Anterolateral Myocardial Infarction Research Articles

Spontaneous coronary artery dissection: An unusual case of myocarditis mimicry with delayed apical thrombus

Introduction: We discuss the occurrence of a unique triad of spontaneous coronary artery dissection (SCAD), myocarditis, and thrombus in a patient without risk factors. Case Report: A 26-year-old male referred to our facility for invasive intervention after presenting with sudden onset chest pain for which an initial electrocardiogram (ECG) showed an anterolateral ST-segment elevation myocardial infarction and a troponin-I level of 425,923 ng/dL. Upon arrival, an urgent coronary angiography revealed a type II spontaneous SCAD of the left anterior descending artery with extensive myocarditis on cardiac magnetic resonance imaging with a subsequent development of an apical thrombus. He was medically optimized and discharged in a stable state. Conclusion: The complex interplay between SCAD, myocarditis, and thrombus development remains unclear and though rare, it serves as a relevant hypothesis-generating basis for future inquiry. Awareness of the concomitant occurrence of these entities is paramount to facilitating tailored management of affected patients.

Improvement in cardiac function and regional LV strain following intramyocardial injection of a theranostic hydrogel early postmyocardial infarction in a porcine model.

Myocardial infarction (MI) is often complicated by left ventricular (LV) remodeling and heart failure. We evaluated the feasibility of a multimodality imaging approach to guide delivery of an imageable hydrogel and assessed LV functional changes with therapy. Yorkshire pigs underwent surgical occlusions of branches of the left anterior descending and/or circumflex artery to create an anterolateral MI. We evaluated the hemodynamic and mechanical effects of intramyocardial delivery of an imageable hydrogel in the central infarct area (Hydrogel group, n = 8) and a Control group (n = 5) early post-MI. LV and aortic pressure and ECG were measured and contrast cineCT angiography was performed at baseline, 60 min post-MI, and 90 min post-hydrogel delivery. LV hemodynamic indices, pressure-volume measures, and normalized regional and global strains were measured and compared. Both Control and Hydrogel groups demonstrated a decline in heart rate, LV pressure, stroke volume, ejection fraction, and pressure-volume loop area, and an increase in myocardial performance (Tei) index and supply/demand (S/D) ratio. After hydrogel delivery, Tei index and S/D ratio were reduced to baseline levels, diastolic and systolic functional indices either stabilized or improved, and radial strain and circumferential strain increased significantly in the MI regions (ENrr: +52.7%, ENcc: +44.1%). However, the Control group demonstrated a progressive decline in all functional indices to levels significantly below those of Hydrogel group. Thus, acute intramyocardial delivery of a novel imageable hydrogel to MI region resulted in rapid stabilization or improvement in LV hemodynamics and function.NEW & NOTEWORTHY Our study demonstrates that contrast cineCT imaging can be used to evaluate the acute effects of intramyocardial delivery of a therapeutic hydrogel to the central MI region early post MI, which resulted in a rapid stabilization of LV hemodynamics and improvement in regional and global LV function.

