Successful recanalisation of chronic total occlusion using retrograde approach

Chronic total occlusion (CTO) is defined as an occlusion of a coronary vessels (TIMI 0 flow) lasting longer than 3 months. Successful recanalisation of CTO improves left ventricular function and survival. Retrograde technique can be used in patients, who have well-developed collaterals, when the antegrade approach is ineffective or difficult to perform. A 68-year-old male was referred for coronary angiography because of exercise angina chest pain. Coronary angiogram showed a CTO of RCA with collaterals from LAD. Following the unsuccessful traditional antegrade approach in 2004, we attempted a retrograde approach. The PCI procedure was performed successfully and without complications

Artykuł oryginalnyPostępowanie wewnątrzszpitalne i śmiertelność u chorych z ostrym zawałem mięśnia sercowego bez uniesienia i z uniesieniem odcinka ST. Dane z Małopolskiego Rejestru Ostrych Zespołów Wieńcowych

Background: According to the presenting electrocardiogram, acute myocardial infarction (MI) can by categorised generally as non-ST-segment elevation MI (NSTEMI) and ST-segment elevation MI (STEMI). Aim: To assess the impact of the different acute MI categories on in-hospital management and mortality in hospitals without on-site invasive facilities. Methods: We identified 380 NSTEMI and 334 STEMI patients treated in the Malopolska Registry of Acute Coronary Syndromes from February to March 2005 and from December 2005 to January 2006. Data concerning in-hospital management and mortality were assessed. Results: Patients with NSTEMI were older and were more likely to have prior angina, prior MI and prior heart failure symptoms than STEMI patients. The NSTEMI patients were less likely to be transferred for invasive treatment (23.9 vs. 41.9%, pWstęp: Na podstawie zmian obserwowanych w zapisie EKG ostry zawał mięśnia sercowego może być ogólnie skategoryzowany jako przebiegający bez uniesienia (NSTEMI) i z uniesieniem odcinka ST (STEMI). Cel: Określenie wpływu różnych kategorii zawału na przebieg postępowania wewnątrzszpitalnego i śmiertelność w szpitalach bez bezpośredniego dostępu do pracowni hemodynamiki. Metody: W Małopolskim Rejestrze Ostrych Zespołów Wieńcowych zidentyfikowano 380 chorych z rozpoznaniem NSTEMI i 334 ze STEMI leczonych w okresie od lutego do marca 2005 r. i w okresie od grudnia 2005 do stycznia 2006 r. Oceniono dane dotyczące postępowania wewnątrzszpitalnego i śmiertelności. Wyniki: Chorzy z NSTEMI byli starsi, częściej stwierdzano u nich wcześniejsze objawy dusznicy bolesnej i niewydolności krążenia oraz przebyty zawał serca niż u chorych ze STEMI. Chorzy z NSTEMI rzadziej byli przekazywani w celu leczenia inwazyjnego (23,9 vs 41,9%,

Chorzy trudni nietypowiUdrożnienie techniką retrograde przewlekle zamkniętej prawej tętnicy wieńcowej

Chronic total occlusion (CTO) is defined as an occlusion of a coronary vessels (TIMI 0 flow) lasting longer than 3 months. Successful recanalisation of CTO improves left ventricular function and survival. Retrograde technique can be used in patients, who have well-developed collaterals, when the antegrade approach is ineffective or difficult to perform. A 68-year-old male was referred for coronary angiography because of exercise angina chest pain. Coronary angiogram showed a CTO of RCA with collaterals from LAD. Following the unsuccessful traditional antegrade approach in 2004, we attempted a retrograde approach. The PCI procedure was performed successfully and without complications

In-hospital management and mortality in elderly patients with non-ST-segment elevation acute coronary syndromes treated in centers without on-site invasive facilities

Background: The purpose was to assess age-related differences in hospital management and mortality in non-ST-elevation acute coronary syndrome (NSTE ACS) patients treated conservatively, with a focus on the influence of aggressive pharmacological treatment on in-hospital clinical outcome. Methods: We identified 807 NSTE ACS patients treated conservatively in the 29 hospitals participating in the Krakow Registry of Acute Coronary Syndromes from February to March 2005 and from December 2005 to January 2006. Out of 807 patients&#8217; 32.1% were less than 65 years of age, 33% from 65 to 74, 30.5% from 75 to 84, and 5.3% &#8805; 85. For all patients, pharmacotherapy index based on the use of pharmacological treatment regimen during hospital stay was assessed. Each patient received 1 point for each of the following guideline-recommended drugs used: aspirin, clopidogrel, glycoprotein IIb/IIIa inhibitor, LMWH, beta-blocker, ACE inhibitor/angiotensin II receptor blocker and statin &#8212; the range of points being from 0 to 7. Results: Significant age-related differences in baseline characteristics and pharmacotherapy index values were found. In-hospital mortality was higher in elderly patients (2.4% vs. 3.4% vs. 8.9% vs. 14.0%, respectively for age groups, p < 0.0001). Similarly, in non-shock patients and in patients with elevated cardiac markers, age-dependent differences in mortality were observed. Independent predictors of in-hospital death were: age, cardiogenic shock, elevated cardiac markers and pharmacotherapy index. Conclusions: Advanced age is associated with less aggressive pharmacological treatment and higher in-hospital mortality in NSTE ACS patients remaining in community hospitals for conservative treatment. Broader implementation of current guidelines and more frequent invasive treatment might improve the outcomes of NSTE ACS patients regardless of age

Paroxysmal sustained ventricular tachycardia with cardiac arrest and myocardial infarction in 29-year-old man addicted to medical marijuana-it never rains but it pours

This article presents the case of a 29-year-old male patient, addicted to prescribed medical marijuana administered for mixed anxiety and depressive disorder and without classic cardiovascular risk factors and history of myocarditis, suffering from episodes of paroxysmal hemodynamically unstable ventricular tachycardia. Cardiovascular magnetic resonance imaging of the heart revealed disseminated non-ischemic myocardial injury lesions of subepicardial and intramuscular location. Additionally, the individual experienced myocardial infarction without ST segment elevation following marijuana intake. Treatment required implantation of a cardioverter-defibrillator and ablation of the myocardial areas responsible for the origin of the arrhythmia, as well as appropriate pharmacotherapy and marijuana addiction treatment