Acute neurogenic stunned myocardium in a patient with Guillain-Barré syndrome: case report.

Autonomic dysfunction is a prevalent symptom of Guillain-Barré syndrome (GBS); cardiovascular involvement in this scenario has been mentioned infrequently in the literature. Case Presentation: A 65-year-old man with GBS presented with reversible left ventricular systolic failure. On first presentation, our patient had no history or indications of heart malfunction. During the clinical manifestation of his autonomic dysfunction, he had electrocardiographic alterations, modestly increased cardiac enzymes, significant left ventricular systolic dysfunction, and segmental wall motion irregularity. Once the initial episode was over, these anomalies and his symptoms resolved quickly. Discussion: We believe the reversible left ventricular dysfunction was caused by the toxic impact of elevated catecholamines as well as transiently injured sympathetic nerve endings in the myocardium, which was apparently caused by GBS. We recommend that echocardiography be performed in patients who exhibit clinical signs of autonomic dysfunction, particularly if they are associated with abnormal electrocardiographic findings, cardiac enzyme elevation, or hemodynamic instability, so that appropriate medical therapy can be instituted as soon as possible. Conclusion: GBS is a not a very rare situation in our context. Thus, doctors are supposed to know the life-threatening complications such as neurogenic stunned myocardium and be prepared to dodge it.

Double the Trouble - One Infarction After Another: A Case Report of Two Consecutive ST-Segment Elevation Myocardial Infarctions in Two Different Coronary Arteries.

In multi-vessel coronary artery disease, concomitant ST-segment elevation myocardial infarction (STEMI) in simultaneous two culprit lesions have been rarely reported. In this regard, the recurrence in a short period of time of a STEMI in a different coronary artery is also rare. We describe the case of a 56-year-old male smoker, who was presented with an anterior STEMI. The coronary angiography demonstrated a significant lesion in the left main coronary (LMC) and an occlusion of the left anterior descending artery (LAD), and was referred for surgery. Four days later, he experienced symptoms of acute ischemia of the inferior territory. A newly formed culprit lesion of the circumflex artery (Cx) was detected and benefited from angioplasty. The patient expired the next day from sudden arrythmia. This case report shows two consecutive STEMI situations in separate coronary arteries, which commonly can occur in atherosclerotic patients with very poor prognosis.

Variant origin of the right coronary artery from the left main coronary artery together with aortic valve stenosis: report of a rare case / Origen variante de la arteria coronaria derecha a partir de la arteria coronaria izquierda junto con estenosis de la valva aórtica: reporte de un caso raro

SUMMARY: Variations in the origin of the right coronary artery have an incidence between 0.09 % and 0.92 %. Herein, we report a rare case of a coronary artery anomaly in which the right coronary artery originates from the left main coronary artery. This variant was found during routine coronarography, combined with an artificial aortic valve. Despite their rare occurrence, some variations in the origins of the coronary arteries can be life threatening and are associated with a higher risk of sudden cardiac death. They can also pose serious technical challenges and predispose to complications during coronary angiographic procedures. Thus, knowledge of such anomalies is paramount for managing the patients correctly.

Las variaciones en el origen de la arteria coronaria derecha tienen una incidencia entre el 0,09 % y el 0,92 %. En este documento, informamos un caso raro de una anomalía de la arteria coronaria en la que la arteria coronaria derecha se originaba en la arteria coronaria izquierda. Esta variante se encontró durante una coronariografía de rutina, combinada con una válvula aórtica artificial. A pesar de su rara aparición, algunas variaciones en los orígenes de las arterias coronarias pueden poner en peligro la vida y se asocian con un mayor riesgo de muerte súbita cardíaca. También pueden plantear serios desafíos técnicos y predisponer a complicaciones durante los procedimientos angiográficos coronarios. Por tanto, el conocimiento de dichas anomalías es fundamental para el manejo correcto de los pacientes.

Variant origin of three main coronary ostia from the right sinus of Valsalva: report of a rare case.