P230 A RARE CASE OF INFECTIVE MYOCARDIAL INFARCTION

Abstract Background Prosthetic valve endocarditis (PVE) occurs in 1–6% of patients with valve prostheses. The most common agent of late PVE are S. aureus and Streptococci. Spondylodiscitis may precede the onset of endocarditis or may be the first clinical manifestation. Coronary embolization is a rare but possible complication of endocarditis. Case report: A 61 years–old man was admitted to the Emergency Department for low back pain, fever and chest pain. Four years before he underwent mitral valve bioprosthesis implantation and hybrid myocardial revascularization (percutaneous on right coronary artery). During observation cardiac arrest from ventricular fibrillation occurred, treated with single shock and evidence of anterolateral myocardial infarction at ECG. An urgent coronarography revealed chronic occlusion of CABG on LAD and acute occlusion, of possible embolic origin, involving LAD mid tract, first diagonal branch and intermediate branch. Thromboaspiration and subsequent PTCA was performed. For hemodynamic instability inotropic and vasopressor supports were started. A transthoracic echocardiogram showed severe left ventricular dysfunction (EF 25%) and 3.5x1mm endocardial vegetation on the mitral bioprosthesis without significant bioprosthesis dysfunction (confirmed by transesophageal echocardiogram). Blood cultures resulted positive for Streptococcus gordonii and antibiotic therapy based on the antibiogram was begun. Cardiac surgery was ruled out due to prohibitive surgical risk despite high probability of embolization. Because of the history of back pain spinal MRI was performed with evidence of cervial and lumbosacral spondylodiscitis. Neurosurgical indications were ruled out. Levosimendan infusion allowed weaning of vasopressor and inotropic therapy, however without improvement of left ventricular ejection fraction. Daily echocardiographic follow–up showed disappearance of the vegetation. Antibiotic targeted therapy was continued for 5 months, given the persistence of spondylodiscitis, in anticipation of intracardiac defibrillator (ICD) implantation in primary prevention. Conclusion PVE is a severe clinical condition associated with high morbidity and mortality. Antibiotic therapy is recommended for at least 6 weeks in PVE, in this case prolonged up to 5 months given the need to implant an ICD. Regarding the treatment of embolic infarction thromboaspiration is recommended as the initial strategy and, if successful, may be the only interventional option.

CE-454610-2 STEREOTACTIC ARRHYTHMIA RADIOABLATION IN VENTRICULAR FIBRILLATION WITH LEFT VENTRICULAR THROMBUS

Stereotactic arrhythmia radioablation (STAR) has been studied for management of refractory ventricular tachycardia (VT) that is not amenable to traditional catheter ablation. We present the case of a patient with recurrent ventricular tachycardia (VT) and left ventricular (LV) thrombus successfully treated with STAR therapy. A 48-year-old man with morbid obesity, paroxysmal atrial fibrillation and infarct related cardiomyopathy was admitted with late presentation of new anterolateral ST elevation myocardial infarction complicated by cardiogenic shock, managed with mechanical circulatory support. He was found to have a 3 x 2.7 cm thrombus in the LV apex (Panel A). He underwent successful percutaneous intervention to an acute left anterior descendinig coronary artery occlusion. During hospitalization, despite aggressive measures, he was noted to have polymorphic ventricular tachycardia (VT), triggered by premature ventricular contractions (PVCs) arising from his LV apical infarct (Panel B). He was treated with multiple antiarrhythmic medications (amiodarone, lidocaine) in addition to electrolyte repletion but unfortunately required repeated external defibrillation for PVC induced VF (Panel C). A dual chamber implantable cardioverter-defibrillator was placed and despite overdrive pacing, he suffered from recurrent life-threatening VT and ventricular fibrillation (VF) requiring additional defibrillation (Panel D). Because he was not a candidate for endocardial ablation, orthotopic heart transplantation, and was deemed too unstable for epicardial ablation, the decision was made to pursue STAR. Surface ECG and 4D computed tomography (Panel E) were used to localize the focus of the VT trigger. A single dose of 25 Gray of radiation was delivered to the LV apex. Our patient has been free of ventricular arrhythmias for 14 months. There has been no clinical evidence of early or late toxicity related to radiotherapy thus far. In challenging cases of PVC induced VT and VF not amenable to traditional therapies, such as our patient, STAR may offer a therapeutic option. Further studies are required.

Acute Myocardial Infarction Following the Consumption of Energy Drink in a 28-Year-Old Male: A Case Report.

Excessive intake of energy drinks is increasingly realized to have a detrimental effect on platelet and endothelial functions with resultant hypercoagulable state and consequently increased risk of thrombosis. A 28-year-old man of African origin presented to the emergency department with an 8-hour history of retrosternal chest pain. His symptoms started 4 hours after consuming 5 cans (1250 cc) of an energy drink whose principal ingredients are caffeine, taurine, sugar, and glucuronolactone. His past medical and surgical history was unremarkable, and he had no apparent cardiovascular risk factor. Physical examination was unremarkable; however, electrocardiogram and echocardiogram showed features of anterolateral myocardial infarction (STEMI). Catheterization confirmed a 100% thrombotic occlusion of the proximal left anterior descending (LAD) artery and revascularization with a drug-eluting stent was successful. In conclusion, sudden onset of chest pain following energy drink consumption should raise an index of suspicion for acute coronary syndrome. With the preponderance of data suggesting increased incidence of energy drink-associated coronary events, it is prudent to advocate a limited consumption of such beverages.

