RESUMEN
PURPOSE: This report highlights the significance of endovascular training for invasive cardiologists. CASE REPORT: 78-year-old morbidly obese male with an inferior wall myocardial infarction underwent primary percutaneous coronary intervention (PCI) which was complicated by laceration of the profunda femoris artery. Endovascular repair of the profunda femoris artery was performed by using Jomed covered stents. CONCLUSION: This case report of endovascular repair of lacerated profunda femoris artery signifies the importance of endovascular training for invasive cardiologist.
Asunto(s)
Arteria Femoral/lesiones , Arteria Femoral/cirugía , Infarto del Miocardio/cirugía , Obesidad Mórbida/complicaciones , Intervención Coronaria Percutánea/efectos adversos , Stents , Anciano , Índice de Masa Corporal , Humanos , Masculino , Infarto del Miocardio/complicaciones , Resultado del TratamientoRESUMEN
BACKGROUND: This is a prospective, observational review of medical records to investigate the associated comorbidities and angiographic anatomy in patients with chronic right bundle branch block (RBBB). METHODS: The analyses of 32,345 consecutive electrocardiograms (EKGs) between October 2010 and January 2012 revealed 583 patients with RBBB. The common comorbidities associated with RBBB were hypertension (82%), diabetes (42%), coronary artery disease (CAD) (44%), valvular heart disease (aortic--16% and mitral--17%) and pulmonary disease (33%). Demographic data including age, sex, EKG and associated comorbidities were analyzed from the medical records. Coronary angiograms within 6 months of EKG in patients with RBBB were available for 184 patients and were accordingly analyzed for significant obstructive CAD. RESULTS: In all, 33 patients had single-vessel disease, 52 patients had 2-vessel disease, and 87 patients had multivessel disease whereas 12 patients had no significant disease. Left anterior descending artery was the most frequent vessel involved (72%) followed by left circumflex (58%) and right coronary artery (53%). CONCLUSIONS: In conclusion, in chronic RBBB, wherever the angiograms were available, CAD predominantly involved left anterior descending artery. Most common associated comorbidities in chronic RBBB were systemic hypertension and CAD.
Asunto(s)
Bloqueo de Rama/epidemiología , Enfermedad de la Arteria Coronaria/epidemiología , Anciano , Anciano de 80 o más Años , Bloqueo de Rama/etiología , Comorbilidad , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/etiología , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , West Virginia/epidemiologíaRESUMEN
BACKGROUND: Percutaneous balloon pericardiotomy (PBP) has been successful in managing large pericardial effusions, particularly in patients with malignant conditions. The objective of this study was to evaluate safety and feasibility of this procedure (PBP) in patients who had recurrent life threatening pericardial effusion at West Virginia University Hospital (WVUH). METHODS: This is retrospective review of consecutive series of pericardial windows by PBP. This report entails our experience of 36 procedures performed from November 2002 to November 2012 by PBP. RESULTS: Thirty-six percutaneous balloon pericardiotomies were performed (20 males and 16 females) with a mean age of 58 ± 15 years. Lung cancer (50%) was the most common diagnosis with small cell type (29%) being most frequent. Other causes of pericardial effusion requiring PBP procedure included breast cancer (13.2%) and gastrointestinal cancer (15.7). Five patients had previously required pericardiocentesis in the past, and 31 patients had PBP as the first treatment for the pericardial effusion. There were no acute complications. The procedures were successful and well tolerated. Technical success of procedure was 100%. The 30-day survival was 81 percent and there were no infectious complications during follow-up. CONCLUSION: Percutaneous balloon pericardiotomy is safe and effective technique for the management of patients with severe recurrent life threatening pericardial effusion.
