Wieslawa Piwowarska

Life-threatening cardiac manifestations of primary antiphospholipid syndrome

We report a rare case of primary antiphospholipid syndrome (APS) in a 43-year-old man presenting as recurrent acute coronary stent thrombosis and complicated by three myocardial infarctions. As illustrated in this report, in APS patients recurrent life-threatening arterial thrombotic events may occur in spite of recommended anticoagulant therapy. We conclude that the APS should be considered as a potential cause of acute coronary syndrome, particularly in young individuals with a history of recurrent thrombotic events and/or with abnormal coagulation test results. Further studies are needed to determine the best therapeutic strategy for APS patients with acute coronary syndrome.

Transient ST-segment elevation in lead aVR associated with tako-tsubo cardiomyopathy

ST-segment elevation in lead aVR in patients with angina at rest can be related to transmural ischemia of the basal part of the interventricular septum, frequently due to left main or multivessel coronary disease. However, this electrocardiographic (ECG) sign may also occur in other clinical conditions manifesting by acute chest pain. We present a case of a 76-year-old Caucasian woman with transient ST-segment elevation in lead aVR associated with tako-tsubo cardiomyopathy. Our report seems to confirm the hypothesis about the role of reversible myocardial ischemia involving the basal part of the interventricular septum in the pathogenesis of tako-tsubo cardiomyopathy. In conclusion, ST-segment elevation in lead aVR in patients with a clinical presentation of acute coronary syndrome may be not related to coronary artery disease. Tako-tsubo cardiomyopathy should be considered among the causes of ST-segment elevation in lead aVR in patients with angina at rest. Further studies are needed to evaluate the occurrence and importance of this ECG sign in patients with tako-tsubo cardiomyopathy.

Ergotamine-induced cardiovascular toxicity: mechanisms and clinical significance.

concluded that an acute elevation of pulmonary capillary wedge pressure does not limit exercise capacity in CHF. In other words a patient could have a very high PCWP but a relatively good oxygen uptake. According to this Fink et al. did not found an improvement of ventilatory efficiency by acute lowering of filling pressures [9]. Our data confirm that the acute cardiac output response is the main central hemodynamic determinant of exercise capacity and not acute pressure changes. Central cardiac pressures derived from PACmeasurements cannot be deduced from the results of a CPX test and may add independent information during the evaluation of heart failure patients. We hypothesize that a subgroup of patients for example with a disparity between symptoms and results of non-invasive tests may profit from PAC procedures. A prospective study on the impact on prognosis of different non-invasive and invasive hemodynamic tests in patients with severe heart failure is warranted.