This study demonstrates some limitations in assessing of diagnostic tests: bicycle ergometry, treadmill test, stress echocardiography, daily ECG monitoring, as well as multispiral CT with determination of coronary calcium that makes possible to confirm or exclude coronary artery disease in women. Two clinical cases are presented. The data on stratification of cardiovascular risk are included.
Malignant tumors of the heart are very rare in clinical practice. The causes of the disease so far have not been established. Therefore, a rare clinical case of in vivo diagnosis of primary cardiac tumor (angiosarcoma, complicated by ventricular tachycardia refractory to antiarrhythmic treatment) is of a clinical interest.
The aim – to explore morphological changes of coronary arteries with severe tortuosity in children. Four autopsy cases of severe coronary artery tortuosity are presented: three cases of intrauterine fetal death (two male patients and one female, at the gestation age of 28, 29 and 39 weeks) and the autopsy case of one-year-old boy. Morphological changes of the coronary arteries were examined by standard histological and histochemical methods (hematoxylin-eosin, Masson’s trichrome, Hart’s elastic stainings). Severe tortuosity of the anterior descending coronary artery was prevalent (in three cases). Detection of tortuous coronary arteries in fetuses, who died prenatally, indicates the congenital genesis of this vascular anomaly.
Heart rhythm disorder is a frequent concomitant disease of cardiovascular and extra-cardiac pathology. A rare variant of heart rhythm disorder, which is not typical for newborns and young people, is atrial fibrillation. Frequency of atrial fibrillation is less than 1 %. The main purpose is analysis of clinical case in newborn with atrial fibrillation. Diagnostic and search effective methods of treatment atrial fibrillation in newborn’s is an actual problem in child cardiology. In this article described successful case of treatment life-threatening atrial fibrillation in newborn by electric cardioversion without cardiovascular pathology. Electric cardioversion in newborn’s with supraventricular tachycardia, which have hemodynamic disorders, is safe and effective therapy method.
Acute coronary syndrome with ST segment elevation remains a serious problem in cardiology and often determines the level of in-hospital mortality. Later, the patient’s admission to reperfusion therapy can lead to deterioration of the immediate and long-term results of treatment. The most difficult problem with percutaneous reperfusion therapy STEMI patients is no-reflow syndrome, i.e. the absence of myocardial perfusion after restoration of the arterial blood flow. Taking into account the data of the clinical case, no-reflow syndrome can be diagnosed even when the coronary artery is open (after spontaneous opening), under the presence of visible parietal thrombi and after long period of complete obstruction of the vessel lumen. However, the full restoration of blood flow is necessary and in the later period (up to 24 hours from the onset of symptoms) in the presence of the clinic ischemia and lack of positive dynamics of ECG. As shown in the illustrated clinical cases, restoration of blood flow in the infarct-related coronary artery, even in the presence of the syndrome «no-reflow» is able to restore myocardial function during short period of observation.
A clinical case of ST-elevation acute myocardial infarction has been presented. Apart from standard drug therapy, percutaneous coronary reperfusion with manual aspiration of thrombi was performed with further histological examination of the obtained materials. Clot formation appeared long before the development of acute myocardial infarction in this patient. It was also demonstrated an important role of inflammation at the initial step of thrombus formation in this case. But earlier coronary arteries were affected by xenobiotics.
The treatment of thrombosis in STEMI patients is one of the most important tasks. Systematic approach is a key element of the reperfusion therapy success. The approach to the invasive treatment should be differentiated, first and foremost based on angiographic assessment of thrombosis.
The maximum effect thrombotic masses aspiration from the infarct-related vessel is achieved in patients with large, floating thrombi of all ages. Efficient removal of the coronary thrombi using contemporary aspiration catheters is the auxiliary procedure providing timely reperfusion therapy in patients with STEMI, reducing distal embolization and improving myocardial perfusion. Accumulation of experience with these catheters and more detailed assessment of the immediate and long-term postoperative results are necessary to make conclusion about their effectiveness and safety in clinical practice.
Several cases of the successful catheter radiofrequency ablation (RFA) of atrial fibrillation in patients aged 40–54 years with severe heart failure and left ventricle systolic dysfunction due to long-term arrhythmia are presented. Procedures were performed due to low efficacy of the drug treatment. Follow-up duration was 1 to 3 years. Left ventricle systolic function restoration after RFA was observed. All patients stopped prophylactic antiarrhythmic therapy and most of them needed no medication treatment afterwards. All patients returned to fully socially active life. Sinus rhythm preservation tactics is more preferable and must take priority, especially in younger patients. RFA is one of the most wide-spread catheter procedures with proven efficacy, being enough patient-safe. It significantly improves quality of life, and today it becomes the most wide-spread of radical arrhythmia treatment. Stable sinus rhythm preservation is more constant in younger patients with less advanced myocardium structure changes and without advanced concomitant pathology.
The paper presents several clinical cases of patients with atrial flutter after an episode of atrial flutter 1:1. The causes of such conditions are analyzed, the effectiveness of the restoration and maintenance of sinus rhythm is shown, further course of the arrhythmia is studied. According to the results of clinical observation, most patients presented permanent atrial fibrillation during short-term follow-up. The management of patients with such conditions was established on the basis of case reports analysis.
The article presents an overview of the problem of fat deposition in the myocardium. Morphological characteristics, clinical and noninvasive imaging techniques, such as echocardiography, multislice computed tomography and magnetic resonance imaging of the heart are presented in the article. Different forms of fat deposits as lipomatose dysplasia after myocardial infarction, arrhythmogenic right ventricular dysplasia, heart lypoma, lipomatose hypertrophy of the interatrial septum, and physiological fat deposition are described. Article is illustrated with original images of various forms of fat deposition in the heart. The clinical case of lipomatose hypertrophy of right ventricle in 55 years old patient with complaints of dyspnea on exertion is presented. During echocardiography unusual thickening and changes of the right ventricular wall structure were found. The diagnosis was confirmed by contrast cardiac MSCT. The patient had also ESC abnormalities. Further observation of patients with so-called physiological adipose tissue of myocardium is necessary in order to evaluate its clinical value and long-term prognosis.