ABSTRACT
The concomitant occurrence of acute type B aortic dissection (TBAD) and acute pulmonary embolism (PE) is a rare but challenging condition. Although anticoagulation therapy is essential in the treatment of PE, it may increase the risk of aortic rupture and bleeding complications. We herein describe a patient with acute TBAD complicated by PE, which was successfully treated with early thoracic endovascular aortic repair (TEVAR) followed by anticoagulation. The present case report demonstrates that early TEVAR not only treats the aortic pathology but also allows the safe initiation of anticoagulation therapy.
ABSTRACT
QT interval parameters have been suggested as a predictor of lethal arrhythmia and mortality in patients with myocardial infarction. The aim of the present study was to compare the value of QT interval indices in patients presenting with non-ST-segment elevation myocardial infarction [NSTEMI] between a group of patients with type 2 diabetes mellitus and a nondiabetic group of patients. This case-control study evaluated QT interval parameters in 115 patients [47 diabetic and 68 nondiabetic patients] diagnosed with NSTEMI between September 2011 and July 2012. The following QT interval indices were analyzed: maximum [max] and minimum [min] QT interval; max and min corrected QT interval [QTc]; QT dispersion [QTd]; and corrected QT dispersion [QTcd]. All the patients were observed for ventricular arrhythmia during their hospital course and underwent coronary angiography. They were selected to undergo coronary artery bypass surgery [CABG] or percutaneous coronary angioplasty [PCI] based on their coronary anatomy. The mean age of the patients was 60.8 +/- 11.4 years. The patients were 40.0% female and 60.0% male. There were no significant differences in clinical characters between type 2 diabetic and nondiabetic patients with NSTEMI. Compared with post-myocardial infarction patients without diabetes, those with type 2 diabetes had higher QTc max, QTd and QTcd [p value < 0.05]. There was a significant difference in QTd and QTcd in the patients needing coronary revascularization with diabetes as opposed to the nondiabetics [p value = 0.035 and p value = 0.025, respectively] as well as those who had ventricular arrhythmia with diabetes [p value = 0.018 and p value = 0.003, respectively]. QTcd was higher in the patients who had higher in-hospital mortality [p value = 0.047]. The QTc max, QTd and QTcd were significantly [all p values < 0.05] associated with ventricular arrhythmia, QTcd with need for revascularization and QTc max with in-hospital mortality in the diabetic patients. Based on the findings of this study, it seems that type 2 diabetics with NSTEMI have greater QTc max, QTd, and QTcd and these QT parameters may have a relationship with worse cardiac outcomes and poorer prognoses
ABSTRACT
A double left anterior descending [LAD] coronary artery emerging from the left and right coronary arteries is classified among rare coronary anomalies. We herein report a 73-year-old man presenting with acute coronary syndrome [posterolateral myocardial infarction]. He was admitted with typical chest pain, and due to his progressive ischemic changes on electrocardiography [ECG] and elevated cardiac enzyme, he was candidated for cardiac catheterization. The coronary angiography revealed an anomalous LAD from the right sinus of Valsalva. The unusual coronary anatomy was perfectly matched with the distribution of ischemia and its clinical evidence on echocardiography and ECG. The culprit lesion was stented, and the patient was discharged in good physical condition from the hospital