Non-selective Aortic Root Angiographic Contrast Injection in a Case of Anomalous Right Coronary Artery Ostium.

Anomalous origin of the right coronary artery (RCA) is a rare congenital cardiovascular anomaly that can pose significant diagnostic challenges during cardiac evaluation. We present a case of a 54-year-old male patient with chest pain and a syncopal episode and subsequently diagnosed with non-ST-elevated myocardial infarction (NSTEMI). Coronary angiography revealed an anomalous origin of the RCA, making it difficult to precisely locate the artery's point of origin with selective contrast injection. During coronary angiography, the use of aortic root non-selective angiographic contrast injection aided in localizing the RCA ostium. Our case highlights the clinical significance of aortic contrast injection as a valuable and safe adjunctive technique in cases of anomalous coronary artery origins. Early detection and precise localization of such anomalies are essential for effective treatment planning and improved patient outcomes. Further studies may help validate the utility of aortic contrast injection in similar cases, thereby enhancing diagnostic accuracy and patient care in the management of anomalous coronary artery ostium.

The power of collateral circulation: a case of asymptomatic chronic total occlusion of the left main coronary artery.

Total occlusion of the left main coronary artery predominantly presents with recurrent angina or myocardial infarction. Long-term survival and myocardial function depends on the well-developed right to left collaterals. We report a case of a 46-year-old man who was referred because of incidental finding of low ejection fraction during work-up for syncope 5 months prior. The patient denied any recurrence or any other symptom after that episode and claimed an unchanged exercise capacity. He had hypertension, hyperlipidemia, and history of 15-pack/year smoking. Except for class II morbid obesity, he had completely normal vital signs, physical examination, and lab tests on admission. The echocardiogram was suggestive of previous anterior wall myocardial infarction and demonstrated a low left ventricle ejection fraction with diffuse hypokinesis of the left ventricle. The patient underwent cardiac catheterization, which revealed total occlusion of the left main coronary artery, dominant right coronary artery with a 95% stenosis in the proximal segment, and collaterals from the right to the left coronary arteries. The patient was immediately referred for coronary artery bypass surgery. This case demonstrates the power of collateral circulation in protecting the patient from symptoms and death despite total occlusion of the left main coronary artery and severe stenosis of the proximal right coronary artery.

Left ventricular geometry and renal function in hypertensive patients with diastolic heart failure.

BACKGROUND: The objective is to define the relationship between cardiac geometry and renal function in hypertensive subjects with and without diastolic heart failure (DHF). METHODS: This is a prospective observational study in a tertiary-care teaching institute in a 15-month period of consecutive hospitalized hypertensive patients. Patients on dialysis therapy or with atrial fibrillation, systolic heart failure, gross proteinuria, and glomerular diseases were excluded. Two-dimensional echocardiography was performed and stable glomerular filtration rate (GFR) was calculated by using the Modification of Diet in Renal Disease formula. Patients were classified into stage 1 to 5 chronic kidney disease (CKD). RESULTS: Five hundred forty hypertensive patients were separated into 2 groups: 286 patients with DHF and 254 patients without DHF. Mean age was 69.1 +/- 13.7 (SD) years in general. In patients with DHF, from stages 1 to 5 CKD, there was a significant graded increase in left ventricular mass index (from 117.3 to 162.4 g/m(2)) and relative wall thickness (from 0.42 to 0.52) and a significant graded decrease in aortic cusp separation (from 1.85 to 1.55 cm). Among echocardiographic variables, left ventricular mass index and relative wall thickness were associated inversely and aortic cusp separation was associated directly with GFR. In the absence of DHF, only left ventricular mass index was associated inversely with GFR, suggesting a prominent role of aortic cusp separation and relative wall thickness in the variability in GFR in patients with DHF through a hemodynamic disturbance. CONCLUSION: Hemodynamic alterations have a prominent role in the variability of GFR in patients with CKD with DHF. Adverse cardiac geometry is linked to the severity of CKD in hypertensive patients, raising the possibility of preserving both cardiac and renal function by means of hypertension control.

Glomerular filtration rate on admission independently predicts short-term in-hospital mortality after acute myocardial infarction.

BACKGROUND: Risk of cardiovascular events is higher in patients with chronic kidney disease. The objective is to evaluate whether glomerular filtration rate (GFR) on admission is an independent predictor of short-term mortality in acute myocardial infarction (AMI), after adjusting with physiologic derangements in an acute setting. METHODS: 220 consecutive patients with an admitting diagnosis of AMI were enrolled in a 1-year prospective observational study at a tertiary care teaching institute. Data were gathered for history, physical examination and laboratory findings. GFR was calculated based on the Modification of Diet in Renal Disease formula. Abnormal categories of physiological derangement indicators were weighted based on APACHE II guidelines. The endpoint was defined as in-hospital all-cause mortality. RESULTS: There were 31 deaths (14.1%). The GFR (mean +/- SD) in survivors as compared to deceased patients was 68.2 +/- 33.8 and 41.7 +/- 25.1 ml/min/1.73 m2, respectively (p < 0.001). The mean age, white blood cell count, blood urea nitrogen, potassium and blood sugar were higher on admission in patients who died in hospital (p < 0.05), while the mean albumin, mean arterial pressure, pulse and respiratory rate were lower in this group compared to survivors (p < 0.05). After adjusting with other covariates, each 10 ml/min/1.73 m2 decrease in GFR was associated with a 1.29 times increased risk of mortality (95% CI 1.08-1.53, p = 0.004). CONCLUSION: GFR on admission is an independent predictor of short-term mortality in a patient after AMI.