1/276. Transient left posterior hemiblock during myocardial ischemia-eliciting exercise treadmill testing: a report of a case and a critical analysis of the literature.We describe a 75-year-old male patient with two-vessel coronary artery disease, who developed transient left posterior hemiblock (LPH) while undergoing an exercise treadmill test (ETT). The intraventricular conduction abnormality initially had the features of alternating LPH, which evolved to stable LPH prior to dissipating, and it occurred at the first minute of recovery. The exercise electrocardiogram and the associated thallium-201 myocardial perfusion scintigraphy (Tl) revealed severe reversible myocardial ischemia. This rare occurrence is discussed in the context of the observed coronary lesions, the distribution of the radionuclide-detected ischemia, and the previous experience from the literature. An insight regarding the low prevalence of transient LPH is afforded, since the described case derives from a series of 2,160 consecutive patients who underwent ETT in conjunction with Tl. Finally, a comment is provided on the complexities of deciphering the specific pathophysiologic mechanism(s) of transient LPH, occurring during ETT.- - - - - - - - - - ranking = 1keywords = artery disease, artery (Clic here for more details about this article) |
2/276. Left ventricular ischemia due to coronary stenosis as an unexpected treatable cause of paroxysmal atrial fibrillation.We present a patient with exercise-induced paroxysmal atrial fibrillation who was eventually scheduled for a Cox-maze operation due to persistence of his complaints of fatigue, impaired exercise tolerance, and predominantly exercise-related irregular palpitations despite treatment with several antiarrhythmic drugs. A preoperative exercise stress test without antiarrhythmic or negative chronotropic drugs, however, showed clear evidence of myocardial ischemia. After coronary angioplasty of a significant stenosis in the left anterior descending artery, there was no recurrence of atrial fibrillation during a follow-up of 7 months.- - - - - - - - - - ranking = 0.1548043092161keywords = artery (Clic here for more details about this article) |
3/276. Significant complications can occur with ischemic heart disease and tilt table testing.We present an elderly patient who had syncope, with known coronary artery disease and a conduction abnormality. Because of a possible vasovagal reaction, the patient underwent a tilt table test prior to evaluation of ischemia or her LV function. During the tilt table test on isoproterenol, the patient developed ventricular fibrillation which was corrected immediately by cardioversion. Subsequently, the patient was found to have significant coronary artery disease which was treated with stenting and angioplasty. After treatment, there were no inducible arrhythmias on full dose isoproterenol. This case reports a significant complication that may occur when tilt table testing with isoproterenol and ischemia.- - - - - - - - - - ranking = 2keywords = artery disease, artery (Clic here for more details about this article) |
4/276. Improvement of myocardial ischemia by subclavian stent implantation in patients with internal mammary grafts: a case report and review of the literature.In patients with coronary bypass which utilizes left (LIMA) or right internal mammary artery (RIMA), recurrent ischemia is often due to stenosis of the distal anastomoses of the grafts. However, occasionally, ischemia may be due to extracoronary causes, such as subclavian disease proximal to the internal mammary artery origins. This case report describes such clinical situation emphasizing the need for careful patient evaluation, and discusses therapeutic interventional options, in particular, safety and effectiveness of self expanding subclavian stent implantation. A review of the literature is also presented.- - - - - - - - - - ranking = 0.3096086184322keywords = artery (Clic here for more details about this article) |
5/276. Rotational atherectomy for left anterior descending artery septal perforator stenosis.Stenosis in large septal perforators can result in significant clinical ischemia. The distribution of the septal arteries is as large as many more commonly treated branch vessels. The interventricular septal blood supply has been ignored as a target for revascularization due to its inaccessibility for surgical revascularization, and the elastic recoil associated with balloon angioplasty in this location. Rotational atherectomy is a new therapeutic option for revascularization in this previously difficult location. The septal perforator ostium is the most common site of lesions and is functionally a branch ostial stenosis. We describe four cases in which rotational atherectomy was performed in patients with reversible ischemia due to septal artery stenosis. The acute angiographic results were stable, without evidence for immediate recoil. By debulking, facilitated angioplasty can yield stable acute results in this location. The small size of most septal branches and their angulated origin make rotational atherectomy challenging, and cases must be selected carefully. This previously ignored lesion location can be considered for revascularization in patients with suitable lesion and vessel morphology.- - - - - - - - - - ranking = 0.7740215460805keywords = artery (Clic here for more details about this article) |
6/276. coronary-subclavian steal syndrome: treatment with percutaneous transluminal angioplasty and stent placement.The aim of this study was to assess the efficacy of percutaneous transluminal angioplasty (PTA) and stenting in the management of the coronary-subclavian steal syndrome (CSSS). A 56-year-old man presented with CSSS due to occlusion of the left subclavian artery. He was treated with PTA and placement of two stents in the left subclavian artery. Systolic blood pressure became equal in both arms and dizziness disappeared. There were no complications. Percutaneous transluminal angioplasty and stenting can effectively and safely manage CSSS.- - - - - - - - - - ranking = 0.3096086184322keywords = artery (Clic here for more details about this article) |
7/276. myocardial ischemia resulting from spontaneous dissection in a patient with massive bilateral sinus of valsalva aneurysms.We describe a patient with large sinus of valsalva aneurysms involving both the left and right coronary sinuses. Spontaneous dissection of the left coronary artery occurred, causing unstable angina, a complication heretofore not associated with this disease. Successful surgical reconstruction of the aortic root, aortic valve replacement, and coronary bypass grafting were performed. pathology revealed cystic medial necrosis.- - - - - - - - - - ranking = 0.1548043092161keywords = artery (Clic here for more details about this article) |
8/276. Anomalous origin of a coronary artery in a transplanted heart.Upon routine coronary angiography one year after surgery in a 62-year-old male recipient of a heart transplant, an abnormal origin of the left anterior descending coronary artery from the pulmonary artery was found in the donor heart. This very rare congenital anomaly had not been detected during harvesting and transplantation of the heart, and to our knowledge it has never been described before in a heart transplant patient. The donor was a 43-year-old male who died of a spontaneous intracranial bleeding. The recipient continues to enjoy a normal functional capacity and is free of anginal complaints, though there is evidence of ischaemia in the left anterior descending artery territory on exercise thallium-201 myocardial perfusion imaging.- - - - - - - - - - ranking = 1.0836301645127keywords = artery (Clic here for more details about this article) |
9/276. Multivessel spontaneous coronary artery dissection in a patient with severe systolic hypertension: a possible association. A case report.Spontaneous coronary artery dissection (SCAD) is an uncommon cause of myocardial ischemia and infarction. hypertension has not been associated with SCAD. The authors report multivessel SCAD in an elderly woman with severe systolic hypertension. They postulate that hypertension of this degree may play a pathophysiologic role in the causation of SCAD.- - - - - - - - - - ranking = 0.7740215460805keywords = artery (Clic here for more details about this article) |
10/276. Vasospastic angina likely related to cisplatin-containing chemotherapy and thoracic irradiation for lung cancer.Vasospastic angina is rarely observed during cancer treatment. The present report describes two males with lung cancer, aged 73 and 61, who developed vasospastic angina during combination treatment of cisplatin-containing chemotherapy and thoracic irradiation. As both patients have smoked and their ages are typical for patients with coronary artery disease, such events may be incidental. However, oncologists should be aware of the possible development of myocardial ischemia during or following administration of antineoplastic agents, especially in elderly patients with pre-existing coronary risk factors or a history of thoracic radiotherapy.- - - - - - - - - - ranking = 1keywords = artery disease, artery (Clic here for more details about this article) |
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