Anomalous origin of the right coronary artery mimicking aortic dissection at transesophageal echocardiography

Transesophageal echocardiography (TEE) is the most common imaging modality for the detection of acute aortic syndromes. However anomalous anatomic structures may be occasionally misunderstood as pathologic due of lack of familiarity with anatomical variations; false-positive diagnosis can result, potentially leading to unnecessary surgical intervention. It is crucial for echocardiographers to be aware of possible pitfalls which may create false positive findings, since the complementary use of other imaging modalities, such as multislice spiral computed tomography (MSCT), could improve the diagnostic accuracy of TEE. We report a case in which an image resembling an acute aortic dissection (AAD) on transthoracic (TTE) and transesophageal echocardiography was found in a patient with acute chest pain; MSCT detected an anomalous origin of the right coronary artery as cause of false aortic dissection image at echocardiography.     

Acute rheumatic fever mimicking an acute coronary syndrome

An elevated troponin measurement does not always reflect myocardial ischaemia secondary to obstructive coronary artery disease. Troponin levels can also be elevated in other disease states including pulmonary emboli, myo‐pericarditis, acute rheumatic fever, and in the critically ill. Thus, patients presenting with chest pain and electrocardiological and biochemical evidence of myocardial necrosis are not always suffering from an acute coronary syndrome.     

初诊为急性冠脉综合征的主动脉夹层患者的经验教训一例

急性主动脉夹层起病凶险,临床表现多样,初诊极易误诊。而按照其他疾病治疗容易加重急性主动脉夹层,导致患者病情恶化。本研究报道1例初诊为急性冠脉综合征的急性主动脉夹层患者诊治过程中的经验教训,为类似病例的多方位检查及诊断提供参考。     

Undiagnosed Takayasu's arteritis mimicking an acute aortic dissection

Takayasu's arteritis (TA) is a vasculitis involving the aorta and its branches. We report a case of undiagnosed TA that presented to the Emergency Department with a chief complaint of chest pain and signs consistent with an aortic dissection.     

Guidewire-induced dissection of the right coronary artery and adjacent aortic wall during percutaneous coronary angioplasty

We describe two patients in whom right coronary artery dissection and retrograde dissection of the sinus of Valsalva occurred during guidewire advancement for percutaneous coronary angioplasty Both patients were treated successfully by coronary stenting. These cases illustrate that contrast medium injection can detect early complications during guidewire advancement for coronary intervention.     

左锁骨下动脉急性闭塞与动脉夹层

目的通过对46例左锁骨下动脉急性闭塞患者的造影诊断和经皮腔内血管成形术治疗,探讨动脉夹层与左锁骨下动脉急性闭塞的关系、病理特点及经股动脉-肱动脉逆行双路径腔内血管支架植入术的治疗方法、疗效、适应证及并发症。方法对46例锁骨下动脉急性闭塞的患者采用经股动脉-肱动脉双路径诊断动脉夹层,采用经股动脉-肱动脉双路径腔内血管支架植入技术治疗左锁骨下动脉急性闭塞患者46例。结果造影证实左锁骨下动脉近端动脉夹层并左锁骨下动脉急性闭塞38例,降主动脉内膜下出血(DebackeyⅢ)不典型型并发左锁骨下动脉急性闭塞8例,植入支架46枚,全部成功,仅4例发生短暂左上肢缺血;支架植入后,造影证实左锁骨下动脉血流方向恢复正常、左椎动脉血流方向恢复正常;术后采用彩色多普勒超声、经颅多普勒超声(TCD)和(或)数字减影血管造影(DSA)复查随访2周至12个月,证实支架位置恒定、血流方向正常、无再狭窄。结论左锁骨下动脉近端动脉夹层、主动脉内膜下出血可引起左锁骨下动脉急性闭塞,而导致锁骨下动脉窃血综合征,经股动脉-肱动脉双路径腔内支架植入术治疗效果可靠、操作方法简单安全。     

Brugada syndrome mimicking acute coronary syndrome

This report describes a 42-year-old man with Brugada syndrome (BRS) mimicking acute coronary syndrome. Chest pain, near-syncope, and electrocardiographic changes were thought initially to be due to ischemia. Cardiac catheterization was performed. The coronary arteries and left ventricular function were normal. Careful review of his electrocardiogram suggested a diagnosis of BRS. BRS may be confused with acute coronary syndrome; early recognition of this syndrome is essential, as implantable cardioverter-defibrillator therapy may be life-saving.     

Asymptomatic occlusion of the left main coronary artery by an aortic pseudoaneurysm

Extrinsic compression of the left main coronary artery is a rare cause of coronary ischemia. We describe a 35-year-old Asian woman with complete asymptomatic occlusion of the left main coronary artery by a large aortic pseudoaneurysm. She underwent repair of the pseudoaneurysm and coronary artery bypass grafting at the Mayo Clinic in Rochester, Minn. The differential diagnosis is discussed. Based on this patient's age and associated vascular lesions, we conclude that Takayasu arteritis was the most likely cause of her condition.     

