Koronární embolizace jako příčina infarktu myokardu je vzácnou, ale důležitou entitou jak z pohledu etiologie, tak z pohledu léčby. Kardioembolizace z levého srdce se nejčastěji projevují embolizací do centrální nervové soustavy a mozkovou příhodou nebo periferní cévní embolizací, vzácně infarktem myokardu. Příčinou systémové embolizace je nejčastěji tvorba trombů v levé síni při fibrilaci síní, z nástěnných trombů v levé komoře, po proběhlém infarktu myokardu, z vegetací na chlopních při infekční endokarditidě, ale vzácně i z trombů na nativní, jinak nepostižené aortální chlopni. Raritně může dojít k paradoxní embolizaci při existenci pravolevého zkratu např. při perzistujícím foramen ovale. Foramen ovale patens je relativně častou variantou, která se vyskytuje v běžné dospělé populaci asi u 25–30 % jedinců. Literární údaje kardioembolizačních infarktů myokardu jsou především kazuistické, statistická data dostupná nejsou. Prezentujeme jeden z našich případů, kazuistiku 74letého muže s akutním infarktem myokardu s elevacemi úseku ST (STEMI) anterolaterální stěny levé komory, způsobených kardioembolizačním uzávěrem středního ramus interventricularis anterior (RIA) a distálního ramus circumflexus (RC) a současně přítomnou plicní embolií při neléčené fibrilaci síní. Při kombinaci embolizace do tepenného řečiště srdce a plic se nabízí vysoká pravděpodobnost výskytu foramen ovale patens. Nemocný odmítá došetření jícnovou echokardiografií, což však neovlivnilo konečný dopad chronické antikoagulační léčby.

Coronary embolization as a cause of myocardial infarction is rare but important entity in terms of both etiology and treatment. Cardioembolization from the left heart is most commonly manifested by central nervous system embolization and stroke or peripheral vascular embolization, rarely myocardial infarction. The cause of systemic embolization is most often the formation of thrombi in the left atrium during atrial fibrillation, from wall thrombi in the left ventricle after myocardial infarction, from vegetations on the valves in infectious endocarditis, but rarely from thrombi on native otherwise unaffected aortic valve. Rarely, paradoxical embolization can occur in the presence of a right-left short circuit, for example in the case of a persistent foramen ovale. Foramen ovale patens is a relatively common variant, which occurs in the general adult population in about 25–30%. Literary data of cardioembolizing myocardial infarctions are mostly casuistic, statistical data are not available. We present one of our cases: a case report of a 74-year-old man, who has urgent STEMI anterolateral wall of left chamber caused by cardioembolization occlusion of the middle LAD and distal LCx and concomitant pulmonary embolism in untreated atrial fibrillation. The combination of embolization into the arterial and pulmonary arteries offers a high probability of foramen ovale patens. The patient refuses to undergo esophageal echocardiography, which did not affect the final impact of chronic anticoagulant therapy, however.

• Keywords
• tromboaspirace,
• MeSH
• Anticoagulants therapeutic use   MeSH
• Chest Pain etiology   MeSH
• Diagnosis, Differential MeSH
• Echocardiography, Transesophageal MeSH
• Echocardiography MeSH
• Electrocardiography MeSH
• Embolism * complications   physiopathology   pathology   MeSH
• Atrial Fibrillation complications   pathology   MeSH
• Foramen Ovale, Patent MeSH
• Thorax diagnostic imaging   pathology   MeSH
• ST Elevation Myocardial Infarction * etiology   drug therapy   complications   pathology   MeSH
• Cardiac Imaging Techniques MeSH
• Cardiovascular Agents therapeutic use   MeSH
• Coronary Angiography MeSH
• Coronary Vessels diagnostic imaging   pathology   MeSH
• Humans MeSH
• Treatment Refusal MeSH
• Pulmonary Embolism diagnostic imaging   complications   pathology   MeSH
• Hypertension, Pulmonary diagnostic imaging   MeSH
• Radiography MeSH
• Aged MeSH
• Single Photon Emission Computed Tomography Computed Tomography MeSH
• Heart diagnostic imaging   physiopathology   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH

