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Special populations 16 17
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Bursi F, Vassallo R, Weston SA, et al. Chronic obstructive pulmonary disease after myocardial infarction in the community. Am Heart J 2010;160:95–101. Rha SW, Li YJ, Chen KY, et al. Impact of chronic obstructive pulmonary disease on the clinical characteristics and outcomes in propensity-matched patients with acute myocardial infarction. Am J Cardiol 2009;103(9):36B–7B. Salisbury AC, Reid KJ, Spertus JA. Impact of chronic obstructive pulmonary disease on post-myocardial infarction outcomes. Am J Cardiol 2007;99:636–41. NICE. Unstable angina and NSTEMI (2013 update). 2010.
IMAGE CHALLENGE
Hazy filling defect on coronary angiography: insights from optical coherence tomography CLINICAL INTRODUCTION A middle-aged patient with previous stent to the left circumflex artery (LCx) 12 months before suffering from angina, now presented with acute-onset severe retrosternal chest pain with an ECG showing ST-elevation in the precordial leads (see online supplementary figure S1). He underwent emergency coronary angiography, which showed normal flow in all arteries and a patent LCx stent. The left anterior descending artery (LAD) contained a hazy filling defect in the mid vessel (figure 1A). Following administration of heparin, the filling defect in the mid-LAD resolved (figure 1B). The left ventriculogram showed
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McAllister DA, Maclay JD, Mills NL, et al. Diagnosis of myocardial infarction following hospitalisation for exacerbation of COPD. Eur Respir J 2012;39:1097–103. Neukamm AMC, Hoiseth AD, Hagve TA, et al. High-sensitivity cardiac troponin T levels are increased in stable COPD. Heart 2013;99:382–7. Hadi HA, Zubaid M, Al Mahmeed W, et al. Prevalence and prognosis of chronic obstructive pulmonary disease among 8167 Middle Eastern patients with acute coronary syndrome in the current era. Circulation 2010;122:E48.
severe systolic dysfunction involving the mid and apical segments (see online supplementary video 1). This was normal on the previous catheterisation. Intracoronary optical coherence tomography (OCT) was performed to further assess the LAD. At the site of the original filling defect in the mid-LAD, the vessel had a normal OCT appearance (figure 1C). OCT frames of angiographically normal proximal LAD are shown (figure 1D, E, see online supplementary video 2). Peak creatine kinase and troponin-I were 372 U/L (n
Special populations 16 17
18 19
Bursi F, Vassallo R, Weston SA, et al. Chronic obstructive pulmonary disease after myocardial infarction in the community. Am Heart J 2010;160:95–101. Rha SW, Li YJ, Chen KY, et al. Impact of chronic obstructive pulmonary disease on the clinical characteristics and outcomes in propensity-matched patients with acute myocardial infarction. Am J Cardiol 2009;103(9):36B–7B. Salisbury AC, Reid KJ, Spertus JA. Impact of chronic obstructive pulmonary disease on post-myocardial infarction outcomes. Am J Cardiol 2007;99:636–41. NICE. Unstable angina and NSTEMI (2013 update). 2010.
IMAGE CHALLENGE
Hazy filling defect on coronary angiography: insights from optical coherence tomography CLINICAL INTRODUCTION A middle-aged patient with previous stent to the left circumflex artery (LCx) 12 months before suffering from angina, now presented with acute-onset severe retrosternal chest pain with an ECG showing ST-elevation in the precordial leads (see online supplementary figure S1). He underwent emergency coronary angiography, which showed normal flow in all arteries and a patent LCx stent. The left anterior descending artery (LAD) contained a hazy filling defect in the mid vessel (figure 1A). Following administration of heparin, the filling defect in the mid-LAD resolved (figure 1B). The left ventriculogram showed
20
21 22
McAllister DA, Maclay JD, Mills NL, et al. Diagnosis of myocardial infarction following hospitalisation for exacerbation of COPD. Eur Respir J 2012;39:1097–103. Neukamm AMC, Hoiseth AD, Hagve TA, et al. High-sensitivity cardiac troponin T levels are increased in stable COPD. Heart 2013;99:382–7. Hadi HA, Zubaid M, Al Mahmeed W, et al. Prevalence and prognosis of chronic obstructive pulmonary disease among 8167 Middle Eastern patients with acute coronary syndrome in the current era. Circulation 2010;122:E48.
severe systolic dysfunction involving the mid and apical segments (see online supplementary video 1). This was normal on the previous catheterisation. Intracoronary optical coherence tomography (OCT) was performed to further assess the LAD. At the site of the original filling defect in the mid-LAD, the vessel had a normal OCT appearance (figure 1C). OCT frames of angiographically normal proximal LAD are shown (figure 1D, E, see online supplementary video 2). Peak creatine kinase and troponin-I were 372 U/L (n
