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Ramcharan P, Katwaroo AR, Hosein R, Maharaj N, Swarath SM, Seecheran V, Seecheran RV, Seecheran NA. Myocardial Bridging-Induced Acute Coronary Syndrome: A Bridge Too Far. Cureus 2024; 16:e62052. [PMID: 38989362 PMCID: PMC11234800 DOI: 10.7759/cureus.62052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 07/12/2024] Open
Abstract
Recent studies suggest a potential association between myocardial bridging (MB) and accelerated atherosclerotic plaque formation. We describe the case report of a 37-year-old South Asian male with no established risk factors for coronary artery disease (CAD) who presented with a non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) with a coincident widowmaker lesion and severe MB. He was successfully managed with comprehensive guideline-directed medical therapy (GDMT) and urgent percutaneous coronary intervention (PCI) of the culprit lesion, sparing the MB segment. The clinician should be cognizant of MB implicating ACS as a major adverse cardiovascular event (MACE) and its key management strategies.
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Affiliation(s)
- Priya Ramcharan
- Cardiology, North Central Regional Health Authority, Mt. Hope, TTO
| | - Arun R Katwaroo
- Internal Medicine, Trinidad Institute of Medical Technology, St. Augustine, TTO
| | - Reyaz Hosein
- Internal Medicine, North Central Regional Health Authority, Mt. Hope, TTO
| | - Nicole Maharaj
- Internal Medicine, North Central Regional Health Authority, Mt. Hope, TTO
| | - Steven M Swarath
- Internal Medicine, North Central Regional Health Authority, Mt. Hope, TTO
| | - Valmiki Seecheran
- Internal Medicine, North Central Regional Health Authority, Mt. Hope, TTO
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2
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Matta A, Roncalli J, Carrié D. Update review on myocardial bridging: New insights. Trends Cardiovasc Med 2024; 34:10-15. [PMID: 35697237 DOI: 10.1016/j.tcm.2022.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022]
Abstract
Myocardial bridging (MB) is a common congenital abnormality that remains asymptomatic in a large proportion of patients. The peak of clinical manifestation occurs during the third and fourth decades of life. MB provokes myocardial ischemia through different mechanisms including supply-demand mismatch, endothelial dysfunction, coronary microvascular dysfunction and external mechanical compression. The association between MB and atherosclerotic disease is controversial. Recent studies established a significant association of MB with myocardial infarction and non-obstructive coronary artery disease. The first line medical treatment is based on beta-blockers and calcium channel blockers. Ivabradine is used in second line therapy. Invasive approaches involving percutaneous coronary intervention, coronary artery bypass graft and myotomy are performed in patients with symptoms refractory to maximally tolerated medical treatment. The choice of revascularization technique depends on anatomical characteristics, clinical condition and physician experience. Available data derived from anecdotal evidence view the lack of randomized clinical trials.
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Affiliation(s)
- Anthony Matta
- Department of cardiology, Institute CARDIOMET, University Hospital of Toulouse, Toulouse, France; Department of cardiology, Intercommunal Hospital Centre Castres-Mazamet, Castres, France; Faculty of medicine, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Jerome Roncalli
- Department of cardiology, Institute CARDIOMET, University Hospital of Toulouse, Toulouse, France
| | - Didier Carrié
- Department of cardiology, Institute CARDIOMET, University Hospital of Toulouse, Toulouse, France.
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Albano GD, Zerbo S, La Spina C, Midiri M, Guadagnino D, D'Anna T, Buscemi R, Argo A. Toxicological Analysis in Tissues Following Exhumation More Than Two Years after Death (948 Days): A Forensic Perspective in a Fatal Case. TOXICS 2023; 11:485. [PMID: 37368585 DOI: 10.3390/toxics11060485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Exhumations are performed in accordance with a court order and are crucial instruments in the investigation of death allegations. When a death is thought to be the result of drug misuse, pharmaceutical overdose, or pesticide poisoning, this process may be used on human remains. However, after a protracted postmortem interval (PMI), it might be difficult to detect the cause of death by looking at an exhumed corpse. The following case report reveals problems associated with postmortem drug concentration changes following exhumation more than two years after death. A 31-year-old man was found dead in a prison cell. Onan inspection of the place, two blister packs, one with a tablet and the other empty, were taken and kept by the police officers. The evening before, the deceased would have taken cetirizine and food supplements consisting of carnitine-creatine tablets. No relevant autopsy findings have been observed. The toxicological analysis was performed by gas chromatography coupled to mass spectrometry and was negative for substances of abuse. Proteomic analysis was positive for creatine detection and negative for other drugs (clarithromycin, fenofibrate, and cetirizine). The presented case shows the methods, the findings, and the limitations of toxicological analysis in an exhumation case with a long postmortem interval (PMI).
