Spontaneous coronary artery dissection as the first presentation of systemic lupus erythematosus.

A 33-year-old woman with no premorbidities presented to us with chest pain and worsening dyspnoea since 1 week. Systemic examination was suggestive of acute pulmonary oedema and preliminary investigations revealed evolved anterior wall myocardial infarction (MI). The patient was stabilised and taken up for angiography which revealed spontaneous coronary artery dissection (SCAD) of the left anterior descending (LAD) artery.

Unprotected distal left main bifurcation drug eluting stent restenosis: first successful experience with simultaneous kissing balloon dilatation using sirolimus coated balloon.

Treatment of unprotected left main (ULM) in-stent restenosis (ISR) in patients with prior drug eluting stent implantation is challenging. Treatment usually involves complex stenting procedures or bypass grafting. Drug coated balloon (DCB) is relatively new concept which is usually used in treatment of ISR.

An atypical case of vasospastic angina: demonstrating the usefulness of Holter monitoring.

Prinzmetal variant angina or vasospastic angina is a clinical syndrome characterised by episodic chest pain and transient reversible ST segment changes in ECG. The aetiology and treatment of the condition are quite different compared to those of conventional coronary artery disease. The crux of the problem in variant angina patients remains the diagnosis, especially if coexisting coronary artery disease is present.

Trifascicular block progressing to complete AV block on exercise: a rare presentation demonstrating the usefulness of exercise testing.

A 41-year-old man presented with dyspnoea and giddiness on exertion for the last 1 month. A resting ECG during showed trifascicular block with complete right bundle branch block, left anterior fascicular block and a prolonged PR interval of >0.24 s.

Coronary steal or large collateral? Three cases of graft failure in sequential and composite grafts.

Coronary bypass grafting using conduits with multiple distal anastomoses continues to demand scrutiny. While on one hand these techniques allow the surgeon to avoid or minimise aortic manipulation, the unique flow and pressure characteristics lead to complex forms of graft failure if the anatomy of the target vascular bed is not carefully taken into consideration. We report three cases of graft failure in patients with coronary bypass grafting performed using multiple distal anastomoses, and percutaneous revascularisation in one patient.