110 ANEURYSMECTOMY AND SURGICAL ABLATION: WHEN?

Abstract A 60-year-old man with a previous myocardial infarction was admitted to our ICU for acute pulmonary edema in the context of an acute antero-lateral non-ST elevation myocardial infarction. Echocardiography showed severe left ventricular (LV) dilatation with extensive wall motion abnormalities, large apical aneurysm and severe systolic dysfunction. Coronary angiography showed a triple-vessel disease with proximal occlusion of the left anterior descending artery. During the hospitalization, multiple episodes of drug-resistant monomorphic ventricular tachycardias occurred, requiring repeated DC Shock. After Heart Team discussion, the patient underwent coronary artery bypass grafting, LV restoration according to the procedure described by Guilmet and surgical cryoablation. The Guilmet septoexclusion is indicated when the interventricular septum is more involved than the free wall. After aneurysm incision, cryolesions were applied at the septum and at the transitional zone of the scar and viable tissue. Thus, the anterior free wall was sewn obliquely to the septum. Finally, the edges of the incision, anterior and septal, were sewn together to assure a definitive hemostasis (overcoat technique). After surgery, an implantable cardioverter-defibrillator was implanted in secondary prevention. The postoperative course and subsequent cardiological follow-up were characterized by a gradual clinical improvement with mild increasing in LV function and reduction in ventricular arrhythmias. Nowadays, combined aneurysmectomy and endocardial ablation are rarely performed, but should be considered in patients with LV aneurysm who manifest drug-resistant ventricular arrhythmias. Encircling cryoablation in a remodelled ventricle is safe and effective in reducing ventricular arrhythmias which are a negative prognostic factor.

Myocardial infarction due to left main coronary artery total occlusion: A unique electrocardiographic presentation

Left main coronary artery (LMCA) total occlusion typically presents as anterolateral ST-segment myocardial infarction with or without right bundle branch block with left anterior fascicular block, and ST-segment elevation in aVR. On the contrary to the previously described electrocardiographic pattern we describe a distinct electrocardiographic presentation in a patient with total LMCA occlusion characterized by the presence of complete LBBB co-existing with upsloping ST-segment depression in precordial leads leading to symmetrical, tall, positive T waves, the so called de Winter's sign.

Early Left Ventricular Thrombus Following Ventricular Fibrillation/Ventricular Tachycardia Electrical Storm.

Left ventricular thrombus (LVT) formation is a serious clinical complication of low-flow states that may be seen in an ischaemic, arrhythmic heart. While LVT formation has a poor prognosis, in the setting of myocardial infarction it is usually a result of post-infarct sequelae such as left ventricle aneurysms, and inflammatory changes from damaged tissue, with the LVT taking several days to form. Arrythmias such as ventricular tachycardia (VT) or ventricular fibrillation (VF) may also lead to thrombus formation, as they contribute to stasis due to decreased cardiac output. Large anterolateral myocardial infarctions can cause electrical or arrhythmic storm, characterized by more than three episodes of VT or VF in a 24-hour period. This prolonged state of dyskinesis further increases the risk of thrombosis, creating a compounding effect. Here, we report the case of a patient who had a VF cardiac arrest with electrical storm secondary to anterolateral myocardial infarction complicated with LVT formation found on echocardiogram after the cardiac arrest, which was absent on presentation. This thrombus formation occurred particularly early during the course of the patient’s arrest, possibly due to the compounding factors increasing the risk of thrombosis. Herein, we discuss in detail the risk factors for LVT formation, its mechanism and management options. A review of the literature also shows that LVT formation in the acute phase of arrest, as seen in our patient, is rare.LEARNING POINTSLeft ventricular thrombus (LVT) formation occurs 3–14 days after myocardial infarction, but in the setting of concomitant ventricular fibrillation arrest, may occur within the first 24 hours.Risk factors for LVT formation include a large infarct, anterior/anterior apical infarction, decreased ejection fraction (particularly <30–35%), left ventricular aneurysm, and delayed time to revascularization.Although diagnosis is generally made on transthoracic echocardiography with intravenous contrast, cardiac MRI with contrast has better sensitivity and specificity.Treatment consists of anticoagulation with a vitamin K antagonist or heparin for 3–6 months with a repeat echocardiogram to confirm the thrombus has organized or resolved. Further trials are needed to assess the efficacy of direct oral anticoagulants.