Asunto(s)
Neoplasias/complicaciones , Derrame Pericárdico , Pericardiectomía , Pericardiocentesis/métodos , Adulto , Anciano , Investigación sobre la Eficacia Comparativa , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiología , Derrame Pericárdico/fisiopatología , Derrame Pericárdico/cirugía , Pericardiectomía/efectos adversos , Pericardiectomía/instrumentación , Pericardiectomía/métodos , Estudios Retrospectivos , Ajuste de Riesgo , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , West VirginiaRESUMEN
This case report highlights a rare case of isolated septal noncompaction of the left ventricle, a congenital condition, in a previously asymptomatic adult patient who presented with syncope. Management of left ventricular noncompaction (LVNC) includes treatment for heart failure, arrhythmias, and thromboembolic events; but no criteria exist for primary prophylaxis in patients that might be at high risk. To our knowledge this is the first report of isolated septal noncompaction in a previously asymptomatic adult patient.
Asunto(s)
No Compactación Aislada del Miocardio Ventricular/diagnóstico por imagen , Humanos , No Compactación Aislada del Miocardio Ventricular/complicaciones , Masculino , Persona de Mediana Edad , Síncope/etiología , UltrasonografíaRESUMEN
Metabolic syndrome (MetS) is the manifestation of a cluster of cardiovascular risk factors and is associated with a threefold increase in the risk of cardiovascular morbidity and mortality, which is suggested to be mediated, in part, by resting left ventricular (LV) systolic dysfunction. However, to what extent resting LV systolic function is impaired in MetS is controversial, and there are no data indicating whether LV systolic function is impaired during exercise. Accordingly, the objective of this study was to examine comprehensively the LV and arterial responses to exercise in individuals with MetS without diabetes and/or overt cardiovascular disease in comparison to a healthy control population. Cardiovascular function was characterized using Doppler echocardiography and gas exchange in individuals with MetS (n = 27) versus healthy control subjects (n = 20) at rest and during peak exercise. At rest, individuals with MetS displayed normal LV systolic function but reduced LV diastolic function compared with healthy control subjects. During peak exercise, individuals with MetS had impaired contractility, pump performance and vasodilator reserve capacity versus control subjects. A blunted contractile reserve response resulted in diminished arterial-ventricular coupling reserve and limited aerobic capacity in individuals with MetS versus control subjects. These findings are of clinical importance, because they provide insight into the pathophysiological changes in MetS that may predispose this population of individuals to an increased risk of cardiovascular morbidity and mortality.
Asunto(s)
Ejercicio Físico/fisiología , Síndrome Metabólico/fisiopatología , Sístole/fisiología , Función Ventricular Izquierda/fisiología , Diástole/fisiología , Tolerancia al Ejercicio/fisiología , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Síndrome Metabólico/diagnóstico por imagen , Persona de Mediana Edad , Ultrasonografía , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/fisiopatologíaAsunto(s)
Extremidad Inferior/irrigación sanguínea , Vena Cava Inferior/anomalías , Trombosis de la Vena/etiología , Vena Femoral/diagnóstico por imagen , Humanos , Vena Ilíaca/diagnóstico por imagen , Masculino , Vena Poplítea/diagnóstico por imagen , Vena Safena/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler , Vena Cava Inferior/diagnóstico por imagen , Trombosis de la Vena/diagnóstico , Adulto JovenRESUMEN
BACKGROUND: Differentiation of ST-segment elevation on electrocardiogram (ECG) from acute pericarditis (AP), normal variant early repolarization (ER) and early repolarization of left ventricular hypertrophy (ERLVH) can be problematic. Hence, the authors evaluated the accuracy of the ST/T ratio in ECG to more optimally differentiate between AP, ST-segment elevation, ER and ERLVH. METHODS: Between September 2006 and July 2010, 80 patients were enrolled in this study consisting of 25 individuals with AP, 27 with ER and 28 with ERLVH. Each ECG was analyzed in a systematic manner including the measurement of PR interval, QRS duration, QT-segment duration, PR-segment deviation, ST-segment deviation and the height of T wave. The ratio of the height of ST segment to the height of T wave was measured in leads I, II, III, aVF and V2 through V6. RESULTS: The mean ages of the patients with AP, ER and ERLVH were 32 ± 16.5, 36 ± 15.4 and 53 ± 16 years, respectively. The ratio of the amplitude of ST segment to the amplitude of the T wave in leads I, V4, V5 and V6 proved to be a significant discriminator at a value of ≥0.25 (P < 0.05 for all). CONCLUSIONS: Leads I, V4, V5 and V6 can all be used to differentiate AP from ER and ERLVH. When ST elevation is present in lead I, the ST/T ratio has the best predictive value (0.82) to more accurately discriminate between AP, ER and ERLVH.
