Anna Posadzy-Małaczyńska

Right coronary artery aneurysm with fistula into the coronary sinus in patient with systemic lupus erythematosus.

A 65-year-old woman was hospitalised in the Department of Hypertensiology, Angiology and Internal Diseases due to occasional chest pain and unsuccessfully treated hypertension. The patient had systemic lupus erythematosus (diagnosed in 2002 and treated with Metypred for 7 years). Physical examination: without deviation. ECG: sinus rhythm 67/min; q in III, aVF; negative T in III, incomplete RBBB. Laboratory tests: ESR 48 mm/h; antibodies ANA > 1:300; anti-Ro (anti-SSA) 8.3; anti-ds DNA < 1:10. Stress ECG: (interrupted in 9 min, 10.8 METs, due to fatigue): 1 mm ST depression in II, III, aVF. Angiography: LM very short, no atherosclerotic lesions; LAD and LCX no atherosclerotic lesions; RCA dilated (aneurysm). Cardiac magnetic resonance imaging (MRI) [cm]: LVIDd 5.1; LA 4.0; RVDd 3.0; LVPWd 0.8; IVSd 1.0; Ao 2.0/3.1/2.5; mild mitral and tricuspid regurgitations; EF 69%; no perfusion myocardial impairment; dilated RCA (6.5 mm) (Fig. 1). Coronary computed tomography angiography: LM and LCX without coronary stenosis, LAD in distal part of proximal segment — atherosclerotic plaque (20–30% narrowing), RCA dilated to 9 mm proximally and 5 mm distally (Fig. 2), winding, length about 40 cm (Fig. 3), in the distal part — the fistula to the coronary sinus (Fig. 4). In the literature data, coronary aneurysms are recognisable in nearly 5% of those undergoing angiography. When large, they may predispose to turbulent blood flow and thrombus formation. Of all the coronary arteries, the RCA is the most commonly dilated and predisposed to fistula formation. The most common aetiologies of an aneurysm are: atherosclerosis (50%), hereditary diseases (20–30%), vasculitis (10–20%) and damage (also iatrogenic). Fistulas between the coronary vessels are usually asymptomatic and discovered incidentally, but they can lead to steal syndromes causing myocardial ischaemia. In this case, due to the coexistence of systemic lupus erythematosus, the inflammatory aetiology of the RCA aneurysm should be recognised. Due to the relief of angina after blood pressure normalisation and the absence of myocardium perfusion impairment, conservative treatment was continued. The MRI failed to show the fistula of dilated RCA. This leads to the conclusion that coronary artery tomography is more accurate for the diagnosis and monitoring of this pathology. The patient remains in clinical observation with effective treatment comprising perindopril (5 mg), indapamide (2.5 mg), amlodipine (10 mg) and aspirin (150 mg).

Gender, subclinical organ damage and cardiovascular risk stratification in hypertensive patients

Abstract Background: The aims of the study were to assess subclinical organ damage in men and women with hypertension and its subsequent effect on cardiovascular risk, and use of new statistical methods for more precise estimation of cardiovascular risk using vascular cardiovascular risk factors: ankle–brachial index (ABI), intima–media thickness (IMT) and pulse wave velocity (PWV). Methods: We studied 200 patients: 100 hypertensive and 100 normotensive. The parameters we evaluated included: patient age, ABI, IMT, PWV, serum uric acid and serum C-reactive protein (CRP). In addition, the cardiovascular risk according to the SCORE and Framingham scales was assessed. Results: In the hypertensive group, there were significant correlations between ABI and the Framingham scale in both sexes. In hypertensive women, there were also significant correlations between IMT and the SCORE scale risk, and IMT and the Framingham scale risk. In normotensive women, there were significant correlations between ABI and the SCORE scale risk, and between ABI and the Framingham scale risk. In normotensive men, there were significant correlations between PWV and the SCORE scale risk, and between PWV and the Framingham scale risk. Lastly, in the group of normotensive men, there were significant correlations between IMT and the SCORE scale risk, and IMT and the Framingham scale risk. The possibility of correctly classifying a patient into the high-risk category by a logistic regression model using synchronous ABI, IMT and PWV was high – 74% for the risk according to the SCORE scale (66% in men, 88% in women), and 98% for the Framingham scale. Conclusions: The addition of recognized subclinical target organ damage tests to the estimation of cardiovascular risk can significantly strengthen the prevention of cardiovascular disease. Cardiovascular risk estimation follow-up with ABI, PWV and IMT increased the probability of correctly classifying people, especially women, into an at least high-risk category according to the SCORE scale, which has valuable therapeutic implications.

Patient with disseminated atherosclerosis, resistant hypertension and quadruple left renal artery

Lucyna Woźnicka-Leśkiewicz, Anna Posadzy-Małaczyńska, Anna Wolska-Bułach, Maciej Frankiewicz, Robert Juszkat 1Department of Hypertensiology, Angiology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland 2Department of Family Medicine, Poznan University of Medical Sciences, Poznan, Poland 3Department of General and Interventional Radiology, Poznan University of Medical Sciences, Poznan, Poland