Case report of an acute coronary syndrome in a patient with artery coronary fistulae.

BACKGROUND: Coronary artery fistulae are rare vascular anomalies. Although they are usually asymptomatic, the presence of symptoms might present a challenge in the diagnostic and therapeutic management. CASE SUMMARY: We present a patient with chest pain whose initial tests were normal, but coronary artery fistulae were found. Single-photon emission computed tomography test showed ischaemia due to coronary artery fistulae and cardiac computed tomography helped in the planning of the percutaneous closure. DISCUSSION: CCT is emerging as an optimal non-invasive tool to characterise the morphology and course of coronary artery fistulae and may be essential for its accurate diagnosis and planning for percutaneous closure.

Successful percutaneous treatment of occlusive spontaneous coronary artery dissection with a 'pull-back injection technique': case report.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a rare condition that can cause acute coronary syndrome, typically in young patients without classical cardiovascular risk factors. Although in SCAD the conservative management is preferable, in cases with complete occlusion of the artery an invasive treatment may be required. In such cases, the goal of the percutaneous intervention should be to restore the connection between the true and false lumen recovering the distal flow of the vessel. CASE SUMMARY: A young man was admitted with acute chest pain and ST segment elevation in precordial v3-v6 leads. An emergent coronary angiogram showed an abrupt occlusion of middle left anterior descending artery compatible with SCAD. A microcatheter was advanced distally into the artery and pulled back with continuous contrast injection through the catheter, restoring the distal flow with a residual spiroid intimal flap and with relief of the chest discomfort. A computed tomography performed during admission showed complete resolution of the lesion. DISCUSSION: In SCAD with complete occlusion of the vessel, the 'pull-back technique' with continuous vigorous injection of contrast through a distal microcatheter may be effective to restore the distal flow enabling the healing of the artery at follow-up and avoiding the stent implant.

Low-Density Lipoprotein Cholesterol Targets in Patients With Coronary Heart Disease in Extremadura (Spain): LYNX Registry.

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) contributes decisively to the development of cardiovascular disease (CVD). In the LYNX registry we determined the rate of achievement of the target value of LDL-C, the use of lipid-lowering therapy (LLT) and the predictive factors of not reaching the target in patients with stable coronary heart disease (CHD). METHODS: LYNX included consecutive patients with stable CHD treated at the University Hospital of Caceres, Extremadura (Spain) from September 2016 to September 2018, and those who must have an LDL-C target below 70 mg/dL according to the European Society of Cardiology (ESC) 2016 guidelines. The variables independently associated with the breach of the LDL-C objective were evaluated by multivariable logistic regression. RESULTS: A total of 674 patients with stable CHD were included. The average LDL-C levels were 68.3 ± 24.5 mg/dL, with 56.7% showing a level below 70 mg/dL. LLT was used by 96.7% of patients, 71.7% were treated with high-powered statins and 30.1% with ezetimibe. The risk of not reaching the target value of LDL-C was higher in women, in active smokers, and in those who had multivessel CHD or had atrial fibrillation. Patients with diabetes mellitus, those who took potent statins or co-administration treatment with ezetimibe were more likely to reach the target level of LDL-C. CONCLUSIONS: The treatment of dyslipidemia in patients with chronic CHD remains suboptimal; however, an increasing number of very high-risk patients achieve the LDL-C objective, although there is still enormous potential to improve cardiovascular outcome through the use of more intensive LLT.

Cambios en el síndrome coronario agudo en una década en un hospital de referencia provincial / Changes in acute coronary syndrome in a decade in a provincial referral hospital

Introducción y objetivo: Determinar el cambio en las características clínicas y pronósticas de pacientes ingresados por síndrome coronario agudo (SCA) durante un periodo de los años 2005 y 2015 en un hospital de referencia provincial. Material y método: Estudio observacional transversal que compara las características del SCA de los años 2005 y 2015. Se analizaron factores de riesgo cardiovascular, tratamientos al alta, complicaciones y mortalidad. Resultados: La incidencia de SCA en 2015 fue un 15,3% menor. La incidencia de hipertensión arterial, diabetes y dislipemia fue similar, pero hubo más fumadores en 2015 (25,9% vs 18,3%; p = 0,005). La reperfusión coronaria y la prescripción de tratamientos de prevención secundaria aumentaron respecto a 2005. La mortalidad hospitalaria fue similar. Conclusión: La incidencia de SCA ha disminuido en la última década en paralelo a una mejoría en el pronóstico relacionado con un uso más frecuente de los tratamientos recomendados en las guías

