Volume 20 - Issue 11 - November, 2008

“Apical Ballooning” — What Is the Cause?

*Sunil Wani, MD, DM, §Kathrin Glatz, MD, *Yves Suter, MD, *Peiman Jamshidi, MD, FESC, *Paul Erne, MD, FESC

Author Affiliations:
From the *Department of Cardiology, Luzerner Kantonsspital, Luzern, and the §Department of Pathology, University Hospital, Basel, Switzerland.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted July 11, 2008, provisional acceptance given September 15, 2008, and final version accepted September 16, 2008.
Address for correspondence: Prof. Paul Erne, Department of Cardiology, Luzerner Kantonsspital, CH- 60000 Luzern 16, Switzerland. E-mail: Paul.erne@ksl.ch

ABSTRACT: The pathophysiology of takotsubo cardiomyopathy remains enigmatic. Here we attempted to define the link between the coronary arteries and the histopathological involvement of the left ven- tricle. We observed similarities and discrepancies between patients. All patients experienced stress prior to the event. We found a reduced coronary flow reserve in all patients and signs of hibernating my- ocardium on biopsy specimen. This raises a strong suspicion of stress- induced endothelial dysfunction with hibernating myocardium in the pathogenesis of this cardiomyopathy.


Microvascular Dysfunction following Primary Percutaneous Coronary Intervention

*Radhakrishnan Ramaraj, MD and *,§,£Mohammad Reza Movahed, MD, PhD

Author Affiliations:

From the *University of Arizona College of Medicine, the §University of Arizona Sarver Heart Center and the £Southern Arizona VA Health Care System, Tucson, Arizona.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted March 13, 2008, provisional acceptance given May 29, 2008, and accepted June 3, 2008.
Address for correspondence: Radhakrishnan Ramaraj, MD, University of Arizona Medical Center, 1501, N. Campbell Avenue, Tucson, AZ 85724. E-mail: drkutty2@gmail.com

In the Setting of ST-Elevation Myocardial Infarction

ABSTRACT: Primary percutaneous coronary intervention (PCI) is an established reperfusion strategy in the treatment of acute myocardial infarction with ST-segment elevation (STEMI). Nevertheless, myocardial damage is not terminated immediately, even with successful primary PCI, which eliminates the epicardial occlusion. Despite the success of contemporary reperfusion therapy and effective restoration of epicardial coronary flow, many patients have suboptimal flow at the tissue level within the myocardium. Studies indicate that the...

Use of Anticoagulants in ST-Elevation Myocardial Infarction Patients undergoing Percutaneous Coronary Intervention

George W. Christy, MD

Author Affiliations:

From the Heart and Vascular Institute, Advocate Christ Medical Center, Oak Lawn, Illinois.
Disclosure: Dr. Christy is a consultant and on the speakers bureau for Sanofi-Aventis. He received editorial writing support in the preparation of this manuscript, funded by Sanofi-Aventis, New Jersey. The author is fully responsible for the content and editorial decisions for this manuscript.
Manuscript submitted June 10, 2008, provisional acceptance given July 29, 2008, and final version accepted August 29, 2008.
Address for correspondence: George W. Christy, MD FACC, Advocate Christ Hospital, 4440 W. 95th Street, Oak Lawn, IL 60453.

A Potential Role for Enoxaparin

ABSTRACT: Unfractionated heparin (UFH) is currently given as the standard anticoagulant therapy in ST-elevation myocardial infarction (STEMI) patients, including those undergoing percutaneous coronary intervention (PCI). Recent data, however, have shown lower rates of death or recurrent myocardial infarction (MI) with the low-molecular-weight heparin (LMWH) enoxaparin compared with UFH in STEMI patients treated with thrombolytics, offsetting an increase in major bleeding. This review compares the use of enoxaparin with UFH in STEMI patients undergoin...

