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PP-235 A RARE CASE OF TYPE IV DUAL LEFT ANTERIOR DESCENDING CORONARY ARTERY
S180
Posters / International Journal of Cardiology 155S1 (2012) S129–S227
PP-234 PRECORDIAL ST-SEGMENT ELEVATION TRIGGERED BY TREADMILL EXERCISE TEST IN A SEDENTARY PATIENT 1 1 U. Canpolat1 , H. Yorgun2 , M. Dural1 , E. Husrevzade ¨ , L. Sahiner ¸ , E.B. Kaya1 , K. Aytemir1 , A. Oto1 . 1 Department of Cardiology, Hacettepe University, Ankara, Turkey; 2 Develi State Hospital, Kayseri, Turkey Objective: Treadmill exercise test is widely used noninvasive test for evaluation of coronary artery disease due to cost and availability. Although incidence of the complications related with the test was low, all physicians should be careful in patient selection for the exercise. Especially, it should be recommended and performed cautiously in patients with sedentary lifestyle. Herein, we presented a patient with sedentary lifestyle who developed asymptomatic precordial ST segment elevation. Methods: A 41-year-old sedentary male patient with no previous cardiovascular risk factor admitted to our department with exertional dyspnea for 2 months. His family history was unremarkable. Examination revealed normal systemic findings. Results: Initial electrocardiography (ECG) showed normal sinus rhythm with no ischemic changes (66 bpm). Transthoracic echocardiography demonstrated normal systolic and diastolic functions with no segmentary wall motion abnormality. He underwent treadmill exercise test for non-invasive evaluation of coronary artery disease. At the beginning of the test, resting ECG showed sinus rhythm with no ischemic changes (Figure 1A). Although the patient was asymptomatic throughout the exercise test, his ECG revealed ST segment elevation in V1–5 leads (3–4 mm) and reciprocal ST segment depression in II, III and aVF derivations (3 mm) at 10th minute (Bruce Stage 4) of the exercise (Figure 1B). The exercise test was terminated immediately and recovery phase was initiated. He also had no symptom thereafter. Recovery phase ECG showed continuation of ST segment elevation in V1–3 derivations with reciprocal changes again (Figure 1C). So, the patient was transferred to the catheterization laboratory immediately. Coronary angiography revealed significant lesion at the proximal segment of left anterior descending artery (LAD) (Figure 1D). Percutaneous transluminal coronary angioplasty and stent implantation was performed to the LAD lesion with no residual stenosis (Figures 1E,F). The patient was hospitalized for 2 days. Cardiac biomarkers were in normal limits. He was discharged uneventfully on 2nd day. He was asymptomatic at 2nd year follow up visit.
coronary artery disease. However, it should be recommended and performed cautiously in patients with sedentary lifestyle. PP-235 A RARE CASE OF TYPE IV DUAL LEFT ANTERIOR DESCENDING CORONARY ARTERY ¨ ¨ c¸ un, O. Baydar, U. Coskun, ¸ C. Bostan, A. Yıldız, A.A. Ozkan, B. Ok ¨ ˙ ¨ M.K. Ersanlı, A.T. Gurmen. ¨ Istanbul Universitesi Kardiyoloji Enstit¨ us¨ u, ˙ Kardiyoloji Anabilim Dalı, Istanbul, Turkey Objective: Coronary artery anomalies are seen in angiographic series about 1.3%.The dual type of left anterior descending (LAD) artery is a rare form of coronary artery anomaly. Dual LAD has been presented in 4 different types depending on the origin of major septal and diagonal branches and course within the anterior interventricular sulcus. Type IV describes the anomaly of a rudimentary LAD artery terminating in the mid-portion of the anterior interventricular sulcus, and the presence of another LAD originating from the right coronary artery and continuing to the anterior interventricular sulcus. A 78-year-old man with a ten-year history of hypertension was admitted to our hospital because of chest pain at rest. The physical examination was normal On surface ECG the rhythm was sinusal and anterior ischemic ST changes was present. On transthoracic echocardiography showed anteroseptal mid, anterior mid apical walls were hypokinetic, EF:% 42. Cardiac biomarkers were detected high and there was no abnormality in other the standard biochemical tests. With these results patient was diagnosed NONSTEMI. Coronary angiography revealed a coronary artery anomaly of type IV dual LAD with a short LAD, which originated from the LMCA and terminated in the mid-portion of the AIVS. The long LAD originated from the right sinus valsalva, entered into the distal part of the AIVS and travelled towards the apex of the heart, also LAD mid % 90 and D1 proximal % 95 stenosis were detected (figure 1). Percutaneus coronary intervention was performed to mid segment of the LAD.Currently, patient is followed without any problems. Conclusions: The LAD is an important coronary artery and being aware of the congenital anomalies of the LAD may help physicians make the correct diagnosis and treatment in patients undergoing percutaneous coronary intervention or CABG operations.
