1/147. Recurring myocardial infarction in a 35 year old woman.A 35 year old woman presented with acute myocardial infarction without any of the usual risk factors: she had never smoked; she had normal blood pressure; she did not have diabetes; plasma concentrations of total cholesterol and high and low density lipoprotein cholesterol, fibrinogen, homocysteine, and Lp(a) lipoprotein were normal. She was not taking oral contraceptives or any other medication. coronary angiography showed occlusion of the left anterior descending coronary artery but no evidence of arteriosclerosis. Medical history disclosed a previous leg vein thrombosis with pulmonary embolism. Coagulation analysis revealed protein c deficiency. The recognition of protein c deficiency as a risk factor for myocardial infarction is important as anticoagulation prevents further thrombotic events, whereas inhibitors of platelet aggregation are ineffective.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/147. Primary percutaneous transluminal coronary angioplasty performed for acute myocardial infarction in a patient with idiopathic thrombocytopenic purpura.A 72-year-old female with idiopathic thrombocytopenic purpura (ITP) complained of severe chest pain. electrocardiography showed ST-segment depression and negative T wave in I, aVL and V4-6. Following a diagnosis of acute myocardial infarction (AMI), urgent coronary angiography revealed 99% organic stenosis with delayed flow in the proximal segment and 50% in the middle segment of the left anterior descending artery (LAD). Subsequently, percutaneous transluminal coronary angioplasty (PTCA) for the stenosis in the proximal LAD was performed. In the coronary care unit, her blood pressure dropped. Hematomas around the puncture sites were observed and the platelet count was 28,000/mm3. After transfusion, electrocardiography revealed ST-segment elevation in I, aVL and V1-6. Urgent recatheterization disclosed total occlusion in the middle segment of the LAD. Subsequently, PTCA was performed successfully. Then, intravenous immunoglobulin increased the platelet count and the bleeding tendency disappeared. A case of AMI with ITP is rare. The present case suggests that primary PTCA can be a useful therapeutic strategy, but careful attention must be paid to hemostasis and to managing the platelet count.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/147. Pressure-wire guided balloon angioplasty in allograft coronary vasculopathy.We report a case of successful percutaneous transluminal coronary angioplasty guided from pressure-wire measurements in a transplanted patient. Fractional flow reserve, a lesion-specific, pressure-independent index of functional stenosis severity, was used to guide the intervention.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
4/147. Cutting balloon angioplasty for intrastent restenosis treatment.We describe here two patients with angiographic diagnosis of intrastent restenosis and regional myocardial ischemia. One stent restenosis was located in a native coronary artery and the other in a vein graft. Both were treated with cutting balloon angioplasty (CBA), inflated at low pressures. Angiographic success was obtained and both patients were discharged in the day after the procedure. Cutting balloon angioplasty using low inflation pressures achieved important luminal gains, in these two cases of intrastent restenosis. Further studies are necessary before the effectiveness of this procedure can be precisely defined.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/147. A case of aortic dissection with transient ST-segment elevation due to functional left main coronary artery obstruction.A 48-year-old man with a history of hypertension and diabetes mellitus was hospitalized with sudden onset of severe chest pain. He was in cardiogenic shock with a systolic pressure of 60 mm Hg. His electrocardiogram (ECG) showed ST-segment elevation in the precordial leads suggestive of acute anteroseptal myocardial infarction. The ST-segment returned to baseline after the systolic blood pressure rose to 100 mm Hg with the administration of sympathomimetic agents. aortography and transesophageal echocardiography demonstrated type A aortic dissection and aortic regurgitation. aortography and short-axis transesophageal echocardiography showed during diastole almost complete collapse of the true lumen of the ascending aorta caused by the intimal flap. The patient underwent surgical repair of the aortic dissection and implantation of Palmaz stents in the carotid arteries. Decreased blood pressure and the presence of aortic regurgitation accelerated the collapse of the true lumen during diastole in the ascending aorta, resulting in functional obstruction of the left main coronary artery, which may have been related to ST-segment changes in this case.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
