ABSTRACT
Spontaneous coronary artery disease (SCAD) is a particular form of acute coronary syndrome affecting preferentially female patient with few or without traditional cardiovascular risk factors. Male patient is exceptionally concerned by SCAD. We report a case of a young male patient presenting with anterolateral STEMI in relation with SCAD of Left main and left anterior descending artery (LAD). He was initially managed by fibrinolysis, which is then complicated by cardiogenic choc. Coronary angiogram covered by intra-aortic balloon pump (IABP) showed an acute double occlusion of proximal LAD and the ostium of the left circumflex artery (LCX). After thrombus aspirations, the angiographic pattern recalled a SCAD, which is confirmed by OCT (Optical Coherence Tomography). The latter highlighted the intimal flap with true and false lumen involving both Left main and proximal LAD with huge thrombus burden. PCI was then performed successfully with implantation of 3 DES (Drug Eluting Stent). But given the cardiogenic shock persistence despite Dobutamin infusion and IABP, ECMO (Extracorporeal membrane oxygenation) was indicated. Unfortunately, the patient died of haemorrhage during ECMO implantation.
Subject(s)
Coronary Vessel Anomalies/drug therapy , Fibrinolytic Agents/therapeutic use , ST Elevation Myocardial Infarction/complications , Tenecteplase/therapeutic use , Vascular Diseases/congenital , Adult , Coronary Angiography , Coronary Thrombosis/diagnostic imaging , Coronary Thrombosis/therapy , Coronary Vessel Anomalies/diagnostic imaging , Drug-Eluting Stents , Extracorporeal Membrane Oxygenation , Fatal Outcome , Fibrinolytic Agents/adverse effects , Humans , Male , Shock, Cardiogenic/chemically induced , Tenecteplase/adverse effects , Tomography, Optical Coherence , Treatment Failure , Vascular Diseases/diagnostic imaging , Vascular Diseases/drug therapyABSTRACT
INTRODUCTION: Contrast-induced nephropathy (CIN) is a common and severe complication in interventional cardiology. OBJECTIVE: The aim of our study was to compare the incidence of contrast-induced nephropathy in two accelerated hydration protocols: the first one by the serum bicarbonate and the second combining the serum bicarbonate and oral vitamin C. METHODS: This is a multicenter prospective, randomized study conducted between October 2012 and May 2013, including 160 patients. RESULTS: The mean age of our study population was 60.8±9.3 years (36-83 years). The two study groups were comparable in terms of cardiovascular risk factors, concomitant medication, and baseline serum creatinine. The CIN incidence was 6.3% in the vitamin C group and 10% in the control group (P=0.38). No significant difference was observed in terms of CIN incidence between the different subgroups analyzed. CONCLUSION: According to our study, ascorbic acid administered orally as part of an accelerated hydration protocol does not reduce the incidence of CIN.
Subject(s)
Ascorbic Acid/administration & dosage , Contrast Media/adverse effects , Kidney Diseases/chemically induced , Kidney Diseases/prevention & control , Sodium Bicarbonate/administration & dosage , Vitamins/administration & dosage , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
The diagnosis of hypertrophic cardiomyopathy is usually established by echocardiography. Recently, there has been greatly increased use of cardiac magnetic resonance (CMR) because of its precise determination of myocardial anatomy and the depiction of myocardial fibrosis. In this review, we describe the role of echocardiography and magnetic resonance in the assessment of this complex disease. In conclusion, there is a complementarity between cardiovascular magnetic resonance imaging and echocardiography for the diagnosis and the management of HCM.
