Pheochromocytoma mimicking a non-ST elevation acute myocardial infarction

We report a 57 year-old male patient admitted with a diagnosis of non-ST elevation acute myocardial infarction. He had suffered from chest pain, diaphoresis and intense asthenia for three days. The electrocardiogram on admission showed a high frequency sinus tachycardia. Troponin T levels were elevated. An echocardiogram suggested an antero-lateral myocardial infarction. Eventually, a left adrenal pheochromocytoma was discovered. Left ventricular function, severely depressed, returned to normal after medical and surgical therapy

Atherosclerotic Monstrous Double Aneurysm of the Left Main Coronary Artery: A Very Rare Angiographic Finding

Coronary artery aneurysm is a rare disease diagnosed in 0.3 to 4.9% of patients undergoing coronary angiography. The incidence of left main coronary artery aneurysm (LMCAA) is extremely rare: 0.1% [1]. Coronary artery aneurysm involves the right coronary artery, the left anterior descending and circumflex coronary arteries in descending order of frequency [2] and atherosclerosis is the most common cause. Other causes include arteritis, Kawasaki disease, angioplasty sequelae, laser procedures, traumatic injury, dissection, connective tissue disorders, Takayasu’s arteritis, congenital (anomaly or genetic disorders such as Ehler-Danlos syndrome, Marfan syndrome) mycotic and idiopathic diseases. Although surgery has been recommended to prevent complication, there are no large available data comparing medical and surgical therapy [3-5]. The LMCAA is a rare clinical entities, encountered incidentally in approximately 0.1% of patients undergone routine angiography [6,7]. The sizes of LMCAAs may be fusiform or saccular. Management of these cases is still controversial, based on anedoctal experience rather than controlled trials.</p

Mitral Valve Obstruction and Pulmonary Hypertension Caused by a Giant Left Atrial Myxoma Prolapsing in the Left Ventricle

Atrial myxomas are the most common primary cardiac tumors to diagnose. They are benign and have variable presentation. They have an excellent prognosis following surgical excision. We report a case of a 60 year old female who presented with initial signs of both right and left heart failure, fever and cough. Auscultation of the heart revealed an apical mid diastolic murmur. Trans-thoracic and transesophageal echocardiography revealed a pedunculated, giant left atrial myxoma that prolapsed through the mitral valve into the left ventricle in diastole producing functional mitral valve stenosis. The patient underwent a successful surgical excision of the tumor. The diagnosis and management of atrial myxomas is here reviewed.</p

Outcome of patients on oral anticoagulation undergoing coronary artery stenting: data from discharge to 12 months in the Warfarin and Coronary Stenting (WAR-STENT) Registry

To obtain further, and more focused, information on the efficacy and safety of the antithrombotic regimens, including triple therapy (TT) of warfarin, aspirin, and clopidogrel; dual therapy (DT) of warfarin and single antiplatelet agent (aspirin or clopidogrel); and dual-antiplatelet therapy (DAPT) of aspirin and clopidogrel, prescribed to patients on oral anticoagulation (OAC) undergoing percutaneous coronary intervention with stent (PCI-S)

Design of the PERSEO Registry on the management of patients treated with oral anticoagulants and coronary stent

Aim Percutaneous coronary intervention with stent implantation (PCI-S) in patients requiring chronic oral anticoagulant therapy (OAC) is associated with an increased risk of bleeding and ischemic complications. Different randomized studies showed a significant advantage of a double antithrombotic therapy and superiority of direct oral anticoagulant (DOAC) compared with warfarin, but real-world data are limited. Aim is to evaluate the antithrombotic management and clinical outcome of patients with an indication for OAC who undergo PCI-S in a 'real-world' setting. Methods The multicentre prospective observational PERSEO (PERcutaneouS coronary intErventions in patients treated with Oral anticoagulant therapy) Registry (ClinicalTrials.gov Identifier: NCT03392948) has been designed to enrol patients requiring OAC treated by PCI-S in 25 Italian centres. A target of at least 1080 patients will be followed for 1 year and data on thromboembolic and bleeding events and changes in antithrombotic therapy will be registered. The primary end point is a combined measure of efficacy and safety outcome (NACE), including major bleeding events and major adverse cardiac and cerebral events at 1-year follow-up in patients treated with DOAC (and dual or triple antiplatelet therapy) compared with the corresponding strategies with vitamin K antagonists. A secondary prespecified analysis has been defined to evaluate NACE in dual versus triple antithrombotic therapy after hospital discharge at 1-year follow-up. Conclusion The PERSEO Registry will investigate in a 'real world' setting the safety and efficacy of DOAC versus warfarin and dual versus triple antithrombotic therapy in patients with indication for oral anticoagulant therapy who undergo PCI-S