6/147. The Jomed Covered Stent Graft for coronary artery aneurysms and acute perforation: a successful device which needs careful deployment and may not reduce restenosis.The Jomed Covered Stent Graft (Jomed International AB, Helsingborg, sweden) is marketed for treatment of coronary artery aneurysms, perforations, dissection or thrombus. Three cases are presented, two with aneurysms, one with an acute coronary perforation. Intravascular ultrasound (IVUS) identified the need for high-pressure deployment of the stent. Although it has been suggested that this stent might lead to reduced rates of restenosis, one case later developed proliferative and occlusive in-stent restenosis and another suffered stent thrombosis at one month shortly after discontinuing clopidogrel. This niche stent clearly has an important role, but high-pressure deployment, IVUS evaluation and prolonged antiplatelet therapy are strongly recommended.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
7/147. Pressure wire kinking, entanglement, and entrapment during intravascular ultrasound studies: a potentially dangerous complication.The simultaneous use of intravascular ultrasound catheters and sensor-tipped guidewires is gaining acceptance during coronary interventions as a means to gain further insights on the significance of coronary stenoses. Herein we describe four patients in whom the distal tip of the pressure wire became entrapped during an intravascular ultrasound examination. In the four patients, a localized kinking of the pressure wire initially prevented the removal of the imaging catheter and eventually the wire-catheter assembly had to be retrieved as a unit into the guiding catheter. In one patient, unraveling of the distal part of the pressure wire was noticed. In two patients, a complete loop with further kinking of the pressure wire was induced during the maneuvers performed to withdraw the imaging system. Three patients experienced transient angina. Although in our patients this technical problem was not associated with any clinical sequelae, interventional cardiologists should be aware of the potential complications associated with the combined use of these two intracoronary diagnostic tools.- - - - - - - - - - ranking = 4keywords = pressure (Clic here for more details about this article) |
8/147. cardiac tamponade complicating closure of a median sternotomy.A case of intraoperative cardiac tamponade manifested during closure of a median sternotomy is presented. We postulate that cardiac tamponade was caused by acute dilatation of the cardiac chambers as a result of intraoartic balloon pumping in a patient with aortic and mitral regurgitation. It has been shown experimentally that acute rises in ventricular end-diastolic pressure result in increased intrapericardial pressure and that if a certain point on the pericardial pressure-volume curve is reached, cardiac tamponade will occur. sternotomy closure was accomplished easily as soon as the need for intra-aortic balloon pumping diminished.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
9/147. Fatal air embolism during thoracotomy for gunshot injury to the lung. Report of a case.Fatal coronary air embolism occurred during thoracotomy in a patient with a gunshot wound involving the hilum of the right lung. Embolism was observed during a second period of failure of heart action. Evidently, air entered the pulmonary veins from the bronchus, which was receiving positive-pressure ventilation. The literature contains reports of only 3 similar cases, but we suspect that air embolism may be responsible for death and morbidity in additional cases in which accidental or iatrogenic lung trauma has produced a pathway between the bronchial tree and the pulmonary veins.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/147. Coronary artery plaque disruption as cause of acute myocardial infarction during cesarean section with spinal anesthesia.A 31-year-old parturient delivered twins at 35 weeks' gestation by cesarean section with spinal anesthesia. Following anesthesia induction, hypotension and bradycardia occurred, and were immediately treated with theodrenaline plus cafedrin (Akrinor) and atropine. blood pressure and heart rate increased to 180/100 mmHg and 140 beats per minute, respectively. Several minutes later, the patient developed a myocardial infarction (MI) that she survived after intensive care treatment without sequelae. Although the coronary angiography showed normal coronary vessels, an intravascular ultrasound study demonstrated an atheroma in the left main coronary artery with ruptured fibrous cap. Laboratory screening for risk factors of coronary artery disease (CAD) showed hypercholesterinemia, increased factor vii activity, and hyperfibrogenemia. Angiographically normal coronary vessels are frequently found in pregnant patients who suffered MI. In these patients, coronary spasms have been discussed as the major mechanism of disease. Our case demonstrates that a significant CAD may be present despite angiographically normal findings. Plaque rupture was triggered by hypertension and led to MI as the first symptom of disease. On the basis of these findings, we believe that MI during pregnancy is more often caused by plaque rupture than may be expected, according to the current literature.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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