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Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
In the early post-operative phase, thrombosis causes total and irreversible graft occlusion usually at the distal anastomosis site (see Fig. 9.30) but is now very rare due to effective anti-platelet therapy. If this area is examined by sectioning, beginning at the anastomosis, it will usually reveal that the distal artery is very small or that there is diffuse distal atherosclerotic disease which is common in diabetic patients. This, and prolonged periods of low-output failure permitting stasis, are the causes of thrombosis within grafts in the early post-operative period. Grafting, combined with atherectomy of the distal coronary vessel, has a high risk of thrombosis and is no longer used. Synthetic grafts are not used for coronary artery bypass surgery because of the very high risk of thrombosis. Re-do coronary artery grafts have a much higher risk than first operations.
Diabetes Mellitus and Ischemic Heart Disease
Published in E.I. Sokolov, Obesity and Diabetes Mellitus, 2020
The mechanism of regulating the tone of the coronary arteries was not studied in detail to date, especially in type II DM patients. It is known that various neuromediators, neuropeptides, and metabolites of the factors circulating in the blood are included into this regulation. All of them influence directly the smooth muscles of the coronary vessels, part of the factors being produced by the endothelium. These influences may be directed oppositely in connection with the postsynaptic and presynaptic influence of various agents, directly or via the endothelium. A spasm of the coronary arteries is based on contraction of the smooth muscles [59, 232, 410, 610].
Traumatic Carotid Sinus Reflex
Published in Burkhard Madea, Asphyxiation, Suffocation,and Neck Pressure Deaths, 2020
Elke Doberentz, Burkhard Madea
In the study group severe arteriosclerosis with plaques of the vessels was not found. In two cases (cases 2 and 7) the heart weight exceeded the critical weight of 500 g. In case 1, relevant stenosis of a coronary vessel was found. Furthermore, the heart muscle did not show pathological alterations in any case.
Use of coronary artery calcium and coronary tomography angiography in the evaluation of ischemic heart disease
Published in Hospital Practice, 2022
Abdullah Zoheb Azhar, Devesh Rai, Dhrubajyoti Bandyopadhyay, Wojciech Rzechorzek, Tauseef Akhtar, Wilbert S. Aronow, Pragya Ranjan
The CAC is calculated noninvasively using multi-detector non-contrast CT. It is the measurement of calcified plaque burden in epicardial coronary vessels. Studies have shown an association between coronary calcium and obstructive coronary artery disease[13]. Coronary artery calcium was defined as a lesion greater than 130 Hounsfield units on CT with an area greater than three adjacent pixels (at least 1 mm2)[14]. The product of the calcified plaque area and the maximal calcium lesion density determines Agatston’s original calcium score (from 1 to 4 based on Hounsfield units)[3]. The CAC score has been divided into standardized categories, with 0 indicating no calcified plaque, 1 to 10 minimal plaque, 11 to 100 mild plaque, 101 to 400 moderate plaque, and ≥400 severe plaque. Current guidelines suggest that a CAC score can help improve cardiovascular risk assessment in asymptomatic persons and play a role in preventative management[15]. Modern coronary calcium scans may be completed in 10 to 15 minutes of total room time at roughly 1 mSv of radiation. The sole requirement is the need to hold one’s breath for 3 to 5 seconds. Newer techniques, such as iterative reconstruction, have substantially reduced the radiation burden as well[16]. Consistent and progressive relationship between coronary artery calcification and ACS has been shown in population-based cohorts such as HNR (Heinz Nixdorf Recall [Risk Factors, Evaluation of Coronary Calcium and Lifestyle]), Rotterdam and MESA (Multi-Ethnic
Three-dimensional virtual and printed models for planning adult cardiovascular surgery
Published in Acta Cardiologica, 2021
Raul A. Borracci, Luis M. Ferreira, José M. Alvarez Gallesio, Osvaldo M. Tenorio Núñez, Michel David, Eduardo P. Eyheremendy
Solid opaque material (polylactic acid), monochromatic or in two colours, was used to replicate hard tissues such as calcifications (Figure 5) or vascular thrombi and tumours. Three-dimensional printed whole heart models seemed to be particularly useful for understanding the relationships between normal and pathological structures. Whole heart models were built in two formats: (1) replicating the external surface of the organs, and (2) reproducing the blood volume inside the heart chambers (blood pool) (Figure 6). Replicas of external structures reproduced the surface anatomy of the epicardium, epicardial coronary vessels, and great vessel surfaces; conversely, blood volume replicated the content of heart chambers and vessels. In these cases, endocavitary tumours and thrombi were seen as a lack of material. Although replicas of isolated heart chambers and great vessels facilitated manual instrumentation of endovascular devices and probes within structures, replicas of the entire anatomy of the heart were better at recognising neighbouring structures and providing a complete perspective of the organ and its relationships as a whole.
Catecholamine-induced cardiomyopathy and multiple organ failure in pheochromocytoma
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Joel Thekekara, Atchayaa Gunasekharan, Young Kwon, Niaz Memon, Joe N Hackworth
Patient was admitted to the intensive care unit (ICU) for ST elevation myocardial infarction (STEMI), hyperglycemia, and sepsis. She was started on heparin drip at 12 Units/kg/hr, metoprolol 12.5 mg two times daily, cefepime 1 g, 30 ml/kg (2.1 L) lactated ringers bolus, and insulin drip at 0.1 Units/Kg/hr. In the ICU, patient had worsening chest pain and palpitations. Her troponin rose from 0.26 ng/mL to 1.00 ng/mL. Emergent echocardiogram showed 40–45% ejection fraction with septal, lateral, anteroseptal, and posterolateral hypokinesis. At this point, the patient was taken for cardiac angiography which surprisingly revealed normal coronary vessels. Considering this patient had no significant past medical history and no signs of infection, her sudden onset of multi-organ failure with cardiomyopathy was proving difficult to elucidate. Myocarditis was briefly considered as the underlying etiology for her clinical presentation; however, an erythrocyte sedimentation rate of 0 mm/hr pointed against this diagnosis.