Figure 1. (a) The short LAD originating from the LMCA terminated in the middle part of the AIVS. (b) The long LAD originating from the right sinus valsalva and entered the distal part of the AIVS. PP-236 THE RELATIONSHIP BETWEEN GRADE OF ISCHEMIA, KIND OF THROMBOLYTIC AND REPERFUSION B. Ayca, ¸ E. Okuyan, F. Akın, F. Katkat, K. Gul ¨ sen, ¸ M. Baskurt, ¸ A. Arat, ¨ c¸ un. M. Ersanlı, T. Gurmen, ¨ B. Ok ¨ Institution of Cardiology, Istanbul University, Istanbul, Turkey Figure 1. Conclusions: In conclusion, due to cost and availability treadmill exercise test is widely used noninvasive test for evaluation of
Objective: This study was conducted to evaluate whether the grade of ischemia can determine reperfusion with thrombolytics and if it is possible to choose thrombolytics according to grade of ischemia in patients with ST elevation myocardial infarction (STEMI).
Posters / International Journal of Cardiology 155S1 (2012) S129–S227
PP-234 PRECORDIAL ST-SEGMENT ELEVATION TRIGGERED BY TREADMILL EXERCISE TEST IN A SEDENTARY PATIENT 1 1 U. Canpolat1 , H. Yorgun2 , M. Dural1 , E. Husrevzade ¨ , L. Sahiner ¸ , E.B. Kaya1 , K. Aytemir1 , A. Oto1 . 1 Department of Cardiology, Hacettepe University, Ankara, Turkey; 2 Develi State Hospital, Kayseri, Turkey Objective: Treadmill exercise test is widely used noninvasive test for evaluation of coronary artery disease due to cost and availability. Although incidence of the complications related with the test was low, all physicians should be careful in patient selection for the exercise. Especially, it should be recommended and performed cautiously in patients with sedentary lifestyle. Herein, we presented a patient with sedentary lifestyle who developed asymptomatic precordial ST segment elevation. Methods: A 41-year-old sedentary male patient with no previous cardiovascular risk factor admitted to our department with exertional dyspnea for 2 months. His family history was unremarkable. Examination revealed normal systemic findings. Results: Initial electrocardiography (ECG) showed normal sinus rhythm with no ischemic changes (66 bpm). Transthoracic echocardiography demonstrated normal systolic and diastolic functions with no segmentary wall motion abnormality. He underwent treadmill exercise test for non-invasive evaluation of coronary artery disease. At the beginning of the test, resting ECG showed sinus rhythm with no ischemic changes (Figure 1A). Although the patient was asymptomatic throughout the exercise test, his ECG revealed ST segment elevation in V1–5 leads (3–4 mm) and reciprocal ST segment depression in II, III and aVF derivations (3 mm) at 10th minute (Bruce Stage 4) of the exercise (Figure 1B). The exercise test was terminated immediately and recovery phase was initiated. He also had no symptom thereafter. Recovery phase ECG showed continuation of ST segment elevation in V1–3 derivations with reciprocal changes again (Figure 1C). So, the patient was transferred to the catheterization laboratory immediately. Coronary angiography revealed significant lesion at the proximal segment of left anterior descending artery (LAD) (Figure 1D). Percutaneous transluminal coronary angioplasty and stent implantation was performed to the LAD lesion with no residual stenosis (Figures 1E,F). The patient was hospitalized for 2 days. Cardiac biomarkers were in normal limits. He was discharged uneventfully on 2nd day. He was asymptomatic at 2nd year follow up visit.
