ABSTRACT
El ecocardiograma de estrés con dobutamina (ESD) es una técnica de uso cada vez más rutinario en el diagnóstico de la enfermedad coronaria. La aparición de alteraciones en el electrocardiograma durante la prueba corresponde habitualmente a una depresión del segmento ST y en raras ocasiones a una elevación del ST, relacionándose con lesiones coronarias graves o infarto agudo de miocardio (IAM) previo. La elevación del ST, en ausencia de lesiones coronarias significativas, es muy infrecuente y se supone relacionada con un mecanismo vasoespástico. Presentamos el caso de un varón joven y con factores de riesgo cardiovascular, ingresado para estudio de dolor torácico y con ergometría negativa, que durante la prueba de dobutamina presenta positividad clínica, eléctrica en forma de ascenso del ST y alteraciones segmentarias de la contractilidad. Coronariografía sin lesiones coronarias significativas. Se comenta el caso y se revisa la literatura. (AU)
Subject(s)
Adult , Male , Humans , Dobutamine , Heart/physiopathology , Coronary Disease , Myocardial Contraction , Electrocardiography , Coronary Vasospasm , Exercise TestABSTRACT
INTRODUCTION AND OBJECTIVES: Efficacy of the hemostatic puncture closure 8 Fr Angio-Seal device for percutaneous puncture closure after a catheterism has been previously demonstrated, but the experience provided has been obtained with 8 Fr devices. At present the device has been modified and its size reduced to 6 Fr. In this pilot study we evaluate the efficacy of the new hemostatic 6 Fr Angio-Seal device and its safety when early deambulation post-diagnostic and/or therapeutic catheterization is established. PATIENTS AND METHODS: Prospective study of 150 consecutive patients randomized either for application of the 6 Fr Angio-Seal device (group A; n = 75), in which early ambulation was indicated, or manual compression (group B; n = 75), with ambulation 12 h after cardiac catheterization. Basal data, including clinical and angiographic characteristics and previous treatment with heparin and platelet aggregation inhibitors were similar in both groups. RESULTS: The time of hemostasia was significantly shorter in group A than in group B (118 +/- 210 s in A vs 1320 +/- 370 s in B; p (3/4) 0,001), and with early ambulation (3,1 +/- 0,4 h in A vs 12,3 +/- 3,1 h in B; p (3/4) 0,001) no local complications were observed. CONCLUSIONS: The 6 Fr Angio-Seal hemostatic device diminished the hemostasia time and early ambulation could be achieved. In this pilot study no complications due to early movilization were observed, but the safety of the new hemostatic device after diagnostic or therapeutic catheterizations needs to be evaluated in greater series.
Subject(s)
Cardiac Catheterization , Hemostasis, Surgical/instrumentation , Absorbable Implants , Female , Humans , Male , Middle Aged , Pilot Projects , Prospective Studies , Punctures , Suture Techniques , Time Factors , WalkingABSTRACT
Mortality in the total occlusion of the left main coronary artery is very high, and the few cases who lived reported were very ill and symptomatic patients. We present a case with angiographic documentation of total occlusion of the left main coronary artery in a patient without angina and with a normal rest electrocardiogram in which a syncope was the only symptom. Severe isolated silent ischemia was induced during an exercise test. Total occlusion of the left main coronary artery associated to silent myocardial ischemia without cardiac failure has never been previously reported.
Subject(s)
Coronary Disease/pathology , Myocardial Ischemia/pathology , Syncope/pathology , Angiocardiography , Coronary Disease/complications , Electrocardiography , Exercise Test , Humans , Male , Middle Aged , Myocardial Ischemia/complications , Syncope/complicationsABSTRACT
Dextrocardia and situs inversus totalis is a rare congenital anomaly in adults. Usually, the patients have structurally normal hearts and experience normal longevity. The risk of coronary atherosclerosis is similar to that of the general population. However, the report of coronary angioplasty and/or coronary arteriography on patients with dextrocardia is scant. We describe herein a case of successful percutaneous transluminal coronary angioplasty to the right coronary artery. We comment the technical particularities of the procedure, and a review of the literature is made.