[MINOCA and Coronary Ectasia: a rare combination of causes of infarction] / MINOCA y Ectasia Coronaria: una combinación inusual de causas de infarto

Objective: to describe a patient with myocardial ischemia with multiple causes. Clinical Case: This clinical case describes a 58-year-old man with a history of hypertension, dyslipidemia, COPD and previous myocardial infarction (AMI). He went to the emergency room with chest pain and dyspnea. Findings included bibasal crackles, electrocardiogram with old anterior fibrosis, elevated NT-ProBNP, and echocardiogram with septoapical akinesia. During hospitalization, he experienced tachyarrhythmia and hemodynamic deterioration, undergoing electrical cardioversion (CVE). Non-ST segment elevation acute coronary syndrome (NSTEACS) complicated with ventricular arrhythmia and acute pulmonary edema was diagnosed. Coronary angiography revealed coronary ectasias without obstructive lesions, but with mild stenosis in three vessels. The patient was successfully treated with non-invasive ventilation, diuretics, vasodilators and anticoagulation. The discharge was granted with the plan to further studies to optimize and guide treatment and finally the diagnosis of Myocardial Infarction with Non-Obstructive Arteries (MINOCA) and the presence of coronary ectasias was addressed. Conclusion: it is important to highlight the non-ischemic causes in MINOCA and the association between coronary ectasia and cardiovascular events, which is why we emphasize the need for more studies to better understand the relationship between these phenomena.

Objetivo: describir un paciente con isquemia miocárdica con múltiples causas. Caso Clínico: En este caso clínico se describe a un hombre de 58 años con antecedentes de hipertensión, dislipidemia, EPOC e infarto de miocardio (IAM) previo. Acudió a urgencias con dolor torácico y disnea. Los hallazgos incluyeron crepitantes bibasales, electrocardiograma con fibrosis anterior antigua, NT-ProBNP elevado y ecocardiograma con acinesia septoapical. Durante la hospitalización, experimentó taquiarritmia y deterioro hemodinámico, siendo sometido a cardioversión eléctrica (CVE). Se diagnosticó síndrome coronario agudo sin elevación del segmento ST (SCASEST) complicado con arritmia ventricular y edema pulmonar agudo. La angiografía coronaria reveló ectasias coronarias sin lesiones obstructivas, pero con estenosis leve en tres vasos. El paciente fue tratado con éxito mediante ventilación no invasiva, diuréticos, vasodilatadores y anticoagulación. Se otorgó el alta con el plan de profundizar estudios para optimizar y guiar tratamiento y finalmente se abordó al diagnóstico de Infarto de Miocardio con Arterias No Obstructivas (MINOCA) y la presencia de ectasias coronarias. Conclusión: es importante destacar las causas no isquémicas en MINOCA y la asociación entre ectasia coronaria y eventos cardiovasculares, por lo que subrayamos la necesidad de más estudios para comprender mejor la relación entre estos fenómenos.

Correlação dos escores de risco com a anatomia coronária na síndrome coronária aguda sem supra-ST / Correlation of risk scores with coronary anatomy in non-ST-elevation acute coronary syndrome

FUNDAMENTO:Há poucas publicações sobre a correlação entre escores de risco e anatomia coronária na síndrome coronária aguda (SCA). OBJETIVO: Correlacionar os escores de risco com a gravidade da lesão coronária na SCA sem supra-ST. MÉTODOS: Foram analisados 582 pacientes entre julho de 2004 e outubro de 2006. Avaliou-se a correlação entre os escores de risco TIMI, GRACE hospitalar e em seis meses com lesão coronária > 50%, por método não paramétrico de Spearman. Modelo de regressão logística múltipla foi realizado para determinar a habilidade preditiva dos escores em discriminar quem terá ou não lesão coronária > 50%. RESULTADOS: Foram 319 (54,8%) homens e a média de idade era 59,9 (± 10,6) anos. Correlação positiva foi observada entre a pontuação dos escores de risco e lesão coronária > 50% (escore de risco TIMI r = 0,363 [p < 0,0001]; escore GRACE hospitalar r = 0,255 [p < 0,0001]; escore GRACE em seis meses r = 0,209 [< 0,0001]). A área sob a curva ROC de cada escore para discriminar quem terá ou não lesão coronária > 50% foi: TIMI = 0,704 [IC95% 0,656-0,752; p <0,0001]; GRACE hospitalar = 0,623 [IC 95% 0,573-0,673; p < 0,0001]; GRACE em seis meses = 0,562 [IC95% 0,510-0,613; p = 0,0255]. Na comparação entre as áreas sob a curva ROC, tem-se: TIMI versus GRACE hospitalar: p = 0,01; TIMI versus GRACE em seis meses: p < 0,0001; GRACE hospitalar versus GRACE em seis meses: p = 0,0461. CONCLUSÃO: Os escores de risco se correlacionam com a gravidade das lesões coronárias, sendo o escore de risco TIMI o que demonstrou melhor habilidade preditiva.

