ABSTRACT
Endovascular treatment of radiation-induced carotid lesions is challenging and very demanding from a technical standpoint. The authors report the case of a 48-year-old male patient who presented in the emergency department with a non-ST elevation acute coronary syndrome. He had a past history of lung carcinoma treated with radiotherapy. Diagnostic workup included coronary angiography (showing predominantly ostial coronary artery disease) and carotid angiography, which showed a long ulcerated lesion in the right carotid artery. Carotid angioplasty was performed using distal cerebral embolic protection. The post-procedure course was uneventful. At 24 months the patient is well and no major adverse cardiovascular events have been reported. The case presented demonstrates that carotid artery stenting can be safely performed in high risk lesions and highlights the importance of stenting technique and of thorough follow-up.
Subject(s)
Carotid Stenosis/therapy , Radiation Injuries/complications , Stents , Angioplasty, Balloon, Coronary/methods , Atrial Fibrillation/therapy , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/etiology , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/etiology , Humans , Lung Neoplasms/radiotherapy , Male , Middle Aged , Myocardial Infarction/therapy , Radiation Injuries/diagnostic imaging , RadiographyABSTRACT
BACKGROUND: Fast and effective diagnosis of patients with acute myocardial infarction (AMI) in the Emergency Department (ED) is needed. Manchester Triage (MT) is based on identification of the patient's main complaint, establishing, through decision flowcharts, a target-time for first observation. This study aimed to evaluate the impact of MT on short-term mortality in AMI and detect potential improvements, and to analyse high-risk groups: diabetic patients, women and older patients. METHODS: 332 consecutive patients (69.0+13.6 years mean age; 34.9% women) with final diagnosis of AMI were assessed in the ED using MT. Data were analysed according to demographics and risk groups, as well as several AMI parameters, admission duration and intrahospital mortality (IHM). Independent predictors of mortality were determined. RESULTS: 82.8% of patients met the ideal goal of ≤10 min target-time for a first observation (ITTFO). This was higher (95%) in typical presentations ('chest pain'), versus 52% in other flowcharts; p<0.01. Patients ≥70 years old were less frequently screened with ITTFO ≤10 min (76.2% vs 90.0% in those under 70; p=0.001) or the 'chest pain' flowchart (66.9% vs 77.5%; p=0.031). IHM was 13.3%. Triage with ≤10 min ITTFO and the 'chest pain' algorithm seems to predict a lower mortality (0.33 OR; 95% CI 0.17 to 0.63; p=0.0005 and 0.49 OR; 95% CI 0.24 to 1.03; p=0.056). CONCLUSION: MT proved to be an effective system. Patients with typical AMI presentation, ST elevation myocardial infarction and less than 70 years old are protected by MT, with lower ITTFO and better short-term survival.
Subject(s)
Myocardial Infarction/diagnosis , Triage/methods , Age Factors , Aged , Diabetes Mellitus , Female , Humans , Male , Portugal , Prognosis , Reproducibility of Results , Retrospective Studies , Sex Factors , Software Design , Survival AnalysisABSTRACT
Acute myocardial infarction is a rare event in the puerperium that can have life-threatening consequences if not diagnosed early. Spontaneous coronary artery dissection is the most frequent causative mechanism in the period immediately after labor. This article reports the case of a 38-year-old woman with acute myocardial infarction due to spontaneous coronary artery dissection on the 7th day after delivery. The authors review this entity and also discuss the prognosis and future management of this patient.
