ABSTRACT
Background Multidetector computed tomography (MDCT) coronary angiography represents one of the most exciting technological revolutions in cardiac imaging and it has been increasingly used in the diagnosis of coronary artery disease. The purpose of this study is to investigate the effect of age and coronary plaque calcification on diagnostic accuracy of MDCT. Methods The patients were examined by using dual-source MDCT and conventional coronary angiography. MDCT results were analyzed with regard to the severity (>50%stenosis) and morphology (non-calcified, mixed, or calcified) of coronary atherosclerotic plaques evaluated in a 16-segment model. Results In total, 181 patients (94 men and 87 women) with 2,687 coronary artery segments were examined with MDCT. Ninety three patients were older than 65 years of age (group A, 42 men) and 88 were younger (group B, 52 men). Two-hundred nine coronary artery segments (7.2%) were ex-cluded because of small distal coronary vessel segments and/or motion artifacts. The overall number of segments with non-diagnostic image quality was similar in both groups of patients. Of the 2,687 evaluated segments, 157 (5.8%) were significantly diseased, and 144 of them were correctly detected by MDCT. Diagnostic evaluation showed that the sensitivity, positive predictive value, specificity, and negative pre-dictive value were 89.5%, 62.5%, 96.0%, and 99.2%, respectively in group A, and 95.2%, 64.8%, 97.5%, and 99.8%in group B, respectively. In addition, detailed segment-based analyses in coronary segments with non-calcified, mixed and calcified plaques in both groups were simi-lar diagnostic accuracy. Conclusions Very high diagnostic accuracy observed in this study suggests that MDCT coronary angiography could be a suitable diagnostic tool for not only younger patients but also for older patients.
ABSTRACT
It was the aim of this study to report an aborted cardiac arrest due to ventricular fibrillation and electrocardiographic changes consistent with Brugada syndrome due to liquorice-induced hypokalemia. Clinical Presentation and Intervention: Ventricular fibrillation was witnessed in a 50-year-old woman who was admitted to our emergency department with a history of liquorice ingestion, a herbal product. After stopping liquorice ingestion, the Brugada-like electrocardiographic pattern changed progressively with potassium replacement. A diagnosis of Brugada syndrome was made after the ajmaline challenge test. The patient was discharged with an implantable cardioverter defibrillator and had an uneventfull follow-up. This report illustrates the importance of the investigation for herbal medications in the detailed history of a patient in the cases of electrolyte disturbances and the potential role of hypokalemia in the induction of malignant arrhythmia in Brugada syndrome