1/53. Interesting cases from the University of texas Medical Branch.This article discusses the cases for four patients with unstable angina. The first case is an example of the "high-risk" patient with widespread ECG changes, heart failure, and enzymatic elevations during an episode of chest pain. The second patient illustrates an unusual cause of unstable angina in a young women. The third patient had a large thrombus visible on angiography and management strategies for dealing with intracoronary thrombus are discussed. The final patient had an extensive past cardiac history with two prior coronary artery bypass operations and we discuss the recent advances made in the treatment of degenerative vein graft disease.- - - - - - - - - - ranking = 1keywords = chest pain, chest, pain (Clic here for more details about this article) |
2/53. Intermittent left coronary occlusion caused by native aortic valve thrombosis in a patient with protein s deficiency.A 77-year-old woman presented with chest pain and cardiogenic shock. Transesophageal echocardiography showed a mobile mass occluding intermittently the left coronary ostium. The mass was surgically resected, and histologic examination revealed an organized thrombus. Coagulation study demonstrated a protein s deficiency. This is the first case of aortic thrombosis associated with protein s deficiency, and it is the first time that transesophageal echocardiography provided definite evidence that a mass can cause intermittent left ostium coronary obstruction.- - - - - - - - - - ranking = 1keywords = chest pain, chest, pain (Clic here for more details about this article) |
3/53. Fatal myocardial embolus after myectomy.Coronary embolism is an infrequent phenomenon. A 56-year-old man with hypertrophic obstructive cardiomyopathy and severe mitral regurgitation who underwent left ventricular septal myectomy and mitral valve annular repair is presented. The patient had a cardiac arrest 36 h after surgery. Cardiac standstill, tamponade and a left ventricular rupture were noted when the chest was opened during attempted resuscitation. autopsy revealed an occlusive embolus of myocardium in the proximal left anterior descending coronary artery. It showed pathological features of hypertrophic cardiomyopathy. There was an extensive acute transmural anteroseptal left ventricular myocardial infarction with rupture of the anterior free wall. embolism of myocardium - to the coronary arteries, the systemic circulation or the pulmonary circulation - is a rare event, with only nine other cases reported in the literature in the past 30 years. This is the first reported case of myocardial embolus to a coronary artery in a patient with hypertrophic obstructive cardiomyopathy following septal myectomy.- - - - - - - - - - ranking = 0.030414361725527keywords = chest (Clic here for more details about this article) |
4/53. Cold pressure test producing coronary spasm, coronary thrombosis and myocardial infarction in a patient with IgM antibodies against Coxsackie B virus.Several lines of evidence have shown that viral infections are capable of causing coronary spasm and precipitating or mimicking clinical myocardial infarction. Here we report the case of a 41-year-old woman with recurrent angina who was admitted to our hospital because of ventricular tachycardia. Laboratory examination revealed positive IgM titers against Coxsackie B virus. coronary angiography showed normal coronary arteries, but following a cold pressure test severe spasm of all coronaries with thrombotic occlusion of the second marginal branch of the circumflex artery occurred. We conclude that coronary spasm should be clinically suspected in patients with chest pain and ventricular arrhythmia in combination with IgM antibodies against Coxsackie B virus. In these patients, a cold pressure test should be avoided, and antithrombotic and antispastic therapy is recommended.- - - - - - - - - - ranking = 1keywords = chest pain, chest, pain (Clic here for more details about this article) |
5/53. Combined therapeutic strategy for multiple coronary thromboemboli.A female with mitral valvular disease presented an acute myocardial infarction. She suddenly complained of recurrent chest pain with symptoms of pulmonary edema. The angiogram evidenced multiple coronary thromboemboli. A combined strategy using intracoronary thrombolysis, a platelet glycoprotein IIb/IIIa antagonist (abciximab) and percutaneous transluminal coronary angioplasty to help disrupt the thrombus was performed. Clinical and angiographic signs of coronary reperfusion were rapidly achieved. No bleeding complications appeared.- - - - - - - - - - ranking = 1keywords = chest pain, chest, pain (Clic here for more details about this article) |
6/53. Cardiac vein thrombosis and haemorrhagic myocardial necrosis; report of a case with review of the literature.A 29-year-old woman, addicted to heroin since the age of 15 years, presented with a 4-day history of acute inspiratory chest pain, dyspnoea and vomiting associated with hypoventilation. She died 3 h after admission to the intensive care unit in spite of active resuscitative measures. The main autopsy findings were limited to the heart, which showed widespread cardiac vein thrombosis, and both ventricles and the atria were associated with multiple areas of haemorrhagic myocardial necrosis. We review the literature of this uncommon pathological entity and discuss its possible pathogenesis.- - - - - - - - - - ranking = 1keywords = chest pain, chest, pain (Clic here for more details about this article) |
7/53. Stenting with intravenous abciximab infusion for the treatment of left main coronary artery thrombosis during coronary angioplasty.A 67-year-old female patient complained of exertional precordial chest pain with radiation to the left shoulder occurring over a two-month period. An acute non-Q wave anterior myocardial infarction was diagnosed. On the third day of admission, coronary angiography revealed two-vessel disease with 73% luminal narrowing of the proximal left anterior descending coronary artery and 50% luminal narrowing of the mid-right coronary artery. The initial attempt to implant a NIR stent (boston Scientific/Scimed, Inc., Maple Grove, minnesota) was unsuccessful. We report on the successful rescue implantation of two MAC (Maximum Arterial re-Creation) stents (Advanced Medical Technologies, germany), in conjunction with the infusion of abciximab for the treatment of an abrupt closure due to thrombus of the left main coronary artery.- - - - - - - - - - ranking = 1keywords = chest pain, chest, pain (Clic here for more details about this article) |
8/53. Space-occupying lesions in the right ventricle of a patient with antiphospholipid syndrome.A 29-year-old woman presented with shortness of breath, vague chest pain, and prominent intermittent ejection systolic murmur. Transthoracic echocardiography showed a large mass in the right ventricular outflow tract. Transesophageal echocardiography demonstrated two masses that were adherent to the tricuspid valve and intermittently prolapsed through the pulmonary valve. Computed tomography of the chest corroborated the echocardiographic findings. Currently, there are no definitive guidelines regarding the optimal management of right heart thrombi in patients with antiphospholipid syndrome. Our patient did not respond to a standard dose of rt-PA used in the treatment of pulmonary embolus. She underwent successful surgical resection of the thrombi without complications.- - - - - - - - - - ranking = 1.0304143617255keywords = chest pain, chest, pain (Clic here for more details about this article) |
9/53. Left ventricular free wall rupture possibly induced by coronary spasm. Surgical repair in the emergency room.A 68-year-old woman complained of chest discomfort after a traffic accident in which she driving hit a child. At about twenty-five minutes later, she went into sudden cardiogenic shock due to acute myocardial infarction caused by non-occlusive intracoronary thrombosis without significant organic coronary stenosis and without any sign of extraluminal contrast pooling on coronary angiography. She was transported to our emergency room by ambulance because of cardiac tamponade caused by a left ventricular free wall rupture following the acute myocardial infarction. On arrival, she was near cardio-pulmonary arrest on intraaortic balloon pumping. We performed emergency open cardiac massage and pericardiotomy. The hairline perforation responsible for the blowout-type left ventricular free wall rupture was successfully closed with Teflon-reinforced sutures. In conclusion, it was strongly suspected that the present case of left ventricular free wall rupture was caused by acute myocardial infarction due to intracoronary thrombosis following coronary spasm without significant organic coronary stenosis or rupture of atheromatous plaque.- - - - - - - - - - ranking = 0.030414361725527keywords = chest (Clic here for more details about this article) |
10/53. Acute myocardial infarction showing total occlusion of right coronary artery and thrombus formation of left anterior descending artery.A 33-year-old Japanese man had an attack of chest pain associated with ST-segment elevation in the inferolateral leads on his electrocardiogram. Emergency coronary angiography showed total obstruction in the mid right coronary artery (RCA) and a movable thrombus in the proximal left anterior descending artery (LAD). We performed emergency percutaneous transluminal coronary angioplasty (PTCA) for the RCA lesion. The operation was successful and we then conducted intracoronary thrombolysis (ICT) with tisokinase 6,400,000 IU for the LAD thrombus. Its size was reduced by ICT. He had an uneventful hospital course. After 1 month, repeat coronary angiography showed no significant stenosis in the RCA nor thrombus in the LAD. A coronary spasm provocation test was performed using acetylcholine. Coronary spasm in the LAD was induced by an intracoronary injection of 100 microg acetylcholine. In this case, we observed a unique condition suggesting simultaneous double coronary artery occlusion.- - - - - - - - - - ranking = 1keywords = chest pain, chest, pain (Clic here for more details about this article) |
| | Next -> |