Multivessel Spontaneous Coronary Artery Dissection in the Setting of Anomalous Left Coronary Arteries

Spontaneous coronary artery dissection (SCAD) is an epicardial coronary artery dissection not associated with atherosclerosis or trauma, and is not iatrogenic. The pathogenesis of SCAD is not fully understood, and the association of coronary artery anomalies and SCAD is not known. We present a case of a 64-year-old woman presenting with non-ST-elevation myocardial infarction (NSTEMI) due to have multivessel SCAD in the setting of anomalous origin of the coronary arteries with all three coronary arteries - right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCx) originating from the right sinus of Valsalva.

LEARNING POINTS

Spontaneous coronary artery dissection (SCAD) and coronary artery anomaly can arise where all three arteries originate from the right coronary cusp;There are possible associations between SCAD and coronary artery anomalies;Treatment and management of multivessel SCAD with a coronary artery anomaly where all three arteries arise from the right sinus of Valsalva.

Venoarterial Extracorporeal Membrane Oxygenation After Autologous Stem Cell Transplantation With Pancytopenia: JACC Patient Care Pathways

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides temporary mechanical circulatory support and simultaneous extracorporeal gas exchange for acute cardiorespiratory failure. By providing circulatory support, VA-ECMO gives treatments time to reach optimal efficacy or may be used as a bridge to a more durable mechanical solution for patients with acute cardiopulmonary failure. It is commonly used when a readily reversible etiology of decompensation is identified with very strict inclusion criteria for extracorporeal cardiopulmonary resuscitation use. We present a unique case in which VA-ECMO/extracorporeal cardiopulmonary resuscitation was used after cardiac arrest with pulseless electrical activity in a patient with recurrent lymphoma of the left thigh with recent autologous stem cell transplant.

Venoarterial Extracorporeal Membrane Oxygenation After Autologous Stem Cell Transplantation With Pancytopenia: JACC Patient Care Pathways

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides temporary mechanical circulatory support and simultaneous extracorporeal gas exchange for acute cardiorespiratory failure. By providing circulatory support, VA-ECMO gives treatments time to reach optimal efficacy or may be used as a bridge to a more durable mechanical solution for patients with acute cardiopulmonary failure. It is commonly used when a readily reversible etiology of decompensation is identified with very strict inclusion criteria for extracorporeal cardiopulmonary resuscitation use. We present a unique case in which VA-ECMO/extracorporeal cardiopulmonary resuscitation was used after cardiac arrest with pulseless electrical activity in a patient with recurrent lymphoma of the left thigh with recent autologous stem cell transplant.

Acute Myocardial Infarction Caused by Spontaneous Coronary Artery Dissection of the First Septal Perforator

Spontaneous coronary artery dissection of the septal arteries is rare and may be overlooked on coronary angiogram. Additionally, dedicated intracoronary imaging may not be feasible due to artery size. Cardiac magnetic resonance imaging has an emerging role in diagnosis, which is critical because management changes significantly if spontaneous coronary artery dissection is diagnosed. (Level of Difficulty: Beginner.).

Wide complex tachycardia discrimination tool improves physicians' diagnostic accuracy

BACKGROUND

Timely and accurate discrimination of wide complex tachycardias (WCTs) into ventricular tachycardia (VT) or supraventricular WCT (SWCT) is critically important. Previously we developed and validated an automated VT Prediction Model that provides a VT probability estimate using the paired WCT and baseline 12-lead ECGs. Whether this model improves physicians' diagnostic accuracy has not been evaluated.

OBJECTIVE

We sought to determine whether the VT Prediction Model improves physicians' WCT differentiation accuracy.

METHODS

Over four consecutive days, nine physicians independently interpreted fifty WCT ECGs (25 VTs and 25 SWCTs confirmed by electrophysiological study) as either VT or SWCT. Day 1 used the WCT ECG only, Day 2 used the WCT and baseline ECG, Day 3 used the WCT ECG and the VT Prediction Model's estimation of VT probability, and Day 4 used the WCT ECG, baseline ECG, and the VT Prediction Model's estimation of VT probability.

RESULTS

Inclusion of the VT Prediction Model data increased diagnostic accuracy versus the WCT ECG alone (Day 3: 84.2% vs. Day 1: 68.7%, p 0.009) and WCT and baseline ECGs together (Day 3: 84.2% vs. Day 2: 76.4%, p 0.003). There was no further improvement of accuracy with addition of the baseline ECG comparison to the VT Prediction Model (Day 3: 84.2% vs. Day 4: 84.0%, p 0.928). Overall sensitivity (Day 3: 78.2% vs. Day 1: 67.6%, p 0.005) and specificity (Day 3: 90.2% vs. Day 1: 69.8%, p 0.016) for VT were superior after the addition of the VT Prediction Model.

CONCLUSION

The VT Prediction Model improves physician ECG diagnostic accuracy for discriminating WCTs.