Rotational Atherectomy in a Dissected Coronary Artery That Propagated Into the Sinus of Valsalva: Is This the Last Hope?

Rotational Atherectomy in a Dissected Coronary Artery That Propagated Into the Sinus of Valsalva: Is This the Last Hope? Rev Cardiovasc Med. 2016;17(3-4):137-139 Authors: Shah AH, Ossei-Gerning N, Mitra R Abstract Percutaneous coronary intervention (PCI) of a resistant, undilatable lesion can result in coronary dissection. Retrograde propagation of a dissection flap into the sinus of Valsalva is a rare phenomenon. It is commonly seen at the time of PCI to a right coronary artery (RCA) and is associated with potentially fatal consequences. Use of rotational atherectomy (RA) is contraindicated in the presence of a coronary dissection. Coronary dissection with preserved flow in asymptomatic patients should be managed conservatively until the dissection heals, but in the case presented here, as coronary flow was compromised, the patient complained of chest pain and ST elevation was observed on electrocardiogram. PMID: 28144021 [PubMed - in process]
Source: Reviews in Cardiovascular Medicine - Category: Cardiology Tags: Rev Cardiovasc Med Source Type: research

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Rationale: Primary percutaneous coronary intervention (PPCI) with immediate stenting provides effective revascularization. While the risks of no-reflow, stent thrombosis, stent undersizing, and malapposition reduced the benefits in patients with high burden thrombosis. Intravascular imaging, especially optical coherence tomography (OCT), offers potential in optimization of percutaneous coronary intervention. Patient concerns: A 51-year-old male underwent coronary angiography (CAG) due to chest pain with minimal ST-segment depression of the electrocardiogram. Diagnoses: Urgent CAG revealed burden thrombus in the mid...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
In this report, we describe the case of a 70-year-old male who presented to emergency department with chest pain. Electrocardiogram showed ST-segment elevation in leads aVR and aVL and ST-segment depression in leads v3, v4, v5, v6, 2, 3, and aVF. Occlusion of the left main coronary artery was suspected. While waiting for percutaneous coronary intervention, the patient experienced sudden refractory ventricular fibrillation with cardiac arrest.
Source: The American Journal of Emergency Medicine - Category: Emergency Medicine Authors: Source Type: research
CONCLUSION: During a 1-year evaluation of the modified pre-hospital triage protocol for patients with acute ischaemic chest pain, over 100 acute MI patients with an initially inconclusive ECG received primary PCI within 90 min. Because of these results, we decided to continue the operation of the modified protocol. PMID: 30357611 [PubMed - as supplied by publisher]
Source: Netherlands Heart Journal - Category: Cardiology Authors: Tags: Neth Heart J Source Type: research
AbstractBackgroundMorphine adversely impacts the action of oral adenosine diphosphate (ADP)-receptor blockers in ST-segment elevation myocardial infarction (STEMI) patients, and is possibly associated with differing patient characteristics. This retrospective analysis investigated whether interaction between morphine use and pre-percutaneous coronary intervention (pre-PCI) ST-segment elevation resolution in STEMI patients in the ATLANTIC study was associated with differences in patient characteristics and management.MethodsATLANTIC was an international, multicenter, randomized study of treatment in the acute ambulance/hosp...
Source: American Journal of Cardiovascular Drugs - Category: Cardiology Source Type: research
CONCLUSION: Prehospital ECG is technologically feasible in Hong Kong and shortens the D2B time. However, shorter reperfusion time was only recorded during daytime hours. PMID: 30262677 [PubMed - as supplied by publisher]
Source: Hong Kong Medical Journal - Category: General Medicine Tags: Hong Kong Med J Source Type: research
Post by Smith, with short article by Angie Lobo (, a third year intermal medicine resident at Abbott Northwestern Hospital CaseA 30-something woman with no past history, who is very fit and athletic, presented with 1.5 hours of substernal chest pressure.  It was non-radiating and without other associated symptoms except for nausea.  She had zero CAD risk factors.Here was her ECG at time zero:What do you think?There is ST elevation in V2 with large fat T-wave.  There is ST depression in II, III, and aVF, and V3 to V6.I saw this before any other information and k...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
​BY TRAVIS SMITH, MD, &MATTHEW ZUCKERMAN, MDParamedics were called for a 42-year-old woman found at a motel by her significant other. The patient was alone at the time of EMS arrival. She was pulseless and apneic, so chest compressions were started, and the cardiac monitor showed pulseless electrical activity.Initial ECG showing STE in the anterior leads with ST depression in the inferior leads.The paramedics gave her 1 mg of epinephrine IV and 1 mg of naloxone IV without obvious response. A laryngeal mask airway was placed, and oxygen was delivered by bag valve mask. She received eight rounds of chest compressi...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
This case comes from Sam Ghali  (@EM_RESUS). A 60-year-old man calls 911 after experiencing sudden onset chest pain, palpitations, and shortness of breath. Here are his vital signs:HR: 130-160, BP: 140/75, RR:22, Temp: 98.5 F, SaO2: 98%This is his 12-Lead ECG:He is in atrial fibrillation with a rapid ventricular response at a rate of around 140 bpm. There are several abberantly conducted beats. There is ST-Elevation in aVR of several millimeters and diffuse ST-Depression with the maximal depression vector towards Lead II in the limb leads and towards V5 in the precordial leads.ECG reading is all ab...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
An 88-year-old man presented to the emergency department with chest pain for 7 hours. An 18-lead electrocardiogram (ECG) on admission showed sinus bradycardia; first-degree atrioventricular block; incomplete right bundle branch block; ST elevation in leads II, III, and aVF and from V3R to V5R, and from V1 to V9; and ST depression in leads I and aVL (Figure  1). The patient was treated with primary percutaneous coronary intervention.
Source: The American Journal of Medicine - Category: General Medicine Authors: Tags: Clinical Communication to the Editor Source Type: research
Authors: Ginanjar E, Yulianto Y Abstract The purpose of this case repots are to evaluate the role of ST elevation in aVR lead and to make analysis between both cases. There are some atypical electrocardiogram (ECG) presentations which need prompt management in patient with ischemic clinical manifestation such as ST elevation in aVR lead. In this case study, we report a 68-year old woman with chief symptoms of shortness of breath and chest discomfort. She was diagnosed with cardiogenic shock, with Killip class IV, and TIMI score of 8. The second case is a 57-year-old man with typical chest pain at rest which could n...
Source: Acta medica Indonesiana - Category: Internal Medicine Tags: Acta Med Indones Source Type: research
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