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PMID = 28867012

Despite substantial advances in the treatment of acute myocardial infarction, ischemic cardiac injury and ventricular dysfunction may develop in patients undergoing reperfusion therapy. In the past few years, several experimental and clinical studies have investigated ways of enhancing myocardial salvage and regeneration. Although clinical evidence suggests that some treatment strategies might be able to enhance myocardial salvage and regeneration, many open questions remain, including the exact mechanisms leading to benefits, the influence of patient characteristics, optimal clinical indication and patient selection, and delivery method, route, and timing of therapies. Further clinical trials are needed to clarify these issues.

Despite the clinical benefit achieved with the adjunct of clopidogrel in percutaneous coronary intervention, a considerable number of patients continue to have cardiovascular events. There are accumulating evidences that recurrence of ischemic complications may be attributed to poor response to clopidogrel. However, current therapeutic alternatives for treatment of clopidogrel resistance remain limited. More aggressive intervention with higher doses of clopidogrel and the use of newer antiplatelet agents may help overcome resistance to antiplatelet agents.

We would like to present and discuss the dilemma of an unusual right coronary artery anomaly in two cases. Double right coronary artery or a high take off of a large right ventricular branch are two diagnostic possibilities that may provide difficulty in differentiating such an unusual orientation of coronary arteries based on angiographic views.

0167-5273/$ – see front matter © 2010 Else doi:10.1016/j.ijcard.2010.04.086 A 40-year-old male patient was admitted to the emergency department with the complaint of severe chest pain just starting 5min after ingesting an oral dose of 500 mg cefuroxime-axetil. His past history was non significant for any allergic disease, hypertension, diabetes mellitus or dyslipidemia. He was a non-smoker. Physical examination including cardiovascular system was normal. There was no apparent sign of allergic reaction. Electrocardiogram showed ST segment elevation in leads D2, D3, aVF compatible with acute inferior myocardial ischemia (Fig. 1A). He was immediately undertaken to the coronary angiography laboratory. When the catheter crossed the ascending aorta, he was relieved from chest pain and ST elevations returned to baseline spontaneously (Fig. 1B). Consequent coronary angiography revealed hemodynamically insignifant plaques in the circumflex and right coronary artery (Fig. 2). He was transferred to the coronary care unit with the diagnosis of coronary spasm secondary to cefuroxime-axetil ingestion. Calcium antagonists and intravenous nitroglycerine were administered. Laboratory analysis showed no elevation of cardiac biomarkers. Transthoracic echocardiography revealed normal wall motions. His recovery was uneventful and he was discharged on his 4th day at the hospital. Development of acute coronary syndrome after exposure to an allergic insult is an unexpected and rarely reported phenomenon. This concept of “the coincidental occurrence of chest pain and allergic reactions accompanied by clinical and laboratory findings of angina pectoris” was first described in 1991 and named as the “Kounis syndrome” [1].

Coronary embolism is an uncommon cause of acute coronary syndromes and there is no standard recommended therapeutic algorithm for this rare entity. Herein, we present a 69-years old female patient diagnosed with non-ST elevation myocardial infarction due to coronary embolism secondary to paroxysmal atrial fibrillation. Considering the clinical characteristics of the patient and also no evidence of atherosclerotic basis for the lesion on the coronary angiogram, thrombus aspiration was decided to be the optimal treatment for this case. She underwent a successful thrombus aspiration procedure and followed by long-term oral anticoagulant therapy with warfarin.

Acute myocardial infarction (AMI) is accompanied by electrophysiological changes in cardiovascular system as well as those in autonomic cardiac control. Heart rate variability (HRV) is depressed due to increased sympathetic activity and/or decreased parasympathetic activity following AMI. Moreover, the frequency of ventricular late potentials (VLP) is increased due to the electrophysiological changes. Based on the hypothesis that the treatments increasing HRV and decreasing the frequency of VLP can improve the prognosis of AMI, we investigated the short-term effects of trimetazidine (TMZ) on HRV and VLP in patients with AMI.The study group consisted of 64 patients (men 49, mean age 55+/-12 years, range 26-70) suffering from first Q-wave AMI. Thirty-one of them were treated with conventional therapy (thrombolytic therapy, aspirin, beta-blocker, heparin and intravenous nitroglycerin) plus TMZ 20 mg tid. The remaining 33 patients served as controls. Holter monitorization between 24 and 48 h, echocardiography at average day 6 (range 4-7 days) and SAECG and sub-maximal exercise at average day 7 (range 6-9 days) were performed to all patients.While HRV parameters reflecting parasympathetic activity (SDSD: 43+/-16 ms-35+/-13 ms, RMSSD: 34+/-14 ms-27+/-8 ms, HF: 7.8+/-5 ms(2) -4.3+/-4 ms(2), P0.05) were of significantly higher levels in TMZ group, the low frequency component mainly reflecting sympathetic activity (LF: 10+/-6 ms(2)-10+/-5 ms(2), P0.05) was similar in both groups. In addition, LF/HF ratio showing sympatho-vagal balance was significantly decreased in TMZ group (1.5-3.0, P=0.005). About VLP, the mean FQRS (105+/-8 ms-107+/-10 ms), LAS (28+/-10 ms-30+/-11 ms) and RMS-40 (34+/-15 microV-41+/-12 microV) were not different in both two groups (P0.05).Our results suggest that TMZ treatment causes changes in sympatho-vagal balance in favor of vagal activity by increasing parasympathetic activity in AMI at early period; however, no effect on VLP was observed.

