Kunt, Hakan Parlar, Orhan Findik, Cagri Duzyol, Ozgur Baris, Canan Balci
BACKGROUND: Metabolic syndrome (MetS) is defined as a cluster of systemic abnormalities: hyperglycemia, dyslipidemia, abdominal obesity, and hypertension. Acute kidney injury (AKI) is one of the devastating complications after cardiac surgery. Age, DM, preexisting renal dysfunction, hypertension, impaired left ventricular function, and severe arteriosclerosis of the aorta are the major risk factors for the development of AKI. The purpose of the current study was to analyze the influence of MetS on AKI occurring after coronary artery bypass grafting (CABG)...
2016: Heart Surgery Forum
Nikolaos Papageorgiou, Effimia Zacharia, Adam Ioannou, Onkar Rehal, Konstantinos Zacharias, Gerasimos Siasos, Dimitris Tousoulis
BACKGROUND: Apart from the acute thrombotic complications that lead to acute coronary syndromes (ACS), platelet activation also plays an important role in the initiation and progression of atherosclerosis. In addition, it is speculated that anti-platelet therapy can be beneficial for patients with stable coronary artery disease (CAD). Of note, patients on optimal anti-platelet treatment still experience thrombotic events, whereas complications, such as bleeding, cannot be ignored. In this light, novel antiplatelet regimens have been used to minimize the residual platelet activation without compromising the normal homeostasis...
June 17, 2016: Current Pharmaceutical Design
K Meenakshi, M Rajendran, S Srikumar, Sundar Chidambaram
OBJECTIVE: Epicardial fat is considered as indicator of cardiovascular risk. Several studies have tested the association between epicardial fat thickness (EFT) and coronary artery disease. The aim of our study is to test the hypothesis that echocardiographic EFT is a marker of coronary artery disease. METHODS: One hundred and ten patients (70 males and 40 females with mean age of 51.5±10.6 and 52.6±9.6, respectively) admitted for coronary angiogram underwent assessment of epicardial fat thickness by echocardiography...
May 2016: Indian Heart Journal
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