Cardiac Computed Tomography Angiography in the Evaluation of Coronary Artery Disease: An Interventional Perspective.

Cardiac computed tomography angiography (CCTA) has become the gold standard for noninvasive anatomic assessment of the coronary arteries. With high positive predictive value and even higher negative predictive value, CCTA allows for rapid determination of the presence or absence of coronary plaque and triage of patients' need for further invasive evaluation and treatment. From an interventional cardiologist's perspective, CCTA (more so than stress testing) is helpful in determining the need for invasive therapy.

Extreme Hyperthermia Due to Methamphetamine Toxicity Presenting As ST-Elevation Myocardial Infarction on EKG: A Case Report Written With ChatGPT Assistance.

We present a case report of a 37-year-old male who presented to the emergency department with altered mental status and electrocardiographic changes suggestive of an ST-elevation myocardial infarction (STEMI). He was ultimately diagnosed with extreme hyperthermia, secondary to drug use, which was managed promptly with supportive measures resulting in a successful outcome. This case highlights the importance of considering drug-induced hyperthermia as a potential cause of altered mental status and EKG changes in patients, especially in those with a history of drug abuse.

Transradial Renal Angioplasty and Stent Placement for Systemic Hypertension Caused by Severe Unilateral Renovascular Stenosis.

Percutaneous transluminal angioplasty and stent placement for renovascular hypertension is a recognized albeit seldom used therapy. We present a case of severe renovascular hypertension, due to renal artery atherosclerosis, treated successfully with stent placement via the radial artery access approach.

Occupation-specific, high-intensity cardiac rehabilitation for return to work of a young police officer after myocardial infarction from traumatic coronary artery dissection.

Following a traumatic coronary artery dissection and subsequent myocardial infarction from a nonpenetrating strike to the chest by an airborne metal pipe, a 33-year-old male police officer completed 12 weeks of high-intensity, symptom-limited cardiac rehabilitation in order to return to active duty. Physiological and perceptual responses to exercise were used to progress the patient through high-intensity activities that challenged the musculoskeletal and cardiorespiratory systems while simulating real work activities. In addition to substantial improvements in functional capacity (8.

Radial Hemostasis Is Facilitated With a Potassium Ferrate Hemostatic Patch: The STAT2 Trial.

Objectives: The aim of this trial was to test whether the potassium ferrate hemostatic patch (PFHP) as an adjunct to the TR Band (TRB) facilitated an early deflation protocol.

Background: Shorter TRB compression times may reduce the rate of radial artery occlusion (RAO) and reduce observation time after transradial access.

Methods: A total of 443 patients were randomized to the TRB or PFHP + TRB, with complete TRB deflation attempted 60 minutes postprocedure.

Antecedent Administration of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Antagonists and Survival After Hospitalization for COVID-19 Syndrome.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) utilizes the angiotensin-converting enzyme-2 (ACE-2) receptor to enter human cells. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARB) are associated with ACE-2 upregulation. We hypothesized that antecedent use of ACEI/ARB may be associated with mortality in coronavirus disease 2019 (COVID-19).

Inpatient Mortality According to Level of Respiratory Support Received for Severe Acute Respiratory Syndrome Coronavirus 2 (Coronavirus Disease 2019) Infection: A Prospective Multicenter Study.

Objectives: To describe patients according to the maximum degree of respiratory support received and report their inpatient mortality due to coronavirus disease 2019.

Design: Analysis of patients in the Coracle registry from February 22, 2020, to April 1, 2020.

Setting: Hospitals in the Piedmont, Lombardy, Tuscany, and Lazio regions of Italy.

Hanging by a thread-urgent coronary artery bypass grafting for ST elevation myocardial infarction in a patient with isolated left main coronary artery disease.

A 78-year-old man presented with a left main stenosis as the culprit lesion in an acute myocardial infarction. He had no significant narrowing in any other coronary territory. This case describes findings in an isolated left main myocardial infarction and discusses appropriate treatment strategies.

Limitations of transoesophageal echocardiogram in acute ischaemic stroke.

Objective: The role of transoesophageal echocardiography (TOE) in identifying ischaemic stroke aetiology is debated. In 2018, the American Heart Association/American Stroke Association (AHA/ASA) issued class IIa recommendation for echocardiography, with the qualifying statement of use in cases where it will alter management. Hence, we sought to determine the rate at which TOE findings altered management in cases of confirmed ischaemic stroke.

Giant Right Coronary Artery Aneurysms.

Described herein are 2 adults with right coronary artery aneurysms measuring ≥4.0 cm in maximal diameter. Each aneurysm contained huge intra-aneurysm thrombus and each coronary artery contained atherosclerotic plaques diffusely.

Considerations for cardiac catheterization laboratory procedures during the COVID-19 pandemic perspectives from the Society for Cardiovascular Angiography and Interventions Emerging Leader Mentorship (SCAI ELM) Members and Graduates.

