1/14. Large intracoronary thrombi with good TIMI flow during acute myocardial infarction: four cases of successful aggressive medical management in patients without angiographically detectable coronary atherosclerosis.Four cases of young patients with acute myocardial infarction are discussed in which urgent angiography showed large intracoronary thrombus and TIMI (thrombolysis in myocardial infarction) flow > or = 2 in the infarct related artery. The rest of the coronary tree appeared to be free of detectable atherosclerosis. Percutaneous transluminal coronary angioplasty was not performed and an aggressive antiplatelet/anticoagulant treatment was administered (acetylsalicylic acid, clopidogrel, abciximab, and heparin). In all cases early angiographic control (1-12 days after AMI) showed disappearance of thrombus, no significant residual stenosis, and normal flow. No deterioration of left ventricular function was observed and the clinical course both in hospital and at five months' follow up was uneventful.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/14. Management of patients with persistent chest pain and ST-segment elevation during 5-fluorouracil treatment: report about two cases.5-fluorouracil, a widely used drug in cancer treatment, is known to have cardiotoxic effects: chest pain with ECG changes, arrhythmias, arterial hypertension or hypotension, myocardial infarction, cardiogenic shock and sudden death have been described in the literature. Coronary artery vasospasm is the pathogenetic mechanism hypothesized in most cases, but mechanisms other than myocardial ischemia had been advocated in some patients. The approach to the patient with persistent chest pain, despite therapy and persistent ST-segment elevation mimicking an acute myocardial infarction, has not been well addressed, and the appropriate diagnostic and therapeutic pathways have not yet been defined. We present our experience regarding 2 patients treated with 5-fluorouracil and referred to our coronary care unit because of prolonged chest pain (in one case with clinical evidence of hemodynamic impairment) and persistent ST-segment elevation, in whom an acute myocardial infarction was suspected. One patient was treated with systemic fibrinolysis, and coronary angiography was performed 6 days later; the other was submitted to urgent coronary angiography shortly after admission. In both cases the ECG and echocardiographic abnormalities were transient and normalized within a few days, the serum markers of myocardial necrosis were persistently in the normal range and the coronary artery trees were normal. The diagnostic and therapeutic approach to patients with this unusual clinical presentation is also discussed.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/14. A new case of Lazarus phenomenon?The international medical literature described sporadical cases of an exceptional event called the "Lazarus phenomenon". This is the spontaneous reviviscence of an individual after a long time of asystolia following a cardiac accident depending on different pathogenesis (i.e. arrhythmia, ischaemic stroke, haemorrhage, brainstem death). All of the reported cases concerned patients presenting recovery after discontinuation of cardiopulmonary resuscitation. Different explanations of the physiopathology of the phenomenon can be given, first of all, the latency of catecholamine action in such patients. We report the case of an 81-year-old woman who experienced a cardiac accident on the street. Once the cardiopulmonary resuscitation was interrupted, the patient presented life activities after some minutes.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
4/14. Essential thrombocytosis and myocardial infarction in an aircrew member: aeromedical concerns.Of essential thrombocytosis (ET) cases, 25% occur in patients younger than 40 yr of age, and are often discovered as an incidental laboratory abnormality. However, the risk for thrombosis remains of concern and needs to be closely evaluated, especially in the aerospace environment. We report on the case of a 40-yr-old, female French military air traffic controller (ATC) admitted for an ST-elevation myocardial infarction. She was a smoker and had no previous medical history of ET. The coronary angiogram showed a thrombus of the left anterior descending coronary artery. She was treated medically with angioplasty and stent. Laboratory data revealed an elevated platelet count (495,000 x mm(-3)), confirmed 6 mo later (645,000 x mm(-3)). The diagnosis of ET was then established. No platelet-lowering therapy was prescribed, aspirin was continued, and this ATC was considered unfit for operational duties. Arterial thrombosis is more frequent than venous in ET, and can affect the whole arterial tree from the microscopic to the main arteries. Thrombosis is unpredictable and, due to abnormalities of the platelet functions and associated cardiovascular risk cofactors, may occur even with an almost normal platelet count. Risk-adjusted therapy is needed, including lifestyle modification to address vascular risk factors, antiplatelet drugs (aspirin), and platelet-lowering agents with their risk of leukomutagenesis. Furthermore, there is no consensus for the prevention of venous thrombosis. The decision for the aeromedical expert is difficult and depends on the specialty of the aircrew member, the type and duration of the mission, the therapeutics used, and the benefit-risk ratio of platelet-lowering agents.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
