Spontaneous coronary artery dissection: An often unrecognized cause of acute coronary syndrome.

Spontaneous coronary artery dissection (SCAD), an intramural hemorrhage leading to a separation of the layers of the coronary artery wall, is traditionally considered a rare condition associated mainly with pregnancy but is likely underdiagnosed in other settings. Its recognition by coronary angiography is key. Medical management is usually indicated, except in certain circumstances in which coronary artery bypass grafting or percutaneous coronary intervention should be considered.

Secondary Hyperparathyroidism in Heart Failure.

Secondary hyperparathyroidism (SHPT) is a well-known pathophysiologic feature of chronic renal failure. In recent years, SHPT has become recognized as a complication of the aldosteronism associated with congestive heart failure and where excretory Ca and Mg wasting results in plasma-ionized hypocalcemia and hypomagnesemia. Elevations in plasma parathyroid hormone have adverse systemic consequences, including intracellular Ca overloading of myocytes and vascular smooth muscle with the induction of oxidative stress.

Lower Extremity Revascularization Using Optical Coherence Tomography-Guided Directional Atherectomy: Final Results of the EValuatIon of the PantheriS OptIcal COherence Tomography ImagiNg Atherectomy System for Use in the Peripheral Vasculature (VISION) Study.

Purpose: To evaluate the safety and efficacy of a novel optical coherence tomography (OCT)-guided atherectomy catheter in treating patients with symptomatic femoropopliteal disease.

Methods: The VISION trial ( ClinicalTrials.gov identifier NCT01937351) was a single-arm, multicenter, global investigational device exemption study enrolling 158 subjects (mean age 67.

Resolution of complete heart block after revascularization of acute marginal branch of the right coronary artery.

A patient presented with typical angina and a non-ST elevation myocardial infarction. Electrocardiogram showed complete heart block, and she was found to have a 90% acute marginal artery stenosis. The block resolved after balloon angioplasty of this artery that does not supply the atrioventricular node.

Successful aspiration and rheolytic thrombectomy of a renal artery infarct and review of the current literature.

The use of revascularization techniques including angioplasty, thrombectomy, and stenting in the coronary, cerebral, and peripheral arteries has revolutionized the entire field of endovascular therapeutics. In renal thromboembolism, the classic treatment has been anticoagulation with possible thrombolysis and surgical thrombectomy. The role of endovascular therapy in renal thromboembolism remains controversial.

High incidence of inaccurate stent placement in the treatment of coronary aorto-ostial disease.

Objectives: The purpose of this study was to evaluate the incidence of inaccurate stent positioning in the treatment of coronary aorto-ostial lesions.

Background: The percutaneous treatment of aorto-ostial disease is challenging, with a paucity of data describing the incidence of stent mispositioning.

Methods: We retrospectively reviewed the accuracy of stent positioning in 100 consecutive coronary aorto-ostial lesions.

Hypovitaminosis D and valvular calcification in patients with dilated cardiomyopathy.

Background: In patients with dilated (idiopathic) cardiomyopathy (DCM), little is known about the presence of valvular calcification and its association with hypovitaminosis D, which may predispose affected tissues to calcification. Our objectives were 2-fold: to conduct a retrospective assessment of echocardiographic evidence of valvular calcification in patients with DCM who were known to have hypovitaminosis D (25(OH)D <30 ng/mL) and to conduct a prospective assessment of serum 25(OH)D in patients with DCM, who had demonstrated echocardiographic evidence of valvular calcification.

Methods: The retrospective study consisted of 48 African American patients (34 men, 14 women; 52.

Fracture risk in men with congestive heart failure risk reduction with spironolactone.

Objectives: The purpose of this study was to determine whether spironolactone use is associated with fractures in men with congestive heart failure (CHF).

Background: In rats with aldosteronism, spironolactone preserves skeletal strength. However, in humans, the relationship of spironolactone to fractures is not known.

Secondary hyperparathyroidism in patients with untreated and treated congestive heart failure.

Background: The congestive heart failure syndrome includes a systemic illness with wasting of soft tissues and bone. We hypothesized secondary hyperparathyroidism (HPT) would be found in hospitalized patients with decompensated congestive heart failure (CHF), where secondary aldosteronism is expected, and who were either untreated or treated medically.

Methods: In 9 consecutive patients (7 males, 2 females; 8 African-American, 1 Caucasian; 33-60 yrs) admitted to the Regional Medical Center during a 28-day period with chronic left ventricular systolic dysfunction (EF<35%) and decompensated CHF (5 untreated; 4 treated with an angiotensin converting enzyme inhibitor, furosemide, and small-dose spironolactone), we measured: plasma parathyroid hormone (PTH); serum calcium corrected for albumin, magnesium, and phosphorus; serum creatinine and calculated creatinine clearance.