A high-take-off single coronary artery is a rare congenital coronary anomaly that may complicate coronary angiography and percutaneous coronary intervention. A 35-year-old man presented with anterior ST-segment elevation myocardial infarction (STEMI). Initial coronary angiography was limited by difficulty in selective engaging the anomalously located coronary ostium, resulting in inadequate contrast opacification. Coronary computed tomography angiography (CCTA) subsequently demonstrated a single high-take-off coronary ostium arising from the ascending aorta, with a prepulmonic course of the left main coronary artery. Despite a coronary artery calcium score of 0, severe approximately 80% proximal left anterior descending artery (LAD) stenosis was identified (CAD-RADS 4A). Repeat invasive coronary angiography demonstrated 95% subtotal proximal LAD occlusion with a hazy appearance suggestive of active thrombus. Primary PCI with two overlapping drug-eluting stents restored TIMI grade 3 fl ow without procedural complications. This case highlights the value of CCTA in defining anomalous coronary anatomy and demonstrates that a calcium score of 0 does not exclude clinically significant obstructive coronary disease.
Background: Angiographic haziness after coronary stent implantation is nonspecific and may represent thrombus, edge dissection, tissue protrusion, intramural hematoma, or stent underexpansion. Case summary: A 61-year-old man with anterior ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention (PCI) of a subtotal mid-left anterior descending artery lesion. One minute after implantation of a 3.0 × 26-mm zotaro-limus-eluting stent, new haziness appeared. It was interpreted as an edge dissection and treated with two additional proximal stents, after which the artery abruptly occluded and cardiogenic shock developed. Aspiration retrieved red thrombus, confirming intraprocedural stent thrombosis. Activated clotting time (ACT), fi rst measured 2 min after the onset of shock, was 150 s. Supplemental heparin and eptifi batide restored TIMI grade 2 fl ow. At staged intravascular ultrasound-guided reintervention on day 4, the vessel was larger than initially estimated and a fluoroscopic balloon waist suggested underexpansion; quantitative imaging data were lost. Conclusion: Thrombotic, anticoagulants, and mechanical abnormalities were documented at different time points, but their relative contribution cannot be established. Haziness that persists after a first mechanical correction should prompt verification of anticoagulation and intracoronary imaging before further stenting.
Myocardial calcification is a rare pathological finding that, when extensive myocardial involvement is present, may lead to the development of restrictive cardiomyopathy and progressive heart failure. We report the case of a 57-year-old woman with long-standing heart failure and a restrictive cardiomyopathy phenotype of unknown etiology. Imaging studies demonstrated massive calcium deposits within the left ventricular myocardium and the interventricular septum. Computed tomography initially suggested constrictive pericarditis; however, subsequent echocardiographic assessment and cardiac magnetic resonance imaging supported the diagnosis of restrictive cardiomyopathy secondary to advanced myocardial fibrocalcinosis. No abnormalities of calcium-phosphate metabolism, chronic kidney disease, coronary artery disease, or any other convincing cause of dystrophic or metastatic calcification were identified. Following an extensive differential diagnostic evaluation, a diagnosis of idiopathic massive myocardial calcification was established. This case illustrates the considerable diagnostic challenges in differentiating restrictive cardiomyopathy from constrictive pericarditis and highlights the pivotal role of a multimodality imaging approach in achieving the correct diagnosis.
Background: Hyperuricemia is a significant risk factor for cardiovascular diseases, particularly acute coronary syndrome (ACS). Elevated serum uric acid levels contribute to endothelial dysfunction, oxidative stress, and inflammation, which ex-acerbate the progression of coronary artery disease. Allopurinol, a xanthine oxidase inhibitor, has demonstrated potential cardio-protective effects beyond its urate-lowering properties. Aim: This study aimed to evaluate the safety and efficacy of allopurinol in patients with hyperuricemia presenting with ACS. Methods: We conducted a prospective study at the Aswan University Hospital from June 2024 to June 2025. A total of 120 patients with ACS were enrolled and divided into two groups: Group A (n = 60) comprised patients with hyperuricemia (serum uric acid > 6.8 mg/dL) who received allopurinol plus standard anti-ischemic therapy, and Group B (n = 60) comprised patients with normal uric acid levels who received standard therapy alone. Allopurinol was administered at 600 mg/day during the acute phase (first 14 days), followed by 200 mg/day for a total of 4 weeks. All patients underwent comprehensive evaluation, including coronary angiography, echocardiography, and laboratory assessments at baseline and after 3-months. Results: Baseline characteristics showed that Group A had a significantly higher BMI (24.7 ± 3.9 vs. 23 ± 3.4 kg/m², p = 0.015), lower HDL cholesterol (39.8 ± 15.2 vs. 74.6 ± 37.8 mg/dL, p < 0.001), and higher troponin positivity (81.7% vs. 20%, p < 0.001) compared to Group B. Angiographic analysis revealed that Group A had more proximal coronary lesions (45% vs. 20%, p < 0.001), higher rates of severe stenosis (93.3% vs. 30%, p < 0.001), and higher SYNTAX scores (23.1 ± 3.6 vs. 17.7 ± 3.9, p < 0.001). Group A also demonstrated a higher prevalence of arrhythmias (48.3% vs. 13.3%, p < 0.001), particularly atrial fibrillation. Following allopurinol therapy, Group A showed significant improvements in left ventricular ejection fraction (from 50.4% to 52.2%, p < 0.001), reduction in left atrial volume index (from 38 to 32.8 m², p < 0.001), and decreased incidence of arrhythmias (from 48.3% to 25%, p = 0.008). Only three patients experienced mild adverse effects (mood and sleep disturbances), with no treatment discontinuation reported. Conclusion: Allopurinol is safe and efficacious in hyperuricemic patients with ACS, demonstrating significant improvements in cardiac function, a reduction in arrhythmic events, and favorable modification of echocardiographic parameters. These findings support the incorporation of uric acid screening and targeted allopurinol therapy in the comprehensive management of ACS patients with hyperuricemia.
Background: Cardiorespiratory fitness (CRF) and physical activity are important indicators of long-term health. However, evidence regarding these measures among medical students in Indonesia following COVID-19 social restrictions remains limited. This study aimed to describe CRF, physical activity levels, and sedentary behavior among medical students enrolled in 2021. Methods: This descriptive cross-sectional study involved 84 medical students, including 48 women and 36 men. CRF was assessed using predicted maximal oxygen uptake (VO2max) derived from the 6-minute walk test (6-MWT). Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) and expressed as metabolic equivalent minutes per week (MET-min/week). Daily sedentary time was also recorded. Results: The median 6-MWT distance was 518.5 m, corresponding to a median predicted VO2max of 19.5 mL/kg/min. All participants were classified as having low or very low CRF based on predicted VO2max. Mean weekly physical activity was 3,808 MET-min/week among men and 2,227 MET-min/week among women. Work/study-related activities contributed the largest proportion of overall physical activity, followed by recreational and transport-related activities. Mean daily sedentary time was 428 minutes among men and 463 minutes among women. Although most participants had moderate or high physical activity levels, low CRF and prolonged sedentary time were common. Conclusion: Medical students exhibited low CRF and prolonged sedentary time despite predominantly moderate-to-high physical activity levels. These findings suggest that total physical activity volume alone may not ensure adequate CRF. Structured aerobic exercise and strategies to reduce sedentary time may help improve fitness in this population. Future longitudinal studies should examine the associations between exercise modalities, body composition, nutritional factors, and changes in CRF.
