We report a case of a 69-year-old man presenting with acute right chest pain radiating to the right shoulder. Physical examination revealed a right sided apex beat with a palpable liver on the left side. Reversed normalizing electrocardiogram are presented, allowing for correct diagnosis of an acute anterior myocardial infarction. Dextrocardia with situs inversus is an uncommon congenital condition, the patient also diagnosed hypertrophic cardiomyopathy by two dimensional echocardiography. Successful percutaneous coronary intervention was performed and the patient was discharged after uneventful recovery.
Cardiomyopathy, Hypertrophic ; Chest Pain ; Dextrocardia ; Echocardiography ; Electrocardiography ; Humans ; Liver ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Physical Examination ; Shoulder ; Situs Inversus

OBJECTIVE: C-reactive protein (CRP), lipoprotein (a)[Lp(a)], and fibrinogen are associated with systemic inflammatory reactions. Statins have anti-inflammatory effects. However, the effect of statins on these parameters is inconsistent. We evaluated the effect of statins on inflammatory markers and variables related to changes in these markers. METHODS: A total of 390 hypercholesterolemic patients were enrolled. Atorvastatin (n=112), lovastatin (n=25), pitavastatin (n=49), rosuvastatin (n=20), and simvastatin (n=184) were administered. Lipids, CRP, Lp(a), and fibrinogen levels were measured before and after 2 months of the therapy. RESULTS: Statins reduced cholesterol, low density lipoprotein (LDL) cholesterol, and triglyceride levels by -28.9+/-9.1% (P=0.000), -41.4+/-12.4% (P=0.000), and -11.6+/-39.4% (P=0.000), respectively and increased high density lipoprotein (HDL) cholesterol level by 2.56+/-13.2% (P=0.014). CRP levels decreased from 1.23+/-1.30 to 1.14+/-1.29 mg/L (P=0.000). Lp(a) levels were not changed (P=0.91) and fibrinogen levels increased from 277.8+/-54.4 to 282.6+/-56.9 mg/dL (P=0.042). Changes in CRP levels were associated with baseline CRP levels (r=-0.56, P=0.000) and changes in HDL cholesterol levels (r=-0.14, P=0.005). Changes in Lp(a) levels were associated with changes in triglyceride (r=-0.24, P=0.000) and baseline aspartate aminotransferase level (r=0.12, P=0.015). Changes in fibrinogen levels were associated with baseline fibrinogen levels (r=-0.40, P=0.000), sex (r=0.18, P=0.001), and changes in HDL cholesterol levels (r=-0.15, P=0.003). CONCLUSION: Inflammatory markers showed different responses to statins and changes in these markers were associated with different parameters. This finding suggests that anti-inflammatory effect of statin is confined to a specific pathway of inflammation.
Aspartate Aminotransferases ; C-Reactive Protein ; Cholesterol ; Cholesterol, HDL ; Fibrinogen ; Fluorobenzenes ; Heptanoic Acids ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Inflammation ; Lipoprotein(a) ; Lipoproteins ; Lovastatin ; Pyrimidines ; Pyrroles ; Quinolines ; Simvastatin ; Sulfonamides ; Atorvastatin Calcium ; Rosuvastatin Calcium

