- Email: [email protected]
Acute myocardial infarction due to right coronary artery occlusion in dextrocardia
International Journal of Cardiology 129 (2008) e71 – e73 www.elsevier.com/locate/ijcard
Letter to the Editor
Acute myocardial infarction due to right coronary artery occlusion in dextrocardia Salvatore Patanè a,⁎, Filippo Marte a , Gianluca Di Bella b a
b
Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me) AUSL5 Messina, Italy Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy Received 10 April 2007; accepted 23 June 2007 Available online 14 September 2007
Abstract Dextrocardia is described as the location of the heart mainly in the right chest and with the cardiac long axis directing to the right and inferiorly. Dextrocardia occurs rarely with a frequency of 1/10,000 in general population. The most important modifications in performing coronary angiography in such patients are opposite-direction catheter rotations and mirror-image angiographic angles. We describe a case of acute myocardial infarction in a 44-year-old Italian man with dextrocardia, situs inversus totalis and right coronary artery stenosis. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Dextrocardia; Right coronary artery stenosis; Situs inversus totalis
1. Case report Dextrocardia is described as the location of the heart mainly in the right chest and with the cardiac long axis directing to the right and inferiorly [1]. Dextrocardia occurs rarely with a frequency of 1/10,000 in general population [2,3]. The most important modifications in performing coronary angiography in such patients are opposite-direction catheter rotations and mirror-image angiographic angles [4–6]. On March 22nd, 2007, at 05,00 a.m., a 44-year-old Italian man was admitted to the emergency department with chest pain and right arm pain. A prior diagnosis of dextrocardia and a history of lipid disorders in treatment were present. A history of current smoke was present too. Blood pressure values were 110/70 mmHg, the heart rate was 63 b/min, and the oxygen saturation was normal. The ECG was performed with right sided precordial leads. The ECG showed ST-segment elevation in II III avF V4–V5–V6 (Fig. 1). Echocardiographic evaluation revealed a mild mitral regurgi-
⁎ Corresponding author. Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me) AUSL5, Via Cattafi, 98051 Barcellona Pozzo di Gotto, Messina, Italy. Tel.: +393402783962. E-mail address: [email protected] (S. Patanè). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2007.06.117
tation, a mild tricuspid regurgitation, a concentric left ventricular hypertrophy, a mild left atrial dilatation and a lateral wall hypokinesia. An ejection fraction of 60% was observed. No pericardial effusion was observed. Initially the patient was treated with thrombolysis (bolus of tenecteplase), aspirin (1000 mg), intravenous heparin (bolus of 5000 IU and 1000 IU/h as a maintenance), nitroglycerin (5 mcg/kg/min), ketorolac tromethamine, and ranitidine. The patient prompt returned asymptomatic and was admitted to the Cardiology Unit. Troponin I peak was 5.86 ng/ml (normal value 0.00– 0.15 ng/ml), and peak of CK-MB mass release was 21.3 ng/ml (normal value 0.0–10.4 ng/ml). Serum uric acid levels were 7.4 mg/dl (normal value 0.00–7), total cholesterol was 259 mg/ dl (normal value b200 mg/dl), low density lipoprotein cholesterol was 186 mg/dl (N 150), triglycerides were 196 mg/dl, white blood cell count was 13500 u/l neutrophil count was 7810 u/l, and lymphocyte count was 4250 u/l. Chest X-ray examination confirmed the presence of a right sided heart. Coronary angiography revealed significant right coronary artery stenosis. Percutaneous transluminal coronary angioplasty with implantation of stent was successfully performed (Fig. 2). We have described a case of acute myocardial infarction in a 44year-old Italian man with dextrocardia, situs inversus totalis and right coronary artery stenosis.
e72
S. Patanè et al. / International Journal of Cardiology 129 (2008) e71–e73
Fig. 1.
Fig. 2.
S. Patanè et al. / International Journal of Cardiology 129 (2008) e71–e73
2. Methods The electrocardiographic images were obtained in the emergency department with a Cardioline Delta 1 Plus. References [1] Ho SY. What do we mean by ‘dextrocardia’? Int J Cardiol 2003;88:155–6. [2] Saha M, Chalil S, Sulke N. Situs inversus and acute coronary syndrome. Heart Apr 2004;90(4):e20.
e73
[3] Zhang Q, Zhang RY, Hu J, Shen WF. Percutaneous drug-eluting stent implantation in dextrocardia: case report. Chin Med J 2007;120 (3):248–50. [4] Wester JP, Ernst JM, Mast EG, Plokker HW, Bal ET, Verzijbergen JF. Coronary angioplasty in a patient with situs inversus totalis and a single coronary artery. Catheter Cardiovasc Diagn Apr 1994;31(4):304–8. [5] Ilia R, Gussarsky Y, Gueran M. Coronary angiography in a patient with mirror-image heart (‘‘situs inversus’’). Int J Cardiol 1988;20:273–5. [6] Papadopoulos DP, Athanasiou A, Papazachou U, et al. Treatment of coronary artery disease in dextrocardia by percutaneous stent placement. Int J Cardiol Jun 8 2005;101(3):499–500.
