Images in cardiology: dual LAD circulation. a rare coronary anomaly.

AIM: We report a case of type IV dual Left anterior descending (LAD) coronary artery detected incidentally in a female who presented with atypical chest pain. METHOD: She underwent coronary angiography which showed dual LAD--one from the LMCA and another from right coronary sinus. RESULTS: Coronary angiography helped in the diagnosis of the rare coronary anomaly. CONCLUSIONS: The identification of anomalous coronary artery is important.

Intra cardiac mass--a diagnostic and therapeutic dilemma.

AIM: We report an unusual case of previously healthy post partum woman who had presented with congestive cardiac failure. She had no significant past history. METHOD: She underwent cardiac evaluation. Echo showed severe left ventricular dysfunction and multiple mobile masses in the left ventricle. Cardiac MRI was done to assess the intracardiac mass. RESULT: Cardiac MRI helped in differentiating clot from intra cardiac tumor. She was effectively treated with anticoagulants. CONCLUSION: Cardiac MRI is a useful investigative modality to differentiate intracardiac tumor and clot and helps in guiding the management.

Platelet glycoprotein IIb/IIIa inhibition using eptifibatide with primary coronary stenting for acute myocardial infarction: a 30-day follow-up study.

The results of primary coronary stenting for acute myocardial infarction (AMI) have been reported to improve significantly with the concomitant administration of platelet glycoprotein IIb/IIIa inhibitor abciximab. There are, however, no data available with the use of eptifibatide, a more cost-effective, small-molecule GP IIb/IIIa blocker with a shorter half-life. In a prospective multicenter feasibility and efficacy study, we assigned 55 consecutive patients with AMI being taken up for primary stenting to receive eptifibatide just before the procedure (two boluses of 180 microg/kg 10 min apart and a 24-hr infusion of 2 microg/kg/min). Clinical outcomes were evaluated at 30 days after the procedure. The angiographic patency of the vessel with TIMI flow rates, TIMI myocardial perfusion (TMP) grade, and corrected TIMI frame counts were assessed at the end of procedure and before hospital discharge. At 30 days, the primary endpoint, a composite of death, myocardial infarction, and urgent target vessel revascularization (TVR) was seen in 12.7% of patients. The TIMI 3 and TMP grade 3 flow, which was seen in 93% and 86% of patient, respectively, at the end of the procedure, declined to 86% and 78%, respectively (P < 0.05) before hospital discharge. Corrected TIMI frame counts also decreased from 25.7 +/- 7.2 to 22.9 +/- 6.8 (P < 0.05). There were five (9.1%) instances of subacute thrombosis (SAT) presenting as AMI, needing urgent TVR in all, within 3-5 days of the primary procedure. No excessive bleeding complication, directly attributable to the use of eptifibatide, was observed. The study was terminated prematurely because of an unacceptable SAT rate. Administration of eptifibatide along with primary stenting for AMI is associated with a high TIMI 3 and TMP grade 3 flow acutely. However, these flows decline significantly before hospital discharge and lead to a high rate of SAT. The dosage and duration of infusion of eptifibatide in this setting needs further evaluation.