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Sidhu NS, Kaur S, Mahla H. Isolated right ventricular myocardial infarction caused by occlusion of an anomalous non-dominant right coronary artery: successful management with percutaneous coronary intervention. BMJ Case Rep 2022; 15:e248674. [PMID: 35351761 PMCID: PMC8966563 DOI: 10.1136/bcr-2021-248674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/04/2022] Open
Abstract
Isolated right ventricular myocardial infarction (RVMI) is a rare clinical presentation of acute coronary syndrome. A high index of suspicion is needed for its timely diagnosis and management to prevent serious complications like heart failure, cardiogenic shock, ventricular arrythmias or sudden cardiac death. Coronary anomalies are rare entities with a varied clinical presentation. We report an interesting case of a middle-aged female who presented with isolated RVMI, with a borderline blood pressure and sinus node dysfunction resulting from occlusion of an anomalous right coronary artery. The successful management of this patient with percutaneous coronary intervention using coronary stenting is also discussed.
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Affiliation(s)
- Navdeep Singh Sidhu
- Cardiology, Baba Farid University of Health Sciences Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Sumandeep Kaur
- Faculty of Nursing, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Himanshu Mahla
- Cardiology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
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de A Chaud MS, Agostinho CA, Malafaia FL, Sampaio MC, Chaccur P, de Barros E Silva PGM, Ribeiro EE, Garcia JCT, Furlan V, Ribeiro HB. A Coronary Artery Anomaly Presenting as Acute Coronary Syndrome: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931561. [PMID: 34465715 PMCID: PMC8420673 DOI: 10.12659/ajcr.931561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Coronary artery anomalies (CAAs) are rare congenital malformations with different clinical presentations and pathophysiological mechanisms. These anomalies are frequently the cause of sudden death in young patients. Most CAAs are incidental findings owing to the lack of symptoms; however, they may be associated with acute coronary syndrome in rare cases. CASE REPORT We describe the case of a 47-year-old man who presented with a 1-day history of progressive typical chest pain and elevated troponin levels. The patient underwent a coronary angiography, which unveiled the anomalous origin of the left main coronary artery arising from the right coronary artery, with an interarterial course between the ascending aorta and the pulmonary artery, without coronary artery disease. Coronary computed tomography angiography confirmed the CAA and its relationship with the symptoms. An uneventful coronary artery bypass graft was undertaken, and at the 1-year follow-up, the patient was asymptomatic, with a normal stress test. CONCLUSIONS This case depicts the presentation of atypical acute coronary syndrome in a young patient with a rare CAA. In such patients, coronary angiography and coronary computed tomography angiography are essential tools to confirm the diagnosis and to determine treatment. Although controversial, in young individuals presenting CAA with an interarterial course, such as the left main coronary artery arising from the right coronary artery, coronary artery bypass graft may be an important treatment option to avoid sudden death in the future.
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Bali HK, Dhindsa A, Bali SK, Chattree KK. A novel malignant anomaly of the coronary arteries (Bali’s girdle). Eur Heart J Case Rep 2021; 5:ytab138. [PMID: 34263114 PMCID: PMC8274649 DOI: 10.1093/ehjcr/ytab138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/19/2021] [Accepted: 04/07/2021] [Indexed: 11/30/2022]
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Virtual endoluminal aortic root views determined at coronary CT angiography - an important tool for improving anomalous coronary artery visualization and surgical planning. Pediatr Radiol 2021; 51:296-306. [PMID: 32889583 DOI: 10.1007/s00247-020-04775-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/20/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
Anomalous origin of the coronary arteries, though uncommon, is of great clinical concern. It can be the cause of sudden cardiac death and abnormal cardiac hemodynamics. Advances in electrocardiographically (ECG)-gated multi-detector CT have increased diagnostic accuracy in detecting anomalous origin of coronary arteries and their interarterial and intramural courses. Recent advances in multi-detector CT image processing software have allowed the creation of virtual endoluminal views of the aortic root and improved assessment of the intramural course (the length and relationship to the intercoronary commissure) of the coronary artery, which is of considerable surgical importance. We review our experience with virtual endoluminal imaging in our first 19 cases of interarterial coronary artery anomalies (17 cases of interarterial with intramural segment and 2 cases of purely interarterial course) diagnosed preoperatively and proven surgically.
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Sen G, Veitch A, Sinha M. Hyper-dominance of the left anterior descending artery-a large territory. BJR Case Rep 2021; 7:20200069. [PMID: 33614115 PMCID: PMC7869128 DOI: 10.1259/bjrcr.20200069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/29/2020] [Accepted: 08/27/2020] [Indexed: 12/04/2022] Open
Abstract
Coronary artery anomalies are rare and a potential cause of significant morbidity and mortality. A hyper-dominant left anterior descending artery is extremely rare with only 17 cases reported in the literature. Occlusion of a hyper-dominant left anterior descending artery can cause a massive myocardial infarction affecting a large myocardial territory and therefore clinicians should be aware of its importance.