OBJECTIVE: Peroxisome proliferator-activated receptor delta (PPAR-delta) is an ubiquitously expressed nuclear receptor that has been implicated in adipose tissue formation, brain development, and atherosclerosis. Despite mouse studies demonstrating that PPAR-delta activation has favorable anti-atherogenic properties by improving systemic lipid profiles, the relationship between PPAR-delta agonist and angiogenesis is unknown. We hypothesized that PPAR-delta ligands modulate the angiogenesis. METHODS: To test this hypothesis we treated primary cultures of bovine aortic endothelial cells with PPAR-delta specific ligand, GW501516 (50-800 nM) for 6 h. RESULTS: GW501516 dose-dependently decreased nitric oxide production without alteration in endothelial nitric oxide synthase (eNOS) expression. Analysis with phospho-specific antibodies against eNOS demonstrated that GW501516 significantly decreased the phosphorylation of eNOS at Serine1179 (eNOS-Ser1179). Concurrently, GW501516 also decreased the Akt phosphorylation. GW501516 did not affect endothelial cell proliferation or induce apoptosis. However, GW501516 inhibited endothelial cell migration, and tube formation in a high nanomolar concentration. The inhibition of endothelial cell tube formation by GW501516 was prevented by addition of the nitric oxide donor, DETA NONOate (5 microM). GW501516 was also found to inhibit angiogenesis in vivo in the chicken chorioallantoic membrane assay. CONCLUSION: These results provide that high nanomolar range of GW501516 inhibits angiogenesis by a mechanism involving dephosphorylation of eNOS-Ser1179.
Adipose Tissue ; Animals ; Antibodies, Phospho-Specific ; Apoptosis ; Atherosclerosis ; Brain ; Chickens ; Chorioallantoic Membrane ; DEET ; Endothelial Cells ; Humans ; Ligands ; Mice ; Nitric Oxide ; Nitric Oxide Synthase Type III ; Nitroso Compounds ; Peroxisomes ; Phosphorylation ; PPAR delta ; Thiazoles ; Tissue Donors

Cardiovascular disease (CVD) is the leading cause of death worldwide and small dense low-density lipoprotein (sdLDL) has been suggested to be a potential risk factor for cardiovascular disease (CVD). We reviewed published studies on formation and measurement of sdLDL, as well as relationship between LDL subfractions and CVD. sdLDL particle formation is highly dependent on triglycerides (TG) levels, and the physicochemical properties of sdLDL particles provide a potential for increased atherogenicity. Various conditions (e.g. hypertriglyceridemia, diabetes mellitus, metabolic syndrome, chronic renal failure and HIV infections) with increased cardiometabolic risk are associated with increased sdLDLs. Most studies suggest that sdLDL particles are associated with increased prevalence of clinical and subclinical CVDs, as well as non-coronary forms of atherosclerosis. Moreover, LDL size seems to be an important determinant of the progression of CVD. Therapeutic modulation (mostly fibrates, but also some statins, as well as niacin and thiazolidinediones) of small LDL size, number and distribution may decrease CVD risk. However, no definitive causal relationship is yet established, probably due to the close association between sdLDL and triglycerides and other risk factors.
Atherosclerosis ; Cardiovascular Diseases ; Cause of Death ; Diabetes Mellitus ; Fibric Acids ; HIV ; Hypertriglyceridemia ; Kidney Failure, Chronic ; Lipoproteins ; Niacin ; Prevalence ; Risk Factors ; Triglycerides

We present a case of a 52-year-old woman with iatrogenic stent deformation occurred after deployment of the left main (LM) stent due to the unintentional undermining of the proximal part of the LM stent with subsequent balloon dilatation. We tried to crush the deformed part of the LM stent against the left coronary cusp by pushing it with a guiding catheter. The deformed stent was stabilized after stent crushing and the patient didn't have any cardiovascular events. This case highlights that stent deformation could be successfully managed by crushing the deformed part of the stent to the coronary sinus.
Catheters ; Coronary Angiography ; Coronary Sinus ; Coronary Vessels* ; Dilatation ; Female ; Humans ; Middle Aged ; Multidetector Computed Tomography ; Stents*

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disease. The main causes of death in ADPKD are cardiovascular disease as well as infections and neurological reasons. ADPKD is causing vasculopathy including aortic root dilation, cerebral artery aneurysm, coronary aneurysm, and aortic dissection. In this case report, we describe a 37-year-old female ADPKD patient with non-ST elevation MI (NSTEMI) caused by coronary artery focal spasm.
Adult ; Aneurysm ; Cardiovascular Diseases ; Cause of Death ; Cerebral Arteries ; Coronary Aneurysm ; Coronary Vessels* ; Female ; Humans ; Myocardial Infarction* ; Polycystic Kidney, Autosomal Dominant* ; Spasm*