ECG-Guided Immediate Intervention at the Time of Primary PCI

Philippe Lachance, Jean-Pierre Déry, MD, MSc, FRCP(C), Jonathan Beaudoin, MD, FRCP(C), Gérald Barbeau, MD, FRCP(C), Bernard Noël, MD, FRCP(C), Olivier F. Bertrand, MD, PhD, FRCP(C), Josep Rodés-Cabau, MD, FRCP(C), Can M. Nguyen, MD, FRCP(C), Guy Proulx, MD, FRCP(C), Onil Gleeton, MD, FRCP(C), Eric Larose, MD, DVM, FRCP(C), Louis Roy, MD, FRCP(C), Robert Delarochellière, MD, FRCP(C)

Author Affiliations:

From the Cardiology Department, Laval Hospital, Québec, Canada.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted April 9, 2008, provisional acceptance granted July 7, 2008, and final version accepted August 11, 2008.
Address for correspondence: Jean-Pierre Déry, MD, MSc, FRCP(C), Cardiology, Laval Hospital, 2725 ch Ste-Foy, Québec, Canada G1V 4G5. E-mail: jean-pierre.dery@med.ulaval.ca

To Reduce Door-to-Balloon Time in ST-Elevation Myocardial Infarction Patients

ABSTRACT: Background. In ST-segment elevation acute myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), all efforts must be made to improve door-to-balloon (DTB) times. This study was designed to assess the impact of electrocardiographic-guided immediate intervention (EGII) without performing a complete coronary evaluation on DTB times and clinical outcomes of STEMI patients treated with primary PCI. Methods. Consecutive STEMI patients undergoing primary PCI...

Cardiac Mass Presenting as ST-Elevation Myocardial Infarction: Case Report and Review of the Literature

Guarav Aggarwala, MD, Nikhil Iyengar, MD, Phillip Horwitz, MD

Author Affiliations:

From the University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Manuscript submitted April 23, 2008, provisional acceptance given June 12, 2008, and final version accepted June 13, 2008.
The authors report no conflicts of interest regarding the content herein.
Address for correspondence: Guarav Aggarwala, MD, Fellow, Division of Cardiovascular Disease, University of Iowa Hospitals and Clinics, 200 Hawkins Dr E318-GH, Iowa City, IA 52242. E-mail: gaurav-aggarwala@uiowa.edu

ABSTRACT: We discuss the case of a 71-year-old female patient who presented with findings suggestive of an acute myocardial infarction. Subsequent evaluation revealed an extrinsic cardiac mass encasing the left circumflex and right coronary arteries (RCA) which caused compression and spasticity of the RCA. Biopsy findings were consistent with a hematologic malignancy. Reports of extrinsic compression of epicardial coronary arteries are uncommon. Neoplasms, either primary cardiac tumors or metastatic disease, are a rare cause of extrinsic compression of coronary arteries.


Editor’s Message

Dear Readers,

This issue of the Journal of Invasive Cardiology continues our series of special focus sections to provide a more in-depth examination of important topics in cardiovascular medicine. The special section for this issue includes articles focusing on treatment of patients who present with ST-elevation myocardial infarction (STEMI). The guest editor for this section is Dr. Samin Sharma from Mount Sinai Medical Center in New York. Dr. Sharma has provided an introduction to the section and a short discussion about the articles that are featured this month. In addition to the foc...

Do Things that Make Sense to Further Improve STEMI Treatment

Guest Editor: Samin K. Sharma, MD

Director, Cath Lab and Intervention
Cardiovascular Institute
Mount Sinai Medical Center, New York, New York
E-mail: Samin.Sharma@mountsinai.org

Primary percutaneous coronary intervention (PCI) using stents (bare-metal or drug-eluting) has become the gold standard of treatment of ST-segment elevation myocardial infarction (STEMI). Numerous studies have established the importance of shortening the door-to-balloon time to ...

