Intravenous esmolol is safe and effective to reach the optimum heart rate in patients assigned for MSCT.

No abstract

We have evaluated the prevalence of left main coronary artery disease (LMCAD) among patients referred to multislice computed tomography (MSCT) coronary angiography examinations. The study Group comprised of 1,000 consecutive patients (750 male and 250 female; mean age 53+/-12 years) who underwent successful 64-slice MSCT examinations. Left main coronary artery (LMCA) was classified into three Groups: normal LMCA; nonsignificant LMCAD with coronary plaques resulting in obstructions 50%. We have found that 24 patients (2.4%) had significant LMCAD. Additional 200 patients (20%) had nonsignificant LMCAD. Univariate analysis revealed that LMCAD was associated with age, male gender, diabetes, hypertension, hyperlipidemia, typical symptoms, history of previous myocardial infarction and previous percutaneous coronary intervention. Only age and male gender were found as independent predictors for LMCAD in multivariate analysis (P < 0.001 and P = 0.001, respectively,). Angiographic follow-up was avaliable for the 24 patients with significant LMCAD, and conventional coronary angiography confirmed the presence of significant LMCAD in all of these patients. Significant LMCAD was found in 2.4% of the 1,000 patients referred to 64-slice MSCT examinations. Age and male gender were the independent predictors for LMCAD.

In April 2012, a 25-year-old lady was seen in our clinic with the chief complaint of chest pain on exertion. The pain was central, crushing like, radiating to her neck, and was typically occurring on exertion. The patient noted that she experienced the pain especially in the mornings when she was rushing to catch her bus to work; the pain was worse when the weather was cold and if she had her breakfast. She was consistently experiencing the pain on exertion for the last 2 years. She did not have any risk factors for atherosclerotic coronary artery disease. Echocardiography findings were within normal limits. A treadmill exercise stress test was performed where she reached the target heart rate and complained of chest pain at peak exercise, but only nondiagnostic subtle upsloping ST depressions were observed. Because of low pretest probability of an obstructive coronary artery stenosis a conventional coronary angiography was not performed at that stage. With the possibility of a coronary artery anomaly the patient was referred for a computed tomography (CT) coronary angiography. The CT scan demonstrated anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva and the proximal course of the RCA between the aorta and pulmonary artery (►Fig. 1).When requestioned in depth, the patient did not report any history of syncope-presyncope or palpitations.While the patients symptoms were typical of angina, to aid in therapeutic decision making an objective criteria for ischemia was searched. A nuclear perfusion scan was performed that revealed a mild stress induced perfusion defect in the inferior segment of the left ventricle (►Fig. 2) (the interpreting physician was aware of patient's typical anginal symptoms and the presence of coronary anomaly, but not of the exact anatomy to avoid any bias). The decision was to refer patient for surgery. Robotic surgery through a minithoracotomy was performed and the right internal mammary artery was anastomosed to the distal RCA, the proximal RCA was tied off to prevent steal phenomenon. After an uneventful surgery, the patient recovered and her chest pain on exertion subsided completely. Two months after the operation, an exercise stress test was performed which confirmed complete relief of symptoms. A further nuclear perfusion study was not performed at that stage not to expose the patient to further radiation.Anomalous coronary arteries are rare congenital abnormalities; however, they may be life threatening. Keywords► coronary anomaly ► ischemia ► computed tomography ► coronary artery disease ► angina AbstractClinical significance of coronary arteries with anomalous origin and/or course is highly heterogeneous. Anomalies with the origin from the opposite sinus and interarterial course can be associated with angina, syncope, and sudden cardiac death. However, there are no clear guidelines for diagnosis and treatment of such cases. We present the case of a young lady who presented with typical angina, and later proved to have an anomalous right coronary ar...