RESUMO
Despite being one of the most prevalent cardiac arrhythmias, the cause of atrial fibrillation (AF) in a vast majority of patients remains unknown. There is growing evidence of associated AF in patients diagnosed with coronary arteriovenous fistula. In this discussion, we have included an example of a patient who presented with new-onset AF and was subsequently diagnosed with an anomalous fistula between the right coronary artery and the superior vena cava. Definitive treatment of the fistula resulted in permanent resolution of the AF. Based on this case and a similar case reported in the literature, it is proposed that further research will unmask this possibly underdiagnosed and very treatable cause of AF.
Assuntos
Fístula Arteriovenosa , Fibrilação Atrial , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Veia Cava Superior/anormalidades , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/fisiopatologia , Fístula Arteriovenosa/cirurgia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/etiologia , Angiografia Coronária/métodos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
OBJECTIVES: The aim of this study was to determine whether a normal stress-only single-photon emission computed tomographic myocardial perfusion tomography (SPECT) study confers the same prognosis as a normal SPECT on the basis of evaluation of stress and rest images. BACKGROUND: Current guidelines recommend stress and rest imaging to confirm that a SPECT study is normal. METHODS: We determined all-cause mortality in 16,854 consecutive patients who had a normal gated stress SPECT. Median follow-up was 4.5 years. A stress-only protocol was used in 8,034 patients (47.6%), whereas 8,820 (52.4%) had both stress and rest imaging. RESULTS: The overall unadjusted annual mortality rate in patients who had a normal SPECT with a stress-only protocol was lower than in those who required additional rest imaging (2.57% vs. 2.92%, p = 0.02). After adjustment for baseline clinical characteristics no significant differences in patient mortality were seen between the 2 imaging protocols, but the stress-only group received a 61% lower radiopharmaceutical dosage. Independent predictors of worse survival included increasing age, male sex, diabetes, history of coronary artery disease, and inability to exercise (all p < 0.001) but not the type of SPECT protocol used to image patients. CONCLUSIONS: Patients determined to have a normal SPECT on the basis of stress imaging alone have a similar mortality rate as those who have a normal SPECT on the basis of evaluation of both stress and rest images. Our results support that additional rest imaging is not required in patients who have a normally appearing initial stress study. A significant reduction in radiation exposure can be achieved with such an approach.
Assuntos
Tomografia Computadorizada por Emissão de Fóton Único de Sincronização Cardíaca , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Teste de Esforço , Imagem de Perfusão do Miocárdio , Adenosina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Dobutamina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Adulto JovemRESUMO
Rupture of an aortic aneurysm into the pulmonary artery is a rare and often a fatal event. This complication results in the development of an acute left to right shunt, volume overload, and rapid right heart deterioration. We describe a case of thoracic aortic aneurysm in whom the diagnosis of a communication with the pulmonary artery was made on the basis of transthoracic echocardiography.
