Surgical Management of Spontaneous Coronary Artery Dissection 13 November 2017

Abstract

Spontaneous coronary artery dissection, which causes acute coronary syndrome and can result in sudden death, is rare; but its true incidence is underestimated, since most patients die suddenly, without diagnosis. The aim of this study was to show the importance of prompt diagnosis and treatment.

In reviewing the records of 5,000 consecutive patients who underwent coronary angiography between January 2001 and August 2006, we found 6 cases of spontaneous coronary artery dissection (an incidence rate of 0.12%). Five patients presented with left main coronary artery dissection and 1 patient, with right coronary artery dissection.

Angioplasty with stenting failed in the patient with right coronary artery dissection. Coronary artery bypass surgery was performed in all patients. The patient with right coronary artery dissection died of sepsis on the 30th postoperative day. The other 5 patients (83.3%) are still free of symptoms, and they had negative results on stress tests at the 6- and 12-month follow-up visits after coronary artery bypass surgery.

The clinical presentation of spontaneous left main coronary artery dissection was similar to that of atherosclerotic disease. However, early diagnosis of spontaneous coronary artery dissection by means of coronary angiography is of paramount importance, because urgent coronary artery bypass grafting can be lifesaving.

Key words: Aneurysm, dissecting/diagnosis/therapy; death, sudden, cardiac/etiology; myocardial ischemia/etiology; pregnancy complications, cardiovascular; puerperal disorders; rupture, spontaneous

Spontaneous coronary artery dissection (CAD), which causes acute coronary syndrome and can result in sudden death, is a rare event. Spontaneous coronary artery dissection has been observed in 3 groups of patients: patients with coronary artery disease, young women during peripartum, and patients with idiopathic disease and no obvious associated factors. The pathogenesis of spontaneous CAD is still unclear.1,2

The clinical presentation of left main coronary artery (LMCA) dissection may be similar to that of a patient with atherosclerotic disease of the LMCA. Early diagnosis and urgent coronary artery bypass grafting (CABG) is lifesaving in patients with LMCA dissection. In this retrospective study, we present an account of our management of spontaneous CAD, and we review the medical literature in order to investigate the potential causes and optimal treatments of this condition. [ ]

Source: Surgical Management of Spontaneous Coronary Artery Dissection

My surgery was done according to the article below.

See also Coronary Bypass Without Opening the Chest

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Watch “Mayo Clinic SCAD Research Program Update: 2017” on YouTube

 

 

Source: https://www.youtube.com/watch?v=h8cEofXDtwQ

Mayo Clinic SCAD Research Program Presentation A high-point for survivors and those impacted by SCAD was the research presentation which followed at Edward Hospital, Naperville, IL. This year attendees enjoyed meeting and hearing about the latest research findings presented by some of the researchers from the Mayo Clinic SCAD Research Programs (Rochester, MN): Sharonne Hayes, MD: Mayo Clinic SCAD Research Program Team Lead and Chair of our Scientific Advisory Committee Marysia Tweet, MD: Co-creator of Mayo Clinic SCAD Registry, Senior Cardiology/Fellow Jeanne Theis, PhD: Research Scientist in SCAD DNA Research Also attending from Mayo Clinic SCAD Research Program were Jill Boyum (SCAD Research Study Coordinator), Toni Sauber (Medical Secretary) and Brenda Speltz (Clinical Research Coordinator, SCAD Biobank).
 
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Strange goings on 7 October 2017

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I have had epilepsy, you could say, all my life and have run  out of anticonvulsants which manage the condition sufficiently.

For the past several month I have been experiencing, to various degrees, episodes when I cannot retain my balance or actually do fall over; accompanied by double vision wherein the second of the object appears to be quite distant from the first. These experiences began when I tried a new drug for me, last year, we discontinued the drug.

Now, using Perampanel I am having the same experiences though more extreme, the events usually occur either early mornings or late at night, though I had one mid-morning on Thursday.

Two days beforehand I was getting myself ready for a dental appointment ( Sydney Dental Hospital) after which I planned to visit Jessica at St. Vincent’s hospital where she has had her heart surgery – all good. I had gone into the bathroom to capture Jessica’s old walking stick hoping to remain upright on two sticks long enough for the episode to wear off and for me to do the usual ‘be in 2 places at once’ thing that is very much part of my life. By this time I was already having the seizure because of the fixated manner of thought processing, in the bathroom I tripped and fell hitting my forehead, back of head and hip on the porcelain toilet pedestal. Still have some very interesting op art on my face and rear.