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Affiliation(s)
- Gautam Sen
- Department of Cardiology, Salisbury Hospital, Odstock Rd, Salisbury, SP2 8BJ, United Kingdom
| | - Alice Veitch
- Department of Radiology, Salisbury Hospital, Odstock Rd, Salisbury, SP2 8BJ, United Kingdom
| | - Manas Sinha
- Department of Cardiology, Salisbury Hospital, Odstock Rd, Salisbury, SP2 8BJ, United Kingdom
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Sen G, Veitch A, Nabais S. Anomalous origin of the left anterior descending artery from the right coronary artery: a rare and malignant anomaly. Eur Heart J Case Rep 2020; 4:1-2. [PMID: 33628998 PMCID: PMC7891251 DOI: 10.1093/ehjcr/ytaa292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/02/2020] [Accepted: 07/31/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Gautam Sen
- Cardiology Department, Salisbury District Hospital, Odstock Rd, Salisbury SP2 8BJ, UK
| | - Alice Veitch
- Cardiology Department, Salisbury District Hospital, Odstock Rd, Salisbury SP2 8BJ, UK
| | - Sergio Nabais
- Cardiology Department, Salisbury District Hospital, Odstock Rd, Salisbury SP2 8BJ, UK
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(An anomalous origin and course of left anterior descending artery). COR ET VASA 2020. [DOI: 10.33678/cor.2020.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ludhwani D, Woo V. Anomalous origin of left main coronary artery from right coronary artery in a patient presenting with inferior wall myocardial infarction: a case report and literature review. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 3:1-6. [PMID: 33123672 PMCID: PMC7574964 DOI: 10.1093/ehjcr/ytz169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/20/2019] [Accepted: 08/26/2019] [Indexed: 11/14/2022]
Abstract
Background Anomalous origin of the coronary arteries is seen in less than 1% of the general population. Single coronary artery (SCA) is a congenital anatomic abnormality identified by a single coronary ostium giving rise to one coronary artery. We present an extremely rare variant of the left main coronary artery (LMCA) branching off from the right coronary artery (RCA) and following a prepulmonic course. Case summary A 72-year-old woman presented due to ongoing chest pain with associated ST-segment elevation involving the inferior leads. Emergent cardiac catheterization revealed a 99% ulcerated lesion in distal RCA, which was intervened on with angioplasty and stent placement. The RCA was noted giving rise to LMCA, which followed a prepulmonic course (anterior to pulmonary artery) before trifurcating into a small caliber left anterior descending, ramus intermedius, and hypoplastic left circumflex arteries. The non-malignant course of the aberrant LMCA was confirmed on the coronary computed tomography angiogram. The patient was discharged home on guideline-directed medical therapy. Discussion The patient illustrated congenital SCA with type RIIA pattern of the aberrant vessel based on the Lipton anatomic classification for SCA. The prepulmonic course of SCA is usually benign and can be managed conservatively.
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Affiliation(s)
- Dipesh Ludhwani
- Chicago Medical School, Rosalind Franklin University, Northwestern McHenry Hospital, 4309 W. Medical Center Drive, McHenry, IL 60050, USA
| | - Vincent Woo
- Chicago Medical School, Rosalind Franklin University, Northwestern McHenry Hospital, 4309 W. Medical Center Drive, McHenry, IL 60050, USA
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Babu Nelagondanahalli Manjunath S, Alex AG, Varghese L, George OK. Bilateral origin of a split circumflex coronary artery. BMJ Case Rep 2020; 13:13/9/e237651. [PMID: 32895256 DOI: 10.1136/bcr-2020-237651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Anoop George Alex
- Cardiology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Lijo Varghese
- Christian Medical College Vellore Association, Vellore, Tamil Nadu, India
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Lee M, Moharem-Elgamal S, Beckingham R, Hamilton M, Manghat N, Milano EG, Bucciarelli-Ducci C, Caputo M, Biglino G. Evaluating 3D-printed models of coronary anomalies: a survey among clinicians and researchers at a university hospital in the UK. BMJ Open 2019; 9:e025227. [PMID: 30852545 PMCID: PMC6430025 DOI: 10.1136/bmjopen-2018-025227] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of three-dimensional (3D) printing models of coronary artery anomalies based on cardiac CT data and explore their potential for clinical applications. DESIGN Cardiac CT datasets of patients with various coronary artery anomalies (n=8) were retrospectively reviewed and processed, reconstructing detailed 3D models to be printed in-house with a desktop 3D printer (Form 2, Formlabs) using white resin. SETTING A University Hospital (division of cardiology) in the UK. PARTICIPANTS The CT