Risk factor comparison in young patients presenting with acute coronary syndrome with atherosclerotic coronary artery disease vs. angiographically normal coronaries.

Acute myocardial infarction is a relatively rare phenomenon in the young population. The incidence has nevertheless increased from years past, likely due to the presence of multiple risk factors from an increasingly younger age. Regardless of whether they have atherosclerotic coronary artery disease or normal coronary angiogram, young patients with risk factors for coronary artery disease (CAD), chest pain, and positive troponin, are initially treated in a similar fashion.

Migration of a Central Venous Catheter in a Hemodialysis Patient Resulted in Left Atrial Perforation and Thrombus Formation Requiring Open Heart Surgery.

Central venous catheterization is widely used in patients on hemodialysis. A rare complication associated with the clinical use of central venous catheters is perforation of the heart or major vessels. We report a case of inadvertent perforation of the left atrium and thrombosis after the placement of a hemodialysis catheter in the right internal jugular vein.

Impact of clinical predictors and routine coronary artery disease testing on outcome of patients admitted to chest pain decision unit.

Background: Chest pain decision unit (CDU) evaluation of patients with acute chest pain (ACP) and nondiagnostic electrocardiogram (ECG) usually includes noninvasive testing for coronary artery disease (CAD).

Hypothesis: CAD evaluation will not improve clinical outcome in low-risk ACP patients.

Methods: We studied 459 adults admitted to CDU with ACP and no troponin release who underwent noninvasive CAD testing (stress testing in 396 and coronary computed tomographic angiography in 63).

Risk factor assessment of young patients with acute myocardial infarction.

Unlabelled: The Middle East represents an attractive area for young individuals to seek employment, where they are exposed to numerous environmental conditions. The pursuit of a better standard of living has driven hundreds to the Middle East over the recent decades. This influx has also resulted in a predisposition to premature coronary artery disease (CAD).

Brugada syndrome with elevated cardiac biomarkers.

A 45-year-old man presented to our hospital with a history of palpitations, presyncope and chest pain. Vital signs and physical examination were unremarkable. Initial ECG  revealed sinus rhythm with non-specific ST changes.

"Lone aspiration thrombectomy" without stenting in young patients with ST elevation myocardial infarction.

Unlabelled: Plaque rupture with thrombotic occlusion without severe underlying coronary atherosclerosis is frequently observed during primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). These lesions are stented even if post thrombectomy mild underlying coronary artery disease (CAD) is noted. The value of mechanical thrombus aspiration alone "lone aspiration thrombectomy" (LAT) without stenting is not well studied.

Aneurysmal coronary cameral fistula.

A 26-year-old asymptomatic man, being medically managed for ventricular septal defect since childhood, presented to the outpatient clinic for a second opinion. Clinically, he was well built with normal vital signs. Cardiac auscultation was significant for a diastolic murmur over the praecordium.

'Mechanical thrombectomy alone' as a definite therapy for rescue angioplasty.

Coronary reperfusion strategies for acute ST segment elevation myocardial infarction (STEMI) include primary percutaneous coronary intervention (PCI), intravenous thrombolytic agents and recently mechanical thrombectomy alone during PCI, the latter reserved for those without significant residual disease post-thrombectomy. We describe the success of 'mechanical thrombectomy alone' in two young patients undergoing rescue angioplasty at our institution. Both patients were thrombolysed for inferior STEMI.

Rare manifestation of Behcet's syndrome: insight from multimodality cardiovascular imaging.

A young Jordanian man was hospitalised with fever of 2 months duration. Preadmission diagnostic assessment including CT thorax and abdomen were inconclusive. Right-sided pleuritic chest pain was present on admission.

Novel variant of dual left anterior descending coronary artery.

A 29-year-old African American man presented with atypical chest pain. Coronary computed tomographic angiography (64-slice) showed a previously not described variant of dual (duplicated) left anterior descending artery (LAD). Duplication of LAD is a rare anomaly and has been categorized into 4 angiographic subtypes based on the origin, course, and termination of the short and long LAD.

Functional anatomy of normal mitral valve-left ventricular complex by real-time, three-dimensional echocardiography.

