Infarct-related left ventricular diverticulum.

Henderson KM. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database of Association between hospital process performance and outcomes among patients with acute coronary syndromes. ExTRACT-TIMI 25 Investigators. Enoxaparin versus unfrac-tionated heparin with fibrinolysis for ST-elevation myocardial infarction. in Unstable angina to prevent Recurrent Events (CURE) Trial Investigators. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non-ST-elevation acute coronary syndrome: the Clopidogrel in Unstable angina to prevent Recurrent ischaemic Events (CURE) Trial. REPLACE-2 Investigators. Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs. heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial. A randomized trial to evaluate the relative protection against post-percutaneous coronary intervention micro-vascular dysfunction, ischemia, and inflammation among antiplatelet and antithrombotic agents: the PROTECT-TIMI-30 trial. Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 random-ized trial. Intracoronary Stenting and Antithrombotic Regimen-Rapid Early Action for Coronary Treatment Study Investigators. A clinical trial of abciximab in elective percutaneous coronary intervention after pretreatment with clopidogrel. A 64-year-old woman presented with sudden onset central chest pain. Her ECG showed dynamic anterior, inferior, and lateral ST changes, suggestive of ischaemia. Her 12 h troponin I was 17.04 ng/mL (normal ,0.1). She was treated with enoxaparin, aspirin, clopidogrel, and atenolol, and in view of recurrent pain, tirofiban was started 2 days later. She subsequently underwent coronary angiography. This showed moderate disease in the proximal LAD and RCA with severe disease in the small but non-dominant circumflex artery. Left ventricular (LV) angiography showed good LV function with filling of a diverticulum (Image); contrast cleared rapidly from the diverticulum, indicating contractile function. To assess further, she had a CT scan. This demonstrated a narrow-necked diverticulum extending from the LV into the posterior wall. Her condition was managed conservatively. She was discharged pain free. LV diverticulae following myocardial infarction are rarely reported. The pathogenesis is unclear but such diverticulae are believed to result from incomplete LV rupture caused by haemorrhagic dissection extending outwards from the endocardium but arrested within the infarcted LV wall. Resorption and organization of the haematoma leads to diverticulum formation. Supplementary movies are available at European Heart Journal …