心血管疾患と診断

Background: Patients with unclear chest pain experience more anxiety compared to those receiving a clear diagnosis, and they also report lower quality of life (QoL) than a general population. The aim was to investigate if there were differences in QoL before coronary angiography compared to six months later.

Methods: This was a quantitative study using the questionnaire EQ-5D. The study population consisted of patients (N=150) with unclear chest pain, referred for elective coronary angiography. They were asked to complete a questionnaire the day before coronary angiography and six months later.

Results: Significant improvements were seen regarding usual activities, pain/discomfort and total health status on the day before coronary angiography compared to at six months follow up.

Conclusions: Patients with unclear chest pain seem to estimate their total health status before coronary angiography worse than both the general population and myocardial infarction patients. Those with coronary artery disease CAD rated better total health status in comparison to those with a final diagnosis of no CAD. However, six months later significant improvements were seen.

A 29 year-old male without any risk factors for coronary artery disease presented with symptomatic sustained ventricular tachycardia. 2-Dimensional (2 D) transthoracic echocardiogram(TTE) did not reveal any abnormality. When we did a 3-Dimensional(3 D) echocardiogram, a small left ventricular(LV) aneurysm was detected near the outflow tract. After catheter ablation, the patient was discharged without any anti-arrhythmic therapy.

Introduction: Wound complications of leg wounds occur in up to 44% of patients after femoral distal bypass surgery. There are technical difficulties in obtaining primary wound closure especially on the anterior tibial wound,particularly in the setting of critical limb ischaemia and oedema.

Technical summary: Primary use of negative pressure dressings in this situation has not been described.We describe a case report and a technique which will help obtain safe wound closure without compromising graft integrity by tunnelling the graft obliquely under the tibialis anterior muscle and then applying primary PicoTM dressing.

Conclusion: By avoiding tension on fragile oedematous tissue safe wound closure may be obtained.

Consent: Informed patient consent was obtained for the treatment as well as for the publication of the photograph

A coronary artery fistula is a communication between a coronary artery and a chamber of the heart (coronary-cameral fistula). Coronary ectasia is the luminal dilatation of the adjacent normal segment, believed to be a form of atherosclerotic process, and is reported in about 3-8% of patients undergoing coronary angiogram. Coronary-cameral fistula and coronary ectasia, when existing concurrently, may present as a prelude to ischemia even in the absence of obstructive disease. We report here one such case seen in an elderly female. She presented with recurrent episodes of angina despite the absence of occlusive coronary artery disease. We also review the literature.

Introduction: Obesity could be implicated in the modification of myocardial structure and function. Mexico has a 70% prevalence of overweight/obesity; therefore, we suggest assessing these changes with a non-invasive technique as the Gated-SPECT. Methods: This is retrospective observational study. Gated-SPECT assessment was conducted in patients suggesting ischemic heart. Multiple regression analysis was used for predicting the value of age, sex, BMI, DM and hypertension for functional parameters. T-test was used to compare DM groups and one-way ANOVA to compare BMI groups. Results: The model statistically significantly predict BMI and smoking to contribute to the prediction of LVEF, p<0.005, adj. R2 = 0.155. BMI, sex and hypertension added statistically significantly to the EDV prediction, p<0.05. EDV, p < 0.005, adj. R2 = 0.202; and sex, age and hypertension to the ESV prediction, p<0.005, adj. R2 = .251. Significant differences between men and women groups in ESV and EDV were found, p<0.000. Conclusions: BMI is associated with the decrease in LVEF and the elevation of EDV without ventricular dysfunction. Sex, age and hypertension counted for predictors for an increase in ESV. There were no significant differences in the diabetic and non-diabetic groups, however obese diabetic patients have an increase in their EDV values. These alterations could be secondary to preliminary changes in left ventricular remodeling. Gated-SPECT is an effective non-invasive technique to discover alterations in structures before fatal events.