The Journal of invasive cardiology
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Review Case Reports
"Broken heart syndrome": catecholamine surge or aborted myocardial infarction?
Takotsubo cardiomyopathy, also called transient left ventricular apical ballooning or "broken heart syndrome", is a cardiac condition that mimics the clinical presentation of acute coronary syndrome but without any evidence of obstructive atherosclerotic coronary artery disease. An episode of intense emotional or physiologic stress, serving as the nidus for a catecholamine surge, has been reported prior to presentation and is presumed to be the triggering factor playing the pathogenic role. ⋯ The "aborted MI" hypothesis is more convincing as an all-inclusive nidus for the pathogenesis and clinical presentation described in Takotsubo syndrome. More detailed studies and research are needed to ascertain the pathogenesis and optimal management of this syndrome.
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This paper provides a comprehensive up-to-date review of the medical and invasive management of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), and ST-elevation myocardial infarction (STEMI), as supported by recent updates to the ACC/AHA Guidelines. The authors have summarized findings from key clinical trials published in recent years that contribute to clinician's understanding of how best to optimize therapy. The goals for the management of NSTE-ACS and STEMI are rapid and accurate risk stratification, appropriate and institution-specific triage to interventional versus medical strategies and optimal pharmacologic therapy - all of which provide for a smooth and seamless transition of care between the emergency department and the cardiology service. ⋯ Dosing recommendations for enoxaparin use in the setting of PCI have been issued by the CATH Panel and have been summarized in this consensus report. Similar recommendations have been presented for the use of oral antiplatelet agents and GP IIb/IIIa antagonists. The addition of statins, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers is also stressed as part of a comprehensive secondary cardioprotective strategy for patients with coronary heart disease.
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Systemic complications of native-valve endocarditis include embolism, abscess formation and development of mycotic aneurysms. To date, only two cases of mycotic coronary aneurysm (MCA) detected by transesophageal echocardiography (TEE) have been reported since 1812. We describe the successful management of infectious mitral valve endocarditis complicated by a MCA involving the left circumflex artery initially detected by TEE. This report illustrates the importance of correlating findings between TEE and coronary angiography, as early detection and prompt management of these rare coronary aneurysms are of paramount importance.
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Radial access is considered clearly impossible in patients who develop radial artery occlusion after a transradial procedure. Radial artery occlusion also prohibits an ipsilateral transulnar approach. ⋯ In some instances, the femoral access is also not an option due to severe aortoiliac disease. We describe a technique that allows the operator to access the proximal circulation from the occluded radial artery.