Coronary anomalies

This type of angina, due to coronary spasm, classically occurs at the same time daily, generally at night and at rest. It more frequently occurs in patients with evident coronary atherosclerosis, which triggers the spasm but rarely there is any coronary anomaly or only small plaque is detected. 

Angelini P, Velasco JA, Flamm S. Coronary anomalies incidence, pathophysiology, and clinical relevance. Circulation 2002 105 2449. 

Congenital complete heart block Peripartum cardiomyopathy Myocarditis Coronary anomalies Bragada syndrome Wolff-Parkinson-White syndrome Catecholaminergic polymorphic ventricular tachycardia... 

The predominance of coronary anomalies is composed of abnormal branching patterns of the proximal segments. CT is therefore used in many instances of suspected coronary anomalies after catheterization angiography to verify or supplement suspected findings. The supplemental function includes visualizing abnormal branches that could either not be reached by the catheter tip during the catheterization procedure or were not at all detected. For this application, CT offers the only way to assess the peripheral parts of that particular branch. Hence, all the restrictions apply as mentioned in the section on initial CAD workup. 

With the advent of prospectively triggered high-resolution coronary CTA that substantially reduces radiation exposure, even its application in assessment of coronary anomalies in a young patient population is justified. 

Patients with the non-obstructive form of hypetrophic cardiomyopathy should not undergo septal ablation. Patients with congential anomalies of the mitral valve apparatus, associated heart lesions (e.g., advanced multivessel coronary artery disease) requiring surgical correction, unfavorable distribution of septal hypertrophy with mild proximal thickening, basal septal wall thickness < 18 mm, or anatomically unsuitable septal perforators should not be candidates for septal ablation. 

VEGF overexpression also produces similar results. The mutant embryos display several developmental anomalies consisting of an attenuated compact layer of myocardium, overproduction of trabeculae, defective ventricular septation, aberrant coronary development due to oversized epicardial vessels, and also abnormalities in outflow track remodeling (Miquerol et al. 2000). These findings suggest that VEGF signaling is critical for cardiovascular development. 

Anomalies in the mid-late part of QRS (as slur-rings, rsr or very low voltage QRS in left precordial leads) may occur, either isolated or with Q wave, as a consequence of necrosis of areas of late depolarisation (Horan and Flowers, 1972 Horan, Flowers and Johnson, 1971). Recently, it has been reported (Das et ah, 2006) that in coronary patients the presence of these anomalies known as fractioned QRS has... 

The presence of congenital defects in the coronary arteries is infrequent ( 1% of the cases), but only a small proportion of them are accompanied by symptoms, generally angina or dyspnoea. The diagnosis of these anomalies has been facilitated by the frequent performance of multislice... 

Cases of Q-wave and non-Q-wave infarctions due to atherothrombosis have also been described in patients with coronary artery anomalies. However, often the restingECGisnormal, but repolarisation abnormalities, generally ST-segment depression, may be seen during exercise, with anginal pain (Figure 8.44). 

This is an anomaly of the course of the coronary arteries, especially the LAD, which partly penetrates epicardial muscular mass. It is frequently, though... 

Coronary sinus anomalies and coronary veins variants... 

The calculation of selectivity values showed that there was discrimination against the incorporation of the deuterated CLA isomers into TAG and CE and a preferential incorporation into PC and phosphatidyl ethanolamine (PE) relative to 9-18 1- /8 and 9, l2-18 2- Q. Comparison of selectivity values for the CLA isomers to r9, l2-18 2- 2 values and values previously reported for c- and r-18 1 positional isomers and 18 0 (17-22) showed that the incorporation of cS,t - and rlO,rl2-CLA matches the r-18 l isomers more than 18 0, 9-18 1, or 9, 12-18 2. This observation is an interesting anomaly since several positive health benefits have been reported for CLA (4), but tram fatty acids (TEA) are considered to have a negative effect on serum cholesterol. Epidemiological studies found a relationship between coronary heart disease risk and dietary intake of TEA from partially hydrated vegetable oils, which mainly contain the t9-, rlO-, and rl 1-18 1 isomers, but no such relationship was found for TEA intake from animal derived foods, whose major TEA isomer is t9-18 1 (vaccenic acid, VA) (19,23,24). 

A 2-month-old boy bom to a mother taking valproate had typical dysmorphic features characteristic of fetal valproate syndrome [342 ]. He had a distinctive facial appearance, a cluster of minor and major anomalies, central nervous system dysfunction, a persistent left superior vena cava draining into a dilated coronary sinus, and mild pulmonary hypertension. 

Snider AR, Ports TA, Silverman NH. Venous anomalies of the coronary sinus detection by M-mode, two-dimensional and contrast echocardiography. Circulation 1979 60 721-7. 

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