Acute myeloid leukemia causing acute thrombosis of the\xa0coronary arteries: a\xa0case report

BackgroundThis case report demonstrates acute myeloid leukemia causing acute thrombosis of coronary arteries with anterolateral ST elevation myocardial infarction and ventricular tachycardia in an otherwise healthy woman. Few case reports have been documented on patients with concomitant conditions of acute myeloid leukemia and acute myocardial infarction, and it is important to note that prognosis for patients with both is worse than that of either condition. While both conditions together are rare, other non-atherosclerotic causes of acute coronary syndromes are likewise important considerations in the context of myocardial ischemia.Case presentationA 59-year-old Caucasian woman with no notable past medical history presented to her primary care provider with 2 weeks of severe fatigue, anorexia, and malaise, associated with chills, night sweats, and myalgias. Peripheral blood smear identified 92% blasts consistent with acute myeloid leukemia and computed tomography identified a right segmental pulmonary embolism and thrombotic infarcts in the spleen, bilateral kidneys, right lung, and liver. Laboratory testing also demonstrated disseminated intravascular coagulopathy. She was admitted to the intensive care unit for treatment and subsequently developed ventricular tachycardia, anterolateral ST segment elevation, acute dysarthria, and nonreactive pupils. Pulseless electrical activity developed with unsuccessful resuscitative measures. The patient died secondary to presumed cerebrovascular and coronary thromboses causing stroke and anterolateral infarct complicated by ventricular tachycardia and pulseless electrical activity.ConclusionThis case is notable as a case of acute myeloid leukemia causing acute thrombosis of coronary arteries with anterolateral ST elevation myocardial infarction, ventricular tachycardia, and pulseless electrical activity. Prognosis of concomitant acute myeloid leukemia and acute myocardial infarction is poor. Management is challenging due to thrombocytopenia, platelet dysfunction, and systemic coagulopathy, and administration of thrombolytic agents can be fatal. This is an extreme presentation of a case of acute myocardial infarction with disseminated intravascular coagulopathy causing acute coronary thrombosis and sudden death with dramatic electrocardiogram and telemetry findings recorded with rapid progression from normal sinus rhythm to acute myocardial infarction to terminal rhythm.

Angiographic Profile of Type 2 Diabetic Patients with ST Elevation Myocardial Infarction: A Cross-sectional Study

Introduction: Coronary atherosclerosis is common in diabetics, and it is diffuse in form, with multivessel involvement. It demonstrates the involvement of multiple vessels rather than a single vessel. Aim: To evaluate the angiographic profile of diabetic patients with ST Elevation Myocardial Infarction (STEMI). Materials and Methods: The present study was a cross-sectional study which enrolled 104 diabetic patients presenting with STEMI from December 2019 to March 2020. Seventy percent or more stenosis in any major coronary artery or its major branches (&gt;2.5 mm) was considered as significant. Results: Mean age of the patients was 55.61±11.32 years, with 75 subjects being males and 29 subjects being females. A total of 28 (26.92%) had Anterolateral Wall Myocardial Infarction (ALWMI), 4 (3.84%) had Anteroseptal Wall Myocardial Infarction (ASWMI) 39 (37.5%) had Anterior Wall Myocardial Infarction (AWMI), 1 (0.96%) had extensive AWMI, 2 (1.9%) had Inferolateral Wall Myocardial Infarction (ILWMI), while 30 (28.84%) patients had Inferior Wall Myocardial Infarction (IWMI). Furthermore, 51 (49.0%) were thrombolysed while 53 (50.96%) patients were non thrombolysed. Thirty eight (36.53%) had single vessel disease, 40 (38.46%) had double vessel disease, while 26 (25%) had triple vessel disease. Among these patients, Left Main Coronary Artery (LMCA) was involved in 3 (2.88%) of patients. Seventy three patients had a Glycated Haemoglobin (HbA1c) of greater than 8.5 and had multivessel involvement, whereas 31 had a HbA1c of less than 8.5. Major Adverse Cardiac Events (MACE) was observed during hospital stay in the form of death, recurrent myocardial infarction and cardiovascular stroke, which occurred in 20 (19.23%) patients of the total 104 diabetic patients. Conclusion: In the present study, the severity and extent of Coronary Artery Disease (CAD) and incidence of triple/multivessel disease was significantly high in diabetics. Diabetic patients with high HbA1c had more coronary vessel involvement. In this case, Coronary Artery Bypass Graft (CABG) is the mode of treatment

