Anomalous origin of the right coronary artery from the proximal left anterior descending artery and a single coronary artery anomaly: Three case reports

AbstractThe anomalous origin of the right coronary artery (RCA) as a branch of the left anterior descending (LAD) artery is a very rare variation of single coronary artery. We have reported three cases in the last 10years. Among 15,000 coronary angiograms, at least 40 cases have been described previously in the literature. The vast majority of previous reports have described a single anomalous vessel with its origin after the first septal perforator of the LAD. Two of our patients presented with acute coronary syndrome and were found to have three vessel disease and left main. They underwent coronary artery bypass graft surgery (CABG) and third case presented with tachycardia had only mild coronary artery disease (CAD) and was treated medically

The Role of Exercise Electrocardiographic Test in Determining the Extent of Coronary Artery Disease in Comparison to Coronary Angiography in Erbil-Iraq

Background and objective: Exercise Electrocardiographic Test (EET) is one of non-invasive modalities used to assess patients with  coronary artery disease (CAD). The objective of this study was to evaluate the role of this test in determining the extent of CAD in comparison with coronary angiography among a sample in Erbil-Iraq. Patients and Methods: The study was conducted from April 2014 to April 2015 in Erbil-Iraq. A total of 160 adult patients with anginal chest pain and normal baseline 12-lead electrocardiographic (ECG) test were evaluated. All patients underwent EET and coronary angiography. Among these patients, only 83 patients (58 males and 25 females) with positive coronary angiographic results were included in this study. Patients with positive coronary angiographic results were classified into three groups according to the number of coronary artery involved. A correlation between EET and coronary angiographic results was studied. Results: There were 160 patients in this study, 115 patients (71.87%) of them had positive EET. Out of 115 patients, only 83 patients (72.1%) had positive coronary angiographic test. Those patients were further classified into three groups according to the number of the coronary artery involved, Group 1; nine patients with one vessel, Group 2; 43 patients with two vessel, and Group 3; 31 patients with three vessel diseases . Typical anginal chest pain, the number of risk factors, ST/HR index, the number of leads with ST segment depression, timing, and depth of ST segment depression showed statistically significant association with the number of vessel involved. Conclusion: Positive EET was more in patients with two and three vessel disease. EET is of greatest diagnostic value in patients with typical anginal chest pain . Keywords: Exercise electrocardiographic test, coronary artery disease, coronary angiography

Accelerated coronary vascular disease in the heart transplant patient: Coronary arteriographic findings

AbstractAnnual coronary arteriograms have been obtained from all heart transplant recipients at Stanford University Medical Center since 1969. Angiographic lesions in 81 transplant patients exhibiting coronary vascular disease were classified into three categories: type A, discrete or tubular stenoses; type B, diffuse concentric narrowing; and type C, narrowed irregular vessels with occluded branches. The 81 arteriograms showing transplant coronary vascular disease were contrasted with 32 from nontransplant patients with coronary artery disease analyzed in a similar fashion.The nontransplant angiograms showed 178 lesions, all of type A (discrete or tubular) morphology, 75% of which were located in primary epicardial coronary vessels and 25% in secondary branch vessels. In the patients with transplant coronary vascular disease, 349 (76%) of 461 lesions were type A: 57% in primary vessels, 42% in secondary branches and 1.4% in tertiary branches. Of the 112 type B and C lesions (diffuse narrowing, tapering and obliteration), 25% were in primary vessels, 44% in secondary vessels and 31% in tertiary branches (p < 0.05 for patients with transplant coronary vascular disease versus patients with nontransplant coronary artery disease). Total vessel occlusion was found in proximal or middle vessel segments in 96% and distally in 4% of patients with “ordinary” coronary artery disease versus 49% distally in patients with transplant coronary disease (p < 0.002). In the presence of total vessel occlusion, collateral vessels were poor or absent in 92% of transplant versus 7% of nontransplant patients with coronary disease (p < 0.002).Therefore, coronary artery disease in transplant patients represents a mixture of typical atheromatous lesions and unique transplant-related progressive distal obliterative disease that occurs without collateral vessel development

Pattern of coronary artery occlusion in patients undergoing coronary angiography at Birat Medical College Teaching Hospital

Introduction: Coronary artery disease (CAD), is the leading cause of death globally. Among different diagnostic and treatment procedures, coronary angiography is considered the gold standard. Birat Medical College Teaching Hospital (BMCTH) is also providing cardiovascular services to people from eastern Nepal and from the neighboring country India. We aim to analyze the pattern of coronary artery occlusion in patients undergoing coronary angiography. Method: A hospital based observational cross-sectional study was conducted at BMCTH from 10 Sep 2022 to 10 Jan 2023. A total of 220 patients were enrolled by consecutive sampling techniques. Ethical approval was obtained from the Institutional Review Committee of BMCTH.  Data was collected on baseline characteristics, risk factors, clinical presentation and degree of coronary artery occlusion. Collected data was entered in Microsoft Excel and analyzed by Statistical Package for Social Sciences version 23. Frequency, mean, percentage were calculated. Result: Nearly half (49.1%) patients had significant, 6(2.7%) had intermittent CAD and 14(6.4%) had non critical CAD. Three patients (1.4%) had left main coronary artery disease. Left anterior descending artery 66(30%) was the most commonly involved. Single vessel disease was present in most patients 49(22.27%).  Double vessel disease 15(46.8%) and triple vessel disease was more common 14(51.8%) in above 65 y of age. Conclusion: The coronary angiography revealed presence of significant coronary artery disease and multiple vessel involvement with increasing age

Olbrzymi tętniak obejmujący kilka tętnic wieńcowych, w tym pień tętnicy wieńcowej lewej, powodujący objawy ostrego zespołu wieńcowego u 23-letniego chorego: nietypowe powikłanie choroby Kawasaki

