Coronary-Cameral Fistula with Angina Pectoris

Coronary-cameral fistula (CCF) is an anomalous connection between a coronary artery and cardiac chamber. Most of CCFs are discovered incidentally during angiographic evaluation for coronary vascular disorder. We report a case of CCF with angina pectoris. Selective coronary arteriography revealed diffuse CCF involving the left anterior descending artery (LAD) emptying into left ventricle (LV) and showed significant two-vessel coronary artery stenosis

ST segment elevation following sinoventricular rhythm in a patient with diabetic ketoacidosis

Diabetic ketoacidosis is a major cause of morbidity and mortality in patients with insulin dependent diabetes. Myocardial infarction is an uncommon but well-recognised precipitating cause of diabetic ketoacidosis, accounting for 1% of cases. Many diabetic patients with ketoacidosis initially present with hyperkelamia, which may affect the electrocardiographic morphology. We present a patient with diabetic ketoacidosis and hyperkalemia, whose initial electrocardiogram showed a sinoventricular rhythm and subsequently pseudoinfarction pattern. (Cardiol J 2007; 14: 497-499

Plasma fibrinogen level may predict critical coronary artery stenosis in young adults with myocardial infarction

Background: This study aims to determine the role of hematological variables in determining critical coronary artery stenosis in young adults with myocardial infarction. Methods: This study includes 76 of 1,804 patients who applied to our hospital between January 2001 and December 2005. All were under 35 years old, diagnosed as acute myocardial infarction with clinical and laboratory findings, and had coronary angiography. Study patients were divided into two groups: those having critical coronary artery lesions (group I) and those having normal coronary arteries (group II). Then we compared these groups for age, sex, body mass index, risk factors, plasma protein C, protein S, antithrombine III and fibrinogen. Student t test, the c2 test, Fisher’s exact test and Mann Whitney U test were used. Results: There were no differences between the two groups in terms of hypertension (p = 0.70), smoking (p = 0.50), hyperlipidemia (p = 0.09), body mass index (p = 0.14), family history (p = 0.10), plasma protein C (p = 0.08), protein S (p = 0.35) or antithrombine III (p = 0.60). Plasma fibrinogen levels were significantly higher in group I than in group II (p = 0.001). Conclusions: Our study shows that high plasma fibrinogen levels may be used as a predictor of critical coronary artery lesions in young patients with acute myocardial infarction

The relationship between coronary artery disease and uric acid levels in young patients with acute myocardial infarction

Background: Serum uric acid concentrations are higher in patients with established coronary artery disease than in healthy controls. This study aimed to determine the role of uric acid in predetermining coronary artery disease in young patients with acute myocardial infarction (AMI). Methods: This study included 80 of 1612 patients who applied our hospital between January 2000 and December 2005. All of the patients were under 35 years old, diagnosed with AMI by clinical and laboratory findings, and had coronary angiography. The study population was divided into two groups, the first having critical coronary artery disease (group I) and the second having normal coronary arteries (group II). Then we compared these groups with age, body mass index, risk factors, serum protein C, protein S, antithrombin III, creatinine and uric acid levels. Results: Myocardial infarction was located in 65% anterior, 15% inferior, 15% inferiolateral and 5% high lateral, respectively. Forty five % of patients had critical coronary artery disease (group I, n = 36) and 55% had normal coronary arteries (group II, n = 44). There were no differences in the two groups with regard to body mass index, family history, hypertension, smoking, cholesterol level, triglyceride level and creatinine level, lack of protein C, lack of protein S or lack of antithrombin III. Serum uric acid levels were found to be higher in group I (7.0 &plusmn; &plusmn; 1.4 mg/dL) than in group II (4.9 &plusmn; 1.1 mg/dL; p = 0.003). Conclusions: This study showed that high serum uric acid levels were associated with critical coronary artery disease in young patients (< 35 years) with AMI (Cardiol J 2008; 15: 21-25

Bidirectional tachycardia in a patient with pulmonary embolism

We report a 55 year-old man with sudden cardiac arrest. Electrocardiography revealed runs of bidirectional ventricular tachycardia, and transthoracic echocardiography showed indirect findings of pulmonary embolism. (Cardiol J 2010; 17, 2: 194-195

Percutaneous coronary intervention of a single coronary artery arising from the right sinus of Valsalva

Anomalous origin of the left main coronary artery from the right sinus of Valsalva is extremely rare when not associated with other congenital cardiac anomalies. In this report we present a patient with a single coronary ostium, with both the left and right coronary artery systems arising from it. The right coronary artery was found to contain a significant flow-limiting lesion that was successfully treated with percutaneous coronary intervention

Rytm zatokowo-komorowy oraz następcze uniesienie odcinka ST u pacjenta z ketonową kwasicą cukrzycową