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Affiliation(s)
- Giuseppe Davide Albano
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Stefania Zerbo
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Corinne La Spina
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Mauro Midiri
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Daniela Guadagnino
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Tommaso D'Anna
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Roberto Buscemi
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
| | - Antonina Argo
- Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy
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Chang YC, Liou JT, Peng YM, Chen GJ, Lin CY, Yang CA. Association of Long Noncoding RNA Expression Signatures with Stress-Induced Myocardial Perfusion Defects. Biomolecules 2023; 13:biom13050849. [PMID: 37238718 DOI: 10.3390/biom13050849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/01/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Stress-induced myocardial perfusion defects found in dipyridamole-thallium-201 single-photon emission computed tomography imaging may indicate vascular perfusion abnormalities and risk of obstructive or nonobstructive coronary heart disease. Besides nuclear imaging and subsequent coronary angiography (CAG), no blood test can indicate whether dysregulated homeostasis is associated with stress-induced myocardial perfusion defects. This study investigated the expression signature of long noncoding RNAs (lncRNAs) and genes involved in vascular inflammation and stress response in the blood of patients with stress-induced myocardial perfusion abnormalities (n = 27). The results revealed an expression signature consisting of the upregulation of RMRP (p < 0.01) and downregulations of THRIL (p < 0.01) and HIF1A (p < 0.01) among patients with a positive thallium stress test and no significant coronary artery stenosis within 6 months after baseline treatment. We developed a scoring system based on the expression signatures of RMRP, MIAT, NTT, MALAT1, HSPA1A, and NLRP3 to predict the need for further CAG among patients with moderate-to-significant stress-induced myocardial perfusion defects (area under the receiver operating characteristic curve = 0.963). Therefore, we identified a dysregulated expression profile of lncRNA-based genes in the blood that could be valuable for the early detection of vascular homeostasis imbalance and personalized therapy.
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Affiliation(s)
- Yu-Chieh Chang
- Division of Nuclear Medicine, China Medical University Hsinchu Hospital, Zhubei City 302, Taiwan
| | - Jun-Ting Liou
- Division of Cardiology, China Medical University Hsinchu Hospital, Zhubei City 302, Taiwan
| | - Yu-Min Peng
- Integrated Precision Health and Immunodiagnostic Center, Department of Laboratory Medicine, China Medical University Hsinchu Hospital, Zhubei City 302, Taiwan
| | - Guan-Jun Chen
- Integrated Precision Health and Immunodiagnostic Center, Department of Laboratory Medicine, China Medical University Hsinchu Hospital, Zhubei City 302, Taiwan
| | - Chien-Yu Lin
- Integrated Precision Health and Immunodiagnostic Center, Department of Laboratory Medicine, China Medical University Hsinchu Hospital, Zhubei City 302, Taiwan
| | - Chin-An Yang
- Integrated Precision Health and Immunodiagnostic Center, Department of Laboratory Medicine, China Medical University Hsinchu Hospital, Zhubei City 302, Taiwan
- College of Medicine, China Medical University, Taichung 404, Taiwan
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu City 300, Taiwan
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Badr el Dine FMM, Attia MH. Assessment of knowledge, perception, attitude, and use of performance-enhancing substances among students of Faculty of Medicine, Alexandria University, Egypt: a pilot study. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022. [DOI: 10.1186/s41935-022-00290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The market for performance enhancement substances (PESs) is currently one of the fastest expanding sectors. Most studies have always concentrated on athletes in terms of PESs’ misuse, ignoring a critical segment of the community: the future health-care workers. Thus, the aim of the study was to probe the knowledge, perception, and attitude of medical students regarding the misuse of PESs in sports and medical academic study. A cross-sectional study was conducted among students of Alexandria Faculty of Medicine, Egypt. Data were collected via self-administered electronic survey from 208 students of both sexes (aged from 18 to 26 years old). Analysis of factors affecting the consumption of PESs like gender differences, and their prior knowledge and perception was performed using logistic regression models.
Results
More than half of the participants have no idea about law concerning the use of doping substances. There were no significant disparities in knowledge and perception between males and females. Female students, on the other hand, consistently reported having a better understanding of the negative impacts of PESs’ misuse. Surprisingly, females are more prone to consume PESs for cognitive enhancement rather than the physical performance.
Conclusions
The study is the first to explore the awareness of the medical students, their attitude, and perception towards different ethical scenarios confronted in the daily practice. This finding pinpoints that the common trend of striving for fitness and an ideal body shape and weight has produced a shift in the prevalence of the PESs use according to gender in Egypt. Moreover, females in medicine academics are more prone to use PESs to improve the cognitive functions albeit it is nonsignificant statistically. Therefore, efforts should be directed to raise the awareness of medical practitioners of diverse categories of these substances, health hazards, laws, and penalties. More importantly, policy measures for their production, marketing, and misuse among university students should be reconsidered by the government.
