Acute coronary syndrome: a rare case of multiple endocrine neoplasia syndromes with pheochromocytoma and medullary thyroid carcinoma.

Pheochromocytoma is a tumor arising from neuroectodermal chromaffin tissues in the adrenal gland or extra-adrenal paraganglia (paragangliomas). The prevalence of the tumor is 0.1%-0.6% in the hypertensive population, of which 10%-20% are malignant. Pheochromocytoma produces, stores, and secretes catecholamines, as well as leads to hypertensive crisis, arrhythmia, angina, and acute myocardial infarction without coronary artery diseases. We report a case of acute coronary syndrome (ACS) with a final diagnosis of multiple endocrine neoplasia with pheochromocytoma and medullary thyroid carcinoma (MTC).

Cardiac metastatic melanoma: Imaging diagnostic clues.

A 47-year-old male was admitted to hospital for severe pericardial effusion; he had undergone surgical removal of cutaneous melanoma 10 years before. Echocardiography-guided pericardiocentesis revealed the presence of intramyocardial masses, which were better defined and characterized, together with pericardial involvement, by cardiac magnetic resonance. Pericardial fluid drained was negative for malignant cells, so video-assisted thoracoscopy was performed and pathologic tissue was biopsied, leading to the diagnosis of metastatic melanoma. Multidisciplinary approach and multimodality imaging played a key role in allowing the diagnostic workup in this complex case. .

Thrombus aspiration before primary angioplasty improves myocardial reperfusion in acute myocardial infarction: the DEAR-MI (Dethrombosis to Enhance Acute Reperfusion in Myocardial Infarction) study.

OBJECTIVES: This study sought to test the hypothesis that thrombus removal, with a new manual thrombus-aspirating device, before primary percutaneous coronary intervention (PPCI) may improve myocardial reperfusion compared with standard PPCI in patients with ST-segment elevation acute myocardial infarction (STEMI). BACKGROUND: In STEMI patients, PPCI may cause thrombus dislodgment and impaired microcirculatory reperfusion. Controversial results have been reported with different systems of distal protection or thrombus removal. METHODS: One-hundred forty-eight consecutive STEMI patients, admitted within 12 h of symptom onset and scheduled for PPCI, were randomly assigned to PPCI (group 1) or manual thrombus aspiration before standard PPCI (group 2). Patients with cardiogenic shock, previous infarction, or thrombolytic therapy were excluded. Primary end points were complete (>70%) ST-segment resolution (STR) and myocardial blush grade (MBG) 3. RESULTS: Baseline clinical and angiographic characteristics were similar in the 2 groups. Comparing groups 1 and 2: complete STR 50% versus 68% (p < 0.05); MBG-3 44% versus 88% (p < 0.0001); coronary Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 78% versus 89% (p = NS); corrected TIMI frame count 21.5 +/- 12 versus 17.3 +/- 6 (p < 0.01); no reflow 15% versus 3% (p < 0.05); angiographic embolization 19% versus 5% (p < 0.05); direct stenting 24% versus 70% (p < 0.0001); and peak creatine kinase-mass band fraction 910 +/- 128 mug/l versus 790 +/- 132 mug/l (p < 0001). In-hospital clinical events were similar in the 2 groups. After adjusting for confounding factors, multivariate analysis showed thrombus aspiration to be an independent predictor of complete STR and MBG-3. CONCLUSIONS: Manual thrombus aspiration before PPCI leads to better myocardial reperfusion and is associated with lower creatine kinase mass band fraction release, lower risk of distal embolization, and no reflow compared with standard PPCI. (Thrombus Aspiration Before Standard Primary Angioplasty Improves Myocardial Reperfusion in Acute Myocardial Infarction; http://clinicaltrials.gov/ct/show/NCT00257153).

Cardiac death and heart failure following primary angioplasty in extensive myocardial infarction: incremental prognostic value of clinical, functional and angiographic data.

BACKGROUND: The incidence of late severe heart failure after primary angioplasty is not clear and few data are available about the clinical prognostic predictors of this event. The aims of our study were a) to evaluate the incidence of cardiac death and heart failure after an extensive acute myocardial infarction treated with primary angioplasty, and b) to identify, among clinical, ECG, functional, and angiographic variables, the outcome predictors and their incremental prognostic value. METHODS: Two hundred and thirty-three patients with ST-segment elevation in > or = 4 leads, without cardiogenic shock, underwent primary angioplasty within 12 hours of symptom onset and were prospectively followed up for a median of 21 months for the combined endpoint of cardiac death and heart failure. The effects of clinical, ECG, functional, and angiographic data on the combined endpoint were evaluated using Cox's analysis. Separate models were developed including all variables of a given model plus significant variables of previous models to reproduce the usual clinical information flow. RESULTS: Twelve (5%) deaths and 23 (10%) heart failures occurred. Diabetes (hazard ratio [HR] 6.46, 95% confidence interval [CI] 1.99-20.98) and peak creatine kinase-MB (HR 1.002, 95% CI 1.001-1.004 per unit increment), wall motion score index (HR 1.46, 95% CI 0.35-6.15 per 0.1 unit increment), and TIMI flow grade < 3 after angioplasty (HR 5.35, 95% CI 2.04-14.02) were the only significant and independent prognostic indicators. ECG information did not improve the model, whilst functional and angiographic data provided incremental prognostic value over clinical information. CONCLUSIONS: At mid-term follow-up, extensive acute myocardial infarction patients undergoing primary angioplasty have a moderate heart failure event rate. The integrated evaluation of data routinely available from diagnostic work-up allows accurate prediction of the outcome; functional and angiographic data provide incremental prognostic information over clinical and ECG variables.

Successful intraventricular thrombolysis during ventricular assist device support.

Different types of mechanical ventricular assist devices are available for treating end stage congestive heart failure. Despite technical improvements, however, various complications are still reported for patients during mechanical support. We report our experience with intraventricular thrombolysis as a treatment for possible thrombosis of a continuous flow device that had been implanted as a bridge to heart transplantation. This approach has been demonstrated to be both effective and safe.