Background And Aim Of The Study: A detailed anatomic examination of the mitral valve (MV)-left ventricular (LV) complex (annulus, leaflets, chordae, papillary muscles, and ventricular wall) is needed for the accurate assessment of functional mitral regurgitation, and for planning patient-specific valve repair. In the past, normal values for the various components of the MV-LV complex have been derived from two-dimensional echocardiography (2DE), but such measurements require unconventional image planes and allow no off-line adjustments. In addition, measurement of the LV volumes and dimensions of irregular structures (mitral annulus) is more accurate by using three-dimensional echocardiography (3DE).

Assessment of right ventricular function by real-time three-dimensional echocardiography improves accuracy and decreases interobserver variability compared with conventional two-dimensional views.

Aims: Two-dimensional echocardiographic (2DE) assessment of right ventricular (RV) function is difficult, often resulting in inconsistent RV evaluation. Real-time three-dimensional echocardiography (RT3DE) allows the RV to be viewed in multiple planes, which can potentially improve RV assessment and limit interobserver variability when compared with 2DE.

Methods And Results: Twenty-five patients underwent 2DE and RT3DE.

Clinical significance of epicardial fat measured using cardiac multislice computed tomography.

Cardiac adiposity defined as increased epicardial adipose tissue and massive deposits of fat within the atrial septum (lipomatous hypertrophy) is seen in overweight persons and is associated with coronary artery disease (CAD), atrial arrhythmias, and increased risk of left ventricular free wall rupture after acute myocardial infarction. Unlike subcutaneous fat, epicardial fat is metabollically active and produces hormones, cytokines, and other vasoactive substances that work systemically or locally to alter vascular endothelial function and may be implicated in the pathogenesis of CAD. The aim of the study was to assess the feasibility of measuring epicardial fat volume (EFV) and identify its clinical correlates using (64-slice) multislice computed tomography (MSCT).

Effects of phospholemman downregulation on contractility and [Ca(2+)]i transients in adult rat cardiac myocytes.

Phospholemman (PLM) expression was increased in rat hearts after myocardial infarction (MI). Overexpression of PLM in normal adult rat cardiac myocytes altered contractile function and cytosolic Ca(2+) concentration ([Ca(2+)](i)) homeostasis in a manner similar to that observed in post-MI myocytes. In this study, we tested whether PLM downregulation in normal adult rat myocytes resulted in contractility and [Ca(2+)](i) transient changes opposite to those observed in post-MI myocytes.

Rescue of contractile abnormalities by Na+/Ca2+ exchanger overexpression in postinfarction rat myocytes.

Previous studies on myocytes isolated from rat hearts 3 wk after myocardial infarction (MI) demonstrated increased cell length, reduced Na(+)/Ca(2+) exchange (NCX1) activity, altered contractility, and intracellular Ca(2+) concentration ([Ca(2+)](i)) transients. In the present study, we investigated whether NCX1 overexpression in MI myocytes would restore contraction and [Ca(2+)](i) transients to normal. When myocytes were placed in culture under continued electrical-field stimulation conditions, differences in contraction amplitudes and cell lengths between sham and MI myocytes were preserved for at least 48 h.

Phospholemman modulates Na+/Ca2+ exchange in adult rat cardiac myocytes.

Previous studies have shown that overexpression of phospholemman (PLM) affected contractile function and Ca(2+) homeostasis in adult rat myocytes. We tested the hypothesis that PLM modulated Na(+)/Ca(2+) exchanger (NCX1) activity. PLM was overexpressed in adult rat myocytes by adenovirus-mediated gene transfer.

Effects of sprint training on contractility and [Ca(2+)](i) transients in adult rat myocytes.

The effects of 6-8 wk of high-intensity sprint training (HIST) on rat myocyte contractility and intracellular Ca(2+) concentration ([Ca(2+)](i)) transients were investigated. Compared with sedentary (Sed) myocytes, HIST induced a modest (5%) but significant (P < 0.0005) increase in cell length with no changes in cell width.

Overexpression of phospholemman alters contractility and [Ca(2+)](i) transients in adult rat myocytes.

Previous studies showed increased phospholemman (PLM) mRNA after myocardial infarction (MI) in rats (Sehl PD, Tai JTN, Hillan KJ, Brown LA, Goddard A, Yang R, Jin H, and Lowe DG. Circulation 101: 1990-1999, 2000). We tested the hypothesis that, in normal adult rat cardiac myocytes, PLM overexpression alters contractile function and cytosolic Ca(2+) concentration ([Ca(2+)](i)) homeostasis in a manner similar to that observed in post-MI myocytes.