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Electrocardiografía , Hipertrofia Ventricular Izquierda/diagnóstico , Pericarditis/diagnóstico , Adolescente , Adulto , Anciano , Dolor en el Pecho/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
A stress-induced myocardial perfusion abnormality (MPS), in the absence of angiographically significant epicardial coronary artery disease, is considered a "false-positive" test result. We hypothesized that echocardiography would provide complementary prognostic and pathophysiologic data relevant to the management of patients with MPS and normal coronary angiograms. Accordingly, left atrial volume index (LAVi) was assessed by echocardiography in 38 patients with false positive MPS as defined by normal coronary angiograms and 26 patients with true negative MPS from a total of 1,356 patients stressed from July 2006-May 2008. Pathologically abnormal elevation of LAVi (≥ 32 mL/m(2)) was observed in 16 of 19 women (84%) and 11 of 19 men (58%) in the false positive MPS (FPMPS) group while none of the patients in the true negative MPS (TNMPS) group had elevated LAVi. In the FPMPS group mean LAVi was significantly higher in women than men (40.64 ± 11.4 mL/m(2) versus 32.6 ± 10.5 mL/m(2), P = 0.01). The mean LAVi in the FPMPS group was significantly different from the TNMPS group (36.6 ± 11.6 versus 21 ± 7 mL/m(2), P = 0.000). A stepwise logistic regression determined BSA, LAV and LAVi as useful in predicting false positive and true negative MPS. All three were significant predictors (P < 0.01) and the area under the ROC curve was 0.91. Our findings in this relatively small cohort suggest that patients with false positive MPS have a greater increased LAVi.
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Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Ecocardiografía , Imagen de Perfusión Miocárdica , Adulto , Anciano , Estudios de Cohortes , Reacciones Falso Positivas , Femenino , Atrios Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Atrial fibrillation (AF) is a cardiac arrhythmia associated with a wide range of other co-morbid medical conditions. The state of West Virginia has a higher prevalence of coronary artery disease (CAD) and CAD risk factors compared to the national average. We hypothesized that West Virginians with atrial fibrillation would also have a higher prevalence of CAD risk factors and higher CHADS2 stroke risk scores. This is particularly important since Louisiana is the only high CAD risk southern state included in the original verification of the CHADS2 risk scoring system (i.e. California, Connecticut, Louisiana, Maine, Missouri, New Hampshire, and Vermont). Accordingly, we performed a retrospective analysis of the association between AF and CAD, CAD risk factors and CHADS2 scores in a cohort of men and women in the West Virginia University Hospital population. We report a greater positive association between AF and hypertension, diabetes mellitus and obesity than the national average. AF was seen more commonly among men. But, CHADS2 scores were higher among women as a result of a higher prevalence of diabetes mellitus. This study indicates that AF is associated with a greater prevalence of CAD risk factors and higher CHADS2 scores among West Virginians in comparison with the rest of the nation.
