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Fulltext Acute coronary syndromes. I. Recent advances in pathogenesis

Yusoff K

Med J Malaysia, 1998 Mar;53(1):117-23; quiz 124.
PMID: 10968152

New knowledge on the pathogenesis of the acute coronary syndromes provides the clinician with a better understanding of these important, often life-threatening, events and opens up new ways of managing them. The identification of the vulnerable plaque whilst important and possible pathologically still requires elaborate and often invasive methods. The central role of inflammation and the platelets in these syndromes has already been translated into practical therapeutics. Identifying and predicting which plaque would rupture and thereby facilitating the formation of an acute obstructive thrombus continue as major challenges to the clinician, but, in the meantime, regressing and stabilising these plaques are achievable goals.

Matched MeSH terms: Coronary Artery Disease/complications*
Incidental congenitally corrected transposition of the great arteries (ccTGA) in an adult with suspected coronary artery disease: review on radiological features and pathophysiology

Sayuti KA, Azizi MYSB

BMJ Case Rep, 2020 Apr 22;13(4).
PMID: 32327461 DOI: 10.1136/bcr-2019-234225

We report a case of a 46-year-old woman who has presented to a peripheral hospital with progressive exertional dyspnoea and chest discomfort. The resting ECG showed features of left-sided ventricular hypertrophy. The initial chest radiograph was reported as cardiomegaly. Initial echocardiography revealed left atrial dilatation and 'left ventricular' hypertrophy with normal ejection fraction. She was treated as possible coronary artery disease and was subsequently referred to our centre for CT coronary angiography. Findings from the CT scan were consistent with congenitally corrected transposition of the great arteries (ccTGA). This report describes the radiological features of ccTGA, its associated cardiovascular anomalies, pathophysiology and potential complications.

Matched MeSH terms: Coronary Artery Disease/complications*
Off-pump coronary artery bypass grafting in a high-risk dextrocardia patient: a case report

Abdullah F, Mazalan SL

Heart Surg Forum, 2004;7(3):E186-8.
PMID: 15262598

We present an interesting but high-risk case of an obese male patient aged 56 years with dextrocardia and a left diaphragmatic hernia. Anterior myocardial infarction was diagnosed in 1994, and the patient later presented with a history of unstable angina. The diagnosis for this chronic smoker was triple-vessel disease, impaired left ventricular function, chronic renal failure, chronic bronchitis, impaired lung function, pulmonary hypertension, hypertension, diabetes, and chronic active gastritis (EuroSCORE of 10). The patient underwent successful off-pump coronary artery bypass grafting with 3 saphenous vein grafts to the left anterior descending, obtuse marginal, and right posterior descending arteries. He was discharged home 8 days later.

Matched MeSH terms: Coronary Artery Disease/complications*
Guidezilla guide extension catheter enhances the delivery of bioresorbable vascular scaffold in an anomalous coronary artery

Yew KL

Int J Cardiol, 2016 Nov 15;223:239-241.
PMID: 27541663 DOI: 10.1016/j.ijcard.2016.07.299
Matched MeSH terms: Coronary Artery Disease/complications
Fulltext Serum high-sensitivity C-reactive protein and lipoprotein(a) levels: a comparison between diabetic and non-diabetic patients with coronary artery disease

Shahid HS, Kurdi MI, Zohair AA

Med J Malaysia, 2011 Jun;66(2):113-6.
PMID: 22106689

OBJECTIVE: The aim of this study was to compare high-sensitivity C-reactive protein (hsCRP) and Lipoprotein(a) levels [Lp(a)] levels between diabetic and non-diabetic patients with coronary artery disease (CAD).
STUDY DESIGN: Cross sectional Study.
PLACE AND DURATION OF STUDY: This study was conducted in the department of Physiology of College of Medicine & King Khalid University Hospital, King Saud University, Riyadh between August 2006 and December 2007.
METHODS: One hundred and three individuals with CAD and 30 healthy individuals matched for age and BMI were studied. CAD patients were divided into two groups based on presence (n=62) and absence (n=41) of type 2 diabetes mellitus. Overnight fasting blood samples were collected, and analyzed for total cholesterol (TC), Triglycerides (TG), Low density Lipoprotein (LDL) and High density lipoprotein (HDL), Lp(a) and hsCRP. Data about CAD severity was obtained from medical records.
RESULTS: Both groups of CAD without and with DM had significantly higher levels of Lp(a) [mg/dl] (25.58 +/- 25.99, 25.90 +/- 24.67 respectively) and hsCRP [mg/dl] (0.52 +/- 0.71, 0.82 +/- 0.78 respectively) when compared with healthy control subjects (Lp(a) =16.93 +/- 15.34 & hsCRP=0.27 +/- 0.21) [p<0.05]. Lp(a) levels between the two CAD groups were non significant. While, hsCRP levels were significantly high in CAD with DM compared to those without DM [p<0.05]. Gensini Score of CAD severity was also higher in CAD with DM [67.60 +/- 45.94] than those without DM [52.05 +/- 42.27, p<0.05].
CONCLUSION: Elevated Lp(a) and hsCRP levels are associated specifically with angiographically defined CAD. However, hsCRP elevation but not Lp(a) is also associated with CAD in type 2 diabetes mellitus. Measurement of hsCRP and Lp(a) may be considered optional markers for better prediction of cardiovascular risk.