BACKGROUND: The literature lacks studies regarding the correlation between risk scores and coronary anatomy in acute coronary syndrome (ACS) OBJECTIVE: Correlate risk scores with the severity of the coronary lesion in ACS with non-ST elevation. METHODS: A total of 582 patients were analyzed between July 2004 and October 2006. The correlation between TIMI risk scores and GRACE (hospital and six months) scores was performed for patients with coronary lesion > 50%, using Spearman´s non-parametric method. Multiple regression logistics was used to determine the predictive ability of the scores to discriminate to discriminate who will have a coronary lesion > 50%. RESULTS: Most subjects were male (319 or 54.8%), mean age of 59.9 (± 10.6) years. A positive correlation was observed between risk scores and >coronary lesion > 50% (TIMI r = 0.363 [p < 0.0001]; hospital GRACE r = 0.255 [p < 0.0001]; GRACE at six months r = 0.209 [< 0.0001]). The area under the ROC curve for each score to determine to discriminate who will have a coronary lesion > 50% was: TIMI = 0.704 [CI95% 0.656-0.752; p <0.0001]; hospital GRACE = 0.623 [CI95% 0.573-0.673; p < 0.0001]; GRACE at six months= 0.562 [CI95% 0.510-0.613; p ;= 0.0255]. Comparing the areas under the ROC curve, it was found: TIMI versus hospital GRACE: p = 0.01; TIMI versus GRACE at six months:p < 0.0001; hospital GRACE versus GRACE at six months: p = 0.0461. CONCLUSION: Risk scores correlate with the severity of coronary lesions, and the TIMI risk score showed the best predictive ability.

Correlation of risk scores with coronary anatomy in non-ST-elevation acute coronary syndrome.

BACKGROUND: The literature lacks studies regarding the correlation between risk scores and coronary anatomy in acute coronary syndrome (ACS) OBJECTIVE: Correlate risk scores with the severity of the coronary lesion in ACS with non-ST elevation. METHODS: A total of 582 patients were analyzed between July 2004 and October 2006. The correlation between TIMI risk scores and GRACE (hospital and six months) scores was performed for patients with coronary lesion ≥ 50%, using Spearman's non-parametric method. Multiple regression logistics was used to determine the predictive ability of the scores to discriminate to discriminate who will have a coronary lesion ≥ 50%. RESULTS: Most subjects were male (319 or 54.8%), mean age of 59.9 (± 10.6) years. A positive correlation was observed between risk scores and coronary lesion ≥ 50% (TIMI r = 0.363 [p < 0.0001]; hospital GRACE r = 0.255 [p < 0.0001]; GRACE at six months r = 0.209 [< 0.0001]). The area under the ROC curve for each score to determine to discriminate who will have a coronary lesion > 50% was: TIMI = 0.704 [CI95% 0.656-0.752; p <0.0001]; hospital GRACE = 0.623 [CI95% 0.573-0.673; p < 0.0001]; GRACE at six months= 0.562 [CI95% 0.510-0.613; p ;= 0.0255]. Comparing the areas under the ROC curve, it was found: TIMI versus hospital GRACE: p = 0.01; TIMI versus GRACE at six months:p < 0.0001; hospital GRACE versus GRACE at six months: p = 0.0461. CONCLUSION: Risk scores correlate with the severity of coronary lesions, and the TIMI risk score showed the best predictive ability.

Tomografia computadorizada e Dor Torácica. A contribuição da tomografia computadorizada na avaliação na avaliação da dor torácica aguda / Tomografia computadorizada e Dor Torácica. A contribuição da tomografia computadorizada na avaliação na avaliação da dor torácica aguda

A doença cardíaca isquêmica é uma das principais causas de morte no mundo. Segundo os dados de 2010 do Heart Disease and Stroke Statistics aproximadamente uma morte a cada segundo mais de 151.000 americanos com menos de 65 anos já morreram este ano de doenças cardiovasculares. Os custos diretos e indiretos com doenças cardiovasculares , acidente vascular cerebral e condições relacionadas nos Estados Unidos da América são estimados em torno de 503,2 bilhões de dólares por ano. Isso inclui custos médicos, cuidados hospitalares, antendimento residencial, medicações, além de custos indiretos relacionados à perda de produtividade...