Ketonowa kwasica cukrzycowa jest jedną z głównych przyczyn hospitalizacji i śmiertelności u chorych na cukrzycę typu 1. Zawał serca jest jednym z rzadkich czynników, choć dobrze rozpoznanym i opisanym, który sprzyja rozwinięciu się ketonowej kwasicy cukrzycowej. Jej częstość ocenia się na około 1% przypadków chorych na cukrzycę. U wielu pacjentów z rozwiniętą ketonową kwasicą cukrzycową pierwszym objawem laboratoryjnym jest hiperkaliemia, która może istotnie zmieniać morfologię zapisu elektrokardiograficznego. W niniejszej pracy przedstawiono przypadek chorego z ketonową kwasicą cukrzycową oraz hiperkaliemią, u którego w badaniu elektrokardiograficznym wykonanym w pierwszej fazie choroby zaobserwowano rytm zatokowo-komorowy, a w późniejszym okresie - elektrokardiograficzną morfologię pseudozawału serca. (Folia Cardiologica Excerpta 2008; 3: 46-49

Subintimal angioplasty and stenting in chronic total femoropopliteal artery occlusions: Early- and mid-term outcomes

Background: This study was conducted to evaluate the initial and mid-term patency rates of chronic total femoropopliteal artery (FPA) occlusions treated by subintimal angioplasty (SIA) and stenting. Methods: From March 2010 to February 2013, 74 patients were included in the study. Seventy two patients with total occlusion of the FPA and good distal runoff (2 or 3 patent vessels) were treated with percutaneous SIA and stenting. All patients had severe claudication or critical limb ischemia. In all cases, the procedure was performed with a contralateral approach. Follow-up was done at 6 months with clinical evaluation and color-Doppler. If it was necessary, peripheric angiography was performed. Results: Immediate technical success was achieved in 72 (97%) patients. Two (3%) distal embolizations, 2 (3%) groin hematomas, 1 (1%) femoral pseudoaneurysm and 1 (1%) rupture of the junction-external iliac-superficial femoral artery occurred. All of the complications were treated successfully. Total occlusion in 1 patient and critical occlusion in 3 patients were showed at the 6th month. Patency rate at the sixth month was 94% with a stent length of 13.4 ± 8.2 cm. Conclusions: Percutaneous SIA and stenting for chronic total of the FPA occlusion showed good initial and mid-term patency rates, with few periprocedural complications

Subintimal angioplasty and stenting in chronic total femoropopliteal artery occlusions: Early- and mid-term outcomes

Background: This study was conducted to evaluate the initial and mid-term patency rates of chronic total femoropopliteal artery (FPA) occlusions treated by subintimal angioplasty (SIA) and stenting. Methods: From March 2010 to February 2013, 74 patients were included in the study. Seventy two patients with total occlusion of the FPA and good distal runoff (2 or 3 patent vessels) were treated with percutaneous SIA and stenting. All patients had severe claudication or critical limb ischemia. In all cases, the procedure was performed with a contralateral approach. Follow-up was done at 6 months with clinical evaluation and color-Doppler. If it was necessary, peripheric angiography was performed. Results: Immediate technical success was achieved in 72 (97%) patients. Two (3%) distal embolizations, 2 (3%) groin hematomas, 1 (1%) femoral pseudoaneurysm and 1 (1%) rupture of the junction-external iliac-superficial femoral artery occurred. All of the complications were treated successfully. Total occlusion in 1 patient and critical occlusion in 3 patients were showed at the 6th month. Patency rate at the sixth month was 94% with a stent length of 13.4 ± 8.2 cm. Conclusions: Percutaneous SIA and stenting for chronic total of the FPA occlusion showed good initial and mid-term patency rates, with few periprocedural complications

Assessment of ventricular and left atrial mechanical functions, atrial electromechanical delay and P wave dispersion in patients with scleroderma

Background: The aim of this study was to investigate ventricular functions and left atrial (LA) mechanical functions, atrial electromechanical coupling, and P wave dispersion in scleroderma patients. Methods: Twenty-six patients with scleroderma and twenty-four controls were included. Left and right ventricular (LV and RV) functions were evaluated using conventional echocardiography and tissue Doppler imaging (TDI). LA volumes were measured using the biplane area- -length method and LA mechanical function parameters were calculated. Inter-intraatrial electromechanical delays were measured by TDI. P wave dispersion was calculated by 12-lead electrocardiograms. Results: LV myocardial performance indices (MPI) and RV MPI were higher in patients with scleroderma (p = 0.000, p = 0.000, respectively) while LA passive emptying fraction was decreased and LA active emptying fraction was increased (p = 0.051, p = 0.000, respectively). P wave dispersion and inter-intraatrial electromechanical delay were significantly higher in patients with scleroderma (25 [10&#8211;60] vs 20 [0&#8211;30], p = 0.000, 16.50 [7.28&#8211;26.38] vs 9.44 [3.79&#8211;15.78] and 11.33 [4.88&#8211;16.06] vs 4.00 [0&#8211;12.90], p < 0.05, respectively). Interatrial electromechanical delay was negatively correlated with LV E wave, (p = 0.018). LV E wave was demonstrated to be a factor independent of the interatrial electromechanical delay (R2 = = 0.270, b = &#8211;0.52, p = 0.013). Conclusions: This study showed that in scleroderma patients, global functions of LV, RV and mechanical functions of LA were impaired, intra-interatrial electromechanical delays were prolonged and P wave dispersion was higher. LV E wave was demonstrated to be a factor that is independent of the interatrial electromechanical delay. Reduced LV E wave may also give additional information on the process of risk stratification of atrial fibrillation. (Cardiol J 2011; 18, 3: 261&#8211;269