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Register a new userSpontaneous Coronary Artery Dissection
التسلخ التلقائي للشريان الإكليلي
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Tishreen University ورقة بحثية
Publication date
2021
fields
Medicine
and research's language is
العربية
Authors
منتجب صالح( باحث )
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Shamra Editor
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تسلخ الشريان الاكليلي التلقائي هو تشخيص نادر وغالبًا ما يتم تفويته بين المرضى الذين يعانون من متلازمة الشريان الاكليلي الحادة. لسوء الحظ، يمكن أن يؤدي التسلخ التلقائي للشريان الاكليلي إلى أمراض خطيرة مثل نقص تروية عضلة القلب والاحتشاء واضطربات نظم القلب البطينية والموت القلبي المفاجئ. يعد غياب المعرفة الجيدة بالتصوير الوعائي من قبل الأطباء عاملاً رئيسًا في نقص التشخيص. مع ظهور طرائق جديدة للتصوير، خاصةً مع التصوير داخل الاكليلي، تم تحسين تشخيص التسلخ التلقائي للشريان الاكليلي. الهدف من هذه المقالة هو مراجعة الوبائيات والمسببات والأعراض والتشخيص والتدبير بالنسبة للتسلخ التلقائي للشريان الاكليلي.
Spontaneous coronary artery dissection (SCAD) is an infrequent and often missed diagnosis among patients presenting with acute coronary syndrome (ACS). Unfortunately, SCAD can result in significant morbidities such as myocardial ischemia and infarction, ventricular arrhythmias and sudden cardiac death. Lack of angiographic recognition from clinicians is a major factor of under-diagnosis. With the advent of new imaging modalities, particularly with intracoronary imaging, there has been improved diagnosis of SCAD. The aim of this paper is to review the epidemiology, etiology, presentation, diagnosis and management of SCAD.
References used
Nienaber CA, Powell JT. Management of acute aortic syndromes. Eur Heart J 2012; 33:26 - 35b
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Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital
anomaly. It presents predominantly in infancy with features of myocardial ischemia or cardiac failure and
may be mistaken for common pediatric cond
itions such as colic, reflux or bronchiolitis. With early
surgical correction the prognosis is good. In this report we present unusual case of a 5-year-old female
with an anomalous left coronary artery arising from the pulmonary artery (ALCAPA) presenting with
chest pain,dyspnea and palpitation during physical exertion.Trans-thoracic echocardiography and
coronary angiography revealed an anomalous origin of the left coronary artery with mitral regurgitation .
She subsequently underwent successful surgical technique where the left internal thoracic(mammary)
artery was used to revascularise the left main coronary artery which is considered as the first unique
procedure in children. Excellent surgical results were obtained and the patient was discharged from the
hospital without complaints.
Platelets play a key role in the development and progression of atherosclerosis.
Platelet volume is an indicator of platelet activation and function, and it can be assessed by
platelet volume indices (PVI) such as mean platelet volume (MPV), platel
et distribution
width (PDW), and Platelet-large cell ratio (P-LCR). PVI are potentially useful markers for
the prediction of acute coronary syndromes. Thus our study aims to evaluate the
relationship between them and clinical features of coronary artery disease (CAD).
Our population is represented by 60 patients undergoing coronary angiography at Al-
Assad University Hospital, Lattakia, Syria. Patients were evenly divided into four groups
according to their clinical presentation; control group, stable angina group, unstable angina
group, and acute myocardial infarction (MI) group. PVI were measured in all patients.
We found a significant increase in MPV (P=0.04), PDW (P=0.03), and P-LCR
(P=0.03) in patients compared to healthy control subjects. We calculated the cutoff points
of these indices to help diagnosing the progressive atherosclerotic plague, P-LCR>28.7%
(P=0.01) [sensitivity 44%, specificity 93%], and diagnosing MI, PDW>13.8 (P=0.01)
[53%, 100%], MPV>10.4 (P=0.004) [60%, 93%], P-LCR>28.7 (P=0.003) [66%, 93%].
In conclusion, PVI are simple and easy methods that can be used as a predictive
marker in CAD patients.
Heart disease, particularly coronary artery disease is a major cause of
morbidity and mortality among patients with diabetes mellitus .
In addition to the increased clinical incidence of coronary artery disease ,
the extent of coronary arteries st
enosed is also greater among diabetics .
T his study showes that diabetics, compared to non-diabetics ,have a higher
incidence of multiple vessel disease (٨٤٪ vs ٤٨٪) and lower incidence of one
vessel disease .
It also showes that left ventricular function and left ventricular wall
movement are more impaired in diabetics .
Prevention is the key to reduce the incidence of Contrast-induced nephropathy (CIN) and it
begins with identification of the high risk patients.
Aim: Identifying the different risk factors for CIN .
Methods: This is a prospective analytical study
that has included 156 patients, all
underwent an objective exam, hematochemical measurements. The patiemts were divided
into two groups depending on the incidence of CIN defined as an increase in creatinine
level equal or more than 25% from baseline values within 48-72 hours after the coronary
procedure.
Results: Several independent risk factors for CIN were identified: age equal or more 70
year (OR:4.11, P:0.004( , contrast volume more than 200 ml )OR:3.2,P:0.01(, anemia
(OR:2.7,P:0.01), urgent cardiac catheterization) OR:3.3,P:0.02(,diabetic nephropathy
(OR:4.9,P:0.04).
Conclusion: . Increased contrast volume ,urgent cardiac catheterization elderly patients ,
anemia and diabetic nephropathy are associated with increased risk for CIN.
Protection against cardiac ischemia/reperfusion injury is the basic objective in open heart surgery, and it may be achieved by pharmacological preconditioning or Postconditioning. In this study, we aimed to compare the effects of two different anest
hetic techniques (inhalation and total intravenous anesthesia) on ischemia-reperfusion injury in Coronary Artery Bypass Graft surgery. 80 CABG patients were randomly assigned into one of tow groups: Group A Sevoflurane (n=40) and Group B total intravenous anesthesia (n=40) with Propofol . data of hemodynamic monitoring and inotrops using were recorded. Arterial blood samples were taken in the preoperative period (T0), 12th hours (T1) ,24th hours (T2) and 48th hours postoperatively, and Troponine I levels were measured . The time of ventilation, ICU and total hospitalization were recorded .
Postoperative levels of troponine I were significantly lower in the Sevoflurane group with less using of inotrops and less staying in the ICU post-op . We conclude that the use of a volatile anesthetic regimen in CABG surgery associate with better preservation of myocardial function and a reduced postoperative release of
troponine I.
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