278 Cardiac involvement in a 23 years old patient with granulomatosis with polyangiitis (GPA)

AimsGranulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis, which could potentially affect any organ system. However, there have only been a few reports on cardiac involvement. In fact, it most commonly involves the sinuses, lungs, and kidneys with necrotizing granulomatous vasculitis. In 12% of a large series of patients with GPA there was cardiac involvement, largely manifested by pericarditis and coronary arteritis.Methods and resultsWe describe a rare case of a 23-year-old girl, with no pathological history, at exception of a recent flu-like syndrome for which she carried out the search for SARS-CoV-2 RNA through nasopharyngeal swab, results negative. After a month, she went to the emergency department for a syncopal episode and subsequent head trauma. On this occasion, echocardiogram performed showed the presence of left ventricular systolic dysfunction due to hypokinesia of the middle distal segments; CT angiography of the chest revealed the presence of pulmonary embolism. For this reason, the patient was admitted to the cardiac intensive care unit, where EKG shown anterolateral myocardial infarction with ST elevation and immediately was performed coronary angiography, that evidenced two-vessel disease, with subsequent ineffective attempt to angioplasty. Due to the intercurrent appearance of hyposthenia and paraesthesia in the left upper limb, CT angiography of the brain was performed with detection of lower right pre central frontal hypodensity, suspected for recent ischaemic lesion and hypodensity of the right carotid artery as recent thrombosis. In light of the multi-organ involvement of ischaemic nature and the young age of the patient, rheumatological evaluation was carried out, with execution of a laboratory tests that showed the presence of positivity for ANCA anti-PR3 antibodies, on the basis of which was diagnosed GPA, and rituximab therapy was immediately initiated, with clinical benefit.ConclusionsCardiac involvement of GPA was first reported by Wegener in 1936. Classical or generalized GPA is characterized by necrotizing granulomatous vasculitis of the upper and lower respiratory tract together with glomerulonephritis. Widespread disseminated vasculitis involving both small arteries and veins occurs to a greater or lesser degree as the disease progresses. A localized form of GPA limited primarily to the upper and lower respiratory tracts has been described. Despite histopathological diagnosis of GPA, with autoantibodies against to circulatory neutrophilic cytoplasmic antigens, we can diagnose GPA easily and early. GPA must be kept in mind as the differential diagnosis of new onset cardiomyopathy, especially in the existence of pulmonary and renal pathologies. The clinical presentation of GPA can be so diverse that the list of differential diagnoses is vast, ranging from infections (fungal, bacterial, and mycobacterial) to other vasculitides, including Henoch–Schönlein purpura, sarcoidosis, Behcet syndrome, and malignancies. Despite that involving the heart is well described, significant cardiac complications occurring during the course of the disease are rare.

