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.

• Klíčová slova
• periferní embolizace,
• MeSH
• antihypertenziva terapeutické užití   MeSH
• arteria femoralis patologie   ultrasonografie   MeSH
• koarktace aorty diagnóza   terapie   MeSH
• koronární angiografie metody   využití   MeSH
• koronární bypass metody   MeSH
• lidé MeSH
• mitrální insuficience chirurgie   MeSH
• senioři MeSH
• tromboembolie etiologie   chirurgie   ultrasonografie   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky 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
• disekce klasifikace   ošetřování   statistika a číselné údaje   MeSH
• infarkt myokardu diagnóza   etiologie   terapie   MeSH
• koronární cévy patofyziologie   účinky léků   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• anomálie koronárních cév radiografie   MeSH
• balónková koronární angioplastika MeSH
• infarkt myokardu diagnóza   etiologie   terapie   MeSH
• lidé MeSH
• stenty využití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• kazuistiky MeSH

• Publikační typ
• abstrakt z konference 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.

• Publikační typ
• časopisecké články MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference 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
• biologické markery krev   MeSH
• koronární angiografie škodlivé účinky   MeSH
• koronární angioplastika škodlivé účinky   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci koronárních tepen terapie   MeSH
• perioperační péče škodlivé účinky   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• troponin krev   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH