Transseptal course of coronary artery has often been described as a benign entity; however, this report and literature analysis provides growing evidence of high risk of serious cardiovascular events in this anomaly. We present a case of unstable angina in a patient with anomalous common origin of left and right coronary arteries from a single coronary ostium at the right sinus of Valsalva, with subsequent transseptal course of the left main artery, review of relevant literature, and discussion of possible management options.
A negative coronary CTA in patients with a low or intermediate pretest probability for significant coronary artery disease predicts a low rate of major cardiovascular events within a 5-year period.
HYPERTENSIONBRITISH 783 MEDICAL JOURNAL in which the blood-pressure should be lowered to improve prognosis (Turner, 1962; Smirk, 1962 Nine patients preferred reserpine with hydrochlorothiazide, three methyldopa with hydrochlorothiazide, and five had no preference. All felt much better on placebo. Neither combination is ideal treatment for symptomless patients who require hypotensive drugs.We are grateful to Mrs. J. Johnstone and Miss J. Fairburn, technicians at the hypertension clinic, who took the bloodpressure readings and assisted in other ways during the study.
Introduction: This study aimed to evaluate the effect of applying Adaptive Statistical Iteractive Reconstruction (ASIR) technique on the radiation dose of cardiac CT.Methods: This was a single centre retrospective observational study looking at all cardiac CT cases archived in our PACS system from 2009 to date. CT scan mode, peak kilovolt (kVp), tube current (mA) and dose length product (DLP) and patient demographics details and scanned heart rate were collected. Quality of scan (good or fair) was determined by two cardiac CT reporters in consensus. All cardiac CT were performed with GE 64-slice CT scanners. Scanning with ASIR was introduced to all scanners on 15th December 2010. All studies were then subcategorised into two cohorts, pre-ASIR and post ASIR. Continuous variables were compared using nonparametric Kruskal-Wallis test while categorical variables were compared using Chi-Square analysis.Results: There were 424 cardiac CT studies were included in this study. There were 368 studies in the pre-ASIR cohort and 54 studies in the post-ASIR. There were no significant different between two cohorts in terms of patients' age and gender, scanned heart rate, kVp and scanned range. However, there were significantly less mA used in the post-ASIR cohort in comparison with pre-ASIR cohort (median tube current 580 mA vs 650 mA respectively, p < 0.001). This has resulted in significant reduction of radiation dose (DLP) in the post-ASIR cohort in comparison with the pre-ASIR cohort (420 mGy/cm vs 585 mGy/cm respectively, p < 0.001). There was no significant difference in the proportion of study with good image quality (76% vs 78%, respectively, p = 0.711).Conclusion: Our preliminary results show that application of ASIR helps to reduce the radiation dose of cardiac CT by nearly 30% without affecting the image quality.
A 62-year-old man presented with episodes of severe right-sided retro-orbital pain of 3-week duration. The pain was associated with ipsilateral tearing, conjunctival injection, and rhinorrhea. The episodes lasted 1-2 hours and occurred at an average frequency of 2 per day, with no consistent temporal pattern. He did not have a history of similar headaches in the past. His past medical history was noted for bilateral common carotid artery stenosis that had been treated with balloon angioplasty; Hodgkin's disease, at age 20 years, treated with radiation to the neck; ischemic heart disease, hypertension, pseudo-aneurysm of the ascending aorta, peripheral vascular disease, and hypothyroidism. His medications included metoprolol, aspirin, levothyroxine, and lansoprazole.On initial examination he had mild exophthalmos and conjunctival injection on the right eye. The neurological examination was normal. Two days later he developed diplopia. Repeat examination at that time revealed right-sided ptosis, paresis of the right medial rectus, superior rectus, and superior oblique muscles, and decreased corneal sensation on the right. MRI of the head showed absence of the normal flow void in the intra-cavernous segment of the right internal carotid artery, compatible with thrombosis ( Fig.).The patient was treated with high-flow oxygen via a non-rebreathable mask during acute pain episodes, with moderate pain relief. Treatment with intravenous heparin was started, and the patient's condition stabilized. The headache episodes decreased A B Figure.-Coronal T2 weighted (A) and axial T1 weighted (B) head MRI showing absence of the normal flow void in the intra-cavernous right internal carotid artery (arrows) compatible with thrombosis.
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