Background: Chronic excessive alcohol consumption has been strongly associated with alcohol-induced cardiomyopathy (AC) in patients with no evidence of coronary artery disease (CAD). AC may cause cardiovascular c...Background: Chronic excessive alcohol consumption has been strongly associated with alcohol-induced cardiomyopathy (AC) in patients with no evidence of coronary artery disease (CAD). AC may cause cardiovascular complications and significant impact on the quality of life. We discuss an interesting case of dilated cardiomyopathy, associated complication, diagnostic work-up and management. Case Report: A young male presented to our service with worsening dyspnea, orthopnea, and scrotal and lower extremity edema. On average, he consumed a pack of 12 beers every day and had a 30-pack-years smoking history. He was found to be in acute heart failure with evidence of pulmonary edema and cardiomegaly on chest imaging. He had biventricular dilatation and severely reduced left ventricular ejection fraction (LVEF) 15% in addition to a thrombus in the LV apex. The cardiac catheterization was unremarkable for CAD. He was diuresed appropriately resulting in significant weight loss and resolution of symptoms. LV thrombus was treated with unfractionated heparin infusion that was transitioned to warfarin. He was maintained on guidelines-directed medical therapy for heart failure. Extensive counseling was provided regarding alcohol and tobacco cessation. On follow-up echocardiogram, his LVEF improved and there was no evidence of LV thrombus. We think, the readership will benefit from our experience of treating a case of AC, and the importance of clinical history. Conclusion: Chronic excessive alcohol use is detrimental to cardiac function leading to alcohol-induced cardiomyopathy. A careful approach to clinical history of alcohol consumption and prompt diagnostic workup negative for ischemic causes may confirm the diagnosis. Cardiac function improves with guidelines-directed medical therapy for heart failure and abstinence from alcohol.展开更多
Background: Anomalous coronary artery (CAA) is a rare condition occurring in less than 1% of individuals. The most common form consists of the left circumflex artery (LCx) arising from the right coronary sinus. These ...Background: Anomalous coronary artery (CAA) is a rare condition occurring in less than 1% of individuals. The most common form consists of the left circumflex artery (LCx) arising from the right coronary sinus. These vascular anomalies have been associated with an increased risk of sudden cardiac death. We present a rare case of an anomalous coronary artery in a patient with all three coronary arteries arising from a shared ostium. Case presentation: A 67-year-old transgender Caucasian male with medical history of dyslipidemia and hypertension presented for ischemic workup due to occasional chest pain prior to undergoing male to female gender reassignment surgery. A Regadenosan stress test with SPECT myocardial perfusion imaging revealed moderate sized, moderate intensity perfusion defect reversible in inferolateral wall and fixed in inferior wall. Coronary angiography revealed anomalous origin of the coronary arteries, with all three major coronary arteries arising from a shared, single, ostium originating from the right coronary cusp. Coronary computed tomographic angiography (CCTA) showed a “malignant course” of LAD running between the pulmonary artery and aorta. A conservative management was pursued in view of mild symptoms with close follow ups. Conclusion: It is important to evaluate all coronary artery anomalies (CAA) for a “malignant” course due to its associated risk for various cardiac events including sudden cardiac death. Surgical management is indicated in high-risk patients with malignant courses. However, asymptomatic patients and those with mild symptoms with or without malignant course can be followed closely.展开更多
文摘Background: Chronic excessive alcohol consumption has been strongly associated with alcohol-induced cardiomyopathy (AC) in patients with no evidence of coronary artery disease (CAD). AC may cause cardiovascular complications and significant impact on the quality of life. We discuss an interesting case of dilated cardiomyopathy, associated complication, diagnostic work-up and management. Case Report: A young male presented to our service with worsening dyspnea, orthopnea, and scrotal and lower extremity edema. On average, he consumed a pack of 12 beers every day and had a 30-pack-years smoking history. He was found to be in acute heart failure with evidence of pulmonary edema and cardiomegaly on chest imaging. He had biventricular dilatation and severely reduced left ventricular ejection fraction (LVEF) 15% in addition to a thrombus in the LV apex. The cardiac catheterization was unremarkable for CAD. He was diuresed appropriately resulting in significant weight loss and resolution of symptoms. LV thrombus was treated with unfractionated heparin infusion that was transitioned to warfarin. He was maintained on guidelines-directed medical therapy for heart failure. Extensive counseling was provided regarding alcohol and tobacco cessation. On follow-up echocardiogram, his LVEF improved and there was no evidence of LV thrombus. We think, the readership will benefit from our experience of treating a case of AC, and the importance of clinical history. Conclusion: Chronic excessive alcohol use is detrimental to cardiac function leading to alcohol-induced cardiomyopathy. A careful approach to clinical history of alcohol consumption and prompt diagnostic workup negative for ischemic causes may confirm the diagnosis. Cardiac function improves with guidelines-directed medical therapy for heart failure and abstinence from alcohol.
文摘Background: Anomalous coronary artery (CAA) is a rare condition occurring in less than 1% of individuals. The most common form consists of the left circumflex artery (LCx) arising from the right coronary sinus. These vascular anomalies have been associated with an increased risk of sudden cardiac death. We present a rare case of an anomalous coronary artery in a patient with all three coronary arteries arising from a shared ostium. Case presentation: A 67-year-old transgender Caucasian male with medical history of dyslipidemia and hypertension presented for ischemic workup due to occasional chest pain prior to undergoing male to female gender reassignment surgery. A Regadenosan stress test with SPECT myocardial perfusion imaging revealed moderate sized, moderate intensity perfusion defect reversible in inferolateral wall and fixed in inferior wall. Coronary angiography revealed anomalous origin of the coronary arteries, with all three major coronary arteries arising from a shared, single, ostium originating from the right coronary cusp. Coronary computed tomographic angiography (CCTA) showed a “malignant course” of LAD running between the pulmonary artery and aorta. A conservative management was pursued in view of mild symptoms with close follow ups. Conclusion: It is important to evaluate all coronary artery anomalies (CAA) for a “malignant” course due to its associated risk for various cardiac events including sudden cardiac death. Surgical management is indicated in high-risk patients with malignant courses. However, asymptomatic patients and those with mild symptoms with or without malignant course can be followed closely.
