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Presented is a case report of a 54-year-old male Jehovah's Witness diagnosed with an anomalous right coronary artery originating from the main pulmonary artery with the initial presentation with a history of episodic fatigue, chest pain, palpitation, and bodily weakness. The patient was managed with reimplantation of the anomalous coronary artery onto the ascending aorta.

Acoustic emission, electrical resistance, and surface optical techniques were used to monitor matrix cracking and fiber-breakage during fatigue in tension for [0/90]2s SiC-based laminate composite single-notch specimens. Acoustic emission sensors were positioned in several locations including on the edge of the specimen which enabled location of events through the width and the location of internal tunnel-type cracks. Surface optical techniques, including digital image correlation, enabled the extent of surface crack growth. From these two sets of data a simple circuit could be constructed of the different damaged and undamaged regions in the region of the notch that was in good agreement with the change in electrical resistance, thus establishing a correlation with change in ER and damage development. The unique placement of AE sensors on the edge of the specimen also enabled the capture and location of what are believed to be fiber failure events prior to ultimate failure.

Background: Many echocardiographic parameters have been proposed to evaluate right ventricular (RV) systolic function. We comprehensively assessed a wide range of quantitative echocardiographic parameters in a single cohort compared with same-day cardiovascular magnetic resonance (CMR). Methods and results: 92 subjects were examined prospectively: Group 1 consisted of 46 healthy controls (21 males, 33.4 ± 11.4 years), Group 2 consisted of 46 patients (20 males, 38.5 ± 18.9 years) undergoing RV functional assessment by CMR (1.5 T). Echocardiography was performed on the same day as CMR; fractional area change (RVFAC), myocardial performance index via spectral Doppler (RVMPI), RVMPI via Doppler tissue imaging (RVMPI-DTI), peak systolic myocardial velocity by DTI (RVSm), tricuspid annular plane systolic excursion (TAPSE), speckle tracking strain, and three dimensional right ventricular ejection fraction (3DE-RV). Linear regression, Bland-Altman and receiver-operator-characteristic (ROC) analyses were performed. At ROC analysis, the most predictive echocardiographic methods were; RVFAC (AUC = 0.892), RVMPI (AUC 0.785), TAPSE (AUC 0.849) and 3DE-RV (AUC 0.909). 3DE-RV appeared the most accurate compared to CMR, although underestimated true RV volumes. Conclusion: As compared to CMR; 3DE-RV, RVFAC, TAPSE and RVMPI were the most reliable predictors of RV function. These parameters can be recommended for clinical use.

Background Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) has been recommended to distinguish Tako-tsubo cardiomyopathy (TTC) from either acute myocardial infarction or myocarditis. Method 44 consecutive patients with confirmed Mayo Clinic criteria for TTC underwent CMR imaging at 1.5 Tesla during the acute phase. 10 patients who had CMRI to exclude scar related ventricular tachycardia, and had negative studies, were used as negative controls. LGE was quantitated at two signal intensity thresholds (CircleCVi software) at > 2 and > 5 standard-deviations (SD) above reference myocardium, and compared to biomarkers. Findings Mean door-to-CMR time was 57 hours. 18 patients (41%) had LGE > 2 SD localized to the area of abnormal wall motion, representing 28.9 ± 11.2% LV mass. In 16 of these 18 patients (89%) LGE signal intensity was > 5 SD above normal myocardium, representing 12.1 ± 10% LV mass. LGE signal intensity was significantly greater in TTC than in matched controls (p 5 SD above normal myocardium. Presence of LGE was associated with worse myocardial injury in the acute setting, with no difference in recovery of function.

Periprocedural anticoagulation continues to be a vital aspect in the management of coronary artery disease. Bivalirudin is a relatively new drug that has caught much attention in the last decade, especially in the context of percutaneous coronary intervention for acute coronary syndromes. Multiple clinical trials have shown the efficacy, safety profile and limitations of bivalirudin in contrast to previously used heparin and glycoprotein IIb/IIIa inhibitors. These trials have included patients with moderate to high-risk stable angina, unstable angina, non-ST-elevation and ST-elevation myocardial infarctions requiring PCI. The growing body of evidence on bivalirudin has also improved the understanding of its applicability and efficacy over other hirudin-based anticoagulants, however continual review of more recent evidence is important in order to integrate bivalirudin more widely across the various guidelines. This article aims to study the cross-section of the evidence base to date on the clinical use, efficacy and risks related to the use of bivalirudin and attempts to provide the clinician with a practical overview of the role of bivalirudin in the most recent guidelines.

Antiplatelet therapy constitutes a cornerstone in the strategies aimed at the effective management of acute coronary syndrome. Abciximab is the oldest and most commonly used intravenous antiplatelet agent in this context, in particular when an invasive strategy is adopted. It is very commonly used in more unstable and high-risk patients. Trials have proven the event-free survival benefits of using abciximab in the right context. This agent also has some adverse outcomes associated with its use that the clinicians need to be well aware of and take precautions against. The comparative cost efficacy with its use too is of significance. There is a growing evidence base on the different ways abciximab is used and the benefits and risks thereof. Since the development and introduction of novel anticoagulants and more potent oral anti-platelet agents, the place of abciximab in the treatment of acute coronary syndrome today needs to be reviewed and clearly defined. This review attempts to study the cross-section of the evidence base to date on the clinical use, efficacy and risks related to the use of abciximab and spotlight the most recent guidelines published by the different global peak bodies to provide a practical overview to the clinician.

Pulmonary hypertension may be left heart driven (post-capillary) or pulmonary mediated (pre-capillary) as determined by invasive pulmonary arterial catheterisation (PAC) which differentiates between the two. The “echocardiographic Pulmonary to Left Atrial Ratio” (ePLAR) is obtained by dividing