Spontaneous coronary artery dissection causing acute coronary syndrome: an early diagnosis implies a good prognosis

Spontaneous coronary artery dissection is an unusual cause of acute coronary syndrome. We describe a series of cases that with an early diagnosis and aggressive treatment, which includes percutaneous angioplasty with stent implantation and cardiac surgery, had a good outcome. The objective was to study the demographic characteristics, clinical settings, treatments, and inhospital course of patients with spontaneous coronary artery dissection. We studied a retrospective case series in 3 coronary care units in third-level university hospitals. The spontaneous coronary artery dissection diagnosis was made by coronary angiography. Seven cases of spontaneous coronary artery dissections were recorded. They were 5 women and 2 men. The age range was 28 to 64 years. Two of them took oral contraceptives and one case occurred in the postpartum period. An acute anterior wall myocardial infarction was the most frequent clinical presentation, occurring in 4 of the 7 cases. In fact, the left anterior descending artery was involved in 6 cases. An urgent coronary angiogram was performed in all cases. Definitive treatment included percutaneous angioplasty and stent implantation in 3 cases, coronary artery bypass surgery in 2 case, and cardiac transplantation in another case. One patient was treated medically. None of the patients died in the hospital. Spontaneous coronary artery dissection remains an unusual cause of acute coronary syndrome. It should be included in the differential diagnosis of acute myocardial infarction, especially when it affects young, healthy females. An early clinical suspicion and diagnosis with urgent coronary angiography and aggressive treatment that includes percutaneous angioplasty with stent implantation and cardiac surgery could improve the prognosis of these patients.     

Anomalous coronary artery, aortic dissection, and acute myocardial infarction.

The combination of acute coronary occlusion and aortic dissection because of involvement of one or other coronary vessels in the dissection flap is uncommon. Furthermore, the occurrence of an anomalous coronary artery and its involvement in acute myocardial infarction is even more uncommon. We describe a patient with acute myocardial infarction in whom an acute aortic dissection involved the ostium of an anomalous circumflex artery.     

右腋动脉和股动脉灌注对急性A型主动脉夹层手术的器官保护作用

目的本研究旨在比较右腋动脉插管(AXC)与右腋动脉+股动脉插管(AXC+FAC)灌注策略的临床效果以及对急性A型主动脉夹层(AAAD)手术的器官保护作用。方法纳入2009年1月到2014年3月本院收治的在深低温停循环(DHCA)结合顺行脑灌注(ACP)下行急性A型主动脉夹层手术的74例患者。根据不同的插管策略,患者被分为两组:AXC组(n=30例),AXC+FAC组(n=44例);分别评估其术后神经功能不全、肾功能不全、肺功能不全、住院死亡等主要不良后果。结果两组患者心肌缺血时间比较差异无统计学意义(P=0.975);体外循环时间(P=0.001),脑灌注时间(P=0.034)和下半身停循环时间(P<0.0001)比较均有显著性差异。AXC+FAC组的△SCr(P=0.005)显著少于AXC组;AXC+FAC组患者血红细胞和血浆输注显著少于AXC组(P=0.020和P<0.0001)。两组患者在机械通气,气管切开,血液透析,神经功能障碍及住院死亡率比较差异无统计学意义(P>0.05)。结论与右腋动脉插管相比,采用右腋动脉和股动脉插管的灌注策略对急性A型主动脉夹层手术是安全的方法,可以有效保护脏器。     

Nail gun penetrating injury of the heart mimicking an acute coronary syndrome

We describe the case of a 75-year-old man admitted to hospital for chest pain and syncope. Physical examination was normal with evidence of a very small wound on the left chest. Considering the presence of multiple coronary risk factors, an acute coronary syndrome was initially suspected, but the electrocardiogram (EKG) was normal and only a slight increase of cardiac enzymes was detected. The hypothesis of aortic dissection was also considered and in order to discriminate between the aortic and coronary syndrome, a thoracic and coronary computed tomography (CT) scan was performed. The CT scan showed a metallic structure, suggestive of a nail, about 6 cm in length, in the deep layers of the left ventricular wall and a small pneumothorax due to a lung lesion. The patient was therefore transferred to our department for urgent cardiac surgery that was performed without complications.     

Acute concomitant pulmonary artery and aortic dissection with rupture

Pulmonary artery (PA) dissection is uncommon and may lead to rupture and sudden death if encountered. A 63-year-old man presented to our emergency room with episodic left chest pain radiating to the back followed by shortness of breath. A 64-row multidetector computed tomography (MDCT) revealed ruptured dissection of the PA and the aorta with hemopericardium, hemomediastinum, and prominent extravasated blood along the central bronchovascular bundles of both lungs. The patient experienced cardiogenic shock immediately following CT study and died after resuscitation. Concomitant PA and aortic dissection with rupture is extremely rare with the pathogenesis remaining investigated. MDCT proves to be a powerful tool in its diagnosis for a timely surgical repair if the patient could survive to have the operation.     

A case of hypothyroidism mimicking acute coronary syndrome

Hypothyroid patients have increased concentrations of creatinine kinase that is mostly due to increased CK-MM. However, CK-MB has also been reported to increase above reference values in hypothyroid patients without apparent myocardial damage. This may create confusion during the evaluation of myocardial injury in a hypothyroid patient presenting with chest pain. Troponin I is considered as a superior marker for the diagnosis of myocardial infarction in hypothyroid patients. However, there are some reports showing an increase in the level of troponin I without any myocardial damage in hypothyroid patients as in our case. In this report, we present a 47 years old male hypothyroid patient who had chest pain, abnormal electrocardiographic findings and increased cardiac enzymes suggesting acute coronary syndrome although he had normal coronary arteriogram. Address for correspondence: Huseyin Gunduz, MD, Department of Internal Medicine and Cardiology, Izzet Baysal Medical Faculty, Izzet Baysal University, Bolu, 14100 Turkey Tel.: +90-374-217-65-20 E-mail: drhuseyingunduz@yahoo.com