Critical stenosis of left main coronary artery as a late presentation after transcatheter aortic valve replacement: A case report and review literature.

Transcatheter aortic valve replacement (TAVR) is an alternative treatment for selected patients with severe aortic valve stenosis who are at high risk for conventional surgery. Critical stenosis of left main coronary artery as a late complication after TAVR is quite rare.

Cardiac Sodium Channel Blockade Due to Antiepileptic Drug Combination.

Drugs that inhibit voltage-dependent sodium channels are commonly used to treat epilepsy. Old and novel antiepileptic drugs are used either as monotherapy or in combination to control epilepsy. For a long time, carbamazepine has been used as the first choice for the treatment of simple and complex partial seizures. In the USA, lacosamide was approved in October 2008 as an adjunctive treatment for partial-onset seizures. We describe the effect of two sodium channel blockers on the heart of a patient with epilepsy. LEARNING POINTS: Approximately 30% of patients with epilepsy require combination therapy with antiepileptic drugs for seizure reduction.Lacosamide and carbamazepine are both sodium channel blockers but exert their effects through different mechanisms.Electrocardiogram monitoring is necessary when lacosamide and carbamazepine are used together as this combination may predispose to seizures, conduction abnormalities and dysrhythmia.

Defining the Cause of Postpartum Myocardial Infarction - Another Use for Optical Coherence Tomography.

Chest pain in a young postpartum female can have many causes; however, when associated with ST elevation on ECG, spontaneous coronary artery dissection (SCAD) should be high on the list. Coronary angiography remains the first step in delineating the coronary lesion in suspected cases of SCAD and optical coherence tomography (OCT) can be crucial when the angiographic appearance remains uncertain. We present a case of a young postpartum female with ST elevation myocardial infarction (STEMI). Coronary angiography revealed a dilated part of the middle segment of the left anterior descending (LAD) artery while intramural haematoma (IMH) of the coronary artery wall was found on OCT, which confirmed the clinically suspected diagnosis of SCAD. LEARNING POINTS: SCAD is a rare entity and considered the most common cause of STEMI in the postpartum state.OCT is an intracoronary imaging modality utilizing light waves for image acquisition with high resolution, assisting in clinical decision-making regarding the pathophysiological mechanism of an acute coronary syndrome (ACS).In suspected cases of SCAD, coronary angiography remains the first diagnostic line and OCT can be crucial in confirming an ambiguous angiographic appearance.

From Wellens To Kounis Syndrome: An Unlucky Patient.

Wellens syndrome (WS) is identified by ECG changes in the precordial leads after resolution of angina chest pain. WS indicates critical stenosis of the proximal left anterior descending (LAD) artery. On the other hand, Kounis syndrome (KS) is an allergic reaction to various substances resulting in acute coronary syndrome. Contrast media can trigger the allergic reaction associated with KS. We describe a patient with WS who developed an allergic reaction to contrast media after percutaneous coronary intervention and experienced recurrent myocardial infarction on re-exposure. LEARNING POINTS: Despite its rarity, physicians and radiologists should be aware of Kounis syndrome triggered by contrast media so it can be rapidly diagnosed and treated.The initial target of the prevention and treatment of KS is avoidance of the precipitating stimulus or allergen.There are three KS variants: angina due to allergic coronary spasm, allergic myocardial infarction and allergy-induced stent thrombosis.

Iatrogenic left main coronary artery stenosis following aortic and mitral valve replacement.

Iatrogenic coronary artery disease following prosthetic valve implantation is a rare complication. This may result from mechanical injury in the intraoperative period. The use of balloon tip perfusion catheter presumably provides the initial insult with local vessel wall hypoxia. Once the diagnosis of coronary ostial stenosis is established, the procedure of choice is coronary artery bypass surgery. We report a case of a young lady who underwent aortic and mitral valves replacement for infective endocarditis. She was then diagnosed with ostial left main stem coronary stenosis after presenting with atypical symptoms. The patient eventually underwent coronary artery bypass surgery.