Impact of Emergency Medical Service Provider Training and Institutional Volume Experience on ST-Elevation Myocardial Infarction Patient Outcomes in Rural Setting.

Introduction: Rural sites provide management challenges for ST-elevation myocardial infarction (STEMI) patients. The impact of emergency medical service (EMS) training and institutional volume experience on STEMI outcomes was examined.

Methods: All STEMI patients transferred to Sanford from 32 sites in rural South Dakota from 2010-2019 were analyzed.

Review on Short Term Dual Antiplatelet Therapy Following Percutaneous Coronary Intervention with Drug Eluting Stent.

The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) have been a debatable topic for several decades. With the newer generation drug eluting stents, risk of major adverse cardiovascular events (MACE) has significantly reduced and hence, shorter duration of DAPT (one to three months) is now recommended especially in patients with high bleeding risk. Our review highlights the current guidelines and the recommendations from the recent trials.

ST-Segment Elevation Myocardial Infarction Due to an Ectatic Infarct-Related Coronary Artery: Case Series and Review of the Literature.

Coronary artery ectasia is an infrequent finding seen in a localized or diffuse fashion in patients undergoing coronary angiogram. This angiographic entity is attributed to coronary artery atherosclerosis. The ectatic coronary artery segment may be a culprit and perpetuate the thrombus formation in patients with acute myocardial infarction due to the altered normal laminar flow and deranged platelet and endothelial activation.

Complete Heart Block Causing Takotsubo Syndrome: A Case Report.

The association of complete atrioventricular (AV) block with Takotsubo syndrome (TTS) is well known, but the cause-and-effect relationship has not been determined. We present the case of a 91-year-old female with complete AV block who went untreated for over a year and later developed Takotsubo syndrome. Reversal of wall movement defects was seen after a permanent pacemaker was implanted, and routine follow-up showed that the implanted pacemaker worked normally.

CYP2C19 genotype-directed PY inhibitor antiplatelet therapy normalizes risk for major adverse cardiovascular events after percutaneous coronary intervention.

Objective: To study the use of CYP2C19 genotyping to guide P2Y inhibitor selection to maximize efficacy, and attenuate risk in appropriate patients who underwent PCI for CAD.

Methods: We performed a retrospective analysis of 868 patients with CAD who received CYP2C19 genotyping after PCI and changed P2Y inhibitor based on the results. Patients were divided into two groups based on clopidogrel metabolizer status.

Extremely Hyperdominant LAD Supplying the Anterior, Inferior, and Lateral Walls of the Left Ventricle.

Hyperdominant left anterior descending artery (LAD) is a rare anomaly in which the LAD gives rise to the posterior descending artery. Our case report describes an extreme case of hyperdominant LAD supplying the anterior, inferior, and partially the lateral walls of the left ventricle. It is crucial that physicians be aware of the possibility of extreme LAD dominance.

Triple-Guidewire Technique for Treating Stent Underexpansion in Severely Calcified Coronary Artery Lesions.

Stent underexpansion, a potential complication of percutaneous coronary intervention in severely calcified and stenotic coronary arteries, may result in in-stent thrombosis and restenosis. Different balloon-based and atheroablative techniques have been proposed to reduce the risk of these complications. We describe a simple triple-guidewire technique that we used to treat stent underexpansion in 2 elderly men.

Optical Coherence Tomography in Intracoronary Diagnostics.

Optical coherence tomography (OCT) has been revolutionary in the field of medical imaging since its inception in 1991, especially in the field of ophthalmology, but its use in coronary artery disease (CAD) and percutaneous coronary intervention (PCI) is still to be explored to its full potential. OCT has proven benefits in guiding PCI when it comes to assessing baseline lesion characteristics, plaque burden and its composition. OCT images provide high axial resolution (10 micrometer) in assessing intra and transluminal coronary structures, which is useful in identifying vulnerable thin fibrous cap atheroma (TCFA) and to differentiate plaque rupture from plaque erosion causing acute coronary syndrome.

A prospective study of contrast preservation using ultra-low contrast delivery technique versus standard automated contrast injector system in coronary procedures.

Background: We aimed to assess the decrease in contrast media volume (CMV) with ultra-low contrast delivery technique (ULCD) developed at our institution versus the usual automated contrast injector system (ACIS) contrast delivery in coronary procedures.

Methods: We analyzed the amount of contrast given in the consecutive 204 patients of the operators who use ULCD technique versus consecutive 200 patients of the other operators who use ACIS without ULCD technique for coronary angiograms and/or percutaneous coronary interventions (PCIs) from May 2017 to July 2018 at our center. We calculated the mean CMV between these groups.

Frequency Domain-optical Coherence Tomography of Coronary Arteries Using a Diluted Iodinated Contrast-saline Mix with 5-Fr Guide Catheters.

Background Optical coherence tomography (OCT) is currently mostly performed using 6-Fr coronary guide catheters via femoral access. Catheters with such large internal diameters are necessary to deliver viscous contrast media and achieve sufficient red blood cell washout. Currently, undiluted iodinated contrast media (15 mL/injection) is used to clear the coronary arteries of red blood cells (RBCs).

A Fish Mouth Appearing Perforation of the Native Aortic Valve Due to Streptococcus infantarius subspecies coli.

Infective endocarditis due to Streptococcus infantarius with the subspecies (subsp.) coli is infrequently encountered in healthy humans. This entity is associated with hepatobiliary malignancies and colorectal neoplasia.

Current Guidelines on Syncope.

Syncope is a very commonly encountered clinical problem in general practice and in the emergency department. In the evaluation of syncope, it is important to identify the specific cause to determine the treatment, to estimate the precise risk to a patient, and to reduce recurrence. Sometimes, making a diagnosis of syncope is difficult, as different mechanisms may often coexist.

A Case of Silent Q Fever Endocarditis.

Q fever endocarditis is a rare, culture negative endocarditis caused by Coxiella burnetii, a spore-forming gram negative coccobacillus. Presenting symptoms can be very non-specific; thus, diagnosis may be delayed. We present a case of a 65-year-old male patient with history of aortic aneurysm who complained of chronic fatigue.

Rural United States Experience of Incorporation of a Technologically Advanced and Procedurally Complex Cardiovascular Program - the Sanford Trans-Catheter Aortic Valve Replacement Experience.

Trans-catheter aortic valve replacement (TAVR) was approved by the U.S. Food and Drug Administration in 2012 for treatment of severe symptomatic aortic stenosis in non-surgical and high risk patients.

Pressure-Guided cryoablation of pulmonary veins in atrial fibrillation: A fast and effective strategy.

Background: Cryoballoon ablation of atrial fibrillation (AF) involves successful electrical pulmonary vein isolation (PVI). Pulmonary vein (PV) ostial occlusion with cryoballoon is classically assessed using PV angiography. A pressure-guided technique to assess ostial occlusion has been evaluated in small cohorts with mixed results.

A novel application of GuideLiner catheter for thrombectomy in acute myocardial infarction: a case series.

Angiographically visible thrombus and distal embolization are relatively common during percutaneous coronary intervention (PCI) in myocardial infarction (MI) and correspond to worse outcomes. Several aspiration and thrombectomy devices have been shown to be effective for prevention of distal embolization. We present a technique with successful use of the GuideLiner catheter (Vascular Solutions) for thrombus aspiration after dedicated manual aspiration thrombectomy devices have failed.