11/55. amyloidosis of epicardial and intramural coronary arteries as an unusual cause of myocardial infarction and refractory angina pectoris.The present case report refers to a 65-year-old male patient with subocclusion of the right coronary artery who had an inferior myocardial infarction that was treated with coronary angioplasty. The patient subsequently developed intractable angina pectoris in the absence of critical coronary stenosis at serial coronary angiography. Doppler wire velocity demonstrated an impaired coronary flow reserve. The patient died of cardiogenic shock. Postmortem examination revealed amyloid involvement of the media of the epicardial coronary arteries and severe amyloid deposition in the media and adventitia with obstruction of the lumen of the intramyocardial coronary arteries. Widespread ischemic areas were present in the myocardium with only slight amyloid deposition. In this patient myocardial infarction and unstable angina were a rare initial manifestation of primary amyloidosis.- - - - - - - - - - ranking = 1keywords = area (Clic here for more details about this article) |
12/55. acute coronary syndrome in a young woman.When should an acute coronary event be suspected in a young woman with chest pain? coronary artery disease is not common in such patients, but the possibility should not be discounted. Correct characterization of the pain, along with presence of known risk factors for CAD, can lead to an accurate diagnosis, even though the presentation may be atypical.- - - - - - - - - - ranking = 3382.6126500462keywords = chest pain, chest, pain (Clic here for more details about this article) |
13/55. Electrocardiographic manifestations of Wellens' syndrome.Wellens' syndrome is a pattern of electrocardiographic T-wave changes associated with critical, proximal left anterior descending (LAD) artery stenosis. The syndrome is also referred to as LAD coronary T-wave syndrome. Syndrome criteria include T-wave changes plus a history of anginal chest pain without serum marker abnormalities; patients lack Q waves and significant ST-segment elevation; such patients show normal precordial R-wave progression. The natural history of Wellens' syndrome is anterior wall acute myocardial infarction. The T-wave abnormalities are persistent and may remain in place for hours to weeks; the clinician likely will encounter these changes in the sensation-free patient. With definitive management of the stenosis, the changes resolve with normalization of the electrocardiogram. It is vital that the physician recognize these changes and the association with critical LAD obstruction and significant risk for anterior wall myocardial infarction.- - - - - - - - - - ranking = 3375.5015389351keywords = chest pain, chest, pain (Clic here for more details about this article) |
14/55. Coronary artery spasm associated with a moderately severe atherosclerotic stenosis in the proximal LAD.Treatment of coronary artery spasm can be difficult; up to 25% of patients continue to have episodes of chest pain despite maximal therapy with calcium antagonists and nitrates. We describe the case of a 42-year-old female with severe coronary artery spasm associated with a moderately severe atherosclerotic stenosis of the proximal left anterior descending coronary artery. We discuss the diagnostic value of intravascular ultrasound and treatment options for spasm associated with atherosclerotic plaques.- - - - - - - - - - ranking = 3375.5015389351keywords = chest pain, chest, pain (Clic here for more details about this article) |
15/55. Exacerbation of lambert-eaton myasthenic syndrome caused by an L-type Ca2 channel antagonist.A 74 year-old Japanese woman, who had suffered from lambert-eaton myasthenic syndrome (LEMS), Sjoegren's syndrome, and discoid lupus erythematosus for 10 years and had been successfully controlled by 3,4-diaminopyridine and prednisolone, began to suffer from chest discomfort at night. Stress-induced myocardial ischemia in the left ventricular anterior septum was detected by thallium-201 scintigraphy. After diltiazem was prescribed, she began to feel systemic malaise and weakness in both thighs. She stopped taking diltiazem and the symptoms improved. coronary angiography revealed 75% stenosis with calcification in the middle of the left anterior descending artery. After atherectomy with a lotablator and coronary stenting, diltiazem was prescribed. She felt malaise again, but continued taking diltiazem. After three months a follow-up coronary angiography showed no restenosis in the lesion and diltiazem was stopped. The weakness and malaise disappeared and her muscle strength recovered. LEMS is an autoimmune disorder of peripheral cholinergic transmission in which autoantibodies to the presynaptic P/Q-type voltage-gated calcium channels (VGCC) decrease the release of acetylcholine at the neuromuscular junction resulting in muscle weakness. P/Q-type VGCC regulates most of the neurotransmitter release and L-type VGCC regulates the remainder. L-type VGCC blockers are thought to have little effect on the neuromuscular junction. but they should be used very carefully. even in the remission stage of LEMS, because of preexisting neuromuscular blocking in transmission.- - - - - - - - - - ranking = 96.34972299169keywords = chest (Clic here for more details about this article) |