Matched MeSH terms: Coronary Artery Disease/complications*
Fulltext Manifestation of Coronary Atherosclerosis in Klang Valley, Malaysia: An Autopsy Study

Rahimi R, Singh MKC, Noor NM, Omar E, Noor SM, Mahmood MS, et al.

J Atheroscler Thromb, 2018 May 01;25(5):405-409.
PMID: 29118310 DOI: 10.5551/jat.39107

AIMS: The present study aimed to determine the epidemiological aspects of medico-legal autopsies and manifestation of coronary atherosclerosis.
METHODS: This was a cross sectional study involving 222 cases recruited from National Institute of Forensic Medicine (NIFM) Hospital Kuala Lumpur (HKL) and Department of Forensic Medicine Hospital Sungai Buloh (HSgB) for a period of 15 months, from December 2012 to April 2014. Sociodemographic and autopsy findings, including the cause and manner of death were documented.
RESULTS: Male and female subjects aged 18-70 years were recruited. Males contributed to 86% of the total subjects and comprised 61% of young adults. Road traffic accidents were the primary cause of death, contributing almost 50% of the subjects. One third of the cases comprised of death due to natural causes, wherein almost 75% of the subjects within this category succumbed to sudden cardiac death. Coronary artery disease (CAD) contributed to 60% of the sudden cardiac death (SCD). Single and double-vessel diseases were the most common pattern of atherosclerosis. In almost 80% of CAD cases, atherosclerosis affected the left anterior descending artery (LAD).
CONCLUSION: Cardiovascular diseases were the most significant natural cause of sudden death with a staggering figure of 75%. CAD was the single most commonly encountered pathology within the SCD. Most cases presented with single and double-vessel diseases, observed in all subjects, as well as the young adult population.

Matched MeSH terms: Coronary Artery Disease/complications*
Coronary artery bypass graft surgery in a young female with systemic lupus erythematosus and its operative challenges: A case report

Gurpreet S, Vendargon SJ, Syed Rasul SH

Med J Malaysia, 2019 12;74(6):549-550.
PMID: 31929487

We understand that autoimmune disorders such as Systemic Lupus Erythematosus increases the likelihood of developing coronary heart disease. However, its implications on patients undergoing cardiac surgery is not well understood. Here we present a female patient with SLE who developed coronary artery disease at a young age and underwent coronary artery bypass graft surgery. As SLE is associated with vasculitis, we wanted to understand regarding the choice of conduit as well as its long term patency. Also whether percutaneous angioplasty has a role to play in patients with SLE.

Matched MeSH terms: Coronary Artery Disease/complications
Fulltext Blood pressure variability and arterial elasticity in hyperlipidaemic subjects

Rafidah HM, Azizi A, Noriah MN

Singapore Med J, 2008 Apr;49(4):297-303.
PMID: 18418521

It is debatable whether the assessment of low density lipoprotein or total cholesterol (TC) alone is sufficient to identify an individual's risk of having myocardial infarction. In the Framingham study, the risk of coronary artery disease was better indicated by an increase in the TC to high density lipoprotein cholesterol (TC: HDL) ratio. The aim of this study is to determine the relationship between blood pressure variability (BPV) and arterial compliances in hyperlipidaemics, which was defined as TC:HDL of more than 5.0 as compared to normolipidaemics.

Matched MeSH terms: Coronary Artery Disease/complications*
Renal outcome following on- and off-pump coronary artery bypass graft surgery

Ooi JS, Abdul Rahman MR, Shah SA, Dimon MZ

Asian Cardiovasc Thorac Ann, 2008 Dec;16(6):468-72.
PMID: 18984756

A prospective study was carried out to compare the outcomes of patients with preexisting non-dialysis-dependent renal dysfunction who underwent coronary artery bypass grafting with or without cardiopulmonary bypass. Elective off-pump coronary artery bypass was performed in 29 patients with renal dysfunction. Their results were compared with those of a similar group of 35 patients who underwent the conventional on-pump coronary artery grafting. There was a significant deterioration in creatinine clearance in the on-pump group on days 1, 2, and 4 after surgery, while creatinine clearance in the off-pump group remained close to the baseline level. Both groups had improved to the preoperative creatinine clearance values on follow-up at 4 weeks. It was concluded that off-pump surgery provided better renal protection than the conventional on-pump technique in patients with preexisting non-dialysis-dependent renal dysfunction.

