Prinzmetal angina is described as episodes of chest pain that occur at rest, associated with electrocardiographic changes in the ST-segment, which may or may not evolve to ischemia, and are not caused by coronary artery disease, having more recently been related to a coronary vasospasm. This diagnosis becomes especially challenging in patients who have already undergone previous percutaneous coronary procedures. We report a case of a patient diagnosed with Prinzmetal angina with a recent percutaneous coronary intervention due to coronary artery disease.
Background: The treatment of coronary arteries with heavily calcified or chronically occluded lesions has the lowest success rates when they undergo a percutaneous procedure. A strategy to reduce the volume of calcified lesions, which was part of the rescue technique to treat non-balloon dilatable stenoses, has evolved to an approach of primary lesion preparation for subsequent stenting. Methods: This is a retrospective analysis of data related to rotational atherectomies performed in complex, high-risk patients, for treating extremely calcified lesions with drug-eluting stent implantation, obtained from the Tasy Electronic Medical Record, between 2012 and 2016. Results: A cohort of 138 individuals was followed up after rotational atherectomy between 2012 and 2016. The most frequently observed risk factors were hypertension (87%), dyslipidemia (69%), diabetes mellitus (44%), and sedentary lifestyle (72%). A total of 244 vessels were treated, 179 of which with the aid of rotational atherectomy, and 308 drug-eluting stents were implanted. The SYNTAX II score was 22.4±11.5, with 18% of individuals classified as high risk (>33 points); femoral arterial access was employed in 76.8%. Lesion transposition was achieved in 98% of cases. Angiographic success was achieved with stenting in 98% of procedures. The length of hospital stay was 2.6±3.7 days. In-hospital mortality was 4%, and 4-year mortality was 14.5%. Long-term follow-up was performed by phone calls up to 4 years after the procedure. Ninety-seven percent of patients maintained regular use of dual antiplatelet therapy. Only 42% reported regular exercise. Angina pectoris was reported by 13% of individuals. Conclusion: Rotational atherectomy showed a low occurrence of adverse events in the immediate and late phases, leading to a high success rate of stent implantation in complex lesions.
A pericardite constritiva (PC) é uma condição na qual a cicatrização e perda de elasticidade do pericárdio resultam em enchimento ventricular prejudicado, disfunção diastólica e insuficiência cardíaca direita. O diagnóstico dessa patologia é desafiador, sendo frequente a necessidade de técnicas de imagem multimodal, dentre as quais a ecocardiografia representa a modalidade de imagem inicial para a avaliação diagnóstica, além de permitir a diferenciação da PC da cardiomiopatia restritiva (CMR) e outras condições que mimetizam constrição.
Coronary anomalies are rare congenital malformations that are associated with an increased risk of arrhythmias, ischemic events and sudden death. Many remain asymptomatic throughout the patient’s life, and are diagnosed incidentally by imaging tests. The treatment is necessary when ischemia is confirmed or in the presence of symptoms, and surgical intervention is the method of choice. However, some studies allow percutaneous treatment to be used as an alternative, especially in anomalies of the right coronary artery. In view of this, the objective of this study was to report three cases of congenital malformation of the right coronary artery treated by percutaneous coronary intervention.
Constrictive pericarditis (CP) is a condition in which scarring and loss of elasticity of the pericardium result in impaired ventricular filling, diastolic dysfunction, and right heart failure. The diagnosis of this pathology is challenging, with frequent need for multimodal imaging techniques, among which echocardiography represents the initial imaging modality for the diagnostic evaluation, in addition to allowing the differentiation of CP from restrictive cardiomyopathy (RCM) and other conditions that mimic constriction.
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