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Gehani, A. A.; Al-Mulla, Abdul Wahid; Chaikhouni, Amer; Ammar, Abdul-Salam; Mahrous, Farouk; Tirkawi, Ramiz; Ashraf, Ali; Hajar, Hajar

doi:10.1097/00043798-200102000-00001

Cited by 13 publications

(3 citation statements)

References 19 publications

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“…Hypertension was documented in 25% and smoking in 53% of the patients. It is feasible that smoking may have a contributory role in the pathogenesis of this patient cohort, possibly via endothelial dysfunction and coronary artery spasm [17]. …”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and role of early cardiac magnetic resonance imaging in patients with suspected ST-elevation myocardial infarction and normal coronary arteries

Stensæth

Fossum

Hoffmann

et al. 2010

Int J Cardiovasc Imaging

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A variety of conditions other than acute myocardial infarction may cause ST-elevation. Our objective was to evaluate the impact of cardiac magnetic resonance (CMR) on differential diagnosis from a prospective series of patients with suspected ST-elevation myocardial infarction (STEMI) and completely normal coronary arteries. Among 1,145 patients with suspected STEMI, 49 patients had completely normal coronary arteries and entered a prospective registry. CMR was done within 24 h, if possible, and included function analyses, T2-weighted imaging (T2 ratio), T1-weighted imaging before and after gadolineum administration (global relative enhancement; gRE), and late gadolineum enhancement (LGE). All patients were asked for a follow-up CMR after approximately 3 months. The incidence of patients with suspected STEMI and normal coronary arteries was 4.3% and mean age was 45 ± 14 years (STEMI group 64 ± 13 years; P < 0.001). 55% had a recent history of infection. Cardiac biomarkers showed a moderate elevation on admission. There was a significant change from baseline to follow-up for LV end-diastolic volumes (EDV) (P < 0.001), LV mass (P < 0.05), mean T2 ratio (P < 0.05), and LGE volume (P < 0.05). Major diagnostic groups were myocarditis (29%), pericarditis (27%), and takotsubo cardiomyopathy (10%). 18% were regarded as non-diagnostic. The study showed an incidence of 4.3% of patients with suspected STEMI and completely normal coronary arteries. Early CMR was valuable in the evaluation of the differential diagnoses and to exclude myocardial abnormalities in patients with uncertain aetiology. Further studies are needed for the assessment of long-term outcome.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics and role of early cardiac magnetic resonance imaging in patients with suspected ST-elevation myocardial infarction and normal coronary arteries

Stensæth

Fossum

Hoffmann

et al. 2010

Int J Cardiovasc Imaging

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“…This discrepancy is explained by the observation that many acute coronary events result from sudden occlusion of a previously unobstructed segment of the artery, while ST depression on exercise detects ischaemia from pre-existing stenosis [52]. The phenomenon of thrombosis in angiographically normal coronary arteries may be related to activation of a small, non-stenotic atherosclerotic plaque and appears more common among smokers [53, 54]. …”

Section: Recommended Baseline Work-upmentioning

confidence: 99%

Sudden Cardiac Death in the Young: A Strategy for Prevention by Targeted Evaluation

Sen‐Chowdhry

McKenna

2006

Cardiology

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The annual incidence of sudden cardiac death (SCD) in the general population is estimated as 1 in a 1,000. Since survival rates from out-of-hospital cardiac arrests are poor, primary prevention is key to reducing the burden of SCD in the community. Prominent causes of SCD include ischaemic heart disease, anomalous coronary arteries, and the primary myocardial diseases: hypertrophic cardiomyopathy, dilated cardiomyopathy, and ar rhythmogenic right ventricular cardiomyopathy (ARVC). In 4% of sudden deaths in the 16–64 age group, post-mortem examination fails to identify a cause, yielding a default diagnosis of sudden arrhythmic death syndrome (SADS). The inherited arrhythmia syndromes (long QT, short QT, and Brugada syndromes, and familial catecholaminergic polymorphic ventricular tachycardia) may be implicated in SADS, owing to their propensity for producing ventricular tachyarrhythmia in the structurally normal heart. Monogenic disorders therefore predominate as causes of SCD in the young. The advent of effective therapies for these diseases, particularly implantable cardioverter defibrillators, has prompted calls for universal screening to enable timely diagnosis of occult cardiac disease. Since prospective cardiac assessment of the general population is not feasible, the solution may be to target high-risk subgroups, namely, patients with cardiac symptoms, relatives of SCD victims, and competitive athletes. The recommended preliminary work-up includes a 12-lead ECG, signal-averaged ECG, transthoracic echocardiogram, exercise test, and ambulatory ECG monitoring. Cardiovascular magnetic resonance is a useful adjunct in patients with suspected ARVC or anomalous coronary arteries. Provocative challenge with a sodium challenge blocker may be of value in unmasking the Brugada syndrome. Identification of disease-causing mutations in affected individuals facilitates cascade screening of families.

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“…Of note, patients with coronary artery spasm and coronary thrombus were more likely to be smokers (data not shown). Smoking has previously been reported to be a major risk factor for MINCA [2,21]. It is tempting to speculate that smoking may predispose an individual with normal coronary arteries to myocardial infarction by inducing coronary spasm, as Yetkin et al [22] have proposed.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy as an Underlying Mediator of Myocardial Infarction with Normal Coronary Arteries

Chen

Chang²,

Chen³

et al. 2010

Cardiology

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Objective: The purpose of the present study was to describe our experience with myocardial infarction with normal coronary arteries (MINCA) with regards to the prevalence, clinical characteristics, possible underlying etiologies (including Takotsubo cardiomyopathy, TCM) and the short- and long-term outcomes associated with this condition. Methods: We retrospectively analyzed the records of 596 consecutive patients presenting with acute myocardial infarction over a 4-year period and identified 24 patients (14 female, 10 male) with angiographically normal coronary arteries. Demographic and clinical variables and outcomes were reviewed. Results: Mean patient age was 59 ± 20 years. The presumed MINCA mechanism was TCM in 10 patients (41.7%), probable myocarditis in 5 (20.8%), coronary spasm in 4 (16.7%), coronary thrombus in 3 (12.5%) and aortic dissection in 2 patients (8.3%). After a mean follow-up of 19 ± 14 months, 2 patients with probable myocarditis had died of cardiovascular causes, 1 patient with aortic dissection had died due to sepsis after surgery and 1 patient with TCM had died of noncardiovascular causes 2 years after discharge. Conclusion: In this study, we found that MINCA occurred in 4% of patients with acute myocardial infarction undergoing emergent coronary angiography, with the most frequent underlying mechanism being TCM.

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Cited by 13 publications

References 19 publications

Clinical characteristics and role of early cardiac magnetic resonance imaging in patients with suspected ST-elevation myocardial infarction and normal coronary arteries

Clinical characteristics and role of early cardiac magnetic resonance imaging in patients with suspected ST-elevation myocardial infarction and normal coronary arteries

Sudden Cardiac Death in the Young: A Strategy for Prevention by Targeted Evaluation

Takotsubo Cardiomyopathy as an Underlying Mediator of Myocardial Infarction with Normal Coronary Arteries

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