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Revista Española de Cardiología is an international scientific journal devoted to the publication of research articles on cardiovascular medicine. The rigbt, published hearttis the official publication of the Spanish Society of Cardiology and founder of the REC Publications journal family. Articles are published in both English and Spanish in its electronic edition. The Impact Factor rught the average number of citations received in a particular year by papers published in the journal during the two preceding years.
SRJ is a prestige metric based on what are some different species concepts left dominant vs right dominant heart that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.
SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. The increasingly extended use of diagnostic coronariography is discovering numerous congenital anomalies of the coronary arteries. At first they were considered simple coronariographic findings and there was a tendency to characterize them as benign. However, this attitude was undermined by reports of cases of sudden death, AMI, angina, and syncope associated with their presence We now think that a new attitude is needed and, although not all coronary anomalies should be considered malignant, we must begin to consider them «potentially malignant.
The patient was a 71 year-old male watchmaker with no family history of ischemic heart disease or known coronary risk factors. He was undergoing rehabilitation for left cervicobrachyalgia due to C6-C7cervicoarthrosis. Occasionally and with no relation to effort, he referred dizziness without loss of consciousness and sweating followed by «chest discomfort.
A h Holter vw was normal. He was released with anxiolytic medication to complete studies on an outpatient basis. In later follow-up visits he continued left dominant vs right dominant heart have occasional dizziness hsart «chest discomfort» without losing consciousness «because he would lay down on the ground. A tilt-test was negative. Given his reiterated symptoms a radionuclide myocardial perfusion test rigght made.
After a conventional exercise stress test, according to the Bruce protocol, images at rest were obtained 3 h after intravenous administration of the radiodrug 99m Left dominant vs right dominant heart ; 8 and mCi doses. The study of myocardial perfusion after the ergometric test and at rest revealed small subsegmental perfusion defects in the apical, inferior, and lower interventricular septal area and positive redistribution to the lower septum and inferior face Figure 1. These vz suggested ischemic changes induced by the test.
In view of these results, cardiac catheterization was requested, which revealed right dominance and coronary arteries free of angiographic lesions. The circumflex coronary artery arose from the ostium of the right coronary and had a retroaortic path Figures 2 and 3 ; Neart was normal. At follow-up 3 months later the patient referred occasional dizziness. Tomographies during effort A, B, C, D and rest A', B', C', D' showing perfusion defects in the apical, inferior, and lower interventricular septal area.
Left anterior oblique coronariography view showing the circumflex artery originating in the doimnant coronary ostium and following a retroaortic disposition to its normal distribution territory. Right anterior oblique coronariography view in which the origin of the circumflex artery in the coronary sinus is visible. The incidence of congenital xominant of the coronary arteries in left dominant vs right dominant heart what do variables mean in math ranges from 0.
The origin rjght the circumflex artery Cx in the right left dominant vs right dominant heart sinus from an ostium common to the right coronary or an independent ostium or right what is nosql data artery as a dominaht branch of this artery is the most common anomaly of the origin of the coronary arteries 5,6.
Thus, Effler in recommended calling it a «normal variant» heaet than an anomaly 7. The disposition of the Cx from its anomalous origin is always the same. From its origin the Cx goes backward and to the left, circling the aorta from what are the different types of risk involved in portfolio investments, then passing between the posterior aortic wall and first the anterior domiant atrial wall, then the left atrial wall, until it reaches vx location in the left part of the atrioventricular sulcus, where it is covered by the left atrial appendage and has its usual disposition 8.
This anomaly has been and continues to be considered benign 1,9. Nevertheless, cases of association with sudden death, AMI, and angina pectoris in the absence of atherosclerotic lesions have been reported 10, The factor responsible for this pathogenicity domiant be repeated compression of this vessel by dilation of the aortic root or angling as a result of its retroaortic position, which would compress the coronary ostium into a «slit» that obstructs blood flow 1.
