The Journal of Cardiovascular Diseases最新文献

{"title":"Case report: A case of an anomalous right coronary artery arising from the left coronary cusp.","authors":"Aftab Ahmed Solangi, Nasrullah Khan Khan","doi":"10.55958/jcvd.v19i1.153","DOIUrl":"https://doi.org/10.55958/jcvd.v19i1.153","url":null,"abstract":"Abstract \u0000An anomalous origin of the right coronary artery is usually asymptomatic. It is mostly found incidentally on an invasive diagnostic angiogram. It does lead to an increased risk of sudden cardiac death, especially in younger patients. We present a case of a 41-year-old who had presented to the hospital with complaints of chest pain. The patient was evaluated by cardiology who performed an angiography that identified an anomalous origin of the right coronary artery arising from the left coronary cusp but no evidence of coronary artery disease. Once identified, these anomalous vessels should be corrected surgically, as these conditions increase the risk of sudden cardiac death arrhythmia and ischemic events. \u0000  \u0000INTRODUCTION \u0000Anomalous aortic origin of the right coronary artery (AAORCA) is an uncommon congenital malformation with varying clinical presentations ranging from asymptomatic to sudden cardiac death (SCD). Those with symptoms or high-risk lesions are usually managed by unroofing or reimplantation, coronary artery bypass graft (CABG), AAORCA treated with right internal memory artery graft with proximal RCA ligation. \u0000  \u0000CASE DESCRIPTION \u0000A 41-year-old female patient with obesity and hypertension presented with a 1-year history of intermittent exertional substernal pressure radiating to left shoulder and back. The pain, which lasted about 10 minutes per episode, had been more frequent and intense over the past week.Upon initial evaluation, she was hypertensive at 150/90 mmHg and heart rate  60 bpm. Blood work was unremarkable, including negative serial troponin levels. Electrocardiography showed sinus bradycardia without ischaemic changes. Anomalous origin of RCA was incidentally discovered from computed tomography (CT) of the chest. Coronary angiography and ascending aortography were then performed, which revealed a patent RCA originating from the left coronary cusp (Fig. 1A). CT heart angiography with reconstruction revealed the RCA ostium in the left coronary cusp with a malignant course between the aorta and pulmonary artery and without an obvious intramural segment \u0000Discussion: \u0000  \u0000 An anomalous origin of the right coronary artery (RCA) is a rare congenital anomaly that was first described in 1948 by White and Edwards. After carrying out angiography in 126,595 patients, Yamanaka and Hobbs reported the incidence of anomalous origin of the right and left coronary arteries as 136 (0.107%) and 22 (0.017%), respectively. The prevalence of an anomalous origin of RCA (ARCA) arising from the left coronary cusp with an inter-arterial course varies between 0.026% and 0.25%. An ARCA is more common than the anomalous origin of the left coronary artery (ALCA), but the latter is shown to be responsible for up to 85% of sudden cardiac deaths (SCD) related to the anomalous origins of arteries. Most coronary anomalies are detected incidentally on diagnostic angiography and are clinically insignificant; some, however, have been associated with ","PeriodicalId":489484,"journal":{"name":"The Journal of Cardiovascular Diseases","volume":"19 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140488693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case report: Para Hisian Atrial Tachycardia","authors":"Amna Zafar Qureshi Qureshi, Abdul Mannan Shahid Shahid, Muhammad Ashraf Dar Dar, Imran Saleem Saleem, Waqar Hasan Hasan","doi":"10.55958/jcvd.v19i2.154","DOIUrl":"https://doi.org/10.55958/jcvd.v19i2.154","url":null,"abstract":"Atrial tachycardia accounts for around 10% of supraventricular tachycardias (1). Atrial      tachycardia can either be focal or macrorenentrant. Focal AT usually start at a focal point and then spreads in a centrifugal fashion to initiate atrial activation. Electrophysiologic studies have demonstrated the propensity of these tachycardias to arise from right atrium in the majority of cases (60%) and rest from the left atrium. There is a great predilection for crista terminalis. On the left side most of these arise from around the pulmonary vein ostia (2). A small proportion of these have tendency for arising from the Para-Hisian region. Incessant focal atrial tachycardia can lead to tachycardia induced cardiomyopathy (3). \u0000       A 55year old woman known hypertensive and diabetic, presented to our outpatient department with complaint of palpitations for the last 7 years. Presentation ECGs were narrow complex regular long RP tachycardia and without pre-excitation in normal sinus rhythm. (Fig 1) Despite oral medications she had multiple ER admissions which required IV medications tom terminate tachycardia. Considering that she was significantly symptomatic and drug refractory, the patient was indicated for invasive electrophysiological study and RF ablation. Her pre-procedure workup was unremarkable for ischemia and structural heart disease. \u0000Fig 1. 12 Lead ECG showing Narrow complex Long RP Tachycardia  \u0000She had a 4 catheter EP study done using conventional system, St Jude’s EP Workmate with 3D mapping system Carto backup. Her intracardiac electrograms from high right atrium, His- bundle location, coronary sinus and right ventricular apex were simultaneously recorded and displayed using a surface ECG. The clinical tachycardia had a CL of 240ms. (Fig 2) This was induced spontaneously and with atrial burst pacing protocol. There was evidence of AV Wenckebach and AV disassociation. A diagnosis of focal right atrial tachycardia was made. for detailed mapping of ablation target site, the procedure was shifted 3D guided mapping and ablation procedure. \u0000Fig. 2 Intracardiac Electrogram: More As than Vs with VA dissociation. \u0000Electroanatomical mapping and ablation was performed using the CARTO 3 system with Navistar catheter. The electroanatomic activation mapping confirmed a focal right atrial tachycardia originating from the anterior interatrial septum in close proximity to the bundle of His (8mm). The intracardiac electrogram recorded from the right atrium recorded the earliest site which was 35ms earlier than the earliest atrial activation. It was then decided to map the aortic cusps in detail due to the close proximity to the interatrial septum. Relative safety of ablation that has been reported previously. Mapping in the non-coronary cusp of the aorta revealed an even earlier site of activation which was 38ms earlier than earliest atrial activation. RF Ablation was performed from the non-coronary cusp at this site at 30W. Additional lesions were given","PeriodicalId":489484,"journal":{"name":"The Journal of Cardiovascular Diseases","volume":"94 3-4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140498215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}