Observing anomalies in the origin of the coronary arteries is a rare but recognised scenario during coronarography. All the major coronary arteries originating from the right sinus of Valsalva is an extremely rare anomaly, its reported incidence being 0.008% in angiographic studies. Most coronary artery variations are benign and are therefore found accidentally or postmortem. However, some anomalies in the origin of the coronary arteries are associated with myocardial ischaemia and a higher risk of sudden cardiac death. Herein, we report a sporadic case of anomalous origin of the coronary arteries, in which the right coronary artery, anterior interventricular artery and left circumflex artery arise separately from the right sinus of Valsalva, each originating from a separate ostium. Regardless of their low incidence rate, coronary artery anomalies can cause serious technical challenges during coronary angiography and percutaneous interventions because of the unusual location and course of the artery. Echocardiography, computed tomography, and magnetic resonance imaging can be useful in such cases.

Effectiveness of Hypnosis for the Prevention of Anxiety During Coronary Angiography (HYPCOR study): a prospective randomized study.

BACKGROUND: Coronary angiography is the gold standard for the diagnosis of coronary artery disease. This intervention is nevertheless a source of anxiety for the patient both by its discomfort and by the consequences linked to the discovery of potential diseases. OBJECTIVES: The aim of this study was to determine the effectiveness of hypnosis in reducing anxiety in patients undergoing coronary angiography. METHODS: One hundred sixty-nine patients with planned coronary angiography and no history of coronary angiography were randomized to a hypnosis or control group. Patients in the hypnosis group underwent a hypnosis session with self-hypnosis posthypnotic suggestions, while those in the control group had a conversational interview with the hypnotherapist. The primary endpoint was pre-exam anxiety level assessed by the Spielberger State-Trait Anxiety Inventory (STAI-Y A). RESULTS: Performing a hypnosis session did not result in a significant decrease in anxiety before the intervention. Age, high trait anxiety, high state anxiety the day before, and belief that hypnosis works in general were associated with increased anxiety before the procedure. No adverse events were reported after hypnosis. There was no statistically significant difference between the 2 groups for the occurrence of complications of the intervention. CONCLUSION: In this study, performing a hypnosis session before coronary angiography did not reduce the state of anxiety measured just before the intervention. In all cases, the hypnotic experience appears to be positive for the patient, encouraging further research efforts. TRIAL REGISTRATION: The research protocol has been registered on the ClinicalTrials.gov registry (NCT02818101; 29/06/2016) and with the ANSM (IDRCB 2016-A00205-46; 02/02/2016).

Spontaneous coronary artery dissection, two case reports of men.

Spontaneous coronary dissection (SCAD) is one of the less common causes of acute coronary syndrome. It mainly affects younger patients without typical risk factors for ischemic heart disease. SCAD usually arises suddenly in otherwise healthy individuals with a previously full quality of life, and given the potential urgency of the condition, it is an important nosological unit in the differential diagnosis of chest pain. With the improving availability of comprehensive diagnostic methods we could see an increase in number of reported cases, and thus the potential for early intervention or active prevention of complications including malignant arrhythmias and cardiac arrest. It is therefore necessary to think about SCAD during examination of patients that are not yet at a cardiovascular risk. The vast majority of published case reports relate to cases described in women. Our article describes two case reports in men.

The possible role of machine learning in detection of increased cardiovascular risk patients - KSC MR Study (design).

Introduction: Currently, just a few major parameters are used for cardiovascular (CV) risk quantification to identify many of the high-risk subjects; however, they leave a lot of them with an underestimated level of CV risk which does not reflect the reality. Material and methods: The submitted study design of the Kosice Selective Coronarography Multiple Risk (KSC MR) Study will use computer analysis of coronary angiography results of admitted patients along with broad patients' characteristics based on questionnaires, physical findings, laboratory and many other examinations. Results: Obtained data will undergo machine learning protocols with the aim of developing algorithms which will include all available parameters and accurately calculate the probability of coronary artery disease. Conclusions: The KSC MR study results, if positive, could establisha base for development of proper software for revealing high-risk patients, as well as patients with suggested positive coronary angiography findings, based on the principles of personalised medicine.

Coronary to pulmonary artery fistula associated with significant coronary atherosclerosis and severe aortic valve stenosis: A Case Report.