5/14. Application of multislice computed tomography coronary angiography for the diagnostic work-up of acute coronary syndromes.Multislice computed tomography coronary angiography has evolved as an accurate tool to identify the extent, morphology and distribution of significant lesions in the coronary tree of selected patients. More recently, the indications to perform MSCT have been broadened and have been applied in experimented centers to improve the diagnostic work-up of patients admitted with acute coronary syndromes. We report a case were MSCT was applied to define the diagnosis and guide the therapy of a patient admitted with an acute coronary syndrome.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
6/14. A case of malignant lymphoma simulating acute myocardial infarction.A patient with malignant lymphoma suddenly collapsed, and ST segment elevation with complete atrioventricular block was observed on his electrocardiogram during an episode resembling acute myocardial infarction. Cardiac cineangiography revealed posterobasal asynergy of the left ventricle with no significant obstruction in the coronary arterial tree. autopsy revealed diffuse invasion of the myocardium by lymphoma cells. Left ventricular wall motion was preserved even in the area of massive invasion; there was no true necrosis. Myocardial biopsy may be indicated in patients in whom there is a discrepancy between coronary pathoanatomy and wall motion abnormalities.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
7/14. Recurrent myocardial infarctions secondary to luetic coronary arteritis in hypertrophic cardiomyopathy. A case report.A 43-year-old coloured man had no risk factors for atheromatous coronary artery disease but suffered two acute myocardial infarctions (MIs) in rapid succession. Serological reactions for previous syphilitic (luetic) infection were positive. Hypertrophic cardiomyopathy (HCM) without obstruction was verified, although right ventricular endomyocardial biopsy specimens did not demonstrate histological features of this disease. Extensive MI was verified on left ventricular cine angiography. Selective coronary arteriography showed that the coronary arterial tree was diffusely aneurysmal in the absence of any obstruction. We postulate that syphilitic coronary arteritis, in the absence of the more pathognomonic coronary ostial stenotic lesions, was present and may have predisposed to coronary thrombus formation and repeated acute MI. Recurrent coronary vasospasm, associated with the HCM, cannot be excluded with certainty.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
8/14. Small vessel disease of the heart resulting in myocardial necrosis and death despite angiographically normal coronary arteries.A 46 year old man who had undergone cardiac transplantation 1 year previously had progressive congestive heart failure without evidence of cardiac rejection. cardiac catheterization and angiography revealed a reduced ejection fraction and cardiac output caused by diffuse left ventricular hypokinesia, but the epicardial coronary arteries were widely patent. The transit time of injected contrast material across the coronary arterial tree was greatly slowed. Within a few days cardiogenic shock and death occurred. The large epicardial coronary vessels were grossly patent at autopsy, although nonstenosing arteriosclerotic plaques were identifiable histologically. However, intramyocardial vessels showed severe arteriosclerotic narrowing, resulting in multiple, diffuse microinfarcts.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
9/14. Coronary artery aneurysms. Report of seven cases and review of the pertinent literature.Coronary artery aneurysm was demonstrated in 7 patients, whose ages ranged from 38 to 66 years, by selective coronary angiography. Four patients had atypical chest pain probably not caused by cardiac ischemia, 1 patient had aortic stenosis and recurrent bouts of atrial fibrillation, and 2 were evaluated following myocardial infarction and found to have triple vessel atherosclerotic coronary disease. mitral valve prolapse and varicosities of the coronary venous tree found in one individual suggest that mucoid degeneration which replaces the normal fibrous tissue resulting in weakness of vessel wall may be responsible for the formation of coronary artery aneurysm and varicosities of the coronary venous system. The unsuspected presentation and benign course of these patients are emphasized and the pertinent literature is reviewed.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
10/14. Concomitant myocardial infarction in identical twins with similar coronary lesions.Two 42-year-old male twins were referred to our hospital for coronary angiography within 3 months. Despite some gross similarities in the aspect of the coronary tree, the coronary dominance pattern was not the same in these twins, but coronary lesions involved almost the same sites. Genetically determined local factors, such as the rheologic profile in some sections of the coronary tree, or the susceptibility to lipid deposition in some spots, may be important in the development of atheromatous lesions in special sites.- - - - - - - - - - ranking = 2keywords = tree (Clic here for more details about this article) |
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