16/55. Preservation of the lima pedicle after cardiac surgery in left upper lobectomy.Left internal mammary artery (LIMA) harvesting for coronary artery bypass grafting often complicates future thoracic procedures because of adhesion formation in the left chest and to the left upper lobe. We describe an adjuvant approach to left upper lobectomy for bronchogenic carcinoma in a patient with previous LIMA harvesting and grafting in which we preserved the LIMA pedicle, while still providing near complete lobe resection.- - - - - - - - - - ranking = 96.34972299169keywords = chest (Clic here for more details about this article) |
17/55. Acquired right coronary artery fistula draining to the right ventricle: angiographic documentation of first appearance following reperfusion after acute myocardial infarction, with subsequent spontaneous closure.Most coronary artery fistulae are congenital in origin but have been reported to be acquired as complications of chest trauma, coronary angioplasty, or rupture of a coronary artery aneurysm. This is the first angiographic documentation of a coronary fistula acquired after myocardial infarction that subsequently closed spontaneously during follow up.- - - - - - - - - - ranking = 96.34972299169keywords = chest (Clic here for more details about this article) |
18/55. Successful implantation of a coronary sinus lead after stenting of a coronary vein stenosis.Dislodgment of the coronary sinus lead was observed in a 79-year-old patient 8 months after implantation of a biventricular pacing system. A severe stenosis in the posterolateral branch, in which the lead was previously positioned, prohibited reinsertion of the lead. Because no other branches with adequate anatomy for lead insertion were available in the targeted area, the stenosis was dilated and stented. Subsequently, the left ventricular lead could be reimplanted in the same vessel.- - - - - - - - - - ranking = 1keywords = area (Clic here for more details about this article) |
19/55. ECG-gated multislice spiral computed tomography to clarify lesion severity in a case of left main stenosis. Multislice spiral computed tomography to clarify lesion severity.This case report describes the use of retrospectively ECG-gated multislice spiral computed tomography (MSCT) for evaluation of lesion severity in a patient with relevant left main stenosis by visual analysis of the coronary angiogram. For further diagnostic evaluation the patient underwent intravascular ultrasound (IVUS) imaging, which showed a maximal 30% area stenosis, and MSCT, which demonstrated a maximal 48% area stenosis. MSCT was useful in this case to defer cardiac surgery and might be used as a noninvasive alternative to IVUS imaging in case of doubtful lesion severity.- - - - - - - - - - ranking = 2keywords = area (Clic here for more details about this article) |
20/55. Endoluminal perspective volume rendering of coronary arteries using electron-beam computed tomography.Remarkable progress has been made in the treatment of coronary heart diseases because of a variety of new interventional devices, but as each new device or procedure has suitability for a particular type of patient or purpose, patient selection is increasingly important. Endoluminal perspective volume renderings of the coronary arteries of a 70-year-old male with old myocardial infarction and recurrent chest pain were carried out using electron-beam computed tomography. Conventional coronary angiography had revealed significant stenosis of the distal portion of the left anterior descending branch, and subsequent conventional balloon angioplasty had failed to expand the stenotic site. Perspective volume rendering images can distinguish differences in objects and evaluate the cross sectional area of the lumen and the morphology of calcification. In the present patient, a huge mass of calcified plaque occupied most of the lumen at a site corresponding to the angiographic site of stenosis. According to this finding, rotational atherectomy was indicated and had a good outcome. The qualitative information for characterizing and determining the morphology of atherosclerotic plaque provided by perspective volume rendering may be useful in selecting the appropriate intervention.- - - - - - - - - - ranking = 3376.5015389351keywords = chest pain, chest, pain, area (Clic here for more details about this article) |
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