I estimate that I was out for about 20 -30 minutes since I came to at the sound of the door being knocked which would have been Jessica’s Tuesday carer – the message to stop all services didn’t make its way to the end of the line. I still could not stand and crawled to the front door, praying she wouldn’t leave before I got to it. Hauling myself up by the lock I opened the door and then almost fell back over but was caught, the ambulance was called and a trip to Prince Of Wales Hospital  Randwick saw me for about 8 ish hours, where no one knew which way was up either.

I surmise that there may be a drug interaction we have missed this else it is something new to me in my older age. When prescribed Epilim with Lamictal quite some years ago the combination brought me to my knees – let’s say, but nothing is recorded connecting Perampanel with any adverse chemical reaction – that I have found.

Now I have to do some Dr Google since it is getting too dangerous to be home alone or out in public alone, and it may be something literally in my head that needs seeing with an MRI- if this is the case it makes for a simple explanation by ???

Andrew

 

 

Andrews having weird seizures

Epilepsy In-Depth Report

Background

Epilepsy is a brain disorder involving repeated, spontaneous seizures of any type. Epilepsy is not a single disorder but rather a wide spectrum of problems. What all types of epilepsy share are recurrent, unprovoked seizures caused by an uncontrolled electrical discharge from nerve cells in the cerebral cortex. This part of the brain controls higher mental functions, general movement, and the functions of the internal organs in the abdominal cavity, perception, and behavioral reactions.

The structures of the brain include the brainstem, consisting of the spinal cord, the medulla oblongata, the pons and the midbrain; the cerebellum; the cerebrum (one half, or hemisphere shown); and the diencephalon.

SEIZURES

Seizures are a symptom of epilepsy. Seizures (“fits,” convulsions) are episodes of disturbed brain function that cause changes in attention or behavior. They are caused by abnormally excited electrical signals in the brain.

A single seizure may be related to a temporary medical problem (such as brain or tumor withdrawal from alcohol). If repeated seizures do not happen again once this underlying problem is corrected, the person does not have epilepsy.

A single, first seizure that cannot be explained by a temporary medical problem has about a 25% chance of returning. After a second seizure occurs, there is about a 70% chance of future seizures and the diagnosis of epilepsy.

TYPES OF EPILEPSY

Epilepsy is generally classified into two main categories based on seizure type:

  • Partial (also called focal or localized) seizures. These seizures are more common than generalized seizures and occur in one or more specific locations in the brain. In some cases, partial seizures can spread to wide regions of the brain. They are likely to develop from specific injuries, but in most cases the exact origins are unknown ( idiopathic ).
  • Generalized seizures. These seizures typically occur in both sides of the brain. Many forms of these seizures are genetically based. There is usually normal neurologic function.

PARTIAL SEIZURES (ALSO CALLED FOCAL SEIZURES)

These seizures are subcategorized as “simple” or “complex partial.”

  • Simple Partial Seizures. A person with a simple partial seizure (sometimes known as Jacksonian epilepsy) does not lose consciousness, but may experience confusion, jerking movements, tingling, or odd mental and emotional events. Such events may include deja vu, mild hallucinations, or extreme responses to smell and taste. After the seizure, the patient usually has temporary weakness in certain muscles. These seizures typically last about 90 seconds.
  • Complex Partial Seizures. Slightly over half of seizures in adults are complex partial type. About 80% of these seizures originate in the temporal lobe, the part of the brain located close to the ear. Disturbances there can result in loss of judgment, involuntary or uncontrolled behavior, or even loss of consciousness. Patients may lose consciousness briefly and appear to others as motionless with a vacant stare. Emotions can be exaggerated; some patients even appear to be drunk. After a few seconds, a patient may begin to perform repetitive movements, such as chewing or smacking of lips. Episodes usually last no more than 2 minutes. They may occur infrequently, or as often as every day. A throbbing headache may follow a complex partial seizure.

In some cases, simple or complex partial seizures evolve into what are known as secondarily generalized seizures. The progress may be so rapid that the partial stage is not even noticed.

GENERALIZED SEIZURES

Generalized seizures are caused by nerve cell disturbances that occur in more widespread areas of the brain than do partial seizures. Therefore, they have a more serious effect on the patient. They are further subcategorized as tonic-clonic (or grand mal), absence (petit mal), myoclonic, or atonic seizures.