Intractable Prinzmetal’s Angina Three Months after Implantation of Sirolimus-Eluting Stent

Mitsuru Abe, MD, Akemi Yoshida, MD, Yoritaka Otsuka, MD

Author Affiliations:

From the Division of Cardiology, National Cardiovascular Center, Osaka, Japan.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted May 14, 2008, provisional acceptance given June 19, 2008, and final version accepted June 30, 2008.
Address for correspondence: Mitsuru Abe, MD, Division of Cardiology, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan. E-mail: mitsuru@ hsp.ncvc.go.jp

ABSTRACT: Sirolimus-eluting stents (SES) prevent neointimal proliferation and have been widely used to treat stenotic lesions in coronary arteries because of a significant reduction of restenosis in comparison with bare-metal stents. Sirolimus, however, may cause endothelial dysfunction by damage to vascular endothelium or impairing vascular repair. Recent studies report the occurrence of exercise- or acetylcholine-induced coronary vasoconstriction in the vessel segments adjacent to the SES. We report here a clinical case of intractable Prinzmetal’s angina 3 months after SES implantation and...

A Variant of Takotsubo Cardiomyopathy: A Rare Complication in the Electrophysiology Lab

*Jacob Collen, MD, §William Bimson, DO, §Patrick Devine, MD

Author Affiliations:
From the *Department of Internal Medicine, and the §Department of
Cardiology, Walter Reed Army Medical Center, Washington, D.C.
Presented at: ACC, Military Chapter Conference, April 2007, Washington,
D.C., Combined Army-Airforce ACP, November 2007, San Antonio, Texas,
National ACP, May 2008, Washington, D.C.
The authors have no conflicts of interest to disclose.
The views expressed in this paper are those of the authors and do not
reflect the official policy of the Department of the Army, Department of
Defense, or the U.S. Government.
Address for correspondence: Jacob F. Collen, MD, 1672 North 21st Street,
Apt. #7, Arlington, VA 22209. E-mail: jacob.collen@amedd.army.mil

ABSTRACT: Catecholamine-induced cardiomyopathy has been recognized for decades. We present the case of a 21-year-old female referred for an electrophysiologic (EP) study who underwent an infusion of isoproterenol and epinephrine in an attempt to unmask an ectopic atrial tachycardia. Prior to leaving the study suite, the patient started complaining of chest pain and shortness of breath. Bedside echocardiography revealed a severely depressed left ventricular ejection fraction (EF) of 25–30% with basal-mid left ventricular cavity hypokinesis, but normal apical wall motion. Her coronary angiogra...

Suitability of Saphenous Vein Graft Lesions for the Use of Distal Embolic Protection Devices

Sameer K. Mehta, MD, Joshua M. Stolker, MD, Andrew D. Frutkin, MD, Steven P. Marso, MD

Author Affiliations:

From the Mid-America Heart Institute, St. Luke’s Hospital, Kansas City, Missouri.
Disclosure: Dr. Marso is a consultant for Volcano Corp., and is a research grant recipient from Volcano Corp., Boston Scientific Corp., and Amylia Corp.
Manuscript submitted May 13, 2008, provisional acceptance given July 7, 2008, manuscript accepted September 5, 2008.
Address for correspondence: Joshua M. Stolker, MD, Mid-America Heart Institute, St. Luke’s Hospital, 4401 Wornall Road, Suite 5601, Kansas City, MO 64111. E-mail: jstolker@saint-lukes.org

ABSTRACT: The use of distal embolic protection devices (EPD) in saphenous vein graft percutaneous interventions (SVG-PCI) has been associated with a decrease in adverse events. Currently, there are limited data regarding the percentage of SVG lesions that are suitable for EPD deployment. We retrospectively reviewed 131 SVG-PCI procedures occurring over 18 months for suitability for EPD deployment, utilizing previously published suitability criteria. We found that 49% of cases were suitable for EPD use, which is similar to results from other studies. Given the data supporting the use of EPD use...

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