Trans Ulnar Approach for Unprotected Left Main Coronary Artery Disease

A 65 year old male presented with chest pain, sweating and uneasiness for four hours and diagnosed as unstable angina. There was no history of hypertension diabetes mellitus or dyslipidemia.

TIMI III flow achieved Dіer stent deployment

On general physical examination, pulse rate was 102 per minute, BP 140/86 mm of Hg, respiratory rate 18 per minute jugular venous pulse was normal. Auscultation of the heart and lung was unremarkable. Electrocardiogram showed ST segment depression of 2 mm in leads I, II, aVL, aVF and V3 to V6 with ST segment elevation in lead aVR. 

Two dimensional echocardiography revealed concentric left ventricular hypertrophy, normal left ventricular function, no regional wall motion abnormality, mild mitral and tricuspid regurgitation and normal chamber dimension. Hematological investigation and routine bio-chemistry were also normal. Read More>>>>>>

Why Treat Chronic Total Occlusion without Stents? - A Short Comment

Chronic total occlusions (CTO) of coronary arteries have been a focus point of research in interventional cardiology for several years. Recanalization, balloon dilatation and implantation of drug eluting stents (DES) are recognized treatment options for patients with symptomatic CTO. 

 

Chronic total occlusions

Recanalization of CTO ranks among the most complicated percutaneous coronary interventions (PCI) and the procedures are to be performed by well-equipped and experienced centers. During the last decades the procedural success rates increased due to improved technical equipment and increasing operator experience. It is still uncertain whether PCI is the optimal treatment method for CTO and it competes with coronary artery bypass grafts (CABG) and medical treatment. Large retrospective registries have shown a reduction of adverse events and a clinical improvement after successful CTO PCI. Read More>>>>>>>

Are we Under Utilizing the Medical Therapies in Preventing the Complications in Peripheral Arterial Disease?

Lower limb Peripheral Artery Disease (PAD) is the third most common cause of atherosclerotic cardiovascular morbidity aіerischemic heart disease and stroke. Lower limb arterial disease is known to affect the quality of life of elderly people and it is associated increased cardiovascular complications and mortality. 
 

Peripheral Arterial Disease

Smoking, Diabetes, Hypertension and hyper-lipidemic are the risk factors for peripheral vascular disease and the associated complications. Нe first global analysis of the lower limb arterial disease found that more than a quarter of a billion people in the world have the disease and poorer countries are disproportionately affected. Like many other life style diseases PAD incidence is also increasing during the past few decades. Read More>>>>>>>>

Monitoring the Blood Pressure of the Patients during Normal Station Hospital Stay

Significant variations of blood pressure are very important clinical events that can lead to serious cardiovascular events, such as stroke, myocardial ischemia, and heart failure. Accordingly, careful measurement of the blood pressure is very important for the classifying the patients, estimation of the associated risks and guiding of the management. Twenty-four hours ambulatory monitoring of the blood pressure remains the method of choice for the diagnosis and risk prediction. 

Blood Pressure

Monitoring of Blood Pressure during Hospital Stay: While the continuous monitoring of blood pressure is applied during the intensive care unit stay, and the acute emergency station stay, the monitoring of the blood pressure during the normal station stay is usually performed through the frequent measurement by the nursing team. Read More>>>>>

The Effect of High-Dose Simvastatin Therapy on Patients with Acute Cerebral Infarction

Cerebrovascular disease (CVD) is the third most common cause of death worldwide. CVD accounts for the major cause of morbidity and mortality in industrialized countries and responsible for stroke and transient ischemic attack (TIA). 

There are about 500,000 new or recurrences stroke cases each year. Simvastatin (epistatin), an HMG-CoA reductase inhibitor, acts by decreasing cholesterol synthesis and by increasing low density lipoprotein (LDL) catabolism via increased LDL receptor activity. Simvastatin was beneficial in a lot of immunologic VCD. Evidences indicated that simvastatin could stable plaque and improve the long-term prognosis of patients with CVD. Read More>>>>>>>>

Trans Ulnar Approach for Unprotected Left Main Coronary Artery Disease

Significant unprotected left main coronary artery (ULMCA) disease occurs in 5-7% of patients undergoing coronary angiography and patients with ULMCA disease treated medically have a three years mortality rate of 50%. 