Tonic-Clonic (Grand Mal) Seizures. The first stage of a grand mal seizure is called the tonic phase, in which the muscles suddenly contract, causing the patient to fall and lie stiffly for about 10 – 30 seconds. Some people experience a premonition or aura before a grand mal seizure. Most, however, lose consciousness without warning. If the throat or larynx is affected, there may be a high-pitched musical sound (stridor) when the patient inhales. Spasms occur for about 30 seconds to 1 minute. Then the seizure enters the second phase, called the clonic phase. The muscles begin to alternate between relaxation and rigidity. After this phase, the patient may lose bowel or urinary control. The seizure usually lasts a total of 2 – 3 minutes, after which the patient remains unconscious for a while and then awakens to confusion and extreme fatigue. A severe throbbing headache similar to migraine may also follow the tonic-clonic phases.

Absence (Petit Mal) Seizures. Absence or petit mal seizures are brief losses of consciousness that occur for 3 – 30 seconds. Physical movement and loss of attention may stop for only a moment. Such seizures may pass unnoticed by others. Young children may simply appear to be staring or walking distractedly. Petit mal may be confused with simple or complex partial seizures, or even with attention deficit disorder. In petit mal, however, a person may experience attacks as often as 50 – 100 times a day.

Myoclonic. Myoclonic seizures are a series of brief jerky contractions of specific muscle groups, such as the face or trunk……

Read more at Epilepsy In-Depth Report – New York Times

Epilepsy – In-Depth Report – NY Times Health. 2017. Epilepsy – In-Depth Report – NY Times Health. [ONLINE] Available at: http://www.nytimes.com/health/guides/disease/epilepsy/print.html. [Accessed 07 October 2017].

What is Chronic Obstructive Pulmonary Disease (COPD)-14 September 2017

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the United States. In this video, Dr. James Kiley and Dr. Tony Punturieri from the National Heart, Lung, and Blood Institute (NHLBI) provide an overview of COPD. Topics discussed include risk factors, signs and symptoms, and treatment options. To learn more, visit the COPD Learn More Breathe Better® Program at copd.nhlbi.nih.gov.

 

Sestamibi Scan posted 27 July 2017

Yesterday Andrew accompanied me to St Vincent’s nuclear Medicine department for a Sestamibi Scan, called ” Mibi” for short, of my heart.

The process involves a baseline scan without any medium followed by a period of rest, you can read about everything through these links here.

Sestamibi Scan – “Mibi”

A sestamibi (MIBI) scan is a test that measures the amount of blood being supplied to your heart.

What is a sestamibi scan?

A sestamibi (MIBI) scan measures the amount of blood being supplied to your heart. The scan is done in two parts:

  1. At rest – sitting and breathing normally
  2. After a chemical or physical stress test – when your heart is beating faster after exercising on a treadmill or exercise bike[   ]      ST. Vincent’s Hospital Heart Health – Sestamibi Scan

What Is A Nuclear Heart Scan?

A nuclear heart scan is a type of heart disease test. It is also known as nuclear stress testing and radionuclide myocardial perfusion imaging. It is performed to assess the condition and health of the heart. During the test, a doctor will inject a radioactive material or dye called a tracer through the vein into the bloodstream. The tracer travels along the veins towards the heart and special cameras outside the body can trace its journey. Two sets of images will be taken. First, the patient will undergo an exercise stress test or chemical stress test so that their blood flow can be monitored while ‘stressed’. The second set of images will be taken several hours or a few days later when the patient is at rest. The two sets of images will be compared for signs of any blockages and areas of damaged heart muscle.  [ http://www.womens-health-advice.com/heart-disease/testing.html  ]

nuclear-scan
Nuclear stress test to Diagnose CHD. 

Also used to gauge the damage to the heart by things such as S.C.A.D.

 http://www.womens-health-advice.com/photos/heart-tests.html

All in all the scan only took 4 hours rather than the 6 mentioned and wasn’t as scary as we had thought.

Due to the radioactivity I was warned to take a taxi home and to stay away from people for 48 hours until the Technetium Tc 99m sestamibi reached safer levels.. Andrew and I took the long blue and white taxi home raight to our doorstep and went out shopping today after I came home from respite.

Popular health advice for women

If you are curios you may read about the Radioactive medium at the following URLs

  1. NAME: Technetium Tc 99m sestamibi [USAN:USP:INN:BAN] RN: 109581-73-9 Molecular formula  C36-H66-N6-O6-Tc
  2. Chemidplus
  3. Information Sources

 

I feel somewhat tired and done it and have gone to bed early these past few nights but will be opening the Shed at Kooloora tomorrow.