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is highly infectious, carries significant morbidity and mortality, and has rapidly resulted in strained health care system and hospital resources. In addition to patient-related care concerns in infected individuals, focus must also relate to diminishing community spread, protection of staff, case selection, and concentration of resources. The current document based on available data and consensus opinion addresses appropriate catheterization laboratory preparedness for treating these patients, including procedure-room readiness to minimize external contamination, safe donning and doffing of personal protective equipment (PPE) to eliminate risk to staff, and staffing algorithms to minimize exposure and maximize team availability.

First and recurrent events after percutaneous coronary intervention: implications for survival analyses.

Using composite endpoints and/or only first events in clinical research result in information loss and alternative statistical methods which incorporate recurrent event data exist. We compared information-loss under traditional analyses to alternative models. We conducted a retrospective analysis of patients who underwent percutaneous coronary intervention (Jan2010-Dec2014) and constructed Cox models for a composite endpoint (readmission/death), a shared frailty model for recurrent events, and a joint frailty (JF) model to simultaneously account for recurrent and terminal events and evaluated the impact of heart failure (HF) on the outcome.

Smeloff-Cutter Mechanical Prosthesis in the Aortic Position for 49 Years.

We describe a 76-year-old male physician who at age 27 underwent replacement of his stenotic aortic valve with a Smeloff-Cutter mechanical prosthesis which functioned normally for 49 years. He died of a noncardiac condition. A normally functioning substitute cardiac valve for this length of time has not been previously reported (1).

Brugada ST elevation masquerading as ST elevation myocardial infarction.

Brugada syndrome (BS) is a genetic cardiac syndrome first described in 1992 that is characterized by distinct abnormalities noted in leads V1 and V2 on electrocardiogram. It often leads to syncope or even sudden death in affected patients due to its propensity for ventricular tachycardia and fibrillation. The characteristic ST elevation seen in these patients can be confused with ischemic ST elevation.

Takotsubo cardiomyopathy in the setting of complete heart block.

Few cases of coincident takotsubo cardiomyopathy and complete heart block (CHB) have been reported. A 62-year-old woman presented with typical chest pain and was found to have CHB with a left ventricular ejection fraction of 35% and apical ballooning on ventriculogram. The patient was transvenously paced and a permanent biventricular pacemaker was placed when the CHB did not resolve.

Utility of routine transesophageal echocardiography in patients with stroke or transient ischemic attack.

In several series of patients with presumed stroke, transesophageal echocardiography (TEE) has seemed advantageous over transthoracic echocardiography (TTE) in that it improves detection of cardiac sources and can lead to changes in the methods of treatment. We hypothesized that the real-world application of TEE in our institution produced results at variance from those previously reported. Our study of 219 patients, referred for TEE for an indication of stroke or transient ischemic attack, found few relevant findings that would have indicated a new diagnosis or required a change in treatment.

Transulnar access for coronary intervention in a 23-year-old with accelerated coronary atherosclerosis due to congenital aortic hypoplasia.

The use of alternative arterial access and advanced imaging is not only applicable to mainstream adult cardiology, but helpful and sometimes necessary in taking care of adult patients with complex congenital heart disease.

Event dependence in the analysis of cardiovascular readmissions postpercutaneous coronary intervention.

Recurrent hospitalizations are common in longitudinal studies; however, many forms of cumulative event analyses assume recurrent events are independent. We explore the presence of event dependence when readmissions are spaced apart by at least 30 and 60 days. We set up a comparative framework with the assumption that patients with emergency percutaneous coronary intervention (PCI) will be at higher risk for recurrent cardiovascular readmissions than those with elective procedures.

A quality framework for the role of invasive, non-interventional cardiologists in the present-day cardiac catheterization laboratory: A multidisciplinary SCAI/HFSA expert consensus statement.

The present-day cardiac catheterization laboratory (CCL) is home to varied practitioners who perform both diagnostic, interventional, and complex invasive procedures. Invasive, non-interventional cardiologists are performing a significant proportion of the work as the CCL environment has evolved. This not only includes those who perform diagnostic-only cardiac catheterization but also heart failure specialists who may be involved in hemodynamic assessment and in mechanical circulatory support and pulmonary hypertension specialists and transplant cardiologists.

Frequency of abnormal fractional flow reserve measurements among major coronary arteries.

Background: Fractional flow reserve(FFR) is a validated tool for evaluating functional severity and guiding the revascularization of angiographically moderate coronary artery lesions.

Objective: To study if there is a higher frequency of positive FFR measurements in the left anterior descending(LAD) versus other major coronary arteries and also evaluate the differences in the total length of the stent placed.

Methods: A retrospective cohort study including all subjects (January 2011 to December 2015) who had fractional flow reserve (FFR) measured during coronary catheterization was conducted.