scans, first and then 3D-printed models were presented to groups of clinicians (n=8) and cardiovascular researchers (n=9). INTERVENTION Participants were asked to assess different features of the 3D models and to rate the models' overall potential usefulness. OUTCOME MEASURES Models were rated according to clarity of anatomical detail, insight into the coronary abnormality, overall perceived usefulness and comparison to CT scans. Assessment of model characteristics used Likert-type questions (5-point scale from 'strongly disagree' to 'strongly agree') or a 10-point rating (from 0, lowest, to 10, highest). The questionnaire included a feedback form summarising overall usefulness. Participants' imaging experience (in a number of years) was also recorded. RESULTS All models were reconstructed and printed successfully, with accurate details showing coronary anatomy (eg, anomalous coronary artery, coronary roofing or coronary aneurysm in a patient with Kawasaki syndrome). All clinicians and researchers provided feedback, with both groups finding the models helpful in displaying coronary artery anatomy and abnormalities, and complementary to viewing 3D CT scans. The clinicians' group, who had substantially more imaging expertise, provided more enthusiastic ratings in terms of models' clarity, usefulness and future use on average. CONCLUSIONS 3D-printed heart models can be feasibly used to recreate coronary artery anatomy and enhance understanding of coronary abnormalities. Future studies can evaluate their cost-effectiveness, as well as potentially explore other printing techniques and materials.
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Affiliation(s)
- Matthew Lee
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Moharem-Elgamal
- National Heart Institute, Giza, Egypt
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | | | - Mark Hamilton
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Nathan Manghat
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Elena Giulia Milano
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Massimo Caputo
- Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
| | - Giovanni Biglino
- Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol, NHS Foundation Trust, Bristol, UK
- Cardiorespiratory Division, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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Kastellanos S, Aznaouridis K, Vlachopoulos C, Tsiamis E, Oikonomou E, Tousoulis D. Overview of coronary artery variants, aberrations and anomalies. World J Cardiol 2018; 10:127-140. [PMID: 30386490 PMCID: PMC6205847 DOI: 10.4330/wjc.v10.i10.127] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/12/2018] [Accepted: 08/31/2018] [Indexed: 02/06/2023] Open
Abstract
Coronary artery anomalies and variants are relatively uncommon congenital disorders of the coronary artery anatomy and constitute the second most common cause of sudden cardiac death in young competitive athletes. The rapid advancement of imaging techniques, including computed tomography, magnetic resonance imaging, intravascular ultrasound and optical coherence tomography, have provided us with a wealth of new information on the subject. Anomalous origin of a coronary artery from the contralateral sinus is the anomaly most frequently associated with sudden cardiac death, in particular if the anomalous coronary artery has a course between the aorta and the pulmonary artery. However, other coronary anomalies, like anomalous origin of the left coronary artery from the pulmonary artery, atresia of the left main stem and coronary fistulae, have also been implicated in cases of sudden cardiac death. Patients are usually asymptomatic, and in most of the cases, coronary anomalies are discovered incidentally during coronary angiography or on autopsy following sudden cardiac death. However, in some cases, symptoms like angina, syncope, heart failure and myocardial infarction may occur. The aims of this article are to present a brief overview of the diverse coronary variants and anomalies, focusing especially on anatomical features, clinical manifestations, risk of sudden cardiac death and pathophysiologic mechanism of symptoms, as well as to provide valuable information regarding diagnostic workup, follow-up, therapeutic choices and timing of surgical treatment.
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Affiliation(s)
- Stylianos Kastellanos
- Cardiology Department, Castle Hill Hospital, Hull and East Yorkshire NHS Trust, Cottingham HU16 5JQ, United Kingdom
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1 Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Konstantinos Aznaouridis
- Cardiology Department, Castle Hill Hospital, Hull and East Yorkshire NHS Trust, Cottingham HU16 5JQ, United Kingdom
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1 Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece.
