The Journal of invasive cardiology
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Review Case Reports
Cocaine-induced postpartum coronary artery dissection: a case report and 80-year review of literature.
The incidence of cocaine-induced myocardial infarction (MI) in pregnancy is unknown. During the peripartum period, cocaine-abusing women are highly susceptible to MI caused by the effect of cocaine on a heart that is already stressed by hemodynamic changes of pregnancy. ⋯ We describe a case of MI diagnosed by increased troponin I levels in a postpartum patient with recent crack cocaine use in the setting of SCAD that required percutaneous coronary intervention of the left anterior descending and diagonal arteries. We also provide a comprehensive review of published literature related to this clinical entity.
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Comparative Study
Provision of gastroprotective medication and bleeding risk following acute coronary syndrome.
Gastrointestinal (GI) bleeding following percutaneous coronary intervention (PCI) is associated with increased mortality. ACCF/AHA/SCAI guidelines recommend prophylaxis to prevent GI bleeding in patients, with the highest GI bleeding risks taking dual-antiplatelet therapy (DAPT). The REPLACE risk score identifies factors predictive of peri-PCI bleeding from vascular access and non-access sites. We determined whether high bleeding risk acute coronary syndrome (ACS) patients taking DAPT were appropriately provided with GI prophylaxis and investigated the association between age and clinical presentation on the likelihood of receiving prophylactic therapy. ⋯ Less than half of ACS patients at high bleeding risk taking DAPT are provided with GI prophylaxis. Increased use of objective bleeding risk scores may help guide risk/benefit decisions in patients taking clopidogrel and proton pump inhibitors.
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Obstructive sleep apnea (OSA) and patent foramen ovale (PFO) are common conditions and may coexist. In patients with OSA, increases in right-to-left shunting across a PFO may result in increased burden of hypoxia, although the effect of this is unknown. ⋯ Although PFO closure can be achieved with minimally invasive techniques and low rates of adverse events, its importance in reducing hypoxia in this population is unknown. PFO closure may result in improvement in apneas and symptoms in selected OSA patients and may impact cardiovascular events in this group through hypoxia-mediated or other unrecognized mechanisms.
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Cardiac arrest carries a considerable mortality. Among survivors, the incidence of neurological dysfunction is considerable. ⋯ We report for the first time a case of successful coronary angiography and primary percutaneous coronary intervention (PCI) during ongoing ventricular fibrillation (VF) supported by mechanical chest compressions following out-of-hospital ST-elevation myocardial infarction (STEMI) and VF cardiac arrest. It illustrates four novel findings permitted by the use of mechanical chest compressions: (1) that it provided a perfusion pressure that facilitated the act of coronary angiography during ongoing VF following out-of-hospital STEMI and VF arrest, which (2) in turn permitted successful primary PCI, with (3) maintained neurological function and survival despite 79 minutes between arrest and PCI, and (4) illustrates the practical considerations that one must consider for PCI during mechanical chest compressions.