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4.
BMC Cardiovasc Disord ; 21(1): 313, 2021 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167471

RESUMO

BACKGROUND: Due to its low incidence and diverse manifestations, paradoxical embolism (PDE) is still under-reported and is not routinely considered in differential diagnoses. Concomitant acute myocardial infarction (AMI) and acute pulmonary embolism (PE) caused by PDE has rarely been reported. CASE PRESENTATION: A 45-year-old woman presented with acute chest pain and difficulty with breathing. Multiple imaging modules including ECG, echocardiography, emergency cardioangiogram (CAG), and CT angiography of the pulmonary arteries showed acute occlusion of the posterolateral artery and acute PE. After coronary aspiration, no residual stenosis was observed. One month later, a bubble study showed inter-atrial communication via a patent foramen ovale (PFO). The AMI in this patient was finally attributed to PDE via the PFO. PFO closure was performed, and long-term anticoagulation was prescribed to prevent recurrent thromboembolic events. CONCLUSIONS: PDE via PFO is a rare etiology of AMI, especially in patients with concomitant AMI and PE. Clinicians should be vigilant of this possibility and close the inter-atrial channel for secondary prevention.


Assuntos
Embolia Paradoxal/etiologia , Forame Oval Patente/complicações , Infarto Miocárdico de Parede Inferior/etiologia , Embolia Pulmonar/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Anticoagulantes/uso terapêutico , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/prevenção & controle , Feminino , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/terapia , Humanos , Infarto Miocárdico de Parede Inferior/diagnóstico por imagem , Infarto Miocárdico de Parede Inferior/prevenção & controle , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/prevenção & controle , Recidiva , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/prevenção & controle , Prevenção Secundária , Resultado do Tratamento
7.
Cardiovasc J Afr ; 31(6): 335-338, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32494800

RESUMO

Coronavirus disease 2019 (COVID-19) is a recently recognised pandemic spreading rapidly from Wuhan, Hubei, to other provinces in China and to many countries around the world. The number of COVID-19-related deaths is steadily increasing. Acute ST-segment elevation myocardial infarction (STEMI) is a disease with high morbidity and mortality rates, and primary percutaneous coronary intervention is usually recommended for the treatment. A patient with diabetes mellitus and hypertension for five years was admitted to the emergency unit with symptoms of fever, cough and dyspnoea. These symptoms were consistent with viral pneumonia and a COVID PCR test was performed, which tested positive three days later. The patient had chest pain on the eighth day of hospitalisation. On electrocardiography, simultaneous acute inferior and anterior STEMI were identified. High levels of stress and increased metabolic demand in these patients may lead to concomitant thrombosis of different coronary arteries, presenting with two different STEMIs.


Assuntos
Infarto Miocárdico de Parede Anterior/etiologia , COVID-19/complicações , Infarto Miocárdico de Parede Inferior/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Infarto Miocárdico de Parede Anterior/diagnóstico por imagem , Infarto Miocárdico de Parede Anterior/terapia , COVID-19/diagnóstico , COVID-19/terapia , Fatores de Risco de Doenças Cardíacas , Humanos , Infarto Miocárdico de Parede Inferior/diagnóstico por imagem , Infarto Miocárdico de Parede Inferior/terapia , Prognóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
9.
Am J Cardiol ; 123(7): 1019-1025, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30658918