Endovascular abdominal aortic aneurysm repair is a safe, durable, and effective procedure. However, complications could occur with stent graft devices. When the renal ostia become obstructed by this device, renovascular hypertension may result. In general, renal artery occlusion secondary to stent graft impingement remains uncommon. We herein describe a patient with renal atrophy, new-onset hypertension, and elevated serum renin and aldosterone levels following endovascular aneurysm repair. Blood pressure and the levels of renin and aldosterone were normalized by renal artery stenting.
Aldosterone ; Aneurysm ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Atrophy ; Blood Pressure ; Blood Vessel Prosthesis ; Endovascular Procedures ; Humans ; Hypertension ; Hypertension, Renovascular ; Renal Artery Obstruction ; Renal Artery* ; Renin ; Stents

A 43-year-old male presented with effort angina. Ammonia positron emission tomography (PET) revealed reversible perfusion defect in left anterior descending artery (LAD) and left circumflex artery (LCX) territories with decreased coronary flow reserve. Coronary angiogram showed significant stenosis in proximal LAD and intermediate diffuse stenosis in LCX and right coronary artery (RCA). Fractional flow reserve (FFR) showed similar results with ammonia PET. After percutaneous coronary intervention for LAD and LCX, flow and pressure checked by PET and FFR showed improvement. Simultaneously use of ammonia PET and FFR could be useful for determining ischemia-inducible lesion especially in diffuse intermediate lesion with discrepancy between functional studies.
Adult ; Ammonia ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Male ; Percutaneous Coronary Intervention* ; Perfusion ; Positron-Emission Tomography*

Coronary artery fistulas (CAFs) are rare, mostly congenital cardiac anomalies. Most are asymptomatic and do not require treatment, but some can cause angina or exertional dyspnea. Symptomatic or hemodynamically significant fistulae can be treated with transcatheter or surgical methods of closure, with the former being a less invasive alternative while showing similar effectiveness and morbidity. We present a 52-year-old man with a complex coronary artery to pulmonary artery fistula causing angina, successfully treated by transcatheter coil embolization. Even without complete closure, this patient showed improvement of symptoms and objective indices of myocardial ischemia.
Coronary Vessels* ; Dyspnea ; Embolization, Therapeutic* ; Fistula* ; Humans ; Middle Aged ; Myocardial Ischemia ; Pulmonary Artery

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the status of LDL-cholesterol level and its relationship with subsequent cardiovascular events in Korean patients with chronic stable angina. METHODS: The patients with stable angina were retrospectively and consecutively enrolled from out-patients clinic during 2007-2009. Mean follow-up duration was 3 years. Occurrences of major adverse cardio-cerebrovascular event (MACCE: a composite of death, myocardial infarction, unstable angina, coronary revascularization, cerebrovascular events, peripheral artery disease and aortic disease requiring hospital admission.) were compared by initial LDL-cholesterol levels using Cox proportional-hazards model. RESULTS: 1,683 subjects were enrolled from 9 hospitals. Initial median LDL-cholesterol by tertile was 62.2, 90.2, and 124.0mg/dL respectively, however, the differences in LDL-cholesterol level among initial 3 tertile groups became narrow at 3rd year (67.8, 85.0, and 91.6mg/dL, respectively). MACCE occurred in 138 (8.2%) subjects, including 127 coronary events, 9 cerebrovascular events and 2 peripheral artery disease during the 3-year follow-up. The adjusted hazard ratio for MACCE was 1.02 (95% confidence interval 0.64-1.64) in the middle tertile of LDL-cholesterol, 1.53 (p=0.063, 95% Confidence Interval 0.98-2.40) in the highest tertile of LDL-cholesterol. The newly diagnosed diabetes mellitus was more frequent in subjects with statin treatment than subjects without statin during the 3-year follow-up (1.5% vs 0.6%). CONCLUSION: Increased cardiovascular risk was observed in angina patients with higher initial LDL-cholesterol levels during the 3-year follow-up, although the differences were statistically insignificant.
Angina, Stable* ; Angina, Unstable ; Aortic Diseases ; Cardiovascular Diseases* ; Diabetes Mellitus ; Dyslipidemias* ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia ; Korea ; Myocardial Infarction ; Outpatients ; Peripheral Arterial Disease ; Retrospective Studies ; Secondary Prevention*