Image in Cardiology
Simultaneous acute closure of the right coronary artery and left anterior descending artery in a young male
Encerramanto agudo simultâneo da artéria coronária direita e da artéria descendente anterior esquerda num homem jovem
Ewa Szczerba, Karol Zbroński
, Zenon Huczek, Robert Kowalik, Grzegorz Opolski
Autor para correspondência
First Department of Cardiology, Medical University of Warsaw, Warsaw, Mazovia, Poland
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"karol.zbronski@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "Zenon" "apellidos" => "Huczek" ] 3 => array:2 [ "nombre" => "Robert" "apellidos" => "Kowalik" ] 4 => array:2 [ "nombre" => "Grzegorz" "apellidos" => "Opolski" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "First Department of Cardiology, Medical University of Warsaw, Warsaw, Mazovia, Poland" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Encerramanto agudo simultâneo da artéria coronária direita e da artéria descendente anterior esquerda num homem jovem" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 635 "Ancho" => 2303 "Tamanyo" => 447718 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Teletransmitted electrocardiogram demonstrating inferior and inferobasal ST-elevation myocardial infarction and suggesting closure of the right coronary artery.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 28-year-old man with no cardiovascular history or cardiovascular risk factors, who denied cigarette smoking or taking any medications, drugs, supplements or steroids, was referred to the cardiology department after an out-of-hospital cardiac arrest preceded by a four-hour angina episode. The initial rhythm (ventricular fibrillation) was successfully defibrillated. Subsequently, the electrocardiogram suggested inferior and inferobasal ST-elevation myocardial infarction (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The coronary angiogram showed simultaneous acute thrombosis of the right coronary artery (RCA) (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>a) and of the left anterior descending (LAD) artery (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>a). Initially, to visualize suspected plaque rupture and to aid the decision whether to implant stents, multiple aspiration thrombectomies were performed, resulting in removal of substantial amounts of thrombotic material (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>). After intravenous and intracoronary administration of abciximab, an everolimus-eluting stent was implanted into the RCA, restoring good epicardial coronary flow (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>b). In the LAD spontaneous reperfusion occurred, revealing a massive thrombus (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>b). After aspiration thrombectomy, a stent was implanted (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>c). Echocardiographic examination revealed inferior wall and basal septal akinesis with ejection fraction of 35%. Right ventricular enlargement (5.4 cm in apical 4-chamber view) and hypokinesis (tricuspid annular plane systolic excursion [TAPSE] 14 mm) were present. Right ventricular function was improved on control echocardiography (TAPSE 27 mm).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Additional diagnostics available in our center failed to identify the cause of massive thrombus formation in both coronary arteries. An inflammatory etiology causing massive atherosclerotic plaque destabilization seemed unlikely, as C-reactive protein levels were normal on admission (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The patient was referred to the hematological department due to suspicion of thrombophilia.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosure</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosure" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-01-15" "fechaAceptado" => "2016-06-20" "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 635 "Ancho" => 2303 "Tamanyo" => 447718 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Teletransmitted electrocardiogram demonstrating inferior and inferobasal ST-elevation myocardial infarction and suggesting closure of the right coronary artery.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 638 "Ancho" => 1082 "Tamanyo" => 149107 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Acute thrombosis of the right coronary artery, TIMI flow 0 (a); status following stent implantation, TIMI flow 3 (b).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 652 "Ancho" => 1658 "Tamanyo" => 186561 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Acute thrombosis of the left anterior descending artery, TIMI flow 0 (a); spontaneous reperfusion revealing a massive thrombus in segment 7 (b); status following stent implantation, TIMI flow 3 (c).