Aortic Dissection Involving the Ostium of Left Main Coronary Artery

Acute aortic dissection can occasionally extend and involve the right coronary artery and lead to a concomitant inferior wall acute myocardial infarction. We herein report a case of an acute aortic dissection involving the left coronary artery, which was initially diagnosed solely as an anterior wall acute myocardial infarction. Such an incomplete diagnosis could lead to thrombolysis or primary percutaneous coronary intervention with catastrophic consequences

Dilated Right Ventricle with Impaired Systolic Function

We describe a 50-year old female admitted to our cardiac department with an episode of palpitations and associated dyspnea. She had never had any previous medical history. Physical examination revealed an irregular heart rate of 130 beats per minute, blood pressure of 122/70 mmHg and no pyrexia. Twelve–lead ECG demonstrated atrial fibrillation. Transthoracic echocardiogram showed a dilated right ventricle... (excerpt

Angiosarcoma of the Heart: from Primary Location to Rapid Extension

A 68-year-old man was admitted to our department with severe dyspnea and hemodynamic instability. The initial echocardiogram revealed a massive pericardial effusion with signs of tamponade. Urgent pericardiocentesis was performed. The cytological examination of the pericardial fluid was negative for malignant cells but the pre-discharge transthoracic echocardiogram depicted a heterogeneous tissue (mass) in the right atrium. The subsequent transesophageal echocardiogram revealed a large sessile heterogeneous mass adherent to the right atrial free wall, extending into the inferior vena cava... (excerpt

Toll/Interleukin-1 receptor member ST2 exhibits higher soluble levels in type 2 diabetes, especially when accompanied with left ventricular diastolic dysfunction

<p>Abstract</p> <p>Background</p> <p>Soluble ST2, a member of the of the Toll/IL-1 superfamily, is a novel biomarker with exceptional predictive value in heart failure and myocardial infarction- related mortality as well as in acute dyspneic states. Soluble ST2 is considered a decoy receptor of IL 33 that blocks the protective effects of the cytokine in atherosclerosis and cardiac remodeling. In the present study we investigated the differences in the levels of soluble ST2, BNP and hs-CRP between healthy controls and patients with type 2 diabetes with and without left ventricular diastolic dysfunction. A secondary aim was to investigate correlations between sST2 and other biomarkers of type 2 diabetes, such as HbA1c.</p> <p>Methods</p> <p>158 volunteers were recruited and underwent a complete Doppler-echocardiographic evaluation of both systolic & diastolic cardiac function. All subjects with ejection fraction < 50% were excluded. The study population was divided in 4 groups as follows: A: 42 healthy controls, B: 18 subjects without diabetes with LVDD, C: 48 patients with type 2 diabetes without LVDD & D: 50 patients with type 2 diabetes & LVDD. ELISA technique was performed to measure sST2 levels. Statistical analysis was performed with Kruskal-Wallis & Mann-Whitney test (continuous variables), chi squared & Fischer exact test (discrete variables), Spearman coefficient (univariate analysis) and step-wise backward method (multivariate analysis).</p> <p>Results</p> <p>Patients with type 2 diabetes with (p < 0.001) or without LVDD (p = 0.007) had higher serum ST2 levels compared to healthy controls, state found also for hs-CRP levels but not for the corresponding BNP levels (p = 0.213 & p = 0.207 respectively). Patients with type 2 diabetes & LVDD had higher serum ST2 in relation to diabetic patients without LVDD (p = 0.001). In multivariate analysis HbA1c positively and independently correlated with sST2 levels in both groups of patients with type 2 diabetes.</p> <p>Conclusions</p> <p>Patients with type 2 diabetes exhibit higher sST2 levels compared to healthy controls. The presence of LVDD in patients with type 2 diabetes is associated with even higher sST2 levels. A significant correlation between glycemic control and sST2 levels was also revealed.</p

Debate of Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting in a Multimorbidity Patient with Complex Coronary Lesions

Background. While complete revascularization in coronary artery disease is of high priority, the method of implementation in patients with complex coronary lesions and multiple comorbidities is not directed by published guidelines. Case Presentation. A 53-year-old female with a chronic total occlusion of the right coronary artery and a bifurcation lesion of the left anterior descending artery and the first diagonal branch, presented with non-ST elevation myocardial infarction. Her past medical history concerned thymectomy and prior chest radiation for thymoma, myasthenia gravis, peripheral artery disease, and cervical cancer treated with surgery and radiation. Although SYNTAX score II favored surgical revascularization, the interventional pathway was finally successfully followed. However, it was complicated with vessel perforation and tamponade managed with pericardiocentesis. Conclusion. Comorbidities are not all involved in common risk models and require individualization until more evidence comes to light