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acute coronary syndrome with normal coronary artery

Israel Ugalde, Ibrar Anjum, Saberio Lo Presti, Alfonso Tolentino
Acute coronary syndrome usually presents with retrosternal chest pain, nausea, vomiting, sweating, and jaw and arm pain. Some patients only present with neck, epigastric, or ear discomfort. A 47-year-old male with a history of hypertension and coronary artery disease presented to the emergency department complaining of bilateral otalgia. He never felt chest pain, jaw pain, nausea, diaphoresis, or shortness of breath. He had a history of 2 acute coronary events and had a stress test 2 months prior to admission, which was unremarkable...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Fateh Ali Tipoo Sultan, Ghufran Adnan
Myocarditis is an inflammatory disease of myocardium with a wide range of clinical presentations. Myocarditis may mimic acute coronary syndrome (ACS) and adequate differential diagnosis is not possible by conventional tests. Cardiac magnetic resonance (CMR) has emerged as a leading imaging modality in the diagnosis of myocarditis in such patients. Here, we report three cases of myocarditis mimicking ACS with normal coronary arteries. CMR was used for confirming the diagnosis of myocarditis in all three patients presented here...
March 2018: JPMA. the Journal of the Pakistan Medical Association
Mohamad Jarrah, Ayman J Hammoudeh, Yousef Khader, Ramzi Tabbalat, Eyas Al-Mousa, Osama Okkeh, Imad A Alhaddad, Loai Issa Tawalbeh, Issa M Hweidi
Objective The aim of this study was to assess the baseline clinical characteristics, coronary angiographic features, and adverse cardiovascular events during hospitalization and at 1 year of follow-up in obese patients compared with overweight and normal/underweight patients. Methods A prospective, multicenter study of consecutive patients undergoing percutaneous coronary intervention was performed. Results Of 2425 enrolled patients, 699 (28.8%) were obese, 1178 (48.6%) were overweight, and 548 (22.6%) were normal/underweight...
January 1, 2018: Journal of International Medical Research
Sanjiv Gupta, Madan Mohan Gupta
Takotsubo syndrome is a reversible acute heart failure frequently precipitated by an emotional or physical stress. The clinical presentation resembles acute coronary syndrome. Pathogenesis is complex and may involve brain-heart axis and neuro-hormonal stunning of the myocardium. Coronary angiography reveals normal epicardial arteries with no obstruction or spasm. NT-ProBNP maybe remarkably elevated. Regional wall motion akinesia (RWMA) of left ventricle extends beyond the territory of one coronary artery. Reduced left ventricle ejection fraction (LVEF) and RWMA recover in 6-12 weeks...
January 2018: Indian Heart Journal
David F Miranda, Angie S Lobo, Brooks Walsh, Yader Sandoval, Stephen W Smith
The 12-lead electrocardiogram (ECG) remains the most immediately accessible and widely used initial diagnostic tool for guiding management in patients with suspected myocardial infarction (MI). Although the development of high-sensitivity cardiac troponin assays has improved the rule-in and rule-out and risk stratification of acute MI without ST elevation, the immediate management of the subset of acute MI with acute coronary occlusion depends on integrating clinical presentation and ECG findings. Careful interpretation of the ECG might yield subtle features suggestive of ischemia that might facilitate more rapid triage of patients with subtle acute coronary occlusion or, conversely, in identification of ST-elevation MI mimics (pseudo ST-elevation MI patterns)...
February 2018: Canadian Journal of Cardiology
Abdullah Haddad, Triston Smith, Aneel Bole, Moneal Shah, Mithun Chakravarthy
Kounis syndrome defined as the occurrence of acute coronary syndrome in the setting of allergic reaction due to mast cells activation and inflammatory mediators release that induces coronary vasospasm, plaque erosion, or even stent thrombosis. A 25-year-old postpartum female with asthma and recurrent episodes of chest pain was admitted with ST-segment elevation myocardial infarction in the setting of coronary artery spasms. The patient was started on calcium channel blockers and nitrite-based medication with no improvement...
January 2018: Avicenna Journal of Medicine
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
Xiaojia Zhang, Liangping Hu, Wen Zheng
ACS patients with renal dysfunction tend to have a poorer prognosis than those with normal renal function. This retrospective cohort study was performed using The Second Drug-Eluting Stent Impact on Revascularization Registry, a retrospective registry, to evaluate the time-dependent relative risk of revascularization strategies in ACS patients with renal dysfunction. The study demonstrated that the short-term MACCE rate was lower after PCI than CABG. However, there was no significant difference in long-term MACCE rate...
February 2, 2018: Scientific Reports
Deborah N Kalkman, Jaya Chandrasekhar, Robbert J de Winter, Roxana Mehran
The novel dual-therapy COMBO stent aims to promote vessel healing after percutaneous coronary intervention (PCI) in patients with coronary artery disease. The pro-healing technique consists of an anti-CD34+ antibody layer that attracts circulating endothelial progenitor cells (EPCs), which bind to the stent surface and allow rapid endothelialization by differentiation of the EPCs into normal endothelial cells. The COMBO stent combines this pro-healing technique with an abluminal drug elution of sirolimus. The promise of this dual-therapy stent is that it may safely allow a shortened duration of dual-antiplatelet therapy (DAPT) after stent placement...
January 29, 2018: Minerva Cardioangiologica
Ori Wand, Mordechai R Kramer
There is an increasing recognition of patients with radiologic features of both pulmonary fibrosis and emphysema. This association has enabled the description of a syndrome termed combined pulmonary fibrosis and emphysema (CPFE) with unique features. Patients are mostly male smokers who suffer from effort dyspnea and hypoxemia, with near-normal spirometric and lung volumes measurements, and abnormalities of gas exchange. On the computerized tomography there is upper-lobe emphysema and lower-lobe interstitial fibrosis...
