Sinus of Valsalva aneurysm as a cause of right proximal coronary artery spasm

Sinus of Valsalva aneurysm (SVA) is an infrequent cardiac anomaly. Variations in the origin and course or distribution of the epicardial coronary arteries are rarely found in the population. SVA can be acquired, secondary to infectious, degenerative or traumatic processes. This paper describes congenital right SVA and abnormal origin of conus branch of right coronary artery as a cause of acute coronary syndrome. After surgical repair of the SVA, the prognosis is usually good, and the risk of recurrence is rare.     

Myocardial bridging as a cause of acute anterior myocardial infarction

Myocardial bridging is systolic compression of an epicardial coronary arterial segment by overlying myocardium. It is a rare coronary anomaly, which is generally considered to be benign. It has been suggested that myocardial ischaemia may be seen. In this article, a case of myocardial infarction caused by myocardial bridging is presented.     

Sinus of valsalva aneurysm presenting as myocardial infarction during dobutamine stress test

We report a patient with an undiagnosed left sinus of Valsalva aneurysm who, during a dobutamine stress test, had myocardial injury and subsequent infarction. Cardiac catheterization revealed an expanding sinus of valsalva aneurysm compressing the circumflex coronary artery. The clinical manifestations of sinus of Valsalva aneurysm are discussed. This report heightens awareness of the possible effects of the pharmacologic stress test. © 1996 Wiley-Liss, Inc.     

Sinus arrest in acute myocardial infarction

The results are given of a 4-year prospective study regarding the occurrence, clinical pattern, and treatment of sinus arrest in patients with acute myocardial infarction. The arrhythmia was observed in 32 of 1665 patients. The detection rate increased from below 1 per cent in the first year to 5 per cent in the last due to better facilities for monitoring. All patients except one had inferior infarction. Paroxysmal atrial fibrillation was observed in 12, corresponding to a frequency approximately similar to that previously reported in patients with sinus arrest unrelated to myocardial infarction. Syncope due to sinus arrest occurred in 7 and hypotension in 19 patients. Small doses of isoprenaline given intravenously were usually effective in restoring normal heart rate, but pacemaker therapy was necessary in 3 patients.     

Sinus arrest in acute myocardial infarction

The results are given of a 4-year prospective study regarding the occurrence, clinical pattern, and treatment of sinus arrest in patients with acute myocardial infarction. The arrhythmia was observed in 32 of 1665 patients. The detection rate increased from below 1 per cent in the first year to 5 per cent in the last due to better facilities for monitoring. All patients except one had inferior infarction. Paroxysmal atrial fibrillation was observed in 12, corresponding to a frequency approximately similar to that previously reported in patients with sinus arrest unrelated to myocardial infarction. Syncope due to sinus arrest occurred in 7 and hypotension in 19 patients. Small doses of isoprenaline given intravenously were usually effective in restoring normal heart rate, but pacemaker therapy was necessary in 3 patients.     

Progressive coronary artery aneurysm presenting as acute myocardial infarction

Coronary artery aneurysms (CAA) are commonly of atherosclerotic origin and asymptomatic. The natural history is uncertain given its uncommon occurrence and lack of longitudinal data. We report a case of CAA, presenting with myocardial infarction. Follow-up coronary angiography revealed enlargement of the CAA, suggesting a progressive nature.     

Possible paradoxical embolism as a rare cause for an acute myocardial infarction

Paradoxical embolus is a rare entity and it has been incriminated as a cause of both cryptogenic strokes and myocardial infarctions (MI). Herein, we present a case of a patient diagnosed with a pulmonary embolism 1 week prior who now presented with an acute MI. Subsequent evaluation revealed a patent foramen ovale and a large thrombus in the right pulmonary artery. It was presumed that the etiology of her infarct was due to paradoxical embolus. The management of the patient is discussed and the literature is reviewed.     

Sinus of Valsalva thrombosis causing renal infarction

A 72-year-old man was admitted to our hospital with a renal infarction. On admission, computed tomography (CT) of the abdomen revealed total occlusion of the right renal artery, which was found to be recanalized with residual thrombus 7 days later. Transesophageal echocardiography and chest CT demonstrated crescent-shaped thrombus in the non-coronary sinus of Valsalva without evidence of aneurysm. After coumadin treatment the patient did not experience recurrent episodes of systemic embolization. Five months after the initiation of anticoagulation, transesophageal echocardiography and chest CT demonstrated disappearance of the thrombus. This is a rare case of renal infarction caused by a thrombus in the non-coronary sinus of Valsalva without aneurysm.     

Sinus node dysfunction in acute myocardial infarction.

The frequency, clinical course, and prognosis of sinus node dysfunction in 431 patients with acute myocardial infarction admitted to the coronary care unit were studied. Sinus node dysfunction occurred in 20 patients. In 13, the principal manifestation consisted of severe sinus bradycardia. In the remaining 7, periods of bradycardia alternating with episodes of supraventricular tachycardia were noted. Though several of the patients with sinus bradycardia required intravenous atropine or temporary pacing, normal sinus rhythm returned in virtually all during follow-up. The clinical course of patients with both bradycardia and tachycardia was less benign, during the acute phase and during follow-up; 5 of the 6 survivors required continued antiarrhythmic therapy or permanent pacing. The differences in the clinical course between these two groups of patients may reflect distinct underlying pathological changes. The findings in this study suggest that in contrast to sinus bradycardia, the occurrence of bradycardia-tachycardia syndrome during the acute phase of myocardial infarction may have important prognostic implications.     

Sinus node dysfunction in acute myocardial infarction.

The frequency, clinical course, and prognosis of sinus node dysfunction in 431 patients with acute myocardial infarction admitted to the coronary care unit were studied. Sinus node dysfunction occurred in 20 patients. In 13, the principal manifestation consisted of severe sinus bradycardia. In the remaining 7, periods of bradycardia alternating with episodes of supraventricular tachycardia were noted. Though several of the patients with sinus bradycardia required intravenous atropine or temporary pacing, normal sinus rhythm returned in virtually all during follow-up. The clinical course of patients with both bradycardia and tachycardia was less benign, during the acute phase and during follow-up; 5 of the 6 survivors required continued antiarrhythmic therapy or permanent pacing. The differences in the clinical course between these two groups of patients may reflect distinct underlying pathological changes. The findings in this study suggest that in contrast to sinus bradycardia, the occurrence of bradycardia-tachycardia syndrome during the acute phase of myocardial infarction may have important prognostic implications.     

Sinus of Valsalva aneurysm presenting with complete heart block

An elderly woman presented with sudden unresponsiveness and complete heart block and subsequently expired. Postmortem examination revealed an aneurysm of the right sinus of Valsalva impinging on the cardiac conducting tissue. Only a few cases associated with complete heart block have been previously reported.