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Alexandre A, Vieira P, Dias-Frias A, Pereira A, Campinas A, Sá-Couto D, Brochado B, Sá I, Silveira J, Torres S. Myocardial Bridging Leading to Cardiac Collapse in a Marathon Runner. J Cardiovasc Dev Dis 2022; 9:jcdd9070200. [PMID: 35877561 PMCID: PMC9317123 DOI: 10.3390/jcdd9070200] [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: 06/04/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 02/01/2023] Open
Abstract
Myocardial bridging (MB) is a congenital coronary anomaly, which is defined as cardiac muscle overlying a portion of a coronary artery. Although traditionally considered benign in nature, increasing attention is being given to specific subsets of MB. Sports medicine recognizes MB as a cause of sudden death among young athletes. We present a case of a 30-year-old man who suddenly collapsed during a marathon running. Diagnostic workup with coronary computed tomography angiography revealed the presence of three simultaneous myocardial bridges in this patient, possibly explaining the exercise-induced syncope. The other diagnostic tests excluded seizures, cranioencephalic lesions, ionic or metabolic disturbances, acute coronary syndromes, cardiomyopathies, myocarditis, or conduction disturbances. Exertional syncope is a high-risk complaint in the marathon runner. In the context of intense physical activity, the increased sympathetic tone leading to tachycardia and increased myocardial contractility facilitates MB ischemia. In this illustrative case, the patient’s syncope might probably be associated with an ischemia-induced arrhythmia secondary to MB and potentiated by dehydration in the context of prolonged stress (marathon running). In conclusion, this case highlights that MB may be associated with dangerous complications (myocardial ischemia and life-threatening ventricular arrhythmias), particularly during intense physical activity and in the presence of a long myocardial bridge.
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Affiliation(s)
- André Alexandre
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
- Correspondence: or
| | - Pinheiro Vieira
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - André Dias-Frias
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
| | - Anaisa Pereira
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
| | - Andreia Campinas
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - David Sá-Couto
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - Bruno Brochado
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - Isabel Sá
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
| | - João Silveira
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
| | - Severo Torres
- Centro Hospitalar Universitário do Porto, 4099-001 Porto, Portugal; (P.V.); (A.D.-F.); (A.P.); (A.C.); (D.S.-C.); (B.B.); (I.S.); (J.S.); (S.T.)
- ICBAS–School of Medicine and Biomedical Sciences, Porto University, 4050-313 Porto, Portugal
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Therapeutic Dilemmas Faced When Managing a Life-Threatening Presentation of a Myocardial Bridge. Case Rep Cardiol 2022; 2022:8148241. [PMID: 35449520 PMCID: PMC9017457 DOI: 10.1155/2022/8148241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/21/2021] [Accepted: 03/07/2022] [Indexed: 11/28/2022] Open
Abstract
Background. Myocardial bridges are congenital abnormalities, where a segment of coronary artery travels intramyocardially, rather than the typical epicardial course. The overlying muscle segment is termed “the bridge”. Most myocardial bridges are asymptomatic, but some can result in myocardial ischaemia, arrhythmias, and sudden cardiac death. Case Presentation. A 31-year-old male with no past medical history presented to our tertiary cardiac centre following an out-of-hospital ventricular fibrillation arrest. Coronary angiography and computed tomography of the coronary arteries revealed a 2 cm myocardial bridge overlying the left anterior descending (LAD) artery. An exercise echocardiogram demonstrated severe apical ballooning and hypokinesis during peak exercise, with corresponding ST-segment elevation, resolving on rest. Options for medical therapy of a symptomatic myocardial bridge include beta blockers, calcium channel blockers, ivabradine, or a combination thereof. Surgical interventions include deroofing the bridge and revascularisation of the affected region with bypass grafting. However, a lack of trial data comparing medical regimens and surgical interventions makes it difficult to ascertain the most effective management strategy for each patient. There was disagreement between experts at different tertiary centres over the optimal management of this patient. He was treated with multiple regimes of medical therapy with ongoing ischaemia on stress testing, before undergoing a negative stress test on amlodipine, diltiazem, and isosorbide mononitrate. It was felt that no further intervention was necessary at this time given his exercise test was now negative for ischaemia. However, after seeking a second opinion, he underwent surgical intervention with bypass grafting of his left anterior descending artery, followed by implantation of an implantable cardiac defibrillator. Subsequently, an angiogram postsurgery demonstrated concomitant spasm of the LAD and he was resumed on medical therapy with calcium channel blockers and nitrates. Discussion. Without randomised trials, it is impossible to determine the optimal management strategy for each patient. It is possible that some patients with myocardial bridges are not being trialled on optimal medical therapy prior to undergoing invasive and irreversible interventions.
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