Coronary artery fistulas are anomalous connections between one or two coronary arteries with either a cardiac chamber or any major blood vessels (coronary sinus, superior vena cava, pulmonary veins and pulmonary artery). It is rarely reported, occurring only in 0.1%-0.2% of patients who undergo coronary angiography. We report a very rare case where myocardial ischaemia may have resulted from the presence of coronary artery fistula, significant coronary artery stenosis and severe aortic valve stenosis. Transthoracic echocardiography showed severe aortic stenosis, while coronary angiography showed a tortuous coronary artery fistula originating from the proximal left anterior descending artery, with a single opening in the main pulmonary artery. Angiography also showed significant stenosis in the middle of the left anterior descending artery. Coronary artery fistula with concomitant significant coronary atherosclerosis and severe aortic stenosis requires optimal therapeutic planning.

[Surgical treatment of patients with abdominal aortic aneurysm and ischaemic heart disease]. / Khirurgicheskoe lechenie bol'nykh s anevrizmami infrarenal'nogo otdela aorty i ishemicheskoi bolezn'iu serdtsa.

Presented herein are the results of treatment of 137 patients with infrarenal aneurysms of the abdominal portion of the aorta in a combination with ischaemic heart disease. Severity of lesions to the coronary bed and the risk of cardiac complications were assessed according to the SYNTAX score. Depending on severity of angina pectoris and the clinical course of infrarenal aortic aneurysms, we used different tactical approaches to operative treatment of patients. In a low risk of coronary complications, we performed isolated prosthetic repair or endoprosthetic reconstruction of the abdominal aorta. In patients with haemodynamically significant lesions of the coronary bed and positive non-invasive tests, the first stage consisted in coronary artery bypass grafting or stenting of coronary arteries taking into account the risk of cardiac complications according to the SYNTAX Score. The second stage consisted in prosthetic repair or endoprosthetic reconstruction of the abdominal aorta. The terms of the second stage differed and were determined by the course of abdominal aortic aneurysms. In symptomatic large aneurysms (more than 8 cm), prosthetic repair of the abdominal aorta was carried out within 2 weeks after previous stenting of coronary arteries. Simultaneous myocardial revascularization and abdominal aortic reconstruction were performed only in patients with severe angina pectoris, lesions of the trunk of the left coronary artery, three-vessel lesions of the coronary bed, high risk of cardiac complications according to the SYNTAX Score and a complicated or symptomatic course of an infrarenal aortic aneurysm. During implantation of stent grafts into the abdominal aorta there were neither lethal outcomes nor cardiac complications. In open operations, the 30-day mortality rate amounted to 2.2%, with the 5-year survival rate of 92%.

Radial Access for Coronary Angiography Carries Fewer Complications Compared with Femoral Access: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND AND AIM: In patients undergoing diagnostic coronary angiography (CA) and percutaneous coronary interventions (PCI), the benefits associated with radial access compared with the femoral access approach remain controversial. The aim of this meta-analysis was to compare the short-term evidence-based clinical outcome of the two approaches. METHODS: The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) comparing radial versus femoral access for CA and PCI. We identified 34 RCTs with 29,352 patients who underwent CA and/or PCI and compared 14,819 patients randomized for radial access with 14,533 who underwent procedures using femoral access. The follow-up period for clinical outcome was 30 days in all studies. Data were pooled by meta-analysis using a fixed-effect or a random-effect model, as appropriate. Risk ratios (RRs) were used for efficacy and safety outcomes. RESULTS: Compared with femoral access, the radial access was associated with significantly lower risk for all-cause mortality (RR: 0.74; 95% confidence interval (CI): 0.61 to 0.88; p = 0.001), major bleeding (RR: 0.53; 95% CI:0.43 to 0.65; p ˂ 0.00001), major adverse cardiovascular events (MACE)(RR: 0.82; 95% CI: 0.74 to 0.91; p = 0.0002), and major vascular complications (RR: 0.37; 95% CI: 0.29 to 0.48; p ˂ 0.00001). These results were consistent irrespective of the clinical presentation of ACS or STEMI. CONCLUSIONS: Radial access in patients undergoing CA with or without PCI is associated with lower mortality, MACE, major bleeding and vascular complications, irrespective of clinical presentation, ACS or STEMI, compared with femoral access.

Fractional Flow Reserve in the Diagnosis of Ischemic Heart Disease in a Patient with Coronary Artery Ectasia.