| | - Charalambos Vlachopoulos
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1 Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Eleftherios Tsiamis
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1 Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Evangelos Oikonomou
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1 Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Dimitris Tousoulis
- Peripheral Vessels Unit and EKKAN (Unit for the athletes and for hereditary cardiovascular diseases), 1 Department of Cardiology, Hippokration Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
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Shaikh SSA, Deshmukh V, Patil V, Khan Z, Singla R, Bansal NO. Congenital Absence of the Left Circumflex Artery With Super-Dominant Right Coronary Artery: Extremely Rare Coronary Anomaly. Cardiol Res 2018; 9:264-267. [PMID: 30116457 PMCID: PMC6089465 DOI: 10.14740/cr749w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 01/05/2023] Open
Abstract
Among the congenital anomalies of the coronary arteries, absent left circumflex artery (LCX) defect is extremely rare. Only a few cases have been reported in the literature. We report a case of a 48-year-old female who presented with a 4-month history of exertional chest pain with positive stress (treadmill) test. Conventional coronary angiogram showed a normal left anterior descending, absent LCX and a super-dominant right coronary artery (RCA) with prominent branches. Aortography also failed to show a separate ostium for the left circumflex artery. Multi-detector computed tomographic coronary angiography was performed to confirm the diagnosis of congenital absence of the LCX. It is a benign incidental finding, however some patients present with angina-like symptoms often resulting in detection of this rare anatomy on coronary angiography. Precise morphological and functional evaluation of the anomalous coronary artery is important for selecting the best treatment modality and better prognosis.
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Affiliation(s)
| | - Vikrant Deshmukh
- Department of Cardiology, Grant Medical College, Sir JJ group of Hospital, Mumbai, India
| | - Vishal Patil
- Department of Cardiology, Grant Medical College, Sir JJ group of Hospital, Mumbai, India
| | - Zahidullah Khan
- Department of Cardiology, Grant Medical College, Sir JJ group of Hospital, Mumbai, India
| | - Rahul Singla
- Department of Cardiology, Grant Medical College, Sir JJ group of Hospital, Mumbai, India
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Varela D, Teleb M, Said S, Fan J, Mukherjee D, Abbas A. Congenital Absence of Left Circumflex Presenting After an Emotional Stressor. Pol J Radiol 2015; 80:529-31. [PMID: 26688703 PMCID: PMC4675400 DOI: 10.12659/pjr.895872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/06/2015] [Indexed: 11/21/2022] Open
Abstract
Background Absence of the left circumflex artery (LCX) is an extremely rare congenital anomaly of the coronary circulation. While some coronary circulation anomalies are associated with significant complications, including sudden cardiac death and premature atherosclerosis, absence of the LCX is largely considered benign, though it has been associated with exertional chest pain, which may mimic acute coronary syndrome. Diagnosis is made when heart catheterization is performed in the work up for acute coronary syndrome or when computed tomography coronary angiography is performed during evaluation of coronary artery disease. Case Report We report a 55 year old female who presented with non-exertional chest pain in the setting of an emotional stressor. The initial work up was only significant for elevated troponins, and subsequent left heart catheterization revealed findings consistent with congenital absence of the LCX. No significant stenosis was appreciated, and no intervention was performed. Following catheterization, the patient’s troponins began to trend down, and her chest pain resolved. Conclusions Congenitally absent LCX is a rare entity detected when work up is performed to rule out acute coronary syndrome in patients presenting with exertional chest pain. This is the first reported case of chest pain unrelated to physical activity reported in a patient with an absent LCX. There is no specific treatment for an absent LCX; however, proper identification of this anomaly and differentiation from complete occlusion of the LCX is important in making an accurate diagnosis of myocardial ischemia and for choosing the best intervention when ischemia is present.
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Affiliation(s)
- Daniel Varela
- Department of Medical Education, Texas Tech University Health Sciences Center, El Paso Paul L. Foster School of Medicine, El Paso, TX, U.S.A
| | - Mohamed Teleb
- Department of Internal Medicine, Texas Tech University Health Sciences Center, University Medical Center, El Paso, TX, U.S.A
| | - Sarmad Said
- Department of Internal Medicine, Texas Tech University Health Sciences Center, University Medical Center, El Paso, TX, U.S.A. ; Department of Cardiology, Texas Tech University Health Sciences Center, University Medical Center, El Paso, TX, U.S.A
| | - Jerry Fan
- Department of Medical Education, Texas Tech University Health Sciences Center, El Paso Paul L. Foster School of Medicine, El Paso, TX, U.S.A
| | - Debabrata Mukherjee
- Department of Internal Medicine, Texas Tech University Health Sciences Center, University Medical Center, El Paso, TX, U.S.A. ; Department of Cardiology, Texas Tech University Health Sciences Center, University Medical Center, El Paso, TX, U.S.A
| | - Aamer Abbas
- Department of Internal Medicine, Texas Tech University Health Sciences Center, University Medical Center, El Paso, TX, U.S.A. ; Department of Cardiology, Texas Tech University Health Sciences Center, University Medical Center, El Paso, TX, U.S.A
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