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1600 "Ancho" => 1200 "Tamanyo" => 310368 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Thrombotic material retrieved via aspiration thrombectomies.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">HDL: high-density lipoprotein; LDL: low-density lipoprotein; TSH: thyroid-stimulating hormone.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total cholesterol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">144 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LDL cholesterol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HDL cholesterol (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Triglycerides (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C-reactive protein (mg/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fibrinogen (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">200 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glucose (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TSH (μIU/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.93 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1305632.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Selected baseline laboratory results.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003600000001/v2_201701040047/S087025511630350X/v2_201701040047/en/main.assets" "Apartado" => array:4 [ "identificador" => "29264" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imagens em Cardiologia" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003600000001/v2_201701040047/S087025511630350X/v2_201701040047/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087025511630350X?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 7 | 4 | 11 |
| 2024 Outubro | 36 | 27 | 63 |
| 2024 Setembro | 47 | 23 | 70 |
| 2024 Agosto | 47 | 26 | 73 |
| 2024 Julho | 37 | 21 | 58 |
| 2024 Junho | 39 | 25 | 64 |
| 2024 Maio | 34 | 18 | 52 |
| 2024 Abril | 45 | 24 | 69 |
| 2024 Maro | 42 | 22 | 64 |
| 2024 Fevereiro | 42 | 34 | 76 |
| 2024 Janeiro | 32 | 30 | 62 |
| 2023 Dezembro | 35 | 28 | 63 |
| 2023 Novembro | 27 | 20 | 47 |
| 2023 Outubro | 20 | 12 | 32 |
| 2023 Setembro | 28 | 17 | 45 |
| 2023 Agosto | 37 | 23 | 60 |
| 2023 Julho | 38 | 10 | 48 |
| 2023 Junho | 29 | 12 | 41 |
| 2023 Maio | 43 | 15 | 58 |
| 2023 Abril | 32 | 4 | 36 |
| 2023 Maro | 32 | 20 | 52 |
| 2023 Fevereiro | 34 | 21 | 55 |
| 2023 Janeiro | 28 | 10 | 38 |
| 2022 Dezembro | 37 | 14 | 51 |
| 2022 Novembro | 42 | 23 | 65 |
| 2022 Outubro | 33 | 23 | 56 |
| 2022 Setembro | 34 | 24 | 58 |
| 2022 Agosto | 39 | 32 | 71 |
| 2022 Julho | 39 | 29 | 68 |
| 2022 Junho | 32 | 24 | 56 |
| 2022 Maio | 29 | 24 | 53 |
| 2022 Abril | 54 | 25 | 79 |
| 2022 Maro | 39 | 26 | 65 |
| 2022 Fevereiro | 32 | 26 | 58 |
| 2022 Janeiro | 43 | 23 | 66 |
| 2021 Dezembro | 33 | 23 | 56 |
| 2021 Novembro | 39 | 41 | 80 |
| 2021 Outubro | 37 | 45 | 82 |
| 2021 Setembro | 31 | 31 | 62 |
| 2021 Agosto | 40 | 31 | 71 |
| 2021 Julho | 31 | 32 | 63 |
| 2021 Junho | 27 | 18 | 45 |
| 2021 Maio | 28 | 25 | 53 |
| 2021 Abril | 35 | 38 | 73 |
| 2021 Maro | 60 | 22 | 82 |
| 2021 Fevereiro | 53 | 11 | 64 |
| 2021 Janeiro | 41 | 13 | 54 |
| 2020 Dezembro | 28 | 14 | 42 |
| 2020 Novembro | 36 | 10 | 46 |
| 2020 Outubro | 26 | 7 | 33 |
| 2020 Setembro | 58 | 8 | 66 |
| 2020 Agosto | 20 | 11 | 31 |
| 2020 Julho | 48 | 8 | 56 |
| 2020 Junho | 44 | 12 | 56 |
| 2020 Maio | 50 | 7 | 57 |
| 2020 Abril | 28 | 10 | 38 |
| 2020 Maro | 64 | 9 | 73 |
| 2020 Fevereiro | 60 | 30 | 90 |
| 2020 Janeiro | 16 | 4 | 20 |
| 2019 Dezembro | 29 | 7 | 36 |
| 2019 Novembro | 16 | 7 | 23 |
| 2019 Outubro | 31 | 5 | 36 |
| 2019 Setembro | 15 | 7 | 22 |
| 2019 Agosto | 37 | 7 | 44 |
| 2019 Julho | 39 | 9 | 48 |
| 2019 Junho | 37 | 7 | 44 |
| 2019 Maio | 44 | 8 | 52 |
| 2019 Abril | 27 | 11 | 38 |
| 2019 Maro | 109 | 7 | 116 |
| 2019 Fevereiro | 112 | 11 | 123 |
| 2019 Janeiro | 41 | 8 | 49 |
| 2018 Dezembro | 27 | 15 | 42 |
| 2018 Novembro | 62 | 9 | 71 |
| 2018 Outubro | 70 | 20 | 90 |
| 2018 Setembro | 27 | 10 | 37 |
| 2018 Agosto | 25 | 10 | 35 |
| 2018 Julho | 10 | 6 | 16 |
| 2018 Junho | 31 | 9 | 40 |
| 2018 Maio | 21 | 7 | 28 |
| 2018 Abril | 42 | 4 | 46 |
| 2018 Maro | 40 | 8 | 48 |
| 2018 Fevereiro | 23 | 5 | 28 |
| 2018 Janeiro | 20 | 10 | 30 |
| 2017 Dezembro | 54 | 16 | 70 |
| 2017 Novembro | 39 | 10 | 49 |
| 2017 Outubro | 21 | 12 | 33 |
| 2017 Setembro | 26 | 16 | 42 |
| 2017 Agosto | 34 | 13 | 47 |
| 2017 Julho | 24 | 14 | 38 |
| 2017 Junho | 32 | 11 | 43 |
| 2017 Maio | 43 | 17 | 60 |
| 2017 Abril | 17 | 8 | 25 |
| 2017 Maro | 22 | 13 | 35 |
| 2017 Fevereiro | 46 | 32 | 78 |
| 2017 Janeiro | 70 | 40 | 110 |
| 2016 Dezembro | 6 | 19 | 25 |
Mostrar tudo
