Alev Arat-Özkan

Radiation-induced coronary artery disease.

Wir berichten von einem 36-jährigen Patienten der wegen neu auftretender Angina-Symptomatik aufgenommen wurde. Er hatte keine Risikofaktoren für koronare Herzkrankheit (KHK). Anamnestisch auffällig war ein Morbus Hodgkin im Alter von 10 Jahren die mit Bestrahlung von Mediastinum behandelt worden war. Koronarangiographie ergab eine zwei Gefäßerkrankung mit komplettem Verschluss von RIA und 70% Stenose der rechten Koronararterie. Beide Verschlüsse wurden erfolgreich wiedereröffnet (Ballondilatation und Stent-Implantation). Kontrollangiographie nach einem Jahr ergab keine Restenose und der Patient war auch klinisch beschwerdefrei. Bei jedem Patienten mit kardialen Beschwerden und anamnestisch bekannter Bestrahlung im Bereich von Mediastinum soll an strahlenbedingte Herzerkrankung gedacht werden. Strahlenschaden kann zur Myokard-, Perikard-, Klappenerkrankungen oder Rythmusstörungen führen. Eine andere Manifestation ist früh ansetzende KHK. In dieser Hinsicht soll Bestrahlung im Bereich von Mediastinum als Risikofaktor für KHK angenommen werden. Da heutzutage Strahlentherapie die Behandlungsmethode für mehrere mediastinale Malignitäten ist, optimale Beschirmung während der Therapie und regelmäßige Kontrolluntersuchungen sind erforderlich um die kurz- und langfristige Komplikationsrate möglichst niedrig zu halten und Komplikationen, besonders KHK früh zu erkennen. Die bevorzugte Behandlungsmethoden für Strahlenbedingte KHK sind Ballondilatation mit Stent-Implantation oder aortakoronare By-pass-Operation. Die Mammaria-Arterien sollen preoperativ kontrolliert werden. Radiation-induced heart disease must be considered in any patient with cardiac symptomatology who had prior mediastinal irradiation. Radiation can affect all the structures in the heart, including the pericardium, the myocardium, the valves and the conduction system. In addition to these pathologies, coronary artery disease following mediastinal radiotherapy is the most actual cardiac pathology as it may cause cardiac emergencies requiring interventional cardiological or surgical interventions. A 36- year-old man was admitted to the clinic with unstable angina pectoris of one month duration. The patient had no coronary artery disease risk factor. The history of the patient revealed that he had mediastinal radiotherapy due to Hodgkin’s disease at 10-year of age. Coronary arteriography showed total occlusion of the left anterior descending artery and 70% stenosis of the proximal right coronary artery. Both arteries are dilated with placement of two stents. Control coronary arteriography at the end of the first year showed patency of both stents and the patient is free of symptoms. Previous radiotherapy to the mediastinum should be considered as a risk factor for the development of premature coronary artery disease. Percutaneous transluminal coronary angioplasty with stent placement or surgical revascularization are the preferred methods of treatment. Preoperative assessment of internal thoracic arteries should be considered prior to surgery. As the radiation therapy is currently the standard treatment for a number of mediastinal malignancies, routine screening of these patients and optimal cardiac prevention during radiotherapy are the only ways to minimize the incidence of radiation-induced heart disease.

Chronic total occlusion of left circumflex artery after radiofrequency ablation of left ventricular outflow tract tachycardia

In this report, we present a 22-year-old female patient referred to our institution for evaluation of anginal chest pain. Her medical history revealed two ablation procedures of the left ventricular outflow tract tachycardia performed 1 month a part, 2 years ago. Coronary angiography revealed chronic total occlusion of the proximal left circumflex artery. To our knowledge, this is the first report of ablation-related chronic total occlusion of a coronary artery.

Admission Hyperglycemia and TIMI Frame Count in Primary Percutaneous Coronary Intervention

We evaluated the relationship between admission blood glucose levels and estimated coronary flow by the thrombolysis in myocardial infarction (TIMI) frame count (TFC) method in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The TFC of 121 consecutive patients with STEMI were evaluated after pPCI. Patients with admission glucose levels >198 mg/dL (11 mmol/L) were defined as hyperglycemic. Hyperglycemia was observed in 36 (29.8%) patients. The TFC was significantly higher in patients with hyperglycemia (70.75 [10-96] vs 56.87 [8-100], P = .04). No-reflow frequency was higher in the hyperglycemia group (44.4% vs 23.5%, P = .02). In multivariate linear regression analysis admission glucose was an independent predictor of high TFC (B = 0.21, P = .02). Our findings suggest that admission blood glucose is a predictor of TFC which reflects coronary blood flow.

Dissecting aneurysm of the vertebral artery mimicking an acute coronary syndrome.

1558-2027 2012 Italian Federation of Cardiology changes are not rarely observed in central nervous system (CNS) events and may lead to misdiagnosis, which can have catastrophic results, including subarachnoid hemorrhage, subdural hematomas and ischemic stroke. We report a case of a patient who presented with syncope and ECG findings of acute coronary syndrome (ACS); however, further work-up revealed dissecting aneurysm of the vertebral artery as the final diagnosis.