Austin journal of clinical cardiology最新文献

{"title":"Recurrent Episodes of ST-Elevation Myocardial Infarction in a 19-Year-Old Male with Fontan Circulation","authors":"Alghammass Ma, Drakos Sg, Lalwani Ak, Martin Hd, L. Kemeyou","doi":"10.26420/austinjclincardiolog.2021.1078","DOIUrl":"https://doi.org/10.26420/austinjclincardiolog.2021.1078","url":null,"abstract":"We describe a case of a 19-year-old male with history of single ventricle physiology status post-Fontan procedure at the age of two who developed thromboembolic phenomena involving his splenic, renal and coronary arteries resulting in multiple infarcts and recurrent in-hospital acute ST-Segment Elevation Myocardial Infarction (STEMI) treated by emergent Percutaneous Coronary Intervention (PCI). This case highlights multiple aspects and challenges of managing young patients with congenital heart disease.","PeriodicalId":90445,"journal":{"name":"Austin journal of clinical cardiology","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74030794","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":"Predictive Value of Apoptotic Factor M30 for Negative Left Ventricular Remodeling in Patients Undergoing Primary Percutaneous Coronary Intervention","authors":"J. Yusuf, S. Mukhopadhyay, Viadya Pn, A. Gautam, Mehta, Gupta, B. Mahajan","doi":"10.26420/austincardiol.2021.1028","DOIUrl":"https://doi.org/10.26420/austincardiol.2021.1028","url":null,"abstract":"Background: Left Ventricular Negative Remodeling (LVNR) following Primary Percutaneous Coronary Intervention (PPCI) is an important cause of LV systolic dysfunction due to Irreversible Myocardial Injury (IMI). Both necrosis and apoptosis contribute to IMI and LVNR. We assessed the role of specific apoptotic marker M30 in predicting LVNR in patients of anterior wall ST Elevation Myocardial Infarction (STEMI) undergoing PPCI within 12 hours of symptom onset. Methods: This prospective study was done on 100 consecutive patients of anterior wall STEMI (87 men and 13 women, mean age 52.15±12.08 years) meeting our inclusion and exclusion criteria. Blood sample for M30 was drawn at 24 hours after symptom onset, when it reaches peak level. Transthoracic echo was done in each patient at 24 hours after PPCI and at 6 months. LVNR was defined as ≥20% increase in LV end diastolic volume at 6 months after PPCI. Results: 44 patients (44%) developed LVNR at 6 months post PPCI. Diabetes mellitus (p=0.032), symptom onset to balloon time (p=0.059), CPK-MB (p=0.007) and M30 level (p=0.012) were independent predictors of LVNR. The cutoff value of M30 for predicting LVNR was 81.18u/ml with positive predictive value of 70.4% (AUC 85.3, p<0.001). Conclusion: In patients of anterior wall STEMI undergoing PPCI, the apoptotic marker M30 is useful for early prediction of LVNR. This can assist in better risk stratification of patients after successful PPCI and identify the subgroup of patients who require more intensive medical follow up with antiremodeling drugs to attenuate the development of LVNR.","PeriodicalId":90445,"journal":{"name":"Austin journal of clinical cardiology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89626802","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":"Myocardial Infarction and Three-Vessel Coronary Artery Disease as Presenting Features of Granulomatosis with Polyangiitis: A Case Report with Review of Literature","authors":"M. Nashawi, Ahmed Ms, M. Abualfoul, Lee Lk, A. Ghali, Chilton Rj","doi":"10.26420/AUSTINJCLINCARDIOLOG.2021.1074","DOIUrl":"https://doi.org/10.26420/AUSTINJCLINCARDIOLOG.2021.1074","url":null,"abstract":"Granulomatosis with Polyangiitis (GPA) is a systemic, autoimmune disorder characterized by inflammatory insult and granulomatous processes in small and medium-sized vessels leading to various clinical presentations from underlying vasculitis. Underlying such inflammatory cascade is the overactivity of Antineutrophil Cytoplasmic Antibodies (c-ANCA) targeting serum Proteinase 3 (PR3), whose aberrant targeting classically modulates molecular signaling pathways leading to clinical manifestations of the Ear, Nose and Throat (ENT), in addition to renal impairment. Peripheral vessel involvement (i.e. limb vasculature) is not generally associated with GPA. With the exception of seldom