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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Publication date: Available online 8 March 2019Source: Journal of Cardiology CasesAuthor(s): Hiroaki Hiraiwa, Ryota Morimoto, Takahiro Okumura, Yoshihito Arao, Hideo Oishi, Hiroo Kato, Shogo Yamaguchi, Tasuku Kuwayama, Tomoaki Haga, Tsuyoshi Yokoi, Toru Kondo, Naoki Watanabe, Takayuki Mitsuda, Kenji Fukaya, Akinori Sawamura, Akihito Tanaka, Hideki Ishii, Itsuro Morishima, Hideyuki Tsuboi, Toyoaki MuroharaAbstractA 23-year-old Japanese man presented to a nearby hospital with a complaint of chest pain. In terms of the risk factors for cardiovascular events, there were no abnormal findings in past medical examinations and no ...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
Rationale: Primary percutaneous coronary intervention (PPCI) is the most effective therapy for patients with an acute ST-segment elevation myocardial infarction (STEMI). However, up to half of STEMI patients suffer from coronary microvascular dysfunction, presenting as the slow flow or no-reflow phenomenon. Patients concerns: A 78-year-old man was admitted to the chest pain center with sudden chest pain and tightness for about an hour. Diagnoses: Electrocardiography demonstrated ST-segment elevation in leads II, III, aVF, and third-degree atrioventricular block. Coronary angiography showed acute total occlusion in ...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
This study is unable to comment on whether patients with STEMI(-) Occlusion MI have benefit from emergent cath, because that is not the population studied and this subgroup is not commented on.This study is just the most recent in a long long line of similar literature. Context is everything for understanding this study. See below for an excerpt from theOMI Manifesto which summarizes the existing literature and provides details on each study:-------------------------------------------------------------------------------------------------------------- Counter-argument:“Haven’t there been RCTs showing no benefit ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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 (https://twitter.com/ALoboMD), 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
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