Letter to the Editor
Acute myocardial infarction due to right coronary artery occlusion in dextrocardia Salvatore Patanè a,⁎, Filippo Marte a , Gianluca Di Bella b a
b
Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me) AUSL5 Messina, Italy Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy Received 10 April 2007; accepted 23 June 2007 Available online 14 September 2007
Abstract Dextrocardia is described as the location of the heart mainly in the right chest and with the cardiac long axis directing to the right and inferiorly. Dextrocardia occurs rarely with a frequency of 1/10,000 in general population. The most important modifications in performing coronary angiography in such patients are opposite-direction catheter rotations and mirror-image angiographic angles. We describe a case of acute myocardial infarction in a 44-year-old Italian man with dextrocardia, situs inversus totalis and right coronary artery stenosis. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Dextrocardia; Right coronary artery stenosis; Situs inversus totalis
1. Case report Dextrocardia is described as the location of the heart mainly in the right chest and with the cardiac long axis directing to the right and inferiorly [1]. Dextrocardia occurs rarely with a frequency of 1/10,000 in general population [2,3]. The most important modifications in performing coronary angiography in such patients are opposite-direction catheter rotations and mirror-image angiographic angles [4–6]. On March 22nd, 2007, at 05,00 a.m., a 44-year-old Italian man was admitted to the emergency department with chest pain and right arm pain. A prior diagnosis of dextrocardia and a history of lipid disorders in treatment were present. A history of current smoke was present too. Blood pressure values were 110/70 mmHg, the heart rate was 63 b/min, and the oxygen saturation was normal. The ECG was performed with right sided precordial leads. The ECG showed ST-segment elevation in II III avF V4–V5–V6 (Fig. 1). Echocardiographic evaluation revealed a mild mitral regurgi-
⁎ Corresponding author. Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me) AUSL5, Via Cattafi, 98051 Barcellona Pozzo di Gotto, Messina, Italy. Tel.: +393402783962. E-mail address: [email protected] (S. Patanè). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2007.06.117
tation, a mild tricuspid regurgitation, a concentric left ventricular hypertrophy, a mild left atrial dilatation and a lateral wall hypokinesia. An ejection fraction of 60% was observed. No pericardial effusion was observed. Initially the patient was treated with thrombolysis (bolus of tenecteplase), aspirin (1000 mg), intravenous heparin (bolus of 5000 IU and 1000 IU/h as a maintenance), nitroglycerin (5 mcg/kg/min), ketorolac tromethamine, and ranitidine. The patient prompt returned asymptomatic and was admitted to the Cardiology Unit. Troponin I peak was 5.86 ng/ml (normal value 0.00– 0.15 ng/ml), and peak of CK-MB mass release was 21.3 ng/ml (normal value 0.0–10.4 ng/ml). Serum uric acid levels were 7.4 mg/dl (normal value 0.00–7), total cholesterol was 259 mg/ dl (normal value b200 mg/dl), low density lipoprotein cholesterol was 186 mg/dl (N 150), triglycerides were 196 mg/dl, white blood cell count was 13500 u/l neutrophil count was 7810 u/l, and lymphocyte count was 4250 u/l. Chest X-ray examination confirmed the presence of a right sided heart. Coronary angiography revealed significant right coronary artery stenosis. Percutaneous transluminal coronary angioplasty with implantation of stent was successfully performed (Fig. 2). We have described a case of acute myocardial infarction in a 44year-old Italian man with dextrocardia, situs inversus totalis and right coronary artery stenosis.
e72
S. Patanè et al. / International Journal of Cardiology 129 (2008) e71–e73
Fig. 1.
Fig. 2.
S. Patanè et al. / International Journal of Cardiology 129 (2008) e71–e73
2. Methods The electrocardiographic images were obtained in the emergency department with a Cardioline Delta 1 Plus. References [1] Ho SY. What do we mean by ‘dextrocardia’? Int J Cardiol 2003;88:155–6. [2] Saha M, Chalil S, Sulke N. Situs inversus and acute coronary syndrome. Heart Apr 2004;90(4):e20.
e73
[3] Zhang Q, Zhang RY, Hu J, Shen WF. Percutaneous drug-eluting stent implantation in dextrocardia: case report. Chin Med J 2007;120 (3):248–50. [4] Wester JP, Ernst JM, Mast EG, Plokker HW, Bal ET, Verzijbergen JF. Coronary angioplasty in a patient with situs inversus totalis and a single coronary artery. Catheter Cardiovasc Diagn Apr 1994;31(4):304–8. [5] Ilia R, Gussarsky Y, Gueran M. Coronary angiography in a patient with mirror-image heart (‘‘situs inversus’’). Int J Cardiol 1988;20:273–5. [6] Papadopoulos DP, Athanasiou A, Papazachou U, et al. Treatment of coronary artery disease in dextrocardia by percutaneous stent placement. Int J Cardiol Jun 8 2005;101(3):499–500.