RESUMEN

Myocardial bridging (MB) is a condition where the coronary artery is intramural instead of its natural course through the epicardium. Here, we present a case of a 25-year-old male without any medical history who presented with intermittent substernal chest discomfort on exertion. EKG was suggestive of ST changes in leads V1-V4 with right axis deviation. A left heart catheterization revealed myocardial bridging of the midportion of the left anterior descending artery. Myocardial bridging is commonly not associated with severe complications. However, it is imperative to diagnose it appropriately, especially in cases of chest pain, and provide immediate treatment to prevent mortality and morbidity.

RESUMEN

Spontaneous coronary artery dissection (SCAD) is the formation of a false lumen within a vessel wall, with an accumulation of blood leading to vessel occlusion, mimicking symptoms of acute myocardial infarction (AMI). Here, we discuss the case of a middle-aged woman with STEMI who was found to have coronary artery dissection on coronary angiography during left heart catheterization. Clinicians should have a high suspicion of SCAD in young females presenting with AMI without traditional risk factors for coronary artery disease. Such patients should receive urgent angiography. Once the diagnosis is confirmed, there are no clear guidelines for treating AMI secondary to SCAD. Hemodynamically stable patients can be managed with the immediate initiation of antiplatelet therapy and beta-blockers. Thrombolytic therapy is avoided due to the risk of dissection and intramural hematoma. Coronary artery bypass graft (CABG) is indicated in patients with multiple vessel involvement or patients who have had a primary coronary intervention fail. Bioresorbable vascular scaffolds (BVS) may be a better option in STEMI or hemodynamic instability. However, current treatment strategies are based on expert opinion and a few case studies.

RESUMEN

Acute ST-elevation myocardial infarction (STEMI) is rarely seen in young adults, however, when encountered, the underlying cause is either a genetic condition leading to early-onset coronary artery disease (CAD), an acquired pro-thrombotic condition, or an idiopathic condition like spontaneous coronary artery dissection (SCAD). Our case describes a healthy 23-year-old female who presented with sudden onset severe angina and was found to have a laminated thrombus in the left anterior descending coronary artery (LAD), with no evidence of intraluminal dissection or plaque rupture. Although the underlying etiology of thrombus formation remains unknown, coronavirus disease 2019 (COVID-19) related thrombotic event is the prime suspect. In addition, another culprit that cannot be excluded is phentermine-induced coronary vasospasm, a commercially available medication for weight loss. This report addresses current literature on acute coronary syndromes in young adults and reviews the potential etiologies for coronary artery thrombosis, which led to a near-fatal acute coronary syndrome in our patient.

RESUMEN

OBJECTIVE: A previously developed pretest score was validated to stratify patients presenting for exercise testing with suspected coronary disease according to the presence of angiographic coronary disease. Our goal was to determine how well this pretest score risk stratified patients undergoing pharmacological and exercise stress tests concerning prognostic endpoints. DESIGN: Retrospective cohort analysis. SETTING: University hospital stress laboratory. PATIENTS: 7452 unselected ambulatory patients with symptoms of suspected coronary disease undergoing stress testing between 1995 and 2004. MAIN OUTCOMES MEASURES: All-cause death, cardiac death and non-fatal myocardial infarction. RESULTS: The rate of all-cause death was 5.5% (CI 5.0 to 6.1) with 4.3 (SD 2.4) years of follow-up (Exercise 2.8% (CI 2.3 to 3.2) v Pharmacological group 11.9% (CI 10.5 to 13.3); p<0.001). The rate of cardiac death/myocardial infarction was 2.6% (CI 2.2 to 3.0) (Exercise 1.4% (CI 1.1 to 1.8) v Pharmacological group 5.3% (CI 4.3 to 6.2); p<0.001). In both groups, stratification by pretest score was significant for all-cause death and the combined endpoint. However, stratification was more effective in the pharmacological group using the combined endpoint rather than all-cause death. Pharmacological stress patients in intermediate and high risk groups were at higher risk than their respective exercise test cohorts. Referral for pharmacological stress testing was found to be an independent predictor of time to death (2.7 (CI 2.0 to 3.6); p<0.001). CONCLUSION: A pretest score previously validated to stratify according to angiographic outcomes, effectively risk stratified pharmacological and exercise stress patients according to the combined endpoint of cardiac death/myocardial infarction.

Asunto(s)

RESUMEN

We report a patient who presented initially with a diagnosis of a mediastinal mass. During the cardiac catheterization, the patient was diagnosed with a saphenous vein graft aneurysm. We proceeded with a catheter-based intervention resulting in occlusion of the aneurysm. Repeat angiogram after three months showed complete occlusion of the vein graft supplying the aneurysm. We believe that in selected patients with saphenous vein graft aneurysm a catheter-based procedure is feasible and successful.

Asunto(s)