BACKGROUND: While there have been a number of studies reporting the incidence and implications of elevated troponin levels after percutaneous coronary intervention (PCI), the body of information about the incidence, associations, and implications of elevated troponin levels following coronary angiography (CAG) is limited. MATERIALS AND METHODS: A total of 220 consecutive patients with stable coronary artery disease or intermediate or low-risk acute coronary syndrome without persistent ST-segment elevation (NSTE-ACS) were included in our study. High-sensitivity cardiac troponin I (hs-cTnI) levels were measured before and after coronary angiography (CAG) in patients with or without PCI and correlated with a number of clinical variables. RESULTS: Hs-cTnI elevations above the 99th percentile upper reference limit (URL), or above 20% of the initially positive, yet already declining values, were found in 60 (37.2%) patients after CAG and in 45 (76.2%) patients undergoing PCI. Significant correlations of hs-cTnI elevation were found with the following variables: volume of contrast, fluoroscopy time, dose-area product, amount of contrast agent injected directly into the coronary arteries, total time of balloon dilation and the number and total length of implanted stents (P<0.001 for all). CONCLUSION: While an asymptomatic elevation of hs-cTnI is a common finding after PCI, it does occur, quite surprisingly, also after CAG. Despite contradictory views regarding the clinical relevance of asymptomatic post-procedural elevated hs-cTnI levels, it is generally believed that a mild elevation is not associated with an increased risk. Still, it may pose a diagnostic quandary following a successful interventional procedure and even more so after an uncomplicated CAG. TRIAL REGISTRATION: Clinicaltrials.gov - NCT02960321.

• MeSH
• Biomarkers blood   MeSH
• Coronary Angiography adverse effects   MeSH
• Percutaneous Coronary Intervention adverse effects   methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Coronary Artery Disease therapy   MeSH
• Perioperative Care adverse effects   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Troponin blood   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

• Publication type
• Meeting Abstract MeSH

BACKGROUND: While there have been a number of studies reporting the incidence and implications of elevated troponin levels after percutaneous coronary intervention (PCI), the body of information about the incidence, associations, and implications of elevated troponin levels following coronary angiography (CAG) is limited. MATERIALS AND METHODS: A total of 220 consecutive patients with stable coronary artery disease or intermediate or low-risk acute coronary syndrome without persistent ST-segment elevation (NSTE-ACS) were included in our study. High-sensitivity cardiac troponin I (hs-cTnI) levels were measured before and after coronary angiography (CAG) in patients with or without PCI and correlated with a number of clinical variables. RESULTS: Hs-cTnI elevations above the 99th percentile upper reference limit (URL), or above 20% of the initially positive, yet already declining values, were found in 60 (37.2%) patients after CAG and in 45 (76.2%) patients undergoing PCI. Significant correlations of hs-cTnI elevation were found with the following variables: volume of contrast, fluoroscopy time, dose-area product, amount of contrast agent injected directly into the coronary arteries, total time of balloon dilation and the number and total length of implanted stents (P<0.001 for all). CONCLUSION: While an asymptomatic elevation of hs-cTnI is a common finding after PCI, it does occur, quite surprisingly, also after CAG. Despite contradictory views regarding the clinical relevance of asymptomatic post-procedural elevated hs-cTnI levels, it is generally believed that a mild elevation is not associated with an increased risk. Still, it may pose a diagnostic quandary following a successful interventional procedure and even more so after an uncomplicated CAG. TRIAL REGISTRATION: Clinicaltrials.gov - NCT02960321.

• Publication type
• Journal Article MeSH

• Publication type
• Meeting Abstract MeSH

Koarktace aorty patří mezi častější vrozené srdeční vady. I když je prognóza neoperovaných pacientů poměrně špatná, můžeme se s koar­ktací aorty setkat i u dospělých. Úvod článku je věnován obecně patofyziologii, diagnostice a terapii tohoto onemocnění. V popisovaném případě byla koarktace aorty diagnostikována při pátrání po zdroji periferní embolizace do a. femoralis. Jsou zde diskutovány vztahy tohoto onemocnění k narušení funkce i struktury cévní stěny, progresi aterosklerózy a možná příčinná souvislost s periferní embolizací. Chirurgická a zatím i intervenční léčba u dospělých s koarktací je zatížena významně vyšším rizikem než u dětí. V tomto případě bylo postupováno konzervativně.

