Viral Heart Disease and Acute Coronary Syndromes - Often or Rare Coexistence?

BACKGROUND: Clinical presentation of viral myocarditis can mimic acute coronary syndrome and making diagnosis of viral heart disease (VHD) may be challenging. The presence of coronary artery disease (CAD) does not always exclude VHD and these entities can coexist. However, the incidence of co-occurrence of CAD and VHD is not precisely known. Moreover, inflammatory process caused by viruses may result in atherosclerotic plaque destabilization. METHODS: The goal of this work is to summarize the current knowledge about co-occurrence of VHD and CAD. This article presents the importance of inflammatory process in both diseases and helps to understand pathophysiological mechanisms underlying their coexistence. It provides information about making differential diagnosis between these entities, including clinical presentation, noninvasive imaging features and findings in endomyocardial biopsy. Although currently there are no standard therapy strategies in coexistence of VHD and CAD, we present some remarkable aspects of treatment of patients, in whom VHD co-occurs with CAD. RESULTS: Viral heart disease may occur both in patients without and with atherosclerotic plaques in coronary arteries. Destabilization of atherosclerotic plaques in coronary arteries can be facilitated by inflammatory process. Increased inflammatory infiltrates in the coronary lesions of patients with VHD can lead to plaques' instability and consequently trigger acute coronary syndrome. CONCLUSION: In this article we attempted to present that co-occurrence of VHD and CAD may have therapeutic implications and as specific antiviral treatment is currently available, proper diagnosis and treatment can improve patient's condition and prognosis.

[The Bland-White-Garland syndrome detected during qualification for surgery, due to significant mitral regurgitation]. / Zespól Blanda-White'a-Garlanda ujawniony w trakcie badan diagnostycznych u chorego kwalifikowanego do operacji z powodu duzej niedomykalnosci mitralnej.

A case of a 57-year-old patient admitted to the hospital due to aggravation of heart failure symptoms is presented. In ECHO examination severe mitral insufficiency was found. During coronary angiography ostium of left coronary artery from pulmonary trunk was found. The patient underwent cardiosurgery: artificial mitral valve implantation, bypass LIMA-LAD grafting and natural opening left coronary artery ligation.

[Acute coronary syndrome in a female patient with multilevel atherosclerosis]. / Ostry zespól wiencowy u kobiety z wielopoziomowa miazdzyca.

A case of 74-years-old woman who was admitted to Department of Interventional Cardiology due to acute coronary syndrome is presented. The multilevel atherosclerosis was diagnosed. The patient was successfully treated with two-stage percutaneous coronary and peripheral revascularisation. During 6-months follow-up patient was in good condition.

Influence of parent vessel - side branch distal angle on restenosis rates after main vessel stenting in coronary bifurcation lesion.

BACKGROUND AND AIM: This study explores predictors of side branch (SB) compromise in the main vessel only stenting group and its influence on long-term follow-up of the patients. METHODS: We hypothesised that the geometric factors determining plaque distribution in branching regions influence SB compromise. Angiographic analysis of bifurcation lesions (all Medina types) was performed before, immediately after, and 9-12 months after the procedure. Control angiography was performed when clinically indicated. Specific attention was given to the influence of angle alpha - the angle between main vessel and SB axes. RESULTS: Fifty-five patients (62 lesions) formed the study group. The LAD lesions were dominant (73%). Drug-eluting stents were used in 48% and kissing balloon inflation in 31%. The value of angle alpha was associated with significant SB stenosis. There was significant worsening of ostial SB stenosis (from 48% to 69%) after main vessel stenting, with the only independent predictor angle alpha. For SB ostial MLD independent predictors were angle alpha, SB vessel diameter and MB reference diameter. Predictors of SB occlusion (6.5%) were angle alpha <30 degrees and age >82 years. At follow-up (mean 11 months) SB restenosis rate was 52%, but was associated with symptoms only if the main vessel was affected (8/55, 15%). Angle alpha and main vessel reference diameter, main branch minimal diameter after stenting and stent type were predictors of target vessel revascularisation rate (25%). CONCLUSION: Angle alpha predicts SB compromise after main vessel stenting and is the main predictor of restenosis in the main vessel.