Nuclear left ventriculography at rest and during atrial pacing in the evaluation of coronary artery disease.
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This study was undertaken to examine the value of rapid atrial pacing (RAP) combined with left-ventricular nuclear (LVN) angiography in the diagnosis of ischemic heart disease. It included 32 patients: 12 normal subjects and 20 with clinical coronary artery disease (CAD) and greater than 50% narrowing of a coronary artery (significant CAD). The ECG and an LVN angiogram (LVNA) were recorded at rest and during graded RAP. In the normal subjects, left-ventricular wall motion was normal at rest and during atrial pacing, but a wall motion abnormality (WMA) appeared in one subject. Left-ventricular ejection fraction (EF) did not change significantly. In the 20 patients with significant CAD, the diagnostic sensitivity of the ECG during RAP was 100% and 90% for the nuclear angiogram (presence or appearance of WMA at rest and during RAP). The mean EF in this group decreased from 0.38 to 0.31. WMA on the LVNA was present in 79% of patients with significant left-anterior descending, in 44% of those with right, and in 33% of those with circumflex coronary artery disease. WMA (at rest or on pacing) occurred in 17% of patients with 50 to 89% narrowing of an artery, in 50% with 90 to 99% narrowing and in 68% with total obstructions. The LVNA (rest and/or RAP) identified patients with significant single-vessel disease, but underestimated the extent of double-and triple-vessel disease. The LVNA at rest and during atrial pacing was an excellent method of evaluating significant coronary artery disease.Keywords:
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ST depression
Coronary arteries
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Left coronary artery
Depression
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Background The determination of infarct related artery in acute inferior myocardial infarction is extremely important for the prediction of potential complication and predicting the probable site of occlusion is worthwhile because proximal occlusions are likely to cause greater myocardial damage and early invasive strategy is indicated. Objectives:To predict the culprit coronary artery whether right coronary artery or left circumflex artery by examining the surface electrocardiography in patients with acute inferior wall myocardial infarction and also to predict the correlation between the proximity of lesion in right coronary artery and severity of ST segment elevation in inferior electrocardiographic leads that is caused by right coronary artery occlusion . Methods: A total of 56 patients with inferior wall myocardial infarction were included in this study underwent coronary angiography. the electrocardiography of these patients were then compared with angiographic finding to correlate with culprit artery (either right coronary artery or left circumflex) and also to correlate the proximity of culprit lesion in right coronary artery with the degree of ST segment elevation in inferior limb leads. Results: After comparing the electrocardiographic findings in inferior and lateral leads ,it was evident that the degree of ST segment elevation in leads III and AVF was significantly higher in right coronary artery group (46 patients) vs left circumflex group (10 patients) 3.16±1.14mm vs 1.53±0.24mm (p 0.05).In respect to lateral limb leads (AVL and I), we found that deeper ST segment depression was in right coronary artery group as compared to left circumflex group 1.11±0.25mm vs 0.2 ±0.34mm (p 0.05)and 2.1± 0.56mm vs 1.73±0.71mm (p>0.05) respectively. Also in right coronary artery group, 15(32.6%) patients had proximal culprit lesion, 19(41.6%) mid and 12(26%) distal culprit lesion. Patient with proximal right coronary artery disease showed a mean ST segment elevation of 11.7±1.8mm and with mid right coronary artery disease 7.2±0.97mm and with distal right coronary artery disease 5.8±0.82mm. Conclusion 1-It is possible to predict the culprit artery whether right coronary artery or left circumflex by examining the surface electrocardiography in patients with acute inferior myocardial infarction. 2-The degree of ST segment elevation is correlated with proximity of the right coronary artery. يجاتلا نايرشلا دادسنا عقوم ؤبنتل يئابرهكلا بلقلا طيطخت ريياعم
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Coronary artery anomalies are rare, with their incidence varying from 1 to 5%. Angiography is a commonly used modality for the assessment of coronary artery anomalies. Based on previous reports, a majority of coronary artery anomalies are of origin or distribution, with separate ostia of the left anterior descending artery and left circumflex artery. Coronary artery anomalies may cause myocardial ischemia secondary to atherosclerosis in the same artery. We present a rare case of duplicated right coronary artery with a separate ostium, which caused myocardial ischemia. Our patient was a 51-year-old diabetic woman with typical chest pain and dyspnea on exertion. Electrocardiography showed left axis deviation, poor R progression, and biphasic T wave in the precordial leads. Echocardiography revealed left ventricular ejection fraction of 30-35% and global hypokinesia. Coronary angiography demonstrated three-vessel disease and a double ostial right coronary artery. We recommended coronary artery bypass graft surgery, but the patient refused it and we continued her treatment with anti-ischemic drugs.
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AIM To study the correlation between the heart rate variability(HRV) and the coronary artery pathology in patients with coronary artery disease(CAD).METHODS One hundred and eleven patients who had had coronary angiography(CAG) and 24 h ECG Holter record were retrospectively studied.The subjects were classified into three groups according to coronary artery pathology in CAG: no abnormality in all coronary artery(n=43),narrowing 50%(n=43) and total occlusion(n=25) at least in one of coronary artery.In each subject,a 24 h ECG Holter tape had been recorded and subsequently analyzed to obtain time-domain HRV(SDNN,SDANNind,SDNNind,Rmssd,PNN50).RESULTS ①SDNN,SDANNind and SDNNind lowered with the degree of coronary narrowing and were the lowest in subjects with total occlusion.② SDNN,SDANNind,SDNNind,rMSSD and PNN50 tended to be lower with the increasing number of coronary artery abnormality.But the change was significant only in subjects who had abnormality in all the three coronary arteries.③ SDNN and SDANNind were significantly lower in subjects with left coronary artery abnormality but not in those with right coronary artery abnormality.CONCLUSION The findings that HRV is significantly lower in patients with coronary artery disease indicate that patients with CAD may have total occlusion in one of the coronary arteries,severe narrowing in all the three coronary arteries and severe narrowing in the left coronary artery.
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Abstract To assess right ventricular (RV) diastolic filling in coronary artery disease (CAD), with special reference to the involved lesions of the coronary arteries and left ventricular (LV) systolic function, gated radionuclide ventriculography was performed at rest in 106 patients with single‐vessel CAD. Based on the site of coronary arterial involvement, patients were classified into three groups: left anterior descending CAD, right CAD, and left circumflex CAD. Patients in each group were further subdivided according to normal or decreased LV ejection fraction, resulting in six groups. Seventeen normal subjects were examined as a control group. Tune‐activity and its first‐derivative curves were computed for the right and left ventricles. RV systolic function was normally preserved in all six groups, even when LV systolic function was damaged severely. The ratio of peak RV filling rate to peak RV ejection rate was significantly decreased in all six groups compared with that in control subjects, indicating that RV filling was impaired in patients with CAD. The ratio was below the lower limit of normal in 14 (23%) of 62 patients with normal LV systolic function and in 13 (30%) of 44 patients with impaired LV systolic function. None of the control subjects showed a decreased ratio of peak RV filling rate to peak RV ejection rate. Thus, in patients with CAD, RV filling is impaired, which may be independent of the site of coronary arterial involvement and of the LV or RV systolic function.
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