Left Ventricular Pseudoaneurysm and Left Ventricular Thrombus in a Patient Presenting with an Acute ST-Elevation Myocardial Infarction

Patient: Male, 73-year-old Final Diagnosis: Pseudoaneurysm • thrombus Symptoms: Chest pain • sycope Medication: — Clinical Procedure: — Specialty: General and Internal Medicine Objective: Unusual clinical course Background:ST-elevation myocardial infarction (STEMI), when associated with acute left ventricular (LV) free-wall rupture, is often a lethal complication, and if not followed by sudden death, the rupture may be contained by the parietal pericardium and a local thrombus, leading to the formation of a left ventricular (LV) pseudoaneurysm. The incidence of LV pseudoaneurysm after STEMI is ~ 0.3%.Case Report:A 73-year-old man who presented with an acute syncopal episode and intermittent chest pain for 7 days was found to have an anterolateral myocardial infarction (MI) with lateral wall rupture and pseudoaneurysm formation. He had an LV thrombosis in the LV aneurysm. While this increased his risk of thromboembolic events, it likely stopped the evolution of the rupture and stabilized the pericardial effusion size. The patient underwent coronary artery bypass grafting (CABG), thrombectomy, and lateral wall repair.Conclusions:Left ventricular pseudoaneurysm and left ventricular thrombus in a patient presenting with an acute ST-elevation myocardial infarction is a rare complication of myocardial infraction, with an incidence of <1%. It is often a lethal complication and requires stabilization and repair if not followed by sudden death.

Middle aortic syndrome: high index of suspicion should be kept in mind

A woman in her early 50s with a history of poorly controlled hypertension was admitted to the intensive care unit for an electrical storm complicating an anterolateral myocardial infarction. After...

ST Elevation in Lead aVR with Malperfusion Syndrome: Sign of Severe Aortic Dissection

Aortic dissection presenting with ST elevation in lead aVR of electrocardiogram is strongly associated with mortality. It is also associated with dissection involving the root of aorta and coronary vessels. We report a case of young male with hypertension, who presented with severe chest pain and unilateral lower limb pain. Physical examination of the left lower limb was consistent with acute limb ischemia. Electrocardiogram revealed acute anterolateral myocardial infarction together with ST elevation in aVR. Bedside transthoracic echocardiography showed a dilated aortic root measuring 4.51 cm with presence of intimal flap which raised the suspicion of dissection of root of aorta and left coronary artery. Computed tomography angiogram revealed aortic dissection from the root of aorta including the intimal flap near the origin of the left coronary artery, down to common iliac extending to the left iliac artery. Unfortunately, the patient opted for non-surgical intervention and succumbed 48 hours later. This case highlights that in case of aortic dissection, which presents with malperfusion syndrome, the presence of ST segment elevation at lead aVR should raise the suspicion for extensive aortic dissection involving the aortic root and left coronary artery which signifies unfavourable outcome

Akut Total LMCA Tıkanıklığı ve Başarılı TAP Stentleme: STEMI'da Hangi Stratejiyi İzlemeliyiz?

The incidence of acute total left main coronary artery (LMCA) occlusion cannot be fully determined precisely, given that most of patients die unfortunately before hospital arrival. This patient group is rarely encountered but mortality is very high due to endangered a large area of myocardium and increases the risk of cardiogenic shock and lethal arrhythmia quickly. We report a case of a 40-year-old woman presented with acute anterolateral myocardial infarction and was managed successful with percutaneous intervention with TAP (T-stenting And small Protrusion) technique stenting. According to current guidelines in LMCA disease, coronary artery bypass graft (CABG) is preferred, but percutaneous coronary intervention (PCI) is life-saving treatment strategy in emergencies for hemodynamic instability patient. On the other hand, there is no specific recommendations given concerning treatment for STEMI due to LMCA and optimal revascularitazion strategy is still uncertain because of absence of a randomized trial. Alternative treatments are; primary angioplasty-stenting, emergency CABG, primary angioplasty followed by emergency CABG.

