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Actual Patient Cases of CHD and MI from My Practice
Published in Mark C Houston, The Truth About Heart Disease, 2023
This patient presented with an “atypical” symptom of fatigue that was caused by CHD. The severe blockage in his left anterior descending artery, which supplies about two-thirds of the heart muscle, did not allow adequate delivery of oxygen, blood, and nutrients to the heart muscle. This resulted in a decreased delivery of oxygen, blood, and nutrients to all the arteries in the body, as the heart function was poor. The result of all of this was fatigue. In addition, the fast heart rate and increased blood pressure could be related to the blockage, as they returned to normal after the stent.
The Coronaries
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
László Göbölös, Johannes Bonatti
An increasing number of publications analyze TECAB intermediate- and long-term outcomes. DeCanniere reported 94.9% freedom from major adverse cardiac or cerebral events (MACCE) at 6 months in BH-TECAB and 91.2% in AH-TECAB in a multicenter study on early TECAB experience [29]. The Dresden experience showed 75.7% freedom from major adverse events in their first 41 patients after 5 years. Overall survival was 92.7%, and freedom from reintervention of the left anterior descending artery was 82.9% [30].
Functions of the Cardiovascular System
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
The left coronary artery arises from the posterior aortic sinus and supplies blood to the left ventricle and left atrium. The left main coronary divides into branches: The left anterior descending artery branches off the left coronary artery and supplies blood to the front of the left side of the heart. It passes along the anterior interventricular groove towards the apex, turns round the inferior border of the heart and anastomoses with the posterior interventricular artery.The circumflex artery branches off the left coronary artery and encircles the heart muscle around the left heart border to anastomose with the posterior interventricular artery. This artery supplies blood to the left atrium and the side and back of the left ventricle.
Feasibility of right coronary artery first ergonovine provocation test
Published in Acta Cardiologica, 2021
Hyun Seok Ham, Ki-Hun Kim, Jino Park, Yeo-Jeong Song, Seunghwan Kim, Dong-Kie Kim, Sang-Hoon Seol, Doo-Il Kim
Sequential IC spasm provocation test is recommended because ergonovine has a long half-life, and simultaneous spasm provocation of both coronary arteries may provoke life-threatening situation. In addition, nitrate should be infused in the spasm-provoked artery, making the spasm provocation result of the other artery unreliable [9]. The JCS guideline suggested the use of the LCA first (20–60 μg) then RCA sequence (20–60 μg) as the standard method of IC ergonovine provocation test. Although concrete reasons were not indicated, most study protocols followed such sequence and the decision was made based on the clinician’s discretion [6,8]. Song et al. revealed the presence of wall motion abnormality on the left anterior descending artery (49%), left circumflex artery (9%), RCA (34%), and multiple areas (6%) according to the IV ergonovine provocation echocardiography findings [15]. However, the crucial standpoint is not which artery could be more spastic but which artery could be diagnostically efficient and safe. Sueda et al. suggested that the LCA first provocation test is better because multi-vessel spasm is frequently provoked in the LCA. If the provocation test will be performed on the RCA first, the administration of nitrate in the RCA may not induce LCA spasm [8]. In addition, a drug injected into the RCA might have more chances of backflow into the LCA because of the lower level of the RCA take-off except for anomalous origin [13,16].
Diagnostic efficacy of fractional flow reserve with coronary angiography in dual-source computed tomography scanner
Published in Acta Cardiologica, 2018
Guozhi Xia, Di Fan, Xiaowei Yao, Gongchang Guan, Junkui Wang
Selective ICA was performed by standard protocol, via either the femoral or the radial approach, with a minimum of two projections obtained per vessel distribution and with the projection angles optimised based on the cardiac position [11]. Intracoronary nitroglycerine (200 μg) was administered to minimise vasospasm prior to the angiographic acquisitions. The ICA images were transferred to an angiographic core laboratory for blinded analysis of all assigned vessels. ICA was evaluated for maximum patients- and vessels-based diameter stenosis by luminal estimation. Per-patient and per-vessel lesions were the maximum stenosis identified in all segments or in all segments within a vessel distribution, respectively. Vessel distributions were categorised as the left anterior descending artery, the left circumflex artery and the right coronary artery.
Spontaneous coronary artery dissection associated with incidental finding of left ventricular thrombus
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Melvin Santana, Nirmal Guragai, Biren Patel, Rahul Vasudev, Preet Randhawa, Meherwan Joshi, Habib Mirette, Fayez Shamoon
The spectrum of clinical presentation can range from chest pain symptoms alone to ST-segment–elevation myocardial infarction (STEMI), ventricular fibrillation, and sudden death [3,4]. The most common association with SCAD are fibromuscular dysplasia (FMD), pregnancy, emotional stressors, and physical activities but the etiology and pathogenesis of SCAD are still uncertain. The coronary distribution of SCAD has been well described. Although any artery can be affected, the left anterior descending artery is the most commonly affected (32%–46% of cases) [5]. LV thrombus is a complication usually seen six to ten days after myocardial infarction (MI), especially after LAD MI associated with anterior wall and apical motion abnormalities, this can occur even in the absence of aneurysm [6].