coronary artery disease. However, it should be recommended and performed cautiously in patients with sedentary lifestyle. PP-235 A RARE CASE OF TYPE IV DUAL LEFT ANTERIOR DESCENDING CORONARY ARTERY ¨ ¨ c¸ un, O. Baydar, U. Coskun, ¸ C. Bostan, A. Yıldız, A.A. Ozkan, B. Ok ¨ ˙ ¨ M.K. Ersanlı, A.T. Gurmen. ¨ Istanbul Universitesi Kardiyoloji Enstit¨ us¨ u, ˙ Kardiyoloji Anabilim Dalı, Istanbul, Turkey Objective: Coronary artery anomalies are seen in angiographic series about 1.3%.The dual type of left anterior descending (LAD) artery is a rare form of coronary artery anomaly. Dual LAD has been presented in 4 different types depending on the origin of major septal and diagonal branches and course within the anterior interventricular sulcus. Type IV describes the anomaly of a rudimentary LAD artery terminating in the mid-portion of the anterior interventricular sulcus, and the presence of another LAD originating from the right coronary artery and continuing to the anterior interventricular sulcus. A 78-year-old man with a ten-year history of hypertension was admitted to our hospital because of chest pain at rest. The physical examination was normal On surface ECG the rhythm was sinusal and anterior ischemic ST changes was present. On transthoracic echocardiography showed anteroseptal mid, anterior mid apical walls were hypokinetic, EF:% 42. Cardiac biomarkers were detected high and there was no abnormality in other the standard biochemical tests. With these results patient was diagnosed NONSTEMI. Coronary angiography revealed a coronary artery anomaly of type IV dual LAD with a short LAD, which originated from the LMCA and terminated in the mid-portion of the AIVS. The long LAD originated from the right sinus valsalva, entered into the distal part of the AIVS and travelled towards the apex of the heart, also LAD mid % 90 and D1 proximal % 95 stenosis were detected (figure 1). Percutaneus coronary intervention was performed to mid segment of the LAD.Currently, patient is followed without any problems. Conclusions: The LAD is an important coronary artery and being aware of the congenital anomalies of the LAD may help physicians make the correct diagnosis and treatment in patients undergoing percutaneous coronary intervention or CABG operations.
Figure 1. (a) The short LAD originating from the LMCA terminated in the middle part of the AIVS. (b) The long LAD originating from the right sinus valsalva and entered the distal part of the AIVS. PP-236 THE RELATIONSHIP BETWEEN GRADE OF ISCHEMIA, KIND OF THROMBOLYTIC AND REPERFUSION B. Ayca, ¸ E. Okuyan, F. Akın, F. Katkat, K. Gul ¨ sen, ¸ M. Baskurt, ¸ A. Arat, ¨ c¸ un. M. Ersanlı, T. Gurmen, ¨ B. Ok ¨ Institution of Cardiology, Istanbul University, Istanbul, Turkey Figure 1. Conclusions: In conclusion, due to cost and availability treadmill exercise test is widely used noninvasive test for evaluation of
Objective: This study was conducted to evaluate whether the grade of ischemia can determine reperfusion with thrombolytics and if it is possible to choose thrombolytics according to grade of ischemia in patients with ST elevation myocardial infarction (STEMI).