Despite clear association between increased level of homocysteine and increased risk for atherothrombotic events, there is currently not enough evidence to initiate homocysteine-lowering vitamins in high risk population in order to improve cardiovascular outcomes in the light of recent clinical trials. Further large-scale adequately powered clinical trials are awaited to clarify this issue.

During diagnostic angiographic procedures or percutaneous coronary angioplasty-stenting of the other coronary arteries, the overall risk for a complication related to the left main coronary artery (LMCA) is low; however, if such complications occur, they tend to be life-threatening and contribute to a large part of the total catheter-related mortality. We encountered a case of iatrogenic significant subtotal left main coronary artery thrombotic stenosis in a patient who had undergone prior percutaneous transluminal coronary artery angioplasty-stenting of the left circumflex artery. In light of the literature, an extremely rare clinical presentation of iatrogenic left main coronary artery thrombosis is discussed.

Ovarian hyperstimulation syndrome (OHSS) is one of the most serious complication of controlled ovarian stimulation. Cerebral infarction, myocardial infarction, death and vascular thrombotic events associated with OHSS had been reported. We report a case of a patient with myocardial infarction associated with OHSS.

Coronary stents have marked an era in the interventional cardiology and have significantly decreased the rates of acute restenosis. Although diminished rates of restenosis have been observed with stents with respect to balloon angioplasty, restenosis is still a major problem of the interventional procedures. Stent thrombosis (ST) after percutaneous coronary intervention (PCI) is a rare and usually poor prognostic event that might result in myocardial infarction (MI) and sudden death .We wanted to summarize the main features of the issue.

Congenital heart defects (CHD) are the leading cause of morbidity and mortality in infants, the etiology of most CHD remains unknown, with the influence of genetics still topic of debate. Heterozygous mutations in the transcription factor, NKX2.5, were among the first evidence of genetic cause for congenital heart disease. For the prevention of CHD identification of specific genetic causes for congenital cardiac malformations will provide insight into the developmental mechanisms that result in normal and abnormal cardiac development and will allow for improved family counseling.

Heart failure with a preserved ejection fraction is more common in elderly. Common comorbidities may have an impact on management of heart failure with preserved ejection fraction. The prognosis in more recent studies has been shown to be essentially similar to heart failure with reduced ejection fraction. Unlike heart failure with reduced ejection fraction for which many medications have been demonstrated to improve morbidity and mortality, no treatment has yet been shown to reduce morbidity and mortality in heart failure with preserved ejection fraction. Therefore, current treatment recommendations are aimed at symptomatic management as well as management of concomitant comorbidities.

We observed transient myocardial bridging of left anterior descending coronary artery (LAD) in 18.75% (12 of the total 64) of the patients during acute inferior myocardial infarction (MI). Myocardial bridging occurred only in the acute phase of inferior MI and not in the chronic phase. In the acute phase of inferior MI, compensatory hypercontraction of the anterior wall is assumed to occur in response to the decrease in the movement of the infarct-related walls. In the chronic phase, disappearance of the myocardial bridging observed due to the resolution of compensatory anterior wall hypercontraction, as a result of the reperfusion of infarct-related coronary artery. Most of the myocardial bridges seen in autopsy series are not seen angiographically. Variation at angiography may in part be attributable to small and thin bridges causing little compression. Adrenergic stimulation or afterload reduction by nitroglycerin facilitates diagnosis of myocardial bridging by increasing coronary compression. Both of these conditions are almost always present in acute MI. We concluded that transient myocardial bridging of LAD can be observed in some patients with acute inferior MI during acute stage.

A huge thrombus was observed in the proximal portion of the right coronary artery (RCA) in a 75-year-old patient. He presented with symptoms of cardiogenic shock due to acute myocardial infarction. Glycoprotein IIb/IIIa inhibitor (Tirofiban) was administered intra-coronary first, coronary angioplasty was performed later and, dramatic thrombus dissolution was observed on control coronary angiography.

We investigated the ventricular repolarization changes during thyrotropin-releasing hormone (TRH) test in 20 euthyroid healthy subjects. TSH elevation was observed in 14 subjects (age: 29±5 years). TSH increased at 20 min (baseline: 1.91±1.18 μU/ml vs. 20 min: 13.7±7.2 μU/ml, P P P

Insulin resistance, metabolic syndrome and ischemic heart disease are all inflammatory conditions having association with low birth weight. The hypothesis that altered gene expression producing a hyper-responsive innate immune system in low birth weight infants may help to explain this relationship.

Coronary embolism is an uncommon cause for myocardial infarction in clinical practice and there is no consensus on the treatment of this subject. Thrombolytic agents and percutaneous intervention are up to date options and yet there are only a few case reports regarding thrombolytic therapy in this special subgroup of patients suffering from myocardial infarction. We reported a 37-year-old woman patient with non-ST elevation myocardial infarction due to coronary embolism who was successfully treated using intravenous thrombolytic theraphy with tissue plasminogen activator.

The rupture of the guide wire is a very uncommon complication that may produce important consequences as occlusion of the artery of systemic embolism. The management of this event may be interventional or conservative, depending on the clinical situation of the patient and the position of the guide wire inside vessel. Here we present a case that we decided to leave the fragment in the artery. The retained filament and the coronary stenotic lesion was stented successfully.