Učestalost anatomskih varijacija radijalne arterije u bolesnika podvrgnutih transradijalnoj kateterizaciji srca

Over the last ten years, transradial cardiac catheterization has been increasingly applied, primarily because of its lower incidence of complications compared to the femoral approach. However, one of the greatest flaws of the transradial approach is a relatively high incidence of catheterization failure (1%-5%). Anatomic variations of radial artery are ranked second among the reasons for this. Previous studies have not provided unambiguous data on the frequency of these anomalies. It was therefore the aim of this study to determine the frequency of anatomic variations using routine angiographies of radial artery during left heart catheterization. This was a retrospective study involving examination of 602 images of routine angiographies of radial artery performed during cardiac catheterization. The frequency of anatomic variations of radial artery was 8.8%, exclusive of tortuosities with a frequency of 12.7%. The most frequent anatomic variation was the high origin of radial artery, found in 31 (5.1%) subjects. Radioulnar loops, being one of the potential contraindications for the procedure, were reported in 2% of cases. Regression analysis revealed that age (p<0.001), female sex (p=0.015) and high origin (p=0.034) considerably contributed to the development of tortuosity. The results indicated the incidence of tortuosity to increase linearly with age. Although it is not a contraindication for continuing with the procedure, we recommend that elderly patients have angiography of radial artery performed at the beginning of the procedure due to the higher frequency of tortuosity.Posljednjih desetak godina kateterizacija srca transradijalnim pristupom sve se više koristi prvenstveno zbog rjeđih i lakših mogućih komplikacija u odnosu na femoralni pristup. Ipak, jedan od većih nedostataka transradijalnog pristupa je relativno visoka učestalost neuspjeha kateterizacije (od 1% do 5%). Na drugom mjestu uzroka iste nalaze se anatomske varijacije radijalne arterije (RA). Dosadašnji radovi nisu dali jednoznačne podatke o učestalosti ovih anomalija, stoga je cilj ovoga istraživanja bio odrediti učestalost anatomskih varijacija pomoću rutinskih angiografija RA prilikom PTCA/PCI. Radi se o retrospektivnoj studiji u kojoj su pregledane 602 snimke rutinskih angiografija RA učinjene prilikom kateterizacije srca. Učestalost anatomskih varijacija RA iznosila je 8,8%, ne uključujući tortuozitete učestalost kojih iznosi 12,7%. Najčešća anatomska varijacija je bila visoko polazište RA u ukupno 31 (5,1%) ispitanika. Radioulnarne petlje kao jedna od potencijalnih kontraindikacija za zahvat pojavile su se u 2% slučajeva. Regresijska analiza je pokazala da godine starosti (p<0,001), ženski spol (p=0,015) i visoko izlazište (p=0,034) značajno doprinose razvoju tortuoziteta. Rezultati ukazuju na to da se učestalost tortuoziteta s godinama linearno povećava. Iako isti nisu kontraindikacija za nastavak zahvata, preporučamo da se zbog veće učestalosti tortuoziteta kod starijih bolesnika na početku zahvata učini angiografija RA s ciljem izbjegavanja potencijalnih komplikacija zahvata

Atrial fibrillation as a contributing factor in the diagnostic algorithm for coronary subclavian steal syndrome and cardiac tamponade following coronary artery bypass graft surgery: a case study

Coronary subclavian steal syndrome (CSSS) is a complica - tion of coronary artery bypass graft (CABG) surgery in pa - tients with coexistent significant subclavian artery stenosis (SAS). It is characterized by a retrograde blood flow through the left internal mammary artery graft from the coronary to subclavian circulation, leading to myocardial ischemia. Current screening for CSSS includes bilateral blood pres - sure measurement for the detection of a significant interarm blood pressure difference. However, the commonly used automated sphygmomanometers have limited accu - racy in patients with atrial fibrillation. Consequently, these patients are often underdiagnosed. We present a case of a 73-year-old man with a medical history of atrial fibrillation, peripheral artery disease, and CABG surgery four months before the current event, who came to the emergency de - partment due to progressive dyspnea. The initial diagnos - tic management showed a large circulatory pericardial effusion, so the patient was admitted to the coronary care unit and underwent pericardial drainage. In the following days, due to a sudden high increase in cardiac troponin, the patient underwent an urgent coronary angiography, which revealed severe left SAS with functional CABG, indi - cating the occurrence of CSSS. Percutaneous transluminal angioplasty was then performed with an optimal angio - graphic result. The patient was discharged in good condi - tion with adequate medicament therapy and instructions. This case report highlights atrial fibrillation as a contribut - ing factor for the diagnosis of CSSS and pericardial tam - ponade after CABG surgery. Furthermore, we suggest a di - agnostic approach that can reduce the incidence of both these severe complication

Causes of Elevated Troponin in Patients with Normal Coronary Angiography

Porast troponina u većini slučajeva upućuje na oštećenje stanica miokarda, no povišene vrijednosti troponina nisu uvijek posljedica infarkta ili ishemije. Svrha je ovog istraživanja bila osvijetliti različite uzroke povišenoga troponina u bolesnika s normalnim nalazom koronarografije. U Kliničkom bolničkom centru Zagreb 2014. godine izdvojeno je 947 bolesnika iz baze podataka Laboratorija za invazivnu kardiologiju, u kojih je učinjena koronarografija radi postavljanja dijagnoze akutnoga koronarnog sindroma (ACS). Trideset dva bolesnika (3,38 %) nisu imala uzrok oštećenja miocita od koronarne bolesti srca (CAD), definiranoj kao stenoza lumena koronarnih arterija veća od 30 %. Porast miokardnoga troponina T (cTnT) u bolesnika s normalnim koronarnim arterijama rezultat su različitih uzroka, uključujući hipertenzivnu bolest srca, Takotsubo sindrom, supraventrikulsku tahikardiju, miokarditis i dilatativnu kardiomiopatiju, da spomenemo samo neke. Osim u ACS-u, cTnT može biti povišen u nizu različitih stanja, o čemu treba razmišljati kada se razmatra klinička slika, i to može biti odraz nekroze miokarda i u odsutnosti značajne CAD.Troponin elevation usually indicates myocardial cell injury. However, elevated values of troponin are not always a consequence of infarction or ischemia. The aim of this study was to elucidate the diverse etiologies of elevated troponin in patients with normal coronary angiography. There were 947 patients at the Zagreb University Hospital Centre identified from the catheterization database who underwent coronary angiography in 2014 due to suspected acute coronary syndrome. We identified 32 (3.38%) patients who had an alternative cause for myocyte injury other than coronary artery disease, defined as coronary artery lumen stenosis above 30%. The elevation of cardiac troponin T (cTnT) in patients with normal coronary angiography was found to be the consequence of diverse etiologies, including hypertensive heart disease, Takotsubo syndrome, supraventricular tachycardia, myocarditis, and dilated cardiomyopathy, to name a few. Apart from acute coronary syndrome, cTnT can be elevated in a number of different conditions, which should be considered according to clinical presentation, and that could still reflect myocardial necrosis even in the absence of significant coronary artery disease