Introduction and objective: To determine the changes in the clinical and prognostic characteristics of patients admitted due to acute coronary syndrome (ACS) during the period between the years 2005 and 2015 in a provincial referral hospital. Material and method: Cross-sectional observational study was conducted comparing the characteristics of ACS between 2005 and 2015. An analysis was made of the cardiovascular risk factors, treatment at discharge, complications, and mortality. Results: The incidence of ACS in 2015 was 15.3% lower. The incidence of hypertension, diabetes and dyslipidaemia was similar, but there were more smokers in 2015 (25.9% vs 18.3%, P=.005). Coronary reperfusion and the prescription of secondary prevention treatments increased compared to 2005. Hospital mortality was similar. Conclusion: The incidence of ACS has decreased in the last decade, in parallel with an improvement in the prognosis related to a more frequent use of the treatments recommended in the guidelines

Changes in acute coronary syndrome in a decade in a provincial referral hospital. / Cambios en el síndrome coronario agudo en una década en un hospital de referencia provincial.

INTRODUCTION AND OBJECTIVE: To determine the changes in the clinical and prognostic characteristics of patients admitted due to acute coronary syndrome (ACS) during the period between the years 2005 and 2015 in a provincial referral hospital. MATERIAL AND METHOD: Cross-sectional observational study was conducted comparing the characteristics of ACS between 2005 and 2015. An analysis was made of the cardiovascular risk factors, treatment at discharge, complications, and mortality. RESULTS: The incidence of ACS in 2015 was 15.3% lower. The incidence of hypertension, diabetes and dyslipidaemia was similar, but there were more smokers in 2015 (25.9% vs 18.3%, P=.005). Coronary reperfusion and the prescription of secondary prevention treatments increased compared to 2005. Hospital mortality was similar. CONCLUSION: The incidence of ACS has decreased in the last decade, in parallel with an improvement in the prognosis related to a more frequent use of the treatments recommended in the guidelines.

Comunicación entre niveles asistenciales: una oportunidad de mejora en la prevención cardiovascular / Communication between levels of care: An opportunity for improvement in cardiovascular prevention

La existencia de una buena coordinación entre los distintos niveles asistenciales constituye un factor fundamental en el desarrollo de una asistencia sanitaria de calidad y eficiente. El médico de atención primaria es fundamental en la prevención secundaria de la enfermedad cardiovascular, y la estrecha colaboración entre atención primaria y cardiología constituye un factor clave en el control de la enfermedad cardiovascular. El proyecto CAPaCERES (Colaboración AP-Cardiología en Cáceres) pretende mejorar la coordinación entre atención primaria y cardiología desde la perspectiva del conocimiento mutuo y la mejora de la comunicación entre los profesionales que la desarrollan, y con ello a mejorar la calidad de la asistencia al paciente crónico con enfermedad cardiovascular

The existence of good coordination between the different levels of care is an essential factor in the development of quality and efficient healthcare. The primary care physician is fundamental in the secondary prevention of cardiovascular disease and the close collaboration between primary care and cardiology is a key factor in the control of cardiovascular disease. The CAPaCERES project (AP-Cardiology Collaboration in Cáceres) aims to improve the coordination between primary care and cardiology from the perspective of mutual knowledge and the improvement of communication between the professionals who develop it, and with that to improve the quality of care chronic patient with cardiovascular disease

Communication between levels of care: An opportunity for improvement in cardiovascular prevention. / Comunicación entre niveles asistenciales: una oportunidad de mejora en la prevención cardiovascular.

The existence of good coordination between the different levels of care is an essential factor in the development of quality and efficient healthcare. The primary care physician is fundamental in the secondary prevention of cardiovascular disease and the close collaboration between primary care and cardiology is a key factor in the control of cardiovascular disease. The CAPaCERES project (AP-Cardiology Collaboration in Cáceres) aims to improve the coordination between primary care and cardiology from the perspective of mutual knowledge and the improvement of communication between the professionals who develop it, and with that to improve the quality of care chronic patient with cardiovascular disease.

A 70-Year-Old Woman With a Prosthetic Mitral Valve and Sudden Chest Pain.

CASE PRESENTATION: A 70-year-old woman presented to the ED with oppressive ongoing chest pain that had lasted for 1 hour and was accompanied by intense sweating. The patient had a previous history of bronchial asthma, severe degenerative mitral regurgitation, and an ostium secundum atrial septal defect that had been treated 6 years ago with a prosthetic mechanical mitral valve, Bicarbon 25, and an atrial septal defect closure. She was being treated with ciclesonide, tiotropium bromide, olodaterol, theophylline, and warfarin, adjusted according to the international normalized ratio. Two weeks before the current event, because of trauma suffered in her leg, her primary care physician changed her treatment to subcutaneous enoxaparin, 80 mg once daily. Considering that her weight was 80 kg and her renal function was normal, the dose of enoxaparin prescribed was subtherapeutic for a mechanical prosthetic valve.