reports in the literature, it is rare for GPA to present with coronary artery involvement. Moreover, reports of multi-vessel disease (e.g. triple-vessel disease) with GPA warranting Coronary Artery Bypass Graft (CABG) are lacking in such accounts. The latter with preceding iliac artery claudication makes such a presentation of GPA exceptionally novel and warrants contextual commentary regarding inflammation and Coronary Artery Disease (CAD). We report the case of a 55-year-old Caucasian male presenting with a 2 years history of right-sided groin cramping and an acute one-week history of claudication in the same area. After advised to follow up as an outpatient, this patient returned shortly thereafter to an acute care setting with hemoptysis and myocardial infarction worked up for GPA and triple-vessel disease. The patient was subsequently treated with immunosuppressive pharmacotherapy prior to CABG. We conducted a review of the literature underpinned in clinical and translational biology with a focus on the salient inflammatory pathways featured in both coronary artery disease and GPA.","PeriodicalId":90445,"journal":{"name":"Austin journal of clinical cardiology","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86663735","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":"COVID-19 and the Risk of Pulmonary Embolism: ECG Findings Can Help","authors":"A. Shojaei, A. Karimi","doi":"10.26420/AUSTINJCLINCARDIOLOG.2021.1073","DOIUrl":"https://doi.org/10.26420/AUSTINJCLINCARDIOLOG.2021.1073","url":null,"abstract":"We appreciate the kind invitation to provide an update on an aspect of our study published before [1]. Therefore, we decided to further discuss the Pulmonary Embolism (PE) in patients with COVID-19. COVID-19 pandemic has affected many countries and their health-care system. COVID-19 also imposes significant diagnostic challenges because of its wide range of complications [2]. Evidence shows that COVID-19 can cause a hypercoagulable state and increases the risk of thromboembolism [3]. The radiological appearance of PE in patients with COVID-19 might differ from COVID-19 (-) patients, and the clots are dominantly seen in peripheral zones [4,5]. This fact supports the idea that COVID-19 can cause PE by in-situ immune thrombosis, and the clots might originate from lung vessels rather than deep veins [6]. There is an overlap between signs and symptoms of COVID-19 infection and pulmonary embolism, making the diagnosis of pulmonary embolism challenging [7]. Elevated D-dimer levels may come to our help and increase our suspect for PE, but it is still not specific to the diagnosis of Venous Thromboembolism (VTE) [8]. Anticoagulant therapy may increase the patients’ survival rate [9]. Dyspnea, chest pain, and tachypnea are common in both PTE and COVID-19 infection. Hemoptysis has also been described as a rare COVID clinical symptom (0-5 %) [10], while this number is 13% for patients with PE [11]. In the case reported by Casey et al. [7], a 42 years old COVID-19 positive male presented with pleuritic chest pain, dyspnea, and hemoptysis. In the physical exam, he was tachypneic, and auscultation revealed bibasilar rhonchi. Electrocardiography demonstrated right axis deviation and an S1Q3T3 pattern with flattening of the T-waves in the II, III, aVL and aVF. These findings increased the probability of PE. Also, Laboratory evaluation showed a D-dimer of 4.8μg/dl. So a Computerized Tomography Angiography (CTA) of the chest was obtained. CTA demonstrated bilateral segmental pulmonary emboli and peripheral ground-glass opacities caused by COVID-19 pneumonia. However, sometimes everything becomes more complicated. In the case reported by Ioan et al. [12], a 61 years old male with a history of hypertension treated with Angiotensin-Converting Enzyme Inhibitor (ACEI) presented with dyspnea and cough. His blood pressure was normal, his heart and respiratory rates were 136 and 30, and oxygen saturation was <85% on room air. His Electrocardiogram (ECG) showed sinus tachycardia, ST depression in I, aVL, and V2-V4, and ST-segment elevation in II, III, aVF. An Echocardiography was obtained, which showed RV dilatation, interventricular septal shift, RV lateral wall akinesia, and a pulmonary arterial systolic pressure of >60mmHg. His