ABSTRACT
Coronary artery aneurysm (CAA) is a rare disease that is associated with dangerous dormant complications. It is associated with atherosclerotic heart disease in half of the cases during a coronary angiogram. Currently, there are no guidelines for the management of such cases. We present a case of acute ST-segment elevation myocardial infarction in a male patient who was found to have diffuse aneurysmal dilation of the coronary arteries along with 100% occlusion of the right coronary artery. The complexity of the lesions caused him not to be a candidate for either percutaneous or surgical intervention. This raises an important question regarding treatment options in such a rare case.
ABSTRACT
A 75-year-old woman with past medical history of coronary bypass, atrial fibrillation, mitral valve repair undergoes percutaneous coronary intervention of left circumflex artery with a drug eluting stent. An Anglo-Seal vascular closure device was used post procedure to obtain hemostasis. Shortly after deployment, frank bleeding was observed necessitating manual compression at the arteriotomy site. After hemostasis was achieved, the right lower extremity was found to be pale, bluish with feeble pulses. Doppler ultrasound was emergently performed revealing decreased blood flow after mid superficial femoral artery (SFA) and an echo lucent object lodged luminally in the SFA. Patient was urgently taken to the vascular laboratory where an Angio-Seal device, including the collagen plug and anchor, was successfully removed endovascularly patient made full recovery and was discharged home the following day.
Subject(s)
Absorbable Implants/adverse effects , Acute Coronary Syndrome/surgery , Angioplasty, Balloon, Coronary/adverse effects , Device Removal/methods , Femoral Artery , Ischemia , Postoperative Hemorrhage , Prosthesis Failure , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/physiopathology , Aged , Angioplasty, Balloon, Coronary/methods , Collagen/therapeutic use , Coronary Angiography , Drug-Eluting Stents , Endovascular Procedures/methods , Female , Femoral Artery/diagnostic imaging , Femoral Artery/physiopathology , Femoral Artery/surgery , Hemostasis, Surgical/adverse effects , Hemostasis, Surgical/instrumentation , Hemostasis, Surgical/methods , Humans , Ischemia/diagnosis , Ischemia/etiology , Ischemia/physiopathology , Ischemia/surgery , Lower Extremity/blood supply , Lower Extremity/physiopathology , Postoperative Hemorrhage/diagnosis , Postoperative Hemorrhage/physiopathology , Postoperative Hemorrhage/surgery , Prosthesis Failure/adverse effects , Prosthesis Failure/etiology , Treatment Outcome , Ultrasonography, Doppler/methodsABSTRACT
BACKGROUND: Several studies have looked at the effects on mood and quality of life (QOL) among patients who underwent on-pump coronary artery bypass grafting (CABG), but few have reported on off-pump CABG (OPCABG). METHODS: We recruited 50 patients undergoing OPCABG. The day before CABG, patients were interviewed using 4 questionnaires: the Beck Depression Index (BDI), Beck Anxiety Index (BAI), Sheehan Disability Scale (SDS), and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). The process was repeated at 1, 3, 6, and 9 months. RESULTS: One month postoperatively, patients showed increased levels of depression (Δ 1.67 in the mean BDI score, P < .05) and disability (Δ 5.28 in the mean SDS score, P < .001) and decreases levels of anxiety (Δ 3.7 in the mean BAI score, P < .001) and QOL compared with baseline. When compared with the first month, at 9 months patients were significantly less depressed (Δ 3.58 in the mean BDI score, P < .001), were less disabled (Δ 5.34 in the mean SDS score, P < .001), and had better QOL (Δ 3.82 in the mean Q-LES-Q score, P = .014). At 9 months, 44% had some degree of depression and 48% had low QOL. CONCLUSION: Despite that all scores returned to or below baseline at 9 months, a high percentage of patients still had depressive symptoms and overall poor quality of life (QOL). BDI scores at baseline are good predictors of QOL at all measured intervals. This should make physicians more prudent in diagnosing and observing these patients.
Subject(s)
Coronary Artery Bypass, Off-Pump/psychology , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Disability Evaluation , Quality of Life/psychology , Adaptation, Psychological , Aged , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Comorbidity , Female , Follow-Up Studies , Humans , Male , Middle Aged , Personality Inventory/statistics & numerical data , Prospective Studies , PsychometricsABSTRACT
PURPOSE: To examine, in women who underwent cardiac catheterization, whether breast arterial calcifications (BACs) seen at screening mammography correlate with coronary heart disease (CHD) seen at coronary angiography. MATERIALS AND METHODS: In an institutional review board-approved, HIPAA-compliant study, 172 women (mean age, 64.29 years +/- 11.97 [standard deviation]) who underwent coronary angiography were recruited, interviewed, and assigned to two groups: those with (CHD+) and those without (CHD-) CHD. The severity and location of the CHD were considered. Their mammograms were reviewed by a breast imaging specialist who was blinded to the CHD status. Student t test, chi(2), and multiple logistic regression tests were performed as appropriate. Presence of BAC was noted and correlated with presence of CHD and presence of cardiac risk factors. RESULTS: There were 104 women with and 68 women without CHD. Thirty-seven (36%) women in the CHD+ group versus 20 (29%) in the CHD-group (P = .40) had BAC. The mean age of the patients with BAC, 72 years +/- 9.8, was significantly older than the mean age of the patients without BAC, 60.4 years +/- 11.1 (P < .001). Therefore, subjects were divided into those younger than 65 years and those 65 years and older. No correlation existed, despite the fact that BAC was associated with some cardiac risk factors. CONCLUSION: The authors did not observe a correlation between BAC and coronary angiography-detected CHD, even when CHD severity was considered. On the basis of these results, caution should be exercised when using screening mammography-detected BAC to identify patients with CHD.