Coronary artery ectasias (CAE) are diffuse dilatations of coronary artery segments with a diameter 1.5 times greater than the largest adjacent normal segment of the vessel. They are found in 0.3-5.0% of coronary angiography. Risk factors for CAE include atherosclerosis, previous percutaneous coronary interventions, arterial inflammation and connective tissue diseases. The diagnosis of CEA in a patient is a considerable diagnostic and therapeutic problem due to the unfavorable prognosis and the lack of guidelines. We present a case of a 69-year-old male patient with a history of retrosternal pain admitted to the clinic for the diagnosis of coronary artery disease. In coronary angiography, numerous ectases of the main coronary arteries and atherosclerotic lesions causing border stenosis of the left anterior descending (LAD), diagonal (2D) and marginal branch (OM). The heart team decided to assess the significance of the changes with the fractional flow reserve (FFR). The FFR was performed and haemodynamically insignificant stenoses of the ectatically dilated coronary arteries were found. The patient was qualified for conservative treatment.

[Coronary aneurysm, it exists !] / L'anévrisme coronarien, ça existe !

Coronary aneurysm has an incidence of 1,1 to 4,9 % in patients undergoing a coronary angiography. Many etiologies may be accused, atherosclerosis is associated in up to 50 % of cases. We report the case of a 76-year-old patient with a large coronary aneurysm.

L'anévrisme coronarien a une incidence de 1,1 à 4,9 % chez les patients bénéficiant d'une coronarographie. De nombreuses étiologies peuvent être incriminées, l'athérosclérose y est associée dans 50 % des cas. Nous rapportons ici le cas d'un patient de 76 ans présentant un volumineux anévrisme coronarien.

[TAVI and coronary revascularization]. / TAVI et revascularisation coronaire.

Transcatheter aortic valve implantation (TAVI) has become the major approach to manage the severe aortic stenosis in inoperable patients that frequently present a coronary artery disease. To date, the available data related to the impact of these coronary lesions on survival is conflicting. When indicated, coronary revascularization could be beneficial for proximal lesions when performed before or during TAVI. The per-procedure coronary artery occlusion is rare, but with a bad prognosis. The coronary occlusion is more frequent with short distance of the coronary implantation and the small aortic sinuses, mostly occurring in the left main coronary. The scan analysis to identify high-risk cases is therefore important before the procedure in order to anticipate and prevent complications by specific techniques. Recently, late occlusion cases have been described and linked to thrombus or fibrosis mechanisms. The rate of success of percutaneous coronary intervention (PCI) after TAVI approach is weak, because of the difficulties of selective catheterization due to the stent of prosthesis. The different techniques of PCI have been outlined according to the type of the prosthesis.

Prospective diagnostic performance of semiconductor SPECT myocardial perfusion imaging: wall thickening analysis reduces the need for an additional prone acquisition.

PURPOSE: To determine whether the assessment of regional wall thickening (WT) in addition to myocardial perfusion from stress supine acquisitions could compensate for the lack of prone acquisition and the corresponding decrease in the diagnostic performance of SPECT myocardial perfusion imaging (MPI) in patients with known or suspected coronary artery disease (CAD). METHODS: The study group comprised 41 patients (123 vessels) with known or suspected CAD prospectively recruited for systematic prone and supine 201Tl stress SPECT MPI. The diagnostic performance of SPECT MPI was determined for various image sets including nongated supine images (supine NG), nongated combined prone and supine images (prone and supine NG) and gated supine images, allowing WT evaluation from NG images in addition to perfusion (supine NG + WT) using invasive coronary angiography and fractional flow reserve as the gold standards. RESULTS: The rate of false positives was significantly higher among the supine NG images (20.8%) than among either the prone and supine NG or the supine NG + WT images (3.3% and 2.7%, respectively, P < 0.05 vs. supine NG). Consequently, specificity was higher for the prone and supine NG images than for the supine NG images (96.1% vs. 76.1%, P < 0.01) and was highest for the supine NG + WT images (96.8%, P not significant vs. prone and supine NG), without significant differences in sensitivity (80.0%, 86.6% and 73.3%, respectively, P not significant for all comparisons). CONCLUSION: The diagnostic performance of supine stress SPECT MPI is improved when WT assessment of ischaemic segments is used as an additional diagnostic criterion to values not significantly different from those with combined prone and supine acquisitions.

[Diagnostic coronarography]. / Coronarographie diagnostique.

