1/39. Ostial stenosis of coronary arteries after complete replacement of aortic root using gelatin-resorcinol-formaldehyde glue.Coronary ostial stenosis between an interposition graft and coronary artery is rare and fatal. A 46-year-old woman who had reconstruction of both coronary arteries using interposition grafts for type A acute dissecting aneurysm presented with acute chest pain. Emergent coronary artery bypass grafting was done with saphenous vein grafts. Inappropriate use of gelatin-resorcinol-formaldehyde glue can be associated with ostial stenosis in the long term. Transesophageal echocardiography is useful to diagnose ostial stenosis of the coronary arteries.- - - - - - - - - - ranking = 1keywords = chest pain, chest (Clic here for more details about this article) |
2/39. Spontaneous coronary artery spasm during coronary angiography in a patient with exercise-induced ST segment elevation.We describe a patient with a history of early morning chest pain who developed ST segment elevation during a treadmill exercise test. Severe coronary artery stenosis was identified initially and was relieved after intracoronary administration of nitroglycerin. A history of vasospastic angina in this patient facilitated prompt diagnosis.- - - - - - - - - - ranking = 1keywords = chest pain, chest (Clic here for more details about this article) |
3/39. Fractional flow reserve in a patient with intermediate coronary stenosis and hypertrophic cardiomyopathy.We discuss the case of a 61-year-old male patient with hypertrophic cardiomyopathy and chest pain on exertion. coronary angiography and intravascular ultrasound revealed an intermediate stenosis in the proximal site of the left anterior descending artery, while Tc-99m myocardial scintigraphy revealed exercise-induced myocardial ischemia in the anteroseptal wall and apical portion. Flow velocity-derived coronary flow reserve (CFR) and pressure-derived fractional flow reserve (FFRmyo) were both low (1.1 and 0.59), suggesting that the stenosis was functionally significant. Directional coronary atherectomy greatly improved the FFRmyo (0.99), the scintigraphic findings, and anginal pain but did not improve the CFR (1.2). FFRmyo was useful in assessing the functional significance of an equivocal coronary stenosis and its interventional resolution.- - - - - - - - - - ranking = 1keywords = chest pain, chest (Clic here for more details about this article) |
4/39. Traumatic total occlusion of left main coronary artery caused by blunt chest trauma.Myocardial infarction is a rare complication that can occur immediately after a blunt chest trauma. We report a 36-year-old male who experienced a fatal anterolateral myocardial infarction after a nonpenetrating chest injury sustained in a car accident. Injuries of the coronary arteries associated with blunt chest trauma predominantly affect the left anterior descending artery. This is the first case of traumatic complete occlusion of the left main coronary artery (LMCA) demonstrated by coronary angiography.- - - - - - - - - - ranking = 0.24156302857207keywords = chest (Clic here for more details about this article) |
5/39. Multiple complex coronary plaques in a patient with acute myocardial infarction.This report describes the case of a patient who developed acute myocardial infarction with ST segment elevation in anterior and inferior leads, simultaneously. After treatment with systemic thrombolysis, and after an initial short-lasting symptomatic improvement, chest pain and ST segment elevation recurred. coronary angiography revealed severe complex stenotic lesions at both the right coronary artery and the left anterior descending (LAD) coronary artery. Percutaneous coronary angioplasty and stent implantation were successfully performed at both lesions. This case supports the concept that, at least in some patients, acute coronary artery disease reflects a diffuse pathophysiologic process that may lead to multifocal plaque instability associated with clinical instability at multiple sites.- - - - - - - - - - ranking = 1keywords = chest pain, chest (Clic here for more details about this article) |
6/39. Cutting balloon angioplasty through stent struts of a jailed sidebranch ostial lesion.The treatment of sidebranch ostial lesions jailed after stent implantation is challenging. We report a case of successful Cutting Balloon angioplasty through stent struts of a severe, elastic sidebranch ostial lesion. Three-day follow-up angiography showed no recurrent stenosis. The patient was discharged with complete resolution of chest discomfort and the post-hospitalization course was uneventful. Cutting Balloon angioplasty may be an optimal strategy for the treatment of elastic ostial lesions in smaller vessels that are suboptimal for stenting. The long-term benefits of using a Cutting Balloon for the treatment of sidebranch ostial lesions are still to be determined.- - - - - - - - - - ranking = 0.034509004081724keywords = chest (Clic here for more details about this article) |
7/39. 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 = 1keywords = chest pain, chest (Clic here for more details about this article) |
8/39. 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 = 1keywords = chest pain, chest (Clic here for more details about this article) |
9/39. 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 = 1keywords = chest pain, chest (Clic here for more details about this article) |
10/39. 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 = 0.034509004081724keywords = chest (Clic here for more details about this article) |
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