RESUMO

Previously reported electrocardiographic (ECG) criteria to distinguish left circumflex (LCCA) and right coronary artery (RCA) occlusion in patients with acute inferior ST-segment elevation myocardial infarction (STEMI) afford a modest diagnostic accuracy. We aimed to develop a new algorithm overcoming limitations of previous studies. Clinical, ECG, and coronary angiographic data were analyzed in 230 nonselected patients with acute inferior STEMI who underwent primary percutaneous coronary intervention. A decision-tree analysis was used to develop a new ECG algorithm. The diagnostic accuracy of reported ECG criteria was reviewed. LCCA occlusion occurred in 111 cases and RCA in 119. We developed a 3-step algorithm that identified LCCA and RCA occlusion with a sensitivity of 77%, specificity of 86%, accuracy of 82%, and Youden index of 0.63. The area under the ROC curve was 0.85 and resulted 0.82 after a 10-fold cross validation. The key leads for LCCA occlusion were V3 (ST depression in V3/ST elevation in III >1.2) and V6 (ST elevation ≥0.1 mV or greater than III). The key leads for RCA occlusion were I and aVL (ST depression ≥ 0.1 mV). Fifteen of 21 reviewed studies had less than 20 cases of LCCA occlusion, only 48% performed primary percutaneous coronary intervention, and previous infarction or multivessel disease were often excluded. The diagnostic accuracy of reported ECG criteria decreased when applied to our study population. In conclusion, we report a simple and highly discriminative 3-step ECG algorithm to differentiate LCCA and RCA occlusion in an "all comers" population of patients with acute inferior STEMI. The diagnostic key ECG leads were V3 and V6 for LCCA and I and aVL for RCA occlusion.


Assuntos
Algoritmos , Oclusão Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Eletrocardiografia/métodos , Infarto Miocárdico de Parede Inferior/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Estudos de Casos e Controles , Angiografia Coronária , Oclusão Coronária/complicações , Feminino , Seguimentos , Humanos , Infarto Miocárdico de Parede Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia
13.
Medicine (Baltimore) ; 96(42): e6095, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29049164

RESUMO

To investigate the diagnostic value of electrocardiographic (ECG) ST-segment in acute inferior myocardial infarction (AIMI) caused by the left circumflex branch (LCX).A total of 240 clinical cases with AIMI in our hospital were retrospectively analyzed. All of them had received percutaneous coronary intervention (PCI) within 12 hours after symptom onset. The clinical features, ECG manifestations, and coronary artery lesion characteristics of the patients were collected.The right coronary artery (RCA) was shown to be the infarct-related artery (IRA) in 177 patients, while LCX was responsible for AIMI in 63 cases. There was no significant difference in the risk factors of coronary heart disease (CHD) (P > .05 for all) between the 2 groups. ST-segment elevation in lead II, III, and AVF could be found in all patients. Moreover, ST-segment depression in lead I (STD I), ST-segment elevation in lead III (STE III), STE III-STE II, STE AVF, STD AVL, STD AVL-STD I and STE v6 lead ST-segment deviation exhibited significant difference in 2 groups (P < .05 for all). The changes of STD I, STE III < STEII, STD AVL < STD I could discriminate between LCX and RCA in AIMI patients with high sensitivity and specificity.ECG may be an effective tool to predict the IRA in patient with AIMI.


Assuntos
Bloqueio de Ramo/diagnóstico por imagem , Oclusão Coronária/diagnóstico por imagem , Eletrocardiografia/métodos , Infarto Miocárdico de Parede Inferior/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Idoso , Síndrome de Brugada/complicações , Síndrome de Brugada/diagnóstico por imagem , Bloqueio de Ramo/complicações , Doença do Sistema de Condução Cardíaco , Doença das Coronárias/complicações , Doença das Coronárias/diagnóstico por imagem , Oclusão Coronária/complicações , Vasos Coronários/diagnóstico por imagem , Feminino , Sistema de Condução Cardíaco/diagnóstico por imagem , Humanos , Infarto Miocárdico de Parede Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Sensibilidade e Especificidade
14.
Cardiovasc Revasc Med ; 18(8): 601-603, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28779859

RESUMO

Double Right Coronary Artery (RCA) is one of the rarest congenital coronary anomalies. Although it can be regarded as a benign condition in the vast majority of cases, it has been associated with acute and life-threatening presentations, including inferior ST-segment elevation myocardial infarction (STEMI), cardiogenic shock and complete heart block, tachyarrhythmias, or even sudden death. However, the role of a double RCA in these conditions is yet to be clarified as more recent data prove no statistically significant association between prevalence of significant atherosclerosis in anomalous coronary arteries in comparison to normal coronary arteries. Here we present a case of inferior STEMI in the context of double RCA, in which one of the two component branches was accidentally found after an "unexpected" jump of the coronary guidewire to treat what was initially considered the main vessel.


