Evagoras Nicolaides

Takayasu arteritis presenting as epileptic seizures: a case report and brief review of the literature.

Neurological manifestations may complicate Takayasu arteritis (TA) but seizures are rare. A 40-year-old man with TA presented with recurrent episodes of epileptic seizures. Episodes consisted of a brief period of unresponsiveness followed by sudden falling, tonic stiffening and limb jerking. A postictal period with drowsiness, urine incontinence and a temporal loss of memory was also present. A carotid and intracranial duplex ultrasound revealed a reverse flow within the left vertebral artery indicating the presence of subclavian stealing syndrome while extracranial MRA suggested some stenosis at the origin of the left common carotid artery. The EEG was consistent with epilepsy. Neurological manifestations are secondary to ischemia caused by decreased blood flow in the involved carotid and vertebral arteries. Antiepileptic treatment proved effective and may be considered as a reasonable first approach. The stenotic lesions can be managed successfully with angioplasty but these procedures are associated with a high failure rate and may not be needed.

False positive ST-segment depression during exercise in subjects with short PR segment and angiographically normal coronaries correlation with exercise-induced ST depression in subjects with normal PR and normal coronaries

The aim of this study was to investigate exercise-induced ST-segment depression in subjects with a 120-ms or shorter PR segment and normal coronary arteries. A population of 86 individuals who demonstrated ST-segment depression of 1.5 mm or more on treadmill testing and had a subsequent normal coronary arteriography was classified into two groups. Group A (n = 71) comprised those with a normal PR interval on baseline electrocardiogram 160.9 +/- 14.8 ms (mean +/- 1 SD), and group B (n = 15) comprised those with a 120-ms or shorter PR interval 113 +/- 8.8 ms (mean +/- 1 SD). All subjects had undergone a symptom-limited treadmill test by the standard Bruce protocol (mainly for evaluation of chest pain or angina-like pain), during which they demonstrated ST depression of 1.5 mm or more in either lead II, lead V2, or lead V5. All had normal or near normal coronary arteries on angiography. In the subjects with short PR segments and angiographically normal coronaries, a trend of greater ST-segment depression during treadmill testing as compared with control subjects was observed in lead V5. In the same group, ST-segment depression at the 9th minute of exercise was more prevalent in lead V5 than in lead II or V2.

The Predictive Value of the Syntax Score in Patients With Chronic Coronary Artery Disease Undergoing Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting: A Pilot Study

Objectives: To evaluate the usefulness of the SYNTAX score (SS) in predicting 1-year clinical outcomes in a population of patients with chronic coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Background: Despite the proven prognostic value of the SS in patients with multivessel and/or left main (LM) CAD, its usefulness in other patient subsets remains uncertain. Methods: This was a prospective single centre cohort study conducted from September 2012 to November 2014 at the Nicosia General Hospital, Cyprus. Patients (n=140; 94% men and 6% women) with chronic CAD undergoing revascularization with either PCI or CABG were evaluated. Results: At 1-year, angina occurred in 20 patients (14.3%), myocardial infarction (MI) in 3 patients (2.1%), repeat revascularization procedures in 9 patients (6.4%) and death in 12 patients (8.6%). The SS independently predicted angina (p=0.024) but was not predictive of MI (p=0.964), death (p=0.292) or repeat revascularization (p=0.069). Conclusion: In this patient population, the SS predicted angina in the year following revascularization but was not predictive of MI, death or repeat revascularization.

Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with second-generation drug-eluting stents for patients with multivessel and unprotected left main coronary artery disease

Objectives: To compare the efficacy and safety of percutaneous coronary intervention using second-generation drug-eluting stents with those of coronary artery bypass grafting among patients with multivessel disease and/or unprotected left main coronary artery disease in terms of mortality, myocardial infarction, repeat revascularization, and angina. Background: Although coronary artery disease is a leading cause of death in the Western world and in many developing countries, its optimal treatment is still a matter of controversy. Several studies have examined the clinical safety and efficacy of percutaneous coronary intervention using first-generation drug-eluting stents over coronary artery bypass grafting in patients with multivessel disease and/or unprotected left main coronary artery disease. However, this study compared the efficacy of percutaneous coronary intervention using second-generation drug-eluting stents to that of coronary artery bypass grafting for multivessel disease and/or unprotected left main coronary artery disease. Methods: This was a prospective single-center cohort study conducted from September 2012 to November 2014 at the Nicosia General Hospital. In total, 140 patients (94% men and 6% women) with chronic coronary artery disease undergoing revascularization with either percutaneous coronary intervention using second-generation drug-eluting stents or coronary artery bypass grafting were evaluated. We examined the differences in clinical outcomes between coronary artery bypass grafting and percutaneous coronary intervention at 1-year follow-up. Results: Percutaneous coronary intervention with second-generation drug-eluting stents as opposed to coronary artery bypass grafting resulted in similar rates of mortality (5.7% vs 11.4%, respectively; p = 0.135), myocardial infarction (0% vs 4.3%, respectively), repeat revascularization (4.3% vs 8.6%, respectively; p = 0.115) and angina (10% vs 18.6%, respectively; p = 0.153). Conclusion: In this patient population, percutaneous coronary intervention with second-generation drug-eluting stents was not inferior to coronary artery bypass grafting in terms of mortality, myocardial infarction, repeat revascularization, or angina.

Symptomatic Type IV Dual Left Anterior Descending Coronary Artery

Dual left anterior descending coronary artery is a rare congenital anomaly with 4 subtypes. Double left anterior descending coronary artery originating from the left main stem and the right coronary artery (type IV dual left anterior descending artery) has been reported to occur in 0.01% to 0.7% of patients undergoing cardiac catheterization. We report a case of a 49-year-old woman who was found to have this anomaly during coronary angiography. The patient had been complaining of chest pain that mimics angina pectoris and exercise tolerance test was positive for myocardial ischemia.

Syncope due to prolonged asystole: an indication for pacing?

The patient reported two fainting attacks in the past, both during pregnancy. Her family history was free of heart disease. She did not receive any medications. Physical examination was unremarkable. Blood pressure (BP) measurements in supine and standing positions did not reveal orthostatic hypotension. The resting 12-lead electrocardiogram was within normal limits. On the basis of the patient’s history and physical examination, neurocardiogenic syncope was suspected as the cause of asystole during the operation as well as the two fainting attacks in the past.