The reported incidence of coronary artery aneurysms (CAA) on angiography varies between 0.3 to 5.3%. Right coronary artery is the most commonly affected followed by left circumflex or left anterior descending artery. Three-vessel or left main involvement is exceedingly rare. Atherosclerosis accounts for the vast majority of CAAs in adults, whereas Kawasaki disease is responsible for most cases in children. We report a rare case of Kawasaki disease associated with giant aneurysms ( > 8 mm) in coronary circulation, including left main coronary artery in 23-year-old male having maturity onset diabetes (MODY), who presented with acute coronary syndrome.The reported incidence of coronary artery aneurysms (CAA) on angiography varies between 0.3 to 5.3%. Right coronary artery is the most commonly affected followed by left circumflex or left anterior descending artery. Three-vessel or left main involvement is exceedingly rare. Atherosclerosis accounts for the vast majority of CAAs in adults, whereas Kawasaki disease is responsible for most cases in children. We report a rare case of Kawasaki disease associated with giant aneurysms ( &gt; 8 mm) in coronary circulation, including left main coronary artery in 23-year-old male having maturity onset diabetes (MODY), who presented with acute coronary syndrome

Insulin Resistance Predicts Severity of Coronary Atherosclerotic Disease in Non-Diabetic Patients

Background: Insulin resistance (IR) in patients with type 2 diabetes mellitus (T2DM) represents a predictor of coronary artery disease (CAD). However, how IR is able to impact the severity of coronary atherosclerosis in non-diabetic patients is unknown. Objectives. We investigated the relation between the IR and the extent and severity of coronary atherosclerosis in non-diabetic patients referred to coronary angiography (CA) Methods: Consecutive patients undergoing to CA for acute coronary syndromes or stable angina were analyzed. The IR was assessed by mean of the homeostasis model assessment of insulin resistance (HOMA-IR) whereas the SYNTAX score (SS) was used as index of the severity of coronary atherosclerosis Results: Overall, 126 patients were included, with a median SS of 12 (IQR 5.25–20.5). Patients were divided in four groups according to the distribution in quartiles of SS (SS1-2-3-4). A significant correlation between HOMA-IR and SS was observed, especially in women. A progressive increase of HOMA-IR was observed in parallel with the increasing severity (from SS1 to SS4) and extension (1-2-3-vessel disease) of coronary atherosclerosis. Multivariable analysis showed that the HOMA-IR was the strongest independent predictor of severe (SS4) and extensive (three-vessel disease) coronary atherosclerosis. Conclusion: Insulin resistance goes hand in hand with the extension and severity of coronary atherosclerosis in non-diabetic patients. The HOMA index is an independent predictor of three-vessel disease at CA. The HOMA index could be useful for risk stratification of CAD even in absence of T2D

Relationship of serum angiogenin, adiponectin and resistin levels with biochemical risk factors and the angiographic severity of three-vessel coronary disease

Background: Patients with advanced coronary artery disease (CAD) have an unfavorable prognosis. Therefore, early identification of this high-risk group is important. The aim of this study was to assess the usefulness of clinical, electrocardiographic and echocardiographic parameters supported by novel atherogenesis and angiogenesis markers in identifying patients with stable, three-vessel coronary artery disease. Methods: The study group comprised 107 patients suffering from three-vessel CAD and a control group of 15 patients presenting with typical angina, a positive exercise stress test and abnormal segmental contractility, but no hemodynamically significant coronary stenosis in their angiograms. In each patient, we characterized a biochemistry test panel including novel markers: angiogenin, resistin, adiponectin, IL-8 and a TNF-a. The angiographic severity of CAD was expressed as a Gensini score. Results: There were significant differences between three-vessel CAD patients and control groups with respect to the serum levels of: hsCRP (2.8 vs 1.4 mg/L, p = 0.01), HDL-cholesterol (45 vs 54 mg/dL, p = 0.04), LDL-cholesterol (102 vs 95 mg/dL, p = 0.04), NT-proBNP (392 vs 151 pg/mL, p = 0.008) and a marker of angiogenetic activity, angiogenin (414 vs 275 ng/mL, p = 0.02), However, no significant differences were found between three-vessel CAD and the control group with respect to the serum level of adiponectin (8.08 vs 7.82 &#956;g/mL), resistin (17.5 vs 21 ng/mL), IL-8 (20.7 vs 26.8 pg/mL) and TNF-a (4.1 vs 4.3 pg/mL). Angiogenin tended to be higher in patients with higher Gensini scores (p = 0.06) but no influence of ejection fraction was noted. Conclusions: Angiogenin is a novel marker of three-vessel coronary disease showing a relationship with the angiographic severity of the disease. (Cardiol J 2010; 17, 6: 599-606

Diabetic patient with three-vessel disease and left main involvement. Surgery yes, but not always

AbstractCoronary artery disease (CAD) is known to be the main cause of morbidity and mortality in patients with diabetes mellitus. Although they do not often show typical recognized symptoms, diabetic patients suffer from more extensive CAD and hence higher incidence of multi-vessel CAD than in non-diabetic subjects. Literature has given the strength of evidence in favor of surgical revascularization in diabetic patients with multi-vessel disease. We report the case of a 61-year old active smoker and diabetic man with atypical symptoms and positive treadmill test. The coronary angiography revealed a severe three-vessel disease and distal left main involvement (SYNTAX score=49). As the patient refused to follow heart team indication to undergo coronary bypass grafting, a percutaneous coronary intervention was successfully performed with intra-aortic balloon counterpulsation support and intravascular ultrasound optimization. The mid-term outcome was good