The significant raise in the number of patients surviving an acute myocardial infarction (AMI) has increased the burden of morbidity and disability due to acute coronary events. This has led to an increasing awareness on the need to develop specific rehabilitation programs, both during the acute phase, as well as in out-patient settings. In the pre-revascularization era, AMI was treated in bed. Regardless of the known therapeutic benefits of bed rest, there are scarce data regarding a standardized protocol for the early rehabilitation of patients with AMI. An extensive group of AMI patients are still exposed to prolonged immobilization, with current data showing a disparity in the length of post-MI bed rest, with a time of immobilization reported to be from 2 to 12 days and 2 to 28 days. The growing body of evidence on the effects of early cardiac rehabilitation programs following an AMI suggests that early mobilization after the index event could improve the inflammatory response and further modulate the ventricular remodeling process. The timing, duration, and intensity of cardiac mobilization has not yet been established, and further research on the effects of mobilization as early as the first 12 to 24 hours after the acute event could be beneficial for both short- and long-term outcomes, inflammation, and ventricular remodeling with subsequent heart failure.
Coronary artery malformations are rare congenital abnormalities, which present non-specific symptoms such as atypical chest pain, malignant arrhythmia, or sudden cardiac death. The proper diagnosis of these abnormalities in emergency conditions can be very difficult, and noninvasive imaging techniques, such as computed tomography or magnetic resonance imaging, along with the gold standard represented by invasive coronary angiography, remain the most frequently used modalities for diagnosing these rare cases. We present four cases of coronary anomalies represented by an abnormal origin of the coronary arteries from the coronary ostium, presenting in emergency conditions with symptoms of acute myocardial infarction, which were diagnosed by urgent angiography.
Computed tomography (CT) in cardiac examination is a powerful imaging tool that has developed rapidly during the last decade and continues to increase its potential by bringing novel technologies. Due to its noninvasive character, cardiac CT became a largely used method in detecting coronary diseases or functional issues at the expense of conventional coronary angiography. The accuracy of images has also increased, especially since new generation dual-source multi-slice detectors were developed. Although there are continuous improvements that serve to gain better-quality images, thus increasing their diagnostic accuracy, there is an inconvenient that became a serious topic for debate in the current literature: exposure to higher doses of radiation during cardiac CT examinations. Fortunately, physicians and manufacturers are taking into consideration the need to apply new strategies for radiation dose-reduction. Thus, this objective can be achieved by using patient-tailored dose-reduction strategies and by modulating the technical features of the CT scanners in order to gather high-quality images with minimal radiation exposure. The aim of this manuscript was to review the current literature data on dose-reduction strategies that are used for cardiovascular computed tomography scans.
Acute coronary syndromes are usually triggered by the erosion or rupture of a vulnerable coronary plaque. A vulnerable plaque (VP) is an atheromatous plaque which, after suffering different transformations, is prone to rupture causing an acute coronary event. Such a VP carries inside several biomarkers considered as “signatures of vulnerability”, which, if identified, can prompt timely initiation of therapeutic measures in order to prevent the development of an acute myocardial infarction. The most freqeuntly used techniques for identification of vulnerability markers are computed tomographic angiography (CTA), intravascular ultrasound and optical coherence tomography. Endothelial shear stress (ESS) represents a new promising biomarker associated with plaque vulnerability. Determination of ESS is nowadays possible using noninvasive imaging techniques, based on complex computational post-processing of multiple datasets extracted from CTA images and advanced computational fluid dynamics technologies. The aim of this systematic review was to evaluate the role of the coronary ESS, determined using advanced computational techniques for image post-processing, as a feature associated with CTA-derived biomarkers of atheromatous plaque vulnerability, underlining the conceptual differences between high ESS and low ESS as promotors of vulnerability.
Given the higher amount of detail it offers, the use of magnetic resonance (MR) in the field of cardiology has increased, thus leading to a decrease in the use of invasive and irradiating methods for diagnosing various cardiovascular disorders. The only precautions for MR imaging are metallic implants and advanced-stage chronic kidney disease. For the acquisition of clear and dynamic myocardial images, methods such as spin echo imaging for anatomical description, steady-state free precession imaging for the assessment of ventricular cavity size and function, flow velocity encoding for blood flow measurements, radiofrequency tagging for dynamics, and even spectroscopy for metabolism evaluation are used. Cardiac magnetic resonance (CMR) is considered the gold standard imaging method for the anatomical characterization of the heart and obtaining information related to myocardial dynamics. In case of ischemic events, CMR is used for a detailed description of the necrotic area and the complications, and for tracking the ventricular remodeling. By administrating a contrast agent (gadolinium), the difference between sub-endothelial and transmural infarctions can be distinguished, highlighting even microvascular lesions responsible for the extension of the necrosis. The assessment of the dynamics of ventricular remodeling and viability through late gadolinium enhancement (LGE) technology highlights the area of fibrosis and the occurrence of late complications.