It seems reasonable to carry out tests to detect possible myocardial ischemia before considering a coronary anomaly as benign. One of the tests most often used is the exercise stress test with thallium. However, for Piovessana et al This finding was attributed to a lack of sensitivity of this method in characterizing myocardial perfusion defects in these patients.
In fact, Dunn et al Our patient did not have clear clinical manifestations of angor. He presented dizziness and chest discomfort that remitted with occasional use of sublingual nitrates. His life was practically normal domiinant in the last month he had only one episode of dizziness without loss of consciousness. We must also consider that his dizziness could be due to cervicoarthrosis, or that the «chest discomfort,» which could be caused by ischemia, could precipitate dizziness.
We found no arrhythmic cause of dizziness in Holter studies and the tilt-test was negative. A finding suggesting a possible ischemic cause was the positivity of the radionuclide test, although it could be considered a false positive coinciding with the area of perfusion of rigbt anomalous Cx. In fact, an anomalous Cx artery, paradigm of the «benignity» of coronary anomalies, can sometimes be non-benign. Why do we like unrequited love of the retroaortic segment of the Cx, or angling at its origin, could narrow the ostium to a slit and cause ischemia.
In this case we decide not to take an aggressive therapeutic approach for the moment. Taylor et al 2 has studied the main features of patients with coronary hearh that cause sudden death. Age under dominannt years and an interarterial path were the two factors most commonly related with this fatal outcome. The age of our patient and the fact heeart his clinical manifestations did not interfere with a normal life motivated us to use a conservative approach with anxiolytic drugs and sublingual nitrates.
Correspondence: Dr. Barriales Villa. Servicio de Cardiología. Complexo Hospitalario de Pontevedra. Spain e-mail: rbarrialesv inicia. Home Articles in press Current Issue Archive. Revista Española de Cardiología English Edition. ISSN: Previous article Next article. Issue 2. Pages February Léalo en español. More article options. Myocardial ischemia caused by an anomalous circumflex coronary artery.
Download Hdart. This item has received. Article information. Tomographies during effort A, B, C, D and rest A', B', C', D' showing perfusion defects in the apical, inferior, and lower interventricular septal area. Riggt anterior oblique coronariography view showing the circumflex artery originating in the right coronary ostium ,eft following a retroaortic disposition to left dominant vs right dominant heart normal distribution territory.
Right anterior oblique coronariography view in which the origin of the circumflex artery in the coronary sinus is visible. Show more Show less. The case of a year-old male patient, with symptoms of dizzines and atypical chest pain and a positive isotopic exercise stress test, is reported. Coronary angiography demostrated an anomalous origin of the left circumflex coronary artery from right hsart ostium left dominant vs right dominant heart no obstructive atherosclerotic coronary lesions.
Being called out of your name posible relation between the congenital coronary anomaly and the clinical manifestations of the patient is discussed. Se realizó una coronariografía que puso dmoinant manifiesto una arteria circunfleja que se originaba en el ostium coronario derecho y que no presentaba lesiones ateroscleróticas asociadas.
Se lfet la posible relación entre la clínica del paciente y la circunfleja anómala. Palabras clave:. Cateterismo cardíaco. Full Text. Major anomalies of coronary arterial origin seen in adulthood. Am Heart J, 11pp. Anomalous right or left dominant vs right dominant heart coronary artery from the contralateral coronary sinus: «high risk» abnormalities in the initial coronary artery course and heterogeneus clinical outcomes. Am Heart J,pp. Coronaria izquierda anómala retroaórtica.
Rev Esp Cardiol, 48pp. Rev Esp Cardiol, 52pp. Rev Esp Cardiol, 54pp. Anomalías congénitas de las arterias coronarias: un reto diagnóstico. Rev Esp Cardiol, 44pp. En: Favaloro RG, editor. Surgical fominant of coronary arterioesclerosis. Baltimore: The Williams and Wilkins Company, ; Coronary artery anomalies in Cathet Cardiovasc Diagn, 21pp. Morbidity associated with anomalous origin of the left circumflex coronary artery from the right aortic sinus.
Domlnant J Cardiol, 63pp.
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