Asunto(s)
Fibrilación Atrial/etiología , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/epidemiología , Hipertensión/complicaciones , Obesidad/complicaciones , Accidente Cerebrovascular/etiología , Adulto , Anciano , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/epidemiología , Índice de Masa Corporal , Enfermedad de la Arteria Coronaria/diagnóstico , Diabetes Mellitus/epidemiología , Femenino , Hospitales Universitarios , Humanos , Hipertensión/epidemiología , Incidencia , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Sobrepeso/complicaciones , Valor Predictivo de las Pruebas , Prevalencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Distribución por Sexo , Fumar/efectos adversos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Factores de Tiempo , West Virginia/epidemiologíaRESUMEN
Intensive lifestyle changes have been shown to regress atherosclerosis, improve cardiovascular risk profiles, and decrease angina pectoris and cardiac events. We evaluated the influence of the Multisite Cardiac Lifestyle Intervention Program, an ongoing health insurance-covered lifestyle intervention conducted at our site, on endothelial function and inflammatory markers of atherosclerosis in this pilot study. Twenty-seven participants with coronary artery disease (CAD) and/or risk factors for CAD (nonsmokers, 14 men; mean age 56 years) were enrolled in the experimental group and asked to make changes in diet (10% calories from fat, plant based), engage in moderate exercise (3 hours/week), and practice stress management (1 hour/day). Twenty historically (age, gender, CAD, and CAD risk factors) matched participants were enrolled in the control group with usual standard of care. At baseline endothelium-dependent brachial artery flow-mediated dilatation (FMD) was performed in the 2 groups. Serum markers of inflammation, endothelial dysfunction, and angiogenesis were performed only in the experimental group. After 12 weeks, FMD had improved in the experimental group from a baseline of 4.23 + or - 0.13 to 4.65 + or - 0.15 mm, whereas in the control group it decreased from 4.62 + or - 0.16 to 4.48 + or - 0.17 mm. Changes were significantly different in favor of the experimental group (p <0.0001). Also, significant decreases occurred in C-reactive protein (from 2.07 + or - 0.57 to 1.6 + or - 0.43 mg/L, p = 0.03) and interleukin-6 (from 2.52 + or - 0.62 to 1.23 + or - 0.3 pg/ml, p = 0.02) after 12 weeks. Significant improvement in FMD, C-reactive protein, and interleukin-6 with intensive lifestyle changes in the experimental group suggests > or = 1 potential mechanism underlying the clinical benefits seen in previous trials.
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Aterosclerosis/sangre , Aterosclerosis/terapia , Proteína C-Reactiva/metabolismo , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/prevención & control , Endotelio Vascular/metabolismo , Conducta de Reducción del Riesgo , Angina de Pecho/sangre , Angina de Pecho/prevención & control , Biomarcadores/sangre , Arteria Braquial/fisiopatología , Estudios de Casos y Controles , Ejercicio Físico , Femenino , Conductas Relacionadas con la Salud , Humanos , Interleucina-6/sangre , Masculino , Persona de Mediana Edad , Óxido Nítrico Sintasa de Tipo III/sangre , Proyectos Piloto , Calidad de Vida , Factores de Riesgo , Estrés Psicológico/prevención & control , Factores de Tiempo , VasodilataciónRESUMEN
Severe coronary artery tortuosity on coronary angiogram has not been previously evaluated to determine whether it is associated with coronary artery disease or risk factors for coronary artery disease. A retrospective analysis of all patients who underwent coronary angiography at West Virginia University Hospital during an eight month period was performed. All patients with severe coronary tortuosity (SCT), defined as two consecutive 180 degrees turns by visual estimation in a major epicardial artery, were identified and their medical records reviewed for the presence of coronary artery disease risk factors and presence of significant coronary artery disease. A randomly chosen group of patients who underwent coronary angiography during the same time who did not have SCT was used for a control group. Multivariable analysis using logistic regression was performed to determine predictors of SCT. Severe coronary tortuosity was found in 12.45% of our 1221 patients. Female gender was found to be significantly higher in the tortuosity group of patients compared to the control group (p = 0.039). The presence of severe tortuosity was associated with a statistically significant lower incidence of significant coronary artery disease (p = 0.003). Hypertension, hyperlipidemia, smoking, family history of coronary artery disease, diabetes mellitus, and age > or =65 years were not predictors of SCT. Our study did not find that coronary artery disease risk factors were predictors of coronary tortuosity. Future investigations may provide further insight into the significance or cause of coronary artery tortuosity.