Coarctation of the aorta belongs to the more common congenital heart defects. Even though the prognosis of the patient not treated surgically is rather poor, we may still encounter adult patients with this condition. The introduction of the article deals in general with the pathophysiology, diagnostics, and treatment of this disease. In our case report, we describe a patient in whom the diagnosis of coarctation of the aorta was established while searching for the source of peripheral embolization to the femoral artery. The relationship between this disease and impaired function and structure of the vascular wall, progression of atherosclerosis as well as the possible causal relationship with the peripheral embolization are discussed below. In adult patients, surgical repair and so far also interventional treatment pose a significantly higher risk than in children. Conservative treatment was chosen in this case.

• Keywords
• periferní embolizace,
• MeSH
• Antihypertensive Agents therapeutic use   MeSH
• Femoral Artery pathology   ultrasonography   MeSH
• Aortic Coarctation diagnosis   therapy   MeSH
• Coronary Angiography methods   utilization   MeSH
• Coronary Artery Bypass methods   MeSH
• Humans MeSH
• Mitral Valve Insufficiency surgery   MeSH
• Aged MeSH
• Thromboembolism etiology   surgery   ultrasonography   MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Coronary Vessel Anomalies radiography   MeSH
• Angioplasty, Balloon, Coronary MeSH
• Myocardial Infarction diagnosis   etiology   therapy   MeSH
• Humans MeSH
• Stents utilization   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Case Reports MeSH

Spontánní disekce koronární tepny je vzácná příčina akutního koronárního syndromu postihující ve větší míře mladé ženy, často v období kolem porodu nebo v souvislosti s užíváním hormonální antikoncepce. Nejčastěji postihuje r. interventricularis anterior. Léčba může být konzervativní, intervenční s použitím koronárního stentu nebo chirurgická revaskularizace se založením aortokoronárního bypassu. Autoři popisují případ opakované spontánní disekce koronární tepny u 31leté ženy.

Spontanous coronary artery dissection is rare cause of acute coronary syndrome involving mostly young women, obviously during the peripartum or in association with oral contraceptive use. SCAD mostly inolves left anterior descending artery. Treatment should be conservative or PCI using koronary stent or surgical by using bypass. The authors support the case of repeated spontneoust coronary artery dissection.

• MeSH
• Dissection classification   nursing   statistics & numerical data   MeSH
• Myocardial Infarction diagnosis   etiology   therapy   MeSH
• Coronary Vessels physiopathology   drug effects   MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

• Publication type
• Meeting Abstract MeSH

Používání drug eluting stentů (DES) redukuje riziko vzniku restenózy. Vzhledem ke zpomalené reendotelizaci DES a potenciálně vyššímu riziku trombózy ve stentu je nutná prolongovaná antiagregační léčba ASA + tienopyridin, při níž je riziko trombózy srovnatelné se standardními kovovými stenty. Autoři popisují případ pozdní trombózy v DES krytém paclitaxelem při předčasně ukončené duální antiagregační léčbě.

The use of drug eluting stents (DES) reduces the risk of restenosis. Prolonged antiplatelet therapy with ASA + thienopyridin is necessary due to delayed reendotelisation of DES, and potentialy higher risk of the in stent thrombosis. The risk of thrombosis in DES is equal to that in bare metal stents in case of prolonged antiplatelet therapy. The authors present a case of late thrombosis in paclitaxel eluting stent due to premature cessation of dual antiplatelet therapy.

• MeSH
• Platelet Aggregation drug effects   MeSH
• Anticoagulants therapeutic use   MeSH
• Adult MeSH
• Cardiac Surgical Procedures MeSH
• Coronary Stenosis pathology   therapy   MeSH
• Drug Delivery Systems MeSH
• Humans MeSH
• Stents MeSH
• Thrombosis pathology   prevention & control   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH