Among patients admitted in the emergency department for acute atypical chest pain those with an acute coronary syndrome (ACS) who are mistakenly discharged home have high mortality. A recent retrospective study has demonstrated that multislice computed tomography (MSCT) coronary angiography could improve triage of these patients. We aimed to prospectively confirm these data on patients with a negative screening including maximal treadmill stress.Patients: 30 patients discharged from the emergency department after negative screening for an ACS were included. All patients underwent MSCT angiography of the coronary artery. Patients with coronary atheroma on MSCT had an invasive coronary angiography to confirm these findings.Results: Seven patients (23%) had obstructive coronary artery disease on MSCT. Invasive coronary angiography (ICA) confirmed the diagnosis in all patients.Conclusion: In patients with no previously known coronary artery disease admitted to the emergency department with atypical acute chest pain and discharged after negative screening, including maximal treadmill stress test, MSCT coronary angiography is useful for the diagnosis of obstructive coronary artery disease. (c) 2008 Elsevier Ireland Ltd. All rights reserved.

We report the case of a 40 year old woman admitted for dilatation and curettage at 12 weeks of amenorrhoea with post-abortion partial placental retention. Clinically she had developed disseminated intravascular coagulation (DIC) complicated by an acute coronary syndrome with persistent ST elevation in the inferior leads. Management of her myocardial ischaemia was symptomatic, due to the underlying complex coagulation disorder making coronary reperfusion techniques impossible. After treatment for the cause of DIC, coronary angiography revealed no detectable angiographic lesion or spasm. In this context, the most likely aetiological hypothesis is a thrombus related to the DIC in an otherwise healthy heart, which was spontaneously lysed.

Coronary to pulmonary artery fistula are the most frequent congenital anomalies of the coronary arteries. When they are symptomatic they have to be treated in order to prevent complications such as sudden death or myocardial infarction. Surgery is the gold standard for their closure. However an increasing number of reports have shown that interventional cardiology could be a safe and efficient alternative. Plexus-like fistula are composed of multiples and tortuous branches that make them difficult to treat. We report the use of polytetrafluoroethylene-covered (PTFE) stent to cure a plexus-like coronary to pulmonary artery fistula, without associated atherosclerosis, responsible for myocardial ischemia.