RESUMEN
Coronary artery aneurysm (CAA) is a rare anomaly. The right coronary artery is the most commonly affected, followed by the left circumflex (LCX), or the left anterior descending artery (LAD). Three-vessel disease or left main (LM) involvement is extremely rare. A giant coronary artery aneurysm (GCAA) has an extremely low incidence and refers to an aneurysm that is 20 mm or greater in size. Most CAAs occur as a consequence of atherosclerosis. Most patients with CAA are males, have three-vessel disease, and a history of myocardial infarction (MI). Thrombosis within the aneurysm can lead to distal embolization and MI. Depending on the severity of coronary stenosis, management of patients with LM CAAs is either surgical or medical.
RESUMEN
Primary care physicians and cardiologists rely on risk scoring systems, which consist of a number of clinical variables used together, to predict stroke risk in patients with atrial fibrillation (AF). Ultimately, this helps in determining the need for anticoagulation. Left atrial size is not used in any stroke risk scoring system to stratify patients at risk for cardioembolic stroke. Throughout the literature, there is much debate surrounding the use of left atrial size as an additional risk factor for stroke in patients with and without AF. This review summarizes the stroke risk scoring systems in the currently available literature and the increasing risk of stroke associated with left atrial size. In conclusion, the authors propose the consideration of a tool to incorporate both the best available stroke risk scoring systems and the left atrial size, for a better risk assessment and management of AF.
Asunto(s)
Fibrilación Atrial/complicaciones , Accidente Cerebrovascular/etiología , Fibrilación Atrial/patología , Atrios Cardíacos/patología , Humanos , Tamaño de los Órganos , Pronóstico , Medición de Riesgo/métodosRESUMEN
High and low levels of ionized serum calcium concentration can produce characteristic changes on the electrocardiogram. These changes are almost entirely limited to the duration of the ST segment, with no change in the QRS complexes or T waves. High ionized serum calcium shortens the ST segment, and low ionized serum calcium prolongs the ST segment. Two common clinical scenarios are presented.
Asunto(s)
Calcio/sangre , Electrocardiografía , Hipercalcemia/fisiopatología , Hipocalcemia/fisiopatología , Adolescente , Adulto , Femenino , Humanos , MasculinoRESUMEN
The case of a patient who presented with angina following a coronary artery bypass (CABG) operation during which the left internal mammary artery was inadvertently anastomosed to a cardiac vein is presented. The literature concerning previously reported cases of aortocoronary arteriovenous fistulas (ACAVF) due to inadvertent grafting of a coronary vein is reviewed and the significance of this complication is discussed. ACAVF due to inadvertent grafting of a coronary vein is a rare complication of CABG and may be a more common cause of graft failure than has previously been recognized. Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors. Some patients present with angina pectoris and heart failure whereas others have no symptoms. The diagnostic test of choice is coronary angiography. Cardiac MRI and CT have a limited role due to the smaller size and the more clearly defined course of these fistulas. Asymptomatic patients are simply observed since spontaneous closure of these fistulas is reported. Symptomatic patients can be treated with combined medical management and percutaneous methods.