A 72-year-old man known with a history of coronary heart disease presents typical chest pain. During the transport to the PCI center, the patient had two episodes of ventricular fibrillation requiring electrical reanimation. ECG shows inferolateral ST depression.
What does the angiography show (Fig. below)?
All of the above. The coronary angiography shows a bifurcation lesion involving the distal left main trunk as well as the ostium of the left anterior descending and left circumflex coronary arteries.
During coronary angioplasty of the RCA, this 72-year-old patient developed sharp chest pain with rapid development of hypotension and tachycardia. The etiology based on Figure below
is:
Perforation of the RCA. The coronary angiography demonstrates extravasation of contrast caused by perforation of the RCA.
For which clinical situation is coronary angiography not recommended in patients with SIHD?
All the mentioned clinical situations do not justify coronary angiography in the initial phase of patient management. According to 2012 AHA/ACC SIHD guidelines, coronary angiography is not recommended as an initial testing strategy to assess risk in the following clinical situations (class III, no benefit):
A 66-year-old man with diabetes with no hypertension but end-stage renal failure treated with hemodialysis in the last 15 years presents with worsening dyspnea and suspicion of ischemia at the stress imaging.
What are the most characteristic findings relating to the coronary arteries to be found at angiography?
Calcified coronary arteries. Patients with long-standing terminal nephropathy have frequently severely calcified vessels including the coronary arteries. Qualitative analysis of the coronary arteries showed significantly more calcified plaques of coronary arteries in patients with end-stage renal failure. Plaques of nonuremic patients were mostly fibroatheromatous, while coronary plaques in patients with end-stage renal failure were characterized by increased media thickness and marked calcification. Deposition of calcium within the plaques may contribute to the high event rate in uremic patients.
A 65-year-old man with SIHD wants to optimize secondary prevention.
Which of the following statements does not apply?
Acupuncture might be used for the purpose of improving symptoms of patients with SIHD. According to 2012 AHA/ACC SIHD guidelines, acupuncture should not be used for the purpose of improving symptoms or reducing CV risk in patients with SIHD (class III, no benefit). Smoking cessation and avoidance of exposure to environmental tobacco smoke at work and home should be encouraged (class I), dipyridamole is not recommended as antiplatelet therapy for patients with SIHD (class III, no benefit), treatment with clopidogrel is reasonable when aspirin is contraindicated in patients with SIHD (class I), and it is reasonable to consider screening SIHD patients for depression and to refer or treat when indicated (class IIa).