January 2018: Harefuah
Eun Ju Chun, Jin Hee Han, Seung Min Yoo, Hwa Yeon Lee, In Sup Song, Charles S White
BACKGROUND: The CT finding of "vulnerable plaque" is widely regarded as similar to that of a culprit lesion in an acute coronary syndrome (ACS). However, this hypothesis may not be accurate, since "vulnerable plaques" may substantially change their morphology when they rupture to cause an ACS. METHODS: We retrospectively evaluated coronary CT angiography data sets of 25 patients with ACS who had vulnerable (n = 10) or culprit plaques (n = 15)...
January 5, 2018: Journal of Cardiovascular Computed Tomography
F J Montero-Pérez, F B Quero-Espinosa, M J Clemente-Millán, J A Castro-Giménez, J de Burgos-Marín, M Á Romero-Moreno
RATIONALE: Acute coronary syndrome (ACS) requires improved diagnostic accuracy through useful, safe and easy-to-apply tools. OBJECTIVES: To obtain an assessment scale for the diagnosis of ACS in patients with chest pain and nondiagnostic electrocardiogram and troponin concentrations. METHODS: A prospective cohort study included 286 patients treated in the emergency department for chest pain, with normal electrocardiogram and troponin levels...
January 6, 2018: Revista Clínica Española
M H Lundberg Slingsby, L Gliemann, M Thrane, N Rytter, J Egelund, M V Chan, P C Armstrong, T D Warner, Y Hellsten
The current guidelines following an acute coronary syndrome recommend dual anti-platelet therapy (aspirin plus a P2Y12 antagonist) alongside lifestyle modifications, including more regular physical activity. It is currently unknown if regular exercise affects the pharmacology of dual anti-platelet therapy. AIM: To explore how exercise-induced improvements in vascular and platelet function affect the efficacy of dual anti-platelet therapy, in a cross-sectional study of men with different physical activity level (training status)...
January 3, 2018: Acta Physiologica
Syed Raza Shah, Richard Alweis
Acute coronary artery dissection is a rare, complex disease occurring particularly in young women without traditional cardiovascular risk factors. The pathophysiology and treatment are different from acute coronary syndrome caused by plaque rupture or erosion. Its clinical presentation may vary from unstable angina to sudden cardiac death. Hence, early detection is crucial to manage the dissection and reduce the mortality and morbidity rates. Most coronary dissections will heal spontaneously, and conservative treatment is recommended for uncomplicated cases...
December 12, 2017: Cardiology in Review
M Chourasiya, S Satheesh, R Selvaraj, B Jayaraman, A A Pillai
The aim was to study the angiographic profile in patients presented as acute coronary syndrome and its relation with risk factors and comparison between genders. This prospective observational study was performed on total 352 patients of acute coronary syndrome were analyzed for various risk factors, angiographic pattern in Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, South India from January 2015 to July 2016. Mean age of presentation was 52.62±11.63 years. Male were 271(77...
October 2017: Mymensingh Medical Journal: MMJ
Yun Cheng, Chenying Lu, Kan Liu
BACKGROUND: Integrated bedside and sophisticated cardiac imaging techniques help characterize the discrepancy between myocardial injury and mechanic dysfunction in acute myocardial infarction. CASE PRESENTATION: A 57 year-old woman presented with sudden onset chest pain and ventricular fibrillation after hearing of her brother's death. The electrocardiography indicated "anterior wall ST segment elevation myocardial infarction". Coronary angiography ruled out obstructive lesion in the major coronary arteries, but revealed fibromuscular dysplasia of the distal left anterior descending artery...
November 30, 2017: Cardiovascular Ultrasound
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
Simone M Mrotzek, Tienush Rassaf, Matthias Totzeck
BACKGROUND Following acute coronary intervention in cardiology patients, the combined medical therapy with the platelet inhibitory drug ticagrelor and a statin medication (e.g., simvastatin) is recommended according to international guidelines. Yet combined therapeutic regimens have the potential of pharmacological interaction with both ticagrelor and simvastatin being metabolized by CYP3A4. Rhabdomyolysis is a known side-effect of statin therapy and combined therapy increases the susceptibility to this complication...
November 23, 2017: American Journal of Case Reports
Barak Zafrir, Ronen Jaffe, Ronen Rubinshtein, Basheer Karkabi, Moshe Y Flugelman, David A Halon
We examined 18,654 patients who underwent cardiac catheterization in a single center to clarify the association between catheterization indication, body mass index (BMI), and long-term survival over a mean follow-up of 81 months. Patients were grouped by indication for catheterization: (a) acute coronary syndromes (ACS), 7,426 patients; (b) coronary artery disease (CAD) evaluation in stable clinical presentation, 6,911 patients; and (c) primarily non-CAD cardiac evaluations, 4,317 patients. Compared with normal weight, overweight and obesity (but not morbid obesity) was associated with lower risk of long-term mortality...
January 1, 2018: American Journal of Cardiology
Audrey Dionne, Nagib Dahdah
Kawasaki disease (KD) is the most common vasculitis of childhood. Coronary artery aneurysms and myocarditis are common cardiovascular complications of KD. While evidence of myocarditis can be found in all patients with KD on histology specimens, only a minority of patients are clinically symptomatic. Occasionally children can present with KD shock syndrome and hemodynamic instability as a result of decreased systolic function and vasoplegia. Several children with KD have depressed shortening fraction on echocardiography...
November 3, 2017: International Journal of Rheumatic Diseases
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