Early reactivation of ischaemia after abrupt discontinuation of heparin in acute myocardial infarction

Intravenous heparin after thrombolytic therapy for acute myocardial infarction is an effective, widely used treatment. Six cases of acute myocardial infarction are reported with early disease reactivation following the abrupt discontinuation of heparin infusion three days after alteplase thrombolysis and concomitant aspirin therapy. Immediate reinfusion of heparin resulted in regression of symptomatic ischaemia in all six patients. The activated partial thromboplastin time values, determined four hours before the discontinuation of heparin therapy, were within the therapeutic range in five of the six patients, and no difference was found in the values obtained one hour after the reinfusion of heparin (P = 0.065).

Myocardial bridging involving more than one site of the left anterior descending coronary artery: an uncommon cause of acute ischemic syndrome

An infrequent angiographic finding is reported of myocardial bridging involving more than one site of the left anterior descending coronary artery in a symptomatic patient with ischemia exacerbated by nitroglycerin administration. Beta-blocker therapy alone was followed by a favorable long-term outcome.

[Aortic stenosis and coronary pathology. Their implications for the transvalvular gradient]

To assess the incidence of coronary artery disease in patients with valvular aortic stenosis and its implication on peak systolic valvular gradient, 31 consecutive patients who underwent cardiac catheterization were examined. Associated significant coronary artery disease (> 50% reduction in luminal diameter evaluated in proximal segments and right dominant circulation) was present in 54.8% of patients. There was no difference in the distribution of risk factors among patients with and without significant luminal narrowings. The prevalence of coronary artery disease was found not to be significantly correlated with age (p = 0.276). There was no relationship between typical angina pectoris and the presence of coronary artery disease (p = 0.063). Fourty-seven percent of cases resulted free of chest pain. Ejection fraction was found to be significantly lower in patients with coronary artery disease (45 +/- 14.2%) than in patients without coronary artery disease (65.1 +/- 3.9%; p = 0.03) and a reverse relationship was observed between the presence of coronary artery disease and peak systolic valvular gradient (p = 0.006) which, in turn, correlated significantly with ejection fraction (r = 0.68; p = 0.023). These data demonstrate that the value of peak systolic valvular gradient, as the only index for the evaluation of the severity of aortic stenosis, is greatly limited in patients with associated coronary artery disease. Moreover, confirming the guidelines of the American College of Cardiology and of the American Heart Association task force, these data also stress the necessity of performing coronary angiography regardless angina pectoris is present or not.

[Unusual anatomic coronary variants: parallel left anterior descending artery. Description of 3 cases]

Three cases with a variation of the classic anatomic left anterior descending artery pattern, encountered unexpectedly during coronary arteriography, are reported. The importance of this unusual and rare coronary artery pattern is only anatomic, and the possibility to carry out these findings by the coronary arteriography, can increase their occurrence instead of an incidental finding.