 

LAO caudal view depicting 70% proximal leі main lesion

Advances in percutaneous intervention techniques and stent technology have allowed evolution of the role of percutaneous coronary intervention (PCI) for left main disease. Left main angioplasty is usually preferred through femoral route because of the larger diameter of the vessel and ease of maneuverability. In recent studies radial route has also been used consistently with better results. Read More>>>>>>

Diffuse Ventricular Hematoma after Heart Transplant and Repeated Myocardial Instrumentation

A 69 year-old male Jehovah’s Witness with a past medical history of non-ischemic cardiomyopathy, coronary artery disease (CAD), obesity, gout, and nephrolithiasis presented to a large academic medical center for evaluation for advanced options. 

 

Ventricular hematoma

He had a myocardial infarction in 2004, requiring a single stent to the left anterior descending artery. He was found to have an ejection fraction of 10% that was thought to be out-of-proportion to his CAD. His cardiac function did not improve with guideline-directed medical therapy, including a biventricular implantable cardioverter-defibrillator, and on presentation he was no longer able to tolerate significant neurohormonal blockade. Of note, family history was notable for a mother with a “large heart,” but the rest of his history was non-contributory. Read More>>>>>>>>     

Left Atrial Mass in a Patient with Rheumatic Mitral Stenosis and Atrial Fibrillation-Thrombus or Myxoma?

A 38-year-old female presented for evaluation of dyspnea on exertion. She also complained of palpitations but gave no history of edema, chest pain, cardioembolism, fever, arthralgia or weight loss. She was in atrial fibrillation (AF) with a controlled ventricular rate. 

Cardiac auscultation revealed a loud S1 with an opening snap and a mid-diastolic rumbling murmur at the apex. There was no presystolic accentuation and no postural variations. Transthoracic echocardiogram revealed thickening and restricted motion of mitral valve leaflets associated with doming of anterior mitral leaflet and severe subvalvular deformity. Mitral valve area was 0.8 cm2. These findings were consistent with severe rheumatic mitral stenosis (MS). Read More>>>>>>>

Prinzmetal or Vasospastic Angina in a Young Woman: An Under-Diagnosed Pathology

We report through this clinical observation the issue of the diagnosis of vasospastic angina or Prinzmetal’s angina (VSA). Mrs. GV, 41 years old, had as a cardiovascular risk factor an active smoking at the rate of 15 packs-year and a family history of coronary heart disease. 

She was admitted to the emergency department for a stable angina evolving for three weeks with episodes at rest. Biology noted an elevation of ultra-sensitive troponins to 220 ng/l. The electrocardiogram was normal, echocardiography noted moderate hypokinesis of left The coronary angiography performed by right radial artery access with a 5 french catheter concluded to intermediate coronary lesions at 50% in the distal part of the left main coronary artery (LMCA), encompassing the origin of the left circumflex artery (LCA) and left anterior descending artery or LAD (Classification Medina 1-0-0), and a lesion of 50% in the distal portion of the middle right coronary artery or RCA. Read More>>>>>>>>

Evolving Concepts in LDL-Lowering Strategies: Are We There?

Several epidemiological studies have clearly shown the existence of a tight correlation between lipid levels in blood and atherosclerotic cardiovascular disease (CVD). The term hyperlipidemia refers to increased levels of lipids in the blood, including cholesterol and triglycerides. 

The main issue related to hyperlipidemia is that this condition does not cause symptoms, but it can silently and significantly increase the risk of developing CVD. The deposition of lipids is progressive and occurs in the arterial wall of almost all vascular district, such as vessels supplying the heart (coronary artery disease), brain (cerebrovascular disease), and limbs (peripheral vascular disease). Read More>>>>

Iron Chelation Therapy for Treatment of Cardiac Hemochromatosis

Hemochromatosis is a clinical syndrome caused by abnormal accumulation of iron in parenchymal organs leading to organ toxicity and dysfunction. Cardiac hemochromatosis is a cardiomyopathy due to primary iron-overload cardiomyopathy which causes congestive heart failure. 

Iron Chelation Therapy

Patients with cardiac hemochromatosis may be asymptomatic early in the disease. Once heart failure develops, there is rapid deterioration. Cardiac hemochromatosis is characterized by a dilated cardiomyopathy with dilated ventricles, reduced ejection fraction, and reduced fractional shortening. Deposition of iron may occur in the entire cardiac conduction system, especially the atrioventricular node. Read More>>>>>>>>