hypoxemia was refractory to invasive mechanical ventilation, so he was intubated and underwent invasive mechanical ventilation without response. For this patient thrombolytic treatment was started due to suspicion of PE. The patient started improv","PeriodicalId":90445,"journal":{"name":"Austin journal of clinical cardiology","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86590037","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":"Controversy in Managing Coronary Artery Anomaly with Co-Existing Coronary Artery Atherosclerosis in a Young","authors":"S. Okoro, A. Kardos","doi":"10.26420/AUSTINJCLINCARDIOLOG.2021.1072","DOIUrl":"https://doi.org/10.26420/AUSTINJCLINCARDIOLOG.2021.1072","url":null,"abstract":"We read the case report by Singh at al. with interest [1]. They present a case of a 34-year-old hypertensive man with symptomatic 3 vessel coronary artery disease on invasive coronary angiography. He underwent myocardial perfusion scintigraphy with normal perfusion at high workload (12.8 METS and with a double product of 35,720 and had normal left ventricular systolic function on echocardiography. The subsequent CT coronary angiography (CCTA) has described non-occlusive plaques in the left anterior descending coronary artery and proximal Right Coronary Artery (RCA) with an incidental finding of the anomalous RCA originating from the left sinus of Valsalva (LSoV). After this reassuring finding patient underwent invasive coronary angiography that has revealed multivessel disease including 75% LAD, OM1 and OM2 85% and RCA 80% stenosis and coronary artery by-pass graft surgery was recommended. We would like to raise some points in arguing the appropriateness of this patient’s surgical management. ESC and ACC/AHA guidelines recommend optimized medical treatment in patients with low-risk presentation based on typicality of chest pain and the functional test results as in this patient [2]. CCTA is known to have low positive predictive accuracy and tends to overestimate the degree of CAD. It was therefore surprising to see that the degree of the diameter stenosis was underestimated as well as the extent of coronary artery disease in this patient by CCTA was not recognized. One may argue that based on the functional and the non-invasive anatomical test results the best medical practice would have been tight risk factors control and guidelines based optimal medical management. The incidental finding of the CCTA of the Congenital Coronary Artery Anomaly (CCAA) with the RCA originating from the LSoV with inter-arterial course, based on the current clinical evidence, should not have changed management. Indeed, several prospective and retrospective observational studies showed that this type of CCAA is not associated with premature or sudden cardia death in contrast with those when the left coronary artery arises from the right sinus of Valsalva with inter-arterial course [3,4]. Our case-controlled study of 10 patients with the anomalous RCA from the LSoV showed no objective evidence of inducible ischemia on different functional test modalities and showed no event free survival difference compared to age sex and coronary artery disease severity disease matched controls in agreement with other studies [3,4]. In addition, since coronary grafts especially venous grafts have limited life expectancy [5], and one would assume that this young patient would need to undergo further revascularization in the future. We would suggest that best guideline based clinical practice with additional supportive evidence should guide our daily clinical judgement even in cases with complex coronary anatomy to the best interest of our patients [6].","PeriodicalId":90445,"journal":{"name":"Austin journal of clinical cardiology","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81411374","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":"Mechanisms of Heart Failure in Type 2 Diabetes Mellitus.","authors":"Shaodong Guo","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":90445,"journal":{"name":"Austin journal of clinical cardiology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4270344/pdf/nihms596125.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32926335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}