Coronarography consists in selective angiography of the coronary arteries obtained invasively. It represents the gold standard for the anatomical exploration of the coronary arteries and establishes the first step for the indication of possible percutaneous or surgical revascularisation. According to substantial progress, it represents an essential diagnostic tool frequently used with, despite its invasive characteristic, a very low complication's rate. The present article describes the patient's preparation for this procedure, technical modalities, major indications, contraindications and possible complications.

La coronarographie consiste en une angiographie sélective des artères coronaires obtenue de manière invasive. Il s'agit de l'examen de référence pour l'exploration anatomique des artères coronaires et constitue la première étape de toute indication à une éventuelle revascularisation percutanée ou chirurgicale. Des progrès considérables en ont fait un outil diagnostique indispensable, très fréquemment utilisé, malgré son caractère invasif avec un taux de complications extrêmement bas. Le présent article décrit la préparation nécessaire du patient à cet examen, ses modalités techniques, ses principales indications, ses contre-indications et les éventuelles complications observées.

Post-mortem thermal angiography: a pilot study on swine coronary circulation.

Thermal imaging (TI) allows the detection of thermal patterns emitted from objects as a function of their temperature in the long-infrared spectrum and produces visible images displaying temperature differences. The aim of this pilot study was to test TI to visualize the coronary circulation of swine hearts. Thirty swine hearts were prepared for ex situ coronarography, and thermal images were acquired through a FlirOne thermal camera (FLIR Systems®) paired with a Google Android Smartphone. Coronary arteries were cannulated, namely the anterior interventricular artery, the circumflex branch of the left coronary artery, and the right coronary artery. The heart was cooled, and contrast medium (CM) consisting of distilled water heated to 40 °C was injected in a coronary vessel, while thermal images were captured. These steps were repeated for each coronary vessel and under experimentally simulated coronary heart disease. Thermal imaging coronarography (TIC) allowed a clear representation of the morphology and course of the coronary vessels and of experimentally simulated coronary heart disease, moreover, demonstrated to be easy to perform during or after autopsies on ex situ hearts, non-destructive, reproducible, and cheap. On the basis of these preliminary results, TIC might allow a subsequent more focused and comprehensive cardiopathological examination of the heart, which remains mandatory for the definitive diagnosis of coronary heart disease. Although these preliminary results seem encouraging, further systematic studies on human hearts, both normal and pathological, are necessary for estimating the sensitivity and specificity of the proposed method and to draw any definitive conclusion.

Clinical study on transesophageal electrocardiogram for measuring left atrioventricular interval in patients with coronary artery disease / 重庆医学

Objective To explore the mechanism and clinical significance of left atrioventricular interval abnormality in the patients with coronary artery disease.Methods A total of 48 patients with coronary artery disease were selected and divided into the left interval atrioventricular shortening group(AV≤100 ms) and the left atrioventricular interval normal group(AR＞100 ms) according to the left atrioventricular interval measured by the esophageal electrocardiogram.The clinical features,cardiac echocardiography and coronary vessel lesions were compared between the two groups.Results The age in the AR≤ 100 ms group was higher than that in the AR＞10 ms group(P=0.018);the proportion of right coronary arterial lesion in the AR ≤ 100 ms group was higher in that in the AR＞10ms group(P=0.038);the left atrial diameter in the AR ≤100ms group was enlarged compared with that in the AR＞ 100 ms group(P=0.041).Conclusion The cardiac electric transduction abnormality exists in the patients with coronary heart disease,the majority of the patients with left atrioventricular interval shortening have the right coronary artery lesion.

[Late discover of a coronaro-pulmonary fistula]. / Une fistule coronaro-pulmonaire de découverte tardive.

Anomalies of the coronary arteries mainly concern a pediatric population, bringing together a wide range of defects. In adults, the evolution is linked to the hemodynamic consequences of fistula. Several therapeutic options have been proposed such as surgery or embolization. We report the case of a 55 years old patient addressed because of dyspnea secondary to aortic insufficiency. The preoperative assessment shown the coexistence of coronary abnormality corresponding to a coronaro-pulmonary fistula. This type of coronary anomaly is rarely described in the adult population, because of its consequences secondary to the closure of the foramen ovale, resulting in angina symptoms in childhood. Without treatment, mortality from this type of malformation is important (90%).