Assuntos
Angioplastia Coronária com Balão , Oclusão Coronária/terapia , Anomalias dos Vasos Coronários/complicações , Infarto Miocárdico de Parede Inferior/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Angioplastia Coronária com Balão/instrumentação , Angiografia Coronária , Oclusão Coronária/complicações , Oclusão Coronária/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Stents Farmacológicos , Feminino , Humanos , Achados Incidentais , Infarto Miocárdico de Parede Inferior/diagnóstico por imagem , Infarto Miocárdico de Parede Inferior/etiologia , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Resultado do Tratamento
18.
Methodist Debakey Cardiovasc J ; 13(3): 165-168, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29744002

RESUMO

We are reporting a case of a 65-year-old female who experienced three ST elevation myocardial infarctions (STEMI) during the course of 3 weeks. The first infarct was related to intramural coronary hematoma that propagated proximally after stenting, the second involved progression of this hematoma with obstruction of the vessel lumen, and the third caused subacute stent thrombosis that required "stent cleaning" using the inflated balloon technique.


Assuntos
Angioplastia Coronária com Balão/instrumentação , Reestenose Coronária/terapia , Trombose Coronária/terapia , Anomalias dos Vasos Coronários/complicações , Stents Farmacológicos , Hematoma/terapia , Infarto Miocárdico de Parede Inferior/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Doenças Vasculares/congênito , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Angiografia Coronária , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/etiologia , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/etiologia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Feminino , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Infarto Miocárdico de Parede Inferior/diagnóstico por imagem , Infarto Miocárdico de Parede Inferior/etiologia , Recidiva , Retratamento , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico por imagem
19.
Medicine (Baltimore) ; 96(52): e9075, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29384900

RESUMO

RATIONALE: The extent of protective effects of hemophilia against thrombotic events such as myocardial infarction (MI) and other acute coronary syndromes remains to be determined, as major risk factors for cardiovascular disease exist despite factor VIII (FVIII) deficiency. We present a case report of a 41-year-old male with severe hemophilia A and several cardiovascular risk factors. PATIENT CONCERNS: This morbidly obese patient developed chest pressure, followed by chest pain and difficulty in breathing shortly after receiving on-demand treatment with intravenous recombinant FVIII (rFVIII) (turoctocog alfa) dosed per body weight. DIAGNOSES: An electrocardiogram revealed a diagnosis of inferior ST-segment elevation MI. INTERVENTIONS: The patient underwent an urgent coronary angiography using a radial artery approach. During the next 12 months, he received dual antiplatelet treatment, acetylsalicylic acid 100 mg, and clopidogrel 75 mg daily. His treatment for severe hemophilia A was changed to plasma-derived FVIII replacement therapy. OUTCOMES: During this 12-month period, he experienced several small bleeds in his elbows. CONCLUSIONS: The temporal relationship between rFVIII infusion and onset of the MI suggests a possible association; however, apart from obesity, the patient also had other major risk factors for arterial thrombosis, such as hypertension and smoking. Furthermore, atherosclerotic disease and underlying atherosclerotic changes could not be excluded with certainty. This case highlights the importance of studies assessing the impact of excess body weight on rFVIII dosing.


Assuntos
Fator VIII/uso terapêutico , Hemofilia A/complicações , Hemofilia A/tratamento farmacológico , Infarto Miocárdico de Parede Inferior/diagnóstico , Infarto Miocárdico de Parede Inferior/etiologia , Adulto , Humanos , Masculino , Obesidade Mórbida/complicações
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