Coronary subclavian steal syndrome: a rare cause of acute myocardial infarction

The coronary subclavian steal syndrome (CSSS) leading to an acute myocardial infarction (AMI) post-coronary bypass is a rare occurrence. We describe an 83-year-old Indian man who presented with AMI and was subsequently found to have CSSS. The patient had severe stenosis of his left subclavian artery ostium with retrograde flow up his left internal mammary artery graft. Angiographical steal from the left anterior descending artery was demonstrated during coronary angiogram and was thought to be the main contributing cause of his AMI. Percutaneous transfemoral angioplasty and stent implantation was performed to the left subclavian artery, with resolution of myocardial blood flow steal and anterior ischaemia.

Major pulmonary embolism treated with a rheolytic thrombectomy catheter

The current treatment of massive pulmonary embolism (PE) has been either thrombolysis or surgical embolectomy. Recently, percutaneous rheolytic thrombectomy has emerged as an alternative treatment in patients with contraindications to thrombolysis. We describe a 45-year-old woman who developed major PE post-operatively, who was treated successfully with the AngioJet system. The principles of percutaneous rheolytic thrombectomy, its effectiveness and potential complications are discussed.

Goldberger's triad in dilated cardiomyopathy--can it predict the severity of left ventricular dysfunction?

Goldberger's triad is a specific, but relatively insensitive, electrocardiographic sign for dilated cardiomyopathy. To study the correlation between the presence of this sign and the severity of left ventricular dysfunction, the electrocardiograms and echocardiographically-determined left ventricular parameters of 17 patients (mean age 59.3 +/- 11.8 years) with dilated cardiomyopathy were examined. Five of the patients had Goldberger's triad. We found that the mean left atrial diameter, the mean left ventricular internal diameters (both end-systolic and end-diastolic) and the mean left ventricular ejection fraction of the group of patients with Goldberger's triad did not differ significantly from the group without. Coronary angiography revealed occult coronary artery disease in 5 of 12 patients. A larger, prospective study is required to verify our finding.