We report a case of a man in his 40s presented to the emergency department twice, 1 month apart, with severe ischaemic sounding chest pain within 1 h of smoking marijuana on both occasions. He had elevated serial biomarkers and ischaemic electrocardiogram changes. His coronary angiograms on both episodes were entirely normal along with normal echocardiogram. This potentially suggests a coronary vasospasm as an underlying mechanism for these non-ST elevation myocardial infarctions. This should alert clinicians and the public alike to this potential risk of cannabis use.

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artery in patients with resistant hypertension. The effect on central BP is less clear. Aim: To compare the effects of RDN on central and peripheral BP. Method: Thirty patients referred to Princess Alexandra Hospital RDN service were screened. Inclusion criteria: (1) peripheral BP >160/90 or (2) 24 ambulatory BP mean >150/90 or (3) home BP diary >150/90 on ≥3 drugs or (4) (i) ≥4 drugs to maintain normotension and (ii) evidence of end organ damage or (5) in the consensus opinion of the RDN Team, unique patient factors are such that the patient could potentially benefit from RDN therapy (e.g. severe intolerance to multiple medications). Patients were required to undergo a reasonable search for secondary causes and a period of appropriate medical therapy up titration. Central BP was measured non invasively using a SyphgmoCor Device. Results: Thirteen procedures on 12 patients. Eleven males. Mean age 54. Median 6 antihypertensives. Results at six months: peripheral systolic BP reduction from 171 ± 29 mmHg to 160 ± 31 mmHg (mean −11 mmHg, 95% CI (−36.4 to 14.4)). Peripheral diastolic BP reduction from 101 ± 21 mmHg to 96 ± 21 mmHg (mean −5 mmHg, 95% CI (−27.4 to 17.4)). Central systolic BP reduction from 149 ± 30 mmHg to 143 ± 36 (mean −6 mmHg, 95% CI (−34.3 to 21.8)). Conclusion: In our experience RDN shows a trend to decreasing peripheral brachial BP by a larger amount than central BP. This may have implications for long term morbidity and mortality benefits. Larger patient numbers will be required to achieve adequate statistical power and the trial is ongoing.

Background: Coronary artery disease (CAD) is the most common cause of sudden cardiac death (SCD) in Australians aged <40 years. The relevance of post-mortem lipid levels in this setting is currently unknown. Aim: We investigated post-mortem lipid levels in consecutive decedents with a spectrum of CAD in whom a coronial inquest was performed to elucidate a cause of death between 2006 and 2009. Methods: Seventy-two decedents aged 39 ± 7 years (range 18-49 years) and 92% males were investigated. Decedents either had obstructive CAD (>70% stenosis, n = 51), non-obstructive CAD (<70% stenosis, n = 15) or normal coronary arteries (n = 6). The post-mortem concluded that CAD was the cause of death in all cases of obstructive CAD, where as CAD was unrelated to the cause of death in non-obstructive cases or where there were normal coronary arteries. Post-mortem blood samples were analysed for total cholesterol, apolipoprotein B (ApoB), high-density lipoprotein (HDL), apolipoprotein AI (ApoAI), lipoprotein(a), cotinine, HbA1c and C-Reactive Protein (CRP). Results: Post-mortem ApoB (1.33 ± 0.5 vs 1.04 ± 0.39 g/L, p = 0.04) and total cholesterol levels (7.98 ± 2.7 vs 5.67 ± 2.39 mmol/L, p = 0.002) were significantly higher in decedents with obstructive CAD compared with non-obstructive CAD. ApoB levels were also significantly elevated when decedents with obstructive CAD were compared to decedents with normal coronary arteries (1.32 ± 0.5 vs 0.87 ± 0.39 g/L, p = 0.04). There were no significant differences in HDL, ApoAI, lipoprotein(a), cotinine, HbA1c and CRP between groups. Conclusions: Post-mortem ApoB and total cholesterol levels may provide insights into mechanisms associated with fatal premature CAD and have implications for screening of first-degree relatives.

Introduction: Stent malapposition is a known risk for stent restenosis and thrombosis. Although coronary angiography is the gold standard modality for imaging the coronary arteries, its 2D-nature and limited resolution make it difficult to accurately assess stent expansion. Optical coherence tomography (OCT) is being increasingly used in the cardiac-cath lab and offers a high resolution making it ideally suited to examine apposition. Aim: We describe our approach using the latest 3D angiographic and OCT techniques to better assess stent apposition. Method: OCT pullbacks were obtained using the iLumien system (St Jude's Medical). Multiplane angiography was performed using Xper-Swing view (Philips systems). This incorporates continuous cine imaging while a rotating C-arm follows a curved trajectory. Using the X-ray angiograms, 3D skeletal curves were created using a stereoscopic projection technique implemented in an inhouse Matlab code. Contours defining the inner wall from the OCT scans were then mapped onto the skeleton before creating a triangulated surface representing the inner lumen. We present 3D OCT/angiographic reconstruction of a complex bifurcation stent. Results: Combination 3D OCT with 3D angiography is feasible and may improve visualisation of coronary vessels in relation to stented segment. Conclusions: 3D angiography helps improve visualisation of optimal viewing angles and thus reducing foreshortening and is particularly suited to assessing complex lesions. Combining cutting edge imaging techniques with 3D reconstructive systems and OCT may offer an improved visualisation of coronary anatomy, lesion complexity and stent apposition and offers a promising ongoing area of research into the future.