Matched MeSH terms: Coronary Artery Disease/complications
Mitochondrial disorder, diabetes mellitus, and findings in three muscles, including the heart

Bhattacharjee M, Venugopal B, Wong KT, Goto YI, Bhattacharjee MB

Ultrastruct Pathol, 2006 Nov-Dec;30(6):481-7.
PMID: 17183762

The authors describe the case of a 50-year-old man with chronic progressive external ophthalmoplegia (CPEO), diabetes mellitus (DM), and coronary artery disease. The patient had no cardiac conduction abnormalities. During coronary artery bypass surgery, his heart and two skeletal muscles were biopsied. All three muscles showed ragged red fibers. The heart muscle showed significant glycogen accumulation. Analysis of mitochondrial DNA (mtDNA) showed a 5019-base-pair deletion, with no duplications. There were morphologically abnormal mitochondria in all 3 muscles, with clinically apparent difference in preservation of function. The combination of diabetes mellitus and mtDNA deletion is fortuitous, as they can be causally linked. The cardiac pathology allows speculation about the possible adaptive processes that may occur in the heart in DM. There are few reported cases with CPEO and excess glycogen in the heart. Most show deposition of fat and poorer clinical outcomes as compared to those with glycogen deposition. This observation may lend support to the hypothesis that in the myocardium, adaptive responses are mediated via changes in glucose handling, whereas alterations in fat metabolism likely represent maladaptation.

Matched MeSH terms: Coronary Artery Disease/complications*
Levodopa-induced myocardial infarction in a patient with Parkinson's disease and severe coronary artery disease

Ng CF, Tiau PW, Tan HJ, Norlinah MI

J R Coll Physicians Edinb, 2019 Mar;49(1):37-39.
PMID: 30838990 DOI: 10.4997/JRCPE.2019.108

Levodopa is the most effective medical treatment for Parkinson's disease (PD) to date. As dopamine is known to increase cardiac inotropism and vasomotor tone, peripheral dopamine decarboxylase inhibitor is coadministered to suppress the peripheral conversion of levodopa to dopamine. Levodopa poses potential cardiovascular risks, thus its use in patients with existing coronary artery disease needs to be carefully monitored. We report a case of an elderly male with newly diagnosed PD who developed non-ST-elevation myocardial infarction following levodopa (Madopar) initiation.

Matched MeSH terms: Coronary Artery Disease/complications*
Fulltext Severe left anterior descending artery stenosis with proximal arteriovenous malformation presenting as acute myocardial infarction

Oteh M, Azarisman SM, Hanim NM, Noorfaizan S

Singapore Med J, 2009 Feb;50(2):e76-8.
PMID: 19296018

Congenital coronary artery anomalies are rare, with an incidence of about 0.06-1.3 percent of all patients undergoing cardiac catheterisation. They are commonly asymptomatic, but potentially serious lesions may lead to myocardial ischaemia, infarction and/or sudden cardiac death. The occurrence of a concomitant stenotic lesion is exceedingly rare. We report an 80-year-old man who presented with acute anterior myocardial infarction. Coronary angiography revealed severe proximal left anterior descending (LAD) and arteriovenous malformation (AVM) from the first septal branch of the LAD. The LAD stenosis and the AVM were successfully treated with two Jomed covered stents.

Matched MeSH terms: Coronary Artery Disease/complications
Fulltext Gene Polymorphisms of the Renin-Angiotensin-Aldosterone System as Risk Factors for the Development of In-Stent Restenosis in Patients with Stable Coronary Artery Disease

Azova M, Timizheva K, Ait Aissa A, Blagonravov M, Gigani O, Aghajanyan A, et al.

Biomolecules, 2021 05 20;11(5).
PMID: 34065198 DOI: 10.3390/biom11050763

This study investigated the renin-angiotensin-aldosterone system (RAAS) gene polymorphisms as possible genetic risk factors for the restenosis development in patients with drug-eluting stents. 113 participants had coronary artery disease and underwent stenting. The control group consisted of 62 individuals with intact coronary arteries. Patients were divided into two groups: with in-stent restenosis (ISR) and without it. The patients with ISR were classified into subgroups by the terms of the restenosis development and age. Real-time PCR and Restriction Fragment Length Polymorphism-PCR were used to genotype the study participants for RAAS gene polymorphisms. We found that the development of restenosis is generally associated with the minor A allele for renin (REN) rs2368564 and the major TT genotype for angiotensinogen (AGT) rs699. The heterozygous genotype for AGT rs4762 acts as a protective marker. A minor A allele for angiotensin II type 2 receptor (AGTR2) rs1403543 is associated with a risk of restenosis in people under 65 years old. Among patients with the early ISR, heterozygotes for angiotensin II type 1 receptor (AGTR1) rs5186 are more frequent, as well as A allele carriers for AGTR2 rs1403543. A minor homozygous genotype for REN rs41317140 and heterozygous genotype for aldosterone synthase (CYP11B2) rs1799998 are predisposed to the late restenosis. Thus, to choose the effective treatment tactics for patients with coronary artery disease, it is necessary to genotype patients for the RAAS polymorphisms, which, along with age and clinical characteristics, will allow a comprehensive assessment of the risk of the restenosis development after stenting.

Matched MeSH terms: Coronary Artery Disease/complications