CT myocardial perfusion imaging complementing coronary CT angiography in a patient with a history of unstable angina: A case report

Coronary computed tomography angiography (CCTA) could show the morphological status of coronary stenosis. Moreover, computed tomography (CT) myocardial perfusion (CTP) could provide additional information to identify hypoattenuating areas that might complement the limitation of CCTA in terms of evaluating the functional status, adding to the diagnostic performance of CCTA. We reported the imaging features of coronary artery disease in a female patient with a history of unstable angina by evaluating the anatomic and functional information through CCTA and CT myocardial perfusion in one stop modality

Role of cardiac MRI in acute myocardial infarction.

Mortality in patients with acute myocardial infarction (AMI) has decreased significantly and appears to be the result of current reperfusion therapeutic strategies. Reperfusion itself may develop into reperfusion injury. Therefore, management of these patients poses several challenges, such as diagnosing and managing heart failure, identifying persistent or inducible ischaemia, estimating the need for anticoagulation, and assessing overall cardiovascular risk. This case presentation will demonstrate the impact of cardiac magnetic resonance imaging (MRI) in the assessment of the pathophysiology of AMI in the current reperfusion era. Cardiac MRI can provide a wide range of clinically useful information which will help clinicians to manage and choose specific therapeutic strategies for AMI patients.

QRS distortion increased risk re-occurrence acute coronary events.

Nearly 50% of patients suffering inferior myocardial infarction will have complications or distinguishing features associated with an increased mortality. This study aimed to identify dominant risk factors related to re-occurrence of acute coronary events in patients with inferior myocardial infarction. This historical cohort included patients with inferior myocardial infarction who received fibrinolytic therapy at emergency department of National Cardiovascular Center Harapan Kita, Jakarta during 2001 to 2004 and was followed-up for two years. Patients with previous myocardial infarction, left bundle branch block, ventricular rhythm, and ventricular pacing were excluded. QRS distortion is ratio between J-point and R wave more than 50% at 2 or more inferior leads. Re-occurrence of acute coronary events is incident of myocardial infarction and unstable angina pectoris. Of 181 subjects with inferior AMI, there were 21 (11.6%) incidents of acute coronary event. Those who had positive than negative QRS distortion had almost three-fold increased risk for re-occurrence of acute coronary events [adjusted relative risk (RRa) 2.88; 95% confidence interval (CI) = 1.05 – 7.90]. In term of TIMI risk score, those with higher than lower risk score had 6.7 times higher risk to be re-occurrence of acute coronary events (RRa = 6.66; 95% CI = 1.94 – 22.92). However, those who had than did not have successful fibrinolysis had 57% lower risk to be re-occurrence of acute coronary event (RRa = 0.43; 95% CI = 0.18 – 1.05; P = 0.065). Re-occurrence acute coronary events were related to QRS distortion, TIMI risk score, and successful fibrinolysis.