A Surprising Evolution of Myocardial Infarction in Young Adults

Abstract Introduction. Ischemic heart disease is the leading cause of death with increasing prevalence. Acute myocardial infarction is a consequence of prolonged acute myocardial ischemia, which appears secondary to an imbalance between oxygen consumption and intake at this level. Case report. We present the case of a male patient, aged 53 years old, admitted in the Cardiovascular Recovery Clinic for moderate dyspnea, intermittent dizziness and muscle pain predominantly in the lower limbs. Regarding his medical history, he suffered an antero-lateral myocardial infarction due to excessive physical effort, which was trombolysed. Following the remission of the acute episode, the evolution over the next 6-12 months was towards heart failure clinically manifested by dyspnea. Considering the presence of heart failure associated with severely diminished ejection fraction, the medication is adjusted and Sacubitril/Valsartan is introduced at a dose of 49/51 mg twice a day, under which our patient presents with both clinical and echocardiography improvement. Cardio-pulmonary stress testing is the most accurate as it provides the best information regarding functional capabilities, beyond the ejection fraction of the left ventricle. Following the treatment with RNAi (angiotensin receptor-neprilysin inhibitor), the parameters evaluated during the stress test were improved, which is clinically transposed by improving the quality of life and implicitly the long-term prognosis. Conclusion. The particularity of this case consists in the occurrence of myocardial infarction at a young age (36 years) in a patient without a heredocolateral history or associated risk factors at that time. The association of ARNI (Sacubitril / Valsartan) in the therapeutic scheme has determined a clinical improvement, as well as paraclinical especially regarding the echocardiographic parameters (the ejection fraction increased from 25% to 40% at the end of the evaluation).

Myocardial Infarction Due to Coronary Artery Injury following High Force Blunt Trauma to the Upper Chest: A Case Illustrating the Prehospital, Hospital and Autopsy Findings

Myocardial infarction (MI) is a rare complication of blunt chest trauma (BCT). We describe an extensive antero-lateral MI due to thrombosis of the left main stem coronary artery following a blow to the lower face and upper anterior chest during an industrial accident in a 52-year-old male. The patient presented with acute left ventricular failure. Our case highlights MI as an important differential in a BCT patient presenting with hypoxia where lung pathology has been excluded. We aim to highlight the importance of cardiac assessment in trauma scenarios particularly where patients are unable to report symptoms. Our patient sadly did not survive his injuries. This case describes MI following BCT from the initial prehospital presentation through to postmortem findings and adds to the limited literature on the pathological mechanisms underpinning this rare complication.

The Scary Bubbles: Management of an Unusual Complication of Percutaneous Coronary Intervention

A 48-year-old man with no risk factors presented with an anterolateral ST-segment elevation myocardial infarction treated with 2 drug-eluting stents. During the primary percutaneous coronary intervention (PCI), difficulty was faced in passing the guidewire distally to the occlusion in the left

The year in cardiology 2018: acute coronary syndromes.

The management of acute coronary syndromes (ACS) is a true success story. Indeed, in 1955 when the then President of the United States Dwight D. Eisenhower had an infarction, the President’s personal physician, Dr Howard Snyder, interpreted his symptoms as a gastrointestinal illness.1 It took 10 h to transfer him to a local hospital where an electrocardiograph had to be brought in from another hospital—a situation that today would be malpractice.2 The electrocardiogram (ECG) showed an anterolateral acute myocardial infarction (AMI) with ST-segment elevation myocardial infarction or a STEMI as we would call it today based on the recent definition of myocardial infarction (MI).3 Based on the Fourth Universal Definition of Myocardial Infarction Eisenhower experienced a clear cut Type 1 infarction (Table 1). Today, we distinguish not only five types of infarction, but also myocardial injury, defined by an elevated cardiac troponin (cTn) value, which is also associated with an adverse prognosis. To differentiate myocardial injury from MI, criteria in addition to abnormal biomarkers are required such as ECG changes and evidence of ischaemia.

Acute Coronary syndrome in a patient newly diagnosed with Charcot-Marie-Tooth Neuropathy: a review of cardiovascular disease in this inherited neuropathy

Whilst we suspect that there is no clear association between the two major diagnoses we made in this patient during this hospitalisation (i.e. coronary artery disease and CMT neuropathy), the literature from a series of published case reports does perhaps show an association between CMT and abnormalities of cardiac conduction. Brief Summary: This case reports follows the occurrence of an antero-lateral ST segment elevation myocardial infarction in a 34-year-old male newly diagnosed with an inherited neuropathy in the form of Charcot-Marie-Tooth type 1A.