Multiple Culprit Coronary Artery Thrombosis in a Patient with Coronary Ectasia

We here report a case of ST-elevation myocardial infarction (STEMI) due to simultaneous acute coronary artery occlusions of two major coronary arteries in a patient with coronary ectasia. The patient had been previously submitted to percutaneous coronary angioplasty with bare metal stent implantation in both culprit vessels. Very late stent thrombosis could be the cause of the first occlusion, triggering the event in the other vessel. In addition, concomitant embolic sources were not identified. Although routine aspiration thrombectomy in STEMI was not proven to be beneficial in randomized clinical trials, it was of great value in this case. We also discuss the relation between coronary ectasia, chronic inflammatory status, and increased platelet activity which may have caused plaque disruption in another already vulnerable vessel

ST elevation myocardial infarction with extensive coronary thrombus in a patient with sickle cell anemia myocardial infarction in patients with sickle cell

O infarto agudo do miocárdio em pacientes com anemia falciforme é, muitas vezes, subdiagnosticado em virtude de fatores de confusão (por exemplo, doença vaso-oclusiva, levando a crises dolorosas). Na maioria dos casos relatados na literatura, as artérias coronárias estavam pérvias e sem lesões. Neste relato de caso, descrevemos a presença de trombo coronariano extenso em paciente com anemia falciforme, apresentando-se sob a forma de infarto agudo do miocárdio com supradesnivelamento do segmento ST, manejado satisfatoriamente com a associação de anticoagulantes e antiplaquetários.Myocardial infarction in patients with sickle cell anemia is often underdiagnosed due to confounding factors (e.g., vaso-occlusive disease leading to painful crisis). In the majority of reported cases, the coronary arteries were pervious and without stenotic lesions. In this case report, we describe the presence of an extensive coronary thrombus in a patient with sickle cell anemia presenting with ST elevation myocardial infarction, managed satisfactorily with the association of anticoagulants and antiplatelet drugs

Ultrasound-guided antecubital vein approach for right heart catheterisation in a Brazilian tertiary centre

Objective As a parallel to the radial approach for left heart catheterisation, forearm veins may be considered for the performance of right heart catheterisation. However, data regarding the application of this technique under ultrasound guidance are scarce. The current study aims to demonstrate the feasibility of right heart catheterisation through ultrasound-guided antecubital venous approach in the highly heterogeneous population usually referred for right heart catheterisation. Methods Data from consecutive right heart catheterisations performed at an academic centre in Brazil, between January 2016 and March 2017 were prospectively collected. Results Among 152 performed right heart catheterisations, ultrasound-guided antecubital venous approach was attempted in 127 (84%) cases and it was made feasible in 92.1% of those. Yet, there was no immediate vascular complication with the antecubital venous approach in this prospective series. Conclusions Ultrasound-guided antecubital venous approach for the performance of right heart catheterisation was feasible in the vast majority of cases in our study, without occurrence of vascular complications

Complete revascularization versus treatment of the culprit artery only in ST elevation myocardial infarction : a multicenter registry

Fundamento: São restritos os dados sobre o manejo e o prognóstico dos pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMCSST) com acometimento multiarterial no Brasil, o que mostra a necessidade de investigar as estratégias de revascularização disponíveis. Objetivo: Avaliar os desfechos relacionados à revascularização completa em comparação com o tratamento da artéria culpada em pacientes multiarteriais com IAMCSST. Métodos: Foi realizada um estudo de coorte prospectiva em dois centros de hemodinâmica do Sul do Brasil, com seguimento de 1 ano após a intervenção índice. O desfecho primário foi composto de óbito cardiovascular, reinfarto ou angina recorrente e secundários acidente vascular encefálico, parada cardiorrespiratória não fatal, sangramento maior ou necessidade de reintervenção. A probabilidade de ocorrência de desfechos foi comparada entre os grupos através de regressão logística binária. Considerou-se como estatisticamente significativo o valor de probabilidade < 0,05. Resultados: Participaram 85 pacientes, com média de idade de 62±12 anos, sendo 61 (71,8%) do sexo masculino. Cinquenta e oito (68,2%) pacientes receberam a estratégia de revascularização completa e 27 (31,8%), a de revascularização incompleta. A chance de ocorrência tanto do desfecho primário quanto do secundário foi significativamente maior entre os indivíduos tratados com revascularização incompleta quando comparados com os tratados com estratégia completa [razão de chances (OR) 5,1, intervalo de confiança de 95% (IC95%) 1,6-16,1 vs. OR 5,2, IC95% 1,2-22,9, respectivamente], assim como os óbitos cardiovasculares (OR 6,4, IC95% 1,2-35,3). Conclusão: Dados deste registro regional, de dois centros do Sul do Brasil, demonstram que a estratégia de revascularização completa esteve associada à redução significativa dos desfechos primário e secundário no seguimento de 1 ano quando comparada à estratégia de revascularização incompleta.Background: Data on the management and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease are limited in Brazil, showing that the available revascularization strategies should be investigated. Objective: To assess the outcomes of complete revascularization versus treatment of the culprit artery only in patients with STEMI and multivessel disease. Methods: A prospective cohort study was conducted at two medical centers in southern Brazil with a 1-year follow-up after the index procedure. The primary outcome was a composite of cardiac death, reinfarction, or recurrent angina, while the secondary outcome was stroke, nonfatal cardiac arrest, major bleeding, or need for reintervention. The probability of outcomes occurring was compared between the groups using binary logistic regression. A p-value < 0.05 was considered statistically significant. Results: Eighty-five patients were included. Their mean age was 62±12 years, and 61 (71.8%) were male. Fifty-eight (68.2%) were treated with complete revascularization and 27 (31.8%) with incomplete revascularization. The chance of both the primary and secondary outcomes occurring was significantly greater among patients treated with incomplete revascularization when compared to those treated with complete revascularization (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6-16.1 vs. OR 5.2, 95% CI 1.2-22.9, respectively), as well as cardiac death (OR 6.4, 95% CI 1.2-35.3). Conclusion: Registry data from two centers in southern Brazil demonstrate that the complete revascularization strategy is associated with a significant reduction in primary and secondary outcomes in a 1-year follow-up when compared to the incomplete revascularization strategy

Heart failure secondary to myocarditis after SARS-CoV-2 reinfection : a case report

Introduction: Cardiac involvement in COVID-19 can range from mild damage to severe myocarditis. The precise mechanism by which COVID-19 causes myocardial injury is still unknown. Myocarditis following administration of COVID-19 vaccines, especially those based on mRNA, has also been described. How- ever, no reports of heart failure following reinfection with SARS-CoV-2 in patients immunized with an inactivated vaccine have been identified. Case description: The patient was a 47-year-old male construction worker of African descent, with type II diabetes and a history of infection by SARS-CoV-2 in December 2020 and May 2021, confirmed by RT-PCR. He received two doses of an inactivated vaccine against COVID-19. Between the two COVID-19 episodes with positive RT-PCR, he had two episodes of bacterial lung infection. After the second episode of SARS-CoV-2 infection, he was diagnosed with severe heart failure as a sequela of myocarditis. Conclusion: It is essential to perform a thorough follow-up after infection with SARS-CoV-2 since, even with proper immunization, it is possible that the patient was reinfected and suffered severe cardiac se- quelae as a consequence. The hypothesis of an etiology associated with the use of an inactivated vaccine against COVID-19, with a potential immune enhancement mechanism following reinfection with SARS-CoV-2, cannot be rejected